GU Flashcards
Majority of varicoceles on what side
left. If found on the right side can be associated with vena cava obstruction (think malignancy!)
Tx stress incontinence (RX)
A agonist (pseudoephedrine) or TCA
Tx urge incontinence (RX)
oxybutynin or anticholinergics, 2nd line botox
TX nephrolithiasis
Stones
Oxalate rich foods
Nuts bran spinach Vit c
Paraphimosis vs Phimosis
Paraphimosis: foreskin is retracted, tourniquet effect; emergency
Phimosis: cannot be retracted, not emergent
Physical exam findings testicular torsion
Negative cremasteric reflex on affected side
High riding testicle
Negative Prehn sign (there is no relief when you lift the testicle. In epididymitis there is a positive Prehn sign, there is relief when lifting the testicle)
Examples of complicated cystitis
pregnancy males s/p foley cath structural abnormality immunocompromised diabetes
Initial tx cystitis: Pregnancy
Macrobid
Initial tx cystitis complicated
Fluoroquinolone
Tx Pyelo
Fluoroquinolone until cultures are done
Epididymitis etio more than 35 y/o
GC/CT less than 35 More than 35 y/o is E. Coli
Positive Prehn sign
Elevating testicle provides relief of pain. Seen in epididymitis
TX Epididymitis
more than 35 y/o Cipro (E Coli)
Tx for orchitis secondary to mumps
Symptomatic: ice, elevate, NSAIDs
Acute prostatitis etio and tx
E coli, Cipro or Septra x 2-4 weeks
Dx with urine culture
Prostatic massage:
No for acute prostatitis
Yes for chronic prostatitis, culture secretions and urine but still difficult to obtain culture so tx empirically x 6 weeks with Cipro or Septra
Most important risk factor for bladder CA
Smoking
Bladder CA usually transitional cell carcinoma
Next step pt > 40 y/o painless hematuria
Cystoscopy, CT
Avg age for testicular CA
15-35
Most common germ cell tumor
Seminoma
What labs elevated with testicular CA
LDH
AFP
HCG
Eval of testicular CA
US
No biopsy due to risk of metastatic spread to lymph nodes
Most common renal malignancy in children
Wilms Tumor
Child with urogenital malformations (cryptorchidism, hypospadias) associated with what?
Wilms Tumor
Child with unilateral painless abdominal mass?
US, concerned about Wilms Tumor. 10% are metastatic at the time of dx
Most common cause Acute Kidney Injury (acute renal failure)
Pre-renal: decrease perfusion
2nd most common cause acute kidney injury
Intrinsic: ATN
How do NSAIDs and contrast affect the kidney?
Constrict afferent arteriole
Tx pre renal acute kidney injury vs intrinsic acute kidney injury
Pre-renal tx: fluids, is reversible
Intrinsic: if ATN: fluids will not help
ESRD is eGFR
less than 15
Initiating an ACEI in CKD
Repeat labs 3d after starting ACEI/ARB. D/C if Cr increases over 30% from baseline or increased K+
What metabolic changes with CKD?
Hyperphosphatemia (reduced excretion)
Hypocalcemia (lack of Vit D activation)
Initially leads to secondary hyperparathyroidism
Sx post streptococcal glomerulonephritis
hematuria, edema, HTN
Most common cause of glomerulonephritis
IgA nephropathy: presents as hematuria a few days after URI
Renal artery stenosis in a woman less than 50?
Fibromuscular dysplasia
Exaggerated rise in creatinine with an ACEI or ARB suspect what?
RAS
Recurrent flash pulmonary edema suspect what condition?
RAS
Nephrogenic DI
PP makes lots of ADH but the kidneys are insensitive to it so ADH is not working. Usually caused by lithium or hypercalcemia. Causes hypernatremia (pt have polyuria) Will have low urine osmolality and high serum osmolality (dilute urine, salty blood)
Tx DI and how to differentiate between nephrogenic and central DI?
ADH
If it fixes the problem (pt urinates less and then urine becomes more concentrated) then the problem was central DI (not producing enough ADH). If it does not fix the problem it is nephrogenic (insensitive to ADH)
SIADH causes what electrolyte abnormality and what does the urine and serum look like?
Retain fluids, causes hyponatremia, high urine osmolality low serum osmolality
Tx asymptomatic hyponatremia?
Fluid restriction. Can also treat with normal saline and possibly a loop diuretic
