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ICP > GU/Renal > Flashcards

GU/Renal Flashcards

1
Q

Uterine Fibroids definition & MC location

A

benign tumors of the myometrium/connective tissue of the uterus

  • Intramural is MC –> within the muscle layer
  • subserosal
  • submucosal (extending into the uterine cavity)
  • pedunculated
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2
Q

Most common symptom of Uterine Fibroids + others

A
  • Abnormal uterine bleeding = MC
  • chronic pelvic pain
  • bulk symptoms
  • Anemia
  • Urinary retention
  • Constipation
  • Infertility/ pregnancy complications
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3
Q

How common are uterine fibroids?

A

Very common! 70-80% of women have them by the tie they are 50 yo

Maybe familial component

MC in AA women

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4
Q

Uterine Fibroid Diagnostics

A
  • CBC w/ diff
  • BUN/Cr
  • TSH
  • Transvaginal U/S&raquo_space;»> pelvic U/S
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5
Q

Uterine Fibroid Management

A
  • Routine pelvic exams to monitor
  • Combo OCP (estrogen + progestin)
  • NSAIDs for pain
  • Surgical options –> hysterectomy vs. myomectomy
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6
Q

Do fibroids cause fertility issues?

A

Yes, they can for younger patients

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7
Q

Is there ever any concern for malignancy w/ fibroids?

A

Typically not, but satellite growths are more concerning for malignancy

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8
Q

What is another treatment option to reduce bleeding w/ fibroids?

A

Tranexamic acid

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9
Q

Acute Bacterial Prostatitis definition

A

A bacterial infection that travels up the urethra & penetrates the prostate

50% of men will have one in their lifetime

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10
Q

MC bacteria in Prostatitis

A

E. coli, Klebsiella, other gram neg bacteria

STI – Gonorrhea or Chlamydia (suspect if penile discharge)

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11
Q

Symptoms of Prostatitis

A
  • Dysuria (painful urination)
  • Frequency & urgency
  • Nocturia
  • Poor stream & Hesitancy
  • blood in urine
  • Perineal pain w/ radiation to back, rectum, or penis
  • Fever & Chills

Severity of symptoms increases if patient also has BPH

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12
Q

Prostatitis Physical Exam

A
  • Examine external genitalia for erythema or swelling of scrotum
  • DRE prostate is exquisitely tender & boggy

DO NOT MILK!! Can spread infection

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13
Q

Prostatitis Lab Diagnostics

A

-Urinalysis (leukocytosis, nitrites, +/- hematuria)
-Urine Culture
-GenProbe if STI concern
-CBC + blood culture if signs of sepsis present
+/- BMP for renal function

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14
Q

Acute Prostatitis management

A

STD risk – Ceftriaxone IM x1 + Doxycycline x10 days

Low STD risk – Cipro, Levo, or Bactrim (TMP/SMX)

follow up in 7 days for repeat urine culture & change of ABX if necessary

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15
Q

Chronic Prostatitis management

A

1st line = Cipro or Levo x4 weeks

2nd line = Bactrim (TMP/SMX) x 1-3 months

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16
Q

Fluoroquinolone education for Prostatitis patients

A
  • avoid antacids w/in 6 hours
  • tendonitis/tendon rupture
  • CNS side effects
  • C. diff associated diarrhea
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17
Q

Patient’s at higher risk of Prostatitis

A
  • indwelling catheter
  • recent urethral surgery or prostate biopsy
  • recent GU tract infection like cystitis or epididymitis
  • immunocompromised (HIV)
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18
Q

BPH definition

A

proliferation of cells in the transition zone surrounding proximal urethra

usually originates in periureteral and transition zones

80% of men have evidence of BPH by 80 yo

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19
Q

______ is the most commonly diagnosed non-skin cancer in men

A

Prostate cancer

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20
Q

Risk Factors for Prostate Cancer

A
  • Age >50 yo
  • Serum PSA >4
  • Abnormal DRE
  • FMHx of prostate cancer or BRCA1/2 mutation
  • AA
  • Obesity
  • High fat, low fiber diet
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21
Q

Risk Factors for BPH

A
  • increased caffeine intake

- lack of physical activity

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22
Q

BPH symptoms

A
  • Urinary hesitancy
  • Decreased caliber and force of stream
  • Incomplete bladder emptying
  • Double voiding
  • Post-void dribble
  • Nocturia
  • DRE = enlarged, non-tender, symmetric
  • Symptom Assessment via AUA*
  • AUASS > 7 = mild symptoms
  • AUASS >13 = moderate symptoms
  • AUASS >19 = severe symptoms
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23
Q

Prostate Cancer symptoms

A
  • can be asymptomatic until later in the disease
  • First symptom may be bone pain…metastases
  • Hematuria
  • Hematospermia
  • Weight loss
  • Fatigue

DRE = indurated, hard nodules, asymmetric

24
Q

PSA recommendation per American Cancer Society

A
  • offer annually for average risk men > 50 yo, up until 76 yo (if > 10 year survival rate)
  • DRE is controversial, but still recommended by ACS*

> 4 ng/mL can be concerning for prostate cancer…
10-20 = 50-75% chance
20 = 90% chance

25
Q

Other PSA Testing for Prostate Cancer

A
  • Free vs. Bound PSA = higher % bound to protein w/ cancer
  • PSA Density = higher density w/ cancer
  • PSA velocity = rate of increase over time, requires 3+ measurements over 18 mo…yearly >0.75 ng/mL increases likelihood of CA when PSA is still within normal limits
26
Q

Imaging to assess for Prostate Cancer

A
  • CT, MRI, or transrectal U/S

- Bone scan for mets

27
Q

When should you refer someone to urology for BPH or suspected prostate cancer?

A
  • PSA > 7
  • Any rise in PSA while taking Fenasteride
  • Abnormal DRE regardless of PSA
  • Severe, intolerable symptoms of BPH
28
Q

Management of Prostate Cancer

A

Depends on stage, life expectancy, pt preference

  • Radical prostatectomy if life expectancy >10 yrs
  • Radiation
  • Hormone therapy
  • chemotherapy
29
Q

BPH management options

A

Lifestyle = avoid caffeine, alcohol, foods or meds that will make it worse – ex: cold & allergy meds, diuretics

Drugs for mild-to-moderate symptoms

  • alpha blockers = Tamsulosin, Doxazosin
  • 5-alpha reductase inhibitors = Finasteride
  • Tadalafil = BPH + ED

If unresponsive to medical therapies = TURP

30
Q

______ & _____ drugs will reduce PSA, causing a falsely low reading

A

Dutasteride & Finasteride

5-alpha-reductase inhibitors

block conversion of testosterone to DHT…reduce size of prostate

31
Q

MCC of Pyelonephritis

A

Gram neg bacilli (95%)

  • Ecoli
  • Klebsiella
32
Q

Triad of Pyelonephritis symptoms

A

-Fever
-Tachycardia
-Flank pain
+UTI symptoms (dysuria, frequency, urgency)

33
Q

Lab work up for Pyelonephritis

A
  • Urinalysis = pyuria + leuks + WBC casts + microheme
  • Urine culture
  • Urine HCG if childbearing age
34
Q

Imaging for Pyelonephritis

A

Most do not require imaging

If no sign of improvement within 72 hours = CT

Complicated pt w/ hx of urologic problems = CT

CT looking for hydronephrosis, stone, anatomic abnormalities, abscess, etc.

35
Q

Treatment for Pyelonephritis

A

Uncomplicated = Ceftriaxone IM + Fluro (Cipro or Levo)

if cannot tolerate fluoro…Bactrim or Augmentin 875

36
Q

When should you admit a patient with Pyelonephritis?

A
  • Bacteremia
  • Inability to tolerate oral fluids
  • Immunocompromised
  • Pregnant**

IV Cipro/Levo, Zosyn, Carbapenem etc.

37
Q

Complications of Pyelonephritis

A
  • renal abscess formation
  • Sepsis
  • Papillary necrosis
  • Acute renal failure
  • Emphysematous pyelonephritis*- necrotizing infxn
  • seen in diabetics
38
Q

Distribution of Pyelonephritis in females & males

A

Females trimodal = 0-4; 15-35; >50 yo

males bimodal = 0-4; >35 yo

Women are 5x more likely to be hospitalized

39
Q

What is the most important risk factor for a Complicated UTI?

A

Urinary tract obstruction

  • Sexual intercourse…esp with new partner
  • Use of spermicide
  • DM
  • Urinary incontinence
40
Q

MC organisms for DM pt w/ Pyelonephritis

A
  • Klebsiella
  • Enterobacteriaceae
  • Clostridia
  • Candida
41
Q

Sepsis Criteria

A

SIRS criteria + Source of Infection

SIRS = ≥ 2

  • temp > 100.4 F
  • HR >90
  • RR > 20
  • WBC >12,000
42
Q

What analgesic can be specifically helpful for patients with dysuria symptoms? (pyelo)

A

Pyridium (aka AZO)

43
Q

Simple cystitis vs. Pyelo

A

Pyelo will have HIGHER fever, CVA tenderness, more ill appearing

44
Q

Polycystic Kidney Disease definition

A

Autosomal dominant disease (PKD1 or PKD2 gene mutation)

MC inherited kidney disease

Leads to continual fluid-filled yst formation and growth in kidneys + other organs (liver, spleen, pancreas)

Will eventually progress to ESRD

45
Q

Common Symptoms of PCKD

A

Most are asymptomatic for first 3 decades of life

  • Gross hematuria (cyst rupture)
  • Flank mass/pain
  • Nephrolithiasis (stones)
  • Elevated BP (RAAS system)
  • Polyuria
  • Nocturia
  • Increased thirst
46
Q

Dx of PCKD

A

Renal U/S

Criteria by age
15 - 39 = at least 3 unilateral or bilateral cysts
40-59 = at least 2 cysts per kidney
60+ = at least 4 cysts per kidney

  • CBC
  • CMP –> BUN, Cr elevated
  • Urinalysis
47
Q

Management of PCKD

A

HTN control = ACE….goal BP 110/75

  • Restrict sodium intake
  • increase fluid intake >3 L per day
  • Pain control – Acetaminophen

*May aspirate or surgically intervene for particularly large and painful cyst

48
Q

Patient Education of PCKD

A

Their kids have a 50% chance of getting it

No cure – important to follow management closely to slow disease progression

49
Q

If PCKD progresses what treatment options exist through nephrology?

A
  • if in ESRD = dialysis
  • kidney transplant
  • nephrectomy
  • aspiration of cysts
50
Q

Extra-renal complications of PCKD

A
  • intracranial hemorrhage leading to SAH
  • Diverticulosis
  • Aneurysms
  • Cardiac abnormalities = MVP, AR
51
Q

Ovarian Torsion definition

A

Twisting of ovary and tube

Rotation around infundibulopelvic & utero-ovarian ligament

-slows venous drainage –> congestion –> Infarction

52
Q

Which side is ovarian torsion MC on? And what age range is MC?

A
  • Right

- Women of reproductive age

53
Q

Dx of Ovarian Torsion

A

Transvaginal U/S with Doppler Flow

  • CBC
  • BMP
  • Urine HCG
  • UA
  • Lactic acid = looking for tissue necrosis
54
Q

Management of Ovarian Torsion

A

Admit! Call OBGYN/Surgery

  • NPO
  • IV access x2
  • IV Morphine 4mg
  • IV Zofran

Surgery for immediate detorsion + cystectomy if mass is present
-if post-menopausal salpingo-oophorectomy is recommended (remove ovaries & tubes)

55
Q

How to prevent recurrence of Ovarian Torsion

A

-High dose oral contraceptives w/ >50 mcg estrogen

-Oophoropexy = tacking ovary to abdominal wall
common in children w/ torsion

56
Q

Pregnancy is associated with a ______ risk of ovarian torsion

A

Increased!

ICP (3 decks)

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