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GU Flashcards

1
Q

Urinary tract infections (UTI’S)

A

Inflammation and infection involving the kidneys, ureters, bladder and/or urethra

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2
Q

Causes of UTI’s

A

Lower: cystitis, urethritis/dysuria frequency syndrome
Upper: Pyelonephritis, renal abscesses
E. Coli #1 cause in women
Proteus species most common in men

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3
Q

S/S of lower UTI’s

A 
Dysuria is key symptom
Frequency
Nocturia
Urgency
Hematuria
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4
Q

Diagnostics of UTI

A

Urinalysis usually shows pyuria (>10WBC)
Presence of nitrate on dipstick (specific but not sensitive for bacteria)
Esterase detection on dipstick (very sensitive but not specific)

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5
Q

Management of lower UTI

A

3-day therapy maximizes benefits and minimizes drawbacks of treatment
Bactrim, Cipro, and augmentin
Pregnancy: amox, nitrofurantoin, cephalexin, for 7-10 days

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6
Q

Acute pyelonephritis s/s

A

Flank, low back pain or abdominal pain
Fever and chills often present and usually indicate upper UTI
N/V
Mental status changes in the elderly

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7
Q

Stress incontinence

A

Causes: muscles impairing urethral support (most common) and intrinsic sphincter deficiencies due to pelvic surgery

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8
Q

Findings of stress incontinence

A

Urine leakage from activities with increased pressure on bladder
Typically a small amount of urine

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9
Q

Urge incontinence causes

A 
Detrusor overactivity by CNS abnormalities such as strokes
Infections of the GU tract
Urinary Stones
Neoplasms
Fecal impaction
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10
Q

Urge incontinence findings

A

Urgency, involuntary urinary loss, nocturia, frequency
Often referred to as “overactive bladder”
Typically a large amount of urine

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11
Q

Management of stress incontinence

A

Timed voids to prevent full bladder
Pessary
Surgery

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12
Q

Management of urge incontinence

A

Urge suppression/distraction
Quick pelvic contractions
Medication

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13
Q

Patient teaching for incontinence

A 
Weight loss (good for urge incontinence)
Fluid management
Avoid caffeine
Pelvic floor exercises
Bladder control strategies (urge =freeze and squeeze, Stress= squeeze before you sneeze)
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14
Q

Muscarinic Receptor antagonists

A

Immediate release: Oxybutynin, Tolterodine, Trospium

Extended release: Darifenacin, fesoterodine, Dirtropan, Solifenacin, Detrol, Oxybutynin transdermal, oxybutynin gel

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15
Q

Varicocele

A

A collection of dilated veins around the spermatic cord

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16
Q

S/s of varicocele

A

Often asymptomatic
Scrotal pain
Scrotum looks like a “bag of worms”
Decreased fertility

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17
Q

Management of varicocele

A

NSAIDs

Surgical ligation, venous embolization

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18
Q

Tanner stage 1 in boys

A

Preadolescent testes, scrotum and penis

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19
Q

Tanner stage 2 in boys

A

Enlargement of scrotum and testes, scrotum roughens and reddens

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20
Q

Tanner stage 3 in boys

A

Penis elongates

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21
Q

Tanner stage 4 in boys

A

Penis enlarges in breadth and development of the glans; rugae appear

22
Q

Tanner stage 5 in boys

A

Adult shape and appearance

23
Q

Epididymitis

A

Acute inflammatory or infection of the scrotum, secondary to an inflamed epididymis
Commonly in men <35 yo w/ chlamydia as causative agent
When >35 yo likely a result of a bacterial ascension from the bladder or bacteria introduced during cauterization and/or surgery

24
Q

S/s of epididymitis

A 
Pain
dysuria
urgency/frequency
low back/perineal pain
Fever/chills
malaise
scrotal edema
25
Q

PE for epididymitis

A

Enlarged, tender epididymitis
Urethral d/c
Positive Prehn’s sign= no pain relief w/ elevation of scrotum

26
Q

Diagnostics for epididymitis

A

STD testing
Urine culture
scrotal US

27
Q

Management of epididymitis

A

Adults under 35= ceftriaxone 250mg IM x1 + doxycycline 100mg BID x14 days OR Azithromycin 1 gm PO once
Adults over 35= Bactrim 1 tab BID x 10 days OR Cipro 250 mg BID x10 days
Ice(early), heat (late)

28
Q

Acute Bacterial Prostatitis

A

Inflammatory infection of the prostate
Usually caused by gm- bacteria (E.coli)
Nonbacterial= mostly in young men, chlamydia, mycoplasma, gardnerella

29
Q

S/S of ABP

A 
Fever/chills
low back pain
dysuria
urgency/frequency
nocturia
30
Q

PE of ABP

A

Edematous prostate, may be warm and tender/boggy to palpation

31
Q

Diagnostics for ABP

A

Urine culture–+ for causative agent

32
Q

Management of ABP

A

Abx= Bactrim, Levofloxacin, nofloxacin, ofloxacin
Sitz bath 3x daily for 30 min each
No sexual intercourse until acute phase resolves

33
Q

Benign prostatic hypertrophy (BPH)

A

Progressive, benign hyperplasia of the prostate
By age of 50, 50% of men will exhibit signs
By 80, 80% of men
Most common cause of bladder obstruction in men over 50

34
Q

S/s of BPH

A

Urgency/frequency
Nocturia
Dribbling
Retention

35
Q

PE of BPH

A

Bladder distention
Prostate non-tender with either asymmetrical or symmetrical enlargement
Smooth, rubbery consistency with possible nodules

36
Q

Diagnostics of BPH

A 
U/A
Uroflowmetry
Abd US
Serum Cr/BUN should be normal
Prostate-specific antigen (PSA): >4ng/ml indicates disease
DRE
37
Q

Management of BPH

A

Alpha-blockers: Terazosin, prazosin, Tamsulosin to relax muscles of the bladder and prostate
5-alpha-reductase ihibitors: Finasteride and dutasteride to shrink large prostates
Saw palmetto–effective for some

38
Q

Prostate cancer

A

Malignant neoplasm of the prostate gland

2nd most common cancer among men

39
Q

S/s of prostate cancer

A

Usually asymptomatic
May appear to be BPH in early stages
In advanced stages= bone pain from metastises, uremia secondary to obstruction may occur

40
Q

PE of prostate cancer

A

Adenopathy
Bladder distention
Prostate palpates harder than normal with obscure boundaries, and nodules may be present

41
Q

Prostate-specific antigens (PSA)

A

Values >4ng/ml=abnormal
The higher the PSA—the more likely the diagnosis of cancer
Approx 40% of pts with prostate cancer with present with normal PSA values!

42
Q

Erectile Dysfunction

A

Inability to sustain an erection capable of intercourse

43
Q

Major causes of ED

A

Stress– psychosocial issues, performance anxiety
Athertosclerosis
Diabetes
Recreational drugs
Meds- diuretics, antihypertensives, H2 blockers, antidepressants, anti-anxiety agents, anti-epileptics, antihistamines, NSAIDS, muscle relaxants, Parkinsons meds

44
Q

Management of ED

A

Fix underlying cause
Check T level
Phosphodiesterase inhibitors: Sildenafil, vardenifil, tadalafil, avanafil (careful with use of nitrates!)

45
Q

What ED drugs can last up to 36 hours and works within 15 minutes?

A

Tadalafil and Avanafil

46
Q

Which ED drugs work in 30 minutes and last 4 hours?

A

Sildenafil and Vardenafil

47
Q

UTI’s in the older adult

A

Most common clinical illness over 65
E. coli
Enterococci
Typically have atypical findings such as incontinence, fecal impaction, lethargy, decreased appetite, dehydration, confusion

48
Q

Renal changes in the older adult

A

Diminished renal blood flow
Kidneys decrease in size
GFR diminishes
Reduced hormonal response to vasopressin
Bladder tone, elasticity and capacity are reduced
Decreased drug clearance

49
Q

How do you determine renal function in the elderly?

A

Creatinine clearance
Cockcroft-Gault Equation:
Males: Cr.Cl= 140 minus age in years x kg
/ 72 x creatinine
Females: multiply the calculated value by 85% (0.85)

50
Q

What is the normal Cr cl values in adults?

A

Males: < 40= 107-139 mL/min or 1.8 to 2.3 mL/sec
Females <40= 87-107 mL/min or 1.5-1.8 mL/sec
*Cr cl values usually decrease as one ages (6.5 mL/min for every 10 years after the age of 20)

GU (1 decks)

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