Urology Nephrology (wk 7)

Question 1

Urinary Frequency - what often accompanies this sx? And what are the red flags?

Answer 1

Often accompanied by Urgency.

Red flags: fever, back pain, lower exremtiy weakness.

Question 2

Urinary Frequency - What should you ask the pt about?

Answer 2

Ask pt about: fluid consumption, flow sxs (hesitancy, nocturia, pain, etc.), fever, hematuria, sexual activity, missed menses, breast swelling, morning sickness (pregnancy).

Question 3

Urinary Frequency - What are some causes?

Answer 3

Causes include: UTI, pregnancy, compression/prolapsed uterus, foreign bodies, stones, excessive fluid intake, substances (coffee, alcohol, diuretics), DM, food sensitivity, BPH, prostatitis, spinal cord injury, urethral stricture, incontinence.

Question 4

Dysuria - what is it? What are the red flags?

Answer 4

Painful/uncomfortable urination from irritation, inflammation, infection, or lesions exposed to urine.

Red flags: fever, flank pain, recent instrumentation, immunocomp., recurrence.

Question 5

Dysuria - What should you ask the pt about?

Answer 5

Discharge, chills/fever, hematuria, sexual activity, timing of pain related to urination, and location of pain: urethra, suprapubic (bladder), flank (renal), abdominal (ureter)

Question 6

Nocturia - what is the etiology?

Answer 6

Excessive fluids in late evening, urine retention, BPH, interstitial cystitis, GU allergies. (Kids w/allergies often have this.)

Question 7

Nocturnal Enuresis - When is it uncommon/abnormal?

Answer 7

Defined as bedwetting after age 5. More common in boys & those w/family Hx (70% if both parents). Normally prevented by ADH secretion at sunset & ability to wake when bladder is full. Normally uncommon after age 4.

Question 8

Nocturnal Enuresis - Etiology of primary & secondary.

Answer 8

Primary: 90% of cases. Child never achieved continence for > 6 mo. Neurological/ developmental delay or genetics.
Secondary: develops after 6 mo of control. Neuro/devel. issues (autism or Down’s), diabetes, hypoglycemia, sickle cell, small bladder, sleep apnea/walking, bladder irritability (UTI/constipation), ADHD, psychological stress (abuse, bullying, birth of sibling, social isolation, divorce/separation, loss of a loved one), food allergies/sensitivity, parasites.

Question 9

Urinary Incontinence - 3 types

Answer 9

Overflow: distended bladder from obstruction, dribbling/frequency common.
Stress: Sudden increase in intra-abdominal pressure (sneeze, cough, etc.) combined with poor sphinctor control (childbirth, obesity, age)
Urge: Frequent sudden urge to urinate with little control (stroke, tumors, MS)

or Mixed.

Question 10

Polyuria - definition, what to ask pt, red flags.

Answer 10

Over 3000 ml/day, needs to be distinguished from frequency.
Ask about onset, fluids, dry membranes, polyphagia, polydipsia, wt loss, night sweats, family hx, drug hx.
Red flags: abrupt onset, night sweats, cough, wt loss, psychiatric disorder

Question 11

Polyuria - Causes

Answer 11

Appropriate response to high sodium intake.
Inappropriate response to pathology: diabetes insipidus, nephrogenic diabetes insipidus, compulsive drinking of excess fluids, osmolar load (spilling glucose)

Question 12

Oliguria & Anuria - define & causes

Answer 12

Oligura = decreased output (

Question 13

Hematuria - Red Flags

Answer 13

Gross hematuria, persistent microscopic hematuria in elderly (age > 50), HTN, edema, and painless hematuria.

Question 14

Hematuria - common etiologies, and special concerns

Answer 14

Inflammatory, Traumatic, Neoplastic, Metabolic, Congenital (PCKD), Hematologic, Vascular, Chemical, Obstruction
In peds - consider abuse. In geriatric - suspect UTI

Question 15

Hematuria - DDX

Answer 15

Pseudohematuria (dehydration, dyes, foods), vaginal source, genital/perineal trauma, rifampin (drug used in TB & leprosy)

Question 16

Hematuria & Pain

Answer 16

Painless - tumors of bladder, kidney adn prostate are main concerns! Could e calculi, PCKD, sickle cell, etc.
Dysuria - infection
Flank pain - Kidney/ureteral stone, PN, trauma or tumor

Question 17

Gross Hematuria & timing

Answer 17

Beginning of pee - anterior urethral lesion
End of pee - bladder trigone, prostate, posterior urethra
Throughout pee - bladder, ureteral, or renal pathology
With menstruation - endometriosis
Between voiding (underwear) - bleeding on either end of urethra

Question 18

Hematuria - what to ask about

Answer 18

Habits (smoking/drugs), meds, exposures, obstructive sx, irritative sx, recent infections, family & drug hx.

Question 19

Renal colic - describe & give red flags

Answer 19

Usu. unilateral, severe crescendo-decrescendo pain originating in flank, radiation across abdomen to genitals and inner thigh. M/b accompanied by N/V, chills/fever, gross hematuria, frequency.
Most common cause is passage of calculi.
Red flags - fever, oliguria or anuria

Question 20

Edema - some etiologies

Answer 20

Heart, liver, kidney dz (nephrotic syndrome, glomerulonephritis, chronic renal failure - from DM or HTN), myxedema, lymph edema

Question 21

UTI causative organisms & when they’re common

Answer 21

E.Coli - 80-90% of cystitis cases
Klebsiella, enterobacter - kids
Pseudomonas, Staph - Nosocomial infx
Staphylococcus sprophyticus - young females w/negative nitrite
Chlamydia trachomatis - routine cultures negative

Question 22

UTI risk factors

Answer 22

Anatomical malformations, DM, pregnancy, vaginal intercourse, hygiene, antibiotic use, catheterization, insufficient hydration, tampons & spermacides

Question 23

GU pain with UTI

Answer 23

Dull pain at costovertebral angle = kidney. Ureter pain is colicky, sudden, severe, and radiating to the scrotum or vulva. Suprapubic pain that’s better w/voiding = bladder. Fullness/dull perineal or low back pain = prostate.

Question 24

Associated sx w/UTI

Answer 24

Nocturia, nocturnal enuresis, incontinence.

Question 25

Urethritis

Answer 25

50% gonococcal. Sx - urgency, frequency, tingling w/urination, urethral itching progresses to burning, discharge.
Confirmed GC/CT are reportable to public health system.
Remember - partner could be asx.
DDx - congenital abnormality, bladder CA, DM, prostatic obstruction, bladder calculus.