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Primary care of adults 2 > Pelvic / UTI (4 questions) > Flashcards

Pelvic / UTI (4 questions) Flashcards

1
Q

Symptoms of nephrolithiasis

A

• unilateral flank pain

• hematuria

  • nausea
  • pain 10/10
  • testicular pain
  • unilateral CVAT
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2
Q

DDx for nephrolithiasis

A
  • appendicitis: usually no hematuria
  • cholecystitis: flank pain w/o hematuria
  • pyelonephritis: fever uncommon in stones
  • MS pain
  • Herpes zoster: usually rash and no hematuria
  • ectopic pregnancy
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3
Q

Lab results for nephrolithiasis

A
  • UA, C+S
  • Flat plate or helical CT - may not be able to visualize depending on stone density
  • Urine dip
      • leukocytes,
    • +++ hematuria in UA
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4
Q

Tx of nephrolithiasis

A
  • goals: pain relief, pass stone, prevent obstruction
  • increase H2O, decrease dark cola
  • strain urine, save stone for analysis
  • RTC if fever or increased pain, gross hematuria
  • Meds:
    • Ketorolac 60mg IM followed by 10mg PO q4 hrs PRN. Pain relief. do not use >5 days
    • Tamsulosin (Flomax) 0.4mg PO QD x 4 weeks - alpha blocker - relaxes muscle for easier passage
  • Long term: prevent recurrence
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5
Q

Does animal protein put a person at higher risk for kidney stones?

A

yes! high animal protein

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6
Q

Does ca++ intake predispose a person to kidney stones?

A

only supplements - not dietary

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7
Q

Why does obesity put a person at higher risk for stones?

A

lowers urinary pH (only in men?)

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8
Q

GI condition that increases risk for stones

A

Crohns - high urinary oxalate d/t increased absorption of dietary oxalate

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9
Q

Conditions associated w/risk for stones

A

diabetes, gout, excessive exercise/physical activity, obesity, crohn’s, Vit D deficiency, dehydration

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10
Q

Where is pain located in upper urethral vs lower urethral obstruction (stones)

A

upper: flank
lower: may radiate to ipsilateral testicle or labium

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11
Q

Symptoms of endometriosis

A
  • classica: dysmenorrhea, dyspareunia, heavy period (menorrhagia), infertility (often why present first)
  • chronic mild lower abd pain
  • cyclic with menses
  • getting worse over time
  • nausea, headache, bloating, lower back pain with menses
  • tenderness on pelvic exam (CMT, uterine and adnexal tenderness)
  • possible rectal bleeding around menses
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12
Q

Differential Dx endometriosis

A
  • PID
  • Adenomyosis
  • Ovarian cancer
  • Pelvic adhesions
  • Colon cancer
  • GI bleed
  • IBS
  • Diverticular disease
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13
Q

Labs / results of endometriosis

A

• urine hCG, GC/CT - r/o other etiology

• + stool hemoccult

  • CA-125 -often high in endometriosis. and ovarian ca
  • ?HE4 - ovarian ca
  • ultrasound - transvaginal

• diagnostic laparoscopy -need biopsy for definitive dx

  • GI workup - FOBT x 3 when no menses
  • maybe colonoscopy

no labs clinically useful for dx

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14
Q

Tx of endometriosis

A

• Short term: pain relief, non-invasive eval

  • Naproxen 500mg BID with food, start 2 days prior to menses and continue until menses day 3
  • if ineffective change to Ponstel

• Long term: pain relief, preserve fertility

  • Lo-Ovral 1 po QD
  • low-fat vegetarian diet (assoc w/dec dysmenorrhea)
  • dairy intake 3-4 servings/day (assoc w/dec Sx)
  • exercis
  • yoga and sexual activity
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15
Q

F/U and Tx if endometriosis not getting better

A
  • Always return 4-6w for review
  • Doing well: continue
  • Not doing well: discuss GnRH vs laparoscopy, ?get pregnant sooner instead of later
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16
Q

Sx of Interstitial cystitis (painful bladder syndrome)

A
  • urinary urgency, frequency, & pain increasing over time
  • pain absent immediately after voiding
  • pain worst in morning
  • hx multiple UTIs
  • nocturia
  • dyspareunia with deep penetration
  • occasional lower abd pain
  • mild tenderness on pelvic exam
17
Q

DDx of Sx of Interstitial cystitis (painful bladder syndrome)

A
  • Leiomyomata
  • PID
  • Atypical IBS
18
Q

What labs would you order for suspected interstitial cystitis

A
  • hCG: r/o
  • GC/CT: r/o
  • C+S: r/o
  • urine cytology: r/o
    • hemoccult
19
Q

Tx of interstitial cystitis

A

Goal: pain relief, tx or mgmt of underlying conditions

  • Amitriptyline 25-100mg PO analgesia + relief of depressive sx w/pain
  • Gabapentin (Neurontin) 100g consider if amitryptiline not effective
  • Pentosan polysulfate sodium (Elmiron) 100mg PO tid, not with food - can combine w/for bladder sx, but is weak blood thinner!
  • local heat/cold
  • bladder training, physical therapy
  • CBT
20
Q

Sx of acute cystitis

A

• urinary pain, frequency, urgency with acute onset

21
Q

DDx acute cystitis

A
  • vaginitis
  • urethritis
  • structural urethral abnormalities
  • painful bladder syndrome
  • PID
  • nephrolithiasis
22
Q

Lab results / UA for acute cystitis

A

• +++ leuks, + nitrites, ++ blood on UA

Possible C+S & GC/CT

23
Q

Tx of acute cystitis

A
  • Nitrofurantoin (Macrobid) 100mg PO BID x 5-7 days
  • Phenazopyridine (Pyridium) 200 mg PO TID x 3 days -orange urine!
  • TMP-SMX (Bactrim) 160/800mg BID x 3 days -not w/impaired kidney function!
  • RTC if fever, no relief ~2 days, blood in urine
  • wipe front to back, keep well hydrated, don’t “hold it”, urinate after sexual activity
24
Q

Sx of pyelo

A
  • urinary pain, frequency, urgency
  • pink-tinged urine
  • fever
  • nausea
  • side pain
  • CVAT
25
Q

DDx pyelo

A

PID, nephrolithiasis

26
Q

Labs ordered for suspected pyelo

A
  • UA: ++++ leukocytes, + nitrites, ++++ blood
  • C+S
  • GC/CT - r/o
  • hCG - r/o
27
Q

Tx pyelo

A
  • Ciprofloxacin 500mg PO BID x 7 days
  • Tylenol for fever
  • clear liquids
  • RTC if fever not going down in 24h, vomiting, or urine sx persist
  • F/U phone call in 2 days
28
Q

When is there a risk for a complicated UTI?

A

• risk fx for complicated UTI: diabetes, pregnancy, renal failure, indwelling catheter, immunosuppression, renal transplantation, abnormality of urinary tract

29
Q

Ectopic pregnancy: Sx

A
  • severe, increasing lower abd pain
  • pressure in rectum
  • nausea
  • skipped menses
  • breast tenderness
  • suprapubic tenderness, adenexal tenderness on exam
30
Q

Ectopic Pregnancy: DDx

A
  • UTI
  • PID
  • Nephrolithiasis
  • Endometriosis
  • Leiomyomata
  • Appendicitis
31
Q

Lab results ectopic pregnancy

A
  • hCG high - urine and serum
  • TVUS
32
Q

Tx of ectopic pregnancy

A

Short term: alleviate pain, prevent fallopian tube rupture, clarify Dx

Long term: preserve fertility

  • refer to OB/GYN
  • increased risk of tubal pregnancy in future
33
Q

BPH Sx

A
  • urinary frequency, urgency, hesitancy, weak stream. No pain. Getting worse
  • boggy prostate upon exam
34
Q

BPH DDx

A
  • urethral stricture
  • bladder neck contracture
  • carcinoma of bladder or prostate
  • bladder calculi
  • UTI and prostatitis
  • neurogenic bladder
35
Q

BPH labs / results

A
  • neg hemoccult
  • UA, C+S, urine cytology - r/o UTI
  • maybe PSA ( <4ng/mL = normal, >10 may be cancer, >40 advanced disease)
  • PV residual US?
36
Q

BPH Tx

A
  • Alpha blocker (terazosin, doxazosin, tamsulosin, alfusosin) 1st line, relieve obstructive sx
  • 5 alpha reductase inhibitor (finasteride, dutasteride) - sx relief takes 3-6mths, up to 12mths for full effect
  • PDE-5 inhibitor (sildenafil, tadalafil, vardenafil) -for erectile dysfunction, relaxes smooth muscle in bladder neck and urethra, penis muscle
  • NSAID (celecoxib 100mg QD) - increases peak urine flow
  • behavior management
37
Q

BPH - what are the two major problems?

A
  • Storage: frequency, urgency, nocturia, incontinence
  • Voiding: weak stream, post void dribbling, straining, hesitancy, incomplete emptying
38
Q

Ovarian cancer: labs

A

CA-125 +HE4 (in combo w/CA125 improved detection of ovarian ca)

39
Q

Pathogenesis of Bladder Pain Syndrome

A

little is known. Possibly abnormal bladder lining, e.g., after infection

Primary care of adults 2 (15 decks)

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