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Z Urology > Conditions/Disease > Flashcards

Conditions/Disease Flashcards

1
Q

ED summary

A

Def: failure to achieve or maintain a penile erection suitable for sexual intercourse

Risk Factors:
Chronic Medical conditions (HTN, DM)
Surgical procedures
Lifestyle
Trauma
Drugs

SS:

Eval:

Txt:
Non Pharm:
Lifestyle changes
psychotherapy
Vacuum erection device
Surgical

Pharm:
Phophodiesterase Type 5 Inhibitors
- Avanafil (Stendra) 100 mg po 30 min prior sex
- Sildenafil (Viagra) 50 mg po 60 min prior sex
- Vardenafil (Levitra) 10 mg po 60 min prior sex
- Tadalafil (Cilalis) 10 mg po 30 min prior sex
Alprostadil
Testosterone

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2
Q

BPH (Benign Prostatic Hyperplasia) summary

A

Def: nonmalignant enlargement prostate

SS:
Difficulty voiding

Eval:
Mild
- asymptomatic
- urinary flow rate < 10 mL/s
- residual urine volume > 25 - 50 mL
- BUN and SCr increased
Moderate
- Mild symptoms and obstructive/irritative voiding symptoms
Severe
- Moderate symptoms and complications of BPH
Txt:
Mild - watchful waiting
Moderate - Pharm
- alpha1 blockers
- alpha1a blockers
- 5 alpha-reductase inhibitor
- PDE5 inhibitor
- Herbals
Severe - Surgery
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3
Q

Urinary Incontinence Summary

A

Def: Involuntary loss of urine

SS:
Urge Incontinence (bladder overactive)
stress incontinence (urethral underactive)
overflow incontinence (urge or stress)
functional incontinence (not bladder or urethral related)
Mixed

Risk Factors:
Delerium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psychological
Excessive urine output
Restricted mobility
Stool impaction

Txt:
NonPharm
- bladder training (Urge)- result in higher improvemtn rate than the the use of naticholinergic medications
- bladder control strategies
- pelvic muscle training (stress); Kegel exercises work best in mild cases of stress inconctinence
- fluid management
-surgery (stress)

Pharm:
Urge
- anticholinergic
- TCA
- topical estrogen
- Beta-3 agonist
Stress
- Duloxetine
- alpha-adrenergic agonist
- Topical estrogen
- Imipramine
Overflow
- cholinomimetics
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4
Q

Renal Cell carcinoma

A

Def: MC kidney cancer

Epidemiology:
Northern European descent
M>F
AA > W
Age ~64
Types:
von Hippel-Lindau
Hereditary Papillary Renal Carcinoma - bilateral
familial Renal Oncocytoma - bilateral
Birt-Hogg-Dube Syndrome
Hereditary Renal Carcinoma
SS:
flank pain
hematuria
flank mass
weight loss
fever
Eval:
Urinalysis
CBC with diff
Electrolytes
Renal Profile
Ultrasound - 1st choice
CT

Txt;
*radical nephrectomy-remains the only known effective tx
chemo

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5
Q

bladder cancer summary

A

Def: *transitional cell carcinoma MC with high recurrence rate

Risk:
*Smoking (risk increase continues long after quitting >10y)
Environment
Drugs

SS:
painless gross hematuria
irritative bladder symptoms
flank pain
palpable mass

Eval:
Urinalysis
FISH
cystoscopy

Txt:
Surgery - TURBT/cystectomy
1 of 3 drugs
- doxorubicin
- Mitomycin C
- BCG
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6
Q

Testicular cancer summary

A

Def: MC solid malignant tumor in men

*Risk:
cryptochidism
genetics
FHx
Infertility
Environment

SS: painless swelling or nodule of one testicle

Eval:
alpha-fetoprotein
beta-hCG
Ultrasound
CT

Txt:
* radical Inginual orchiectomy and retroperitoneal lymph node dissection

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7
Q

Prostate Cancer summary

A

Def: MC noncutaneous cancer in men

*Risks:
elevated levels of luteinizing hormone and
testosterone:dihydrotestosterone ratios

Epidemiology:
AA > W

SS:
urinary complaints or retention
back pain
hematuria

Eval:
PSA
biopsy

Txt:
watchful waiting
*metastatic prostate cancer is rarely cureable
radical prostatectomy
radiation
cryotherapy
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8
Q

Wilm’s Tumor summary

A

Def: *MC childhood abdominal malignancy

SS:
asymptomatic abdominal mass

Eval:
CBC
chemistry profile
Kidney function tests
electrolytes
urinalysis
coagulation studies
Ultrasound
CT

Txt:
Nephrectomy and contralateral kidney explored

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9
Q

Urinary Tract Infection Summary

A

Def: infection/inflammation of lower urinary tract

Epidemiology:
F > M

Risk:
poor wiping technique
sexually active
preg
obstruction
incontinence
Cause:
Serratia
E coli (MC)
Enterobacter
Klebsiella
Proteus
Pseudomonas
SS:
Frequency
Urgency
Dysuria
suprapubic pain
Hematuria
Odiferous urine
Eval:
History
Urinanalysis
Preg test
Xrays - usually not done

Txt:
antibiotics
OTC
Fluids

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10
Q

Pyelonephritis summary

A

Def: Infection/inflammation of kidneys

Risks:
UTI
preg
PMHx
catheters
Cause:
E. coli
Proteus
Klebsiella
Pseudomonas
Staph
SS:
N/V
dysuria
frequency
urgency
flank/loin/back pain
fever
CVA tenderness
ab tender
dry mouth
Eval:
Urinalysis
CBC
CT - stones, abscessess
blood culture

Txt:
antibiotics
pain meds
fluids

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11
Q

urethritis summary

A

Def: sexually transmitted infection in men

Cause:
Gonorrhea
Chlamydia (MC)
Trichomonas
HSV

SS:
dysuria
discharge

Eval:
Urethral swab
first void urine

Txt:
abx
partner txt

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12
Q

Upper Urinary Tract obstruction summary

A

Def: blockage anywhere in the path from Kidney to where ureter enters bladder

Cause:
spasms of ureter
Acute/Chronic renal failure
UTI
pelvic tumors
prostate
gynecologic/ab surgery
SS:
Acute:
flank Pain
ipsilateral back/groin pain
N/V
Fever, chills, dysuria
Hematuria

Chronic:
asymptomatic
fever, chills, dysuria

Eval:
UA
RBC
Urine pH
Metabolic panel
Hyperkalemia
CBC
US
CT
Cystoscopy

Txt:
Partial:
analgesics
abx

Surgery

  • catheter
  • stent
  • percutaneous nephrostomy tube
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13
Q

Lower Urinary Tract Obstruction summary

A

Def: blockage anywhere in the path below bladder/urethra

Cause:
spasms of ureter
Acute/Chronic renal failure
UTI
pelvic tumors
prostate
gynecologic/ab surgery
SS:
urgency
frequency
incontinence
decreased stream
dysuria
hematuria
uterine/bladder prolapse
Eval:
UA
RBC
Urine pH
Metabolic panel
Hyperkalemia
CBC
US
CT
Cystoscopy

Txt:
Partial:
analgesics
abx

Surgery

  • catheter
  • stent
  • percutaneous nephrostomy tube
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14
Q

Kidney Stones summary

A

Def: renal calculi (usually *calcium)

Cause:
Genetics
*diet protein/salt high (supersaturation mechanism or deopsition of calcium oxalate)
*low fluid intake (low volume of urine production and high concentrations of stone forming solutes)

SS:
pain flank/groin (majority will have CVA tenderness)

Eval:
Urinary sediment
Urine culture
SCr
CBC
Serum and urinary pH level
*CT (1st) Nonconstrast abdominopelvic CT scan
US
XRAY

Txt:
Encourage spontaneous passage of stone
Surgery if needed

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15
Q

hydrocele

A

def: fluid filled sac surrounding a testicle that results in swelling of the scrotumnon-communicating gets stuck in the middle of the processes vaginalis
communicating flows straight through to processes vaginalis and *accumulates in the front of the testes

  • S/s: painless, *cremasteric reflex intact
    tx: observation, especially in infants; surgical intervention for sx lesions; aspiration not appropriate by itself
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16
Q

varicocele

A

def: abnormal dilation of a vein within the spermatic cord* Left side is affected nearly 100% of the time

s/s: painlesstx: surgery to relieve sx

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17
Q

epididymitis

A

def: inflamm of the epididymis; usually caused by infection
men 35: enterobacteriea, pseudomonas aureoginosa

s/s: painful palpation of the epididymis, swelling, *positive Prehn sign (pain is relieved with elevation), *cremasteric reflex intact

Dgx: radionuclide scan is most accurate imaging study for dgx

Tx: 35: TMP/SMX, ciprofloxacin

18
Q

Orchitis

A

def: acute inflamm of the the testes and is uncommon

s/s: inflamm, may have systemic infection (mumps is MC), local extension of epididymitis

Tx: elevation, support, hot/cold packs, abx, anti-inflamm

19
Q

crytochordism

A

condition of testicular maldescent

s/s: undescended testes

tx: needs to be followed carefully and surgically corrected if not resolved by one year of age

make sure to r/o physiologic crytochordism from a cold room d/t the cremasteric reflex

20
Q

testicular torsion

A

rotation of the testes; twisting of the testes and the spermatic cord resulting in acute ischemia, impeded venous and lymphatic drainage

s/s: acute scrotal pain, N/V, anorexia, trauma may contribute; testes “riding high”, swelling, extreme tenderness, *ABSENT cremasteric reflex, *negative prehn sign (elevation does NOT decrease pain)

tx: *surgical emergency!! cell necrosis can occur in a few hours; manual detorsion by untwisting towards the middle

21
Q

testicular malignancy

A

peak incidence between 20-40 years old, *MC germ cell tumors (split into 2 categories)-seminoma (40%): MC (best one to have) only seminomatous elements on histopathology-nonseminoma (worse prognosis)

s/s: solid tumors DO NOT transilluminate, dgx: there are dif labs for dif cancers : increase AFP r/o seminoma, increase beta human chorionic gonadotropin more indicative of nonseminoma

tx: ext beam radiation, surgery

22
Q

prostatitis

A

inflamm of the prostate; ascending urethral infectionmany diff classifications (see other section)

tx: abx, alpha-blockers

23
Q

benign prostatic hyperplasia

A

hyperplasia of the prostatic epithelium defined histologically

s/s: irritative voiding sx of dysuria, nocturia, urgency, frequency and sx of bladder outlet obstruction

dgx: PSA may be elevated, may have an enalarged gland
tx: 5 alpha reductase inhibitors, alpha blockers

24
Q

urethritis

A

gonococcal and non-gonococcal (C. trachomatis, mycoplasma); could be d/t caffeine, irritants

s/s: urethral discharge or dysuria and urethral inflamm documented by mucopurulent discharge or leukocytes on gram stain

tx: appropriate eval and abx (azithro or doxy) consider metronidazole, decease caffeine, avoid irritants

25
Q

balanitis

A

inflamm of the glans penis; can be caused by candida spexies

s/s: inflamm, smegma, sloughed cells, angioedema

tx: circumcision prevents recurrances

26
Q

erectile dysfunction

A

persistent inability to obtain or maintain sufficient rigidity of the penis to allow satisfactory sexual performance

vasculogenic: alteration in blood flow to and from the penis; unrestricted outflow may occur with increased adrenergic activity or decreased parasympathetic tone to the affected area
neurogenic: spinal cord lesion, MS, peripheral neuropathy
endocrinologic: testosterone levels are probably a factor
diabetic: multifactoral
psychogenic: performance anxiety or excess sympathetic tone
tx: oral phosphodiesterase 5 inhibitors (alprostadil, sildenafil, tadalafil, vardenafil)

27
Q

Acute uncomplicated cystitis summary

A

Def: healthy young female with UTI in bladder and urethra

SS:
Dysuria
frequency
urgency
low back/ab pain
Eval:
UA
- > 100,000 bacteria
- > 10 WBC
- LE +
- Nitrate +
Cause:
E coli
Klebsiella
Proteus
Enterococcus
Txt:
< 20% resistance:
TMP/SMX 1 DS po bid 3 days
Sulfa: Nitrofurantoin 100 mg po bid x 5 days
>20% resistanse
Cipro 250 mg bid
28
Q

Complicated cystitis (preg) cause/txt

A

Cause:
E coli
Staph

Txt:
TMP/SMX 1 DS po bid x 7 days (not within 2 weeks due date)
Amox/Clav 875/125 mb bid x 7 days

29
Q

Complicated cystitis STD cause/txt

A

Cause:
Chlamydia

Txt:
Azithromycin 1 gm po x 1
Doxycycline 100 mg po bid x 7 days

30
Q

recurrent cystitis young women txt

A

TMP/SMX SS qd long term
OR
TMP/SMX DS @ post-coitus or onset

31
Q

Recurrent cystitis postmenopausal women cause/txt

A

Cause:
E coli
Enterococcus
Staph

Txt:
treat like uncomplicated cystitis

32
Q

cystitis males summary

A

Cause:
E coli
Klebsiella
Proteus

Txt:
TMP/SMX 1 DS po bid 10-14 days
Cipro 250 mg bid 10 - 14 days

33
Q

acute pyelonephritis outpatient summary

A 
SS:
fever
rigors
HA
N/V
malaise
flank pain
CVA tender
ab pain
Eval:
UA
- > 100,000 bacteria
- > 10 WBC
- LE +
- Nitrate +

Cause:
E coli
Enterococcus

Txt:
Cipro 500 mg bid po x 7 days
AM/CL 875/125 mg bid 14 days

34
Q

Acute pyelonephritis hospitalized cause/txt

A 
Cause:
E coli
Enterococcus
Proteus
Klebsiella
Pseudomonas

Txt:
Cipro 500 mg bid po x 14 days (IV until no fever 48 then oral)
Amp + gent
cetriaxone

35
Q

Polycystic kidney disease summary

A

autosomal recessive - cysts in collecting ducts
autosomal dominant - cysts anywhere nephron

Txt:
Not curable
control HTN 130/80 optimal

Test ?:
Hepatic cysts & cerebral aneurysm

36
Q

cystic renal failure summary

A

Def: progressive irreversible damage to nephron and glomeruli

Causes: DM and HTN

SS: azotemia
polyuria (musty order)

Txt:
diet
3 forms of renal replacement therapy:
peritoneal dialysis
hemodialysis
renal transplant
37
Q

Acute renal failure summary

A

def: abrupt < 48 hr reduction kidney function with absolute increase in serum creatine

Cause:
Prerenal - not enough blood to kidney
Intrarental - DM, glomerulonephritis
Postrenal - obstruction of urine flow

SS:
from associated disease
- fever, rash, join pain
proceeding pharyngitis

Eval:
H&P
volume status
Renal US
look urine
urinary indices

txt:
fluid replacement
relief obstruction
discontinue meds

38
Q

rhabdomyolysis summary

A

def: crush injury cause breakdown of muscle

SS:
CPK > 10,000
+ dipstick for blood but no RBC

Txt:
volume expansion
no calcium repletion

39
Q

hyperkalemia

A

def: potassium >5.5

S/s: *Peaked T waves on EKG

tx: first look at ekg, if cardiotoxicity is present, tx with *calcium
then, give insulin and glucose, inhaler beta agonist, and bicard

40
Q

pseudohyperkalemia

A

occurs when red cell hemolysis occurs during the blood draw
there is a lot of potassium in the cell (because it is higher inside than out, sodium is the opposite) so when RBC get broken down a lot of potassium spills out
tx: give them bicarb (make it more alkalosis) and it will go back into the cell

41
Q

hypokalemia

A

causes: *iatrogenic

s/s: general fatigue, don’t feel well

tx; identify why the pt is losing potassium and correct that problem, then give potassium to replenish depletion

42
Q

hyponatremia

A

s/s: *coma and sz usually occur when there is an abrupt drop in serum sodium to less than 120 mEq/L

Z Urology (14 decks)

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