Exam 2: GU/Renal Flashcards
(158 cards)
1
Q
Methods to treat hemorrhoids include
A
- Increasing fiber (20-30 G per day) and water (1 1/2-2 L per day)
- Sitz baths
- Stool softeners (docusate sodium)
2
Q
Internal hemorrhoids can be treated with
A
Office banding or sclerotherapy
3
Q
Diverticulitis can be Dx with
A
Contrast CT scan
4
Q
Outpatient tx of Diverticulitis includes
A
Liquid diet x 2-3 days then advance to soft foods
5
Q
what Antibiotics do we discharge a diverticulitis pt with?
A
Either ciprofloxacin plus metronidazole or augmentin (10-14 day course)
6
Q
Inpatient tx of Diverticulitis includes
A
- Liquids / bowel rest
- IV antibiotics: Metronidazole + 3rd gen cephalosporin
- Pain control (Acetaminophen or morphine)
7
Q
International prostate sx score (IPSS) / American urological association sx index can be used to diagnose
A
BPH (benign prostatic hyperplasia)
8
Q
Other helpful tools to confirm dx of BPH (benign prostatic hyperplasia) includes
A
- Urinalysis to rule out UTI
- Post-void residual volume (can see how much urine gets trapped)
9
Q
What post void residual volume would be considered abnormal?
A
Abnormal is >250 mL
10
Q
Medication tx for BPH (benign prostatic hyperplasia) can include
A
Alpha-1-receptor blockade: Tamsulosin (Flomax) 0.4 mg po daily
11
Q
One contra-indication of Tamsulosin for BPH tx is
A
**Cataract surgery! can cause intra-op floppy iris syndrome
12
Q
A common surgical tx of BPH (benign prostatic hyperplasia) includes
A
Transurethral resection of the prostate (TURP)
13
Q
Pts with BPH (benign prostatic hyperplasia) should have what done annually?
A
DRE and PSA annually
14
Q
What is a complication of BPH?
A
Bladder outlet obstruction
15
Q
An undescended or maldescended testis that does not ascend by 4 months of age is known as
A
Cryptorchidism
16
Q
Treatment / surgical exploration of cryptorchidism us
A
orchidopexy/orchidectomy
17
Q
Those with cryptorchidism have a risk for
A
testicular tumor development
18
Q
Dx of a unilateral undescended testis WITHOUT hypospadias is done via
A
Surgical exploration
19
Q
Unilateral or bilateral undescended testis WITH hypospadias or bilateral non-palpable testis should under go
A
- Karyotype for sex determination and some other tests
- Plus surgical exploration
20
Q
Bilateral cryptorchidism have decreased
A
fertility
21
Q
NPT (nocturnal penile tumescence testing) testing can be used for
A
Erectile dysfunction
22
Q
First line medication therapy for erectile dysfunction is
A
- PDE5 inhibitors 1st- sildenafil (viagra)
23
Q
Varicoele is more common in
A
left testicle
24
Q
Unilateral varicoceles can sometimes be associated with
A
malignancy
25
Dx method of choice for a varicocele
High-resolution color-flow doppler ultrasonography
26
Primary treatment for a varicocele is
Surgery
27
Transillumination is POSITIVE in a
Hydrocele (NOT diagnostic)
28
Diagnosis of a hydrocele is
Ultrasound
29
what is THE BEST TEST for bladder contractility and the extent of bladder outlet obstruction? Confirms stress incontinence.
Voiding Cystometrogram
30
The most sensitive clinical imaging modality for calcifications / suspected nephrolithiasis / urolithiasis is
Helical CT scanning without contrast material
31
The definitive therapy for paraphimosis is
Circumcision
32
The definitive therapy for phimosis is
Circumcision
33
Breakdown the grading score of Phimosis
Grade I = Fully retractable prepuce w/ stenotic ring in the shaft
Grade II = Partial retractibility with partial exposure of the glans
Grade III = Partial retractibility with exposure of the meatus only
Grade IV = No retractability
34
Testicular salvage in a pt with testicular torsion most likely occurs if the duration of torsion is LESS than
6-8 hrs
35
The cremasteric reflex is ABSENT in patients with
testicular torsion
36
Definitive diagnosis of testicular torsion is
scrotal color doppler sonogram
37
Treatment of choice for testicular torsion is
(manual detorsion) or surgical exploration; correction or orchiectomy if needed
38
if a patient presents with sudden onset of severe testicular pain and the testicle is high-riding and horizontal you should suspect
Testicular torsion
39
The most sensitive clinical imaging modality for calcifications is
Helical CT scanning with contrast
40
The most common metabolic abnormality related to nephrolithiasis and urolithiasis is
hypercalciuria
41
surgical treatment of kidney stones includes
Extracorpeal shock wave lithotripsy
42
Indications for surgery for a pt with kidney stones is
Pain, infection, and obstruction; Stone > 4weeks
43
Hypospadias is when
the meatus on ventral side (underside) of the penis
44
Diagnosis of hypospadias is
via examination!
- refer to urology
45
Tx of hypospadias includes
- avoiding circumcision in neonates
- surgery is done btw 6 mo - 1 yr
- can require multiple surgeries
46
Epispadias is when the
urethral meatus located on the dorsum of the penus
47
Dx tool of choice for peyronie's dz is
Ultrasound
48
Tx of peyronie's dz if LESS than < 30 degree curvature and normal function is
observation
49
Tx of peyronie's dz if greater than >30
NSAIDs and Pentoxifylline x 3 months 1st
50
Dx test of a spermatocele is
Ultrasound
51
Most common cause of acute urinary retention is
Outflow obstruction
52
Dx of acute urinary retention is
Ultrasound of the bladder >300 cc (may be MUCH more)
53
Dx of Chronic urinary retention is
Ultrasound of the bladder >300 cc (may be MUCH more)
54
Acute treatment of chronic urinary retention is
Bladder decompression via catheterization
EITHER - urethral OR suprapubic
55
Most common cause of UTIs is
E. coli **
56
Dx of UTIs is
Urinalysis (UA)
57
Leukocyte esterase and nitrites on UA are suggestive of
UTI
58
First line antibiotics for a simple UTI is
Nitrofurantoin (Macrobid) 100mg PO q12 x 5 days
59
First line antibiotics for a complicated UTI is
Ciprofloxacin (Cipro) PO or IV (500 mg po BID x 5-10 days)
60
When to obtain a culture with suspected UTI?
- Males w/ sx of UTI
- Females that have had >2 UTIs within 6 mo
- Pts that don't resolve in 2-4 wks
- pregnant women
- anyone w/ fever
- anyone w/ signs of pyelonephritis
61
Dx of pyelonephritis is
Urinalysis (UA)
62
- White cell casts on UA
- Leukocytosis w/ left shift on CBC
both are indicative of
Pyelonephritis
63
Tx of pyelonephritis includes
Ciprofloxacin (cipro) PO or IV* better as initial therapy* for 14 days
64
Organism likely to cause acute prostatits in pts <35 yo
STDs are more likely
65
Organism likely to cause acute prostatitis in pts > 50 yo
E. coli
66
First line treatment of acute prostatitis is
Any will work
- Trimethoprim - sulfamethoxazole (Bacterim)**
- Ciprofloxacin (Cipro)
- Levofloxacin (levaquin)
67
Pts < 35 yo with acute prostatitis - what should be added into their treatment plan?
Add tx to cover STD: Ceftriaxone
68
What is Prehn's sign
lifting testicle relieves pain in epididymitis NOT pain caused by testicular torsion
69
epididymitis in sexually active men is likely
Chlamydia trachomatis
70
epididymitis in less sexually active men is likely
E. coli and pseudomonas species
71
If E.coli is the suspected cause of epididymitis tx with
Levofloxacin 500 mg orally once daily for 10 days
72
If an STI is the suspected cause of epididymitits tx with
Ceftriaxone (gonorrhea) PLUS Doxycycline (chlamydia)
73
Orchitis is mostly associated with
viral mumps infection
74
Interstital cystitis is a diagnosis of
exclusion*
75
Cystoscopy may help in the dx of
interstitial cystitis
76
Hunner lesions are seen in
interstitial cystitis
77
Lesions affecting all layers of the bladder wall; brownish-red patches on the mucosa are known as
Hunner lesions
78
Tx of interstitial cystitis includes
No cure - reassurance and education
- Amitriptyline (TCA)*
- Anti-inflammatory meds
- Antihistamines
79
what are two tests/ that can directly observe urine loss?
- Cough stress test
- Marshall test (aka. Marshall-Bonney test)
80
what does the cough stress test evaluate?
Evaluates for cough leak pressure point
81
What does the Marshall test, test for?
Placing an index finger and the second finger on either side of the bladder neck, advise pt to Valsalva and observe for leakage
82
most common urologic emergency is
Acute urinary retention
83
IgA nephropathy aka "Berger Disease" is dx via
Positive IgA staining on renal biopsy
84
dx of Goodpasture syndrome
- Anti GBM antibodies in 90%
- Renal biopsy shows cresent formation
85
Kimmelstiel-Wilson nodules is pathognomic for
Diabetic Nephropathy
86
Minimal change disease is tx with
prednisone
87
Most common cause of proteinic renal dz in children in the world is
Minimal change disease
88
Malignancy of plasma cells is
Multiple myeloma
89
Presence of light chain Ig (Bence Jones proteins) in the urine is dx of
Multiple myeloma
90
Dx gold standard for tuberculosis is
Sterile urine culture
91
Best initial dx test for a Wilms tumor is
Ultrasound
92
Definitive dx of Wilms tumor is
Histology/biospy
93
MC type of hernia is
Indirect hernia
94
A hernia through the internal ring of the inguinal ring and that touches the TIP of your finger on exam is likely a
Indirect hernia
95
A hernia that passes through the external inguinal ring at Hesselbach's triangle is
Direct hernia
96
Femoral hernias are more common in
Females
97
A hernia that appears at birth, goes away by age 13 and protrudes when the pt coughs or bears down is
Umbilical hernia
98
Biggest risk factors for bladder cancer are
Environmental exposures and SMOKING
99
90-95% of bladder cancers are
urothelial or transitional cell carcinomas
100
painless gross hematuria is suspicious of
Bladder cancer (until proven otherwise)
101
Gold standard for initial dx and staging of bladder cancer is
Cystoscopy with biopsy
102
Surgery to remove bladder cancer is
Transurethral resection of the bladder tumor (TURBT)
103
Follow up care/studies for bladder cancer includes
Cystoscopy and bladder wash cytology every
- 3mo for 2 yrs
- 6mo for 2 yrs
- At LEAST yearly
104
Most prostate cancers are what and in which zone
- Adenocarcinoma
- 70% in the peripheral zone
105
Risk factors for Prostate cancer
- increasing age
- African American
- + FHx
106
Hematospermia is suspicious of
Prostate cancer
107
DRE findings of nodular, asymmetric prostate is suspicious of
Prostate cancer
108
What PSA level is normal
Less than 4
109
Risk of a PSA 4-10 ng/mL
20-30% risk
110
Risk of a PSA 10-20 ng/mL
50-75% risk
111
Risk of a PSA above 20 ng/mL
90% risk
112
A PSA rate/rise of what in a year is concerning
0.4-0.8
113
When do you do a TRUS in a pt suspected of prostate cancer
If PSA is elevated with abnormal DRE
114
Dx and staging of prostate cancer
Transrectal ultrasound and biopsy (TRUS)
115
what is the Gleason score used for
Tells differentiated vs anapestic cells of prostate cancer
116
A classic triad of Hematuria, a palpable abdominal mass, and flank pain is suspicious of
Renal cell carcinoma
117
Dx of renal cell carcinoma is
CT and ultrasonography
118
Testicular cancer presents in what age group
males 15-35yrs
119
Cryptorchidism is a risk factor of
Testicular cancer
120
Serum tumor markers for testicular cancer include
- HCG
- AFP
- LDH
121
Surgery for testicular cancer is
Orchiectomy
122
Penile cancer is usually
squamous cell carcinoma
123
The most likely cause of Thromboembolic disease is
90% originate in the Heart; commonly happen from atrial fibrillation
124
Best test dx for Thromboembolic disease
CTA
125
Tx of Thromboembolic disease includes
1) Anticoagulation w heparin
2) Thrombolytic therapy
3) Best option = Percutaneous transluminal renal angioplasty (PTRA)
126
Polyarteritis nodosa is treated with
Prednisone / Glucorticoids
127
Polyarteritis nodosa is dx with
Biopsy
128
Atheroembolic disease is dx with
CTA
129
Definitive dx of atheroembolic dz is
Biopsy (BUT NOT DONE)
130
If a pt has refractory HTN and on multiple meds / good lifestyle changes but nothing is working, you should consider what condition?
Renal artery stenosis (RAS)
131
Renal artery stenosis (RAS) is dx with
Duplex US
132
TTP (Thrombotic thrombocytopenia purpura) pentad is
1. hemolytic anemia
2. thrombocytopenia
3. fever
4. Renal sx
5. CNS sx
133
TTP can be treated with
TPE - therapeutic plasma exchange
134
Triad of hemolytic anemia, thrombocytopenia, and acute renal failure indicates
HUS - Hemolytic uremic syndrome
135
HUS - Hemolytic uremic syndrome tx is
Supportive!!! AVOID antibiotics
136
Elevated levels of both BUN and Creatinine is
Azotemia / Renal failure
137
Urine MUSST be examined within how many hours of collection?
1 HOUR
138
what is most commonly used for the assessment of GFR?
Creatinine
139
An elevated BUN WITH elevated creatinine likely indicates a
Kidney issue
140
If the BUN to creatinine ratio raises TOGETHER maintaining the ratio it suggests
Renal Parenchymal disease
141
If there is excess urea production increasing the BUN to creatinine ratio it us likely due to
GI bleeding, catabolic drugs, or decreased urine flow
142
A decrease in the BUN/creatine ratio may indicate
Extremely low protein ingestion
143
GFR can be measured indirectly by calculating
the renal clearance of plasma substances
144
Hematuria with dysmorphic RBC and RBC casts on UA indicate
Glomerulonephritis
145
Proteins and lipids on UA indicate
Nephrotic syndrome
146
WBC and WBC casts on UA indicate
Interstitial nephritis or pyelonenephritis
147
Proteinuria in an adult is
>150-160 mg/24 hrs
148
Nephrotic syndrome is
3.5 g/24 hrs
149
what are two meds that can help lower the intraglomerular pressure
- ACE inhibitors and ARBs
150
Hematuria is
>3-5 RBS / high power field of UA
151
Dx imaging for kidneys is
Ultrasound
152
Contrast injection is contraindicated in those
increased risk for acute renal failure (DM, Creatinine >2mg/dl, or dehydration)
153
Muddy brown casts indicates
Acute tubular necrosis
154
Fatty casts indicate
Nephrotic syndrome
155
RBC and Granular casts indicate
Nephritic syndrome
156
Waxy and pigmented granular casts indicates
Chronic renal failure
157
Muddy brown casts indicates
Acute tubular necrosis
158
Hyaline casts are
Normal
