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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
Urinary incontinence management
* Treat underlying condition → move commode to bedside * Voiding diaries * Behavioral therapies * Medications: anticholinergic, alpha adrenergic agonist, antimuscarinic * Surgery
26
Acute vs chronic prostatitis
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
Acute prostatitis symptoms
* Fever, chills, malaise, myalgias, arthralgias * Urinary hesitancy, frequency, urgency, nocturne, dysuria, sensation of incomplete bladder emptying * Low back pain, perineal pain, suprapubic pain
28
Chronic prostatitis symptoms
* More varied than acute prostatitis * History of recurrent UTIs * Perineal, inguinal, suprapubic pain * Frequency, urgency, dysuria
29
Prostatitis diagnostic studies
* UA and culture * CBC * DRE → not recommended, massage will spread the causative organism * Abdominal exam * Consider STI testing
30
Acute prostatitis management
* 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
Causes of BPH
Bladder outlet obstruction, lower urinary tract symptoms, or a combination of the two
32
Symptoms associated with obstructive BPH
* Urinary hesitancy * Decreased caliber and force of stream * Post void dribbling
33
Symptoms associated with irritative causes of BPH
Frequency, urgency, nocturia, hematuria
34
BPH clinical presentation
* 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
BPH diagnostic studies
* UA to exclude UTI or hematuria * Post void ultrasound
36
Management for BPH (not medication)
Limiting fluids before bed, limit use of caffeine and alcohol, double voiding
37
Treatment for BPH * Alpha adrenergic antagonist therapy (e.g. terazosin, doxazosin)
Relax smooth muscle in the bladder neck, prostate capsule, and prostatic urethra
38
Treatment for BPH * 5 alpha reductase enzyme inhibitor therapy (e.g. finasteride, dutasteride)
* 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
Treatment for BPH * Antimuscarinics
Help relax bladder muscle which can reduce urinary frequency, urgency, nocturia, and incontinent
40
Treatment for BPH * Phosphodiesterase type 5 inhibitors (e.g. sildenafil, tadalafil)
Promote blood vessel dilation (vasodilation) and [smooth muscle](https://www.osmosis.org/learn/muscular_system_anatomy_and_physiology) relaxation in certain parts of the [body](https://www.osmosis.org/answers/fruiting-body-of-aspergillus)
41
Management of severe BPH
* _Surgeries_: transurethral resection of the prostate (TURP), transurethral incision of the prostate, open prostatectomy → for severe BPH
42
Prostate cancer risk factors
* Advancing age * African American * Positive family history (BRCA gene, first degree relative)
43
How to differentiate prostate cancer from BPH symptoms
Prostate cancer symptoms tend to increase in intensity during a 1-2 months period vs BPH which is slower progressing
44
Prostate cancer symptoms
* Urinary hesitancy, urgency, nocturia, frequency, hematuria * Advanced disease → back pain, impotence, bone pain, weight loss
45
Prostate cancer screening
* 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
DRE findings with prostate cancer
Firm nodule, induration, stony, asymmetric prostate
47
Prostate cancer diagnostic studies
* 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
What is paraphimosis?
**Medical emergency** Retracted foreskin that cannot be reduced to the normal position → constriction of glans
49
Causes of paraphimosis
* Following masturbation * Sexual activity * Forceful retraction * Sexual abuse
50
Paraphimosis management
* Manual reduction * Surgical emergency
51
When should the PCP refer a pediatric patient with undescended testicles?
Referral made by six months old; if not taken care of by 2 years, will have permanent damage (infertility, malignancy)
52
True/false: undescended testicles normally descend by six month
True - if not, refer
53
Phimosis clinical presentation (history)
* Inflammation of penis * Pain, dysuria * Signs of urinary obstruction → ballooning due to urine collecting in foreskin
54
Phimosis physical exam findings
Tight, pinpoint opening of the foreskin with minimal ability to retract the foreskin; foreskin flat and effaced
55
Phimosis management and treatment
* Normal cleansing with gentle stretching of the foreskin until resistance is felt. * Never forcefully retract the foreskin. * Steroid cream * Surgery if phimosis continues
56
What is a hydrocele?
Painless, gradual enlargement of scrotum with marked edema
57
Hydrocele clinical presentation (history)
* Bulge or lump in scrotum * Tense overlying skin * Bluish discoloration in area of bulge * No distress or vomiting
58
Hydrocele physical examination findings
* Cremasteric reflex present * Transllumination
59
Hydrocele management and treatment
* 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
True/false: there is a six hour window before ischemic damage occurs with testicular torsion
True
61
Testicular torsion history and clinical findings
* Ill appearing * Sudden onset of unilateral scrotal pain * N/V * “Blue dot” sign - painless, firm, blue scrotal mass in newborns
62
Testicular torsion physical examination findings
* Absent cremastueric reflex * Scrotal swelling with redness, warmth, tenderness * Slight elevation of testis
63
Testicular torsion treatment and management
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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