Nocturia

Question 1

What is the definition of nocturia?

Answer 1

Getting up to urinate more than 2 times a night

Question 2

What is the definition of dysuria?

Answer 2

Difficulty urinating, occurring at more external locations like hte urethra, bladder, and suprapubic area or as the urine exits the body

(Pain with urination imo)

Question 3

What is the definition of urinary incontinence?

Answer 3

Inability to control the urine flow

Question 4

What are 4 intake-related factors that lead to nocturnal polyuria?

Answer 4

Fluid intake

Late afternoon and evening intake

Caffeine

Alcohol

Question 5

What peripheral edema related factors can lead to nocturnal polyuria?

Answer 5

Venous insufficiency

Congestive heart failure

Question 6

What 5 medications lead to nocturnal polyuria?

Answer 6

Gabapentin

Pregabalin

Thiazolidinediones

NSAIDs

Pyridine calcium blockers (e.g. nifedipine)

Question 7

What are some voiding sx?

Answer 7

Sx that occur at the time of urination:

Slow/intermittent urine stream

Hesitancy

Prolonged termination of urination

Dysuria

Question 8

What are some storage sx?

Answer 8

Sx that occur during bladder storage and filling:

Urinary urgency/frequency

Nocturia

Incontinence

Question 9

What is stress incontinence?

Answer 9

Leakage of urine upon coughing, sneezing, or standing

Question 10

What is urge incontinence?

Answer 10

Urgency and inability to delay urination

Question 11

What does DIAPPERS stand for and what is a mnemonic for?

Answer 11

It is a mnemonic for transient causes of urinary incontinence

D- delirium
I- infection
A- atrophic urethritis and vaginitis
P- pharmaceuticals
P- psychological factors
E- excess urinary output
R - restricted mobility
S - stool impaction

Question 12

What 7 pharmaceuticals lead to transient urinary incontinence?

Answer 12

Potent diuretics

Anticholinergics

Psychotropics

Opioid analgesics

Alpha-blockers (in women)

Alpha-antagonists (in men)

Calcium channel blockers

Question 13

What factors lead to excess urinary output in transient urinary incontinence?

Answer 13

Diuretics

Excess fluid intake

Metabolic abnormalities (hyperglycemia, hypercalcemia, diabetes insipidus)

Peripheral edema and its associated nocturia

Question 14

What is the most common cause of established geriatric incontinence?

Answer 14

Detrusor overactivity leading to urge incontinence

Question 15

What is the most common cause of stress incontinence in older men?

Answer 15

Urethral incompetence

Could be due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostatic cancer

Question 16

What are 5 signs and sx of atrophic urethritis and vaginitis?

Answer 16

Vaginal mucosal friability

Erosions

Telangiectasia

Petechiae

Erythema

Question 17

What is the most important aspect from a physician standpoint in regard to BPH?

Answer 17

Symptom management and ensuring there is no evidence of cancer

Question 18

Which has more malignant potential- hypertrophy or hyperplasia?

Answer 18

Hypertrophy

Question 19

What is LUTS and its associated sx?

Answer 19

LUTS = lower urinary tract symptoms due to benign prostatic hyperplasia

Obstructive sx: hesitancy, straining, weak stream, dribbling, prolonged voiding

Irritative sx: increased frequency, urgency, nocturia, urge incontinence

Question 20

What is the etiology of benign prostatic hyperplasia?

Answer 20

A blocked urethra or a bladder that is overworked from trying to pass urine through the blockage

Question 21

What is considered mild, moderate, and severe on the AUA symptom scale?

Answer 21

0-7 = mild

8-10 = moderate

20-35 = severe

Question 22

What is the most common pharmacologic agent for treatment of overactive bladder?

Answer 22

Anticholinergics

Question 23

In what demographic should you avoid a PSA test?

Answer 23

Asymptomatic men with a short life expectency (>75 y/o)

Unless they have a higher than median PSA before age 70 or in excellent health

Question 24

What do you do with men who have a PSA of 4-7 ng/ml?

Answer 24

Refer to urology IF their symptom score is moderate to severe

Question 25

What is the main distinguishing feature between cystitis and pyelonephritis?

Answer 25

Fever

Question 26

What disease presents with a high-spiking “picket-fence” pattern and resolves over 72h of therapy?

Answer 26

Pyelonephritis

Question 27

If a patient is complaining of “pressure” or “pain” in the area between the scrotum and anus, and can manifest as difficulty sitting for extended periods?

Answer 27

Prostatitis

Question 28

What are most urinary stones comprised of and how do they show up on x-ray?

Answer 28

85% contain calcium

Appear radiopaque

Question 29

What kind of stones are due to absorptive, resorptive, and renal disorders?

Answer 29

Hypercalciuric calcium nephrolithiasis

Question 30

What kind of stones are due to dietary excesses or uric acid metabolic defects?

Answer 30

Hyperuricosuric calcium nephrolithiasis

Question 31

What kind of stones are due to primary intestinal disorders, like chronic diarrhea, IBS, or steatorrhea?

Answer 31

Hyperoxaluric calcium nephrolithiasis

Question 32

What kind of stones are due to disorders associated with metabolic acidosis including chronic diarrhea, type I (distal) renal tubular acidosis, and long-term hydrochlorothiazide treatment?

Answer 32

Hypocitraturic calcium nephrolithiasis

Question 33

What urease-producing organisms lead to struvite calculi?

Answer 33

Proteus

Psuedomonas

Providencia

(Also less commonly Klebsiella, Staphylococcus, and mycoplasma)

** NOT E. COLI **

Question 34

What bacteria are common with acute bacterial prostatitis?

Answer 34

E. Coli and Pseudomonas

Less commonly enterococcus