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Internal Med EOR > Urology 1 > Flashcards

Urology 1 Flashcards

1
Q

mnemonic anion gap metabolic acidosis

A

MUDPILERS

Methanol
Uremia
DKA/alcoholic KA
Propylene glycol
Isoniazid, infection
Lactic Acidosis
Ethylene glycol
Rhabdo/renal failure
Salicylates (presents w respiratory alkalosis then progresses to metabolic acidosis)

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2
Q

non-gap metabolic acidosis mnemonic

A

HARDUPS

Hyperalimentation
Acetozolamide
Renal tubular acidosis
Diarrhea
Uretero-pelvic shunt
Post-hypocapnia
Spironolactone

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3
Q

mnemonic acute respiratory acidosis

A

CHAMPP

CNS depression
Hemo/Pneumothorax
Airway obstruction
Myopathy
Pneumonia
Pulmonary edema

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4
Q

mnemonic metabolic alkalosis

A

CLEVER PD

Contraction
Licorice
Endo (Conn’s Cushing’s)
Vomiting
Excess alkali
Refeeding alkalosis
Post-hypercapnia
Diuretics

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5
Q

mnemonic respiratory alkalosis

A

CHAMPS

CNS disease
Hypoxia
Anxiety
Mech Ventilators
Progesterone
Salicylates/Sepsis

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6
Q

normal pH

A

7.35-7.45

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7
Q

normal PCO2

A

35-45 mmHg

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8
Q

normal HCO3-

A

22-26 mEq/L

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9
Q

risk factors for cystitis /UTI

A

women - sexual intercourse
pregnancy
elderly and postmenopausal
infants

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10
Q

MC cause of cystitis

A

E coli mc
staphylococcus saphrophyticus 2nd most common

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11
Q

dx cystitis

A

UA - pyuria (>10 WBCs/hpf), hematuria, leukocyte esterase, nitrites

Urine culture - definitive; needs to be clean catch; epithelial/squamous cells = contamination; may show >/= 1000 CFU/mL ur-pathogens

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12
Q

tx cystitis

A

1st line - nitrofurantoin or TMP-SMX or fosfomycin
2nd line - fluoroquinolone (Cipro or levofloxacin)

adjunct: phenazopyridine is a bladder analgesic –> turns urine orange

no tx if asx unless pregnancy

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13
Q

MC pathogen in pyelonephritis

A

E coli

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14
Q

Risks pyelo

A

DM
Recurrent UTIs/kidney stones
pregnancy
urinary tract malformations

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15
Q

sx pyelo

A

fever, chills, back/flank pain, nausea and vomiting

dysuria, urgency, frequency

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16
Q

PE pyelo

A

CVA tenderness, fever, tachycardia

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17
Q

dx pyelo

A

UA: pyuria > 10 WBCs/hpf, leukocyte esterase, nitrites, WBC CASTS!!!

urine culture - defintiive

CBC - leukocytosis w left shift

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18
Q

tx pyelo

A

fluoroquinolone - levo or Cipro

pregnancy - IV ceftriaxone

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19
Q

MC causes of prostatitis

A

> 35 - E coli
< 35 - chlamydia and gonorrhea

kids - mumps

chronic - e coli

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20
Q

sx prostatitis

A

frequency, urgency, dysuria,

hesitancy, poor or interrupted stream, straining

acute - spiking fever, chills, perineal pain

chronic - recurrent UTIs or intermittent dysfunction

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21
Q

PE prostatitis

A

boggy (firm, edematous) prostate

acute - exquisitely tender, boggy

chronic - nontender, boggy

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22
Q

dx prostatitis

A

pyuria and bacteriuria in acute; often negative in chronic
avoid prostatic massage –> bacteremia

23
Q

tx prostatitis

A

acute > 35 - fluoroquinolone or TMP-SMX

Acute < 35 or STI likely - ceftriaxone plus doxy (azithromycin alternative to doxy)

refractory - transurethral resection of prostate

24
Q

causes of epididymitis

A

males 14-35 - chlamydia (MC) or neisseria

men > 35 - E coli

25
Q

sx epididymitis

A

gradual onset (few hours –> days) of localized testicular pain and swelling

26
Q

PE epididymitis

A

positive prehn sign - relief of pain w scrotal swelling
positive (normal) cremasteric reflex - elevation of testicle after stroking inner thigh

27
Q

dx epididymitis

A

scrotal US best initial - enlarged epididymis and increased testicular blood flow; rules out testicular torsion

UA - pyuria, positive leukocyte esterase, bacteriuria

NAAT for gonorrhea and chlamydia

28
Q

tx epididymitis

A

< 35 or STI likely - cover chlamydia and gonorrhea - doxycycline plus ceftriaxone

anal intercourse - ceftriaxone plus fluoroquinolone

> 35, low risk STI - fluoroquinolone (Cipro or levo)

29
Q

risk testicular torsion

A

adolescents 10-20 years and neonates at highest risk

true urologic emergency

30
Q

sx testicular torsion

A

abrupt onset of moderate to severe scrotal, inguinal, or lower abdominal pain

nausea or vomiting –> torsion

31
Q

PE testicular torsion

A

swollen, tender retracted testicle (high-riding)

negative prehn sign - no relief w scrotal elevation
negative (absent) cremasteric reflex on affected side - no elevation in testicle after stroking inner thigh

32
Q

dx testicular torsion

A

clinical

surgical exploration - definitive

testicular doppler US - most commonly used imaging; decreased or absent testicular blood flow

33
Q

tx testicular torsion

A

surgical exploration w urgent detorsion and orchiopexy ideally within 6 hours of pain onset

orchiectomy if testicle is not salvageable

34
Q

hydrocele

A

serous fluid within the parietal and visceral layers of the tunica vaginalis which directly surrounds the testis and spermatic cord

35
Q

what is the MC cause of painless scrotal swelling

A

hydrocele

36
Q

type of hydrocele

A

communicating - peritoneal/abdominal fluid enters the scrotum via a patent processus vaginalis that failed to close

noncommunicating - derived from fluid from the mesothelial lining of the tunica vaginalis (no connection to peritoneum)

37
Q

sx hydrocele

A

painless scrotal swelling - may increase throughout the day

may complain of heavy sensation

38
Q

PE hydrocele

A

translucency - scrotal sac transilluminates well

swelling worse w valsalva if communicating

39
Q

dx hydrocele

A

testicular US - rules out tumor, masses, epididymitis, orchitis

40
Q

tx hydrocele

A

watchful waiting - resolves within 12 months of life in infants; self-limited in adults

surgical excision after 1 year

41
Q

spermatocele and epididymal cyst

A

epididymal cyst (scrotal mass) that contains sperm

spermatocele if > 2 cm or larger

42
Q

sx spermatocele/epididymal cyst

A

painless mass

43
Q

PE spermatocele/epididymal cyst

A

round soft mass in head of epidermis superior, posterior and separate from testicle

freely movable

transilluminates

44
Q

tx spermatocele/epididymal cyst

A

no tx

45
Q

varicocele

A

cystic testicular mass of varicose veins - pampiniform venous plexus and internal spermatic vein

46
Q

what is the MC surgically correctable cause of male infertility

A

varicocele

47
Q

why are most varicoceles left sided

A

increased left renal vein pressure transmitted to left gonadal vein bc it enters theft renal vein at a perpendicular angle

48
Q

sx varicocele

A

asx
testicular atrophy
usually painless
may have dull ache/heaviness

49
Q

PE varicocele

A

soft scrotal mass w a bag of worms feel superior to the testicle
dilation worsens w patient upright or w valsalva

50
Q

dx varicocele

A

clinica
US - dilation of pampiniform plexus > 2 mm

51
Q

tx varicocele

A

observation

surgery if pain, infertility, delayed testicular growth

52
Q

right sided varicocele associations

A

retroperitoneal or abdominal malignancy

53
Q

left sided varicocele associations

A

left sided varicocele in an older man may be due to renal cell carcinoma

54
Q
A

Internal Med EOR (17 decks)

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