GU Flashcards
What is needed to diagnose UTI?
At least 100,000 organisms in asymptomatic pt and more thatn 100 org/ml iwth pyuria in symptomatic pt
UTIs are more common in sexually active woman? T/F
True
What is the leading cause of UTI in young men?
STI
What is the leading cause of UTI in older men?
Prostate issues
What is findings on urine dip are associated with UTI?
+ Nitrites & leukocytes
What is the first line therapy in female uncomplicated UTI?
Nitrofurantoin (macrobid) 100mg bid x 7d (5d)
Keflex
Bactrim DS bid X 3 days
What is the standard treatment for UTI in males?
Young men: Doxycycline 100mg bid x 7-10 days
Older men: cipro 500mg bid x 7-10 days
What are the common causative organisms for UTI in women?
E Coli #1 Klebsiella Proteus Staph/Strep (usually sexual activity) B strep in pregnant females are always treated
What findings are present in acute pyelonephritis?
Systemic findings: Fever, tachycardia, N/V and general illness
Flank pain & CTA tenderness
When should a pt w/ pyelonephritis be referred to the ED & admitted?
Pregnancy, severe N/V and dehydration, or fever >101
Also- ill elderly
What is the recommended treatment for pyelonephritis?
Rocephin 500-1000mg IM then:
- Cipro 500mg bid 5-7 days
- levofloxacin 750mg qd x 5-7d
- Bactrim DS 7-10day (only if known pathogen)
- Augmentin bid 10-14 days
- cefdinir 300mg bid 10-14 days
How often should an OP pyelonephritis return for re-eval?
In 24-48 hrs then in 3-5 days for repeat UA if improving
What 2 tests are standard to elevalute prostate for CA/BPH?
DRE & PSA
What is the normal PSA?
<4
What is the first line treatment for BPH and how does it work?
Alpha 1 receptor agonist relax the smooth muscle of the bladder neck and prostate/urethra: (terazosin, doxazosin, tamulosin)
What drugs reduce the size of the prostate gland?
5alpha reductase inhibitors: Finasteride & dutasteride blocks DHT
Can 5 alpha reductase inhibitors and alpha-1 blockers be combined?
Yes
What other type of drugs can be used to treat sx of BPH?
Anticholinergics: Oxybutynin and Tolterodine help with urinary sx (frequency, nocturia and urgency)
If a patient is on finasteride, would an elevated PSA be considered normal?
No
+ Phren sign is commonly found in_____?
Epididymitis (pain is relieved w/ testicular elevation)
What would be the recommended treatment for a man under the age of 35 for epidymitis?
Rocephin 500mg IM x1
And
Axithromycin1g PO once
OR Doxycycline 100mg bid x 10 days
What would be the recommended treatment for a man over the age of 35 with low risk for STI for epidymitis?
Cipro 500mg bid x10d
OR
Levofloxacin 500mg qd x10d
Testicilar torsion usually lacks which two signs
Absent cremasteric sign
-phren sign
What are the common presenting symptoms with acute prostatitis?
decreased urine flow & dysuria Lower back/rectal pain Pain with ejaculation or defecations Increased pain with sitting Fever/chills/malaise
What is the treatment for prostatitis unlikely to be related to STI?
Cipro 500mg bid x 3-4 weeks
Doxycycline 100mg bid x 3-4 weeks
Bactrim DS bid x 3-4 weeks
Levaquin 500mg q day x 3-4 weeks
If prostatitis is possible related to Gonorrhea or Chlamydia, what is the treatment of choice?
Rocephin 1gm x 1
Doxycycline 100mg bid x7days
What can be used to treat the discomfort of prostatitis?
NSAIDS & stool softners
Testicular torsion generally presents as?
Young atheletic male sudden onset severe unilateral testicular pain without cremasteric sign and - phren sign.
What are two differentiators between epidymitis and torsion?
epidymitis with have + prehns sign and + cremasteric sign
Torsion will be negative to both
At what age should both testicles be decended?
1 year
A varicele is_____?
A dilated spermatic vein, resembles a “bag of worms”
Can be painless or painful
Reproduced when standing and resolves w/ sitting
Tx w/ NSAIDS and referral
Functional incontinence is when?
There is a physiologicial or cognitive disability
Sudden sensation of urge, difficulty in making it to the bathroom in time, and leakage is usually found in this type of incontinence?
Urge
Overflow incontinence causes _____?
Dribbing from over-distended bladder due to chronic distention & poor emptying of urine
Overactive and unstable detrusor muscle causes what type of incontinence?
Urge incontinence
Stress incontinence is generally treated with?
Kegel exercises, bladder training, and timed voiding. Estrogen cream twice weekly for post menopausal women.
Urge incontinene is usually treated with?
Toviaz, Vesicare, Ditropan and oxybutynin to treat over-active bladder
Overflow incontinence is commonly seen with _____ conditions?
Neurological disorders (spinal cord, myesthenia gravis, dementia, parkinsons)
Outlet obstruction (prostate, mass, cystocele)
Fecal impaction
Medications (sedatives/opiates)
