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Senoir 21-2 > GU BLOCK II > Flashcards

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

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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

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3
Q

If lesion is inconsistent w/ a simple cyst on CT what is the next step

A

Surgical exploration

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4
Q

What is the standard of care for a benign cyst

A

CT non con

And periodic evaluation

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5
Q

What is the most common inherited kidney Dz

A

Polycystic Kidney Dz

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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

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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!!!

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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.

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9
Q

What is the Tx for hematuria in PKD

A

bed rest & hydration

If persistent → consider renal cell carcinoma (esp., men >50yo)

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10
Q

If a pt has persistent hematuria with PKD think

A

If persistent → consider renal cell carcinoma (esp., men >50yo)

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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)

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12
Q

What is the treatment for nephrolithiasis

A

Hydration and pain control

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13
Q

What pregnancy problem is increased in a pt with PKD

A

ectopic pregnancy

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14
Q

A pt presents with abdominal flank and back pain
Hematuria
HTN
And has cerebral aneurysms

Think

A

PKD

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15
Q

A pt presents with Swiss cheese appearance of the kidney

Think

A

Medullary cyst

MEDULLARY SPONGE DZ

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16
Q

How does medullary sponge kidney present

A

Hematuria
(gross or microscopic)

Recurrent UTIs

Nephrolithiasis

UA may show High urine PH and HyperCa2+

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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.

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18
Q

How does Medullary sponge Kidney Show on IVP

A

Bouquet of flowers/ paintbrush appearance

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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
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20
Q

What is the population that gets acquired renal cystic Dz

A

Largely confined to the ESRD population on dialysis.

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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.

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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

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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!

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24
Q

An infant presents with polyuria, pallor, growth failure and lethagy

Think what kidney problem

A

Nephronophthisis

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25
Q

What is the definitive Dx for Medullary Cystic Kidney Dz

A

Mutational analysis is required for definitive diagnosis.

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26
Q

THe majority of urothelial cancers are…

A

urothelial cell carcinomas.

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27
Q

What is the only know sig RSK fx for renal cell carcinoma

A

Cigarette smoking is the only known significant environmental risk factor.

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28
Q

What is the triad of renal cell carcinoma

A

Flank pain, hematuria, and palpable mass

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29
Q

What is the most valuable imaging test for renal cell carcinoma

A

CT or MRI w/ and w/o con

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30
Q

A solid renal mass is a…..

A

Solid renal masses are renal cell carcinoma until proven otherwise.

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31
Q

What is the Tx for renal cell carcinoma

A

Surgical nephrectomy

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32
Q

What kind of cancer is most often seen in pts with tuberous sclerosis

A

Angiomyolipomas are rare benign tumors composed of fat, smooth muscle, and blood vessels.

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33
Q

What is the most common metz cancer to the kidney

A

Lung Cancer

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34
Q

What is the most common primary malignant renal tumor of childhood

A

Nephroblastoma (Wilm’s Tumor)

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35
Q

What is the most common presenting symptom for a Nephoblastoma

A

Abdominal MASS!!

HTN, PAIN, PAINLESS HEMATURIA.

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36
Q

What is the tx approach to Nephroblastoma (Wilms Tumor)

A

The treatment includes surgery and chemotherapy with or without radiotherapy.

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37
Q

What are all the rads that you order for a kid with nephroblasotma

A

Abd US

CT abdomen, pelvis, chest

Bone scan/ Brain imaging

Eventually Bx

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38
Q

Abd mass in a kid

Think

A

Wilms tumor

nephroblastoma

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39
Q

What is the most common solid renal tumor found in neonates

A

Mesoblastic nephroma

Found before 6months of age

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40
Q

What are the manifestations of pain assoc with the GU tract

A

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

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41
Q

What is the differences between infection pain and obstruction pain

A

Infection pain: constant, pt may lie still

Obstruction pain: waxes and wanes, typically tend to move about

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42
Q

Define renal colic

A

Assessed clinically at costovertebral angle (CVA)

May radiate to umbilicus and/or be referred to the ipsilateral testicle/labia

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43
Q

Where does prostatic pain radiate to

A

May radiate to lumbosacral spine, inguinal canals, or lower extremities

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44
Q

What are the irritative voiding S/s

A

Frequency, Nocturia, Urgency, Dysuria

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45
Q

What are the obstructive Voiding S/s

A

Hesitancy, decreased force/ caliber, intermittency, post void dribbling, double voiding

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46
Q

A pt presents with pneumaturia
cc of bubbles in urine and malodourus
Think

A

Usually secondary to a fistula between bladder & GI tract

Diverticulitis, Colon cancer, Crohn’s Disease

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47
Q

If an elderly pt presents wtih urethral DC and is bloody

What must you R/o

A

Urethral Carcinoma

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48
Q

If a pt presents with hematuria while on anti platelet or anti coag meds what must you do

A

a complete evaluation is warranted consisting of upper tract imaging, cystoscopy, and urine cytology.

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49
Q

What is the test of choice for hematuria

A

CT urogram

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50
Q

What is the test of choice to eval for bladder cancer

A

Cystoscopy

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51
Q

What does PP on This mean

A

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
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52
Q

AN OLD PERSON W/ A HISTORY OF SMOKING (esp., male) PRESENTING W/ PAINLESS HEMATURIA HAS WHAT UNTIL PROVEN OTHERWISE!!

A

BLADDER CANCER!

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53
Q

What is the most common cause of UTI

A

Coliform bacteria (E.Coli)

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54
Q

What study is recommended for pts with UTI

A

Urine Culture

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55
Q

What is the mechanism that protect the walls of the urinary tract

A

Protective glycosaminoglycan layer → interferes w/ bacterial adherence to walls of urinary tract

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56
Q

What defines complicated UTI

A

Obstructive conditions (at any level)

Neurologic diseases affecting lower urinary tract function

Diabetes

Pregnancy

Foreign bodies (stones, catheters, stents)

“Complicated UTI”

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57
Q

What is the most common agent of uncomplicated UTI

A

E. Coli

Others: Klebsiella, Proteus, Entrobacter

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58
Q

Uncomplicated cystitis in men is rare and implies

A

Infected Stone
Prostatitis
Chronic Urinary Retention

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59
Q

Pts with acute cystitis typically present with S/s when

A

Symptoms often appear following sexual intercourse

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60
Q

If a male presents with uncomp cystitis

Get what W/u

A

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.
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61
Q

If you think a pt has pyelonephro

What should you Oder

A

Follow up CT

Think this in pts with recurrent infections

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62
Q

Define uncomplicated UTI

A

Acute cystitis in an otherwise healthy non-pregnant adult woman

Anything else is complicated

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63
Q

What is the tx approach for Umcomp UTI

A

Short Term ABX

1st line: TMP/ SMX
Nitrofurantoin !!!
Fosfomycin

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64
Q

What is the tx approach for post menopausal women with acute cystitis

A

Postmenopasual women with recurrent cystitis may benefit from vaginal estrogen cream 0.5g nightly for two weeks, then twice weekly.

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65
Q

When would we use prophylactic agents in Recurrent Cystitis

A

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

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66
Q

What is the tx approach for a pt with a postive urine culture with no S/s

A

Typically, don’t require treatment unless pregnant or undergoing invasive urinary tract procedures.

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67
Q

What is the 1st line tx in a pregnant pt with asymptotic baceriuria

A

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

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68
Q

What is the most common agents of acute pyelonephritis

A

E. coli, Proteus, Klebsiella, Enterobacter, & Pseudomonas

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69
Q

What is a mandatory lab for a pt with pyelonephro

A

URINE CULUTRE

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70
Q

What is the f/u time line for pts with pyelonephritis

A

Within 48 hours

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71
Q

What is the tx approach to a pt with uncomplicated pyelonephro

A

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!

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72
Q

What is the admission criteria for pts with pyelonephro

A

Severe infection

Obstructions

DM

Renal Failure

Resistant microbes

PREGNANT!

Uncontrolled S/s
(Outpt failure with no improvement in 48hours)

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73
Q

What is the duration of tx for inpt pyleonephro

A

Inpatient, Intravenous antibiotics are continued for 24 hours after fever resolves, and oral antibiotics are given to complete a 14-day course of therapy.

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74
Q

If a pt with pyleonephro with a fever that persists pup to 72 hours

What should you do

A

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

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75
Q

What is the agent that causes Acute epididymitis most often

A

STI from Chlamydia or Neisseria G.

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76
Q

What agent is common in older men with acute epididmytis

A

Men who practice insertive anal intercourse may have acute epididymitis from sexually transmitted and enteric organisms.

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77
Q

Stoped at slide 39 k

A
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78
Q

What are the common cuases of Acute epididmytis

A

Chlamydia trachomatis or Neisseria gonorrhoeae.

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79
Q

What the only way to rule out torsion

A

US

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80
Q

If treating a STI empirically, what two drugs do us use

A

Ceftriaxone 500 mg IM PLUS 10 days of oral doxycycline 100 mg four times daily.

81
Q

If treating a STI emperically for insertive anal intercourse

What Rx

A

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
Q

What are the Rx for treating non STI epididmytis i

A

TMP/SMX or Levo/Cipro

83
Q

What is the common cause of urethritis

A

STI

84
Q

What is the gold standard for Urethritis Eval

A

Urine Culture

However NAAT is the go to test

85
Q

What is the urethritis called in women

A

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
Q

What are the CDC recommendations for Urethritis

A

Doxy x 7 days
And Ceftriaxone Single Dose

Avoid sex for 7 days

87
Q

What should be considered in any child with a UTI

A

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
Q

What is bladder pain syndrome

A

Interstitial cystitis

Dx of exclusion

Pain with bladder filling

Common in Women at age 40

89
Q

A pt presents with pain that is RELIEVED by urination

Think

A

Interstitial Cystitis

90
Q

What should you order to evaluate Interstitial Cystitis

A

Cystoscopy under Bx

91
Q

What are the 5 major types of urinary stones

A 
Calcium Oxalate 
Calcium Phosphate 
Struvite 
Cystine 
Uric Acid
92
Q

What is the most common type of urinary stone

A

Calcium

93
Q

Fx for kidney stone development

A

High protein intake
High salt intake
Inadequate hydration
Sedentary lifestyles → ↑ stone incidence

94
Q

What is the role of urinary citrate in stone formation

A

Urinary citrate is the most important inhibitor of stone formation, and low citrate levels increase risk of stones.

95
Q

How does pH effect urinary citrate

A

Acidosis → ↓ urinary citrate

Alkalosis → ↑ urinary citrate

96
Q

Women with recurrent UTI are more likely to have what kind of stone

A

Struvite Stones

97
Q

A calculi that extends to at least 2 calyces and are composed of Struvite

Think

A

Stag horn Calculi

98
Q

What is the only amino acid that is in soluable in urine

A

Cystine

These stones are radio Luce t

99
Q

What two drugs can help with stone passage

A

Alfuzosin or Tamsulosin

100
Q

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

A

Ureterscopic Stone extraction

Best if in the lower 1/3 of the ureter

101
Q

What is the approach to stones in the renal pelvic that are unable to pass

A

Shock wave therapy

102
Q

Can pts take NSAIDs and get Shock wave Tx

A

No, D/c nsaids 3 days prior

103
Q

What is the bottom line of tx for Acute Stone Pts

A

Fluid intake

Pain Control

Confirm stone if 1st presentation

Admit if failure of tx

Refer as necessary

104
Q

What underlying D/o should you R/o in stone pts

A

Serum PTH, uric acid → r/o primary hyperparathyroidism or gout

105
Q

What is the tx approach to a pt with recurrent stone formations

A

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
Q

What is the tx approach to chronic stone formers

A

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
Q

How is blood flow supplied to the penis for erections

A

Arterial blood flow supplied by the paired cavernosal arteries

108
Q

Define erectile dysfunction

A

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
Q

What are the classes of drugs that cause ED

A

Anti hypertensive

Antihistamines

Antidepressants

Opiods

hormone Agents

Prostate Rx

110
Q

A ED score greater than _____ defines the Dx

A

21

111
Q

A complete loss of nocturnal and morning erections indicates

A

Vascular and Neurological Dz

112
Q

What is the testosterone threshold hold labs

A

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
Q

What is the normal number of nocturnal erections

A

Can eval with a Nocturnal penile tumescene test

Recommended criteria for normal NPTR include four to five normal erectile episodes per night.

114
Q

If a pt does not respond to oral PDE-5 Inh. For ED

What can be the next step

A

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
Q

If a pt fails injections for ED

What can be the next step

A

Penile duplex Doppler ultrasound (gold-standard)

Penile Cavernosography

Pudendal arteriography

116
Q

What are the common ADE of PDE-5 Inh

A

Hypotension from Alpha Blockade

Priapism (rare)

C/I Nitro/ Nitrates

(caution in pts wtih HF, CAD, HOTN)

Careful use with grapefruit juice

117
Q

What is needed for a PDE-5 Inh to work

A

Stimulation

118
Q

When should Avanafil be taken before sexual activities

A

15 min before

119
Q

What is Alprostadil

A

Injectable ED meds

120
Q

What should you r/o in ED

A

Rule out prostate cancer

121
Q

Define infertility

A

A couple’s inability to conceive a child after 1 year of sexual intercourse without contraceptive use

122
Q

If a male pt has less than 15 million sperm/ml what is this defined as

A

Oligozoospermia

123
Q

What is the time frame for spermatogenesis

A

74 days ( a few months)

124
Q

What are the infectious causes of infertility

A

Mumps orchitis, epididymitis, STIs

125
Q

What is the initial study for male infertility

A

Semen Analysis

Performed after~7 days of ejaculatory abstinence

Analyze w/in 1 hr. of specimen collection

126
Q

How many semen analysis are required for male infertily W/u

A

Always at least 2 samples on 2 separate occasions

Semen analysis retesting separated by at least 30 days

127
Q

If a male is only able to produce less than 1.5 ml of semen

What should you do

A

Obtain post-ejaculation urine samples

Centrifuged & analyzed for sperm to exclude retrograde ejaculation

128
Q

When should you initiate genetic testing for a pt with infertility (male)

A

If sperm concentration <10 million/mL or azoospermia

Test for Y chromosome microdeletions & karyotypic abnormalities (i.e., Klinefelter syndrome)

129
Q

A male pt presents with galactorhea and infertility

Think

A

Evaluation of pituitary with MRI for Endo tumor

130
Q

Should pts with infertility use lubricants

A

YES AVOID ALL

Even if they are not spermicidal

131
Q

What is the general prostate growth time frame

A

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
Q

What is the offending agent of acute bacterial Prostatitis

A

Gram Neg: E. Coli, Pseudomonas

133
Q

Should you massage the prostate in acute bacterial Prostatitis

A

NO!

134
Q

What is the W/u for acute Bac Prostatitis

A

UA
(Pyuria, bacteriuria, hematuria)

CBC

Urine Culture

Transrectal Ultrasound
(May need sedation)

135
Q

What is the tx approach to Acute Bac Prostatitis

A

Cipro

Or

Double strength TMP/SMX x 6 weeks

COnsider Ceftriaxone/ Doxy for STI X 10 days

136
Q

When a pt has acute bac Prostatitis
And they cant take oral meds or have major comorbidities

What ABX should they be started on

A

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
Q

If a pt has acute Bac Prost with urinary retention

What should be attempted

A

Urethral catheterization should be attempted but not forced.

138
Q

What is the bug typically associated with chronic bac prostatitis

A

Gram-negative rods: most common etiologic agents, but only Enterococcus is associated with chronic infection.

139
Q

A pt with low back pain and a boggy, indurated prostate

Think

A

Possible Bacterial Prostatitis

Think acute or chronic depending on time

140
Q

What special tests can be done for a pt with voiding s/s

A

Urodynamics

141
Q

What is the Tx approach to CHRONIC. Bac prostatitis

A

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
Q

What is the common s/s of non Bac prostatitis

A

Pain during or after ejaculation is one of the most prominent and bothersome symptoms in many patients

143
Q

What should you R/o before Dx of non bac prostatitis

A

In older men with irritative voiding symptoms and negative cultures, bladder cancer must be excluded.

144
Q

What is the tx approach to non bac prostatitis

A

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
Q

What is the most common benign tumor of the prostate

A

BPH

146
Q

Where does obstruction usually occur in BPH

A

In the transition zone

Which can lead to recurrent infection

147
Q

When should you consider a PSA test on a pt with BH

A

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
Q

If a pt with BPH has a AUA score above 8

What studies can be ordered

A

Urodynamic studies

PVR (post void residual)

149
Q

When should we do renal US/ CT for pts with BPH

A

Concomitant urinary tract disease

BPH complications:
Hematuria
UTI
Chronic kidney disease
H/O urinary stone disease
150
Q

What are the absolute indications for Surgical Intervention for BPH

A

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
Q

What are the Rx for BPH

A

Prazosin

Doxazosin

Terazosin

Tamsulosin/ Alfuzosin
(Alpha 1a)

152
Q

What is the conventional surgery for BPH

A

Transurethral resection of the prostate (TURP)

153
Q

What is the most common non cutaneous malignancy in men

A

Prostate cancer

154
Q

What is the major red flag that clues you in for prostate cancer

A

Lumbar spine pain

155
Q

Elevated PSA is a sign of…

A

Prostate CA

Most cancers confined to the prostate: PSA <10 ng/mL
Advanced disease: PSA >40 ng/mL

Refer to urology

156
Q

What is the preferred study to eval Prostate CA

A

Transrec US

157
Q

Should routine screening of prostate CA be done>?

A

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
Q

Who should be screened for Prostate CA

A

Age 55-69
African American
With suspected or likely prostate CA

159
Q

A PSA increasing 0.75ng/ml per year

Think

A

Prostate CA

160
Q

What is the main treatment approach to Prostate cancer

A

Active surveillance

+/- retro pubic radical prostatectomy
(95% of pts)

+/- external beam radiation

+/- brachytherapy

161
Q

A pt with a prostatectomy and hot flashes can be treated with what medication

A

Venlafaxine

162
Q

What is balanitis and

Balanoposthitis

A

Balanitis: Inflammation of glans penis

Balanoposthitis: Inflammation of glans, penis, and/or foreskin.

163
Q

What is the tx for recurrent Balaitis and balanposthitis

A

Urologic referral is needed for reassessment and possible circumcision in recurrent cases.

164
Q

What is the Rx for trichomonas

A

Metronidazole

165
Q

What is the Rx for Fungal infections of the penis

A

Clotimazole

Or fluconazole

166
Q

What is the Rx for bacterial infections of the penis

A

Topical ABX

Cephalexin

167
Q

What should be done with all pts with paraphimosis

A

Following successful reduction, all patients w/ paraphimosis require urological referral for circumcision in order to prevent recurrence.

168
Q

Describe penile fractures

A

Penile fracture occurs when there is an acute tear of the penile tunica albuginea.

169
Q

What is a congenital ventral curvature of the penis called

A

Chordee

170
Q

What is the tx approach to Peyronies Dz

A

Spontaneous improvement → 10% of patients

Medical therapies:
Collagenase clostridial histolyticum injection (only FDA-approved medication)
Calcium channel blocker or interferon intraplaque injections.

171
Q

What are the risk factors for penile cancer

A

Uncircumcised/ Phimosis

HPV-16

Smoking

172
Q

What is the most common penile cancer

A

SCC

173
Q

Masses arising in the testes are usually…

A

MALIGNANTT!

174
Q

A painless, firm, solid lesion that does not transilluminte is..

A

CA UPO

175
Q

If a pt has a hydrocele

Get an US to R./o

A

CA

176
Q

Do we need to treat epididymal cysts

A

No, send for US and reassure

177
Q

A pt with a tortious mass in the scrotum that increases when they stand up

Think

A

Varicocele

worst if found on the R SIDE

178
Q

What is typically the cause of a indirect hernia in men

A

In men, usually due to congenitally patent processus vaginalis

179
Q

What is a direct hernia

A

Arises from the protrusion of abdominal viscera through a weakness of the posterior wall of the inguinal canal(acquired)

180
Q

A pt that wakes up in the middle of the night with abdominal pain and scrtoal pain

Think

A

Torsion UPO

181
Q

What is the most sensitive physical exam finding for torsion

A

Absent cremaster reflex

182
Q

What is the classic sign of finding of testicular torsion

A

High riding testicle and bell clapper deformity

183
Q

What is prehn sign

A

Relief of pain with elevation of the testicle

184
Q

What is the most common cause of scrotal pain

A

Epididymitis/ Orchitis

185
Q

What is the tx approach to epididmytis/ orchititis

A

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
Q

A blue dot sign on the testicles is an indication of…

A

Infarction/necrosis of appendix testis

187
Q

What are the major RSK fxs for Bladder Cancer

A

Cig smoking

Industrial Dyes or Solvents

Schistosomiasis

188
Q

What is the Dx labs for Bladder Cancer!?

A

UA w/ microscopy

Urine Cytology

And CBC (Anemia)

189
Q

What are the Tx options for bladder cancer

A

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
Q

What is the most common neoplasm in men aged 15-35

A

Test. Cancer

191
Q

A pt presents with a painless enlargement of the testis
With a heavy sensation
+/-o hydrocele

A

Testicular cancer

192
Q

On labs there is elevated hCG
AFP
LDH

Think of what in men

A

Test,. Cancer

193
Q

If in doubt about scrotal d/o obtain

A

US!

194
Q

What is the most common secondary testicular cancer

A

Lymphoma

195
Q

Define urinary incontience

A

Involuntary leakage

196
Q

What is the control of the bladder neck and sphincter

A

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
Q

What changes in the bladder due to age

A

Capacity remains the same, but sensation and contractility decrease

198
Q

Define urge incontinence

A

leakage that follows abrupt onset or intense desire to void; leakage of a moderate to large of urine; frequency, nocturia, and nocturnal incontinences.

199
Q

What is stress incontinence

A

Instant leakage flowing increased abd pressure

Senoir 21-2 (77 decks)

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