19-4 Flashcards
1
Q
presence of blood in the urine, may not be visible to the eye, may be microscopic
A
Hematuria
2
Q
blood in the urine, visible to the naked eye
A
gross hematuria
3
Q
upper urinary tract source includes
A
kidneys and ureters
4
Q
lower tract source includes
A
bladder and urethra
5
Q
Microscopic hematuria in the male is most commonly from
A
benign prostatic hyperplasia
6
Q
Initial hematuria, the presence of blood at the beginning of the urinary stream that clears during the stream, implies
A
anterior (penile) urethral source
7
Q
Terminal hematuria, the presence of blood at the end of the urinary stream, implies
A
bladder neck or prostatic urethral source
8
Q
Total hematuria, the presence of blood throughout the urinary stream, implies
A
bladder or upper tract source
9
Q
Hematuria associated with renal colic suggests
A
ureteral stone
10
Q
Irritative voiding symptoms in a young woman may suggest
A
acute bacterial infection and associated cystitis
11
Q
absence of other symptoms, gross hematuria may be more indicative of…
A
tumor
12
Q
Proteinuria and casts suggest…
A
renal origin
13
Q
Irritative voiding symptoms, bacteriuria, and a positive urine culture in the female suggest…
A
urinary tract infection
14
Q
responsible for most Urinary tract infections
A
Coliform bacteria
15
Q
most common Coliform bacteria for UTI
A
E. coli
16
Q
most common route of UTI
A
Ascending infection from the urethra
17
Q
most uncommon route of UTI
A
Hematogenous spread to the urinary tract
18
Q
Tx for Acute Cystitis
A
- Nitrofurantoin (Macrobid)
- Trimethoprim/sulfamethoxaz (Bactrim)
- Ciprofloxacin
- & Phenazopyridine (Pyridium)
19
Q
Women who have more than how many episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy?
A
3
20
Q
3 most commonly used oral agents for prophylaxis are:
A
1) Trimethoprim-sulfamethoxazole
2) Nitrofurantoin
3) Cephalexin
21
Q
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis.
A
Pyelonephritis
22
Q
what are the most common causative agents of Pyelonephritis?
A
Gram-negative bacteria
23
Q
- Fever
- Flank pain
- Irritative voiding symptoms (urgency, frequency, dysuria)
- Rigors
- Nausea and vomiting
- Diarrhea
- Tachycardia
- CVA tenderness
A
S&S of Pyelonephritis
24
Q
Treatment for Pyelonephritis
A
- Ampicillin & Gentamicin
- Ciprofloxacin
- Levofloxacin
- & Phenazopyridine (Pyridium)
25
Inflammation and infection of the prostate gland
Acute Prostatitis
26
Acute Prostatitis is usually caused by
gram-negative rods
E coli and Pseudomonas species
27
* Warm and often exquisitely tender prostate is detected on examination
* Perineal, sacral, or suprapubic pain
* Fever
* Irritative voiding symptoms
S&S of Acute Prostatitis
28
Tx for Severe Prostatitis
* Ampicillin & gentamicin
* 4-6 week course of therapy
29
Tx for Acute Prostatitis
* Ciprofloxacin (Cipro)
* Levofloxacin (Levaquin)
* Acetaminophen/NSAIDS
30
Chronic Bacterial Prostatitis
* Irritative voiding symptoms
* Low back and perineal pain
* Suprapubic discomfort
* Hx of UTIs
* Abnormal prostatic secretions
31
Tx for Chronic Bacterial Prostatitis
* Trimethoprim-sulfamethoxazole (Bactrim)
* Ciprofloxacin/Levofloxacin
* NSAIDS
* Sitz bath
32
* following heavy lifting, trauma, or sexual activity
* pain in the scrotum, radiates along spermatic cord or to the flank
* Fever
* Irritative voiding sx
* Scrotal swelling
* elevation of the scrotum improves pain
Epididymitis
33
Tx for Sexually transmitted Epididymitis
* Ceftriaxone (Rocephin)
* PLUS Doxycycline
34
Tx for Non-sexually transmitted Epididymitis
* Trimethoprim/sulfamethoxazole (Bactrim)
* Ciprofloxacin (Cipro)
* Levofloxacin (Levaquin)
* NSAIDS
35
* colicky stabbing ipsilateral flank pain
* severe localized flank pain
* nausea & vomiting
* occurs suddenly
* constantly moving to find comfortable position
* pain radiates over abdomen, referred to ipsilateral groin
Renal Calculi
36
Tx for Renal Calculi
* Alpha-blockers Tamsulosin
* NSAIDS
* Prednisone
37
Prevention for Renal Calculi
* Dietary mods:
* increase water intake
* decrease salt
* decrease protein intake
38
Tx for Erectile Dysfunction
* Phosophodiesterase-5 inhibitor:
* Sidenafil (Viagra)
* Vardenadil (Levitra)
* Tadalafil (Cialis)
39
Most common benign tumor in men and its incidence is age related…
Benign Prostatic Hypertrophy
40
At age 55, approximately what % of men report obstructive voiding symptoms?
25%
41
At age 75, what % of men report decrease in the force and caliber of the urinary stream?
50%
42
* obstructive or irritative voiding sx
* may have enlarged prostate on DRE
* sensation of incomplete bladder emptying
Benign Prostatic Hypertrophy
43
Labs for Benign Prostatic Hypertrophy
Prostate specific antigen test (PSA)
44
Tx for Benign Prostatic Hypertrophy
* AUA less than 7 watchful waiting
* Alpha-blocker (Tamsulosin)
* 5-alpha-reductase inhibitors (Finasteride)
* Phosphdiesterase-5 inhibitors (Tadalafil)
45
When should you refer Benign Prostatic Hypertrophy?
AUA score \< 7
46
Most common non-cutaneous cancer in American men and second leading cause of cancer related death in men.
Prostate Cancer
47
3 Common Risk factors of Prostate Cancer:
1. African-American
2. FMHx Prostatic Cancer
3. Hx of high dietary fat intake
48
* Prostatic firmness on DRE
* Asymptomatic
* May have systemic sx
Prostate Cancer
49
what % of men with 4.1 - 10 ng/mL will be found to
have prostate cancer?
8 - 30%
50
what % of men with \<10 ng/mL will be found to have prostate cancer?
50% - 70%
51
what is the standard method for detection and confirmation of prostate cancer?
Transrectal ultrasound guided biopsy
52
Prostate specific antigen testing baseline at what age?
50 y/o
53
Prostate specific antigen testing w/ risk factors at what age?
40-45y/o
54
3 Common Risk factors for Prostate Cancer:
1. African American male
2. FMhHx of Prostate Cancer
3. BRCA1 or BRCA2
55
Tx for Prostate Cancer
* Active surveillance
* Prostatectomy
* Radiation therapy
56
Tx for Scrotal Trauma
* Blunt or Penetrating refer to Urology
* Lacerations or avulsions can be repaired by IDC
57
Necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissues of the perineum often involving the scrotum.
Fournier's Gangrene
58
* Pain out of proportion to exam
* tense edema
* fever
* scrotal, rectal, or genitalia pain
* abscess
* crepitus
Fournier's Gangrene
59
Tx for Fournier's Gangrene
* Ertapenem
* Fluids
* MEDEVAC
60
* dilation of the pampiniform plexus of spermatic veins, generally left sided
* Usually asymptomatic mass, separate from testis
* Feels like "bag of worms"
* Size increased by Valsalva maneuver.
Varicocele
61
* Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord
* Gradually enlarging painless cystic mass
* Transilluminates
Hyrdocele
62
* fluid filled cyst at the head of the epididymis that may contain nonviable sperm.
* Painless
* Palpated as distinct from the testis
* Typically transilluminates as cystic in nature
Spermatocele
63
diagnostic imaging of choice for scrotal and testicular abnormalities
Ultrasound
64
* Age 20-35 years
* Painless enlargement of the testes
* Sensation of heaviness
* Diffuse testicular enlargement
* Sensation of heaviness
Testicular Cancer
65
If you suspect a patient has a testicular tumor, you can run a…
urine hCG
66
Tx for Testicular Cancer for Diagnosis is made by…
inguinal orchiectomy
67
* Acute onset
* constant unilateral groin pain
* occurs after trauma or spontaneously
* unrelieved w/ elevation
* common in young adults
* nausea and vomiting
Testicular Torsion
68
Tx for Testicular Torsion
* Manual detorsion
* MEDEVAC if doesn't detorse manually
69
* Fibrous constriction of the foreskin preventing retraction
* Can be the result of Balanitis, Balanoposthitis
* May cause urinary retention
Phimosis
70
Tx for Phimosis
* Foley catheter/Suprapubic catheterization
* Good hygiene
* Topical antifungal: Clotrimazole, Miconazole
71
Urologist can perform what to temporize Phimosis?
dorsal slit circumcision
72
Definitive treatment for Phimosis?
complete circumcision
73
* True Urologic emergency
* fixed constricted foreskin
* swollen and painful
* gangrenous
* urinary retention
Paraphimosis
74
Tx for Paraphimosis
* compress the glans 5-10min
* 2in elastic band for 5min
* icing area
* dorsal slit
* circumcision
75
increase in serum creatinine is characterized as…
Acute Kidney Injury
76
AKI can be divided into 3 categories:
1. Prerenal
2. Instrinsic kidney disease
3. Postrenal
77
what AKI is (low blood flow or pressure)?
Prerenal
78
what AKI is (Obstructive)?
Postrenal
79
MOST common etiology of AKI is…
Prerenal
80
Most common electrolyte abnormality in hospitalized patients?
Hyponatremia
81
Hyponatremia is defined as serum sodium concentration less than
135
82
Tx for Hyponatremia
* Restriction of free water
83
* Dehydrated patient
* Lethargy
* Irritability
* Weakness
Hypernatremia
84
Hypernatremia is defined as serum sodium concentration more than…
145
85
Hypokalemia is defined as serum potassium concentration less than…
3.5
86
Severe hypokalemia may induce…
arrhythmias and rhabdomyolysis
87
* Muscular weakness, Fatigue, Muscle cramps
* Flaccid paralysis
* Hyporeflexia
* Hypercapnia
* Tetany
* Rhabdomyolysis
Hypokalemia
88
The most common cause of hypokalemia is…
gastrointestinal loss from infectious diarrhea
89
* Muscular weakness
* Fatigue
* Muscle cramps
* Flaccid paralysis
* Hyporeflexia
* Hypercapnia
* Tetany
* Arrhythmias
* Rhabdomyolysis
Hypokalemia
90
Hypokalemia will show what on EKG?
ST depression
91
Tx for Hypokalemia
* Oral potassium supplement
92
Hyperkalemia is defined as serum potassium concentration greater than…
5.0
93
what meds cause Hyperkalemia?
* ACE inhibitors
* Angiotensin receptors
* Potassium diuretics
94
* Muscle weakness
* Flaccid paralysis
* Ileus
Hyperkalemia
95
Hyperkalemia will show what on EKG?
Peaked T waves
V-Fib
96
Tx for Hyperkalemia
* withholding potassium
* insulin, bicarbonate, and beta-agonists
* Hemodialysis chronic kidney injury
* Loop diuretics: Furosemide
