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CPR Exam 3 > Nocturia > Flashcards

Nocturia Flashcards

1
Q

Differentiate glomerular versus non-glomerular hematuria

A

acanthocytes (dysmorphic urine RBC)
Red Cell Casts
New Proteinuria
Elevated Serum Creatinine

Non-glomerular: more likely to have visible BC

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2
Q

________- is one of first things to consider in workup of hematuria

A

urine culture

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3
Q

Most hematuria is found on _______ and can easily be diagnosed by ________

A
  • routine urine exam

- ruling out infection

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4
Q

____________ is size and stage tumor in RCC

A

CT abdomen

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5
Q

In patients patients WITHOUT symptoms of dysuria, nocturia or incontinence, what is NOT recommended?

A
  • PSA

- DRE

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6
Q

________________ increases a patient’s risk for prostate cancer

A

1st degree relative w prostate cancer

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7
Q

Dx and Tx of prostate cancer is ________

A

individualized

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8
Q

With is a surgical concern with Urinary Tract Stone Disease?

A

concommitant infection

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9
Q

What will pt with Urinary Tract Stone Disease

present on in PE

A
  1. Severe flank pain that radiates to groin
  2. Urinary frequency, hesitancy, hematuria
  3. N/V
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10
Q

What can we use on a pt with Urinary Tract Stone Disease to see stones on imaging?

A

CT

UD

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11
Q

There are 7 ________ causes of geriatric urinary incontinence (aka ____________)

A
  • reversible

- transient urinary incontinence

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12
Q

What are the 7 reversible causes of transient urinary incontinence?

A

DIAPPERS

Delirium
Infection
Atrophic vaginitis 
Pharmaceuticals
Psychosocial/Psychiatric
Excess urine: diuresis, hyperglycemia
Stool impaction
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13
Q

MCC of fever

A

infection

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14
Q

Other causes of fever

A
  1. AI disease
  2. CNS disease (head trauma, lesion)
  3. Cancer (esp lymphoma, leukemia, RCC, primary or metastic liver cancer
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15
Q

Nocturia

A

getting up to pee more than 2x/night, which often occurs in the setting of dysuria and/or UI

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16
Q

Dysuria

A

hard time peeing, occurring at more external locations like urethra, bladder and suprapubic area or as the urine exits the body

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17
Q

Urinary incontinence

A

can’t control the flow of urine

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18
Q

Leaking of urine when coughing, sneezing or standing

A

stress incontinence

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19
Q

urgency and inability to hold pee

caused by?

A

urge incontinence

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20
Q

_____ incontinence has variable presentation

A

overflow incontinence

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21
Q

What is the MCC of established geriatric incontinence (2/3 of cases?

A

Detrusor overactivity (urge incontinence)

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22
Q

What are the causes of:

  1. Stress incontinence
  2. Urge incontinence
  3. Overflow incontinence
A
  • Stress incontinence is d/t urethral incontinence (urethral obstruction, prostate enlargement, stricture, bladder neck contraction)
  • Urge incontinence is d/t detrusor overactivity
  • Overflow incontinence is d/t detrusor underactivity
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23
Q

What is the LCC of incontinence?

A

Detrusor overactivity

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24
Q

Dysuria DDx

A 
o	Cystitis
o	Uretheritis (gon or chlamydia)
o	Pyelonephritis 
o	Vaginitis 
o	Epididymis
o	Balantis 
o	Prsastitis 
o	URetheral syndrome 
o	Genital herpes 
o	Reactive arthritis (reiters syndrome)
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25
Q

How can we diagnose detrusor overactivity (=> urge incontinece) vs uretheral incompetence (=> stress incontinence?

A

Standing full bladder stress test: ask the patient to stand while coughing

  • immediate release of urine => urethral incompetence
  • few second delay release of urine => detrusor overactivity (uninhibited bladder contraction)
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26
Q

What distinguishes detrusor overactivity from underactivity and urethral incontinence?

A

Destrusor underactivity has a high postvoid residual (generally over 450 mL)

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27
Q

lab tests for incontinence

A
  1. review meds
  2. UA, urine culture for infection
  3. Tests for hyperglycemia, hypercalcemia, DI
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28
Q

lab tests for incontinence

A

US to see if postvoidal residual

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29
Q

In regard to prostate cancer, the decision is always based on

A

risk vs benefit

30
Q

______ is a pathologic process that contributes to the development of lower urinary tract symptoms (LUTS)

A

BPH

31
Q

LUTS are subdivided into what symptoms

A

Obstructive symptoms (urinary hesistancy, straining, weak stream, terminal dribbling, prolong voinding, incomplete emptying)

irritative symptmos (increase in freq, urgency, nocturia, incontinence, small boided bolumes)

32
Q

diagnostic symptoms score of BPH (AUA sx scale) = tells us sx severity and prostate cancer risk

A

0-7: mild

8-19: moderate

20-35: severe

33
Q

In patients with symptoms, ___________ can identify those with normal flow rates who are unlikely to benefit from treatme

A

urine flow studies

34
Q

_____________ can identify those with high postvoid residuals who may need intervention

A

bladder US

35
Q

_____________studies detect primary bladder dysfunction

A

pressure-flow (urodynamic) studies

36
Q

________ is recommended if hematuria is documented and to assess the urinary outflow tract before surgery

A

cytoscopy

37
Q

___________ is advised for patients with hematuria, a history of calculi, or prior urinary tract problems.

A

imaging of upper tracts

38
Q

Symptoms of benign prostatic hyperplasia most often come from

A
  1. blocked uretha

2. Overworked bladder

39
Q

_________ is the most common reason men seek treatment for BPH, and therefore the goal of therapy for BPH.

A

sympmatic relief ((alpha-adrenergic ANT)

surgery is a 2nd line threapy

40
Q

__________I as combination therapy seeks to provide symptomatic relief while preventing progression of BPH

A

alpha-adrenergic receptor antagonist and a 5ARI

41
Q

First, avoid PSA in _______
Second, do not treat __________
3rd; refer _______ to urologist

A

men with little-no gain

2nd: those who do not need tx; screen detected prostatte cancer does not need immediate treatment and can be managed w surviellence
3rd: refer men who do not need tx to

42
Q

before performing PSA, do what?

A

determine pts risk for BPH and prostate cancer.
DRE is likely not considered unless pt is high risk; even then does not impact decision making
R

43
Q

refer men with PSA of _______ to urology if symotom score is moderate -severe

A

4-7 ng/ml

44
Q

DDx for cystitis

A 
o	Pyelonephritis
o	Urethritis
o	Vaginitis
o	Prostatitis
o	Asymptomatic bacteriuria (ASB)
45
Q

, ____ occurs in the absence of symptoms attributable to the bacteria in the urinary tract and usually does not require treatment, while _____ has more typically been assumed to imply symptomatic disease that needs ABX therapy.

A

ASB

UTI

46
Q

I often diagnose ASB in elderly patients or those with ________s. Often, they do not need therapy, such as antibiotics!

A

chronic indwelling catheters

47
Q

patient does not have local or systemic symptoms referable to the urinary tract

usually bacteriuria detected incidentally

A

ASB

48
Q

The typical symptoms of cystitis are

A

dysuria, urinary frequency, and urgency

49
Q

. _____ is the main feature distinguishing cystitis from pyelonephritis.

A

fever

50
Q

prostatitis is almost always _______ in nature and will often compaoin of pain where

A

bacterial

between scrotum and anus (perineal)

51
Q

a symptomatic episode of cystitis or pyelonephritis in a pt with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy.

A

complicated UTI

52
Q

symptoms of LHF

A
  1. breathless (dyspnea)
  2. Orthopnea
  3. PND
  4. hemoptysis
  5. high RR and HR
    6/ rales
    7 base of lungs are dull to percussion bc of congestion of luid in lungs
53
Q

volume overload is a typical process that is commonly treated with ______ and other medications to_________, _______ afterload and _____ preload

A

diuretics
increase contractility
increase afterload
decrease preload

54
Q

why can HF lead to nocturia?

A

HF causes decrease renal perfusion during day when standing up; when laying down it goes back to normal => diuresis

55
Q

essential of dx of kidney stone dz

A
  1. severe flank pain
  2. N/V
  3. Id on non-constrast CT or US
56
Q

Epidemo of kdinewy stones

A

male
30-40a
hot summer months

57
Q

struvite calci are most likely due to

A

urease producing organisms (proteus, pseudomas, providencia)

58
Q

• Laboratory Tests for kidney stones

A

UA; will see gross/microscopic hematuria in 90% of pts

urinary pH

59
Q

Persistent urinary pH < 5.5 is suggestive of…

A

uric acid or cystine stones

60
Q

Persistent urinary pH ≥ 7.2 is suggestive of a

A

struvite infection stone

61
Q

Urinary pH between 5.5 and 6.8 typically indicates

A

calcium-based stones

62
Q

what iwll detect most stones

A

plain film of abdomen (KUB; kidney, ureter, bladder)

63
Q

b. Prevention of kidney stones

A
  1. increase fluid intake to pee out 1.5-2 l
  2. drink during meals, 2 hours after, before bed and at night
  3. decrease Na+ intake
  4. decrease animal protein
64
Q

when to refer for kidney stones

A
  1. urinary obstrauction
  2. kidney stone + flank pain
  3. abnormal kidney
  4. concomiitant pyelonephritisi or recurrent infection
65
Q

when to admit for kidney stones

A
  1. N/V to manage sx

2. Obstruction stone with sign of infection (CONSULT UROLOGY ASAPROONY)

66
Q

when to admit for kidney stones

A
  1. N/V to manage sx

2. Obstruction stone with sign of infection (CONSULT UROLOGY ASAPROONY)

67
Q

acute bacterial prostatits mcc

A

e.coli and pseudomas

68
Q

Prostatitis, Acute Bacterial

• Essentials of Diagnosis

A 
o	Fever
o	Irritative voiding symptoms
o	Perineal or suprapubic pain
o	Exquisite tenderness on rectal examination
o	Positive urine culture
69
Q

acute bacterial prostatits

CBC:
UA:
Urine culure

A

CBC: leukocytosis and left shift
UA: pyuria, bacteruria, hematuria
culture: +

70
Q

why can diabetic pts experience nocturia

A

DB => hyperglycemia => high glucose => osmotic diuresis => nocturia

71
Q

why can diuretics cause nocturia

A

HF pts are congested; diuretics restribute volume => lying down changes venous pressure and increases VR => kidneys filter more fluid at night

CPR Exam 3 (10 decks)

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