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nephrology & urology > genito-urinary > Flashcards

genito-urinary Flashcards

(101 cards)

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1
Q

prehns sign

A

decreased pain with scrotal elevation

+ in epididymitis

  • in torsion
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2
Q

what is urge incontinence

A

bladder contractions that cannot be controlled by the brain

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3
Q

stress incontinence

A

dysfunction of the urethral sphincter, allow urine to leak with increased intra abdominal pressure

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4
Q

overflow incontinence

A

when urinary retention leads to bladder distention and overlow of urine

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5
Q

functional incontinence

A

untimely urination caused by physical or cognitve disability, preventing a person from reaching a toilet

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6
Q

tx for urge incontinence

A

anticholinergics such as oxybutynin or tolterodine

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7
Q

tx for stress incontinence

A

estrogen, kegel, electrical muscle stimulation, bladder training, pessaries or implants

sling

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8
Q

tx for overactive and overflow bladder

A

overactive: tolterodine and oxybutynin
overflow: cath with or w/out indwelling

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9
Q

asymptomatic abdominal mass found in childhood

A

do u/s then CT][po, look for wilms tumor

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10
Q

dactinomycin, vincristine, doxorubicin

A

tx for wilms tumor since it is chemo-sensitive

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11
Q

cystitis commonly caused by what organism

A

coliform bacteria (E. Coli 80-85%)

occ gram + bacteria

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12
Q

cystitis route of infection and gender

A

ascending from urethra

women

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13
Q

clinical findings in cystitis

A

irritative voiding sx(frequency, urgency, dysuria)

suprapubic discomfort

microscopic hematuria

exam nml in elderly

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14
Q

UA and culture for cystitis

A

UA: pyuria, bacteriuria, varying hematuria

culture: positive for offending organism

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15
Q

tx of uncomplicated cystitis in women and men

A

FQ or nitrofurantoin 3-5 days

resistant E coli is common, bactrim can be used

men rarely have this

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16
Q

phenazophridine

A

urinary analgesic

turns urine dark orange or red

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17
Q

epididymitis acquired how

A

retrograde spread of organisms through the vas deferens

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18
Q

epididymitis organisms

A

younger than 35 y/o: chlamydia and gonococci

older than 35 y/o: E. Coli

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19
Q

epididymitis presentation

history may reveal what

A

heaviness and dull aching discomfort which can radiate up the ipsilateral flank

maybe heavy lifting, trauma, or sex

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20
Q

epididymitis exam

A

markedly swollen and TTP

eventually warm, erythematous, enlarged scrotal mass

maybe fevers/chills

prehn sign classic, not very reliable

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21
Q

epididymitis UA and culture

A

UA: pyuria and bacteriuria

culture: positive for organism

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22
Q

epididymitis tx

A

younger than 35 y/o: ceftriaxone 250 IM plus doxy 100mg BID

or azithromycin 1 gm po 1 week. test in 1 week

older than 35 y/o: cipro 500mg BID for 10-14 days

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23
Q

orchitis caused by what process

in who/when

A

caused by ascending bacterial infection from the urinary tract

occurs in 25% postpubertal males who have mumps infection

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24
Q

occurs in 25% postpubertal males who have mumps infection

A

orchtitis

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25
orchitis sx
testicular swelling and tenderness usually UNIlateral fever and tachycardia
26
orchitis UA, culture, other test
UA: pyuria and bacteriuria culture: + for organism ultrasonography if abscess or tumor suspected to rule out testicular torsion
27
orchitis tx
if mumps is the cause: symptomatic relief if bacteria is the cause: treat like epididymitis scrotal elevation and ice
28
painful etiologies of scrotal swelling
epididymitis, STDs, prostatis, and testicular torsion
29
all prostatitis forms present how
irritative bladder symptoms: frequency, urgency, dysuria and some obstruction
30
chronic pelvic pain syndrome commonly assoc with what cause
chronic nonbacterial prostatitis most common of the prostatitis syndromes cause unknown
31
sudden onset of high fevers, chills, and low back and perineal pain
acute prostatitis
32
UA in prostatitis
pyuria may have hematuria and bacteriuria
33
how to distinguish a chronic prostate infection from another urinary tract infection
4 glass localization test
34
what occurs in 25% postpubertal males who have mumps infection
orchitis
35
prostatitis presentation on exam
prostate swollen and tender; BOGGY NO vigorous prostate exam because it can cause septicemia
36
painless etiologies of scrotal swelling
hydrocele, varicocele
37
prostatitis fluid
reveals leukocytosis acute infections will have E. Coli Chronic infections will have recurrence of same organism or enterococcus
38
prostatitis tx acute uncomplicated chronic
hospitalize acute. treat with FQ, or gentamycin and ampicillin uncomplicated: Cipro 500 BID or Levaquin 500 qd for 2-6 wks or bactrim 160/800 BID for 6 weeks do culture urine after 1 week chronic: FQ 1-3 weeks more effective than bactrim 1-3 months LONG TIME TREATMENT
39
effective analgesicis for prostatitis what if lower urinary tract symptoms present
NSAIDs alpha blockers
40
chronic, recurrent, or resistant prostatitis with or without prostatic calculi
may require transurethral resection of the prostate for ultimate resolution
41
pyelonephritis acute and chronic differences
acute is an infectious inflammatory process involving the kidney parenchyma and renal pelvis chronic is the result of progressive inflammation of the renal interstitium caused by bacterial infection.
42
bacteremia in pyelo
occurs in 10% of acute pyelo more common in diabetics and elderly
43
organisms in pyelo comes from where
E. Coli (85%) proteus, klebsiella, enterobacter, pseudomonas ascends from lower urinary tract
44
pyelo symptoms
fever, flank pain, shaking chills, irritative voiding symptoms N/V and diarrhea uncommon
45
fever, flank pain, shaking chills, irritative voiding symptoms N/V and diarrhea uncommon
pyelo symptoms
46
pyelo sx in kids
fever and abdominal discomfort in kids
47
fever and abdominal discomfort in kids
pyelo sx in kids
48
CVA tenderness! fever and tachycardic
pyelo
49
pyelo CBC UA culture other tests
CBC: leukocytosis and left shift UA: pyuria, bacteriuria, varying hematuria; maybe WBC casts culture: obtain before antibx. get renal ultrasonography if complicated pyelo, may show hydronephrosis secondary to obstruction KUB!!
50
pyelo tx outpatient inpatient
outpt: FQ or bactrim 1-2 wks. treat longer in immunocompromised pts inpt: IV FQ or ampicillin and gentamycin until afebrile. then oral for 2 weeks
51
most common serious medical complication of pregnancy
Pyelo untreated bacteriuria: 20-30% of pts will develop this
52
gram neg diplococci
N. Gonorrhorea epididymitis
53
culture in epididymitis has no visible organisms
chlamydia
54
boggy prostate
prostatitis
55
urethritis symptoms
women are usually asymtomatic
56
urethritis organisms
chlamydia and gonorrhorea
57
urethritis presentation
purulent discharge(neisseria) or clear discharge(chlamydia) painful voiding, frequency
58
testing for urethritis
urethral swab
59
urethritis tx
azithromycin ceftriaxone doxy
60
overactive vs underactive detruser muscle in incontinence
overactive: urge underactive: overflow
61
mixed incontinence is what
stress and urge
62
untreated overflow incontinence can lead to what
hydronephrosis and obstructive nephropathy
63
diagnostic studies for incontinence
UA(glycosuria, UTI) post void residual urine (measure urinary retention) urodynamic studies, anatomical studies
64
90% of what will have hematuria on UA
nephro/uro lithiasis
65
paraphimosis vs phimosis which one is more serious
para: entrapment of foreskin behind glans penis (think rubber band) phimosis: inability to retract foreskin over the glans penis paraphimosis needs emergent treatment
66
phimosis congenital vs acquired
- congenital is physiologic in kids and adolescents - acquired from poor hygiene and chronic balanitis, consider DM in men with chronic infections
67
phimosis dx tx
dx: ## Footnote erythema with tenderness and possible purulent drainage cannot retract foreskin over glans penis obstructed urinary stream, hematuria, pain of the prepuce tx: circumcision if symptomatic broad spectrum antibx if infected. may steroid creams or NSAID ointments
68
paraphimosis 1) from what 2) sx 3) tx
1) many caths without reducing foreskin, forcibly retracting a constricted foreskin for cleaning or cath, vigorous sex 2) pain, edema, tenderness, erythema of glans and foreskin 3) manual reduction: firmly squeeze glans for 5 min to reduce tissue edema and decrease size, then try to bring foreskin back over glans; surgery, maybe cirumcision
69
hydrospadias
common defect where the urethra ends on the underside of the penis. surgical correction maybe
70
torsion 1) ages 2) symptoms/exam
1) 12-18 years of age 2) sudden onset of unilateral severe pain and scrotal swelling testis painful to palpation; neg prehns sign
71
cremasteric reflex
lightly stroke medial thigh and cremaster muscle should pull the testis up on the side that is was stroked torsion
72
torsion 1) tests 2) tx time frame?
1) doppler ultrasound, radioisotope 2) surgical emergency! manual detorsion: twist outward and laterally 6 hour time frame orchiopexy of both testis!
73
BPH age of onset
60-65 years but can occur at 45 y/o
74
BPH is what
proliferation of the fibrostomal tissue of the prostate that can lead to compression of the prostatic urethra
75
main medications for BPH
a-adrenergic agonists (prazosin) 5a-reductase inhibitors (finasteride, dutasteride) phosphodiesterase 5-inhibitors (tadalafil/Cialis, vardenafil)
76
LUTS secondary to BPH w/out elevated post-void residual and when LUTS are predominantly irritative
anticholinergics
77
LUTS and overactive bladder treatment
tamsulosin plus tolterodine extended release
78
what improves international prostate symptom score with symptomatic BPH
intramuscular cetrorelix (60mg, then 30 mg at 2 weeks)
79
surgical treatment of BPH
transurethral resection of prostate(TURP) or transurethral incision of prostate
80
where does BPH usually occur
in the central(periurethral) zone and may not be detected on a DRE
81
MOA of alpha blockers
relax smooth muscle in the prostate and bladder neck tamsulosin, prazosin, and terazosin
82
MOA of 5a-reductase inhibitors
inhibit the production of dihydrotestosterone
83
cryptorchidism 1) occurs in what percentage 2) risk factors
failure of one or both testes to fully descend 1) 1-2% of males 2) premature birth, low birth weight
84
cryptochidism 1) assoc with what bad thing 2)dx 3)tx
1) increased risk of testicular cancer 2) cannot be manipulated into scrotal sac 3) orchiopexy for prepubertal boys; orchiectomy if after puberty
85
point and shoot
Parasympathetic nervous system mediates the erection and the Sympathetic nervous system mediates the ejaculation
86
major predictors of ED (4)
HTN, DM, hyperlipidemia, CV disease
87
most ED primarily have an organic or psychogenic cause?
organic; nearly all have a secondary psychogenic component
88
what BP med can contribute to ED
Beta blockers
89
dx a ED pt with hormonal abnormalities
FSH, LH
90
how to differentiate organic from psychogenic cause in ED
nocturnal penile tumescence testing
91
how to induce an erection in men with an intact vascular system
direct injection of vasoactive substance if unsuccessful, do studies to evaluate arterial and venous vasculature like an U/S, pelvic arteriography, and cavernosonography
92
7 tests to initially get for ED
prolactin, serum testosterone, thyroid, lipid, CBC, UA, glucose
93
SE of phosphodiesterase-5 drugs
dyspepsia, rhinitis, vision, priaprism, HA, flushing
94
what is a hydrocele
mass of fluid filled congenital remnants of tunica vaginalis
95
hydrocele 1) symptoms 2) dx 3) tx
1) painless if palpable; uncomfortable if very large 2) TRANSILLUMINATE 3) elective repair
96
you can transilluminate what
hydrocele and spermatocele
97
what is a spermatocele and symptoms
benign painless cystic mass containing sperm but uncomfortable if very large
98
spermatocele 1) size 2) location 3) dx
1) less than 1 cm in size 2) lie superior and posterior and are distinct from testes 3) scrotal ultrasonography; will transilluminate too \*\*NO needle aspiration
99
varicocele is what future problems?
formation of venous varicosity within the spermatic vein (pamphiniform plexus) can decrease sperm count due to elevated temperature
100
variocele 1) sx 2) dx 3) tx
1) aching, non tender mass; left side 2) does not transilluminate; increases in size with valsalva and decreases in size with elevation of scrotum or supine 3) surgery: lt spermatic vein ligation
101
what side does a varicocele occur
left spermatic vein has an increased incidence of varicosity b/c the vein is longer and joins the left renal vein at right angles

nephrology & urology (7 decks)

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