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PANCE 2024 > GU > Flashcards

GU Flashcards

1
Q

Urge incontinence do what first

A

Check UA

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2
Q

What is the problem with urge incontinence

A

Detrusor muscle over activity

Sensation proceeding urination

Age is a large risk factor ;; obesity ;; neuro ;; pregnancy

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3
Q

Pharm therapy two big meds for URGE incontinence

A

Oxybutin
Mirabegron

THINK ANTICHOLINERGIC CLASS

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4
Q

OVERFLOW INC. = WHAT SXS

A

Poor stream

Incomplete

Involuntary loss of pee

Bladder Distention

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5
Q

Overflow incontinence best test

A

Post void residual

Pee more than remaining = normal flow

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6
Q

Management of overflow incontinence

A

Self cath

Cholinergic agents = bethenachol

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7
Q

MC cause of hydrocele

A

Extension of the peritoneum from patent processes vaginalis

Open channel

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8
Q

is hydrocele painful

A

NO!

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9
Q

Communicating vs. non communicatin

A

Comm = expands with rising abdominal pressure

Non -comm = independent of abdominal pressure

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10
Q

Varicocele leads most commonly to what if untreated

A

Infertility

PAMPANIFORM PLEXUS

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11
Q

Is varicocele painful // does it illuminate

A

It can be dull ; Left is worse than the right

IT DOES NOT ILLUMINATE

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12
Q

Varicocele on the right =

A

Malignancy - abdominal mass

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13
Q

Definitive mangement of torsion

A

Surgical de torsion and orchiopexy

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14
Q

Tetsticular torsion has what testicular finding

A

Swelling in the scrotum

High riding testicle = risk factor

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15
Q

Reflexes lost in torsion

A

Cremaster = thigh ball rise

Prehn sign = rise the testicul = decrease in pain [this is not going to work in torsion]

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16
Q

Time to get de torsion in testicular torsion

A

6 hours

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17
Q

Epididymitis before age 35 is usually

A

C/G - STI

Over 35 = E. Coli

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18
Q

Epididymal pain is ;; U/S flow?

A

GRADUAL ;; slow ish

U/S = more blood flow

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19
Q

Epididymitis E. Coli antibiotic

A

FQ or Bactrim

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20
Q

BPH treatment of choice is

A

Alpha blockers -“zosin” = initial;

But Finasteride will shrink it!

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21
Q

Chronic bacterial prostatitis

A

Recurrent UTI

Usually no fever

Normal UA

At least 6 weeks

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22
Q

MC cause of acute cystitis

A

E Coli

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23
Q

Suprapubic discomfort think what

A

Cystitis

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24
Q

+ urine culture = how many CFUs

A

100,000

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25
Q

Complicated UTI think pregnancy think what drugs

A

Oral FQ or Bactrim

Pregnancy Cephalexin

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26
Q

how long can you use phenazopyridine

A

2 days

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27
Q

Organism in pyelo MC

A

E. Coli

It’s ascending infection

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28
Q

Type of casts in Pyelo

A

WBC casts ; nephron is effected.

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29
Q

Outpatient pyelo vs. in patient pyelo

A

PO FQ

In patient = IV Ceftriaxone// Cipro

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30
Q

Confirmatory test in pyelo

A

CT

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31
Q

MC presenting sxs of bladder cancer

A

Painless hematuria

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32
Q

Type of bladder cancer most common

A

Transitional cell carcinoma = 1st

Then SCC, adeno

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33
Q

Bladder cancer is pretty common in what job

A

Hair care ; because they work with chemicals

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34
Q

Gold standard imaging for bladder cancer

A

Cystoscopy

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35
Q

Prostate cancer most common cancer type

A

Adenocarcinoma

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36
Q

Prostate cancer most common in

A

AA

Most common risk factor = AGE

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37
Q

Prostate cancer with bone pain think what

A

Metastatic

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38
Q

What does a cancer prostate feel like ; get what for dx

A

Lumpy bumpy irregularly shaped

GET : BX

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39
Q

How do you stage prostate cancer

A

Gleason score

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40
Q

PSA screening in what ages

A

55-69

Men with family history of prostate cancer with AA race or have BRCA or BRCA1

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41
Q

Risk factors that high risk in prostate cancer

A

Men with family history of prostate cancer with AA race or have BRCA or BRCA1

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42
Q

MC type of testicular cancer

A

Germ cell

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43
Q

Testicular cancer effects what age ; what sxs

A

Med 15-35 ;dull to no pain with test mass ; negative illumination

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44
Q

2 markers elevated in testicular cancer

A

bHCG and AFP

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45
Q

MC type of kidney stone

A

Calcium oxalate

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46
Q

MC location for developing kidney stones

A

The UVJ = uterovesicular junction at the narrowest point

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47
Q

Recurrent UTI stone is what type usually

A

Struvite

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48
Q

Kidney pain is what

A

Sudden persistent and with hematuria

Stones = cant sit still!

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49
Q

Management of kidney stone

A

Less than 5 mm = on its own

5-10 mm less likely to pass its on its own

Initial management :
-alpha blocker

Lithotomy or Lithotripsy = definitive for large stones over 10mm

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50
Q

Treatment for paraphimosis commonly

A

Surgical reduction

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51
Q

Para vs. Phimosis

A

Para = around the base of the glands with swollen fore skin

Phimosis = cant pull the fore skin back

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52
Q

2 labs to understand why they have phimosis

A

Diabetes

A1C and Serum glucose

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53
Q

Which foreskin patholog you is a urological emergency

A

Paraphimosis

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54
Q

With neurogenic bladder think brain cause for

A

Overflow incontinence

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55
Q

DRE for BPH and characteristics

A

Smooth rubbery prostate that is symmetric
Benign tumor
FUD sxs

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56
Q

Management BPH

A

Alpha blockers
5 alpha reductase
PDE-5 - tadalafil

Surgery = TURP , Laser, Prostatectomy

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57
Q

What type of waste is built up in AKI

A

Nephrotoxic —> nitrogenous waste

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58
Q

6 nephrotoxins to be aware of

A

ACE/ARBs

NSAIDs

Lithium

Some ABX

IV contrast dye

Loop and Thiazide diuretics

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59
Q

Defintion of oliguria

A

Greater 15 mL/hour

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60
Q

What can detect AKI 1-2 days before Creatinine

A

Serum cystatin C

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61
Q

MC location for AKI

A

Pre renal

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62
Q

MC cause of prerenal Azotemia

A

Volume Depletion = (Dehydration, Burns, GI losses, Hemorrhage)

↓ Effective Circulating Volume = (CHF, Ascites, Nephrotic Syndrome)

Impaired Renal Blood Flow = (ACEI’s, NSAID’s, Renal Artery
Stenosis)

Systemic Vasodilation = (Sepsis, Vasodilatory Drugs)

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63
Q

Post renal Azotemia think what

A

BPH
Nephrolithiasis/Bladder Outlet Obstruction BILATERALLY

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64
Q

Endogenous vs. Exogenous causes of ATN

A

Endogenous = rhabdo; hemolysis

Exogenous = cisplatin , amphotericin B , contrast Dye

ischemia and sepsis

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65
Q

Main cause of interstitial nephritis =

A

Drugs = Penicillin, cephalosporins, sulfa, NSAID’s

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66
Q

Glomerulonephritis think what 4 causes

A

IgA Nephropathy

Post Strep

GPA/Goodpastures

HUS - Hemolytic Uremic Syndrome

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67
Q

MC UA finding for ATN

A

Muddy brown casts
Renal tubular epithelial cells/ granular casts

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68
Q

ATN Labs =

A

BUN : Cr < 20:1

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69
Q

ATN treatment

A

Prevent Further Kidney Injury: Remove Toxins, Treat Cause

Loop Diuretics
Low protein diet
Correct electrolytes
Dialysis if necessary
Reversible unless cortical necrosis (rare and assoc with anuria)

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70
Q

UA and labs for Interistial nephritis ?

A

UA = Eosinophils and WBC casts

Labs = peripheral blood EOSINOPHILIA

think drug reaction

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71
Q

Assoc. with URI symptoms,(H flu), gastroenteritis
Presents with intermittent hematuria
Most common cause worldwide

A

IgA Nephropathy/ Bergers

Glomerulonephritis

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72
Q

(+) ASO Titer, ↑C3
Develops 2-6 wks post-impetigo and 1-3 wks post-strep pharyngitis
Prognosis good in children, not as good in adults

A

PSGN

TXM = Low protein, Low sodium diet, manage HTN,

Steroids NOT
helpful for PSGN

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73
Q

Good pasture syndrome treatment =

A

Plasma exchange

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74
Q

Formerly known as Wegener’s Granulomatosis
Effects small and medium sized vessels
Associated w/granuloma formation airway, lung, skin ↑ c-ANCA
Associated with URI sx’s; Rhinitis most common first symptom

A

GPA !

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75
Q

2 associations other than uremia for hemolytic uremic syndrome

A

Hemolytic anemia

Low platelets

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76
Q

Symptoms related to underlying cause
Hematuria, HTN & Edema: periorbital and scrotal edema, flank
pain

A

Glomeruloneprhitis

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77
Q

Urinalysis: Tea-colored/Coca Cola urine with Red Cell Casts,
proteinuria, hematuria
Other labs depend on cause: CBC, Complement levels, ASO
Titer, anti-GBM antibodies, ANCA, ANA

A

Glomerulonephritis

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78
Q

Glomerulonephritis can be treated with what

A

High dose steriods

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79
Q

Few Hyaline Casts, Possible RBC, No
protein
<1 Early
>1 Late
None or Trace Oligo- / Anuria
+/- HTN

A

Post renal Azotemia think : BPH

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80
Q

What metabolic waste is MC built up in CKD

A

Uremia

Think : Metallic taste and Edema !

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81
Q

Lab findings consistent with CKD

U/S Finidings ?

A

Renal Function: ↑ BUN/Cr, ↑ creat,↓ GFR (for 3 or more mo.)

Other lab abn: Anemia, ↑ K, ↑Phos, ↓ Ca2+ , met acidosis

Urinalysis: proteinuria

U/S may show echogenic kidneys

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82
Q

TXM vs. Prevention for CKD

A

TXM = low protein, sodium water potassium phosphate diet

Dialysis // Transplant

Prevention = Treat HTN , ACE-I or ARB to delay progression

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83
Q

What GFR is indicated for hemolysis and what is normal?

A

Hemolysis = 15

Normal = above 90

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84
Q

Bilateral hydronephrosis will do what

A

Drop GFR

85
Q

6 causes of hydronephrosis commonly

A

BPH

Congenital (VUR)

Nephrolithiasis- esp. ureteropelvic junction

Pregnancy

Large Fibroids

Neurogenic Bladder

86
Q

Treatment of ACUTE hydronephrosis based on etiology :

BPH

Neurogenic Bladder

Infection

A

Treat Cause!
Catheter (If BPH),

Meds (Anticholinergic if neurogenic
bladder)

Procedures: IF INFECTION, NEED EMERGENT STENTING
OR NEPHROSTOMY
Stenting, Pyeloplasty, Percutaneous Nephrostomy

87
Q

3 primary causes of nephrotic syndrome

A

Minimal change disease -KIDS!!!!!!!!!

Focal GMN

Membranous Nephropathy

88
Q

2 secondary causes of nephrotic syndrome

A

DM

Amyloidosis

89
Q

Diangsostivs// Labs for nephrotic syndrome

A

Proteinuria >3gm/day
Oval fat bodies: Lipids are passed into urine

Maltese Crosses: Appearance of the oval fat bodies under
microscope with polarized light

↓Albumin, Hyperlipidemia, anemia

Renal bx – useful for idiopathic,
NOT necessary in DM and HTN

90
Q

Nephrotic syndrome mgmt

A

Diet: Low protein, restrict salt
Tx of hyperlipidemia, Tx hypercoaguability
Diuretics (thiazide/loop) and ACE inhibitors early on

91
Q

Genetics of PCKDz

A

Most common hereditary disease in U.S. (Autosomal Dom)

Usually presents age 30’s-40’s, 50% will have ESRD by age 60

92
Q

Signs/Symptoms:

Gross hematuria + Abdominal/flank pain + Secondary HTN
Large palpable kidneys
UTI’s and nephrolithiasis are frequent

A

PCKDz

93
Q

25 % of PCKDz folks also have what cardiac valvular abnormality

A

MVP

94
Q

What medical mangement can delay ESRD in PCKDz

A

Vasopressin

95
Q

Horseshoe kidney has increased risk of what

A

Increased risk of renal calculi
and infection

96
Q

What happens to pts with RAS when given ACE

A

Rapid increase in creatinine

97
Q

Screening and Gold Standards Dx for RAS

A

Screening = U/S

Dx = Renal arteriography

98
Q

PCo2 feeds the ___ and HCO3 feeds the ___

A

PCo2 = acidic

HCO3 = basic

99
Q

Cut off numbers for PCO2 and HCO3

A

PCO2 should be 40

HCO3 should be 24

100
Q

Respiratory vs. Metabolic affects on PC02 and HCO3

A

Respiratory: Alterations in pCO2
Metabolic: Alterations in
HCO

101
Q

Metabolic acidosis can occur with what type of anion gap

A

Over 12 — or high normal

102
Q

Anion gap equation

A

Anion Gap = Na+ - (HCO3- + Cl-)

103
Q

Causes of increaesd anion gap MUDPILES

A

Methanol,
Uremia,
DKA,
Propylene Glycol,
Isoniazid,
Lactic Acidosis,
Ethanol,
Salicylates

104
Q

Low HCO3 is likely to occur with what type of breathing

A

Kussmauls

Shallow low depth; retained PC02

105
Q

Low bicarbonate associated with diarrhea often results in what type of ABG defecit

A

Metabolic acidosis w/ normal anion gap

106
Q

What is the compensation for metabolic acidosis

A

Increased ventilation

To blow off CO2

107
Q

Causes of metabolic alkalosis

A

Vomiting, Aggressive suctioning of gastric contents
Diuretics
Overcorrection of met acidosis or ingestion of bicarb

108
Q

What is the compensation for metabolic alkalosis

A

Decreased ventilation to increase PCo2

109
Q

Metabolic disturbances assoc with metabolic alkalosis

A

Hypocalcemia

Hypokalemia

110
Q

Causes assoc with respiratory acidosis

A

Causes:
Anything that decreases respiration/The lungs fail to blow off CO2
effectively

COPD, paralysis of chest from neuromuscular disorders, Narcotic
OD

111
Q

Compensation for respiratory acidosis

A

Incr reabsorption of HCO3
- by kidneys

112
Q

Respiratory acidosis treatment

A

Treatment:
Fix underlying cause
Assist ventilation
Try naloxone if all else fails

113
Q

Causes of respiratory alkalosis

Key SXS

A

Causes: anything that ↑ resp/blows off too much CO2

Hysterical hyperventilation (most common)
Salicylate intoxication
Pulmonary Embolism

SXS = Rapid breathing
Lightheadedness
Perioral paresthesias

114
Q

Compensation in respiratory alkalosis

A

Compensation: Increased elimination of HCO3
- by kidneys

115
Q

When do people have sxs with hyponatremia

A

Less than 125

116
Q

Low sodium would cause what to DTR’s

A

Decrease them

117
Q

Causes: Prolonged Vomiting, Diarrhea, Diuretic use, Addisons
Disease
Sx: Dehydrated
UA: Urine Sodium is LOW

Think what type of hyponatremia?
TXM?

A

Hypovolemic
“Water and Sodium lost; ADH causing water retention; but Na+ still low”

TXM = volume replacement ; to decrease ADH

118
Q

Causes: SIADH, Hypothyroidism, psychogenic polydipsia
Sx: NO signs of volume overload
UA: Urine Sodium HIGH (>20 mEqu/L), unless psychogenic
polydipsia

Think what type of hyponatremia ?

TXM?

A

Euvolemic
“Kidneys conserving too much water”

Water restriction = TXM

119
Q

↑↑↑extracellular water compared with Na+
Causes: Cirrhosis, CHF, Nephrotic Syndrome, Renal Failure
Sx: Edema, volume overload
UA: Urine Sodium LOW ( <20mEq/L)

What type of hyponatremia?
TXM

A

Hypervolemic

TXM = water restriction +/- diuretics

120
Q

Mc cause of hypertonic hyponatremia

A

Hyperglycemia

121
Q

If you correct sodium too quickly what can happen

A

Central pontine mylenolysis

122
Q

Hypernatremia is defined as

A

Sodium over 145

123
Q

2 causes of hypernatremia

A

Impaired thirst mechanism or lack of access to water

Meds : Lactulose and Mannitol

Diabetes Insipidus

124
Q

Decrease sodium by no more than what to prevent what?

A

1meq/L/Hr

Prevents cerebral edema

125
Q

Definition of SIADH

A

Continued excretion of (ADH) despite normal or increased plasma volume.

Too much ADH for an inappropriate reason.
-Guilin Barre / Infxn ‘
-Small cell cancer/Cancer
-PNA/TB
-SSRIs / Chemo

126
Q

SIADH is what type of hyponatremia

TXM

A

Euvolemic ;

TXM = fluid restriction ; furosemide

127
Q

What is severe Hypokalemia

A

Less than 2.5

128
Q

Reflex and muscle changes with Hypokalemia

A

Flaccid paralysis, hyporeflexia, tetany, rhabdo

129
Q

EKG findings of Hypokalemia

A

Flattened or inverted T waves, U waves, freq PVC’s

130
Q

1 Cause of hyperkalemia

A

Renal disease

131
Q

4 drug causes of hyperkalemia

A

Spironolactone

ACE/ARBs

NSAIDs

132
Q

Severe hyperkalemia sxs

A

Hyperreflexia —> flaccid paralysis —> Vfib —> death.

133
Q

3 treatment goals for hyperkalemia

A

Stabilize the heart:
1. Calcium Gluconate

Drive K+ back into cells:
1. Insulin + Glucose
2. Albuterol
3. Sodium Bicarb

Excrete K+
1. Kayexalate and Hemodialysis

CBIGK

134
Q

CA2+ is defined low as =

Causes =

A

Less than 8.5 mg/dL

Causes = hypoparathyrodism ; hypoalbuminemia ; Vit D deficiency

135
Q

Most Asx. Muscle cramping, paresthesias, ↑DTR’s, confusion, seizures

Chvostek Sign: Facial muscles contract when tap facial nerve
Trousseau Sign: Carpal spasm when BP cuff inflated for 3
min.

EKG: Prolonged QT interval→ Ventricular Arrhythmias]

Think?

A

LOW CALCIUM

136
Q

Hypercalcemia is defined as =

Causes =

A

Over 10.5 mg/dL

Causes
90% Hyperparathyroidism
Cancer: Renal cell carcinoma, Multiple Myeloma, Lung Cancer: All
produce PTH

137
Q

Only if >12mg/dL: Anorexia, constipation, polyuria, dehydration,
lethargy, coma

EKG: Shortened QT intervals

Think?
TXM?

A

Hypercalcemia

TXM = IV Fluids and Loop Diuretics

138
Q

4 causes of LOW Magnesium

A

Chronic Alcoholism,

Chronic Diarrhea,

Hypoparathyroidism,

Hyperaldosteronism

139
Q

Hypomagnesia may lead to what

A

Refractory Hypokalemia / hypocalcemia

140
Q

Think what arrythmia for low magnesium

A

Torsades or Long QT

141
Q

Diets associated with kidney stones

A

Diets high in oxalate rich foods:
Leafy veggies, nuts, tea, coffee

Diets high in purines

142
Q

Kidney stone gold standard

A

CT non con

143
Q

Kidney stone management based on size

Less 5; 5-10 ; and over 10mm

A

If < 5mm: passable; Give strainer to catch stone for analysis.
If 5-10mm: Less likely to pass spontaneously
If >10mm: Will not pass; Admit, stent/nephrostomy/lithotripsy

144
Q

Kidney stone mgmt based on location

Urethral vs. Renal

A

If Ureteral* – basket ureteroscopy OR laser lithotripsy
If Renal – shock-wave lithotripsy

145
Q

Struvite stones are assoc with what ? (2)

A

Infections

Staghorn stones ; ABx dont penetrate ; increased risk of sepsis

146
Q

Unique image findings of uric acid stones

A

Radiolucent and not seen on KUB

147
Q

Urge incontenince think

A

Gotta go now!
Increased detrusor muscle function

148
Q

Urge in continence treatment

A

Treatment: Bladder training #1

Oxybutinin (Ditropan XL),

149
Q

Stress incontinence think what ?

A

Due to ↑ abdominal pressure. Dysfunction of urethral sphincter

Leak with cough l sneeze I valsalva

TXM = Kegels, estrogen, surgery (mid-urethral sling 80-90%
effective)

150
Q

Outlfow incontenince think

A

Outlet Obstruction → Distention → Overflow

Think BPH; high PVR exam

TXM = relieve obstruction / catherterize

151
Q

3 risk factors for cystocele

A

• Vaginal birth
• Advanced age
• Pelvic surgery

152
Q

Supportive and surgical treatment for cystocele

A

• Supportive: weight loss, Kegel
exercises, pessary

• Surgical: colpopexy

153
Q

What location of the prostate is effected by BPH

A

Cells in the transitional zone

154
Q

Obstructive vs irritative sxs vs DRE for BPH

A

Obstructive Symptoms: Hesitancy- slow, weak stream; dribbling

Irritative Symptoms: Frequency, dysuria, urgency, nocturia

On DRE: smooth, elastic, symmetric enlargement in men over 50
yo

155
Q

BPH meds mainstay

A

α Blockers (tamsulosin, doxazosin, terazosin): Relaxes smooth
muscles

5α reductase Inhibitors (finasteride, dutasteride): Blocks
formation of DHT

156
Q

How do 5a reductase inhibitors effect PSA

A

Reduces score by 50% ; must double the reported number of

157
Q

What PSA score is usually surgerized

A

Over 100

158
Q

Medical conditions associated with with erectile dysfunction

A

Medical Conditions: DM, HTN, Androgen Deficiency, CAD, High chol

159
Q

Medications associated with erectile dysfunction

A

α blockers, β Blockers, diuretics, tobacco, ETOH

160
Q

Mgmt of erectile dysfunction

A

Vasoactive Therapy: Oral PDE-5 inhibitors (sildenafil)- NEVER with Nitro!

Hormonal replacement: gel, patch, injectable. Never with Prostate CA

Assistive Devices: Vacuum Erection device and Penile Prosthesis

161
Q

Priapism is defined as lasting longer than when

A

4 hours

162
Q

Medical conditions and drugs assoc with priapism

A

Conditions : sickle cell ; leukemia ; MM

Drugs : cocaine and ecstasy

163
Q

Priapism treatment

A

Terbutaline. If this fails…
Aspiration of corpus cavernosum- Aspirate from 2 or 10 o’clock

164
Q

Peyronies has a plaque where ?

A

Tunica Albuginea

165
Q

Peyronies txm

A

Intraplaque injection of Verapamil or Interferon
Surgery to remove plaque- NO guarantee of normal function

166
Q

2 things helpful for dx urethral stricture

A

Retrograde Urethrogram (RUG) or voiding cystourethrogram

167
Q

• Red/purple annular mass at urethral meatus
• Bleeding, dysuria, friable tissue

Think? And what TXM?

A

Urethral prolapse

TXM = sitz bath ; topical estrogen

168
Q

Balanitis what to know what bout it?

A

Swelling of the foreskin and glans penis

Causes:
Poor hygiene
More likely in uncircumcised
More likely to be fungal in diabetics

Treatment
Children: None
Adults: topical steroids
topical antifungal

169
Q

Phimosis ; what to know bout it?

A

Foreskin is unable to be retracted over the glans penis.

Cause
Children: Physiologic mostly, no intervention
Adult: Often due to chronic low grade infection, Lichen
sclerosis

Treatment
Betamethazone cream
Stretching of foreskin
Circumcision

170
Q

Paraphimosis; what to know bout it?

A

Foreskin is trapped in a retracted position.

Edema → Compromised Blood
Supply→ Necrosis.

Cause
Pts w/ long-term Foley are at risk

Treatment
Manual reduction or emergent
dorsal slit// SURGICAL EMERGENCY

171
Q

3 important facts about hypospadia

A

Urethra meatus is ventral & proximal to normal position

Repair before the child is 18 months old

Hypospadias + Bilateral Cryptorchidism =Sex Hormone
abnormality

BELOW

172
Q

1 fact of Epispadia

A

Urethra meatus is dorsal & proximal to normal position
Surgery

ABOVE

173
Q

Chordee [ventral curvature] is assoc with what other congenital abnormality

A

Hypospadia

174
Q

VUR ; 4 important facts

A

Urine passes retrograde from bladder to kidneys during voiding.
Result of an incompetent vesicoureteral sphincter
30-60% will have Reflux Nephropathy at time of diagnosis
Typical patient: Child with recurrent UTI’

175
Q

TXM for VUR

A

Treat HTN, ACE inhib, Abx and freq urine cx, Surgery for Severe Reflux

176
Q

Reflux Nephropathy leads to what

A

HTN

177
Q

Definition of cryptordchidism and what are you at risk for with this

A

Testes are still inside abdomen have not descended , distend usually at 7 mos gestation

Testicular cancer = risk

178
Q

4 risk factors for cryptorchidism

A

Prematurity,
Low birth weight
Maternal exposure to estrogens in the 1st trimester
Family History

179
Q

Bilateral with cryptorchidism hypospadias indicates

A

—> other sex hormone
abnormalities.

Usually only RIGHT sided

180
Q

Mgmt cryptorchidism

A

HCG injections or surgical correction at 1 year

181
Q

Varicosities within scrotum that feel like a “bag of worms”.
May have an achy feeling. L>R
Increases with Valsalva, Decreases when lying supine.
Rarely treated unless indicated by infertility.

A

Varicocele

182
Q

Retention cyst of the head of the epididymis
Painless, (+) Transillumination
No treatment; only removed if causing discomfort

A

Spermatocele confirmed by U/S

183
Q

1 RF for testicular torsion

A

Bell clapper deformity

Ages 10-20

184
Q

Prehns and cremaster reflex in TESTICULAR TORSION

A

(-) Prehn’s sign=
NO relief with elevation of testicle

(-) Cremasteric Reflex=
NO retraction of ipsilateral testis when medial thigh is stroked

185
Q

Learning points on epidymtitis (3)

A

Pathogens vary by age and sexual history
<35 yo/sexually active men:
Usually STD (GC and Chlamydia)

Not sexually active, young and older:
Usually uropathogens (E Coli)

If chronic (>6 weeks): Inflammation not
infection

186
Q

3 findings in epidymitis

A

Scrotal inflammation, redness, enlargement, and/or reactive
Hydrocele

Urethral discharge and Irritative voiding symptoms possible

(+) Prehn’s sign, (+) Cremasteric Reflex

—> GET U/S to R/o Torsion

187
Q

ABX management for epidydmitis

Uropathogen

Vs.

G/C STD

A

If Uropathogen: Ofloxacin or Levofloxacin Abx if infection

If STD: Ceftriaxone 250 mg IM + Doxycycline for 10 days.
TREAT PARTNER

188
Q

4 common sxs in orchitis

A

Develop 1 week after onset of mumps parotitis

Marked pain and swelling in one or both testicles

N/V, fever, Urinary symptoms +/- proteinuria and hematuria

Testes are enlarged, tender and indurated

189
Q

Gonnorhea
//
Chlymadia treatment

A

Ceftriaxone 250 mg IM [Gonnorhea] + Doxycycline for 7days [chlamydia]

190
Q

Cystitis in men is associated with [4]

A

Prostatis

FOB

Obstruction

Infxn stones

191
Q

When do you get an U/S vs. CT for pyelo

A

U/S = if you think obstruction

CT = if you think stone involvement / infxn

192
Q

Pyelo management

A

Admit: elderly/ pregnant/ co-morbid/ obstructed/ not tolerating PO

IV for 24 hours after fever: Ampicillin plus Aminoglycoside prior to
sensitivity

Uncomplicated: Oral abx x 14 days: Ciprofloxacin or other Quinolone

193
Q

What do you not do in septic prostatitis

A

Prostate massage = can cause septicemia

194
Q

What study can you get for bacterial prostatitis

A

Transrectal U/S or CT to r/o abscess
CBC
UA

195
Q

Mangement for acute bacterial prostatitis

A

4-6 weeks of TMP/SMX or a fluoroquinolone.
Analgesia, fluids, rest.

If septic, hospitalize for IV Abx (ampicillin and aminoglycoside) x14 days [2 days IV —> PO]

196
Q

DRE findings in chronic bacterial prostatitis

A

Normal
Boggy
Tender

Expressed Prostatic Secretions (EPS) =
↑ WBC’s, “Lipid Ladden Macrophages”, (+) cultures

197
Q

Chronic bacterial prostatitis management

A

TMP/SMZ, Quinolones x 6-12weeks, NSAID’s, α
Blockers, Hot sitz baths

198
Q

Prostatodynia is negative for what

A

Fever
UA findings
UA culture
Prostatic secretion growth

199
Q

Type of testicular cancer most common

A

GERM CELL
-seminomas
-nonseminomas

200
Q

2 common fxs of testicular cancer

A

Painless testicular mass

Testicular enlargement, R>L.

201
Q

Non seminomas labs that indicate testicular cancer

A

AFP high
LDH high
BHCG high

202
Q

Testicular cancer management

A

Radical orchiectomy for everyone

Seminomas: Add external beam radiotherapy +/-
Chemo (cisplatin)

Nonseminomas: Surveillance, May add Chemo.
Nonseminomas are NOT responsive to XBRT

203
Q

What type of bone is susceptible to Prostate cancer Metz

A

Axial skeleton

204
Q

What score is used for tissue differentiation with respect to prostate cancer

A

Gleason score

higher score = less diff. = Poorer Prognosis

205
Q

Medication class used in the treatment of prostate cancer

A

Leuprolide Goserelin = LNRH agonists

206
Q

SMOKING #1 Risk Factor.

Occupational exposures: dyes, solvents, petroleum, leather,
printing.

Male (3:1)
>40yo

90% of cases are Transitional Cell Carcinoma aka Urothelial
Cell Carcinomas

THINK ? TXM ?

A

Bladder cancer
PAINLESS HEMATURIA/ ESP. SMOKER

TXM = Location Based :

Does not invade bladder wall = transurtheral resection

Does invade = radical cystectomy

207
Q

What are 3 risk factors for Renal cell carcinoma

A

Risk factors:
Smoking
Men (3:1)
Obesity, HTN

208
Q

Renal cell carcinoma patients are at an increased risk for what

A

Paraneoplastic syndromes

Producing occlusive thrombi in renal veins and IVC

209
Q

Peak Incidence 2-3 yo
#1 common solid renal tumor in kids
5% of childhood cancers
Signs and Symptoms
Palpable Abdominal Mass (60%)
Abdominal pain
Hematuria
N/V, anorexia, fever

THINK?

TXM?

A

Wilms Tumor

no Bx as this will spread tumor cells

TXM =
Surgical resection
Nephrectomy
Chemotherapy
Radiation

PANCE 2024 (15 decks)

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