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Adult Primary Care > T3- GU > Flashcards

T3- GU Flashcards

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
Q

What procedure is used only for OAB or UUI?

A

BOTOX injection to detrusor muscle.

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26
Q

No improvement in_________ of behavioral therapy or pharmacotherapy, then refer to urology for possible surgical intervention.

A

6-8 weeks

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27
Q

Proteinuria is > ________/day. Micro vs macro?

A

150mg
30-150
>300

28
Q

Causes of transient proteinuria?

A

Orthostatic, dehydration, fever, exercise, emotional stress, CHF, seizure

29
Q

What determines persistent proteinuria?

A

1+ protein on standard dipstick two ore more times in 3 months.

30
Q

What are the 2 leading causes of proteinuria?

A

HTN and DM

31
Q

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

A

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
Q

T/F: hydronephrosis can lead to irreversible renal damage.

A

True.

33
Q

What is microscopic hematuria? Is this always concerning?

A

> 3 RBCs per HPF from 2 of 3 properly collected specimens.
May be incidental, however is associated with malignancy in 10% of adults.

34
Q

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?

A

Glomerular.

35
Q

If you had many clots, normal RBCs, no casts and proteinuria <500mg/day and pink urine, would you suspect glomerular or extraglomerular bleeding

A

Extraglomerular.

36
Q

BPH, intrinsic glomerular disease, cancer of bladder, kidney and prostate, poly cystic kidney disease are more likely to have transient or persistent proteinuria?

A

Persistent

37
Q

If you have transient proteinuria in a patient <40yo, what causes could you consider?

A

Transient unexplained ,UTI, stones, Exercise, trauma or endometriosis.

38
Q

T/F: Endometriosis can cause transient proteinuria.

A

True

39
Q

T/f: semen in the urine can may produce a positive dipstick for heme/protein.

A

True. usually <3RBC/HPF

40
Q

Most common organism causing UTIs

A

E. Coli/Gram-neg of colonic origin

41
Q

NitrAtes are _______ in urine. NitrItes are ______ in urine.
_______ turn into _________ through bacteria metabolism.

A

Normal
Abnormal
Nitrates
Nitrites.

42
Q

Why might you admit a patient with pyelo who has N/v?

A

They need abx onboard RIGHT AWAY, and if there is any chance of them throwing up the meds, then they need IV.

43
Q

Complicated pyelo is presence of _________ . Same s/s but for weeks.

A

Abcess or papillary necrosis.

44
Q

What is the definition of a COMPLICATED UTI!

A

UTI in the presence of comorbidities such as DM, pregnancy, renal function impairment or physiologic and structural anomalies.

45
Q

What is IC/PBS?

A

Interstitial Cystitis/Painful Bladder Syndrome

All causes of urinary pain that can’t be attributed to other causes.

46
Q

IC/PBS is a diagnosis of _______

A

Exclusion

47
Q

Pharm tx options for IC/PBS?

A

Amitryptoline (TCA), Cimetadine (H2RA), Hydroxyzine (anticholinergic/antihistamine), Pentosan polysulfate (cystitis agent)m DMSO (Organosulfur), Botox

48
Q

5 types of prostatitis

A

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
Q

90% of prostatitis is _________

A

Non bacterial (with or without inflammation)

50
Q

We need CLOSE follow up for bacterial prostatitis because ________

A

Can easily develop to sepsis/bacteremia.

51
Q

How do you diagnose prostatitis?

A

UA

52
Q

Acute prostatitis with STI risk? Treat with?

A

Rocephin IM x1 (500mg) and 100mg Doxy po BID x10 days

53
Q

Causes of prostatitis

A

Kidney stones, UTI, rectal infection, urinary retention.

54
Q

Non-pharm tx for prostatitis

A

Limit fluids, caffeine, increase physical activity, no alcohol.

55
Q

5 ARIs for BPH - take ______ to take effect and work by _______ the restate.

A

6-12mo
Shrinking

56
Q

BPH does/does not increase the risk for prostate cancer?

A

Does not

57
Q

BPH arrives from the ______ zone while adenocarcinoma of the prostate arises from the ______ zone.

A

Transition
Peripheral

58
Q

If you’re doing a PE for ED, then do a _________ exam!

A

Cardiovascular

59
Q

What should you think about as far as the patient’s partner before you start prescribing PDE-5 inhibitors?

A

Make sure the partner is well estrogenized so she doesn’t have trauma!

60
Q

PDE-5 - education and contraindications.

A

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
Q

Some differences between epididymitis and testicular torsion

A

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
Q

What are some risk factors for torsion?

A

Age 12-18, exercise, trauma, bell-clapper deformity

63
Q

Torsion must be corrected within _____

A

6 hours

64
Q

Epididymitis in pre-pubertal boys is usually a sign of

A

UTI or structural defect.

65
Q

Infants need these 3 supplements

A

Vitamin D in breast fed babies
Iron starting at 6mo
Zinc from 6-12mo

Adult Primary Care (18 decks)

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