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Clin Med > GU > Flashcards

GU Flashcards

1
Q

What is stress incontinence?

A

Leakage of urine with activities causing increased intra-abdominal pressure (coughing, laughing, sneezing, etc.)

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2
Q

What are 2 diagnostic tests for stress incontinence?

A

Cough stress test (pos if urine leak w/cough)
Cotton swab test (pos if angle change is > 30*)

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3
Q

What is the treatment for stress incontinence?

A

Conservative: avoid excess fluids, scheduled voiding, pelvic floor rehab
Meds: non are FDA approved; can try phenylpropanolamine or duloxetine
Surgery: intravesicular balloon, sling procedure, urethropexy

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4
Q

What is urge incontinence?

A

Sudden urge to urinate w/subsequent leakage, leakage of urine prior to reaching toilet, or bladder contraction stimulated by senses (running water, cold weather, arriving home, etc.)

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5
Q

What is the treatment for urge incontinence?

A

Conservative: avoid excess fluid, scheduled voiding, pelvic floor rehab
Meds: Antimuscarinics (darifenacin or solifenacin, tolterodine or fesoterodine, oxybutynin) topical vaginal estrogen (mirabegron) (not FDA approved)
Surgery: neuromodulation, botox A injection

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6
Q

In terms of treatment, if someone presents with mixed incontinence, how do you treat it?

A

Focus on addressing the predominant symptoms

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7
Q

What is overflow incontinence?

A

Urinary dribbling, leakage of urine without preceding urge, weak urinary stream, sensation of incomplete bladder emptying

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8
Q

What diagnostic test can be performed for overflow incontinence?

A

Pelvic ultrasound w/post-void residual volume (pos if > 200mL remains in bladder)

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9
Q

What is the treatment for overflow incontinence?

A

Conservative: intermittent cath, indwelling cath
Meds: alpha-adrenergic antagonists (terazosin or tamsulosin)
Surgery: suprapubic cath

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10
Q

When does functional incontinence occur?

A

In pts with normal urinary tracts, but have cognitive or physical barriers to toileting (dementia, severe depression, physical disability, etc.)

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11
Q

What is enuresis?

A

Incontinence while sleeping after the age that bedwetting is common (> 7 yo)

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12
Q

What is the treatment for enuresis?

A

Avoid caffeine later in the evening
Avoid fluids just before bed
Bed moisture alarms

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13
Q

What is the most common formulation of nephrolithiasis (kidney stone)?

A

Calcium oxalate

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14
Q

What are signs/symptoms of nephrolithiasis?

A

Stone in kidney: asymptomatic
Stone in ureter: restlessness, frequent/painful urination, flank pain that radiates to groin on affected side, hematuria

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15
Q

What is the test of choice for nephrolithiasis if the pt has hematuria?

A

Renal CT without contrast

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16
Q

What is the treatment for nephrolithiasis?

A

Pain management (NSAIDs or opioids)
Increase fluid intake
Dilation of ureters w/tamsulosin (flomax) (take before bed)

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17
Q

When would nephrolithiasis require surgery/admission to the hospital?

A

Surgery: stone is > 6mm or delayed passage (nephrolithotomy, rigid & flexible ureteroscopy, shockwave lithotripsy)
Admit: obstructed/infected upper urinary tract, intractable vomiting or pain, anuria or deteriorating renal function, hx of kidney transplant/solitary kidney w/obstructing stone

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18
Q

What are the formulations of stones based on urine pH level?

A

pH > 8: calcium and phosphate
pH < 6: uric acid or crystine

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19
Q

What size of a kidney stone is likely to pass on its on, and when should you refer to urology?

A

< 4mm will pass on its own
Refer to urology if stone is > 6mm or stone is < 6mm but has not passed in 4 weeks

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20
Q

Where in the urinary tract are stones more/less likely to pass from?

A

Proximal ureter: less likely to pass
Distal ureter: more likely to pass

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21
Q

What causes 90% of acute bacterial prostatitis?

A

E. coli

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22
Q

What are signs/symptoms of acute bacterial prostatitis?

A

Fever/chills
Fatigue
Myalgias
Dysuria
Urinary frequency
Urinary hesitancy
Suprapubic/pelvic/perineum pain
Recent hx of UTI, prostate biopsy, prostate manipulation

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23
Q

What test should be performed when working up a pt for acute bacterial prostatitis who is < or = to 35 yo or has high-risk sexual activity?

A

Gonorrhea/chlamydia

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24
Q

What is the treatment for acute bacterial prostatitis?

A

Mild-mod: Bactrim or Cipro x 6 weeks
Severe: Ampicillin 2g IV q6 hrs + Gentamicin 5mg/kg QD until afebrile, once afebrile/stable Bactrim or Cipro x 6 weeks

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25
Q

What med that is used for acute bacterial prostatitis should you not give if the pt has an underlying arrhythmia?

A

Cipro

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26
Q

What test SHOULD NOT be performed in suspected acute bacterial prostatitis?

A

Prostate massage (could induce sepsis)

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27
Q

How is chronic bacterial prostatitis different from acute bacterial prostatitis?

A

Chronic: lasts > 3 months with urine culture showing same bacterial species
Sx: no fever, no myalgias/fatigue

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28
Q

What is the preferred and alternative test for chronic bacterial prostatitis?

A

Preferred: 4 glass pre/post-prostatic massage test
Alternative: 2 glass pre/post prostatic massage test

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29
Q

What is the preferred treatment for chronic bacterial prostatitis?

A

Cipro 500mg BID OR Levofloxacin 500mg QD x 6 weeks

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30
Q

What is the 1st line treatment for pts w/chronic prostate/pelvic pain syndrome (prostate/pelvic pain > 3 months with negative workup)?

A

Bactrim or Cipro x 6 weeks

31
Q

What is a nonmalignant growth of prostate tissue?

A

Benign prostatic hyperplasia

32
Q

What are the signs/symptoms of benign prostatic hyperplasia?

A

Urinary hesitancy
Stream weakness or dribbling
Prolonged time to empty urine
Sensation of incomplete bladder emptying
Nocturia

33
Q

What diagnostic tests may be ordered for benign prostatic hyperplasia?

A

Prostate specific antigen (PSA)
Cystoscopy
Post-void residual volume

34
Q

What is the treatment for benign prostatic hyperplasia?

A

Early/intermittent symptoms: watchful waiting & lifestyle changes
Regularly symptomatic: alpha blockers (tamsulosin), alpha reductase inhibitors (finasteride) or antimuscarinics (solifenacin, oxybutynin)
Advanced disease: surgery via transurethral resection prostatectomy (TURP), holmium laser enucleation of the prostate (HoLEP) or urolift

35
Q

What is the normal size of a prostate?

A

Size of a walnut (3 cm)

36
Q

What is the most common urinary tract neoplasm?

A

Bladder cancer

37
Q

What are signs/symptoms of bladder cancer?

A

Pelvic or lower back pain
Persistent microscopic hematuria
Gross hematuria
Feeling of constant menstrual cramping

38
Q

What is the gold standard diagnostic test for bladder cancer?

A

Cystoscopy with biopsy

39
Q

What procedure is performed when treating bladder cancer?

A

Transurethral resection of bladder tumors (TURBT) (for non-muscle invasive tumors)

40
Q

What is the most common therapy for treatment of bladder cancer?

A

BCG (immunotherapy derived from strain of bacteria)

41
Q

Is there currently any screening done for bladder cancer?

A

No

42
Q

What is the most diagnosed malignancy worldwide and the 5th leading cause of cancer death in men?

A

Prostate cancer

43
Q

What are the signs/symptoms of prostate cancer?

A

Frequent urination
Nocturia
Stream weakness
Gross hematuria
Dysuria
Difficulty achieving erection
Painful ejaculation
Firm/hard/asymmetric prostate nodule on PE

44
Q

What is the gold standard diagnostic test for prostate cancer?

A

Prostate biopsy

45
Q

What test is used to screen men aged 55 to 70 for prostate cancer?

A

Prostate specific antigen (PSA)

46
Q

What is the treatment for prostate cancer?

A

Low grade: annual PSA, 1 additional biopsy 12-18 months later
Low-intermediate w/o mets & > 10 yr life expectancy: surgical excision/prostatectomy, radiation, hormone therapy
High grade: prostatectomy, radiation, chemo hormone & immunotherapy
With mets: no curative treatment

47
Q

What system is used to grade tissue from a prostate biopsy?

A

Gleason Scoring System

48
Q

What side effects should pts be warned about when being treated for prostate cancer?

A

Erectile dysfunction
Urinary incontinence
Loss of libido
Loss of bone density

49
Q

What is the most common malignancy in men aged 15-45?

A

Testicular cancer

50
Q

What are signs/symptoms of testicular cancer?

A

Lower abd/pelvic pain
Unilateral testicular mass
Painless scrotal swelling

51
Q

What is the treatment for testicular cancer?

A

Radical inguinal orchiectomy (side w/mass)
Chemo
Radiotherapy

52
Q

What pts can have an uncomplicated UTI (cystitis/lower UTI)?

A

Pts w/female organs w/no structural abnormality, no diabetes, are < 65 yo, are not pregnant, and are not immunocompromised

53
Q

What are the signs/symptoms of cystitis/lower UTI?

A

Dysuria
Urinary frequency/urgency
Suprapubic discomfort or fullness
Cloud urine
AMS (in elderly)

54
Q

What pts get treated for a UTI even if they are asymptomatic?

A

Pregnant pts
Amoxicillin or Cephalexin (Keflex) x 3-7 days

55
Q

What is the treatment for uncomplicated UTI?

A

Bactrim OR Keflex (1st line in Roanoke) OR Macrobid x 3-7 days

56
Q

What types of pts/symptoms are considered a complicated UTI?

A

Uncomplicated characteristics & 1 or more of the following:
Symptoms lasting > 7 days
Symptoms in the upper urinary tract
Pt w/male organs

57
Q

What is the treatment for complicated UTI?

A

Mild-mod: Cipro or Bactrim x 5-14 days
Severe: admission with IV ceftriaxone, levofloxacin, or bactrim

58
Q

What meds used to treat UTI should be cautioned/not used in pregnancy?

A

Bactrim cannot be used after 3rd trimester
Levofloxacin cannot be used at all

59
Q

What is different in pyelonephritis than a UTI?

A

Infection is in the upper urinary tract
May have CVA tenderness on PE

60
Q

What is the treatment for pyelonephritis?

A

Uncomplicated: Cipro or Bactrim x 5-14 days
Complicated: admit w/IV ceftriaxone, levofloxacin, gentamicin, or bactrim

61
Q

How is recurrent UTI defined?

A

Greater than 2 infections in 6 months OR
3 infections in 1 year

62
Q

What is the treatment for recurrent UTI?

A

Education on hygiene
Vitamin C supplementation
Prophylactic post-coital abx (nitrofurantoin)
Estrogen vaginal cream 2x/week (for postmenopausal women)

63
Q

What is 1st line treatments for erectile dysfunction?

A

Lifestyle/behavioral mods
1st line meds: Sildenafil (viagra) Tadalafil (Cialis)

64
Q

What is the gold standard treatment for premature ejaculation?

A

Behavioral therapy

65
Q

What are signs/symptoms of balanitis?

A

Penile discharge
Pain/difficulty retracting foreskin
Itching
Tenderness
Difficulty urinating
Inflammation of glans

66
Q

What is the treatment for balanitis?

A

Clean it
Topical antifungals if candida suspected

67
Q

What is Peyronie’s disease?

A

Painful/curved penis during erection

68
Q

What is the treatment for Peyronie’s disease?

A

Surgical fixation

69
Q

What is priapism?

A

Persistent (> 4 hrs), painful erection

70
Q

What diagnostic test is used when working up priapism?

A

Dopper ultrasound

71
Q

What is the treatment for priapism?

A

Consult urology
Terbutaline (PO or sub q)
Corporal aspiration & saline irrigation
Intracavernosal injection
Urological surgical intervention

72
Q

What pt demographic is most common to see testicular torsion?

A

Males < 30 yo

73
Q

What are the signs/symptoms of testicular torsion?

A

Acute onset of severe pain that is constant
N/V
Scrotal swelling
High position of testes
Abnormal cremasteric reflex

74
Q

What is the treatment for testicular torsion?

A

Attempt de-torsion
Surgery

Clin Med (15 decks)

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