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Gyn/Wellwoman > Gyn/WW > Flashcards

Gyn/WW Flashcards

contraception WW Sexual health breast health

1
Q

If on Yaz or Yazmin, one should avoid these classes of meds for K+ overload.

A

ACE inhibitors and ARBs

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2
Q

When should screening for GC/CT occur?

A

annually <25 y/o or those at risk.

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3
Q

Sites of GC/CT

A

endocervix, urethra, anus, pharyngeal

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4
Q

Potential sequelae for GC/CT

A

PID, ectopic pregnancy, infertility (female), epididymitis

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5
Q

S/sx for GC/CT

A

Usually asymptomatic

Post-coital bleeding, dysuria, vaginal or penile d/c, mucopurulent cervical d/c

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6
Q

Testing for GC/CT

A

NAAT using urine, vaginal, endocervix, rectum

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7
Q

Recommended treatment for CT

A

1g Azithromycin

100 Doxycycline BID x7d

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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.

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9
Q

In the US, type __ and __ cause 90% of genitals warts

A

6 & 11

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10
Q

The most common viral STI

A

Human papillomavirus

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11
Q

How to diagnose HPV warts

A

visual inspection or biopsy (cauliflower-like)

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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
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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–
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14
Q

Potential sequelae for GC

A

septic arthritis, bacteremia, Gonorrhea ophthalmia neonatorium, pregnancy complications, Skene or bartholin’s gland, PID, infertility, ectopic, epididymis.

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15
Q

Dual therapy for GC

A 
Ceftriaxonne 250mg IM +
Azithromycin 1g
Alt: 
Cefixime 400mg +Azithro 1g
Gentamicin 240mg IM + Azithro 2g
(Allergy?--consult!)
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16
Q

If + for GC/CT, treat all sex partners in the past __ days

A

60 days (2 mons)

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17
Q

GC treatment failures should be re-tested with ___

A

culture to allow susceptibility testing

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18
Q

TOC for pharyngeal GC in __ days

A

14 days

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19
Q

Primary infection of HSV-1 or HSV-2

A

Asymptomatic
+/- flu-like symptoms, tender inguinal lymphadenopathy
+/- small painful vesicles with rupture

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20
Q

Most sensitive HSV testing

A

PCR (direct testing)

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21
Q

HSV symptoms for recurrent infections

A

Shorter, less severe, (usually one vesicle)

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22
Q

HSV screening is or is not recommended

A

IS NOT!

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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

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24
Q

Suppressive treatment for HSV for pregnancy starting at 36wks

A

Valacyclovir 500mg BID

Acyclovir 400mg TID

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25
Q

What is molluscum contagious?

A

Pox virus, not always sexually transmitted.

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26
Q

S/sx of molluscum contagious?

A

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

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27
Q

Tx of molluscum contagious

A
  • Usually resolve spontaneously w/o scarring (8 mons)

- Incision and removal of core, but may cause scarring

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28
Q

Syphilis is caused by…

A

Treponema pallidum, bacterial spirochete

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29
Q

How many stages in syphilis?

A

4: early, early latent (<12mons), late latent (>12 mons), tertiary
(CNS involvement can occur at any stage)

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30
Q

S/sx of primary syphilis

A

Asymptomatic, primary painless, ulcerated chancre (disappears 3-6wks) with raised border

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31
Q

S/sx of primary syphilis

A

Asymptomatic, primary painless, ulcerated chancre with raised border (disappears 3-6wks)

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32
Q

S/sx of secondary syphilis

A

+/- systemic: lymphadenopathy, flu-like symptoms

Localized or diffuse mucocutaneous lesions (on palms, soles, mucous patches, and +/-condylomata lata)

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33
Q

S/sx of tertiary syphillis

A

NOT infectious
Gummas (nodular lesions)
Cardiac symptoms
Neurosyphilis

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34
Q

How to diagnose syphilis

A

non-treponemal test: RPR, VDRL (titers-quantitative–4-fold change is diluted 2x)
&
Treponemall tests: dark field microscopes, FTA-ABS, TPPA

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35
Q

Tx for syphilis

A

2.4mu Benzathine penicillin IM

Late latent/HIV+/Neuro: 3 doses, 1 wk apart

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36
Q

f/u of syphilis

A

Titers repeated at 6 and 12 mons

Titers should decline at least 4-fold w/in 12-24 mons

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37
Q

What causes chancroid?

A

Haemophilus ducreyi, a short, nonmotile, gram-negative rod

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38
Q

S/sx of chancroid

A

Asymptomatic, papules or painful ulcerations, bilateral inguinal lymph (bubos)
Lesions resolve 1-2 wks when treated

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39
Q

Dx of chancroid

A

Culture from lesion or bubo (<80% sensitive)
Neg test for HSV & syphilis
PCR tests

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40
Q

Tx of Chancroid

A

1 g Azithro
250mg Ceftriaxone IM
500mg Ciprofloxacin BID x3d
500mg Erythromycin base TID x7d

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41
Q

F/u for Chancroid

A

re-examine in 3-7days

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42
Q

Tx for LGV

A

Doxy 100mg BID x21d
Erythro 500mg QID x21d
f/u until symptoms resolved

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43
Q

Tx for nongonococcal urethritis (NGU)

A

1g Azithro

100mg doxy BID x7d

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44
Q

Tx for PID

A 
Ceftriaxone 250mg IM
Doxy 100mg BID x14d
Metronidazole 500mg BID x14d
f/u in 72 hrs
PARTNER TX
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45
Q

When should hospitalize PID?

A

Pregnancy, pelvic abscess, surgical emergency cannot be ruled out, severe fever, severe N/V, failure of outpatient therapy

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46
Q

Bacterial vaginosis tx

A

Metronidazole 500mg BID x7d (avoid EtOH)
Metrogel 0.75% x5d
Clindamycin 2% x7d (weaken condoms)
(SAFE IN PREGNANCY)

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47
Q

Trichominiasis tx:

A 
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
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48
Q

What is BV?

A

Alteration of normal flora of the vagina w/overgrowth of anaerobic bacteria (not usually inflamed)

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49
Q

S/sx of BV?

Dx of BV?

A 
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)
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50
Q

Dx of Trichomonas vaginalis

A

microscopy (50-60%)
NAAT (vaginal or urine)
Culture
non-amplified molecular

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51
Q

What is trichomonads?

A

Anaerobic, motile flagellated protozoan parasite (tear-drop shaped)

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52
Q

S/sx of trichomonads

A 
5.6-7 pH
Irritaation, pruritus
dysuria
frothy d/c
strawberry cervix
post-coital bleeding
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53
Q

What is vulvovaginal candidiasis (VVC)?

A

Yeast infection, usually caused by Candida albicans

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54
Q

S/sx of VVC

A 
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
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55
Q

Define “recurrent VVC”

A

> /= 4 cases/1year

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56
Q

Tx of VVC

A

-azoles (Clotrimazole, terconazole, miconazole, fluconazole)

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57
Q

Tx of recurrent VVC

A

2 doses of fluconazole, 72hrs apart

-azoles intravaginally weekly for 6 mons

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58
Q

Tx of complicated VVC (non-albicans)

A
  • 600mg boric acid in gelatin capsules, vaginally 1/d x2wks

- Nonfluconazole azole regimen for 7-14d (first-line)

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59
Q

Tx for VVC in pregnancy

A

7 day course of intravaginal azoles

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60
Q

S/sx of mullerian abnormalities

A 
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)
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61
Q

Dx of Mullerian abnormalities

A

Ultrasound/hysterosalpingogram, Physical exam, IVP, renal u/s, MRI.

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62
Q

What is androgen insensitivity/resistance syndrome?

A

X-linked recessive syndrome

46 XY karyotype with female phenotype (varies) , mullerian regression. Tissues do not respond to testosterone or DHT

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63
Q

S/sx & Dx of androgen insensitivity syndrome

A

NB: inguinal masses

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64
Q

S/sx & Dx of androgen insensitivity syndrome

A 
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
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65
Q

Medical management for androgen insensitivity syndrome

A 
CAIS (females): HRT, estrogen
PAIS (males): DHT therapy
Referrals:
genetic counseling for parents
endocrinologist
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66
Q

What is Turner’s syndrome?

A

45 X (only 1 X)

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67
Q

S/sx of Turner’s syndrome

A 
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
Q

Dx of Turner’s

A 
Karyotyping
MRI/ultrasound
renal ultrasound
FSH/LH
TFT
69
Q

Management of Turner’s syndrome

A

Endocrinology

E/P and growth hormone replacement

70
Q

Normal menstrual cycle length

A

28d +/-7d

21-35d

71
Q

Normal menses duration

A

2-8d

72
Q

Normal blood volume lost

A

<80cc (avg=30cc)

73
Q

Abnormal uterine bleeding is…

A

abnormal routine, frequency, duration, or volume of menses or interferes w/quality of life.

74
Q

In r/o causes of AUB, we use PALM-COIEN, which stands for…

A 
Structural: PALM
P-Polyps
A-Adenomyosis
L-Leiomyoma
M-Malignancy
Non-structural: COIEN
Coaguloapathy
Ovulatory dysfunctions (PCOS)
Endometrial
Iatrogenic
Not otherwise classified
75
Q

Chronic AUB is >____

A

6 mons

76
Q

Absent menstrual pattern is defined as no period > ____

A

90 day period

77
Q

Leiomyomas (fibroids) are…

A

benign, firm, non-tender irregular tumor

78
Q

Adenomyosis

A

Benign tender growth of endometrial tissue into uterine wall. Globular and soft

79
Q

Diagnosing cause of AUB

A

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
Q

T or F:

Endometrial thickness in premenopausal women is helpful

A

FALSE, endometrial thickness only valuable in post-menopausal women

81
Q

Get EMB for AUB for women/people who are …

A

> 45y/o
<45y/o with h/o unopposed estrogen, obese, PCOS
At risk for endometrial cancer
failed medical mgmt or persistent AUB

82
Q

Treatment for heavy AUB

A

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
Q

What is considered an adequate hgb rise after iron implementation?

A

2g/dL rise in 3 wks

2 in 3!

84
Q

Define primary amenorrhea

A

no menses or secondary sex characteristics by age 14
or
No menses by age 15

85
Q

Define secondary amenorrhea

A

absence of 3 cycles (or 6 mons) in women/ppl who have previously menstruated

86
Q

lab work up for amenorrhea

A 
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
Q

Expected lab values for PCOS

A

Low FSH
Normal to mildly increased T, DS, LH
+/-hirsutism

88
Q

Management for PCOS

A 
Lifestyle
Cyclic progesterone (Provera/MPA) 10mg PO for 10-14d
OCP
Metformin
Ovulation induction (clomid)
89
Q

Management for hypothalamic amenorrhea

A

lifestyle
cyclic progesterone
non-oral E2 to maintain bone heaalth
Team/psych (eating disorder(

90
Q

Tx for hyperprolactinemia

A

dopamine agonists
MRI
Endocrine
Tumor eval

91
Q

Tx for ovarian failure

A

E2/progesterone to protect bones and endometrium

+endocrine referral

92
Q

PCOS is a state of chronic anovulation associated LH-dependent ovarian overproduction of________

A

androgens

93
Q

Most common endocrine disorder of women of reproductive age

A

PCOS

94
Q

People who have PCOS are at risk for…

A

CVD
non-insulin dependent DM
endometrial carcinoma

95
Q

PCOS is a group of symptoms characterized by…

A 
Androgen excess
Ovulatory dysfunction
Polycystic ovaries
Insulin resistance (low SHBG)
96
Q

Diagnosis of PCOS

A

Rotterdam criteria: 2/3 of the following:

  • oligo/anovulation
  • polycystic ovaries (U/S)
  • clinical/biochem hyperandrogen (acne, hirsutism)
97
Q

Metabolic syndrome dx:

A 
Waist circumference >35
Dyslipidemia
Elevated BP
Elevated c-ractive protein
prothrombotic state
Type 2 DM (at risk)
98
Q

Tx for PCOS

A

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
Q

Primary dysmenorrhea

A

6-12 months after menarche; pain peaks with maximal blood flow

100
Q

Secondary dysmenorrhea

A

painful menses associated with pelvic disease

101
Q

PID dx

A

Uterine, adnexal, or cervical tenderness + abdominal pain

++ if fever, vaginal d/c

102
Q

Gold standard for tx of dysmenorrhea

A

NSAIDs (start a few days before menses or onset of sx)

103
Q

Tx of dysmenorrhea

A

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
Q

What is endometriosis?

A

Endometrial mucosa found in locations other than uterine cavity or muscle. (endometriomas)

105
Q

Complications of endometriosis

A 
infertility
dysmenorrhea
bloating
n/v
constipaation
dyspareunia
Dyschezia (pain on defecation)
Heavy/irreg bleeding
low back pain
fatigue/weariness
urinary frequency
inguinal pain
106
Q

How to diagnose endometriosis

A

Gold Standard: Laparoscopy and biopsy

PE and history (don’t need confirmation prior to tx)

107
Q

Treatment of endometriosis

A

NSAIDs
CHCs
Progestogens

108
Q

Treatment of adenomyosis

A 
hysterectomy
uterine artery embolization
adenomyomectomy
NSAIDs
GnRH agonists
Androgens: Danazol
LNG-IUS
CHCs
Aromatase-Inhibitors
109
Q

Diagnosis of PMS

A

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
Q

Diagnosis of PMS

A

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
Q

Tx of PMS

A

NSAIDs
CHCs
SSRIs>TCAs
Spironolactone

112
Q

PMDD Dx:

A

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
Q

PMDD tx

A 
NSAIDs
CHCs
spirolactone
Beta blockers
SSRIs
114
Q

Infertility is defined as …

A

no pregnancy for 12 months of unprotected sex (6 mons if >35y.o)

115
Q

Common causes of male infertility

A

Scarring of vas deferens
Poor sperm production
Hypogonadism (age >50)

116
Q

Testing for infertility

A

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
Q

Normal FSH, Estrogen, and AMH

A

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
Q

Normal semen analysis (SA)

A 
Volume > 1.5mL
Concentration >15 mil/cc
Total sperm count > 39 million
Motility >32%
Morphology >4%
119
Q

Management of oligospermia

A

repeat in 8-12 weeks

120
Q

Methods to induce ovulation

A 
Weight loss if BMI>27
Clomiphene Citrate (Clomid) 50mg
Letrozole (Femara)-NS aromatase inhibitor (increases FSH/GnRH) 
Metformin
Refer for injectable gonadotropins
121
Q

Dose regimen for clomid

A

50-200mg days 3-8 or 5-9

122
Q

SE/ADE of clomid

A

Pseudomenopause symptoms
SERM (increases FSH/LH)
Risk: multiples (8-10%)

123
Q

Dose regimen for Letrozole (femara)

A

2.5-5mg taken days 3-7 or 5-9 (better SE profile than Clomid but not FDA approved)

124
Q

Doses for metformin

A

500mg (slowly increase)

125
Q

When is hysterosalpingogram performed?

A

Before ovulation, after menses

126
Q

How to manage abnormal HSG?

A

SIS or hysteroscopy

127
Q

When to refer after infertility mgmt?

A

4 cycles

128
Q

Peak fertility is ___ y/o in women

A

20-24 y/o

129
Q

How long do sperm and egg survive?

A

Sperm: 5 days
egg: 24 hrs

130
Q

Ovulation predictor kits may be problematic with folks w/…

A

PCOS

131
Q

What vaginal lubricants decrease fertility?

A

water-based

NO KY

132
Q

What is Lichen simplex chronicus?

A

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
Q

Exam findings of lichen simplex chronicus (LSC)?

A

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
Q

How to diagnose lichen simplex chronicus (LSC) and lichen sclerosus?

A

Biopsy

Wet mount & yeast culture

135
Q

Treaatment

A

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
Q

What is lichen sclerosus?

A

Multifactorial autoimmune chronic progressive skin condition that causes pruritus, burning, dyspareunia, & dysuria.

137
Q

Exam findings for lichen sclerosus (LS)?

A

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
Q

Treatment for Lichen Sclerosus

A

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
Q

Complication of Lichen sclerosus and lichen planus?

A

Squamous cell carcinoma (90% of vulvar & vaginal cancer is SCC)

140
Q

What is Lichen planus?

A

Inflammatory disorder involving mucosal and keratinized tissue (+/- autoummune?)
Most often affecting women, 30-60y/o
Can occur in gums and mouth too.

141
Q

S/Sx of Lichen planus

A 
Raw sensation
Pruritus
burning
dyspareunia
vaginal bleeding and discharge (greed, malodor)
Dysuria
142
Q

Physical exam findings of Lichen Planus

A

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
Q

Treatment w/Lichen Planus

A

Corticosteroids, protectants, emollients, and dilators

144
Q

What is vulvodynia?

A

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
Q

Signs and symptoms of generalized vulvodynia?

A

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
Q

Signs and symptoms of localized vulvodynia

A

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
Q

What is the Marinoff scale used for?

A

To rate entry dyspareunia.

148
Q

Diagnosis for vulvodynia

A

Q-tip test, diagnosis based on exclusion–STI testing and Wet mount

149
Q

Treatment for vulvodynia

A 
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
Q

No. 1 cause of UTIs

A

E. Coli

151
Q

Signs and symptoms of uncomplicated cystitis:

A

Abrupt onset, frequency, urgency, dysuria, foul smelling urine, hematuria, supra pubic pain. CAN BE ASYMPTOMATIC.

152
Q

Signs and symptoms of complicated pyelonephritis:

A 
frequency, urgency, dysuria, odor, hematuria, supra pubic pain
fever
N/V
CVA tenderness
flank/abdominal pain
153
Q

Diagnostic test for UTI

A 
Urine dipstick
-Nitrites, leukocytes
Urine culture and sensitivity: >100,000
Urine microscopy
STI and wet mount
154
Q

Treatment for uncomplicated UTIs

A

3 day treatment of Trimethoprim-sulfamethaxozole (TMP/SMX) (Bactrim) or Fluoroquinolones (ciprofloxacin)

155
Q

Treatment for uncomplicated UTI for pregnant women or w/DM

A

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
Q

Treatment for recurrent UTI

A 
Retest and retreat
Single-dose of nitrofurantoin, bactrim, cephalexin, norfloxacin, or oflaxacin after sex
Consider estrogen if issue
void after intercourse
Referral
157
Q

What meds should you avoid prescribing with someone with G6PD?

A 
Nitrofurans: Nitrofurantoin (Macrobid)
Sulfas: TMP/SMX (Bactrim)
Quinolones: -floxacin
Pyridium
--> causes hemolysis!
158
Q

Treatment for complicated UTI or acute pyelonephritis

A

14 days of usual regimen & REFER, REFER, REFER

159
Q

What is interstitial cystitis (IC) (AKA: painful bladder syndrome)

A

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
Q

Physical exam findings of IC

A

Interstitial cystitis:

  • suprapubic tenderness
  • tender/spastic levator muscles, anterior vaginal wall/urethra
  • perineal tenderness
161
Q

IC diagnostic tests:

A

Interstitial cystitis:

frequency/volume chart, post-void residual, UA/culture

162
Q

IC treatment

A

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
Q

Describe the different types of urinary incontinence

A

Stress: r/t urethral dysfunction
Urgency: r/t bladder dysfunction/detrusor overactivity
Mixed: both

164
Q

Urinary incontinence testing

A 
voiding diary
Post void residual
UA and C&amp;S
urodynamic testing
cystoscopy
Pelvic exam: organ prolapse, atrophy, obesity
165
Q

Treatment for stress urinary incontinence

A

Weight loss, pessaries, pelvic floor PT, smoking cessation, surgery

166
Q

Treatment of urgency incontinence

A

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

Gyn/Wellwoman (4 decks)

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