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NUNP 547 - Older Adult > Genitourinary - Final > Flashcards

Genitourinary - Final Flashcards

1
Q

T/F

UI severity increases without treatment

A

True

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2
Q

T/F

Annual routine screening for UI in older adults is not indiciated

A

Fale, reccomended

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3
Q

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

A

False

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4
Q

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

A 
Anticoagulants
Antidepressants (SSRI & TCA)
Hormonal contraceptives
Tamoxifen - treatment for breast ca. 
Antipsychotics (first generation and risperidone), Corticosteroids
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5
Q

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

A

Herbs: ginseng, chasteberry, danshen
Alcohol
Vitamin E

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6
Q

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

A

Transvaginal US - endometrial thickness of 99% for endometrial cancer

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7
Q

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

A 
Age >60
postmenopausal status
nulliparity
diabetes
obesity, (BMI>30) 
PCOS
HNPCC- Hereditary non-polyposis colorectal cancer
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8
Q

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

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

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9
Q

Red flags to rule out for urinary incontinence

A

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

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10
Q

DIAPERS mnemonic for reversible causes of urinary incontinence

A

D

Delirium

I

Infection (urinary tract)

A

Atrophic

P

Pharmacological

P

Psychological

E

Endocrine/excess urine output

R

Restricted mobility

S

Stool impaction

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11
Q

What diagnostics to consider for urinary incontinence?

A 
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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12
Q

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

A

Overflow incontinence

BPH

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13
Q

Pharm treatment of overflow incontinence?

A

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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14
Q

Most common type of incontinence in older adults

A

Urge

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15
Q

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

A

12 months

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16
Q

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.

A

True

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17
Q

Contraindications to HRT

A 
Unexplained vaginal bleeding
Known or suspected breast cancer
Acute liver dx
Active VTE dx
Acute CVD
Recent CVA
Pregnancy
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18
Q

Function of PSA

A

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

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19
Q

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

A

50

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20
Q

90% of males have BPH by the age of ___

A

85

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21
Q

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

A

False, can be benign hyperplastic nodules

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22
Q

T/F? PSA is elevated in BPH?

A

True

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23
Q

Treatment of BPH

A

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

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24
Q

Patho of BPH

A

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

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25
Q

Most common causes of prostatitis in older adults

A

E. coli

Pseudomonas

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26
Q

Warm, tender and boggy prostate on DRE indicates

A

Prostatitis

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27
Q

Which of the following are associated with chronic prostatitis presentations?

  • fever
  • low back pain/pelvic pain
  • dysuria
A
  • low back pain/pelvic pain
  • dysuria

NO fever

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28
Q

BPH stands for benign prostatic hypertrophy. T/F?

A

False, hyperplasia (increase in cell #)

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29
Q

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

A

True

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30
Q

4 characteristic symptoms of BPH

A

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

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31
Q

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

A

6-12 months

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32
Q

Onset of action for alpha 1 blockers for BPH?

A

Days - weeks

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33
Q

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

A

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

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34
Q

Common S&S with prostate cancer

A

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

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35
Q

What scoring tool is used for BPH?

A

International prostate symptom score (IPSS)

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36
Q

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

A

10 years

37
Q

IPSS score < 7 indicates what treatments for BPH

A

non-pharm

38
Q

Non-pharm mgmt of BPH

A 
Avoid caffeine, ETOH
Fluid restrict at night
Bladder retraining
Avoid constipation
Pelvic floor exercises
39
Q

Most common SE of alpha 1 blockers

A

Dizziness
ED - increased with tamosulin
Floppy iris syndrome

40
Q

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

A

False

41
Q

PSA < 1 ng/ml repeat Q __years

A

4

42
Q

PSA 1-3 ng/ml repeat Q ___years

A

2

43
Q

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

A

D/C PSA testing

44
Q

Surgical referral for BPH requires an IPSS >____

A

8

45
Q

True/False

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

A

true

46
Q

T/F

Anticholinergics can be given if PVR <250 mls

A

True

47
Q

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

A

6 months

48
Q

What is a 4 glass test used for ?

A

Prostatitis

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

49
Q

Pharm tx of acute prostatitis

A

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

50
Q

Pharm tx of chronic prostatitis

A

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

51
Q

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

A

REFER

52
Q 
All of the following are symptoms of which: obstructive or irritative BPH?
Slow stream
Splitting or spraying
Intermittent stream
Hesitancy
Straining
Terminal dribble
A

Obstructive

53
Q

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)

A

Irritative

54
Q

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

A 
diuretics
antidepressants (SSRI, TCA)
Antihypertensives (ex. CCB, BB)
H2 antagonists (ranitidine)
Hormones (corticosteroids, 5 alpha reductase inhibitors)
Methotrexate
Anticholinergics

Recreational drugs - EtOH, cocaine

55
Q

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

A

SHIM, Sexual Health Interview for Men

56
Q

What BW is indicated for ED?

A

Testosterone level, if normal no further testing indicated

57
Q

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

A

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

58
Q

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

A

sildenafil (VIAGRA)

59
Q

PDE5 red flags -

A

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

60
Q

When to treat asymptomatic bacteriuria

A

Treat ONLY if upcoming instrumentation or if pregnant

61
Q

Treatment for uncomplicated UTI

A

Nitrofurantoin 100 mg BID x 5 days

Alternative:
Fosfomycin 3gms x 1 dose

62
Q

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).

A

True

63
Q

Complicated UTI tx

A

Cefixime 400mg PO daily x 10 days

64
Q

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

A

complicated

65
Q

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

A

Every 2 years

66
Q

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

A

Every year

67
Q

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

A

Every year

68
Q

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

A

Talk to doctor

69
Q

Screening for breast cancer: 75+

A

Talk to provider

70
Q

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.

A

Every year

71
Q

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)

A

You are not eligible for a screening mammogram

72
Q

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

A

diagnostic

ultrasound

73
Q

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

A

diagnostic mammogram and ultrasound

74
Q

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

A

Risk factors for breast cancer

75
Q 
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
A

D) all of the above

76
Q

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

A

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

77
Q

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

A

voiding

78
Q

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
A

All of the above

79
Q

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

Dysuria

Urgency

Frequency

Nocturia

A

Dysuria

80
Q

Which of the following conditions can contribute to abnormal voiding patterns?

Dementia

All of these are correct

Anxiety

Depression

None of these are correct.

A

all of the above

81
Q

Studies have shown a strong association between OAB in men and which of the following conditions?

Hypertension

Prostate Cancer

Erectile Dysfunction

Bladder Outlet Obstruction

A

Bladder Outlet Obstruction

82
Q

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

A

None of these

83
Q

What is the average duration of vasomotor symptoms associated with menopause?

≤ 2 years

5-10 years

2-5 years

15+ years

A

5-10 years

84
Q

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

True
False
A

True

85
Q

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

A

Second line

86
Q

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

A

Women aged 65 years or older

87
Q

Phosphodiesterase-5 Inhibitors are associated with which of the following side effects?

Headaches

All Answers are Correct

Flushing

Back pain

Dyspepsia

A

All Answers are Correct

88
Q

Menopause prior to which age is considered premature menopause?

45

48

40

50

A

40

NUNP 547 - Older Adult (19 decks)

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