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Week 10: GU and gyne Flashcards

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1
Q

what is the expected ages to achieve voluntary/intentional urination in kids?

A

girls: 5
boys: 6

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2
Q

what is the difference between primary and secondary enuresis?

A

primary: never achieved continence
secondary: incontinence after 3-6 months of dryness

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3
Q

polysymptomatic enuresis (urgency, frequency, dribbling) is associated with ________

A

constipation

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4
Q

what are risk factors for enuresis?

A
  • low SES
  • large family
  • single parent
  • low birth weight
  • OSA
  • short height
  • poor speech coordination
  • FAMILY HX
  • ADHD
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5
Q

organic causes of secondary enuresis?

A
  • UTI
  • DM
  • diabetes insipidus
  • nocturnal seizures
  • sickle cell anemia
  • medication
  • emotional stress
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6
Q

strategies to help with enuresis?

A
  • reward chart for dry nights in conjunction with other strategies
  • conditioning with alarms
  • dry bed training (parents wake them every hour, then stretch out the intervals)
  • bladder retention training (load with fluids, ask to hold for 5-10 min)
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7
Q

what is the difference between retentive and non-retentive encopresis?

A

retentive: fecal incontinence from functional constipation (liquid stool seeps around hard retained feces aka overflow)

non-retentive: no constipation/retention of stool

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8
Q

risk factors for encopresis?

A
  • males
  • family history
  • enuresis
  • ADHD
  • autism
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9
Q

what are some benefits associated with oral contraceptives?

A

○ prevention of pregnancy
○ protection against ovarian and endometrial cancers
○ decreased risk of functional ovarian cysts and benign breast conditions
○ improvement of acne
decreased menstrual blood loss and menstrual symptoms, such as dysmenorrhea

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10
Q

What are the two distinct time periods where it is normal to have physiologic vaginal discharge in pre-pubescent girls?

A
  • after birth (secondary to effects of maternal estrogen)

- 6 months 1 year before onset of menarche (around tanner stage 4)

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11
Q

history questions to ask with vaginitis in pre-pubescent girls?

A
  • colour, consistency, amount
  • duration
  • odour
  • itching
  • changes in bladder/bowel
  • urinary symptoms, abdo pain
  • changes in behaviour (nightmares, anxiety)
  • change in soap/detergents
  • bubble baths
  • recent illness
  • recent abx use
  • hygiene practices (wiping self, front to back etc)
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12
Q

DDX for vaginitis in pre-pubescent girls

A
  • irritant from soaps and detergents
  • irritant from tight fighting clothes
  • poor hygiene
  • pinworms
  • candida
  • STI
  • congenital abnormality
  • vulvar skin disease (lichen sclerosis, contact deramtitis, psoriasis, zinc)
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13
Q

if casts are present in hematuria, consider ______ origin of hematuria

A

casts = glomerular

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14
Q

common causes of hematuria without casts?

A 
• UTI 
	• Trauma 
	• Bleeding diathesis (hemophilia, ITP) 
	• Renal tumors 
	• Obstruction of the urinary tract 
	• Renal stones 
	• Hypercalciuria 
	• Hemolytic uremic syndrome 
Schistosomiasis (in endemic areas)
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15
Q

History for gross hematuria

A

trauma to trunk, abdo, or perineum

  • recent skin infection or pharyngitis
  • dysuria, abdo or flank pain
  • Presence at onset or end of voiding is urethral or bladder trigone
  • does child look puffy/edema?

FmHx: hematuria, kidney disease, hearing loss, SLE, bleeding diathesis, hemolytic anemia, or inborn error of muscle metabolism

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16
Q

workup if suspicion of glomerulonephritis (eg casts in urine micro)?

A

-ASO titre
-ANA
-C3
-CBC
-Bun, cr
-Alb
-
random urine for creatinine-protein ratio

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17
Q

how is microscopic hematuria defined?

A

3 or more UA with >6 RBC

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18
Q

Causes of microscopic hematuria?

  • infection
  • structural
  • trauma

-interstitial nephritis from….

A

infection: UTI, adenovirus, vaginitis, prostatitis

structure: renal vessel thrombosis, polycystic kidney, urinary obstruction, tumour
- hypercalciuria
- trauma
- interstitial nephritis from drugs

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19
Q

microalbuminuria in urine can be predictive of ________

A

glomerular nephritis

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20
Q

urine micro is best done when?

A

first morning sample

repeat 3 x

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21
Q

glomerulonephritis

most common causes?

A
  • acute post-strep
  • HSP
  • IgA nephropathy
  • SLE
  • hemolytic urea syndrome
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22
Q

what are some signs and symptoms associated with

  • post-strep glomerulonephritis?
  • HSP
  • HUS
A

post-strep:

  • gross hematuria
  • edema
  • HTN

HSP:

  • rash to lower extremities
  • abdo pain
  • proteinuria

HUS

  • bloody diarrhea
  • abdo pain
  • pallor
  • severe HTN
  • decreased urine output
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23
Q

UTI

causative organism for first infections?

other organisms?

A

E coli (80-90% first infections)

remainder are gram neg enteric bacilli (proteus, klebsiella, enterobacter)

gram positive cocci (enterococci, staph saprophyticus)

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24
Q

define difference between:

  • recurrent UTI
  • persistent UTI
  • relapse UTI
A

recurrent: reinfection with new organism (same or different species)

persistence: from med non-compliance or wrong abx
- when repeat urine cx remains positive after 14 days

relapse: symptoms recur within 2 months after initial episode even after negative cx was obtained at 14 days after abx completed (ie infection latent and flared)

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25
how would you differentiate between cystitis and acute pyelo?
pyelo: urinary symptoms PLUS high fever, chills, flank pain, vomiting
26
AAP (2016) recommends that children younger than 2 years old should have ________ after first UTI
renal and bladder ultrasound
27
method of collecting urine specimen from: - young infant - older kiddo
infant: catheter (bag not reliable) older kids: midstream
28
first line treatment of cystitis? alternate?
-nitrofurantoin x 5 days OR cefixime x 5 days alternate: Septra or amox-clav
29
first line treatment of pyelo?
cefixime x 7-10 days OR Septra for 7-10 days OR Amox-Clav x 7-10 days
30
what is the most common benign breast tumour in pts <20?
fibroadenoma
31
what is the first sign of puberty in females?
thelarche: breast bud beneath areola - increase in estrogen (increase in fat) - progesterone causes alveolar budding and lobular growth)
32
what are some medications associated with galactorrhea?
``` — Opiates — Estrogens — Digitalis — Butyrophenones (haloperidol) — Phenothiazines — Risperidone — Metoclopramide — Isoniazid — Reserpine — Cimetidine — Benzodiazepines — Tricyclic antidepressants - illicit drugs: marijuana, heroin ```
33
when do regular ovulatory menses usually start?
2-3 years after menarche
34
thelarche occurs ______ years before menarche Growth acceleration begins _____ years before thelarche
thelarche: 2-3 years before menarche growth: 1 year before thelarche
35
what is the difference between primary and secondary dysmenorrhea?
primary: absence of pelvic pathology secondary: underlying pathology eg PID, endometriosis, cysts * *endometriosis most common
36
what hormone is involved in dysmenorrhea?
prostaglandins boooooooo
37
how is primary amenorrhea defined?
- no spontaneous menstruation in F of reproductive age - absence by age 15 if normal pubertal development - absence by age 13 with no secondary sexual development - absence of menarche within 1-2 years of full sexual maturation (SMR 5)
38
Abnormal uterine bleeding definition of: - prolonged bleeding - excessive bleeding - frequent bleeding
prolonged: >8 days excessive: >6 pads/tampons per day frequent: cycles under 21 days
39
Secondary amenorrhea - definition - DDX
3+ consecutive months of amenorrhea DDx: - pregnancy - systemic illness - weight change - stress - intense physical activity - eating disorder - meds - PCOS
40
treatment of: - mild to moderate dysmenorrhea: - moderate to severe dysmenorrhea
mild to mod: OTC NSAIDs -take 1-2 days before menses mod to severe: naproxen as alternative - COCP with 30-35 estrogen for 3-4 months minimum - consider extended use
41
treatment of: abnormal uterine bleeding
monophasic COCP PLUS supplemental iron (ferrous gluconate preferred over sulfate)
42
what dietary modification is recommended to improve PMS?
-calcium and vit D supplement
43
Use of COCP for PMS?
- conventional 21 day active 7 day placebo regime does not completely suppress ovulation --> often will exacerbate PMS during withdrawal week - lower estrogen (20 mcg), use of drospirenone (progestin) and extended use can reduce PMS
44
varicocele 90% are located on ____ side
left
45
surgical repair of hydrocele indicated if persisting beyond ______ (age)
one year old
46
risk factors for neonatal hernia
``` - Risk factors for neonatal hernia ○ Abdo wall defect ○ Ascites ○ Connective tissue disease ○ CF ○ FmHx ○ Low birth weight ○ Mucopolysaccharidosis ○ Preterm birth (most significant risk factor) ○ Undescended testis Urologic malformations ```
47
Testicular torsion physical exam will show: Torsion of appendix testis: physical exam will show:
testicular torsion absent cremasteric reflex scrotal erythema, edema, tenderness appendix testis: blue dot sign, cremasteric reflex present scrotal erythema, edema, NO tenderness
48
positive Prehn's sign is seen in:
- orchitis - epididymitis * *not a reliable sign in children*** relief of pain with elevation
49
EPIDIDYMITIS signs and symptoms investigations
- gradual onset pain - not common to have dysuria, frequency, discharge - hard to tell difference with torsion cremasteric reflex PRESENT scrotal erythema, edema, tenderness Urinalysis: can be normal urine culture often neg STI testing
50
ORCHITIS signs and symptoms possible causes treatment
- intermittent bilateral testicular pain - scrotal erythema, edema, tenderness - shiny overlying skin viral: mumps, rubella, coxsackie, provirus Supportive: rest, NSAIDs, ice packs
51
Common organisms associated with balanitis
candida gardnerella, staph, trich HSV, HPV, syphilis, scabies(!), mycoplasma
52
treatment of balanitis
retract foreskin wash twice daily with warm salt water if no improvement or is circumcised, treat empirically with clotrimazole BID x 1 week
53
complication of SUBMUCOSAL fibroid?
infertility | interfere with embryo transfer and implantation
54
most common symptoms of fibroids?
``` menorrhagia dyspareunia bloating pelvic pressure urinary symptoms (urgency, frequency) infertility ```
55
treatment of fibroids?
definitive is surgical: - hysterectomy - myomectomy ``` GnRH agonist (leuprolide) shrinks fibroids temporarily, limit use to 6 months COC, NSAIDs ```
56
what are factors that LOWER risk of endometriosis?
- higher parity - breastfeeding - exercise - long term omega 3 intake
57
risk factors for endometriosis
``` menarche before age 11 cycle length <27 days heavy cycles eating animal fat/trans fat family hx in first degree relative ```
58
endometriosis signs and symptoms
Progressive dysmenorrhea: does not respond to COC or NSAIDS Deep dyspareunia (worse during menses) Chronic pelvic pain infertility Ovarian mass Sacral back ache w/menses Painful defecation during menses (most predictable symptoms of deeply infiltrating endometriosis) + severe dyspareunia GI/GU: perimenstrual tenesmus, diarrhea or constipation, dyschezia, dysuria, hematuria, nausea, distention, early satiety Resp: thoracic endometriosis can present w/CP, pneumothorax, or hemothorax, hemoptysis, or scapular/neck pain *can be asymptomatic
59
first line treatment for endometriosis
definitive: TAH + BSO COC and NSAIDs Progestins (depo provera) IUD
60
vulvodynia definition
persistent vulvar pain with no identifiable cause present for at least 3 months
61
mucopurulent cervicitis signs and symptoms
often asymptomatic | cervical friability, copious discharge need to r/o PID so swab for everything
62
disseminated gonococcal infection signs/symptoms
fever, arthritis, rash
63
collect culture for gonorrhea along with NAAT in these situations
- any obvious discharge (cervix, urethra, rectal) - suspected PID - treatment failure - sexual contacts outside of Canada - sexual assault
64
gonorrhea test of cure - by culture: timeframe - by NAAT: timeframe
culture: 3-7 days after starting - pharyngeal - not typical treatment - failure or resistance suspected - uncertain compliance - re-exposure - pregnant - PID/disseminated gonococcal infection NAAT: 2-3 weeks after starting
65
PID what to assess during history
Review risk factors LMP (lots of PID during first half of menstrual cycle) Urinary symptoms suggestive of urethritis Intramenstrual bleeding, dysmenorrhea, dyspareunia Vaginal discharge Abdominal or pelvic pain RUQ if peri-hepatitis Systemically unwell - fever, n/v, malaise (not always present)
66
PID 3 DDX investigations
ectopic pregnancy appendicitis ovarian torsion swab for everything CBC, CRP, full STI panel u/a and cx if dysuria PREG TEST pelvic ultrasound
67
Follow up of PID - time frame - if IUD in situ?
close f/u in 48-72 hours -if no improvement --> send to ER for admission IUD does not need to be removed unless no improvement 72 hours after abx
68
Syphilis - transmission - symptoms
- contact with syphilitic lesions - vertical transmission (congenital syphilis) primary: painless indurated chancre, local lymphadenopathy secondary: systemic (fever/chills, headache, malaise) diffuse maculopapular reddish brown rash to palms and soles, condylomata lata, slopecia early and late latent: no symptoms
69
syphilitic genital lesions also test for (ie rule out these DDX)
- syphilis (NAAT) - chlamydia (NAAT) - HSV
70
most common STI in US (according to Berk)
HPV
71
HPV risk factors
- sex at young age - multiple partners - no condom use - concurrent STI - SMOKING
72
SYPHILIS complications in pregnancy? complications in newborn?
``` In pregnancy: • Miscarriage • Preterm birth • Low birth weight • Stillborn or death in neonate ``` ``` In newborn with congenital syphilis: • Bony deformity • Severe anemia • Hepato and splenomegaly • Jaundice • CNS: blind, deaf, meningitis rash ```
73
HSV type specific serology is ordered for these conditions:
-pregnancy: if partner + for HSV (if negative, repeat at 32-34 weeks) - atypical/recurrent disease - serodiscordant couples
74
PMDD premenstrual dysmorphic disorder diagnostic criteria
mood (depressed, anxiety, labile, irritable) starting or stopping within few days of onset of period -absent one week after period stops - impacts functioning - confirmed with daily ratings for minimum 2 consecutive symptomatic menstrual cycles

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