L4 Genitourinary Flashcards

Question

Urine color

Answer 1

varies from almost colorless to dark yellow depends on fluid, supplement, dietary intake

Answer 2

should not be strong (normal)

Answer 3

a measure of solutes in the urine should be 1.002 to 1.028

Answer 4

4.6 to 8.0

Answer 5

glucose, ketones proteins Hb/RBcs Bilirubin WBCs, bacteria

Answer 6

diabetes or keto diet

Answer 7

GFM damaged, kidney disease

Answer 8

cancer, excessive exercise

Answer 9

live or bile duct problems

Answer 10

Increased levels are indicative of decreased renal function

Answer 11

24 hr urine test, approximates GFR decreased Cr clearance is indicative of decreased renal function

Answer 12

increased BUN indicates: decreased renal function or fluid intake, increased muscle catabolism, increased protein intake, acute infection To implicate decreased renal function, BUN levels need to be correlated with plasma Cr levels

Answer 13

alterations in BUN and creatinine levels may lead to alteration in patients mental status

Answer 14

kidney stone

Answer 15

blood flow

Answer 16

inspection of inside of bladder

Answer 17

force of flow test

Answer 18

diagnosis of kidney function mostly used for those that need to receive a kidney

Answer 19

shape of kidney

Answer 20

infection within the urinary tract

Answer 21

bladder and/or urethra

Answer 22

kidneys and/or ureters

Answer 23

-highest incidence in individuals in skilled nursing/extended care facilities -most common is urinary catheterization -Increased age, diabetes, sexually active females

Answer 24

altered mental status, shortness of breath, nausea/vomiting

Answer 25

more likely to fall with altered mental status

Answer 26

lower immune system, decreased personal hygiene, increased sedentary time

Answer 27

decreased immune response, increased bacteria, neuropathy

Answer 28

usually gram-negative bacteria ascending into the urinary tract from the urethra

Answer 29

frequency, urgency, dysuria, nocturia, dyspareunia cloudy, bad-smelling urine, or hematuria

Answer 30

generally sudden onset of symptoms hallmark: dysuria

Answer 31

typically gradual onset and systemic symptoms like fever, chills, malaise

Answer 32

suprapubic, lower abdomen, groin, flank or back pain, shoulder pain possible

Answer 33

infectious agents and/or inflammatory mediators can diffuse locally and activate afferent endings in diaphragm visceral pain can be referred to shoulder pain due to the convergence of sensory neurons on the same group of dorsal horn neurons in spinal segment

Answer 34

make sure to ask about history of recent infection ask about changes in voiding habits, systemic S/S

Answer 35

Dx: History and urinalysis Tx: increased hydration, ABX Cranberry juice is statistically insignificant for treatment, and does not prevent

Answer 36

infectious, inflammatory disease presumed to be caused by bacterial invasion of renal parenchyma Can be acute or chronic

Answer 37

most common cause is backwards flow of infected urine from bladder into upper urinary tract. often called ascending UTIs sometimes caused by blood borne pathogens

Answer 38

kidneys become increasingly damaged due to repeated urinary infections can lead to scarring and loss of kidney function

Answer 39

fever, chills, flank pain pain over costovertebral angle urinary frequency, dysuria, suprapubic discomfort physical findings can vary

Answer 40

weakness, loss of appetite, HTN, anemia, protein and blood in urine

Answer 41

ipsilateral for involved kidney

Answer 42

renal calculi or lithiasis 3rd most common GU disorder Can be in the urinary tract or kidneys Generally due to increased blood concentration and urinary excretion, infection can cause urinary obstruction

Answer 43

Dietary intake can impact reoccurrence Calcium/calcium oxalate= 75% Struvite = 15% Uric acid = 6% Cystine = 2%

Answer 44

30s-50s males excessive calcium, oxalate, purines dehydration

Answer 45

HALLMARK COMPLAINT: abrupt pain associated with urinary tract obstructions, known as renal collic pain starts with stone leaves kidney. Generally abrupt onset

Answer 46

urinalysis, looking for hematruia, infection, crystals. Can identify location of stones with IVP or CT

Answer 47

time, plus pain meds, hydration, ABX if needed extracorpreal shock wave therapy (ESWL)

Answer 48

needed for high rate of recurrence hydration, dietary change (specifically spinach to decrease oxalate)

Answer 49

Group of disease that damages glomerular portion of the kidney condition accounts for 50% of pts requiring dialysis

Answer 50

diabetes systemic lupus HTN

Answer 51

immunologic problems !! drug toxin effects vascular diseases systemic disorders

Answer 52

Immune: immune complexes form in the circulation and get trapped in membrane, producing inflammatory reaction and histological changes vascular: capillaries become permeable, leading to proteinuria, hematuria, edema

Answer 53

HTN proteinuria, pyuria, hematuria edema (albumin pulls water towards it)

Answer 54

Dx: urinalysis, HTN Tx: SAIDs, dietary changes, dialysis, renal transplant. Treatment of primary disease!

Answer 55

pts with DM, SLE, hepatitis, HTN, vasculitis have higher chance of chronic glomerulonephritis be alert to NEW edema and HTN ask about hematuria and oliguria, pts are often on diuretics call primary physician to report new S/S

Answer 56

muscle weakness or cramps, fatigue, nausea, headache, dizziness, orthostatic hypotension, hypokalemia

Answer 57

progressive loss of renal function with permanent loss of nephrons due to multiple causes that continues to worsen even after causes are removed deterioration of kidney function is variable >30 mi americans are affected

Answer 58

1. leading causes of new cases are DM (44%) and HTN (27%). Higher incidence in african americans 2. Overconsumption of NSAIDs 3. Age >65

Answer 59

5 stages, s/s depend on severity and rapidity of failure, each stage is defined by eGFR fatigue, weight loss, metallic taste in mouth, nausea, pruritus

Answer 60

<15% of kidney function

Answer 61

mental dullness renal osteodystrophy, bone demineralization muscle, joint, bone pain extraskeletal calcification restless leg syndrome

Answer 62

dyspnea, orthopnea edema HTN pericardial chest pain (nerves get bugged by edema)

Answer 63

1. Kidney failure, decreased GFR, calcitriol 2. Secondary hyperparathyroidism, altered calcium set point 3. Gut absorption of Ca, decreased calcium absorption, increased phosphate retention 4. Bone remodeling, bone resorption Altered set point of blood calcium, it all causes increased mobilization of calcium into blood. hyper phosphate in blood

Answer 64

S/s Bun and Cr values (from eGFR) imaging serum PTH

Answer 65

Mortality rate of those >65 yr on dialysis is 7x that of age matched norms not on dialysis People >60 year who start dialysis have life expectancy of 5 yrs

Answer 66

Conservative: HTN tx, dietary changes, anemia control, calcitriol meds. For everyone, every stage End stage: renal replacement, dialysis, transplant

Answer 67

Active form of vitamnin D = CALCITRIOL Promotes mineralization of new bone increases calcium and phosphate absorption from gut stimulates calcium, phospahte reabsorption overall result of Vit D: increased plasma concentrations of Ca and phosphate

Answer 68

dialysis renal transplant Kidneys comprise 2/3 of organ transplant waiting list median waiting time is 3.6 years

Answer 69

71% unemployment little improvement in survival after dialysis no significant improvement in health related QOL

Answer 70

improves BP control and lipid profiles improve glucose metabolism increase hematocrit and hemoglobin resistance training helps with bone density increase functional capcity

Answer 71

Benefits of exercise for CKD 26% decrease in use of antihypertensive meds after 3 months of cycling during dialysis $885 savings annually combined aerobic and resistance is the best for those with CKD

Answer 72

lack of awareness of benefits fear that it will cause harm

Answer 73

20-60 min of continuous activity 3-5 days a week can use 3-5 min bouts Resistance: 65% to 75% of 1 RM. Make sure to estimate, don't perform

Answer 74

BP >200/100 mmHP Serum K> 5 mEq WBC <5000 or 10000 w/fever Hct <25% or Hb <8 Platelets <20,000

Answer 75

be alert to infection risk hand-washing is essential do not measure BP on UE avoid placing weight or pressure on the fistula

Answer 76

3.7 to 5.1

Answer 77

use it to guide exercise intensity because HR is unreliable for this population aim for 9-13, talk but not sing

Answer 78

perform during first half to avoid hypotensive episodes pedaling and stepping devices are common don't exercise arm with permanent AV access continuous peritoneal dialysis might require fluid to be drained before exercising

Answer 79

generally wait 2 hours after dialysis, due to fatigue

Answer 80

occurs in epithelial cells lining the kidneys not common cancer, but common KIDNEY cancer has four stages incidence is rising, peak is 60-70 year of age, men.

Answer 81

smoking, obesity, increased red meat, decreased fruit/veggie consumption, chemical occupational exposure increase risk

Answer 82

hematuria flank pain palpable abdominal mass

Answer 83

Grading = histologic differentiation Staging = degree of spread

Answer 84

Tx: surgery has better results than radiation Prognosis: needs to be caught early for surgery to be effective

Answer 85

if pt complains of new unexplained abdominal flank, back pain, sternal pain, cough or hematuria, contact PCP immediately

Answer 86

1. shrinkage of testes 2. thickening of seminiferous tubules (decreased sperm production) 3. Enlargement of prostate gland, can double in size 4. Decreases in plasma testosterone level (loss of muscle, changes in bone density)

Answer 87

1. Urinary frequency/nocturia 2. Problems stopping/starting urination 3. Weak urine flow 4. Bladder never completely empty

Answer 88

(young man condition) inflammation of prostate gland, can be acute or chronic. PTs are more likely to encounter pts with chronic prostatitis

Answer 89

Prevalence higher in men <40 yrs old Lower UTI Urinary catheterization multiple sex partners strong vibrations

Answer 90

4 categories of prostatitis most common type is chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) causes are urine reflux, pelvic floor dysfunction

Answer 91

CP: low back and perineal pain. Pain w/prolonged sitting, voiding problems, sexual dysfunction Dx: urinalysis, digital rectal exam, differentiated from BPH and prostate CA by presence of PAIN

Answer 92

low back and perineal pain

Answer 93

Prevention: decrease time in seated position. try different bike seats Tx: anti inflammatories, ABX, relaxants. PT (biofeedback, stretching)

Answer 94

age related nonmalignant enlargement of prostate gland Men >50 yr of age Moderate intake of alcohol has a decreased risk

Answer 95

unknown, maybe hormonal changes multiple nodules comprised of proliferating cells progressively narrow the urethra

Answer 96

decreased force of urinary flow urinary frequency, nocturia untreated progression, UTI, bladder wall changes, hydroureter

Answer 97

history uroflowmetry palpation

Answer 98

Monitoring Surgery = TURP, resection of prostate Common meds: alpha reductase inhibitors (shrinks prostate), alpha adrenergic blockers (relaxes smooth muscle)

Answer 99

tachycardia dizziness orthostatic hypotension increased risk of falls

Answer 100

young man diseases abnormal, rapid, invasive growth of malignant cells in testicles most common cancer in males 15-35

Answer 101

past medical history of undescended testicles, abnormal development, previous testicular cancer family history caucasian

Answer 102

1. enlargement, lump, swelling of testicle 2. pain or feeling of heaviness in scrotum 3. Dull ache in back/lower abdomen (may be ONLY symptom >20% of cases) 4. Dyspnea 5. Gynecomastia, excessive breast tissue

Answer 103

Dx: urologic history and exam, painless mass in testicle in key sign Tx: chemotherapy, radiation, ectomies Prevention: testicular self exam every 6 months, early detection

Answer 104

In males with this referral pattern with no mechanical source: 1. ask about testicular self-exam 2. Assess supraclavicular lymphadenopathy 3. Perform iliopsoas test 4. Refer to MD

Answer 105

transition when ovaries stop releasing eggs, menstrual activity decreases and eventually ceases estrogen and progesterone decrease, 1 year without menstruation occurs age 50

Answer 106

labia atrophy changed libido hot flashes, mood changes, sleep disturbances decrease in pelvic muscle tone

Answer 107

endometrial tissue becomes implanted outside uterus; most commonly implants form on fallopian tubes, ovaries, or tissue lining pelvis

Answer 108

women of childbearing age w/out children early menarche, short menstrual cycles, long menstrual period family hx

Answer 109

causes is unknown, roles suggested for hormones and immune system Common theory: mentrual blood containing endometrial cells is retrogradely flushed back through tubes into pelvic caivty endometrial cells form implants throughout the body

Answer 110

DYSMENORRHEA, DYSPAREUNIA, INFERTILITY excessive bleeding, pain, symptoms vary on growth

Answer 111

the classic triad laparoscopy/laparotomy

Answer 112

No cure. Goal is pain relief and preservation of fertility NSAIDs, surgery, hyterectomy

Answer 113

if pain is present regardless of sexual position, pain source is less likely to be a joint dysfunction

Answer 114

cancer of uterine lining most common cancer of female organs incidence peaks in 60-70 yrs old

Answer 115

increasing age obesity increased level of estrogen inactivity

Answer 116

abnormal bleeding abdominal/LE edema

Answer 117

surgery hysterectomy salpingo-oophorectomy hormonal therapy radiation usually diagnosed early

Answer 118

cancer that forms in cervix pap smears help to control the amount of cases HPV is the primary cause

Answer 119

dx: pap smear tx: based on stage of disease. Pre would be excision, laser. Later would be surgery, chemo, radiation

Answer 120

HPV turns of cells tumor suppressing genes, allowing abnormal changes in cervical epithelium to perpetuate CP: early stages are asymptomatic, advanced are abnormal bleeding, bowel bladder problems

Answer 121

usually diagnosed late malignant neoplasm located on the ovaries fairly uncommon but leading cause of death in female cancers. Usually dx when it has metastizied

Answer 122

more cycles, more risk age >40 year never breast fed family history of breast, ovarian, colon

Answer 123

unknown cause correlated with number of times a woman ovulates spreads locally to pelvis, abdominal cavity, bladder can spread to lymph nodes

Answer 124

often vague and nonspecific sense of pelvic heaviness vague lower abdominal bloating unexplained back pain that worsens over time gait disturbance due to brain metastases

Answer 125

Dx: screening test, pelvic exam that can show edema in perionetal cavity Tx: surgery, chemo. Low survival rate due to being diagnosed late

Answer 126

due to risk of recurrence, PT should note gait changes

Answer 127

implantation of pregnancy in any location other than the uterus, often in fallopian tube

Answer 128

things that disrupt fallopian tube structure STDs, prior tubal surgery, IUD, history, pelvic inflammatory disease

Answer 129

dealyed ovum transport fertilization and implantation occurs in tube pregnancy outgrown blood supply possibility of ruptured fallopian tube

Answer 130

variable, delayed or slight vaginal bleeding sudden, sharp, stabbing pain

Answer 131

emergency call to physician is warranted

Answer 132

Dx: pelvic ultrasound, elecated hCG, laparoscopy Tx: medication, removal of egg