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PANCE Review > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

acute kidney injury (AKI) - definition, risk factors

note: good summary table on side 14 of PPT

A

sudden dec. in renal fx (GFR) which causes build up of nitrogenous waste (uric acid)

  • over hrs to days
  • severity based on inc. in BUN and Cr and reduction of urine output (oliguria)
  • can be pre-renal, intrinsic, or post-renal

risk factors:

  • age, heart and liver dz
  • exposure to nephrotoxins
  • surgery, sepsis, vol. depletion
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2
Q

important nephrotoxins

A 
IV contrast dye
ACE-I and ARBs
Loop and thiazide diuretics
lithium
NSAIDs
statins
some ABX
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3
Q

acute kidney injury (AKI) - sxs, dx

A

sxs: vary depending on cause
- +/- oliguria
- change in urine color
- N/V, malaise, abd pain, itching

dx:

  • BUN/Cr ratio rises
  • image/biopsy may be done
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4
Q

acute kidney injury (AKI) - pre-renal causes and tx

A

Pre-renal (most common):

  • vol. depletion: dehydration, blood loss
  • dec. effective circulating vol: CHF, ascites, nephrotic syndrome
  • impaired renal blood flow: ACEIs, NSIADS, renal artery stenosis
  • systemic vasodilation: sepsis

Tx: treat cause, maintain euvolumia, check K+

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5
Q

acute kidney injury (AKI) - intrinsic causes (3)

A
  1. acute tubular necrosis
    - ischemia
    - endogenous nephrotoxins: rhabdomyolysis, hemolysis
    - exogenous nephrotoxins: amphotericin B, contrast dye
    - sepsis/infection
  2. interstitial nephritis
    - drugs: Penicillin, cephalosporins, sulfa, NSAIDs
  3. glomerularnephritis
    - IgA nephropathy
    - post strep (antibody against strep antigen that settled in kidney)
    - Good pastures (antibody against basement membranes of kidney and lung
    - HUS: hemolytic uremic syndrome (E. Coli)
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6
Q

acute kidney injury (AKI) - post-renal causes and tx

A

Post-renal (think obstruction; least common):

  • BPH
  • nephrolithiasis (bilateral)
  • bladder outlet syndrome

tx: catheterization or stent

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7
Q

acute tubular necrosis - causes, dx, tx

A

most common intrinsic cause of AKI

causes:

  • ischemia
  • endogenous nephrotoxins: rhabdomyolysis, hemolysis
  • exogenous nephrotoxins: amphotericin B, contrast dye
  • sepsis/infection

dx:

  • U/A: “muddy brown sediment” and granular casts
  • Labs: hyperkalemia, high phase, FeNa>1, BUN:Cr<20:1

tx:

  • remove toxin or tx cause to prevent further kidney injury!
  • loop diuretic, correct electrolytes
  • dialysis if needed
  • low protein diet
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8
Q

interstitial nephritis - causes (drugs), sxs, dx, tx

A

inflammation of renal tubules and interstitial
- intrinsic cause of AKI

causes:

  • DRUGS: Penicillin, cephalosporins, sulfa, NSAIDs
  • infection: strep, CMV
  • immune d/c: sarcoid, SLE (Lupus)

sxs: fever, maculopapular rash

dx:

  • U/A: WBC casts, eosinophils
  • CBC: peripheral blood eosinophils

Note: this is a hypersensitivity reaction to drug… why we see eosinophils

tx:

  • address underlying cause
  • urgent dialysis
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9
Q

glomerulonephritis - causes (many)

Note: only intrinsic cause list out on blueprint!

A

inflammatory lesions of glomerulus from immune complex deposition or development of antibodies against glomerulus
- intrinsic cause of AKI

causes:

  • IgA nephropathy (aka Berger dz): assoc. w/ URI sxs, gastroenteritis; hematuria
  • Post strep (immune complex deposition): occurs 2-6 wks post-impetigo and 1-3 wks post-strep pharyngitis; +ASO, inc. C3; steroids NOT helpful
  • Good pastures: autoantibodies against basement membrane; tx is plasma exchange
  • HUS (hemolytic uremic syndrome): uremia, low platelets, hemolytic anemia
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10
Q

glomerulonephritis - sxs, dx, tx

Note: only intrinsic cause list out on blueprint!

A

sxs:

  • related to underlying cause
  • hematuria, HTN and edema (periorbital and scrotal edema), flank pain

dx:
- U/A: tea or coca-cola colored urine w/ red cell casts

tx:

  • treat underlying cause
  • high dose corticosteroids (except if post-strep)
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11
Q

AKI - what medical calculation can help you determine cause?

A

FeNa

FeUrea - can be used on patients on diuretics

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12
Q

chronic renal failure - definition, sxs

A

destruction of nephrons leading to progressive decline in kidney fx

  • common (1 in 9 adults)
  • often with other chronic diseases
  • most people die of other cause (CVD) and not ESRD

sxs:

  • HTN (#1 sx)
  • uremic syndrome
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13
Q

uremic syndrome

A

build-up of metabolic wastes w/ advanced chronic kidney dz

sxs:

  • urinary changes
  • fatigue, dec. appetite, pruritus, edema, SOB
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14
Q

chronic renal failure - dx, tx, prevention

A

Dx:

  • renal fx: inc. BUN/Cr, inc. Cr, dec. GFR (< 60 for 3+ mo)
  • hyper K, metabolic acidosis, proteinuria, etc.

tx:

  • diet: protein restriction, also salt, water, potassium, and phosphate restriction
  • dialysis or transplant

Prevent:
- treat HTN: ACE-I or ARB

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15
Q

chronic renal failure - stages

A

based on GFR

1: normal, but evidence of kidney dz; GFR 90+
2: mild; GFR 60-89
3: moderate: GFR 30-59
4: severe; GFR 15-29
5: failure (ESRD); GFR<15 (on hemodyalysis)

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16
Q

hydronephrosis - definition and cuases

A

distention of renal calyces and pelvis of kidney(s) by urine

  • is the result of urinary blockage anywhere along urinary tract
  • will see dec. GFR if bilateral

causes:

  • BPH
  • VUR
  • nephrolithiasis (esp. at ureteropelvic jx)
  • pregnancy
  • large fibroids
  • neurogenic bladder
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17
Q

hydronephrosis - sxs, dx, tx

A

sxs:
- pain, sxs related to cause

dx: U/S
- can also use IV urogram or CT

tx: treat cause!
- catheter for BPH
- anticholinergics for neurogenic bladder
- emergent stenting or nephrostomy for infection

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18
Q

nephrotic syndrome - definition, causes, sxs

A

increased permeability of glomerular capillary walls that allows passage of large amounts of protein into urine
- proteinuria + hypoalbuminemia + edema

Primary causes:

  • minimal change dz
  • focal glomerulosclerosis
  • membranous nephropathy
  • menbranous proliferative nephropathy (MPGN)

Secondary causes:

  • DM
  • amyloidosis

sxs:

  • edema: periorbital and scrotal (also feet and ankles)
  • pleural effusion: SOB
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19
Q

nephrotic syndrome - dx, management

A

Dx:

  • proteinuria > 3g/day
  • oval fat bodies: lipid passed into urine, as well (maltese crosses are signs of oval fat bodies under microscope)

Manage:

  • diet: low protein, salt restriction
  • tx hyperlipidemia and hypercoaguability
  • diuretics (thiazide, loop) and ACE-I
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20
Q

polycystic kidney disease - definition, sxs, dx

A

genetic, cystic d/o of the kidneys often resulting in massive enlargement
- MOST common hereditary dz in US

sxs:

  • present in 30-40’s; ESRD by age 60
  • hematuria + abd/flank pain + 2ndary HTN
  • large, palpable kidneys
  • frequent UTIs and nephrolithiasis

dx:
- U/S for screening
- CT or MRI give anatomic details

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21
Q

polycystic kidney disease - complications, management

A

complications:

  • pain from cyst and rupture
  • renal infection
  • nephrolithiasis
  • HTN: must tx aggressively!
  • cerebral aneurysms
  • MVP (mitral valve prolapse)
  • cysts in other locations

Management:

  • treat complications
  • aspirate cysts
  • treat HTN aggressively
  • VASOPRESSIN receptor antagonist delays ESRD
  • renal transplant
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22
Q

renal artery stenosis

A

narrowing of 1 or both renal arteries

sxs:

  • HTN onset <20 or >50 y/o
  • HTN resistant to meds
  • renal bruits

dx:

  • U/S: screening
  • renal arteriography: gold standard

tx:

  • renal artery angioplasty +/- stent
  • antihypertensives
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23
Q

renal vein thrombosis - definition, causes, sxs, dx, tx

A

acute or chronic thrombosis of renal vein

causes:

  • Kids: severe dehydration
  • Adults: infection, ascending thrombosis of vena cava, clotting d/o

sxs:

  • flank pain
  • palpable kidney
  • nephrotic syndrome if bilateral

dx:

  • renal U/S
  • renal venography

tx:

  • eliminate cause
  • anticoagulation or thrombolytic therapy
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24
Q

Acid-Base Basics

A

acid-base balance is coordinated by lungs and kidneys to keep optimal pH

  • goal pH: 7.35-7.45
  • lungs regulate pCO2
  • kidneys regulate HCO3-

Note: when one system fails, the other tries to compensate to bring back balance

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25
Q

acidosis

A

results when pH is too low (<7.35)

  • pCO2 is HIGH (>40)
  • HCO3 is LOW (<24)

Note: think of CO2 as Hydrogen

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26
Q

alkalosis

A

results when pH is too high (>7.45)

  • HCO3- is HIGH (>24)
  • pCO2 is LOW (<40)
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27
Q

acid-base question: approach

A
  1. identify if you have an acidic or basic state
    - acidic: pH<7.35
    - basic: pH>7.35
  2. identify if it is metabolic (HCO3-) or respiratory (pCO2) underlying the cause
  3. Consider underlying cause and correct
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28
Q

metabolic acidosis (w/ elevated anion gap) - causes

A

low pH, low HCO3-
anion gap > 16

causes: MUDPILERS

M: methanol
U: uremia
D: DKA
P: propylene glycol, acetaminophen, 
I: iron, isoniazid (due to seizures), inborn errors of metabolism
L: lactic acidosis
E: ethanol (due to lactic acidosis), ethylene glycol
R: rhabdomyolysis
S: salicylates/ASA/Aspirin
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29
Q

anion gap

A

positive ions minus negative ions

anion gap = Na+ - (HCO3- + Cl-)

normal: 8-16 mEqu

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30
Q

metabolic acidosis (w/ normal anion gap) - causes

A

low pH, low HCO3-
anion gap b/t 8-16

causes:
- dec. bicarb with diarrhea

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31
Q

metabolic acidosis - what is compensation

A

increased ventilation to blow off CO2

- can get Kussmaul breathing

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32
Q

metabolic alkalosis - causes, compensation, other s/sx, tx

A

high pH, high HCO3-

causes: loss of H+ or excess HCO3-
- vomiting, suction gastric contents
- diuretics
- overcorrect metabolic acidosis

compensation: decreased ventilation (inc. pCO2)

other s/sx:

  • hypocalcemia: paresthesias, confusion, coma
  • hypokalemia: polyuria, polydipsia, weakness

tx: fix underlying cause, IV fluids

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33
Q

respiratory acidosis - causes, compensation, tx

A

low pH, high CO2

causes: anything that dec. respirations (COPD, narcotics OD)
compensation: inc. reabsorption of HCO3- by kidneys

tx:
- fix underlying cause, assist ventilation, naloxone (if all else fails)

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34
Q

respiratory alkalosis - causes, s/sx, compensation, tx

A

high pH, low CO2

causes: anything that inc. respirations and blows off too much CO2
- hysterical hyperventilation
- salicylate intoxication
- pulmonary embolism

s/sx: rapid breathing, lightheadedness

compensation: inc. elimination of HCO3- by kidneys
tx: underlying cause

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35
Q

hyponatremia - 1st step, s/sx

A

serum sodium <135
- can be due to excess total body water

s/sx: N/V, weakness, HA, dec. DTRs, delirium, coma

Must 1st determine volume status (hypo-, eu-, hyper volemic)

36
Q

hyponatremia (hypovolemic): causes, sx, results of UA, tx

A

water and Na+ are lost; causes ADH to be released (for water retention)

causes: vomiting, diarrhea, diuretic use, Addisons dz
sx: dehydrated

UA: urine Na is LOW

tx: volume replacement to suppress ADH

37
Q

hyponatremia (euvolemic): causes, sx, results of UA, tx

A

causes: SIADH (kidney conserves too much H2O), hypothyroidism, psychogenic polydipsia
sx: NO vol. overload

UA: urine sodium is HIGH

Tx: water restrict, correct cause

38
Q

hyponatremia (hypervolemic): causes, sx, results of UA, tx

A

inc. extracellular water compared to Na+
causes: cirrhosis, CHF, nephrotic syndrome, renal failure
sx: edema, vol. OL

UA: urine Na LOW

tx: water restrict, diuretics

39
Q

hyponatremia (hypertonic) - definition, cause, tx/correction

A

hypertonic: excess extracellular solute creates gradient so water moves out of cells
cause: hyperglycemia (most common)

tx: hypertonic saline
- BE CAREFUL - do not correct Na too rapidly = Central Pontine Myelinolysis

40
Q

hypernatremia

A

serum Na >145
- can be due to low total body water

causes:
- impaired thirst mechanism, lack of access to water
- diabetes insipidus

s/sx: dehydration, hyperthermia, delirium, coma

tx: volume replace and rehydrate
- BE CAREFUL - do not dec Na too rapidly = cerebral edema (neuro impairment)

41
Q

SIADH

A

syndrome of inappropriate secretion of ADH - leading to water retention

causes: MANY (CVA, trauma, infections, cancers, pneumonia, drugs and meds)

s/sx: hyponatremia

dx: diagnosis of exclusion
tx: fluid restrict, furosemide, tx cause

42
Q

hypokalemia: causes, s/sx, EKG changes, tx

A

serum K < 3.5 (severe: <2.5)

causes:
- diarrhea (most common)
- vomiting, diuretics

s/sx: weakness, fatigue, muscle
- may cause arrhythmias

EKG: flattened or inverted T waves, U waves, frequent PVCs

Tx: oral or IV replacement
- monitor EKG

Recall: hypo K means hypo Mag

43
Q

hyperkalemia: causes, s/sx, EKG changes, tx

A

serum K >5 (sever: >6.5)

causes:
- end stage renal dz (#1) - kidneys can’t excrete
- drugs: spirinolactone (K sparing diuretics), NSAIDs, ACE, ARBs
- burns, rhabdo
- lab erros

s/sx: muscle wekaness, hyperreflexia, flaccid paralysis
- life threatening arrhythmias (V-Fib –> death)

EKG: peaked T-waves, widened QRS, sine waves, death

tx: repeat lab
- stabilize heart: calcium gluconate
- drive K+ back into cells (insulin, albuterol, sodium bicarb)
- excrete K: kayexalate (stool), furosemide (urine) hemodialysis

44
Q

hypocalcemia: causes, s/sx, EKG changes, tx

- recall: bound to albumin so much check ionized Ca to be sure not result of low albumin

A

serum Ca++ <8.5
- lowers neuromuscular and CV excitation thresholds (more sensitive to stimulation)

causes:
- chronic kidney dz (#1)
- hypoparathyroidism, hypoalbuminemia, vit D deficiency

s/sx:

  • muscle cramping, inc. DTRs
  • Chvostek sign: facial muscles contract when facial nerve tapped
  • Trousseau sign: carpal spasm when BP cuff inflate for 3 min

EKG: prolonged QT –> ventricular arrhythmias

tx: oral of IV Ca++; replace Mg as needed

45
Q

hypercalcemia

A

serum Ca++ > 10.5
- increases neuromuscular and CV excitation thresholds (less sensitive to stimulation)

causes:
- hyperparathyroidism (anything that makes high PTH)

s/sx: anorexia, constipation, polyuria, dehydration (only if >12)

EKG: shortened QT intervals

Tx: IV fluids, loop diuretics

46
Q

hypomagnesemia: which patients, causes, s/sx, EKG tx

A

serum mag <1.5

patients: hospitalized, ICU

causes:
- chronic ETOH
- chronic diarrhea
- hypo PTH
- hyperaldosteronism
- diuretics, malnutrition

s/sx:
- can lead to hypo K and hypo Ca++

EKG: long QT leading to arrhythmia (TORSADES)

Tx: oral, IM, IV Mag
- monitor EKG

47
Q

hypermagnesemia: what population does this occur in

A

rare - except in CKD patients

48
Q

nephrolithiasis: definition, risk factors, s/sx

A

saturation of urine w stone-forming salts causes precipitation of crystals

risk factors:

  • male, 3rd or 4th decade
  • drugs: antacids, carbonic anhydrase inhibitors, loop diuretics, vit. C
  • hyperparathyroidism
  • diets high in oxalate-rich foods (leafy veggies, nuts, tea/coffee)
  • diets high in purines

s/sx:

  • SEVERE flank pain (radiates to abdomen or groin)
  • hematuria, frequency, urgency, N/V
49
Q

nephrolithiasis: dx, tx, prevention

A

Dx:

  • imaging: spiral CT (gold standard); KUB (x-ray) helps to track stones
  • U/A (culture), CBC, electrolytes

Tx:

  • PAIN CONTROL: NSAIDs are best)
  • Management depends on stone size and location
  • <5mm: passable; 5-10mm (likely to pass), >10mm: admit for stent, nephrostomy, lithotripsy

Prevention:
- inc. FLUIDS, diet changes, tx underlying cause

50
Q

nephrolithiasis: types of stones

A

calcium: most common (85%)
- radio-opaque

struvite: 15%
- assoc. w/ infections, staghorn
- urine pH<7.2
- ABX do not penetrate staghorn, so inc. risk of urosepsis (may ned surgery)

uric acid: 8%

  • radiolucent (not seen on KUB)
  • urine pH<5.5

cystine: <1%
- hereditary condition

51
Q

urinary incontinence: definition, general categories of causes

A

NOT normal with aging
- women>men

can be caused by issues within and outside urinary tract

52
Q

urinary incontinence: causes outside urinary tract

A 
Outside: DIAPPERS (r/o first)
D: delirium
I: infection
A: atrophic urethritis
P: pharmaceuticals (alpha and beta blockers, diuretics, alcohol, anti-psych, narcotics)
P: psychiatric illness
E: excessive urinary output (hyperglycemia, CHF)
R: restricted mobility
S: stool impaction
53
Q

urinary incontinence: 4 types of pathology within urinary tract

A
  1. Urge: “gotta go now”
    - caused by overactive bladder
    - most common in elderly
    - tx: bladder training is 1st choice; Oxybutinin
  2. Stress: due to inc. abdominal pressure / dysfx of urethral sphincter
    - adult women
    - leak w/ cough, sneeze, valsalva
    - tx: Kegels
  3. Overflow: due to outlet obstruction –> distention –> overflow
    - leakage from BPH
    - dx using post-void residual (large)
    - tx: relieve obstruction w/ cath or foley
  4. Functional: urine system is normal, but cannot get to bathroom in time (immobility, cognitive problem)
54
Q

benign prostatic hyperplasia (BPH): pathophysiology, s/sx

A

increase in # of cells in prostate which surrounds urethra

pathophys:
- dihydrotestosterone causes hyperplasia and age increases sensitivity to DHT
- >90% of men over 80

s/sx:

  • obstructive sxs: hesitancy, weak flow
  • irritative sxs: frequency, urgency nocturia
  • DRE: smooth, enlarged prostate
55
Q

BPH: dx and tx

A

Dx: R/O other cases (UA, PSA, creatinine, post void residual, flow rate, cystoscopy)

Tx:

  1. watchful wait if very minor
  2. alpha blockers (tamulosin, doxazosin, terazosin): relaxes smooth muscle
  3. 5alpha reductase inhibitors (finasteride, dutasteride): block formation of DHT
    - NOTE: these reduce PSA by 50%
  4. Surgery:
    - TURP, TUIP, TUNA, TUMT, prostatectomay
56
Q

erectile dysfunction: definition, causes, dx, management

A

inability to attain or maintain erection
- >50% men 40-70 y/o

causes:

  • medical conditions: DM, HTN, androgen deficiency, CAD, high chol
  • surgery: complications of tx for prostate cancer
  • drugs: alpha and beta blockers, diuretics, tobacco, ETOH

dx: good H&P; labs to r/o contributing conditions

tx:

  1. treat underlying cause / limit risk factors
  2. vasoactive therapy: oral PDE-5 inhibitors (sildenafil / Viagra); - Note: NEVER with nitro (severe hypotention)
57
Q

priapism: causes, tx

A

painful, persistent erection lasting > 4 hours
- can lead to permanent penile necrosis!

causes:

  1. medical conditions: sickle cell dz, leukemia, multiple myeloma
  2. medications: anti-psychotics, sildenafil (rare)
  3. illicit drugs: cocaine, ecstasy

tx:

  • terbutaline, if fails…
  • aspiration of corpus cavernosum
58
Q

peyronie’s: definition, cause, tx

A

fibrotic plaque of tunica albuginea leading to penile curvature

cause: unclear, repeat trauma (occurs in men >40)

tx:

  • intra-plaque injection of Verapamil or interferon
  • Surgery to remove plaque (NO guarantee of normal fx)
59
Q

foreskin conditions - 3 main ones

A

balanitis
phimosis
paraphimosis

60
Q

balanitis: definition, cause, tx

A

swelling of foreskin and glans penis

causes:

  • poor hygiene
  • more likely if uncircumcised
  • can be fungal in DM

tx:

  • kids: none (hygiene)
  • adults: topical steroids or antifungals
61
Q

phimosis: definition, cause, tx

A

foreskin unable to be retracted over glans penis

cause:
- kids: physiologic (no intervention)
- adults: chronic low grade infection (Lichen sclerosis)

tx:

  • betamethazone cream
  • stretch foreskin
  • circumcision
62
Q

paraphimosis: definition, cause, tx

A

foreskin trapped in retracted position

  • edema, compromised blood supply
  • can cause necrosis > EMERGENCY

cause:
- long-term foley

tx:

  • manual reduction
  • emergent dorsal slit
63
Q

hypospadias: definition and tx

A

congenital abnormality when urethral meatus is ventral and proximal to normal position

tx: repair b/f 18 months
note: if hypospadias + bilateral cryptorchidism = think sex hormone abnormality

64
Q

chordee: definition and tx

A

congenital abnormality resulting in ventral penile curvature, often associated with hypospadias

tx: surery 6-18 months

65
Q

vesicoureteral reflux (VUR): definition, population, dx, tx, complication

A

congenital abnormality when urine passes retrograde from bladder to kidneys during voiding
- results from incompetent vesicoureteral sphincter

population: child with recurrent UTIs
dx: IVP (intravenous pyelogram), renal U/S, radionuclide cystogram, voiding cystourethrogram

tx:
- tx HTN (ACE-I)
- ABX for frequent urine cx
- surgery for severe reflux

complication:

  • renal nephropathy: scarring associated w/ intra-renal reflux of infected urine
  • can lead to HTN
66
Q

cryptorchidism: definition, risks, PE, tx

A

congenital abnormality when testicle fails to descend from abdomen into scrotum
- normally, descent at 7 mo gestation but can get caught in inguinal ring

risks: premature, low birth weight, MOC exposure to estrogens in 1st trimester, FH

PE:

  • empty hemiscrotum/absence of scrotal rugae
  • must confirm not just retracted (pulled up into pubic area but can be “milked” into scrotum) - resolves by puberty w/o tx

tx:

  • hCG IM daily for 3 days (25% will descend)
  • surgical correction by 1 y/o (inc. in testicular cancer and infertility if not)
67
Q

hydrocele: definition, tx

A

accumulation of serous fluid in membranes around testicle (not fluid in scrotum)

  • benign and painless
  • must transilluminate testicles
  • no tx required
68
Q

varicocele

A

varicosities in scrotum that feel like “bag of worms”

  • may be achy
  • increases with valsalva; dec. when supine
  • rarely tx unless effecting fertility
69
Q

testicular torsion: definition, clinical features, s/sx

A

testis rotates on spermatic cord causing vascular occlusion

clinical:

  • 10-20 y/o males
  • bell clapper deformity (testes not anchored)

s/sx:

  • SUDDEN, SEVERE testicular pain, N/V
  • neg. Phren’s sign: NO relief w/ elevation
  • neg. cremasteric reflex: NO retraction of ipsilateral testis when medial tight is stroked
70
Q

testicular torsion: Ddx, imaging, tx

A

Ddx:
- epididymitis (less acute, + Phren’s sign, + cremasteric reflex)

Image:
- doppler U/S shows dec. arterial flow

Tx:

  • SURGICAL EMERGENCY!
  • surgery in 4-6 hrs to save testicle
  • manual detorsion: in to out (open book)
71
Q

epididymitis: definition, pathogens, s/sx, dx, tx

A

infection of epididymis
- most common cause of adult scrotal pain

pathogens:

  • < 35 y/o sexually active = GC/CT
  • not sexually active (young or older): E. Coli (uropathogens)

s/sx:

  • gradual, severe, unilateral scrotal pain
  • scrotal inflammation, redness
  • urethral D/C and irritative voiding sx possible
    • Phren’s sign
    • Cremasteric reflex

Dx: doppler U/S to r/o torsion
- labs: U/A, GC/CT, CBC

tx:

  1. bed rest, scrotal elevation, tight briefs, NSAIDS
  2. if E. Coli: Ofloxacin or Levofloxin ABX
  3. If STD: Ceftriaxone IM + Doxycycline for 10 days (cover for both GC and CT)
    - treat partner!
72
Q

orchitis: defintion, s/sx, tx, complications, prevention

A

inflammation of one or both testes

  • associated with MUMPS
  • can also be spread of epididymitis

s/sx:

  • 1 week after onset of parotitis
  • marked pain and swelling in 1 or both testes (large, tender, indurated)
  • N/V, fever, urinary sxs

tx:

  • bed rest, scrotal support, ice, analgesics
  • ABX if due to epididymitis

complications:

  • 1/2 develop testicular atrophy; 20% infertile
  • abscess and chronic epididymitis

prevention: vaccine (MMR)!!

73
Q

urethritis: causes, s/sx, dx, tx, complications

A

inflammation of urethra
- usually infectious cause (GC/CT)

s/sx:

  • urethral d/c (purulent), dysuria
  • may be asymptomatic

dx: urine or urethral swab for gram stain or PCR

tx: MUST treat BOTH GC and CT
- ceftriaxone IM + azithromycin (PO)
- ceftriaxone IM + doxycycline x 7 days

complications:

  • men: epididymitis, disseminated GC infection, reactive arthritis
  • women: PID, ectopic preg, infertility
74
Q

cystitis: pathogen, s/sx, dx, tx (in pregnancy)

A

infection of bladder
- ascending infection, more common in women

pathogen: E. Coli

s/sx: dysuria, frequency, urgency, hematuria
- low back pain, public pain, malaise

Dx:

  • clean catch U/A (w/ cx)
  • urologic w/up if recurrent

tx: ABX for 3-7 days
- TMP/SMX, quinolones (cipro and levaquin), nitrofurantoin (only active in urinary tract)

Note: nitrofurantoin in pregnancy!

75
Q

pyelonephritis: pathogen, s/sx, dx, tx

A

renal inflammation

pathogens: E/ Coli (most common)

s/sx:

  • irritative voiding sx
  • fever, chills, flank pain and CVA tenderness, N/V
  • can develop sepsis!

dx:

  • U/A: nitrites, WBC, RBC, WBC casts
  • urine cx
  • CBC: leukocytosis
  • imaging: only if obstruction suspected

tx:

  • Uncomplicated: oral ABX x 14 days (Cipro or quinolone)
  • Admit: elderly, pregnant, etc. - IV ampicillin + aminoglycoside
76
Q

prostatitis - 4 types

A

inflammation of prostate

  1. acute bacteria prostatitis
  2. chronic bacterial prostatitis
  3. non-bacterial prostatitis (chronic pelvic pain syndrome)
  4. prostatodynia
    - condition of normal prostate with no abnormal labs
    - thought to be due to musculature or spasm
77
Q

acute bacterial prostatitis: pathogen, s/sx, what to avoid, dx. tx

A

pathogen: E. Coli

s/sx:

  • perianal pain
  • toxic appearing, fever, chills, body aches

DO NOT DO DRE - can become septic!

dx:
- fever, +U/A, + urine cx, DO NOT DO prostatic secretions

tx:

  • 4-6 WEEKS TMP/SMX or fluoroquinolone
  • analgesia, fluids, rest
78
Q

chronic bacterial prostatitis: pathogen, s/sx, what to avoid, dx. tx

A

recurrent infection of prostate

Pathogen: usually gram neg rods (E. Coli)

s/sx: milder than acute, not systemic

  • irritative voiding
  • low back and perineal pain
  • DRE: boggy and tender

dx:
- no fever, neg. U/A, positive urine cx, prostatic secretions w/ inc. WBCs

Tx (>50% relapse):

  • TMP/SMZ, quinolones x 6-12 WEEKS
  • NSAIDs, alpha-blockers, sitz baths
79
Q

nonbacterial prostatitis (CPPS: chronic pelvic pain syndrome): definition, s/sx, dx, tx

A

sxs of chronic prostatitis w/o infection

s/sx:

  • chronic pelvic pain (wax and wane)
  • can be inflammatory or non inflammatory
  • cause unknown / dx of exclusion
  • NO hx of acute bacterial prostatitis

dx:
- no fever, neg. U/A, neg. urine cx, may have WBC in prostatic secretions if inflammatory

tx:
- ABX usually tried but do not help
- alpha blockers, NSAIDs, benzos??

80
Q

testicular carcinoma: risks, population, tumor type, s/sx, dx, tx, prognosis

A

risks:

  • cryptorchidism (40%!)
  • FH or personal hx
  • males 15-35 y/o (most common neoplasm)

tumor type: most are germ cell tumors (nonseminomas and seninomas)

  • bHCG and LDH elevated in both
  • AFP elevated in nonseminomas

s/sx:

  • PAINLESS testicular mass
  • usually does not MET (to lungs and brain if it does)

dx:

  • scrotal U/S
  • CT (abd, pelvis, chest) and MRI (brain) for mets

tx:

  • radical orchiectomy
  • radiation w/ seminomas
  • no radiation w/ nonseminomas

prognosis: excellent (90-95% cure rate)

81
Q

prostate cancer: risks, tumor type, s/sx, PE, mets

A

risks: age, AA, FH

tumor type: adenocarcinomas (95%)

s/sx:

  • many asymptomatic
  • pain, obstructive urinary sxs, erectile dysfunction

PE:
- DRE: indurated, hard prostate gland; may feel nodules

Mets: bone (axial skeleton - low back)

82
Q

Prostate specific antigen (PSA)

A

Good for staging, trending dx, detecting recurrence

NOT for screening
- only if FH

Not: PSA is reduced by 50% by 5 alpha reductase inhibitors (used to tx BPH)

83
Q

prostate cancer: dx, prognosis, tumor surveillance, tx

A

Dx: trans-rectal U/S-guided biopsy

Gleason score:

  • evaluates tissue sample
  • higher score = cells less differentiated/irregular = poorer prognosis

tumor surveillance:

  • CT abd and pelvis
  • bone scan
  • MRI

Tx: many options

  • prostatectomy
  • radiation
  • cryotherapy
  • hormone therapy / androgen deprivation (LHRH agonists, antiandrogen meds, orchiectomy)
  • chemotherapy (if hormone therapy failed)
84
Q

bladder cancer: risks, s/sx,

A

risks:

  • smoking (#1)
  • industrial dyes, solvents
  • male, > 40y/o

s/sx:

  • PAINLESS hematuria (bladder cancer until proven otherwise)
  • may have irritative voiding sxs

dx:
- cystoscopy w/ biopsy

tx: depends on penetration of bladder wall
- Ta, T1: does not invade wall - transurethral resection +/- intravesical chemo
- >T2: invades wall - radical cystectomy + pelvic lymphadenactomy +/- chemo and radiation

85
Q

renal cell carcinoma: risk factors, s/sx, paraneoplastic syndrome, dx, tx

A

NOT common

Risks:
- smoking, male, obesity, HTN
Note: risk of producing occlusive thrombi in renal vein and IVC!!

s/sx:

  • hematuria
  • flank pain or mass

20% will have paraneoplastic syndromes (tumor produces ectopic hormones)

  • hypercalcemia
  • erythrocytosis
  • HTN
  • anemia

dx:

  • imaging: CT w/ eval for mets (CXR, bone scan)
  • labs: U/A, studies for paraneoplastic syndromes

tx:

  • if localized, radical or partial nephrectomy
  • if mets: palliative care
86
Q

Wilms tumor (aka nephroblastoma): definition, population, s/sx, dx, tx, prognosis

A

cells meant to form kidney fail to develop properly

  • peak incidence 2-3 y/o
  • 5% childhood cancers

s/sx:

  • PALPABLE ABDOMINAL MASS (60%)
  • abdominal pain
  • hematuria
  • N/V, anorexia, fever

Dx:

  • imaging
  • biopsy is not done b/c could spill tumor cells

tx:
- surgical resection, nephrectomy, chemo, radiation

prognosis: 85% curable

PANCE Review (16 decks)

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