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Adult Primary Care > T3- GU > Flashcards

T3- GU Flashcards

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1
Q

What should you NOT see in urine?

A

Blood, glucose and protein.

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2
Q

How do kidneys affect the different parts of the body?
Neuro
Cardio
Derm
Repro
MSK
Pulm
GI
ENT

A

Neuro: Lethargy, fits, coma, peripheral neuropathy
Cardio: anemia, bruising, hypertension, pericarditis, HF
Derm: frost, mucosal pallor, pruritic excoriations, sallow pigmentation, edema, nail changes
Repro: amenorrhea, impotence, infertility
MSK: myopathy, bone pain
Pulm: pleurisy, DOE
GI: anorexia, nausea, vomiting
ENT: epistaxis, red eye

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3
Q

What questions can you ask in the ROS related to renal?

A

Skin changes, edema, fatigue, weakness, exertional dyspnea, urine/voiding changes, pain.

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4
Q

30-50% of women and 17% of men have urinary incontinence.

A
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5
Q

T/F: wt loss helps with Urinary incontinence.

A

True.

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6
Q

There are 5 types of UI:

A

Stress (SUI) - anatomic and intrinsic sphincter deficiency
Urinary urge (UUI) - detrusor over activity (DO) and poor bladder compliance
Mixed (SUI + UUI)
Overflow incontinence
Functional Incontinence (transient)

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7
Q

What’s the difference between SUI and UUI?

A

Stress (SUI) - anatomic and intrinsic sphincter deficiency
Urinary urge (UUI) - detrusor over activity (DO) and poor bladder compliance

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8
Q

What is another term for Urge UI or detrusor over activity?

A

Over active bladder (OAB)

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9
Q

Stress UI is due to an increase in _________ and a weakness of ________

A

Intra abdominal pressure
Urinary Sphincter.

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10
Q

Which type of incontinence is more common in men?

A

Overflow incontinence.

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11
Q

What is overflow incontinence

A

Urinary leakage or dribbling proceeded by the incomplete emptying of the bladder. Bladder outlet obstruction and poor detrusor contractility.
Bladder pressure < sphincter and urethral pressure.

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12
Q

What are the DIAPPERS that can cause UI?

A

Delirium or confused state
Infection - urinary (only symptomatic)
Atrophic vaginitis
Pharmaceuticals
Psychological, especially severe depression (rare)
Excess urinary output (CHF, hyperglycemia)
Restricted mobility
Stool impaction

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13
Q

T/F: UI is a normal part of aging.

A

False! There are things we can do!

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14
Q

Meds that cause decreased bladder contractility would cause__________ type of incontinence (ACEi, all the antis, CCBs, opioids, sedatives, muscle relaxant)

A

Retention and overflow UI

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15
Q

Medications that cause increased detrusor irritability cause __________ type UI (Alcohol, caffeine, diuretics)

A

Urge

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16
Q

Medications that cause increased urethral sphincter tone cause ____________ type UI (AA agonists, amphetamines, TCAs)

A

Retention and overflow UI

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17
Q

Meds that cause decreased urethral sphincter tone cause _________ type UI (AA antagonists)

A

Stress.

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18
Q

T/F: always do a pelvic exam when evaluating UI.
What can it tell you?

A

False. Only if you ask first and only if they are symptomatic.
R/o prolapse, infection.

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19
Q

PVR > ________ is definitely abnormal.

A

200ml

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20
Q

What is LUTS?

A

Lower Urinary Tract Symptoms

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21
Q

What things does a voiding diary include?

A

What you eat, activities, times to the bathroom, episodes of UI
For 3-7 consecutive days.

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22
Q

What are some behavioral therapies to help with SUI?

A

Timed voiding, double voiding, wt loss, smoking cessation, pelvic muscle exercises, pessary, bowel management and removal of bladder stimulants.

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23
Q

What are some medication therapies to help with SUI?

A

Topical ERT, TCA imipramine, SNRI duloxetine (used in Europe)

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24
Q

What are some medications used to treat UUI?

A

Anticholinergics anti Muscarinic s (Detrol) tolterodine tartrate, TCAs. Miabegron.

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25
What procedure is used only for OAB or UUI?
BOTOX injection to detrusor muscle.
26
No improvement in_________ of behavioral therapy or pharmacotherapy, then refer to urology for possible surgical intervention.
6-8 weeks
27
Proteinuria is > ________/day. Micro vs macro?
150mg 30-150 >300
28
Causes of transient proteinuria?
Orthostatic, dehydration, fever, exercise, emotional stress, CHF, seizure
29
What determines persistent proteinuria?
1+ protein on standard dipstick two ore more times in 3 months.
30
What are the 2 leading causes of proteinuria?
HTN and DM
31
What do the following mean on a microscopic UA? Fatty casts, free fat or oval fat bodies Leukocytes, leukocyte casts with bacteria Leukocytes, leukocyte casts without bacteria Normal-shaped erythrocytes Dysmorphic erythrocytes Erythrocyte casts Waxy, granular or cellular casts Eosinophiluria Hyaline casts
Fatty casts, free fat or oval fat bodies = nephrotic range proteinuria (>3.5g/24h) Leukocytes, leukocyte casts with bacteria = UTI Leukocytes, leukocyte casts without bacteria = Renal interstitial disease Normal-shaped erythrocytes = suggest lower urinary tract lesion Dysmorphic erythrocytes = suggest upper urinary tract lesion Erythrocyte casts = glomerular disease Waxy, granular or cellular casts = advanced chronic renal isease Eosinophiluria = suggests drug-induced acute interstitial nephritis Hyaline casts = no renal disease; present with dehydration and with diuretic therapy.
32
T/F: hydronephrosis can lead to irreversible renal damage.
True.
33
What is microscopic hematuria? Is this always concerning?
>3 RBCs per HPF from 2 of 3 properly collected specimens. May be incidental, however is associated with malignancy in 10% of adults.
34
If you had red cell casts, dysmorphic red cells, proteinuria >500mg/day, brown, Coca-Cola colored urine, absence of clots, would you suspect glomerular or extraglomerular bleeding?
Glomerular.
35
If you had many clots, normal RBCs, no casts and proteinuria <500mg/day and pink urine, would you suspect glomerular or extraglomerular bleeding
Extraglomerular.
36
BPH, intrinsic glomerular disease, cancer of bladder, kidney and prostate, poly cystic kidney disease are more likely to have transient or persistent proteinuria?
Persistent
37
If you have transient proteinuria in a patient <40yo, what causes could you consider?
Transient unexplained ,UTI, stones, Exercise, trauma or endometriosis.
38
T/F: Endometriosis can cause transient proteinuria.
True
39
T/f: semen in the urine can may produce a positive dipstick for heme/protein.
True. usually <3RBC/HPF
40
Most common organism causing UTIs
E. Coli/Gram-neg of colonic origin
41
NitrAtes are _______ in urine. NitrItes are ______ in urine. _______ turn into _________ through bacteria metabolism.
Normal Abnormal Nitrates Nitrites.
42
Why might you admit a patient with pyelo who has N/v?
They need abx onboard RIGHT AWAY, and if there is any chance of them throwing up the meds, then they need IV.
43
Complicated pyelo is presence of _________ . Same s/s but for weeks.
Abcess or papillary necrosis.
44
What is the definition of a COMPLICATED UTI!
UTI in the presence of comorbidities such as DM, pregnancy, renal function impairment or physiologic and structural anomalies.
45
What is IC/PBS?
Interstitial Cystitis/Painful Bladder Syndrome All causes of urinary pain that can’t be attributed to other causes.
46
IC/PBS is a diagnosis of _______
Exclusion
47
Pharm tx options for IC/PBS?
Amitryptoline (TCA), Cimetadine (H2RA), Hydroxyzine (anticholinergic/antihistamine), Pentosan polysulfate (cystitis agent)m DMSO (Organosulfur), Botox
48
5 types of prostatitis
Acute bacterial (acute urogenital symptoms with evidence of bacterial infection) Chronic bacterial (chronic or recurrent) Chronic non-bacterial inflammatory Chronic non-bacterial non inflammatory Asymptomatic inflammatory prostatitis.
49
90% of prostatitis is _________
Non bacterial (with or without inflammation)
50
We need CLOSE follow up for bacterial prostatitis because ________
Can easily develop to sepsis/bacteremia.
51
How do you diagnose prostatitis?
UA
52
Acute prostatitis with STI risk? Treat with?
Rocephin IM x1 (500mg) and 100mg Doxy po BID x10 days
53
Causes of prostatitis
Kidney stones, UTI, rectal infection, urinary retention.
54
Non-pharm tx for prostatitis
Limit fluids, caffeine, increase physical activity, no alcohol.
55
5 ARIs for BPH - take ______ to take effect and work by _______ the restate.
6-12mo Shrinking
56
BPH does/does not increase the risk for prostate cancer?
Does not
57
BPH arrives from the ______ zone while adenocarcinoma of the prostate arises from the ______ zone.
Transition Peripheral
58
If you’re doing a PE for ED, then do a _________ exam!
Cardiovascular
59
What should you think about as far as the patient’s partner before you start prescribing PDE-5 inhibitors?
Make sure the partner is well estrogenized so she doesn’t have trauma!
60
PDE-5 - education and contraindications.
Take on an empty stomach with no alcohol Don’t take with nitrates, high or low BP, heart failure, unstable angina or alpha blockers.
61
Some differences between epididymitis and testicular torsion
Epididymitis onset is gradual over days, torsion is acute. Epididymitis has + Phren’s sign - pain improves with lifting of the testicle, torsion does not improve with lifting
62
What are some risk factors for torsion?
Age 12-18, exercise, trauma, bell-clapper deformity
63
Torsion must be corrected within _____
6 hours
64
Epididymitis in pre-pubertal boys is usually a sign of
UTI or structural defect.
65
Infants need these 3 supplements
Vitamin D in breast fed babies Iron starting at 6mo Zinc from 6-12mo

Adult Primary Care (18 decks)

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