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FNPII Test 3 > GU > Flashcards

GU Flashcards

1
Q

inflammation of the glans penis and the foreskin (prepuce of uncircumcised male)

A

Balanitis (penis only)/balanoposthitis (penis + foreskin)

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2
Q

Inflammation, erythema, drainage, foul odor, phimosis (foreskin is too tight to be pulled back over the head of the penis), Paraphimosis (urologic emergency, occurring in uncircumcised males, in which the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue)

A

Balanitis (penis only)/balanoposthitis (penis + foreskin)

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3
Q

how to dx and tx Balanitis (penis only)/balanoposthitis (penis + foreskin)

A

Diagnostic =Urine culture

Tx
Based on cause → tx per urine culture results
Proper hygiene
Topical OR systemic abx
Avoid irritants (bubble baths, powders; sexually active: spermicides, lubricants)

clean between the foreskin and the glands with a cotton swab, rinse with clear water to avoid forcibly retracting the foreskin in young boys

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4
Q

Congenital defect of male urethra with abnormal ventral placement of urethral opening (can be on glans, penile shaft, scrotum or perineum)

A

Hypospadias

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5
Q

Newborns: asymmetrical foreskin (no circumcision!)
Urine stream deflection, may not be able to stand while urinating; erectile issues r/t penile curvature, intercourse difficulties
Chordee = curvature

A

Hypospadias

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6
Q

Occurs in groin when a segment of bowel has slipped through the inguinal ring

A

Inguinal hernia

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7
Q

inflammation of unilateral or bilateral testicles r/t systemic blood-borne infection
Usually seen with epididymitis

A

Orchitis

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8
Q

Sudden onset of scrotal pain (24-48 hours); pain and edema of scrotum, fever, dysuria, associated reactive hydrocele, leukocytosis, + Prehn’s sign
Seen with mumps in 20-30% of cases
50% will develop atrophy in area, 30% → infertility

A

Orchitis

Supportive therapy + abx → sx resolution in 4-5 days

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9
Q

Acute or chronic inflammation of the epididymis most often from bacterial infection (acute <6 wks; chronic >6 wks)
Most common cause of scrotal pain in primary care
Recurrent epididymitis should be evaluated for structural abnormalities of urinary tract
CM
SEVERE edema/pain to scrotum
Fever, rigors, urinary symptoms

A

Epididymitis

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10
Q

Common pathogens for Epididymitis
Men <35
Men >35

A

Men <35: STI → chlamydia, gonorrhea
Make sure you do a thorough sexual hx!
Men >35: e coli, pseudomonas

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11
Q

Acute: induration and edema of involved epididymis, severe scrotal tenderness, possible erythema, reactive hydrocele, Prehn’s sign* (elevate scrotum → decreases pain)
Chronic: subtle epididymal induration and tenderness, with or without edema, inflammatory nodule may be palpable

A

Epididymitis

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12
Q

How to dx and tx Epididymitis

A

Dx= PE + urine study
STI cultures for patients with urethral discharge
US if ANY concerns for testicular torsion!

tx= Ice, scrotal elevation, NSAIDs, jock straps
STI: ceftriaxone + doxy/azithromycin (1x dose)
Enteric organism: ofloxacin OR levofloxacin (fluoroquinolones) 10 days of abx, may need more
Severe epididymitis and testicular pain → refer to urology for possible surgery; septic → ED

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13
Q

Acquired buildup of fibrous tissue on tunica albuginea → penil deformity, mass (plaques), pain, curvature and potentially erectile dysfunction
ED typically first sign of any plaque buildup (before CV sx!!)
Cause: unknown

A

Peyronie’s Disease

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14
Q

Palpable plaque or induration noted on penile shaft

A

Peyronie’s Disease

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15
Q

tx of Peyronie’s Disease?

A

Refer to urology, counseling (body image and ED problems)

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16
Q

foreskin is too tight to be pulled back over the head of the penis

A

phimosis

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17
Q

urologic emergency, occurring in uncircumcised males, in which the foreskin becomes trapped behind the corona and forms a tight band of constricting tissue

A

Paraphimosis

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18
Q

formation of stones typically made up of calcium, oxalates, and uric acid
RF: Obesity, diet high in salt, animal protein, organ meat. Inadequate water intake

A

Renal Calculi

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19
Q

colic with pain radiating to ipsilateral abdomen or groin, n/v, hematuria, fever, chills, dysuria, vague abd, flank, or groin pain.
PE: no signs of peritoneal irritation, soft, nontender, nondistended abdomen. Fever, tachycardia, elevated BP, CVA tenderness, diaphoresis.

A

Renal Calculi

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20
Q

Diagnostics for Renal Calculi?

A

UA (hematuria) and urine C&S (UTI). Strain urine, CMP, CBC if fever present, 24-hr urine sample (2 are preferred). If serum Ca elevated suspect hyperparathyroidism and obtain PTH and vitamin D (low vit D can mask hyperparathyroid).
ABD x-ray or KUB
Low-dose non-contrast CT (NCCT) gold standard for diagnosis
Renal US for pregnant women and children

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21
Q

How to tx Renal Calculi?

A

oral hydration, pain management, and passage of stone= NSAIDs, CCB or alpha-blocker (aid in relaxing smooth muscles and widen channels to allow stone passage) Nifedipine or tamsulosin
10cm or larger need surgical tx, refer children to a urologist

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22
Q

Stone-specific pharm management-> Calcium

A

thiazide diuretics; persistent → allopurinol

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23
Q

Stone-specific pharm management->Uric acid

A

potassium citrate, allopurinol if unsuccessful, febuxostat if gout

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24
Q

Stone-specific pharm management-> Struvite

A

ABX and surgical intervention

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25
Q

Stone-specific pharm management-> Cystine→

A

D-Penicillamine and tiopronin (Thiola)

26
Q

Diagnostics for scrotal trauma

A

UA; Hematuria → injury to bladder, kidneys or urethra

Transillumination
If not clear → could be hematoma

Doppler US-> Preferred method of evaluation!

27
Q

Epididymal sperm-filled cyst arising above testes
Nontender, palpable, movable mass
Transillumination

A

Spermatocele

28
Q

Peritoneal fluid accumulation b/ween parietal and visceral layers of the tunica vaginalis of the testicle
Can occur as reaction to->
testicular torsion, tumor, epididymitis, orchitis, trauma
All must be ruled out!

Usually asymptomatic; considerable scrotal edema, may increase in size throughout day OR during valsalva maneuver

A

Hydrocele

29
Q

Diagnostic and tx for Hydrocele

A

Cystic scrotal fluid collection will transilluminate! (tumor will not)

Treatment
Not necessary unless pain/pressure
Usually resolve when underlying is treated
Surgical excision of hydrocele sac

30
Q

Dilation of the pampiniform plexus of spermatic veins (spermatic cord has the texture of a bag of worms); typically present for infertility issues

A

Varicocele

31
Q

Asymptomatic or dull, aching pain; discomfort relieved by recumbent position; testicular atrophy or decreased fertility

PE: Feels like a bag of worms; most often left-sided; decreases when pt is supine (clinical pearl for diagnosis!!)

A

Varicocele

32
Q

Dx for varicocele?

Tx?

A

Semen analysis → test infertility
Graded 1-3 (1 small, only palpable upon standing; 3 is large and palpable)
US→ dilated pampiniform plexus vessel >2-3mm

tx: NSAIDS, scrotal support
Urologic surgery referral for infertility (usually reverses)

33
Q

Palpable mass often associated w/ swelling-
Painless, firm, non-movable mass

Younger males (20-35 y/o), scrotal trauma, atrophy, cryptorchidism (undescended testicle) not repaired in first 2 years of life, exogenous estrogen exposure, fam hx of testicular cancer

A

Testicular Masses/ Testicular Cancer

34
Q

Dx and Tx of Testicular Masses/ Testicular Cancer?

A

US
Beta hCG, LDH, alpha-fetoprotein → if elevated it is likely testicular cancer

Tx= REFERRAL!

35
Q

Rotation of testicle and twisting of spermatic cord → reduced blood flow and ischemia to testicle
Time = testicle!
<6 hours twisted = 90-100% survival rate; >12 hours = 20-50%; >24 hours = 0-10%

A

Testicular Torsion

36
Q

Unilateral testicular pain SEVERE, n/v, ill appearing, anxious, avoiding mvmt, teste swollen unilaterally

A

Testicular Torsion

37
Q

Testicular Torsion rating Scale

A 
n/v (1 point)
Testicular swelling (2 points)
Hard testis on palpation (2 points)
High riding testes (1 point)
Absent cremasteric reflex (1 point)
Score > or equal to 5  = 76% likely to be TT; < or equal to 2 excludes with 100%
38
Q

Diagnostic for testicular torsion

A

UA (usually normal in TT), if positive → look at epididymitis/orchitis
Doppler US: look for ischemia → tx based on results
Typically done in ED after referred out!!
Differential dx: torsion of appendage teste (tx with NSAIDs, warm compress)

39
Q

Risk factors for pedi UTIs

A

Infant uncircumcised males during 1st year of life
Males in general are at lower risk
UTIs are generally more common in females
Neurogenic bladders
Sexual activity in young females

40
Q

Clinical Presentation of pedi UTIs

A

Infants
Fever, foul smelling urine, vomiting, diarrhea, poor feeding,

Older children/adolescents
Fever, dysuria, frequency, incontinence, suprabubic discomfort, abdominal pain,

41
Q

Clinical tests/ findings for UTIs

Best =

A

catheterized; midstream clean catch otherwise

42
Q

Clinical tests/ findings for UTIs

Urine dipstick=

A

Positive leukocytes, nitrites, WBCs, RBCs

Nitrites have to sit in bladder for 4 hours for be detected (neg nitrite can lead to false neg)

43
Q

Clinical tests/ findings for UTIs

Conventional UA vs. Enhanced UA

A

Use centrifuge, look at urine under microscope
5 or > WBC or high-powered field and bacteria → UTI

enhanced= Conventional + gram stain
Ex: WBC + positive gram stain → UTI
The most common pathogen found in urine culture → e. coli

44
Q

treating pedi UTIs

A

(usually with 3rd gen cephalosporin) ex. Cefdinir, cefixime, Cefuroxime
If symptomatic → treat while waiting on cx results

Children 2–24 months of age with a febrile UTI, UTI, or urinary tract abnormalities should receive 7–14 days of antibiotic therapy
Older children without fever or significant history, likely to have uncomplicated cystitis, can receive a short course of antibiotics for 5–7 days

45
Q

frequency, urgency, dysuria, suprapubic pain, odorous urine, hematuria.

Complicated CM: CVA tenderness, n/v

A

UTI- Adult

46
Q

how to dx adult UTI?

A

UA and urine dipstick(blood). Urine culture (definitive)
Leukocyte esterase → WBC in urine, not always present

US for: Children younger than 2 with febrile UTI, Any age recurrent febrile UTI, Fam hx of urologic or kidney problems

Retest for cure in all men with UTI

47
Q

how to tx uncomplicated UTI in nonpregnant women 16 & older:

A

nitrofurantoin (avoid in G6PD deficiency) OR trimethoprim-sulfamethoxazole

48
Q

how to tx Lower UTI pregnant in 1st trimester

A

1st trimester: cephalexin, amoxicillin, augmentin, and ampicillin

49
Q

how to tx UTI in men?

A

trimethoprim-sulfamethoxazole, nitrofurantoin, and augmentin. Alt: cipro and cephalosporins

50
Q

How to tx postmenopausal women with recurrent UTI

A

add topical estrogen

51
Q

UTI education for women?

A

void after intercourse, drink adequate water, wipe front to back, wear appropriate fitting underwear (not too tight)

52
Q

Bacterial infection of kidneys resulting from ascending, untreated, or inadequately treated lower UIT

A

Pyelonephritis

53
Q

how to tx Pyelonephritis?

A

broad spectrum ABX cephalosporins and fluoroquinolones. Improvement should be seen within 48-72 hrs of tx initiation.

54
Q

the retrograde passage of urine from the bladder into the upper urinary tract

predisposes patients to acute pyelonephritis, which could lead to HTN, renal scarring, end-stage renal disease

A

Vesicoureteral Reflux (VUR)

55
Q

Most common…failure of the anti reflux mechanism is due to a congenitally short intravesical ureter

A

primary VUR

56
Q

less common… Caused by high pressures in UVJ (not able to close) = bladder/ bowel dysfunction/ neurogenic bladder

A

secondary VUR

57
Q

Which children should have a diagnostic/radiologic workup after a UTI for VUR?

A 
Recurrent febrile UTI
A febrile UTI under two years old
Boys with UTI
Hypertension
Family hx of urinary tract abnormalities
58
Q

when to get Renal/bladder US to r/o VUR?

A

(2-24 months following 1st febrile UTI)

Goal = prevent renal scarring

59
Q

Established presence and degree of VUR - takes pictures as child is urinating, done when child is asymptomatic/ last days of abx b/c use catheter.
Avoid until after 2nd febrile UTI or abnormalities 1st time

A

Voiding cystourethrogram (VCUG)

60
Q

Nuclear med test to dx VUR … no radiation with the scan but with the injected isotope
Used for follow up … not initial test
Diagnosis of reflux!

A

Radionuclide cystogram (RNC)

61
Q

Treatment plan for UTI/Pyelonephritis prevention/ Antibiotic prophylaxis indication with VUR

A

All children not toilet trained
All children with bladder and bowel dysfunction (BBD)
All children with high grade reflux (grade III to V)

62
Q

Prophylactic VUR antibiotic recommendations and dosing:

A

Over the age of two months: Bactrim (TMP-SMX) or TMP alone based on TMP dosed at 2mg/kg/day daily
Macrobid (Nitrofurantoin) 1–2mg/kg daily (meds can be changed if side effects)
Can cause hyperbilirubinemia <2 y/o!!

STOP prophylactic abx if:
VUR resolves spontaneously, surgical correction
MUST be verified by normal VCUG test

FNPII Test 3 (7 decks)

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