Genitourinary Exam 2 Cards Flashcards
(211 cards)
1
Q
Acute UTI
A
Usually 1 organism
2
Q
Chronic UTI
A
may be 2+ organism
3
Q
MCC of UTI
A
E. coli
4
Q
CFU count indicative of a potential UTI
A
Over 100,000 cfu/mL is suggestive but NOT diagnostic
5
Q
Bacteriuria
A
10^5 cfu/mL, 2 consecutive specimens in women - recommended not to screen in children and women
6
Q
Unresolved bacteriuria - 3 etiologies
A
Failure to sterilize urinary tract during UTI tx
Noncompliance
resistance
Multiinfections
7
Q
Persistent bacturia - 4 etiologies
A
Keeps coming back - prostate, catheter, stones, fistula
8
Q
4 ways UTIs can spread
A
Ascending - MC, skin up urethra
Direct extension - From local infected tissue
Hematogenous - Staph from blood
Lymphatic - Rare from lymph
9
Q
4 Risk factors for UTI
A
Abnormal voiding
Renal disease
Deficient mucosal lining
Abnormal pH or osmolality of urine
10
Q
Male and female risk factors for UTI
A
Female - Short urethra and sex
Male - Prostatitis and foreskin
11
Q
Etiology of acute cystitis
A
Nearly always bacterial - E. coli MC
Up the urethra
Rare in adult men
12
Q
Clinical presentation of acute cystitis
A
Dysuria
Frequency/Urgency
Suprapubic pain
May see blood in urine
13
Q
Labs for acute cystitis
A
WBCs - leukocyte esterase
Nitrites - Made by bacteria
Hematuria also possible
14
Q
First Line Treatment for acute cystitis
A
NEW GUIDLINES COMING
5 days - nitrofurantoin
3 days - Bactrim (can just do TMP if sulfa allergic)
Single Dose - Fosfomycin
15
Q
Second line treatment for acute cystitis
A
Augmentin 5-7 days
Cephalosporin - Podoxime, Dinir, Keflex
16
Q
Third line for acute cystitis
A
FQ for 3 days
17
Q
Soothing Adjunct therapy for acute cystitis - side effects and considerations
A
Phenazopyridine - sooths bladder
Discolored urine - interferes with UA dip!!
Only 2 days so we know if pain is gone
18
Q
Toxic urine adjunct for acute cystitis
A
Methenamine - metabolizes to formaldehyde and ammonia in urine
Renal and liver failure CI
Interacts with Sulfa
2-3 days
19
Q
Non pharm adjunct treatments for acute cystitis
A
Sitz bath - warm comfort bath
Fluid intake
Cranberry juice
Vaginal estrogen in post menopausal women
20
Q
Non-pharm acute cystitis prevention
A
Voiding after sex
Hydration
Wiping from front to back
Breathable undergarments - cotton
D-mannose from cranberry juice
21
Q
Diabetes med that can cause a UTI
A
SGLT-2 inhibitor - gliflozin
22
Q
Frequent UTI
A
3+ in 12 months for women
23
Q
Pharm for recurring cystitis
A
Any UTI drug low dose or PRN
Work ‘em up
24
Q
Etiology of acute pyelonephritis
A
E. coli, Staph (blood), Kelbsiaella, Pseudomonas
Ascent up urethra
Less common than cystitis - usually follows
25
Clinical presentation of acute pyelonephritis
Fever, chills, NVD, flank pain, gross hematuria
26
Imaging for acute pyelonephritis
CT preferred - shows renal inflammation
US can show hydronephrosis
27
Fluid on a CT scan
Appears dark
28
Lab results from acute pyelonephritis
Positive urine culture
Leukocyte esterase and casts
Urine nitrite
Leukocytosis on CBC
29
Outpatient treatment for acute pyelonephritis
Can be out if healthy
Fluids and abx - or IV if you can
30
Initial IV abx for acute pyelonephritis
Rocephin, Ciprofloxacin, Gentamicin
31
Oral abx for acute pyelonephritis
Levaquin, Cipro, Bactrim, MAY use augmentin
32
2 CI drugs for acute pyelonephritis
Nitrofurantoin
Fosfomycin
33
Therapy duration for acute pyelonephritis outpatient
7 days -FQ 14 days non-FQ
34
Inpatient pharm for acute pyelonephritis
4 normal
3 for resistance
IV - Rocephin, Gent/Amp, FQ, pip and taz
IF
Suspicion of resistant - Carbapenem, Vanc, Cefepime
14 days
35
Complications fro pyelonephritis
Abcess
Nephron loss
36
Etiology of acute urethritis
4 MCC in order
Gonnorrhea = MC
Chlamydia
Mycoplasma genitalia
Trichomonas
Usually and STI - MC in men
37
Clinical presentation of acute urethritis
Pain with urination
Discharge (gon is more purulent)
May be asymptomatic
38
Labs for urethritis
Gram stain (G- is gon), now we usually use NAAt for Gon,Chly
UA - first stream sample
39
Pharm for gonorrhea
Ceftriaxone - 1 dose IM
40
Pharm for chlamydia
Doxy for 7 days (preferred)
Z-max - 1 dose IM
41
Clinical presentation of prostatitis
Heamturia - gross or microscopic
Irritative voiding symptoms
42
Indication that might mean prostate cancer
Gross hematuria
43
Dysuria
May be painful, may just be uncomfortable
44
Nocturia
abnormal if several times per night
45
Urine hesitancy
Don't start urinating right away
46
4 types of incontinence
Overflow
Urge
Stress
Total
47
Acute bacterial prostatitis etiology
Ascent up urethra
Risk factors for UTI
Trauma
Dehydration
MCC -E. coli may need to consider STIs
48
Presentation of bacterial prostatitis
Fever, chills, mailaise
Irritative voiding
Pain can be perineal, sacral, suprapubic
Prostate tenderness and warmth
49
DRI in bacterial prostatis
Too much massage can cause sepsis
50
Labs for bacterial prostatitis
Leukocytosis
Pyuria and bacturia
+ culture
51
Imaging for bacterial prostatitis
Check for abcess CT or US if no respnse to therapy
52
Pharm therapy for bacterial prostatitis
IV
Nosocomial
Oral
ABX therapy based on C/S
Start FQ+Aminoglycoside - IV
Carb, Ceph, Aminoglycoside - Nosocomial
Bactrim, Cipro - Oral
53
Therapy length for bacterial prostatitis
4 weeks
54
Etiology of chronic bacterial prostatitis
More often E. coli
May skip to chronic before acute
55
Clinical pres of chronic bacterial prostatitis
Say they have bladder infectio - Men
Dull pain suprapubic
May have a mildly tender boggy prostate - may be normal
56
Labs for chronic bacterial prostatitis
Only positive upon prostate palpation followed by urination
Lipid laden macrophages
May see prostate stones on imaging
57
Pharm treatment for chronic bacterial prostatitis
FQ or Bactrim for 6 weeks - may need 12 weeks
58
Side effects of FQs
C. diff, CNS toxicity, Tendon rupture
59
Nonbacterial prostatitis/Chronic pelvic syndrome
Pelvic pain - unclear if prostate is cause
60
Clinical presentation of nonbacterial prostatitis
May report auto immune
No softness of the prostate
Negative cultures and imaging
61
Pharm Treatment for nonbacterial antibiotics
FQ or erythromycin for 6 weeks
Alpha blocker for urinary symptoms (tamsulozin, silodosin, alfuzosin are specific) can be more than 6 weeks
62
Adjunct pharm for chronic pelvic pain syndrome
5 alpha reductase inhibitors
NSAID
Qcertain can help
63
Percent of men who have BPH
80% of men over 80
50% of men 51-60
8% of men 31-40
Not all have symptoms
64
Risk factors for BPH - Lifestyle, ethnicity, drugs
Black ethnicity
Beta blocker use/Heart disease
Sedentary
Smoking/alcohol reduces
65
2 problems a large prostate can cause
Mechanical obstruction - narrow lumen
Dynamic obstruction - alpha 1 receptor stimulation
66
Clinical presentation of BPH
Obstructive voiding
Double voiding (twice in 2 hours)
Strain to urinate
Dribbling
MAY have irritative voiding
67
AUA score
Evaluates likelihood for BPH
68
Physical exam for BPH
Not rock hard
Smooth firm elastic enlargement
Neuro and abd exam
69
Labs for BPH
Normal UA
Check PSA - may not be cancer
Only biopsy if cancer concern
70
BPH treatment
Watchful waiting (0-7 score) - may regress
71
Best alpha blocker type for BPH
Alpha 1 a
72
3 Non selective alpha blockers for BPH
Prazosin, Doxazosin, Terazosin
73
Selective alpha blockers for BPH
Silodosin, Tamsulosin, Alfuzoson
74
Side effects for alpha 1a blockers
Dizziness, Orthostatic hypotension, Floppy iris syndrome, rhinitis, retrograde ejaculation
75
Drug interactions of alpha blockers for BPH
PDE-5 inhibitor
76
5 alpha reductase inhibitors for BPH
Block testosterone but take time
Reduce PSA and risk of prostate cancer
Finasteride and Dutasteride
77
Side effects of 5 alpha reductase inhibitors
Low sex drive, fatigue, ED
78
First line for BPH
Alpha blocker and 5 alpha reductase inhibitor
79
PDE-5 inhibitor for BPH
Tadalafil (Cialis) adjunct for ED and BPH
80
Herbals for BPH
Saw Palmetto - not first line
81
More invasive surgeries for BPH
TURP - Trans Urethral Resection - risk of retrograde ejaculation or incontinence. Removes prostate tissue from inside the urethra
82
Transurethral resection syndrome
Hypervolemic, hyponatremic state from irrigation solution used in the surgery
Altered mental status, confusion, N/D
83
Transurethral incision of the prostate
Cut muscle around bladder neck - less invasive than TURP
84
Open prostectomy
When prostate is too larger for endoscopic removal - many complications
85
Laser therapy for BPH
TULIP - burn prostate and it dies, no biopsy and sloughing for a while after
TUNA - Uses a radio frequency instead
86
Implant to Open Prostatic urethra
Device that pulls urethra open
87
Rezum
Steam therapy that causes thermal destruction - less invasive - scars tissue to open urethra
88
Risk factors for prostate cancer
Black ethnicity
High fat diet
89
Clinical presentation of prostate cancer
May have an abnormal DRE - not very sensitive
Lymphedema or obstructive voiding is possible
90
Labs for prostate cancer
Elevated PSA
Elevated alkaline phos
High BUN/Cr if obstructing
91
Imaging for Prostate cancer
US guided biopsy of concerning area
MRI for lymph nodes
CT for mets
92
Gleason system
Staging for prostate cancer differentiation 1 is best 5 is worse
93
T scoring for prostate cancer
T1 - Only know about it through PSA
T2 - Tumor confined to prostate
T3 - Tumor extends through capsule, maybe in seminal vescicle
T4 - Tumor is fixed or invades other structures
94
Treatment for prostate cancer
Watch if non-aggressive or sort life expectancy
Radical prostatectomy if large
Radiation or cryosurgery if small
Chemo if mets
95
Pharm for prostate cancer
LHRH agonist - Leuprolide
LHRH antagonist - Degrelix
Wear out or just block LH
96
Cells that produce PSA
Produced by benign AND malignant cells
Small cancer may mean normal PSA
97
Intermediate, High and normal range for PSA
N - 0-4
I 4-10
H - 10+ (very concerning)
40+ ADVANCED
98
4 drugs that influence PSA
5A reductase inhibitors
NSAID
Statin
Thiazide diuretics
99
Other factors that can increase PSA
Bike riding, sex, surgery
100
Free PSA
Higher % = lower risk of cancer
Look for trends
101
Screening for prostate cancer
Grade C for 55-69 - screen annually start younger if high risk
102
Hydrocele
Fluid around the testicle - can be communicating or noncommunicating
103
3 types of noncommunicating hydrocele
Testicular, Inguinal scrotal, Cord
104
Clinical presentation of hydrocele
Inguinal lump if cord
Anterior mass to testis with little or no pain
Transillumination present
105
Diagnostics for hydrocele
UA - Infection
US to look for other etiologies
Findings will be boring if it is a hydrocele
106
Treatment for hydrocele
Benign in under 12-18 months - watch
Needle aspirate, Hydrocelectomy is definitive treatment is recurring
107
Varicocele
Scrotal swelling caused by varicose veins in the scrotum - often on the left
108
Clinical presentation of varicocele
Infertility, Dull pain, Bag of worms in the scrotal sac that enlrages with valsalva, may be asymptomatic
109
Diagnostic for varicocele
Ultrasound
110
Treatment for varicocele
Don't have to treat if not worried about fertility
Conservative - support/NSAID
Surgery if they want fertility or refractory - ligation, coil embolization
111
Complications of varicocele
Infertility
Do self exams to check
112
Testicular torsion
Twist in the spermatic cord causing a loss of blood flow - inconsolable infant
113
Risk factors of TT - including deformity
Trauma
Exersice/Sex
Bell Clapper deformity - Tunica vaginalis all around so it can turn
114
Clinical presentation of TT
Extreme testicular pain - may have had episodes of it
No urinary symptoms
High riding testis
No cremasteric reflex
115
Prehn's sign
Lack of pain relief with support of scrotum indicates TT
116
Diagnostics for TT
Doppler ultrasound - go straight to surgery if unsure - can order a UA
117
Treatment for testicular torsion
Try to untwist - medial to lateral
Still needs surgery even if detorsed
Pain relief
Surgically fix to the scotum - Needs surgery w/in 6 hours
118
TWIST score
Evaluates for possibility of testicular torsion - if it's high enough (5+) don't bother with US
119
Testicular appendage torsion
Little flaps of tissue on testes that get twisted and become ischemic
120
Presentation of testicular appendage torsion
Slight pain - less general swelling
Blue dot sign
Testicle has normal blood flow on US with small area
121
Treatment for testicular appendage torsion
NSAIDs
Observe
122
Phimosis
Inability to retract foreskin over glans penis
MCC - Chronic infection/poor hygeine
123
Clinical presentation of phimosis
May be asymptomatic
Ballooning of prepuce with urination
124
Pharm Treatment for phimosis infection
Treat infection -
Clotrimazole, nystatin, fluconazole - fungal
Bacitracin or Metro - Bacterial
Keflex - extended infection
125
Mechanical treatment for phimosis
Hemostat dilation
Frenar stretch - steroids
Dorsal slit
Circumcision
126
COmplications of phimosis
Crystals formed - prepupertal calculi
Squamous cell carcinoma may be associated
127
Paraphimosis
Inability to protract foreskin - can occlude bloodflow to glans penis
Can be a complication of Malaria
128
Presentation of paraphimosis
Donut sign
Swollen foreskin pushed back and swollen glans
129
Treatment for paraphimosis
Manual reduction (squeeze the glans)
Needle decompression
Dorsal slit
Osmotic agent
May need antibiotics and will need circumcision (will need even with reduction)
130
MCC of priapism
Intracavernous ED treatment
131
Medications that can cause priapism
Antihypertensives, Psych meds (ADHD), ED meds,
132
High flow priapism
Non-ischemic
High oxygen and painless
Excessive flow in
133
Low flow priapism
Problem with the Veins causes high CO@ and low O2
Can cause fibrosis of corpora cavernosa
Painful
Glans and dorsal side will be non-swollen
134
Treatment for priapism
Anesthesia
Aspirate blood
Alpha agonist
Winter procedure - shunt or other shunts for release
135
Peyronies disease
Fibrosis of dorsal covering sheeths
DM, trauma, Vasculitis, Inflammation, contracture
136
Presentation of peyronies disease
Curved penis with painful erection but not when flacid
May be able to palpate the plaque
137
Treatment for peyronies disease
Observe
Vitamin E, Para-aminobenzoic acid orally'
Verapamil, steroids, dimethylsulfoxide, PTH inject
Radiation
Surgical excision
138
Complications of Peyronies disease
ED, impotence
139
MC penile cancer
Squamous cell carcinoma
Rare in developed countries
140
Risk factors for penile cancer
HPV or HIV
Phimosis
Tobacco use
141
Presentation of penile cancer
Lesion, Rash, Painless lump, Adenopathy
142
Treatment for low risk of recurrence penile cancer
Limited excision
Laser or topical therapy
143
Treatment of high risk recurrence penile cancer
Partial or total penile amputation
May use chemo or radiation
144
Epididymitis
Inflammation from infection or amiodarone
STD in younger men, assoc with prostatitis in older men
145
Clinical presentation of epididymitis
Top of testicle tender first
Urine signs
Positive Prehn's sign
146
Labs for epididymitis
UA - with bacteria etc
PCR for Gon Chly
147
Treatment for epididymitis
Rule out testicular torsion
Bed rest and ice packs
Ceftriaxone and Doxy if STD suspected
Levo or Bactrim if prostatitis suspected
148
Orchitis
Scarier than epididymitis
Bacterial, granulomatous (autoimmune), Viral (mumps, HFM, etc.)
149
Clinical presentation of Orchitis
UTI hx
Hydrocele
Fever nausea, vomiting
Inguinal lymphadenopathy
More gradual onset with positive prehn's sign
150
Evaluation for orchitis
UA
PCR
151
Treatment for orchitis
Rocephin and Doxy
If practicing anal sex - Rocephin and Levo
152
Complications of orchitis
Sepsis, Abscess, fibroplasia, atrophy, loss of fertility
153
Epididymal cyst
Little cyst at head of epididymis - non tender, non-concerning, fluid filled
154
Spermatocele
Epididymal cyst over 2 cm superior and distinct from the testis
US
Surgical excision if desired
155
MC age of testicular cancer
20-35
156
Risk factors for testicular tumor
Cryptorchidism
Infertility
HIV
High fat diet
157
Presentation of testicular tumors
Painless enlargement of testis - heaviness or nodules
10% have pain
10% have mets
158
Labs and imaging for testicular tumors
Alpha fetoprotein, hCG, LDH
Scrotal US
Stage with CT
159
Treatment for testicular cancer
Have to take out the whole testicle - NO BIOPSY
May use chemo
160
Medication that cannot be taken with PDE-5 inhibitor
Nitrate - ie. nitroglycerin
161
4 things needed for a normal male sexual response
Libido
Penile erection
Ejaculation
Detumnescence
162
Erectile Dysfunction
Inability to attain or maintain a sufficiently rigid penile erection for sexual performance - NOT a normal part of aging
163
Associated factors of ED
DM, BPH, Prostate cancer, HTN - Vascular and neuropathic issues
Smoking
Local radiation/surgery
Psych issues
164
Etiologies of ED
Failure to initiate, fill or store - may be more than 1
DM, Atherosclerosis, Meds
Vasculogenic or Neurogenic
165
Medications that can cause ED - 4ish
Beta blocker/Thiazide
Estrogen, GnRH agonists, TCAs or SSRIs
166
Testosterone for ED
Only beneficial if there is documented hypogonadism or low testosterone levels
Consider prostate issues, Sleep apnea, CHF
167
Transdermal, Intramuscular and Oral Testosterone
Transdermal - Easy to use and stable levels can transfer to others
Intramuscular testosterone - Cheap and effective, fluctuation in serum levels
Oral - Hepatotoxicity and questionable
168
Side effects of testosterone
Erythrocytosis, Skin irritation, Aggression, increased bone density
169
Monitoring for testosterone therapy
Measure 2-3 months after initiation
Every 6-12 months check between drugs
170
4 hr duration PDE-5 inhibitors
Sildenafil
Vardenafil
Avanafil - CAN take with food
171
Extended duration PDE-5 inhibitor
Tadalafil (Cialis) helps with BPH works for 36 hours
172
Side effects of ED
Headache, flushing, dyspnea, dizziness, hypotension - all related to vasodilation
173
Prostaglandings for ED
Intracavernosal injection or urethral suppository - painful, avoid blood vessels
174
Vacuum device for ED
Sucks blood into penis, cumbersome and restricts blood flow into the penis so only 20-30 minutes
175
Vascular surgery for ED
Bypass arteries or ligate veins to improve blood flow, not as effective as it should be
176
Penile prosthesis
Semi rigid or inflatable - invasive with risk of infection
Can protrude through the skin
177
Treatment for decreased libido
Treat underlying conditions:
Psych
ED
SSRIs
Therapy
178
Premature ejaculation
Brief latency of ejaculation that they can't stop
May be ED
179
Treatment for premature ejaculation
SSRIs
Topical anesthetics
180
Delayed ejaculation
Physical or Psych - treat underlying cause
181
Retrograde ejaculation
Dry orgasm - semen goes into bladder - caused by surgery or alpha blockers
Only a problem if fertility is an issue
182
Ideal urine sample
Clean catch urine
183
Most urine dips parameters
RBC, Leukocyte esterase, nitrite, albumin, pH, specific gravity, glucose, bilirubin, urobilinogen
184
Red urine
Blood, beets, phenazopyridine
185
Bright yellow urine
Vitamin B12
186
Ammonia odor of urine
Bladder retention/Long standing
187
Fishy urine odor
UTI
188
Causes of acidic or alkaline urine
Acidic - High protein/cranberries
Alkaline - Vegeterian, low carb, citrus
189
Diagnostic criteria for hematuria
Must see on microscopy
May see false negative from menstrual bleeding
190
Other causes of leukocyte esterase and things that can hide it
Renal disease, Asymptomatic bacteruria
False negatives from High concentration, Vit C, medications (rifampin)
191
Nitrites in urine
Gram - bacteria
Not definitive for UTI - suggestive
192
Bilirubin/Urobilinogen in urine
May indicate hemolysis
Vitamin C false negative
193
Glucose in urine
Diabetes or on an SGLT2 inhibitor
194
Ketones in urine
Trace is NOT a concern
Elevated may be a concern
195
Urine protein
Does not catch urine microalbumin, can be high with UTI, underestimate of urine protein
196
True hematuria microscopy
5 per high power field or 3 on multiple occasions
197
Determination of hematuria cause
Dysmorphic - glomerular disease from pushing through glomerulus
Round - UTI, cancer etc.
198
Causes of WBCs in urine
Casts = Kidney issue
Can be UTI, Kidney stone, any other trauma
199
Tubular epithelial cells in urine
Nephrotic syndrome, CKD, a few is normal
200
Squamous epithelial cells in urine
Indicate skin contamination
201
Transitional epithelial cells
If present in high number suggestive of a neoplasm
202
Hyaline casts
Seen in dehydration
203
Granular casts
ATN suggestive
204
Broad waxy casts
Suggest CKD
205
Cystoscopy
Can get a better look at the bladder than imaging
206
Workup for hematuria
UA, CBC, GFR
Imaging - IV pyelogram, CT
Cystoscopy
Kidney workup
Refer to Urology or monitor
207
Indications for catheterization
Impeded urine flow
Get sterile Urine
Treat neurogenic bladder
Sever refractory incontinence
208
Relative contraindications for catheter
Stricture, GU surgery, Artificial urinary sphincter
209
Absolute contraindications for catheter
Pelvic trauma, urethral injury
210
Complications of a urinary catheter
Infectious, Mechanical (baloon fibers), Bladder or urethral damage
211
How far should a foley catheter be inserted
See a flash of urine and go for 1 more inch
