Incontinence
A patient leaks urine whenever she coughs, sneezes, or laughs. What type of UI does the NP suspect?
Stress urinary incontinence
This type of discharge is thick, white, and associated with intense vulvar itching.
Vulvovaginal candidiasis
This test is the preferred method for diagnosing chlamydia and gonorrhea.
Nucleic acid amplification test (NAAT)
What advice should you give a patient after prescribing antibiotics for chlamydia regarding sexual activity?
No sexual activity until 7 days post treatment completion
This medication class for urinary incontinence should be used cautiously in older adults because of cognitive adverse effects.
Anticholinergics (Oxybutynin)
What conservative intervention is considered first-line treatment for most women with urinary incontinence.
Pelvic floor physiotherapy
A patient presents with thin gray discharge and a fishy odour that worsens after intercourse.
Bacterial Vaginosis
Which initial investigation should be performed in almost every patient presenting with urinary incontinence?
Urinalysis
Name two lifestyle modifications that may improve symptoms of urge urinary incontinence.
A patient was diagnosed with BV after swabs were completed with routine HPV cervical cancer screening. They deny symptoms and have no other risk factors. Do they require treatment?
In asymptomatic patients, treatment is unnecessary unless high-risk pregnancy (e.g., prior pre-term delivery), prior to IUD insertion, gynecologic surgery, induced abortion, or upper tract instrumentation.
For which type of incontinence will the NP evaluate a 66 year old postmenopausal patient who states she has "been leaking urine"?
Urge
(Urge incontinence is common after menopause)
This infection classically produces a frothy yellow-green discharge and requires treatment of both the patient and their sexual partner(s)
Trichomonas
Besides testing for chlamydia and gonorrhea, what additional STI screening should be offered to most patients diagnosed with an STI?
HIV and syphilis testing (and consider hepatitis B/C based on risk factors)
A patient with chlamydia says:
"My boyfriend feels fine."
Does he still require treatment?
Yes. Most people with chlamydia are asymptomatic.
You are seeing a patient in the clinic for follow up of routine STI screening. On his bloodwork, his RPR for syphilis came back reactive and based on history, the NP diagnoses them with secondary syphilis. What is the treatment? No allergies
Benzathine penicillin G-LA 2.4 million units IM as a single dose
This condition is NOT true incontinence but is often confused with it and involves sudden inability to reach the toilet due to mobility or cognitive barriers.
Functional incontinence
A 21-year-old presents with dysuria and vaginal discharge. During your assessment she also reports:
What finding would change your diagnosis from uncomplicated cervicitis to PID?
Cervical motion tenderness (or uterine/adnexal tenderness on pelvic examination)?
Diabetes mellitus
A patient has recurrent UTIs. Name two non-antibiotic prevention strategies you would discuss.
A patient presents with painful genital ulcers and generalized symptoms of fever, headache and fatigue. Upon physical exam, the vesicles are 2-4mm with underlying erythema and are progressing to erosions and ulcerations. The patient denies a hx of genital lesions and this is the first occurrence. What is the treatment?
Acyclovir - 400mg TID for 5-10 days
Famiciclovir - 250mg TID for 5-10 days
Valacyclovir - 1000mg BID for 5-10 days
Name three red flags in a patient with urinary incontinence that would prompt referral or further investigation
Difficulty urinating, radiation therapy, constant leakage of urine, unable to control bowel movements, blood in the urine, persisting bladder or urethral pain, a history of recurrent urinary tract infection (≥2 infections in six months or ≥3 infections in one year), pelvic surgery, clinically benign pelvic masses, suspected urogenital fistulae, previous continence surgery, suspected neurological disease
A 32-year-old presents with recurrent vaginal discharge. She has been treated three times in the past year for "yeast infections" with over-the-counter antifungals, but her symptoms keep returning. She now reports thin gray discharge with a fishy odour.
What is the biggest clinical mistake that has likely been made?
Assuming the diagnosis without confirming the cause of the discharge
A 24-year-old presents with dysuria, urinary frequency, and vaginal discharge. Name three investigations you would order.
This is the timeframe for notifying sexual partners for chlamydia/gonorrhea exposure
All partners within the past 60 days
A 25 year old female pt complains of dysuria, severe vaginal pruritic and malodorous vaginal discharge. Pelvic exam reveals a strawberry coloured cervix and frothy yellow discharge. What is the correct pharmacologic therapy for this condition?
Oral metronidazole either 2g single dose or 500mg BID for 7 days
(Trichomonas)