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Flashcards in Urology-Day 1 Deck (82)
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1

Define Hydrocele

Collection of fluid around the testicle, forming between the parietal tunica vaginalis and visceral tunica vaginalis

2

List the etiology of hydrocele

1. Epididymitis
2. Torsed appendix testis
3. Idiopathic=majority

3

Hydrocele treatment

1. Needle aspiration with injection of sclerosis agent
2. Hydrocelectomy

4

Define Varicocele

Dilated veins of pampiniform plexus

5

Varicocele effects

1. Pain
2. Testis damage
3. Testis atrophy
4. Infertility

6

Define Grade I Varicocele

Small size
Not grossly visible
Palpable during Valsava

7

Define Grade II Varicocele

Moderate size
Not grossly visible
Palpable while standing

8

Define Grade III Varicocele

Large size
Grossly visible

9

Varicocele Management

1. Surveillance
2. Surgery: Varicocele repair/varicocelectomy

10

What could a right sided varicocele indicate?

Malignancy: RCC

11

Surgery indications

1. Symptomatic
2. Palpable varicocecle with abnormal semen analysis in eval of infertile couple
3. Varicocele with small testis

12

Surveillance indications

1. Palpable varicocele with normal semen analysis in young men: Semen analysis q 1-2 yr
2. Varicocele with normal testis size in children and pre-sexual adolescents:

13

Define Phimosis

Prepuce stuck distal to glans

14

Phimosis Treatment

Circumcision

15

Define Paraphimosis

Prepuce stuck proximal to glans
Foreskin unable to be reduced

16

IF Paraphimosis if left untreated, what can result?

Penile Necrosis

17

Paraphimosis treatment

Reduction

18

If manual reduction is unsuccessful, what would be the next intervention for Paraphimosis?

Dorsal slit or circumcision

19

Testicular Torsion Risk Factor's

1. Undescended Testis
2. "Bell clapper" deformity

20

Testicular Torsion clinical presentation

1. ACUTE onset
2. Severe pain
3. Absent swelling
4. MC in males ages 12-18

21

Testicular Torsion Physical exam findings

1. Absent cremasteric reflex
2. Horizontal lie
3. No pain relief with elevation
4. High riding testis

22

Doppler US findings in testicular torsion

Decreased blood flow

23

Testicular Torsion treatment

Surgery-Detorse testis

24

If testis is viable, what would you perform during surgery?

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