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STEP 2 Cardio + Renal > Renal. Hydronephrosis+ BPH+ED (08-02) (1) > Flashcards

Renal. Hydronephrosis+ BPH+ED (08-02) (1) Flashcards

1
Q

FA. Hydronephrosis. definition? and mechanism?

A

dilation of the urinary tract.

Dilation is secondary to downstream obstruction of urinary tract.

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2
Q

FA. Hydronephrosis. causes in children 3

A

obstruction at the ureteropelvic junction

may also be at ureterovesicular junction

or at bladder outlet (eg from posterior urethral valves)

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3
Q

FA. Hydronephrosis. causes in adults?

A

BPH
aortic aneurysm

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4
Q

FA. Hydronephrosis. causes in both children and adult? 3

A

neurogenic bladder (spinal cord injuries), tumors, renal calculi.

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5
Q

FA. Hydronephrosis.
Apart from obstruction can be caused by excessively high out-put urinary flow and vesicoureteral reflux.

A

.

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6
Q

FA. Hydronephrosis.
Symptoms? 3

A

may be asymptomatic

may present with flank/back pain, abdominal pain, UTI

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7
Q

FA. Hydronephrosis.
Diagnosis? 2

A

UG or CT

seen dilation of renal pelvis, calyces, and/or ureter

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8
Q

FA. Hydronephrosis. treatment.
pediatric - some resolve spontaneusly

A

.

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9
Q

FA. Hydronephrosis. treatment. usual method?

A

surgically treated to correct anatomic obstruction or reflux

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10
Q

FA. Hydronephrosis. treatment for neurologic bladder?

A

can start a clean intermitent cath regimen for bladder emptying.

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11
Q

FA. Hydronephrosis. 2 surgical methods?

A

stent
percutaneous nephrostomy

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12
Q

FA. Hydronephrosis. when need catheter? 2 methods

A

Foley
or
suprapubic cath. may be required for lower urinary tract obstruction (eg BPH)

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13
Q

FA. BPH.
in what proc of male seen?

A

seen in > 80 proc by age of 80.

It is normal part of aging

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14
Q

FA. BPH. in what age most commonly occur?

A

> 50 y/o

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15
Q

FA. BPH. does it cause cancer?

A

NO

but can coexists together

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16
Q

FA. BPH.
what are obstructive symptoms?

A

hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness, acute urinary retention following surgery

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17
Q

FA. BPH.
Irritative symptoms?

A

nocturia, daytime frequency, urge incontinence, opening hematuria

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18
Q

FA. BPH. DRE?

A

uniformly enlarged with rubbery texture.
Suspect cancer if hard or irregular lesions.

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19
Q

FA. BPH. DRE. Why may not be detected?

A

BPH occurs in central zone (periurethral)

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20
Q

FA. BPH. what labs?

A

Urine culture and Urinalysis to rule out infection and hematuria.

PSA - would be increased, but the need contraversial.
Further workup needed if inc. BPH correlates with findings suggesting cancer.

Creatinine - to evaluate renal insuf. or obstructive uropathy.
+ do electrolytes if tubular dysfunction due to obstruction.

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21
Q

FA. table.
BPH risk factor?

A

age > 50

22
Q

FA. table.
prostate cancer risk factor?

A

age > 40, family history

23
Q

FA. table.
BPH zone affected?

A

central

24
Q

FA. table.
prostate cancer affected?

A

lateral lobe

25
Q

FA. table.
BPH zone DRE examination?

A

smooth symetrically enlarged

26
Q

FA. table.
Prostate cancer examination?

A

firms with nodules and asimmetrically enlarged

27
Q

FA. ED. what prevalence?

A

10-25 proc. in middle age men.

28
Q

FA. ED. classification?

A

failure to initiate
failure to fill
failure to store

29
Q

FA. ED.
failure to initiate - causes? 3

A

psychologic, endocrinologic, neurologic

30
Q

FA. ED. failure to fill cause 1?

A

arteriogenic

31
Q

FA. ED. failure to store cause?1

A

veno-occlusive dysfunction

32
Q

FA. ED. risk factors?

A

DM, atherosclerosis, drugs- BAB, SSRI, TCA, diuretics, hypertension, heart disease, surgery or radiation for prostate cancer, spinal cord injury.

33
Q

FA. ED.
initially - ask about risk factors, medications, psycho stressors.

A

.

34
Q

FA. ED.
distinction between psychologic vs oranic ED?

A

it is based on
Situational dependence (eg occurs with only one partner) and the presence of nocturnal or early mornin erections with penile tumescence testing (if presents, it is non organic)

35
Q

FA. ED. diagnosis?1

A

CLINICAL

36
Q

FA. ED. what evaluate initially? 2

A

neurologic dysfunction and for hypogonadism

neuro - anal tone, lower extremity sensations

hypog - small testes, loss of secondary sexual characteristics.

37
Q

FA. ED. neurologic evaluation?

A

anal tone, lower extremity sensations

38
Q

FA. ED. hypogonadism evaluation?

A

small testes, loss of secondary sexual characteristics

39
Q

FA. ED. other workup? 5

A

screening for DM and cardiovascular disease, measurement of TSH and testosterone
prolacting - elevated can resul in decr. androgen activity.

40
Q

FA. ED. key fact. innervation. erection?

A

PNS

41
Q

FA. ED. key fact. innervation. ejaculation?

A

SNS

42
Q

FA. ED. best initial treatment?

A

Psychologic cause - psychotherapy involving discussion and exercise with partner.

43
Q

FA. ED. drugs?

A

p/os
sildenafil, vardenafil, tadalafil

44
Q

FA. ED. drugs what group and mechanism?

A

PDE-5 inhibitors, that prolong action of cGMP-mediated smooth muscle relaxation and inc. blood flow to corpora cavernosa.

45
Q

FA. ED. drugs contraindicated with what?

A

nitrates

46
Q

FA. ED. in what case give testosterone?

A

useful if hypogonadism of testicular or pituitary origin

dont use if normal testosterone levels

47
Q

FA. ED. what treatment if PDE5 fails or contraindicated? many methods

A

vacuum pumps, intracavernosal injections of prostaglandins, surgical implantation of semirigid or inflatable penil prostheses.

48
Q

FA. BPH. treatment.
INITIAL medical?

A

a-blockers (tamsulosin, terazosin) -relax smooth muscles in prostate and bladder neck

49
Q

FA. BPH. treatment.
SECONDARY medical?

A

5alfa reductase inhibitors (finasteride) - inhibits production of dihydrotestosterone

50
Q

FA. BPH. treatment. surgical?
for what patients

A

TURP, open, laparoscopic, robotic ,,simple prostatectomy”

moderate to severe symptoms/complications (renal insuf, recurent UTI, bladder stones)

51
Q

FA. BPH. treatment. in case of bladder obstruction?

A

urgent catheterization while waiting more definitive management.

STEP 2 Cardio + Renal (26 decks)

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