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ER EOR > GU Geriatrics > Flashcards

GU Geriatrics Flashcards

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Royal College: Emergency Medicine 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
Q

what should be avoided in prostatitis

A

prostatic massage

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26
Q

tx prostatitis

A

> 35 - fluoroquinolones
< 35 - doxy + cef

tx for 4-6 weeks

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27
Q

MC type of bladder CA

A

urothelial (transitional cell)

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28
Q

MC risk for bladder CA

A

tobacco smoking

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29
Q

sx bladder CA

A

hematuria - gross, painless

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30
Q

dx bladder CA

A

UA to rule out benign
cystoscopy
renal function tests
CT urography
cystoscopy with bx - criterion standard

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31
Q

tx bladder CA

A

TURP

radical cystectomy if invading muscle

metastatic - platinum-based chemo

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32
Q

MC type prostate CA

A

adenocarcinoma

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33
Q

RF prostate CA

A

increasing age
black
genetics

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34
Q

sx prostate CA

A

asx - most
urinary sx
back or bone pain

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35
Q

PE prostate CA

A

hard, indurated, nodular, enlarged, asymmetrical prostate

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36
Q

most accurate test for prostate CA

A

transrectal US-guided needle biopsy

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37
Q

what grading scale for prostate CA

A

Gleason grading system

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38
Q

tx prostate CA

A

GnRH agonist - Leuprolide, Goserelin
GnRH antagonist - Degarelix, Relugolix

prostatectomy

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39
Q

MCC erectile dysfunction

A

vascular - atherosclerosis, DM

40
Q

how to determine if erectile dysfunction is due to psychological or systemic issues

A

abrupt onset most likely psychological

gradual worsening is systemic

41
Q

tx erectile dysfunction

A

PDE5 inhibitors - sildenafil, tadalafil

don’t use with patients w nitrates or CV dz

42
Q

sx nephrotic syndrome

A

edema - usually worse in the morning (periorbital, lower extremity, genital)

frothy urine

hyper coagulable state - DVT and PE

43
Q

PE nephrotic syndrome

A

HTN
Edema

44
Q

dx nephrotic syndrome

A

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
Q

tx nephrotic syndrome

A

edema - thiazides or loops + 1 liter fluid and sodium restriction

proteinuria reduction - ACEI or ARB

hyperlipidemia - diet and statins

46
Q

nephrotic syndrome is characterized by

A

proteinuria (> 3.5 g/day), hypoalbuminemia, hyperlipidemia, edema

47
Q

MCC chronic renal failure in the US

A

DM

48
Q

MC primary cause of nephrotic syndrome in caucasian adults

A

membraneous nephropathy

49
Q

bx membranous nephropathy

A

light microscopy - uniform thickening of the glomerular basement membrane

immunofluorescent - immune complex deposition (IgG and C3)

50
Q

acute glomerulonephritis is characterized by

A

HTN
hematuria (RBC casts) - cola colored
azotemia
proteinuria (edema)

51
Q

pre renal AKI is characterized by

A

decreased renal perfusion with nephrons still structurally intact

52
Q

causes of pre renal AKI

A

hypovolemia

afferent arteriole vasoconstriction - NSAIDs

efferent arteriole dilation - RAAS blockers

53
Q

dx pre renal AKI

A

BUN: Creatinine ratio > 20:1
FENA < 1%
high urine specific gravity
increased urine osmolarity

54
Q

tx pre renal AKI

A

volume repletion w normal saline

55
Q

MC type of intrinsic AKI

A

acute tubular necrosis

56
Q

causes of ATN

A

ischemic - prolonged pre renal azotemia

nephrotoxic - radio contrast dye, ahminoglycosides, vancomycin

57
Q

dx ATN

A

UA - renal tubular epithelial casts and granular (muddy brown) casts

low urine specific gravity
low urine osmolarity
FENA > 2%

58
Q

tx ATN

A

remove offending agents and IV fluids

59
Q

most important noninvasive test for KAI

A

UA

60
Q

what is acute interstitial nephritis

A

a type of intrinsic AKI characterized by an inflammatory or allergic tubulointerstitial injury

61
Q

causes acute interstitial nephritis

A

drug hypersensitivity - MC - NSAIDs, PCNs, Sulfa drug, PPIs

62
Q

sx acute interstitial nephritis

A

triad - fever, transient maculopapular rash, arthralgias

63
Q

dx acute interstitial nephritis

A

UA - white cells (sterile pyuria with positive leukocyte esterase), red cells, white cell casts, proteinuria

increased serum IgE

64
Q

tx acute interstitial nephritis

A

identification and discontinuation of offending meds

65
Q

post renal azotemia is characterized by

A

obstruction of the passage of urine – both kidneys need to be obstructed

66
Q

dx post renal azotemia

A

increased serum creatinine
UA - usually normal
Renal imaging - US
PVR - > 100 mL urine

67
Q

tx post renal azotemia

A

remove obstruction - catheterization

68
Q

RF for CKD

A

DM
HTN
chronic NSAID use
AA/hispanic/asian
Age > 60
SLE
kidney transplant
FHx kidney dz

69
Q

stages CKD

A

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
Q

second MCC CKD

A

HTN

71
Q

dx CKD

A

proteinuria - spot urine albumin/creatinine ratio preferred over 24H

Broad waxy casts on UA
GFR

US - small kidneys classic

72
Q

BP goal for CKD

A

< 140/90

73
Q

heritability of polycystic kidney dz

A

autosomal dominant disorder due to mutations in PKD1 or PKD2

74
Q

where do cysts for in PKD

A

kidney
liver - second MC
spleen
pancreas

75
Q

what stimulates cysts to grow in PKD

A

vasopressin

76
Q

sx PKD

A

abdominal and flank pain
cerebral “berry” aneurysms - can cause subarachnoid hemorrhage
MVP
colonic diverticula

77
Q

PE PKD

A

HTN
palpable flank masses or large kidneys

78
Q

dx PKD

A

UA - hematuria, decreased urine concentrating ability, proteinuria
US - most widely used imaging test
genetic testing after US

79
Q

tx PKD

A

ACEI or ARB for HTN
increase fluids
Tolvaptan - vasopressin 2 receptor antagonist

80
Q

what can result for CKD

A

secondary hyperparathyroidism - hypocalcemia, increased PTH, increased phosphate

81
Q

normal pH

A

7.35-7.45

82
Q

normal PCO2

A

35 - 45

83
Q

normal HCO3-

A

22-26

84
Q

what is renal cell carcinoma

A

tumor of the proximal convoluted renal tubule cells

85
Q

MC renal cell carcinoma

A

clear cell

86
Q

RF for renal cell carcinoma

A

smoking
HTN
obesity
men
dialysis

87
Q

sx renal cell carcinoma

A

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
Q

dx renal cell carcinoma

A

CT best initial
erythrocytosis often present

89
Q

tx renal cell carcinoma

A

radical nephrectomy

can do chemo

90
Q

what is multiple myeloma

A

CA of the plasma cells leading to IgG, IgA, IgM

91
Q

MC primary bone malignancy in adults

A

multiple myeloma

92
Q

sx multiple myeloma

A

BREAK

bone pain - MC - vertebral involvement MC
recurrent infections
elevated calcium
anemia
kidney injury - increased BUN and creatinine

93
Q

dx multiple myeloma

A

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
Q

tx multiple myeloma

A

autologous stem cell transplant most effective

95
Q
A

ER EOR (28 decks)

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