NM 701 MODULE 7 QUESTIONS ANSWERED CORRECTLY GRADED A+
Bacterial vaginosis discharge - Answers ▪ thin white grayish discharge,
▪ fishy odor,
▪ worse after sex or period
Vulvovaginal candidiasis clinical presentation - Answers ▪ vaginal vulvar itching,
▪ burning,
▪ cottage cheese discharge,
▪ erythema,
▪ excoriation
Trichomoniasis clinical presentation - Answers ▪ yellow to greenish, frothy, mucopurulent,
copious, malodorous discharge.
▪ Inflammation of vulva, vagina, or both may be present &
▪ may have irritation, pruritus, dysuria, or dyspareunia
▪ (discharge may worsen during & after menstruation).
Burning on urination may be associated with - Answers ▪ yeast vaginitis
▪ urinary tract infection
▪ interstitial cystitis
▪ primary outbreak of genital herpes
the hallmarks of UTI. - Answers ▪ Dysuria
▪ urgency
▪ frequency
Interstitial cystitis often presents with - Answers ▪ dysuria, urgency and frequency.
▪ BUT, no responsible microorganism
▪ Sterile inflammation & bladder epithelium irritation the cause.
a primary outbreak of herpes causes - Answers ▪ intense inflammation of the genitals,
▪ occlusion of the urethra in extreme cases.
,▪ Burning on urination is common
▪ fever is common
Urinary incontinence is a normal aging change. - Answers No.
▪ Incontinence may be common,
▪ it is not normal
▪ deserves a full workup & management plan.
How *condyloma accuminata* commonly presents lesions, discharge, or both - Answers lesions
How *Syphyllis* commonly presents lesions, discharge, or both - Answers Both
▪ A single, painless lesion called a chancre is the way primary syphilis presents.
▪ However, we OFTEN miss this stage, and syphilis is the great imitator.....
How *Trichomonas* commonly presents lesions, discharge, or both - Answers discharge
-frothy green yellow malodorous copious mucopurolent
How Genital Herpes commonly presents lesions, discharge, or both - Answers Both.
Outbreaks of this condition may present with both genital blisters and a watery vaginal
discharge.
How Bacterial vaginosis presents lesions, discharge, or both - Answers discharge-thin, gray
white
How *Yeast vaginitis* presents lesions, discharge, or both - Answers discharge-cottage cheese
appearing
MOST sexually transmitted infections in women are: - Answers silent
Women can & do contract a number of STIs that are asymptomatic. This is one of the reasons
STIs have been so successful at spreading themselves around! Herpes, Trichomonas,
Gonorrhea, Chlamydia, & the HPV viruses that cause genital warts may ALL be silent. Syphilis is
dormant, sometimes for years, between stages. men are even LESS likely than women to have
symptoms!
Why should female partners of women w/ BV be treated? - Answers because vaginal flora is
most often concordant between women who have sex with one another.
Why don't male partners of women w/ BV need to be treated? - Answers BV is not sexually
transmitted between heterosexual partners.
,When is treatment of sexual partners of women with BV indicated? - Answers ▪ It depends on
the sex of the partner.
▪ Female sexual partners of women with BV should be treated.
▪ male partners should not be treated.
Forensic examination of the woman who experiences sexual assault is within the general scope
of practice of the CNM or WHNP. - Answers No. Women who experience sexual assault should
be offered specialized care from a Sexual Assault Nurse Examiner (SANE), who has training in
both evidence collection & patient care. CNMs & WHNPs are eligible to become certified as
SANE providers, but need to undergo the training if they plan to provide forensic examination.
Some women will decline forensic examination, & this module will focus on how to care for
women who present to the generalist CNM/WHNP & who decline specialist care.
All women with dysuria & urinary frequency need a urine culture & sensitivity. - Answers No. Only
women with complicated urinary tract infections need a urine culture & sensitivity. These
include women with signs & /or symptoms of upper tract disease, pregnant women, women
recently exposed to antibiotics, & women with immunocompromise. Women without these risk
factors may be treated without culture & sensitivity.
UTI aka cystitis - Answers ▪ a relatively simple infection involving only the the urinary bladder.
▪ S/S: dysuria with urinary frequency & urgency.
UTI Uncomplicated - Answers ▪ Occurs in a woman who is not pregnant,
▪ has not had any recent treatment with antibiotics,
▪ has not had another UTI in last 6 months (or 2 UTIs in last 12 months),
▪ has no decreased immunity due to other conditions, &
▪ has no signs of upper tract infection
▪ Can be treated without a culture
▪ Can be treated without a u/a in women who have had UTIs frequently in the past & have
classic symptoms.
UTI Complicated: - Answers ▪ Occurs in women who are pregnant,
▪ have had recent antibiotics,
▪ have had another UTI within the last 6 months (or 2 UTIs in last 12 mos), or
▪ have decreased immunity from another condition.
, ▪ Require culture & sensitivity to dx & to determine the appropriate tx.
pyelonephritis - Answers ▪ an infection involving one or both kidneys (upper tract infection)
▪ occurs when infection in the bladder ascends into the kidneys.
▪ S/S: typically include fever, chills, back pain, CVA tenderness, & flank pain.
▪ Some patients experience dysuria, frequency, urgency, hematuria, N/V & diarrhea.
▪ Consider silent pyelo in any woman who present with illness & has a hx of repeated UTI
especially if the UTI ascended to the kidneys.
pyelonephritis Uncomplicated - Answers ▪ Occurs in a woman who has s/s of upper tract
infection, but is not pregnant,
▪ w/o N,V (able to tolerate oral tx)
▪ Most of these infections can be trx'd on an outpatient basis.
pyelonephritis Complicated - Answers ▪ Patients who are pregnant,
▪ vomiting,
▪ hypotensive,
▪ immunodeficient
should usually be hospitalized for treatment.
To R/O upper tract infection or complicated UTI, other hx must be elicited such as: - Answers ▪
Are you or could you be pregnant?
▪ Have you had any fever or chills?
▪ Do you have any flank pain or back pain?
▪ Any N/V
▪ Have you ever had a UTI before?
▪ Have you taken any meds recently?
▪ Do you have any other medical problems?
Management Uncomplicated non-recurrent bacterial UTI, - Answers ▪ can be tx based on the
patient's hx alone,
▪ no lab testing required.
Bacterial vaginosis discharge - Answers ▪ thin white grayish discharge,
▪ fishy odor,
▪ worse after sex or period
Vulvovaginal candidiasis clinical presentation - Answers ▪ vaginal vulvar itching,
▪ burning,
▪ cottage cheese discharge,
▪ erythema,
▪ excoriation
Trichomoniasis clinical presentation - Answers ▪ yellow to greenish, frothy, mucopurulent,
copious, malodorous discharge.
▪ Inflammation of vulva, vagina, or both may be present &
▪ may have irritation, pruritus, dysuria, or dyspareunia
▪ (discharge may worsen during & after menstruation).
Burning on urination may be associated with - Answers ▪ yeast vaginitis
▪ urinary tract infection
▪ interstitial cystitis
▪ primary outbreak of genital herpes
the hallmarks of UTI. - Answers ▪ Dysuria
▪ urgency
▪ frequency
Interstitial cystitis often presents with - Answers ▪ dysuria, urgency and frequency.
▪ BUT, no responsible microorganism
▪ Sterile inflammation & bladder epithelium irritation the cause.
a primary outbreak of herpes causes - Answers ▪ intense inflammation of the genitals,
▪ occlusion of the urethra in extreme cases.
,▪ Burning on urination is common
▪ fever is common
Urinary incontinence is a normal aging change. - Answers No.
▪ Incontinence may be common,
▪ it is not normal
▪ deserves a full workup & management plan.
How *condyloma accuminata* commonly presents lesions, discharge, or both - Answers lesions
How *Syphyllis* commonly presents lesions, discharge, or both - Answers Both
▪ A single, painless lesion called a chancre is the way primary syphilis presents.
▪ However, we OFTEN miss this stage, and syphilis is the great imitator.....
How *Trichomonas* commonly presents lesions, discharge, or both - Answers discharge
-frothy green yellow malodorous copious mucopurolent
How Genital Herpes commonly presents lesions, discharge, or both - Answers Both.
Outbreaks of this condition may present with both genital blisters and a watery vaginal
discharge.
How Bacterial vaginosis presents lesions, discharge, or both - Answers discharge-thin, gray
white
How *Yeast vaginitis* presents lesions, discharge, or both - Answers discharge-cottage cheese
appearing
MOST sexually transmitted infections in women are: - Answers silent
Women can & do contract a number of STIs that are asymptomatic. This is one of the reasons
STIs have been so successful at spreading themselves around! Herpes, Trichomonas,
Gonorrhea, Chlamydia, & the HPV viruses that cause genital warts may ALL be silent. Syphilis is
dormant, sometimes for years, between stages. men are even LESS likely than women to have
symptoms!
Why should female partners of women w/ BV be treated? - Answers because vaginal flora is
most often concordant between women who have sex with one another.
Why don't male partners of women w/ BV need to be treated? - Answers BV is not sexually
transmitted between heterosexual partners.
,When is treatment of sexual partners of women with BV indicated? - Answers ▪ It depends on
the sex of the partner.
▪ Female sexual partners of women with BV should be treated.
▪ male partners should not be treated.
Forensic examination of the woman who experiences sexual assault is within the general scope
of practice of the CNM or WHNP. - Answers No. Women who experience sexual assault should
be offered specialized care from a Sexual Assault Nurse Examiner (SANE), who has training in
both evidence collection & patient care. CNMs & WHNPs are eligible to become certified as
SANE providers, but need to undergo the training if they plan to provide forensic examination.
Some women will decline forensic examination, & this module will focus on how to care for
women who present to the generalist CNM/WHNP & who decline specialist care.
All women with dysuria & urinary frequency need a urine culture & sensitivity. - Answers No. Only
women with complicated urinary tract infections need a urine culture & sensitivity. These
include women with signs & /or symptoms of upper tract disease, pregnant women, women
recently exposed to antibiotics, & women with immunocompromise. Women without these risk
factors may be treated without culture & sensitivity.
UTI aka cystitis - Answers ▪ a relatively simple infection involving only the the urinary bladder.
▪ S/S: dysuria with urinary frequency & urgency.
UTI Uncomplicated - Answers ▪ Occurs in a woman who is not pregnant,
▪ has not had any recent treatment with antibiotics,
▪ has not had another UTI in last 6 months (or 2 UTIs in last 12 months),
▪ has no decreased immunity due to other conditions, &
▪ has no signs of upper tract infection
▪ Can be treated without a culture
▪ Can be treated without a u/a in women who have had UTIs frequently in the past & have
classic symptoms.
UTI Complicated: - Answers ▪ Occurs in women who are pregnant,
▪ have had recent antibiotics,
▪ have had another UTI within the last 6 months (or 2 UTIs in last 12 mos), or
▪ have decreased immunity from another condition.
, ▪ Require culture & sensitivity to dx & to determine the appropriate tx.
pyelonephritis - Answers ▪ an infection involving one or both kidneys (upper tract infection)
▪ occurs when infection in the bladder ascends into the kidneys.
▪ S/S: typically include fever, chills, back pain, CVA tenderness, & flank pain.
▪ Some patients experience dysuria, frequency, urgency, hematuria, N/V & diarrhea.
▪ Consider silent pyelo in any woman who present with illness & has a hx of repeated UTI
especially if the UTI ascended to the kidneys.
pyelonephritis Uncomplicated - Answers ▪ Occurs in a woman who has s/s of upper tract
infection, but is not pregnant,
▪ w/o N,V (able to tolerate oral tx)
▪ Most of these infections can be trx'd on an outpatient basis.
pyelonephritis Complicated - Answers ▪ Patients who are pregnant,
▪ vomiting,
▪ hypotensive,
▪ immunodeficient
should usually be hospitalized for treatment.
To R/O upper tract infection or complicated UTI, other hx must be elicited such as: - Answers ▪
Are you or could you be pregnant?
▪ Have you had any fever or chills?
▪ Do you have any flank pain or back pain?
▪ Any N/V
▪ Have you ever had a UTI before?
▪ Have you taken any meds recently?
▪ Do you have any other medical problems?
Management Uncomplicated non-recurrent bacterial UTI, - Answers ▪ can be tx based on the
patient's hx alone,
▪ no lab testing required.
