GU

Question 1

Urinary tract infections (UTI’S)

Answer 1

Inflammation and infection involving the kidneys, ureters, bladder and/or urethra

Question 2

Causes of UTI’s

Answer 2

Lower: cystitis, urethritis/dysuria frequency syndrome
Upper: Pyelonephritis, renal abscesses
E. Coli #1 cause in women
Proteus species most common in men

Question 3

S/S of lower UTI’s

Answer 3

Dysuria is key symptom
Frequency
Nocturia
Urgency
Hematuria

Question 4

Diagnostics of UTI

Answer 4

Urinalysis usually shows pyuria (>10WBC)
Presence of nitrate on dipstick (specific but not sensitive for bacteria)
Esterase detection on dipstick (very sensitive but not specific)

Question 5

Management of lower UTI

Answer 5

3-day therapy maximizes benefits and minimizes drawbacks of treatment
Bactrim, Cipro, and augmentin
Pregnancy: amox, nitrofurantoin, cephalexin, for 7-10 days

Question 6

Acute pyelonephritis s/s

Answer 6

Flank, low back pain or abdominal pain
Fever and chills often present and usually indicate upper UTI
N/V
Mental status changes in the elderly

Question 7

Stress incontinence

Answer 7

Causes: muscles impairing urethral support (most common) and intrinsic sphincter deficiencies due to pelvic surgery

Question 8

Findings of stress incontinence

Answer 8

Urine leakage from activities with increased pressure on bladder
Typically a small amount of urine

Question 9

Urge incontinence causes

Answer 9

Detrusor overactivity by CNS abnormalities such as strokes
Infections of the GU tract
Urinary Stones
Neoplasms
Fecal impaction

Question 10

Urge incontinence findings

Answer 10

Urgency, involuntary urinary loss, nocturia, frequency
Often referred to as “overactive bladder”
Typically a large amount of urine

Question 11

Management of stress incontinence

Answer 11

Timed voids to prevent full bladder
Pessary
Surgery

Question 12

Management of urge incontinence

Answer 12

Urge suppression/distraction
Quick pelvic contractions
Medication

Question 13

Patient teaching for incontinence

Answer 13

Weight loss (good for urge incontinence)
Fluid management
Avoid caffeine
Pelvic floor exercises
Bladder control strategies (urge =freeze and squeeze, Stress= squeeze before you sneeze)

Question 14

Muscarinic Receptor antagonists

Answer 14

Immediate release: Oxybutynin, Tolterodine, Trospium

Extended release: Darifenacin, fesoterodine, Dirtropan, Solifenacin, Detrol, Oxybutynin transdermal, oxybutynin gel

Question 15

Varicocele

Answer 15

A collection of dilated veins around the spermatic cord

Question 16

S/s of varicocele

Answer 16

Often asymptomatic
Scrotal pain
Scrotum looks like a “bag of worms”
Decreased fertility

Question 17

Management of varicocele

Answer 17

NSAIDs

Surgical ligation, venous embolization

Question 18

Tanner stage 1 in boys

Answer 18

Preadolescent testes, scrotum and penis

Question 19

Tanner stage 2 in boys

Answer 19

Enlargement of scrotum and testes, scrotum roughens and reddens

Question 20

Tanner stage 3 in boys

Answer 20

Penis elongates

Question 21

Tanner stage 4 in boys

Answer 21

Penis enlarges in breadth and development of the glans; rugae appear

Question 22

Tanner stage 5 in boys

Answer 22

Adult shape and appearance

Question 23

Epididymitis

Answer 23

Acute inflammatory or infection of the scrotum, secondary to an inflamed epididymis
Commonly in men <35 yo w/ chlamydia as causative agent
When >35 yo likely a result of a bacterial ascension from the bladder or bacteria introduced during cauterization and/or surgery

Question 24

S/s of epididymitis

Answer 24

Pain
dysuria
urgency/frequency
low back/perineal pain
Fever/chills
malaise
scrotal edema

Question 25

PE for epididymitis

Answer 25

Enlarged, tender epididymitis Urethral d/c Positive Prehn's sign= no pain relief w/ elevation of scrotum

Question 26

Diagnostics for epididymitis

Answer 26

STD testing Urine culture scrotal US

Question 27

Management of epididymitis

Answer 27

Adults under 35= ceftriaxone 250mg IM x1 + doxycycline 100mg BID x14 days OR Azithromycin 1 gm PO once Adults over 35= Bactrim 1 tab BID x 10 days OR Cipro 250 mg BID x10 days Ice(early), heat (late)

Question 28

Acute Bacterial Prostatitis

Answer 28

Inflammatory infection of the prostate Usually caused by gm- bacteria (E.coli) Nonbacterial= mostly in young men, chlamydia, mycoplasma, gardnerella

Question 29

S/S of ABP

Answer 29

``` Fever/chills low back pain dysuria urgency/frequency nocturia ```

Question 30

PE of ABP

Answer 30

Edematous prostate, may be warm and tender/boggy to palpation

Question 31

Diagnostics for ABP

Answer 31

Urine culture--+ for causative agent

Question 32

Management of ABP

Answer 32

Abx= Bactrim, Levofloxacin, nofloxacin, ofloxacin Sitz bath 3x daily for 30 min each No sexual intercourse until acute phase resolves

Question 33

Benign prostatic hypertrophy (BPH)

Answer 33

Progressive, benign hyperplasia of the prostate By age of 50, 50% of men will exhibit signs By 80, 80% of men Most common cause of bladder obstruction in men over 50

Question 34

S/s of BPH

Answer 34

Urgency/frequency Nocturia Dribbling Retention

Question 35

PE of BPH

Answer 35

Bladder distention Prostate non-tender with either asymmetrical or symmetrical enlargement Smooth, rubbery consistency with possible nodules

Question 36

Diagnostics of BPH

Answer 36

``` U/A Uroflowmetry Abd US Serum Cr/BUN should be normal Prostate-specific antigen (PSA): >4ng/ml indicates disease DRE ```

Question 37

Management of BPH

Answer 37

Alpha-blockers: Terazosin, prazosin, Tamsulosin to relax muscles of the bladder and prostate 5-alpha-reductase ihibitors: Finasteride and dutasteride to shrink large prostates Saw palmetto--effective for some

Question 38

Prostate cancer

Answer 38

Malignant neoplasm of the prostate gland | 2nd most common cancer among men

Question 39

S/s of prostate cancer

Answer 39

Usually asymptomatic May appear to be BPH in early stages In advanced stages= bone pain from metastises, uremia secondary to obstruction may occur

Question 40

PE of prostate cancer

Answer 40

Adenopathy Bladder distention Prostate palpates harder than normal with obscure boundaries, and nodules may be present

Question 41

Prostate-specific antigens (PSA)

Answer 41

Values >4ng/ml=abnormal The higher the PSA---the more likely the diagnosis of cancer Approx 40% of pts with prostate cancer with present with normal PSA values!

Question 42

Erectile Dysfunction

Answer 42

Inability to sustain an erection capable of intercourse

Question 43

Major causes of ED

Answer 43

Stress-- psychosocial issues, performance anxiety Athertosclerosis Diabetes Recreational drugs Meds- diuretics, antihypertensives, H2 blockers, antidepressants, anti-anxiety agents, anti-epileptics, antihistamines, NSAIDS, muscle relaxants, Parkinsons meds

Question 44

Management of ED

Answer 44

Fix underlying cause Check T level Phosphodiesterase inhibitors: Sildenafil, vardenifil, tadalafil, avanafil (careful with use of nitrates!)

Question 45

What ED drugs can last up to 36 hours and works within 15 minutes?

Answer 45

Tadalafil and Avanafil

Question 46

Which ED drugs work in 30 minutes and last 4 hours?

Answer 46

Sildenafil and Vardenafil

Question 47

UTI's in the older adult

Answer 47

Most common clinical illness over 65 E. coli Enterococci Typically have atypical findings such as incontinence, fecal impaction, lethargy, decreased appetite, dehydration, confusion

Question 48

Renal changes in the older adult

Answer 48

Diminished renal blood flow Kidneys decrease in size GFR diminishes Reduced hormonal response to vasopressin Bladder tone, elasticity and capacity are reduced Decreased drug clearance

Question 49

How do you determine renal function in the elderly?

Answer 49

Creatinine clearance Cockcroft-Gault Equation: Males: Cr.Cl= 140 minus age in years x kg / 72 x creatinine Females: multiply the calculated value by 85% (0.85)

Question 50

What is the normal Cr cl values in adults?

Answer 50

Males: < 40= 107-139 mL/min or 1.8 to 2.3 mL/sec Females <40= 87-107 mL/min or 1.5-1.8 mL/sec *Cr cl values usually decrease as one ages (6.5 mL/min for every 10 years after the age of 20)