Renal. Hydronephrosis+ BPH+ED (08-02) (1)

Question 1

FA. Hydronephrosis. definition? and mechanism?

Answer 1

dilation of the urinary tract.

Dilation is secondary to downstream obstruction of urinary tract.

Question 2

FA. Hydronephrosis. causes in children 3

Answer 2

obstruction at the ureteropelvic junction

may also be at ureterovesicular junction

or at bladder outlet (eg from posterior urethral valves)

Question 3

FA. Hydronephrosis. causes in adults?

Answer 3

BPH
aortic aneurysm

Question 4

FA. Hydronephrosis. causes in both children and adult? 3

Answer 4

neurogenic bladder (spinal cord injuries), tumors, renal calculi.

Question 5

FA. Hydronephrosis.
Apart from obstruction can be caused by excessively high out-put urinary flow and vesicoureteral reflux.

Answer 5

.

Question 6

FA. Hydronephrosis.
Symptoms? 3

Answer 6

may be asymptomatic

may present with flank/back pain, abdominal pain, UTI

Question 7

FA. Hydronephrosis.
Diagnosis? 2

Answer 7

UG or CT

seen dilation of renal pelvis, calyces, and/or ureter

Question 8

FA. Hydronephrosis. treatment.
pediatric - some resolve spontaneusly

Answer 8

.

Question 9

FA. Hydronephrosis. treatment. usual method?

Answer 9

surgically treated to correct anatomic obstruction or reflux

Question 10

FA. Hydronephrosis. treatment for neurologic bladder?

Answer 10

can start a clean intermitent cath regimen for bladder emptying.

Question 11

FA. Hydronephrosis. 2 surgical methods?

Answer 11

stent
percutaneous nephrostomy

Question 12

FA. Hydronephrosis. when need catheter? 2 methods

Answer 12

Foley
or
suprapubic cath. may be required for lower urinary tract obstruction (eg BPH)

Question 13

FA. BPH.
in what proc of male seen?

Answer 13

seen in > 80 proc by age of 80.

It is normal part of aging

Question 14

FA. BPH. in what age most commonly occur?

Answer 14

> 50 y/o

Question 15

FA. BPH. does it cause cancer?

Answer 15

NO

but can coexists together

Question 16

FA. BPH.
what are obstructive symptoms?

Answer 16

hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness, acute urinary retention following surgery

Question 17

FA. BPH.
Irritative symptoms?

Answer 17

nocturia, daytime frequency, urge incontinence, opening hematuria

Question 18

FA. BPH. DRE?

Answer 18

uniformly enlarged with rubbery texture.
Suspect cancer if hard or irregular lesions.

Question 19

FA. BPH. DRE. Why may not be detected?

Answer 19

BPH occurs in central zone (periurethral)

Question 20

FA. BPH. what labs?

Answer 20

Urine culture and Urinalysis to rule out infection and hematuria.

PSA - would be increased, but the need contraversial.
Further workup needed if inc. BPH correlates with findings suggesting cancer.

Creatinine - to evaluate renal insuf. or obstructive uropathy.
+ do electrolytes if tubular dysfunction due to obstruction.

Question 21

FA. table.
BPH risk factor?

Answer 21

age > 50

Question 22

FA. table.
prostate cancer risk factor?

Answer 22

age > 40, family history

Question 23

FA. table.
BPH zone affected?

Answer 23

central

Question 24

FA. table.
prostate cancer affected?

Answer 24

lateral lobe

Question 25

FA. table. BPH zone DRE examination?

Answer 25

smooth symetrically enlarged

Question 26

FA. table. Prostate cancer examination?

Answer 26

firms with nodules and asimmetrically enlarged

Question 27

FA. ED. what prevalence?

Answer 27

10-25 proc. in middle age men.

Question 28

FA. ED. classification?

Answer 28

failure to initiate failure to fill failure to store

Question 29

FA. ED. failure to initiate - causes? 3

Answer 29

psychologic, endocrinologic, neurologic

Question 30

FA. ED. failure to fill cause 1?

Answer 30

arteriogenic

Question 31

FA. ED. failure to store cause?1

Answer 31

veno-occlusive dysfunction

Question 32

FA. ED. risk factors?

Answer 32

DM, atherosclerosis, drugs- BAB, SSRI, TCA, diuretics, hypertension, heart disease, surgery or radiation for prostate cancer, spinal cord injury.

Question 33

FA. ED. initially - ask about risk factors, medications, psycho stressors.

Answer 33

.

Question 34

FA. ED. distinction between psychologic vs oranic ED?

Answer 34

it is based on Situational dependence (eg occurs with only one partner) and the presence of nocturnal or early mornin erections with penile tumescence testing (if presents, it is non organic)

Question 35

FA. ED. diagnosis?1

Answer 35

CLINICAL

Question 36

FA. ED. what evaluate initially? 2

Answer 36

neurologic dysfunction and for hypogonadism neuro - anal tone, lower extremity sensations hypog - small testes, loss of secondary sexual characteristics.

Question 37

FA. ED. neurologic evaluation?

Answer 37

anal tone, lower extremity sensations

Question 38

FA. ED. hypogonadism evaluation?

Answer 38

small testes, loss of secondary sexual characteristics

Question 39

FA. ED. other workup? 5

Answer 39

screening for DM and cardiovascular disease, measurement of TSH and testosterone prolacting - elevated can resul in decr. androgen activity.

Question 40

FA. ED. key fact. innervation. erection?

Answer 40

PNS

Question 41

FA. ED. key fact. innervation. ejaculation?

Answer 41

SNS

Question 42

FA. ED. best initial treatment?

Answer 42

Psychologic cause - psychotherapy involving discussion and exercise with partner.

Question 43

FA. ED. drugs?

Answer 43

p/os sildenafil, vardenafil, tadalafil

Question 44

FA. ED. drugs what group and mechanism?

Answer 44

PDE-5 inhibitors, that prolong action of cGMP-mediated smooth muscle relaxation and inc. blood flow to corpora cavernosa.

Question 45

FA. ED. drugs contraindicated with what?

Answer 45

nitrates

Question 46

FA. ED. in what case give testosterone?

Answer 46

useful if hypogonadism of testicular or pituitary origin dont use if normal testosterone levels

Question 47

FA. ED. what treatment if PDE5 fails or contraindicated? many methods

Answer 47

vacuum pumps, intracavernosal injections of prostaglandins, surgical implantation of semirigid or inflatable penil prostheses.

Question 48

FA. BPH. treatment. INITIAL medical?

Answer 48

a-blockers (tamsulosin, terazosin) -relax smooth muscles in prostate and bladder neck

Question 49

FA. BPH. treatment. SECONDARY medical?

Answer 49

5alfa reductase inhibitors (finasteride) - inhibits production of dihydrotestosterone

Question 50

FA. BPH. treatment. surgical? for what patients

Answer 50

TURP, open, laparoscopic, robotic ,,simple prostatectomy" moderate to severe symptoms/complications (renal insuf, recurent UTI, bladder stones)

Question 51

FA. BPH. treatment. in case of bladder obstruction?

Answer 51

urgent catheterization while waiting more definitive management.