Exam 3 Flashcards
What lab result would approximate the GFR?
creatinine clearance
What is an early finding of chronic renal disease?
Persistent proteinuria
What finding could rule out diagnosis of testicular cancer?
Trans-illumination of suspected mass
What is the primary treatment for a patient diagnosed with testicular cancer?
Radical orchiectomy
What is the appropriate treatment for a patient with benign BPH and an AUSI score of 6?
Reevaulate symptoms in 1-4 months
What is the most common diagnosis for a 63 year old male with chief complaint of nocturia?
BPH
What finding could indicate testicular torsion?
Absent cremasteric reflex
What would finding during illumination of the scrotum would indicate hydrocele?
Scrotum would appear light pink or yellow
A 19-year old male is seen with complaints of severe testicular pain. What should the clinician suspect?
Testicular torsion; this is a urologic emergency
What lab would you test on a young male with complaints of low libido?
Testosterone level
What is the most common gram negative bacteria that causes acute and chronic bacterial prostatitis?
E. Coli
How long should a 56 year old male with chronic bacterial prostatitis be treated with Bactrim?
6-12 weeks
What is the most common causative organism for a sexually active male with epididymitis?
Chlamydia
What is the most common organism causing UTI in women?
E. Coli (gram negative)
Diagnostic tests for UTI
Urinalysis: shows cloudy urine, alkaline pH, hematuria, elevated nitrates, leukocytes, and sediments of bacterial overgrowth
Urine culture
Antibiotic sensitivities
Treatment for UTI
-Bactrim for three days OR 10-day course of ampicillin
-Nitrofurantoins (macrodantin/macrobid) for 7 days in patients with sulfa allergy or ABX use in last 3 months
How to differently diagnose UTI, interstitial cystitis, and pyelonephritis
-Pyelonephritis: WBC casts (neutrophils passing through the renal tubules) on UA; kidney infection. These patients will be ill-appearing with fever and more severe symptoms
-UTI: Would show leukocytes on UA but not WBC casts
-Interstitial cystitis: similar presentation as UTI but UA would be normal
Patient education for UTI
-Complete full course of ABX
-Increase fluid intake to 10 8oz glasses/day
-Cotton instead of nylon panties
-Avoid harsh soaps
-Void after sex
-Proper hygeine
-Showers instead of baths
Diagnosis for BPH
-UA
-PSA (should be less than 10ng/mL)
S&S of hydrocele
-Scrotal swelling
-Often is painless, described as heaviness
-Transillumination shows trapped fluid
-swelling in groin or upper scrotum
S&S of prostate cancer
-Often patients are asymptomatic
-bone pain, weight loss, lymphedema, anemia
Diagnosis for prostate cancer
-PSA (not cancer specific)
-If CA is suspected, referral to urology for transrectal biopsy or TRUS
What should you suspect in a patient presenting for the 3rd time with dysuria and frequency but normal UA?
Interstitial cystitis
What is a pre-disposing factor for pyelonephritis?
pregnancy
Patient education point for a patient with stress incontinence
stop smoking
What medication is known to be a bladder irritant?
Sudafed
Define overflow incontinence
Inability to empty the bladder resulting in over-distention and frequent loss of small amounts of urine
A 42 YOf is seen in the clinic with fever, chills, vomiting, and severe dysuria and is diagnosed with acute pyelonephritis and dehydration. How should she be treated?
Hospitilization
What would you do if ABX treatment for UTI is failing (symptoms persisting)?
Order urine cultures
Patient education for overactive bladder diagnosis
Decrease or eliminate caffeine intake
What information is essential to know before prescribing Bactrim DS for UTI?
Date of last menstrual period (contraindicated in lactation or late pregnancy)
What diagnosis is most likely for a patient with CVA tenderness and several days of fever, chills, and dysuria?
Pyelonephritis
UA shows more than 10 leukocytes/ml and dipstick + for nitrates. What is the most likely diagnosis?
Lower UTI
Treatment for stress incontinence
Kegel exercises
What over-the counter medication could cause hematuria?
Ibuprofen
When would chronic renal failure patient need dialysis?
If GFR is less than 15
What are some causes of chronic renal failure?
Uncontrolled HTN, DM, glomerulonephritis, cystic disease, renal artery stenosis, chronic ischemia
S&S of testicular cancer
scrotal swelling, painless enlargement of testes, heaviness in lower abdomen, firm nontender lymph nodes in abdomen and supraclavicular areas
Diagnostic for testicular cancer
biochemical markers, scrotal ultrasound
What is an AUASI score?
7 questions to assess symptoms of BPH on a Likert type scale. The higher the number, the more severe the symptoms
Scoring for AUASI
0-7: mild
8-19: Moderate
20-35: Severe
S&S of testicular torsion
-Severe pain, swelling in testicle areas usually unilateral
-Absence of the cremasteric reflex
-May have small palpable lump on superior pole of testes (blue dot sign)
-involved testicle may be higher than the other (bell clapper)
Risk factors for testicular torsion
Runner or contact sports, trauma or injury
How is hydrocele diagnosed?
-Transillumination of shows pink, yellow, or red fluid
-US, abdominal X-ray
Important lab to test for erectile dysfunction
testosterone level- low could cause ED
Tx for pyelonephritis
Septra DS BID (7-10 days for moderate, 14 days for severe, 21 for slow responders)
When to consider hospitilization for pyelonephritis
-If patient doesn’t respond to treatment in 48 hours
Differential diagnosis for hematuria
-UTI/pyelonephritis, bladder cancer, kidney stones, BPH
Sign of UTI in elderly
Altered mental status
Tx for UTI
Bactrim 800/160 PO BID for 3 days
Amoxil 500 mg PO BID for 3 days
Macrobid 100 mg PO BID for 7 days (avoid in males!)
Treat males for longer (7-10 days)
What is stress incontinence?
increase in abdominal pressure resulting in loss of urine often due to sphincter weakness
Management of stress incontinence
Kegels
Weight loss
Vaginal estrogen
Bladder training
Tx for overactive bladder
Anticholinergic such as oxybutynin, tolterodine
What would cause overflow incontinence?
distended bladder
When is a UTI considered recurrent?
2 or more in 6 months, 3 or more in 12 months
Tx for recurrent UTI
-Macrobid 50-100 daily for up to 12 months
-Self-medicate for 3-4 days when symptoms begin
-Start Tx after UTI resolution
Common bladder irritants to avoid in patients with urinary problems
Sudafed, caffeine, smoking, sugar, wines, carbonation, citrus
What is interstitial cystitis?
UTI symptoms with no infection; chronic inflammation of the bladder
Management of interstitial cystitis
Bladder training
Pentosan 100 mg TID or 200 mg BID for 2-4 months
Common causes of epididymis
STI (chlamydia/gc)
S&S of epididymis
-dysuria, urgency, frequency
-discharge from penis
-abdominal and pelvic pain
-blood in semen
S&S of prostatitis
-tenesmus, lower back pain, weak bladder flow, urgency, frequency, and Hx of prostatic calculi
-Warm, tender, boggy prostate (with acute infection)
Tx for prostatitis
-Levaquin 750 PO daily x5
-Cipro 750 mg PO BID x5
-bactrim 800/160 PO BID x10-14 days
Tx for BPH
-Alpha 1 blocker: (Prazosin, terazosin, doxazosin)(must titrate due to risk of hypotension)
-Alpha 1A blockers: Tamsulosin (more selective for prostate, do not need to titrate)
-5 alpha reductase inhibitor to reduce size of prostate (Finasteride)
When to initiate treatment for prostatitis?
moderate symptoms; refer to urology if symptoms become severe
Stages of CKD
1: GFR normal
2: GFR 60-89
3: GFR 30-59
4: GFR: 15-29
5: ESRD, GFR <15
Kidney stones S&S
-Site of obstruction determines lcoation of pain, the location may change as the stone progresses
-Hematuria may be present
-N/V/dysuria/ decreased UOP
Epididymitis Tx
-Tx for both chlamydia and gonorrhea if under 35
-Rocephin 250 mg IM
-Doxycycline 10 day course OR azithromycin 1 gm 1 time
-If over 35 or low risk for STI treat with Levaquin or bactrim (causative e. coli or pseudomonas)
Tx for pyelonephritis
-Bactrim: One DS tablet BID for 7-14 days (longer depending on severity)
-Ceftriaxone (rocephin) 1g IV daily (if admitted)
Diagnostics for kidney stones
-Urinalysis (could be normal or have abnormalities such as crystals and RBCs), CBC, CMP
-24-hour urine (increased creatinine, uric acid)
-BUN/creat: elevated secondary to obstruction or kidney damage
-Kidney and upper bladder ultrasound
-IV pyelogram
-CT scan
-Cystourethroscopy
Tx for kidney stones
-Adequate water intake indefinitely
-Treat pain with NSAIDs or narcs
-Antispasmodics: flavoxate or oxybutynin
-Thiazide diuretics reduce stone-forming substances
-Surgical intervention
-Lithotripsy
Pharmacological treatment for overactive bladder
-Bladder antispasmodic such as ditropan
-Tricyclic antidepressant such as amitriptyline
-Botox (for neurogenic conditions)
Symptom management for UTI
phenazopyrydine 200 mg TID for no more than 2 days
Causes of AKI
Prerenal: decreased blood flow (hypotension/hemorrhage), liver failure, fluid and electrolyte depletion, NSAID use
Intrarenal: ischemia, toxins, myoglobinuria, glomerulonephritis
Postrenal: prostatism, bladder tumor, renal calculi
Risk factors for bladder cancer
cigarette smoking, renal tumors, exposure to amine dyes and arsenic, chronic use of analgesics, use of saccharin, chronic lower UTI, recurrent nephrolithiasis
S&S of bladder cancer
-Hematuria , dysuria, urinary frequency, fever/chills, weight loss, urgency, pelvic pain = advanced disease
-UA shows gross hematuria
-CBC may show anemia
When would testosterone therapy for ED be contraindicated?
HTN, clotting disorders, OSA
Tx for ED
-Testosterone replacement if low
-Sildenafil (viagra), vardenafil (Levitra)
What is Prehn’s sign?
relief of pain with elevation of testicle (would indicate epididymitis instead of torsion)
What is hydrocele?
collection of peritoneal fluid within scrotum and around the testes
What is varicocele?
abnormal venous dilation of pampiniform plexus above the testes. causes “bag of worms” feeling; tx is referral to surgeon
S&S of epididymitis
Dysuria, urgency, frequency, penile discharge, abdominal/pelvic pain, blood in semen
Creatinine level normals
0.74-1.35 mg/dL for men
0.59-1.05 mg/dL for women
BUN normal levels
6-24 mg/dL
