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FNP 3- Test 3 > GU > Flashcards

GU Flashcards

1
Q

hesitancy, decreased caliber and force of stream, post void dribbling

A

Bladder outlet obstruction (BOO)

- sx of BPH

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2
Q

frequency, urgency, nocturia

A

lower urinary tract sx (LUTS):

- sx of BPH

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3
Q

One of most common disorders in older men
Increased # of stromal and epithelial cells within the prostate gland itself → enlargement
Associated with lower urinary tracts sx (LUTS)
Divided into 3 groups: filling and storage sx, voiding sx, post-micturition sx
These have a large impact on QOL → monitor closely

A

BPH

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4
Q

PE for PBH

A

DRE (nontender, rubbery and smooth, often can’t feel median sulcus), quantify sx using AUA Symptom index for BPH, lower ABD exam, neuro exam (focused to assess sacral nerve roots)

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5
Q

Diag for BPH

A

U/A, BMP, bladder ultrasound for post void residual, PSA?

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6
Q

How to manage BPH

A

Behavioral modifications
Alpha-blockers, 5ɑ-reductase inhibitors, phosphodiesterase 5 inhibitors
TURP (transurethral incision of the prostate), Prostatectomy

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7
Q

Shrink the gland, can take 6-12 mos for effect. Avodart can affect PSA results. Given for BPH

A

5ɑ-reductase inhibitor: dutasteride and finasteride

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8
Q

administer at bedtime to reduce dizziness and assist urine flow. Given for BPH

A

alpha -adrenergic antagonists: Terazosin and doxazosin

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9
Q

Asymptomatic in early stages then may develop -> urinary hesitancy, urgency, nocturia, frequency & hematuria.
> advanced = back pain and impotence, signs of metastasis

A

Prostate cancer

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10
Q

How to manage prostate cancer

A

watchful waiting - monitoring PSA and DRE- if no mets

Radiation, Brachytherapy, hormonal therapy (goal = suppress testosterone), surgery

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11
Q

Diagnosing Prostate CA?

A

PSA (above 4 ng/mL; although can be normal)
4-10ng/mL may suggest early prostate CA;

above 10 ng/mL suggest CA; PSA velocity (rate of rise) more than 0.75ng/mL; DRE, TRUS (transrectal US) with biopsy.

Younger men PSA > 2.6ng/mL consider biopsy

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12
Q

What to do after tx for prostate cancer?

A

recheck PSA at 6 and 12 mos and then annually; any subsequent increase in PSA warrants biopsy

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13
Q

Screening for prostate cancer?

A

shared decision-making. Greatest benefit age 55-69 q2 yrs.

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14
Q

bacterial infection

Chills, fever, blood in urine/ semen, urinary sx.

A

prostatitis

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15
Q

Dx and labs for prostatitis

A

dx: DRE
Labs: CBC, BMP, PSA, UA with gram stain and culture
Consider STI te

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16
Q

Tx of acute prostatitis

A

Acute bacterial:
Severely ill bacterial prostatitis: hospitalization for IV fluoroquinolones (levo or cipro).
Consider hospital if febrile.

Outpatient tx: trimethoprim-sulfamethoxazole (Bactrim) AND fluoroquinolones for 2-4 weeks.

Sitz baths, analgesics, antipyretics, and stool softeners. Consider bed rest.

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17
Q

Tx of chronic prostatitis

A

trimethoprim-sulfamethoxazole (Bactrim) DS 1 tab (PO BID x 6 weeks) or Cipro 500 mg PO BID x 6 weeks

May combine with alpha-blockers for sx relief and reduce recurrence. Avoid coffee, tea, and alcohol. Assess use of anticholinergics, sedatives, and antidepressants.
Nonbacterial: fluoroquinolones with alpha- blockers and NSAIDs

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18
Q

Education for prostatitis

A

use condoms to prevent reintroduction of bacteria into urethra; avoid anal intercourse with acute bacterial prostatitis.

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19
Q

Basic guidelines for managing PSAs? referral…

A

Urology referral

  1. PSA > 4 = (age adjusted) and no signs of prostatitis OR
  2. PSA increase > 0.75 ng/mL in 1 year (even in level under 4)
  3. nodule on DRE
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20
Q

Screening PSAs?

A

always do DRE with PSA. get family hx

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21
Q

Age adjusted PSA threshholds

A

age 40-49 = 2.5
age 50-59= 3.5
age 60-69= 4.5
age 70-79= 6.5

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22
Q

common in kids. Common causes: fever. Persistent may be a/w renal disease. 24hr urine protein recommended. If not able can get spot first morning urine.

A

proteinuria

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23
Q

How to manage asymptomatic hematuria in kids?

A

requires periodic evaluation every 1 to 2 years to reevaluate for coexisting conditions or proteinuria, and to revisit family history of hematuria or hearing deficits.

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24
Q

Dx hematuria in kids?

A

Urine dipstick analysis for pyuria, proteinuria, hematuria, and concentration
If greater than 1+ hematuria by dipstick- microscopic examination for RBCs is needed to differentiate RBCs from hemoglobinuria or myoglobinuria.

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25
Q

What to do if proteinuria found in kids?

A

common
repeat lab - early am
if neg or trace - recheck 1 year
if >2 + refer

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26
Q

what to do if Wilms tumor or nephrolithiasis is suspected

A

Renal ultrasound

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27
Q

suggestive of an upper tract disorder in kids

A

flank pain

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28
Q

suggests an obstruction, such as Wilms tumor, cystic disease, or posterior valves in kids

A

Abdominal or flank mass

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29
Q

Malformed ears

A

congenital renal disease

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30
Q

persistent proteinuria, hypoalbuminemia, HLD, and peripheral edema
Often immunologic in children (atopic disease), DM #1 cause in adults

A

nephrotic syndrome

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31
Q

periorbital edema; ill appearing, muscle wasting, HTN, GI sx

A

nephrotic syndrome

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32
Q

What to do if you suspect nephrotic syndrome?

A

REFER to hospital; can lead to renal failure
UTD on routine immunizations; salt and protein restriction. Prompt tx of infections. Risk of recurrence- chronic condition. Tx w/ corticosteroids

33
Q

Labs for nephrotic syndrome

A

UA, CBC with diff, CMP, lipid panel

34
Q

Gross proteinuria
hypoalbuminemia
hyperlipidemia
peripheral edema

A

nephrotic syndrome

35
Q

Gross hematuria

recent infection: throat/ skin

A

Glomerulonephritis

36
Q

unilateral; a/w congenital anomalies (cryptorchidism, ureteral duplication, and hypospadias). Familial or idiopathic. Mets present in 10-15% of cases on diagnosis
Often diagnosed b/t 3.5-4yrs old
Cure rate 90%
CM: asymptomatic unilateral mass. Abd pain/distention. HTN, n/v, FUO

Diag: CBC, CMP, UA, US; ABD and pelvis MRI or CT w/ contrast and chest CT for mets
Tx: Chemo, kidney resection. Radiation in advanced cases.

A

Wilms tumor/Nephroblastoma

37
Q

most common in children 4-14yo
1-2wks after strep throat and 3-5 wks after strep skin infection
CM: hematuria* (macroscopic or microscopic) can persist for 1-2 weeks and show up as microscopic on UA for 2 yrs, edema, htn

A

Post streptococcal glomerulonephritis-

38
Q

Dx and tx of Post streptococcal glomerulonephritis-

A

Dx: UA (RBC casts, hematuria, proteinuria)

  • ASO (antistreptolysin antibody)- strep infection
  • Anti-DNAce B (usu + following impetigo)
  • Complement profile (low C3, Normal C4)
  • US
  • Renal biopsy if disease course is atypical

Tx: fluid and NA restriction, ABX, loop diuretics, supportive care. Hospitalize if severe oliguria and HTN.

39
Q 
Gross hematuria 
oliguria 
lethargy 
anorexia 
may have htn
A

glomerulonephritis

40
Q

Renal cell carcinoma (RCC) most common
RF: smoking, abdominal imaging, obesity, long-term dialysis, and fam hx. M>W; higher incidence in black men
Mets often to lungs; mets often present at diagnosis
Prognosis poor
Surgery only cure

A

kidney cancer

41
Q

obstruction or tumor of ureters can cause hydronephrosis

A

ureter cancer

42
Q

RF: cigarette smoking
CM: intermittent hematuria throughout urination. May have urgency, frequency, and dysuria.
Diag: CT urogram, refer for cystoscopy
Tx: transurethral resection of tumor; radical cystectomy

A

bladder cancer

43
Q

with increased ABD pressure (coughing, sneezing)

Anatomic vs intrinsic sphincter deficiency (bladder neck remains open, even mild increase in pressure causes leakage)

A

Stress incontinence

44
Q

incontinence most often associated with BPH

A

overflow

45
Q

urinary and frequency common - may not have overflow incontinence

A

OAB (over active bladder)

46
Q

DIAPPERS for incontinence

A

Delirium, Infection, atrophic urethritis/vaginitis, Pharmaceuticals, psychological (severe depression; rare), excess UOP (CHF, hyperglycemia), Restricted mobility, Stool impaction

47
Q

PE for incontinence

A

abd, GU, pelvic, rectal, neuro, extremity edema
Men: phimosis, balanitis, infection, rectal masses, prostate nodules, fecal impaction.
Women: urethral mobility (Q-tip test), cough (observe for incontinence) supine or standing, pelvic organ prolapse, bladder distention. Lack of estrogen is r/t incontinence

48
Q

Dx for incontinence

A

UA w/ culture, BUN/creat, post-void residual, bladder stress test, BMP, glucose/ HgbA1C

49
Q

Tx for incontinence … stress

A

timed voiding, double voiding, pelvic muscle exercises, pessary placement, bowel management. Tobacco cessation (bladder irritant and cough increases ABD pressure), bowel management

Refer: pelvic floor PT, pessary fitter

Meds:; alpha-adrenergic agonists (pseudoephedrine (Sudafed)), estrogen replacement.

Periurethral Estrogen cream (daily for 2 weeks, twice weekly after)- counsel on risk vs benefit and use for shortest time possible
Imipramine or other TCAs for younger pts if other txs ineffective. 10-25mg one-three times daily

50
Q

Tx for incontinence … urge

A

same as stress; bladder training (resist urge and void on a schedule). Avoid spicy, acidic, and caffeinated foods. Chocolate, tomatoes, citrus fruits or juices, nuts, coffee, tea, dark soda, alcohol. Moderation of fluid intake to 48-64 oz/day

Meds: anticholinergic-antimuscarinics
Tolterodine tartrate (Detrol) and oxybutynin chloride (Ditropan)- can contribute to cognitive decline in elderly
Vaginal estrogen for postmenopausal women
TCAs

51
Q

Tx for incontinence … mixed

A

Duloxetine/cymbalta

52
Q

Tx for incontinence … overflow

A

timed and double voiding; clean intermittent catheterization, pessary, surgery

Meds men only!: for BPH- tamsulosin (Flomax) terazosin (Hytrin), finasteride (Proscar), dutasteride (Avodart)

53
Q

RF: heavy cigarette use, obesity, OSA, HTN, DM, CV disease, psychological issues, stressors
Determine if organic or psychogenic cause

DDx: cardiovascular disease

*Common SE of SSRI, SNRIs, and TCAs

A

Male sexual disease

54
Q

Tx for Male sexual disease

A

therapy, PDE5 inhibitors: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis) (once daily), and avanafil (Stendra) → cannot be taken with nitrates; caution with alpha blockers

2nd line: intraurethral suppositories, intracavernous injections, vacuum pump devices

Alprostadil (prostaglandin E1): neurogenic, psychogenic, or angiogenic causes→ refer to urology for management

55
Q

Workup for ED?

A

CBC w/ diff, TSH, fasting serum glucose or A1C, electrolytes, BUN & creatinine, PSA, Testosterone, prolactin levels, lipids, UA

56
Q

What to screen for in all men with ED?

A

Cardiac- ASCVD risk

57
Q

increases risk of CV disease and ESRD. Predictor of HTN. Can be exercise induced

A

protinuria

58
Q

hallmark of renal disease

A

Proteinuria: More than 150 mg/day (10-20 mg/dL) hallmark

59
Q

sign of early renal disease, esp with diabetes. 30-150 mg protein/day

A

Microalbuminuria

60
Q

Macroalbuminuria

A

> 300 mg/day

61
Q

Dx labs proteinuria ?

A

1. repeat UA, CBC with diff, BMP, HgA1c, lipids, urine c/s, SPEP/UPEP, albumin/ Cr ratio, protein/ Cr ratio, 24 hr urine protein

proteinuria (1+ or greater) on urine dipstick should be investigated. 24-hr urine protein and creatinine (urine protein >150 mg in 24hrs).

62
Q

3.5g/day or more of protein; with hypoalbuminemia, hyperlipidemia, and edema → send to a nephrologist

A

Nephrotic syndrome

63
Q

Bence Jones proteins in urine (SPEP/UPEP)

A

Multiple myeloma

64
Q

Tx of proteinuria?

A

Manage underline disease, and eliminate trigger meds.

ACE or ARB; control DM, HTN, and hyperlipidemia. May need Na and protein-restricted diet

ACE inhibitors and ARBs reduce proteinuria by lowering the intraglomerular pressure, reducing hyperfiltration. These drugs tend to raise the serum potassium level and reduce the glomerular filtration rate (GFR). _ must monitor the serum K, Cr levels, and the GFR

65
Q

Proteinuria in pregnancy

A

after 24wks thinking preeclampsia/ before 24wks think infectious cause (glomerulonephritis)

66
Q

most common sign of bladder CA

A

hematuria

67
Q

Definition of hematuria

A

3 or more RBCs per high-power field.

68
Q

Gross vs microhematuria

A

visible vs not visible

69
Q

decreased GFR, increased serum creatinine, and albumin in urine.
Regular UAs are recommended for pts with HTN and DM to assess urinary albumin/creatinine ratio to detect early kidney disease.

A

renal failure

70
Q

↑ serum creatinine of 0.3 mg/dL over 48 hrs OR ↑ serum creatinine to 1.5x baseline in 7 days OR UOP < 0.5 mL/kg/h for 6 hours.

A

AKI

71
Q

Decrease in kidney function over 3mos. Decrease in GFR and albumin in urine are first signs.
pts who receive dialysis or a kidney transplant are eligible for Medicare regardless of age

A

CKD

72
Q

CM: typically asymptomatic until GFR <35. ARF: confusion, anorexia, n/v, edema, and weight gain.

PE: fundoscopic (AV nicking, diabetic retinopathy, papilledema), peripheral pulses, fluid overload (JVD, adventitious lung sounds, edema), pericarditis. Auscultate for renal artery bruits, palpate kidneys, abd for ascites and percussion for bladder distention. Skin: ecchymosis and rashes, uremic frost

A

CKD

73
Q

DIag CKD?

A

serum creat with eGFR and urine sample for albuminuria. ACR(albumin creatinine ratio) >30 mg/g confirm with a first morning urine

74
Q

Tx CKD?

A 
avoid nephrotoxins (NSAIDs, contrast dye), manage fluid intake, low protein and low salt diet, ACE-I or ARB (only d/c inf creat increases 30%). Monitor serum potassium (thiazide diuretic may need to be added to manage hyperkalemia). If pt can’t take ACE-I or ARB, next is nondihy CCB
Avoid potassium-containing salt substitutes

Ensure UTD on vaccines (flu, pneumococcal and hep B) qualify for pneumococcal earlier than 65. Assess for depression, insomnia, anxiety and sexual dysfunction.
GFR <30 (or >25% decrease)→ initiate advance-care planning and refer to nephrologist
Monitor for anemia once-twice yearly
Replace vit D when <30 ng/mL

75
Q

How to manage diabetics with CKD

A

d/c metformin if GFR<30, consider switching when GFR <45
Medicare will cover annual medical nutritional therapy with a registered dietician for pts with DM or CKD at no cost to pt

76
Q

Management of Stage 3 CKD

diet? Supplements?

A 
3a= 45-59 GFR
3b= 30-44 GFR

limit phosphates in diet (excretion is decreased … hyperphosphatemia and hyperparathyroidism leads to calcium removal from bones)
Ca: 1000 mg/day for adults and 1200 mg/day for older adults.
Calcium acetate recommended for later stage CKD, helps remove phosphate

77
Q

What to give to tx Hyperlipidemia in pts with CKD?

A

atorvastatin requires no renal dosing. Only use fluvastatin in pts with severe renal dysfunction

78
Q

Chronic inflammation of the bladder
CM: Bladder pain, urinary frequency or urgency, or nocturia in the absence of another disease that could cause the sx. Suprapubic pain or pain in low back or buttocks

A

interstitial cystitis

FNP 3- Test 3 (5 decks)

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