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UWorld Medicine HY > GU > Flashcards

GU Flashcards

1
Q

Required workup for painless hematuria in an adult over 35

A

Assessment for bladder cancer w/ CT urogram and cystoscopy

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2
Q

Medication linked to hemorrhagic cystitis and bladder cancer

A

Cyclophosphamide

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3
Q

What can be used to prevent cyclophosphamide bladder toxicity?

A

Mesna (concentrates in bladder and forms conjugate with the toxic metabolite of cyclophosphamide, acrolein)

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4
Q

Diagnostic test for kidney stones

A

Non-contrast CT or ultrasound

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5
Q

Radiolucent kidney stone associated with needle-shaped crystals in the urine

A

Uric acid stones

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6
Q

Kidney stones linked to fat malabsorption

A

Calcium oxalate (unabsorbed fat chelates calcium in the gut, freeing oxalate to be absorbed)

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7
Q

Kidney stones seen in primary hyperparathyroidism and renal tubular acidosis

A

Calcium phosphate

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8
Q

Kidney stones seen with acidic urine

A

Uric acid stones

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9
Q

Kidney stones seen with increased cell turnover

A

Uric acid stones

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10
Q

Treatment of uric acid stones

A

Hydration, low-purine diet, and alkalinization of the urine with oral potassium citrate. (Can add allopurinol if this regimen fails)

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11
Q

Kidney stones seen patient with genetic defect in amino acid transporters

A

Cystine stones

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12
Q

Radioopaque kidney stones with hexagonal crystals in the urine

A

Cystine stones

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13
Q

Kidney stones associated with alkaline urine due to urease-producing bacteria

A

Struvite stones

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14
Q

Organism associated with struvite stones

A

Proteus (could be other urease-producing bacteria)

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15
Q

Management of kidney stones by size

A

<1 cm: may pass, give analgesia and hydration.

Larger will require surgery

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16
Q

Treatment for uncomplicated acute cystitis

A

Nitrofurantoin, TMP-SMX, or fosfomycin
(Quinolones only if all 3 of these cannot be used in uncomplicated acute cystitis - but these are primary for complicated acute cystitis)

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17
Q

Treatment for complicated acute cystitis

A

Fluoroquinolones are mainstay (sometimes broader-spectrum, like amp/gent, in more severe cases)

18
Q

What makes acute cystitis “complicated?”

A 
Patient factors:
1. Diabetes
2. Pregnancy
3. Immunosuppression
4. Renal failure
5. Urinary tract obstruction
Situational factors:
6. Indwelling catheter
7. Urinary procedure
8. Hospital acquired
19
Q

UTI with alkaline urine

A

Urease-producing bacteria, most commonly Proteus mirabillis (can lead to recurrent UTIs and struvite stones)

(Klebsiella is a less common urease-producing bacterial cause of UTI)

20
Q

When does pyelonephritis need imaging?

A
  1. Symptoms persist after 48-72 hours of appropriate treatment
  2. History of kidney stones
  3. Unusual findings (gross hematuria, suspicion for obstruction)
21
Q

What is complicated pyelonephritis?

A

Pyelonephritis with any of:

  1. Corticomedullary abscess
  2. Perinephric abscess
  3. Emphysematous pyelonephritis
  4. Papillary necrosis
22
Q

Urinary incontinence with coughing and sneezing

A

Stress incontinence (due to pelvic floor instability)

23
Q

Urinary incontinence with sudden, frequent need to empty bladder

A

Urge incontinence

24
Q

Urinary incontinence with constant dribbling and incomplete emptying

A

Overflow incontinence

25
Q

General treatment for all types of urinary incontinence

A

Lifestyle modifications and pelvic floor exercises

26
Q

Treatment for stress incontinence

A

Pessaries, then pelvic floor surgery

27
Q

Treatment for urge incontinence

A

Bladder training and lifestyle modification first, then oxybutynin or other antimuscarinics

28
Q

Treatment for overflow incontinence

A

Bathanechol (cholinergic agonist) or periodic self-catheterization

29
Q

Potentially reversible causes of urinary incontinence in the elderly

A 
DIAPPERS:
Delirium
Infection (e.g. UTI)
Atrophic urethritis/vaginitis
Pharmaceuticals (alpha blockers, diuretics)
Psychologic (depression)
Excessive urine output (e.g. DM, CHF)
Restricted mobility (e.g. post-surgery)
Stool impaction
30
Q

First treatment for BPH

A

Alpha1-blockers (e.g. tamsulosin, doxazosin, terazosin)

(5-alpha reductase inhibitors (e.g. finasteride, dutasteride) are either adjuvants or second-line if alpha1-blockers not tolerated)

31
Q

Treatment for chronic prostatitis

A

Antibiotics, alpha-blockers, 5-alpha reductase inhibitors

32
Q

Erectile dysfunction with loss of bulbocavernosus reflex

A

Neurogenic erectile dysfunction

Bulbocavernosus reflex: squeeze glans or tug on catheter, anal sphincter should contract

33
Q

Types of causes or organic erectile dysfunction

A
  1. Vascular (most common)
  2. Neurogenic
  3. Medication-induced
  4. Endocrine (e.g. hypogonadism)
34
Q

Medications that can lead to erectile dysfunction

A
  1. Antihypertensives (especially beta blockers and thiazides)
  2. SSRIs
  3. Anti-androgenic medications (e.g. spironolactone)
35
Q

Most common cause of priaprism, especially in an adolescent

A

Sickle cell disease

36
Q

Medications that can lead to priaprism

A
  1. Trazadone (atypical antidepressant with some alpha-block)
  2. Valproate
  3. Alpha1-blokers for BPH
  4. Anticoagulants
  5. Cocaine
37
Q

First step in diagnosis of possible testicular cancer based on suggestive exam?

Next step?

A

First: Ultrasound
Second, if high likelihood of cancer from imaging: orchiectomy

(FNA and biopsy are CI due to risk of seeding lymphatics and blood with cancer cells)

38
Q

Hormone(s) produced by Leydig cell testicular tumor

A

Testosterone and estrogen

39
Q

Hormone(s) produced by choriocarcinoma testicular tumor

A

beta-HCG

40
Q

Hormone(s) produced by endodermal sinus testicular tumor a.k.a. yolk sac tumor

A

AFP

41
Q

Hormone(s) produced by seminoma testicular tumor

A

Usually none

42
Q

UTI symptoms with perineal pain and fever and chills in a man.
Diagnosis? Key test? Treatment?

A

Diagnosis: Acute bacterial prostatitis
Test: Urine culture to direct antibiotics
Treatment: 4-6 weeks of antibiotics

UWorld Medicine HY (7 decks)

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