Day 9 - GU3

Question 1

BPH dx

Answer 1

Clinical scoring system based on sx; R/o other pathologies using history; Considerations; DRE to r/o malignancy, Hematuria (prostatitis, etc.), Post void residual, serum BUN/Cr (pre-renal), Max urinary flow rate (weak/intermittent stream)

Question 2

Tx BPH

Answer 2

Isoflavones, Saw palmetto (proven as effective as Finasteride); (1) Non-selective alpha blockers (-zosin) if HTN; OR Tamsulosin (aka Flomax) = selective (to urethra) alpha blocker; (2) 5-alpha reductase inhibitor (e.g., Finasteride) OR Saw palmetto; Combine 1 & 2

Question 3

Prostate CA screening consideration in pts being tx for BPH

Answer 3

These drugs decrease PSA level by about 50%, so double it to assess for prostate CA; Also cause impotence, etc.

Question 4

Most common surgery for BPH

Answer 4

TURP = transurethral resection of prostate

Question 5

Next step 65 yo M p/w inability to urinate & painful bladder distention

Answer 5

Decompression bladder w/ 15-18 gauge French foley catheter; If hx of BPH, may require cathether with stiff tip (Kuday?); If unable to pass urethral catheter, then suprapubic cath with ultrasound guidance; or suprapubic needle decompession as last resort

Question 6

60 yo M p/w well male exam, DRE hard nodules prostate, elevated PSA

Answer 6

Transrectal US & prostate needle bx

Question 7

Characteristic feat of varicocele

Answer 7

Dilated of parapiniform plexus of scrotum; Testicular mass that transilluminates, dull-aching scrotal pass, testicular atrophy on affected side, infertility common; most commonly on left side; Color doppler us - retrograde flow; May point to RCC

Question 8

Meds causing Erectile dysfunction

Answer 8

SSRIs, spironolactone, sympathetics (clonidine, methyldopa, guanidine), beta-blockers, ketoconazole, cimetidine, antipsychotics

Question 9

Tx ED

Answer 9

Phosphodiesterase inhibitors (e.g., sildenafil), Penile self-injectable drugs (e.g., alprostadil), Vacuum & constriction devices, Penile prosthesis/implantation, Hormone replacement (if low levels)

Question 10

Classic presentation of most common renal tumor in children

Answer 10

Wilm’s tumor; P/w age 2-4 yrs, palpable flank mass; Ab pain, hematuria, HTN, possible congenital anomalies (WAGR)

Question 11

Enuresis - age of dx & tx

Answer 11

5 yo physically & developmentally for dx; 7 yo Tx; 1st line - behavioral - motivational, fluid restriction before bed, nighttime , enuresis alarm (most effective); 2nd line - pharm - imipramine or indomethacin suppository (pharm may lead to relapse once meds stopped)