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PANCE/EOC > Genitourinary #1 > Flashcards

Genitourinary #1 Flashcards

1
Q

Urge incontinence is due to _____ and is MC in ______

A

Detrusor muscle overactivity and is most common in older women

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2
Q

Management of urge incontinence

A
  • Bladder training
  • Diet (avoid spicy foods, chocolate, alcohol, and caffeine)
  • Antimuscarinics: Tolterodine, Oxybutynin
  • Mirabegron
  • TCA
  • Surgical: injection of Botox, bladder augmentation
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3
Q

Overflow incontinence is due to _____ and some common etiologies include…

A

Bladder detrusor muscle under activity

-Neurological disorders, autonomic dysfunction, BPH, prior pelvic floor surgery

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4
Q

How does overflow incontinence differ from the other types of incontinence?

A

-Loss of urine with no warning (as in urge) or triggers (as in stress)

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5
Q

What is the gold standard to diagnose a patient with overflow incontinence?

A

Post void residual > 200 mL

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6
Q

Treatment for overflow incontinence

A
  • Intermittent or indwelling catheter first-line

- Cholinergics: Bethanechol (increases detrusor muscle activity)

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7
Q

What is the pathophysiology of stress incontinence?

A

-Leakage of urine that occurs once increased abdominal pressure > urethtral pressure

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8
Q

When does stress incontinence occur usually?

A

-Exertion, coughing, sneezing, laughing

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9
Q

Common etiologies of stress incontinence include

A
  • Laxity of pelvic floor muscles (childbirth, surgery)

- Urethral hyper mobility

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10
Q

Treatment for stress incontinence

A
  • Pelvic floor (Kegel) exercises
  • Lifestyle modifications: weight loss, smoking cessation, drink small amounts of water throughout the day
  • Pessaries
  • Surgery: Midurethral sling (definitive)
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11
Q

Uterine Prolapse is when the uterus herniates into the vagina. Risk factors include weakness of pelvic support structures such as after childbirth. There are Grades 0-4 of this condition. Describe them.

A

Grade 0: no descent
Grade 1: uterus descent into the upper 2/3 of the vagina
Grade 2: the cervix approaches the introitus
Grade 3: the cervix is outside the introitus
Grade 4: entire uterus is outside the vagina

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12
Q

Treatment for uterine prolapse

A
  • Mechanical: pessaries elevate and support uterus

- Surgical: Hysterectomy or ligament fixation

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13
Q

What is Peyronie Disease?

A

-Acquired localized fibrotic changes of the tunica albuginea leading to abnormal penile curvature

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14
Q

Treatment for Peyronie Disease

A
  • Observation: if curvature is 30 degrees or less

- Medical: if curvature 30 degrees or more or associated with sexual dysfunction

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15
Q

What is vesicoureteral reflux?

A

-Retrograde passage of urine from the bladder into the upper urinary tract

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16
Q

MC clinical manifestation of VUR

A

-Febrile UTI

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17
Q

What is the initial diagnostic that is usually ordered for VUR and what is the diagnostic that is the imaging test of choice?

A
  • Renal and bladder US (initial)

- Voiding cystourethrogram (diagnostic of choice)

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18
Q

Treatment for VCUG, for all grades

A
  • Grades I-II: observation or ABX prophylaxis to reduce risk of recurrent UTI
  • Grades III - IV: surgical correction
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19
Q

MCC of acute cystitis

A

-E. Coli

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20
Q

However, what is the most common cause of acute cystitis in sexually active women?

A

Staph Saprophyticus

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21
Q

What is the MCC of acute cystitis with indwelling catheters?

A

Enterococci

22
Q

Symptoms of acute cystitis

A
  • Dysuria, frequency, urgency

- Hematuria, Suprapubic pain and tenderness

23
Q

Diagnostics for acute cystitis

A
  • UA: Pyuria ( > 10 WBC’s/hpf)

- Urine Culture: definitive diagnosis. Clean catch specimen. Women > 1000 CFU/ml

24
Q

Medical management of acute cystitis

A
  • Nitrofurantoin or Bactrim (first line)

- Fluoroquinolones (if sulfa allergy) - Cipro, Levo, Moxi

25
Q

What are some other adjunct treatment recommendations for patients with acute cystitis?

A
  • Increased fluid intake
  • Void after intercourse
  • Hot Sitz baths
  • Phenazopyridine is a bladder analgesic (turns urine orange color)
26
Q

What are some examples of a complicated acute cystitis?

A
  • Symptoms > 7 days
  • Pregnancy
  • Diabetics
  • Elderly
  • Males
  • Indwelling Catheters
27
Q

What are the treatment options for a complicated acute cystitis?

A
  • Fluoroquinolones PO or IV

- Aminoglycosides (Gentamicin, Tobramycin)

28
Q

What drug should be used for acute cystitis in pregnancy?

A

Amoxicillin or Augmentin

29
Q

Pyelonephritis is an infection of

A

The upper genitourinary tract

30
Q

MCC of pyelonephritis

A

-E. Coli

31
Q

Symptoms of pyelonephritis

A
  • Fever, chills, back or flank pain, N/v

- Urinary symptoms

32
Q

-What are the hallmark symptoms of pyelonephritis though

A
  • CVA tenderness
  • Tachycardia
  • Fever
33
Q

For diagnostics for pyelonephritis, what should you order and what do you see?

A
  • UA: Pyuria (WBC > 10/hpf), cloudy urine, hematuria
  • -WBC casts!!!!
  • Urine culture: Definitive diagnosis
34
Q

Outpatient management for pyelonephritis

A

-Fluoroquinolones (Cipro, Levo, Moxi)

35
Q

Inpatient management of pyelonephritis

A
  • 3rd or 4th gen Cephalosporins
  • Fluoroquinolones
  • Aminoglycosides
  • Penicillins
  • —Any one of these for 2 weeks
36
Q

If the patient is pregnant, what medication should be given for pyelonephritis?

A

-IV Ceftriaxone (Aztreonam if PCN allergy)

37
Q

MCC of orchitis

A

-Viral (Mumps, Echovirus)

38
Q

Treatment for orchitis

A

-Symptomatic first line, NSAIDs, bed rest, cool packs

39
Q

Symptoms of orchitis

A

-Scrotal pain, swelling, tenderness, erythema

40
Q

What is cryptorchidism?

A

Testicle that has not descended into the scrotum by four months of age

41
Q

Risk factors for cryptorchidism

A
  • Prematurity
  • Low birth weight
  • Maternal obesity or DM
42
Q

Treatment for cryptorchidism

A
  • Orchiopexy at 4-6 months of age and DEFINITELY before 2 years old
  • Observation if < 6 months of age can be done
43
Q

What is the major complication of cryptorchidism?

A

Increased risk for testicular cancer, decreased fertility, Testicular torsion, inguinal hernia

44
Q

MC causes of urethritis

A
  • Chlamydia: purulent or mucopurulent discharge

- Gonorrhea: abrupt onset of symptoms, opaque/yellow thick discharge

45
Q

Clinical symptoms of urethritis

A
  • Urethral discharge and penile or vaginal pruritus
  • Dysuria
  • Abdominal pain and abnormal vaginal bleeding
46
Q

Diagnostic for urethritis

A

NAAT: Most sensitive

47
Q

Treatment for urethritis

A
  • Ceftriaxone + Azithromycin (Gonorrhea)

- Azithromycin or Doxy (Chlamydia)

48
Q

What is enuresis defined as?

A

Any urinary incontinence while sleeping in children 5 years of age or older

49
Q

What is the difference in primary and secondary enuresis?

A
  • Primary: absence of any period of nighttime dryness (MC type)
  • Secondary: enuresis after a dry period of at least 6 months. Occurs after stressful event (divorce, death, etc.)
50
Q

Treatment for enuresis

A
  • Behavioral, bladder training
  • Enuresis alarm: most effective long term therapy
  • Desmopressin/DDAVP: synthetic ADH which reduces urination
  • Imipramine: TCA used in refractory cases

PANCE/EOC (63 decks)

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