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nephrology & urology > genito-urinary > Flashcards

genito-urinary Flashcards

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
Q

orchitis sx

A

testicular swelling and tenderness

usually UNIlateral

fever and tachycardia

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26
Q

orchitis UA, culture,

other test

A

UA: pyuria and bacteriuria

culture: + for organism

ultrasonography if abscess or tumor suspected to rule out testicular torsion

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27
Q

orchitis tx

A

if mumps is the cause: symptomatic relief

if bacteria is the cause: treat like epididymitis

scrotal elevation and ice

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28
Q

painful etiologies of scrotal swelling

A

epididymitis, STDs, prostatis, and testicular torsion

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29
Q

all prostatitis forms present how

A

irritative bladder symptoms: frequency, urgency, dysuria

and some obstruction

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30
Q

chronic pelvic pain syndrome commonly assoc with what

cause

A

chronic nonbacterial prostatitis

most common of the prostatitis syndromes

cause unknown

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31
Q

sudden onset of high fevers, chills, and low back and perineal pain

A

acute prostatitis

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32
Q

UA in prostatitis

A

pyuria

may have hematuria and bacteriuria

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33
Q

how to distinguish a chronic prostate infection from another urinary tract infection

A

4 glass localization test

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34
Q

what occurs in 25% postpubertal males who have mumps infection

A

orchitis

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35
Q

prostatitis presentation on exam

A

prostate swollen and tender; BOGGY

NO vigorous prostate exam because it can cause septicemia

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36
Q

painless etiologies of scrotal swelling

A

hydrocele, varicocele

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37
Q

prostatitis fluid

A

reveals leukocytosis

acute infections will have E. Coli

Chronic infections will have recurrence of same organism or enterococcus

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38
Q

prostatitis tx

acute

uncomplicated

chronic

A

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

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39
Q

effective analgesicis for prostatitis

what if lower urinary tract symptoms present

A

NSAIDs

alpha blockers

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40
Q

chronic, recurrent, or resistant prostatitis with or without prostatic calculi

A

may require transurethral resection of the prostate for ultimate resolution

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41
Q

pyelonephritis

acute and chronic differences

A

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
Q

bacteremia in pyelo

A

occurs in 10% of acute pyelo

more common in diabetics and elderly

43
Q

organisms in pyelo

comes from where

A

E. Coli (85%)

proteus, klebsiella, enterobacter, pseudomonas

ascends from lower urinary tract

44
Q

pyelo symptoms

A

fever, flank pain, shaking chills, irritative voiding symptoms

N/V and diarrhea uncommon

45
Q

fever, flank pain, shaking chills, irritative voiding symptoms

N/V and diarrhea uncommon

A

pyelo symptoms

46
Q

pyelo sx in kids

A

fever and abdominal discomfort in kids

47
Q

fever and abdominal discomfort in kids

A

pyelo sx in kids

48
Q

CVA tenderness!

fever and tachycardic

A

pyelo

49
Q

pyelo

CBC

UA

culture

other tests

A

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
Q

pyelo tx

outpatient

inpatient

A

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
Q

most common serious medical complication of pregnancy

A

Pyelo

untreated bacteriuria: 20-30% of pts will develop this

52
Q

gram neg diplococci

A

N. Gonorrhorea

epididymitis

53
Q

culture in epididymitis has no visible organisms

A

chlamydia

54
Q

boggy prostate

A

prostatitis

55
Q

urethritis symptoms

A

women are usually asymtomatic

56
Q

urethritis organisms

A

chlamydia and gonorrhorea

57
Q

urethritis presentation

A

purulent discharge(neisseria)

or clear discharge(chlamydia)

painful voiding, frequency

58
Q

testing for urethritis

A

urethral swab

59
Q

urethritis tx

A

azithromycin

ceftriaxone

doxy

60
Q

overactive vs underactive detruser muscle in incontinence

A

overactive: urge
underactive: overflow

61
Q

mixed incontinence is what

A

stress and urge

62
Q

untreated overflow incontinence can lead to what

A

hydronephrosis and obstructive nephropathy

63
Q

diagnostic studies for incontinence

A

UA(glycosuria, UTI)

post void residual urine (measure urinary retention)

urodynamic studies, anatomical studies

64
Q

90% of what will have hematuria on UA

A

nephro/uro lithiasis

65
Q

paraphimosis vs phimosis

which one is more serious

A

para: entrapment of foreskin behind glans penis

(think rubber band)

phimosis: inability to retract foreskin over the glans penis

paraphimosis needs emergent treatment

66
Q

phimosis

congenital vs acquired

A
  • congenital is physiologic in kids and adolescents
  • acquired from poor hygiene and chronic balanitis, consider DM in men with chronic infections
67
Q

phimosis

dx

tx

A

dx:

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
Q

paraphimosis

1) from what
2) sx
3) tx

A

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
Q

hydrospadias

A

common defect where the urethra ends on the underside of the penis.

surgical correction maybe

70
Q

torsion

1) ages
2) symptoms/exam

A

1) 12-18 years of age
2) sudden onset of unilateral severe pain and scrotal swelling

testis painful to palpation; neg prehns sign

71
Q

cremasteric reflex

A

lightly stroke medial thigh and cremaster muscle should pull the testis up on the side that is was stroked

torsion

72
Q

torsion

1) tests
2) tx

time frame?

A

1) doppler ultrasound, radioisotope
2) surgical emergency!

manual detorsion: twist outward and laterally

6 hour time frame

orchiopexy of both testis!

73
Q

BPH age of onset

A

60-65 years but can occur at 45 y/o

74
Q

BPH is what

A

proliferation of the fibrostomal tissue of the prostate that can lead to compression of the prostatic urethra

75
Q

main medications for BPH

A

a-adrenergic agonists (prazosin) 5a-reductase inhibitors (finasteride, dutasteride) phosphodiesterase 5-inhibitors (tadalafil/Cialis, vardenafil)

76
Q

LUTS secondary to BPH w/out elevated post-void residual and when LUTS are predominantly irritative

A

anticholinergics

77
Q

LUTS and overactive bladder treatment

A

tamsulosin plus tolterodine extended release

78
Q

what improves international prostate symptom score with symptomatic BPH

A

intramuscular cetrorelix (60mg, then 30 mg at 2 weeks)

79
Q

surgical treatment of BPH

A

transurethral resection of prostate(TURP) or transurethral incision of prostate

80
Q

where does BPH usually occur

A

in the central(periurethral) zone and may not be detected on a DRE

81
Q

MOA of alpha blockers

A

relax smooth muscle in the prostate and bladder neck tamsulosin, prazosin, and terazosin

82
Q

MOA of 5a-reductase inhibitors

A

inhibit the production of dihydrotestosterone

83
Q

cryptorchidism 1) occurs in what percentage 2) risk factors

A

failure of one or both testes to fully descend 1) 1-2% of males 2) premature birth, low birth weight

84
Q

cryptochidism 1) assoc with what bad thing 2)dx 3)tx

A

1) increased risk of testicular cancer 2) cannot be manipulated into scrotal sac 3) orchiopexy for prepubertal boys; orchiectomy if after puberty

85
Q

point and shoot

A

Parasympathetic nervous system mediates the erection and the Sympathetic nervous system mediates the ejaculation

86
Q

major predictors of ED (4)

A

HTN, DM, hyperlipidemia, CV disease

87
Q

most ED primarily have an organic or psychogenic cause?

A

organic; nearly all have a secondary psychogenic component

88
Q

what BP med can contribute to ED

A

Beta blockers

89
Q

dx a ED pt with hormonal abnormalities

A

FSH, LH

90
Q

how to differentiate organic from psychogenic cause in ED

A

nocturnal penile tumescence testing

91
Q

how to induce an erection in men with an intact vascular system

A

direct injection of vasoactive substance if unsuccessful, do studies to evaluate arterial and venous vasculature like an U/S, pelvic arteriography, and cavernosonography

92
Q

7 tests to initially get for ED

A

prolactin, serum testosterone, thyroid, lipid, CBC, UA, glucose

93
Q

SE of phosphodiesterase-5 drugs

A

dyspepsia, rhinitis, vision, priaprism, HA, flushing

94
Q

what is a hydrocele

A

mass of fluid filled congenital remnants of tunica vaginalis

95
Q

hydrocele 1) symptoms 2) dx 3) tx

A

1) painless if palpable; uncomfortable if very large 2) TRANSILLUMINATE 3) elective repair

96
Q

you can transilluminate what

A

hydrocele and spermatocele

97
Q

what is a spermatocele and symptoms

A

benign painless cystic mass containing sperm but uncomfortable if very large

98
Q

spermatocele 1) size 2) location 3) dx

A

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
Q

varicocele is what future problems?

A

formation of venous varicosity within the spermatic vein (pamphiniform plexus) can decrease sperm count due to elevated temperature

100
Q

variocele 1) sx 2) dx 3) tx

A

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
Q

what side does a varicocele occur

A

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 (6 decks)

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