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SMUPASPG19-MED 1 > RENAL-Male GU > Flashcards

RENAL-Male GU Flashcards

1
Q

Pain Male GU

A

severe
Urinary tract obstruction

Inflammation -parenchyma of a GU organ
Pyelonephritis
Prostatitis
Epididymitis

Discomfort
Cystitis
Urethritis

GI- n/v/d, illeus

Tumor-painless
BUT…pain if obstruction or extends

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2
Q

Renal Pain

A

Ipsilateral CVA- lateral to the sacrospinalis muscle and beneath 12th rib

D/t-Acute distention of the renal capsule

DDX- irritation of the costal nerves, most commonly T10–T12

Not colicky/intermittent

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3
Q

Bladder Pain

A

overdistension

inlfammed

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4
Q

Prostatic Pain

A 
Inflammation 
distention capsule
Poorly localized
Lower abdominal
Inguinal
Perineal
Lumbosacral
Rectal pain
Irritative urinary sx  
Acute urinary retention
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5
Q

Penile Pain

A

Erecion d/t
Peyronie’s disease
priapism

Flaccid
inflammation bladder
urethra

Paraphimosis - cicumcised

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6
Q

Testicular Pain

A

Acute
Epididymitis
Torsion testicle

Chronic scrotal pain
Hydrocele, Varicocele
Dull, heavy, not radiate
Referred pain to kidneys or retroperitoneum

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7
Q

Lower Urinary Tract Symptoms

A 
Irritative Symptoms:
Urinary frequency
Nocturia
Dysuria
Incontinence
Stress
Urge
Obstructive Symptoms:
Decreased force 
hesitancy 
Intermittency/colic
Post void dribbling 
Straining
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8
Q

Infections

A

Urethral Discharge

Fever and Chills:
Pyelonephritis
Prostatitis
Epididymitis (acute)

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9
Q

PMH risk

A 
Systemic diseases:
Diabetes Mellitus 
Multiple Sclerosis
TB
Schistosomiasis

Family history
Prostate cancer
Stones (cystine)
Renal tumors (some types)

Surgical History

Cigarette smoking
bladder cancer
Erectile dysfunction

Chronic alcoholism
Impaired urinary fx
Sexual dysfunction
Testicular atrophy

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10
Q

Physical Examination

A 
General Observations 
Cachexia -Malignancy, TB
Jaundice or pallor 
Gynecomastia 
 Endocrinologic dz
 Alcoholism 
 Hormonal therapy

Kidney mass

Bladder- percuss MC
Bimanual-anestheia ideal

Penius-
hypospadius-ventral side (below glans spot)
epispadius-dorsal (above glans

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11
Q

Physical Examination- inferior

A

Scrotum and Contents
Painful:
Torsion
Epididymitis

Painless
Spermatocele
Hydrocele
Varicocele

Transillumination
Cystic (ligts up) vs solid
***Painless solid testicular mass is tumor until proven otherwise

Rectal and Prostate
Digital rectal examination (DRE):
Every male after age 50 years (controversial)
Men who present for urologic evaluation

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12
Q

BPH epidem

A

40-50% men aged 51-60 years
>80% men >80 years
Considerable disability
Low rate of mortality

Size/volume- prostate inc. w/ age and tone, Urinary flow dec.

Post void residual inc. d/t pressure on the urethra from prostate

Develops in the periurethral or transitional zone

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13
Q

Diagnosis of BPH

A 
Frequency
nocturia
hesitancy
urgency
weak stream (LUTS)
Sx progress gradually
Rule out 
UTI/Prostatitis,
urethral stricture, 
bladder or prostate cancer, 
bladder calculi, 
neurogenic bladder
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14
Q

Normal- smooth rubbery, firm, symmetrical

Evaluation for BPH

A

GU
DRE: Size, consistency, nodules (bladder), induration (infxn), symmetry
Neurologic exam- sphincter tone
UA-UTI/prostatitis- hematuria
Serum creatinine, blood glucose-Bladder outlet obstruction, renal/pre-renal dz, DM

Serum Prostate Specific Antigen (PSA)* >4.0 ng/mL prostate cancer

Total serum PSA, %free PSA ration:
% free PSA
LOW= prostate cancer,
HIGH= BPH

(Urology):Maximal urinary flow rate
<15 mL/sec indicates obstruction
Post void residual urine volume
>12 mL abnormal in men

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15
Q

Treatment of BPH MILD-SEVERE

A

MILD 0-7 AUA
Monitor
Treat symptoms
Prevention - behavior modification- no fluids past 7pm, avoid diuretics meds/food
Herbal-Saw palmetto (EU) plant extract, controversial
No- FDA, No standards

Severe >20
Transurethral resection of the prostate (TURP)
Standard

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16
Q

TX OF BPH MOD

A

Moderate BPH-combo no EVB, long therapy
DOC 1st- **α-1-adrenergic antagonists (terazosin, doxazosin)
helps outlet obstruction d/t tension of prostatic smooth muscle
NO change in volume
SE-orthostatic hypotension, start low 1-6wks titrate to TD

5-α-reductase inhibitors-(finasteride, dutasteride)
NO ED
Inhibit conversion of testosterone to dihydrotestosterone
Reduce size of the prostate
Side effects: decreased libido, erectile dysfxn
Decrease in serum PSA levels-

Phosphodiesterase (PDE-5) inhibitors
BPH with ED
Tadalafil (Cialis) approved by FDA for this purpose
also dec BP- Inc hypotensive effects of α-blockers

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17
Q

Erectile Dysfunction:

A

Inability to acquire or sustain erection
Impotence = symptoms >75% of the time

Normal Requires vascular, neurologic, hormonal, and psychological systems

Sexual competency - libido, erection, ejaculation and orgasm

ROS-Rapidity of onset
local trauma
Nocturnal or early morning erection
interpersonal conflict
PMH
Risk Factors
Cigarette smoking
Diabetes mellitus
Hypertension
Underlying cardiovascular disease
Hypogonadism 
Substance abuse
Obesity
Depression
18
Q

Erectile Dysfunction:Physical Examination

A 
CV, Neuro, GU exam
PV- pulses,  bruits
Breast: gynecomastia L
Abdomen: ascites
GU:  penile lesions, testicular atrophy, asymmetry or masses
Endocrine-
Acanthosis nigricans-DM, central obesity
Visual field defects if pituitary tumor
19
Q

Erectile Dysfunction:Treatment

A

Lifestyle modifications to reduce risk factors
Restore the capacity to acquire and sustain penile erection
Reactivation of libido
Medication

Penile self-injections
Vacuum erection devices
Penile prostheses

Medications
1st Phophodiesterase-5 inhibitors
Increase intracavernosal cyclic GMP levels to restore erectile function (vasoactive)
**caution in any patient with CV disease
**Contraindicated in patients taking nitrates and α-adrenergic antagonists (hypotension)

Psychogenic- SSRI’s

20
Q

Hypogonadism

A

Decrease in sperm and/or testosterone production
Primary: dz of testes
Secondary: dz. of pituitary or hypothalamus

S/S-dec. energy and libido, loss of body hair and muscle mass, infertility, gynecomastia, hot flashes, dec. bone density
obesity
aging;

Diagnosis: serum total testosterone
If low, repeat and order LH
Infertility eval: order semen analysis; if sperm count low, order FSH

Primary: testosterone and/or sperm count low, LH and/or FSH high

Secondary: testosterone and/or sperm count low, LH and/or FSH normal or low

Refer

21
Q

Hypogonadism Treatment i

A

androgen replacement therapy
Check PSA in men >50 yrs, Hct

Contraindications: prostate ca, severe OSA, Hct >50%, severe LUTS, uncontrolled CHF

ADE: inc PSA, worse BPH, erythrocytosis, worse OSA

FU: at 2-3 mos, then q 6-12 mo: Serum testosterone, serum LH if primary hypogonadism, Hct, PSA

22
Q

Varicocele

A

Collection of dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord
d/t increased venous pressure and incompetent valves

10-25% adolescents
L side

S/S- dull ache or fullness in scrotum on standing
“bag of worms” that increases with Valsalva or standing
Grade 1: small; palpable only with Valsalva
Grade 2: moderate; not visible on inspection, but palpable upon standing
Grade 3: large; visible on gross inspection

23
Q

Varicocele: Management

A

observation
Abnormal: if right sided, acute onset, or persist when supine
-Order Doppler US
- IVC obstruction (IVC thrombus, right renal vein thrombosis, abdominal mass)

Surgery:
Cosmetic
Pain
Infertility
Testicular Atrophy
Surgical ligation or testicular vein embolization
smaller than unaffected side
Bil
Grade 3
Scrotal pain is present
24
Q

Hydrocele

A

Fluid accumulation in the potential space of the tunica vaginalis d/t:
Peds: processus vaginalis not close
Adult: epididymitis, orchitis, testicular torsion, torsion of the appendix testis, tumor, or trauma

S/S
Soft, cystic, anterior scrotal mass
Communicating-increase during day disappear at night
Non communicating-do not change with straining
transilluminates to indicate fluid
Doppler US

TX-Treat underlying cause
Non-communicating- < 2 y is supportive care
Communicating risk for incarcerated inguinal hernia

Surgical repair child-> 2 y or if scrotum tense to improve blood flow to testicles

25
Q

Pt. Male dysuria, scotal , perineal pain. Fever, N, frequncy, hesitancy. DRE tender, boggy.

A

Prostatitis
Comman all ages. E.coli, Proteus, GC/Chlam, enters via urethra, bladder or epididymis. Trauma, dehydration, abstinence, catheter, structure

S/S- pelvic/scrotal, bladder, hematospermm, chills, malaise, myalgia. (FLUish), but pelvic pain, odor cloudy urine

DX- DRE-caution bacteremia
UA, culture, CBC, ESR, CRP

TX- 4-6wk, ABX, NSAIDs 2wk

26
Q

Pt w/ Prostatis has + Nitrites and Staph which ABX?

A

Cephalxin

27
Q

What is 1st line for Prostatisis?

A

floroquinolones- LEVO, MOX
Gram Neg and Pos
Empircally while waiting

28
Q

What ABX if M culture shows enteroccocus?

A

Ampicillin

29
Q

Pt now suffered from epidymitis… What other complications could occure?

A

Bacteremia
Prostatic abscess-drain
Chronic- Urology

Not common
Refer!

30
Q

Pt M c/o scotral pain. NO trauma, dc, urinary sx, no fever, no n/v. NO mass. PE- LEFT tender scotom. Lab- +UA. what is this?

A

Epididymitis
Subacute common d/t sex, exercise, bike, instrumentation.
Acute Rare infection, but serious-UTI PRostatiis.

DX- KEY PE tender induration. ,35y Chlamydia*, >35, MSM, E.coli, GC

31
Q

Pt young athlete, has acute diffuse pain

w/ high ridin testis (bell clapper, swelling INC. Negative Cremaster REfex? What is this TX?

A

Testicular Torsion

Surgery- Open the book

32
Q

Pt has subacute upper pole pain. Postive cremeaster reflex. Blue dot sign.

A

Appendix of testis necrotics

33
Q

Pt M c/o scotral pain. NO trauma, dc, urinary sx, no fever, no n/v. NO mass. PE- LEFT tender scotom. Lab- +Nitries UA. what TX?

A

Empirically while waiting
Nitirest- Ofloxacin or Levfloxacin

Ceftriaxone+#1Doxycycline (GC/C) x10d

RICE- NSAIDs
F/U

Febrile- IV ABX

34
Q

If PT has a NEG UA after 100mi bike ride…what is TX and cause?

A

2nd to reflux via ejaculatory ducts and vas.
Neg UA

TX-conservaive RICE
ABX Doxy (while waiting)
35
Q

M PT w/ thick d/c, dysuria, in developed US recent unprotected sex?

A

MC GU
or NGU
co-infectin w/ Chlalm 15-25%

36
Q

WHat is preffered test for GU of Urehriris and Cervicitis?

A

PCR- neutrophils sensitive 95% GC

Swab urethra hurts

37
Q

M PT w/ thick d/c, dysuria, in developed US recent unprotected sex, skin rash, swollen joint?

A

Dissmenitaed Gonorrhea

38
Q

What is 1st line of GU TX

A

NEVER Tetrcyclin, Cirp, or PCN- HIGH RESisistance

1-IM ceftriaxon
TX partner-AVOID sex 7d.]
Any uretritis treat for both GC and Chlamy

39
Q

What is the most common cause of urethritis and cervicitis?

A

NGU
Chlamydia Trachomatis
OIB
Reinfection common

s/s-ASX, gradual 50% sx 4d post incub 7-21D. MUCUS d/c

DX- PCR, genital culture

TX- AZI 1gm PO single
Ceftrixone

40
Q

What does Metronidazole TX? What are the ADRS

A

Trichomoniasis

TX- give emeitcs d/t N/V ADR

parasite flagella
Like w/ other STI
Preg, menses, sex
Also in M 70% of time

SMUPASPG19-MED 1 (27 decks)

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