GU BLOCK II Flashcards
1
Q
What is the criteria for a benign cyst on US
A
Echo free (anechoic)
Sharply demarcated mass w/ smooth walls
Enhanced back wall → indicating good transmission through the cyst
2
Q
What is the criteria for a benign cyst on CT
A
Smooth thin wall that is sharply demarcated
No enhancement w/ contrast media
3
Q
If lesion is inconsistent w/ a simple cyst on CT what is the next step
A
Surgical exploration
4
Q
What is the standard of care for a benign cyst
A
CT non con
And periodic evaluation
5
Q
What is the most common inherited kidney Dz
A
Polycystic Kidney Dz
6
Q
What is the presentation for a patient with PKD
A
Age 20-40
Abdominal or Flank Pain
Hematuria
(Microscopic or Gross)
Mild-Moderate Proteinuria
Family History (75%)!!! Hypertension (50%)!!!
Low urinary pH
Recurrent UTI or Nephrolithiasis
7
Q
How do you Dx PKD
A
Ultrasound
Diagnostic in patient with positive family history and renomegaly in the 3rd or 4th decade of life.
Negative US is less accurate in ruling out disease in patients younger than 30 years so CT or MRI is recommended!!!
8
Q
What is the treatment for pain in PKD
A
Bed rest, analgesics (non-NSAID), cyst decompression, avoid long-term use of analgesics, tricyclic antidepressants for chronic pain.
9
Q
What is the Tx for hematuria in PKD
A
bed rest & hydration
If persistent → consider renal cell carcinoma (esp., men >50yo)
10
Q
If a pt has persistent hematuria with PKD think
A
If persistent → consider renal cell carcinoma (esp., men >50yo)
11
Q
What is the treatment for renal infection in PKD
A
Antibiotics that will penetrate cystic wall
(may require up to 2 weeks of IV antibiotics)
12
Q
What is the treatment for nephrolithiasis
A
Hydration and pain control
13
Q
What pregnancy problem is increased in a pt with PKD
A
ectopic pregnancy
14
Q
A pt presents with abdominal flank and back pain
Hematuria
HTN
And has cerebral aneurysms
Think
A
PKD
15
Q
A pt presents with Swiss cheese appearance of the kidney
Think
A
Medullary cyst
MEDULLARY SPONGE DZ
16
Q
How does medullary sponge kidney present
A
Hematuria
(gross or microscopic)
Recurrent UTIs
Nephrolithiasis
UA may show High urine PH and HyperCa2+
17
Q
What do you need to Dx Medullary Sponge Kidney
A
CT scan: shows cystic dilatation of DCT, a striated appearance in this area, & calcifications in renal collecting system.
18
Q
How does Medullary sponge Kidney Show on IVP
A
Bouquet of flowers/ paintbrush appearance
19
Q
What is the Tx for sponge Kidney
A
Treatment directed toward complications:
-Pyelonephritis/UTI
- Renal calculi → ↑ fluids (2 L/day) to prevent stone formation
- If hypercalciuria → thiazide diuretics to ↓ calcium excretion
- If renal tubular acidosis → alkali therapy
20
Q
What is the population that gets acquired renal cystic Dz
A
Largely confined to the ESRD population on dialysis.
21
Q
What is the most signifigant complication of Aquired Renal cystic Dz
A
Most significant complication is the malignant conversion of cysts into renal cell carcinoma.
22
Q
What is the Dx for Acquired Renal Cystic Dz
A
Made by ultrasonography or CT demonstrating multiple and bilateral renal cysts in patients with CKD or ESRD, and there is NO family history PKD.
Renal CT or MRI is preferable to assess for malignant conversion.
CT with or without Con
23
Q
What is nephronophthisis
A
Is characterized pathologically by renal interstitial fibrosis, tubular atrophy with basement membrane thickening and disruption.
Kidney size is generally normal or reduced.
Typically a PEDIATRIC problem!
24
Q
An infant presents with polyuria, pallor, growth failure and lethagy
Think what kidney problem
A
Nephronophthisis
25
What is the definitive Dx for Medullary Cystic Kidney Dz
Mutational analysis is required for definitive diagnosis.
26
THe majority of urothelial cancers are…
urothelial cell carcinomas.
27
What is the only know sig RSK fx for renal cell carcinoma
Cigarette smoking is the only known significant environmental risk factor.
28
What is the triad of renal cell carcinoma
Flank pain, hematuria, and palpable mass
29
What is the most valuable imaging test for renal cell carcinoma
CT or MRI w/ and w/o con
30
A solid renal mass is a…..
Solid renal masses are renal cell carcinoma until proven otherwise.
31
What is the Tx for renal cell carcinoma
Surgical nephrectomy
32
What kind of cancer is most often seen in pts with tuberous sclerosis
Angiomyolipomas are rare benign tumors composed of fat, smooth muscle, and blood vessels.
33
What is the most common metz cancer to the kidney
Lung Cancer
34
What is the most common primary malignant renal tumor of childhood
Nephroblastoma (Wilm’s Tumor)
35
What is the most common presenting symptom for a Nephoblastoma
Abdominal MASS!!
HTN, PAIN, PAINLESS HEMATURIA.
36
What is the tx approach to Nephroblastoma (Wilms Tumor)
The treatment includes surgery and chemotherapy with or without radiotherapy.
37
What are all the rads that you order for a kid with nephroblasotma
Abd US
CT abdomen, pelvis, chest
Bone scan/ Brain imaging
Eventually Bx
38
Abd mass in a kid
| Think
Wilms tumor
| nephroblastoma
39
What is the most common solid renal tumor found in neonates
Mesoblastic nephroma
Found before 6months of age
40
What are the manifestations of pain assoc with the GU tract
Distention of a hollow organ
(Obstruction, or retention)
Inflammation of an organ against its capsule
(Prostatitis, or pyleonephro)
Malignancy is usually a late sign of advanced Dz
41
What is the differences between infection pain and obstruction pain
Infection pain: constant, pt may lie still
Obstruction pain: waxes and wanes, typically tend to move about
42
Define renal colic
Assessed clinically at costovertebral angle (CVA)
May radiate to umbilicus and/or be referred to the ipsilateral testicle/labia
43
Where does prostatic pain radiate to
May radiate to lumbosacral spine, inguinal canals, or lower extremities
44
What are the irritative voiding S/s
Frequency, Nocturia, Urgency, Dysuria
45
What are the obstructive Voiding S/s
Hesitancy, decreased force/ caliber, intermittency, post void dribbling, double voiding
46
A pt presents with pneumaturia
cc of bubbles in urine and malodourus
Think
Usually secondary to a fistula between bladder & GI tract
Diverticulitis, Colon cancer, Crohn’s Disease
47
If an elderly pt presents wtih urethral DC and is bloody
What must you R/o
Urethral Carcinoma
48
If a pt presents with hematuria while on anti platelet or anti coag meds what must you do
a complete evaluation is warranted consisting of upper tract imaging, cystoscopy, and urine cytology.
49
What is the test of choice for hematuria
CT urogram
50
What is the test of choice to eval for bladder cancer
Cystoscopy
51
What does PP on This mean
DDX for hematuria
```
Period (menses)
Prostate, papillary necrosis
Obstructive uropathy
Nephritic syndrome
Trauma, tumor, tuberculosis, thrombosis (renal vein)
Hematologic (blood disorder, sickle cell)
Infection/inflammation
Stones
```
52
AN OLD PERSON W/ A HISTORY OF SMOKING (esp., male) PRESENTING W/ PAINLESS HEMATURIA HAS WHAT UNTIL PROVEN OTHERWISE!!
BLADDER CANCER!
53
What is the most common cause of UTI
Coliform bacteria (E.Coli)
54
What study is recommended for pts with UTI
Urine Culture
55
What is the mechanism that protect the walls of the urinary tract
Protective glycosaminoglycan layer → interferes w/ bacterial adherence to walls of urinary tract
56
What defines complicated UTI
Obstructive conditions (at any level)
Neurologic diseases affecting lower urinary tract function
Diabetes
Pregnancy
Foreign bodies (stones, catheters, stents)
“Complicated UTI”
57
What is the most common agent of uncomplicated UTI
E. Coli
| Others: Klebsiella, Proteus, Entrobacter
58
Uncomplicated cystitis in men is rare and implies
Infected Stone
Prostatitis
Chronic Urinary Retention
59
Pts with acute cystitis typically present with S/s when
Symptoms often appear following sexual intercourse
60
If a male presents with uncomp cystitis
Get what W/u
Because uncomplicated cystitis is rare in men, elucidation of the underlying problem with appropriate investigations, such as -abdominal ultrasonography
- post-void residual testing
- cystoscopy, is warranted.
61
If you think a pt has pyelonephro
What should you Oder
Follow up CT
Think this in pts with recurrent infections
62
Define uncomplicated UTI
Acute cystitis in an otherwise healthy non-pregnant adult woman
Anything else is complicated
63
What is the tx approach for Umcomp UTI
Short Term ABX
1st line: TMP/ SMX
Nitrofurantoin !!!
Fosfomycin
64
What is the tx approach for post menopausal women with acute cystitis
Postmenopasual women with recurrent cystitis may benefit from vaginal estrogen cream 0.5g nightly for two weeks, then twice weekly.
65
When would we use prophylactic agents in Recurrent Cystitis
Women w/ >3 episodes/yr. → candidates for prophylactic antibiotics:
Confirmed by urine culture w/symptoms.
DEFINITLTY REFER!
ABX: TMP/SMX, Nitro, or Cephalexin
Single dose at bed time or at time of intercourse
66
What is the tx approach for a pt with a postive urine culture with no S/s
Typically, don’t require treatment unless pregnant or undergoing invasive urinary tract procedures.
67
What is the 1st line tx in a pregnant pt with asymptotic baceriuria
Amoxicillin 500mg PO two to three times daily for 3 to 7 days
Nitrofurantoin 100 mg PO two time daily for 5-7 days
Cephalexin 500 mg two to four times daily for 3 to 7 days
68
What is the most common agents of acute pyelonephritis
E. coli, Proteus, Klebsiella, Enterobacter, & Pseudomonas
69
What is a mandatory lab for a pt with pyelonephro
URINE CULUTRE
70
What is the f/u time line for pts with pyelonephritis
Within 48 hours
71
What is the tx approach to a pt with uncomplicated pyelonephro
Empiric PO antibiotics, pain control, anti-emetic, close follow up
Typically begin w/ quinolone & adjust based on cultures
Fluoroquinolones:
-Levofloxacin 750mg daily x 5 days
Ciprofloxacin 750mg twice daily x 7 -days
If TMP/SMX is used as 1st line then add on ceftriazxone!
72
What is the admission criteria for pts with pyelonephro
Severe infection
Obstructions
DM
Renal Failure
Resistant microbes
PREGNANT!
Uncontrolled S/s
(Outpt failure with no improvement in 48hours)
73
What is the duration of tx for inpt pyleonephro
Inpatient, Intravenous antibiotics are continued for 24 hours after fever resolves, and oral antibiotics are given to complete a 14-day course of therapy.
74
If a pt with pyleonephro with a fever that persists pup to 72 hours
What should you do
Failure to respond w/in 48 hrs. → order imaging (CT or US) to exclude complicating factors (i.e., abscess or obstruction)
Follow-up urine cultures are mandatory
75
What is the agent that causes Acute epididymitis most often
STI from Chlamydia or Neisseria G.
76
What agent is common in older men with acute epididmytis
Men who practice insertive anal intercourse may have acute epididymitis from sexually transmitted and enteric organisms.
77
Stoped at slide 39 k
78
What are the common cuases of Acute epididmytis
Chlamydia trachomatis or Neisseria gonorrhoeae.
79
What the only way to rule out torsion
US
80
If treating a STI empirically, what two drugs do us use
Ceftriaxone 500 mg IM PLUS 10 days of oral doxycycline 100 mg four times daily.
81
If treating a STI emperically for insertive anal intercourse
What Rx
Ceftriaxone 500 mg IM PLUS 10 days of an oral fluoroquinolone (e.g., ciprofloxacin 500 mg twice daily) to cover sexually transmitted and enteric organisms.
82
What are the Rx for treating non STI epididmytis i
TMP/SMX or Levo/Cipro
83
What is the common cause of urethritis
STI
84
What is the gold standard for Urethritis Eval
Urine Culture
However NAAT is the go to test
85
What is the urethritis called in women
Internal dysuria (w/o urinary urgency, frequency, pyuria, and an absence of uropathogen)
External dysuria – usually associated with vulvar herpes or vulvovaginal candidiasis. Cased by painful contact with urine to inflamed labia introitus.
86
What are the CDC recommendations for Urethritis
Doxy x 7 days
And Ceftriaxone Single Dose
Avoid sex for 7 days
87
What should be considered in any child with a UTI
Vesicoureteral Reflux
Consider in any child w/ UTI prior to toilet training (esp., young males)
Consider US/VCUG & refer
Fever
Consider UTI as a source of fever in small children and old people!
88
What is bladder pain syndrome
Interstitial cystitis
Dx of exclusion
Pain with bladder filling
Common in Women at age 40
89
A pt presents with pain that is RELIEVED by urination
Think
Interstitial Cystitis
90
What should you order to evaluate Interstitial Cystitis
Cystoscopy under Bx
91
What are the 5 major types of urinary stones
```
Calcium Oxalate
Calcium Phosphate
Struvite
Cystine
Uric Acid
```
92
What is the most common type of urinary stone
Calcium
93
Fx for kidney stone development
High protein intake
High salt intake
Inadequate hydration
Sedentary lifestyles → ↑ stone incidence
94
What is the role of urinary citrate in stone formation
Urinary citrate is the most important inhibitor of stone formation, and low citrate levels increase risk of stones.
95
How does pH effect urinary citrate
Acidosis → ↓ urinary citrate
| Alkalosis → ↑ urinary citrate
96
Women with recurrent UTI are more likely to have what kind of stone
Struvite Stones
97
A calculi that extends to at least 2 calyces and are composed of Struvite
Think
Stag horn Calculi
98
What is the only amino acid that is in soluable in urine
Cystine
These stones are radio Luce t
99
What two drugs can help with stone passage
Alfuzosin or Tamsulosin
100
What is the Tx approach to a pt that has passed a stone in 4 weeks or is unable to pass a stone that is in the lower 1/3 of the ureter
Ureterscopic Stone extraction
Best if in the lower 1/3 of the ureter
101
What is the approach to stones in the renal pelvic that are unable to pass
Shock wave therapy
102
Can pts take NSAIDs and get Shock wave Tx
No, D/c nsaids 3 days prior
103
What is the bottom line of tx for Acute Stone Pts
Fluid intake
Pain Control
Confirm stone if 1st presentation
Admit if failure of tx
Refer as necessary
104
What underlying D/o should you R/o in stone pts
Serum PTH, uric acid → r/o primary hyperparathyroidism or gout
105
What is the tx approach to a pt with recurrent stone formations
If high urinary calcium:
Thiazide diuretics
(HCTZ, chlorthalidone) → ↓ urinary calcium
If low urinary citrate or low urine pH:
-Potassium citrate therapy:
—To raise citrate in calcium stone formers
To raise pH in uric acid or cystine stone formers
106
What is the tx approach to chronic stone formers
Repeat 24 hr. urine collection in 6 months
Assess response to interventions & prevention measures
Repeat stone analysis if interventions are failing
Consider yearly CT to assess for new formation
Correlate clinically
107
How is blood flow supplied to the penis for erections
Arterial blood flow supplied by the paired cavernosal arteries
108
Define erectile dysfunction
The consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance.
The most common cause of erectile dysfunction is a decrease in arterial flow resultant from progressive vascular disease.
109
What are the classes of drugs that cause ED
Anti hypertensive
Antihistamines
Antidepressants
Opiods
hormone Agents
Prostate Rx
110
A ED score greater than _____ defines the Dx
21
111
A complete loss of nocturnal and morning erections indicates
Vascular and Neurological Dz
112
What is the testosterone threshold hold labs
Testosterone Deficiency (<300ng/dL)
At least two-morning serum total testosterone measurements.
If abnormal → order free testosterone & luteinizing hormone (LH) → distinguishes hypothalamic-pituitary dysfunction vs primary testicular failure
113
What is the normal number of nocturnal erections
Can eval with a Nocturnal penile tumescene test
Recommended criteria for normal NPTR include four to five normal erectile episodes per night.
114
If a pt does not respond to oral PDE-5 Inh. For ED
What can be the next step
If inadequate response to oral PDE-5 inhibitors → direct injection of vasoactive substances (i.e., prostaglandin E1, papaverine, phentolamine, or combo) into the penis:
115
If a pt fails injections for ED
What can be the next step
Penile duplex Doppler ultrasound (gold-standard)
Penile Cavernosography
Pudendal arteriography
116
What are the common ADE of PDE-5 Inh
Hypotension from Alpha Blockade
Priapism (rare)
C/I Nitro/ Nitrates
(caution in pts wtih HF, CAD, HOTN)
Careful use with grapefruit juice
117
What is needed for a PDE-5 Inh to work
Stimulation
118
When should Avanafil be taken before sexual activities
15 min before
119
What is Alprostadil
Injectable ED meds
120
What should you r/o in ED
Rule out prostate cancer
121
Define infertility
A couple’s inability to conceive a child after 1 year of sexual intercourse without contraceptive use
122
If a male pt has less than 15 million sperm/ml what is this defined as
Oligozoospermia
123
What is the time frame for spermatogenesis
74 days ( a few months)
124
What are the infectious causes of infertility
Mumps orchitis, epididymitis, STIs
125
What is the initial study for male infertility
Semen Analysis
Performed after~7 days of ejaculatory abstinence
Analyze w/in 1 hr. of specimen collection
126
How many semen analysis are required for male infertily W/u
Always at least 2 samples on 2 separate occasions
Semen analysis retesting separated by at least 30 days
127
If a male is only able to produce less than 1.5 ml of semen
What should you do
Obtain post-ejaculation urine samples
Centrifuged & analyzed for sperm to exclude retrograde ejaculation
128
When should you initiate genetic testing for a pt with infertility (male)
If sperm concentration <10 million/mL or azoospermia
Test for Y chromosome microdeletions & karyotypic abnormalities (i.e., Klinefelter syndrome)
129
A male pt presents with galactorhea and infertility
Think
Evaluation of pituitary with MRI for Endo tumor
130
Should pts with infertility use lubricants
YES AVOID ALL
| Even if they are not spermicidal
131
What is the general prostate growth time frame
Grows slowly in size from birth to puberty
At puberty grows rapidly until age 30 then remains stable until age 45 when further enlargement may occur
132
What is the offending agent of acute bacterial Prostatitis
Gram Neg: E. Coli, Pseudomonas
133
Should you massage the prostate in acute bacterial Prostatitis
NO!
134
What is the W/u for acute Bac Prostatitis
UA
(Pyuria, bacteriuria, hematuria)
CBC
Urine Culture
Transrectal Ultrasound
(May need sedation)
135
What is the tx approach to Acute Bac Prostatitis
Cipro
Or
Double strength TMP/SMX x 6 weeks
COnsider Ceftriaxone/ Doxy for STI X 10 days
136
When a pt has acute bac Prostatitis
And they cant take oral meds or have major comorbidities
What ABX should they be started on
Piperacillin-tazobactam, 3.375 to 4.5 grams IV
OR
Cefotaxime with an aminoglycoside
After patients are afebrile for 2 days, they can be transitioned to oral antibiotics for upwards of 6 weeks.
137
If a pt has acute Bac Prost with urinary retention
What should be attempted
Urethral catheterization should be attempted but not forced.
138
What is the bug typically associated with chronic bac prostatitis
Gram-negative rods: most common etiologic agents, but only Enterococcus is associated with chronic infection.
139
A pt with low back pain and a boggy, indurated prostate
Think
Possible Bacterial Prostatitis
Think acute or chronic depending on time
140
What special tests can be done for a pt with voiding s/s
Urodynamics
141
What is the Tx approach to CHRONIC. Bac prostatitis
Consider admission
For IV ampicillin
+/- gentamicin or cephalosporin or fluoroquinolones
IF Outpt: trimethoprim-sulfamethoxazole, fluoroquinolones, or an extended-spectrum beta-lactamase antibiotic
Duration 4-6 weeks
142
What is the common s/s of non Bac prostatitis
Pain during or after ejaculation is one of the most prominent and bothersome symptoms in many patients
143
What should you R/o before Dx of non bac prostatitis
In older men with irritative voiding symptoms and negative cultures, bladder cancer must be excluded.
144
What is the tx approach to non bac prostatitis
Treat the S/s
Patients with voiding symptoms are treated with an alpha-blocker (tamsulosin, alfuzosin, silodosin).
Psychosocial disorders are treated with cognitive behavioral therapy, antidepressants, and anxiolytics.
Neuropathic pain is treated with gabapentinoids, amitriptyline, neuromodulation, acupuncture, or, if necessary, referral to a pain management specialist.
Sexual dysfunction with pain symptoms is treated with sexual therapy and PDE-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil).
145
What is the most common benign tumor of the prostate
BPH
146
Where does obstruction usually occur in BPH
In the transition zone
Which can lead to recurrent infection
147
When should you consider a PSA test on a pt with BH
Serum PSA test* (optional), clinicians should consider obtaining a serum PSA test in patients whose life expectancy is longer than 10 years, at an earlier age in high-risk.
148
If a pt with BPH has a AUA score above 8
What studies can be ordered
Urodynamic studies
| PVR (post void residual)
149
When should we do renal US/ CT for pts with BPH
Concomitant urinary tract disease
```
BPH complications:
Hematuria
UTI
Chronic kidney disease
H/O urinary stone disease
```
150
What are the absolute indications for Surgical Intervention for BPH
Refractory urinary retention (failing at least 1 attempt at catheter removal)
Large bladder diverticula
BPH sequelae:
- Recurrent UTI
- Recurrent/persistent gross hematuria
- Bladder stones
- Chronic kidney disease (i.e., renal insufficiency/failure)
151
What are the Rx for BPH
Prazosin
Doxazosin
Terazosin
Tamsulosin/ Alfuzosin
(Alpha 1a)
152
What is the conventional surgery for BPH
Transurethral resection of the prostate (TURP)
153
What is the most common non cutaneous malignancy in men
Prostate cancer
154
What is the major red flag that clues you in for prostate cancer
Lumbar spine pain
155
Elevated PSA is a sign of…
Prostate CA
Most cancers confined to the prostate: PSA <10 ng/mL
Advanced disease: PSA >40 ng/mL
Refer to urology
156
What is the preferred study to eval Prostate CA
Transrec US
157
Should routine screening of prostate CA be done>?
In 2018, the USPSTF issued a revised (Grade C) recommendation for men aged 55 to 69 years that the decision to undergo periodic PSA–based screening should be an individual one.
Clinicians should not screen men who do not express a preference for screening, OR a willingness to proceed further based on results.
158
Who should be screened for Prostate CA
Age 55-69
African American
With suspected or likely prostate CA
159
A PSA increasing 0.75ng/ml per year
Think
Prostate CA
160
What is the main treatment approach to Prostate cancer
Active surveillance
+/- retro pubic radical prostatectomy
(95% of pts)
+/- external beam radiation
+/- brachytherapy
161
A pt with a prostatectomy and hot flashes can be treated with what medication
Venlafaxine
162
What is balanitis and
| Balanoposthitis
Balanitis: Inflammation of glans penis
Balanoposthitis: Inflammation of glans, penis, and/or foreskin.
163
What is the tx for recurrent Balaitis and balanposthitis
Urologic referral is needed for reassessment and possible circumcision in recurrent cases.
164
What is the Rx for trichomonas
Metronidazole
165
What is the Rx for Fungal infections of the penis
Clotimazole
Or fluconazole
166
What is the Rx for bacterial infections of the penis
Topical ABX
Cephalexin
167
What should be done with all pts with paraphimosis
Following successful reduction, all patients w/ paraphimosis require urological referral for circumcision in order to prevent recurrence.
168
Describe penile fractures
Penile fracture occurs when there is an acute tear of the penile tunica albuginea.
169
What is a congenital ventral curvature of the penis called
Chordee
170
What is the tx approach to Peyronies Dz
Spontaneous improvement → 10% of patients
Medical therapies:
Collagenase clostridial histolyticum injection (only FDA-approved medication)
Calcium channel blocker or interferon intraplaque injections.
171
What are the risk factors for penile cancer
Uncircumcised/ Phimosis
HPV-16
Smoking
172
What is the most common penile cancer
SCC
173
Masses arising in the testes are usually…
MALIGNANTT!
174
A painless, firm, solid lesion that does not transilluminte is..
CA UPO
175
If a pt has a hydrocele
Get an US to R./o
CA
176
Do we need to treat epididymal cysts
No, send for US and reassure
177
A pt with a tortious mass in the scrotum that increases when they stand up
Think
Varicocele
| worst if found on the R SIDE
178
What is typically the cause of a indirect hernia in men
In men, usually due to congenitally patent processus vaginalis
179
What is a direct hernia
Arises from the protrusion of abdominal viscera through a weakness of the posterior wall of the inguinal canal (acquired)
180
A pt that wakes up in the middle of the night with abdominal pain and scrtoal pain
Think
Torsion UPO
181
What is the most sensitive physical exam finding for torsion
Absent cremaster reflex
182
What is the classic sign of finding of testicular torsion
High riding testicle and bell clapper deformity
183
What is prehn sign
Relief of pain with elevation of the testicle
184
What is the most common cause of scrotal pain
Epididymitis/ Orchitis
185
What is the tx approach to epididmytis/ orchititis
If STI: Ceftriaxone + doxy
(consider treating sexual partner)
Non STI: Ofloxacin or levofloxacin x 10 days
(+ UTI eval)
ALL Pts:
Bed Rest
Scrotal Elevation
186
A blue dot sign on the testicles is an indication of…
Infarction/necrosis of appendix testis
187
What are the major RSK fxs for Bladder Cancer
Cig smoking
Industrial Dyes or Solvents
Schistosomiasis
188
What is the Dx labs for Bladder Cancer!?
UA w/ microscopy
Urine Cytology
And CBC (Anemia)
189
What are the Tx options for bladder cancer
Non Invasive: transurethral resection and/or intravesical chemotherapy
Invasive:
radical cystectomy OR chemotherapy + surgery or irradiation
+/- chemotherapy prior to radical cystectomy
Usually require pelvic lymphadenectomy
To include prostatectomy -men
190
What is the most common neoplasm in men aged 15-35
Test. Cancer
191
A pt presents with a painless enlargement of the testis
With a heavy sensation
+/-o hydrocele
Testicular cancer
192
On labs there is elevated hCG
AFP
LDH
Think of what in men
Test,. Cancer
193
If in doubt about scrotal d/o obtain
US!
194
What is the most common secondary testicular cancer
Lymphoma
195
Define urinary incontience
Involuntary leakage
196
What is the control of the bladder neck and sphincter
Continence is dependent upon a compliant reservoir & an efficient sphincter that has two components:
- Involuntary smooth muscle of bladder neck
- Voluntary skeletal muscle of external sphincter
197
What changes in the bladder due to age
Capacity remains the same, but sensation and contractility decrease
198
Define urge incontinence
leakage that follows abrupt onset or intense desire to void; leakage of a moderate to large of urine; frequency, nocturia, and nocturnal incontinences.
199
What is stress incontinence
Instant leakage flowing increased abd pressure
