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FNP Review > GU/GYN > Flashcards

GU/GYN Flashcards

(52 cards)

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1
Q

Dx criteria for candida

A

Vaginal pH-

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2
Q

Treatment of candida

A

1st choice vaginal insert med

-azole antifungal, oral (Diflucan), vaginal (miconazole, terconazole)

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3
Q

Dx criteria of bacterial vaginosis

A

Vaginal pH- >4.5
Thin, homogeneous, white/gray discharge
Positive Whiff test-fishy odor
>20 clue cells, few or no WBC’s

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4
Q

Treatment of bacterial vaginosis

A

Metronidazole (topical Metrogel), or oral Flagyl.

Clindamycin vaginal cream or ovules (Cleocin)

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5
Q

Dx criteria for atrophic vaginitis

A

Vaginal pH- >5
Scant, white-clear discharge
Few or absent lactobacilli
Sx-itching/burning but often without sx

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6
Q

Treatment of atrophic vaginitis

A

Topical and/or vaginal estrogen if sx are recurrent or if recurrent UTI
Ex- Premarin cream (conjugated estrogen), estrace cream

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7
Q

Acute, uncomplicated UTI treatment

A

Primary- TMP/SMX-DS x 3days, nitrofurantoin (Macrobid) 100mg BID x5days or fosfomycin (Monurol) 3gram X1 dose
*all with pyridium (phenazopyridine)

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8
Q

Alternative tx for UTI (for e-coli resistance to Bactrim or sulfa allergy)

A

Ciprofloxacin 250mg BID, ciprofloxacin ER 500mg QD, Levofloxacin 250mg QD, Moxifloxacin 400mg QD, (all x 3days plus pyridium)

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9
Q

Epididymoorchitis definition

Organisms?

A

Upper reproductive tract infection with inflammation of epididymis/testis
35= enterobacteriaceae

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10
Q

Tx of epididymoorchitis

A

35- Levofloxacin 500mg po QD or Ofloxacin 300mg po BID for 10 days.

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11
Q

Prehn’s test

A

Relief of discomfort with scrotal elevation

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12
Q

Organisms with acute bacterial prostatitis?

A

35- Enterobacteriaceae

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13
Q

Treatment of acute bacterial prostatitis?

A

35- ciprofloxacin 500mg po BID or Ofloxacin 200mg po for 14 days

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14
Q

Urge incontinence sx/tx

A

Reports of strong sensation of needing to void.

Tx- anticholinergics=tolterodine (Detrol), oxybutynin (Ditropan), solifenacin succinate (Vesicare)

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15
Q

Stress incontinence sx/tx

A

Associated with lifting
Tx- support with use of vaginal tampon, urethral stents, and pessary use. Kegel exercises, pelvic floor rehabilitation and bladder training. Surgical intervention in select patients.

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16
Q

Functional incontinence sx/tx

A

Often occurs in presence of mobility problems

Tx- Ameliorated by having assistant who is aware of voiding cues available to help with toileting.

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17
Q

Transient incontinence sx/tx

A

Occurs during an acute illness

Tx- treat underlying process, discontinuation of offending medications.

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18
Q

Phimosis

A

The foreskin cannot be pulled back to expose the glans

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19
Q

Paraphimosis

A

Retracted foreskin that cannot be brought forward to cover the glans

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20
Q

Variocele

A

A palpable “bag of worms” scrotal mass that is only evident in standing position.

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21
Q

Hydrocele

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A

Collection of serous fluid that causes painless scrotal swelling easily recognized by transillumination

22
Q

Testicular torsion

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A

Scrotal pain and loss of the cremasteric reflex

23
Q

Cryptochidism

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A

Testicle located in inguinal canal or abdomen

24
Q

Anticholinergics/Antispasmodics action and examples

Study These Flashcards
A

Action- relaxes bladder smooth muscle, inhibits involuntary detrusor muscle contractions
Ex- tolterodine (Detrol LA)
Oxybutynin (Ditropan XL)
Solifenacin (Vesicare)

25
Alpha-1 adrenergic blocking agents action and examples
Selectively antagonizes prostate alpha adrenergic receptors relaxing smooth muscle and improving urine flow. Ex- tamsulosin hydrochloride (Flomax) Terazosin hydrochloride (Hytrin) Doxazosin mesylate (Cardura)
26
Causes of hematuria
Isolated- bleed anywhere from renal pelvis to the urethra. RBC casts- injury to nephron. Gross hematuria- acute cystitis, urethritis. Proteinuria and hematuria- glomerular or interstitial nephritis. Colicky flank pain- urethral stones
27
Meds/foods that may cause hematuria or act as bladder irritants
Meds- beta-lactam antibiotics, sulfonamides, NSAIDS, rifampin, cipro, zyloprim, Tagamet, Dilantin, anticoagulants. Foods- caffeine, spices, chocolate, ETOH, citrus, soy sauce
28
Causes of proteinuria
If more than 2g in 24 hrs, glomerular cause is most likely. Benign functional- orthostatic proteinuria, environmental conditions, fever, acute illness. *When found in a low-risk patient, urine should be tested for Bence-Jones protein (associated with multiple myeloma)
29
Proteinuria 3-3.5 g/day is inductive of what condition?
Nephrotic syndrome
30
Nephrotic syndrome definition
Syndrome in which protein is lost through the kidney (proteinuria), this causes low protein in the blood (hypoalbuminemia), this causes water to shift to soft tissue (edema). *refer to nephrology
31
Pyelonephritis definition
Upper UTI, infection of the kidney, characterized by infection within the renal pelvis, tubules or interstitial tissue. Acute- infection ascending from the bladder Chronic- usually no specific pathological explanation
32
UA findings with pyelonephritis
Positive bacteria, proteinuria, leukocyte esterase, urinary nitrates, hematuria, pyuria, and WBC casts.
33
What finding can help differentiate pyelonephritis from cystitis?
WBC casts. This is seen with pyelonephritis and it indicates inflammation of the kidney- such casts will not form except in the kidney.
34
What "zone" does BPH develop? CA develop?
BPH- transitional zone | Prostate CA- peripheral zone
35
BPH diagnostics
UA to rule out infection (prostatitis) PSA- usually less than 10ng/ml Urine cytology should be performed to rule out carcinoma particularly when hematuria is present
36
BPH sx
``` Nocturia Urine frequency Urgency/dysuria Urge incontinence/retention Decreased force of stream Hesitancy Post-void dribbling ```
37
BPH treatment
Alpha1-adrenergic agonists (Minipress, Hytrin, Cardura) Subtype alpha1a- adrenergic receptor targets (Flomax, Uroxatral) 5-alpha reductase inhibitors (Proscar, Avodart)
38
Erectile dysfunction dx tests
``` BG to rule out DM Lipid profile TSH Testosterone level CBC PSA ```
39
Organic causes of ED
Obesity (BMI >31), metabolic syndrome, smoking, lack of exercise, DM, hyper cholesterol, HTN, age >40 meds- HCTZ, antidepressants
40
ED treatments
``` Sildenafil (Viagra) 25-100mg on demand dosing Tadalafil (Cialis) 5mg QD or 10-20mg on demand Vardenafil hydrochloride (Levitra) 10-20 mg on demand ```
41
Vaginal bleeding in a post menopausal woman is a red flag for what disease?
Endometrial cancer
42
Polycystic ovary syndrome definition
Defined by the presence of anovulation, polycystic ovaries on US, and clinical or biochemical hyper-androgenism *genetic factors and insulin resistance play a role in the pathogenesis of PCOS
43
Pathophysiology of PCOS
The result of a defect in the hypothalamic pituitary-ovarian circuit.
44
PCOS diagnostic criteria
Any 2/3 confirmed: - Oligomenorrhea or amenorrhea - Hyperandrogenism (hirsutism, acne, alopecia or - Hyperandrogenemia (high levels of testosterone) - Polysystic ovaries on US
45
Long term health risks of PCOS
T2DM, CAD, Metabolic syndrome/insulin resistance, 2.7 fold increased risk of endometrial CA, mood disorders (anxiety/depression)
46
Management of PCOS
Weight reduction, lipid lowering meds (statins, nicotinic acid), insulin sensitizers (metformin, TZD's), oral contraception and anti-androgens
47
Genital herpes clinical findings/tx
Painful, ulcerated lesions, marked lymphadenopathy with initial lesion. Grouped vesicles on erythematous base. Tx-acyclovir (Zovirax), vancyclovir, famciclovir
48
Chlamydia trachomatis clinical findings/tx
Occasional mucopurulent discharge | Tx- Azithromycin 1g PO one time dose
49
Gonococcal inf clinical findings/tx
Occasional purulent discharge | Tx- Ceftriaxone 250mg IM one time dose, plus Azithromycin 1g (co-treat for chlamydia)
50
Trichomoniasis clinical findings/tx
Yellow-green vaginal discharge, occasionally frothy, cervical petechial hemorrhages Tx- oral metronidazole 2g as one time dose Alt option metronidazole 500mg po BID x7 days
51
Syphillis clinical findings and treatment
Primary- painless genital lesion/anal ulcer. Secondary- non-pruritic rash on palms and soles, mucus membranes Latent- neurosyphillis, dementia, ataxia Tx- Injectable PCN, doxycycline in pts with beta lactam allergy
52
Genital warts (condyloma) clinical findings/tx
Verruca form lesions can be subclinical or unrecognized Tx- prevention with immunization. imiquimod (Aldara), surgical removal, cryotherapy

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