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Clinical Medicine 2 > Exam 3 - GU > Flashcards

Exam 3 - GU Flashcards

1
Q

When do testes descend into scrotum?

A

4-6 weeks before birth

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2
Q

Etiology of Cryptorchidism

A

Gubernaculum is not firmly attached to the scrotum causing the testis to not be pulled into the scrotum

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3
Q

Complications from Cryptorchidism?

A
  • Infertility. Worse with bilateral.

- Testicular cancer, even if corrected.

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4
Q

Is ultrasound in cryptorchidism warranted prior to referral?

A

No. Doesn’t help with decision making process.

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5
Q

At what point/age should surgery be used to correct cryptorchidism?

A

If no spontaneous descent by 6 months of age. Surgery within 1 year.

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6
Q

What to counsel PT with hx of cryptorchidism?

A

Long-term risk of infertility and cancer risk.

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7
Q

First step in work-up for cryptorchidism?

A

Consult with specialist

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8
Q

How to definitely diagnose and treat cryptorchidism?

A

Laparoscopy

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9
Q

What type of hernia is seen with cryptorchidism?

A

Inguinal hernia

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10
Q

Inguinal hernia due to patent…?

A

Patent processes vaginalis

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11
Q

When does the Processes Vaginalis normally close?

A

Within the first year of life

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12
Q

Who gets Acquires Hydrocele? How?

A

Adults. Injury, infection, or inflammation.

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13
Q

Are pediatric hydrocele acquired or congenital?

A

Congenital. Resolve within 1st year of life.

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14
Q

A patient Processus Vaginalis causes what type of Hydrocele?

A

Communicating Hydrocele

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15
Q

When are Communicating Hydroceles usually discovered?

A

Infancy

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16
Q

What are Noncommunicating Hydroceles due to?

A

Minor trauma, inflammation

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17
Q

Acute Reactive Hydrocele due to

A

Epididymitis, testicular torsion, varicocele operation, or testicular tumor

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18
Q

What is a Hydrocele?

A

Cystic collection of fluid in testicle. Main cause of painless scrotal swelling.

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19
Q

Can a Hydrocele be transilluminated?

A

Yes!

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20
Q

What sort of imaging for Hydrocele? What to evaluate for

A

Scrotal Ultrasound- to evaluate for reactive hydrocele due to testicular neoplasm or other etiology

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21
Q

Tx for Idiopathic Hydrocele?

A

Oservation only. Surgical treatment only if increase pressure, pain, or chronic irritation of scrotal skin

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22
Q

Tx for Communicating Hydrocele?

A

Surgical closure of patent Processes Vaginalis

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23
Q

Etiology of Varicocele?

A

Dilation of panpiniform plexus. Left side 95% of time.

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24
Q

Why left side worse in Varicocele?

A

Left spermatic vein enters left renal vein at 90 degree angle

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25
Q

How does Varicocele cause male infertility?

A

Increased temp from increased venous flow inhibits spermatogenesis.

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26
Q

PE of Varicocele?

A

“Bag of worms”

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27
Q

What positon should a PT be in when examining for Varicocele?

A

Upright. Will disappear when supine.

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28
Q

DX for Varicocele?

A

Scrotal ultrasound

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29
Q

Etiology of Epididymitis? (Hint: diff for children and adults)

A

Children=Viral from mumps

Adults=Chlamydia under 35; E Coli or Kleb over 35

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30
Q

Raped or insidious onset in Epididymitis?

A

Insidious

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31
Q

S/Sx or Epididymitis?

A

Gradual over few days. Unilateral scrotal pain, erythema, swelling.

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32
Q

Phren’s sign in Epididymitis?

A

Yes. Relief of pain with elevation of scrotum.

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33
Q

Cremasteric reflex in Epididymitis?

A

Yes. Normal.

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34
Q

Dx of Epididymitis?

A

UA=Pyuria or bacteruria

Scrotal US=enlarged epididymis, increased testicular flow

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35
Q

Etiology of Orchitis?

A

Viral!

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36
Q

What is Orthitis?

A

Acute inflammation of testis secondary to infection

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37
Q

PE of Orchitis?

A

Very swollen and painful testis

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38
Q

What important to rule out with Orthitis?

A

Testicular torsion

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39
Q

Tx for Orchitis? Abx?

A

Supportive. Bed rest, hot/cold packs, analgesia, scrotal elevation.

Under 35 and sex-active=Ceft+Doxy or Ceft+Azith
Over 35=Add FLQ or Bactrim for Gram Negative coverage

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40
Q

Etiology in Testicular Torsion?

A

Spermatic cord twists and cuts off testicular blood supply. 180-720 degree twist.

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41
Q

Which side affected more in Testicular Torsion?

A

Left more than right

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42
Q

What is Bell Clapper deformity?

A

Hanging testy not attached to gubernaculum. In Testicular Torsion.

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43
Q

How does PT with Testicular Torsion walk?

A

Hunched over

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44
Q

S/Sx of Testicular Torsion?

A

Severe pain, N/V; red, swollen, tender scrotum

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45
Q

Testicular Torsion transilluminates?

A

NO! Non-illuminating mass.

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46
Q

Tunica Vaginalis and Testicular Torsion?

A

inappropriately high attachment of the tunica vaginalis ->testicle rotates freely on the spermatic cord within the tunica vaginalis

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47
Q

Phren Sign in Testicular Torsion?

A

NO!!!!!

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48
Q

Onset of pain in Testicular Torsion?

A

Sudden! Severe!

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49
Q

Cremasteric Reflex in Testicular Torsion?

A

NO!

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50
Q

Tx of Testicular Torsion?

A

Surgery to detorse within 6h to save the testicle

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51
Q

What is Phimosis?

A

Foreskin can’t be retracted over glans penis

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52
Q

When is Phimosis treated?

A

Difficulty urinating or with sex

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53
Q

Tx for Phimosis?

A

Steroid creams, manual stretching, change masturbation habits, presomething, circumcision

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54
Q

What is Paraphimosis?

A

Foreskin unable to be retracted back from behind the glans penis. Causes ischemia to glans penis!

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55
Q

Paraphimosis only occurs in who?

A

Uncircumcised or partially circumcised

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56
Q

Is Paraphimosis a urological emergency?

A

YES!

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57
Q

What can paraphimosis cause?

A

Gangrene and autoamputation!

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58
Q

Tx options for Paraphimosis?

A

Conservative=gentle retraction of foreskin

Surgery=dorsal slit, then circumcision

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59
Q

How is kidney stone formed?

A

Normally soluble material (Ca, PO4, uric acid) supersaturates the urine and begins the process of crystal formation

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60
Q

What are 60-80% of kidney stones made of?

A

Calcium stones. Ca oxalate > Ca phosphate

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61
Q

How does dehydration cause kidney stones?

A

Increased urine concentration

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62
Q

Stuvite Stones go along with which infection

A

UTI

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63
Q

S/Sx of nephrolithiasis?

A

Severe unilateral flank pain radiating to groin/testicle/labia. Pacing, rocking, writhing motion and unable to find position of comfort.

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64
Q

Stone in kidney causes pain where?

A

Vague flank pain, hematuria

65
Q

Stone in Prox Ureter causes pain where?

A

Renal colic, flank pain, upper abd pain

66
Q

Stone in midureter causes pain where?

A

Renal colic, flank pain, anterior abdomen/groin pain

67
Q

Stone in dister ureter causes pain where?

A

Renal colic, flank pain, dysuria, urinary frequency, urgency, hesitancy, ant abd/groin pain, testicular/labial pain,

68
Q

Is ultrasound good for dx kidney stones? Who gets U/S?

A

Nope, only good for hydronephrosis. Patients who should avoid radiation, including children, pregnant women and woman in childbearing age.

69
Q

Test of choice for kidney stones? Who not?

A

Noncontrast helical CT.

Not first-line for preggers, children, or gyn etiology

70
Q

Tx of kidney stones?

A

IV hydration, analgesics (NSAIDs, Keterolac), narcotics. Admit to hosp if can’t PO meds or drink.

71
Q

What should PT do with urine when passing kidney stone?

A

Strain urine and bring in stone for analysis

72
Q

When to call urology for kidney stones?

A

Stone ≥6mm, multiple stones, preggers, blocking ureter (hydronephrosis), more than 2 weeks with stone

73
Q

Tx for kidney stone >5mm?

A

Extracorporeal shock wave therapy

74
Q

PT with kidney stone should be made to pee out how much?

A

2L/day

75
Q

Tx for Staghorn Calculi?

A

PNL surgical then PNL and ECSW (shockwave)

76
Q

What type of stone and how many calycies are Staghorn Calculi?

A

Struvite stone. At least 2 calycies.

77
Q

When do to metabolic workup on nephrolithiasis PT?

A

After second stone

78
Q

What test guides further dx and tx of nephrolithiasis?

A

24h urinalysis

79
Q

Nephrolithiasis dietary counseling?

A

Reduce dietary sodium, Reduce dietary animal protein, Increase po fluid intake such that 2L/d urinary output

80
Q

What does the Prostate do?

A

Secretes fluid that nourishes and protects sperm

81
Q

Two most common bacteria in Acute Bacterial Prostatitis?

A

E coli and Pseudomonas

82
Q

Route of infection in Acute Bacterial Prostatitis? Who gets the most?

A

Ascent of infected urine up the urethra into prostatic ducts. Occurs most in young and middle-aged men

83
Q

DRE findings in Acute Bacterial Prostatitis?

A

Exquistely tender prostate. Warm and erythematous prostate.

84
Q

UA and CBC in Acute Bacterial Prostatitis?

A

CBC=Leukocytosis w/left shift.

UA=pyuria, bacteruria, hematuria

85
Q

When to image Acute Bacterial Prostatitis? What to think?

A

CT or MR if no improvement in 48h. Think prostate abscess.

86
Q

When to admit Acute Bacterial Prostatitis?

A

Septic, can’t do PO abx, multiple comorbidities

87
Q

Which abx for Acute Bacterial Prostatitis?

A

FLQs or Bactrim for 4-6 weeks

88
Q

Which bacteria in Chronic Bacterial Prostatitis?

A

Most common E Coli

89
Q

When does Chronic Bacterial Prostatitis develop?

A

After acute prostatitis infection which progresses into chronic

90
Q

How does Chronic Bacterial Prostatitis present?

A

Some is ASx. Irritative voiding that won’t go away, dull pelvic or perianal pain.

91
Q

Is prostate tender in Chronic Bacterial Prostatitis?

A

Not tender! Feels boggy, firm, or normal.

92
Q

UA results normal in Chronic Bacterial Prostatitis?

A

Often normal

93
Q

How to increase UA/culture yield in Chronic Bacterial Prostatitis?

A

Prostate massage

94
Q

Tx of Chronic Bacterial Prostatitis?

A

Bactrim for 6-12 weeks.

95
Q

What is the most common Prostatic sydrome?

A

Inflammatory Prostatitis

96
Q

Etiology of Inflammatory Prostatitis?

A

Unknown

97
Q

Inflammatory Prostatitis aka?

A

Lance Armstrong Syndrome

98
Q

Inflammatory Prostatitis identical in S/Sx to what?

A

Chronic Prostatitis

99
Q

Labs in Inflammatory Prostatitis?

A

Normal!

100
Q

Tx of Inflammatory Prostatitis?

A

NSAIDS.

Trials of abx directed at ureaplasma, mycoplasma, and chlamydia.

101
Q

What is most common cause of acute onset of scrotal pain in adults?

A

Epididymitis

102
Q

Epididymitis pain unilateral or bilateral?

A

Unilateral

103
Q

Epididymitis pain radiates to where?

A

Flank

104
Q

Does Epididymitis alter the Cremasteric Reflex?

A

No. Unaltered!

105
Q

Epididymitis caused by which gram negative diplococci?

A

Gonorrhea

106
Q

Epididymitis with no organisms but increased WBC caused by?

A

Chlamydia or non-gonococcal urethritis

107
Q

Tx Epididymitis d/t gonorrhea and chlamydia?

A

Doxy + Ceft for 10-21 days

108
Q

Tx Epididymitis not d/t sexually transmitted?

A

Bactrim, Cipro

109
Q

Tx of Orchitis?

A

DEC and Anthel 10-14 days

110
Q

What is Urethritis?

A

Inflammation of the urethra

111
Q

Urethritis commonly a manifestiation of what?

A

STD

112
Q

Urethritis two classifications?

A

Gonococcal or Non-gonococcal

113
Q

Urethritis most commonly from which 2 bacteria?

A

N. gonorrhoeae

C. trachomatis

114
Q

PE in Urethritis?

A

Brown/green discharge

Pruritus and burning at the urethral meatus

115
Q

What sort of UA in Urethritis?

A

First catch urine WITHOUT cleaning

116
Q

Tx for gonorrhea Urethritis?

A

250mg Ceftriaxone IM + 1 gram Azithromycin PO. Doxycycline BID for 7 days can be given with ceftriaxone.

117
Q

Tx of chlamydia Urethritis?

A

Azithromycin 1 gram PO x 1
Doxycycline 100 mg PO BID x 7 days
Erythromycin 500 mg PO QID x 7 days

118
Q

Which med causes a LOT of urinary incontinence

A

Anticholinergics

119
Q

Nocturia definition

A

> 2 pee when sleeping

120
Q

Which sacral nerves are perianal innervations?

A

S2-S4

121
Q

What sort of test should women with urinary incontinence have?

A

Stress test with full bladder and standing. Relax and cough.

122
Q

In men with a large Post Void Residual volume what test?

A

Renal U/S

123
Q

Lifestyle change in Urinary Incontinence?

A

2L UO daily, avoid caffeine

124
Q

Urinary Incontinence med?

A

Oxybutoinin

125
Q

What is most common infectious illness over 65?

A

UTI

126
Q

Breakdown of skin barrier in elderly causes what?

A

Compromised immune function

127
Q

Fever present in elderly with UTI?

A

Absent in 30-50%

128
Q

Baseline body temp in elderly is high or low?

A

Low, below 37C

129
Q

Diagnostic testing in elderly with suspected UTI reserved for…?

A

Fever, dysuria, gross hematuria, worsening incontinence, suspected bacteremia

130
Q

Rule for abx use in elderly?

A

Start low, go slow

131
Q

Abx for elderly UTI work best when levels of the drug _____ the MIC?

A

Far exced the MIC

132
Q

Drug levels should be monitored for what?

A

Avoid toxicity or subtherapeutic dosing

133
Q

Duration of abx in elderly female UTI?

A

3-6 days

134
Q

Elderly male UTIs complicated or uncomplicated? Abx duration?

A

Complicated.

Abx longer duration

135
Q

First line Tx of GERD?

A

PPIs

136
Q

Most common complaint with Diverticulitis?

A

LLQ Abdominal pain (sigmoid colon)

137
Q

Diverticulitis dx?

A

CT scan!

138
Q

Tx for mild diverticulitis?

A

IV abx for gram - and anaerobic until inflammation stabilized and pain resolving, 3-5 days. Then PO abx for total of 10-14 days on abx.

139
Q

Chronic Constipation for at least how many weeks?

A

12 weeks

140
Q

Constipating definition

A

Less than 3 poops/week

141
Q

Constipation a symptom or disease?

A

Symptom

142
Q

Alarm symptoms of constipation gets what test?

A

Abdominal CT

143
Q

Which are the poop softeners?

A

Psyllium, cellulose, calcium poly, wheat dextrose, PEG, lactulose, MG salts

144
Q

Which are the poop move fasters?

A

Stimulants: Bisacodyl, Senna
Secretory: Lubiprostone, Linaclotide

145
Q

Diarrhea definition?

A

Decrease of fecal consistency more than 4 weeks

146
Q

C. Diff and antidiarrheal agents?

A

AVOID! Can cause ileus and megacolon!

147
Q

Tx for mild small bowel overgrowth?

A

Bismuth

148
Q

Tx for severe small bowel overgrowth?

A

Cipro, Neomycin, rifaxim 14-21 days

149
Q

Fecal Incontinence definition?

A

At least 1 month of continuous or uncontrolled passing of fecal material

150
Q

Fecal Incontinence and DRE?

A

Check internal and external anal sphincter tone

151
Q

Fecal Incontinence tx?

A

Disimpaction, schedule toilet poops, modify risk factors

152
Q

Dentate line marks what for hemorrhoids?

A

Internal vs external

153
Q

Internal hemorrhoids arise from which plexus?

A

Superior

154
Q

External hemorrhoids arise from which plexus?

A

Inferior plexus

155
Q

Hemorrhoid bleeding when? Painful?

A

When poop. Not painful.

156
Q

When to scope butt for hemorrhoids?

A

50 y/o, or at 40 if 1st degree relative with colon cancer

157
Q

Grade I hemorrhoid vs Grade 4

A

1=Do not prolapse below denate line

4=irreducable and bulge like a mofo

158
Q

Most common tx for internal hemorrhoids?

A

Rubber band ligation

159
Q

Tx NEVER to use on internal hemorrhoids?

A

Rubber band ligation

Clinical Medicine 2 (14 decks)

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