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Urology > Week 1 - lecture pt 1A, 1B > Flashcards

Week 1 - lecture pt 1A, 1B Flashcards

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1
Q

daily urine volume and required water intake qh?

A

~1500-2500 mL, requires ~150-250 mL water intake qh

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2
Q

ddx of GU cause of fever?

A

acute PN
malignancy
acute prostatitis
epididymitis

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3
Q

ddx of GU complains with no fever?

A

simple cystitis, chronic PN

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4
Q

ddx of GU complaints with weight loss?

A

advanced cancer

renal insufficiency dt obstruction or infection

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5
Q

ddx of failure to thrive in children (GU causes)?

A

chronic obstruction, UTI, both, etc.

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6
Q

area/pattern of pain: localized to ipsilateral CVA

refers to umbilicus, testicle, labium

A

KD

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7
Q

pain is constant vs pain comes and goes

A

constant: KD origin, infectious

comes and goes: KD origin, obstructive

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8
Q

distention vs spasm pain?

A

distention will cause a dull ache
spasms present more as colic
both usu pain is coming from ureters

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9
Q

DDX of pain from bladder: burning pain w/voiding felt in suprapubic area? painful suprapubic area? little or no pain?

A

burning pain w/voiding in suprapubic area = acute cystitis
painful suprapubic area = acute urinary retention
little or no pain = chronic retention

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10
Q

vague discomfort, fullness in perineal, rectal or lumbrosacral area?

A

prostate (BPH)

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11
Q

pain in flaccid penis dt? pain in erect penis dt?

A

flaccid: inflammation dt STI, paraphimosis
erect: Peyronie’s dz, priapsim

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12
Q

testicular pain relieved with elevating the testicle?

A

epididymitis

torsion pain will NOT BE relieved with elevation of the testicle

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13
Q

renal pain caused by what? causes?

A

sudden distention of the renal capsule

causes: acute PN, acute ureteral obstruction

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14
Q

radicular pain caused by what?

A

poor posture, arthritic changes to local jts, impingement of subcostal nerve, intervertebral disc pressure, herpes zoster

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15
Q

ssxs of irritative micturation?

A

urgency, frequency, dysuria, nocturia

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16
Q

ssxs of obstructive micturation?

A

hesitancy, decreased force of stream, dribbling

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17
Q

20-40 M/F, pain throughout micturation, burning pain, no referral, no fever, polyuria, urethral d/c, inflamed urethra, no suprapubic pain w/palpation, (=) CVA tenderness, UA shows pyuria, bacteriuria and hematuria?

A

urethritis

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18
Q

F 15+ yrs, M: infant and elderly, pain midstream and late, burning pain, no referral pain or may cause dull abd or perineal pn, no fever, polyuria, gross hematuria, fatigue, suprapubic pn w/palpation, mildly (+) CVA, pyruia, bacteriuria, hematuria on UA

A

cystitis

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19
Q

F 15+ yrs, M: infant and elderly, variable timing of pn, mb burning pain, flank and abd pn, fever usu present and usu high, polyuria, myalgia, fatigue, weakness, N/V, painless suprapubic palpation unless concomitant dz process, CVA strongly (+), pyuria, bacteriuria, hematuria on UA

A

pyelonephritis

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20
Q

M 30+ yrs, variable timing of pn w/micturation, dull pelvic pn, pain referred to testes, general pelvic region, no fever, polyuria, altered libido, pn w/ejaculation, painless suprapubic palpation, mildly (+/=) CVA, pyuria or negative UA

A

chronic prostatitis

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21
Q

volumes related to bladder outlet obstruction?

A

20-25 ml/s in M, 25-30 mL/s in F = normal
<15 mL/s = suspect obstruction
<10 mL/s = definitive evidence of obstruction

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22
Q

if hesitancy, loss of force of stream, terminal dribbling suspect what?

A

BPH, urethral stricture

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23
Q

if urinary retention suspect what? what two forms are there?

A

acute: sudden inability to urinate, agonizing suprapubic pn w/urgency
chronic: hesitancy, reduced force, little discomfort, dribblign

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24
Q

if interruption of stream suspect what?

A

bladder stone, pain may radiate to urethra

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25
if sense of residual urine could be what?
recurrent cystitis
26
if experiencing incontinence assume what anatomical abn?
sphincter abn
27
oliguria vs anuria?
oliguria <500 mL urine/d | anuria <100 mL urine/d
28
definition of microscopic hematuria?
excretion of >3 RBC/hpf | can come from anywhere along the tract
29
asx microscopic hematuria usu from where? gross hematuria usu from where?
asx microscopic: usu renal | gross hematuria: uroepithelial
30
gross, painless hematuria often 1st manifestation of what?
urothelial tumor
31
RFs for hematuria?
smoking, analgesic abuse, occupational exposures, medications, recent URI, HTN, pelvic irradiation, FHx of renal dz
32
if painless hematuria what do you need to assume it is until you rule it out?
tumor of bladder, kidney or prostate
33
if hematuria at start of urination? if end? if throughout? if cyclically with menstruation (but not vaginal source)? if blood btw voidings?
start: anterior urethral lesion end: bladder trigone, prostate, bladder neck, posterior urethra throughout: bladder, ureteral, renal pathology cyclically: endometriosis of urinary tract blood btw: bleeding on either end of the urethra
34
causes of hematuria? (VINDIC[A]TE)
Vascular: hemangioma, AV malformation, renal vein thrombosis, arterial emboli to KD Inflammatory: UTI, STI, GN, PN, radiation nephritis/cystitis, IC, TB, endocarditis Neoplasm: prostate, urethra, bladder, ureter, KD, BPH, endometriosis Drugs: nephrotoxins, aminoglycosides, cyclosporine Idiopathic: oral contraceptives Congenital: cystic dz, polycistic KD, solitary renal cyst, benign familial hematuria, Alport syndrome Trauma: exercise-induced, abd trauma, pelvic fx, iatrogenic (catheterization), foreign body Endocrine/metabolic: bleeding dyscrasias, hemophilia, Henoch-Scholein purpura, sickle cell animea
35
DDX hematuria?
dyes, pseudohematuria from dehydration, foods (beets, rhubarb, berries), vaginal source, genital/perineal trauma, drugs
36
workup for hematuria?
UA, complete microscopy, urine C and S, coag screen, renal fxn tests, PTT, CBC, PSA (when indicated), urine cytology be sure to consider hx: if UA clear, repeat in 1 week if hx of trauma or exercise induced then repeat in 24-48 hrs consider if it actually was a CCMS complete UA should be done in all high risk groups for CA, previous hx of stones or renal dz
37
what to do if cause is unclear?
refer to urologist/nephrologist
38
when palpating the KDs, if tender what can this indicate? if mass? if pitting edema in the area? if abd stystolic bruits hear? is visible mass in child?
tender: infxn mass: hydronephrosis, tumor or infxn pitting: perinephritic infxn systolic bruits: stenosis or aneurysm of renal artery visible mass in child: Wilm's tumor
39
when is it C/I to do DRE?
acute urethral d/c acute prostatitis acute prostocystitis CaP
40
4 clues to renal abn on general PE?
1. gross deformity of external ear in child & ipsilateral maldevelopment of facial bones may have congenital abn of ipsilateral KD 2. lateral displacement of the nipples can be assoc. w/BL renal hypoplasia 3. renal abn seen w/congenital scoliosis and kyphosis 4. general appearance - skin brown, pallor, uremic frost
41
if urine smells like ammonia? sweet-brown or frothy? fruity-sweet? maple syrup? foul smelling?
``` ammonia= bacterial sweet-brown or frothy = bile fruity-sweet = ketones maple syrup = MSUD, fenugreek foul = fecal contamination ```
42
random SG >1.020 is a good indication of what?
intrinsic KD dz
43
optimal pH on UA? protein should be? glucose (+) when blood glucose above what? blood? nitrite? leukocyte esterase? ketones? urobilinogen? bilirubin?
pH ~6.5 optimally - acidic in lung dz, DM, diarrhea, dehydration; alkaline in renal failure, proteus infxn, hyperventilation protein should be (=), dip picks up albumin not globulin! if >3.5 g/d on 24 hr collection then nephrotic syndrome! glucose should be (=), spills into urine when >170 blood should be (=), dilute urine SG <1.008 will lyse RBCs nitrites should be (=), can indicate coagulase-splitting bac (E. Coli, enterobacter, pseudomonas) leukocyte esterase should be (=) ketones should be (=), could indicate DM, anorexia, dehydration, N/V, fasting, wt loss, EtOH intoxication urobilinogen should be (=), often first sign of viral hepatitis!! bilirubin should be (=)
44
if elevated bilirubin and urobilinogen suspect what?
liver dysfxn
45
if high bilirubin but neg uro suspect what?
biliary stasis
46
if high urobilinogen but neg bili suspect what?
hemolytic cause
47
when do you see RBC casts?
acute GN or vasculitis
48
when do you see broad, waxy casts?
nephrotic syndrome - renal failure casts
49
what crystals do you seen in acidic urine? alkaline urine?
acidic: uric acid and calcium oxalate alkaline: triple phosphate
50
SG value showed diminished renal fxn?
as approaching 1.010
51
urine osmolality measures what?
measure of urine concentration
52
BUN rises when?
first with decreased GFR | influenced by dehydration, dietary protein, GI bleeds, drugs
53
urine creatinine vs serum creatinine?
urine is stable # | serum can raise w/muscle metabolism, affected by diet, MS mass
54
BUN:Cr ratio > 20:1 indicates what? BUN:Cr ratio <10:1 indicates what?
>20:1 indicates prerenal ARF | <10:1 indicates renal damage leading to decreased reabsorption of BUN and increase in serum Cr = intrinsic ARF
55
>3.5 g/d protein collection on 24 hr urine collection?
nephrotic syndrome = GBM damage
56
cystatin C use?
serum levels will increase as GFR decrease - more sensitive than Cr, less dependent on age, gender, race, ms mass
57
gold standard for measuring GFR?
inulin infusion
58
fractional excretion of sodium used to measure what?
predictive of incipient ARF <1% suggests prerenal ARF >1% suggests intrarenal ARF
59
type of anemia seen in CRF?
normochromic normocytic anemia
60
PSA level that correlates with CaP?
>4.0
61
indications for renal bx?
persistent hematuria nephrotic syndrome to guide tx rapidly progressing GN unexplained RF
62
uroflowmetry measures what? cystometry measures what? pressure flow study measures what? electromyography used to assess what?
uroflowmetry: measures vol voided, time, flow rate, max flow rate cystometry: measures volume, storage capacity, P in bladder pressure flow study: measures both urine flow and bladder P electromyography: can assess pelvic floor or periurethral ms activity for abn contraction/relaxation

Urology (9 decks)

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