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GU > Clin Med: Buzzwords, Tx, and Jim Gems > Flashcards

Clin Med: Buzzwords, Tx, and Jim Gems Flashcards

1
Q

What part of the prostate is involved in BPH?

A

Transition zone

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2
Q

What is the 1st line tx for BPH?

A

a-blockers, such as tamsulosin

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3
Q

What is NOT an appropriate tx for elevated PSA?

A

Do not give antibiotics for elevated BPH

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4
Q

What is the 1st line tx for ED?

A

PDE5 inhibitors such as slidenafil, tadalafil, and vardenafil

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5
Q

What are contraindications and AEs associated with the 1st line tx for ED?

A

PDE5 inhibitors are absolutely contraindicated for use in patients with access to nitrates

Relative contraindication in patients on a-blockers

AEs: HA, flushing, congestion, dizziness, visual disturbance, rare priapism

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6
Q

What is the first line tx for peyronie disease?

A
  • Xiaflex - only FDA approved option
  • Often used in conjunction with PO pentoxifyline

(Refer peyronie disease)

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7
Q

What is the first and second line txs for overactive bladder? What are the associated AEs and contraindications?

A
  • Behavioral management
  • Antimuscarinics:
    • AE: dry mouth, CNS effects, urinary retention, constipation
    • CIx in patients with narrow angle glaucoma; use with caution in patients on other antimuscarinic drugs
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8
Q

What are three tx options for phimosis?

A

Betamethasone
Circumcision
Dorsal slit procedure

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9
Q

What is a characteristic of BXO that can help differentiate from a cancerous lesion?

A

In BXO the glans is unaffected

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10
Q

What are the MC causes of hematuria?

A

Hematuria is most commonly from the lower tract. The three mc causes are:

  • Infection
  • Bladder carcinoma
  • BPH

When it is from the upper tract, the kidneys or ureters are the most common source

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11
Q

After a patient is treated for bladder cancer, what must be considered?

A

Bladder cx has a high rate of recurrence, so the patient should undergo cystoscopic surveillance indefinitely.

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12
Q

What is the MC form of kidney cancer?

A

Clear cell

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13
Q

What is the classic presentation of kidney cx?

A

Classic triad:

  • Hematuria
  • Flank pain
  • Abdx mass
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14
Q

Your patient had an abdominal CT which shows a renal mass that is 8 HU. Should this be referred?

A

No - do not refer masses <10 HU

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15
Q

Your patient had an abdominal CT which shows a renal mass that is 21 HU. Should this be referred?

A

Yes: renal masses that are >20 HU are renal cell carcinoma until proven otherwise

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16
Q

What is the treatment for kidney cancer?

A

Nephrectomy: partial if possible.

If not a surgical candidate, ablation (radio or cryo).

For our purposes, no chemo or radiation for kidney cancer.

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17
Q

Your patient is a 60 YO circumcised male presenting with a shiny, erythematous penile lesion. What is your Ddx and how will you Dx?

A
  • Zoon balanitis most likely
  • Penile cx unlikely in a circumcised patient
  • R/o STI, BXO

Often cannot tell via PE alone, must biopsy.

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18
Q

Your patient is a 30 YO male complaining of the presence of a painless “third testicle”. What is your immediate concern?

A

Testicular cancer

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19
Q

What is the most common primary testicular cancer?

A

Non-seminomatous germ cell tumor

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20
Q

What is the MC bilateral + primary testicular cancer?

A

Seminoma

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21
Q

What is the MC bilateral testicular cancer?

A

Lymphoma

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22
Q

What is the MC metastatic testicular cx?

A

Lymphoma

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23
Q

What is the MC testicular cx in men > 50 YO?

A

Lymphoma

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24
Q

What testicular condition(s) is/are MORE likely to occur in the right testicle?

A

Testicular cx (due to higher incidence of r-sided cryptorchidism)

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25
Q

Buzzword: painless testicular nodule

A

Testicular cancer

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26
Q

Buzzwords: Smoker + flank pain

A

Kidney cx

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27
Q

Buzzword: Hard/indurated prostate

A

Prostate Cx

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28
Q

What part of the prostate is involved in prostate cancer?

A

Peripheral zone

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29
Q

What is the MC type of prostate cancer?

A

Adenocarcinoma

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30
Q

What is the mainstay of treatment for testicular cancer?

A

Orchiectomy

+/- RPLND, Chemo, radiation

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31
Q

What is the mainstay of treatment for prostate cancer? What are some associated risks and benefits?

A

Prostatectomy:

  • potentially curative
  • allows for better staging
  • Incontinence and ED are likely
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32
Q

In addition to prostatectomy, what are adjunctive therapies for prostate cancer?

A

Radiation

Androgen deprivation

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33
Q

What are the guidelines for PSA screening for prostate cancer?

A
  • < 40 YO: not recommended
  • 40 - 55 YO: consider if there is risk
  • 55 - 69 YO: screen every 1 or 2 years as long as life expectancy > 10 years
  • > 70 YO: not recommended
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34
Q

What are the two urologic emergencies we learned about?

A

Fournier gangrene

Testicular torsion

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35
Q

What are 6 major risk factors that should prompt heightened suspicion in a patient with scrotal edema?

A

Patients with these risk factors are at increased risk for Fournier gangrene, even with an apparently small initial source of infection:

  • Immunocompromise
  • DM
  • Advanced age
  • Malnutrition
  • Alcohol abuse
  • IV drug use
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36
Q

How is Fournier gangrene definitively diagnosed?

A

CT of pelvis +/- abdomen – be specific when requisitioning radiology.

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37
Q

What is the treatment for Fournier gangrene?

A

Immediate ED/urology referral

  • Emergency surgical resection/debridement
  • PCN G + aminoglycoside + clindamycin
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38
Q

Buzzword: Bell-Clapper Deformity

A

Testicular torsion

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39
Q

Buzzword: High-riding testicle

A

Testicular torsion

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40
Q

How is testicular torsion diagnosed?

A

Scrotal US (but if suspicion is high enough, it is not inappropriate to send straight to surgery)

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41
Q

Buzzword: Prehn’s sign

A

NEGATIVE in testicular torsion

Positive result = relief of pain when scrotum is elevated

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42
Q

If you are in a remote area without immediate surgical access, what can be attempted as treatment for testicular torsion?

A

Manual detorsion - external rotation

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43
Q

What is the treatment for testicular torsion?

A

Surgical exploration:

  • Detorsion and orchiopexy if salvagable
  • Orchiectomy if not salvagable
  • Orchiopexy of contralateral side
44
Q

Buzzword: absent cremasteric reflex

A

Testicular torsion

45
Q

Abnormally located ventral urethral opening

A

Hypospadias

46
Q

Abnormally located dorsal urethral opening

A

Epispadias

47
Q

What is the treatment for hypospadias?

A

Surgery: buccal mucosa graft, usually after 3 mo and before 2 YO

Do NOT circumcise!!!

48
Q

What are three characteristic findings that are associated with hypospadias?

A

Any one constitutes hypospadias:

  • Ectopic urethral meatus
  • Chordee (bent penis)
  • Hooded foreskin
49
Q

What is the difference between a communicating vs non-communicating hydrocele? How can they be differentiated on PE?

A

Communicating: filled with peritoneal fluid due to open processus vaginalis. Reducible on PE and may change size during day or with valsalva.

Non-communicating: filled with fluid from mesothelial lining of the tunica vaginalis. Not reducible on PE.

50
Q

Buzzword: Bag of Worms

A

Varicocele

51
Q

What testicular condition(s) occur more frequently on the L testicle?

A

Varicocele

**If patient presents with unilateral R varicocele, strong suspicion for renal cell carcinoma: send for rental CT and refer to urology

52
Q

What is the first line tx for uncomplicated acute cystitis?

A

Bactrim 800/160 x 3 days

53
Q

How is cystitis diagnosed?

A

NOT on UA alone!

Must get UA + microscopy to assess for hematuria, but C&S is diagnostic for UTI

54
Q

How is asymptomatic bacteruria treated?

A

It’s not!

55
Q

How is complicated cystitis treated?

A

Bactrim 800/160 7-10 days, refer to urology

56
Q

What is the first line treatment for interstitial cystitis?

A

Stress management and behavioral modifications –> pelvic floor PT

57
Q

Buzzword: Hunner’s lesions

A

Interstitial cystitis

58
Q

What are some complications of acute pyelonephritis?

A
  • Sepsis
  • Emphysematous pyelonephritis
  • Xanthogranulomatous pyelonephritis
59
Q

What is the treatment for acute pyelonephritis?

A

Admit (or low threshold, at least)

IV ampicillin + gentamicin, then transition to PO cipro/FQ

60
Q

What imaging is done when acute pyelonephritis is suspected?

A

Renal US or CT to assess for presence of stone, abscess, or hydronephritis

61
Q

Buzzword: Warm, boggy prostate

A

Acute prostatitis

62
Q

What is the first line treatment for acute prostatitis?

A

Doxycycline 100 BID 2-6 weeks

can also consider Bactrim, cipro, levo

63
Q

Buzzword: ejaculatory pain

A

Chronic pelvic pain syndrome/chronic prostatitis

64
Q

What is an appropriate medical therapy for chronic prostatitis?

A

a-blockers for new onset

Ok to do an extended antibiotic trial ONLY if it is first occurrence/low suspicion of non-infectious cause. This scenario will probably not be on the test, so don’t go with antibiotics.

65
Q

Your patient is an otherwise-healthy 35 YO male presenting with scrotal swelling, urethral discharge, and acute pain with palpation of the testicle. What is at the top of your Ddx?

A

Epididymo-orchitis, most likely sexually transmitted (suspect ST in patients <40 YO)

66
Q

What is the treatment for sexually transmitted epididymo-orchitis?

A

1 dose IM Ceftriaxone + azithromycin

67
Q

Your patient is a 45 YO male presenting with scrotal swelling, irritative LUTS, and acute pain with palpation of the testicle. What is at the top of your Ddx?

A

Non-sexually transmitted epididymo-orchidis (suspect non-ST in patients > 40 YO).

68
Q

Buzzword: Dumbbell crystals

A

Ca2+ oxalate urolithiasis

69
Q

Buzzword: Coffin lid crystals

A

Struvite urolithiasis

70
Q

Buzzword: Rosette crystals

A

Uric acid urolithiasis

71
Q

When is it necessary to admit and urgently refer a patient with urolithiasis?

A

When the stone is causing obstruction and infection

72
Q

What are the criteria for diagnosing vesicourethral reflux?

A

(Pediatric patient):
2+ febrile UTIs

OR

1 febrile UTI + any of the following:

  • abnormal renal US
  • high temp + species other than E coli
  • poor growth & HTN
73
Q

Cryptorchidism more commonly occurs in which testicle?

A

Right - gets stuck in inguinal canal or abdomen

74
Q

What is the treatment for cryptorchidism?

A

Surgical orchiopexy - should refer ~4-6 months of age, and definitely before 2 YO

75
Q

Buzz word: abdominal mass in pediatric patient

A

CAN’T MISS: Wilm’s tumor

76
Q

How is a Wilm’s tumor diagnosed?

A

Abdx US

77
Q

What is an important consideration in patients with ambiguous genitalia?

A

At risk for congenital adrenal hyperplasia - need to promptly eval for CAH

78
Q

What is the tx for gonococcal urethritis?

A

Single dose IM ceftriaxone (Hassan also includes single dose azithromycin, UpToDate does not recommend)

79
Q

What is the tx for cervicitis?

A

Single dose IM ceftriaxone (Hassan also includes single dose azithromycin, UpToDate does not recommend)

80
Q

What is the treatment for bacterial vaginosis?

A

Metronidazole

81
Q

What is the tx for candidiasis?

A

Azole antifungal

82
Q

What is the tx for trichomoniasis?

A

Metronidazole

83
Q

What is the tx for syphilis?

A

Single dose IM PCN G

84
Q

What is the tx for chancroid?

A

Single dose azithromycin

85
Q

What is the tx for lymphogranuloma venerum?

A

Doxycycline

86
Q

What is the tx for HSV?

A

Acyclovir (to manage symptoms, transmission, and shedding)

87
Q

Buzzword: purulent urethral discharge

A

Gonoccocal urethritis

88
Q

Buzzword: Gray/yellow vaginal discharge

A

Cervicitis (chlamydia or gonorrhea)

89
Q

Buzzword: non-painful chancre

A

Syphilis, primary stage

Treponema pallidum

90
Q

Buzzword: maculopapular rash

A

Syphilis, secondary stage

Treponema pallidum

91
Q

Buzzword: spirochete

A

Syphilis: Treponema pallidum

92
Q

Buzzword: frothy vaginal discharge

A

Trichomoniasis

93
Q

Buzzword: strawberry cervix

A

Trichomoniasis

94
Q

Buzzword: bouncing motility

A

Trichomoniasis vaginalis

95
Q

Buzzword: school of fish

A

Chancroid (H ducreyi)

96
Q

Buzzword: painful chancre

A

Chancroid (H ducreyi)

97
Q

Buzzword: Buboes

A 
Chancroid (H ducreyi - occur with painful chancres)
or 
LGV (L-serovars of Chlamydia - occur with non-painful lesions)
98
Q

Buzzword: vesicular lesions

A

HSV

99
Q

Buzzword: granulations on microscopy

A

HSV

100
Q

Buzzword: Multi-nucleated giant cells

A

HSV (appears on Tzanck smear)

101
Q

Buzzword: Koilocytosis

A

HPV

Also: Haloes or Halo cells

102
Q

Buzzword: infection at squamous/columnar junction

A

HPV

103
Q

Buzzword: Clue cells

A

BV

104
Q

Buzzword: Fishy odor

A

BV

105
Q

Buzzword: Cottage cheese-like discharge

A

Candidiasis

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