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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
Q

How do you use the AUA symptom scale?

A

have pt fill out questionairre; 0-7 = mild, 9-19 = moderate, 20-35 = severe

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26
Q

What are the respective effects of alpha Receptor inhibitors and 5 ARIs in tx of BPH?

A

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)

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27
Q

What are the main pharm agents for tx of overactive bladder sx?

A

anticholinergics

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28
Q

When would you do surgery to tx BPH?

A

second line therapy done after a trial of medical therapy that has failed

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29
Q

why should you take a genitourinary family hx?

A

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)

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30
Q

How effective are DRE and PSA at detecting prostate cancer?

A

DRE = 3.2% detection

PSA = 4.6%

combined = 5.8%

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31
Q

How should you use DRE and PSA?

A

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

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32
Q

What is the difference btw UTI and ASB?

A

ASB = asymptomatic bacteruria

dont have to tx this w/ antibiotics

tx UTI bc this implies it is symptomatic

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33
Q

What makes the dx and tx of cystitis ambiguous?

What is the main distinguishing factor btw cystitis and pyelonephritis?

A

many elderly pts can’t mount a fever response

fever is the main distinguishing factor btw cystitis and pyelonephritis - fever in kidney infxn

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34
Q

What is emphysematous pyelonephritis?

A

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

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35
Q

What is xanthogranulomatous pyelonephritis?

A

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
Q

When should an intraparenchymal kidney abscess be suspected?

A

when a pt has continued fever and/or bacteremia despite antibacterial therapy

37
Q

What can bethe first indication of rare bilateral papillary necrosis?

A

rapid rise in serum creatinine

38
Q

which is more common, bacterial prostatitis or chronic pelvic pain syndrome?

A

chronic pelvic pain syndrome is much more common

39
Q

How can heart failure lead to nocturia?

A

reduced renal perfusion during the day when pt upright –> normalizes only at night when pt is supine –> consequent diuresis

40
Q

What are the essentials of diagnosis of urinary stones?

A

severe flank pain

nausea and vomiting

ID of stone on non-contrast CT scan or U/S

41
Q

What are most urinary stones like?

A

85% contain calcim and are radiopaque

uric acid stones are radiolucent

42
Q

What are hyperoxaluric calcium stones due to?

A

primary intestinal disorders, including chronic diarrhea, inflammatory bowel dz, or steatorrhea

43
Q

What cause hypocitraturic calcium stones?

A

secondary to disorders associated w/ metabolic acidosis including chronic diarrhea, typ I tubular acidosis, and long-term thiazide tx

44
Q

What are the contributing factos to uric acid calculi?

A

low urinary pH

myeloproliferative disorders

malignancy w/ increased uric acid production

abrupt and dramatic weight loss

uricosuric medications

45
Q

What is the urine pH in struvite calculi?

A

7.2 or greater

46
Q

What stones are suggested by peristent urinary pH < 5.5?

A

uric acid

or cystine

47
Q

What is the most accurate imaging tool to evaluate pyelonephritis?

A

spiral CT

(plain film and renal u/s also work, but most ED docs will choose CT)

48
Q

How do you prevent urinary stones?

A

increase fluid intake to void 1.5-2.0 L/day to reduce stone recurrence

reduce sodium intake

reduce animal protein intake

49
Q

When do you admit someone w/ a urinary stone?

A

intractable nausea/vomiting or pain

obstructing stone w/ signs of infection (consult urology asap)

50
Q

What are the usual and unusual causes of acute bacterial prostatitis?

A

usual: E coli and pseudomonas
unusual: enterococcus

51
Q

What do you see on labs in acute bacterial prostatitis?

A

CBC: leukocytosis and left shift

Urinalysis: pyuria, bacteriuria, hematuria

urine culture: positive

52
Q

What are your medication options for tx of acute bacterial prostatitis?

A

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

ciprofloxacin BID for 21 days

ofloxacin BID for 21 days

trimethoprim-sulfamethoxazole BID for 21 days (increasing resistance noted)

53
Q

What is the first step in management if a pt presents to you with red or brown urine?

A

must confirm gross hematuria with centrifuge unless sx are strongly suggestive

54
Q

Should pts be routinely screened for microscopic hematuria?

A

no, US Preventive Health Services Task Force does not recommend it

55
Q

What is the relationship of microscopic hematuria to bladder cancer?

A

low predictive value, even in high-risk elderly pts

no evidence that early detection improves prognosis

56
Q

If there is a positive supernatant for hemoglobin by urine dipstick, what are the ddx?

A

hemoglobinuria (intravascular hemolysis)

myoglobinuria (breakdown of skeletal muscle)

57
Q

If there is negative gross hematuria, neg hemoglobin, but positive red, brown or black supernatant, what are your ddx?

A

red: beet or blackberry, drugs (rifampin, sulfa, thiazines)

brown or black: liver dz, acute porphyria, ochronosis, melanoma

58
Q

what is the definition of gross hematuria?

A

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
Q

What is the definition of microscopic hematuria?

A

2-3 RBCs per high-power field on urine microscopy

60
Q

What are the 3 highlighted Ddxs for hematuria?

A

renal cell carcinoma

glomerulonephritis

medullary sponge kidney

61
Q

What are risk factors for bladder cancer?

A

smoking

occupational exposure to chemicals

heavy phenacetin use

past tx w/ high dose cyclophosphamide

aristolochic acid found in some herbal weight-loss preparations

62
Q

What should you consider with hematuria in pts on anticoagulants?

A

shouldn’t be attributed solely to the anticoagulant

63
Q

How can hematuria be related to dysuria?

A

blood in urine can be an irritant –> can cause dysuria even in the absence of UTI or kidney stone

64
Q

What should be considered with hematuria in older men?

A

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
Q

what upper UTI microbe can cause hematuria?

A

schistosoma haematobium

66
Q

What are alarm sx associated w/ hematuria?

A

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
Q

What can a hx of irregular heartbeat and hematuria suggest?

A

renal embolus from atrial fibrillation

68
Q

What can a hx of nephrotic syndrome and hematuria suggest?

A

renal vein thrombosis

69
Q

What do visible blood clots within bloody urine suggest?

A

never due to a glomerular cause

indicate lower urinary tract source of hematuria

70
Q

What pivotal points help distinguish glomerular hematuria from non-glomerular causes?

A

dysmorphic RBCs

red cell casts

new or acutely worsening HTN or proteinuria

increased creatinine

71
Q

What are the essentials of dx of renal cell carcinoma?

A

gross or microscopic hematuria

flank pain or mass

systemic sx (fever, weight loss, etc)

solid renal mass on imaging

72
Q

What are the best imaging studies to detect renal cell carcinoma?

A

CT and MRI - confirm character of the mass, stage the lesion

73
Q

What are the prognosis of T1-4 renal cell carcinomas?

A

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
Q

What is the highlighted familial syndrome with renal cell carcinoma?

A

Von Hippel-Lindau syndrome

(autosomal dominant, see tumors in many places in the body)

75
Q

What can IgA nephropathy be secondary to?

A

hepatic cirrhosis

celiac dz

HIV infection

cytomegalovirus infection

76
Q

What is the most common primary glomerular dz in the world, esp in Asia?

Who gets it and what is the classic presentation?

A

IgA nephropathy

usually occurs in kids and young adults, males 2-3x more than females

episodic gross hematuria during URIs

77
Q

What do you see on IF in IgA nephropathy?

A

mesangial IgA and C3 deposits

78
Q

What intrisic kidney dzs most commonly present as gross hematuria?

A

IgA nephropathy

cyst rupture in ADPKD

79
Q

What tests confirm IgA nephropathy?

A

serum IgA elevated in 50% of pts

dx confirmed by IgA deposits in mesangium on renal biopsy

80
Q

What is the Oxford IgA nephropathy MEST classification?

A

standardized diagnosis tool for IgA nephropathy

Mesangial hypercellularity

Endocapillary hypercellularity

Segmental glomerulosclerosis

Tubular atrophy/ interstitial fibrosis

81
Q

What genetics cause medullary sponge kidney (MSK)?

A

autosomal dominant mutations in:

MCKD1 on chr 1

MCKD2 on chr 16

82
Q

Where are the cysts in MSK?

A

medullary and interpapillary collecting ducts`

83
Q

How does MSK present?

A

gross or microscopic hematuria, recurrent UTIs, or nephrolithiasis

often found indidentally

84
Q

What are common abnormalities/complications of MSK?

A

decreased urinary concentrating ability

nephrocalcinosis

85
Q

What do you see on CT of MSK?

A

cystic dilation of distal collecting tubules

striated appearance in this area

calcifications in collecting sys

86
Q

What imaging in the past and present detects MSK?

A

in the past, often made by IV pyelography

now CT urography has replaced, but its not as sensitive in detecting MSK

87
Q

What kind of kidney stones are increased in freq in MSK (medullary sponge kidney)?

A

calcium phosphate

calcium oxalate

CPR-2 (28 decks)

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