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PAM Semester 2 > Clinical Medicine Exam 3 GU > Flashcards

Clinical Medicine Exam 3 GU Flashcards

1
Q

Bladder disorders

A

Incontinence
Overactive bladder
Prolapse

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2
Q

Congenital and acquired abnormalities

A

Cryptochidism
Peyronies Disease
Trauma
Vesicoureteral reflux

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3
Q

Infectious disorders

A 
Cystitis
Epididymitis
Orchitsi
Prostatitis
Pylonephritis
urethritis
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4
Q

Neoplasms

A

Bladder cancer
Penile cancer
prostate cancer
testicular cancer

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5
Q

Penile disorders

A

Erectile dysfunction
Hypospadias/epispadias
Paraphimosis/phimosis

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6
Q

Prostate disorders

A

• Benign prostatic hyperplasia

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7
Q

Testicular disorders

A
  • Hydrocele/varicocele

* Testicular torsion

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8
Q

Urethral disorders

A
  • Prolapse

* Stricture

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9
Q

Cystitis aka

A

UTI

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10
Q

Cystitis
Uncomplicated
vs
complicated

A

Complicated is infection above bladder

Complicated has fever, chills, fatigue, malaise, rigors, Flank pain, CVA angle tender,

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11
Q

Cystitis

Complicated

A

E.coli (predominates)

Gram negs- Klebsiella, proteus, pseudomonas, morganella, acinetobacter, citrobacter

Gram Positive +
Entor

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12
Q

Cystitis

Complicated

A

E.coli (predominates)

Gram negs- Klebsiella, proteus, pseudomonas, morganella, acinetobacter, citrobacter

Gram Positive +
Enterococci and S Aureus

Yeasts

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13
Q

Risk factors for UTI

A

iatrogenic / Drugs
Catheter, antibiotic use, spermicides

Behavioral
Voiding dysfunction, frequent sexual intercourse

Anatomic/physiological
vesicouretreal reflux, female sex, pregnancy

Genetic
Familial tendency
susceptible uroepithilial cells, vaginal mucous properties

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14
Q

UTI Path

A

Colonization

Uroepithlium penetration

Ascension

Pyelonephritis

AKI

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15
Q

UTI Comorbidities

A

Diabetes, urinary tract abnormalities

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16
Q

UTI risk factors

A

Women
recent sex
use of spermicides, condoms w spermicide, diaphragms

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17
Q

UTI world wide numbers

A

90% Cystitis

10%pylonephritis

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18
Q

UTI classic presentation

A

Dysuria
Frequency
Urgency
Suprapubic pain

Hematuria is often observed

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19
Q

Pyuria in women with cystitis

A

Pyuria is present in almost all women with acute cystitis;

its absence strongly suggests an alternative diagnosis.

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20
Q

pyuria

A

WBC in urine (more than 10)

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21
Q

UTI DDX

A

UTI

Vaginitis
Urethritis
PID

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22
Q

Most common cause of microbial UTI

A

E. Coli

others can be:
Enterobacteriaceae
Klebsiella
Proteus
Staph saprophyt
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23
Q

Fix

A

Urinalysis (either by microscopy or by dipstick) for evaluation of pyuria is a valuable laboratory diagnostic test for UTI. It is not indicated in women with typical symptoms of acute simple cystitis (in whom the diagnosis can reliably be made on symptoms alone), but it can be helpful in cases in which the clinical presentation is not typical.

Pyuria is present in almost all women with acute cystitis; its absence strongly suggests an alternative diagnosis.

Dipsticks are commercially available strips that detect the presence of leukocyte esterase (an enzyme released by leukocytes, reflecting pyuria) and nitrite (reflecting the presence of Enterobacteriaceae, which convert urinary nitrate to nitrite). The dipstick test is most accurate for predicting UTI when positive for either leukocyte esterase or nitrite, with a sensitivity of 75 percent and a specificity of 82 percent.

However, results of the dipstick test provide little useful information when the clinical history is strongly suggestive of UTI, since even negative results for both tests do not reliably rule out infection in such cases.

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24
Q

UTI Treatment

simple uncomplicated with no MDR risk factors

A

start nitrofurantoin, TMP-SMX, or fosfomycin.

After this, Augmentin, or some cephalosporins such as Keflex

After this fluoroquinolones, then Cipro or Levaquin

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25
Q

Acute complicated UTI =

A

Pyelonephritis

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26
Q

Cystitis S/S

A

dysuria, urinary frequency and urgency, suprapubic pain, and hematuria

may also have fever chill rigors fatigue malaise

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27
Q

Pyelonephritis s/s

A

fever, chills, flank pain, costovertebral angle tenderness, and nausea/vomiting

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28
Q

Acute complicated UTI can also present with

A

bacteremia, sepsis, multiple organ system dysfunction, shock, and/or acute renal failure

More likely with UT obstruction, physical abnormality

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29
Q

Pyelonephritis DX

A

Leukocyte left shift (CBC)

UA shows pyuria, bacteriuria, and possible hematuria

Urine Culture

If very complicated pyelonephritis, then renal U/S may show hydronephrosis secondary to obstruction

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30
Q

If suspect pyelonephritis on inpatient

A

Treat with ESBL and MRSA coverage-Imipenem or meropenem or doripenem plus vancomycin

If no risk factors for MDR gram- infection then either: ceftriaxone, piperacillin-tazobactam, ciprofloxacin, or levofloxacin with possible vancomycin

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31
Q

Pyelonephritis outpatient

A

mild to moderate and out patient

they get cipro or levoquine

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32
Q

Urethritis

A

Urethritis, or inflammation of the urethra, is a common manifestation of sexually transmitted infections among men

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33
Q

Gonoccocal Urethritis

bug

A

Neisseria gonorrhea

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34
Q

nonGonoccocal Urethritis

bugs

A 
Chylamydia trachomatis
m genitalium
U urealyticum
T vaginalis
others
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35
Q

Urethritis risk factors

A

Family (genetic)
multiple sex partners
anal / risky types of sex
damaged condoms

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36
Q

Infectious urethritis is typically caused by

A

sexually transmitted pathogen;

thus, most cases are seen in young, sexually active men

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37
Q

2 common bugs for Infectious urethritis

A

Neisseria gonorrhoeaeandChlamydia trachomatisare common

also Mycoplasma genitalium

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38
Q

Urethritis presentation

A

Dysuria = chief complaint in men

others: pruritus, burning, and discharge at the urethral meatus.

can have watery or purulent or mucoid discharge

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39
Q

Urethritis can be diagnosed in with one of the following

A

Mucopurulent or purulent discharge on examination

≥2 white blood cells (WBC) on gram stain

Positive leukocyte esterase (“dipstick”) or the presence of ≥10 WBCs

If none of these findings are present, a presumptive or suspected diagnosis of urethritis can be made in sexually active men with suggestive symptoms.

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40
Q

Urethritis Tx gonococcal

A

IM 500mg Cef

if Chlamydia is suspected = also give doxy 100 BiD x 7d

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41
Q

Urethritis Tx nongonococcal

A

when gonococcal is not found, treat for suspected chylamydia

Azithromycin

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42
Q

Urethritis Prevention

A

refrain from sex x 7 days

follow treatment

testing at 3 months to rule out reinfection (chlamydia/gonorrhea)

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43
Q

Acute Epididymitis

A

Acute epididymitis is most commonly infectious in etiology but can also be from noninfectious causes such as trauma and autoimmune diseases

N. gonorrhoeaeandC. trachomatismost common in under 35

E.coli in older men

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44
Q

Intracellular enterococci

A

Gonorrhea

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45
Q

Epididymitis risk factors

A 
sex with multpile partners
not using condoms
uncircumsized
recent surgery
structural problems
catheter use.
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46
Q

Epididymitis & orchitis

A

Inflammatory conditions are more common in epididymis than in testes

But syphillis will begin in the testes

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47
Q

Most common cause of scrotal pain in adults in the outpatient setting

A

Acute epididymitis

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48
Q

epididymitis presentation

A

Testicular pain with tenderness and swelling on palpation of the affected epididymis, which is located posteriorly on the testis.

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49
Q

Prehn sign

A

Relief of scrotal pain after elevation

not a reliable way to distinguish between epididymitis and torsion

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50
Q

epididymitis dx

A

Dx is made presumptively based on history and physical examination after ruling out other causes requiring urgent surgical intervention

A urinalysis, urine culture, and a urine nucleic acid amplification test (NAAT) forN. gonorrhoeaeandC. trachomatisshould be performed

Id of pathogen on urine or swab testing supports the presumptive diagnosis.

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51
Q

Most common organisms responsible for acute epididymitis in men under the age of 35

A

N. gonorrhoeaeandC. trachomatis

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52
Q

Most common organisms responsible for acute epididymitis in older men

A

Escherichia coli, other coliforms, andPseudomonasspecies are more frequent in older men, often in association with obstructive uropathy from benign prostatic hyperplasia

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53
Q

epididymitis Tx general

A

Management of acute epididymitis varies according to its severity.

Most cases can be treated on an outpatient basis with oral antibiotics, nonsteroidal antiinflammatory drugs (NSAIDs), local application of ice, and scrotal elevation.

Acutely ill patients may warrant hospitalization for parenteral antibiotics and intravenous hydration.

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54
Q

epididymitis Tx

A

under 35 at risk std = coverage for Gonorrhea/chlamydia
500 IM Cef plus Doxy 100mg Bid x 10 days

Patients 35 years of age or older
low sexual risk
levofloxacin500 mg orally once daily for 10 days

insertive anal intercourse
Cef 500 mg IM, plusa fluoroquinolone (levofloxacin500 mg orally once daily for 10 days).

55
Q

acute epididymitis should improve when?

A

within 48 to 72 hours after starting appropriate antibiotic therapy

If not better, other causes of scrotal pain should be considered. Scrotal ultrasound and referral to a urologist for consultation are advised.

56
Q

Orchitis causes

A

Inflammation / infection of the testicles

Swelling, pain, tenderness, erythema, shininess

Viral: mumps, coxsackie, echovirus, parvovirus

Bacterial : brucellosis

57
Q

Orchitis Presentation

A

Unilateral testicular swelling and tenderness occur.

Fever and tachycardia are common

58
Q

Orchitis DX

A

U/A reveals pyuria and bacteriuria with infection.

Positive urine cultures.

U/S is useful if possible abscess or tumor is suspected and to rule testicular torsion

59
Q

Orchitis Tx

A

If mumps is the cause,
symptomatic relief with ice and analgesics,

If bacteria is the cause,
see epididymitis. Evaluate any scrotal masses.

60
Q

Prostatitis classes

A

Classified in four categories

1: Acute bacterial prostatitis
2: Chronic Bacterial Prostatitis
3: Chronic prostatitis, chronic pelvic pain syndrome
4: Asymptomatic inflammatory prostatitis

61
Q

Prostatitis Risk Factors

A

cystitis, urethritis, or other urogenital tract infections.

anatomical anomalies (eg, urethral strictures)

Prostate infections following urogenital instrumentation, including chronic indwelling bladder catheterization, intermittent bladder catheterization, and prostate biopsy are well documented.

62
Q

Bacterial prostatitis

A

Inflammation of prostate

Altered prostate secretory functions
(low zinc, decreased prostate antibacterial factor)

Manipulation of prostate
(catheters, instruments, prostatectomy)

63
Q

Prostatitis bugs

A

Gram-negative infections, especially with Enterobacteriaceae, are the most common

Of Enterobacteriaceae,Escherichia coliis the most typical, followed byProteus.

E.coli 58-88%, Proteus 3-6%, Pseudo 3-7%
Other entero 3-11%

The pathogens associated with acute prostatitis reflect the spectrum of organisms causing cystitis, urethritis, and deeper genital tract infections (such as epididymitis).

64
Q

Prostatits Tx

A

Empiric - gram negative bugs =
bactrim 1 DS Q12 or cipro/levo 500mg QD

Under 35 should be treated with regimens that cover chlamydia and gonorrhea

usually out patient unless comorbidities or bacteremia, also acute urinary retention

65
Q

main function of theurinary system

A

eliminate the waste products ofmetabolism from the body by forming and excretingurine

Other functions included:
maintaininghomeostasisofmineralions in extracellular fluid

regulating theacid-basebalance in the body

controlling the volume of extracellular fluids, including theblood

66
Q

Amount of urine produced per day

A

Between 1 and 2 liters

67
Q

Hormones that affect urine

A

ADH : Conserves Water
PTH : Regulate thebalance ofmineral ions
Aldosterone : Regulates BP and causes the kidneys to excrete less sodium and water inurine

68
Q

Types of UA

A

Complete = microscope
rapid = dipstick
24 hour collection = helps look at renal function

69
Q

Urinary incontinence

A

leakage at inappropriate times

Stress urinary incontinence (women)

Urgency urinary incontinence (men)

Mixed urinary incontinence (both types)

Overflow incontinence (least common)(blockage)

70
Q

2 types of BPH

A

obstructive (Crushing around the bladder)

irritative (Crushing around urethra and up into bladder)

71
Q

Obstructive BPH

A

Swelling of prostate

72
Q

Irritative BPH

A

Frequency
Urgency
Nocturia
Urgent urinary incontinence

73
Q

TURP

A

transurethral resection of the prostate

74
Q

TUIP

A

transurethral incision of the prostate

75
Q

PSA

A

bad test

only one we have

76
Q

Torsion

A

bell clapper
vertical testicle to horizontal testicle

twisting of testicular cord

no cremasteric reflex

Prehns sign negative (Pain may increase)

Asymmetric high riding testicle (usually left)

77
Q

Torsion Time frame

A

Urgent 6 to 8 hours or lose testicle

78
Q

Torsion Risk factors

A

Cryptum orchid teste (undescended teste)

Trauma (50% happen during sleep)

Bell clapper testicle deformity already present

79
Q

torsion testing

A

no cremasteric reflex

Prehns sign negative (Pain may increase)

Doppler ultrasound

80
Q

Torsion treatment

A 
Surgery
Manual detorsion (open book)
81
Q

hydrocele

A

lumps and swelling of the scrotal sac

Fluid from the peritoneal space (into the scrotum
usually a secondary sign due to other cause)

82
Q

Varicocele

A

lumps and swelling of the scrotal sac

swelling and twisting of the scrotal veins

*****Bag of worms

15-20% post puberty males
v-v Varicocele = veins

left internal spermatic vein (most common)

80% of cases non tender mass (varicocele)

83
Q

hydrocele Tx

A

most do not need intervention

intervention only if extreme pain or scrotal sac integrity is compromised (incision)

84
Q

hydrocele Dx

A

Transilluminate (75%)

Doppler Ultrasound

85
Q

Varicocele Tx

A

Surgery

Almost all varicocele surgery will
left spermatic vein ligation

86
Q

Varicocele Dx

A

Doppler ultrasound

87
Q

Priapism

A

Penis/clitoris
longer than 4 hours not associated with sexual stimulation

sickle cell

ischemic vs non ischemic

ischemic is urological emergency

non-ischemic is self limiting

88
Q

ischemic priapism

A

low flow

89
Q

non ischemic

A

arterial high flow

90
Q

Interstitial cystitis

A

DX of exclusion, rule out everything else

is a condition involving chronic bladder pain or discomfort

more common in women

no tests,
nsaids, kegels, elavil, botox, neuromodulation

refer to urology

91
Q

Phimosis

A

cant roll up

circumcision

92
Q

Pararphimosis

A

cant roll down

urological emergency

circumcision

93
Q

Peyronies disease

A

Penile fibrosis

Crooked penis

can cause deformity, ED, pain mass

Scar tissue,

94
Q

Peyronies disease Tx

A

Oral pentoxifylline-increases blood flow to the affected microcirculation

Surgical

95
Q

Vesicoureteral reflux

A

the retrograde passage of urine from the bladder into the upper urinary tract.

predisposes patients to acute pyelonephritis by transporting bacteria from the bladder to the kidney

may lead to renal scarring, hypertension, and end-stage renal disease

Most common form is inadequate closure of the ureterovesical junction

second is high pressure in bladder

96
Q

Vesicoureteral reflux Dx

A

Primary VUR is most common urologic finding in children, occurring in approximately 1 percent of newborns.

cystourethrogram (VCUG) or radionuclide cystogram.

97
Q

When you don’t give IV contrast

A

High Creatinine

Kidney issues

98
Q

VUR Tx

A

Vesicoureteral reflux

Cotrimoxazole /Macrobid (grade 3)

Surgical (grade 4-5)

99
Q

Urethral strictures

A

Urethral strictures are relatively common in men

common etiology is idiopathic

Iatrogenic injuries = account for 45 percent of all cases

100
Q

Urethral prolapse

A

Red papule at the urethral meatus that is seen in premenarchal or postmenopausal individuals.

101
Q

Urethral prolapse prepubescent females Tx

A

prepubescent females

topical estrogen therapy
Sitz bath

102
Q

Urethral prolapse Tx (nonsurgical)

A

pessaries
Topical Hormones (estrogen)
Kegels
Lifestyle changes

103
Q

ED Risk Factors

A 
Sedentary
obesity
smoking
hypercholesterolemia
Metabolic syndrome (h-BP, h-Chol, h-belly fat, h-BGL))
Diabetes
104
Q

ED

A

In men, the most common sexual problem is ED

Thorough history/physical

105
Q

ED Labs

A 
CBC
UA
Lipids
Test
CMP
106
Q

ED Tx

A

Psych
PDE5 (-afil)
inject, pump, prosthesis
Hormone replacement

107
Q

Congenital or Pediatric Urinary conditions

A 
Meatal stenosis
Chordee
Hypospadias/Epispadias
Enuresis
Cryptorchidism
108
Q

Meatal stenosis

A

tissue over urethral opening causing “sprinkler”
in circumcised boys,
rare in uncircumcised

109
Q

Chordee

A 
Curved Penis (cosmetic)
fibrous band pulls penis sideways

This condition is frequently observed in young males who have hypospadias

less than 30 degree curve ok to circumcize

greater than 30 do not circumsize

110
Q

Hypospadias

A

Urethral opening under

111
Q

Cryptorchidism

A

most common congenital abnormality of the genitourinary tract.

Most cryptorchid testes are undescended, but some are absent

Risk factors = premeies, low birth weight

5% of all boys have this

Orchiopexy

112
Q

Orchiopexy

A

Surgically descend a testicle into the scrotum

113
Q

Enuresis

A

Urinary incontinence is a common problem in children

usually potty trained by 5y/o

Usually due to developmental delay
or
Genetics

Tx desmopressin

114
Q

Painless hematuria over 35 y/o

A

Cancer until proven otherwise

115
Q

Bladder Cancer

A

Bladder cancer is the most common malignancy involving the urinary system

Hematuria (Most common)

If Pain, usually advanced cancer

116
Q

Bladder cancer Dx

A

CBC, CMP

UA, Urine cytology, cystoscopy,

117
Q

Bladder cancer Dx

A

CBC, CMP

UA, Urine cytology, cystoscopy (Cell scrape),

118
Q

Prostate cancer

A

1 in 6 will be diagnosed

Higher in AA

119
Q

Prostate cancer Exam

A

(DRE) may detect prostate nodules, induration, or asymmetry that can occur with prostate cancer

frequency, urgency, nocturia, and hesitancy are usually associated with BPH

120
Q

Prostate cancer Risks

A 
Elevated PSA (most common test for bladder cancer)
However not completely reliable
121
Q

Prostate Cancer Tx

A

Tumor
Nodes
Metastatsized
PSA

122
Q

Prostate Cancer Tx

A

Tumor
Nodes
Metastatsized
PSA

Waiting
Surgery
External beam Radiation
brachytherapy
proton therapy
Sterrotactic body radiation
123
Q

Penile Cancer

A

always has skin abnormality
usually on glans
painless lump, ulcer

Inguinal adenopathy is present in 30 to 60 percent of cases at diagnosis

124
Q

Testicular Cancer

A

Germ cell tumors (GCTs) account for 95 percent of testicular cancers

Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1 percent of all cancers in men.

125
Q

Testicular Cancer Dx

A

Ultrasound

3 markers
Alphafetoprotein
beta HcG
Lactate dehydrogenase

126
Q

Nephrolithiasis/urolithiasis

Renal calculi

A

80% of patients form calcium stones

Risk Factors Diabetes Mellitus is a Big One

CT gold standard

More in Males than females by 2-3 times especially in 3-4th decade of life.

Reoccurrence to happen up to 50%

127
Q

Radiopaque stones

A

Calcium

128
Q

Radiolucent

A

Uric Acid

129
Q

3 places for kidney stones

A

Ureteropelvic junction

Pelvic prim

Ureterovesicular junction

130
Q

Stone size

A

5mm will pass on own

Bothtamsulosin (alpha-1 blocker) andnifedipine (calcium channel blocker)have been shown to increase the likelihood of stone passage

stone 5-10mm likely to pass
if fever, hematuria, massive pain= admit
infection = antibiotics
lithotripsy

10mm and up not likely to pass
Stent, pain meds, stent,
Percutaneous nephrostomy (Gold standard)
131
Q

Neurogenic Bladder

A 
Stroke
Parkinson's disease
Multiple sclerosis
Spinal cord injuries
Spinal surgeries
Cerebral palsy
Spinal bifida
Sacral agenesis
Other causes
Erectile dysfunction
Trauma/accidents
Central nervous system tumors
Heavy metal poisoning
132
Q

Pyelonephritis Treatment

A

Treatment with urinary tract obstruction

2. Treatment with no suspected urinary tract obstruction

133
Q

Pyelonephritis-Treatment with no urinary tract obstruction

A

Outpatient Basis (Uncomplicated)
ciprofloxacin (Cipro) for 7 days
Or
trimethoprim/sulfamethoxazole (Bactrim) for 7 days

Outpatient but mostly Inpatient Basis (Complicated)
ciprofloxacin (Cipro) for 14 days
Or
trimethoprim/sulfamethoxazole for 14 days (Bactrim)

134
Q

Stone types

A

Calcium Oxalate

Calcium Phosphate

Uric Acid

PAM Semester 2 (22 decks)

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