Urologic disorders

Question 1

Acute polynephritis

Answer 1

subpubic, R/LLQ tenderness, burning w/ urination, CVA tenderness, concentrated urine, TNTC bacteria, WBC casts, left shift, pyuria, hematuria, possible blood culture positive

Question 2

Acute polynephritis treatment

Answer 2

first line: cipro 500 mg BID 7-10 days, could also use bactrim, macrolid+pyridium, do sensitivity test

Question 3

Complicating factors of acute polynephritis

Answer 3

pregnancy, age, high WBC, positivie culture, hydronephrosis

Question 4

Cystitis

Answer 4

bladder infection, common in women, dysuria, abd pain, nausea, irrative voiding, bacturia might not show up if entercoccus

Question 5

Treatment of cystitis

Answer 5

bactrim, Cipro, macrobid, pyridium

Question 6

Acute prostatitis

Answer 6

fever, irrative voiding, perineal/ subpubic pain, severe tenderness on rectal exam, leucocytosis, pyuria, bacteriuria, hematuria, ecoli and pseudomonas most common, could also be STD

Question 7

Acute prostatitis treatment

Answer 7

if high fever/ in severe pain, admit to hospital and give ampicillin and gentamycin until organism identified, if afebril, Levaquin 500 mg daily 4 wks, doxycycline may also be used, do not cath, suprapubic tube required to drain

Question 8

Orchitis

Answer 8

25% due to mumps, fever tachycardia, testicular swelling and tenderness is unilateral, pyuria, bacteriuria, pos cultures

Question 9

Treatment of Orchitis

Answer 9

if mumps- ice and analgesic, if bacteria- Cipro 500 mg BIDx12 days

Question 10

Epididymitis

Answer 10

retrograde infection through vas deferens, heaviness/dull/ache in scrotum, pain in scrotum, inguinal area and into flank on affected side, epididymis markedly swollen and tender to palpation, scrotal mass, phrehn’s sign

Question 11

Treatment of epididymitis

Answer 11

Ceftriaxone 250 mg IM, plus doxycyclin 100 mg bidx10 days, cipro 500 mg bidx14 days, ejaculation

Question 12

UTI preventative measures

Answer 12

urinate after sex, drink plenty of water, urinate often, dec caffiene, protected sex, wipe front to back

Question 13

Glomerulonephritis

Answer 13

damage to glomeruli by protein being deposited into glomerular membranes, 60% are 2-12yo, can be focal involves

Question 14

Focal causes

Answer 14

benign hematuria, henoch-schonlein, purpura, mild postinfections GN, Adults: IgA nephropathy, hereditary nephritis, IgA nephropathy, hereditary nephritis, SLE

Question 15

Diffuse causes

Answer 15

postinfections GN, membranoproliferative GN; Adults: SLE membranoproliferative GN, rapidly progressive GN, postinfectious GN, vasculitis

Question 16

GN symptoms

Answer 16

blood in urine or tea colored urine, dec or no urine output, swelling of face and eyes in morning and of feet and ankles in pm, HTN common, dec complement, abnormal RBCs

Question 17

GN treatment

Answer 17

steroids and immunosuppressive therapy, abx if due to PSGN, dietary management (dec Na and fluid), dialysis, ACEI, treat other medical conditions

Question 18

Nephrotic syndrome

Answer 18

excretion of 3.5g of protein per 1.73m in 24hr, manifests- hypoalbuminemia, lipiduria, hypercholesterolemia, edema, predisposing factors- thrombosis

Question 19

Causes of nephrotic syndrome

Answer 19

primary renal disease, secondary disease-drugs

Question 20

Nephrotic syndrome

Answer 20

malaise, bloating, anorexia, facial edema/puffy eyelids, dec urination, scrotal swelling, dyspnea, wt gain, ascites, edema, HTN, orthostatic hypoTN, retinal sheen, skin striae, foamy urine, proteinuria, hyperlipidemia

Question 21

Nephrotic syndrome treatment

Answer 21

dependent on cause and complications, usually use ACEI and diuretics, otherwise treatment of cause

Question 22

Acute tubular necrosis

Answer 22

AKI due to tubular damage, approx 85% of intrinsic AKI, caused by ischemia or nephrotoxin, P and K elevated, UA- brown, granular casts

Question 23

Nephrotoxins

Answer 23

Exogenous: aminoglycosides, amphotericin B, Vanco, IV acyclovir, cephalosporins, contrast; Endogenous: heme containing products, uric acid, paraproteins, myoglobinuria, bence jones protein

Question 24

Renal cell carcinoma

Answer 24

most common type of renal malignancy, more common in men, >55, black, unknown cause, linked to smoking, gross or microscopic hematuria, pain or abd mass, normocytic anemia, ESR inc

Question 25

What is diagnostic modality of choice for RCC

Answer 25

CT scan

Question 26

Treatment of RCC

Answer 26

radical nephrectomy based on furman grading, radiation therapy for palliation in pts w/ metastatic lesions

Question 27

Bladder CA

Answer 27

irritative voiding, painless hematuria, do cytoscopy, treatment- transurethral resection

Question 28

Nephrolithiasis

Answer 28

more common in males, calcium stone most common, unilateral back pain, renal colic that waxes and wanes, hematuria, dysuria, urinary frequency, fever, chills, nausea, vomiting; spiral CT w/out contrast

Question 29

Treatment of nephrolithiasis

Answer 29

stones10 impatient, ureteral stent or percutaneous nephrostomy

Question 30

5 classifications of incontinence

Answer 30

Urge, stress, overflow, functional, an dmixed

Question 31

Urge incontinence

Answer 31

results from bladder contraction that cannot be controlled by brain, common sx is strong desire to void, followed by loss of urine

Question 32

Stress incontinence

Answer 32

dysfunction of urethral sphincter, allowing urine to leak w/ inc intra-abd pressure, “sneezing”

Question 33

Overflow incontinence

Answer 33

urinary retention leads to bladder distention and overflow of urine through the urethra untreated can lead to hydronephrosis and obstructive nephropathy

Question 34

Functional incontinence

Answer 34

untimely urination caused by physical or cog disability, preventing the person from reaching the toilet

Question 35

Reversible causes of incontinence

Answer 35

SE of medications, recent prostatectomy, excess fluid, atrophic vaginitis, fecal impaction, UTI, impaired mobility, glycosuria

Question 36

Treatment of incontinence

Answer 36

kegels, electrical muscle stimulation, biofeedback, bladder training, pessaries, oxybutynin (Ditropan), and tolterodine (Detrol), estrogen, catherization

Question 37

Wilms tumor

Answer 37

account for 5-6% of tumors of kidney found in children, most common kidney tumor in children, curative if removed