Gyn/WW Flashcards
contraception WW Sexual health breast health (166 cards)
1
Q
If on Yaz or Yazmin, one should avoid these classes of meds for K+ overload.
A
ACE inhibitors and ARBs
2
Q
When should screening for GC/CT occur?
A
annually <25 y/o or those at risk.
3
Q
Sites of GC/CT
A
endocervix, urethra, anus, pharyngeal
4
Q
Potential sequelae for GC/CT
A
PID, ectopic pregnancy, infertility (female), epididymitis
5
Q
S/sx for GC/CT
A
Usually asymptomatic
Post-coital bleeding, dysuria, vaginal or penile d/c, mucopurulent cervical d/c
6
Q
Testing for GC/CT
A
NAAT using urine, vaginal, endocervix, rectum
7
Q
Recommended treatment for CT
A
1g Azithromycin
100 Doxycycline BID x7d
8
Q
TOC for GC/CT: T or F?
A
False, we are testing in 3 mons for possible reinfection unless pregnant–TOC in 2-3wks.
9
Q
In the US, type __ and __ cause 90% of genitals warts
A
6 & 11
10
Q
The most common viral STI
A
Human papillomavirus
11
Q
How to diagnose HPV warts
A
visual inspection or biopsy (cauliflower-like)
12
Q
Treating HPV with patient-applied treatment: (3 options: SIP)
A
Imiquimod 3.75-5% cream Sinecatechins 15% ointment Podofilox 0.5% solution or gel --Imiquimod and sinecatechins may weaken latex condoms-- --AVOID all in pregnancy
13
Q
Provider-applied treatment for HPV warts
A
- Cryotherapy w/ liquid nitrogen or cryoprobe
- Surgical removal/elctrosurgery
- TCA or BCA-trichloroacetic 80-90% solution
- -okay in pregnancy–
14
Q
Potential sequelae for GC
A
septic arthritis, bacteremia, Gonorrhea ophthalmia neonatorium, pregnancy complications, Skene or bartholin’s gland, PID, infertility, ectopic, epididymis.
15
Q
Dual therapy for GC
A
Ceftriaxonne 250mg IM + Azithromycin 1g Alt: Cefixime 400mg +Azithro 1g Gentamicin 240mg IM + Azithro 2g (Allergy?--consult!)
16
Q
If + for GC/CT, treat all sex partners in the past __ days
A
60 days (2 mons)
17
Q
GC treatment failures should be re-tested with ___
A
culture to allow susceptibility testing
18
Q
TOC for pharyngeal GC in __ days
A
14 days
19
Q
Primary infection of HSV-1 or HSV-2
A
Asymptomatic
+/- flu-like symptoms, tender inguinal lymphadenopathy
+/- small painful vesicles with rupture
20
Q
Most sensitive HSV testing
A
PCR (direct testing)
21
Q
HSV symptoms for recurrent infections
A
Shorter, less severe, (usually one vesicle)
22
Q
HSV screening is or is not recommended
A
IS NOT!
23
Q
Treatment for primary HSV
A
(all for 7-10 days)
Acyclovir 400 TID or 200mg 5x/d
Valacyclovir 1g BID
Famciclovir 250mg TID
24
Q
Suppressive treatment for HSV for pregnancy starting at 36wks
A
Valacyclovir 500mg BID
Acyclovir 400mg TID
25
What is molluscum contagious?
Pox virus, not always sexually transmitted.
26
S/sx of molluscum contagious?
Multiple non-tender, waxy, smooth, firm, spherical papule with umbilicate center containing central plug, ranging from pinhead to 2-5mm
Seen in low abdominal wall, inner thigh, pubic area, genitalia
27
Tx of molluscum contagious
- Usually resolve spontaneously w/o scarring (8 mons)
| - Incision and removal of core, but may cause scarring
28
Syphilis is caused by...
Treponema pallidum, bacterial spirochete
29
How many stages in syphilis?
4: early, early latent (<12mons), late latent (>12 mons), tertiary
(CNS involvement can occur at any stage)
30
S/sx of primary syphilis
Asymptomatic, primary painless, ulcerated chancre (disappears 3-6wks) with raised border
31
S/sx of primary syphilis
Asymptomatic, primary painless, ulcerated chancre with raised border (disappears 3-6wks)
32
S/sx of secondary syphilis
+/- systemic: lymphadenopathy, flu-like symptoms
| Localized or diffuse mucocutaneous lesions (on palms, soles, mucous patches, and +/-condylomata lata)
33
S/sx of tertiary syphillis
NOT infectious
Gummas (nodular lesions)
Cardiac symptoms
Neurosyphilis
34
How to diagnose syphilis
non-treponemal test: RPR, VDRL (titers-quantitative--4-fold change is diluted 2x)
&
Treponemall tests: dark field microscopes, FTA-ABS, TPPA
35
Tx for syphilis
2.4mu Benzathine penicillin IM
| Late latent/HIV+/Neuro: 3 doses, 1 wk apart
36
f/u of syphilis
Titers repeated at 6 and 12 mons
| Titers should decline at least 4-fold w/in 12-24 mons
37
What causes chancroid?
Haemophilus ducreyi, a short, nonmotile, gram-negative rod
38
S/sx of chancroid
Asymptomatic, papules or painful ulcerations, bilateral inguinal lymph (bubos)
Lesions resolve 1-2 wks when treated
39
Dx of chancroid
Culture from lesion or bubo (<80% sensitive)
Neg test for HSV & syphilis
PCR tests
40
Tx of Chancroid
1 g Azithro
250mg Ceftriaxone IM
500mg Ciprofloxacin BID x3d
500mg Erythromycin base TID x7d
41
F/u for Chancroid
re-examine in 3-7days
42
Tx for LGV
Doxy 100mg BID x21d
Erythro 500mg QID x21d
f/u until symptoms resolved
43
Tx for nongonococcal urethritis (NGU)
1g Azithro
| 100mg doxy BID x7d
44
Tx for PID
```
Ceftriaxone 250mg IM
Doxy 100mg BID x14d
Metronidazole 500mg BID x14d
f/u in 72 hrs
PARTNER TX
```
45
When should hospitalize PID?
Pregnancy, pelvic abscess, surgical emergency cannot be ruled out, severe fever, severe N/V, failure of outpatient therapy
46
Bacterial vaginosis tx
Metronidazole 500mg BID x7d (avoid EtOH)
Metrogel 0.75% x5d
Clindamycin 2% x7d (weaken condoms)
(SAFE IN PREGNANCY)
47
Trichominiasis tx:
```
2g Metronidazole (avoid EtOH=disulfiram reaction)
2g Tinidazole (avoid in pregnancy)
500mg Metro BID x7d
CDC for recurrence
Screen for other STIs
Repeat testing in 3 mons
```
48
What is BV?
Alteration of normal flora of the vagina w/overgrowth of anaerobic bacteria (not usually inflamed)
49
S/sx of BV?
| Dx of BV?
```
S/sx: asymptomatic, malodor, whitish-gray vaginal d/c, normal vulva and vagina
Dx: 3+/4
1. Elevated pH >4.5
2. Homogeneous vaginal d/c
3. + whiff test
4. >20% clue cells
OR
Gram stain (nugget criteria)
```
50
Dx of Trichomonas vaginalis
microscopy (50-60%)
NAAT (vaginal or urine)
Culture
non-amplified molecular
51
What is trichomonads?
Anaerobic, motile flagellated protozoan parasite (tear-drop shaped)
52
S/sx of trichomonads
```
5.6-7 pH
Irritaation, pruritus
dysuria
frothy d/c
strawberry cervix
post-coital bleeding
```
53
What is vulvovaginal candidiasis (VVC)?
Yeast infection, usually caused by Candida albicans
54
S/sx of VVC
```
irritation, which, white, curd-like d/c, pain with intercourse, erythema at vulva and/or vaginal walls.
pH NORMAL <4.5
Amine test (whiff test) NORMAL
Yeast buds or pseudohyphae on KOH slide
```
55
Define "recurrent VVC"
>/= 4 cases/1year
56
Tx of VVC
-azoles (Clotrimazole, terconazole, miconazole, fluconazole)
57
Tx of recurrent VVC
2 doses of fluconazole, 72hrs apart
| -azoles intravaginally weekly for 6 mons
58
Tx of complicated VVC (non-albicans)
- 600mg boric acid in gelatin capsules, vaginally 1/d x2wks
| - Nonfluconazole azole regimen for 7-14d (first-line)
59
Tx for VVC in pregnancy
7 day course of intravaginal azoles
60
S/sx of mullerian abnormalities
```
NORMAL XX-46 chromosomes
NORMAL ovaries
Dysregulationof differentiation of mullein ducts and urogenital sinus (urogenital, vaginal agenesis or doubling)
Age appropriante external genitalia
Menstrual disorders
Ob complications (SABs)
```
61
Dx of Mullerian abnormalities
Ultrasound/hysterosalpingogram, Physical exam, IVP, renal u/s, MRI.
62
What is androgen insensitivity/resistance syndrome?
X-linked recessive syndrome
| 46 XY karyotype with female phenotype (varies) , mullerian regression. Tissues do not respond to testosterone or DHT
63
S/sx & Dx of androgen insensitivity syndrome
NB: inguinal masses
64
S/sx & Dx of androgen insensitivity syndrome
```
S/sx:
NB: inguinal masses
gynecomastia
dyspareunia
infertility
primary amenorrhea
inguinal hernia
impaired penile growth
Absent uterus/ovaries
scant body hair
tall stature
Dx: Karyotype
T and DHT, DHEA, Androstenedione, 17-HP, 17-P
Ultrasound
```
65
Medical management for androgen insensitivity syndrome
```
CAIS (females): HRT, estrogen
PAIS (males): DHT therapy
Referrals:
genetic counseling for parents
endocrinologist
```
66
What is Turner's syndrome?
45 X (only 1 X)
67
S/sx of Turner's syndrome
```
Short suture, webbed neck, shield chest, absence of puberty, low hair line, low set ears, swollen hands/feet at birth
small/streak ovaries
present uterus
cardiac murmur
hearing loss
goiter
Does not usually affect intellect
```
68
Dx of Turner's
```
Karyotyping
MRI/ultrasound
renal ultrasound
FSH/LH
TFT
```
69
Management of Turner's syndrome
Endocrinology
| E/P and growth hormone replacement
70
Normal menstrual cycle length
28d +/-7d
| 21-35d
71
Normal menses duration
2-8d
72
Normal blood volume lost
<80cc (avg=30cc)
73
Abnormal uterine bleeding is...
abnormal routine, frequency, duration, or volume of menses or interferes w/quality of life.
74
In r/o causes of AUB, we use PALM-COIEN, which stands for...
```
Structural: PALM
P-Polyps
A-Adenomyosis
L-Leiomyoma
M-Malignancy
Non-structural: COIEN
Coaguloapathy
Ovulatory dysfunctions (PCOS)
Endometrial
Iatrogenic
Not otherwise classified
```
75
Chronic AUB is >____
6 mons
76
Absent menstrual pattern is defined as no period > ____
90 day period
77
Leiomyomas (fibroids) are...
benign, firm, non-tender irregular tumor
78
Adenomyosis
Benign tender growth of endometrial tissue into uterine wall. Globular and soft
79
Diagnosing cause of AUB
history
PE
Lab tests: Pregnancy test, GC/CT, CBC +serum iron, TIBC, &ferritin, Prolactin, TFTs, TSH, coagulation tests: Von-willebrands?, LFTs
Imaging tests: ultrasound, saline infusion sonohysterography, MRI, hysteroscopy, TVUS
Biopsy-EMB
80
T or F:
| Endometrial thickness in premenopausal women is helpful
FALSE, endometrial thickness only valuable in post-menopausal women
81
Get EMB for AUB for women/people who are ...
>45y/o
<45y/o with h/o unopposed estrogen, obese, PCOS
At risk for endometrial cancer
failed medical mgmt or persistent AUB
82
Treatment for heavy AUB
Iron 325mg (65mg elemental iron)
progestin therapy
NSAIDs
LNG-IUD
COCs
-TXA 10mg/kg IV (max 600mg) TID x5d
-Conjugated equine Estrogen 25mg IV q4-6hrs for 24 hrs
-Monophasic COCs w/35mcg of ethinyl E2 TID for 7d
-Medroxyprogesterone acetate 20mg TID for 7d
83
What is considered an adequate hgb rise after iron implementation?
2g/dL rise in 3 wks
| 2 in 3!
84
Define primary amenorrhea
no menses or secondary sex characteristics by age 14
or
No menses by age 15
85
Define secondary amenorrhea
absence of 3 cycles (or 6 mons) in women/ppl who have previously menstruated
86
lab work up for amenorrhea
```
Beta hCG, TSH/T4, AMH, FSH, & prolactin (fasting, before 8am)
If low FSH, consider:
-karyotype if <30y.o
-obtain T, DS, LH
-ovarian failure
```
If hyperprolactimemia, order MRI, refer to end
TVUS
87
Expected lab values for PCOS
Low FSH
Normal to mildly increased T, DS, LH
+/-hirsutism
88
Management for PCOS
```
Lifestyle
Cyclic progesterone (Provera/MPA) 10mg PO for 10-14d
OCP
Metformin
Ovulation induction (clomid)
```
89
Management for hypothalamic amenorrhea
lifestyle
cyclic progesterone
non-oral E2 to maintain bone heaalth
Team/psych (eating disorder(
90
Tx for hyperprolactinemia
dopamine agonists
MRI
Endocrine
Tumor eval
91
Tx for ovarian failure
E2/progesterone to protect bones and endometrium
| +endocrine referral
92
PCOS is a state of chronic anovulation associated LH-dependent ovarian overproduction of________
androgens
93
Most common endocrine disorder of women of reproductive age
PCOS
94
People who have PCOS are at risk for...
CVD
non-insulin dependent DM
endometrial carcinoma
95
PCOS is a group of symptoms characterized by...
```
Androgen excess
Ovulatory dysfunction
Polycystic ovaries
Insulin resistance (low SHBG)
```
96
Diagnosis of PCOS
Rotterdam criteria: 2/3 of the following:
- oligo/anovulation
- polycystic ovaries (U/S)
- clinical/biochem hyperandrogen (acne, hirsutism)
97
Metabolic syndrome dx:
```
Waist circumference >35
Dyslipidemia
Elevated BP
Elevated c-ractive protein
prothrombotic state
Type 2 DM (at risk)
```
98
Tx for PCOS
Lifestyle
CHC
Metformin 500mg
Statins if dyslipidemia
Clomiphene citrate or letrozole for infertility
Acne: Abx and astringents
Hirsutism: electrolysis, laser, epilation, bleaching, vaniqa (prevents regrowth)
99
Primary dysmenorrhea
6-12 months after menarche; pain peaks with maximal blood flow
100
Secondary dysmenorrhea
painful menses associated with pelvic disease
101
PID dx
Uterine, adnexal, or cervical tenderness + abdominal pain
| ++ if fever, vaginal d/c
102
Gold standard for tx of dysmenorrhea
NSAIDs (start a few days before menses or onset of sx)
103
Tx of dysmenorrhea
NSAIDS***
Ovulatory inhibitors (OCPs, DMPA, implant, LNG-IUS)
Montelukast 10mg/d on days 21-end of bleeding (Not FDA approved, but affect leukotrienes in smooth muscle)
104
What is endometriosis?
Endometrial mucosa found in locations other than uterine cavity or muscle. (endometriomas)
105
Complications of endometriosis
```
infertility
dysmenorrhea
bloating
n/v
constipaation
dyspareunia
Dyschezia (pain on defecation)
Heavy/irreg bleeding
low back pain
fatigue/weariness
urinary frequency
inguinal pain
```
106
How to diagnose endometriosis
Gold Standard: Laparoscopy and biopsy
| PE and history (don't need confirmation prior to tx)
107
Treatment of endometriosis
NSAIDs
CHCs
Progestogens
108
Treatment of adenomyosis
```
hysterectomy
uterine artery embolization
adenomyomectomy
NSAIDs
GnRH agonists
Androgens: Danazol
LNG-IUS
CHCs
Aromatase-Inhibitors
```
109
Diagnosis of PMS
At least one affective (depression, anxiety, etc.) and one somatic symptom (weight gain, breast swelling, headache, etc.) during the 5 days BEFORE menses in each of the prior 3 menstrual cycles.
110
Diagnosis of PMS
At least one affective (depression, anxiety, etc.) and one somatic symptom (weight gain, breast swelling, headache, etc.) during the 5 days BEFORE menses and received w/in4 days of onset of menses in each of the prior 3 menstrual cycles
111
Tx of PMS
NSAIDs
CHCs
SSRIs>TCAs
Spironolactone
112
PMDD Dx:
5/11 symptoms in luteal phase and absent after menses:
Marked depression, anxiety, affective lability, persistent anger, decreased interest, difficulty concentrating
*Must interfere w/school, work, sex, or social life.
*Must r/o other causes & be r/t menstrual cycle
*at least 2 cycles charted
113
PMDD tx
```
NSAIDs
CHCs
spirolactone
Beta blockers
SSRIs
```
114
Infertility is defined as ...
no pregnancy for 12 months of unprotected sex (6 mons if >35y.o)
115
Common causes of male infertility
Scarring of vas deferens
Poor sperm production
Hypogonadism (age >50)
116
Testing for infertility
Semen analysis
Uterine/f.t eval: HSG, sonohystogram
Labs: FSH/Estrogen/LH (Days 2-4)
TVUS antral follicles (5-10, <10mm--During days 1-5)
AMH: Anti-mullerian hormone (best biomarker, secreted by granulose cells)
Other labs: STI testing, CBC, rubella, TSH, vitD, prolactin
117
Normal FSH, Estrogen, and AMH
FSH 3.5-12 IU/ >10 is concerning
E >70pg/mL is abnormal
AMH<1 is abnormal (avoid while on CHCs, higher levels w/PCOS)
118
Normal semen analysis (SA)
```
Volume > 1.5mL
Concentration >15 mil/cc
Total sperm count > 39 million
Motility >32%
Morphology >4%
```
119
Management of oligospermia
repeat in 8-12 weeks
120
Methods to induce ovulation
```
Weight loss if BMI>27
Clomiphene Citrate (Clomid) 50mg
Letrozole (Femara)-NS aromatase inhibitor (increases FSH/GnRH)
Metformin
Refer for injectable gonadotropins
```
121
Dose regimen for clomid
50-200mg days 3-8 or 5-9
122
SE/ADE of clomid
Pseudomenopause symptoms
SERM (increases FSH/LH)
Risk: multiples (8-10%)
123
Dose regimen for Letrozole (femara)
2.5-5mg taken days 3-7 or 5-9 (better SE profile than Clomid but not FDA approved)
124
Doses for metformin
500mg (slowly increase)
125
When is hysterosalpingogram performed?
Before ovulation, after menses
126
How to manage abnormal HSG?
SIS or hysteroscopy
127
When to refer after infertility mgmt?
4 cycles
128
Peak fertility is ___ y/o in women
20-24 y/o
129
How long do sperm and egg survive?
Sperm: 5 days
egg: 24 hrs
130
Ovulation predictor kits may be problematic with folks w/...
PCOS
131
What vaginal lubricants decrease fertility?
water-based
| NO KY
132
What is Lichen simplex chronicus?
Epithelial thickening and hyperkeratosis resulting from "chronic itch-scratch cycle"
- heat, sweat, rubbing from tight clothes, pad wearing, fragrant soaps, laundry products, topical products
- 2ndary to yeast infections, psoriasis, neoplasia
133
Exam findings of lichen simplex chronicus (LSC)?
Lichenification often on labia majora, but can be in other places
-Dusky red to grayish white coloring with hyperkeratosis
+/- Fissures & excoriations
S/Sx: itching +/- burning
134
How to diagnose lichen simplex chronicus (LSC) and lichen sclerosus?
Biopsy
| Wet mount & yeast culture
135
Treaatment
Low to medium corticosteroids (Ointment based only)
A&D ointment or zinc oxide as skin protectant
Vegetable based oils as skin emollient
Baking soda or Domeboro soaks
136
What is lichen sclerosus?
Multifactorial autoimmune chronic progressive skin condition that causes pruritus, burning, dyspareunia, & dysuria.
137
Exam findings for lichen sclerosus (LS)?
Thin, white, parchment with layer of hyperkeratosis.
+/- Lost of normal vulvar structures and oblitertion of labia minora and peri-clitoral structures, & flattening of perianal area.
+/- Introital stenosis
138
Treatment for Lichen Sclerosus
Topical Corticosteroids (ointment based): Clobetasol (ultra potent) to get it under control, then switch to mod-high potent steroid (triamcinolone).
Remove irritants
Vegetable based oils
A&D ointment or zinc oxide
139
Complication of Lichen sclerosus and lichen planus?
Squamous cell carcinoma (90% of vulvar & vaginal cancer is SCC)
140
What is Lichen planus?
Inflammatory disorder involving mucosal and keratinized tissue (+/- autoummune?)
Most often affecting women, 30-60y/o
Can occur in gums and mouth too.
141
S/Sx of Lichen planus
```
Raw sensation
Pruritus
burning
dyspareunia
vaginal bleeding and discharge (greed, malodor)
Dysuria
```
142
Physical exam findings of Lichen Planus
Sharply demarcated erythamatous patches from introitus to apex of the vaginal fornices, +/- cervix
Wickham's striae=Gray-white lacy strands of hyperkeratosis
Stenosis and synechiae
>5 pH and ++WBCs on wet mount
143
Treatment w/Lichen Planus
Corticosteroids, protectants, emollients, and dilators
144
What is vulvodynia?
Generalized or localized vulvar discomfort, often described as burning, without any visible findings for at least 3 months. Diagnosis is based on exclusion and is thought to be multifactorial and is associated with PBS and IBS
145
Signs and symptoms of generalized vulvodynia?
Pain described as burning, stinging, soreness, rawness, irritation, achiness, stabbing, or itching...and it occurs around on on vulva: mons pubis, labias, and perineum.
146
Signs and symptoms of localized vulvodynia
Pain described as burning, tearing, throbbing, tingling "razor blades" or "cut glass" localized to vestibule and clitoris that can last hours to days. Avoidance of sex, exercise, pelvic exams, tight clothing, etc..
147
What is the Marinoff scale used for?
To rate entry dyspareunia.
148
Diagnosis for vulvodynia
Q-tip test, diagnosis based on exclusion--STI testing and Wet mount
149
Treatment for vulvodynia
```
Neuropathic pain meds:
-Gabapentin (Neurontin)
-Pregabalin (Lyrica)
-Amitriptyline or desipramine
Psychotherapy
Hypnosis
Acupuncture
Topical nitroglycerin
topical capsaicin
interferon inection
surgeery
sacral neuromodulation
TENS
Decrease stress--flares up w/stress
```
150
No. 1 cause of UTIs
E. Coli
151
Signs and symptoms of uncomplicated cystitis:
Abrupt onset, frequency, urgency, dysuria, foul smelling urine, hematuria, supra pubic pain. CAN BE ASYMPTOMATIC.
152
Signs and symptoms of complicated pyelonephritis:
```
frequency, urgency, dysuria, odor, hematuria, supra pubic pain
fever
N/V
CVA tenderness
flank/abdominal pain
```
153
Diagnostic test for UTI
```
Urine dipstick
-Nitrites, leukocytes
Urine culture and sensitivity: >100,000
Urine microscopy
STI and wet mount
```
154
Treatment for uncomplicated UTIs
3 day treatment of Trimethoprim-sulfamethaxozole (TMP/SMX) (Bactrim) or Fluoroquinolones (ciprofloxacin)
155
Treatment for uncomplicated UTI for pregnant women or w/DM
7-10 day treatment of TMP/SMX (Bactrim) or nitrofurantoin (Macrobid) ONLY in 2nd trimester
1 dose of Fosfomycin 3g
3-7d of:
-Keflex/Cephalexin 500mg QID OR
-Ampicillin or Augmentin 500mg TID or 875mg BID
156
Treatment for recurrent UTI
```
Retest and retreat
Single-dose of nitrofurantoin, bactrim, cephalexin, norfloxacin, or oflaxacin after sex
Consider estrogen if issue
void after intercourse
Referral
```
157
What meds should you avoid prescribing with someone with G6PD?
```
Nitrofurans: Nitrofurantoin (Macrobid)
Sulfas: TMP/SMX (Bactrim)
Quinolones: -floxacin
Pyridium
--> causes hemolysis!
```
158
Treatment for complicated UTI or acute pyelonephritis
14 days of usual regimen & REFER, REFER, REFER
159
What is interstitial cystitis (IC) (AKA: painful bladder syndrome)
Pain, pressure or discomfort perceived to be related to the urinary bladder w/lower urinary tract symptoms (frequency & urgency) of >6 weeks duration in the ABSENCE of infection or other causes.
Etiology: permeability and thinning of epithelium, allergic component, neuro signals, autoimmunity.
160
Physical exam findings of IC
Interstitial cystitis:
- suprapubic tenderness
- tender/spastic levator muscles, anterior vaginal wall/urethra
- perineal tenderness
161
IC diagnostic tests:
Interstitial cystitis:
| frequency/volume chart, post-void residual, UA/culture
162
IC treatment
Interstitial cystitis:
-relaxation/stress management
-self care, water!
-physical therapy
PHARM:
-TCAs/Neuro (amitriptyline), Acid reducer (cimetidine), antihistamines (hydroxyzine)
Intravesical: dimethyl sulfoxide (DMSO), heparin, lidocaine.
163
Describe the different types of urinary incontinence
Stress: r/t urethral dysfunction
Urgency: r/t bladder dysfunction/detrusor overactivity
Mixed: both
164
Urinary incontinence testing
```
voiding diary
Post void residual
UA and C&S
urodynamic testing
cystoscopy
Pelvic exam: organ prolapse, atrophy, obesity
```
165
Treatment for stress urinary incontinence
Weight loss, pessaries, pelvic floor PT, smoking cessation, surgery
166
Treatment of urgency incontinence
Bladder retraining, avoidance of constipation and irritants/caffeine, kegal exercises, weight loss
Botox
Meds: Anticholinergic and antimuscarinic agents, beta-3adrenergic agonist
(Oxybutynin/Ditropan, darifenacin, fesoterodine, trospium)
Sacral neuromodulation--interstim
PTNS
