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ER EOR > GU Geriatrics > Flashcards

GU Geriatrics Flashcards

1
Q

where does prostate hyperplasia typically occur in BPH

A

periurethral or transitional zone

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2
Q

sx BPH

A

irritative sx - frequency, urgency, nocturia, incontinence
obstructive sx - weak flow, incomplete emptying

DRE - uniform, enlarged, smooth, firm, contender, rubbery prostate

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3
Q

tx BPH

A

observe - lifestyle
alpha-1 blockers - best initial but don’t change prostate size (tamsulosin – other zosins)
5-alpha reductase inhibitors - reduces size of prostate (finasteride and dutasteride)

TURP

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4
Q

what is paraphimosis

A

retracted foreskin in an uncircumcised male that cannot be returned to normal

EMERGENCY

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5
Q

tx paraphimosis

A

manual reduction

granulated sugar, injection o hyaluronidase

incision or circumcision= definitive

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6
Q

what is phimosis

A

inability to retract foreskin over glans

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7
Q

tx phimosis

A

proper hygiene and stretching of skin

4-8 weeks of topical steroids

circumcision = definitive

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8
Q

MC population affected by urge incontinence

A

older women

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9
Q

pathophys of urge incontinence

A

detrusor muscle overactivity

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10
Q

another name for urge incontinence

A

overactive bladder

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11
Q

tx urge incontinence

A

bladder training !!!!!

lifestyle + Kegel

beta-3 agonists - mirabegron, vibegron

antimuscarinic drugs - trospium, darifenacin, tolterodine

botox injections

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12
Q

overflow incontinence is caused by either ____ or ____

A

bladder detrusor muscle under activity or bladder outlet obstruction (like BPH)

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13
Q

dx overflow incontinence

A

clinical
PVR > 200

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14
Q

tx overflow incontinence

A

intermittent or indwelling catheter
cholinergic (Bethanechol)

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15
Q

MC bacterial cause of cystitis

A

E coli

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16
Q

dx cystitis

A

UA - pyuria (>10 WBCs/hpf)
Urine culture - definitive - needs to be clean catch

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17
Q

tx cystitis

A

1st line - nitrofurantoin, TMP-SMX, or fosfomycin

2nd line - fluroquinolones

phenazopyridine is a bladder analgesic (turns fluids orange)

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18
Q

MC bacterial cause of pyelo

A

E coli

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19
Q

dx pyelo

A

UA - pyuria (> 10 WBCs/hpf); WBC casts are hallmark

Urine culture - definitive

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20
Q

tx pyelo

A

fluoroquinolones - cipro or levo

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21
Q

MCC prostatitis

A

> 35 E coli
< 35 chlamydia and gonorrhea

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22
Q

sx prostatitis

A

spiking fever, chills, perineal pain
recurrent UTIs

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23
Q

PE prostatitis

A

boggy and exquisitely tender prostate - acute

nontender, boggy prostate - chronic

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24
Q

dx prostatitis

A

UA and urine culture - pyuria and bacteriuria

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25
what should be avoided in prostatitis
prostatic massage
26
tx prostatitis
> 35 - fluoroquinolones < 35 - doxy + cef tx for 4-6 weeks
27
MC type of bladder CA
urothelial (transitional cell)
28
MC risk for bladder CA
tobacco smoking
29
sx bladder CA
hematuria - gross, painless
30
dx bladder CA
UA to rule out benign cystoscopy renal function tests CT urography cystoscopy with bx - criterion standard
31
tx bladder CA
TURP radical cystectomy if invading muscle metastatic - platinum-based chemo
32
MC type prostate CA
adenocarcinoma
33
RF prostate CA
increasing age black genetics
34
sx prostate CA
asx - most urinary sx back or bone pain
35
PE prostate CA
hard, indurated, nodular, enlarged, asymmetrical prostate
36
most accurate test for prostate CA
transrectal US-guided needle biopsy
37
what grading scale for prostate CA
Gleason grading system
38
tx prostate CA
GnRH agonist - Leuprolide, Goserelin GnRH antagonist - Degarelix, Relugolix prostatectomy
39
MCC erectile dysfunction
vascular - atherosclerosis, DM
40
how to determine if erectile dysfunction is due to psychological or systemic issues
abrupt onset most likely psychological gradual worsening is systemic
41
tx erectile dysfunction
PDE5 inhibitors - sildenafil, tadalafil don't use with patients w nitrates or CV dz
42
sx nephrotic syndrome
edema - usually worse in the morning (periorbital, lower extremity, genital) frothy urine hyper coagulable state - DVT and PE
43
PE nephrotic syndrome
HTN Edema
44
dx nephrotic syndrome
proteinuria - oval Maltese cross-shaed fat bodies (fatty casts) on urine microscopy hypoalbuminemia < 3 hyperlipidemia spot urine protein creatinine > 300-350 mg/mmol - may be easier than 24H urine 24H urine protein > 3-3.5 g/day - gold standard renal biopsy - definitive
45
tx nephrotic syndrome
edema - thiazides or loops + 1 liter fluid and sodium restriction proteinuria reduction - ACEI or ARB hyperlipidemia - diet and statins
46
nephrotic syndrome is characterized by
proteinuria (> 3.5 g/day), hypoalbuminemia, hyperlipidemia, edema
47
MCC chronic renal failure in the US
DM
48
MC primary cause of nephrotic syndrome in caucasian adults
membraneous nephropathy
49
bx membranous nephropathy
light microscopy - uniform thickening of the glomerular basement membrane immunofluorescent - immune complex deposition (IgG and C3)
50
acute glomerulonephritis is characterized by
HTN hematuria (RBC casts) - cola colored azotemia proteinuria (edema)
51
pre renal AKI is characterized by
decreased renal perfusion with nephrons still structurally intact
52
causes of pre renal AKI
hypovolemia afferent arteriole vasoconstriction - NSAIDs efferent arteriole dilation - RAAS blockers
53
dx pre renal AKI
BUN: Creatinine ratio > 20:1 FENA < 1% high urine specific gravity increased urine osmolarity
54
tx pre renal AKI
volume repletion w normal saline
55
MC type of intrinsic AKI
acute tubular necrosis
56
causes of ATN
ischemic - prolonged pre renal azotemia nephrotoxic - radio contrast dye, ahminoglycosides, vancomycin
57
dx ATN
UA - renal tubular epithelial casts and granular (muddy brown) casts low urine specific gravity low urine osmolarity FENA > 2%
58
tx ATN
remove offending agents and IV fluids
59
most important noninvasive test for KAI
UA
60
what is acute interstitial nephritis
a type of intrinsic AKI characterized by an inflammatory or allergic tubulointerstitial injury
61
causes acute interstitial nephritis
drug hypersensitivity - MC - NSAIDs, PCNs, Sulfa drug, PPIs
62
sx acute interstitial nephritis
triad - fever, transient maculopapular rash, arthralgias
63
dx acute interstitial nephritis
UA - white cells (sterile pyuria with positive leukocyte esterase), red cells, white cell casts, proteinuria increased serum IgE
64
tx acute interstitial nephritis
identification and discontinuation of offending meds
65
post renal azotemia is characterized by
obstruction of the passage of urine -- both kidneys need to be obstructed
66
dx post renal azotemia
increased serum creatinine UA - usually normal Renal imaging - US PVR - > 100 mL urine
67
tx post renal azotemia
remove obstruction - catheterization
68
RF for CKD
DM HTN chronic NSAID use AA/hispanic/asian Age > 60 SLE kidney transplant FHx kidney dz
69
stages CKD
stage 1 - proteinuria, abnormal UA, serum, imaging but GFR > 90 (normal) stage 2 - GFR 89-60 stage 3 - 59 - 30 stage 4 - 29 - 15 stage 5 - < 15 - requires dialysis and/or transplant
70
second MCC CKD
HTN
71
dx CKD
proteinuria - spot urine albumin/creatinine ratio preferred over 24H Broad waxy casts on UA GFR US - small kidneys classic
72
BP goal for CKD
< 140/90
73
heritability of polycystic kidney dz
autosomal dominant disorder due to mutations in PKD1 or PKD2
74
where do cysts for in PKD
kidney liver - second MC spleen pancreas
75
what stimulates cysts to grow in PKD
vasopressin
76
sx PKD
abdominal and flank pain cerebral "berry" aneurysms - can cause subarachnoid hemorrhage MVP colonic diverticula
77
PE PKD
HTN palpable flank masses or large kidneys
78
dx PKD
UA - hematuria, decreased urine concentrating ability, proteinuria US - most widely used imaging test genetic testing after US
79
tx PKD
ACEI or ARB for HTN increase fluids Tolvaptan - vasopressin 2 receptor antagonist
80
what can result for CKD
secondary hyperparathyroidism - hypocalcemia, increased PTH, increased phosphate
81
normal pH
7.35-7.45
82
normal PCO2
35 - 45
83
normal HCO3-
22-26
84
what is renal cell carcinoma
tumor of the proximal convoluted renal tubule cells
85
MC renal cell carcinoma
clear cell
86
RF for renal cell carcinoma
smoking HTN obesity men dialysis
87
sx renal cell carcinoma
triad - hematuria, flank or abdominal pain, palpable abdominal or flank mass left sided varicocele METs - canon ball mets to the lungs; may also met to bone
88
dx renal cell carcinoma
CT best initial erythrocytosis often present
89
tx renal cell carcinoma
radical nephrectomy can do chemo
90
what is multiple myeloma
CA of the plasma cells leading to IgG, IgA, IgM
91
MC primary bone malignancy in adults
multiple myeloma
92
sx multiple myeloma
BREAK bone pain - MC - vertebral involvement MC recurrent infections elevated calcium anemia kidney injury - increased BUN and creatinine
93
dx multiple myeloma
rouleaux formation - RBCs with a stack of coins appearance due to increased plasma protein increased ESR Hypercalcemia serum protein electrophoresis - monoclonal proteini spike - IgG urine protein electrophoresis - Bence-Jones proteins (kappa or lambda light chains) radiographs - punched out lytic lesions bone marrow aspiration - plasmacytosis (clonal plasma cells) >/= 10% = definitive
94
tx multiple myeloma
autologous stem cell transplant most effective
95

ER EOR (28 decks)

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