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PD3 > MALE GU 2 > Flashcards

MALE GU 2 Flashcards

1
Q

Lower UTI:

A

bladder (cystitis),

prostate (prostatitis)

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2
Q

Upper UTI

A

pyelonephritis

Urethritis

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3
Q

normal renal structure and function

A

Uncomplicated UTI:

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4
Q

structural/functional abnormality of the GU tract

A

Complicated UTI :

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5
Q

Risk factors for UTI

A

↑bacterial inoculation
i.e. sexual activity

↑binding of uropathogenic bacteria
i.e. decrease estrogen, menopause

↓urine flow
i.e. dehydration, obstruction

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6
Q

Frequency, dysuria, urgency, polyuria, hematuria

Suprapubic pain/ tenderness/ distension

A

Cystitis

Vaginal d/c: consider PID

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7
Q

Fever, chills, nausea, vomiting

NO DYSURIA
Pain/ tenderness: flank, CVA

A

Acute pyelonephritis

Dysuria only if with cystitis

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8
Q

Pain: perineum, rectum, scrotum, penis, bladder, lower back

Fever, malaise, nausea, vomiting

Urinary Sx

Swollen or tender prostate

A

Prostatitis

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9
Q

Infection-induced inflammation of the urethra (typically from a STI)

Majority are asymptomatic
Urethral discharge

Dysuria (in men)

A

Urethritis

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10
Q

UTI investigations

A

Urinalysis
Gram stain and urine culture
DNA probe/ NAAT
CBC

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11
Q

Imaging should be considered in a MALE patient with

A

Hx of kidney stones (esp. struvite - staghorn calculi
Diabetic Pt
Polycystic kidneys
TB

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12
Q

Plain film imaging (KUB)

A

May show radiopaque stones

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13
Q

Renal Ultrasound

A

to detect hydronephrosis, pyonephrosis, and perirenal abscess

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14
Q

Transrectal U/S

A

prostate abscess

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15
Q

CT scan

A

helpful for stones

Non-contrast: obstructive nephrolithiasis

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16
Q

F>M
Associated with psychiatric disorders (anxiety) & pain syndromes (fibromyalgia)

Clinical presentation:
Chronic bladder (suprapubic) pain with filling, relief with voiding
Urgency, frequency
Dyspareunia

Diagnosis:
Bladder pain with no other attributable cause for > 6 weeks*
Urinalysis: normal; Culture: negative
Cystoscopy: Hunner lesions or glomerulations (submucosal petechiae)

A

Interstitial Cystitis

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17
Q

Age < 35: Sexually transmitted (Chlamydia, gonorrhea)
Age > 35: Bladder outlet obstruction (E. coli)

Gradual* onset of testicular pain
Epididymal tenderness

Positive Prehn’s sign: pain relief with testicular elevation

U/S: Enlarged, thickened epididymis with increased blood flow on color Doppler;

A

Acute Epididymitis

Ultrasound r/o testicular torsion

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18
Q

Mumps (most common)
Could be bacterial

Abrupt onset of testicular pain

U/S**
Swollen testicles with hypoechoic and hypervascular areas; striated testicle

A

Acute Orchitis

Ddx: Testicular torsion

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19
Q

also called condyloma acuminata

Caused by human papillomavirus

verrucous and moist papules on the penis and perianal areas

A

Genital warts

20
Q

A cluster of small vesicles and pustules that turn to shallow, painful, nonindurated ulcers on a red base

Associated with systemic Sx

Usually fewer lesions on reinfection

A

Genital Herpes

21
Q

Caused by *Haemophilus ducreyi

Tender papule to pustule to nonindurated, painful ulcer with a purulent base and undermined or ragged borders.

Unilateral tender(painful) inguinal adenopathy to bubo

A

Chancroid

22
Q

Caused by *Treponema pallidum

Occurs in stages:
Primary: chancre*- oval or round, dark red, painless erosion or ulcer with an indurated base

Nontender enlarged inguinal lymph nodes

Secondary: rash, *condyloma lata, swollen glands, systemic symptoms

A

Syphilis

23
Q

Subfertility - bc increase temperature

Dull, scrotal pain or heaviness

Soft scrotal mass (“bag of worms

dilation of the pampiniform venous plexus and the internal spermatic vein

11% of men with RCC have this

L sided is most common

A

Varicocele

24
Q

Varicocele investigation

A

U/S and Doppler

Dilation of pampiniform plexus veins
Retrograde venous flow
Tortuous, anechoic tubules adjacent to the testis

25
Q

Collection of serous fluid resulting from a defect or irritation in the tunica vaginalis

Patent (peds) or non-patent (adults) procesus vaginalis

Association: indirect inguinal hernia, trauma, infection, testicular tumor

Investigation
U/S: fluid collection around the testis

A

Hydrocele

26
Q

PE:
10-20 yo
Acutely inflamed testis
Abnormal elevation and/or axis (horizontal lie) of the affected testicle
*Ipsilateral loss of the cremasteric reflex
(-) Prehn’s sign

Recurrent/ acute twisting of the spermatic cord
“Bell clapper” deformity

Ultrasound and doppler: absent flow*

A

testicular torsion

+ reflex does not R/O torsion

27
Q

Solid firm mass within the testis

Painless testicular swelling

10% have an associated hydrocele which transilluminates

More common before age 40
Risk factor: cryptorchidism

Seminoma: + ↑beta-hCG, normal AFP

A

testicular cancer

28
Q

Painless mass (unless strangulated)
Inguinal bulge that may increase in size and disappear when recumbent
Testis separable from hernia
No transillumination unless with hydrocele

A

indirect inguinal hernia

29
Q

Irritative Sx: F/U/D
Obstructive Sx: dribbling & hesitancy

Perineal/ suprapubic pain

Very tender, warm, swollen, boggy, enlarged gland

risk factors: Unprotected anal intercourse
UTI, Acute epididymitis

Mid-stream urine C/S: usually E. coli

A

Acute Bacterial Prostatitis

30
Q

Recurrent exacerbations of acute prostatitis-like symptoms

Post-ejaculatory pain

Normal prostate OR enlarged, boggy, moderately-severe tender prostate

Expressed prostatic secretion (EPS) > 10 WBC/HPF AND
Urine culture: E. coli most common

A

Chronic Bacterial Prostatitis

31
Q

Bone pain may be the presenting symptom

Urinary frequency, urgency, nocturia, and hesitancy 2ndary to BPH

: Slightly enlarged asymmetric prostate with nodularity noted

elevated PSA

A

Prostate Cancer

32
Q

BPH vs Prostate Cancer slide 37

A 
BPH:
•Age >50
•Central portion (transitional zone)
•Symmetrically enlarged, smooth prostate
•Can have ↑PSA

Prostate cancer
•Age> 40
•African American
•Family Hx
•Usually peripheral zone but can be anywhere
•Asymmetrically enlarged, nodular, firm prostate
•Markedly ↑PSA

33
Q

Urine + for HB and RBC casts

A

glomerulonephritis

34
Q

Urine + for HB but no RBC

A

hemoglobinuria (hemolytic anemia)

myoglobinuria (↑creatine kinase (CK) levels)

35
Q

painful hematuria

A

RCC
ADPKD
Calculus
Trauma

36
Q

painless hematuria

A

bladder cancer
RCC
ADPKD

37
Q

Urine - for Hb and no RBC

psuedohematuria

A

Foods: Beets, blackberries, rhubarb
Meds: Levodopa, rifampin, phenytoin
Metabolites: Porphyrin, bilirubin

38
Q

asymptomatic, usually incidental finding
“Painless hematuria” (40%)
“Too Late Triad”(10%) – advanced disease
flank pain, hematuria, and a palpable abdominal renal mass
Paraneoplastic Syndrome: 1/3 of patients:
EPO, renin, PTHrP

Risk Factors
Smoking
HTN
Obesity

U/A: +RBC
Abdominal CT is imaging of choice

A

RCC

39
Q

persistent (> 3 mos) inability to achieve or maintain a penile erection
precedes angina by 3 years
Investigations: Testosterone, HgbA1C, Lipid Panel

A

Erectile Dysfunction

40
Q

Non-colicky flank pain

Recurrent infections, or infections that will not clear

A

Kidney Stone:

41
Q

Severe waxing and waning flank pain radiating to groin, testis, or tip of the penis
Painful hematuria
Writhing, nausea, vomiting, diaphoresis

A

Ureteral Stone:

42
Q

Most common in men secondary to BPH

Storage and voiding LUTS, terminal hematuria, suprapubic pain

A

Bladder Stone:

43
Q

Branched stones that occupy a large portion of the collecting system,
Typically filling the renal pelvis and several or all of the calyces

A

Staghorn Calculus

44
Q

Hypertension (early onset)
Palpable abdominal masses (usually bilateral)
Urinalysis: Proteinuria, hematuria
Progressive renal insufficiency to chronic kidney disease

Ultrasonography: enlarged kidneys +
multiple renal cysts

A

Autosomal Dominant Polycystic Kidney Disease (ADPKD)

45
Q

Asymptomatic
Intermittent, gross, painless hematuria, present throughout micturition
Irritative symptoms: frequency, urgency, dysuria, incontinence

NO FLANK MASS

A

Bladder Cancer

PD3 (11 decks)

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