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PANRE > Genitourinary 6% > Flashcards

Genitourinary 6% Flashcards

1
Q

Benign prostatic hyperplasia

A

Enlargement of transitional zone.

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2
Q

Benign prostatic hyperplasia, diagnosis

A

PSA is often elevated; < 4 considered normal.

PSA > 4 think BPH, prostate CA and prostatitis.

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3
Q

Benign prostatic hyperplasia, treatment

A

Symptomatic: Alpha blocker (Tamsulosin = Flomax).
Decrease prostate size: 5 alpha reductase inhibitors (Finasteride = Proscar).
Definitive: TURP

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4
Q

Congenital abnormalities

A 
Vesicoureteral reflux (VUR) - retrograde passage of urine from the bladder back into the ureter and collecting system - diagnosed with a Voiding CystoUrethroGram (VCUG).
Hypospadias and Epispadias urethra opens onto the underside/topside of the penile shaft.
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5
Q

Cryptorchidism

A

A condition in which one or both of the testes fail to descend from the abdomen into the scrotum.
If still non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy.
↑ Risk in premature infants 30%.
If not repaired risks infertility and malignancy.
Treatment: Orchiopexy by age 1.

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6
Q

Erectile dysfunction

A

The most common vascular cause is atherosclerosis. Consider psychological cause.
Nocturnal penile tumescence used to evaluate sleep erections.
Phosphodiesterase 5 inhibitors Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra).
Do not use with nitrates may cause hypotension.

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7
Q

Hydrocele/varicocele

A

Hydrocele: On physical exam mass will transilluminate. Varicocele: Dilation of the pampiniform plexus. Bag of worms in scrotum (made worse when patient is upright and improves when patient is supine). More common on left.

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8
Q

Incontinence, Stress

A

Urine leakage due to abrupt increases in intra-abdominal pressure (eg, with coughing, sneezing, laughing, bending, or lifting).
Treatment: strengthen pelvic floor or surgery.

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9
Q

Incontinence, Urge

A

Results from an overactive detrusor muscle. Increased frequency. Vaginal delivery.
Treatment: Oxybutynin

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10
Q

Incontinence, Overflow

A

Cannot empty bladder, just leaks. High PVR.

Treatment: Self catheterization.

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11
Q

Incontinence, Functional

A

Mobility issue .

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12
Q

Incontinence, Mixed

A

Combo of stress and urge; most common.

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13
Q

Nephrolithiasis/urolithiasis, symptoms

A

Flank pain radiating to groin, hematuria, CVA tenderness.

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14
Q

Nephrolithiasis/urolithiasis, types

A

Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque.
Struvite (10%): Associated with UTI with Klebsiella and Proteus species, radiopaque.
Uric Acid (7%): Excess meat/alcohol, gout, radiolucent.
Cystine (1%): Rare genetic, radiolucent.

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15
Q

Nephrolithiasis/urolithiasis, treatment

A

Lithotripsy: Stones > 1 cm unlikely to pass. Lithotripsy is indicated in patients with stones > 6 mm in size or intractable pain.
Hydration: Stones < 5 mm likely to pass.

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16
Q

Paraphimosis

A

Inability to return foreskin to normal position causes tourniquet effect, is a medical emergency.
Entrapment of the foreskin behind glans.
More acute than phimosis.

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17
Q

Phimosis

A

Inability to retract the foreskin, usually resolves by age 5, betamethasone topically, if no improvement circumcision.
Unable to retract foreskin.
More chronic than paraphimosis.

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18
Q

Testicular torsion

A

Teenage males.

Asymmetric high riding testicle; “bell clapper deformity”.

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19
Q

Testicular torsion, symptoms; signs

A

Very tender to palpation. Cremaster reflex absent.
Prehn’s sign: negative (lifting of testicle will not relieve pain).
Blue dot sign: Tender nodule 2 to 3 mm in diameter on the upper pole of the testicle.

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20
Q

Testicular torsion, diagnosis; treatment

A

Radionuclide study and ultrasound.

Surgical emergency: Repair both testes within 4-6 hours.

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21
Q

Cystitis

A

Infection of the bladder and is characterized by dysuria without urethral discharge.
E. coli (most common).

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22
Q

Cystitis, treatment

A

Nitrofurantoin (Macrobid) (not over age 65), Bactrim, Fosfomycin.
Ciprofloxacin- reserved for complicated cases.

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23
Q

Cystitis, Postcoital UTI, treatment

A

Single-dose TMP-SMX or cephalexin (Keflex) may reduce frequency of UTI in sexually active women.

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24
Q

Cystitis, Lower UTI in pregnancy, treatment

A

Nitrofurantoin (Macrobid): 100 mg PO BID × 7 days

Cephalexin (Keflex): 500 mg PO BID × 7 days

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25
Q

Epididymitis, presentation

A

Epididymitis is characterized by dysuria, unilateral scrotal pain and swelling.
+ Prehn’s sign: relief with elevation is a classic sign.

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26
Q

Epididymitis, etiology; treatment

A

< 35yo chlamydia and gonorrhea;
Doxycycline 100mg PO BID for 10 days + Ceftriaxone 250 mg IM × 1.

> 35yo E.coli;
Levofloxacin x 10 days.

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27
Q

Orchitis, presentation

A

Unilateral swollen testicle with erythema and shininess of the overlying skin. Orchitis is rarely seen without epididymitis unless patient has mumps.
25 % are associated with MUMPS

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28
Q

Orchitis, etiology; treatment

A

<35: Gonorrhea and chlamydia;
Ceftriaxone + doxycycline/azithromycin.

> 35: E. coli;
Levofloxacin.

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29
Q

Prostatitis, presentation

A

Sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency and dysuria.

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30
Q

Prostatitis, etiology; treatment

A

< 35: Chlamydia and Gonorrhea;
ceftriaxone and azithromycin (or Doxycycline).

> 35 - E. coli;
Fluoroquinolones or bactrim x 1 month

If you suspect acute prostatitis DO NOT massage the prostate this can lead to sepsis

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31
Q

Prostatitis, Chronic prostatitis, treatment

A

Fluoroquinolones or bactrim x 6-12 weeks.

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32
Q

Pyelonephritis, presentation

A

Irritative voiding, fever, flank pain, nausea and vomiting, CVA tenderness.

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33
Q

Pyelonephritis, diagnosis; etiology; treatment

A

Urinalysis: Bacteria and WBC casts.
E. coli.
Outpatient: ciprofloxacin/levofloxacin +/- ceftriaxone IM.
Inpatient: Ciprofloxacin/levofloxacin or imipenem for more severe disease.

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34
Q

Urethritis, symptoms

A

Dysuria and,

primarily in men, urethral discharge.

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35
Q

Urethritis, diagnosis; etiology

A

Nucleic Acid Amplification Test (NAAT)

N. gonorrhoeae (gram negative diplococci) and C. trachomatis.

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36
Q

Urethritis, treatment

A

Ceftriaxone 250 mg intramuscular in a single dose for treatment of gonococcal infection PLUS Azithromycin (1 gram in a single oral dose) for possible additional activity against N. gonorrhoeae and for treatment of potential chlamydia coinfection.

Doxycycline (100 mg orally twice daily for seven days) is an alternate option for a second agent to administer with ceftriaxone.

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37
Q

Bladder cancer

A

Painless hematuria in a smoker, transitional cell carcinoma is the most common type.

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38
Q

Prostate cancer, findings

A

Most common area: Peripheral zone.
Digital Rectal Exam: hard, irregular, nodular prostate.
Tumor marker: PSA (also elevated in BPH).

PSA is considered normal < 4.
PSA > 4 think BPH, prostate CA and prostatitis.

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39
Q

Prostate cancer, screening

A

Annual prostate screening:
White male average risk: 50 years old.
Black male + Family History or + BRCA mutations: 40 years old.

40
Q

Renal cell carcinoma, presentation

A

Classic triad of flank pain + hematuria + painless abdominal/renal mass.

Smoking is the most significant risk factor.

41
Q

Renal cell carcinoma, etiology

A

Renal clear cell carcinoma is the most common type (80%).

Transitional cell is the second most common type (20%)

42
Q

Testicular cancer, presentation

A

Presents as a firm, painless, non tender testicular mass.

Risk factors include history of cryptorchidism.

43
Q

Testicular cancer, etiology

A

Seminoma is the most common type (60%).

44
Q

Testicular cancer, diagnosis

A

Diagnostic studies: Initial-Ultrasound.

Tumor markers: AFP, βHCG.

45
Q

Wilms tumor

A

Child with painless, unilateral abdominal mass with no other signs of symptoms, also known as nephroblastoma.

46
Q

Acute renal failure, Acute Tubular Necrosis (ATN), Etiology

A

Kidney ischemia or toxins

47
Q

Acute renal failure, Acute Tubular Necrosis (ATN), urinalysis; labs

A

Muddy brown casts. Renal tubular epithelial cells + high urine osmolality.
FENa > 2%.

48
Q

Acute renal failure, interstitial nephritis, etiology

A

Immune-mediated response:
Drugs: PCN, sulfa, NSAIDs, phenytoin etc.
Immunologic and infectious disease: strep, SLE, CMV, Sjogren’s, Sarcoidosis.

49
Q

Acute renal failure, interstitial nephritis, urinalysis

A

WBC casts and eosinophils

50
Q

Acute renal failure, glomerulonephritis, etiology

A

IGA nephropathy (Berger disease), postinfectious, membranoproliferative.

51
Q

Acute renal failure, glomerulonephritis, urinalysis

A

Oliguria, hematuria and RBC casts.

52
Q

Chronic kidney disease

A

CKD is a progression of ongoing loss of kidney function (GFR) defined as < 60 mL/min/1.73 m² or presence of kidney damage (proteinuria, glomerulonephritis or structural damage from polycystic kidney disease) for > 3 months.

53
Q

Chronic kidney disease, diagnosis

A

Measurement of GFR is the gold standard.
The Cockcroft - Gault formula (requires age, body weight, and serum creatinine) or
Modification of Diet in Renal Disease equation.

54
Q

Chronic kidney disease, etiology

A

Diabetes, hypertension, glomerulonephritis

55
Q

Chronic kidney disease, findings

A

Fatigue, pruritus, Kussmaul respirations, asterixis (flapping tremor), muscle wasting, broad waxy casts.

56
Q

Glomerulonephritis (Nephritic Syndrome)

A

Immune-mediated glomerular inflammation results in glomerular damage which results in urinary protein and RBC loss.

57
Q

Glomerulonephritis (Nephritic Syndrome), findings

A

Proteinuria, HTN, azotemia, oliguria (<400 ml urine/day), hematuria (RBC casts) hallmark, edema is not as much as nephrotic syndrome.

58
Q

Glomerulonephritis (Nephritic Syndrome), diagnosis

A

Urinalysis: proteinuria < 3.5 grams per day, hematuria, RBC casts.
Biopsy: hypercellular, immune complex deposition.

59
Q

Acute Glomerulonephritis (Nephritic Syndrome), etiologies

A

IgA Nephropathy (Berger disease).
Postinfectious.
Membranoproliferative glomerulonephritis.

60
Q

Rapidly progressive glomerulonephritis (Nephritic Syndrome), findings; etiologies

A

Crescent formation on biopsy due to fibrin and plasma protein deposition.
Goodpasture’s syndrome.
Vasculitis.

61
Q

Glomerulonephritis (Nephritic Syndrome), IgA Nephropathy (Berger disease)

A

Most common cause of acute glomerulonephritis worldwide - often affects young males within days (24-48 hours) after URI or GI infection.

62
Q

Glomerulonephritis (Nephritic Syndrome), Postinfectious

A

Group A strep: 10-14 days after infection - diagnosed with ASO titers and low serum complement.

63
Q

Glomerulonephritis (Nephritic Syndrome), membranoproliferative glomerulonephritis

A

Due to SLE, viral hepatitis.

64
Q

Rapidly progressive glomerulonephritis (Nephritic Syndrome), due to Goodpasture’s syndrome

A

(+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide.

65
Q

Rapidly progressive glomerulonephritis (Nephritic Syndrome), due to vasculitis

A

Lack of immune deposits (+) ANCA antibodies.

66
Q

Hydronephrosis

A

Urine outflow obstruction causes renal distention.

Treat underlying cause.

67
Q

Nephrotic syndrome

A

Glomerular damage results in increased urinary protein loss.

68
Q

Nephrotic syndrome, findings

A

Proteinuria, hypoalbuminemia, edema, hyperlipidemia, edema is predominant feature, transudative pleural effusion.

69
Q

Nephrotic syndrome, diagnosis

A

Urinalysis: proteinuria >3.5 grams on 24-hour urine, fatty casts, oval fat bodies.
Biopsy: hypo-cellular minimal change disease loss of podocytes on microscopy.

70
Q

Nephrotic syndrome, most common primary causes

A

Membranous nephropathy.
Minimal change disease.
Focal segmental glomerulosclerosis.

71
Q

Nephrotic syndrome, membranous nephropathy

A

Most common in non-diabetic adults associated with malignancies.

72
Q

Nephrotic syndrome, minimal change disease

A

80% of nephrotic syndrome in kids. Responds to corticosteroids.

73
Q

Nephrotic syndrome, focal segmental glomerulosclerosis

A

Obese patients, heroin, and HIV black males.

74
Q

Nephrotic syndrome, most common secondary causes

A

Lupus
Diabetes.
Preeclampsia.

75
Q

Nephrotic syndrome, lupus

A

Both nephritic and nephrotic.

76
Q

Nephrotic syndrome, diabetes

A

Common cause of nephrotic syndrome and subsequent renal failure.

77
Q

Polycystic kidney disease

A

Autosomal dominant genetic disorder presents as back and flank pain. Associated with cerebral aneurysms.

78
Q

Polycystic kidney disease, diagnosis; treatment

A

Ultrasound will demonstrate many fluid-filled cysts.

No cure, treatment is supportive; BP control.

79
Q

Renal vascular disease

A

Narrowing of one or both of the renal arteries, most often caused by atherosclerosis or fibromuscular dysplasia.

80
Q

Renal vascular disease, diagnosis

A

May hear a renal artery bruit on auscultation.

Renal Arteriography is Gold Standard for diagnosis.

81
Q

Renal vascular disease, treatment

A

Percutaneous transluminal angioplasty (PTA) plus stent placement or surgical bypass of the stenotic segment.

82
Q

Hyponatremia, defined; presentation

A

Serum sodium of < 135 mmol/L.

Muscle cramps and seizures.

83
Q

Hypervolemic hyponatremia

A

CHF, nephrotic syndrome, renal failure, cirrhosis, water excess.

84
Q

Euvolemic hyponatremia

A

SIADH, steroids, hypothyroid.

85
Q

Hypovolemic hyponatremia

A

Sodium loss (renal, non-renal).

86
Q

Hyponatremia, treatment

A

Serum Na should be corrected slowly—by ≤ 10 mEq/L over 24 h to avoid osmotic demyelination syndrome.

87
Q

Hypernatremia

A

Serum sodium of > 145 mmol/L.

88
Q

Hypernatremia, etiologies

A

Diarrhea, burns, diuretics, hyperglycemia, deficit of thirst, hypovolemia, diabetes insipidus.

89
Q

Hypernatremia, treatment

A

Rapid overcorrection causes cerebral edema and pontine herniation.

90
Q

Hypernatremia, due to diabetes insipidus

A

Low urine sodium (but high serum sodium) and polyuria usually indicate diabetes insipidus.

91
Q

Acid/Base values

A

Average values “24/7 40/40”

24 (HCO3, base) / 7.40 (pH) / 40 (CO2, acid)

92
Q

Respiratory Acidosis

A

pH < 7.35, pCO2 > 45, HCO3 > 26
Lungs fail to excrete CO2.
Breathing too slow (holding onto CO2), pulmonary disease, neuromuscular disease, drug-induced hypoventilation - opiates, barbiturates.

93
Q

Respiratory Alkalosis

A

pH > 7.45, pCO2 < 35, HCO3 < 22
Excessive elimination of CO2.
Breathing too fast (blowing off CO2), pulmonary embolism, fever, hyperthyroid, anxiety, salicylate intoxication, septicemia.

94
Q

Metabolic Acidosis

A

pH <7.35, pCO2 < 35, HCO3 < 22
Need to calculate anion gap: Anion Gap = Na – (Cl + HCO3-) = 10-16
Increased ion gap (>16): Addition of hydrogen ions (lactic acidosis (think metformin), diabetic ketoacidosis, aspirin overdose).

95
Q

Metabolic Acidosis, increased ion gap (>16), etiologies

A 
Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Infection
Lactic Acidosis
Ethylene Glycol
Salicylates
96
Q

Respiratory Alkalosis, low anion gap (<16), etiologies

A

Loss of bicarbonate (diarrhea, pancreatic or biliary drainage, renal tubular acidosis).

97
Q

Metabolic Alkalosis

A

pH > 7.45, pCO2 > 45, HCO3 > 26

Loss of hydrogen (vomiting), bulimia, overdose of antacids, addition of bicarbonate (hyperalimentation therapy).

PANRE (9 decks)

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