Urology and Sexual Health Notes PDF

**Urology/Sexual Health**   115\.                 Is urinary incontinence a normal part of aging? a\.     No 116\.                 Which type of urinary incontinence is most common in elderly a\.     Detrusor overactivity -- bladder contractions occurring before bladder is full 117\.          ...

**Urology/Sexual Health**   115\.                 Is urinary incontinence a normal part of aging? a\.     No 116\.                 Which type of urinary incontinence is most common in elderly a\.     Detrusor overactivity -- bladder contractions occurring before bladder is full 117\.                 Urinary incontinence occurring when laughing, exercising, sneezing, coughing is considered which type of incontinence a\.     Stress incontinence (KNOW the **common treatments for this type of incontinence)** - Pelvic muscle exercises (Kegel), estrogen therapy (for those w/o uterus), estrogen/progestin therapy (for those w/ uterus), surgery for transvaginal or transabdominal bladder neck suspension (80-95% success), peri-urethral infection (collagen, synthetic materials) that support and narrow the bladder neck (for those unable to undergo surgery) lasting about avg. 4-5 years, pessary application  118\.                 Uterine prolapse can cause a\.     Overflow incontinence - caused by the force and caliber of the urinary stream and incomplete voiding caused by outlet obstruction (BPH, CA, genitourinary prolapse) and bladder contractile dysfunction (diabetic or alcoholic neuropathy, spinal cord lesions, narcotics, tricyclic antidepressants) 119\.                 An example of someone with functional incontinence a\.     Dementia, impaired mobility 120\.                 Example of anticholinergic/antispasmodic agents for bladder control a\.     Tolterodine (Detrol), oxybutynin (Ditropan) 121\.                 Example of meds to help BPH a\.     Terazosin alpha blocking agents (terazosin/Hytrin, tamsulosin/Flomax) 122\.                 Vaginal pessaries are used to stop a\.     Stress incontinence, overflow incontinence   123\.                 The most common bacterial cause of UTIs a\.     E. Coli   124\.                 s/s of UTI are a\.     suprapubic pain, fever, flank pain, hematuria, dysuria, frequency, urgency 125\.                 Medications often used to treat UTIs a\.     Bactrim, macrodantin, Cipro, Keflex, pyridium.   126\.                 How long should you give pyridium for with UTIs a\.     No more than 2-3 days because it can mask the s/s of UTIs, and make the patient think the antibiotic is working (ALSO, know the patient education needed to treat UTIs in peds and adults. - Patient education for peds - Adults - Treatment: pain management (pyridium)- but only for no more than 2 days, antibiotic (bactrim DS, macrodantin, ciprofloxin, augmentin, amoxicillin doxycycline), fever management, STD treatment (if needed), cranberry juice/tabs (controversial), increased fluid intake, increased bathroom breaks, wiping front-back, avoid continuous wearing of panty liners, avoid "thong" underwear for a few days, urinate after sex, cut chemical irritants from diet -- caffeine, spicy food, nicotine, carbonated drinks, avoid bubble baths or use only fragrance free personal hygiene products, control co-morbidities (diabetes) 127\.                 Bacterial vaginosis is usually caused by a\.     Gardnerella vaginalis - Bacterial -- asymptomatic or discharge thin, malodorous, grayish white or yellow, vaginal pain is uncommon, pruritus can occur 128\.                 Vaginitis can be caused by a\.     Yeast, atrophy from estrogen deficiency 129\.                 A patient has taken Amoxicillin for the last 7 days for a strep throat, now complains of whitish, itchy vaginal discharge, you suspect a\.     Yeast (know the other common cause of vaginal yeast) 130\.                 Upon vaginal exam of a patient you notice a "strawberry" appearance to her cervix, with c/o of frothy greenish discharge, you suspect a\.     Trichomoniasis 131\.                 Treatment of BV a\.     Metronidazole or clindamycin 132\.                 Treatment of yeast vaginitis a\.     Miconazole, Diflucan, acidophilus, reduce alcohol intake, cotton underwear, decrease douching 133\.                 Treatment of trichomoniasis a\.     Metronidazole 134\.                 If you are doing a vaginal exam, know the following a\.     PH levels b\.     Preparing slides and what you would see c\.     Also, know the steps of a well woman exam! Physical exam: Evaluate external genitalia, intravaginal Cervical motion tenderness (CMT) Pelvic pain with bimanual exam Cystocele, rectocele Send off cultures/pap etc. if needed. 135\.                 If you start the HPV vaccine in a child younger that 15 yo you give how many doses a\.     2, otherwise if older, you give 3 -- usually not given to those men 21 or women 26 and older, unless they have not been sexually active 136\.                 Can someone pass genital herpes even though sores are not present? a\.     Yes, also know s/s of genital herpes, dx, causes and treatment 137\.                 Podophyllin is used sometimes to treat a\.     Genital warts 138\.                 If you start the HPV vaccine in a child younger that 15 yo you give how many doses a\.     2, otherwise if older, you give 3 -- usually not given to those men or women over 45 yo 139\.                 Can someone pass genital herpes even though sores are not present? a\.     Yes, also know s/s of genital herpes, dx, causes and treatment 140\.                 Podophyllin is used sometimes to treat a\.     Genital warts 141\.                 The most come types of HPV found that can lead to cervical CA are a\.     Type 16/18 and then they should be sent out for colposcopy; if it any other type of HPV and is has atypical cells of undetermined significance (ASC-US) they should go for colposcopy; if it is any other type of HPV and it is negative for intraepithelial lesion (NILM) needs repeat PAP in 1 year.   142\.                 Fibrocystic breast can lead to breast CA a\.     False, they can, however, hide tumors 143\.                 Her2 over-expressive breast CAs are slow growing tumors a\.     False, very aggressive and is treated with Herceptin 144\.                 Tamoxifen, femara, arimidex are drugs use for which type of breast CA a\.     Estrogen/progesterone positive breast CA (but have a possible side effects of DVT, PE, CVA, uterine CA 145\.                 Those patients who test positive for BRCA1 and/or BRCA 2 genes are more likely to develop a\.     Breast and ovarian CA at a younger age 146\.                 BRCA testing should always be offered to those who had or family member's had a\.     Had breast CA before age 50 b\.     Cancer in both breasts c\.     Both breast and ovarian CA in the same woman or same family d\.     Multiple breast CAs e\.     2 or more types of BRCA cancers in a single family member f.      cases of male breast CA in the family g\.     Ashkenazi Jewish ethnicity with family hx. of breast CA 147\.                 A true negative BRCA is when a\.     A direct family member has had a positive BRCA 1 or 2 but you test negative 148\.                 Sometimes if one test positive for BRCA 1 or 2, one can have which type of surgery a\.     TAH, Mastectomy   149\.                 This line of drugs is thought to possible reduce the risk of ovarian CA a\.     Oral contraceptive agents 150\.                 Ovarian cancer can still recur because a\.     The cancer arises in the peritoneum in the lining of the ovary 151\.                 CA-125 should be done on all female patients as part of their routine blood draw a\.     False 152\.                 Dysfunctional uterine bleeding (DUB) is most common in what age groups a\.     Before 20 and after 40/peri-menopausal 153\.                 Which test is used if you suspect the DUB is due to CA a\.     Endometrial biopsy 154\.                 How is DUB treated a\.     Short course of provera, ocps, IUD, HRT, depo, TAH or myomectomy (fibroid removal) or a D&C 155\.                 Average age for uterine CA is a\.     About 60 yo 156\.                 Positive cervical motion tenderness can be related to a\.     Pelvic inflammatory disease 157\.                 Testing of PID should include a\.     Urine HCG, STD testing, CBC, urinalysis, blood cultures- KNOW the treatment for PID and also know that we would treat for other STDs empirically 158\.                 A 20 yo female who presents with abnormal uterine bleeding, acne, obesity, excess hair growth, skin changes (acanthosis nigricans) should be worked up for a\.     Polycystic ovarian disease (FSH, LH, prolactin, testosterone, pelvic US, CBC, Blood sugar, thyroid function, lipids 159\.                 Treatment of PCOS can include a\.     Progesterone if heavy bleeding, spironolactone, ocps with low androgenic effects to regulate periods 160\.                 The most common form of ectopic pregnancy occurs a\.     In the fallopian tubes 161\.                 The most severe effect of ectopic pregnancy is a\.     Uterine/tube rupture and severe bleeding 162\.                 A pregnancy without an embryo is called a\.     A hydatiform mole 163\.                 Women who have had molar pregnancies must be watched for a\.     Choriocarcinoma: a rare, fast-growing, malignant cancer that can develop in the uterus, ovaries, or testes 164\.                 Spontaneous abortion is defined as a\.      a loss of pregnancy before 20 weeks gestation 165\.                 A missed abortion means a\.     That the fetus is no longer viable, but not expelled   166\.                 Risk factors for SAB a\.     Advanced maternal age b\.     Alcohol use c\.     Caffeine use d\.     Chronic disease e\.     Smoking f.      Illegal drug use g\.     Conception 3-6 months after delivery h\.     IUD use 167\.                 Therapeutic abortion can be done by using a\.     Medication -- misoprostol b\.     D&C --surgical abortion 168\.                 Retained fetal products after a TAB can cause a\.     Pelvic infection, sepsis 169\.                 By age 85 how many men will report prostate problems a\.     85-90% 170\.                 What is your concern when treating a patient with BPH and HTN a\.     Hypotension related to antihypertensives and alpha adrenergic blockers (minipress, Cardura, Flomax, hytrin) 171\.                 Should the PSA be the standard test done at every male physical a\.     No, unless symptomatic, hx. of prostate CA, African American heritage 172\.                 Bacterial Prostatitis is usually caused by a\.     E. coli, Enterobacter, serratia and pseudomonas  but can be caused by STDs 173\.                 S/S of bacterial prostatitis are a\.     Fever, perineal pain, dysuria, pelvic pain, urethral discharge 174\.                 Treatment for bacterial and non-bacterial prostatitis a\.     Bacterial -- treat for possible STD (rocephin, Zithromax), Cipro or Bactrim ds b\.     Non-bacterial, chronic -- terazosin (Hytrin), tamsulosin (Flomax) 175\.                 The median age for testicular CA is a\.     33 (mostly Caucasian) 176\.                 Balanitis most often occurs in males who are a\.     Uncircumcised, and often is yeast , treatment clotrimazole and clean under foreskin 177\.                 Varicocele can cause what in about 40% of males a\.     Infertility 178\.                 Chlamydia is most common in which age group a\.     Adolescent and young adult 179\.                 Is Chlamydia reportable to public health a\.     Yes 180\.                 Patient c/o of pelvic pain, whitish/yellow discharge, bleeding after sex, what questions do you ask her: a\.     Are you having sex b\.     Are you using birth control c\.     How many partners have you had d\.     Are you or do you think you are pregnant e\.     When was your LMP f.      Have you or your partner every had an STD 181\.                 What is the treatment for chlamydia a\.     doxycycline for 7 days, can empirically treat for gonorrhea with ceftriaxone (Rocephin) 500mg IM, repeat chlamydia/GC test in 6 weeks, give partner treatment, use condoms for 1 week or refrain from sex for 1 week, check for gonorrhea, HIV and RPR too   182\.                 Can someone who has had chlamydia or gonorrhea get re-infected? a\.     Yes 183\.                 The primary stage of syphilis is one or more chancre sores, what is stage 2: a\.     Rough, reddish rash on palms, patchy hair loss, pharyngitis, fever, some neurological changes, organ failure 184\.                 Tests used to diagnose syphilis usually consist of a\.     Rpr. VDRL, (RPR gives a lot of false positive, so need to do a FTA-ABS 185\.                 Treatment of syphilis us a\.     Benzathin penicillin G, if pcn allergic use doxycycline, teach importance of using condoms -- KNOW the stages of syphilis 186\.                 An 15 yo comes in for her depo provera, how do you dose it, what teaching needs to be done and when does she come back a\.     Depo 150mg IM b\.     If this is her first shot, get a urine HCG, even if she tells you she is on her period, tell her to use condoms for the next 2 weeks after the shot, return in 3 months for next shot, remind her that this doesn't protect against STDs 187\.                 What is Plan B and Ella when do you take it a\.     It is to prevent conception, NOT an abortion pill, best taken within 24-72 hours after having unprotected sex b\.     Ella is more effective if the woman has a higher BMI and is 4-5 days post sex; it is not over the counter, need rx. c\.     You can take plan b more than once in a month but recommend a more permanent type of contraception d\.     Plan B and Ella are not abortion pills 188\.                 How should the oral contraceptive be taken? a\.     One pill every day, around the same time every day and if one is missed take it the next day.  If you continue to miss pills, reconsider a different method and use condoms.  KNOW how OCPs work and the difference between monophasic and triphasic 189\.                 What can be the problem with lambskin condoms a\.     While they are good for those with latex allergies, they are not very protective against HIV, herpes or HPV because they are more porous.  If there is a latex allergy, advise they use a Polyurethane condom with another method as well ex. Ocps, depo etc. 190\.                 What should a man using a condom do when pulling out of his partner a\.     Hold on to the condom 191\.                 If the condom breaks and she isn't on any other form of birth control, the woman should do what a\.     Get Plan B or Ella 192\.                 What is the difference between monophasic and triphasic pills a\.     Monophasic -- one set of daily hormones b\.     Triphasic -- progestin goes up every week 193\.                 Which population of women should not take ocps a\.     Women over 35 who smoke b\.     You can give Ocps to women with HA and depression, as long as these sx aren't getting worse c\.     In diabetics, they feel ocps may raise BP, so sometimes a progestin only type of birth control is advised. However, if a she has controlled diabetes, any type of birth control can be used. d\.     Know some of the common side effects when first starting the pill   194\.                 What birth control method should nursing mothers use a\.     Progestin only pills, depo or implanon, IUD, condoms -- Breastfeeding by itself is only semi-protective against pregnancy -- a woman can still get pregnant! 195\.                 What is the Mirena and how long does it last? a\.     IUD 5-7 years 196\.                 Which IUD will most likely cause heavier periods at the start of the implant a\.     Paragard -- copper (non-hormonal -- lasts about 10-12 yrs) 197\.                 Can anyone get Plan B over the counter a\.     Yes 198\.                 How long should a women stay on depo provera a\.     2-3 years only because of risk of bone mineral loss 199\.                 How is the nuvaring used a\.     3 weeks in, 1 week out (period comes) then after period, place a new ring 200\.                 What happens if the ring falls out during sex a\.     Stop sex, rinse off ring and place back or place a new one in 201\.                 Why do women sometimes stop using depo? a\.     Their periods become very unpredictable and wt gain 202\.                 What type of testing should be offered to all women starting birth control a\.     Pregnancy and STD testing, ( for guys always offer STD testing as well) 203\.                 At what age do you start doing PAP smears, a\.     Over 21 yo 204\.                 What is the age range for menopause a\.     45-55 yo 205\.                 You suspect a woman is going through menopause, what s/s tell you this a\.     Irregular menses (ocps, HRT) b\.     Hot flashes, (HRT) c\.     Vaginal dryness, decreased libido (lubricant, HRT, OCP, estrogen creams/ring) d\.     Skin is drier, breast sag, abdomen loses tone e\.     Emotion swings, HA and insomnia (exercise, stress reduction, antidepressants) f.      Increased GI symptoms (antacids, diet change) 206\.                 What labs can you draw to see if patient is menopausal a\.     LH, FSH ( high if going through menopause), estradiol (low) 207\.                 When can you give unopposed estrogen for menopause a\.     Only if no hx. of breast CA and no uterus.  If there is a uterus must give both estrogen and progesterone (Prempro) 208\.                 What are some homeopathy meds used to treat menopause a\.     Black cohash, yam powder, flax seed, soy powder, Vitamin B complex 209\.                 What happens to a women's body when estrogen levels go down a\.     Menopause, b\.     Bone mineral loss c\.     Increased lipid panel d\.     Lung cancer rates equal those of men ** **