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Renal-Genitourinary > Exam 3 Review > Flashcards

Exam 3 Review Flashcards

1
Q

what is the most common benign GU tumor in men?

A

BPH

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2
Q

patient is experiencing obstructive urinary voiding symptoms like problems starting/stopping, decreased force, straining, hesitancy, dribbling, difficulty emptying bladder, and double voiding. they also have irritative urinary storage like frequency, dysuria, urgency, and nocturia. Dx?

A

BPH

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3
Q

what reduces the risk for BPH?

A

vitamin C

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4
Q

what 4 parts of the PE should be done for a patient with BPH?

A

abdominal
neuro
external genitalia
DRE

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5
Q

what does prostate feel like during DRE of BPH? (4)

A

smooth
firm
rubbery
loss of median furrow

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6
Q

what labs should we get for BPH? (3)

A

urinalysis
urine culture
+/- PSA

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7
Q

treatment for BPH with AUA scores 0-7?

A

watchful waiting + behavior modifications

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8
Q

what are 3 medication types used to treat BPH?

A

alpha antagonists (terazosin)
5 alpha-reductase inhibitors (finasteride)
PDE5 inhibitor (tadalafil/cialis)

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9
Q

what are 3 combination therapy options for BPH that is severe or have a large prostate > 40 grams

A

finasteride + terazosin
finasteride + doxazosin
dutasteride + tamsulosin

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10
Q

what is the gold standard surgery for BPH?

A

transurethral resection of prostate

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11
Q

patient presents with painless hematuria, irritative symptoms, and urethra obstruction. urinalysis shows presence of RBCs and WBCs, BMP shows azotemia, and CBC shows anemia. Dx?

A

bladder cancer

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12
Q

diagnostic used for bladder cancer?

A

cystoscopy with transurethral biopsy

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13
Q

treatment for bladder cancer that is non-muscle invasive (Tis, Ta, or T1)?

A

transurethral resection +/- bacillus calmette (chemo)

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14
Q

treatment for bladder cancer that is a high grade T1?

A

radical cystectomy + chemo + radiation therapy

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15
Q

treatment for bladder cancer that is invasive but localized (T2-T3)?

A

neoadjuvant chemo + radical cystectomy

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16
Q

treatment for bladder cancer that has mets? (5)

A

neoadjuvant chemo
radical cystectomy
chemo
immunotherapy
radiation

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17
Q

cryptorchidism that never developed (agenesis) or atrophied

A

absent

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18
Q

previously descended, then spontaneously ascends and remains

A

ascending/acquired cryptorchidism

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19
Q

normal testicle retracts to the supra-scrotal position due to exaggerated cremasteric reflex

A

retractile / pseudo-cryptorchidism

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20
Q

testes stops along the normal path of descending

A

true undescended testes

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21
Q

what is the most common site for true undescended testes?

A

abdomen

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22
Q

normal descent through the inguinal ring occurs, then diverts to an abnormal position

A

ectopic undescended testes

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23
Q

what is the most common site for ectopic undescended testes?

A

superficial inguinal pouch

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24
Q

patient presents with dysuria, frequency, urgency, hematuria, malodorous urine. Patient denies fever. Clean catch midstream urinalysis shows + leukocyte esterase, nitrite, and hematuria. Dx?

A

acute cystitis

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25
Q

what is the 1st line treatment for acute cystitis? (3)

A

nitrofurantoin/macrobid
+
trime-sulfa
+
fosfomycin 1 time

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26
Q

what is the 2nd line treatment for acute cystitis?

A

fluouroquinolone (cipro or levo)

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27
Q

what is the treatment for recurrent cystitis? (3 options)

A

nitrofurantoin/macrobid
OR
trime-sulfa
OR
cephalexin/keflex

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28
Q

what is the treatment for honeymoon cystitis? (2 options)

A

trime-sulfa
OR
cipro

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29
Q

what analgesics can be used for cystitis?

A

phenazopyridine/pyridium

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30
Q

patient presents with fever, suprapubic tenderness, CVA tenderness, AMS, and hypotension. urinalysis shows a cloudy, malodorous urine. Dx? treatment for gram -? treatment for gram +?

A

catheter associated UTI

gram -: ceftriaxone OR levo/cipro
gram +: vancomycin

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31
Q

patient presents with chronic, debilitating bladder pain. they state pressure and pain with a full bladder that is relieved with urination or standing, but worsened with sitting and intercourse. Dx?

A

interstitial cystitis

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32
Q

what 4 labs should be done for interstitial cystitis?

A

urinalysis
microscopy
culture + sensitivity
urine cytology

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33
Q

what is the initial diagnostic test for interstitial cystitis?

A

cystoscopy

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34
Q

what is the first line treatment for interstitial cystitis? (4)

A

amitriptyline or antihistamine
NSAIDs/tramadol/tylenol
CBT
pelvic floor exercises

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35
Q

patient presents with unilateral pain and swelling of the scrotum, abdominal/flank pain, rectal/back pain, and inguinal canal pain. They have a high fever, chills, rigors, and testicular exams indicates indurated, erythematous skin, reactive hydrocele with an intact cremasteric reflex and a positive prehn sign. Dx?

A

epididymitis

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36
Q

what is the pathophysiology of epididymitis?

A

retrograde infection spreads from urethra or bladder to ejaculatory duct, to vas deferens, to epididymis

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37
Q

no emission of seminal fluid with orgasms; post-ejaculate urine does not have sperm

A

anejaculation

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38
Q

no emission of seminal fluid with orgasms because the seminal fluid is redirected backwards into the bladder; post-ejaculation urine will show sperm

A

retrograde ejaculation

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39
Q

what diagnostic can be used for erectile dysfunction?

A

penile color doppler (atherosclerosis)

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40
Q

what is used to diagnose erectile dysfunction and help differentiate between a psychological vs an organic problem?

A

nocturnal penile tumescence testing (stamp test)

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41
Q

what is the 1st line treatment for erectile dysfunction? (2)

A

CBT
PDE5 inhibitors (sildenafil)

42
Q

what should be avoided when taking PDE5 inhibitors? (2)

A

nitroglycerin
nitrites

43
Q

patient presents with change in size of swelling of testicle with position. it is a painless, dull ache that is swollen, and swelling of the testicle that transilluminates like a lantern. what imaging should we get? Dx?

A

US
hydrocele

44
Q

a patient presents with painless/heaviness with scrotal swelling that looks like a “bag of worms” that becomes worse when standing and valsalva, and is relieved with lying down. what imaging should we get? Dx?

A

US
varicocele

45
Q

patient has displacement of the urethral meatus along the ventral side of the glans/shaft of penis/scrotum/perineum. they have abnormal urination during newborn exam or after circumcision. Dx?

A

hypospadias

46
Q

rare congenital birth defect that shows as a urethra opens on top of glans/shaft in boys. in girls, the urethra opens above the clitoris or abdomen. what imaging helps? Dx?

A

US
epispadias

47
Q

2 year old patient presents with incontinence. what imaging (2) should be ordered? Dx?

A

renal/bladder US
voiding cystourethrogram

enuresis

48
Q

what is the treatment for nocturnal enuresis?

A

resolves by adolescence

treat underlying cause

49
Q

what are 2 conditional therapies used to treat enuresis?

A

enuresis alarm
time training

50
Q

what medication is used to treat enuresis?

A

desmopressin / DDAVP

51
Q

leakage due to increased abdominal pressure and weak internal and external urethral sphincter muscles (laughing, coughing, sneezing)

A

urethral incompetence / stress incontinence

52
Q

most common form of incontinence; sudden urgency due to bladder contraction and leakage

A

detrusor overactivity / urge incontinence

53
Q

urinary frequency and urgency with or without incontinence

A

overactive bladder

54
Q

involuntary release of urine from a full bladder; detrusor underactivity

A

overflow incontinence

55
Q

what lab is used to diagnose stress urinary incontinence?

A

bladder stress test

56
Q

what lab is used to diagnose overflow urinary incontinence?

A

postvoid residual

57
Q

what is the most common cause of urinary incontinence in hospitalized patients?

A

delirium

58
Q

what is the treatment for urinary incontinence caused by atrophic urethritis or vaginitis?

A

topical estrogens

59
Q

what is the most common type of renal stone?

A

calcium stone

60
Q

what kind of renal stone is made up of Magnesium, Ammonium, and Phosphate? (MAP)

A

struvite stones

61
Q

patient presents with acute, severe colicky flank pain that radiates anteriorly to abdomen, groin, and testicles. They have gross hematuria with irritative symptoms. Dx?

A

renal stones (nephrolithiasis)

62
Q

in a patient with suspected nephrolithiasis, what does a pH < 5.5 suggest? what about >8?

A

uric acid / cystine
calcium

63
Q

what is the gold standard and diagnostic study for nephrolithiasis?

A

non-contrast helical abdominal/pelvis CT

64
Q

what is the treatment for nephrolithiasis of stones < 9mm in a stable patient? (5)

A

hydrate
NSAIDs
metoclopramide for N/V
tamsulosin (alpha1 blocker)
+/- prednisone

65
Q

what is the treatment for nephrolithiasis of stones 10mm at presentation?

A

call urology for percutaneous nephrolithotomy / ureterolithotomy

66
Q

patient presents with abrupt onset of unilateral testicular pain, swollen parotid glands, +/- irritative symptoms. on PE, testis are tender and swollen and so is prostate. patient is suspect for STI. Dx? treatment? (2)

A

Orchitis

bacterial (STI, no anal) - ceftriaxone + doxycycline OR azithromycin

bacterial (STI, anal) - ceftriaxone + levofloxacin

67
Q

patient presents with abrupt onset of unilateral testicular pain, swollen parotid glands, +/- irritative symptoms. on PE, testis are tender and swollen and so is prostate. patient is low risk for STI. Dx? treatment? (2)

A

orchitis

levofloxacin OR trime-sulfa

68
Q

patient presents with inability to retract foreskin over glans, difficulty urinating, frequent UTIs and blood from site. Dx? treatment?

A

phimosis

topical steroids (betamethason/diprolene)

69
Q

patient presents with severe pain and swelling of the penis, dysuria, decreased urine stream and sometimes complete urinary retention. on PE, the foreskin and glans is swollen, glans penis is swollen, and shaft is unaffected. Dx? treatment?

A

paraphimosis

control pain
manual reduction w/ local anesthesia +/- ER

70
Q

patient presents with a painless lump, mass, ulcer on their penis with a red rash-like, foul-smelling discharge. Dx? treatment? (3)

A

penile cancer

< T2 = topical chemo (fluorouracil or imiquimod)
T2-T4 = penectomy
regional nodes = dissection, chemo or radiation

71
Q

patient presents with pain w/ erections, nodules, induration, curvature / deformity of the penis, sexual dysfunction that has gotten worse over the 6 months. what imaging should we get?

A

US

72
Q

patient presents with pain w/ erections, nodules, induration, curvature / deformity of the penis, sexual dysfunction that has gotten worse over the 6 months. Dx? treatment?

A

peyronie disease

mild, no pain = watchful waiting

active, painful = NSAIDs + pentoxifylline +/- clostridial injections

73
Q

what 2 labs will help diagnose prostate cancer? what change indicates prostate cancer?

A

PSA
PSA Velocity (increased > 0.75 over 1 year)

74
Q

what are the 2 ways to check the prognosis of prostate cancer?

A

kattan nomogram
CAPRA nomogram

75
Q

what does the american cancer society say about PSA screening? (3)

A

50 w/ > 10 year life expectancy
45 w/ high risks
40 w/ family history at <55 yo

76
Q

what is the prognosis/ 5 year survival rate if prostate cancer is locally confined?

A

100%

77
Q

what is the prognosis/ 5 year survival rate if prostate cancer is metastasized?

A

35%

78
Q

what is the most common urinary tract problem in men younger than 50yo?

A

prostatitis

79
Q

patient presents acutely ill with fever, chills, malaise, frequency, urgency, dysuria, nocturia, incontinence, N/V, pelvis pain, painful ejaculation, and urinary retention. on PE, patient is febrile, tachycardic, has urethral discharge, swollen lymph nodes and scrotum, and DRE reveals a painful, edematous, and firm prostate. Dx?

A

prostatitis

80
Q

what labs should be done for prostatitis? (4)

A

UA
culture and sensitivity
gram stain
CBC w/ diff

81
Q

what 2 labs are not necessary for prostatitis?

A

PSA
meares stamey

82
Q

patient presents with fever, chills, rigors, flank pain, NVD, CVA tenderness, urgency, dysuria, and frequency. They later experience AMS. on PE, they have an elevated BP, hematuria, and appear toxic. labs reveal leukocyte esterase, nitrites, and WBC casts. Dx? treatment?

A

pyelonephritis

IV antibiotics 1x (ceftriaxone, cipro, or gentamicin)
then oral cipro, levo, or bactrim

83
Q

patient presents with painless hard mass on their testicle, feel heaviness in testicle. testicle is irregular, not fluctuant, and cannot transilluminate. the patient also has gynecomastia. Dx? treatment?

A

testicular cancer
radical orchiectomy

84
Q

what lab helps diagnose testicular cancer?

A

AFP

85
Q

patient presents with sudden onset of severe unilateral testicular pain, N/V, abdominal and inguinal pain that improves with rest. on PE, there is an absent cremasteric reflex and prehn’s sign. Dx? treatment?

A

testicular torsion

surgery for detorsion + orchiopexy (fixes testicle to scrotum)

86
Q

patient presents with a palpable localized tender mass with a nontender testes, they have a + blue dot sign and normal cremasteric reflex, no relief with prehn’s sign. Dx?

A

torsion of appendix testis

87
Q

what is the most common cause of anterior urethral injury; causing testicular injury, degloving, zippers, and pelvic fractures?

A

blunt trauma

88
Q

trauma caused by GSW, stabbings, and bites

A

penetrating

89
Q

trauma caused by flames, hot liquids, and chemicals

A

burn injuries

90
Q

male patient presents with a butterfly hematoma on GU. what is intact? what kind of injury?

A

colle’s fascia

straddle injury

91
Q

male patient presents with an eggplant-looking penis on GU. what is intact? what kind of injury?

A

buck’s fascia

penile fracture

92
Q

patient presents with a bulge that is “protruding” or “falling out of their vagina”. they feel a heaviness or pelvic pressure, urinary incontinence, obstructed voiding, UTIs, and decreased sexual satisfaction. Dx?

A

pelvic organ prolapse

93
Q

patient presents with a scar that obstructs the anterior urethral lumen; presents with chronic obstructive s/s or irritative s/s. Dx? treatment? (3)

A

urethral stricture

1: minimally invasive endoscopic techniques

2: urethral reconstruction / urethroplasty

3: urinary diversion

94
Q

patient presents with dysuria, discharge, fever, chills, joint pain, rash, rectal pain, and red eyes. Dx?

A

urethritis

95
Q

what is the TOC for urethritis?

A

NAAT

96
Q

patient presents with urge incontinence, recurrent UTIs, dysuria, infrequent voiding, abdominal pain, constipation and soiling. Dx? treatment? (4)

A

vesicoureteral reflux

laxatives
time frequent voiding
+/- antibiotics (un-potty trained)
+/- surgery

97
Q

how does a prenatal occurrence of vesicoureteral reflux present?

A

hydronephrosis

98
Q

how does a postnatal occurrence of vesicoureteral reflux present?

A

recurrent febrile UTIs

99
Q

how does an adult occurrence of vesicoureteral reflux present?

A

asymptomatic

100
Q

patient presents with inflammation of the glans penis and c/o of rash, lesions, itching, burning, and swelling. Dx? treatment? (3)

A

balanitis

topical nystatin / clotrimazole
dilute aluminum acetate soaks

+/- clindamycin / metro + fluconazole

Renal-Genitourinary (7 decks)

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