Final Exam - Genitourinary

Question 1

Causes of functional urinary incontinence

Answer 1

• Delirium
• fecal impaction
• lack of manual dexterity
• decreased mobility
• taking the following medications: diuretics, hypnotics, alcohol, narcotics, decongestants

Question 2

Causes of stress incontinence

Answer 2

due to history of vaginal deliveries, urine leakage with cough or sneezing

Question 3

Work up for urinary incontinence

Answer 3

A urinalysis and urine culture and sensitivity should be done, measurements of serum electrolytes, blood urea nitrogen, creatinine, calcium (for polyuria in the absence of diuretics), and glucose.

Catheterization to assess post-void residual volume is important even on initial evaluation of the patient.

Question 4

Overactive bladder

Answer 4

syndrome of symptoms that include urgency, frequency, and nocturia, all of which are associated with involuntary contractions of the detrusor muscle; more common in women

Question 5

Urinary incontinence

Answer 5

The sudden intense urge to urinate and an involuntary loss of urine.

May or may not be a feature of overactive bladder, as about one-third of patients with OAB have urge incontinence, not all.

Question 6

How to diagnose UTI

Answer 6

the subjective complaints of the patient and a clean-catch midstream urine sample showing the presence of bacteria, especially if more than 100,000 organisms/mL

Question 7

Diagnosing a UTI in the elderly

Answer 7

altered mental status may be the sole manifestation of UTI and should create a high level of suspicion

Question 8

What is the gold standard for diagnosing a UTI?

Answer 8

Urine culture is considered the gold standard with the greatest sensitivity for laboratory confirmation of UTI, urinalysis with microscopy is also helpful and provides rapid results in the primary care setting.

Question 9

Pyridium

Answer 9

medication used for relief of pain, burning, urgency, and frequency from UTI.

Question 10

Priapism

Answer 10

A prolonged erection of the penis, usually without sexual arousal

Question 11

First line treatment for priapism

Answer 11

Phenylephrine (Neo-Synephrine) is the drug of choice for first-line treatment of low-flow priapism because the drug has almost pure alpha-agonist effects and minimal beta activity.

Question 12

Phimosis

Answer 12

Is an unusually long foreskin or a foreskin that cannot be retracted over the glans penis during physical examination

It occurs in uncircumcised males and is normal in infancy.

In anyone older than infancy, refer to urologist

Question 13

Hypospadias

Answer 13

Condition where the opening of the penis is on the underside of the organ.

More common in infants with a family history of hypospadias.

A circumcision should never be done on a newborn with hypospadias because the surgeon who ultimately corrects the hypospadias may need the prepuce to repair the defect.

Question 14

Treatment for hypospadias

Answer 14

Surgical correction should be undertaken by the time the child enters the first grade.

Question 15

Varicocele

Answer 15

Abnormal degree of venous dilation of the pampiniform plexus in the spermatic cord above the testes, which usually results in pain and engorgement of the testis.

Ascular engorgement of the internal spermatic vein.

Question 16

Physical exam findings for varicocele

Answer 16

On exam, there will be soft and movable blood vessels underneath the scrotal skin upon palpation.

Palpation of varicose veins, described as a “bag of worms”, in the scrotum is a classic example of a varicocele, an abnormal tortuosity and dilation of the veins of the pampiniform plexus within the spermatic cord.

Question 17

Undescended Testes and treatment

Answer 17

In boys with undescended testes, less than 1% have their testes descend after the first year.

Orchiopexy needs to be performed before age 6 to promote normal spermatogenesis and hormone production, prevent tumor formation, and leave the testis in a location where it can be easily palpated.

Question 18

Benign Prostatic Hypertrophy

Answer 18

Nodular hyperplasia of the prostate. Begins enlarging after age 50

Question 19

Treatment of BPH

Answer 19

5-alpha-reductase inhibitors include finasteride (Proscar) and dutasteride (Avodart)

After 6 months of therapy with finasteride (Proscar) for benign prostatic hyperplasia, the PSA should decrease by about 50%.

Testing can then be repeated annually. If the PSA has not decreased, you should suspect prostate cancer and proceed to evaluate for such.

Question 20

Patient teaching after BPH surgery

Answer 20

Within 4 to 6 weeks after surgery, it is safe to resume a full sex life, including intercourse. Before this time, the spasmodic contractions that occur in the prostatic urethra at the time of ejaculation could trigger delayed bleeding.

After 6 weeks, the risk of delayed bleeding is very slight. However, if the area has not completely healed, there may be slight discomfort because of the spasms.

Question 21

Erectile dysfunction determining the cause

Answer 21

Perform a medication history to determine if one of those could be causing the ED

The following medications have been shown to cause ED:
- antiandrogens
- antihypertensives such as beta blockers and central sympatholytics (reserpine)
- anticholinergics
- antidepressants
- antipsychotics
- central nervous system depressants
- drugs of abuse such as alcohol, tobacco, and heroin

Question 22

Chronic bacterial prostatitis

Answer 22

Recurrent bacterial infection of the prostate and urinary tract, affects men aged 50 to 80.

Most common cause is E. Coli.

Young adult males in their 20s usually have acute prostatitis from gonorrhea or other bacterial infections.

Question 23

Symptoms of chronic bacterial prostatitis

Answer 23

• bladder obstruction symptoms such as weak urine stream, hesitancy or dribbling, hematuria, hematospermia, and/or painful ejaculation.

Question 24

What is acute bacterial prostatitis always associated with?

Answer 24

UTI and has a characteristically abrupt onset. Fever, chills, low back pain, tenesmus, and urinary complaints typical of UTI are common.

Question 25

Exam for bacterial prostatitis

Answer 25

The rectal examination should be performed gently because vigorous manipulation of the prostate can result in septicemia. Therefore, prostatic massage is contraindicated.

Question 26

Prostate cancer

Answer 26

Associated with human cytomegalovirus

A man with a first degree relative with prostate cancer is twice as likely to develop the disease.

Men with diets high in fat, particularly animal fat and smoking are also risk factors.

Question 27

Prostate cancer symptoms

Answer 27

• bone pain
• weight loss
• anemia
• shortness of breath
• lymphedema
• lymphadenopathy

Question 28

Treatment for prostate cancer

Answer 28

Goserelin acetate (Zoladex) and leuprolide acetate (Lupron) block the release of FSH and LH administered intramuscularly.

Also surgery.