GU 1 Flashcards
MC site of obstruction for nephrolithiasis
ureterovesciular junction
MCC of nephrolithiasis
Inadequate Fluid Intake
What gender is more prone to nephrolithiasis?
Males
Meds predisposing to nephrolithiasis (4)
Loop diuretics
Acetazolamide
Antacids
Chemotherapy agents
MC nephrolithiasis stone
Calcium
4 types of nephrolithiasis stones
- Calcium
- Uric acid
- Struvite stones
- Cystine stones
Radiodense stones
Calcium
Struvite
Radiolucent stones
Uric acid
Cystine stones
persistently acidic urine can results in what type of stone?
uric acid
2nd MC nephrolithiasis stone
uric acid
nephrolithiasis stone type that is common in individuals with recurrent UTIs with urease-producing organisms
struvite stones
nephrolithiasis stones of alkaline urine
Struvite stones
nephrolithiasis stones with a genetic predisposition
cystine
Sudden onset of severe pain due to the stone moving through the ureter with obstruction and spasming is called
renal colic
Is N/V present in nephrolithiasis?
very common to have N/V
initial test for detection of stones that is often times skipped
kidney ureter bladder plain film test (KUB)
most useful test for defining degree and extent of urinary tract obstruction occurring in nephrolithiasis
intravenous pyelography (IVP)
radiology test that detects hydronephrosis or hydroureter that is not that helpful in visualization of a stone
renal u/s
Main thing to do when treating nephrolithiasis
IV fluids
severe pain management with opioids
ultrasound shock waves used to break up the stone in nephrolithiasis
extracorporeal shock wave lithotripsy
Fluids that can help prevent nephrolithiasis
real, natural lemonade
lotsa fluids
Diet modifications for nephrolithiasis
limit animal protein in hyperuricosuria patients
limit calcium intake in those that form calcium stones
med treatments for nephrolithiasis
thiazides reduce urinary calcium
allopurinol reduces uric acid in urine
Acute cystitis is MC in what gender
females
MC acute cystitis pathogen in children
E. coli
MC acute cystitis pathogen in sexually active young adults
C. trachomatis
MC acute cystitis pathogen in very young females learning to wipe
Enterococcus
Organism that is a common cause of acute cystitis that you should remember
Staphylococcus saprophyticus
What patients do you need blood cultures in with acute cystitis?
urosepsis patients
elderly patients
What common pharm agent is used as a first line in acute cystitis but is not to be selected if you suspect a possible pyelo or is an early pyelo?
Nitrofurantoin
urine analgesic for cystitis
phenazopyridine - turns things ORANGE
Do not use phenazopyridine in patients that have ____ allergies.
sulfa
Pregnant female acute cystitis pharm treatment
ampicillin
amoxicillin + CA
cephalosporins
Treatment duration for pregnant females with acute cystitis
7 - 10 days
Men with a UTI require what physical exam?
Digital Rectal Exam (DRE) to r/o prostatitis
Warfarin patients with acute cystitis are treated with what pharmacology agents
PCN
Cephalosporoins
Doxy
AVOID: FQ, TMP/SMX
Common complication of acute pyelonephritis
urosepsis and then onto septic shock
Common complication of acute pyelonephritis in diabetic patients
Emphysematous pyelonephritis due to gas-producing bacteria
GNR acute pyelonephritis treatment
TMP/SMX or FQ for 10 - 14 days
GPC acute pyelonephritis treatment
Amoxicillin for S. saprophyticus
How is treatment started in patients with acute pyelonephritis? (before you start them on a full regimen of ABX, you give this particular one time ABX to start)
Ceftriaxone or Gentamicin
Severe complicated acute pyelonephritis
ampicillin and getamicin IV
OR
cipro IV
interstitial cystitis is AKA
painful bladder syndrome
commonly affected population group for interstitial cystitis
females
> 40
hx of bladder problems as a child
Dx interstitial cystitis
painful filling of the bladder that is relieved with micturition
dx of exclusion
damaged bladder transitional epithelium and vasculature that results in bleeding
hemorrhagic cystitis
common viral causes of hemorrhagic cystitis
adenovirus (esp. in boys), influenza (immunocompromised)
male incontinence is usually from
BPH or after prostate surgery
MC incontinence in elderly
urge
MC incontinence in < 70
stress
Increased intraabdominal pressure results in _____ incontinence
stress
____ incontinence causing losses of large volumes of urine
urge
____ incontinence causing losses of spurts & small volume of urine
stress
____ incontinence causing frequent losses of small amounts of urine
overflow
_____ incontinence that has a large volume of residual urine after voiding
overflow
pharm agents for urge incontinence
anticholinergics - reduces the OAB
pharm agents for stress incontinence
estrogen replacement
pharm agents for overflow incontinence
cholinergic agents (increases bladder contractions to empty)
alpha adrenergics (decreases sphincter resistance)
initial test of choice for urinary tract obstruction
renal U/S
MC type of malignancy in GU
bladder carcinoma
type that predominates in bladder carcinomas
transitional cell carcinomas
definitive diagnostics of bladder carcinoma
cystoscopy & biopsy
pharm agent that frequently causes hemorrhagic cystitis
cyclophosphamide
chancroid disease is caused by…
Haemophilus ducreyi
Differences between chancroids of H. ducreyi and syphilis chancre
H. ducreyi: soft, ragged edges that is painful with tender LAD
Syphilis: painless “punched out” indurated, raised borders that’s crater like
school of fish gram staind
Chancroid (H. ducreyi)
Painful chancroid + suppurative lymphadenopathy = pathognomonic for _____
Chancroid (H. ducreyi)
painless, crater-like chancre (also described as “punched out”, indurated, raised borders, red/smooth base)
Syphilis primary stage
4-8 weeks after chancre
Maculopapular rash on palms/soles
Conydlomata lata (moist lesions on genitals) HIGHLY contagious
Syphilis secondary stage
positive serological tests with sx
Syphilis latent stage
can occur anytime after primary infection
Syphilis tertiary stage
small, irregular pupil that constricts normally to near accommodation but not to light
Argyll-roberson pupils of syphilis
posterior column deterioration, leading to ataxia, areflexia, burning pain, weakness
tabes dorsalis of syphilis
dementia, personality changes, HAs, meningitis, incontinence
neurosyphilis
syphilitic aortitis with ascending AA
CV effects of syphilis