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NPTE Study > 5.2 - GU System > Flashcards

5.2 - GU System Flashcards

Week 5, Tuesday

1
Q

How can the presentation of cervical cancer vs ectopic pregnancy differ?

A

Ectopic pregnancy may cause unilateral shoulder pain (or mid and lower back)
- Bc higher up in fallopian tubes

Cervical CA is unlikely to cause shoulder pain
- Bc much lower compared to fallopian tubes

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2
Q

Describe the general s/sx of GU conditions

A

Classic Symptoms:
- Unilateral costovertebral tenderness
- LBP, flank, inner thigh pain
- Ipsilateral shoulder

Urinary changes:
- Dysuria
- Noctuira
- Hematuria
- Polyuria
- Incomplete emptying
- hesitancy

  • Dyspareunia
  • Sexual dysfunction

Systemic s/sx - fever, chills, fatigue, malaise, anorexia, weight loss

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3
Q

Describe the upper urinary vs lower urinary tract

A

Upper: Kidneys & ureters

Lower: Bladder & urethra

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4
Q

Define oliguria

A

Little amount of urine (<400 mL / 24hr)

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5
Q

Define anuria

A

Almost no urine (<100mL / 24hr)

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6
Q

Define dyspareunia

A

pain w/ sexual intercourse

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7
Q

Common upper urinary tract conditions (4)

A

Renal failure
Renal infections (pyelonephritis)
Glomerulonephritis
Renal necrosis, renal tuberculosis

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8
Q

Common lower urinary tract conditions

A

Bladder infection (cystitis)
Urethritis
Renal calculi

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9
Q

Describe symptoms in the upper vs lower urinary tract

A

Upper tract:
- Unilateral costovertebral tenderess
- Flank pain, ipsilateral shoulder pain

Lower tract:
- Increased urinary frequency, urgency
- LBP, pelvic pain, lower abdominal pain

Both: change in bladder habits

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10
Q

Describe risk factors for UTIs

A

Older adults
Females
Diabetes mellitus

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11
Q

In an older adult with mental status changes, what should be one of the first thoughts we have about what is causing this change?

A

UTI

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12
Q

Renal Calculi

What is it?
Clinical presentation

A

Kidney stones

Clinical Presentation:
- “Colicky” flank pain - “ebb & flow”; intense pain comes and go; pain occurs when the stone is moving
- Pain location dependent on stone location

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13
Q

Cystitis

What is it?
Clinical presentaiton

A

Inflammation of the bladder

Clinical Presentation:
- Increased urinary frequency, urgency

Bladder acts “hyperreflexic” because of irritation

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14
Q

Prostatitis

What is it?
Clinical Presentation

A

Inflammation of the prostate

Risk Factors:
- Prevalence higher in YOUNGER men <40 yo (differs from BPH)
- Multiple sex partners
- Bicycling or jogging on a regular basis

Clinical Presentation:
- Low back, inner thigh pain
- Testicular, penis pain
- Nocturia, dysuria
- Weak urine stream
- Fever, chills, malaise

Can eventually progress to overflow incontinence due to difficulty emptying the bladder

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15
Q

Describe how to identify prostatitis vs BPH vs prostate cancer

A

Prostatitis:
- Prevalence higher in YOUNG men <40 yo
- Presence of PAIN

BPH:
- OLDER men >50 yo
- Obstruction of urethra –> decreased FORCE of urinary flow; difficulty with urination (especially initiating); increased frequency

Prostate Cancer:
- HEMATURIA
- LBP

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16
Q

What is the hallmark symptoms of UTIs?

A

Dysuria

17
Q

Describe risk factors for a UTI

A

Urinary catheterization!!!
Increased age
Diabetes

18
Q

Describe the clinical presentation of a UTI in older adults

A

Change in MENTAL STATUS
N/v
SOB, cough

19
Q

Describe the 4 types of incontinence

Stress
Urge
Overflow
Functional

A

Stress
- WEAK support for bladder
- Leakage w/ increased intra-abdominal pressure (laughing, sneezing, lifting)

Urge
- Involuntary contraction of the detrusor muscle

Overflow
- Acontractile or deficient detrusor –> inability to empty completely –> overdistention of the bladder

Functional
- Decreased mobility or physical impairments impair the ability to get to the bathroom in time

20
Q

BPH is a common cause of __________________ incontinence.

A

Overflow incontinence

21
Q

Describe the absolute contraindications to aerobic exercise during pregnancy

A

Hemodynamically significant heart disease
Restrictive lung disease

Incompetent cervix
Vaginal bleeding
placenta previta (placenta may detach)
Multiple gestation w/ risk of premature labor
Preecamplsia (high BP that occurs during pregnancy)
Rupture of membrane (“water broke”
Maternal type I diabetes
Severe anemia

22
Q

Review the precautions and relative contraindications to exercise during pregnancy

A

Discontinue exercise and contact PCP:
Vaginal bleeding
Persistent pain
Leakage of amniotic fluid
Regular painful uterine contractions
Decreased fetal movements
Persistent SOB, irregular heartbeat
Dizziness, faintness, pain in calf, difficulty walking

Relative contraindications:
- Poorly controlled T1DB, HTN, seizure disorder, hyperthyroidism
- History of extremely sedentary lifestyle
- Overhearting
- Morbid obesity or extreme underweight
- Diastasis recti
- heavy smoker
- Arrhythmias, bronchitis

23
Q

Describe how to assess for diastasis recti

A

Hooklying

Palpable separation of the rectus abdominis (2 cm)

24
Q

A PT is treating a pregnant patient (32 wks gestation). The treatment requires the patient in supine. Which modifications to the supine position would be MOST appropriate?

A

Place pillows under R hip

Places patient in a semi L s/l position –> offloads the inferior vena cava that travels on the R side

25
Q

When should supine be avoided during pregnancy?

A

Do not exceed 5 min in supine after the 1st trimester

Use a towel or wedge under the R hip instead

26
Q

What other position (besides supine) should be avoided during mid-to-late pregnancy?

A

Prone

27
Q

Why should pregnant patients be cautioned about orthostatic hypotension?

A

Increased BF to placenta

28
Q

Describe each of the following considerations during pregnancy

Valsalva
Bladder emptying before exercise
SL exercises

A

Discourage / avoid Valsalva

Encourage complete bladder emptying before exercise

Limit SL exercises
- Relaxin hormone –> increased ligament laxity in pelvis
- SL exercises –> increased shear forces in pelvis / SI joint

29
Q

Describe each of the following pelvic floor interventions

Contract-relax
Quick contractions
Pelvic floor relaxation

A

Contract-relax
- Contract pelvic floor
- Avoid valsalva maneuver

Quick contractions
- 15-20 reps of quick contractions
- Stimulate type II fibers to withstand quick pressure (sneezes, cough, etc.)

Pelvic floor relaxation
- Used for pelvic floor overactivity, dyspareunia

30
Q

What muscles / movements can be used to improve recruitment of the pelvic floor musculature?

A

“Pelvic floor overflow recruitment”

Hip ERs & IRs
Hip adductors

31
Q

What cue can be used to promote contraction of the pelvic floor?

A

“Stop the flow of urine”

32
Q

Describe the easiest to hardest positions for pelvic contractions

A

Easiest –> hardest

Supine –> hooklying –> quadruped –> seated –> standing –> during activity

33
Q

What is the Crede maneuver?

A

Application of manual downward pressure over the lower abdomen to promote bladder emptying in those w/ a flaccid bladder

34
Q

What is suprapubic tapping?

A

Stimulates the detrusor muscle to assist w/ bladder emptying

35
Q

Describe the primary interventions for each of the types of incontinence

Stress
Urge
Overflow
Functional

A

Stress
- Pelvic floor strengthening

Urge
- Pelvic floor strengthening
- scheduled voiding

Overflow
- Pelvic floor training
- Fluid regulation
- Improve flow (ex: surgery)

Functional:
- PT!
- Improve functional mobility

36
Q

At what spinal cord level does micturition control arise from?

A

S2-4

37
Q

How does the location of a SCI impact bladder function?

A

Lesion above the conus medullaris (L1 vertebral body) –> spastic / hyperreflexic bladder
- “UMN lesion”
- Reflex arc intact
- Reflexively empties w/ adequate filling pressure

Lesion below the conus medullaris –> flaccid / areflexic bladder
- “LMN lesion”

38
Q

Describe the management of a spastic vs flaccid bladder

A

Spastic bladder:
- Suprapubic tapping

Flaccid bladder:
- Catheterization
- Valsalva maneuver straining

39
Q

Describe how the location of a SCI can impact bowel function

Describe the management of each

A

Above conus medullaris –> spastic / reflexive bowel
- Reflex defecation when rectum fills
- Digital stimulation

Below conus medullaris - flaccid / areflexive bowel
- Manual evacuation

NPTE Study (49 decks)

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