Exam 3 Flashcards

1
Q

What lab result would approximate the GFR?

A

creatinine clearance

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2
Q

What is an early finding of chronic renal disease?

A

Persistent proteinuria

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3
Q

What finding could rule out diagnosis of testicular cancer?

A

Trans-illumination of suspected mass

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4
Q

What is the primary treatment for a patient diagnosed with testicular cancer?

A

Radical orchiectomy

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5
Q

What is the appropriate treatment for a patient with benign BPH and an AUSI score of 6?

A

Reevaulate symptoms in 1-4 months

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6
Q

What is the most common diagnosis for a 63 year old male with chief complaint of nocturia?

A

BPH

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7
Q

What finding could indicate testicular torsion?

A

Absent cremasteric reflex

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8
Q

What would finding during illumination of the scrotum would indicate hydrocele?

A

Scrotum would appear light pink or yellow

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9
Q

A 19-year old male is seen with complaints of severe testicular pain. What should the clinician suspect?

A

Testicular torsion; this is a urologic emergency

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10
Q

What lab would you test on a young male with complaints of low libido?

A

Testosterone level

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11
Q

What is the most common gram negative bacteria that causes acute and chronic bacterial prostatitis?

A

E. Coli

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12
Q

How long should a 56 year old male with chronic bacterial prostatitis be treated with Bactrim?

A

6-12 weeks

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13
Q

What is the most common causative organism for a sexually active male with epididymitis?

A

Chlamydia

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14
Q

What is the most common organism causing UTI in women?

A

E. Coli (gram negative)

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15
Q

Diagnostic tests for UTI

A

Urinalysis: shows cloudy urine, alkaline pH, hematuria, elevated nitrates, leukocytes, and sediments of bacterial overgrowth
Urine culture
Antibiotic sensitivities

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16
Q

Treatment for UTI

A

-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

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17
Q

How to differently diagnose UTI, interstitial cystitis, and pyelonephritis

A

-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

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18
Q

Patient education for UTI

A

-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

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19
Q

Diagnosis for BPH

A

-UA
-PSA (should be less than 10ng/mL)

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20
Q

S&S of hydrocele

A

-Scrotal swelling
-Often is painless, described as heaviness
-Transillumination shows trapped fluid
-swelling in groin or upper scrotum

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21
Q

S&S of prostate cancer

A

-Often patients are asymptomatic
-bone pain, weight loss, lymphedema, anemia

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22
Q

Diagnosis for prostate cancer

A

-PSA (not cancer specific)
-If CA is suspected, referral to urology for transrectal biopsy or TRUS

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23
Q

What should you suspect in a patient presenting for the 3rd time with dysuria and frequency but normal UA?

A

Interstitial cystitis

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24
Q

What is a pre-disposing factor for pyelonephritis?

A

pregnancy

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25
Q

Patient education point for a patient with stress incontinence

A

stop smoking

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26
Q

What medication is known to be a bladder irritant?

A

Sudafed

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27
Q

Define overflow incontinence

A

Inability to empty the bladder resulting in over-distention and frequent loss of small amounts of urine

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28
Q

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?

A

Hospitilization

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29
Q

What would you do if ABX treatment for UTI is failing (symptoms persisting)?

A

Order urine cultures

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30
Q

Patient education for overactive bladder diagnosis

A

Decrease or eliminate caffeine intake

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31
Q

What information is essential to know before prescribing Bactrim DS for UTI?

A

Date of last menstrual period (contraindicated in lactation or late pregnancy)

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32
Q

What diagnosis is most likely for a patient with CVA tenderness and several days of fever, chills, and dysuria?

A

Pyelonephritis

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33
Q

UA shows more than 10 leukocytes/ml and dipstick + for nitrates. What is the most likely diagnosis?

A

Lower UTI

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34
Q

Treatment for stress incontinence

A

Kegel exercises

35
Q

What over-the counter medication could cause hematuria?

A

Ibuprofen

36
Q

When would chronic renal failure patient need dialysis?

A

If GFR is less than 15

37
Q

What are some causes of chronic renal failure?

A

Uncontrolled HTN, DM, glomerulonephritis, cystic disease, renal artery stenosis, chronic ischemia

38
Q

S&S of testicular cancer

A

scrotal swelling, painless enlargement of testes, heaviness in lower abdomen, firm nontender lymph nodes in abdomen and supraclavicular areas

39
Q

Diagnostic for testicular cancer

A

biochemical markers, scrotal ultrasound

40
Q

What is an AUASI score?

A

7 questions to assess symptoms of BPH on a Likert type scale. The higher the number, the more severe the symptoms

41
Q

Scoring for AUASI

A

0-7: mild
8-19: Moderate
20-35: Severe

42
Q

S&S of testicular torsion

A

-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)

43
Q

Risk factors for testicular torsion

A

Runner or contact sports, trauma or injury

44
Q

How is hydrocele diagnosed?

A

-Transillumination of shows pink, yellow, or red fluid
-US, abdominal X-ray

45
Q

Important lab to test for erectile dysfunction

A

testosterone level- low could cause ED

46
Q

Tx for pyelonephritis

A

Septra DS BID (7-10 days for moderate, 14 days for severe, 21 for slow responders)

47
Q

When to consider hospitilization for pyelonephritis

A

-If patient doesn’t respond to treatment in 48 hours

48
Q

Differential diagnosis for hematuria

A

-UTI/pyelonephritis, bladder cancer, kidney stones, BPH

49
Q

Sign of UTI in elderly

A

Altered mental status

50
Q

Tx for UTI

A

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)

51
Q

What is stress incontinence?

A

increase in abdominal pressure resulting in loss of urine often due to sphincter weakness

52
Q

Management of stress incontinence

A

Kegels
Weight loss
Vaginal estrogen
Bladder training

53
Q

Tx for overactive bladder

A

Anticholinergic such as oxybutynin, tolterodine

54
Q

What would cause overflow incontinence?

A

distended bladder

55
Q

When is a UTI considered recurrent?

A

2 or more in 6 months, 3 or more in 12 months

56
Q

Tx for recurrent UTI

A

-Macrobid 50-100 daily for up to 12 months
-Self-medicate for 3-4 days when symptoms begin
-Start Tx after UTI resolution

57
Q

Common bladder irritants to avoid in patients with urinary problems

A

Sudafed, caffeine, smoking, sugar, wines, carbonation, citrus

58
Q

What is interstitial cystitis?

A

UTI symptoms with no infection; chronic inflammation of the bladder

59
Q

Management of interstitial cystitis

A

Bladder training
Pentosan 100 mg TID or 200 mg BID for 2-4 months

60
Q

Common causes of epididymis

A

STI (chlamydia/gc)

61
Q

S&S of epididymis

A

-dysuria, urgency, frequency
-discharge from penis
-abdominal and pelvic pain
-blood in semen

62
Q

S&S of prostatitis

A

-tenesmus, lower back pain, weak bladder flow, urgency, frequency, and Hx of prostatic calculi
-Warm, tender, boggy prostate (with acute infection)

63
Q

Tx for prostatitis

A

-Levaquin 750 PO daily x5
-Cipro 750 mg PO BID x5
-bactrim 800/160 PO BID x10-14 days

64
Q

Tx for BPH

A

-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)

65
Q

When to initiate treatment for prostatitis?

A

moderate symptoms; refer to urology if symptoms become severe

66
Q

Stages of CKD

A

1: GFR normal
2: GFR 60-89
3: GFR 30-59
4: GFR: 15-29
5: ESRD, GFR <15

67
Q

Kidney stones S&S

A

-Site of obstruction determines lcoation of pain, the location may change as the stone progresses
-Hematuria may be present
-N/V/dysuria/ decreased UOP

68
Q

Epididymitis Tx

A

-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)

69
Q

Tx for pyelonephritis

A

-Bactrim: One DS tablet BID for 7-14 days (longer depending on severity)
-Ceftriaxone (rocephin) 1g IV daily (if admitted)

70
Q

Diagnostics for kidney stones

A

-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

71
Q

Tx for kidney stones

A

-Adequate water intake indefinitely
-Treat pain with NSAIDs or narcs
-Antispasmodics: flavoxate or oxybutynin
-Thiazide diuretics reduce stone-forming substances
-Surgical intervention
-Lithotripsy

72
Q

Pharmacological treatment for overactive bladder

A

-Bladder antispasmodic such as ditropan
-Tricyclic antidepressant such as amitriptyline
-Botox (for neurogenic conditions)

73
Q

Symptom management for UTI

A

phenazopyrydine 200 mg TID for no more than 2 days

74
Q

Causes of AKI

A

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

75
Q

Risk factors for bladder cancer

A

cigarette smoking, renal tumors, exposure to amine dyes and arsenic, chronic use of analgesics, use of saccharin, chronic lower UTI, recurrent nephrolithiasis

76
Q

S&S of bladder cancer

A

-Hematuria , dysuria, urinary frequency, fever/chills, weight loss, urgency, pelvic pain = advanced disease
-UA shows gross hematuria
-CBC may show anemia

77
Q

When would testosterone therapy for ED be contraindicated?

A

HTN, clotting disorders, OSA

78
Q

Tx for ED

A

-Testosterone replacement if low
-Sildenafil (viagra), vardenafil (Levitra)

79
Q

What is Prehn’s sign?

A

relief of pain with elevation of testicle (would indicate epididymitis instead of torsion)

80
Q

What is hydrocele?

A

collection of peritoneal fluid within scrotum and around the testes

81
Q

What is varicocele?

A

abnormal venous dilation of pampiniform plexus above the testes. causes “bag of worms” feeling; tx is referral to surgeon

82
Q

S&S of epididymitis

A

Dysuria, urgency, frequency, penile discharge, abdominal/pelvic pain, blood in semen

83
Q

Creatinine level normals

A

0.74-1.35 mg/dL for men
0.59-1.05 mg/dL for women

84
Q

BUN normal levels

A

6-24 mg/dL