GU Flashcards
A 45-year-old man with a history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including nocturia and weak stream. What is the most appropriate initial pharmacological treatment?
Alpha-blockers
Alpha-blockers are effective in managing the symptoms of BPH by improving urinary flow and reducing discomfort associated with urinary obstruction.
A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer?
Prostate-specific antigen (PSA) test every year starting at age 50
PSA testing is used as a screening tool to detect prostate cancer early, before symptoms develop. Prostate cancer is one of the most common cancers in men, and early detection can improve treatment outcomes.
A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is:
Sexually transmitted infection
A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no allergies. What is the most appropriate first-line antibiotic treatment?
Nitrofurantoin
Overall, Nitrofurantoin is a preferred choice for treating uncomplicated UTIs, especially in otherwise healthy individuals where local resistance patterns support its efficacy.
Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis?
UA with presence of WBC casts
UA with WBC casts suggests pyelonephritis. UA with RBC suggests glomerulonephritis.
Presence of hematuria is non-specific and a UC positive for proteus is not specific to either, as both cystitis and pyelonephritis could have proteus as the bacterial agent.
Causes of acute AKI
- Aminoglycosides
- contrast agents
- nonsteroidal anti-inflammatory drugs (NSAIDs),
- angiotensin-converting enzyme (ACE) inhibitors
- protease inhibitors
S/S Acute Pyleonephritis
- high fever
- chills
- nausea/vomiting
- dysuria
- frequent urination
- unilateral flank pain(described as a deep ache)
- nausea (with/without vomiting)-
- may have a recent history of urinary tract infection (UTI)
Bladder CA S/S
- painless hematuria
- May have irritative voiding symptoms (dysuria, frequent urination, nocturia) that are not related to a UTI.
Patients who have advanced disease with metastases may complain of lower abdominal or pelvic pain, perineal pain, low-back pain, or bone pain.
Rhabdomyolysis s/s
- acute onset of muscle pain (not related to physical exertion)
- muscle weakness
- dark urine (myoglobinuria)
Oliguria is defined as…
Urinary output of <400 to 500 mL/day (adults)
Serum Creatinine
product of creatine metabolism in skeletal muscle; also is derived from dietary meat intake.
Males is 0.7 to 1.3 mg/dL
Females is 0.6 to 1.1 mg/dL
Creatinine Clearance (24-hour Urine)
Used to evaluate patients with proteinuria, albuminuria, and microalbuminuria.
eGFR
Normal is >90 mL/min
<60 mL/min for at least 3 months indicates CKD
Blood Urea Nitrogen
Measure of the kidneys’ ability to excrete urea (waste product of protein metabolism).
Elevated levels with decreased blood flow to the kidneys or damage to the kidneys.
Bun-to-creatinine Ratio
A decrease in the blood flow of the kidneys will increase the BUN:Cr ratio.
Used to evaluate dehydration, hypovolemia, and acute kidney failure.
A rise in BUN:Cr ratio is suggestive of decreased kidney perfusion (prerenal disease).
UA
Neutrophils - associated with bacteria
Leukocytosis - associated with cystitis
Protein - suggests kidney damage is present
Nitrates - Increase due to breakdown of urea into nitrite by bacteria - indicative of UTI
WBC casts - seen with infections
RBC casts - indicate glomerulonephritis
pH - kidney stones and infections
WBC casts with proteinuria and hematuria are associated with what condition?
Pyelonephritis
Stages of CKD
Stage 1 ≥ 90 mL/min Kidney damage with normal or high kidney function
Stage 2 60 to 89 mL/min Mild loss of kidney function
Stage 3a 45 to 59 mL/min Mild-to-moderate loss of kidney function
Stage 3b 30 to 44 mL/min Moderate-to-severe loss of kidney function
Stage 4 15 to 29 mL/min Severe loss of kidney function
Stage 5 < 15 mL/min Kidney failure
Prerenal AKI
Usually due to hypoperfusion of the kidneys.
- hypovolemia
- HF, edema, MI
- ACE, ARB, NSAIDS
Intrarenal AKI
Caused by damage to the tissues of the kidney or renal tubule, involving pathology of the vessels, glomeruli, or tubules-interstitial
- Acute tubular necrosis
- Nephrotoxins
- Glomerular disease
- Thrombosis in renal artery/vein
Postrenal AKI
Usually due to the obstruction of the flow of urine in the renal tubular system to the urethra.
- Bladder obstruction
- Urethral/renal obstruction
- neurogenic bladder
Complicated pyelonephritis presents in patient with…
- underlying renal disease
- male sex, kidney stone
- anatomic urinary tract abnormality
- immunosuppression
Should be referred to ED
Treatment for pyelonephritis
Oral fluoroquinolone (levofloxacin, ciprofloxacin)
gold-standard test for measuring protein excretion of the kidneys
24 hour urine collection
