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NURS 502 > Exam 3 - GU > Flashcards

Exam 3 - GU Flashcards

1
Q

Complicated vs uncomplicated UTI

A

Complicated: associated with condition, men, pregnant women, children

Uncomplicated: healthy, immunocompetent, non pregnant women with no significant history of UTIs or structural abnormalities

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2
Q

Recurrent UTI definition

A

UTIs at least three times in one year or twice in six months

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3
Q

UTI - relapse vs reinfection

A
  • Relapse: infection caused by bacterial persistence (infection by the previously treated pathogen) which was not completely eradicated by antibiotics
  • Reinfection: recurrence of infection by introduction of a new bacterial strain or regrowth of same organism after complete eradication of the same organism after complete eradication with treatment
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4
Q

Diagnostic studies for UTI

A
  • Urine dipstick (leukocytes, nitrites, blood)
  • Definitive → urine culture (e. coli most common pathogen)
  • Urinalysis
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5
Q

UTI treatment for non pregnant patients

A
  • Nitrofurantoin (macrobid)
  • TMP-SMZ (bactrim)
  • Alternatives → keflex, fosfomycin, ciprofloxacin
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6
Q

UTI treatment for pregnant patients

A

Treat even if patient has asymptomatic bacteruria

  • Keflex
  • Amoxicillin
  • Augmentin
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7
Q

Indications for referral for UTI

A
  • Presence of macroscopic hematuria
  • Suspected malignancy
  • Recurrent UTIs or infections that do not respond to standard antimicrobial therapy
  • Older adults with acute, severe symptoms
  • History of chronic conditions
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8
Q

What is interstitial cystitis?

A

Chronic inflammatory condition of the bladder

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9
Q

Interstitial cystitis symptoms

A
  • Bladder pain
  • Urinary frequency or urgency
  • Nocturia
  • Suprapubic pain (relieved after voiding)
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10
Q

UTI vs interstitial cystitis

A
  • Urinalysis with few leukocytes, no bacteria, occasional hematuria
  • Negative urine culture
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11
Q

What is urethritis?

A
  • Caused by infection characterized by discharge of mucoid or purulent material
  • Burning with urination
  • Often caused by neisseria gonorrhea (symptomatic)
  • Chlamydia often asymptomatic
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12
Q

Urethritis symptoms

A
  • Men: dysuria, frequency, urethral discharge, pruritus at distal end of penis
  • Women: vaginal discharge or bleeding from concomitant cervicitis, lower abdominal pain
    • Women typically asymptomatic
  • Pain, itching, redness
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13
Q

Causes of urethritis

A
  • Infectious - gonorrhea, chlamydia
  • Non infectious - enteric organisms (MSM, anal sex)
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14
Q

Urethritis diagnostic studies

  • Chlamydia and gonorrhea
A

NAAT testing

  • Men: first catch urine
  • Women: vaginal swabs (first line), first catch urine
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15
Q

Gonorrhea (urethritis) treatment

A

Persons with gonorrhea have a coexistent chlamydia infection

  • Dual ceftriaxone + azithromycin or doxycycline
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16
Q

Non gonococcal urethritis treatment

A

Doxycycline 100 mg PO bid for 7 days

OR

Azithromycin

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17
Q

Can providers treat for gonorrhea and chlamydia at the same time?

A

Treat empirically for both infections if you do not have lab evidence of just one infectious cause

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18
Q

What is stress incontinence?

A

Loss of urine associated with activities that increase intra-abdominal pressure (sneezing, coughing) → overcomes sphincter and urethral pressure

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19
Q

What is urge incontinence?

A

Involuntary loss of urine usually preceded by a strong, unexpected urge to void (aka overactive bladder)

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20
Q

What is mixed incontinence?

A

Urge and stress incontinence together

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21
Q

What is overflow incontinence?

A

An involuntary loss of urine associated with incomplete emptying

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22
Q

Causes of urinary incontinence?

A
  • Detrusor overactivity
  • SCI below T11 to L1
  • Poor bladder compliance
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23
Q

What is Resnick’s Diappers mnemonic?

  • Identifies pathologic conditions external to the urinary tract that cause incontinence
A
  • D - delirium or confusional state
  • I - infection (urinary)
  • A - atrophic urethritis, vaginitis
  • P - pharmaceuticals
  • P - psychological (severe depression)
  • E - excess urinary output (CHF, hyperglycemia)
  • R - restricted mobility
  • S - stool impaction
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24
Q

Urinary incontinence diagnostic studies

A
  • Urinalysis - exclude hematuria, pyuria, glycosuria, proteinuria
  • Urine cytologic studies
  • Urine culture
  • BUN/creatinine,glucose, calcium
  • Postvoid residual (PVR)
  • Ultrasound or MRI to rule out anatomical or functional abnormalities
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25
Q

Urinary incontinence management

A
  • Treat underlying condition → move commode to bedside
  • Voiding diaries
  • Behavioral therapies
  • Medications: anticholinergic, alpha adrenergic agonist, antimuscarinic
  • Surgery
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26
Q

Acute vs chronic prostatitis

A

Acute and chronic prostatitis are caused by bacterial infection, but chronic prostatitis has a slower development of inflammation and duration of symptoms for 3 months

27
Q

Acute prostatitis symptoms

A
  • Fever, chills, malaise, myalgias, arthralgias
  • Urinary hesitancy, frequency, urgency, nocturne, dysuria, sensation of incomplete bladder emptying
  • Low back pain, perineal pain, suprapubic pain
28
Q

Chronic prostatitis symptoms

A
  • More varied than acute prostatitis
  • History of recurrent UTIs
  • Perineal, inguinal, suprapubic pain
  • Frequency, urgency, dysuria
29
Q

Prostatitis diagnostic studies

A
  • UA and culture
  • CBC
  • DRE → not recommended, massage will spread the causative organism
  • Abdominal exam
  • Consider STI testing
30
Q

Acute prostatitis management

A
  • If severe, IV fluoroquinolone(-floxacin) in ER
  • Outpatient, TMP/SMX and fluoroquinolone
  • Acute for 3 weeks; chronic for 3-6 weeks to prevent chronic prostatitis
  • Pain management
31
Q

Causes of BPH

A

Bladder outlet obstruction, lower urinary tract symptoms, or a combination of the two

32
Q

Symptoms associated with obstructive BPH

A
  • Urinary hesitancy
  • Decreased caliber and force of stream
  • Post void dribbling
33
Q

Symptoms associated with irritative causes of BPH

A

Frequency, urgency, nocturia, hematuria

34
Q

BPH clinical presentation

A
  • DRE → findings suggestive of prostate cancer include nodules or induration
  • BPH may have a uniform or focal enlargement of the prostate, median sulcus is obliterated, non tender, rubbery and smooth in consistency
35
Q

BPH diagnostic studies

A
  • UA to exclude UTI or hematuria
  • Post void ultrasound
36
Q

Management for BPH (not medication)

A

Limiting fluids before bed, limit use of caffeine and alcohol, double voiding

37
Q

Treatment for BPH

  • Alpha adrenergic antagonist therapy (e.g. terazosin, doxazosin)
A

Relax smooth muscle in the bladder neck, prostate capsule, and prostatic urethra

38
Q

Treatment for BPH

  • 5 alpha reductase enzyme inhibitor therapy (e.g. finasteride, dutasteride)
A
  • Second line if patients cannot tolerate alpha adrenergic antagonists
  • Shrink prostatic glandular hyperplasia by decreasing tissue DHT levels
  • Can take 6-12 months to see improvement in symptoms
39
Q

Treatment for BPH

  • Antimuscarinics
A

Help relax bladder muscle which can reduce urinary frequency, urgency, nocturia, and incontinent

40
Q

Treatment for BPH

  • Phosphodiesterase type 5 inhibitors (e.g. sildenafil, tadalafil)
A

Promote blood vessel dilation (vasodilation) and smooth muscle relaxation in certain parts of the body

41
Q

Management of severe BPH

A
  • Surgeries: transurethral resection of the prostate (TURP), transurethral incision of the prostate, open prostatectomy → for severe BPH
42
Q

Prostate cancer risk factors

A
  • Advancing age
  • African American
  • Positive family history (BRCA gene, first degree relative)
43
Q

How to differentiate prostate cancer from BPH symptoms

A

Prostate cancer symptoms tend to increase in intensity during a 1-2 months period vs BPH which is slower progressing

44
Q

Prostate cancer symptoms

A
  • Urinary hesitancy, urgency, nocturia, frequency, hematuria
  • Advanced disease → back pain, impotence, bone pain, weight loss
45
Q

Prostate cancer screening

A
  • No screening for men younger than 40 years or ages 40-54 years who have average risk
  • Shared decision making with provider for men ages 55-69 years (if yes, screen every two years)
  • Not recommended for men older than 70 years old or men with less than a 10-15 year life expectancy
46
Q

DRE findings with prostate cancer

A

Firm nodule, induration, stony, asymmetric prostate

47
Q

Prostate cancer diagnostic studies

A
  • PSA level combined with DRE (PSA <4 ng/mL is normal)
    • If PSA is high, transrectal ultrasound (TRUS) is recommended for initial biopsy
  • CT scan of abdomen and pelvis important to assess regional lymph nodes and metastasis
48
Q

What is paraphimosis?

A

Medical emergency

Retracted foreskin that cannot be reduced to the normal position → constriction of glans

49
Q

Causes of paraphimosis

A
  • Following masturbation
  • Sexual activity
  • Forceful retraction
  • Sexual abuse
50
Q

Paraphimosis management

A
  • Manual reduction
  • Surgical emergency
51
Q

When should the PCP refer a pediatric patient with undescended testicles?

A

Referral made by six months old; if not taken care of by 2 years, will have permanent damage (infertility, malignancy)

52
Q

True/false: undescended testicles normally descend by six month

A

True - if not, refer

53
Q

Phimosis clinical presentation (history)

A
  • Inflammation of penis
  • Pain, dysuria
  • Signs of urinary obstruction → ballooning due to urine collecting in foreskin
54
Q

Phimosis physical exam findings

A

Tight, pinpoint opening of the foreskin with minimal ability to retract the foreskin; foreskin flat and effaced

55
Q

Phimosis management and treatment

A
  • Normal cleansing with gentle stretching of the foreskin until resistance is felt.
  • Never forcefully retract the foreskin.
  • Steroid cream
  • Surgery if phimosis continues
56
Q

What is a hydrocele?

A

Painless, gradual enlargement of scrotum with marked edema

57
Q

Hydrocele clinical presentation (history)

A
  • Bulge or lump in scrotum
  • Tense overlying skin
  • Bluish discoloration in area of bulge
  • No distress or vomiting
58
Q

Hydrocele physical examination findings

A
  • Cremasteric reflex present
  • Transllumination
59
Q

Hydrocele management and treatment

A
  • Generally self resolves
  • No treatment indicated unless it is so large that it is uncomfortable or persists longer than 1 years
  • If persists, refer to surgery
60
Q

True/false: there is a six hour window before ischemic damage occurs with testicular torsion

A

True

61
Q

Testicular torsion history and clinical findings

A
  • Ill appearing
  • Sudden onset of unilateral scrotal pain
  • N/V
  • “Blue dot” sign - painless, firm, blue scrotal mass in newborns
62
Q

Testicular torsion physical examination findings

A
  • Absent cremastueric reflex
  • Scrotal swelling with redness, warmth, tenderness
  • Slight elevation of testis
63
Q

Testicular torsion treatment and management

A

Surgical emergency

  • Manual reduction, but follow up within 6-12 hours to prevent retorsion, preserve fertility, prevent abscess and atrophy

NURS 502 (43 decks)

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