GU Flashcards
A 55y/o male presents with increased urinary frequency, nocturia, hesitancy, and a weak stream – dx? How do you confirm?
BPH
Confirm with PSA and UA
If a male has BPH symptoms and HTN how would you treat?
Alpha Blockers
How do we treat BPH?
Tamulosin
What are the most common causes of erectile dysfunction?
Vascular, diabetes, SSRI’s, and psychogenics
What should we always remember about phosphodiesterace inhibitors?
They are contraindicated in pts taking nitrates!
How do we treat urge incontinence?
Oxybutynin
How do we treat stress incontinence?
Vaginal estrogen
What are the 3 MC types of stones that cause nephrolithiasis?
Calcium Oxylate
Cystine – autosomal disorder, can’t absorb amino acid cysteine.
Struvite – urea splitting bacteria
What’s the gold standard diagnostic for nephrolithiasis?
UA shows hematuria
*Non-contrast helical CT
How do we treat kidney stones?
Hydrate, NSAIDs Stones less than 10mm – Tamulosin Stones greater than 10mm – lithotripsy
What types of foods should someone with chronic kidney stones avoid?
Oxalate rich foods (nuts, bran, spinach, and vit C)
If a pt has painless intermittent hematuria – what should you always think of? Dx? And Tx?
Bladder CA Dx – Cystoscopy and CT Tx – TURBT
How do we handle prostate cancer?
Risk stratify patients with PSA
What is the MC malignancy in young males? How do we dx and tx?
Testicular CA Dx – U/S DO NOT BIOPSY and CT Tx – Radical inguinal orchiectomy
What are the MC causes of cystitis?
E. coli, staph, proteus, and klebsiella
What would make a complicated UTI?
Preggo, male, foley cath, DM, immunocompromised, or structural abnormality
What finding in a UA is most specific to an infection?
Nitrites
How do we treat an uncomplicated vs complicated UTI?
Uncomplicated: Nitrofurantoin, TMP-SMX
Complicated: TMP-SMX, Cipro or levo
*If a man, does NOT improve after 7 days, think prostatitis
What is prostatitis? What would you see on PE?
Inflammation of the prostate (from e. coli)
The prostate feels tender, warm, and edematous
How do you treat prostatitis?
Floro or trimethoprim-sulfameth.
What would you see on PE with pyelonephritis?
Cystitis PLUS fever, chills, flank pain, and CVA tenderness
What would you see on UA with pyelonephritis?
Same as cystitis PLUS WBC’s and casts
How do we treat pyelo?
Floroquinolones – ciprofloxacin
If we see testicular pain, erythema, and swelling – what is it called? What does it usually occur with? If it occurs alone, what should we think of?
Known as – Orchitis Occurs with epididymitis Occurs alone think MUMPS
How do we diagnose epididymitis? Tx?
NAAT + U/A and culture
If over 35 tx with fluoroquinolone
If a male has dysuria and penile discharge, the gram-stain is positive for gonorrhea – dx? Confirm? Tx?
Urethritis Dx – NAAT for gonorrhea Tx – Ceftriaxone + azith or doxy *Must treat all partners regardless of sxs
How do we treat for chlamydia?
Azithromycin 1g (single dose) or Doxy x 10 days
What type of herpes causes oral components vs genital?
HSV1 = oral
HSV2 = genital
How do we diagnose and treat herpes?
Dx – PCR
Tx – Acyclovir or valavivlovir (within 72 hours)
How do we diagnose and treat Gonorrhea?
Dx – NAAT
Tx – Ceftriaxone
How do we diagnose and treat Chlamydia?
Dx – NAAT
Tx – Doxy or Azith
How do we diagnose and treat Trichomonas?
Dx – Naat
x – Metronidazole
IF we see an increased Cr by .3 or by 50% within 48 hours – what do you think of? What are the different types?
Acute Kidney Injury
- Pre-renal
- Intrinsic
- Post-Renal
Are there any sxs associated with acute kidney injury?
Either Asymptomatic or edema, HTN, fatigue
What are the MC causes of pre-renal AKI?
decreased renal perfusion = dehydration, vomiting, diarrhea, CHF
Also, NSAIDs, contrast, and ACE
How do you Dx pre-renal AKI?
UA = normal
BUN/Cr >20:1
Urine Na <20
Urine Osmol = increased
How do treat pre-renal AKI?
Increase renal perfusion via GIVE FLUIDS!
If you see muddy brown casts, tubular cell casts, and dysmorphic RBC’s on UA – Dx?
Intrinsic renal disease
What is the MC cause of Intrinsic AKI?
ATN (caused by ischemia secondary to prolonged decreased renal perfusion)
*thrombus, scleroderma, malignant HTN or aminoglycosides and sulfonamides
How do you dx intrinsic AKI?
UA = granular muddy brown casts, tubular cell casts, dysmorphic RBC’s, hematuria, and/or proteinuria
BUN/Cr 10:1
Urine Na >40
Urine Osmol = decreased
How do we treat intrinsic AKI?
Treat underlying cause (fluids DO NOT improve ATN)
What causes post-renal AKI? Tx?
Due to outflow obstruction
Tx – Cath or remove obstruction
What are some life threatening issues associated with AKI?
Hyperkalemia (dialysis for peaked T waves), uremia, and metabolic acidosis
What will cause a false-positive for blood in the urine?
Rhabdo from Hyperkalemia
If a pts GFR has been decreased over the past 3 months – dx? What is a decrease in GFR?
Chronic renal failure
Less than 60 = decreased GFR
What other ways can we see kidney damage?
Protein uria, casts, small echogenic kidneys on U/S
So a GFR of 45-59 is known as what?
3A
So a GFR of 30-44 is known as what?
3B
So a GFR of 15-29 is known as what?
4
So a GFR of less than 15 is known as what?
5
How do we treat chronic renal failure?
start with protein and sodium restriction
If someone has CKD and HTN how do we treat them?
ACE/ARB and loop diuretic
*be careful of hyperkalemia!!
When we start an ACE what lab finding do we often see?
Transient drop in GFR
*Why you need a baseline Cr and K, followed by a re-check, if Cr increases by over 30% stop ACE
CKD is viewed as an equivalent to what?
Coronary artery disease
What are some indications for dialysis?
Uremia, significant bleeding, refractory metabolic acidosis, hyperkalemia, pericarditis, and malnutrition, and GFR of 5!
What is the normal range for a pH?
7.35-7.45
What is normal PCO2?
35-45
What’s a normal bicarb?
24-30
If the pH is down – what state are you in?
Acidosis
If the pH is up – what state are you in?
Alkalosis
If both the pH and bicarb are down – what state are you in? Cause? Tx?
Metabolic Acidosis (both go down = metabolic) MUDPILES Tx underlying cause
What does MUDPILES stand for?
Methanol, uremia, DKA, propylene glycol, infection/isonized, lactic acidosis, ethylene glycol/ethanol, and salicylates (ASA)
If the pH is low but the bicarb is high – what state are you in? What can cause it? Tx?
Respiratory acidosis Caused by svere COPD or drug OD Tx = ventilator support or narcan
If the pH is up but the bicarb is down – what state? Cause? Tx?
Respiratory alkalosis Caused by hyperventilation Tx = breath into a bag
If the pH is up and the bicarb is up – state? Cause? Tx?
Metabolic Alkalosis Severe vomiting with hypokalemia Isotonic fluids and electrolytes
If your pt has kussmal breathing, tinnitus, and anxiety/delirium – what are you worried about?
Aspirin OD
How do we treat aspirin OD?
Bicarb and dialysis
If a pt have RUQ for 48 hours and they are jaundiced – what do you think?
Acetaminophen OD
What will we see on labs with acetaminophen OD?
Re-draw labs every 4 hours because it can take a long time to see results (AST/ALT, BUN/Cr, Lactate, ABG’s)
How do we treat an acetaminophen OD?
Oxygen, cardiac monitor, N-acetylcystine within 8 hours
