GU Flashcards by Kelly Barrett

What is needed to diagnose UTI?

At least 100,000 organisms in asymptomatic pt and more thatn 100 org/ml iwth pyuria in symptomatic pt

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UTIs are more common in sexually active woman? T/F

True

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What is the leading cause of UTI in young men?

STI

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What is the leading cause of UTI in older men?

Prostate issues

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What is findings on urine dip are associated with UTI?

+ Nitrites & leukocytes

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What is the first line therapy in female uncomplicated UTI?

Nitrofurantoin (macrobid) 100mg bid x 7d (5d)
Keflex
Bactrim DS bid X 3 days

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What is the standard treatment for UTI in males?

Young men: Doxycycline 100mg bid x 7-10 days

Older men: cipro 500mg bid x 7-10 days

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What are the common causative organisms for UTI in women?

E Coli #1
Klebsiella
Proteus 
Staph/Strep (usually sexual activity)
B strep in pregnant females are always treated

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What findings are present in acute pyelonephritis?

Systemic findings: Fever, tachycardia, N/V and general illness
Flank pain & CTA tenderness

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When should a pt w/ pyelonephritis be referred to the ED & admitted?

Pregnancy, severe N/V and dehydration, or fever >101

Also- ill elderly

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What is the recommended treatment for pyelonephritis?

Rocephin 500-1000mg IM then:

Cipro 500mg bid 5-7 days
levofloxacin 750mg qd x 5-7d
Bactrim DS 7-10day (only if known pathogen)
Augmentin bid 10-14 days
cefdinir 300mg bid 10-14 days

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How often should an OP pyelonephritis return for re-eval?

In 24-48 hrs then in 3-5 days for repeat UA if improving

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What 2 tests are standard to elevalute prostate for CA/BPH?

DRE & PSA

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What is the normal PSA?

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What is the first line treatment for BPH and how does it work?

Alpha 1 receptor agonist relax the smooth muscle of the bladder neck and prostate/urethra: (terazosin, doxazosin, tamulosin)

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What drugs reduce the size of the prostate gland?

5alpha reductase inhibitors: Finasteride & dutasteride blocks DHT

Can 5 alpha reductase inhibitors and alpha-1 blockers be combined?

Yes

What other type of drugs can be used to treat sx of BPH?

Anticholinergics: Oxybutynin and Tolterodine help with urinary sx (frequency, nocturia and urgency)

If a patient is on finasteride, would an elevated PSA be considered normal?

+ Phren sign is commonly found in_____?

Epididymitis (pain is relieved w/ testicular elevation)

What would be the recommended treatment for a man under the age of 35 for epidymitis?

Rocephin 500mg IM x1
And
Axithromycin1g PO once
OR Doxycycline 100mg bid x 10 days

What would be the recommended treatment for a man over the age of 35 with low risk for STI for epidymitis?

Cipro 500mg bid x10d
OR
Levofloxacin 500mg qd x10d

Testicilar torsion usually lacks which two signs

Absent cremasteric sign

-phren sign

What are the common presenting symptoms with acute prostatitis?

decreased urine flow & dysuria
Lower back/rectal pain
Pain with ejaculation or defecations
Increased pain with sitting
Fever/chills/malaise

What is the treatment for prostatitis unlikely to be related to STI?

Cipro 500mg bid x 3-4 weeks Doxycycline 100mg bid x 3-4 weeks Bactrim DS bid x 3-4 weeks Levaquin 500mg q day x 3-4 weeks

If prostatitis is possible related to Gonorrhea or Chlamydia, what is the treatment of choice?

Rocephin 1gm x 1 | Doxycycline 100mg bid x7days

What can be used to treat the discomfort of prostatitis?

NSAIDS & stool softners

Testicular torsion generally presents as?

Young atheletic male sudden onset severe unilateral testicular pain without cremasteric sign and - phren sign.

What are two differentiators between epidymitis and torsion?

epidymitis with have + prehns sign and + cremasteric sign | Torsion will be negative to both

At what age should both testicles be decended?

1 year

A varicele is_____?

A dilated spermatic vein, resembles a “bag of worms” Can be painless or painful Reproduced when standing and resolves w/ sitting Tx w/ NSAIDS and referral

Functional incontinence is when?

There is a physiologicial or cognitive disability

Sudden sensation of urge, difficulty in making it to the bathroom in time, and leakage is usually found in this type of incontinence?

Urge

Overflow incontinence causes _____?

Dribbing from over-distended bladder due to chronic distention & poor emptying of urine

Overactive and unstable detrusor muscle causes what type of incontinence?

Urge incontinence

Stress incontinence is generally treated with?

Kegel exercises, bladder training, and timed voiding. Estrogen cream twice weekly for post menopausal women.

Urge incontinene is usually treated with?

Toviaz, Vesicare, Ditropan and oxybutynin to treat over-active bladder

Overflow incontinence is commonly seen with _____ conditions?

Neurological disorders (spinal cord, myesthenia gravis, dementia, parkinsons) Outlet obstruction (prostate, mass, cystocele) Fecal impaction Medications (sedatives/opiates)