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Repro Med Test 2 > BPH Prostate Cancer / Urinary Tract Disorders > Flashcards

BPH Prostate Cancer / Urinary Tract Disorders Flashcards

1
Q

stratified epithelium lined with layer of cuboidal or columnar cells

arranges like a tree with larger ducts draining into small ones

A

prostate glandular tissue about 30% of prostate

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2
Q

types of tissue in prostate

A

glandular
stroma
acini

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3
Q

prostate stroma definition

A

collagen elastic & fibrous tissue that supports glandular tissue

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4
Q

__% of prostate is glandular tissue and __% of prostate is stroma

A

30% prostate = glandular

70% prostate = stroma

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5
Q

contains strands of smooth muscle as well

lets prostate contract and expel secretions

A

stroma

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6
Q

the smallest structure in the glandular part of prostate

A

acini

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7
Q

acini proliferation leads to

A

BPH

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8
Q

4 prostate zones

A

periurethral
peripheral
central
transition

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9
Q

periurethral zone contains

A

contains mucosal and submucosal glands

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10
Q

peripheral zone

A

majority of glandular tissue location

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11
Q

where 70% of prostate adenocarcinomas occur

A

peripheral zone

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12
Q

cone shaped and has 25% of glandular tissue

also location about 1-5% of prostate cancers

A

Central Zone

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13
Q

Transition Zone surrounds..

A

prostatic urethra

contains mucosal glands

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14
Q

only about 20% of prostate cancer arises from …

A

the transition zone

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15
Q

t/f BPH normal part of aging

A

true

90% of men by age 80

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16
Q

BPH is more progressive and severe in __

A

blacks

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17
Q

role of 5 reductase

A

turns testosterone into DHT

binds to receptors in prostate = BPH

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18
Q

where are A1 adrenergic receptors located

A

muscle of stroma
capsule of prostate
bladder neck (causes smooth muscle contraction and contributes to worsening urinary sx)

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19
Q

LUTS

A

lower urinary tract sx

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20
Q

sx of LUTS or urinary incontinence are exacerbated by what med?

A

cold meds especially decongestants (Sudafed)

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21
Q

medications to help with urinary BPH sx specifically to “open the gland”

A

non selective alpha blocker : doxazosin, terazosin

selective alpha-blocker: tamsulosin, silodosin

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22
Q

meds to “shrink the gland”

A

5 alpha reductase inhibitors : finasteride, dutasteride

takes about 6 mo to work

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23
Q

additional med for BPH

A

antimuscarinics such as oxybutinin

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24
Q

TUMT

A

surgical bph option..microwave tx

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25
Q

TUNA

A

surgical bph option: insert hot wire under direct vision = coagulative necrosis

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26
Q

TURP

A

bph surg option: resect extra tissue

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27
Q

PVP

A

bph surg option: vaporize the obstructing tissue w/ laser

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28
Q

REZUM

A

bph surg option shoots steam into prostate

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29
Q

most common non skin cancer in men

A

prostate cancer

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30
Q

2nd leading cause of cancer death in men

A

prostate cancer

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31
Q

prostate cancer prognosis

A

excellent if detected early

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32
Q

PSA is the ezyme that..

A

liquefies ejaculate sperm swim free

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33
Q

T/F DRE is both ore specific and sensitive for prostate cancer than PSA

A

TRUE

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34
Q

what is included in annual prostate exam?

A

DRE + PSA

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35
Q

who needs biopsy? (4 criteria)

A

men under 50 if + 1st degree relative
Age 40 and African American
+ FH and PSA is 2.5
PSA under 4 but has increased over past 3 checks

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36
Q

DRE limitation

A

only 85% of cancers arise peripherally and are palpable

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37
Q

grading of prostate tells me

A

what type of cancer cells and how aggressive

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38
Q

staging of cancer tells me

A

how much of cancer and where it is (if spread how far)

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39
Q

PNB process

A

Local anesthetic, pt awake
transrectal ultrasound guided
sextant sample (right and left apex mid and base)

40
Q

risks of prostate needle biopsy (PNB)

A

SL bleeding even in semen

41
Q

gleason scoring

A

for prostate cancer

assigns all observed cancer cell types a score 1-10 with 2 most common types receiving a final combined score

42
Q

besides gleason score what is workup for prostate cancer

A
  1. CXR
  2. CBC, LFT alk phos
  3. Bone scan if PSA over 20
  4. CT of pelvis if high risk
43
Q

4 prostate cancer tx options

A
  1. RRP radical retropubic prostatectomy
  2. radiotherapy (brachytherapy seed implnt)
  3. androgen suppressive therapy
  4. active surveillance
44
Q

what tx is best for localized, contained, low Gleason score cancer

A

radiotherapy: brachytherapy seeds irradiated and implanted in prostate

45
Q

gold standard prostate tx

A

RRP: radiacal retropubic prostatectomy

46
Q

what is common RRP complication

A

urinary dysfunction

47
Q

dysuria

A

painful urination

48
Q

hematuria

A

blood in urine (microscopic vs gross)

49
Q

urgency

A

sudden, strog urge to pass urine

50
Q

frequency

A

complication of voiding too often

51
Q

UTI

A

urinary tract infection

52
Q

recurrent UTI

A

reccurent generally due to diff organisms or resistance

53
Q

persistenet UTI

A

organism never clears, frequently identical suseptability profile

54
Q

unresolved uti

A

inadequate tx

55
Q

complicated uti

A

uti in context that increase risk of therapy failing

56
Q

acute uncomplicated uti aka

A

acute cystitis: UTI in healthy / normal individual

57
Q

asymptomatic bacteria

A

bacteria in urine, without significant host response sx

58
Q

80% acute cystitis caused by

A

e coli

59
Q

__turns urine orange

A

pyridium ..dipstick is unreliable

60
Q

specific gravity tells me

A

hydration

ranges 1.005-1.030

61
Q

ph

A

ranges 5-8
over 7.5 = urea splitting organism Proteus
under 6 = uric acid stones

62
Q

blood in UA

A

none to 3+

confirm with microscopic analysis

63
Q

protein ranges

A

none to 4+

64
Q

glucose in ua

A

always abnormal if present

renal threshold corresponds to serum glucose of 180

65
Q

ketones in urine

A

sign of hunger or DM

66
Q

nitrite in urine

A

if + = infection

- ..may still have infxn

67
Q

leukocytes in urine

A

none to 3+

+ ifxn or contaminatd sample

68
Q

RBC in urine more than 3 is..

A

abnormal think glomerularnephritis dz

69
Q

epithelial cells in urine

A

common to have squamous cells for females

70
Q

casts in urine

A

RBC cast think GN

WBC cast think pyelonephritis and GN

71
Q

crystals in urine

A

associated with stone formation

72
Q

bacteria in urine in males

A

always has to be cultured

73
Q

who needs a urine culture?

A

all men with UTI
women with recent abx, early recurrence, DM, pregnant or recent pregnancy, surgical complexity OR

UTI sx for more than 7 days

74
Q

RF for UTI

A

anatomy

behaviors: spermicidal use, activities, baths vs showers etc
environment: catheter, pessary, alteration in native flora - host post menopausal females

75
Q

tx UTI

A

TMP/SMX

76
Q

if UTI is PCN sensitive

A

cephalexin

77
Q

if UTI is ampicillin sensitive

A

amoxicillin

78
Q

first line UTI tx

A

TMP/SMX

or nitrofurantoin non monohydrate

79
Q

infxn of renal parenchyma and collecting system (upper UTI)

A

pyelonephritis

80
Q

most common cause of pyelonephritis

A

ecoli

81
Q

hallmark finding of pyelonephritis

A

CVA tenderness

82
Q

workup pyelonephritis

A

UA and culture, blood culture, CBC, chem 8, renal sonogram to exclude obstruction

83
Q

tx pyelonephritis

A

IV abx, hydration and glucose monitoring

low threshold for hospitalization (DM, Preggers etc)

84
Q

what if there is obstruction with pyelonephtritis?

A

decompress with percutaneous tube or ureteral stent

85
Q

stomes with: hyper calciuria, hyperoxaluria (bypass pt), hypocitraturia, low urine volume

A

calcium stones

86
Q

uric acid stone signs

A

acidic urine, elevated serum uric acid

87
Q

struvite stones

A

from chronic upper tract infection, urease positive organisms, can lead to staghorn calculi

88
Q

Cystine stones

A

from autosomal recessive disorder

89
Q

mucnex stones or HIV drug stones

A

will be cysteine stones

90
Q

most common stone

A

calcium containing

91
Q

3 tight spots for urinary stones

A
  1. UPJ: ureterpelvic junction
  2. Iliac vessels / pelvic brim
  3. Ureteropelvic junction (UVJ)
92
Q

if stone in distal ureter__% will pass

A

if under 4 mm, 90% pass

93
Q

when is surgery indicated for ureteral stones

A
  1. too large to pass
  2. pain severity
  3. recurrent UTI
  4. high risk non compliant
  5. staghorn calculi
94
Q

hypercalciuria tx

A

loop diuretics

95
Q

hypocitraturia tx

A

citrate supplementation - avoid excess vit. C

96
Q

hyperoxaluria tx

A

calcium supplementation

Repro Med Test 2 (6 decks)

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