GU

Question 1

A 55y/o male presents with increased urinary frequency, nocturia, hesitancy, and a weak stream – dx? How do you confirm?

Answer 1

BPH

Confirm with PSA and UA

Question 2

If a male has BPH symptoms and HTN how would you treat?

Answer 2

Alpha Blockers

Question 3

What are the most common causes of erectile dysfunction?

Answer 3

Vascular, diabetes, SSRI’s, and psychogenics

Question 4

What should we always remember about phosphodiesterace inhibitors?

Answer 4

They are contraindicated in pts takin nitrates!

Question 5

How do we treat urge incontinence?

Answer 5

Oxybutynin

Question 6

How do we treat stress incontinence?

Answer 6

Vaginal estrogen

Question 7

What are the 3 MC types of stones that cause nephrolithiasis?

Answer 7

Calcium Oxylate
Cystine – autosomal disorder, can’t absorb amino acid cysteine.
Struvite – urea splitting bacteria

Question 8

What’s the gold standard diagnostic for nephrolithiasis?

Answer 8

UA shows hematuria

*Non-contrast helical CT

Question 9

How do we treat kidney stones?

Answer 9

Hydrate, NSAIDs

• Stones less than 10mm – Tamulosin
• Stones greater than 10mm – lithotripsy

Question 10

What types of foods should someone with chronic kidney stones avoid?

Answer 10

Oxalate rich foods (nuts, bran, spinach, and vit C)

Question 11

If a pt has painless intermittent hematuria – what should you always think of? Dx? And Tx?

Answer 11

Bladder CA

Dx – Cystoscopy and CT

Tx – TURBT

Question 12

How do we handle prostate cancer?

Answer 12

Risk stratify patients with PSA

Question 13

What is the MC malignancy in young males? How do we dx and tx?

Answer 13

Testicular CA

Dx – U/S DO NOT BIOPSY and CT

Tx – Radical inguinal orchiectomy

Question 14

What’s the difference between a hydrocele and a varicocele?

Answer 14

Hydrocele = painless swelling with transillumination.                Dx: with U/S
Varicocele = abnormal dilation of the spermatic veins.  Painless MASS that “feels like a bag o worms”.                Tx = observation or surgical

Question 15

If you are concerned about testicular torsion, what special signs might you see? How do you diagnose?

Answer 15

ABSENT creamasteric reflex

Negative Phren sign (no pain relief with lifting the testicle)

Dx – Dopper U/S or OR STAT

Question 16

What are the MC causes of cystitis?

Answer 16

E. coli, staph, proteus, and klebsiella

Question 17

What would make a complicated UTI?

Answer 17

Preggo, male, foley cath, DM, immunocompromised, or structural abnormality

Question 18

What finding in a UA is most specific to an infection?

Answer 18

Nitrites

Question 19

How do we treat an uncomplicated vs complicated UTI?

Answer 19

Uncomplicated: Nitrofurantoin, TMP-SMX
Complicated: TMP-SMX, Cipro or levo
*If a man, does NOT improve after 7 days, think prostatitis

Question 20

What is prostatitis? What would you see on PE?

Answer 20

Inflammation of the prostate (from e. coli)

The prostate feels tender, warm, and edematous

Question 21

How do you treat prostatitis?

Answer 21

Floro or trimethoprim-sulfameth.

Question 22

What would you see on PE with pyelonephritis?

Answer 22

Cystitis PLUS fever, chills, flank pain, and CVA tenderness

Question 23

What would you see on UA with pyelonephritis?

Answer 23

Same as cystitis PLUS WBC’s and casts

Question 24

How do we treat pyelo?

Answer 24

Floroquinolones – ciprofloxacin

Question 25

f we see testicular pain, erythema, and swelling – what is it called? What does it usually occur with? If it occurs alone, what should we think of?

Answer 25

Known as – Orchitis Occurs with epididymitis Occurs alone think MUMPS

Question 26

How do we diagnose epididymitis? Tx?

Answer 26

NAAT + U/A and culture If over 35 tx with floroquinolone

Question 27

If a male has dysuria and penile discharge, the gram-stain is positive for gonorrhea – dx? Confirm? Tx?

Answer 27

Urethritis Dx – NAAT for gonorrhea Tx – Ceftriaxone + azith or doxy *Must treat all partners regardless of sxs

Question 28

What type of herpes causes oral components vs genital?

Answer 28

HSV1 = oral HSV2 = genital

Question 29

How do we diagnose and treat herpes?

Answer 29

Dx – PCR Tx – Acyclovir or valavivlovir (within 72 hours)

Question 30

How do we diagnose and treat Gonorrhea?

Answer 30

Dx – NAAT Tx – Ceftriaxone

Question 31

How do we diagnose and treat Chlamydia?

Answer 31

Dx – NAAT Tx – Doxy or Azith

Question 32

How do we diagnose and treat Trichomonas?

Answer 32

Dx – Naat Tx – Metronidazole

Question 33

What causes syphilis?

Answer 33

Treponema pallidum

Question 34

If a pt has painless genital ulcers, what stage of syphilis would they be in? Dx? Tx?

Answer 34

Primary Dx – Dark field microscopy, possible RPR, or VDRL Tx – Azith or ceftriaxone or Pen G

Question 35

A pt presents with a diffuse rash over the palms and soles of the feet, some fever, and grey/white mucous patches – dx? Confirm? Tx?

Answer 35

Secondary syphilis (weeks to months after genital ulcer) Dx – RPR or VDRL (confirm with FTA-ABS) Tx – Pen G

Question 36

A pt presents with a HA, N/V, and neck stiffness, and a new murmur – dx? Confirm? Tx?

Answer 36

Tertiary syphilis Dx - RPR or VDRL (confirm with FTA-ABS) Tx – IV Pen G x 10-14 days

Question 37

What’s the new murmur often associated with tertiary syphilis?

Answer 37

Aortitis – aortic regurg