Urology-Day 1 Flashcards
(82 cards)
1
Q
Define Hydrocele
A
Collection of fluid around the testicle, forming between the parietal tunica vaginalis and visceral tunica vaginalis
2
Q
List the etiology of hydrocele
A
- Epididymitis
- Torsed appendix testis
- Idiopathic=majority
3
Q
Hydrocele treatment
A
- Needle aspiration with injection of sclerosis agent
2. Hydrocelectomy
4
Q
Define Varicocele
A
Dilated veins of pampiniform plexus
5
Q
Varicocele effects
A
- Pain
- Testis damage
- Testis atrophy
- Infertility
6
Q
Define Grade I Varicocele
A
Small size
Not grossly visible
Palpable during Valsava
7
Q
Define Grade II Varicocele
A
Moderate size
Not grossly visible
Palpable while standing
8
Q
Define Grade III Varicocele
A
Large size
Grossly visible
9
Q
Varicocele Management
A
- Surveillance
2. Surgery: Varicocele repair/varicocelectomy
10
Q
What could a right sided varicocele indicate?
A
Malignancy: RCC
11
Q
Surgery indications
A
- Symptomatic
- Palpable varicocecle with abnormal semen analysis in eval of infertile couple
- Varicocele with small testis
12
Q
Surveillance indications
A
- Palpable varicocele with normal semen analysis in young men: Semen analysis q 1-2 yr
- Varicocele with normal testis size in children and pre-sexual adolescents:
13
Q
Define Phimosis
A
Prepuce stuck distal to glans
14
Q
Phimosis Treatment
A
Circumcision
15
Q
Define Paraphimosis
A
Prepuce stuck proximal to glans
Foreskin unable to be reduced
16
Q
IF Paraphimosis if left untreated, what can result?
A
Penile Necrosis
17
Q
Paraphimosis treatment
A
Reduction
18
Q
If manual reduction is unsuccessful, what would be the next intervention for Paraphimosis?
A
Dorsal slit or circumcision
19
Q
Testicular Torsion Risk Factor’s
A
- Undescended Testis
2. “Bell clapper” deformity
20
Q
Testicular Torsion clinical presentation
A
- ACUTE onset
- Severe pain
- Absent swelling
- MC in males ages 12-18
21
Q
Testicular Torsion Physical exam findings
A
- Absent cremasteric reflex
- Horizontal lie
- No pain relief with elevation
- High riding testis
22
Q
Doppler US findings in testicular torsion
A
Decreased blood flow
23
Q
Testicular Torsion treatment
A
Surgery-Detorse testis
24
Q
If testis is viable, what would you perform during surgery?
A
Orchiopexy
25
If the testis is NOT viable, what would you perform during surgery?
Orchiectomy
| Orchiopexy of contralateral testis.
26
Cystitis Risk Factors
1. Immunocompromised
2. Urinary stasis/obstruction
3. Congenital GU abnormality
4. Sexual activity
5. Urinary incontinence
6. Cystocele or pelvic prolapse
7. Spermicide/Diaphgragm use
27
Cystitis UA findings
1. Leukocyte esterase +
2. Nitrite +
3. Pyuria >5 WBC
4. Bacteria
28
MC organism in cystitis
E. coli
29
Cystitis Treatment
1. TMP-SMZ x3 days
| 2. Nitrofurantoin x5-7 days
30
What is long term use of Nitrofurantoin associated with in the elderly?
Pulmonary fibrosis
31
What abx is effective against enterococcus?
Ampicillin
| Amoxicillin
32
Urgency treatment
Antimuscarinics
33
Dysuria treatment
Phenazopyridine
34
Re-infection prevention
1. Avoid spermicides/diaphragm
| 2. Topical vaginal estrogen
35
Infectious causes of urethritis
1. Gonococcal urethritis
| 2. Non-gonococcal urethritis: Chlamydia trachomatis
36
urethritis presentation
1. Dysuria
2. Urethral discharge
3. Urethral pruritis
37
What is the best diagnostic test for urethritis? Findings?
Frist Void UA: Leukocyte esterase >10 WBC
38
What do you want to make sure you test for in urethritis?
1. Gonorrhea
| 2. Chlamydia
39
How do you test for gonorrhea and chlamydia?
1. Culture: urethral swab-gives sensitivities
| 2. NAAT- does not give sensitives
40
Gonorrhea treatment
Ceftriaxone 250 mg IM x 1 dose
41
Chlaymdia treatment
Azithromycin 1 g po x 1 dose OR Doxycylcline x 7d
42
Who needs to follow-up after chlamydia treatment?
Pregnant women
43
When do patients need to follow-up after gonorrhea treatment?
3 months
44
Epididymitis etiology
1. Behcet's dz: Painful oral and genital ulcers, uveitis, non-mucous membrane skin lesions
2. Amiodarone
3. Testis or epididymal tumor
4. Acute bacterial infection
5. Viral
45
What bacterial organisms causes Epididymitis in Men <35?
Neisseria gonorrhoeae Chlamydia trachomatous
46
What bacterial organisms causes Epididymitis in Men >35?
E. coli
47
Epididymitis physical exam findings
1. Swollen, painful testicle
2. Fever
3. Hydrocele
48
Epididymitis treatment
1. Scrotal support
2. Analgesia
3. Abx
49
Abx treatment if STD suspected in Epididymitis
Ceftriaxone 250 IM x1 AND Doxycycline x10 days
50
Abx treatment if STD is NOT suspected in Epididymitis
Levofloxacin
51
Chronic Epididymitis definition
3 months or more
52
What is the hallmark of prostatitis?
Prostatic pain
53
Acute bacterial prostatitis presentation
1. Fever
2. Urgency/Frequency
3. Warm, boggy tender prostate
54
MC organism that causes Acute bacterial prostatitis
E.coli
55
Acute bacterial prostatitis evaluation
1. Urine culture-Not post prostate massage
2. CBC
3. Blood culture
4. H &P- No vigorous prostate exam
56
Indications for admission in acute bacterial prostatitis for IV abx
1. Fever
| 2. Highly elevated WBC
57
How long do you treat with abx after you discharge a patient with acute bacterial prostatitis?
4-6 weeks
58
If a patient is persistently febrile with acute bacterial prostatitis, what do you want to order? why?
CT pelvis
| R/O prostatic abscess
59
Chronic bacterial prostatitis presentation
1. Pain in: Genitals, Urinary tract, Perineum, Low back
2. Dysuria
3. Urgency
4. Frequency
5. Pain with ejaculation
60
Who does chronic bacterial prostatitis commonly occur in?
Older men
61
MC organism that causes chronic bacterial prostatitis
E. coli
62
Lab evaluation of chronic bacterial prostatitis
1. Expressed prostatic secretion (EPS)
| 2. Post prostate massage urine culture
63
chronic bacterial prostatitis treatment
1. Abx- Empiric tx and adjust based on culture results
2. NSAIDs
3. Alpha blockers
4. Anticholinergic/antimuscarinics
64
Inflammatory Chronic Pelvic Pain Syndrome clinical presentation
1. Hx of "UTI's" with negative cultures
| 2. Prostatic tenderness
65
Inflammatory Chronic Pelvic Pain Syndrome lab findings
Prostatic fluid with leukocytes, BUT cultures do not grow out bacteria
66
Inflammatory Chronic Pelvic Pain Syndrome Treatment
TMP-SMX x6-8 weeks
67
IF they are not responsive to TMP-SMX x6-8 weeks in the treatment of Inflammatory Chronic Pelvic Pain Syndrome, what would you. prescribe next?
Doxycycline
68
Noninflammatory Chronic Pelvic Pain Syndrome lab findings
No bacteria on culture
| No leukocytes in prostatic fluid
69
Pyelonephritis physical exam findings
1. Fever
| 2. CVA tenderness
70
UA findings in pyelonephritis
WBCs
| WBC casts
71
Pyelonephritis imaging
1. CT urogram (CTU)
| 2. Renal US
72
CT urogram findings in Pyelonephritis
1. Perinephric stranding
2. Kidney enlargement
3. Decreased nephrogram
4. Renal collecting system dilated but not obstructed
73
Pyelonephritis abx treatment
Fluoroquinolone x7 days
74
Indications for admission in Pyelonephritis
Fever >72 hrs
| No clinical improvement
75
If patient is not improving with Pyelonephritis, what other conditions should you consider?
1. Acute bacterial nephritis
| 2. Renal abscess
76
Define Acute bacterial nephritis
Bacterial interstitial nephritis of the renal cortex, causing a renal mass
77
What organisms are the MC cause of renal abscess?
Gram negative
78
Who does renal abscess MCly occur in?
DM
| Immunocompromised
79
Renal Abscess treatment
1. IV abx
2. Percutaneous drainage
3. Surgical drainage
4. F/u with imaging
80
Chronic Pyelonephritis presentation
1. Hypertension
2. Anemia of chronic disease
3. Proteinuria
4. Renal insufficiency
5. Recurrent UTIs
81
Radiographic findings in Chronic Pyelonephritis
Caliceal blunting
82
Chronic Pyelonephritis Tx
1. Manage UTI risk factors
2. Control HT
3. Nephrectomy
