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Flashcards in GU tract dysfunction Deck (51):
1

What is the most common organism of UTIs in men?

proteus

2

What will urinalysis show in UTI

pyuria, >10 wbc

3

What will dipstick show in UTI

nitrate (specific not sensitive)
esterase (sensitive but not specific)

4

management of lower UTIs (primary and other considerations)

3 days therapy
trimethoprim-sulfa (bactrim), cipro and amox/clavulanate(augmentin)

Other considerations: amoxicillin, levofloxacin, nitrofurantoin (macro bid), trimethoprim, fosfomycin

5

treatment of UTI in pregnancy

amoxicillin, nitrofurantoin (macrobid) cephalexin (keflex) FOR 7-10 days!!! (increase the duration

6

Management of UPPER UTIs

14 day course vs 6 week course
TMP/SMX: bactrim
cipro or other quinolone
amoxicillin/clavulanate (augmentin)
amino glycosides (gent/tobra)

7

When would you hospitalize a patient with upper UTI (pyelonephritis)

nausea/ vom or more severe illness

8

Cause of stress (urethral incompetence) incontinence

Muscles impairing urethral support (most common)
intrinsic sphincter deficiencies due to pelvic surgery

9

findings of stress incontinence

urine leakage from activities with increased pressure on the bladder (lifting, coughing, exercise, sneezing, laughing, climbing, stairs)

10

Management of stress incontinence

times voids to prevent full bladder
pessary
surgery
squeeze before you sneeze
pelvic floor exercise

11

Causes of urge incontinence

detrusor overactivity
causes- detrusor hyperactivity by CNS abnormalities such as stroke
infectious agent of the GU tract
urinary stones
neoplasms

12

findings of urge incontinence

Urgency, involuntary urinary loss, nocturia, frequency
often referred as "overactive bladder"

13

Management of urge incontinence

urge suppression/ distraction
quick pelvic contractions
medication
freeze and squeeze

14

Pharmacotherapy for incontinence

Muscarinic receptor antagonists
immediate release: oxybutynin, tolterodine, trospium
extended release petrol LA, ditropan XL

15

Tanner stage 1 boys

Preadolescent testes, scrotum and penis

16

Tanner stage 2 boys

Enlargement of the scrotum and testes; scotrum roughens and reddens

17

Tanner stage 3

penis elongates

18

Tanner stage 4

Penis enlarges in breadth and development of glans; rugae appear

19

Tanner stage 5

adult shape and appearance

20

Age epididymitis common

35 yo likely from catheterization

21

causative organism in prostatitis

gram negative e coli

22

findings on physical exam for epididymitis

enlarged, tender, epididymis
urethral discharge
positive prehn's sign

23

What is prehns sign

relief of pain when testes elevated

24

diagnostic tests for epididymitis

STD testing, culture of urine, scrotal US

25

tx of epididimytis for under 35 yo

ceftriaxone 250mg IM x1 plus doxy 100mg BID OR
azithromycin 1 gram orally once
ice early, heat late
analgesics
bed rest

26

tx of epididimytis for over 35 yo

TMP/SMZ-DS 1 tab BID for 10 days or cipro 250mg BD for 10 days
ice early, heat late
analgesics
bed rest

27

physical findings for prostatitis

edematous prostate, may be warm and tender/ boggy to palpation, pain

28

diagnostics for prostatitis

urine culture- positive for causative agent

29

tx for prostatitis

consult/ refer if any urinary retention
antibiotics: TMP/SMZ (bactrim), levo or other quinolone
sitz bath TID for 30 minutes each
no sexual intercourse until acute phase resolves

30

Physical exam with BPH

prostate is non-tender with asymmetrical or symmetrical enlargement
smooth rubbery consistency with possible nodules

31

physical exam with prostate CA

adenopathy
bladder distension
prostates palpates harder than normal with obscure boundaries, and nodules may be present

32

diagnostics for BPH

UA rules out UTI, no hematuria
uroflowmetry
abdominal US
BUN/ cr normal
PSA >4
DRE

33

When can you start PSA and DRE?

PSA at 50 unless black or hx start at 40
DRE start at 40

34

about ___% of patients with prostate CA present with normal PSA values

40

35

Management of BPH

Observe condition
consult/refer as needed
Alpha-blockers: Terazosin (hytrin), prazosin (minipress), tamsulosin(flomax)
5-alpha-reductase inhibitors: finasteride (proscar) and dutasteride (avodart)
saw palmetto effective for some patients

36

How do alpha-blockers work?

relax muscles of the bladder and prostate

37

What are medications that cause erectile dysfunction

Diuretics
antihypertensives
H2 blockers
antidepressants
antianxiety agents
anti-epileptics
antihistamines
NSAIDS
muscle relaxants
parkinsons disease medications

38

What do you have to caution with concurrent use of with phosphodiesterase inhibitors

caution with the use of nitrates!

39

Which phosphodiesterase inhibitors do you have to take without food?

Sildenafil (viagra) and vardenafil (levitra)

40

Which phosphodiesterase inhibitors last up to 36 hours?

tadalafil (cialis) and avanafil )stendra)

41

How much does renal blood flow diminish after the age of 30?

renal blood flow and GFR decreased 10% every decade after 30/40

42

What makes the geriatric patient more at risk for dehydration?

reduced hormonal response to vasopressin and impaired ability to conserve sodium

43

How do you determine the GFR in the elderly?

by calculating the creatinine clearance

44

What is the normal creatinine clearance value in adults

males: 107-139 ml/min or 1.8-2.3ml/sec
females: 87-107 ml/min or 1.5-1.8ml/sec

45

How does cr clearance usually decrease as one ages?

decrease 6.5ml/min for every 10 years after the age of 20

46

What do you use to calculate the cr clearance?

cockcroft-gault equation

47

Cockcroft-gault equation

(140-age in years)x(body weight in kg)/ 72x(serum cr)
women: multiply by 85% (.85)

48

What are the gram negative causes of UTI

e coli
pseudomonas aeruginosa

49

What are the gram positive causes of UTI

enterococci
coagulase negative staph
strep agalactiae
s. aureas

50

What are some atypical UTI findings in the hero patient

incontinence
fecal impaction
lethargy
decreased appetite
dehydration
confusion

51

What considerations about UTI diagnostics should you consider?

in the urinalysis, WBCs may not be present in large numbers
leucocyte esterase and nitrates may be negative