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PANCE 2.0 > Genitourinary #5 > Flashcards

Genitourinary #5 Flashcards

1
Q

What is paraphimosis?

A

Retracted foreskin that cannot be returned to the normal position

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2
Q

What are the symptoms of paraphimosis?

A

Severe penile pain and swelling of the penis

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3
Q

What is the treatment for paraphimosis?

A

Manual reduction. Restore original position of the foreskin. Cool compresses.

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4
Q

Pharm therapy for paraphimosis

A

granulated sugar, injection of hyaluronidase

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5
Q

What is the definitive management for paraphimosis?

A

incision or circumcision

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6
Q

What is phimosis?

A

Inability to retract the foreskin over the glans`

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7
Q

True or False. Paraphimosis is a urological emergency, whereas phimosis is not?

A

True

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8
Q

What is the pathophysiology of phimosis (what causes it)?

A

Distal scarring of the foreskin (trauma, inflammation, or infection)

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9
Q

Conservative treatment for phimosis

A

Proper hygiene
Stretching exercises (may spontaneously resolve)
4-8 weeks of topical corticosteroids can increase foreskin retractility

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10
Q

What is the definitive treatment for phimosis?

A

Circumcision

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11
Q

Benign prostatic hyperplasia leads to ______

A

bladder outlet obstruction

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12
Q

BPH is common in older men. Hyperplasia is part of the normal aging process and hormonally dependent on increased ________ production

A

dihydrotestosterone

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13
Q

Symptoms of BPH

A

Irritative symptoms: frequency, urgency, nocturia
Obstructive symptoms: hesitancy, weak force, incomplete emptying, dribbling.

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14
Q

What is one common medication that can worsen BPH

A

Pseudoephedrine

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15
Q

What is the prostate like on digital rectal exam in a patient with BPH?

A

uniformly enlarged, firm, nontender, rubbery prostate

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16
Q

What is the best initial therapy to relieve symptoms of BPH?

A

Alpha blockers (Tamsulosin, Terazosin, Doxazosin)

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17
Q

What is the MC adverse effect of alpha blockers?

A

Hypotension

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18
Q

True or False: Alpha blockers reduce the size of the prostate

A

False, they do not

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19
Q

5-alpha reductase inhibitors, such as _____ and ______, do reduce the size of the prostate over time

A

Finasterine
Dutasteride

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20
Q

If BPH symptoms persist with medication for 12-24 months, what is the next step in management?

A

TURP: removes excess prostate tissue

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21
Q

What is the MOA of Tamsulosin?

A

Smooth muscle relaxation of prostate and bladder neck leading to increased urinary outflow, obstruction relief, and decreased urethral resistance

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22
Q

Two common side effects of Tamsulosin/Terazosin/Doxazosin/Alfuzosin (alpha-1 blockers)

A

Orthostatic hypotension and dizziness

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23
Q

What is the MOA of 5-alpha reductase inhibitors?

A

Androgen inhibitor: inhibits conversion of testosterone to dihydrotestosterone suppressing prostate growth, reduces bladder outlet obstruction

24
Q

What are some adverse effects of Finasteride and Dutasteride?

A

Sexual or ejaculatory dysfunction
Decreased libido
Breast tenderness
Breast enlargement

25
Q

After _____ cancer, prostate cancer is the most common cancer in men in the US

A

Skin

26
Q

MC type of prostate cancer

A

Adenocarcinoma

27
Q

Risk factors for prostate cancer

A

-Increasing age (strongest risk factor)
-Genetics
-African American race
-Diet

28
Q

Although most patients with prostate cancer are asymptomatic, what is a common symptom and why?

A

Back or bone pain: increased incidence of METS to bone

29
Q

What is the prostate like on exam in a patient with prostate cancer?

A

-hard, indurated, nodular, enlarged, asymmetrical prostate

30
Q

Even though an abnormal PSA can be seen in other disorders, what is the DEFINITIVE test for prostate cancer?

A

Transrectal US-guided needle biopsy

31
Q

When is the Transrectal US done in prostate cancer?

A

If PSA > 4 or palpable mass

32
Q

What grading system is used to grade aggressive vs non-aggressive prostate cancer?

A

gleason grading system

33
Q

What are three options for definitive treatment for prostate cancer?

A

-External beam radiation therapy
-Brachytherapy
-Radical prostatectomy

34
Q

What are two adverse effects of a prostatectomy

A

-Incontinence and erectile dysfunction

35
Q

For advanced prostate cancer, external beam radiation therapy is an option. What is another medical option that exists?

A

Androgen deprivation: Flutamide

Or Chemotherapy

36
Q

MCC of hematuria in a patient under 40 years old (three common causes)

A

-Inflammation of bladder/prostate
-Infection of bladder/prostate
-Nephrolithiasis

37
Q

MCC of microscopic hematuria in men

A

BPH

38
Q

Name three medications that can cause hematuria

A

-Cyclophosphamide
-Rifampin
-Ibuprofen

39
Q

Best initial test of choice for hematuria

A

-Urinalysis

Repeat 6 weeks of treatment for resolution of hematuria

40
Q

What is the workup of choice after noninfectious UA in patients > 40 years old with hematuria?

A

CT urography and cystoscopy

41
Q

When should you refer to nephrology with hematuria?

A

Gross hematuria with NO visible clots

42
Q

When would US be the initial test of choice AFTER Urinalysis in hematuria?

A

If the patient is pregnant and cannot handle contrast (such as in CT urography)

43
Q

What type of kidney stone is the MC type?

A

Calcium oxalate

44
Q

Struvite kidney stones, made of ______, may form ______ in the renal pelvis due to urea-splitting organisms such as _____

A

Magnesium phosphate
Staghorn calculi
Protein, Klebsiella, Pseudomonas

45
Q

Symptoms of nephrolithiasis

A

-Renal colic: sudden, constant upper lateral back or flank pain over the CVA radiating to the groin or anteriorly
-May be difficult to find a comfortable position
-Nausea, vomiting
-Frequency, urgency, hematuria
-Pain varies based on location of stone

46
Q

After a UA, what is the initial imaging of choice for a kidney stone?

A

Noncontrast CT abdomen and pelvis

47
Q

On UA, there is hematuria usually present with a kidney stone. What type of urine is associated with the types of kidney stones?

A

Acidic urine (ph<5.0): uric acid and cystine
Alkaline urine (ph > 7.2): struvite

48
Q

When is a renal US used in diagnosing kidney stones?

A

In children or if CT contraindicated (pregnancy)

49
Q

On KUB radiographs, what type of stones are radiopaque (visible on radiographs)?

A

-Calcium
-Struvite

50
Q

Management of kidney stones if < 5 mm in diameter

A

-80% chance of spontaneous passage
–IVF and analgesics, antiemetics
–Tamsulosin to facilitate passage

51
Q

Where is the location that may make passage of kidney stones difficult?

A

At the ureterovesicular junction (narrow point of the urinary tract)

52
Q

Management for stones 5-10 mm in diameter

A

20% chance of spontaneous passage
–Extracorporeal shock wave lithotripsy: break up larger stones
–Ureteroscopy with or without stent: immediate relief
–Percutaneous nephrolithotomy: used for large stones > 10 mm, struvite, or if other methods fail

53
Q

What should you do if the stone is uric acid in nature?

A

Alkalize the urine to pH to > 6.5 to help dissolve the stone

54
Q

MC risk factor for calcium kidney stones

A

Decreased fluid intake

55
Q

Other risk factors for calcium stones

A

-Males
-Medications (loop diuretics, antacids, chemotherapy drugs, topiramate)
-High animal protein intake
-Increased Vitamin C intake in men

56
Q

How do you PREVENT calcium kidney stones?

A

-Increase fluid intake
-Thiazide diuretics
-Low sodium diet
-Citrate
-Decreased animal protein diet

PANCE 2.0 (62 decks)

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