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Family Medicine > GU > Flashcards

GU Flashcards

1
Q

BPH

A

MC benign tumor in men: hyperplastic process d/t inc cell number; originates from Transition Zone*
- incidence is age related

Sxs: hesitancy, dec force of stream, sensation of incomplete emptying, double voiding, straining

  • early: OVS
  • late: IVS

Dx: eval sxs using AUA I-PSS survey

  • DRE (round w/medium sulcus); UA, BUN/SCr; PSA
  • Other: post-void residual, US, TRUS, bx, renal U/S
Tx: 
AUA 0-7: watchful waiting
AUA 8+: 
- alpha 1a AAG: tamsulosin
- 5 alpha reductase inhibitor: finasteride, dutasteride [dec PSA levels, cause ED, dec libido]

Refractory or complications: TURP

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2
Q

Erectile dysfunction

A

MC cause: atherosclerosis (MetSyn)

Sx: libido vs. erection vs. ejaculation

Dx: U/S or angiography

Tx:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

Other: injection of prostaglandin, vacuum or inflatable penis prosthesis

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3
Q

Hydrocele

A

Collections of serous fluid in tunica vaginalis or persistent processes vaginalis

Sxs: fluctuant nontender, ovoid, mobile

Congenital (MC, 0-2yo) - a/w inguinal hernia, communicate w/abd cavity
Secondary (men >40) - infection, trauma, torsion, CA, post renal transplant, radiation

Dx: transillumination* [can see through it, not solid]
- consider U/S to r/o other more serious pathology

Tx: refer to urology
- congenital resolve spontaneously

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4
Q

Varicocele

A

Engorgement of testicular veins (pampiniform plexus)

Sxs: acute onset may be indicative of RCC

  • usually left sided
  • asx or “bag of worms” feeling
  • dec in size when patient supine
  • may affect semen quality/fertility

Dx: PE

Tx: refer to urology for surgery

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5
Q

Stress incontinence

A

MC: middle aged women (post-vaginal deliveries)
- d/t weakened pelvic floor muscles

Sxs: involuntary loss of uring during periods of increased intraabdominal pressure
- coughing, laughing, sneezing, exercise

Tx:

  • pelvic floor muscle training w/PT (kegels)
  • biofeedback
  • suburethral sling (surgery) if conservative mgmt fails
  • last option: duloxetine
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6
Q

Urge incontinence

A

Causes:

  • neurogenic (stroke)
  • obstruction
  • inflammation (cystitis)
  • DM
  • iatrogenic

Sxs: involuntary loss of urine preceded by urgency [leakage prior to reaching bathroom]
- detrusor instability

Dx: GU exam, stress test, PVR

Tx:

  • bladder retraining*
  • prompted voiding, kegels, fluid mgmt
  • 2nd line: antimuscarinics (oxybutynin)
  • surgery
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7
Q

Mixed incontinence

A

Stress incontinence + symptomatic urgency

Tx depending on predominant sx

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8
Q

Overflow incontinence

A

Causes: BPH, prostate CA, stricture, uterine prolapse
- meds: CCBs, nasal decongestant, antihistamine, antipsychotics, morphine

Sxs: involuntary loss of urine a/w bladder distension
- bladder outlet obstruction OR inadequate bladder contraction

Dx: PVR, catheter, urodynamics, imaging

Tx: correct reversible causes; timed voiding
- selective alpha blockers (Tamsulosin)

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9
Q

Phimosis

A

Contracted foreskin cannot be retracted over glans

  • commonly d/t chronic infection* from poor hygiene
  • usually uncircumscribed males

Sxs: edema, erythema, foreskin tenderness; purulent d/c; inability to retract foreskin

Tx: abx; possible circumcision (refer to uro)

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10
Q

Paraphimosis

A

Retracted foreskin over glans cannot be placed in normal position

  • may lead to impaired blood and lymphatic flow
  • resulting in arterial occlusion and possible glans necrosis

Tx:

  • manual reduction* may require incision of constricting ring under L.A.
  • circumcision by Uro = definitive tx
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11
Q

Cystitis

A

Uropathogen colonizes periurethral mucosa and ascends through urethra and bladder
- MC: e. coli

RF: prior UTI, Fhx, sex, new partner w/in last year, use of spermicide
- common in women after sex; looks like Chlamydia

Uncomplicated: absence of structural or functional abnormalities
Complicated: underlying renal disease

Sxs: acute dysuria, inc frequency, suprapubic pain
- systemic toxicity absent

Dx: UA > 10 WBC [+LE, nitrates] and Ucx > 10^3 cfu/ml
- urine pregnancy

Tx:

  • <20% E coli: TMP-SMX 160/800mg bid x 3d
  • > 20% E coli: Nitrofurantoin 100mg bid x 5d OR Fosfomycin 3g x 1

Other:

  • cipro/levo x 3d (careful for c. diff)
  • phenazopyridine (pyridium) for pain control and hot sitz baths
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12
Q

Epididymitis & Orchitis General

A

Inflammation of epididymis, testes +/- infection

  • acute < 6wk
  • subacute 6wk-3mo
  • chronic >3mo

Orchitis: epididymis inflammation spreads to adjacent testicle
- isolated orchitis a/w mumps or amiodarone use*

Bimodal distribution: 16-30yo; 50-70yo [MC 18-35]

RF: unprotected sex, MSM, INC # of partners, STDs, GU abn

Sxs:

  • testicular pain, swelling, usually beginning posteriorly over epididymis
  • lower UTI sxs possible
  • +/- fever
  • assess CVA tenderness
  • suprapubic pain to r/o UTI
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13
Q

Epididymitis & Orchitis Dx/Tx

A

Testicular exam
Prehn Sign: relief of pain w/elevation of testes* = epididymitis
Inguinal exam for hernia or LAD

First-void “dirty” UA:
- +LE, >10 WBC/hpf = urethritis, favoring dx of epididymitis
UCx
Gram stain: gram-negative intracellular diplococci = gonococcal

Testicular color doppler U/S: thickening epididymis w/INC blood flow suggesting hyperemia

Tx:

  • sexually active men <35 (or older men w/RF for STI): ceftriaxone 250mg x1 IM + doxy 100mg po bid x 10d
  • > 35 or no RF for STI: levofloxacin 500mg Po x 10d

supportive: NSAIDs for pain, ice/elevation of testes while at rest

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14
Q

Acute Bacterial Prostatitis

A

Inflammation of prostate from infection: ascending infection from bladder into prostatic ducts result in immune response secondary to bacterial infection resulting in edema and hyperemia of prostate
- MC adult men

Pathogens:

  • men 14-35: N. gonorrhea, C. trachomatis [tx: cef + doxy]
  • Boys < 14, men > 35: E. coli [tx: FQ or TMP-SMX]

Sxs: abrupt onset fever, chills; IVS; perineal/sacral/suprapubic pain

PE: gentle DRE = enlarged, tender, warm, boggy prostate

  • abdominal exam to detect distended bladder
  • CVAT

Dx: blood work if admitted
- UCx - gonorrhea/chlamydia NAAT

Tx: abx, hydration, pain control, straight cath prn

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15
Q

Chronic bacterial prostatitis

A

Prostate infection >3mo + urine culture shows same bug
- 80% e. coli; 15% enterococcus

Sxs: not ill appearing, just discomfort

  • presents w/recurrent or relapsing UTIs, urethritis, or epididymitis w/same bacteria
  • IVS, testicular/perineal/low back pain
  • afebrile, normal DRE

Dx: UA, Clx

Tx:

  • FQ x 4-6wk, may treat up to 3-4mo
  • refer to uro
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16
Q

IVS

A

(storage)

frequency
urgency
urge incontinence
nocturia

17
Q

OVS

A

(voiding)

hesitancy
poor +/- intermittent stream
straining
prolonged micturition
feeling of incomplete bladder emptying
dribbling

Family Medicine (17 decks)

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