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Flashcards in GU Deck (45):

testicular cancer

-common in 15- 35 men
- RF: undescended testicles

seminonam and nonseminoams

presentation: painless testicular mass
-mets signs ( brain mets, retroperitoneal mets)

nonseminomas- very high bHCG, AFP, LDH

seminomas: slight high bHCG, non-elevated, elevated LDH

imaging: scrotal sonogram
surveillance for mets and brain

tx: radical orchiectomy for every one
seminona- rad tx with chemo

nonseminona- no rad tx
chemo tx

px: excellent


prostate cancer

adenocarcinoma , AA,

s/s: 2/3 asymptomatic when diagnosed
- rectal exam: hard and nodule
advanced dz: specific to mets ( does, nodes, rectum, and bladder)

labs: PSA> 4.0 good for monitoring and following pt with cancer
changed recs; over dx of cancer and tx

PSA can be high with other cancers
transrectal us/ guided bx
- do for anyone with positive DRE

Gleason score: evaluate tissue sample

tumor surveillance: CT abdomen/ pelvis, bone scan, MRI

tx: active surveillance
radical prostatectomy
rt and androgen therapy( luron, orchiectomy, anti-androgen)

screening: Lots of disagreement
- need to screen in AA and fix


bladder cancer

linked to manufacture (leather, rubber, cig smoking, dyes)

transitional cells
- s/s: painless hematuria

labs: UA

studies; bx

tx: how much penetrattion of bladder wall

Transurethral resection with fulguration with chemo IP - Ta/ T1

invasive bladder: radical cystectomy with pelvic lymphadectomy chemo/t x


renal cell carcinoma

- occlusive thrombi in renal veina
-associated with paraneoplastic syndrome

- diagnosed on incidental scan

s/s: flank pain with hematuria

dx: CT scan and met work up
labs: check LFTs, CBC, CMP

tx: radial partial nephrectomy
with met ( lung, bones, and brain --> poor px


wilms tumor

2-3 y/o
tumors in the kidneys
palpable ab mass, and pain, and hematuria

cannot bx- spill tumor cell and increase stage

tx; surgical resection, nephrectomy, chemotherapy, rad tx

px: depends on histology


acute renal failure

-sudden rise in BUN/Cr
- build up of nitrogenous waste

s/s: uremic ( nausea/ itching)

labs: BUN/Cr

causes: pre renal azotemia, intrinsic renal ( failure, post renal azoetmia

major cause: pre-renal azotemia
- volume deplete
- no blood flow to kidneys

tx: tx the cause
monitor K

post renal azotemia-
bilat obstruciotn


acute tubular necrosis

- damage of renal of tubules
-muddy sediment, granular case
cause: MI, sepsis,nephrotoxic, IV constrast

tx: tx the cause, low protein diets, dialysis

- can repair itself


interstitial nephritis

inflame of renal tubules


s/s : fever, rash, arthalgias

labs: WBC casts and eosinophils

tx: remove cause
-pts get better



inflame of glomerulus from immune complex deposition

Immune complex- strep in kids
- tea colored urine
- puffy on eyes and scrotum
-positive ASO titer

IGA nephropathy- starts with URI or H. flu and have hematuria

lupus nephritis- auto ab production
+ ANA and ANCA

Good Pasteur syndrome: assoc with pulmonary hemorrhage
tx: plasmapheritis

Vasculitis: effects small and medium sized vessels
- assoc with granuloma formation airway, lung skin,

Vascular: hemolytic uremic syndrome
-uremia, low plts, hemolytic anemia

s/s: hematuria, HTN, edema, tea colored urine with RBC casts

dx: renal bx

tx: steroids except for post strep pt

Good pasteur- plasmapheresis


chronic renal failure

destruction of nephrons least to progressive decline

causes: HTN and DM

dx: HTN, high BUN/ Cr, SOB
UA: proteinuria, U/s shows small echogenic kidneys

tx: renal diet, dialysis
and or transplant

ACE or ARB to delay progression


nephrotic syndrome

increased permeability of glomeulr capillary walls ) glomeulr becomes a sieve)
proteinuria, hypoalbuimnaea and edema
causes: primary
minimal change dz
membranous nephropathy

dx: proteinuria > 3 gm
oval fat body( Maltese cross)

management: low ptn diet, restrict salt, tx of hyperlipidemia, anemia
diuretics and ACE inhibitors


polycystic kidney disease

hereditary dz ( 30s and 40s)

clinical features: cross hematuria, abd flank pain,

complications: cysts rupture, stones, HTN, Cerebral aneurysms, aspirate cyst

tx: agressive HTN tx,
renal transplant


rental artery stenosis

HTN 50
abd exam: renal bruit
if you give ACE--> creatine goes up

dx: renal arteriography

tx: renal artery angioplasty with stunting


renal vein thrombosis

causes: children - severe dehydration
adults: infection, ascending thrombus of v. cava

sxs: flank pain and palpable kindness

dx: renal us, renal venography

tx: eliminate cause, anticoagulant or thrombolytic



-affect CNS
- low sodium
- total body watery and total body sodium



-brain produces ADH despite normal plasma volume

- causes: trauma, strok, small cell lung ca

labs: Urine:

tx: fluid restrict, and tx the cause



Na> 145 mEq/L
Causes: impaired thirst, lack of access to water, lactulose and mannitol

s/s: dehydraiton, hyperthermia, delirium

tx: volume replacement and dehydration

Decrease serum sodium by no more than 1 meQ/:

too fast--> neuro edema


diabetes insipidus

problem wth ADH
central DI: head injury
nephrogentic- kindney not listening to ADH

dx: water deprivation test (

tx: volume replacement for everyone
central: desmopression
nephrogenic ID: treat underlying cause



-sxs in mm



K > 5, > 6.5 severe

when severe
V.fib--> death

causes: renal disease, hypoaldosterism, drugs ( NSAiDs, ACE, and ARBs), burns, rehab,
s/s: mm weakness, hyperreflexia, flaccid paralysis

ekg: peaked T waves

tx; confirm that lab result i real
-treat cause

1. stabilize heart- calcium gluconat

2. dive K back into cells

insulin+ glucose
sodium bicarb

excrete- kayelate





> 10.5
less sensitive to stimulation

cause: hyperparthathyrid, renal cell carcinoma, MM
s/s: anorexia, diagnostic, polyuria

EKG: shortened QT interval

tx: IV fluids and loop diuretics




Acid -base basics

body wants a ph of 7.4

CO2 and bicarb maintain this

if bicarb drops- ph goes how

if ph high -high bicarb or low CO2

when ph is too low=acidosis
pCo2 is high and HC03 is low

When ph is too high = alkalosis
HCo3 is high and Pco2 is low

respiratory: alteration in pc02
metabolic - alteration in Hc bicarb ( kidneys)

when on system fails--> other system kick in


metabolic acidosis

ph is low, bicarb issue
too much H ion then positive ion gap

- MUDPILES- rise in H ion
lactic acidosis

compensation: increased ventilation ( kassuma)

tx: fix underlying cause


metabolic alkalosis

high bicarb and high ph

causes: due to loss of H or too much bicarb

vomiting , aggressive suction of gastric content

compensation; dec ventilation to increase pC02

s/sx; associated with low CA and low K

tx: fix underlying cause and associated metabolic problems
IV fluids


respiratory acidosis

low ph, high Co2
- causes: COPD, narcotic overdose

compensation: reabsorption of bicarb by kidneys

tx; fix underlying cause


resp alkalosis

low co2 and high ph

cause: hysterical hyperventilaion, salicylate intoxication, PE

sx: rapid breathing, lightheadedness, perioral paresthia

compensation; incr eliminate of bicarb by kidney

tx: tx underling cause


kidney stones

calcium 85% , struviet ( infection) uric acid, cystine

s/s: M >F
inc calcium, diets in oxalate ( chocolate, tea, coffee), diets high in purine

sever pain- radiation got the flank or labia

dx; spiral CT scan
and do KUB
UA/ culture

tx: meds, pain control- tordal , flomax
if stone 10 mm



-distension of renal calices

causes by urinary blockage
- kidney stone
s/s: pain

dx; UA, check BUN/ Cr

tx: tx causes
catheter, anticholingerica
infeciotn- needing emergent stunting or nephrostomy



requires evluaiotn

women> men

stress: incr ab press
tx: kegel, estrogen, surgery

urge: overative bladder ( irritable bladder)
- oxcybutin and petrol LA
bowel training

overflow: outlet obstruction ( big BPH)
functional- unable to urinate on own


bening prostatic hyperplasia

enlargement of prostate due to inc. number of cells

- s/s; obstructive sxs; hesistany, slow, weak, dribbling

irritative sxs; frequency
on DRE: smooth, firm, elastic enlargement in move over 50 y/o

dx: UA, check PSA, cr
, cystoscopy, flow rates

tx; depends on symptoms
alpha blockers: tamsulosin, doxaxoin- relaxes smooth muscle

- finasterid, dutasterid- blocks formation of DHT

surgery; TURP, TUIP, TNA


erectile dysfunction

not able to attain or maintain a rigid penile erection

- check UA, tesosteroi, FSH, thyroid panel,

psychogenic: check for erections at night

management: treat underlying cause

viagra- careful who have CAD or h/o MI
don't give with Nitro

vacuums erection device, penile prosthesis

priapism: erection > 4 hours
medical causes: SC, leukemia, illicit drugs
meds: terbutaline

Peyronies dz- penis becomes curved

tx: intraplaque injection of verapamil or interferon

cause: repetive trauma



swollen foreskin d/t hygiene

tx: children: no tx
Adults: abx cream, steroid cream, anti fungal



foreskin is unable to br retracted
tx; betamethazoe
stretch the fore skin

paraphiosis- emergency
-edema- compromised blood ---> surgery


congenital abn

hypospaids- urethera meatus is ventral and proximal to normal positive
- repat before kid is 18 month old

chord- ventral penile curvature
- surgery

veisicoureteral reflux: urine passess retrograde from bladder to kidneys

lead to:

reflux nephropathy: renal scarring assoc with infrarenal reflux

child with recurrent UTi

test: IVD, renal us,
tx: Tx HTN, Ace, abx



testes don't descent from abdomen

- s/s: empty hemiscrotitum on right

tx; hCG 1500 X 3 days
if not,must tx surgically
incr risk for testicual cancer and infertility


scrotal masses

hydrocele: fluid in membranes around the testicle
- transillumination
- no tx required

varicocele: varicose veins in scrotum
-may feel achy
-rarely treated unless indicted by infertility

sprematocel- retention cuts of the head of the epididmysis
no tx


testicular torsion

testicel rotate on spermatic cord causing occlusion

s/s: sudden, severe tesitcular pain, n/v
- Preh's sign- no relief with elevation of testicle

- cremaster reflex
- no retraction of ipsilateral testis when medial thigh is stocked

imaging u/s

tx: surgical emergency
( 4-6 hours)
- need to detorse it ( in to out)



most common cause of adults scrotal pain

- caused by STI or E. col

s/s: gradual sever, scrotal pain

dx; must do doppler u/s

labs; UA, GC/ chlamydia

tx: abx if infection, bed rest, scrotal election/ tight fitting briefs, NSAIDs
if STI- ceftriaxome



seen with mumps

-s/s: develop 1 week after parrots

marked pain and swelling in one or both testicles

n/v, fever, urinary sxs,

tx; bed rest, scrotal support, ice
abx d/t epidimytis

complication: testicular




s/s: d/c

labs; check urine

tx: cefrixone and doxycycline
treat partner



common in women,

s/s: dysruai, flank pain

labs; UA and culture

tx; abx X 3-7 days, longer if elderly, DM, pregnant, men
Bactrim, microbic, quinones



fever/ chills, sepsis, vomiting, flank pain

labs: WBC casta
urine culture
blood cultures

imaging; u/s r/o hydronephrosis

Ct scan

tx; admit
ampicillin and aminoglycoides



acute bacterial- gram neg rods, sick
perineal, lower back pain
no DRE
dx: CBC, UA,
tranrectal uS

tx: bacterium or quinolone
analgesis, fluids, rest

if septic--> admit

chronic: recurrent infection of prostate
- gram neg rods

s/s: vary, milder
h/o UTI or sexual dysfunction

dx; UA : norma, expressed prostatic secretions ( manage prostate and milk out pus)
two glass test

tx: bacterium, quinolone X 6-12 weeks, alpha blocker

chronic nonbacterial prostates
- no bacteria
same sxs
- no bacterial on prostate secretions

tx; alph blocker, NSAiDS
try bacterium 4- 6 weeks

WBC on prostate fluids
feel fine
no tx