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Final Flashcards

1
Q

Two jobs of the testis!

A 
Produce sperm
Secrete hormones (testosterone)
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2
Q

Scrotum (3) points

A

Contains testi at lower temperature to allow for optimal sperm production
Prone to injuries
Easy to exam (6x4cm)

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3
Q

Testicular masses are (4)

A

Often firm solid
Painless
Do not trans illuminate
Usually malignant

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4
Q

Scrotal masses and those in the epididymis or spermatic cord are (3)

A

Painful
Transilluminate
Usually benign

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5
Q

Erecticle mechanisms

A

Corpora cavernous a

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6
Q

Contains urethra

A

Corpus spongiform

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7
Q

Surrounds erectile tissue

A

Tunica albuginea

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8
Q

American academy of pediatrics and circumcision

A

Found links between circumcision and decreased risk of urinary tract infections, rare penile cancer, HPV, HIV and other STI’s

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9
Q

Cons of circumcision (5)

A 
Hemorrhage
Infection
Pain/trauma
Diminished sensation
> mother/child bonding
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10
Q

What do seminal vesicles do?

A

Secretes 70% of fluid components of semen = energy/fluidity for sperm

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11
Q

Hypothalamus -> ___ -> pituitary -> __ & __

A

Hypothalamus -> GnRH -> pituitary -> LH & FSH

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12
Q

Leydig cells produce ?

A

Testosterone

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13
Q

What acts on leydig cells to produce testosterone?

A

LH

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14
Q

What two hormones stimulate spermatogenesis?

A

testosterone and FSH

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15
Q

How many sperm does a man produce each day?

A

70-100 million

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16
Q

Penile disorders (7)

A 
Lesion (HPV, molluscum, Bowens)
Balanitis
Posthitis
Hypospadius
Peyronie's disease
Priapism
Tumors
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17
Q

What is the peak age of tumors?

A

60.

These are rare, tend to involve the prepuce or glans

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18
Q

HPV

A

Painless, enlarging wart-like growth (condylomata acuminata)

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19
Q

Leukoplakia

A

Hyperkeratotitic
Scaly
White patches
On penile epithelium

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20
Q

What is necessary with suspected leukoplakia?

A

Biopsy!

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21
Q

Bowen’ disease (5)

A

Intraepdidermal PRECANCEROUS infuriated erythematous plaque
Ulcerated center
Development of pinkish or brownish applies covered with a thick horny layer (haha horny!?)

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22
Q

What is necessary with suspected Bowen’s disease?

A

Biopsy!

Also leukoplakia

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23
Q

2 skin cancers to worry about with penile lesions

A

Squamous cell carcinoma

Melanoma

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24
Q

Balantis. What is it and what percentage of urology patients?

A

Inflammation of glans in 11%

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25
Q

Causes for balantis (8)

A 
Uncircumcised with poor hygiene or over hygiene
Diabetes
Chemical irritants
CHF, cirrhosis, nephorsis
Drug allergies
Obesity
Infections
Penile cancers
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26
Q

What are 6 infections that can cause balantis?

A 
Candida 
HPV
Anaerobes
Treponema
Gardnerella
Trichomonas
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27
Q

Hyposadius

A

Urethral opening on ventral surface

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28
Q

Is hyposadius or episadius more common?

A

Hyposadius

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29
Q

What is episadius?

A

Urethral opening on the dorsal surface

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30
Q

What are 3 causes of hyposadius and episadius?

A

Exposure to PG hormone
Finesteride and lack of T in utero
Inherited

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31
Q

What are hyposadius and episadius often associated with? (2)

A

Inguinal hernias

Cryptorchorchidism

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32
Q

Priapism - what is it?

A

Non-erotic sustained painful erection with acute onset.

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33
Q

Priapism - why?

A

Glans remains soft because involves the corpora cavernous a but not spongiosum

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34
Q

What is the cause of priapism? (2)

A

Unknown
Possible associated with leukemia, mets, local trauma, sickle cell disease, SC trauma, circulatory disturbances, medications (viagra, levitra)

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35
Q

Treatment for priapism (2)

A

Spontaneously resolves in few hours, ice water, enema

Pharmaceutical intervention, drainage is rare cases

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36
Q

Peyronie’s

A

Plaques/strands of dense fibrous tissue surrounding corpus cavernosum
This leads to deformity and painful erection; impotence

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37
Q

Signs and symptoms of peyronie’s (4)

A

Hardened tissue
Pain during erection
Curvature with erection
Distortion (indentation, shortening)

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38
Q

Indicdence of peyronie’s and common age group

A

1-3% of men

MC in 45-60 years old

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39
Q

Etiology/risk factors of peyronie’s (5)

A 
Unknown
Trauma (surgery, injury)
Inherited HLA-B7 (SLE, scleroderma)
30% of patients develop fibrotic tissue in other area of body (Dupuytrens contracture)
Diabetics
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40
Q

How to diagnose peyronie’s

A

Exam and vasoactive injection to cause erection

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41
Q

Treatment for Peyronie’s (3)

A

Watch and wait 1-2 years, often resolves
Non-surgical treatment within 6 months of diagnosing (Calcium channel blockers, collagenase, cortisone)
Surgery in severe/persistent cases. Can cause partial loss of erectile function, penis length, urethral damage, infection, sensation

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42
Q

Symptoms of penile cancer (3)

A

Penile growths or sores
Abnormal penile discharge
Bleeding

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43
Q

Where is the most common site for penile cancer (2)

A

Glans and foreskin

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44
Q

Risk factors for penile cancer (4)

A

NON CIRCUMCISED DIRTY MEN
HPV infection (only certain strains, low risk factor)
Smoking
Mostly >50 years old

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45
Q

Stats for chance of penile cancer circumcised vs. uncircumcised

A

1/600 uncircumcised

Circumcised 1/1500

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46
Q

Penile cancer treament (3)

A

Surgery (excision, laser, circumcision, partial to complete penectomy, nodal dissection)
Radiation
Chemotherapy (topical, oral/IV)

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47
Q

Scrotal masses/disease (6)

A 
Hydrocele
Variococele
Inguinal hernia
Epididymitis
Orchitis
Testicular cancer
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48
Q

Characteristics of scrotal masses (4)

A

Painless or painful lump or swelling
Solid or cystic, on or around testicles
Can develop at any age
Malignant OR benign

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49
Q

How would one evaluate a scrotal mass?

A

ULTRASOUND!

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50
Q

What is the MC reason for visit/referral to a urologist?

A

SCROTAL MASSES

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51
Q

How do most men discover scrotal masses?

A

By touching themselves.

I mean, by performing their own scrotal exam

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52
Q

Causes of scrotal masses (5)

A 
Cysts
Infection
Inflammation
Hernia
Tumors (benign or malignant)
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53
Q

Where are malignant tumors of the scrotum?

A

MC within the testicles

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54
Q

What IS crytorchidism? (2)

A 
Undescended testes
Abdominal testicle
Pubo-scrotal testicle
Femoral testicle
Perineal testicle
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55
Q

Preterm infants have 30% risk of what?

A

Cryptorchidism

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56
Q

What is cryptorchidism associated with? (3)

A

Risk of testicular cancer
Infertility
Torsion

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57
Q

An individual with testicular torsion will present with what? (3)

A

Sudden severe pain, swelling, erythema
Lower abdominal pain, N/V
Worse with lifting the testicle (ddx epididymitis)

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58
Q

How would you ddx testicular torsion from epididymitis?

A

Pain is worse with listening the testicle

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59
Q

Testicular torsion affects how many males before what age?

A

1/160 males before 25 years old

MC 10-16 years of age

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60
Q

T/F: testicular torsion is a medical emergency

A

TRUE.
Surgery within 6-8 hours may prevent atrophy; 80% good prognosis.
Preservation is doubtful after 2 hours

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61
Q

What is advised if surgery is delayed for testicular torsion beyond 48 hours?

A

Orchiectomy.

Take dem balls out

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62
Q

Hydrocele - what is it?

A

Collection of fluid in sheath (tunica) that holds the testicle

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63
Q

Cause of hydrocele?

A

Excess fluid production or decreased fluid absorption

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64
Q

Signs and symptoms of hydrocele (5)

A 
Painless
Swollen
Soft
Uni or bilateral mass
WILL TRANSILLUINATE (ddx variocele)
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65
Q

What is on your ddx for a painless, swollen, soft unilateral or bilateral mass that will transilluminate? (1)

A

Hydrocele (varicoceles do not transilluniate)

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66
Q

These occur most often in older men

A

Hydrocele

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67
Q

Hydrocele etiology (4)

A

Trauma
Radiation therapy
Inflammation
Congenital

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68
Q

Bag of worms

A

Varicocele

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69
Q

Varicocele. What is it?

A

Blood backs up in the veins leading form the testicles due to valve dysfunction.
BENIGN PAINLESS SCROTAL SWELLING

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70
Q

Benign painless scrotal swelling

A

Varicocele

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71
Q

Varicoceles are most common on what side of the body?

A

LEFT SIDE

  • left spermatic vein empties into left renal vein
  • Right spermatic vein empties into inferior vena cava
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72
Q

Signs and symptoms of varicocele

A 
May feel heavy
Better with lying down
Achy
Testicular atrophy
Infertility 
Visibly enlarged vein
WILL NOT TRANSILLUMINATE (ddx from hydrocele)
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73
Q

What scrotal mass will transilluminate?

A

Hydrocele

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74
Q

Varicocele incidence, MC age group and what percent of infertile men?

A

10-20%
15-25 years
40% of infertile men (d/t increased testicular temperature)

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75
Q

Risks for varicocele (3)

A

Pelvic floor stress (constipation, heavy lifting)
Vascular damage
Hereditary tumor

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76
Q

Diagnostic evaluation of varicocele (2)

A

Ultrasound

Venogram (dye/xray)

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77
Q

Treatment for varicocele (4)

A

Scrotal support (tighter underwear)
Surgical ligation (Varicocelectomy)
Embolizastion
Laparoscopy

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78
Q

Recurrence rate and what percent develops a hydrocele?

A

5-20% reoccur

2-5% develop a hydrocele

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79
Q

Inguinal hernia

A

Protrusion of abdominal contents (usually small bowel) through weak point of abdominal wall
- usually where vas deferens passes

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80
Q

Signs and symptoms of inguinal hernia (2)

A

Bulge in the groin area that may extend into the scrotum

Painful or uncomfortable

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81
Q

Treatment for inguinal hernia

A

Surgical repair

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82
Q

Which inguinal hernia is more common? Direct/indirect

A

Indirect!

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83
Q

Epididymitis

A

Infection in tubular coil (epididymis)

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84
Q

What does epididymis do?

A

Collects sperm from testes

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85
Q

Where is pain felt with epididymitis?

A

Pain in top and rear of scrotum

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86
Q

What is epididymitis often a complication of? (4)

A

Gonorrhea/chlamydia

Enterobacteriaceae or pseudomonas (w/ prostatitis)o

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87
Q

Signs and symptoms of epididymitis (2)

A

Pain is generally severe and insidious

Fever and swelling are common

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88
Q

Treatment for epididymitis (2)

A

Antibiotics

STI screen

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89
Q

Orchitis - what is it?

A

Inflammation of testis

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90
Q

What is orchitis d/t ? (2)

A

Bacterial infection
Mumps virus
- 20-35% mump cases will progress to orchitis

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91
Q

What is irreversibly damaged in 30% of mumps cases?

A

Spermatogenesis

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92
Q

Orchitis may be concurrent with what two conditions?

A

Prostatitis or epididymitis

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93
Q

What are three signs and symptoms of orchitis?

A

Pain
Swelling
Heaviness

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94
Q

Orchitis can cause permanent damage to testicles resulting in what 3 things?

A

Diminished size
Inadequate hormone production
Infertility

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95
Q

Scrotal mass differential diagnosis (6)

A 
Epididymitis
Hydrocele
Variococele
Hernia
Orchitis
Cancer!
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96
Q

This cancer is highly treatable (95%)when detected and treated early

A

Testicular cancer

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97
Q

This is the MC cancer in men 15-34 years old

A

Testicular cancer

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98
Q

Testicular cancer risk factors (6)

A 
Cryptorchidism
Genetic
Caucasian increased incidence 4-5 x
Family history (2%)
HIV
No icnreased risk with injury or vasectomy
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99
Q

What aspects of cryptorchidism increases your risk of testicular cancer ? (2)

A

Treatment of cryptorchidism

3-17 x higher risk if cryptorchidism is left untreated

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100
Q

What two genetic conditions increase your risk of testicular cancer

A

Klinefelter’s syndrome (congenital XXY)

Chromosome 12 abnormality

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101
Q

Symptoms of testicular cancer (7)

A
  1. No symptoms
  2. Unilateral enlargement or change in way it feels
  3. Painless lump or swelling or collection of fluid (thus self screen every month!)
  4. Dull ache in back, groin or lower abdomen!
  5. Gynecomastia &/or mastalgia
  6. Testicular discomfort/pain or feeling of heaviness
  7. Occasionally, initial symptoms are related to mets of lungs, abdomen, pelvis or brain
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102
Q

Secondary testicular cancer (3)

A

Cancer metastasizes from primary cancer (ie. Hodgkins)
Testicular lymphoma = MC than testicular cancer in men
Others: prostate, lung, skin

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103
Q

Staging and 5 year survival rates in patients with testicular cancer

A

1 (just in testicle) - 98%
2 (mets to nodes) - 97%
3 (mets above diaphragm or to viscera) - 72%

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104
Q

How would one diagnose testicular cancer from the physical exam? (3)

A

Firm, non-tender testicular mass that DOESN’T TRANSILLUMINATE
Fluid collection
Regional LAD

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105
Q

Imaging for testicular cancer

4

A
  1. US
  2. CXR
  3. Abdominal CT
  4. Biopsy if other tests inconclusive
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106
Q

Blood tests for testicular cancer (DIAGNOSIS)

A

AFP, beta HCG, LDH
- these can also be used to monitor response to treatment
NO SCREENING TESTS

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107
Q

Treatment for testicular cancer (6)

A

Radical inguinal orchiectomy
Retroperitoneal lymph node dissection with metastatic disease
Testicular prosthesis available
Sperm bank before treatment
Radiation ~ adjunct treatment to orchiectomy
Chemotherapy

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108
Q

Prostate disorders (4)

A

Prostatitis
Prostadynia
Benign prostate hyperplasia (BPH)
Prostate cancer

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109
Q

Prostatitis types (2)

A

Acute

Chronic (Bacterial and non-bacterial)

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110
Q

Prostate related complaints (3)

A

Pain, discomfort, urinary and sexual problems
2nd leading cause of urinary tract problems
Prostate is common cause of visits to PCP and urologists

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111
Q

Definition of prostatitis

A

Inflammation of the prostate

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112
Q

T/F Prostatitis is contagious and considered an STI

A

False: not contagious; not STI unless due to NG/Ct

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113
Q

Symptoms of prostatitis (7)

A

Very symptomatic (Acute) to asymptomatic (chronic)
Tender/swollen prostate
Fever, chills (in acute)
Dysuria, nocturnal, urgency, hesitancy, frequency, hematuria
Pelvic/abdominal pain
LBP, joint/muscle pain
Painful ejactulation

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114
Q

Risk factors for prostatitis (7)

A 
Catheterization
Unprotected vaginal and/or rectal intercourse (GC, CT)
Abnormal urinary tract
Recent cystitis
Enlarged prostate (BPH)
Diabetes
Immunocompromised
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115
Q

Acute bacterial prostatitis symptoms (7)

A

Sudden onset, chills, fever, LBP, body aches, dysuria/frequency/urgency/nocturnal, perineal pain

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116
Q

Cause of acute bacterial prostate ‘tis (2)

A

Overgrowth of bacterial normally found in prostatic fluid (ie escherichia coli which also causes most UTI’s)
STI

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117
Q

Treatment of acute bacterial prostatitis (2)

A

ER referral

Treat with antibiotics

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118
Q

PE for acute bacterial prostatitis (2)

A

Tender, swollen, infuriated prostate

Purulent prostatic secretions, if obtained

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119
Q

What often accompanies acute bacterial prostatitis?

A

Bacteriuria

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120
Q

Chronic prostatitis two groups

A 
Chronic bacterial (infectious) prostatitis
Chronic non-bacterial prostatitis
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121
Q

Symptoms of chronic prostatitis (6)

A 
Suprapubic pain
LBP
Dysuria
Nocturnal
Intermittent
Waxing/waning
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122
Q

Chronic bacterial (infectious) prostatitis often follows

A

Episodes of acute prostatitis

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123
Q

Signs and symptoms of chronic bacterial (infectious) prostatitis

A

Insidious onset
Often associated with recurrent UTI’s
Symptoms less severe/intermittent vs. acute prostatitis (thus no fever, although they may come and go)

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124
Q

Causes of chronic bacterial (infectious) prostatitis (2)

A

Chlamydia trachomatis

Ureaplasma urealyticum

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125
Q

T/F longstanding prostatitis maybe associated with underlying prostate defect which harbors presistent bacteria (BPH, anatomical variant)

A

True

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126
Q

Chronic NON bacterial prostatic

A

MOST GENERAL AND MC = still waxes and wanes but no apparent cause
Symptoms similar to CBP WITHOUT FEVER AND BACTERIAL INFECTION

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127
Q

Pathogenesis of chronic bacterial prosatatis

A

Usually unknown: WBC in urine/prostatic secretions without identifiable causative agent

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128
Q

Theories for chronic non-bacterial prostatitis (5)

A

Infectious agents undetected by standard lab tests
Heavy lifting causing urine retention
Physical activity may irritate/inflame prostate
Pelvic muscle spasm may lead to increased prostate pressure
Structural abnormalities; urethral narrowing = pressure

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129
Q

Diagnosis of chronic non-bacterial prostatitis

A

DIAGNOSIS OF EXCLUSION

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130
Q

Diagnosing prostatits - Lab (5)

A

Prostate stripping (massage) and culture discharge (expressed prostatic secretion (EPS0
WBCs in EPS is not diagnostic of bacterial prostatitis; also associated with nonbacterial prostatitis, urethritis, prostatic stones, recent ejaculation
PH of prostatic fluid rises when infection is present, 6.5 > 8.0
Pre/post massage collection of urine for culture
PSA levels often elevated (collect pre-DRE) - repeat testing 6 weeks after resolution of prostate tissue

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131
Q

DRE in prostatitis (6)

A

Size, symmetry, consistency, lumps/nodules, discomfort/pain

May palpate prostatic stones (stones may cause recurrent infections)

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132
Q

Classic presentation of prostatitis

A

Symptomatic patient
Enlarged, soft/boggy gland
Moderately-to-severely tender on palpation

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133
Q

Acute prostatitis lab work

A

WBCs and bacteria in urine/prostate fluid with acute onset and systemic symptoms

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134
Q

Chronic bacterial lab work

A

WBCs and bacteria in urine/prostate fluid with insidious onset

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135
Q

Chronic non-bacterial lab work

A

May see WBC in urine or prostate fluid

No evidence of infection

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136
Q

Treatment of acute prostatitis

A

Antibiotics 7-10 days, repeat if symptoms do not resolve

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137
Q

Treatment of chronic prostatitis (3)

A

Antibiotics 4-12 weeks 60% will clear up
NSAIDS to palliative symptoms
Sits bath may provide symptomatic improvement

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138
Q

Treatment of non-infectious prostatitis (2)

A

Reduce inflammation: NSAIDs, natural COX2 inhibitors

Relax tissue, decrease congestion

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139
Q

If recurrent prostatitis,what should you look for?

A

Underlying causes:

Diabetes, encourage safe sex, test/treat STI

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140
Q

Prosatdynia - what is it?

A

symptoms of prostatitis-like pain occur in 11% of american men (without known cuasE)

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141
Q

T/F: Approxiamtely 95% of men diagnosed as chronic prostatitis have no evidence of bacterial infection or inflammatory cells in the prostatic fluid.

A

True

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142
Q

Prostadynia AKA

A

Chronic pelvic pain syndrome (cpps0

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143
Q

Symptoms of prostadynia (3)

A

Prostatits symptoms without inflammation or bacterial infection
Pain in pelvis or perineum, can extend to penis, testes, rectum
May cause voiding or sexual dysfunction

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144
Q

Cause of prostadynia:

A

Unknown; pain may be due to muscle spasms or MSK conditions, like nerve entrapment

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145
Q

What may be helpful in decreasing symptoms and is routinely prescribed?

A

Finesteride (for BPH)

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146
Q

Pudendal nerve entrapment causes (3)

A

Impact trauma
Surgery
Congenital malformations

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147
Q

Symptoms of pudendal nerve entrapment (4)

A

Pain in penis, scrotum, perineum or anorectal area
Prostatitis like pain and voiding/sexual dysfunction = hallmark of PNE
Aggravated by sitting, relieved by standing, lying
PNE is a clinical diagnosis

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148
Q

What is aggravated by sitting, relieved by standing/lying?

A

Pudendal nerve entrapment

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149
Q

What is the hallmark symptom of pudendal nerve entrapment?

A

Prostatitis like pain and voiding/sexual dysfunction

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150
Q

Diagnosis and treatment of PNE (7)

A 
Imaging = no good
R/O causes of prostatitis (Urology referral)
DC (Evaluation and management)
Acupuncture
PT
Meds/supplements
Decompression surgery
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151
Q

Mechanism of PNE (4)

A

At ischial spine b/w sacrotuberous and sacrospinous ligaments
Nerve may be ensheathed by ligamentous expansions that form a perineural compartment
At pudendal canal, nerve can be compressed by falciform process of sacrotuberous ligament
If thickened, duplication of obturator fascia may act as an entrapment site

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152
Q

Benign prostate hyperplasia (BPH): malignant potential?

A

No - it’s benign, not precancerous!

153
Q

Incidence of BPH

A

25% by 40
50% by 60
75% by 70
90% over 80

154
Q

Increased incidence of BPH in what population?

A

African americans

155
Q

Etiology of BPH (4)

A

Unknown
AGE
Hormones (low testosterone, high estrogen; increased sensitivity to DHT in prostate)
Hyperplasia nearly always occurs in transitional zone (around prostatic urethra and extends peripherally. This is easy to feel!)

156
Q

What percentage of patients have symptoms with BPH?

A

20%

157
Q

What are some symptoms of BPH (5) and why?

A

Partial obstruction of lower urinary tract

  • difficulty initiating urine stream (hesitancy)
  • Interruption of stream
  • increased frequency
  • increased urgency
  • Nocturia
158
Q

What is found in the rectal exam with BPH? Vs. cancer? Vs. prostatitis?

A 
BPH = Non-tender, soft, boggy
Cancer = rock-hard
Prostatitis = painful
159
Q

Natural history of BPH

A

If untreated, it will progress!

160
Q

Complications of BPH (4)

A

Decreased QOL, ADL’s
Residual urine increases risk of UTI and acute urinary retention: rare but ER referral
Complete obstruction = surgery
DOES NOT, by definition increase risk of developing prostate carcinoma

161
Q

How to diagnose BPH through history and physical

A

DRE

AUA symptom index questionnaire

162
Q

How to diagnose BPH through Labs?

A

PSA elevated !

163
Q

PSA will be elevated in what conditions (4)

A

BPH
Prostate cancer
Recent ejaculation/DRE(~2 days)
Prostatitis

164
Q

T/F: Anything that stimulates, bothers or runs through prostate will cause PSA to increase.

A

True

165
Q

Digital rectal exam (DRE) - what is it used for?

A

Screening exam for colorectal cancer and prostate cancer

166
Q

What do you do in a DRE? (4)

A

Palpate prostate. Normal = rubbery, walnut size 4cm, symmetricaland absent of any nodules or polyps
Evaluate rectal wall on your way out
Start at age 50 (Earlier with symptoms or risk factors)
Rectum: smooth without abnormalities or unusual lumps, swelling or tenderness

167
Q

PSA is produced by

A

Cells of prostate capsule and periurethral glands.

Increases w/ age, although normals vary with age (thus look at PSA velocity!)

168
Q

What are normal levels of PSA?

A

0-4.0ng/mL

169
Q

When do you refer patients for transracial ultrasound (TRUS) (5)

A

PSA 4-10ng/mL with abnormal DRE
PSA >10ng/mL, regardless of DRE
Consider PSA velocity
Palpable nodule on DRE, regardless of PSA
Patients with UTI, prostate THIS, recent biopsy should have PSA test deferred to avoid potentially unnecessary biopsy

170
Q

Finasteride (proscar) inhibits peripheral conversion of testosterone to DHT, blocking growth effects of DHT. What is this associated with lower risk of?

A

Acute urinary retention and need for surgery
Note: finasteride is a 5-alpha reductase inhibitor
Other meds include alpha blockers which relax smooth muscle but don’t decrease prostate size

171
Q

What is TURP (Transurethral resection of the prostate)

A

Core out middle part of prostate to open lumen

172
Q

What are other options other than TURP?

A

Laser/thermoablation

Prostatectomy

173
Q

Complementary care for BPH

A

Reduce hyperplasia by inhibiting conversion of T to DHT
Prevent estrogen from binding to estrogen receptors
SAW palmetto!

174
Q

What are the benefits of SAW palmetto?

A

May improve urine flow and decrease symptoms while avoiding negative SE of conventional tx
DOESN’T AFFECT PSA LIKE MEDICATIONS (EXAM Q)

175
Q

Which CAM produce doesn’t affect PSA like medications?

A

Saw Palmetto

176
Q

Side effects of saw palmetto? (3)

A

HA
Nausea
Dizziness

177
Q

Other supplements and botanicals for BPH (4) for mild/moderate symptoms

A 
Amino acids
Beta-sitosterol
Zinc picolinate
Pygeum
Nettles (urticaria diocia)
178
Q

Male sexual dysfunction is 50% greater in what age group?

A

Men over 40

179
Q

What do you see with male sexual dysfunction? (3) which is most common?

A 
Decreased libido
Ejaculatory disturbances
Erectile dysfunction (MC)
180
Q

Physical causes of male sexual dysfunction

4

A

Drugs
Blood flow abnormalities
Nerve abnormalities
Hormonal abnormalities (andropause, testosterone levels declining between 40-70 years old; SHBG increases as well)

181
Q

Psychological causes (4)

A

Depression
Stress
Performance anxiety
Misinformation about sexuality

182
Q

Androgen decline in aging men (ADAM) symptoms (5)

A 
Mood dysfunction
Sexual dysfunction (libido loss, erectile dysfunction)
Osteoporosis
Muscle atrophy
Cognitive changes
183
Q

Lab testing for ADAM (2)

A

Free and total testosterone (diurnal variation)

LH, PRL

184
Q

Other factors that may compound testosterone deficiency in ADAM? (5)

A 
Stress: physical and psychological
Obesity
Diabetes, IR
Pituitary tumors
Drugs (cimetidine, digoxin spirnolactone)
185
Q

What must you rule out with ADAM? (4)

A

Hypothyroid
Depression
Anemia
Prolactinoma

186
Q

Which cancer is MC type of cancer in Men in US and the second leading cause of cancer death in men

A

PROSTATE CANCER!

187
Q

1/6 men will get which cancer?

A

Prostate! Damn !

188
Q

Etiology of prostate cancer

A

Unknown cause

Genetic, hormonal, environmental factors may play a role

189
Q

Carcinoma growth can be inhibited by (2)

A

Orchiectomy or use of estrogen therapy

Decrease/eliminate testosterone which feeds prostate cancer cell growth

190
Q

Risk factors for prostate cancer (6)

A
  1. Age >50
    African american (testing should begin at 40 years old) (AA>caucasian>asian)
    Family history (Testing should begin at 40 years old)
    High fat diet, sedentary lifestyle and obesity
    Vasectomy
    SMOKING
191
Q

How to decrease the risk of prostate cancer? (4)

A

Annual DRE & PSA (50 w/out risk factors; 40 with)
Educate patients (finesteride reduces prevalence)
Diet (soy, vitamin E, selenium, fruits, lycopene)
Lifestyle (smoking, obesity, sedentary, ejaculation 4x’s/week)

192
Q

Majority of prostate carcinomas arise in

A

Peripheral tissues thus they’re palpable (they feel like a pebble)

193
Q

T/F: Prostate cancer is less likely to cause urinary obstruction

A

TRUE! Because it’s peripheral, not central circa urethra (BPH)

194
Q

Prostate cancer METS go where? (5)

A

Regional lymph nodes, seminal vesicles, spine, rectum bladder are most common

195
Q

Prostate carcinoma clinicals are

A 
Often silent (no inflammatory processes)
Peripheral not central so do not cause obstruction
196
Q

15-20% prostate carcinoma are discovered in what?

A

TURP’s (Transurethral resection of prostate)

197
Q

When are TURP’s performed?

A

BPH, not for cancer!

198
Q

Signs and symptoms of prostate cancer (3)

A

Blood in urine or semen
Pain/stiffness in back, hips, upper thigh or pelvis
Often if patient also has BPH (nocturnal, inability to urinate, painful ejaculation, pain or burning during urination, weak or interrupted urinary flow)

199
Q

T/F: BPH causes cancer

A

FALSE!

BPH does NOT cause cancer, but CAN coexist!

200
Q

Diagnosis for prostate cancer (6)

A

DRE
PSA
TRUS (transrectal ultrasound) & biopsy (Diagnosis)
PAP - prostatic acid phosphatase (increases as disease progresses)
Gleason scoring: based in size and path
CT scan, bone scan: check for mets

201
Q

PSA is produced by (2)

A

Both normal and neoplasticism cells

202
Q

PSA is elevated in

A

BPH
PROSTATITIS
Adenocarcinoma of prostate

203
Q

Elevated PSA values take on much more significance when combined with (4)

A

DRE
Repeated PSA = velocity
TRUS
Needle biopsy

204
Q

Serial follow up of PSA in patients with prostate cancer is useful to monitor (2)

A

Recurrence

Progression

205
Q

PSA increases accuracy of what in staging? (2)

A

DRE and TRUS

206
Q

Following radical surgery or radiotherapy PSA levels should be normal after how many months?

A

18 months

207
Q

Rising PSA level may indicate what?

A

Residual/recurrent disease and should be investigated

208
Q

Gleason score

A

2 tissue samples taken from different areas of tumor. Sum of two produces gleason score:
2-4 = well differentiated
>6 = potentially indolent
5-7 = moderately differentiated
8-10 = poorly differentiated
> 10 = aggressive tumor likely requires aggressive treatment

209
Q

Stages of prostate cancer

A

Stage one in one area of prostate
Stage two bigger and in two areas of prostate
Stage three in multiple areas extended passed areas of prostate
Stage four spread to lymph nodes

210
Q

Low risk (3)

A

PSA <10
Gleason <6
Stage T1c, T2a

211
Q

Intermediate risk (3)

A

PSA 10-20
Gleason 7
Stage T2b

212
Q

High risk (3)

A

PSA>20
Gleason 8-10
stage T2c

213
Q

T/F: when cancer is confined to prostate, disease is often curable

A

True:

85-90% 10 year survival in patients with limited disease

214
Q

When there is metastitis, life expectancy is often less than how many years?

A

3 years

10-15% 10 year survival in patients with disseminated disease

215
Q

Medical treatment for prostate cancer

A 
Determined by stage, age, overall health
Watchful waiting (elderly, poor health, early stage)
Hormone therapy (antiandrogens, viaduct
216
Q

What are side effects of hormone therapy for prostate cancer? (8)

A 
Depression
Gynecomastia
HA
He matures
Hot flashes
Decreased energy
Urethral or bladder outlet obstruction
Local reaction
217
Q

Treatment for bone metastasis (2)

A

Bone mets = hypercalcemia, fractures

Bisphosphonates (fosamax) increases bone density and slows loss

218
Q

What therapy is used for smaller tumors?

A

Brachytherapy - radioactive capsule implants “Seeds”

219
Q

Which radiation therapy is most optimal when disease has spread to surrounding tissues?

A

External radiation treatment (XRT)

220
Q

What surgical options are available for treatment of prostate cancer

A

Cryosurgery
Radical prostatectomy (prostate, seminal vesicles, pelvic lymphnodes)
Laparoscopic radical prostatectomy

221
Q

What type of diet increases risk for prostate cancer

A

High fat diet

Omega 6 FA stims prorstate cancer cell growth

222
Q

What other dietary supplements or modifications are beneficial for prostate cancer? (5)

A 
Soy decreases growth of prostate cancer cells (mice)
Vitamin E
Vitamin A (deficiency = risk factor)
Vitamin D (deficiency = risk factor)
Selenium = protective effect
223
Q

Animal fat increases levels of what (2)

A

Circulating Testosterone and estrogen

224
Q

What inhibits prostate cancer in vitro?

A

Soy foods (isoflavanoids)

225
Q

Examples of lycopene

A

Fruits and vegetables :

Tomatoes, pink grapefruit, watermelon

226
Q

Vitamin E decreased incidence of prostate cancer in what demographic?

A

SMOKERS!

227
Q

Which vitamin in vitro inhibited prostate cancer cells from spreading?

A

Vitamin C

228
Q

Function of kidney

A

Waste removal!!!

- filtering occurs in nephrons. Na+, phosphorous and K+ are removed and reabsorbed into blood

229
Q

Kidneys produce what 3 important hormones

A

EPO (stimulates bone marrow to make RBCs
Renin (regulates blood pressure)
Calcitriol (active form of vitamin D to regulate calcium)

230
Q

Renal function lower than 25% =

A

Serious health problems

231
Q

Renal function <10-15% requires

A

Form of renal replacement therapy

  • dialysis
  • transplant
232
Q

2 MC causes of kidney disease

A

Diabetes (increased blood glucose can’t be metabolized/excreted, damages nephrons)
HTN (Damages renal microvasculature which then can’t filter wastes from blood)

233
Q

National heart, lung and blood institute (NHLBI) recommends what BP for diabetes or reduced kidney function

A

130/80mmHg

234
Q

Other causes of kidney disease (6)

A

Glomerular disease
Autoimmune disease (IgA nephropathy - excess; SLE)
Infection (post-strep, HIV, HAV/HVC, bacterial endocarditis leading to CKD)
Sclerotic diseases (SLE, DM, focal glomerulosclerosis
Other: membranous neuropathy
Inherited and congenital kidney diseases (PKD)
Poisons/trauma (OTC: aspirin, acetaminophen and ibuprofen = MOST dangerous to kidneys!)

235
Q

Signs and symptoms of kidney disease (6)

A 
Proteinuria
He matures
Peripheral edema
Hypoproteinemia and anemia
Decreased GFR
HTN
236
Q

Diagnosis of kidney disease (3)

A

ID causative systemic disease
US
Biopsy

237
Q

3 MC UT disorders

A
  1. CYstitis
  2. Prostate
  3. Nephrolithiasis
238
Q

Constant suprapubic/lower abdominal pain, flank pain, pressure =

A

Infection

239
Q

Intermittent suprapubic/lower abdominal pain, flank pain, pressure =

A

Obstruction

240
Q

Systemic symptoms indicative of infection (4)

A

Chills
Fever
N/V
He matures

241
Q

Increased urinary output could indicate (3)

A

DM or DI
Excess fluids
Diuretics

242
Q

Decreased functional capacity (4)

A 
Outlet obstruction (BPH)
Neurogenic causes
Extrinsic compression (tumor, fibroids, pregnancy)
Psychological factors (anxiety)
243
Q

Obstructive voiding symptoms (4)

A

Hesitancy
Decreased stream force
Intermittency
Post - void dribbling

244
Q

Ddx for obstructive voiding symptoms (5)

A 
BPH
Urethral stricture (narrowing)
Stone
Neurogenic bladder
Carcinoma
245
Q

PE and lab tests for obstructive voiding symptoms

A 
BP
UA
Urine C &amp; S
CBC
CMP (comp metabolic panel)
246
Q

What is occasional the first finding in UA associated with kidney disease?

A

Low specific gravity

247
Q

Positive leukocyte esterase test suggests

A

Pyuria = UTI

Main cause of false positive = vaginal contamination (not a good clean catch!)

248
Q

Gram-negative bacteria reduces nitrates to what?

A

Nitrites, indicating UTI

249
Q

If bilirubin in UA =

A

Hepatitis

Biliary tract obstruction

250
Q

Urobilinogen if positive indicates what? (4)

A

Liver disease:

  • cirrhosis
  • hepatitis
  • liver mets
  • liver infarction
251
Q

Proteinuria is a clinical marker for

A

Underlying renal disease
Kidneys fail to separate protein (albumin) form waste!
Protein/albumin:creatinine ratio more sensitive test for this!

252
Q

If first test is postitive with proteinuria, do what?

A

Repeat 1-2 weeks later (rules out hard workout)

253
Q

If second test confirms proteinuria, do what?

A

Refer or order more tests to eval kidney function (24-h urine, CMP (BUN, creatinine, albumin)

254
Q

Severe proteinuria> 3.5 in 24 hours =

A

Glomerulonephritis

Can be idiopathic in young adults and children

255
Q

Renal causes of proteinuria as a symptom (6)

A 
UTI
Nephrolithiasis
Acute kidney failure
Glomerulonephritis
Nephrotic syndrome
Renal mets
256
Q

Functional causes of proteinuria (2)

A

Fever

Exercise

257
Q

Systemic causes for proteinuria (8)

A 
SLE
Preeclampsia
Amyloidosis
Infections (EBV, typhoid)
Cardiac (HTN, CHF)
DM
Liver cirrhosis
Medications (sulfa, chemo)
258
Q

RBC’s in urine a sign of what (5)

A 
Bleeding in GU tract
Kidneys
Ureters
Prostate gland
Bladder
Urethra
--indicates diff probs in men and women
259
Q

Microscopic hematuria

A

Seen on UA or microscopic vision

May be idiopathic

260
Q

Gross hematuria

A

Visibly discolored
May contain small blood clots
Amount of blood doesn’t necessarily reflect seriousness of underlying problem
1mL of blood will turn urine red

261
Q

Pseudohematuria

A

Reddish urine not caused by blood

262
Q

Cause of pseudohematuria

A

Excessive consumption of beets, berries or rhubarb
Food coloring
Certain laxatives and pain meds

263
Q

What do you have to rule out with hematuria first and foremost?

A

CANCER

264
Q

Hematuria at onset of urination (initial hematuria)

A

Urethra or prostate

265
Q

Hematuria throughout urination (total hematuria) (3)

A

Bladder, ureter or kidneys

266
Q

Hematuria at end of urination (terminal hematuria)

A

Bladder or prostate

267
Q

Hematuria + abdominal pain

A

Inflammation of kidney/ureter by trauma, infection or tumor

268
Q

Hematuria with decreased urinary force, hesitance or incomplete voiding

A

Lower urinary tract, BPH, tumor

269
Q

Hematuria with fever

A

Infection, typically of kidney or ureter

270
Q

Hematuria with pain in flank

A

Kidney infection
Trauma
Tumor

271
Q

Hematuria with urinary urgency, pain or frequency

A

Bladder infection

Cancer

272
Q

Progress of diagnostic imaging for hematuria

A

+ dip -> microscopic -> cystoscopy -> IVP -> CT/US

*IVP = intravenous pyelogram, gives a good view of whole system

273
Q

CAUSES OF HEMATURIA

A 
SITT
Stone
Infection
Trauma
Tumor
274
Q

Rare diseases and genetic disorders that cause hematuria (3)

A

Sickle cell anemia
SLE (chronic inflammatory disorder of CT)
Von Hippel-Landau disease (benign tumors all over)

275
Q

+ RBC casts
+ proteinuria
Indicates

A

RENAL DISEASE

276
Q

Epithelial cell casts

A

Acute tubular necrosis
Interstitial nephritis
Eclampsia

277
Q

RBC casts

A

Glomerulonephritis (may be normal in collision sports)

278
Q

WBC casts

A

Pyelonphritis
Glomerulonephritis
Interstitial nephritis

279
Q

Hyaline/mucoprotein casts

A

Normal finding
Chronic renal disease
Glomerulonephritis

280
Q

Granular casts

A

Severe renal disease

281
Q

Waxy casts

A

Severe renal disease

282
Q

Fatty casts

A

Nephrotic syndrome

Hypothyroidism

283
Q

Serum urea nitrogen and creatinine

A

Not sensitive indicators of early renal disease
Associated with 50% functional loss before levels increase
Once elevated = sensitive markers for disease progression

284
Q

BUN

A

Blood carries protein to cells -> cells use protein -> urea = waste products returned to blood (Contains nitrogen)
Urea eliminated in urine; stays in blood in kidney disease

285
Q

Other possible causes of elevated BUN (5)

A 
Dehydration
Heart failure
GI hemorrhage
Large protein meal
Ketoacidosis (DM)
286
Q

Elevated creatinine clearance (2)

A

Ketoacidosis

Drugs

287
Q

Reduced creatinine clearance (8)

A 
Advanced age
Cachexia
Liver disease
Shock
Nephrotoxicity
Acute/chronic GN
HTN nephorslcerosis
Polycystic kidneys
288
Q

GFR based on creatinine clearance

A

GFR: calculation of how efficiently kidneys filter wastes from blood
Creatinine = waste product in blood created by normal breakdown of muscle during activity
Normally removed by urine but in kidney disease, creatinine builds up in blood

289
Q

IVP = x-ray of what 3 structures

A

Kidneys, ureter, bladder to detect stones, visualize enlarged prostate, tumors in kidney, ureters or urinary bladder

290
Q

What is best indicator of kidney function?

A

GFR

291
Q

What increases risk of CKD? (5)

A 
DM
HTN
family history of CKD
>65 years old
African americans
292
Q

Stages of chronic kidney disease

A

1: kidney damage with normal GFR (90+)
2. Kidney damage w/ mild decrease in GFR (60-89)
3. Moderate decrease in GFR (30-59). CKD at this stage = anemia and bone problems
4. Severe reduction in GFR (15-29) dialysis or transplant!
5. Kidney failure (GFR <15): dialysis or transplant!

293
Q

Symptoms of CKD (8)

A 
Fatigue
Poor concentration
Poor appetite
Insomnia
Nocturnal muscle cramping
Peripheral and periocular edema
Dry, itchy skin
Increased frequency, nocturia
294
Q

Lifestyle/diet considerations (5)

A 
Protein (limit)
Cholesterol (is high)
Smoking
Sodium (limit)
Potassium (increase it)
295
Q

Infection occurs where in urinary tract?

A

Anywhere
Urethra (urethritis, STI)
Bladder (cystitis)
Kidney (pyelonephritis)

296
Q

Epidemiology

A

Infants = male>female
1-65 years = females>males (males have longer urethras)
Age>65 = male = females

297
Q

Relapse vs. re-infection of UTI = what percent has recurrence/reinfection?

A

20% of treated have recurrence

80% treated have reinfection

298
Q

Acute UTI symptoms

A

Usually disappear within 24-48 hours after treatment begins

299
Q

Chronic/recurrent UTI (>2 in 6 months) (3)

A

Don’t respond to usual treatment
Last longer than 2 weeks
Do not resolve in 24-48 hours after treament

300
Q

Etiology of UTI’s

A

90-95% of UTI are secondary to E. coli

– positive nitrites on UA

301
Q

UTI risk factors (top 3)

A

Sexual activity (80% occur within 24 hours of intercourse)
Hygiene
Hormones (IUD)

302
Q

Symptoms of lower tract UTI (6)

A 
Sudden onset
Urgency, urge incontinence
All the freaking time!
Suprapubic, flank or LBP
Dysuria
Hematuria (microscopic)
303
Q

Symptoms of upper tract UTI (5)

A

Systemic symptoms! Fever, chills, N/V
Flank pain/CVA tenderness
Lethargy, myalgia
Odorous urine, macroscopic hematuria

304
Q

Diagnosis of UTI

A

UA
Dipstick: RBC, proteinuria, nitrites, leukocyte esterase
Microscopic: >19 wbc/hpf “too numerous to count” bacteria

305
Q

R/O w/ UTI (6)

A 
STI
IC
Stones
Epididymitis
Prostatitis
Vaginitis
306
Q

Imaging to diagnose UTI (6)

A 
ABD US
KUB (Frontal supine imaging of abdomen)
MRI
IVU
Cystoscope
Renogram
307
Q

UTI treatment uncomplicated

A

3 days antibiotic treatment

308
Q

Complicated UTI treatment (3)

A

Underlying abnormality or medical condition
Broad spectrum antibiotics 7-10 days; pyelo = 10 days
Must treat pregnant women, with or without symptoms!

309
Q

UTI prevention for women (4)

A

Cranberry
Hydration
D-Mannose
Lactobacillus

310
Q

UTI prevention for men with BPH (5)

A 
Urinate frequently
Saw palmetto
Cranberry
Hydration
Lactobacillus
311
Q

Pyelonephritis

A

Infection/inflammation of kidney/renal pelvis

Gram negative is MC

312
Q

Pyelonephritis is secondary

A

to ascending lower UTI.

313
Q

Pyelonephritis signs and symptoms (top 5)

A 
*similar to lower UTI*
Fever > 102F
CVA tenderness/flank pain
Chills
Tachycardia
N/V
314
Q

Ddx for pyelonephritis (8)

A 
Cystitis
Appendicitis
Cholecystitis
Pancreatitis
Diverticulitis
Epididymitis
Prostatitis
Ectopic pregnancy
PID
315
Q

Pyelonephritis treatment

A

Oral or IV abx

Renal imaging if not responding to ABX

316
Q

Complications of pyelonephritis (4)

A

Recurrence of pyelonephritis
Perinephric abscess (infection around kidney)
Sepsis
Acute renal failure (=> death!)

317
Q

Nephrolithiasis

A

Calculus in kidneys

318
Q

Ureterolithiasis

A

Calculus in ureter

Usually originate in kidneys

319
Q

Incidence of urinary stones

A

WHITE Male

320
Q

ETIOLOGY OF URINARY STONE

A

Salts can become concentrated if volume of urine is significantly reduced or if abnormal high amounts of crystal forming salts are present

321
Q

Risk factors for urinary stones (9)

A 
Pregnancy
Urinary tract abnormalities
Southern US (diet)
Specific foods (diets high in animal protein and low in fiber/fluids)
Weight
Stress
Bedridden
Medical conditions (HTN, IBD)
Medications (thyroid hormones, diuretics, antacids)
322
Q

Symptoms of urinary stones (7)

A

Sudden onset pain; acute, colicky flank pain radiating to groin; back/flank pain
Location of pain travels with stone
Localized pain w/o rebound tenderness
Dysuria, urinary urgency and increased frequency
CVA tenderness
Hematuria
Systemic symptoms (diarrhea, N/V, diaphoresis)

323
Q

T/F: size of stone does not predict severity of pain

A

True

324
Q

Diagnosis of urinary stones (3)

A

Urinalysis (85% of patients with urinary calculus exhibit hematuria)
CBC (high WBC = renal/systemic infection; low RBC = chronic dz; chronic hematuria)
Serum electrolytes, creatinine, calcium, uric acid and phosphorus
If calcium elevated, PTH levels obtained to r/o hyperparathyroidism

325
Q

Diagnosis of recurrent diagnosis stones(3)

A 
24 hour urine collection
Urine output of 2-3 L decreases risk of stone formation
PH
Calcium*
Uric acid*
Oxalate*
Phosphate
Citrate

*elevation can indicate predisposition to stone formation

326
Q

Imaging for urinary stones (3)

A

X-rays will show stone
Non-contrast spiral CT (highly sensitive and specific)
IVP = risk of increased pressure and pain and UT rupture, if stone is obstructing the tract. Can be slow

327
Q

Ddx for urinary stones MALE (5)

A 
Testicular torsion
Pyelonephritis
Acute prostate THIS
Appendicitis
Pancreatitis
328
Q

Female urinary stone ddx (6)

A 
Ovarian cyst
Ovarian torsion
Ectopic PG
Pyelonephritis
Appendicitis
Pancreatitis
329
Q

Treatment of urinary stones

A

More aggressive for patients <30
After dx renal colic = r/o obstruction and infection
If neither = analgesics (stone will pass if diameter is <5mm)
If both = ER surgery is required
Medical expuslive therapy (MET)
NSAIDS

330
Q

T/F: Analgesic therapy with MET dramatically improves stone passage, addresses pain and reduces need for surgical treatment

A

True

331
Q

Diet/supplement

A

EFA’s

332
Q

Hypercalciuria diet/supplements

A

Dandelion leaf

DON’T limit Ca intake (associated with almost 100% increase in incidence of ca-oxalate stones)

333
Q

Hyperoxaluria diet/supplements

A

Magnesium can block oxalate absorption and increase solubility of calcium oxalate
Pyridoxine (b6) = reduces oxalate production by enzyme induction
Limit oxalate intake (spinach, rhubarb, beets, tea, strawberries, chocolate, wheat, bran, nuts

334
Q

Incontinence definition

A

Involuntary loss of urine sufficient to be perceived as a problem by the patient

335
Q

Who is more likely to have incontinence = women or men?

A

Women

336
Q

Voiding requires

A

Coordination of destructor contraction with external sphincter relaxation
Many neurological disorders from CNS, spinal cord and peripheral nn. Can result in incontinence

337
Q

Stress incontinence (MC)

A

Involuntary leakage from effort, exertion or sneezing or coughing
Usually related to poor sphincter function and/or increased urethral mobility

338
Q

Urge incontinence

A

Involuntary leakage accompanied/proceeded by urgency

Usually related to destructor overactivity/instability, BPH

339
Q

Mixed incontinence

A

Features of both urge and stress incontinence

More common in women >65

340
Q

Overflow incontinence

A

Associated with overdisgtention/filling

341
Q

Risk factors for incontinence(14)

A 
Damage to pelvic floor muscles/nerves
Vaginal deliveries
Chronic increases in intra-abdominal pressure
Pelvic organ prolapse
Smoking
Pelvic/prostate surgery
Estrogen deficiency
BPHUTI
Bladder outlet obstruction
Foreign bodies
Neurological disorders (parkinson's, stroke, MS, SC injuries)
Diabetes
Medications
342
Q

Management of incontinence (7)

A 
Pelvic floor muscle evaluation and rehabilitation
Pharmaceuticals
Electric stimulation
Pessaries/urethral barriers
Behaviour also treatment/modification
Absorbent productions
Surgery
343
Q

Medications for incontienence (6)

A 
Anticholinergic agents
Antispasmodic medications (MC used for urge incontinence)
Tricyclics antidepressants
Calcium channel blockers
Beta agonist
Estrogen
344
Q

Interstitial cystitis aka

A

Painful bladder syndrome

345
Q

What is interstitial cystitis ?

A

A condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region

346
Q

Prevalence of interstitial cystitis (3)

A

Women 90%
Caucasian
40 year olds

347
Q

Interstitial cystitis symptoms (6)

A 
Mild discomfort, pressure, tenderness or intense pain in bladder/pelvic area
Urgency
Nocturnal
Frequency
Premenstrual exacerbation
Dysparuenia
348
Q

Etiology of interstitial cystitis (5)

A 
Infectious
Autoimmune
Mechanical injury
Mast cell activation
Alteration in bladder lining (decreased gag's)
349
Q

IC gender associations female (4)

A

Chronic pelvic pain
Dysparunia
Vulvodynia
Improve with pregnancy

350
Q

IC male gender association (3)

A

Chronic NB prostatitis
BPH
Prostadynia

351
Q

Must r/o what with IC/ (4)

A

UTI
Gynecological disease
Prostate disease
Bladder cancer

352
Q

Confirmation of IC (2)

A

Cystoscope with hydrodistention

Bladder biopsy

353
Q

Treatment for IC

A

Bladder distention = diagnostic test and initial therapy
Increases capacity and interfere with pain-inducing signals transmitted by nerves in the bladder.
Symptoms may temporarily worsen 24-48 hours after distention but return in 2-4 weeks

354
Q

Oral drugs for IC (9)

A 
PE tos an polysulfate sodium
Aspirin and ibuprofen
Tricyclics antidepressants
Antihistamines
Narcotic analgesic
Calcium channel blockers
 Immune suppression
Heparin
Hyaluronic acid
355
Q

What foods or drinks may contribute to bladder pain and inflammation? (7)

A 
Alcohol
Tomatoes
Spices
Chocolate
Caffeinated
Citrus beverages
Acidic foods
-- symptoms may worsen after eating or drinking products contains artificial sweeteners
356
Q

IC lifestyle changes (4)

A

Smoking = worse
Exercise = relieves
Bladder training
Diet changes = eliminate alcohol caffeine, spicy foods

357
Q

Nutrition/herbs for IC (4)

A

Support GAG’s (N-acetyl glucosamine and chondroitin)
Decrease NO as may be linked to damage (L-arginine)
Bioflavonoids linked with decreased symptoms
IC blend 3 caps tied (vitanica)

358
Q

Where does bladder cancer usually occur?

A

In bladder lining

359
Q

Stages of bladder cancer?

A 
Low stage (superficial)
High stage (muscle invasive)
360
Q

Transitional cell carcinoma

A

90% of cases originate in the transitional epithelial cells

361
Q

Schistosomiasis haematobium

A

Developing countries 75% of cases a re squamous cell carcinomas caused by this

362
Q

Rare types of bladder cancer include(4)

A

Small cell carcinoma, carcinosarcoma, primary lymphoma and sarcoma

363
Q

Primary symptom of bladder cancer

A

Hematuria

Other symptoms = frequent urination and dysuria

364
Q

Highest incidence of bladder cancer occurs where?

A

Industrialized countries

365
Q

T/f incidence of bladder cancer decreases with age

A

False

366
Q

Bladder cancer is 2-3x more common in what gender?

A

Men
4th most common type of cancer in men
8th MC in women
MC in caucasians vs. AA and hispanics

367
Q

Carcinogens in the urine may lead to the development of bladder cancer. What else? (11)

A 
Smoking (50% of cases)
Age
Chronic bladder inflammation (recurrent UTI, urinary stones)
Consumption of Aristolochia fangchi
Diet high in saturated fat
External beam radiation
Family history of bladder cancer
Gender (male)
Infection of schistosomiasis haematobium
Caucasian
Treatment with certain drugs
368
Q

Prognosis of bladder cancer superficial

A

5 year survival rate 85%

369
Q

Prognosis of invasive bladder cancer

A

~5% of patients with metastatic cancer live 2 years of diagnosis
Cases of recurrent bladder cancer i ndcate aggressive tumor and poor prognosis

370
Q

Renal cancer accounts for what percent of all cancers

A 
3%
6th leading cause of cancer death
Males 2x greater
Increased incidence in african american
50-70 years old
MC = renal cell = renal adenocarcinoma
371
Q

T/f most solid kidney tumors (>90%) are malignant

A

True

372
Q

Risk factors for renal carcinoma (11)

A

Smoking doubles risk
Obesity particularly in women
HTN
Unopposed estrogen therapy
Occupational exposure to petroleum products, heavy metals, solvents, emissions or asbestos
Abuse of phenacetin-containing analgesics
Cystic kidney disease
Renal dialysis
Tuberous sclerosis
Renal transplantation: with associated immunosuppression = 80 fold increase in the risk
VHL disease an inherited disease

373
Q

Renal transplntation = 80 fold increase in risk of what

A

Renal cancer

374
Q

Kidney tumors can cause symptoms by (3)

A

Compressing, stretching or invading structures near or within the kidney

375
Q

Symptoms of renal cancer

A 
Lack of symptoms
HTN
He matures
Superclavicular adenopathy
Symptoms associated with mets (lung, soft tissue, bone, liver, cutaneous sites, CNS)
Paraneopalstic syndrome
376
Q

Paraneoplastic syndrome (4)

A

30% patients with kidney cancer can occur in any stage
Clinical symptoms = include weight loss, loss of appetite, fever, night sweats, HTN
Resolution of symptoms follows successful treatment of primary tumor or metastatic Fock

377
Q

Lab findings with paraneoplastic syndrome (6)

A 
Elevated ESR
Low RBC count (anemia)
Hyeprcaclemia 
Abnormal liver function tests
Elevated ALP
Elevated WBC count
378
Q

Prognosis of renal cancer

A 
5 year survival rate stage 1 : 66%
2: 64%
3: 42%
4: 11%
Except for stage 1, these survival stats have remained unchanged

GU (3 decks)

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