Nephrology & Urology Flashcards

1
Q

# #

Normal PaCO2

A

35-45 mmHg

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2
Q

Normal PaO2

A

85%

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3
Q

Normal HCO3

A

22-32 mmol/L

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4
Q

Normal PH

A

7.40-7.45

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5
Q

urinary urgency + urinary frequency + nocturia

A

Overactive bladder

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6
Q

Peaked T-waves are seen in lead V2,V3,V4 and V5 + widening of QRS, decreased amplitude of P waves

A

hyperkalaemia

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7
Q

ACE inhibitors + spironolactone

A

Increased risk of hyperkalaemia

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8
Q

Causes of hyperkalaemia

A

– Renal failure.
– Metabolic acidosis.
– Addison’s disease.
– Use of aldosterone antagonists like spironolactone.
– ACEi.
– NSAIDs.

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9
Q

Renal stone recurrence management

A
  • Increase water intake about 2.5 to 3 litres/day
  • calcium-rich foods
  • thiazide diuretics
  • lewer oxalate-rich foods (Oxalate stones)
  • Allopurinol
  • urinary alkaliniser (potassium citrate)
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10
Q

Renal stones initial investigation

A

1st case: CT KUB
2nd recurrent: ultrasound + X-ray KUB

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11
Q

Renal stones diagnostic investigation

A

spiral CT KUB non-contrast

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12
Q

alkaline urine + “Staghorn calculi”

A

Struvite stones

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13
Q

Proteus pathogen renal stone

A

Struvite
-magnesium ammonium phosphate

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14
Q

Uric acid stone treatment

A
  • Allopurinol
  • urine alkalinization
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15
Q

Oxalate stone treatment

A
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16
Q

Renal stones in renal pelvis management

A

< 2.5cm: Extracorporeal lithotripsy
< 2.5cm: Percutaneous lithotripsy

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17
Q

Renal stones in ureter

A

Upper half < 1cm: Lithotripsy
Upper half: >1 cm: Lithotripsy or nephrolithotomy
Lower half < 1cm: Lithotripsy
Lower half > 1cm: Lithotripsy or endoscopy

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18
Q

Renal stones in bladder

A

< 3cm: Transurethral lithotomy
> 3cm: Cystotomy

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19
Q

Low potassium + hypertension

A

Investigate serum aldosterone

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20
Q

Most common complication of radical prostatectomy

A

Erectile Dysfunction (ED)

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21
Q

Premature ejaculation treatment

A

1st line: SSRI (raises orgasm threshold)

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22
Q

main complication of retroperitoneal lymph node dissection (RPLND)

A

Retrograde ejaculation

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23
Q

most common complication of TURP

A

Urinary tract infection (UTI)

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24
Q

UTI requiring hospitalisation

A

any infant < than 3 months
- increased risk of urosepsis

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Infant UTi treatment
- IV trimethoprim/gentamicin, benzyl penicillin
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Erectile Dysfunction (ED) management
Initial : - Optimise modifiable risk factors / related comorbidities (HTN, DM, diet/exercise etc) - Treat reversible causes (Low testosterone, Medication-induced erectile dysfunction, Psychogenic erectile dysfunction – consider referral to a therapist) - Pharmacological/Surgical treatment - 1st line: phosphodiesterase type 5 inhibitor (sildenafil) - 2nd line: penile injections, vacuum erection devices, external shock wave lithotripsy 3rd line: penile prosthesis
27
polycystic kidney disease features
- Polyuria and nocturia – Renal failure – Hypertension – Abdominal wall and inguinal hernias – Colonic diverticulosis – Hepatic cysts – Subarachnoid or cerebral haemorrhage – Cardiac anomalies including mitral valve prolapse
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albuminuria in diabetes
first void spot specimen Urinary albumin to creatinine (ACR) ratio
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URTI + proteinuria + haematuria + immediate onset
IgA nephropathy
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IgA nephropathy treatment
Asymptomatic microscopic haematuria: 2 positive UAs out of 3 in 2-3 weeks Symptomatic: corticosteroids
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URTI + proteinuria + haematuria + onset within weeks + facial oedema
Poststreptococcal glomerulonephritis (PSGN)
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HIV px + taking indinavir + haematuria + loin pain
Indinavir induced nephrolithiasis - Only detectable on US - Remove/Change indinavir
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onset within weeks + HIV hx + haematuria + proteinuria
Focal segmental glomerulosclerosis (FSGS)
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HIV-associated nephropathy (HIVAN)
-Nephrotic range proteinuria -Azotaemia -Normal to large kidneys on ultrasound images -Focal segmental glomerulosclerosis (FSGS)
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shortened QTc interval on ECG
Severe hypercalcaemia
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Dialysis indications
1. Pericarditis or pleuritis (urgent indication). 2. Progressive uraemic encephalopathy or neuropathy (confusion, asterixis, myoclonus, wrist or foot drop, or, in severe cases, seizures (urgent indication). 3. A clinically significant bleeding diathesis attributable to uraemia (immediate indication). 4. Persistent metabolic disturbances that are refractory to medical therapy (hyperkalemia, metabolic acidosis, hypercalcemia,hypocalcemia, hyperphosphatemia) 5. Fluid overload refractory to diuretics
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Dialysis metabolic abnormalities
- hyperphosphatemia - Vitamin D deficiency - hypocalcaemia - secondary hyperparathyroidism - hyperphosphataemia
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Dialysis skeletal abnormalities
renal osteodystrophy: - Osteomalacia - osteosclerosis - osteitis fibrosa cystica
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Most common acute complication of haemodialysis
Hypotension
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Paradoxical hypertension
Increase dialysis duration
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Acute renal failure risk
- Advanced liver cirrhosis - Ascites medication
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Chronic renal failure risk
- Ischemic heart disease - Type 2 DM
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Most common neurologic complication of chronic renal failure
Peripheral neuropathy
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Hypercalcaemia manifestations
- constipation - anorexia - nausea and vomiting - abdominal pain - ileus – Bone pain. – Muscular weakness - Peptic ulceration. – Pancreatitis. – Neurological - Short QT interval on ECG renal impairment: - polyuria, nocturia, and polydipsia >Ca 3mmol/L: - emotional labiality - confusion, - delirium - depression/psychosis - stupor - coma
45
Hypercalcaemia risk factors
Paraneoplastic syndromes: - squamous cell carcinoma of the head and neck - Renal cell carcinoma - Carcinoma of lung - Multiple myeloma
46
Hypocalcaemia manifestations
- Paraesthesia and numbness of the fingertips and perioral area. -Chvostek’s sign: Twitching of the ipsilateral facial musculature (perioral, nasal, and eye muscles) by tapping over cranial nerve VII at the ear. -Trousseau’s sign: carpal spasm induced by inflation of the blood pressure cuff around the arm. -Spontaneous muscle cramps. -Tetany is seen in severe hypocalcaemia
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Causes of confusion in kidney disease
without spasm: uraemia with spasms: hypercalcaemia
48
Treatment of urge incontinence
**1st line: Bladder retraining 2nd line: TCA/intravesical botulism 3rd line: Surgery
49
Haematuria+ hypertension + bilateral palpable kidneys + abdomen and flank fullness
Polycystic kidney disease (PCKD)
50
autosomal dominant polycystic kidney disease (ADPKD) dx
Presence of 2 or more cysts in each kidney
51
autosomal dominant polycystic kidney disease (ADPKD) complications
cerebral aneurysms
52
Polycystic kidney disease (PCKD) high BP mechanism
increased activity of renin angiotensin system
53
Polycystic kidney disease (PCKD) risk factors
– Younger age dx – Black Race. – Male sex. – Presence of polycystin-1 mutation. – Hypertension.
54
Good cyst penetration medication
Fluoroquinolones (lipid soluble)
55
Painless haematuria investigation protocol
1. urine microscopy and culture to rule out urinary tract infection 2. serum electrolytes, urinary proteins, red cell casts in the urine and check BP to rule out glomerulonephritis 3. urinary tract US and cystoscopy 3. CT abdomen non contrast
56
Scrotal lumps investigation
**malignant unless proven otherwise** initial: US lab test for tumour markers: 1. The beta subunit of beta-hCG 2. AFP 3. actate dehydrogenase (LDH)
57
most common cause of lower urinary tract symptoms (LUS)
Benign prostate hyperplasia (BPH)
58
Benign prostate hyperplasia (BPH) management
- 1st line: Finasteride that needs to be bridged with selective α-blocker such as doxazosin, terazosin, or pprazosin - gold standard: Transurethral resection of the prostate (TURP)
59
Benign prostate hyperplasia (BPH) complications
hydronephrosis and kidney damage
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Most common expected Longterm complication of TURP
Retrograde ejaculation 80-90%
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lower urinary tract symptoms (LUS) symptoms
Filling: -urinary frequency, - urgency, - dysuria, - nocturia. Voiding: - poor stream - hesitancy - terminal dribbling, - incomplete voiding - overflow incontinence (occurs in chronic retention)
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fever + perineal region pain + frequency, urgency, dysuria + oliguria + leukocytosis + prostate tenderness + with/o hypotension and tachycardia
Prostatitis
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Prostatitis treatment
Borad spectrum antibiotics for 3 weeks
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elderly patient + sclerotic changes in vertebrae and pelvis
Prostatic cancer
65
Prostate cancer T staging
T1 - impalpable T2 - confined to one nodule T3a - outside capsule T3b - into seminal vesicle
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Prostate cancer active surveillance criteria
- PSA ≤ 10.0 ng/mL - clinical stage T1–2a - Gleason score ≤ (3 + 4 = 7) and pattern 4 component < 10% after pathological review
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Prostate cancer active surveillance protocol
- PSA measurements every 3 months - PE + DRE every 6 months - Repeat prostate biopsy within 6–12 months of starting protocol
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Prostate PSA
40–49 years: <2.5 ng/mL 50–59 years: <3.5 60–69 years: <4.5 70+ years: <6.5
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Gleason grade
1: mild - no intervention 2:-3 moderate - conservative measures 3-5: high - requiring surgical intervention
70
Gleason score
< 6: low risk 7 (3+4) 7 (4+3) 8 9-10
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urethral injury initial investigation
retrograde urethrogram followed by Foley (bladder or urinary) catheter
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indwelling catheter (Foley) contraindications
Pelvic injury with urethral meatus blood
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suprapubic catheter contraindications
– Coagulopathy – Urinary Bladder carcinoma – Pregnancy – Ascites – Severe obesity – Lower abdominal scar tissue, mesh or adhesions from previous surgeries, pelvic cancer or radiation treatment
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testicular torsion management
Immediate surgery to prevent infarction
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testicular tumour malignancy investigation
1. scrotal ultrasound with colour Doppler 2. CT abdomen and chest x-ray 3. inguinal orchiectomy
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testicular tumour lymphatic spread would indicate the worst prognosis
Cervical
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young male+ low haemoglobin & haematocrit + hypertension + haematuria + proteinuria + with/o haemoptysis/SOB/cough/dyspnoea
Anti–glomerular basement membrane disease (Goodpasture’s)
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Anti–glomerular basement membrane disease
Goodpasture’s disease: - Young males most common - development of autoantibodies against the non-collagenous domain of type IV collagen - haemoptysis may also be a feature (smokers)
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Anti–glomerular basement membrane disease treatment
- plasma exchange - corticosteroids - cytotoxic therapy
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Sudden onset of severe testicular pain + nausea and vomiting + Asymmetric high riding testes + Absent cremasteric reflex + Negative Prehn’s sign
Testicular torsion
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fever & rigors + tender upper pole of testes + positive Prehn’s sign + lower urinary tract symptoms
epididymitis
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sudden onset + painless testicular swelling that decreases when supine + " bag of worms" sensation
varicocele (renal tumour) - mostly on the left side
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Painless haematuria w/o other symptoms
bladder carcinoma
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bladder carcinoma risk factors
- male - smoking - printing/leather dye industry work
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Bladder carcinoma diagnostic investigation
Cystoscopy
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Drug is associated with increased risk of bladder carcinoma
Pioglitazone
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Hypertension post dialysis treatment
- Conservative: remove excess sodium and dry weight reduction - 1st line: BB Atenolol -2nd line: CCB amlodipine - ACEi or ARBs -Diuretics (monitor for ototoxicity)
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most common opportunistic pathogen in transplant
Cytomegalovirus (CMV)
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Graft rejection treatment
- steroid boost - monoclonal antibodies to CD3 (OKT3) - pooled antibodies against lymphocytes (ALGs)
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Renal artery stenosis (RAS) treatment
Unilateral: ACEi Bilateral: CCB, BB
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Hyponatremia causing medication
- thiazide diuretics (indapamide)
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Smoking cessation medication
– 1st line: Varenicline – Nicotine replacement therapy – Bupropion (1st line pregnancy)
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stress incontinence management
- Pelvic floor exercises (Kuegels) - Bladder neck suspension/sling
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Partial nephrectomy
< 7 cm - not centrally located - expected to live > 5 years with/o other comorbidities
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Total nephrectomy
- size > 7cm - central location - lymph node involvement - associated with renal vein/IVC thrombus - Direct extension into ipsilateral adrenal gland
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Painless haematuria
Rule out malignancy
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HEMATURIA 2 TYPES:
gross = investigations ? microscopic
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hematuria when? start, end all trough? clots? renal medical disease?
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hematuria 1. HISTORY AND PHYSICAL EXAMINATION 2. INITIAL INVESTIGATION 3. INVESTIGATIONS
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HEMATURIA ## Footnote ALGORTIMO - microscopic/macroscopic ? imaging
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glomerular vs non glomerular characteristis
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Managment hematuria children
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recall
ciclofosfamida = CISTITIS (dolor ) + HEMORRAGICA
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type of stones
**NO X RAY** -A) **Struvita** stones = staghorn caluculus (proteus, psudomonas, klebsiella) B) **uric** acid stones ( DM, gout, rapid weight loss, hemolitic anemia, chronic diarrea) (dissolvde with urina alkalinizaition >6,5) C) **Indinavir** D) **Cystine** ## Footnote nephrolitiasis
105
next step indivanir stones= ULTRASOUND (also pregnant lady) most appropiate next step = non contrast CT scan ## Footnote nephrolitiasis
Non-enhanced CT is the ‘gold-standard’ for diagnosis of ureteric colic. ●Low-dose CT protocols can be effectively used in acute renal colic ●Immediate imaging is required when patients do not improve after treatment and / or when there is fever and / or leukocytosis and / or the patient has renal failure or a single kidney ●However, because of concerns about ionisingradiation and because the vast majority ofureteric stones pass without the need for intervention, **ultrasound (US) has been increasingly recommended and used as the initial imaging modality**, with no sacrifice in patient outcome, thus avoiding the need for CT in about 70% of cases ●Ultrasound is also capable of identifying most of the alternative diagnoses listed as mimickers of renal colic ●US in combination with plain x-ray KUB misses very few clinically important stones ●**In pregnant patients US**, but it should be borne in mind that unless a calculus is visualized it may be difficult to differentiate obstructive hydronephrosis due to a calculus from ‘physiological’ hydronephrosis of pregnancy. In selected cases, MRI urography may be then required **●Conventional IVP can now be considered almost obsolete for the diagnosis of renal colic** ●Ultrasonography may be useful in patients in whom avoiding radiation is necessary (egyoung people, women who are pregnant), but CT is still the preferred imaging modality of urologists as it allows better decision-making for further management. Ultrasonography can be useful for following calyceal stones, butis much less accurate than CT at detecting ureteric stones and at measuring stone size (a key determinant of further management). ●Imaging is important for confirming diagnosis and guiding treatment. Computed tomography (CT) and X-rays of the kidneys, ureters and bladder (KUB) should be ordered and performed on the same day
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nephrolitiasis Tx! ## Footnote Stone passage: 70% of stones <5mm will pass , 5-7mm 60% will pass, >10 mm very unlikely
1. **Pain control: **During an acute episode of renal colic, management is **focused on pain control.** Both nonsteroidal anti-inflammatorydrugs (NSAIDs). Mind renal function. (**Australia uses ketorolaco**) 2. **Medical expulsion therapy: **stones >5mm and <=10 Ureter location -with alpha-blockers (tamsulosin) x 4 weeks facilitate expulsion -Alpha-1a antagonists are contraindicated in patients with end-stage hepatic or renal failure, and patients with severe orthostatic hypotension –Not PBS 3.**Confirmation of stone passage:** US, KUB Xray, CT (X-ray KUB if the stone is definitely seenon initial X-ray, or CT KUB if it is not seen) should be organisedfor **four weeks after the initial visit,** unless a stone has been collected and verified by the GP or urologist ●**Straining urine: **Patients should be instructed to strain their urine for several days and bring in any stone that passes for analysis. ●**Treatment of urinary tract infection** —Patients with evidence of a concurrent urinary tract infection should be promptly treatedwith antibiotics. ●**Urologic consultation** —Urgent urologic consultation is warranted in patients with urinary tract **infection**, acute **kidney** **injury** beyond that expected from unilateral obstruction, anuria, and/or unyielding pain, nausea, or vomiting, Stones >7 mm are less likely to pass, conservative management for three weeks and have not passed their stone ●Lastly, patients who have passed stones but have ongoing blood in the urine should be referred to a urologist for investigation of haematuria, preferably with three urine cytology tests and a CT IVP.
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nephrolitiasis (Surgical Management) when? emergency vs elective ## Footnote Nephrolithiasis
2. 1. UTI 2. DOS rinones + aki 3. UN solo rinon + aki
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(Surgical Management) proximal distal mm
**1. laser lithiotripsy / called SWL **2. extracorporeal shock wace lothotripsy 3. percutaneous nephrolithotomy (>2cm)
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Which of the following interventions is most likely to prevent renal calculi formation in the future for this patient? A.Decreasing calcium intake B.Decreasing sodium intake C.Increasing consumption of nuts and seeds D.Loop diuretic pharmacotherapy E.Urine acidification with cranberry juice
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recall indications surgery ## Footnote Nephrolithiasis
indications surgery
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key points Nephrolithiasis
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UTI Cystitis Adults Clinical Presentation? sterile pyruia?
sterile pyruia tb cancer chlamidia cistitis + fever = PIELONEFRITIS
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MICROBIOLOGY UTI
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UTI Cystitis Adults dx initial? confirmatory? pregnancy test before ATB always send to culture in: empirical therapy in :
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UTI Cystitis Adults tx Non-pregnant adults “symptomatic” Cystitis:
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Pregnant women “symptomatic” Cystitis and **Asymptomatic** bacteuria:
116
A-symptomatic bacteuria adults: when to treat?
Screening for and treatment of asymptomatic bacteriuria is Not recommended unless: ●Pregnancy ●Urolithiasis ●Vesicouretericr eflux ●Renal transplant recipients ●The immunocompromised, and ●Before instrumentation of the urinary tract. **elderly and delirius yes treat , if neurological normal dont**
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UTI Pyelonephritis Adults clinical presentation?
UTI Pyelonephritis Adults dx
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UTI Pyelonephritis Adults tx
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UTI Pyelonephritis Adults dx image when ct contrast?
120
UTI Children Cystitis and Pyelonephritis clinical presentation dx
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UTI Children Cystitis and Pyelonephritis ultrasound when? voiding cystourethrogram when?
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UTI Children Cystitis and Pyelonephritis tx oral iv
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UTI Children Cystitis and Pyelonephritis key points read
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never fluoroquinolones in australia
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tips cystitis adults ## Footnote read
126
This patient's dysuria, increased urinary frequency, and mild suprapubic tenderness in the absence of fever, malaise, and costovertebral angle tenderness is concerning for an uncomplicated acute cystitis. Uncomplicated acute cystitis is empirically treated with antibiotics without needing further diagnostic evaluation.Acute cystitis describes inflammation of the lower urinary tract and bladder and is caused by ascension of uropathogensvia the urethra and into the bladder. Acute cystitis is said to be uncomplicated if the patient is immunocompetent, premenopausal, not pregnant, and there is no evidence that the infection has extended beyond the bladder (e.g., flank pain or costovertebral angle tenderness) or having symptoms suggestive of systemic illness (e.g., fever, rigors, significant fatigue, and sepsis). Women with acute uncomplicated cystitis present with dysuria, increased urinary frequency, urinary urgency, and suprapubic discomfort. The diagnosis is clinically made and often further evaluation (e.g., urinalysis with urine culture, cystography) is not necessary. Most women with symptoms highly suggestive of acute uncomplicated are empirically treated with first-line antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. If symptoms resolve with antibiotic treatment, follow-up urine studies are not necessary.
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urethritis
**first pass of urine test**
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urethritis tx
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prostatitis
133
prostatitis
134
renal TB
135
scrotal swelling painful vs painless
136
Hidrocele vs Varicocele ## Footnote definition, clinic, dx, tx
hidrocel
137
varicocele think of renal cell carcinoma retroperitoneal tumor portal hypertension ## Footnote tip: left testicular vein drains to **left RENAL VEIN **
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varicocele ## Footnote clinic, physical exam , investigations, TX
**CT with contrast (look for malignancy**
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spermatocele - cyst of epididymis
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epididymitis and orchitis ## Footnote theory
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diagnostic to approach a scrotal mass
144
Testicular Torsion and Torsion of the testicular appendix
145
hematocele
146
testicular cancer
147
testicular cancer types preventive meassure ## Footnote testicular cancer
## Footnote testicular cancer
148
## Footnote testicular cancer
## Footnote testicular cancer
149
## Footnote testicular cancer , clinical presentation, dx,
tx ? ## Footnote testicular cancer treatment
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Benign prostatic hyperplasia
161
Benign prostatic hyperplasia TURP complications
162
Benign prostatic hyperplasia when PSA
163
## Footnote This patient presents with signs and symptoms consistent with benign prostatic hypertrophy (BPH); this condition places one at increased risk for hydronephrosis.BPH is a common condition seen in older men. It typically presents with any number of lower urinary tract symptoms ("LUTS"), including: increased frequency, nocturia, hesitancy, urgency, and weak stream. Enlarged prostate on examination can confirm the diagnosis. Over time, the retrograde pressure caused by BPH can cause hydronephrosis and even renal failure; this is also associated with bladder diverticula. Patients with BPH are at increased risk for developing urinary tract infections, but not prostate cancer.Incorrect Answers:Answers A, C, D: All of these are not associated with BPH, whereas hydronephrosis is.Answer E: Although bladder stones can be associated with BPH, nephrolithiasis is not.
164
## Footnote This patient is presenting with syncope whenever he tries to urinate, suggesting a diagnosis of situational syncope secondarytobenign prostatic hyperplasia (BPH).Situational syncope is a type of vasovagal syncope that only occurs during certain situations such as dehydration or during straining with bowel movements or urination in BPH. Situations that increase intra-abdominal pressure can lead to a vagal response that causes sudden bradycardia and hypoperfusion of the CNS resulting in syncope. Patients presenting with syncope should be worked up for acardiac or neurologic process before making the diagnosis of situational syncope. Incorrect Answers: Answer 1: Transient ischemic attack presents with sudden stroke-like symptoms (loss of vision and unilateral weakness) that typically self-resolve by the time the patient presents. This patient's symptoms are reproducible with urination, suggesting an alternate diagnosis. Answer 2: Postural hypotension presents with syncope when a patient stands up suddenly. A slow increase in vascular tone resultsin temporary blood pooling in the lower extremities and hypoperfusion of the CNS which can cause syncope. This patient's symptoms only occur when he tries to urinate. Answer 3: Seizure presents with symptoms during the episode and a post-ictal state. This patient does not seem to have a post-ictal state and has symptoms reproducible with urination. Answer 4: Cardiac arrhythmia is a possible diagnosis in this patient, and an EKG should be performed to rule out a cardiac diagnosis. In the setting of syncope specific to certain situations, situational syncope is a more likely diagnosis. Bullet Summary:Situational syncope is a type of vasovagal syncope that only occurs in certain circumstances (most commonly dehydration or straining).
## Footnote This patient is presenting with sudden-onset urinary retention in the setting of benign prostatic hyperplasia (BPH) and startingan alpha-1 agonist (phenylephrine), suggesting his symptoms are secondary to this medication.Urinary retention typically presents in men with BPH and can present with straining to urinate, a painful and distended bladder,and incomplete voiding. Chronic treatment for BPH is finasteride, which is a 5-alpha-reductase inhibitor that can slow the progression of BPH. Acute treatments include tamsulosin, which is an alpha-1 antagonist which can aid in voiding. Patients who start medications with anticholinergic properties or alpha-1 agonist medications can worsen their urinary retention. Anticholinergics decrease cholinergic tone on the bladder which is required for urination.On the other hand, alpha-1 agonists increase the tone of the urinary tract sphincters making it more difficult to urinate. The treatment of medication-induced urinary retention is to stop the offending agent and to potentially start tamsulosin if symptomspersist. Incorrect Answers: Answer A: Constipation is a potential etiology of urinary retention and could possibly be worsening this patient’s symptoms of urinary retention. However, the patient’s symptoms started 3 days ago, and his symptoms did not improve with a bowel movement 2 days ago. Though this patient’s constipation should be better managed, it is not the most likely etiology of his urinary retention. Answer C: Prostatic adenocarcinoma is unlikely to cause urinary retention when compared to benign prostatic hypertrophy. Prostatic adenocarcinoma typically presents with a rock hard and nodular prostate in contrast to a soft, symmetric, and enlarged prostate in BPH and is less likely to obstruct the urinary tract. Answer D: Urinary tract infection would present with symptoms of dysuria including urinary urgency, burning, and increased frequency rather than urinary retention.Answer E: Worsening benign prostatic hyperplasia is a possible contributing etiology to this patient’s urinary retention; however, it would not cause a sudden onset of urinary retention as was seen in this patient. Rather, it would be a gradual worsening of urinary retention
165
Erectile dysfunction
**ED is common in men with systemic disorders such as hypertension, ischemic heart disease, and diabetes mellitus, and its prevalence increases with age. Although sexual dysfunction is more common in older men, it also affects younger men (ages 18 to 25 years)** **phosphodiesterase-5 (PDE5) inhibitors, **
166
Sildenafil can cause :
167
Erectile dysfunction labs tilogy
168
stepwise approach to erectile dysfunction tx
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infertility in males DEFINITION? oligo azo asthenoazo teratoazo
174
infertility in males symptoms physycal exam syndrome?
175
infertility investigation
176
infertility males 2 syndromes labs?
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klinefelter syndrome clinical labs
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drugs potential male infertility ## Footnote chemotherapy, lithium, SSRs
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URINE INCONTINECE STRESS INCONTINENCE:
184
URGE INCONTINENCE OR OVERACTIVE BLADDER:
185
overflow incontinence
186
187