Module 1 Flashcards
Prostatitis: Acute
-is it common to see a fever?
-with exam, what will you find?
-yes, common for fever
-exquisitely tender prostate with palpation
Prostatitis: how many types are there? what are they called?
3 types
Acute, Chronic, nonbacterial
Prostatitis: acute
-sx
irritative voiding, suprapubic or perineal pain
Prostatitis: acute
-are you allowed to massage the prostate?
-what pathogens should be considered for acute prostatitis?
-NO! can cause bacteria to leak out and trigger septicemia
-neisseria gonorrheae and chlamydia trachomatis
Prostatitis: acute
-UA –> what is typically positive or negative in UA?
bacteria, leukocytes, hematuria
Prostatitis: acute
-UA–> should it be sent off or no?
YES, sent off for culture and sensitivity
Prostatitis: acute
-what could CBC possibly show?
left shift with leukocytosis present
Prostatitis: acute
-tx (drug and timeline)
fluoroquinolones for at least 30 days if not 6 weeks
Prostatitis: chronic
-what is this typically associated with?
-associated with BPH
Prostatitis: chronic
-how does patient present?
-is prostate tender?
-intermittent dysuria, obstructive voiding, and recurrent UTIs
-prostate is NOT tender (it is soft, boggy and indurated)
Prostatitis: chronic
-can you massage prostate to culture secretions?
YES
Prostatitis:
-what is the main culprit (infectious agent/cause)?
e-coli
Prostatitis: chronic
-TX (drug and timeline)
Bactrim (not bactrim DS) BID for 6-12 weeks
Prostatitis: chronic
-what type of patient is this disease usually found with?
patients who are HIV positive, have CMV, or inflammatory conditions such as sarcoidosis
Prostatitis: nonbacterial
-possible sx
-what can this be related to?
-perineal pain (testicular, penile, or pubic pain)
-can be related to LUTS (lower urinary tract sx), ejaculatory duct obstruction, pelvic side wall tension, or nonspecific prostatic inflammation
Prostatitis: nonbacterial
-will culture be positive or negative?
-should you try an antibiotic?
-NEGATIVE
-you can try antibiotic for 2 weeks, then continue for 4 weeks
Prostatitis: nonbacterial
-how to help with LUTS sx (TX)
-what should be monitored at home if taking these tx modalities?
-when should this medication be given?
-add an alphablocker such as terazosin or doxazosin; newer options include tamsulosin (Flomax) and silodosin (Rapaflow) –> newer options have fewer SE
-remind patient to complete follow-up BP checks at home; monitor for orthostatic hypotension
-give this medication at night (d/t hypoorthostasis)
Prostatitis: nonbacterial
-what can alpha blocker medications used to treat nonbacterial prostatitis be combined with if necessary?
-5-alpha reductase inhibitors (finasteride (Proscar) or dutasteride (Avodart)
Acute epididymitis:
-sx
-what should be considered?
-irritative voiding sx with enlarged/painful epididymis
-consider chlamydia and/or gonorrhea
Acute epididymitis
-what can trigger this?
-where can pain radiate from and to?
-sexual activity, physical strain or trauma
-pain from scrotum may radiate to flank of affected side
Acute epididymitis
-what can be useful for dx?
-what are we hoping to differentiate acute epididymitis from?
-US
-differentiate from testicular torsion
Acute epididymitis
-TX
rocephin (ceftriaxone), levaquin (levofloxacin), bactrim (trimethoprim-sulfa), doxycycline, etc.
Interstitial cystitis
-sx
-how is pain relieved?
-painful bladder when full; also urinary urgency. urgency, frequency, and nocturia (not associated with other dx (no UTI, no chronic cystitis)
-relieved by voiding (which is different than acute cystitis)
Interstitial cystitis
-what is used for workup (dx testing)?
UA, prostate culture, US, CT
** will all be negative
Interstitial cystitis
-TX
-lifestyle changes (dec caffeine, inc water intake, void often)
-wear loose fitting clothes
-Implement low impact exercise
-quit smoking
-decrease stress
-PT
-Medications ie amitriptyline, Elmiron, hydroxyzine, and DMSO
Renal calculi
-occurs more often in what circumstance?
when hot outside; drinking less (water)
Renal calculi: pain
-severe? dull? intermittent? constant?
severe, intermittent
Renal calculi: pain location vs stone location
-flank
-lateral
-mid
-tip of penis
-kidney itself
-ureter
-bladder
-U/V junction
Renal calculi: common components of calculi
calcium oxalate is most common
-calcium phosphate, struvite, uric acid and cysteine
Renal calculi: triggers
high temps, humidity, high protein, sedentary lifestyle, poor hydration
Renal calculi: what disease can predispose patients?
hx of gout
Renal calculi: dx
CT of abd with protocol for renal stones (with contrast)
Renal calculi: TX
push fluids, pain medications
Renal calculi: when to refer patient
if stone size is bigger than 7mm
Erectile dysfunction:
-causes
arterial, venous, neurogenic, hormonal, or psychogenic
Erectile dysfunction: priapism
occurs when an erection lasts >4hrs
Erectile dysfunction: causes of anejaculation
androgen deficiency or sympathetic denervation
Erectile dysfunction: retrograde ejaculation
mechanical disruption of the bladder neck
Erectile dysfunction: premature ejactulation
primary or secondary to ED
Erectile dysfunction: peyronie’s disease
chronic condition that causes a significant bend in the penis, sometimes along with pain or difficulty with sexual function
Erectile dysfunction: peyronie’s disease
-what causes this disease?
occurs when scar tissue builds up on outer covering of the erectile bodies which can cause curved and painful erections (scar tissue is called plaque)
Erectile dysfunction: postage stamp test
???
Erectile dysfunction: treatment options
PDE-5 inhibitors: cialis, viagra, levitra
***needs sexual arousal for drug to work
Erectile dysfunction: possible SE of PDE-5 inhibitors
priapism, HA, vision changes, low back pain (cialis), dizziness/hypotension
Erectile dysfunction: what can’t you use PDE-5 inhibitors in combination with?
Nitrates!
Peyronie’s disease: tx options
-Xiaflex (collagenase clostridium histolyticum)
-gentle stretching and flexing
-surgery is most effective but reserved for severe cases
Hypogonadism:
-related to what?
-possible sx
-obesity, pituitary tumors, adrenal insufficiency, or just normal aging (andropause)
-ED, depression, decreased libido, loss of exercise tolerance and muscle mass, hot flashes
Hypogonadism:
-what test will be done to dx?
-what is the value of this test that indicates dx?
-Bloodwork serum testosterone
- (AM) <320mg/dL
Hypogonadism:
TX
-Replace testosterone (injections, gels, patches, implants)
-weight loss
Hypogonadism:
-what is testosterone an automatic R/F for?
prostate cancer
Hypogonadism: what must be monitored during tx?
PSA (if >4 or if nodule present, refer to urology)
Gynecomastia:
-what population is this most common in?
-what other things can gynecomastia be related to?
-young pubescent males; older males
-medications (anabolic steroids)
Gynecomastia: what lab work to check?
-prolactin, estrogen panel, testosterone, TSH
Gynecomastia:
-what should be encouraged?
-what diagnostic test should be considered?
-weight loss
-consider mammogram/US
Hepatitis: 5 main types
A, B, C, D, E
Hepatitis A:
-how is this disease spread?
-discrete or obvious sx onset?
-food/water born
-discrete
Hepatitis A:
-sx
Fever, HA, malaise, anorexia, N/V, diarrhea, abd pain, dark urine AND must include:
-jaundice or total bilirubin >=3.0mg/dL OR elevated serum ALT levels >200IU/L and LACK of better dx
Hepatitis A:
-what sx only occurs with HAV?
diarrhea
Hepatitis A: what lab values are positive?
-Immunoglobulin M (IgM) antibody to hepatitis A virus (anti-HAV)
-nucleic acid amplification test (NAAT - PCR or genotyping) for hepatitis A virus RNA
Hepatitis A:
-incubation period
-how long does this illness last?
-once you have Hep A, do you produce antibodies forever?
-28 days
-2 months up to 6 months
-Yes, forever
Hepatitis A: risk factors associated with transmission
MSM, international travelers, drug users both injectable and other routes, homelessness, international adoptees
Hepatitis A: once you have hep A, are the antibodies you produce temporary or permanent?
you produce antibodies against hep A for life
Hepatitis A: prevention
-wash hands
-clean surface
-vaccine
Hepatitis A: vaccine options
-Hep A vaccine: 2 vaccines; <40yrs
-Post exposure treatment: immunoglobulin must be given w/i 2 weeks of known/suspected exposure; >=40yrs; lasts up to 3 months
Hepatitis B:
-transmission
-can it lead to chronic illness?
-can mother pass to child?
-parenteral contact with body fluids; sexual contact
-yes
-yes
Hepatitis B:
-are symptoms discrete or rapid?
-what are the sx of this disease?
-discrete
-fever, HA, malaise, anorexia, H/V, clay-colored stools, abd pain, dark urine, joint pain (no diarrhea)
Hepatitis B: is diarrhea a sx of hep B?
NO
Hepatitis B: lab values associated with positive findings
-hepatitis B surface antigen (HBsAg): + means you have Hep B (acute or chronic)
-anti-hep b surface antibody (anti-HBs): + you are protected AGAINST hep B
-total anti-HBC or HBcAB (anti-hep B CORE antibody): past or current infection
Hepatitis B:
-incubation period
-can you catch acute HBV again?
-what can chronic HBV lead to?
-90 days
-once you have it and recover (acute), you do not “catch” it again
-chronic infection leads to cirrhosis, hepatocellular carcinoma
Hepatitis B: is there a connection between chronic HBV and patients who contract disease from mother at birth?
-YES: commonly, pts contract HepB from mother, which often (95%) develop chronic hep B infection
Hepatitis B: who should be screened?
-all pregnant women
-infants born to HBsAg-positive mothers and anti-HVs are only recommended
-people born in regions with intermediate/high risk HIBV endemicity
-MSM
-injected drugs
-alanine aminotransferase levels
-end-stage renal disease + hemodialysis
-pts receiving immunosuppressive therapy
-pts with HIV
-blood/plasma/organ/tissue/semen donors
Hepatitis B:
-risk factors/transmission
-percutaneous, mucosal, nonintact skin exposure to infectious blood, semen, and other body fluids
-transmitted through: birth to infected mother; sexual contact with infected person
Hepatitis B: what is the preferred treatment for preventative measures?
vaccination
Hepatitis B: vaccination of Hep B among adults
-what is the vaccination schedule?
2 doses, 1 month apart; or three doses over 6 month period, depending on manufacturer
Hepatitis B: what patients should have confirmatory testing after vaccinations?
-healthcare workers
-public safety workers
-hemodialysis pts
-HIV and other immunocompromised pts
-Sexual partners of pts who have chronic Hep B
Hepatitis B: treatment options
post exposure prophylaxis with hep B vaccine –> can give Hep B immunoglobulin
Hepatitis C:
-does it lead to chronic illness?
-what is the most common way of transmission?
-can this be treated?
-yes, leads to chronic illness
-sexual contact
-CAN BE TREATED WITH MEDS
Hepatitis C:
-is onset discrete or insidious?
-what are the sx?
-discrete
-fever, HA, malaise, anorexia, N/V, clay-colored stools, abd pain, dark urine, joint pain
Hepatitis C: lab values used to determine if positive for virus?
Assay for anti-HCV
-qualitative assay for antiHCV (NAT) to detect
-quantify presence of virus (HCV RNA)
Hepatitis C: incubation period
2-12 weeks (can be up to 24 weeks)
Hepatitis C:
-how long does this disease tend to have lasting effects?
2-6 months
Hepatitis C:
-how many pts positive for acute HCV develop into chronic?
50-85%
Hepatitis C: who should be screened for Hep C?
EVERYONE!!
-all adults aged 18yrs and older, at least once
-all pregnant women during each pregnancy
-People who currently inject drugs/share needles/share syringes
-people with HIV
-those who receive hemodialysis
-those with persistently abnormal ALT levels
-prior recipients of transfusions/organ transplants
Hepatitis C: what generation of people are at highest risk to contract HCV?
baby boomers (born between 1945-1965)
Hepatitis C: what lab value automatically qualifies any patient for a hepatitis screen?
LFTs
Hepatitis C: prevention
-don’t get exposed
-no vaccine available
Hepatitis C: is there a vaccine available?
NO
Hepatitis C: treatment of Hep C
-is there an advantage to treating this infection ASAP or waiting a bit?
TREAT ASAP! DON’T WAIT!!
Hepatitis C: what percent of HCV positive patients can be cured within 8-12 weeks of treatment?
90%
Hepatitis C: who do you refer patients to if positive for HCV?
GI
Hepatitis D: how is this virus transmitted?
parenteral contact with body fluids
Hepatitis D: what other disease do these patients have?
Hep B
Hepatitis D: is this virus short or long term?
may be short or long term
Hepatitis D: treatment
supportive measures
Hepatitis E: how is this virus usually transmitted?
usually food or water borne
Hepatitis E:
-what locations is this virus usually found in?
-in what other instances does this virus present to the public?
-developing countries
-present in areas with recent natural disasters, refugee camps, overcrowded conditions
Hepatitis:
-other risk factors
-what else should we screen hepatitis patients for?
-what should we consider for co-existing issues with hepatitis?
-tattoo needles
-ETOH/drug use
-co-existing issues such as HIV
Hepatitis:
-what are aggravating factors to hepatitis?
-APAP (Tylenol) use, ETOH/drug use
HIV: risk factors
-MSM
-Injection drug users having sex w/ someone HIV +
-Healthcare workers
-Born to HIV + mother
-blood transfusions
-contact between HIV+ blood and open wounds on body
-tattooing/body piercing
Hepatitis:
-what should be stressed in treatment?
compliance to treatment plan!
HIV: what are ways HIV is not spread?
air, water, toilet seats, tears, saliva, sweat, casual closed mouth kiss, through insects such as mosquitos, fleas, or ticks, handshakes or sharing dishes
HIV: risk factors for spread related to mouth
-eating pre-chewed food from HIV+ person
-being bitten by someone who is HIV+
-oral sex with someone who has HIV
-open mouth kissing with someone who has HIV and has open sores or bleeding gums in the mouth
HIV: onset of symptoms (what are the symptoms at onset?)
asymptomatic or very mild
-mononucleosis like S/S
HIV:
-should all patients be screened for HIV?
-if so, at what age?
-YES, at least once (annually with risk factors)
-13 and older
HIV: what infection usually co-exists with HIV?
TB
HIV: people at risk for HIV
-anyone seeking tx for STI who present with new complaints/sx
-injection drug users and sex partners
-persons who exchange sex for money
-sex partners of HIV+ individuals
-MSM and heterosexual persons who themselves (or their sex partners) have had more than 1 partner since their last HIV screening
HIV: testing
-what must be advised to patient
-how should the consent be worded?
-is confirmatory testing required?
-does the patient need to notify past sexual partners?
-what is the health department’s involvement?
-verbal or written that patient will be screened unless they specifically opt out
-clear and concise, in plain terms (not medical language)
-yes
-once confirmed, past sex partners must be informed
-health department may be involved in updating other sexual partners
HIV: what else should you screen the patient for if HIV+?
TB, other possible STIs, hepatitis
HIV: other labs used to screen patients positive HIV
lipids, CBC, CMP, urinalysis
HIV: treatment
-ART: should CD4 count be taken into effect when considering to use this medication for treatment?
NO, start treatment regardless of CD4 count
HIV: treatment
-is ART lifelong or short-term treatment?
lifelone
HIV: treatment
-ART: can patients go on and off this med for treatment, or do they need to consistently take it?
consistently take it. adherence is key
HIV: PrEP (Pre-Exposure Prophylaxis)
-are the patients that take this med HIV+ or HIV-?
-negative, but high risk for contracting disease
HIV: those at high risk for contracting HIV (good candidates for PrEP)?
-Gay/bisexual male; multiple partners; partner has multiple partners; do not use condoms; if partner is HIV+ but you are negative; if you have had a recent STI/STD
-heterosexual but have HIV+ partner; injectable drugs or have sex with persons who use injectable drugs
HIV: PrEP
-how often are HIV- patients using PrEP receiving follow-up and medication refills?
every 3 months
HIV: PrEP
-is this medication used for exposure purposes?
YES!
HIV: what two drugs are approved for PrEP?
Truvada and descovy
HIV: truvada
-what population should utilize this drug?
-how often is this med dosed?
-PrEP
-for people at risk through sex or injection drug use
-taken once a day by mouth
HIV: descovy
-what population should utilize this drug?
-who cannot take this drug?
-for people at risk through sex
-not for people assigned female at birth who are at risk for HIV through receptive vaginal sex (the efficacy of descovy has not been studied for vaginal (receptive sex)
HIV: apretude
-what type of medication is this?
-how is it given?
-how often is this medication given?
-PrEP
-shot
-once a month for 2 consecutive months, then once every other month
HIV: Pep (post exposure prophylaxis)
-what population is this medication for?
-when should this medication be given?
-similar to PrEP?
-patients who may have possibly been exposed within the past 72 hours to HIV
-the earlier you can treat the better; do not wait!
-NO! Pep is emergency use only; PrEP is prophylactic
HIV: Pep
-what is the preferred HIV drug regimen?
-how long is this medication regimen?
-raltegravir (PO twice daily) + truvada (once PO daily)
-28 days after exposure
which versions of hepatitis lead to chronic infection?
BCD
Which hepatitis viruses have treatments?
-hep A - vaccine
-hep B - vaccine
-hep C - no vaccine,
-hep D - vaccine (Hep B)
-hep E - vaccines available not in US
what lab confirms HAV?
anti-HAV (immunoglobulin M (IgM) antibody to hepatitis A virus
which is positive in acute infection for HAV?
-HAV IgM or anti-HAV IgG?
acute = HAV IgM (M = miserable = active infection)
Which is positive in resolved HAV?
-HAV IgM or anti-HAV IgG?
anti-HAV IgG (G = gone, had it, but not active anymore)
if both HAV IgM and anti-HAV IgG are negative, what does that mean?
never infected
-possibly means patient was properly vaccinated because they should come back with positive antibodies
HAV: how to test for acute infection?
nucleic acid amplification test (NAAT - such as polymerase chain reaction PCR; or genotyping)
*antibody first, then confirm NAATs
HAV: transmission route
fecal oral route (contaminated food/water)
HAV: lifelong protection?
YES; continue to produce antibodies rest of life after acquiring acute HAV
is HAV vaccine preferred prior or after exposure?
2 series vaccine preferred prior to exposure
when is Immune globulin given for HAV?
given for short term protection (lasts up to 3 months) or given AFTER exposure for tx (must be given within 2 weeks of exposure)
immune globulin
-treatment is preferred in what aged patients?
-when must this be given after exposure?
->40yrs
-within 2 weeks of exposure
when is immunoglobulin treatment the preferred method of prevention/treatment for HAV?
> 75yo, immunocompromised, <12M, allergy to vaccine, chronic liver disease
HBV: transmission
blood and body fluids
HBV: how is the virus not spread? (methods)
sneezing, coughing, breastfeeding, use of same water source, utensils, hugging, kissing, handholding
complications of HBV?
cirrhosis and hepatocellular carcinoma
HBV: will patient have antibodies for life?
YES, develop antibodies and cannot experience a recurrence of infection
is there a vaccine for HCV?
NO
HCV: transmission
blood and body fluid (injectable drug use, needle stick injuries, mother to child during birth)
HCV: when should children born to HCV+ mothers be tested?
Not before age 18MO as there may be maternal antibodies present prior to that age (could get false negative)
is there treatment for HCV?
Yes, oral therapy
-provides significant cure rates for pts who adhere to tx
HEV: transmission
fecal oral route
When does HIV patient test positive?
after 10-21 days
Acute retroviral syndrome
-sx
Fever (<102 degrees), fatigue, erythematous maculopapular rash on the face, trunk, or palms of hands/soles of feet, headache, generalized lymphadenopathy, pharyngitis, myalgia/arthralgia, N/V/diarrhea, hepatosplenomegaly, night sweats, aphthous ulcers or thrush, genital ulcers, malaise, anorexia, weight loss, or wasting (>10% of body weight lost without explanation)
Acute retroviral syndrome
-contagious or not?
YES, contagious
is ART lifelong or temporary treatment?
lifelong; adherence is key
what lab work must be done before starting PrEP or PEP?
negative HIV
-also pregnancy test
is breastfeeding recommended in HIV + patients?
NO
When is HIV testing on infant suggested?
12-21 days, 1-2 months, 4-6 months; children aged 2 years and older who are high risk may have annual screenings
-in HIV + patients, what does the HIV virus attack?
-when is someone considered to have AIDS?
-CD4 cells (increases risk to other infections)
-when CD4 count is <200 (stage 3 HIV)
why is it helpful in determining the viral load during HIV treatment?
Can help determine if person’s HIV treatment is controlling HIV in the body
what does a high HIV viral load indicate?
what does a decreased HIV viral load indicate?
what does a low HIV viral load indicate?
-recent HIV transmission, untreated, uncontrolled (generally highest right after contracting HIV)
-body’s immune system fights against HIV but increase again over time as CD4 cells die off
-relatively few copies of HIV in the blood = GOOD
Erectile dysfunction:
-at what age does this tend to occur?
-what should be considered if able to obtain but not maintain an erection?
-40-70yrs
-cardiovascular cause
what labs should be considered with erectile dysfunction?
lipid profile, glucose, (free) testosterone, LH
what characteristics are important to determine in regards to ED?
severity, intermittency, timing of ED
priapism
penile erection >4hrs
-venous congestion and cessation of arterial inflow –> leads to ischemic injury of the corpora cavernosa
is priapism an emergency?
YES
treatment for ED
-lifestyle modification (reduction of CV factors - smoking cessation, reduction of alc intake, diet, exercise, tx of DM, HLD, HTN)
-Long-acting 1. tadalafil (cialis) –> longest half life; 2. sildenafil (viagra)
if using tadalafil or sildenafil for ED, what medications cannot be used simultaneously?
-nitrate medications –> exaggerated cardiac preload reduction and hypotension
BPH:
-sx
-what is the highest risk factor for BPH?
-obstructive or irritative voiding sx
-age-related
what is the most important tool to evaluate BPH?
AUA (annual urologic association) sx index
-calculate for ALL patients before treating them
-7 questions that rate the severity of obstructive or irritative complaints
-scale of 0-5 used
-score range 0-35, in increasing severity of sx
what PSA level is considered elevated?
> 4 refer to urology. >10 is what book says
urinary stones:
-which sex are urinary stones more common?
-most common type of stone?
-most common S/S
-men
-calcium
-severe flank pain, nausea, and vomiting
urinary stone:
-on a plain abd xray, color do the stones appear on this test?
radiopaque
urinary stone
-what test is used to ID stones?
non-contrast CT or ultrasound
urinary stones
-what dietary factors impact stone formation?
-when to refer based on size of stone?
-high protein, high salt intake, inadequate hydration
-refer if >7mm
urinary stones
-clinical findings
-constantly moving around, trying to find comfortable position
-pain is episodic and can radiate anteriorly
-stone progresses down ureter –> referred into ipsilateral groin
-stone becomes lodged at uretero-vesicular junction –> marked urinary urgency and frequency; men have pain at tip of penis
-after stone passes into bladder, minimal pain with passage through urethra
does size of kidney stone correlate with severity of sx?
NO
urinary stones: TX
-dietary modification is important: metabolic evaluation, increased fluid intake (ensure voiding 2.5L/day), do not dec dietary calcium or calcium supplements
Turner syndrome (X):
-more common in males or females?
-are these patients fertile or infertile?
-what labs are high and low?
-females
-infertile
-estrogen low, FSH and LH are high
Turner syndrome (X):
-clinical findings
-complications
-web neck, short stature, delayed puberty (amenorrhea), learning difficulties
-coarctation of aorta, infertility
Turner syndrome (X):
-TX
-estrogen: development of secondary sex characteristics, normal menstruation, prevents osteoporosis
-growth hormone: increases height of affected girls (GnRH)
Neurofibromatosis type 1:
-autosomal dominant or recessive?
-what does this disease affect?
-clinical findings?
-dominant
-affects growth of nerve cell tissue
-cafe au lait spots (>20 on patient, want to get a work up for this); lisch nodules (gold tin mass on the eye)
Acute cystitis:
-sx
-febrile?
-culture is + or -?
-irritative voiding sx
-afebrile
-+
Acute cystitis:
-most common pathogen?
-what should men be worked up for additionally if tested positive for acute cystitis?
-TX
-e-coli
-STD
-bactrim/macrobid/cephalexin
Acute cystitis:
prophylaxis
if >3 episodes per year, bacterim/macrobid/cephalexin can be given
Acute pyelonephritis
-sx
-labs
-diagnostic test
-irritative voiding sx; CVA tenderness, fever, urine culture is positive
-UA, CBC, (shows leukocytosis with left shift)
-renal US
Acute pyelonephritis:
-is the urine culture positive or negative?
-what is the common pathogen for this illness?
-purpose of prevention
-positive
-e-coli or dlebsiella
-to decrease risk of UTI
Acute pyelonephritis:
-when is someone considered a candidate for prophylactic antibiotic therapy?
-common abx
->3 episodes of cystitis per year
-bactrim, nitrofurantoin, cephalexin
Acute pyelonephritis:
-relationship of fever with acute pyelonephritis tx
-fevers may persists for up to 72 hours even with appropriate antibiotics
-failure to respond within 48 hours warrants imaging (CT or ultrasound) to exclude complicating factors that may require intervention
Prostatitis: acute bacterial prostatitis
-sx
-perform prostatic message?
-fever, irritative voiding sx; perineal or suprapubic pain; SEVERE TENDERNESS with rectal exam, +urine culture (commonly ecoli or pseudomonas)
-NO
Prostatitis: acute bacterial prostatitis
-what is the main sx of acute bacterial prostatitis?
-is urine culture positive or negative?
-if positive, common pathogens?
-SEVERE TENDERNESS with rectal exam
-postivie
-ecoli or pseudomonas
Prostatitis: acute bacterial prostatitis
-labs
-TX
-UA, exam of secretions after completing abx therapy
-hospitalize these patients and then give abx; once afebrile 1-2 days, can switch to PO abx (levaquin)
Prostatitis: chronic bacterial prostatitis
-sx
-fever or no?
-+ or - prostatitis secretions?
-is UA abnormal or normal?
-irritative voiding sx - perineal or suprapubic discomfort (dull, poorly localized)
-NO fever
-+ prostatic secretions
-UA is normal!!! Unless secondary cystitis.
Prostatitis: chronic bacterial prostatitis
-how is dx made?
-TX
-culture the secretions to make dx
-bactrim 2x daily for 6-12 weeks, then indomethacin or ibuprofen for pain; hot sitz baths for symptomatic treatment
Prostatitis: nonbacterial prostatitis
-sx
-are prostatic secretions + or - for pathogen?
-is UA + or -?
-febrile or afebrile?
-irritative voiding sx; perineal or suprapubic discomfort (dull, poorly localized)
-+
–
-afebrile
Prostatitis: nonbacterial prostatitis
-what is seen in prostatic secretions?
-TX
-elevated leukocytes present; culture is negative
-NSAIDs to dec inflammation
Prostatodynia:
-sx
-TX
-chronic nonbacterial prostatitis; dysfunctional voiding sx; pelvic floor musculature dysfunction (noninflammatory issue (no hx of UTI, normal numbers or leukocytes))
-TX: -zosin drugs (terazosin or doxazosin) to help bladder neck spasms; if pelvic floor muscle dysfunction, can use diazepam + biofeedback techniques
Acute epididymitis:
-sx
-precipitated by?
-if <40, most commonly associated with?
-if >40, most commonly associated with?
-fever, irritative voiding sx, painful, enlargement of epididymis
-acute physical strain (heavy lifting, trauma, sexual activity)
-STIs are a risk factor
-UTIs and prostatitis
Acute epididymitis:
-what drug can cause Acute epididymitis?
-what imaging is diagnostic? what are we determining?
-amiodarone (phenomenon)
-scrotal US (gold standard); want to determine if epididymitis or testicular torsion (presents the same)
Acute epididymitis:
-Prehn sign
-TX
-elevation of scrotum above pubic symphysis improves pain from epididymitis (may be helpful but not reliable)
-bed rest with scrotal elevation; rocephin, levaquin, bactrim, doxy (if STI, 10-21 days of abx + tx of partner. if non-sexual, 21-28 days of abx (use UA to ID underlying disease))
Acute epididymitis:
TX
-bed rest with scrotal elevation; rocephin, levaquin, bactrim, doxy (if STI, 10-21 days of abx + tx of partner. if non-sexual, 21-28 days of abx (use UA to ID underlying disease))
Interstitial cystitis:
-sx; when is pain relieved?
-dx
-pain with full bladder or urinary urgency; pain relieved by emptying
-dx of exclusion; no cure for this
*cystoscopy with biopsy: the presence of submucosal mast cells is not needed to make dx of interstitial cystitis
Interstitial cystitis: what is not needed to be present to make this dx?
submucosal mast cells
Interstitial cystitis:
-TX
amitriptyline
-lifestyle changes - drink more water, less caffeine, low impact exercise (yoga), quit smoking, void often
stamp test for ED
-screens for ED
-wear boxer briefs or briefs
-wrapping a moistened stamp around penis
-sleeping on back
-check if stamp is broken when wake up
-broken stamp: suggests you had nighttime erections and cause may be psychological
-untorn stamp: may indicate lack of nocturnal erections, which could be a sign of physical cause
Peyronie Disease
-Def
-TX
-benign fibrotic disorder of the penis that causes pain, penile deformity and sexual dysfunction
-xiaflex + stretching/flexing of penis
in order for viagra to work, what is needed?
sexual stimulation
Klinefelter Syndrome:
-what are the sex chromosomes for this disorder?
-how many males does this effect in the general population?
-47,XXY (extra X chromosome)
-1 in 660
Klinefelter Syndrome:
-S/S (and when do they tend to occur?)
-after puberty
-height greater than peers (long arms and legs that are disproportionate to their body)
-small testes
-gynecomastia
-sparse body hair
-female escutcheon (pubic hair growth pattern - female being flat topped rather than peak towards umbilicus)
-infertility due to azoospermia
Klinefelter Syndrome:
-what is infertility related to?
azoospermia (no sperm in ejaculate)
Klinefelter Syndrome: labs
-testosterone (low or high)
-glucose intolerance?
-low
-yes, glucose intolerance
Klinefelter Syndrome: TX
Testosterone
-helps with sex drive, ED, and can help somewhat with depressive sx
-does not reverse infertility; but mature sperm have been aspirated from testes –> make sure to genotest)
Neurofibromatosis
-how many types?
2 types
- Type 1 (Recklinghausen disease)
-Type 2
Neurofibromatosis Type 1:
-S/S
*which nerves are typically affected
-spinal and cranial nerves typically affected, especially 8th cranial nerve (vestibulocochlear nerve)
-multiple neurofibromas present –> palpable mobile nodules
-cafe au lait spots (cutaneous lesions)
-Multiple hyperpigmented macules, Lisch nodules, neurofibromas and mutations on chromosomes 17 = dx
Neurofibromatosis Type 1
-Dx by what sx/characteristics?
-Multiple hyperpigmented macules, Lisch nodules, neurofibromas and mutations on chromosomes 17
Lisch nodules
-def
-what disease are these associated with?
-dome shaped gelatinous masses that develop on surface of iris and are common sx of NF 1 (can grow to be 2mm in diameter)
-Neurofibromatosis Type 1
Marfan Syndrome:
-S/S
-tall, long arms and legs along with arachnodactyly (long digits)
-scoliosis
-anterior chest wall deformity
-mitral valve prolapse
-aortic root dilatation –> aortic regurg or aortic dissection and rupture
-ophthalmologic disorders (severe myopia, ectopia lentis)
heart issues in Marfan Syndrome
-mitral valve prolapse
-aortic root dilatation may lead to aortic regurgitation or aortic dissection and rupture
Marfan’s Syndrome:
-dx test?
-what diagnostic criteria are used?
-NONE
-Ghent Nosology
Marfan’s Syndrome: cardinal features
ectopia lentis
aortic root dilatation
Turner’s Syndrome:
-males or females?
-how often does this occur?
-what are the sex chromosomes?
-females
-1 in 10,000 females
-1 X or 2 X’s but one is not complete
Turner’s Syndrome:
-inherited?
not usually; primarily result from error in cell division
Turner’s Syndrome:
S/S
-webbed neck
-triangular face
-short stature
-wide set nipples
-amenorrhea
-absence of secondary sex characteristics
-coarctation of aorta and genitourinary malformations are common
Turner’s Syndrome:
-what heart condition is common?
-coarctation of aorta
Turner’s Syndrome:
-when is short stature detected?
-how is it treated?
-age 5
-human growth hormone
Turner’s Syndrome:
-TX
*short stature
*secondary sex characteristics (and normal menstruation)
-human growth hormone
-estrogen replacement therapy
Turner’s Syndrome:
-other S/S
learning disabilities
behavioral problems
developmental delays
*normal IQ is present
Cyrptochism
absence of one or both testes
AIP (acute intermittent porphyria):
-def
-excessive secretions of what?
-group of hereditary diseases that involves defect in heme metabolism
-excessive secretions of porphyrins and porphym precursors
AIP (acute intermittent porphyria):
-S/S
-abd pain
-neuropathies - peripheral neuropathies
-constipation
-seizures
-altered LOC
-psychiatric sx
-psychosis
-NO RASH
-urine may go from clear/normal to dark when exposed to air and light
AIP (acute intermittent porphyria):
-dx
-tx
-increased levels of porphobilinogen in urine during acute attack
-avoid triggers: barbiturates, sulfonamides, starvation/low carbs
*tx of choice: hematin - treats severe attacks and for prevention
AIP (acute intermittent porphyria):
-more common in men or women?
-what type of diet is helpful during attacks?
-at what age is onset of this disease?
-women
-high carbohydrate diet
-onset late teens, early 20’s is common
Down Syndrome:
-risk associated with maternal age
*25yo
*31yo
*35yo
*40yo
-1 in 1250
-1 in 1000
-1 in 400
-1 in 100
Down Syndrome:
-facial feature characteristics
flat occiput
epicanthal folds
single palmar crease
large tongue
Down Syndrome:
-heart defects
congenital (AV canal defects)
Down Syndrome:
-nonfacial feature characteristics
heart defects (congenital ie AV canal defects)
duodenal atresia
hearing impairment
intellectual disabilities
visual defects are common
Down Syndrome:
-memory loss
short term memory loss (similar to Alzheimer’s) begins early –> 40yrs
-the earlier the onset of dementia, the shorter the lifespan
Down Syndrome:
-testing for syndrome
between 15-20 weeks, test for alpha fetoprotein (AFP)
-if raised, concern for trisomy 21 and 18
Fragile X:
-common in males or females?
-what gene has expanded? to what extent has this gene expanded for this disease?
-males
-FMR1 gene expanded trinucleotide repetition with >200 copies being present
Fragile X: S/S
-males
-Intellectual disabilities
-Autism spectrum disorders –> impulsivity, repetitive, aggressive behaviors
-after puberty, testes enlarged (macro orchidim)
-large ears, prominent jaw, high pitched voice
Fragile X: S/S
-females
-only physical signs: early menopause (ovarian failure)
-intellectual disabilities –> more sensory issues and learning disabilities
Fragile X: DX
determine X of trinucleotide repeats near FMRI gene
-done on any woman/man w/ unexplained mental retardation
-higher the number, higher the chance of passing on to future generations
