GU Flashcards
0
Q
Red flag sx of BPH.
A
Rapid onset, filling sx without voiding sx
1
Q
What is BPH?
A
No cancerous abnormal hyperplasia of prostate, clinical: blockage I passing of urine, increased frequency, increased urgency
Exam: rubbery enlarged firm prostate
Dx: cystoscope
2
Q
Treatment of BPH?
A
Alpha adrenergic inhibitors: doxazosin watch for ortho static hypotension and retrograde ejaculation
Surgery: TURP
3
Q
Common cause of ED?
A
Hx of DM or coronary vascular dz
4
Q
Tx of ED?
A
Testosterone, sildenafil (if not on nitros), injectables, vacuum, prosthesis
5
Q
What is a hydrocele?
A
Fluid between 2 layers of tunica vaginalis, dx by ultrasound
Smooth and non tender on exam
6
Q
What must you rule out in dx of hydrocele? Tx?
A
Testicular tumor, surgery if older than 18 months
7
Q
What is a varicocele and how does it look on exam.
A
Engorgement of internal spermate veins….. Bag of worms non tender, non transilluminable mass usually on left side, ache with standing and diminishes when supine
8
Q
Less than 10 yrs or sudden onset of ride side varicocele think….
A
Retroperitoneal malignancy
9
Q
Sudden onset of left sided varicocele think……
A
Renal cell carcinoma
10
Q
Describe a testicular torsion.
A
Testis twists on spermatic cord.
Acute pain, elevation of testicle worsens pain, non transilluminable, absent creamaster reflex.
11
Q
What is the blue dot sign?
A
Torsion of the appendix of the tesetes.
12
Q
What is a bell clapper deformity?
A
Congenital malformation of the posterior anchoring of the teste.
13
Q
How do you dx and treat a testicular torsion?
A
Doppler ultrasound and surgery (scrotal orchiopexy)
14
Q
What are the risk factors of nephro/urolithasis?
A
High calcium intake, purine foods, chronic UTI, gout, dehydration
15
Q
Clinical signs of kidney stones?
A
Can’t sit still, flank pain, awaking at night, pain waxes and wanes, radiation to groin, scrotum and vulva, hematuria, nausea and vomiting
exam: CVA tenderness, soft abdomen, NMl exam
16
Q
Outcome of stone 10 mm?
A
Pass without difficulty, pass 50% of the time, obstruction
17
Q
Most common kidney stone?
A
Calcium oxalate from hypercalcemia, sarcoidosis, hyperparathyroidism, idiopathic
18
Q
Struvite stone causes?
A
UTI from proteus, alkaline urine
19
Q
Uric acid stone from?
A
Gout, high purine diet
20
Q
Dx test of choice for kidney stones?
A
Helical CT, cystine and uric acid stone not seen on X-ray
21
Q
Treatment for kidney stones?
A
Pain control with narcotics, hydration, change diet, metabolic eval
22
Q
What issues phimosis?
A
Fibrous constriction of foreskin preventing retraction, tx circumcision
23
Q
What is para phimosis?
A
Retracted foreskin developed fixed constriction proximal to glans, head swollen and painful.
Tx: reduction and circumcision
24
What is priapism?
Persistent involuntary erection, may be secondary to sickle cell, leukemia, etoh, marijuana or ecstasy.
25
Describe blood pressure control through the kidneys.
Decreased blood flow to kidney -kidney releases renin in blood - reacts with angiotensinogen - makes angiotensin 1- mixes with ACE breaks into - angiotensin 2 which is a strong vasoconstrictor and stimulates the release of aldosterone from the adrenals- 3 Na are reabsorbed from the urine into the bood bringing water with it- blodd pressure increases and feedback stops the release of renin.
26
Etiology of UTI?
Most common is e. Coli but don't forget staph safraliticus in young females
27
Clinical presentation of cystitis?
Dysuria, frequency, urgency, discomfort, foul smelling urine, cloudy urine
28
Treatment for uncomplicated cystitis?
Bactrim x 3-5 days, 7 day course in pregnancy/DM/elderly. Nitrofurantoin safe in pregnancy
Pyridium
Change in mental status may be only sign in elderly or DM!
29
What is orchitis?
Inflammation of testicles usually from mumps, treat sx
30
Clinical presentation of epididymitis?
Male with presentation of swollen, firm, tender epididymitis. Dull aching pain, slow onset with gradual increase, pain improves with elevation of scrotum
31
Causes of epidymitis in young boy, less than 35
| , and greater than 35?
Young-anatomical or h. Flu
| 35- e. Coli- bactrim
32
Signs and symptoms of acute bacterial prostatitis?
Fever, Dysuria, perineal pain, malaise, with enlarged tender prostate
33
PSA in acute bacterial prostatitis does what?
Increases then returns to normal post tx.....NO prostate massage!
34
Treatment for acute bacterial prostatitis?
Fluroquinolones or bactrim x 4-6 wks
35
Describe signs, sx, and exam of chronic bacterial prostatitis.
In elderly and recurrent UTI, Dysuria, voiding discomfort, back pain but little pain, in lab UA is neg but prostate massage dx is pos
36
Tx for chronic bacterial prostatitis?
Bactrim or fluroquinolones x 6-12 wks
37
White blood cell casts?
Think pyelonephritis
38
What is pyelonephritis and the MC causes?
Infection of the parenchyma of the kidney
| E. Coli, klebsiella, enterobactor, pseudomonas
39
Clinical features and exam of patient with pyelonephritis.
Fever, chills, anorexia, flank pain, and UTI signs. UAa and culture required.
40
Who should be treated in patient for pyelonephritis? And what Meds?
Children, pregnant women and septic patients
| Fluroquinolones , ceftriaxone
41
Painless hematuria think?
Bladder cancer
42
Risk factors for bladder carcinoma?
Smoking, occupational exposure, recurrent infections
43
Dx and treatment of suspected bladder cancer?
Cystoscopy with biopsy and chemo/radiation or cystectomy
44
Prostate cancer mets common to?
Bone
45
Risk factors for prostate cancer?
Age, positive family hx, black, high fat diet. NOT vas or BPH.
46
PE for prostate ca?
DRE hard enlarged prostate with nodules. Bone pain and LE edema in late stage
CT/MRI for staging BIOPSY for dx.
47
Classic triad for renal cell carcinoma?
Flank pain
Abdominal mass
Hematuria
48
Risk factors for renal cell carcinoma?
Mere common in black men. Obesity, HTN, smoking and diuretic use.
49
Treatment for renal cell carcinoma?
Surgery and immunonodularity with interleukin 2
Resistant to chemo and radiation.
50
Describe testicular carcinoma.
Young males 20-40, painless solid testicular swelling, likely asymptomatic. Risk factor is chyptochidism.
51
Dx and treatment of testicular carcinoma?
Dx with ultrasound and increase in BHCG
| Treat with orchectomy #1
52
Lab diagnosis of acute renal failure?
Abrupt increase in creatine, by 0.3ml/dal or 50%
53
Describe prerenal causes of acute renal failure.
Perfusion problem!
| Shock, dehydration, decreased cardiac output, renal artery obstruction
54
Describe causes of postrenal causes of acute renal failure.
Think obstruction!
| Neoplasm, stones, prostate dz, blocked foley
55
Describe renal causes of acute renal failure.
Think inside kidney.
| Nephritis, HUS, toxins are MOST common (aminogylcosides, NSAIDs, contrast)
56
Signs and symptoms of acute renal failure?
Orthostatic hypotension, tachycardia, rales, JVD, edema, bladder distension, anuria
57
Treatment for acute renal failure?
Remove toxins, low sodium and potassium diet, fluid balance, dialysis
58
Chronic renal failure is multi system. What are the #1 and #2 causes?
Diabetes and HTN
59
Treatment of chronic kidney failure depends on stage.
BP control with ACEI, decrease salt, exercise, low protein diet, calcium supplement, dialysis, transplant
60
This so damage to renal glomeruli due to deposits of inflammatory proteins secondary to an autoimmune event.
Glomerulonephritis
61
Red blood cell casts think?
Glomerulonephritis
62
Clinical presentation of glomeruli nephritis?
Tea colored urine, hematuria, oligouria, edema, HTN.
63
Dx and tx of glomeruli nephritis?
Renal biopsy,
| Treat underlying cause, monitor salt and fluids, dialysis.
64
What is hypernatremia?
Too much Na. Over 145. Typically reflects a decrease in total body water compared to sodium. This cause water to leave the brain cells and the cells shrink!
65
Signs of hypernatremia?
Severe thirst unless mental confusion. Seen in elderly, young, or neuro impaired.
66
Clinical presentation and treatment of hypernatremia?
Decreased skin turgor, tachycardia, hypotension, mental status changes.
Treat with isotonic solution slowly or else cerebral edema
67
A surgeon taking out an adrenal mass by removing the 12 th rib May injure what!
Diaphragm
68
What is the most common cause of idiopathic nephropathy?
IgA nephropathy. Hematuria following a sore throat.
69
What is the MC cause of glomerulonephritis?
IgA nephropathy. Dx with renal bx, usually follows URI. More common in Asian and tx with corticosteroids.
70
Good pasture syndrome?
Acute glomerulonephritis with hemoptasis NAND rapid decline in renal function. Tx is plasma exchange and corticosteroids.
71
Describe wegners granulomatosis.
Fever, malaise, weight loss associated with respiratory tract infection. Treat with corticosteroids.
72
Patient with hx of smoking, urinary obstruction, hematuria think?
Bladder cancer
73
What is nephrotic syndrome?
Any disease that causes
1. protienuria >3.5
2. Hypoalbuminemia
3. Edema
74
Pyelonephritis with high fever and WBC over 18,000?
Inpatient with IV abx
75
Effacement of podocytes or foot processes?
Minimal change disease
76
Child 2-6 yrs old with edema, protienuria, dyslipidemia?massive protienuria!
Minimal change disease.
77
First lab test for pheochromocytoma?
24 hr urine catecholamines
78
Lab test for Cushing dz?
24 hr free cortisol
79
What is Orthostatic protienuria?
Increase in urine protein in young males during the day. Test is split 24 hr protein and no tx required.
80
NSAIDs can cause mild renal failure so avoid in whom?
Patients with kidney dz
81
What is the only oral med for pseudomonas?
Cipro or levaquin. Fluroquinolones.
82
First step in evaluating a palpable thyroid nodule?
Ultrasound!
83
Biopsy for solid thyroid nodule less greater than 3 cm?
Cutting needle biopsy
84
Thyroid nodule cystic and less than 3 cm!
FNA
85
Type of nephropathy seen in black IV drug users with aids?
Focal segmental glomerular sclerosis
86
Kid with strep or impetigo with HTN and edema?
Post infectious GN
87
Patient with painless hematuria and just had flu or uri?
IgA nephropathy
88
GN with hemoptasis HTN, edema and anti-GMP positive?
Goodpastures dz
89
RBC casts?
Glomerulonephritis
90
What are the 4 signs of nephrotic syndrome?
Protein >3.5, hyper albumin, hyper lipids, edema
91
Common presentation of nephrotic syndrome?
Abdominal distension, anorexia, oligouria, puffy eyes, sob, wt gain, edema, HTN, hematuria
92
Common lab findings of nephrotic syndrome?
Oval fat bodies and fatty casts
93
Treatment for nephrotic syndrome?
Steroids, dietary changes, avoid toxic drugs and ACE inhibitors.
94
Patient presents with palpable kidney...dx?
PCOS
95
Define hyponatremia.
Sodium less than 135
96
Signs and symptoms of hyponatremia?
Nausea, headache, weakness, mental confusion, seizures, coma, death
97
How do you treat hyponatremia?
Treat underlying cause, hypertonic solution, water restriction
98
What to watch for when correcting Na imbalance?
Do not increase Na by more than 12-24 over a 24 hr period or may have cerebral edema.
99
Describe SIADH.
Excessive release of ADH from posterior pituitary. Which increases water reabsorbtion by the kidney.... Holds onto water.
100
Causes of SIADH?
Small cell lung cancer, brain tumor, head trauma, SSRI, TCA, ecstasy
101
Treatment for SIADH?
Treat underlying cause.
Fluid restriction to 800-1000 ml /day
Demeclocycline
102
Describe hypernatremia.
Na greater than 145. Initiates severe thirst unless mental confusion, common in elderly, very young or neuro-impaired.
Clinical: turgor, hypotension, mental status changes
Treat with IV fluid slowly, watch for cerebral edema
103
What is hyperkalemia?
Potassium over 5.5
104
Signs and symptoms of hyperkalemia?
Weakness, paralysis, abdominal distension, diarrhea.
| EKG has peaked t waves
105
Treatment for hyperkalemia?
IV bicarbonate, calcium gluconate.
Glucose and insulin
Diuretics and dialysis last
106
Describe hypokalemia.
Potassium less than 3.5. Causes muscle weakness, lethargy, paresthesias, polyuria, constipation and severe ileus, flaccid paralysis
Flattened t waves on EKG
107
Treatment for hypokalemia?
Treat underlying cause and potassium supplements
108
Describe hypocalcemia.
Calcium less than 8.5. Patient. Presents with abdominal and muscle cramps, tetany, and seizures.
EKG may show prolonged QT interval.
109
What is crvustek sign?
Tapping the facial nerve causing a spasm. Test for hypocalcemia.
110
What is trousseau sign?
BP cuff causes carpal spasm. Positive in hypocalcemia.
111
Treatment for hypocalcemia?
Treat underlying disorder and give calcium gluconate.
112
Hypercalcemia please describe.
Pt has polyuria, constipation, abdominal pain, thirst, dehydration and HTN. Calcium over 10.5.
Can be caused by malignant melanoma.
113
In metabolic acidosis what is the pH and bicarbonate?
Ph is low (less than 7.4) and bicarbonate is low.
114
Signs and symptoms of metabolic acidosis?
Dyspnea, hyperventilation, fatigue, acetone breath
115
Causes of metabolic acidosis?
MUDPILES
| Methanol, uremia, DKA, propylene glycol, ingestion, lactic acid, antifreeze (ethalyne glycol), salicylates
116
Signs and symptoms of metabolic alkalosis?
Weakness, malaise, lethargy, hyporeflexia, tetany, muscle weakness. Causes vomiting or NG tube, diuretics, laxatives.
117
What are ketones in the urine from?
Fatty acids and fat metabolism
118
What does nitrite in the urine indicate?
Detects the presence of bacteria
119
What does leukocytes in the urine indicate?
Presence of white blood cells. Indicates pyuria.
120
What do hyaline casts in the urine indicate?
Clear colorless casts indicate decrease in filter rate. Few normal from exercise, stress, fever. Can indicate issues.
121
What do red blood cells casts in the urine indicate?
Active inflammatory or vascular disorder. (Think glomerulonephritis)
122
What doe WBC casts in the urine indicate?
Renal infection. Think pyelonephritis!
123
What do waxy casts in the urine indicate?
Extreme renal stasis. Chronic renal failure or renal disease.
