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Genitourinary > GU Review > Flashcards

GU Review Flashcards

1
Q

What dx would you think if a pt presented with microscopic hematuria?

A

Nephrolithiasis

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2
Q

What 5 sxs would indicate that a pt with nephrolithiasis needs to be admitted to the hospital?

A
  • Concomitant obstruction and infxn
  • Intractable vomiting
  • Uncontrollable pain
  • Urinary extravasation
  • Hypercalcemic crisis
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3
Q

What is the MC type of bladder cancer?

A

Transitional cell carcinoma

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4
Q

What are the risk factors for bladder cancer?

A
  • Cigarette smoking

- Industrial (aniline) dye

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5
Q

What is the MC type of prostate cancer?

A

Adenocarcinoma

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6
Q

What are the risk factors for prostate cancer?

A
  • Age
  • AA
  • High fat diet
  • Fam hx
  • Exposure to herbicides and pesticides
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7
Q

What is the MC type of testicular cancer?

A

Germ cell tumor-Seminomas (95%)

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8
Q

What are the risk factors for testicular cancer?

A
  • Cryptorchidism
  • Painless mass/lump
  • Firmness of teste
  • Gynecomastia
  • Klinefelter syndrome
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9
Q

What is the MC type of penile cancer?

A

Squamous cell

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10
Q

What are the risk factors for penile cancer?

A
  • 7th decade of life
  • Uncircumcised
  • HSV and HPV 18
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11
Q

When treating incontinence what do you treat first, urge or stress?

A

Treat urge before stress

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12
Q

What are the Urge/OAB treatment options (both pharm and non-pharm)

A
  • Bladder training: timed/prompted voiding helps avoid full bladder
  • Antimuscarinics: Oxybutynin
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13
Q

What is the MOA of Oxybutynin?

A

MOA: relax/block excess detrusor activity

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14
Q

What are the treatments for stress incontinence?

A
  • Kegel exercises
  • Beta-3 Agonist (Mirabegron)
  • Estrogen therapy
  • Paralytic agents: botulinum toxin A intravesical injection
  • Pessary
  • Surgery: mid urethral sling
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15
Q

What is the MOA of Beta-3 Agonist (Mirabegron)?

A

MOA: relaxes the detrusor smooth muscle during urine storage phase thus increasing bladder capacity

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16
Q

What is the MOA of Estrogen therapy?

A

MOA: plumps up tissue around bladder sphincter

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17
Q

What is stress incontinence d/t?

A

D/t increase abdominal pressure under stress (weak pelvic floor muscles)

[coughing, sneezing, or laughing]

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18
Q

Tell me if there are any of these in stress incontinence?

  • Urgency
  • Frequency
  • Nocturia
  • Episode during physical activity
  • Leakage volume
A
  • Urgency: Rare
  • Frequency: Rare
  • Nocturia: No
  • Episode during physical activity: Yes
  • Leakage volume: Small
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19
Q

What is urge incontinence d/t?

A

D/t involuntary contraction of bladder muscles occurring day or night.

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20
Q

Tell me if there are any of these in urge incontinence?

  • Urgency
  • Frequency
  • Nocturia
  • Episode during physical activity
  • Leakage volume
A
  • Urgency: Yes
  • Frequency: Yes
  • Nocturia: Yes
  • Episode during physical activity: Rare
  • Leakage volume: Large
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21
Q

What is overflow incontinence d/t?

A

D/t blockage of the urethra, poor stream, and incomplete emptying

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22
Q

Tell me if there are any of these in overflow incontinence?

  • Urgency
  • Frequency
  • Nocturia
  • Episode during physical activity
  • Leakage volume
A
  • Urgency: Yes
  • Frequency: Sometimes
  • Nocturia: No
  • Episode during physical activity: Rare
  • Leakage volume: Small
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23
Q

What would you see on a UA in a pt with nephrolithiasis?

A
  • Microscopic or gross hematuria
  • Pyuria or bacteriuria
  • Crystal composition
  • pH: acidic
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24
Q

What would you see on a UA in a pt with UTI (acute cystitis)?

A
  • Bacteriuria >1 organism
  • Pyuria >10 leukocytes
  • Leukocyte Esterase
  • Nitrites
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25
Q

What would you see on a UA if it was not a clean catch?

A

Presence of squamous epithelial cells = vulvar or urethral contamination

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26
Q

What would you see on a UA in a pt with pyelonephritis?

A
  • Leukocyte casts
  • Pyuria
  • Bacteriuria
  • Hematuria and proteinuria may be noted
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27
Q

What would you see on a UA in a pt with hemorrhagic cystitis?

A
  • WBC (sterile pyuria)
  • RBC
  • Bacteria usually negative
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28
Q

What would you see on a UA in a pt with bladder cancer?

A

Painless hematuria

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29
Q

What would you see on a UA in a pt with bacterial prostatitis?

A

Numerous sheets of leukocytes

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30
Q

What is Phenazopyridine used for?

A
  • Tx for dysuria, numbs the bladder

- Use BID in the 1st and 2nd day of UTI

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31
Q

What should you tell your pts when prescribing Phenazopyridine?

A

Will turn urine bright orange

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32
Q

What is the clinical presentation of Nephrolithiasis?

A
  • Sudden onset of severe pain
  • Pain begins in the flank then radiates towards groin
  • N/V
  • Hematuria
  • UTI
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33
Q

What is the MC to least common stone type?

A
  • Calcium oxalate: bipyramidal/biconcave ovals
  • Calcium phosphate: amorphous
  • Uric acid: flat square plaques
  • Struvite: staghorn
  • Cystine: haxagon shape
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34
Q

What imaging would you get for a pt with Nephrolithiasis?

A
  • Initial imaging: plain film XR
  • Gold standard for dx and most sensitive: spiral CT scan w/o contrast
  • IVP: more useful for defining the degree and extent of urinary tract obstruction
  • Renal US: detection of hydronephrosis of hydroureter (where blockage is)
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35
Q

What stones are radiopaque (seen on XR)?

A
  • Calcium oxalate
  • Calcium phosphate
  • Struvite
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36
Q

What stones are radiolucent (seen on CT, US, IVP)?

A
  • Uric Acid

- Cystine

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37
Q

What is the management for a pt with Nephrolithiasis?

A
  • Vigorous IV hydration
  • Analgesics: opioids, Ketorolac
  • Antibiotics: if UTI present
  • Tamsulosin: smooth muscle to easier pass stone
  • Consult if not passed in 3 days
  • Surgery
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38
Q

What are the surgical options for Nephrolithiasis?

A
  • Extracorporeal shock wave lithotripsy

- Ureteroscopic stone removal

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39
Q

What is extracorporeal shock wave lithotripsy? and what size stone is best for this tx?

A
  • MC surgical method
  • Breaks stones into small pieces
  • Best for stones >5mm but <2 cm in diameter
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40
Q

What is Ureteroscopic stone removal? and what size stone is best for this tx?

A
  • Used if shock wave fails
  • Best for larger stones
  • Surgical removal and may incorporate use of stent
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41
Q

What are the dietary prevention measures for a pt with Nephrolithiasis?

A
  • High fluid intake (2L/day)
  • Natural lemonade
  • Limit animal protein
  • Limit calcium intake
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42
Q

What are the pharm prevention measures for a pt with Nephrolithiasis?

A
  • Thiazide diuretics

- Allopurinol

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43
Q

What is a spermatocele?

A

Epididymal cyst containing sperm aka: scrotal mass

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44
Q

What are the characteristics of a spermatocele?

A
  • > 2 cm
  • Painless, cystic testicular mass on PE
  • Round, soft, freely mobile
  • Benign
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45
Q

What are the characteristics of the testicular cancer: germ cell embryonal carcinoma? and what are the mets?

A
  • Highly malignant
  • Hemorrhage and necrosis are common
  • Mets to abdominal lymphatics and lungs early
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46
Q

What are the characteristics of the most aggressive testicular cancer: germ cell choriocarcinoma? and what are the mets?

A
  • Rare

- Metastases usually occur prior to diagnosis

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47
Q

What are the characteristics of the non-germ cell testicular cancer: Leydig cell tumor?

A
  • Hormonally active, secretes estrogen and androgens
  • Associated precocious puberty in children
  • Gynecomastia in adults
  • Usually benign but poor prognosis if metastasize
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48
Q

What is Fournier’s gangrene?

A

Rapidly spreading necrotizing infxn of scrotum that progresses to gangrene and may travel to abdomen

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49
Q

What are the risk factors for Fournier’s gangrene?

A
  • DM
  • Obesity
  • Pelvic trauma
  • Immunocompromised
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50
Q

What is the causative agent for Fournier’s gangrene?

A
  • Polymicrobial

- Causative agent may originate from integumentary, urethra, or rectum.

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51
Q

What is testicular torsion? and is the onset acute or gradual?

A
  • Ischemia to teste leading to infarction, twisting of 3 spermatic cords
  • Onset: Acute
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52
Q

What are the clinical manifestations of testicular torsion?

A
  • Swelling and tenderness
  • Elevated testicle (bell clapper deformity)
  • Absent prehns sign
  • Absent cremasteric reflex
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53
Q

What is the diagnostic studies used to dx testicular torsion?

A
  • UA: normal

- Doppler US or clinical dx

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54
Q

What is the tx for testicular torsion?

A

Emergent surgery within 6 hrs

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55
Q

What is Epididymitis? and is the onset acute or gradual?

A
  • Inflammation of epididymis, erythematous, painful swelling

- Onset: Gradual

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56
Q

What is associated with sexually transmitted Epididymitis? and what are the MC causative agents?

A
  • Associated with urethritis

- MC agents: C. trachomatis and N. Gonorrhea

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57
Q

What is associated with non-sexually transmitted Epididymitis? and what are the MC causative agents?

A
  • Associated with prostatitis or acute cystitis

- MC agents: E. coli, Pseudomonas, Klebsiella

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58
Q

What are the clinical manifestations of Epididymitis?

A
  • Swelling and tenderness
  • Fever/Chills
  • Urethral d/c
  • Positive Prehns sign
  • Positive Cremasteric reflex
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59
Q

What is the diagnostic studies used to dx Epididymitis?

A
  • UA: may develop pyuria

- Doppler US to distinguish between testicular torsion

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60
Q

What is the tx for Epididymitis?

A

Antibiotics

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61
Q

What is varicocele and what does it result from?

A
  • Dilation of veins that drained into the internal spermatic veins
  • Results from incompetent internal spermatic vein valves
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62
Q

What are the S/Sxs and PE findings in a pt with varicocele?

A
  • Dilated tortuous veins “bag of worms”
  • Heavy sensation
  • Swelling decreases when pt is laying supine
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63
Q

What is the cause of primary varicocele?

A

Usually idiopathic in nature.

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64
Q

What is the cause of secondary right side varicocele?

A

Abdominal mass compression of the renal veins

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65
Q

What is the cause of secondary left side varicocele?

A

Superior mesenteric artery compression of the left renal vein (aka “Nutcracker Syndrome”) MC’y d/t RCC

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66
Q

What are S/Sxs of prostate cancer?

A
  • Asymptomatic in early course
  • Begins in periphery of gland then moves centrally (starts to press on urethra)
  • Difficulty in voiding/starting stream
  • Dysuria
  • Increased urinary frequency
  • Weight loss
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67
Q

Where are the mets for prostate cancer?

A

Mets to lymph nodes or bone (spine and pelvis)

- Causes back pain

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68
Q

What are the DRE findings in a pt with prostate cancer?

A

Hard, nodular, irregular in morphology (feels like knuckle)

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69
Q

What is the management for prostate cancer?

A
  • Radical prostatectomy: MC complications are ED and urinary incontinence.
  • Orchiectomy: used in pts who were noncompliant w/ medical therapies
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70
Q

What is characteristics of acute bacterial prostatitis?

A
  • Less common

- Younger men

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71
Q

What are the causative agents for both acute and chronic bacterial prostatitis?

A
  • > 35 YOA: E. coli

- <35 YOA: N. gonorrhea and C. Trachomatis

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72
Q

What are the S/Sxs of acute bacterial prostatitis?

A
  • Fever/Chills
  • Dysuria
  • Perineal pain
  • LBP
  • Increased urinary frequency, hesitancy, urgency, and retention
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73
Q

What are the DRE findings in a pt with acute bacterial prostatitis?

A

Bogy, exquisitely tender prostate

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74
Q

What is the tx for acute bacterial prostatitis?

A

If severe hospitalize, start on antibiotics:

  • Trimethoprim-sulfamethoxazole
  • Fluoroquinolones
  • Doxy
  • Ceftriaxone
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75
Q

What is characteristics of chronic bacterial prostatitis?

A
  • More common

- Men 40-70 yo

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76
Q

What are the S/Sxs of chronic bacterial prostatitis?

A
  • Commonly asymptomatic
  • Fever is uncommon and typically don’t appear ill.

If sxs are present they are:

  • Frequent UTI w/ irritative urination and/or obstructive sxs
  • Dull poorly localized pain in LB, perineum, scrotum, or suprapubic region.
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77
Q

What are the DRE findings in a pt with chronic bacterial prostatitis?

A

Enlarged usually non-tender

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78
Q

What is the tx for a pt with chronic bacterial prostatitis?

A

Fluoroquinolone: Cipro, levofloxacin, etc.

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79
Q

What are the S/Sxs of BPH?

A

HI FUN

  • H: hesitancy
  • I: intermittence, incontinence
  • F: frequency, fullness
  • U: urgency
  • N: nocturia
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80
Q

What is the dx study for BPH?

A

DRE: enlargement of prostate

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81
Q

What is the tx for BPH?

A
  • Alpha 1 blockers: Tamsulosin, Doxazosin, Alfuzosin, Silodosin
  • 5-alpha reductase inhibitors: Finasteride, Dutasteride
  • Surgical: TURP
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82
Q

What are the pathogens responsible for Prostatitis?

A
  • E. coli
  • N. gonorrhea
  • C. Trachomatis
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83
Q

What are the pathogens responsible for Epididymitis?

A
  • N. gonorrhea
  • C. Trachomatis
  • E. coli
  • Pseudomonas
  • Klebsiella
84
Q

What are the pathogens responsible for Balanitis?

A

Candida albicans

85
Q

What is the MCC of ED?

A

Decreased arterial flow d/t progressive vascular disease

86
Q

What are other causes/risk factors for ED?

A
  • HTN
  • Smoking
  • Dyslipidemia
  • DM
87
Q

What is Priapism?

A

Painful, prolonged erection >4hrs long

88
Q

What are the medications that causes of Priapism?

A
  • Trazodone
  • Phenothiazine
  • PDE5-Inhibitors
  • Papaverine injection
89
Q

Aside from medications what are the other causes of Priapism?

A
  • Spinal cord injury
  • Sickle cell
  • Leukemia
90
Q

What are the CI for testosterone therapy?

A
  • Prostate CA
  • Elevated Hematocrit >55% -polycythemia
  • CHF
  • Women/Pregnancy
91
Q

What is phimosis?

A

Inability to retract the foreskin

92
Q

What is paraphimosis?

A
  • Inability to reduce the foreskin back to the anatomic position
  • a medical emergency, the foreskin can create tourniquet effect on penis
93
Q

What is balanitis?

A

Inflammation of the superficial tissues of the glans (mushroom top)

94
Q

What is balanoposthitis?

A

Inflammation of the foreskin and glans

95
Q

What is hypospadias?

A

Urethral meatus opens onto the ventral side of the penis

Coronal is MC

96
Q

What is Peyronie’s disease? and what is the cause?

A
  • Abnormal curvature and shortening of the penis during an erection.
  • Caused by scarring of the tunica albuginea
97
Q

What is the clinical presentation of Peyronie’s disease?

A
  • Tenderness over the scar tissue area of penile shaft
  • Painful curvature of erected penis
  • Eggplant deformity
98
Q

What condition is associated with Peyronie’s disease?

A

Dupuytrens contracture

99
Q

What is the causative agent for Chlamydia?

A

Chlamydia trachomatis

MC bacterial sexually transmitted infxn

100
Q

What is the causative agent for Gonorrhea?

A

Neisseria Gonorrhoeae

101
Q

What is the causative agent for Syphilis?

A

Treponema pallidum - spirochetal infxn

102
Q

What is the causative agent for Chancroid?

A

Haemophilus Ducreyi

- MC in subtropical and tropical regions of the Caribbean and Africa

103
Q

What is the causative agent for Phthisis Pubis?

A

Lice-smaller and wider than head lice

104
Q

What is the causative agent for Genital herpes?

A

HSV-2

105
Q

What is the clinical presentation in men and women with Chlamydia?

A
  • Men: dysuria, purulent urethral d/c, scrotal pain and swelling, fever
  • Women: purulent urethral d/c, intermenstrual or postcoital bleeding, dysuria
106
Q

What is the clinical presentation in men and women with Gonorrhea?

A
  • Men: purulent d/c, dysuria, urethral meatus erythema and edema, increased urinary frequency
  • Women: usually asymptomatic, purulent d/c, dysuria, intermenstrual bleeding, dyspareunia
107
Q

What is the tx for Chlamydia?

A

Azithro 1g PO or Doxy x7 days
+
tx for gonorrhea: Ceftriaxone IM x1

108
Q

What is the tx for Gonorrhea?

A

Ceftriaxone IM x1 + Azithro 1g PO x1

109
Q

What are complications in men and women caused by Chlamydia?

A
  • Men: epididymitis, proctitis
  • Women: infertility d/t tubal scarring, PID/salpingitis, tubo-ovarian abscess, ectopic pregnancy, fitz-high-curtis syndrome
110
Q

What are complications caused by Gonorrhea?

A

Disseminated gonococcal infection:

  • Fever, arthralgias, tenosynovitis (hands and feet)
  • Endocarditis
  • Skin rash on palms and soles (erythematous halos, necrotic center)
  • Ocular gonorrhea
111
Q

What are S/Sxs of primary stage of syphilis?

A
  • Chancre- painless crater like “punched out” lesions
  • Clean bases
  • Appears 3-4 wks after exposure
112
Q

Is primary stage contagious and how do you treat this stage?

A
  • Highly contagious

- Heals in 1-4 wks w/o management

113
Q

What are S/Sxs of secondary stage of syphilis?

A
  • Maculopapular and papulosquamous rash, including palms and soles.
  • Condylomata lata: moist lesions on genitals
114
Q

Is secondary stage contagious and what happens if it is left untreated?

A
  • Highly contagious

- If left untreated can develop into latent syphilis

115
Q

What are S/Sxs of latent stage of syphilis?

A

Asymptomatic

116
Q

What are S/Sxs of tertiary stage of syphilis?

A
  • May occur anytime (40+ yrs)
  • CV effects
  • Neurosyphilis
  • Gummas
  • Tabes Dorsalis
  • Argyll-roberson pupils
117
Q

What are the CV effects caused by the tertiary stage of syphilis?

A

Syphilitic aortitis w/ ascending aortic aneurysm

118
Q

What are the neuro caused by the tertiary stage of syphilis?

A

Dementia, personality changes, HA, hearing/vision loss

119
Q

What are Gummas caused by the tertiary stage of syphilis?

A

SubQ granulomas

120
Q

What are Tabes Dorsalis caused by the tertiary stage of syphilis?

A

Posterior column deterioration, leading to ataxia, areflexia, burning pain and weakness

121
Q

What are Argyll-roberson pupils caused by the tertiary stage of syphilis?

A

Small irregular pupil that constricts normally to near accommodation but not to light

122
Q

When is congenital syphilis transmitted?

A

Vertical transmission in 3rd month of pregnancy

123
Q

What are the S/Sxs of congenital syphilis?

A

Skin and bone lesions:

  • Hutchinson teeth
  • Mulberry molars
  • Saddle nose
  • Hepatosplenomegaly
  • Interstitial keratitis
  • 8th nerve deafness
124
Q

What is the tx for syphilis?

A

Penicillin G benzathine IM x1

125
Q

What is the description of chancroid lesions?

A
  • Begins as papules or nodules
  • painful well circumscribed non-indurated soft ulcers, tender
  • Inguinal lymphadenopathy
126
Q

What are the clinical presentations in men and women with chancroid?

A
  • Men: single lesion

- Women: multiple lesions (kissing ulcers)

127
Q

What is pathognomonic for chancroid?

A

Painful ulcers + suppurative LAD

128
Q

What is the tx for chancroid?

A

Azithro PO or Ceftriaxone IM

129
Q

What is the complication of chancroid?

A

Tissue destruction

130
Q

What is the clinical presentation of Phthisis Pubis?

A
  • Intense pruritus, erythema, papules, excoriation hemorrhagic crusts
  • Lesions may also be on lower abdomen, pubic/perianal region, and thighs
131
Q

What is the tx for Phthisis Pubis?

A

5% permethrin cream or 1% lindane shampoo

- Permethrin cream safest and most effective

132
Q

How do you tell your pt to use permethrin cream?

A
  • Applied to all hair bearing areas and left on overnight
  • Rinsed in the AM
  • Repeat in 1 wk
133
Q

What is the clinical presentation for first episode of genital herpes?

A

Most are asymptomatic but first episode are associated w/severe local sxs:

  • Painful bilateral genital ulcer or vesicles
  • Inguinal adenopathy
  • Fever
  • Malaise
  • Myalgia
134
Q

What is the clinical presentation for recurrent episodes of genital herpes?

A
  • Prodromal itching
  • Burning
  • Tingling
135
Q

What is the tx for genital herpes?

A
  • Acyclovir
  • Valacyclovir
  • Famciclovir
136
Q

What are the MC bugs that cause UTIs?

A
  • > 35 YOA: E.Coli
  • <35 YOA: Chlamydia Trachomatis
  • Enterococcus: young females learning to wipe
137
Q

What is the clinical presentation of an UTI?

A
  • Fever
  • Suprapubic tenderness
  • Vomiting
  • Dysuria
  • Urgency
  • Frequency
  • Enuresis
  • Change in urine color
  • Foul odor
  • Gross hematuria (sometimes)
138
Q

What is the management for an UTI?

A
  • TMP/SMX (Bactrum DS)
  • Cephalexin (works against e.coli)
  • Nitrofurantoin - do not use in early pyelo
  • Fosfomycin- do not use in early pyelo
  • Amoxicillin- less popular d/t high rates of resistant microbes
  • Fluroquinolones (ciro levo) - warning tendonopathies
  • Ceftriaxone + doxy or azithro if chlamydia is suspect
139
Q

What is the dysuria management for a patient with an UTI?

A

Phenazopyridine: urinary analgesic

-Caution w/ sulfa allergy

140
Q

What is the management for a pregnant women with an UTI?

A
  • Ampicillin, amoxicillin, oral cephalosporins

- Avoid fluroquinolones

141
Q

What is the management for a man with an UTI?

A

flouroquinolones due to good penetration into prostate tissue

142
Q

What is the management for patients on warfarin and has an UTI?

A
  • Penicillins, cephalosporins, doxy

- Avoid fluroquinolones and TMP/SMX

143
Q

What is the most common bug causing pyelonephritis (upper UTI)?

A

E.coli

144
Q

What are the signs and symptoms of pyelonephritis?

A
  • Fever/Chills
  • Flank pain
  • Sxs of cystitis-dysuria
  • N/V/D
  • Tachycardia
  • Appear more ill (septic)
  • CVA tenderness
  • Abdominal tenderness
145
Q

What is the management for uncomplicated pyelonephritis?

A
  • TMP/SMX or fluroquinolone
  • Amoxicillin (good for S. saprophyticus and enterococci)
  • Ceftriaxone or gentamicin (IM)
146
Q

What is the management for complicated pyelonephritis?

A

Ampicillin + gentamicin or cipro

147
Q

What is the etiology of interstitial cystitis?

A
  • Unknown
  • Negative urine culture
  • Hx of pediatric bladder problems
  • Thinning of epithelial lining
148
Q

What are the symptoms of interstitial cystitis?

A
  • Pain w/ filling bladder
  • Relieved with micturition
  • Increased frequency and urgency
  • Nocturia
149
Q

What is the management for interstitial cystitis?

A
  • Hydrodistension
  • Amitriptyline
  • Nifedipine (CCB)
  • Pentosan polysulfate sodium: restores epithelial integrity
150
Q

What is the definition of cryptorchidism?

A

Undescended testicle, testicle is not within the scrotal sac and cannot be manipulated down into the scrotum
-Most descent spontaneously and within the first 6 mos of life

151
Q

What is are bilateral undescended testicles suggestive of?

A

disorder of sexual development and lab evaluation is needed

152
Q

What is done if the testicle is still undescended by 6 months of age?

A

Refer to urology for orchiopexy

  • Viable undescended testicle is manipulated into scrotum and sutures into place
  • If non-viable teste, it is removed
153
Q

What is done if teste is distally located?

A

Hormonal therapy may be effective

- IM of human chorionic gonadotropin

154
Q

What is nocturnal enuresis?

A
  • Immature of cortical control of bladder
  • Decreased function bladder capacity
    (night time)
155
Q

Are strong family history or genetics associated with nocturnal enuresis?

A

yes

156
Q

Who is daytime incontinence most common in?

A

girls

157
Q

What is daytime incontinence most commonly due to?

A

waiting too long to void

158
Q

What is giggle (stress) incontinence?

A
  • Sudden relaxation of urinary sphincter during giggling or Valsalva maneuver
  • Results in loss of total urinary volume in bladder
  • Girls ages 7-15
159
Q

What is grade 1 of vesicoureteral reflux?

A
  • Reflux into the ureter w/o dilation

- No tx needed

160
Q

What is grade 2 of vesicoureteral reflux?

A
  • Reflux into the ureter and collecting system w/o dilation

- No tx needed

161
Q

What is grade 3 of vesicoureteral reflux?

A
  • Reflux into the ureter and collecting system w/ mild dilation of ureter and blunting of calyces
  • Prophylactic antibiotics w/ follow up VCUG to see if there is resolution
162
Q

What is grade 4 of vesicoureteral reflux?

A
  • Reflux into the ureter and collecting system w/ more significant dilation of ureter and blunting of calyces
  • Surgical intervention
163
Q

What is grade 5 of vesicoureteral reflux?

A
  • Massive reflux w/ dilation and tortuosity of ureter and dilation of collecting system.
  • Surgical correction
164
Q

What is the follow-up eval for infant with recent febrile UTI?

A

renal/bladder ultrasound

165
Q

What is the presentation of syphilis?

A
  • Primary and secondary have painless ulceration lesions calls chancres. Highly infective at this stage.
  • Tertiary: asymptomatic, organ involvement
166
Q

What is the treatment for syphilis?

A
  • Benzathine Pen G 1.4 million units IM
  • Late latent infxn: Benzathine Pen G 2.4 million units q wk x3
  • Beta-lactam allergy: doxy 100mg BID x 14 days
167
Q

What is the treatment for pyelonephritis?

A

Empiric tx (PO, outpatient) is FQ

  • Cipro 500mg PO BID x7days
  • Levo 750mg PO 5-7 days

Consider initial dose of parenteral agent then complete tx based on culture and sensitivity

  • Cipro 400mg IV x1 dose
  • Ceftriaxone 1gm IM or IV x1 dose
168
Q

What is the treatment for acute cystitis?

A
  • Nitrofurantoin 100mg BID x5 days

- TMP/SMX BID x3 days

169
Q

How is CroFab prepared?

A
  • CroFab is a sheep-derived antivenim
  • 18 mL of 0.9% Sodium Chloride is added to the vial and mixed by continuous manual inversion until no solid material is visible in the vial
  • Do not shake
  • Further dilute the entire dose with 0.9% Sodium Chloride to a total volume of 250 mL
170
Q

How is CroFab administered?

A
  • Slowly infuse then increase if tolerated, Infuse each dose intravenously over at least 1 hour
  • Start with 6 vials, if initial control does not occur in 1 hr repeat 6 vials
  • If initial control does occur maintain with 2 vials every 6 hours x3 if needed
171
Q

What are the causes and clinical presentation for anticholinergic?

A

Mydriasis, dry flushed skin, delirium, hyperthermia, tachycardia, urinary retention, hypoactive bowels
“cant see, cant pee, cant shit, cant spit”,
ataxia, agitation, delirium, hallucinations, coma, incoherent speech, visual hallucinations

172
Q

What is the antidote for atropine?

A

physostigmine

173
Q

What is the antidote for TCAs?

A

Sodium bicarbonate

174
Q

What are the causes/clinical presentations of cholinergic?

A

SLUDGE

  • S: salvation
  • L: lacrimation
  • U: urination
  • D: diaphoresis
  • G: GI (diarrhea)
  • E: emesis
175
Q

What is the antidote for cholinergic?

A

Tx with atropine: bronchorrhea, bronchospasm, bradycardia, hypoTN
-May have muscular weakness including diaphragm caused by nicotinic stimulation that will NOT response to atropine

176
Q

What is the antidote for organophosphates?

A
  • Atropine

- Pralidoxime

177
Q

When do you give flumazenil?

A

reversal for pure benzo sedation, ie when benzo has been administered in hospital setting

178
Q

When do you not give flumazenil?

A

not recommended to give to OD victims d/t seizure risks

179
Q

Management for acetaminophen overdose - NAPQI

A

NAPQI is a toxic byproduct that is usually immediately detoxified in the liver however in conditions such as an APAP OD it is not effectively detoxified and causes severe liver necrosis.

180
Q

What is the antidote for APAP OD?

A

NAC (N-acetylcysteine)

  • Administered if >8hr post ingestion or if unknown time of ingestion.
  • NAC replenishes glutathione (which is a key role in detoxifying reactions) and acts as a glutathione substitute to bind to NAPQI to make it a nontoxic product.
181
Q

What is the antidote for cyanide?

A

Amyl nitrate then Hydroxocobalamin (Cyanokit): sodium nitrate then sodium thiosulfate

182
Q

Is IV access needed to administer amyl nitrate?

A

no it isn’t

183
Q

Is IV access needed to administer Cyanokit?

A

yes it is needed

184
Q

What is the treatment for cyanide poisoning?

A
  • Activated charcoal: Ingested cyanide salts
  • Water: skin and eyes
  • Hemodialysis: removed extracellular reserve of cyanide, corrects severe metabolic acidosis.
185
Q

What is the antidote for carbon monoxide?

A

oxygen

186
Q

What is the treatment for carbon monoxide poisoning?

A

treat cardiac arrest or dysrhythmias via ACLS guidelines and removed pt from area of exposure.

187
Q

What is the antidote for serious bleeding after warfarin overdose

A

Kcentra

  • Replacement produce indicated for urgent reversal of acquired coagulation factor deficiency induced by warfarin therapy in adult pts w/ acute major bleed or need for urgent surgery.
  • Must be followed by IV Vitamin K as Kcentra has short half-life and clotting factors need to be rebuilt.
188
Q

What is the antidote for warfarin overdose?

A

Vitamin K

  • If serious bleed follow Kcentra with 10 mg IV Vitamin K (monitor for anaphylactoid rxns)
  • If INR is >10 or <10 but needs to be decreased quickly hold warfarin and use PO Vitamin K if possible
189
Q

What is the treatment for warfarin overdose?

A
  • Replace missing clotting factors (Kcentra)
  • Provide Vitamin K
  • If it is an acute bleed both may be needed (INR >3, trauma INR 2-3)
  • If no significant bleed may just be able to give Vitamin K
190
Q

What is the antidote for lead?

A

Calcium EDTA, Dimercaprol (BAL), Succimer, or D-Penicillamine
-All are chelators

191
Q

What should be given immediately after the second dose of BAL and continues for 5 days?

A

IV Calcium EDTA

192
Q

What is the antidote for iron?

A

deferoxamine

193
Q

What is the MOA for antimuscarinics?

A

relax/block excess detrusor activity

194
Q

What is the MOA for Beta-3 agonist (mirabegron)?

A

relaxes the detrusor smooth muscle during urine storage phase thus increasing bladder capacity

195
Q

What is the MOA for local estrogen (applied to vagina/external urethra)?

A

plumps up the tissue around the bladder sphincter

196
Q

What is the MOA for paralytic agents: Botulinum Toxin A intravesical injection?

A

Prevents muscular contraction by inhibiting acetylcholine release at the neuromuscular junction

197
Q

What is MOA of Alpha-1 blockers?

A

synthetic testosterone derivative, decreases synthesis of DHT

198
Q

What is the MOA of 5-Alpha Reductase Inhibitor?

A

Reduce prostate volume

199
Q

What is the MOA of 5-PDE inhibitors for BPH?

A

improves sxs of BPH by SM relaxation of prostate tissue

200
Q

What are the indications for nitrofurantoin?

A

first line for simple acute cystitis and recurrent UTI

201
Q

What medications have better penetration in management of first uncomplicated UTIs?

A
  • Nitrofurantoin

- TMP/SMX

202
Q

What is Torsion of Testicular Appendix?

A
  • Small, hard, tender nodule
  • ischemic appendage
  • located: the superior aspect of testicle
203
Q

How does torsion of Testicular Appendix differ from testicular torsion?

A

In Torsion of Testicular Appendix the testicle as a whole is not tender only the nodule.

204
Q

What is a classic clinical finding of Torsion of Testicular Appendix? and when do you refer?

A
  • The blue dot sign

- Referral to urology or primary care provider within 1 wk

205
Q

What is the key neurotransmitter that initiates and sustains an erection?

A

Nitric Oxide

Genitourinary (2 decks)

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