Urology Exam Flashcards
(239 cards)
1
Q
Upper UTIs
A
To kidneys
pyelonephritis: renal abscess, perirenal abscess
2
Q
Lower UTIs
A
urethritis, cystitis, (prostatitis)
3
Q
Classifications of UTIs
A
community acquired
nosocomial (from catheter)
upper v lower
complicated v non-complicated
4
Q
UTI in elderly
A
40-50% asymptomatic bacteruria
5
Q
group w/highest prevalence of UTIs
A
reproductive age females
6
Q
Renal abscess
A
pus pocket in kidneys
7
Q
perirenal abscess
A
abscess in fascia and fat
8
Q
Mechanisms of UTI
A
Ascending infection
hematogenous
fistula
9
Q
Pregnancy effect on UTIs
A
4-10% incidence
20-40% untreated get pyelonephritis
10
Q
What bacteria causes 80% of first UTIs?
A
E. coli (1, 4, 6, 18, 75)
11
Q
What are the two differential diagnoses for UTIs?
A
dysuria (infectious, non-infect)
acute intra-abdominal diseases (appendicitis, cholecystitis, etc.)
12
Q
What organism causes UTI in 10-15% young females?
A
staph. saprophyticus
13
Q
Factors that predispose UTI
A
Age pregnancy diabetes MS spinal cord injuries immun compromised malignancy
14
Q
Organisms that cause complicated and uncomplicated UTIs
A
uncomplicated: E. coli
complicated: s. saprophyticus, resistant: pseudomonas, proteus
15
Q
UTI is one of top ten concurrent illness with…?
A
Diabetes!
16
Q
UTI general symptoms
A
suprapubic pain/heaviness
hematuria
pain near/in epigastrium - radiate inferiorly
17
Q
How many colonies of pathogen accounts for acute urethral syndrome (urethritis)? and what is it during pregnancy?
A
<100,000
pregnancy: 10,000
18
Q
definition of hemorrhagic cystitis
A
bladder inflammation w/dysuria, hematuria, or hemorrhage
19
Q
interstitial cystitis (aka bladder pain syndrome)
A
pain w/full bladder (urinary urgency, pain relieved by emptying)
Dx of exclusion (unknown cause)
20
Q
most common symptoms of interstitial cystitis*
A
bladder pain, nocturia, frequency, urgency, suprapubic pain
21
Q
Hunner’s lesions (ulcers)
A
In interstitial cystitis
thinning of bladder wall and pinpoint bleeding
causes pain if come in contact w/other bladder surfaces
22
Q
Pyelonephritis
A
infection of renal parenchyma and pelvis
women 5X men
23
Q
Presentation of pyelonephritis
A
fever >102F, chills (may be absent in 1/3 elderly) flank pain N/V CVAT- UNI-lateral pyuria leukocytosis
24
Q
How to Dx Pyelonephritis
A
CBC: leukocytosis urine culture: 90% positive!! Urinalysis: pyuria, nitrates, hematuria Gram Stain: before empiric Tx Blood cultures: only if Dx uncertain
25
Normal urine culture results
<10,000 organisms/ml
26
Abnormal urine culture results
>100,000 organisms/ml - WOMEN
| >10,000 organisms/ ml - PREG, MEN
27
Pyelonephritis Tx
fluoroquinolone (Cipro)
| amoxicillin
28
azotemia
elevated BUN
| get w/late renal obstruction
29
Red Flags for urolithiasis
```
flank pain
fever
elevated WBC
gravel (small stones)
immunocompromised
children
recurrent/nonresolving infection
```
30
Tx for urolithiasis
Penicillins - can have resistance quickly (E. coli)
Sulfonamides - G6PD deficiency (hemolysis)
macrobid (nitroflurantoin)
cipro - least resistance for e. coli
31
Tx for interstitial cystitis
elmiron (PO)
| DMSO - through catheter into bladder to coat lining
32
Moderate to Severe kidney infection tx
IV ceftrioxone or gentamycin
33
Dx for UTI
urinalysis
urine dip stick
culture: predispositions
34
What does cranberry juice do for UTIs?
Acidify urine
35
Why does prostate involvement in UTIs cause lower back pain?
prostate drains to sacral lymph node and up spine
36
What urine is best for urinalysis?
First voided urine
| mid-stream (vulva/plans penis cleansed beforehand)
37
When is microscopic urinalysis done and what does it look at?
if urinalysis/dipstick abnormal
| cellular elements, cats, crystals, RBC, WBC, yeast, malignancy
38
Basic urinalysis/dip stick
gross exam
| chemical: pH, glu, bili, protein, ketones, blood, nitrate
39
milky urine
pyruia, lipiduria, chyluria (lymph fluid)
40
cloudy urine
bacteria, yeast, calculi, fecal, sperm, prostate fluid
41
How can myoglobinuria (from muscle trauma) change urine
red or bown-black
42
Rhabdomyolysis
muscle breakdown --> kidney damage --> black urine
43
Pseudomonas infection change urine to...?
blue, green, blue-green (also chlorophyll: cancer, wound healing, weight control, liver detox)
44
specific gravity
density of specimen, correlates w/urine osmolality
| normal: 1.001-1.035
45
urine osmolality
particles/weight of fluid
46
fixed specific gravity at 1.01
isosthenuria (intrinsic renal insufficiency)
47
normal urine pH
5.0 - 6.0
48
relative hydration v relative dehydration in specific gravity
value of less than 1.010 --> relative hydration
| value greater than 1.020 --> relative dehydration
49
causes of low specific gravity
DI, pyleno/glomerulo, diuretics, adrenal insufficiency
50
causes of high specific gravity
dehydration, glycosuria, impaired renal function, SIADH
51
Relationship between urinary pH and serum pH*
urinary pH reflects the pH in the serum
52
Risk of alkaline pH
staghorn calculi
| pseudomonas, proteus infection
53
How to further evaluate persistent positive proteinuria on dipstick?
24hr urine collect
54
Postural Proteinuria
prolonged standing --> proteinuria
(during day but not night)
"orthostatic" proteinuria
55
order of severity of different proteinurias
microalbuminuria --> albuminuria --> proteinuria --> heavy proteinuria
56
microalbumin helps detect..?
early DM (--> renal mortality)
57
Glycosuria in..?
DM
Fanconi's syndrome
liver/pancreatic disease
58
How to determine site of bleeding
blood beginning of stream: urethral
diffuse: bladder or above (total, all throughout)
blood end of stream: prostate, base of bladder
59
Dipstick in detecting UTI
85-95% effective as culture
| >10 WBC/hpf --> inflam.
60
How do nitrites get in urine?
bacteria produce reductase to reduce urinary nitrate to nitrite
E. coli, klebsiella, enterobacter, proteus, staph., pseudomonas
61
significance of conjugated bilirubin and urobilinogen in urine
usually undetectable levels in urine
liver dysfunction, biliary obstruction
hemolysis (urobilinogen)
62
What part of urine is examined in microscopic exam?
centrifuged sediment
| very helpful as confirmatory and detecting new info
63
casts (urine)
tube shaped proteins
| helps localize disease to specific location in GU
64
What amount of RBC is abnormal in urine
>3 RBC/HFP
65
Most common cause of WBC in urine*
UTI
66
ATN = acute tubular necrosis
kidney disorder: damage to tubule cells of kidneys --> acute kidney failure
67
significance of a lot of squamous epithelial cells in urine sediment
contamination
68
Painless gross hematuria is...?*
CANCER UNTIL PROVEN OTHERWISE
(85% bladder, 40%renal cell)
usually uroepithelial tumor
69
Is hematuria screened?
No, bc common and asymptomatic in many
70
Types of hematuria diseases
maple syrup urine disease: autosomal recessive, branched chain AAs
iced tea urine: dehydration or acute kidney injury
coca-cola urine: choluria, bile in urine
71
clots in urine USUALLY indicate...?
lower urinary tract source
72
True or false: Amount of blood loss does not correlate to color change
true
73
1st step w/gross hematuria specimen*
centrifugation
74
after centrifugation, SEDIMENT is red. what does it mean?
hematuria
75
after centrifugation, supernatant is red. what does it mean?
need to dipstick for other causes
76
Red supernatant, heme negative dipstick
porphyria, phenazopyridine, beeturia
77
Red supernatant, heme positive dipstick
myoglobinuria (clear plasma), hemoglobinuria (red plasma)
78
microscopic hematuria is found...?
incidentally
79
Source of microscopic hematuria*
most commonly RENAL
80
Source of gross hematuria*
most commonly UROEPITHELIAL
81
causes of hematuria
prerenal: systemic
renal: glomerular, non-glomerular
postrenal: ureters, bladder, urethra, prostate
82
Prerenal hematuria: systemic examples
coagulopathy
anticoagulation
collagen vascular disease
sickle cell
83
Red cell casts and what can be Dx*
```
cylindrical structure (microscopy)
Dx: glomerulonephritis or vasculitis --> kidney biopsy
```
84
Isomorphic RBC in urine sediment marks what type of bleeding?
non-glomerular
85
Dysmorphic RBC in urine sediment marks what type of disease?
glomerular diseases
86
What to rule out w/postrenal causes?*
malignancy of bladder and ureter!
87
Differential Dx of hematuria
TICS
88
What is a big risk factor for malignancy from hematuria findings?*
tobacco use (2x)
89
most common urologic cancer
transitional cell carcinoma (bladder cancer)
90
what Phenazopyridine (Pyridium) do to urine?
make it dark orange to red
91
when is cytology used?
in conjunction w/other tests for cancer (only in sepcific situations)
92
What can CT urography show?
stones very well (more than U/S)
blood
cancers
93
when to use cystoscopy
gross hematuria:
- no evidence of glomerular disease or infection
- OR with clots
94
conditions that causes ulceration of penis*
HPV
Syphilis
chancre
chancroid
95
categories of prostate disease
benign neoplastic (BPH)
infectious (prostatitis)
malignant (prostate ca)
96
Leading cancer diagnosed in males?
prostate cancer (men die with not of)
97
crenated cell*
RBC with spikey appearance
| when in hypertonic urine
98
ghost cell*
RBC that lost hemoglobin bc in hypotonic cell and absorbed water --> swollen
99
waxy cast
deteriorated from granular cast
| smooth
100
Frequency of BPH (benign prostatic hyperplasia)
50% males at 50yo
101
Functions of prostate
muscle seals off bladder during ejaculation, propels
30% semen
gland: secrete alkaline fluid, protects sperm in acidic vagina
102
prostate specific antigen (PSA) function
produced by prostate that dissolves cervical mucous cap
| evaluated for prostate function
103
Growth of prostate accessory organs are dependent on what?
androgens (have androgen receptors)
104
What hormone regulates prostate?
5-alpha reductase metabolize testosterone to DHT --> regulates prostate
105
3 zones of prostate
central
transitional
peripheral: post lat
106
which zone of prostate is where 70% of cancer
peripheral zone
107
which zone of prostate is responsible for BPH
Transitional
108
When does growth phase begin again for prostate?
40-50yo
109
Symptoms of BPH (LUTS)*
bladder outlet obstruction
hypertrophy of detrusor muscle
decreased capacity of bladder
110
most common urologic emergency
Acute Urinary Retention
111
Bladder volume in Acute Urinary Retention*
≥300 cc of urine
112
Absolute contraindication for catheterization in urologic emergencies?*
urethral injury (blood) at meatus or hematuria
113
Most common pathogen in UTI for men/women*
E. coli
114
Renal colic
type of pain w/kidney stones on affected side
comes in waves
stone stuck in urinary tract
115
what size stone usually passes through?
<10mm
116
Significance of UTI in males?*
ALWAYS complicated!
117
What is urosepsis caused by?
UTI traveling up --> systemic infection
| emergency
118
Tx of testicular torsion
surgical detorsion
4-6 hrs: 100% viability
12hrs: 20%
24hrs: 0%!!!
119
most common age for testicular torsion?
12-18 yo
120
differential Dx for testicular torision
twisting of vestigial appendage along testicle (younger pts) - blue dot sign (necrosis/infarct)
use doppler U/S to differentiate
pain resolves 5-10 days
121
penile fracture
rupture of one of tunica albuginea
"eggplant deformity"
during tumescence
122
priapism
prolonged erection not w/sex stimulus
doppler U/S
ISCHEMIC V NON-ISCHEMIC
123
Ischemic v Non-ischemic priapism
ischemic: blood doesn't drain from penis properly --> can permanent ED, emergency surgery, painful
non-ischemic: Connection forming b/t an artery and corpus cavernosum, painless, not emergency
124
azoospermia*
no sperm in semen
125
What can kill sperm?
high temp
126
PRE-TESTICULAR cause of infertility
gonadotropic hypogonadism
pituitary disease
endocrine: androgen excess, glucocorticoid, thyroidisms
hyperprolactinemia: inhibit GNRH
127
examples of gonadotropic hypogonadism in pre-testicular infertility
isolated gonadotropin (Kalman's)
isolate LH or FSH
congenital
128
examples of pituitary disease in pre-testicular infertility
pituitary insufficiency
hemochromatosis: iron deposits
exogenous hormones: excess estrogen
129
TESTICULAR causes of infertility
GENETICS: primary failure
varicocele: 40% primary and secondary
130
Most common attributable cause of primary and secondary infertility in males- 40%*
varicocele
131
Which side is more common for varicocele?
left (80-90%)
132
POST-TESTICULAR cause of infertility
disorders of sperm transport
| disorders of sperm motility/function: congenital, maturation
133
Globozoospermia*
maturation defect
| No acrosin-no penetration of zona pellucida
134
Sperm DNA fragmentation
greater than 30% index --> reduce fertility
| “Normal” (morphology and motility) sperm may have DNA fragmentation!*
135
biggest concern for sperm DNA fragmentation
age! >46yo
136
biggest cause of azoospermia*
40% obstructive
137
what happens in andropause by age 80?**
testosterone levels around pre-pubertal levels
138
Psychological symptoms of andropause?
anxiety
| depression
139
sexual symptoms of andropause?*
impotence: loss of erection
140
Physiologically, what does low testosterone do?
increase cholesterol (precursor)
141
function of draping
separate surgically clean areas away from non-surgically clean areas to prevent further contamination
142
International prostate symptom score
1-7 mild
| 20-35 severe
143
Tx of BPH
mild: watch
mild-moderate: alpha blocker (hytrin)
severe: alpha blocker, 5 alpha reductase inhibitor (effective on 30% patients)
severe: surgery (TURP)
144
turp
trans urethral resection of prostate
| gold standard for BPH
145
Effect of chronic bacterial prostatitis
recurrent UTIs, uncommon (acute least common)
146
Types of prostatitis
acute/chronic bacterial prostatitis
chronic prostatitis
asymptomatic inflammatory prostatitis
147
rectal exam result in acute bacterial prostatitis
exquisitely tender, swollen, firm and hot prostate
148
prostate cancer symptoms
may be asymptomatic or mimic BPH
149
Gleeson grading system
quantify cancer aggressiveness
150
Prostate cancer treatment in young patients
radical prostatectomy
151
lab result in BPH
PSA slightly elevated
152
Conditions for ulcerations of penis*
chancre: primary syphilis, painless, palpate edge
chancroid: painful, soft edge, inguinal adenopathy
syphilis
HSV: ulcerating painful lesions
Erythroplasia of Queyrat
fixed drug eruption
153
Phimosis v. Paraphimosis*
Phi: foreskin cannot be fully retracted
Para: UROLOGIC EMERGENCY; foreskin cant go back over glans!
154
Paraphimosis*
Inability to return the retracted foreskin to its natural position covering the glans. --> EDEMA AND CONGESTION OF GLANS* --> PENILE NECROSIS
155
Meatal Stenosis, in child?
narrowing of the opening of the urethra
| sx: Urine flow reduced and hesitant. Urine stream goes upward instead of downward
156
Hypospadius*
```
urethral meatus more proximal
unknown cause (hormonal defic. or compression in utero?)
```
157
Peyronie's Disease*
by fibrous scarring or plaques within the tunica albuginea
cause: micro/macrotrauma (break penis)
"saxophone penis"
158
Reactive Arthritis*
REITER’S SYNDROME
159
Another name for Erythroplasia of Queyrat*
Bowman's disease of glans penis
160
Chordee (assoc w/hypospadius)
deficiency of ventral skin compared to dorsal skin
| illusion of curvature OF GLANS when the penis is erect
161
Chordee (assoc w/hypospadius)*
deficiency of ventral skin compared to dorsal skin
| illusion of curvature OF GLANS when the penis is erect
162
risk assoc w/hypospadius*
9% cryptorchidism (cancer risk)
| 9% inguinal hernia (w/hydrocele)
163
RISK FACTORS FOR PEYRONIE'S DISEASE**
```
HTN
DM
gout
beta-blockers
possible vit E deficiency
NOT hygiene
```
164
Peyronie's disease --> associated disorders?
Dupuytren's contractures
ledderhose disease
autoimmune conditions
165
Dupuytren's contractures
progressive thickening and shorting of the palmar fascia leading to debilitating digital contractures
166
Ledderhose disease
plantar fibromatosis characterized by thickening of the foot's deep connective tissue
167
Indications for surgical Tx of peyronie's disease
disease for 1 year
Dx for 6 months
severity in sexual dysfunction
168
Phimosis
foreskin cannot be fully retracted (urine breaks down skin)
| congenital or acquired
169
Risk of acquired phimosis*
```
repeated catheterization; forceful foreskin retraction***
infections
poor hygiene
lichen sclerosis
DM
```
170
common symptoms of phimosis
Unable to retract prepuce
Narrowing or diversion of the urinary stream
Ballooning of prepuce with urination
171
Tx of phimosis
elective circumcision - procedure of choice
| children: wait until 5 yo (may resolve)
172
Risk of paraphimosis*
Iatrogenic: Health care provider leaves foreskin retracted after penile examination, cleaning, cystoscopy, or catheter insertion.
173
Balanoposthitis*
Inflammation of glans (balanitis) and foreskin (posthitis)
| causes: STD
174
Fournier's Gangrene*
Bacterial infection of the skin on genitals and perineum from wound infection
175
Penile cancer can start from what?*
condyloma accuminata, HPV 16 50%
176
Penile cancer
get bad very quickly, need to be caught early!
177
Buschke-Löwenstein tumor
HPV 6 and 11 - verrucous carcinoma of the penis
178
Erythroplasia of Queyrat
In situ form of squamous cell carcinoma on glans penis
| multiple red plaques
179
who is most commonly affected by Erythroplasia of Queyra
older uncircumcised men
180
psoriasis on penis
thick, scaly plaques
181
Reiter's disease
reactive arthritis
infection Autoimmune response (chlamydia)
Sx: arthritis, conjunctivitis, and urethritis (can’t see, can’t pee, can’t climb a tree)
20-40% (men): painless penile lesions (balanitis circinata) distinctive winding erosions
182
cremaster reflex
stroke inside of thighs, testicle rises
183
testicular pain differentials
Epididymitis/Epididymo-Orchitis
Orchitis
Testicular Torsion
Torsion of Testicular appendix
184
torsion testicle
abrupt severe pain
no cremaster reflex affected side
high riding testing, transverse lie
prehn's sign
185
prehn's sign
lack of pain relief with testicle elevation
| in testicular torsion
186
How to Dx testicular torsion
U/S
| dont wanna miss!! Timing critical!
187
How to Dx testicular torsion*
U/S
| SURGICAL EMERGENCY
188
Testicular torsion causes
testes "swinging freely" - anatomical defect
| "bell clapper deformity": no normal posterior anchoring
189
intravaginal v extravaginal testicular torsion
Intravaginal: testicle rotates on the spermatic cord within the tunica vaginalis
Extravaginal: torsion OUTSIDE the tunica vaginalis (scrotal ligament)
190
bell clapper deformity
testis lies HORIZONTALLY
| tunica vaginalis extends up over spermatic cord --> testis suspended in tunica vaginalis by spermatic cord.
191
Testicle salvage rate after 24hrs
0-10%
192
Appendiceal Torsion
affect upper pole
92% remnant of mullerian duct
"blue dot sign"
193
blue dot sign
Appendiceal Torsion - necrosis of appendage
194
Tx for epididymitis*
<35yo: doxycycline 14 days
| >50yo: cipro (WITH CAUTION)
195
Mumps virus can cause...?*
orchitis (70% unilaterally) -
| most common cause of orchitis
196
Orchitis usually accompanied by...?
epididymitis
197
bacterial orchitis Tx*
<35yo: Ceftriaxone AND either doxycycline or azithromycin
| >50yo: Fluoroquinolone
198
VIRAL ORCHITIS tX
Bedrest
| supportive care
199
Orchitis Sx
pain
swollen testes
hematuria
200
testicular cancers are..?*
painless scrotal mass
201
most common side of varicocele
left side
202
Hydrocele etiology*
Failure of patent processus vaginalis to close & failure of peritoneal fluid to be re-absorbed
common in newborn boys
203
transilluminating mass on exam
hydrocele
204
hydrocele can be associated with..?
indirect hernia
205
Non-communicating forms of hydrocele may result from...?*
trauma, infection, or neoplasm
206
hydrocele Tx
may resolve on its own
| surgical resection
207
communicating v noncommunicating hydrocele
communicating: free flow of abdominal fluid to sac
non: doesnt
208
spermatocele
Usually asymptomatic, small mass of the epididymis
benign (epididymis dilation)
epididymal cyst >2cm
209
Where you feel inguinal hernias during exam
direct: side of finger
indirect: tip
210
complications of hernias*
incarceration: not easily reduced
| strangulation --> need herniorrhaphy (emergency)
211
complications of cryptorchidism*
infertility
| malignancy
212
Klinefelter's (XXY) put you at risk for...? (testicular disorder)
testicular cancer
| hypogonadism
213
most common sign of testicular cancer*
hard, painless lump
214
most common type of testicular cancer*
germ cell tumors
215
before metastasis of testicular cancer...
nearly 100% cure!
216
Cystoscopy
rigid v flexible
| can resect bladder tumor, prostate (TURP)
217
Malecot & Pezzer catheters
Surgical placement
218
ionic v nonionic IV contrast material
ionic: higher osmolality, more side effects
| non-ionic: lower, less
219
IV contrast in high risk patients
dont use them! use other!
220
IV contrast risks
acute renal impairment
221
Iv contrast and DM pts
can cause Fatal metabolic acidosis (lactic acidosis)
222
IV contrast risks
acute renal impairment
| nephrotoxic
223
Iv contrast and DM pts
can cause Fatal metabolic acidosis (lactic acidosis)
| hold metformin if using contrast
224
idiosyncratic rxn to IV contrast
iodine anaphylactoid response
225
How many views in an abdominal series X-ray
3 views:
CXR
abdominal "flat plate" (kidney, ureter, bladder)
upright abdominal film
226
abdominal flat plate
KUB: kidney, ureter, bladder
| "scout film"
227
CT
“Multiple plain films”
| Computer reconstruction of 2D view, CUTS
228
spiral CT (sCT ) or helical CT
Thin collimation of 1-mm image reconstruction and multiple detectors
229
CT
“Multiple plain films”
Computer reconstruction of 2D view
cross section
230
When to use CT scan in urology
renal: mass, cyst (U/S 1st), trauma, calculi
231
BEST IMAGING FOR RENAL CALCULI*
Spiral/Helical CT
232
MRI urology
Very useful for soft tissue GU diagnosis
| gadolinium contrast - safer than iodinated
233
Transrectal Ultrasound (TRUS)
good for prostate
234
Radionuclide Imaging
IV administration of radionuclide tagged cells
identify where the cells have traveled/concentrated
good for physiologic studies (blood flow, kidney function, excretion)
235
GU angiograph
Radio-opaque contrast injected IV and then imaged using x-ray based imaging modality such as fluoroscopy (real-time moving x-ray images)
236
Voiding Cystourethrogram
1. Water-soluble contrast material delivered to bladder
2. "spot film" taken while pts void
(used in voiding difficulties, vesicoenteric fistula)
237
static cystograms**
films taken prior to voiding
238
Intravenous Pyelograms (IVP)
3 films: w/contrast
scout film
nephrogram phase (after 2-3min)
excretion films (after 15-20min)
239
Retrograde Pyelography (RGP)
Demonstrates ureter and renal collecting system (pelvis & calyces).
FILL CONTRAST INTO URETER w/cystoscope(NOT IV)
