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CPR-2 > Tyler Pee Stuff DSAs + CIS > Flashcards

Tyler Pee Stuff DSAs + CIS Flashcards

1
Q

What defines nocturia?

A

getting up to urinate more than 2x a night

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2
Q

What is the definition of urinary incontinence?

A

inability to control the urine flow

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3
Q

what are the 3 main cuases of nocturnal polyuria?

A
  1. age-related delay in urine excretion
  2. peripheral edema
  3. Medications (gabapentin, pregabalin, thiazolinediones, NSAIDs, CCBs)
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4
Q

What 5 meds are associated w/ nocturnal polyuria?

A

gabapentin

pregabalin

thiazolidinediones

NSAIDs

CCBs

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5
Q

What are internal and external dysuria?

A

internal: localized to the internal genital structures (urethra, bladder, suprapubic area)

external: localized to external genital structures (labia minora and majora) and occurs as urine exits the body

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6
Q

What is a complicated UTI?

A

UTI in individuals w/ functional or structural abnormalities of the urinary tract

at higher risk of tx failure

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7
Q

What is stress incontinence?

A

leakage of urine upon coughing, sneezing, or standing

due to urethral incompetence

common in older men - can be due to prostatic enlargement, urethral stricture, bladder neck contracture, or prostate cancer

in women - cystoceles or other anatomic problems

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8
Q

What is urge incontinence?

A

urgency and inability to delay urination

due to detrusor overactivity

most common cause of geriatric incontinence, usually idiopathic

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9
Q

What is overflow incontinence?

A

variable presentation

involuntary loss of urine caused by detrusor underactivity

idiopathic or due to sacral lower motor nerve dysfunction

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10
Q

What are the transient causes of urinary incontinence?

A

DIAPPERS

Delirium

Infection

Atrophic urethritis and vaginitis

Pharmaceuticals

Psychological factors

Excess urinary output caused by diuretics, excess fluid intake, metabolic abnormalities, peripheral edema

Restricted mobility

Stool impaction

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11
Q

What is DHIC?

A

detrusor hyperactivity with incomplete contractions

subtype of urge incontinence that can present with urgency w/ incomplete bladder emptying

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12
Q

Who gets stress incontinence most often?

A

women

(can be seen in men following prostatectomy)

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13
Q

What are sx of urethral obstruction?

A

dribbling, urge incontinence, and overflow incontinence

detrusor overactivity (coexists in 2/3 of cases) may cause sx of urgency

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14
Q

What distinguishes detrusor underactivity from detrusor overactivity and stress incontinence?

A

elevated post-void residual

generally over 450 mL

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15
Q

What are signs and sx of atrophic urethritis and vaginitis?

A

vaginal mucosal friability

erosions

telangiectasia (thread-like red lines on mucosa due to dilated small vessels)

petechiae

erythema

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16
Q

what lab tests should you run to evaluate incontinence?

A

review medications

check urinalysis and urine culture

consider tests for hyperglycemia, hypercalcemia, diabetes insipidus

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17
Q

What diagnostic test do you do for stress incontinence?

A

have pt relax her perineum and cough once while standing w/ full bladder

instant leakage –> stress incontinence if urinary retention has been excluded by postvoid residual determination using ultrasound

delay of several seconds or persistent leakage –> problem is caused by an uninhibited bladder contraction induced by coughing

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18
Q

What diagnostic procedures should you do for detrusor overactivity/urge incontinence and why?

A

detrusor overactivity may be due to bladder stones or tumor

if abrupt onset, esp if accompanied by perineal or suprapubic discomfort or sterile hematuria –> do cystoscopy and cytologic exam of the urine

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19
Q

What is the difference btw prostate hypertrophy and hyperplasia and its clinical management?

A

hypertrophy tends to have more malignant potential

hyperplasia tends to be more benign

ensure no cancer –> Sx management

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20
Q

What is the significance in tx choice of prostate cancer?

A

prostate cancer is super common in old men

always do risk benefit - are they going to die of this cancer or are there other co-morbidities that make the cancer less significant?

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21
Q

What are the two things that contribute to LUTS sx in BPH?

A

both size of prostate and also age-related detrusor dysfunction

“I like to think of the size of the bagel up someon’s butt vs the ability for them to adequately squeeze out pee” - Dr. Tyler

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22
Q

What are urine flow studies, bladder US, and Pressure-flow studies used for in BPH management?

A

urine flow studies: can ID those with normal flow rates who are unlikely to benefit from tx

bladder U/S: can id those w/ high postvoid residuals who may need intervention

pressure-flow (urodynamic) studies: detect primary bladder dysfunction

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23
Q

when would you do a cystoscopy in BPH/ LUTS sx?

A

if ther is hematuria

to assess urinary outflow tract before surgery

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24
Q

What are LUTS?

A

urinary frequency, urgency, retention, and incontinence

trouble starting urine stream

weak or interrupted stream

dribbling at end of urination

nocturia

pain after ejaculation or during urination

urine w/ unusual color or smell

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25
How do you use the AUA symptom scale?
have pt fill out questionairre; 0-7 = mild, 9-19 = moderate, 20-35 = severe
26
What are the respective effects of alpha Receptor inhibitors and 5 ARIs in tx of BPH?
Alpha blockers: tx dynamic aspect of BPH by reducing sympathetic tone of bladder outlet 5 ARIs: treat static aspect by reducing prostate volume; delayed effect (often used in combo to tx sx and delay progression)
27
What are the main pharm agents for tx of overactive bladder sx?
anticholinergics
28
When would you do surgery to tx BPH?
second line therapy done after a trial of medical therapy that has failed
29
why should you take a genitourinary family hx?
risk of being dx w/ prostate cancer increases 2.5-fold if one 1st degree relative is affected fivefold if two or more are affected (estimated 40% of early onset and 5-10% of all prostate cancers are hereditary)
30
How effective are DRE and PSA at detecting prostate cancer?
DRE = 3.2% detection PSA = 4.6% combined = 5.8%
31
How should you use DRE and PSA?
do not measure PSA in asymptomatic men with a short life expectancy DRE and PSA not recommended in routine screening determine risk for BPH and prostate cancer before getting PSA for men w/ PSA of 4-7, refer to urology if sx score is moderate to severe
32
What is the difference btw UTI and ASB?
ASB = asymptomatic bacteruria dont have to tx this w/ antibiotics tx UTI bc this implies it is symptomatic
33
What makes the dx and tx of cystitis ambiguous? What is the main distinguishing factor btw cystitis and pyelonephritis?
many elderly pts can't mount a fever response fever is the main distinguishing factor btw cystitis and pyelonephritis - fever in kidney infxn
34
What is emphysematous pyelonephritis?
severe form of dz associated w/ production of gas in renal and perinephric tissues occurs almost exclusively in diabetic pts often found thru U/S
35
What is xanthogranulomatous pyelonephritis?
occurs when chronic urinary obstruction (often by staghorn calculi), together w/ chronic infection, leads to suppurative destruction of renal tissue residual tissue is often yellow w/ infiltration by lipid-laden macrophages
36
When should an intraparenchymal kidney abscess be suspected?
when a pt has continued fever and/or bacteremia despite antibacterial therapy
37
What can bethe first indication of rare bilateral papillary necrosis?
rapid rise in serum creatinine
38
which is more common, bacterial prostatitis or chronic pelvic pain syndrome?
chronic pelvic pain syndrome is much more common
39
How can heart failure lead to nocturia?
reduced renal perfusion during the day when pt upright --\> normalizes only at night when pt is supine --\> consequent diuresis
40
What are the essentials of diagnosis of urinary stones?
severe flank pain nausea and vomiting ID of stone on non-contrast CT scan or U/S
41
What are most urinary stones like?
85% contain calcim and are radiopaque uric acid stones are radiolucent
42
What are hyperoxaluric calcium stones due to?
primary intestinal disorders, including chronic diarrhea, inflammatory bowel dz, or steatorrhea
43
What cause hypocitraturic calcium stones?
secondary to disorders associated w/ metabolic acidosis including chronic diarrhea, typ I tubular acidosis, and long-term thiazide tx
44
What are the contributing factos to uric acid calculi?
low urinary pH myeloproliferative disorders malignancy w/ increased uric acid production abrupt and dramatic weight loss uricosuric medications
45
What is the urine pH in struvite calculi?
7.2 or greater
46
What stones are suggested by peristent urinary pH \< 5.5?
uric acid or cystine
47
What is the most accurate imaging tool to evaluate pyelonephritis?
spiral CT (plain film and renal u/s also work, but most ED docs will choose CT)
48
How do you prevent urinary stones?
increase fluid intake to void 1.5-2.0 L/day to reduce stone recurrence reduce sodium intake reduce animal protein intake
49
When do you admit someone w/ a urinary stone?
intractable nausea/vomiting or pain obstructing stone w/ signs of infection (consult urology asap)
50
What are the usual and unusual causes of acute bacterial prostatitis?
usual: E coli and pseudomonas unusual: enterococcus
51
What do you see on labs in acute bacterial prostatitis?
CBC: leukocytosis and left shift Urinalysis: pyuria, bacteriuria, hematuria urine culture: positive
52
What are your medication options for tx of acute bacterial prostatitis?
**IV ampicillin and an aminoglycoside** until afebrile for 24-48 hrs, then **oral quinolone** for 4-6 weeks **ampicillin**, 1 g IV every 6 hours, **gentamicin** 1 mg/kg IV **every 8 hrs for 21 days** **cipro**floxacin BID for 21 days **ofloxacin** BID for 21 days **trimethoprim-sulfamethoxazole** BID for 21 days (increasing resistance noted)
53
What is the first step in management if a pt presents to you with red or brown urine?
must confirm gross hematuria with centrifuge unless sx are strongly suggestive
54
Should pts be routinely screened for microscopic hematuria?
no, US Preventive Health Services Task Force does not recommend it
55
What is the relationship of microscopic hematuria to bladder cancer?
low predictive value, even in high-risk elderly pts no evidence that early detection improves prognosis
56
If there is a positive supernatant for hemoglobin by urine dipstick, what are the ddx?
hemoglobinuria (intravascular hemolysis) myoglobinuria (breakdown of skeletal muscle)
57
If there is negative gross hematuria, neg hemoglobin, but positive red, brown or black supernatant, what are your ddx?
red: beet or blackberry, drugs (rifampin, sulfa, thiazines) brown or black: liver dz, acute porphyria, ochronosis, melanoma
58
what is the definition of gross hematuria?
presence of blood in the urine in sufficient quantity to be visible to naked eye 95% of clinicians will only recognize when \> 3500 RBCs per high-power field
59
What is the definition of microscopic hematuria?
2-3 RBCs per high-power field on urine microscopy
60
What are the 3 highlighted Ddxs for hematuria?
renal cell carcinoma glomerulonephritis medullary sponge kidney
61
What are risk factors for bladder cancer?
smoking occupational exposure to chemicals heavy phenacetin use past tx w/ high dose cyclophosphamide aristolochic acid found in some herbal weight-loss preparations
62
What should you consider with hematuria in pts on anticoagulants?
shouldn't be attributed solely to the anticoagulant
63
How can hematuria be related to dysuria?
blood in urine can be an irritant --\> can cause dysuria even in the absence of UTI or kidney stone
64
What should be considered with hematuria in older men?
gross or micro hematuria are more likely to be due to a GU malignancy diagnostic eval should be pursued even in the presence of sx suggesting BPH
65
what upper UTI microbe can cause hematuria?
schistosoma haematobium
66
What are alarm sx associated w/ hematuria?
increased age + male sex --\> cancer constitutional sx --\> cancer or chronic infection personal and social hx risks --\> cancer pos fam hx of deafness or renal dz --\> familial dz (alport syndrome)
67
What can a hx of irregular heartbeat and hematuria suggest?
renal embolus from atrial fibrillation
68
What can a hx of nephrotic syndrome and hematuria suggest?
renal vein thrombosis
69
What do visible blood clots within bloody urine suggest?
never due to a glomerular cause indicate lower urinary tract source of hematuria
70
What pivotal points help distinguish glomerular hematuria from non-glomerular causes?
dysmorphic RBCs red cell casts new or acutely worsening HTN or proteinuria increased creatinine
71
What are the essentials of dx of renal cell carcinoma?
gross or microscopic hematuria flank pain or mass systemic sx (fever, weight loss, etc) solid renal mass on imaging
72
What are the best imaging studies to detect renal cell carcinoma?
CT and MRI - confirm character of the mass, stage the lesion
73
What are the prognosis of T1-4 renal cell carcinomas?
T1-T2 confined to renal capsule = 5 yr dz-free survival of 90-100% T3-T4: extending beyond capsule = 50 - 60%; node-positive = 0-15% Solitary resectable mets w/ radical nephrectomy and resection of mets = 15-30% 5 yr dz-free survival
74
What is the highlighted familial syndrome with renal cell carcinoma?
Von Hippel-Lindau syndrome (autosomal dominant, see tumors in many places in the body)
75
What can IgA nephropathy be secondary to?
hepatic cirrhosis celiac dz HIV infection cytomegalovirus infection
76
What is the most common primary glomerular dz in the **world**, esp in Asia? Who gets it and what is the classic presentation?
IgA nephropathy usually occurs in kids and young adults, males 2-3x more than females episodic gross hematuria during URIs
77
What do you see on IF in IgA nephropathy?
mesangial IgA and C3 deposits
78
What intrisic kidney dzs most commonly present as gross hematuria?
IgA nephropathy cyst rupture in ADPKD
79
What tests confirm IgA nephropathy?
serum IgA elevated in 50% of pts dx confirmed by IgA deposits in mesangium on renal biopsy
80
What is the Oxford IgA nephropathy MEST classification?
standardized diagnosis tool for IgA nephropathy Mesangial hypercellularity Endocapillary hypercellularity Segmental glomerulosclerosis Tubular atrophy/ interstitial fibrosis
81
What genetics cause medullary sponge kidney (MSK)?
autosomal dominant mutations in: MCKD1 on chr 1 MCKD2 on chr 16
82
Where are the cysts in MSK?
medullary and interpapillary collecting ducts`
83
How does MSK present?
gross or microscopic hematuria, recurrent UTIs, or nephrolithiasis often found indidentally
84
What are common abnormalities/complications of MSK?
decreased urinary concentrating ability nephrocalcinosis
85
What do you see on CT of MSK?
cystic dilation of distal collecting tubules striated appearance in this area calcifications in collecting sys
86
What imaging in the past and present detects MSK?
in the past, often made by IV pyelography now CT urography has replaced, but its not as sensitive in detecting MSK
87
What kind of kidney stones are increased in freq in MSK (medullary sponge kidney)?
calcium phosphate calcium oxalate

CPR-2 (28 decks)

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