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GU Flashcards

0
Q

Red flag sx of BPH.

A

Rapid onset, filling sx without voiding sx

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1
Q

What is BPH?

A

No cancerous abnormal hyperplasia of prostate, clinical: blockage I passing of urine, increased frequency, increased urgency
Exam: rubbery enlarged firm prostate
Dx: cystoscope

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2
Q

Treatment of BPH?

A

Alpha adrenergic inhibitors: doxazosin watch for ortho static hypotension and retrograde ejaculation
Surgery: TURP

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3
Q

Common cause of ED?

A

Hx of DM or coronary vascular dz

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4
Q

Tx of ED?

A

Testosterone, sildenafil (if not on nitros), injectables, vacuum, prosthesis

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5
Q

What is a hydrocele?

A

Fluid between 2 layers of tunica vaginalis, dx by ultrasound

Smooth and non tender on exam

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6
Q

What must you rule out in dx of hydrocele? Tx?

A

Testicular tumor, surgery if older than 18 months

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7
Q

What is a varicocele and how does it look on exam.

A

Engorgement of internal spermate veins….. Bag of worms non tender, non transilluminable mass usually on left side, ache with standing and diminishes when supine

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8
Q

Less than 10 yrs or sudden onset of ride side varicocele think….

A

Retroperitoneal malignancy

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9
Q

Sudden onset of left sided varicocele think……

A

Renal cell carcinoma

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10
Q

Describe a testicular torsion.

A

Testis twists on spermatic cord.

Acute pain, elevation of testicle worsens pain, non transilluminable, absent creamaster reflex.

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11
Q

What is the blue dot sign?

A

Torsion of the appendix of the tesetes.

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12
Q

What is a bell clapper deformity?

A

Congenital malformation of the posterior anchoring of the teste.

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13
Q

How do you dx and treat a testicular torsion?

A

Doppler ultrasound and surgery (scrotal orchiopexy)

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14
Q

What are the risk factors of nephro/urolithasis?

A

High calcium intake, purine foods, chronic UTI, gout, dehydration

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15
Q

Clinical signs of kidney stones?

A

Can’t sit still, flank pain, awaking at night, pain waxes and wanes, radiation to groin, scrotum and vulva, hematuria, nausea and vomiting
exam: CVA tenderness, soft abdomen, NMl exam

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16
Q

Outcome of stone 10 mm?

A

Pass without difficulty, pass 50% of the time, obstruction

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17
Q

Most common kidney stone?

A

Calcium oxalate from hypercalcemia, sarcoidosis, hyperparathyroidism, idiopathic

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18
Q

Struvite stone causes?

A

UTI from proteus, alkaline urine

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19
Q

Uric acid stone from?

A

Gout, high purine diet

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20
Q

Dx test of choice for kidney stones?

A

Helical CT, cystine and uric acid stone not seen on X-ray

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21
Q

Treatment for kidney stones?

A

Pain control with narcotics, hydration, change diet, metabolic eval

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22
Q

What issues phimosis?

A

Fibrous constriction of foreskin preventing retraction, tx circumcision

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23
Q

What is para phimosis?

A

Retracted foreskin developed fixed constriction proximal to glans, head swollen and painful.
Tx: reduction and circumcision

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24
Q

What is priapism?

A

Persistent involuntary erection, may be secondary to sickle cell, leukemia, etoh, marijuana or ecstasy.

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25
Q

Describe blood pressure control through the kidneys.

A

Decreased blood flow to kidney -kidney releases renin in blood - reacts with angiotensinogen - makes angiotensin 1- mixes with ACE breaks into - angiotensin 2 which is a strong vasoconstrictor and stimulates the release of aldosterone from the adrenals- 3 Na are reabsorbed from the urine into the bood bringing water with it- blodd pressure increases and feedback stops the release of renin.

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26
Q

Etiology of UTI?

A

Most common is e. Coli but don’t forget staph safraliticus in young females

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27
Q

Clinical presentation of cystitis?

A

Dysuria, frequency, urgency, discomfort, foul smelling urine, cloudy urine

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28
Q

Treatment for uncomplicated cystitis?

A

Bactrim x 3-5 days, 7 day course in pregnancy/DM/elderly. Nitrofurantoin safe in pregnancy
Pyridium

Change in mental status may be only sign in elderly or DM!

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29
Q

What is orchitis?

A

Inflammation of testicles usually from mumps, treat sx

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30
Q

Clinical presentation of epididymitis?

A

Male with presentation of swollen, firm, tender epididymitis. Dull aching pain, slow onset with gradual increase, pain improves with elevation of scrotum

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31
Q

Causes of epidymitis in young boy, less than 35

, and greater than 35?

A

Young-anatomical or h. Flu

35- e. Coli- bactrim

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32
Q

Signs and symptoms of acute bacterial prostatitis?

A

Fever, Dysuria, perineal pain, malaise, with enlarged tender prostate

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33
Q

PSA in acute bacterial prostatitis does what?

A

Increases then returns to normal post tx…..NO prostate massage!

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34
Q

Treatment for acute bacterial prostatitis?

A

Fluroquinolones or bactrim x 4-6 wks

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35
Q

Describe signs, sx, and exam of chronic bacterial prostatitis.

A

In elderly and recurrent UTI, Dysuria, voiding discomfort, back pain but little pain, in lab UA is neg but prostate massage dx is pos

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36
Q

Tx for chronic bacterial prostatitis?

A

Bactrim or fluroquinolones x 6-12 wks

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37
Q

White blood cell casts?

A

Think pyelonephritis

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38
Q

What is pyelonephritis and the MC causes?

A

Infection of the parenchyma of the kidney

E. Coli, klebsiella, enterobactor, pseudomonas

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39
Q

Clinical features and exam of patient with pyelonephritis.

A

Fever, chills, anorexia, flank pain, and UTI signs. UAa and culture required.

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40
Q

Who should be treated in patient for pyelonephritis? And what Meds?

A

Children, pregnant women and septic patients

Fluroquinolones , ceftriaxone

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41
Q

Painless hematuria think?

A

Bladder cancer

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42
Q

Risk factors for bladder carcinoma?

A

Smoking, occupational exposure, recurrent infections

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43
Q

Dx and treatment of suspected bladder cancer?

A

Cystoscopy with biopsy and chemo/radiation or cystectomy

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44
Q

Prostate cancer mets common to?

A

Bone

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45
Q

Risk factors for prostate cancer?

A

Age, positive family hx, black, high fat diet. NOT vas or BPH.

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46
Q

PE for prostate ca?

A

DRE hard enlarged prostate with nodules. Bone pain and LE edema in late stage

CT/MRI for staging BIOPSY for dx.

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47
Q

Classic triad for renal cell carcinoma?

A

Flank pain
Abdominal mass
Hematuria

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48
Q

Risk factors for renal cell carcinoma?

A

Mere common in black men. Obesity, HTN, smoking and diuretic use.

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49
Q

Treatment for renal cell carcinoma?

A

Surgery and immunonodularity with interleukin 2

Resistant to chemo and radiation.

50
Q

Describe testicular carcinoma.

A

Young males 20-40, painless solid testicular swelling, likely asymptomatic. Risk factor is chyptochidism.

51
Q

Dx and treatment of testicular carcinoma?

A

Dx with ultrasound and increase in BHCG

Treat with orchectomy #1

52
Q

Lab diagnosis of acute renal failure?

A

Abrupt increase in creatine, by 0.3ml/dal or 50%

53
Q

Describe prerenal causes of acute renal failure.

A

Perfusion problem!

Shock, dehydration, decreased cardiac output, renal artery obstruction

54
Q

Describe causes of postrenal causes of acute renal failure.

A

Think obstruction!

Neoplasm, stones, prostate dz, blocked foley

55
Q

Describe renal causes of acute renal failure.

A

Think inside kidney.

Nephritis, HUS, toxins are MOST common (aminogylcosides, NSAIDs, contrast)

56
Q

Signs and symptoms of acute renal failure?

A

Orthostatic hypotension, tachycardia, rales, JVD, edema, bladder distension, anuria

57
Q

Treatment for acute renal failure?

A

Remove toxins, low sodium and potassium diet, fluid balance, dialysis

58
Q

Chronic renal failure is multi system. What are the #1 and #2 causes?

A

Diabetes and HTN

59
Q

Treatment of chronic kidney failure depends on stage.

A

BP control with ACEI, decrease salt, exercise, low protein diet, calcium supplement, dialysis, transplant

60
Q

This so damage to renal glomeruli due to deposits of inflammatory proteins secondary to an autoimmune event.

A

Glomerulonephritis

61
Q

Red blood cell casts think?

A

Glomerulonephritis

62
Q

Clinical presentation of glomeruli nephritis?

A

Tea colored urine, hematuria, oligouria, edema, HTN.

63
Q

Dx and tx of glomeruli nephritis?

A

Renal biopsy,

Treat underlying cause, monitor salt and fluids, dialysis.

64
Q

What is hypernatremia?

A

Too much Na. Over 145. Typically reflects a decrease in total body water compared to sodium. This cause water to leave the brain cells and the cells shrink!

65
Q

Signs of hypernatremia?

A

Severe thirst unless mental confusion. Seen in elderly, young, or neuro impaired.

66
Q

Clinical presentation and treatment of hypernatremia?

A

Decreased skin turgor, tachycardia, hypotension, mental status changes.
Treat with isotonic solution slowly or else cerebral edema

67
Q

A surgeon taking out an adrenal mass by removing the 12 th rib May injure what!

A

Diaphragm

68
Q

What is the most common cause of idiopathic nephropathy?

A

IgA nephropathy. Hematuria following a sore throat.

69
Q

What is the MC cause of glomerulonephritis?

A

IgA nephropathy. Dx with renal bx, usually follows URI. More common in Asian and tx with corticosteroids.

70
Q

Good pasture syndrome?

A

Acute glomerulonephritis with hemoptasis NAND rapid decline in renal function. Tx is plasma exchange and corticosteroids.

71
Q

Describe wegners granulomatosis.

A

Fever, malaise, weight loss associated with respiratory tract infection. Treat with corticosteroids.

72
Q

Patient with hx of smoking, urinary obstruction, hematuria think?

A

Bladder cancer

73
Q

What is nephrotic syndrome?

A

Any disease that causes

  1. protienuria >3.5
  2. Hypoalbuminemia
  3. Edema
74
Q

Pyelonephritis with high fever and WBC over 18,000?

A

Inpatient with IV abx

75
Q

Effacement of podocytes or foot processes?

A

Minimal change disease

76
Q

Child 2-6 yrs old with edema, protienuria, dyslipidemia?massive protienuria!

A

Minimal change disease.

77
Q

First lab test for pheochromocytoma?

A

24 hr urine catecholamines

78
Q

Lab test for Cushing dz?

A

24 hr free cortisol

79
Q

What is Orthostatic protienuria?

A

Increase in urine protein in young males during the day. Test is split 24 hr protein and no tx required.

80
Q

NSAIDs can cause mild renal failure so avoid in whom?

A

Patients with kidney dz

81
Q

What is the only oral med for pseudomonas?

A

Cipro or levaquin. Fluroquinolones.

82
Q

First step in evaluating a palpable thyroid nodule?

A

Ultrasound!

83
Q

Biopsy for solid thyroid nodule less greater than 3 cm?

A

Cutting needle biopsy

84
Q

Thyroid nodule cystic and less than 3 cm!

A

FNA

85
Q

Type of nephropathy seen in black IV drug users with aids?

A

Focal segmental glomerular sclerosis

86
Q

Kid with strep or impetigo with HTN and edema?

A

Post infectious GN

87
Q

Patient with painless hematuria and just had flu or uri?

A

IgA nephropathy

88
Q

GN with hemoptasis HTN, edema and anti-GMP positive?

A

Goodpastures dz

89
Q

RBC casts?

A

Glomerulonephritis

90
Q

What are the 4 signs of nephrotic syndrome?

A

Protein >3.5, hyper albumin, hyper lipids, edema

91
Q

Common presentation of nephrotic syndrome?

A

Abdominal distension, anorexia, oligouria, puffy eyes, sob, wt gain, edema, HTN, hematuria

92
Q

Common lab findings of nephrotic syndrome?

A

Oval fat bodies and fatty casts

93
Q

Treatment for nephrotic syndrome?

A

Steroids, dietary changes, avoid toxic drugs and ACE inhibitors.

94
Q

Patient presents with palpable kidney…dx?

A

PCOS

95
Q

Define hyponatremia.

A

Sodium less than 135

96
Q

Signs and symptoms of hyponatremia?

A

Nausea, headache, weakness, mental confusion, seizures, coma, death

97
Q

How do you treat hyponatremia?

A

Treat underlying cause, hypertonic solution, water restriction

98
Q

What to watch for when correcting Na imbalance?

A

Do not increase Na by more than 12-24 over a 24 hr period or may have cerebral edema.

99
Q

Describe SIADH.

A

Excessive release of ADH from posterior pituitary. Which increases water reabsorbtion by the kidney…. Holds onto water.

100
Q

Causes of SIADH?

A

Small cell lung cancer, brain tumor, head trauma, SSRI, TCA, ecstasy

101
Q

Treatment for SIADH?

A

Treat underlying cause.
Fluid restriction to 800-1000 ml /day
Demeclocycline

102
Q

Describe hypernatremia.

A

Na greater than 145. Initiates severe thirst unless mental confusion, common in elderly, very young or neuro-impaired.
Clinical: turgor, hypotension, mental status changes
Treat with IV fluid slowly, watch for cerebral edema

103
Q

What is hyperkalemia?

A

Potassium over 5.5

104
Q

Signs and symptoms of hyperkalemia?

A

Weakness, paralysis, abdominal distension, diarrhea.

EKG has peaked t waves

105
Q

Treatment for hyperkalemia?

A

IV bicarbonate, calcium gluconate.
Glucose and insulin
Diuretics and dialysis last

106
Q

Describe hypokalemia.

A

Potassium less than 3.5. Causes muscle weakness, lethargy, paresthesias, polyuria, constipation and severe ileus, flaccid paralysis
Flattened t waves on EKG

107
Q

Treatment for hypokalemia?

A

Treat underlying cause and potassium supplements

108
Q

Describe hypocalcemia.

A

Calcium less than 8.5. Patient. Presents with abdominal and muscle cramps, tetany, and seizures.
EKG may show prolonged QT interval.

109
Q

What is crvustek sign?

A

Tapping the facial nerve causing a spasm. Test for hypocalcemia.

110
Q

What is trousseau sign?

A

BP cuff causes carpal spasm. Positive in hypocalcemia.

111
Q

Treatment for hypocalcemia?

A

Treat underlying disorder and give calcium gluconate.

112
Q

Hypercalcemia please describe.

A

Pt has polyuria, constipation, abdominal pain, thirst, dehydration and HTN. Calcium over 10.5.
Can be caused by malignant melanoma.

113
Q

In metabolic acidosis what is the pH and bicarbonate?

A

Ph is low (less than 7.4) and bicarbonate is low.

114
Q

Signs and symptoms of metabolic acidosis?

A

Dyspnea, hyperventilation, fatigue, acetone breath

115
Q

Causes of metabolic acidosis?

A

MUDPILES

Methanol, uremia, DKA, propylene glycol, ingestion, lactic acid, antifreeze (ethalyne glycol), salicylates

116
Q

Signs and symptoms of metabolic alkalosis?

A

Weakness, malaise, lethargy, hyporeflexia, tetany, muscle weakness. Causes vomiting or NG tube, diuretics, laxatives.

117
Q

What are ketones in the urine from?

A

Fatty acids and fat metabolism

118
Q

What does nitrite in the urine indicate?

A

Detects the presence of bacteria

119
Q

What does leukocytes in the urine indicate?

A

Presence of white blood cells. Indicates pyuria.

120
Q

What do hyaline casts in the urine indicate?

A

Clear colorless casts indicate decrease in filter rate. Few normal from exercise, stress, fever. Can indicate issues.

121
Q

What do red blood cells casts in the urine indicate?

A

Active inflammatory or vascular disorder. (Think glomerulonephritis)

122
Q

What doe WBC casts in the urine indicate?

A

Renal infection. Think pyelonephritis!

123
Q

What do waxy casts in the urine indicate?

A

Extreme renal stasis. Chronic renal failure or renal disease.

Panre (18 decks)

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