Y2S1B3 - Cs - Block 3 Overview

Front 1

Up to __% of UTIs are complicated.

Back 1

8%

150 million cases of UTIs a year, 90% cystitis, 10% higher up
75% sporadic
25% recurrent
up to 60% of adult women lifetime incidence

Front 2

What is the MC nosocomial infection?

Back 2

UTIs

40% of nosocomial infxns, 1 million cases/yr (usually d/t catheter)

Front 3

What are complicated UTIs??

Back 3

DM
Pregnancy (pyelonephritis can lead to pre-term labor, sepsis, ARDS)
Immunosuppression (AIDS, sickle cell, chronic CS's)
Indwelling urinary catheter (nursing home, older men w/ BPH)
Hx of polycystic kidney dz or kidney transplant
Urolithiasis (any stones)
Neurogenic bladder
recent UT instrumentation (cystoscopy)
MEN

Front 4

The gold standard for dx of UTI is urine culture & sensitivity. Dx is classically based on >______ colony forming units.

BUT, if from catheter or symptomatic, then >_____ CFUs.

Back 4

100,000

100

If > 100,000 clean-catch or >100 catheter w/ 1 bacteria and asymptomatic (asymptomatic bacteriuria), no tx is needed UNLESS there are complicating factors (then treat as complicated cystitis)

Front 5

In urine dipstick test, which finding is the MOST specific for UTI?

Back 5

Nitrite (b/c nitrate is converted to nitrite in bladder by gram negs

You are also looking for WBCs/pyuria.
Can see protein (esp w/ kidney involvement) or blood

Front 6

You can give what drug for symptomatic (only) relief of UTIs (dysuria specifically)?

Back 6

Phenazopyridine (pyridium, azo)

topical analgesic effect on UT mucosa
orange-red color to urine/feces

Front 7

What are 2 DOCs for uncomplicated cystitis?

Pregnancy specifically?

Back 7

TMP-SMX 3 days (unless bacteria has >20% resistance; not recommended in clark county d/t e coli resistance)

Nitrofurantoin 5 days (cheaper, better for clark county resistance)

(or Cipro 3 days (includes pseudomonas and proteus))

Pregnancy: Nitrofurantoin 2x daily 7-10 days or Cefpodoxime 2x daily 7 days

Front 8

What are 2 DOCs for complicated cystitis?

Back 8

Ciprofloxacin 10 days
Levofloxacin 5 days

Front 9

You can treat pyelonephritis as outpatient if the patient...

Back 9

doesn't appear toxic
can tolerate PO intake (fluoroquinolones can be taken IV or PO)
has support at home
can follow up frequently
has NO complicating factors

Re-evaluate at 3 days if still symptomatic

Front 10

Peds are most susceptible to renal scarring d/t UTIs in first ____ yrs of life.

Back 10

4

most important risk factors are Vesicoureteral reflux, Posterior urethral valves, Ureterocele.
MC presenting feature: Fever
greatest diagnostic challenge b/w 90 days and 4 yrs

Front 11

What imagine should be done in peds UTI?

Back 11

US to assess integrity of UT

VCUG (voiding cystourethrogram) for pts LESS THAN 3 yo (looking for VUR mostly)

Front 12

Increased vaginal discharge d/t sudden hormone changes is called what?

Back 12

Physiologic leukorrhea

Front 13

Normal vaginal pH is usually what?

Back 13

<4.5

semen can increase pH

Front 14

DOC for bacterial vaginosis?

Back 14

Metronidazole 7 days

don't drink alcohol w/ it or you'll throw up a lot!

Front 15

DOC for vulvovaginal candidiasis?

Back 15

Topical antifungals or Diflucan 1 day

Front 16

DOC for trichomoniasis?

Back 16

Metronidazole 1 day (or same as BV for 7 days if not sure)

must also treat male partner (STI)

Front 17

___% of HSV transmission is from asymptomatic viral shedding (no visible lesions).

Back 17

70%

only 10-20% of infected know they have it

Front 18

What is possible tx for HPV (usually for cosmetic reasons)?

Back 18

Topical:
Podipophyllin (MC)
TCA or BCA
Imiquimod
Podofilox

Surgery: (MC)
Cryotherapy (MC)
Excision
Electrocautery
Intralesional interferon injections

Front 19

Estimated ___% of untreated chlamydia progresses to PID.

Back 19

30 (15 for gonorrhea)

70% of women have no symptoms, 50% of men

Front 20

Tx for Chlamydia?

Back 20

Doxycycline 7 days or
Azithromycin once

Front 21

Tx of Gonorrhea?

Back 21

*Ceftriaxone IM
Cefixime once
Azithromycin once (for people who are allergic; it's hard to keep down)

Front 22

DOC for PID?

Back 22

Levofloxacin 14 days

Front 23

____% of infants born to non-treated HIV+ mothers will be infected.

Back 23

25-30%

>60 million worldwide infected w/ HIV-1, 90% from developing countries, 40% from heteresexual sex

Front 24

HIV ELISA & Western blot may be false neg in first ____ wks of infection.

Back 24

2.

check RNA & core p24 antigen.

If recent exposure, check ELISA at 6 wks and again at 3 mos

Front 25

___% of adolescents develop AIDS at 10 yrs.

Back 25

<30% (slower rate of progression)

Front 26

In AIDS patients, which vaccine is gets a better Ab response at a higher CD4 level?

Back 26

Pneumococcal

Front 27

Without treatment of symptomatic AIDS, there's a risk of death in __ - ___ months.

Back 27

3-18 months

Front 28

MC cause of FUO & anemia w/ CD4<50 in AIDS?

Back 28

MAI

bone marrow biopsy & blood cultures (need to rule out NHL; possibly splenomegaly & lymphadenopathy --> biopsy)

Front 29

What can be used to treat oral ulcers in AIDS patients?

Back 29

Thalidomide (also CS's, antiviral)

Front 30

__-__% of palpable lesions from clinical breast exams are not identified on mammogram.

Back 30

9-22%

Front 31

Postpartum mastitis is MC how long after birth?

Back 31

2nd and 3rd weeks

Front 32

Tx for postpartum mastitis?

Back 32

Dicloxacillin
Amoxicillin-clavulanate
Cephalexin
10-14 day course

if no improvement after 2 days, consider MRSA --> TMP-SMX

Front 33

Tx for cyclic mastalgia (if affecting lifestyle)?

Back 33

Evening primrose
NSAIDs/acetaminophen
Abstain from caffeine
Danazol
lower estrogen dose in HRT
Vit E supplementation
fat for fibrocystic changes

Front 34

Diagnostic tests for galactorrhea?

Tx?

Back 34

Prolactin, TSH
trial of bromocriptine

tx: underlying cause or Antipsychotics

Front 35

Pharm tx options for ED?

Back 35

PD5 inhibitors (1st line, viagra, cialis, levitra, CI w/ nitroglycerins d/t precip drop in BP)

Injections (PGE1, doesn't require stimulation)

Front 36

Tx for priapism?

Back 36

Oral terbutalline or Salbutamol

remove some blood (w/ heparin&saline)

exercise, walking, ejaculation

Front 37

1 out of how many women will develop ovarian CA?

Back 37

1/70, and 1/100 will die. 4th leading cause of death in women.

<5% are BRCA1+

Women 60-69 yo have TWELVE TIMES the malignancy risk of 20-30 yo

Front 38

BRCA1 chromosome region?

BRCA2 chromosome region?

Back 38

17q21

13

Front 39

CA125 is most useful in what tumors?

Back 39

Nonmucinous epithelial

elevated in 80%, but in only 50% at stage one (low utility for screening)

Front 40

What chemo is indicated for ovarian cancers?

Back 40

carboplatin/cisplatin + taxol IV every 3-4 wks for at least 6 cycles (beginning 1-4 wks after surgery)

carboplatin can be given outpatient

can also do intraperitoneal/abdominal monthly for 6 months

Front 41

Which type of ovarian cancer is MC?
Which subtype of this is 2nd MC?

Back 41

Epithelial ovarian CA

Endometroid tumor (2-4% of all ovarian tumors, 80% are malignant, represent 10-20% of ovarian CA; 5yr survival rate 83%)

Front 42

Endodermal sinus tumors make up __% of malignant germ cell tumors?

Back 42

10

Front 43

Granulosa cell tumors are malignant in __% of pts w/ dx.

Back 43

20%

women 50-55 yo w/ postmenopausal bleeding

Front 44

MC malignant germ cell tumor?

Back 44

Dysgerminoma

<30 yo, bilateral in 10%, 15% secrete HCG

Front 45

Microscopic Call-Exner bodies a/w what?

Back 45

Granulosa-theca cell tumors

low-grade malig potential, produce estrogen, 5% before puberty, may be large and present as ruptured mass

Front 46

Paraneoplastic hypercalcemia MC a/w what ovarian CA?

Back 46

Clear cell carcinoma

low survival rate, 57 yo

Front 47

__% of women have abruptio placenta, usually in the last ___ weeks of pregnancy.

Back 47

1%, 12 wks