Exam 3 Review Flashcards
1
Q
what is the most common benign GU tumor in men?
A
BPH
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
3
Q
what reduces the risk for BPH?
A
vitamin C
4
Q
what 4 parts of the PE should be done for a patient with BPH?
A
abdominal
neuro
external genitalia
DRE
5
Q
what does prostate feel like during DRE of BPH? (4)
A
smooth
firm
rubbery
loss of median furrow
6
Q
what labs should we get for BPH? (3)
A
urinalysis
urine culture
+/- PSA
7
Q
treatment for BPH with AUA scores 0-7?
A
watchful waiting + behavior modifications
8
Q
what are 3 medication types used to treat BPH?
A
alpha antagonists (terazosin)
5 alpha-reductase inhibitors (finasteride)
PDE5 inhibitor (tadalafil/cialis)
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
10
Q
what is the gold standard surgery for BPH?
A
transurethral resection of prostate
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
12
Q
diagnostic used for bladder cancer?
A
cystoscopy with transurethral biopsy
13
Q
treatment for bladder cancer that is non-muscle invasive (Tis, Ta, or T1)?
A
transurethral resection +/- bacillus calmette (chemo)
14
Q
treatment for bladder cancer that is a high grade T1?
A
radical cystectomy + chemo + radiation therapy
15
Q
treatment for bladder cancer that is invasive but localized (T2-T3)?
A
neoadjuvant chemo + radical cystectomy
16
Q
treatment for bladder cancer that has mets? (5)
A
neoadjuvant chemo
radical cystectomy
chemo
immunotherapy
radiation
17
Q
cryptorchidism that never developed (agenesis) or atrophied
A
absent
18
Q
previously descended, then spontaneously ascends and remains
A
ascending/acquired cryptorchidism
19
Q
normal testicle retracts to the supra-scrotal position due to exaggerated cremasteric reflex
A
retractile / pseudo-cryptorchidism
20
Q
testes stops along the normal path of descending
A
true undescended testes
21
Q
what is the most common site for true undescended testes?
A
abdomen
22
Q
normal descent through the inguinal ring occurs, then diverts to an abnormal position
A
ectopic undescended testes
23
Q
what is the most common site for ectopic undescended testes?
A
superficial inguinal pouch
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
25
what is the 1st line treatment for acute cystitis? (3)
nitrofurantoin/macrobid
+
trime-sulfa
+
fosfomycin 1 time
26
what is the 2nd line treatment for acute cystitis?
fluouroquinolone (cipro or levo)
27
what is the treatment for recurrent cystitis? (3 options)
nitrofurantoin/macrobid
OR
trime-sulfa
OR
cephalexin/keflex
28
what is the treatment for honeymoon cystitis? (2 options)
trime-sulfa
OR
cipro
29
what analgesics can be used for cystitis?
phenazopyridine/pyridium
30
patient presents with fever, suprapubic tenderness, CVA tenderness, AMS, and hypotension. urinalysis shows a cloudy, malodorous urine. Dx? treatment for gram -? treatment for gram +?
catheter associated UTI
gram -: ceftriaxone OR levo/cipro
gram +: vancomycin
31
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?
interstitial cystitis
32
what 4 labs should be done for interstitial cystitis?
urinalysis
microscopy
culture + sensitivity
urine cytology
33
what is the initial diagnostic test for interstitial cystitis?
cystoscopy
34
what is the first line treatment for interstitial cystitis? (4)
amitriptyline or antihistamine
NSAIDs/tramadol/tylenol
CBT
pelvic floor exercises
35
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?
epididymitis
36
what is the pathophysiology of epididymitis?
retrograde infection spreads from urethra or bladder to ejaculatory duct, to vas deferens, to epididymis
37
no emission of seminal fluid with orgasms; post-ejaculate urine does not have sperm
anejaculation
38
no emission of seminal fluid with orgasms because the seminal fluid is redirected backwards into the bladder; post-ejaculation urine will show sperm
retrograde ejaculation
39
what diagnostic can be used for erectile dysfunction?
penile color doppler (atherosclerosis)
40
what is used to diagnose erectile dysfunction and help differentiate between a psychological vs an organic problem?
nocturnal penile tumescence testing (stamp test)
41
what is the 1st line treatment for erectile dysfunction? (2)
CBT
PDE5 inhibitors (sildenafil)
42
what should be avoided when taking PDE5 inhibitors? (2)
nitroglycerin
nitrites
43
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?
US
hydrocele
44
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?
US
varicocele
45
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?
hypospadias
46
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?
US
epispadias
47
2 year old patient presents with incontinence. what imaging (2) should be ordered? Dx?
renal/bladder US
voiding cystourethrogram
enuresis
48
what is the treatment for nocturnal enuresis?
resolves by adolescence
treat underlying cause
49
what are 2 conditional therapies used to treat enuresis?
enuresis alarm
time training
50
what medication is used to treat enuresis?
desmopressin / DDAVP
51
leakage due to increased abdominal pressure and weak internal and external urethral sphincter muscles (laughing, coughing, sneezing)
urethral incompetence / stress incontinence
52
most common form of incontinence; sudden urgency due to bladder contraction and leakage
detrusor overactivity / urge incontinence
53
urinary frequency and urgency with or without incontinence
overactive bladder
54
involuntary release of urine from a full bladder; detrusor underactivity
overflow incontinence
55
what lab is used to diagnose stress urinary incontinence?
bladder stress test
56
what lab is used to diagnose overflow urinary incontinence?
postvoid residual
57
what is the most common cause of urinary incontinence in hospitalized patients?
delirium
58
what is the treatment for urinary incontinence caused by atrophic urethritis or vaginitis?
topical estrogens
59
what is the most common type of renal stone?
calcium stone
60
what kind of renal stone is made up of Magnesium, Ammonium, and Phosphate? (MAP)
struvite stones
61
patient presents with acute, severe colicky flank pain that radiates anteriorly to abdomen, groin, and testicles. They have gross hematuria with irritative symptoms. Dx?
renal stones (nephrolithiasis)
62
in a patient with suspected nephrolithiasis, what does a pH < 5.5 suggest? what about >8?
uric acid / cystine
calcium
63
what is the gold standard and diagnostic study for nephrolithiasis?
non-contrast helical abdominal/pelvis CT
64
what is the treatment for nephrolithiasis of stones < 9mm in a stable patient? (5)
hydrate
NSAIDs
metoclopramide for N/V
tamsulosin (alpha1 blocker)
+/- prednisone
65
what is the treatment for nephrolithiasis of stones 10mm at presentation?
call urology for percutaneous nephrolithotomy / ureterolithotomy
66
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)
Orchitis
bacterial (STI, no anal) - ceftriaxone + doxycycline OR azithromycin
bacterial (STI, anal) - ceftriaxone + levofloxacin
67
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)
orchitis
levofloxacin OR trime-sulfa
68
patient presents with inability to retract foreskin over glans, difficulty urinating, frequent UTIs and blood from site. Dx? treatment?
phimosis
topical steroids (betamethason/diprolene)
69
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?
paraphimosis
control pain
manual reduction w/ local anesthesia +/- ER
70
patient presents with a painless lump, mass, ulcer on their penis with a red rash-like, foul-smelling discharge. Dx? treatment? (3)
penile cancer
< T2 = topical chemo (fluorouracil or imiquimod)
T2-T4 = penectomy
regional nodes = dissection, chemo or radiation
71
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?
US
72
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?
peyronie disease
mild, no pain = watchful waiting
active, painful = NSAIDs + pentoxifylline +/- clostridial injections
73
what 2 labs will help diagnose prostate cancer? what change indicates prostate cancer?
PSA
PSA Velocity (increased > 0.75 over 1 year)
74
what are the 2 ways to check the prognosis of prostate cancer?
kattan nomogram
CAPRA nomogram
75
what does the american cancer society say about PSA screening? (3)
50 w/ > 10 year life expectancy
45 w/ high risks
40 w/ family history at <55 yo
76
what is the prognosis/ 5 year survival rate if prostate cancer is locally confined?
100%
77
what is the prognosis/ 5 year survival rate if prostate cancer is metastasized?
35%
78
what is the most common urinary tract problem in men younger than 50yo?
prostatitis
79
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?
prostatitis
80
what labs should be done for prostatitis? (4)
UA
culture and sensitivity
gram stain
CBC w/ diff
81
what 2 labs are not necessary for prostatitis?
PSA
meares stamey
82
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?
pyelonephritis
IV antibiotics 1x (ceftriaxone, cipro, or gentamicin)
then oral cipro, levo, or bactrim
83
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?
testicular cancer
radical orchiectomy
84
what lab helps diagnose testicular cancer?
AFP
85
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?
testicular torsion
surgery for detorsion + orchiopexy (fixes testicle to scrotum)
86
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?
torsion of appendix testis
87
what is the most common cause of anterior urethral injury; causing testicular injury, degloving, zippers, and pelvic fractures?
blunt trauma
88
trauma caused by GSW, stabbings, and bites
penetrating
89
trauma caused by flames, hot liquids, and chemicals
burn injuries
90
male patient presents with a butterfly hematoma on GU. what is intact? what kind of injury?
colle's fascia
straddle injury
91
male patient presents with an eggplant-looking penis on GU. what is intact? what kind of injury?
buck's fascia
penile fracture
92
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?
pelvic organ prolapse
93
patient presents with a scar that obstructs the anterior urethral lumen; presents with chronic obstructive s/s or irritative s/s. Dx? treatment? (3)
urethral stricture
1: minimally invasive endoscopic techniques
2: urethral reconstruction / urethroplasty
3: urinary diversion
94
patient presents with dysuria, discharge, fever, chills, joint pain, rash, rectal pain, and red eyes. Dx?
urethritis
95
what is the TOC for urethritis?
NAAT
96
patient presents with urge incontinence, recurrent UTIs, dysuria, infrequent voiding, abdominal pain, constipation and soiling. Dx? treatment? (4)
vesicoureteral reflux
laxatives
time frequent voiding
+/- antibiotics (un-potty trained)
+/- surgery
97
how does a prenatal occurrence of vesicoureteral reflux present?
hydronephrosis
98
how does a postnatal occurrence of vesicoureteral reflux present?
recurrent febrile UTIs
99
how does an adult occurrence of vesicoureteral reflux present?
asymptomatic
100
patient presents with inflammation of the glans penis and c/o of rash, lesions, itching, burning, and swelling. Dx? treatment? (3)
balanitis
topical nystatin / clotrimazole
dilute aluminum acetate soaks
+/- clindamycin / metro + fluconazole
