Genitourinary

Question 1

UTI; Urethritis, Cystitis

Answer 1

Sx: Sore colicky pain, suprapubic pain, frequency, urgency, hematuria, nocturia
PE: Kidney punch, palpate abd, Man >50 do prostate exam
Labs: UA, Urine Culture, Fasting CMP for glucose if chronic
Ddx: Pyelo, GC/CT, Prostatitis, Bladder CA
Tx: TMP sulfa antibx, Unsweetened cranberry juice, Avoid sugar

Question 2

Benign Prostatic Hyperplasia

Answer 2

Sx: Frequency, urgency, boggy prostate
PE: Prostate exam
Labs: UA, BUN, CBC leukocytosis, PSA
Ddx: Prostatitis, prostate CA
Tx: Alternating hot cold, surgical resection, prostate massage

Question 3

Prostate CA

Answer 3

Sx: mb none, hematuria
PE: stony hard non tender asymmetrical prostate
Imx: US
Labs: Free PSA (low number=high risk), Alk phase (elevated if metastasis to bone), US for dx
Ddx: BPH, Prostatitis
Tx: Diet, Chelation, Surgical removal

Question 4

Acute Urolithiasis

Answer 4

Sx: sx 4-6pm, Colicky unilateral pain in the flanks, CVA and across abdomen, mb inner thigh. Hematuria.
PE: Flank tenderness, CVA
Imx: Xray, CT
Labs: US, blood or pus
Ddx: Appendicitis, cholecystitis, pancreatitis, UTI, peritonitis
Tx: Kava tincture, Mg, B6, fluids

Question 5

Pyelonephritis

Answer 5

Sx: Rapid onset, chills, fever, N/V, abd rigidity
PE: CVA
Imx: None-CT if no response to tx in 48 hr
Labs: WBC casts (UA), Urine culture >100000, pregnancy test
Ddx: Cystitis, Appendicitis, Cholecystitis, Pancreatitis
Tx: TMP sulfa 500mg, hydrotx, diet