Genitourinary - Final Flashcards by Brittany Morrison

T/F

UI severity increases without treatment

True

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T/F

Annual routine screening for UI in older adults is not indiciated

Fale, reccomended

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UI is a normal part of aging. T/F?

False

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What medications increase the risk of postmenopausal PV bleeding? (6)

Anticoagulants
Antidepressants (SSRI & TCA)
Hormonal contraceptives
Tamoxifen - treatment for breast ca. 
Antipsychotics (first generation and risperidone), Corticosteroids

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What herbs/vitamins/social factors increase the risk of postmenopausal PV bleeding?

Herbs: ginseng, chasteberry, danshen
Alcohol
Vitamin E

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What diagnostic test is indicated to rule out endometrial hyperplasia vs malignancy?

Transvaginal US - endometrial thickness of 99% for endometrial cancer

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What are identified major risk factors for endometrial cancer? (7)

Age >60
postmenopausal status
nulliparity
diabetes
obesity, (BMI>30) 
PCOS
HNPCC- Hereditary non-polyposis colorectal cancer

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Which patient is at the highest risk of developing endometrial cancer?

A 25-year-old premenopausal woman who smokes, with a BMI of 27
A 70-year-old multiparous, postmenopausal woman with a BMI of 26
A 35-year-old premenopausal woman with hypertension and a BMI of 35
A 65-year-old nulliparous, postmenopausal woman with Type 2 diabetes and a BMI of 35

A 65-year-old nulliparous, postmenopausal woman with Type 2 diabetes and a BMI of 35

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Red flags to rule out for urinary incontinence

Presence of fever, dysuria, abdominal or pelvic pain, and hematuria, perineal anesthesia, changes in gait or new onset neurological symptoms

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DIAPERS mnemonic for reversible causes of urinary incontinence

Delirium

Infection (urinary tract)

Atrophic

Pharmacological

Psychological

Endocrine/excess urine output

Restricted mobility

Stool impaction

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What diagnostics to consider for urinary incontinence?

Urine dip, Urinalysis, Urine culture
Cr, BUN, 
Na, K, Cl, 
BG or A1C
Bladder diary
U/S for Post void residual

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Most common type of urinary incontinence in men and most common cause?

Overflow incontinence

BPH

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Pharm treatment of overflow incontinence?

Most common in men is over flow related to BPH use Alpha-adrenergic blockers (Flomax). One important adverse effect of AABs that may be significant in some patients is intraoperative floppy-iris syndrome (IFIS).

5-alpha-reductase inhibitors. The ARIs finasteride, Dutasteride (Avodart) are also used to treat BPH, but usually in men with advanced disease or when AABs are contraindicated. ARIs are often combined with AABs because of their slow onset of action, which necessitates the use of AABs for more rapid symptom relief.

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Most common type of incontinence in older adults

Urge

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Any unexpected vaginal bleeding that occurs after _______ of
amenorrhea is considered postmenopausal bleeding and should be
investigated

12 months

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True/False
Survivors of breast cancer using aromatase inhibitors have more
sexual dysfunction due to vulvovaginal atrophy than do women
using tamoxifen or control subjects.

True

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Contraindications to HRT

Unexplained vaginal bleeding
Known or suspected breast cancer
Acute liver dx
Active VTE dx
Acute CVD
Recent CVA
Pregnancy

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Function of PSA

helps to liquefy semen after ejaculation ie. freeing sperm to swim

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Approximately 50% of men have BPH by the age of ___

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90% of males have BPH by the age of ___

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Smooth elastic and firm nodules on prostate are always concerning. T/F?

False, can be benign hyperplastic nodules

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T/F? PSA is elevated in BPH?

True

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Treatment of BPH

Finasteride (5-alpha reductase inhibitor)
Flomax (alpha 1 blocker)
Surgery - transurethral resection

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Patho of BPH

Increase in 5-alpha reductase activity in prostate –> increased dihydrotestosterone –> increased prostate cell growth

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Most common causes of prostatitis in older adults

E. coli | Pseudomonas

Warm, tender and boggy prostate on DRE indicates

Prostatitis

Which of the following are associated with chronic prostatitis presentations? - fever - low back pain/pelvic pain - dysuria

- low back pain/pelvic pain - dysuria NO fever

BPH stands for benign prostatic hypertrophy. T/F?

False, hyperplasia (increase in cell #)

Enlargement of prostate is normal aspect of aging. T/F?

True

4 characteristic symptoms of BPH

dribbling hesitancy dysuria feeling of incomplete bladder emptying +/- overflow incontinence

How long for symptom improvement of BPH following 5-alpha reductase inhibitor use?

6-12 months

Onset of action for alpha 1 blockers for BPH?

Days - weeks

Where is the most common area of mets for prostate cancer?

Bones in vertebrae and pelvis --> increase in Alk phos in BW

Common S&S with prostate cancer

Hip/lower back pain ** worse at night and not relieved with position changes Difficulty urinating Hematuria Pain with urination/ejaculation

What scoring tool is used for BPH?

International prostate symptom score (IPSS)

PSA testing is only indicated for people who have > ____ years life expectancy and testing will change mgmt

10 years

IPSS score < 7 indicates what treatments for BPH

non-pharm

Non-pharm mgmt of BPH

``` Avoid caffeine, ETOH Fluid restrict at night Bladder retraining Avoid constipation Pelvic floor exercises ```

Most common SE of alpha 1 blockers

Dizziness ED - increased with tamosulin Floppy iris syndrome

True/False Initiate management in patients with low-risk prostate cancer (T1/T2, PSA < 10 ng/ml, and Gleason score < 7) before discussing active surveillance

False

PSA < 1 ng/ml repeat Q __years

PSA 1-3 ng/ml repeat Q ___years

If >/= 60 years with PSA < 1 >/= 70 years

D/C PSA testing

Surgical referral for BPH requires an IPSS >____

True/False | 5-Alpha reductase inhibitors reduces PSA so will need to consider for prostate cancer surveillance pts

true

T/F | Anticholinergics can be given if PVR <250 mls

True

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) duration > _____

6 months

What is a 4 glass test used for ?

Prostatitis | 1) initial stream urine 2) MSU 3) expressed prostatic secretions 4) post-prostatic massage urine

Pharm tx of acute prostatitis

Ciprofloxacin 500-750mg BID x 2-4 weeks OR TMP/SMX 1 DS tab PO BID x 2-4 weeks

Pharm tx of chronic prostatitis

Ciprofloxacin 500-750mg BID x 4-6 weeks OR TMP/SMX 1 DS tab PO BID x 4-6 weeks OR

Treatment of Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) = > 6 months

REFER

``` All of the following are symptoms of which: obstructive or irritative BPH? Slow stream Splitting or spraying Intermittent stream Hesitancy Straining Terminal dribble ```

Obstructive

All of the following are symptoms of which: obstructive or irritative BPH? ↑ daytime frequency Nocturia Urgency Incontinence Bladder sensation (ie. normal, increased, decreased, absent or non-specific)

Irritative

Classes of medications that can cause ED and what recreational drugs?

``` diuretics antidepressants (SSRI, TCA) Antihypertensives (ex. CCB, BB) H2 antagonists (ranitidine) Hormones (corticosteroids, 5 alpha reductase inhibitors) Methotrexate Anticholinergics ``` Recreational drugs - EtOH, cocaine

What scoring tool can be used for sexual dysfunction in males?

SHIM, Sexual Health Interview for Men

What BW is indicated for ED?

Testosterone level, if normal no further testing indicated

What is the most common type of ED in older adults? What is it secondary to?

Vascular ED, secondary to DM, HTN, dyslipidemia, PAD

Randomized trials demonstrate that _____ (med) is effective in most etiologies of ED with efficacies of up to 80%.

sildenafil (VIAGRA)

PDE5 red flags -

hypotension, erection > 4 hours, hearing loss, angina chest pain, vision loss

When to treat asymptomatic bacteriuria

Treat ONLY if upcoming instrumentation or if pregnant

Treatment for uncomplicated UTI

Nitrofurantoin 100 mg BID x 5 days Alternative: Fosfomycin 3gms x 1 dose

True/False Beers recommends avoiding long-term use of nitrofurantoin in those ≥65 years of age due to risk of adverse effects (e.g. pneumonitis).

True

Complicated UTI tx

Cefixime 400mg PO daily x 10 days

UTI with functional or anatomic abnormalities of GU tract OR males is considered ...

complicated

Screening for breast cancer: 50-74 years no additional risk factors

Every 2 years

Screening for breast cancer: 40-74 with first degree relative with breast cancer

Every year

Screening for breast cancer: 40-74 with first degree relative with breast cancer

Every year

Screening for breast cancer: 40-49 without a family hx of breast cancer

Talk to doctor

Screening for breast cancer: 75+

Talk to provider

Screening for breast cancer: 39-74 with high risk for breast cancer/ at least one of the following applies to you: You are a BRCA1 or BRCA2 carrier; You are an untested first degree relative of BRCA1 or BRCA 2 carrier; You have a very strong family history1 of breast cancer; or, You have had prior chest wall radiation.

Every year

All of the following are criteria are examples of what: Have breast implants Are pregnant or breastfeeding Have a previous history of breast cancer. Have any new breast complaints such as a lump or nipple discharge (see your health care provider immediately if you experience any new problems). Have had a mammogram on both breasts in the last 12 months (you must wait at least one year before having another screening mammogram)

You are not eligible for a screening mammogram

Women aged ≤ 30 years with breast complaints and/or symptoms (e.g., nipple discharge, mass) should have ______ as the initial investigation.

diagnostic | ultrasound

Women aged ≥ 30 years with breast complaints and/or symptoms should have _________ ___________as the initial investigations.

diagnostic mammogram and ultrasound

all of the following are what: • early menarche (before 12 years old) • late menopause (after 55 years old) • nulliparity or late age at first birth • use of hormone replacement therapy long-term • increasing age • breast density • personal history of breast cancer, lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia (ADH) • family history of breast cancer and/or ovarian cancer, particularly in a patient’s close relatives* on the same side of the family • personal or family history of mutation of the BRCA1/BRCA2 genes

Risk factors for breast cancer

``` True/False Which of the following baseline tumour markers may be considered for metastatic disease work-up for breast cancer? A) carcinoembryonic antigen (CEA) B) CA 125 C) cancer antigen (CA) 15-3 D) All of the above ```

D) all of the above

For patient with breast conserving interventions/radiation with + breast ca. What is the frequency of follow up?

Mammography: First diagnostic mammogram at 6 months after radiation completion and then annually for five years.

A _________ diary is an effective tool to help differentiate between real small volume frequency (associated with OAB) and polyuria.

voiding

First line treatment for OAB includes patient education. Which of the following are recommended topics for education? 1. Weight control 2. Physical Exercise 3. Management of bowel regularity 4. Smoking Cessation 5. Urgency Control & Suppression techniques 6. Management of fluid intake

All of the above

Which of the following are NOT considered Lower Urinary Tract symptoms (LUTS) of storage? Dysuria Urgency Frequency Nocturia

Dysuria

Which of the following conditions can contribute to abnormal voiding patterns? Dementia All of these are correct Anxiety Depression None of these are correct.

all of the above

Studies have shown a strong association between OAB in men and which of the following conditions? Hypertension Prostate Cancer Erectile Dysfunction Bladder Outlet Obstruction

Bladder Outlet Obstruction

Conjugated Estrogens/Bazedoxifene (CE/BZA) therapy can be safely and effectively paired with additional systemic: None of these Estrogen(s) Progestogen(s) SERM(s) Any of these

None of these

What is the average duration of vasomotor symptoms associated with menopause? ≤ 2 years 5-10 years 2-5 years 15+ years

5-10 years

Phosphodiesterase-5 Inhibitors are indicated for treatment of Lower Urinary Tract Symptoms in males. True False

True

What is the recommended place of non-hormonal drugs (e.g., antidepressants, gabapentin) in the management of vasomotor symptoms associated with menopause? Second line First line Not indicated

Second line

Hormone Therapy (HT) is generally contraindicated in all of the following scenarios EXCEPT: None of these Women with a history of breast cancer Women aged 65 years or older Women with acute CAD

Women aged 65 years or older

Phosphodiesterase-5 Inhibitors are associated with which of the following side effects? Headaches All Answers are Correct Flushing Back pain Dyspepsia

All Answers are Correct

Menopause prior to which age is considered premature menopause? 45 48 40 50