Genitourinary Exam 2 Cards Flashcards

1
Q

Acute UTI

A

Usually 1 organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Chronic UTI

A

may be 2+ organism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MCC of UTI

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CFU count indicative of a potential UTI

A

Over 100,000 cfu/mL is suggestive but NOT diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bacteriuria

A

10^5 cfu/mL, 2 consecutive specimens in women - recommended not to screen in children and women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Unresolved bacteriuria - 3 etiologies

A

Failure to sterilize urinary tract during UTI tx
Noncompliance
resistance
Multiinfections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Persistent bacturia - 4 etiologies

A

Keeps coming back - prostate, catheter, stones, fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

4 ways UTIs can spread

A

Ascending - MC, skin up urethra
Direct extension - From local infected tissue
Hematogenous - Staph from blood
Lymphatic - Rare from lymph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 Risk factors for UTI

A

Abnormal voiding
Renal disease
Deficient mucosal lining
Abnormal pH or osmolality of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Male and female risk factors for UTI

A

Female - Short urethra and sex
Male - Prostatitis and foreskin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Etiology of acute cystitis

A

Nearly always bacterial - E. coli MC
Up the urethra
Rare in adult men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical presentation of acute cystitis

A

Dysuria
Frequency/Urgency
Suprapubic pain
May see blood in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Labs for acute cystitis

A

WBCs - leukocyte esterase
Nitrites - Made by bacteria
Hematuria also possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

First Line Treatment for acute cystitis

A

NEW GUIDLINES COMING
5 days - nitrofurantoin
3 days - Bactrim (can just do TMP if sulfa allergic)
Single Dose - Fosfomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Second line treatment for acute cystitis

A

Augmentin 5-7 days
Cephalosporin - Podoxime, Dinir, Keflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Third line for acute cystitis

A

FQ for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Soothing Adjunct therapy for acute cystitis - side effects and considerations

A

Phenazopyridine - sooths bladder
Discolored urine - interferes with UA dip!!
Only 2 days so we know if pain is gone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Toxic urine adjunct for acute cystitis

A

Methenamine - metabolizes to formaldehyde and ammonia in urine
Renal and liver failure CI
Interacts with Sulfa
2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Non pharm adjunct treatments for acute cystitis

A

Sitz bath - warm comfort bath
Fluid intake
Cranberry juice
Vaginal estrogen in post menopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Non-pharm acute cystitis prevention

A

Voiding after sex
Hydration
Wiping from front to back
Breathable undergarments - cotton
D-mannose from cranberry juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diabetes med that can cause a UTI

A

SGLT-2 inhibitor - gliflozin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Frequent UTI

A

3+ in 12 months for women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pharm for recurring cystitis

A

Any UTI drug low dose or PRN
Work ‘em up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Etiology of acute pyelonephritis

A

E. coli, Staph (blood), Kelbsiaella, Pseudomonas
Ascent up urethra
Less common than cystitis - usually follows

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clinical presentation of acute pyelonephritis

A

Fever, chills, NVD, flank pain, gross hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Imaging for acute pyelonephritis

A

CT preferred - shows renal inflammation
US can show hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Fluid on a CT scan

A

Appears dark

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Lab results from acute pyelonephritis

A

Positive urine culture
Leukocyte esterase and casts
Urine nitrite
Leukocytosis on CBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Outpatient treatment for acute pyelonephritis

A

Can be out if healthy
Fluids and abx - or IV if you can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Initial IV abx for acute pyelonephritis

A

Rocephin, Ciprofloxacin, Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Oral abx for acute pyelonephritis

A

Levaquin, Cipro, Bactrim, MAY use augmentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

2 CI drugs for acute pyelonephritis

A

Nitrofurantoin
Fosfomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Therapy duration for acute pyelonephritis outpatient

A

7 days -FQ 14 days non-FQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Inpatient pharm for acute pyelonephritis
4 normal
3 for resistance

A

IV - Rocephin, Gent/Amp, FQ, pip and taz

IF

Suspicion of resistant - Carbapenem, Vanc, Cefepime

14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Complications fro pyelonephritis

A

Abcess
Nephron loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Etiology of acute urethritis
4 MCC in order

A

Gonnorrhea = MC
Chlamydia
Mycoplasma genitalia
Trichomonas

Usually and STI - MC in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical presentation of acute urethritis

A

Pain with urination
Discharge (gon is more purulent)
May be asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Labs for urethritis

A

Gram stain (G- is gon), now we usually use NAAt for Gon,Chly
UA - first stream sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pharm for gonorrhea

A

Ceftriaxone - 1 dose IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pharm for chlamydia

A

Doxy for 7 days (preferred)
Z-max - 1 dose IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Clinical presentation of prostatitis

A

Heamturia - gross or microscopic
Irritative voiding symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Indication that might mean prostate cancer

A

Gross hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Dysuria

A

May be painful, may just be uncomfortable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Nocturia

A

abnormal if several times per night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Urine hesitancy

A

Don’t start urinating right away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

4 types of incontinence

A

Overflow
Urge
Stress
Total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Acute bacterial prostatitis etiology

A

Ascent up urethra
Risk factors for UTI
Trauma
Dehydration
MCC -E. coli may need to consider STIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Presentation of bacterial prostatitis

A

Fever, chills, mailaise
Irritative voiding
Pain can be perineal, sacral, suprapubic
Prostate tenderness and warmth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

DRI in bacterial prostatis

A

Too much massage can cause sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Labs for bacterial prostatitis

A

Leukocytosis
Pyuria and bacturia
+ culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Imaging for bacterial prostatitis

A

Check for abcess CT or US if no respnse to therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Pharm therapy for bacterial prostatitis
IV
Nosocomial
Oral

A

ABX therapy based on C/S
Start FQ+Aminoglycoside - IV
Carb, Ceph, Aminoglycoside - Nosocomial
Bactrim, Cipro - Oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Therapy length for bacterial prostatitis

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Etiology of chronic bacterial prostatitis

A

More often E. coli
May skip to chronic before acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Clinical pres of chronic bacterial prostatitis

A

Say they have bladder infectio - Men
Dull pain suprapubic
May have a mildly tender boggy prostate - may be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Labs for chronic bacterial prostatitis

A

Only positive upon prostate palpation followed by urination
Lipid laden macrophages
May see prostate stones on imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Pharm treatment for chronic bacterial prostatitis

A

FQ or Bactrim for 6 weeks - may need 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Side effects of FQs

A

C. diff, CNS toxicity, Tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Nonbacterial prostatitis/Chronic pelvic syndrome

A

Pelvic pain - unclear if prostate is cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Clinical presentation of nonbacterial prostatitis

A

May report auto immune
No softness of the prostate
Negative cultures and imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Pharm Treatment for nonbacterial antibiotics

A

FQ or erythromycin for 6 weeks
Alpha blocker for urinary symptoms (tamsulozin, silodosin, alfuzosin are specific) can be more than 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Adjunct pharm for chronic pelvic pain syndrome

A

5 alpha reductase inhibitors
NSAID
Qcertain can help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Percent of men who have BPH

A

80% of men over 80
50% of men 51-60
8% of men 31-40

Not all have symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Risk factors for BPH - Lifestyle, ethnicity, drugs

A

Black ethnicity
Beta blocker use/Heart disease
Sedentary

Smoking/alcohol reduces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

2 problems a large prostate can cause

A

Mechanical obstruction - narrow lumen
Dynamic obstruction - alpha 1 receptor stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Clinical presentation of BPH

A

Obstructive voiding
Double voiding (twice in 2 hours)
Strain to urinate
Dribbling
MAY have irritative voiding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

AUA score

A

Evaluates likelihood for BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Physical exam for BPH

A

Not rock hard
Smooth firm elastic enlargement
Neuro and abd exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Labs for BPH

A

Normal UA
Check PSA - may not be cancer
Only biopsy if cancer concern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

BPH treatment

A

Watchful waiting (0-7 score) - may regress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Best alpha blocker type for BPH

A

Alpha 1 a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

3 Non selective alpha blockers for BPH

A

Prazosin, Doxazosin, Terazosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Selective alpha blockers for BPH

A

Silodosin, Tamsulosin, Alfuzoson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Side effects for alpha 1a blockers

A

Dizziness, Orthostatic hypotension, Floppy iris syndrome, rhinitis, retrograde ejaculation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Drug interactions of alpha blockers for BPH

A

PDE-5 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

5 alpha reductase inhibitors for BPH

A

Block testosterone but take time
Reduce PSA and risk of prostate cancer
Finasteride and Dutasteride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Side effects of 5 alpha reductase inhibitors

A

Low sex drive, fatigue, ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

First line for BPH

A

Alpha blocker and 5 alpha reductase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

PDE-5 inhibitor for BPH

A

Tadalafil (Cialis) adjunct for ED and BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Herbals for BPH

A

Saw Palmetto - not first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

More invasive surgeries for BPH

A

TURP - Trans Urethral Resection - risk of retrograde ejaculation or incontinence. Removes prostate tissue from inside the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Transurethral resection syndrome

A

Hypervolemic, hyponatremic state from irrigation solution used in the surgery
Altered mental status, confusion, N/D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Transurethral incision of the prostate

A

Cut muscle around bladder neck - less invasive than TURP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Open prostectomy

A

When prostate is too larger for endoscopic removal - many complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Laser therapy for BPH

A

TULIP - burn prostate and it dies, no biopsy and sloughing for a while after
TUNA - Uses a radio frequency instead

86
Q

Implant to Open Prostatic urethra

A

Device that pulls urethra open

87
Q

Rezum

A

Steam therapy that causes thermal destruction - less invasive - scars tissue to open urethra

88
Q

Risk factors for prostate cancer

A

Black ethnicity
High fat diet

89
Q

Clinical presentation of prostate cancer

A

May have an abnormal DRE - not very sensitive
Lymphedema or obstructive voiding is possible

90
Q

Labs for prostate cancer

A

Elevated PSA
Elevated alkaline phos
High BUN/Cr if obstructing

91
Q

Imaging for Prostate cancer

A

US guided biopsy of concerning area
MRI for lymph nodes

CT for mets

92
Q

Gleason system

A

Staging for prostate cancer differentiation 1 is best 5 is worse

93
Q

T scoring for prostate cancer

A

T1 - Only know about it through PSA
T2 - Tumor confined to prostate
T3 - Tumor extends through capsule, maybe in seminal vescicle
T4 - Tumor is fixed or invades other structures

94
Q

Treatment for prostate cancer

A

Watch if non-aggressive or sort life expectancy
Radical prostatectomy if large
Radiation or cryosurgery if small
Chemo if mets

95
Q

Pharm for prostate cancer

A

LHRH agonist - Leuprolide
LHRH antagonist - Degrelix

Wear out or just block LH

96
Q

Cells that produce PSA

A

Produced by benign AND malignant cells
Small cancer may mean normal PSA

97
Q

Intermediate, High and normal range for PSA

A

N - 0-4
I 4-10
H - 10+ (very concerning)
40+ ADVANCED

98
Q

4 drugs that influence PSA

A

5A reductase inhibitors
NSAID
Statin
Thiazide diuretics

99
Q

Other factors that can increase PSA

A

Bike riding, sex, surgery

100
Q

Free PSA

A

Higher % = lower risk of cancer
Look for trends

101
Q

Screening for prostate cancer

A

Grade C for 55-69 - screen annually start younger if high risk

102
Q

Hydrocele

A

Fluid around the testicle - can be communicating or noncommunicating

103
Q

3 types of noncommunicating hydrocele

A

Testicular, Inguinal scrotal, Cord

104
Q

Clinical presentation of hydrocele

A

Inguinal lump if cord
Anterior mass to testis with little or no pain
Transillumination present

105
Q

Diagnostics for hydrocele

A

UA - Infection
US to look for other etiologies
Findings will be boring if it is a hydrocele

106
Q

Treatment for hydrocele

A

Benign in under 12-18 months - watch
Needle aspirate, Hydrocelectomy is definitive treatment is recurring

107
Q

Varicocele

A

Scrotal swelling caused by varicose veins in the scrotum - often on the left

108
Q

Clinical presentation of varicocele

A

Infertility, Dull pain, Bag of worms in the scrotal sac that enlrages with valsalva, may be asymptomatic

109
Q

Diagnostic for varicocele

A

Ultrasound

110
Q

Treatment for varicocele

A

Don’t have to treat if not worried about fertility
Conservative - support/NSAID
Surgery if they want fertility or refractory - ligation, coil embolization

111
Q

Complications of varicocele

A

Infertility
Do self exams to check

112
Q

Testicular torsion

A

Twist in the spermatic cord causing a loss of blood flow - inconsolable infant

113
Q

Risk factors of TT - including deformity

A

Trauma
Exersice/Sex
Bell Clapper deformity - Tunica vaginalis all around so it can turn

114
Q

Clinical presentation of TT

A

Extreme testicular pain - may have had episodes of it
No urinary symptoms
High riding testis
No cremasteric reflex

115
Q

Prehn’s sign

A

Lack of pain relief with support of scrotum indicates TT

116
Q

Diagnostics for TT

A

Doppler ultrasound - go straight to surgery if unsure - can order a UA

117
Q

Treatment for testicular torsion

A

Try to untwist - medial to lateral
Still needs surgery even if detorsed
Pain relief
Surgically fix to the scotum - Needs surgery w/in 6 hours

118
Q

TWIST score

A

Evaluates for possibility of testicular torsion - if it’s high enough (5+) don’t bother with US

119
Q

Testicular appendage torsion

A

Little flaps of tissue on testes that get twisted and become ischemic

120
Q

Presentation of testicular appendage torsion

A

Slight pain - less general swelling
Blue dot sign
Testicle has normal blood flow on US with small area

121
Q

Treatment for testicular appendage torsion

A

NSAIDs
Observe

122
Q

Phimosis

A

Inability to retract foreskin over glans penis
MCC - Chronic infection/poor hygeine

123
Q

Clinical presentation of phimosis

A

May be asymptomatic
Ballooning of prepuce with urination

124
Q

Pharm Treatment for phimosis infection

A

Treat infection -
Clotrimazole, nystatin, fluconazole - fungal
Bacitracin or Metro - Bacterial
Keflex - extended infection

125
Q

Mechanical treatment for phimosis

A

Hemostat dilation
Frenar stretch - steroids
Dorsal slit
Circumcision

126
Q

COmplications of phimosis

A

Crystals formed - prepupertal calculi
Squamous cell carcinoma may be associated

127
Q

Paraphimosis

A

Inability to protract foreskin - can occlude bloodflow to glans penis
Can be a complication of Malaria

128
Q

Presentation of paraphimosis

A

Donut sign
Swollen foreskin pushed back and swollen glans

129
Q

Treatment for paraphimosis

A

Manual reduction (squeeze the glans)
Needle decompression
Dorsal slit
Osmotic agent
May need antibiotics and will need circumcision (will need even with reduction)

130
Q

MCC of priapism

A

Intracavernous ED treatment

131
Q

Medications that can cause priapism

A

Antihypertensives, Psych meds (ADHD), ED meds,

132
Q

High flow priapism

A

Non-ischemic
High oxygen and painless
Excessive flow in

133
Q

Low flow priapism

A

Problem with the Veins causes high CO@ and low O2
Can cause fibrosis of corpora cavernosa
Painful
Glans and dorsal side will be non-swollen

134
Q

Treatment for priapism

A

Anesthesia
Aspirate blood
Alpha agonist

Winter procedure - shunt or other shunts for release

135
Q

Peyronies disease

A

Fibrosis of dorsal covering sheeths
DM, trauma, Vasculitis, Inflammation, contracture

136
Q

Presentation of peyronies disease

A

Curved penis with painful erection but not when flacid
May be able to palpate the plaque

137
Q

Treatment for peyronies disease

A

Observe
Vitamin E, Para-aminobenzoic acid orally’
Verapamil, steroids, dimethylsulfoxide, PTH inject
Radiation
Surgical excision

138
Q

Complications of Peyronies disease

A

ED, impotence

139
Q

MC penile cancer

A

Squamous cell carcinoma
Rare in developed countries

140
Q

Risk factors for penile cancer

A

HPV or HIV
Phimosis
Tobacco use

141
Q

Presentation of penile cancer

A

Lesion, Rash, Painless lump, Adenopathy

142
Q

Treatment for low risk of recurrence penile cancer

A

Limited excision
Laser or topical therapy

143
Q

Treatment of high risk recurrence penile cancer

A

Partial or total penile amputation
May use chemo or radiation

144
Q

Epididymitis

A

Inflammation from infection or amiodarone
STD in younger men, assoc with prostatitis in older men

145
Q

Clinical presentation of epididymitis

A

Top of testicle tender first
Urine signs
Positive Prehn’s sign

146
Q

Labs for epididymitis

A

UA - with bacteria etc
PCR for Gon Chly

147
Q

Treatment for epididymitis

A

Rule out testicular torsion
Bed rest and ice packs
Ceftriaxone and Doxy if STD suspected
Levo or Bactrim if prostatitis suspected

148
Q

Orchitis

A

Scarier than epididymitis
Bacterial, granulomatous (autoimmune), Viral (mumps, HFM, etc.)

149
Q

Clinical presentation of Orchitis

A

UTI hx
Hydrocele
Fever nausea, vomiting
Inguinal lymphadenopathy
More gradual onset with positive prehn’s sign

150
Q

Evaluation for orchitis

A

UA
PCR

151
Q

Treatment for orchitis

A

Rocephin and Doxy
If practicing anal sex - Rocephin and Levo

152
Q

Complications of orchitis

A

Sepsis, Abscess, fibroplasia, atrophy, loss of fertility

153
Q

Epididymal cyst

A

Little cyst at head of epididymis - non tender, non-concerning, fluid filled

154
Q

Spermatocele

A

Epididymal cyst over 2 cm superior and distinct from the testis
US
Surgical excision if desired

155
Q

MC age of testicular cancer

A

20-35

156
Q

Risk factors for testicular tumor

A

Cryptorchidism
Infertility
HIV
High fat diet

157
Q

Presentation of testicular tumors

A

Painless enlargement of testis - heaviness or nodules
10% have pain
10% have mets

158
Q

Labs and imaging for testicular tumors

A

Alpha fetoprotein, hCG, LDH
Scrotal US
Stage with CT

159
Q

Treatment for testicular cancer

A

Have to take out the whole testicle - NO BIOPSY
May use chemo

160
Q

Medication that cannot be taken with PDE-5 inhibitor

A

Nitrate - ie. nitroglycerin

161
Q

4 things needed for a normal male sexual response

A

Libido
Penile erection
Ejaculation
Detumnescence

162
Q

Erectile Dysfunction

A

Inability to attain or maintain a sufficiently rigid penile erection for sexual performance - NOT a normal part of aging

163
Q

Associated factors of ED

A

DM, BPH, Prostate cancer, HTN - Vascular and neuropathic issues
Smoking
Local radiation/surgery
Psych issues

164
Q

Etiologies of ED

A

Failure to initiate, fill or store - may be more than 1
DM, Atherosclerosis, Meds
Vasculogenic or Neurogenic

165
Q

Medications that can cause ED - 4ish

A

Beta blocker/Thiazide
Estrogen, GnRH agonists, TCAs or SSRIs

166
Q

Testosterone for ED

A

Only beneficial if there is documented hypogonadism or low testosterone levels
Consider prostate issues, Sleep apnea, CHF

167
Q

Transdermal, Intramuscular and Oral Testosterone

A

Transdermal - Easy to use and stable levels can transfer to others
Intramuscular testosterone - Cheap and effective, fluctuation in serum levels
Oral - Hepatotoxicity and questionable

168
Q

Side effects of testosterone

A

Erythrocytosis, Skin irritation, Aggression, increased bone density

169
Q

Monitoring for testosterone therapy

A

Measure 2-3 months after initiation
Every 6-12 months check between drugs

170
Q

4 hr duration PDE-5 inhibitors

A

Sildenafil
Vardenafil
Avanafil - CAN take with food

171
Q

Extended duration PDE-5 inhibitor

A

Tadalafil (Cialis) helps with BPH works for 36 hours

172
Q

Side effects of ED

A

Headache, flushing, dyspnea, dizziness, hypotension - all related to vasodilation

173
Q

Prostaglandings for ED

A

Intracavernosal injection or urethral suppository - painful, avoid blood vessels

174
Q

Vacuum device for ED

A

Sucks blood into penis, cumbersome and restricts blood flow into the penis so only 20-30 minutes

175
Q

Vascular surgery for ED

A

Bypass arteries or ligate veins to improve blood flow, not as effective as it should be

176
Q

Penile prosthesis

A

Semi rigid or inflatable - invasive with risk of infection
Can protrude through the skin

177
Q

Treatment for decreased libido

A

Treat underlying conditions:
Psych
ED
SSRIs
Therapy

178
Q

Premature ejaculation

A

Brief latency of ejaculation that they can’t stop
May be ED

179
Q

Treatment for premature ejaculation

A

SSRIs
Topical anesthetics

180
Q

Delayed ejaculation

A

Physical or Psych - treat underlying cause

181
Q

Retrograde ejaculation

A

Dry orgasm - semen goes into bladder - caused by surgery or alpha blockers
Only a problem if fertility is an issue

182
Q

Ideal urine sample

A

Clean catch urine

183
Q

Most urine dips parameters

A

RBC, Leukocyte esterase, nitrite, albumin, pH, specific gravity, glucose, bilirubin, urobilinogen

184
Q

Red urine

A

Blood, beets, phenazopyridine

185
Q

Bright yellow urine

A

Vitamin B12

186
Q

Ammonia odor of urine

A

Bladder retention/Long standing

187
Q

Fishy urine odor

A

UTI

188
Q

Causes of acidic or alkaline urine

A

Acidic - High protein/cranberries
Alkaline - Vegeterian, low carb, citrus

189
Q

Diagnostic criteria for hematuria

A

Must see on microscopy
May see false negative from menstrual bleeding

190
Q

Other causes of leukocyte esterase and things that can hide it

A

Renal disease, Asymptomatic bacteruria

False negatives from High concentration, Vit C, medications (rifampin)

191
Q

Nitrites in urine

A

Gram - bacteria
Not definitive for UTI - suggestive

192
Q

Bilirubin/Urobilinogen in urine

A

May indicate hemolysis

Vitamin C false negative

193
Q

Glucose in urine

A

Diabetes or on an SGLT2 inhibitor

194
Q

Ketones in urine

A

Trace is NOT a concern
Elevated may be a concern

195
Q

Urine protein

A

Does not catch urine microalbumin, can be high with UTI, underestimate of urine protein

196
Q

True hematuria microscopy

A

5 per high power field or 3 on multiple occasions

197
Q

Determination of hematuria cause

A

Dysmorphic - glomerular disease from pushing through glomerulus
Round - UTI, cancer etc.

198
Q

Causes of WBCs in urine

A

Casts = Kidney issue
Can be UTI, Kidney stone, any other trauma

199
Q

Tubular epithelial cells in urine

A

Nephrotic syndrome, CKD, a few is normal

200
Q

Squamous epithelial cells in urine

A

Indicate skin contamination

201
Q

Transitional epithelial cells

A

If present in high number suggestive of a neoplasm

202
Q

Hyaline casts

A

Seen in dehydration

203
Q

Granular casts

A

ATN suggestive

204
Q

Broad waxy casts

A

Suggest CKD

205
Q

Cystoscopy

A

Can get a better look at the bladder than imaging

206
Q

Workup for hematuria

A

UA, CBC, GFR
Imaging - IV pyelogram, CT
Cystoscopy
Kidney workup
Refer to Urology or monitor

207
Q

Indications for catheterization

A

Impeded urine flow
Get sterile Urine
Treat neurogenic bladder
Sever refractory incontinence

208
Q

Relative contraindications for catheter

A

Stricture, GU surgery, Artificial urinary sphincter

209
Q

Absolute contraindications for catheter

A

Pelvic trauma, urethral injury

210
Q

Complications of a urinary catheter

A

Infectious, Mechanical (baloon fibers), Bladder or urethral damage

211
Q

How far should a foley catheter be inserted

A

See a flash of urine and go for 1 more inch