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Cpr 3 other > (3.1) Nocturia [DSA-Tyler] > Flashcards

(3.1) Nocturia [DSA-Tyler] Flashcards

1
Q

Getting up to urinate more than 2x a night can be defined as ___

A

Nocturia

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2
Q

What are the main causes of nocturnal polyuria? (3)

A

Age-related delay in urine excretion (time and volume of fluid intake, caffeine, ETOH)

Peripheral edema

Medications (gabapentin, NSAIDs, nifedipine)

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3
Q

How long must dysuria occur to be considered acute?

A

<1 week

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4
Q

What structures may be involved in internal dysuria?

A

Internal genital structures:

Bladder

Urethra

Suprapubic area

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5
Q

What structures may be involved in external dysuria?

A

External genital structures:

Labia minora/majora

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6
Q

What are the main voiding symptoms?

A

Slow/intermittent stream

Hesitancy

Dribbling

Dysuria

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7
Q

Complicated UTI may occur in what population?

A

Individuals with functional/strucutral abnormalities of urinary tract

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8
Q

Transient causes of urinary incontinence?

A

DIAPPERS

Delirium

Infection

Atrophic urethritis and vaginitis

Pharmaceuticals (diuretics, anticholinergics, CCBs, a-blockers in men, a-agonists in women, opioids)

Psychological factors

Excess urinary output caused by: diuretics, excess fluid

Restricted mobility

Stool impaction

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9
Q

Established causes of urinary incontinence? (3)

A

Detrusor overactivity (urge incontinence)

Urethral incompetence (stress incontinence)

Detrusor underactivity (overflow incontinence)

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10
Q

What is the most common cause of established geriatric incontinence?

A

Detrusor overactivity (urge incontinence)

Uninhibited bladder contractions that cause leakage

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11
Q

What population is urethral incompetence (stress incontinence) more common in?

A

Most common in women (not older women?)

Older men following prostatectomy

Urethral obstruction due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostatic CA

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12
Q

What may cause urethral incompetence (stress incontinence) in older women?

A

Cystoceles or other anatomic problems

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13
Q

What distinguishes detrusor underactivity from detrusor overactivity and stress incontinence?

A

Elevated postvoid residual (>450 mL)

Via ultrasonography

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14
Q

What distinguishes detrusor underactivity from urethral obstruction in men?

A

Urodynamic testing

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15
Q

What is the standing full bladder stress test? What do the results indicate?

A

Test for stress incontinence

Have pt relax perineum and cough 1x while standing with full bladder

Instant leakage = + stress incontinence if retention excluded using US

Delay several sec or persistent leakage = uninhibited bladder contraction

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16
Q

What are the obstructive LUTS of BPH?

A

Urinary hesitancy

Straining

Weak stream

Terminal dribbling

Prolonged voiding, encomplete emptying

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17
Q

What are the irritative LUTS of BPH?

A

Urinary frequency

Urgency

Nocturia

Urge incontinence

Small voided volumes

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18
Q

The American Urological Association Symptom Index (AUASI) is used to measure what? What do the ranges indicate?

A

Lower urinary tract symptoms (LUTS)

0-7: Mild

8-19: Moderate

20-35: Severe

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19
Q

What is the most common reason men seek treatment for BPH?

A

Symptomatic relief

Also usually the goal of therapy for BPH

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20
Q

What drugs treat the dynamic aspect of BPH?

Static aspect?

A

Dynamic: a-adrenergic receptor antagonists - reduce sympathetic tone

Static: 5 ARIs - reduce prostate volume

May be used in combination with variable success

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21
Q

What drugs may treat the LUTS of BPH?

A

PDE5 inhibitors

Sildenafil, vardenafil, tadalafil, avanafil

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22
Q

What are the most common drugs for treating overactive bladder sx?

A

Anticholinergics

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23
Q

When is surgical therapy considered for pts with BPH?

A

Second-line therapy after a trial of medical therpay has failed

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24
Q

What ethnic group has a higher incidence of prostate CA and present at a more advance stage?

A

African Americans

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25
Q

What is the risk of being diagnosed with prostate CA if first degree relatives are affected?

A

2.5x if 1 relative affected

5x if >2 relatives are affected

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26
Q

How are the clinical states of prostate cancer defined?

A
  1. If CA diagnosis has been established
  2. If metastases are detectable on imaging studies and testosterone levels in blood
27
Q

What are the 3 guidelines for administering the PSA test?

A
  1. Avoid in men with little to no gain (i.e. asymptomatic men with short life expectancy)
  2. Do not treat those who do not need treatment (can be managed by active surveillance, phases of prostate CA)
  3. Refer who do need treatment to a urologist - PSA 4-7 ng/ml
28
Q

Why is DRE and PSA for prostatic CA detection controversial?

A

Low specificity and sensitivity with low rates of detection

29
Q

What is the difference between asymptomatic bacteriuria (ASB) and UTI?

A

ASB occurs in the absence of sx attributable to the bacteria in the urinary tract

Detected incidentally, does not usually require tx (i.e. old people with chronic indwelling catheters do NOT need abx)

30
Q

What distinguishes cystitis and pyelonephritis?

A

Mild fever - mild pyelonephritis

High fever - severe pyelonephritis

Elderly pts with cystitis may not be able to mount a fever response

31
Q

What sx in cystitis may indicate upper urinary tract involvement?

A

Unilateral back/flank pain

32
Q

Fever in a patient with cystitis may indicate involvement of what organs?

A

Invasive infection of kidney or prostate

33
Q

How long does a fever in pyelonephritis take to resolve?

A

72 hours of therapy

34
Q

Pt w/ hx of diabetes presents with pyelonephritis. What renal pathology might you be concerned about?

A

Obstructive uropathy associated with acute papillary necrosis when sloughed papillae enter the ureter

35
Q

What form of pyelonephritis is often found on ultrasound in diabetic patients?

A

Emphysematous pyelonephritis

Production of gas in renal and perinephric tissues

36
Q

What form of pyelonephritis may occur when chronic urinary obstruction and chronic infection leads to suppurative destruction of renal tissue?

A

Xanthogranulomatous pyelonephritis

Infiltration by lipid-laden macrophages

37
Q

When would an intraparenchymal abscess be suspected in a patient with pyelonephritis?

A

Pt has continued fever and/or bacteremia despite antibacterial therapy

38
Q

Infectious prostatitis is almost always ___ in nature

A

Bacterial

39
Q

How might a complicated UTI present?

A

Symptomatic episode of cystitis or pyelonephritis in pt with anatomic disposition to infection

FB in urinary tract

Factors predisposing to a delayed response to therapy

40
Q

What sx most commonly present in a patient with L ventricular failure?

A

Dyspnea

Orthopnea

Paroxysmal nocturnal dyspnea

(May have hemoptysis)

41
Q

Typical PE findings on a patient with LV heart failure?

A

Pulsus alternans

Rales

Lung bases dull to percussion

S3 and S4

42
Q

What population is most effected by urinary stone diseases?

A

Males

Age: 30s-40s

43
Q

What genetic/environmental factors may increase risk of urinary stone formation?

A

Cystinuria

Distal RTA

High protein/salt intake

Sedentary occupations

44
Q

What type of urinary stone is radiolucent?

A

Uric acid

45
Q

What form of nephrolithiasis can be caused by absorptive, resorptive, and renal disorders?

A

Hypercalciuric calcium nephrolithiasis

46
Q

What form of nephrolithiasis is secondary to dietary excess or uric acid metabolic defects?

A

Hyperuricosuric calcium nephrolithiasis

47
Q

What form of nephrolithiasis is due to primary intestinal disorders (chronic diarrhea, IBS, steatorrhea)?

A

Hyperoxaluric calcium nephrolithiasis

48
Q

A patient on long term hydrochlorothiazide treatment is at risk for what form of nephrolithiasis? What are the other risk factors?

A

Hypocitraturic calcium nephrolithiasis

Risk factors: disorders associated with metabolic acidosis (chronic diarrhea, Type 1 RTA)

49
Q

Urease-producing organisms produce what kind of calculi?

A

Struvite (magnesium-ammonium-phosphate “staghorn” calculi)

50
Q

What bacteria is associated with recurrent UTI but does not produce urease?

A

E. Coli

51
Q

A patient presents with colicky flank pain and is unable to get comfortable. What pathology might they have?

A

Urinary stone formation

52
Q

Persistent urinary pH <5.5 is suggestive of ____ stones

A

Uric acid or cystine

53
Q

Persistent urinary pH > 7.2 is suggestive of ___ stones

A

Struvite infection

54
Q

Urinary pH in what range suggests calcium-based stones?

A

5.5 - 6.8

55
Q

What kind of metabolic evaluation is done for urinary stone formation?

A

Stone analysis

Serum Ca++, electrolytes, uric acid

Reduce Na+ and ptn intake

Fluid intake

56
Q

What imaging studies will detect most stones?

A

KUB

Renal US

Most ED physicians go for CT because it is most accurate

57
Q

When would you admit a patient with a urinary stone?

A

Intractable nausea/vomiting or pain (manage sx)

Obstructing stone with signs of infection

58
Q

What diagnostic criteria are found in a patient with acute bacterial prostatitis?

A

Fever

Irritative voiding sx

Perineal/suprapubic pain

Exquisite tenderness on rectal exam

+ Urine culture

59
Q

Most common organisms causing acute bacterial prostatitis?

A

E. Coli and Pseudomonas

60
Q

What lab results would be foundon a pt for suspected acute bacterial prostatitis?

A

CBC: leukocytosis, left shift

UA: pyuria, bacteriuria, hematuria

+ Urine culture

61
Q

When would you admit a patient with acute bacterial prostatitis?

A

Signs of sepsis

Need for surgical drainage of the bladder or prostatic abscess

62
Q

Medications for acute bacterial prostatitis?

A

IV ampicillin + aminoglycoside until afebrile

Ampicillin and gentramicin

Ciprofloxacin

Ofloxacin

TMP-SMX

63
Q

When would you refer a patient with acute bacterial prostatitis?

A

Evidence of urinary retention or chronic prostatitis

64
Q

Why might a diabetic patient have nocturia?

A

Diabetic patients tend to be hyperglycemic which may cause osmotic diuresis

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