Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med III > Nephrology, Male GU > Flashcards

Nephrology, Male GU Flashcards

1
Q

Kidney functions (7)

A
  • Acid-base regulation
  • Water balance
  • Electrolyte balance
  • Toxin excretion
  • BP
  • EPO production
  • Vit D & renin secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for AKI

A
  • HTN
  • CHF (low-flow)
  • DM
  • MM
  • Chronic infection
  • Myeloproliferative disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is RIFLE criteria?

A

Assess AKI based on SCr elevation & urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does RIFLE stand for?

A

Risk
Injury
Failure
2 outcomes - Loss of renal fx (>4wks), ESRD (>3 mo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pre-renal causes of AKI

A
  • Hypovolemia
  • Decreased CO
  • NSAIDs
  • ACEI/ARBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Intrinsic causes of AKI

A
  • Ischemia
  • Toxins
  • Vascular (renal a./v. obstruction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common post-renal causes of AKI

A
  • BPH
  • Malignancy
  • Neurogenic bladder
  • Pregnancy
  • Med crystals (acyclovir, methotrexate, idinavir)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Labs for pre-renal AKI

A
  • BUN:Cr >20:1
  • FeNa <1%, FeUrea<35% or FeUA <9%
  • Hemoconcentration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would you see in pre-renal AKI urine?

A

Hyaline casts & high specific gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx for pre-renal AKI

A
  • IVF
  • Diuretics, nitrates, dobutamine if decr. CO
  • Dose-adjust/hold meds cleared by kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intrinsic renal diseases (6)

A
  • Acute interstitial nephritis
  • Acute tubular necrosis
  • Post-streptococcal glomerulonephritis
  • IgA nephropathy
  • Henoch-Schonlein Purpura
  • Nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Labs for acute tubular necrosis

A
  • Elevated BUN/Cr
  • HyperK+, hyperPO4, hyperuricemia
  • FeNa >2%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What would you see in acute tubular necrosis urine?

A

Pigmented granular casts (muddy-brown casts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx for acute tubular necrosis

A
  • Aggressive volume replacement
  • Consider high dose loop diuretic if oliguria
  • Protein restriction
  • Dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Etiology of post-streptococcal glomerulonephritis

A

Strep-A containing immune complex deposition in glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of PSGN

A
  • AKI 7-12 days s/p sore throat/impetigo
  • HTN
  • Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tx for PSGN

A
  • Antibiotics (usually PCN)

- Anti-HTN meds, salt restriction, diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

IgA nephropathy urine

A

Red or coca-cola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dx IgA nephropathy

A

Renal biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx for IgA nephropathy

A
  • ACEI/ARB
  • Steroid
  • Renal transplant if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Who is commonly affected by HSP?

A

Children ~6 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Classic presentation of HSP

A
  • Rash esp. LE, butt
  • Abd pain, vomiting
  • Arthralgias
  • Edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx HSP

A

Supportive (immunosuppressants and/or plasmapharesis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Etiology of HSP

A

IgA complex deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Classic presentation of nephrotic syndrome (4)

A
  • Heavy proteinuria (>3.5g/24hr)
  • Hypoalbuminuria (<3g/24hr)
  • Peripheral edema
  • Lipiduria (foamy urine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How do cells in minimal change dz look?

A

Diffuse effacement (flat) of epithelial cell foot processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Tx for minimal change dz

A

Prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Presentation of postrenal AKI

A

Anuria!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Tx for postrenal AKI

A
  • Tx underlying cause

- Catheterization (Foley, suprapubic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

2 components of polycystic kidney disease

A

Multisystem & Cyst formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What’s so bad about polycystic kidney dz?

A
  • 50% need transplant/dialysis by age 60

- Intracranial aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Si/Sx of polycystic kidney dz

A
  • Pain
  • Bleeding
  • HTN
  • Nodular hepatomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dx polycystic kidney dz

A

U/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tx for polycystic kidney dz

A
  • ACEI/ARBs
  • NO NSAIDs (bleeding)
  • Surgical cyst decompression
  • Nephrectomy
  • Transfusions prn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Indications for dialysis

A
  • Acidosis (hyperK+, hyperPO4, hypoCa2+)
  • OD
  • Volume overload
  • Uremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Acute vs. chronic kidney disease

A 
Acute = rapid &amp; reversible
Chronic = progressive &amp; irreversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Normal GFR

A

≥90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

GFR of ___ indicates kidney dysfunction

A

<60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

GFR of ___ indicates ESRD

A

<15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Approach to pt with new renal dysfunction

A
  • Consider etiologies (pre-renal, renal, post-renal)
  • GFR/SCr
  • Urine dipstick (protein, RBC)
  • US or CT w/out contrast
  • Urinalysis (casts)
  • Consider MM via serum/urine protein electrophoresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

GFR of _____ for _____ indicates CKD

A

<60mL/min for >3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

3 risk factors for CKD

A
  • Diabetes
  • HTN
  • African ancestry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Sx’s of CKD

A
  • Asx until Stage 3 or 4

- Anemia, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ESRD sx’s

A
  • Encephalopathy
  • Muscle twitches/cramps
  • LE edema
  • Pruritus
  • Uremic syndrome (sx’s associated w/ azotemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Labs for CKD

A
  • 24hr urine
  • Elevated BUN, SCr
  • HyperK+, hyperphosphatemia, hypocalcemia
  • Proteinuria on UA
  • RBC/WBC casts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Complications of CKD

A
  • Anemia (decr. EPO)
  • Metabolic acidosis (decr. HCO3 reabsorption)
  • Poor Vit D, Ca2+, phosphorus metabolism
  • Fractures
  • Volume overload
  • Hyperkalemia
  • Uremia
  • CV issues (HTN, athero, CHF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Tx for CKD

A
  • Tx underlying disorder
  • Dialysis (ARF or ESRD)
  • Eventual transplant for ESRD (kidney-pancreas for T1DM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When would you refer CKD pt to nephrologist?

A
  • GFR <30
  • Rapidly progressing
  • Poorly controlled HTN on 4 agents
  • Rare/genetic causes of CKD (polycystic)
  • Suspected RAS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Staging of CKD

A 
Stage 0: GFR>90
Stage 1: Kidney damage w/ normal GFR
Stage 2: GFR 60-89
Stage 3: GFR 30-59
Stage 4: GFR 15-29
Stage 5: GFR <15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Microalbuminuria

A

30-300mg/L of albumin in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Macroalbuminuria

A

> 300mg/L of albumin in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Leading cause of ESRD

A

DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

First sign of diabetic nephropathy

A

Microalbuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Tx for diabetic nephropathy

A

ACEI/ARB +/- diuretic (for HTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is the BP goal for diabetic nephropathy?

A

<130/80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the BP goal for hypertensive nephropathy

A

<140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

First line for hypertensive nephropathy

A

ACEI/ARB - may cause AKI (d/c if doesn’t improve), hyperkalemia (reduce K+ retaining drugs if >6mmol/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

___% pts will have recurrent urinary calculi (kidney stones)

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Types of kidney stones

A
  • Ca2+ (most common)
  • Struvite
  • Uric acid
  • Cystine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Risk factors for Ca2+ stone

A
  • Dehydration
  • Increased oxalate absorption (short bowel syndrome)
  • Grapefruit, tomato, apple juice
  • Sodas w/ phosphoric acid
  • High salt & protein intake
  • Loop diuretics (esp. thiazides)
  • TONS of antacids
  • Long-term steroids
  • Vit D/C
  • Hyperparathyroidism
  • Malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Risk factors for uric acid stones

A
  • Gout
  • Hyperuricosuria
  • Chronic diarrhea
  • HTN, DM, obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Risk factors for struvite stones

A

UTI’s - esp. Proteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Presentation of nephrolithiasis

A
  • Waxing/waning, colicky pain
  • Constant writhing
  • N/V, diaphoresis
  • Tachycardia, hypotn
  • Dysuria, frequency, urgency, hematuria (distal stones)
  • CVA tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Top imaging choices for nephrolithiasis

A

Non-contrast CT UNLESS pregnant/child (US instead)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

CT findings consistent with nephrolithiasis

A
  • Ureteral, collecting system dilatation
  • Perinephric, periureteric stranding (inflammation)
  • Nephromegaly
  • “Rim sign” around stone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Pros/cons of US for kidney stones

A

(+) Pregnant, child, signs of obstruction (hydroureter, loss of ureteric jet)
(-) Poor visualization unless at UPJ or UVJ, can’t measure size of stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Besides CT & US, what are 2 other imaging options for kidney stone dx

A
  • IV pyelography (measure SCr first b/c uses contrast)

- KUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Pros/cons for IV peylography

A

(+) Size, location, radiodensity, degree of obstruction

-) Not for RF, poor visualization of non-GU stuff (can’t r/o other d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

KUB’s not really the best option for nephrolithiasis. Name 3 reasons.

A
  • Only sees radiolucent stones
  • Stones can be covered by stool, gas, bones
  • Non-urologic radiopacities may be mistaken as stones (calcified LNs, gallstones, stool, phleboliths)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Management of nephrolithiasis

A
  • IVF, NSAIDs (bridge w/ narcotics?), metoclopramide (anti-emetic), tamsulosin?, abx?
  • Can alkalnize w/ K+ citrate if uric acid stone
  • If able to tolerate PO, stay home → strain urine, bring back for analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What’s so great about NSAIDs for kidney stones?

A
  • Analgesic
  • Antispasmodic
  • Antiemetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Indications for referral of kidney stones to urology

A

> 5mm
1 stone
Hydronephrosis
Pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

3 options for >5mm kidney stone mgmt

A
  • Extracorporeal shock wave lithotripsy (proximal stones)
  • Ureteroscopy (mid-distal stones)
  • Percutaneous nephrolithotomy (>2cm, complex stones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Criteria for extracorporeal shock wave lithotripsy

A
  • Radiopaque <2cm renal or <1cm ureteral
  • Not morbidly obese
  • No hard/cystine stones
  • C/I pregnancy, tightly impacted stones, untreatable bleeding d/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Complications of extracorporeal shock wave lithotripsy

A
  • Perinephric hematoma

- Requires spontaneous passage of fragments, which can obstruct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Struvite = _____

A

Staghorn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Most common bacteria that causes struvite stones

A

Proteus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Tx for struvite stones

A

Percutaneous nephrolithiotomy +/- ESWL

Medication not enough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When would you want to send someone w/ kidney stones for metabolic evaluation?

A

Recurrent stones (usually uric acid, cystine) or strong FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What kind of cells are involved in bladder cancer?

A

Transitional cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Risk factors for bladder cancer

A
  • Smoking
  • Occupational exposures
  • Chronic urinary inflammation (SCI, indwelling catheter)
  • Previous pelvic radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Si/Sx of bladder cancer

A
  • Painless hematuria +/- LUTS

- Advanced = LE edema, bony/pelvic/flank pain, palpable mass

83
Q

Gold standard for dx bladder cancer

A

Cytoscopy w/ bx (also therapeutic)

84
Q

Typical metastatic destinations of bladder cancer

A
  • Bone
  • Brain
  • Lung
85
Q

Tx for non-muscle invasive bladder cancer

A
  • Endoscopic transurethral resection of bladder tumor or radical cystectomy
  • Intravesicle instillation (catheter) of BCG vaccine or chemo
86
Q

Tx for muscle-invasive bladder cancer

A

Neoadjuvant chemo followed by radical cystectomy w/ regional LN dissection +/-radiation

87
Q

Risk factors for RCC

A
  • Smoking
  • Obesity
  • HTN
  • Renal transplant/dialysis w/ cystic renal dz
88
Q

Si/Sx for RCC

A
  • “Classic” triad: Hematuria, flank pain, flank mass

- Paraneoplastic syndromes (hyperCa2+, non-met liver dysfunction, HTN, erythrocytosis)

89
Q

Diagnostic imaging of choice for RCC

A

CT w/ contrast (alternative = US)

90
Q

Which is more common, cystitis or pyelonephritis?

A

Cystitis

91
Q

Risk factors for cystitis in men

A

Insertive intercourse, uncircumcised

92
Q

Most common bacterial cause of cystitis

A

E. coli (also Klebsiella, Proteus)

93
Q

Risk factors for cystitis

A
  • Recent sex
  • Spermicide
  • Diaphragms
  • Indwelling catheters
  • Diabetes, obesity
  • Short urethra syndrome
94
Q

What kind of urine sample do you want for cystitis assessment?

A

Midstream, unspun

95
Q

Tx for cystitis

A

Bactrim, cipro or Macrobid

+/- Pyridium (phenazopyridine) bladder analgesic (orange urine ADR)

96
Q

Most common bacterial causes of pyelonephritis

A

E. coli (also Klebsiella, Proteus)

Pseudomonas in healthcare exposures

97
Q

In addition to LUTS similar to cystitis, what else might pyelonephritis sx’s include?

A

Fever, chills, N/V

98
Q

Indications for hospitalization in pyelonephritis

A
  • Sepsis
  • Persistent fever
  • Unable to tolerate PO
  • Urinary tract obstruction
99
Q

Tx for pyelonephritis

A
  • Outpatient → Cipro or levo
  • Inpatient → Augmentin, Bactrim, cefpodoxime
    +/- Pyridium, Motrin, Tylenol, Zofran, IVF
100
Q

Sx’s of cystitis in pregnant pt

A

Usually asx - cystitis found incidentally on routine UA

101
Q

Tx for cystitis in pregnancy

A

Macrobid, Augmentin, cefpodoxime, or fosfomycin

102
Q

Tx for pyelonephritis in pregnancy

A
  • Beta lactams
  • PCN derivatives
  • Cefazolin
  • Ceftriaxone
    +/- admission
103
Q

Tx for asx bacteriuria

A

Don’t treat in elderly

Bactrim, Macrobid, cipro (same as cystitis)

104
Q

Most common causes of RAS

A
  • Atherosclerosis (most common)

- Fibromuscular dysplasia

105
Q

Angiogram of atherosclerosis vs. fibromuscular dysplasia

A
  • Atherosclerosis = narrowing of contrast at renal artery

- FMD = “string of beads”

106
Q

Risk factors for RAS

A
  • CKD
  • DM
  • Tobacco
  • HTN
107
Q

When should you consider revascularization in RAS

A

> 70% angiographic stenosis OR 50-70% angiographic stenosis associated with resting mean pressure gradient >10mmHg, systolic hyperemic pressure gradient >20mmHg or renal fractional flow reserve <0.8

108
Q

2 components of RVHTN

A

HTN d/t RAAS + RAS

109
Q

Si/Sx’s that may indicate RAS

A
  • Severe/refractory/sudden-onset HTN (e.g. <160/100)
  • Flash pulmonary edema
  • Atherosclerosis
  • Retinopathy
  • Abdominal bruits
110
Q

Lab findings associated w/ RAS

A
  • Hypokalemia (hyperaldosteronism)
  • Azotemia s/p ACEI/ARB
    +/- incr. Cr, proteinuria
111
Q

Gold standard for RAS dx

A

Renal artery angiography

112
Q

Alternatives to renal artery angiography for RAS dx

A
  • MRA (C/I if CrCl <30)
  • CTA (C/I if CrCl <60) → preferred for FMD
  • Duplex US (operator dependent)
113
Q

1st line tx for RAS

A

Medications → anti-HTN (ACEI/ARB) + statins + antiplatelet

114
Q

When would you prefer CCB over ACEI/ARB in RAS tx

A
  • Bilateral RAS
  • Single kidney w/ RAS
  • Can’t monitor SCr, electrolytes
115
Q

2nd line tx for RAS

A

Percutaneous renal angioplasty +/- stenting → preferred for FMD (w/ stent), refractory, intolerance to meds, bilateral RAS or single kidney

116
Q

What is the last line tx for RAS? Indications?

A

Renovascular bypass → pts w/ unsuccessful PTRAS or extensive atherosclerosis in aorta

117
Q

What is Wilm’s tumor?

A

2nd most common abdominal tumor in children

118
Q

Common metastatic locations for Wilm’s tumor

A
  • IVC
  • Lungs
  • Liver
119
Q

Is Wilm’s tumor curable?

A

Yes! 90% cure rate w/ resection +/- chemo/radiation

120
Q

Risk factors for cryptorchidism

A
  • Low birth weight

- Premature baby

121
Q

What is cryptorchidism?

A

Undescended testis mostly d/t gubernaculum defect

122
Q

Most intra-abdominal testes are found ______ in cryptorchidism

A

Within a few cm of internal inguinal ring

123
Q

Cryptorchidsm hx increases future risk of ____ and ____ and ____

A

Testicular cancer
Infertility (esp. if bilateral)
and indirect hernia

124
Q

Refer infants w/out spontaneous testicular descent by _____

A

6 months (corrected for gestational age)

125
Q

Surgery needed for cryptorchidsm by ____

A

age 1

126
Q

Pediatric hydroceles are…..

A

Normal - resolve by age 1

127
Q

Noncommunicating vs communicating hydrocele

A
  • Noncommunicating d/t trauma, inflammation

- Communicating d/t patent processus vaginalis

128
Q

How do you differentiate hydrocele from other penile d/o’s?

A

Transillumination!

129
Q

Tx for hydrocele

A

Mostly observation

Surgical closure of patent processus vaginalis if communicating hydrocele

130
Q

Varicocele is more common on the….

A

left side

131
Q

Grading of varicoceles

A

Grade I → palpable only w/ Valsalva
Grade II → palpable at rest but invisible
Grade III → easily visible

132
Q

What differentiates varicocele from other penile d/o’s?

A

Bag of worms

133
Q

Tx for varicocele

A

Nothing or embolization

134
Q

Tx for hypospadias

A

Nothing or surgery (make sure not to circumcise - need that skin for repair) +/- testosterone pretx

135
Q

Risk factor for hypospadias

A

Low birth weight

136
Q

Is phimosis normal?

A

In newborns, yes - usually resolves by adolescence

Pathological if difficulty urinating or abdnormal sex

137
Q

Causes of phimosis

A
  • Tip of foreskin too narrow to pass over glans
  • Inner surface of foreskin fused w/ glans
  • Frenulum too short to allow for complete foreskin retraction
138
Q

Tx for phimosis

A

Manual stretching, change masturbation, preputioplasty, circumcision

139
Q

Paraphimosis is….

A

Urological emergency!!

Ischemia can turn to gangrene or autoamputation

140
Q

Higher incidence of paraphimosis in ____

A

uncircumcised men (but can happen in circumcised w/ external objects)

141
Q

Tx for paraphimosis

A
  • Gental retraction

- If severe, dorsal split procedure w/ eventual circumcision

142
Q

Testicular torsion is ……

A

A urological emergency!

143
Q

Irreversible damage after _____ in testicular torsion

A

12 hrs of ischemia

144
Q

What kind of irreversible damage can occur d/t testicular torsion?

A

Infertility, even in contralateral testis

145
Q

Manifestation of testicular torsion

A
  • Severe testicular pain
  • Negative cremasteric reflex
  • “Bell clapper” sign (high-rising horizontal testis)
146
Q

What kind of imaging can be used to confirm testicular torsion?

A

US w/ Doppler flow

147
Q

Managment of testicular torsion

A

Manual/surgical detorsion (most torsions are medially rotated) → bilateral gubernacular fixation after

148
Q

Most prostate cancers are located in ______

A

Peripheral zone

149
Q

Most common bacterial causes of acute bacterial prostatitis

A

GNR - most common E. coli & Psuedomonas

150
Q

Risk factors for acute bacterial prostatitis

A
  • UTIs
  • Prostate bx
  • Catheter
  • Structural abnormalities
151
Q

Presentation of acute bacterial prostatitis

A
  • Fever
  • Dysuria
  • Perineal, suprapubic, or back pain
  • Extremely tender, warm, edematous prostate on DRE
    +/- Urinary retention
152
Q

Labs for acute bacterial prostatitis

A 
Leukocytosis w/ left shift
UA - pyuria, bacteriuria, hematuria
UCx
Elevated inflammatory markers (CRP, ESR)
Elevated PSA
153
Q

Imaging for acute bacterial prostatitis

A

Usually none unless doesn’t improve in 48hrs w/ abx → CT, MRI

154
Q

Indications for admission for acute bacterial prostatitis

A
  • Sepsis
  • Cant tolerate PO
  • Concern for adherence
  • Multiple comorbidities
155
Q

Tx for acute bacterial prostatitis

A

Bactrim, cipro, levo, gentamycin

156
Q

Si/Sx of chronic bacterial prostatitis

A

Asx or subtle

  • LUTS
  • Low grade fever
  • Dull pelvic, perineal, testicular pain
  • Prostate usually not tender
157
Q

Labs for chronic bacterial prostatitis

A
  • UA frequently normal → UCx

- Expressed prostate secretions = WBC, bacteria

158
Q

Imaging for chronic bacterial prostatitis

A

Usually none - if super chronic, may see prostate calculi on x-ray

159
Q

Tx for chrnoic pbacterial prostatitis

A

Bactrim (if resistant, quinolones or cephalexin)

160
Q

Inflammatory prostatitis

A

Prostate pain w/out bacteria; dx of exclusion

161
Q

Labs for inflammatory prostatitis

A
  • UA/UCx normal
  • Expressed prostate secretions → leukocytosis, incr. macrophages
  • Prostate bx → inflammatory tissue
162
Q

Tx for inflammatory prostatitis

A

Tamsulosin or cipro

+/- dutasteride (5-alpha reductase inhibitor) → only in older men b/c affects sperm

163
Q

Classification of epididymitis

A

Sexually transmitted vs. non-sexual transmitted

164
Q

Most common causes of sexually transmitted epididymitis

A

Gonorrhea & Chlaymdia

165
Q

Most common causes of non-sexually transmitted epididymitis

A

E. coli

166
Q

Presentation of epididymitis

A
  • Unilateral pain/swelling
  • Urethral discharge
  • Dysuria
  • Fever
  • Normal cremasteric reflex
167
Q

Imaging for epididymitis

A

Scrotal US

168
Q

Tx for epididymitis

A
  • Bed rest, scrotal elevation, ice
  • Sexually transmitted → azithro, ceftriaxone, doxy
  • Non-sexually transmitted/low-risk → levo
169
Q

Orchitis is most often associated with _____

A

Mumps

170
Q

Bacterial causes of orchitis

A

N. gonorrhea in age 14-35

E. coli in age <14, >35

171
Q

Presentation

A
  • Associated parotitis 4-7 days prior
  • Unilateral swollen red testis
  • Fever, malaise, myalgia
172
Q

Imaging for orchitis

A

Scortal US to differentiate from epididymitis

173
Q

Tx for orchitis

A

Supportive - scrotal elevation, NSAIDs, ice

174
Q

Urethritis is most common in ______

A

Young, sexually active men

175
Q

Causes of urethritis

A

Gonococcal vs. non-gonococcal (mostly chlamydia)

176
Q

Presentation of urethritis

A
  • Dysuria, pruritus, burning at urethral meatus
  • Discharge (purulent = gonorrhea, watery = chlamydia)
  • Non-gonococcal commonly asx
  • Inguinal LAD
177
Q

Labs for urethritis

A
  • First catch UA → leukocytes

- Gram stain of urethral dischrage (PMN = chlamydia, G- diplococci = gonorrhea)

178
Q

Tx for urethritis

A

Azithro + doxy + ceftriaxone

179
Q

Classification of testicular ca

A
  • Germ cell tumors → NSGCT vs. seminoma

- Sex cord-stromal tumors

180
Q

Risk factor for testicular ca

A

Cryptorchidism hx

181
Q

Testicular ca is slightly more common on ________

A

Right side

182
Q

Presentation of testicular malignancy

A
  • Asx
  • Painless nodule/enlargement of testis
  • Gynecomastia if GCT
  • Supraclavicular LNs
183
Q

Order of operations for dx testicular cancer

A

Scrotal US → cryopreservation of sperm → CT → serum tumor markers → radical inguinal orchioectomy + retroperitoneal LN dissection to determine histology, staging, tx

184
Q

Scrotal US finding for malignancy

A

Cystic or fluid-filled mass
Hypoechoic w/out cystic area = seminoma
Non-homogenous w/ cystic area/calcifications = NSGCT

185
Q

Serum tumor markers for testicular ca

A
  • AFP, HCG elevated in NSGCT

- LDH in any GCT

186
Q

Why do you need to do retroperitoneal LN dissection for testicular ca?

A

Only reliable method for finding micromets, important for staging, decr. relapse risk

187
Q

Risk factors for prostate Ca

A
  • African ancestry
  • High dietary fat
  • FHx
188
Q

Presentation of prostate ca

A

Most are asx

  • Abnormaly prostate (nodules, asymmetry, indurated)
  • LUTS (might be d/t BPH)
  • Boney pain
  • LE edema
  • Urinary retention
189
Q

Screening for prostate ca

A

DRE + PSA (but PSA not specific)

190
Q

Diagnosis of prostate ca

A

Abnormal DRE + High PSA + transrectal US-guided bx → can repeat bx 1-2x if negative but PSA high

191
Q

Imaging for staging prostate ca

A

MRI > TRUS

192
Q

Gleason staging

A

Prognosis of prostate cancer

193
Q

Main tx for metastatic prostate ca

A

Palliative androgen deprivation tx (ADT)

194
Q

ED is associated with ___

A

CAD → ED w/o obvious cause should be screened for CVD

195
Q

peyronie’s dz

A

Penile deformity/curvature d/t subtle trauma/fibrosis

196
Q

Diagnostic studies for Peyronie’s dz

A
  • Nocturnal penile tumescence testing (normal = psychogenic/hormonal; impaired = vascular or neurogenic)
  • Duplex doppler or angio (venous leak or artery obstruction)
197
Q

Tx for Peyronie’s dz

A

PDE-5 inhibitors (sildenafil, vardenafil, tadalfafil, avanafil)

198
Q

C/I for PDE5 inhibitors

A

Nitrates

Relative C/I w/ alpha-adrenergic antagonists (-zosin)

199
Q

If medical tx didn’t work for Peyronie’s and your pt doesn’t want to resort to surgery yet, what options are there?

A
  • Vacuum-assisted erection device

- Penile self-injection/intraurethral prostaglandin-E1

200
Q

Surgical options for Peyronie’s

A
  • Penile prosthesis

- Penile revascularization (super strict criteria)

201
Q

Criteria for priapism

A

prolonged erection >4 hrs unresolved by ejaculation

202
Q

Priapism is….

A

Urological emergency

203
Q

Tx for priapism

A

Nerve block w/ lidocaine → phenylephrine injection → aspirate blood +/- saline irrigation → surgery

Clin Med III (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions