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EOR - Family Med > Urology > Flashcards

Urology Flashcards

1
Q

pain, redness, and a foul-smelling discharge from under the foreskin of penis

A

Balanitis

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2
Q

Tx of balanitis

A

Topical antifungal agents: clotrimazole 1% or miconazole 2%, each applied twice daily for one to three weeks

For suspected anaerobic infection: metronidazole 0.75% applied twice daily for seven days
In extreme cases, the foreskin may need to be removed (circumcision)

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3
Q

In BPH which area is affected the most

A

Enlargement of transitional zone;PSA often elevated > 4

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4
Q

Tx options of BPH

A

Relax the bladder/urethra: α-1 blockers - tamsulosin (Flomax)

Decrease prostate size (shrink prostate): 5 alpha-reductase inhibitors (finasteride) and (dutasteride

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5
Q

Tx of chlamydia

A
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6
Q

Determine cystitis from pylenephritis

A
  • Absence of fever, chills, or flank pain. Change in urine color/odor
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7
Q

Cystitis tx

A

Nitrofurantoin (not over age 65), Bactrim, Fosfomycin

  • Ciprofloxacin - reserved for complicated cases
    • Postcoital UTI: single-dose TMP-SMX or cephalexin may reduce the frequency of UTI in sexually active women
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8
Q

a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF

A

Epididymitis

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9
Q

Epididymitis pathogens based on age (over 35 and under 35)

A

The pathogen is based on the patient’s age and risk factors:

  • men < 35 chlamydia and gonorrhea
  • men > 35 E.coli
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10
Q

dysuria, unilateral dull aching scrotal pain that can radiate up the ipsilateral flank

A

Epididymitis

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11
Q

Tx of epididymitis in men over 35

A
  • Levofloxacin (Levaquin) 500 mg/day PO for 10 days (21-30 days if associated prostatitis)
  • For patients who are unable to take fluoroquinolones, trimethoprim-sulfamethoxazole (one double-strength tablet twice a day for 10 days) is a good alternative
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12
Q

Tx of epididymitis under 35

A
  • Doxycycline 100 mg PO BID for 10 days PLUS ceftriaxone 500 mg IM × 1 (or 1 g if the patient weighs 150 kg or greater)
  • Refer sexual partner(s) for evaluation and treatment if contact within 60 days of the onset of symptoms
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13
Q

inflammation of glomeruli causing protein and RBC leakage into the urine, typically caused by an immune response

A

Acute glomerulonephritis

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14
Q

edema + HTN + hematuria + RBC Casts/dysmorphic RBCs + proteinuria 1-3.5 g/day + azotemia

A

Nephritic syndrome

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15
Q

Urinary excretion of > 3 g of protein in a 24-hour urine sample due to a glomerular disorder plus edema and hypoalbuminemia

A

Nephrotic syndrome

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16
Q
  • HTN, azotemia, oliguria (<400 ml urine/day), hematuria (RBC casts) hallmark, edema is not as much as nephrotic syndrome
  • Urinalysis: proteinuria < 3.5 grams per day, hematuria, RBC casts
A

Nephritic syndrome

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17
Q

a child with idiopathic nephrotic syndrome improves after treatment with corticosteroids.

A

Minimal change disease

18
Q

obese patients, heroin, and HIV+ black males.

A

Focal segmental glomerulosclerosis (FSGS)

19
Q

Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum

A

Indirect inguinal hernia

20
Q

Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum

A

Direct inguinal hernia

21
Q

right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray

A

Nephrolithiasis

22
Q

Nephrolithiasis diagnostic study

A
  • CT scan (spiral CT) without contrast of the abdomen and pelvis is the gold standard for diagnosis
  • Urinalysis will often show microscopic hematuria
  • BUN and Cr levels (for evaluation of renal function) and also calcium, uric acid, and phosphate levels
23
Q

Four types nephrolithiasis

A
  • Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque - avoid grapefruit juice (makes calcium oxalate stones worse)
  • Struvite (10%): Associated with chronic UTI with Klebsiella and Proteus species, radiopaque
  • Uric Acid (7%): Form in individuals with persistently acidic urine - Excess meat/alcohol, gout, radiolucent
  • Cystine (1%): Rare genetic, radiolucent (young boy with kidney stones)
24
Q

Tx for nephrolithiasis

A
  • Analgesia: IV morphine, parenteral NSAIDs (ketorolac)
  • Vigorous fluid hydration—beneficial in all forms of nephrolithiasis
  • Antibiotics—if UTI is present
  • Alpha-blocker therapy (Flomax) for patients with symptomatic ureteral stones >5 mm and ≤10 mm to facilitate ureteral stone passage (usually given to most patients independent of size)
25
Q

unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema and shininess of the overlying skin.

A

Orchitis

26
Q

inflammation of the testicles. It can be caused by either bacteria or a virus

A

Orchitis

27
Q

MCC of orchitis

A
  • scending bacterial infection from urinary tract
  • Occurs in 25% of postpubertal males with MUMPS
  • Unilateral swollen testicle/tenderness with erythema and shininess of the overlying skin, fever/tachycardia
  • Orchitis is rarely seen without epididymitis unless the patient has mumps
28
Q

Tx of orchitis

A

If mumps is the cause, treat mumps (+ ice/analgesia)

If bacteria is the cause, treat it like epididymitis

  • Age <35 or sexually active postpubertal males (cover for GC/Chlamydia)
    • Ceftriaxone 500 mg IM once PLUS doxycycline 100 mg PO BID for 10 days
    • Azithromycin 2 g PO once PLUS doxycycline 100 mg BID if severe PCN allergy
  • Age >35 (STI not suspected) - Levofloxacin 500 mg/d PO once daily for 10 days (21 days if associated prostatitis)
29
Q

Ascending infection of gram-negative rods into prostatic ducts

A

Prostatitis

30
Q

Acute and chronic symptoms of prostatitis

A
  • Acute: sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency, and dysuria
  • Chronic: variable – asymptomatic ⇒ acute symptomatology
31
Q

Prostatitis diagnostics

A

Urinalysis will reveal pyuria and hematuria

  • Prostatic fluid = leukocytosis, culture typically positive for E.coli in acute infections
    • chronic usually have enterococcus
  • If you suspect acute prostatitis DO NOT massage the prostate this can lead to sepsis!
32
Q

Tx of orchitis

A
  • Men < 35: Chlamydia and Gonorrhea - ceftriaxone and doxycycline
  • E coli and pseudomonas in men > 35 - treat with fluoroquinolones or Bactrim for 4-6 weeks to ensure eradication of the infection – culture urine 1 week after the conclusion of therapy
33
Q

Pyelonephritis

A

Pyelonephritis

34
Q

MCC bug in pyelonephritis

A

Organism: E. coli

  • Urinalysis: Bacteria and WBC casts
35
Q

Tx of pyelonephritis inpt vs outpt

A
  • Outpatient: FQ (Cipro/Levaquin)/Bactrim for 1-2 weeks (longer if immunocompromised)
  • Inpatient: IV FQ, 3rd/4th gen cephalosporins, extended-spectrum penicillins, gentamicin
36
Q

22-year-old male who develops a firm, painless, non-tender testicular mass with elevated serum β-HCG

A

Testicular cancer

37
Q

firm, painless, non-tender testicular mass and a feeling of heaviness in the scrotum

A

Testicular cancer sx

38
Q

MC type and RF for testicular cancer

A
  • Seminoma is the most common type (60%)
  • Risk factors include a history of cryptorchidism
39
Q

Tumor marker of testicular cancer

A

AFP, βHCG

40
Q

Dx of urethritis

A

First-void or first-catch urine and sometimes urine culture

  • Positive leukocyte esterase on urine dipstick or having ≥ 10 WBC/HPF on microscopy is suggestive of urethritis
  • Diagnosis by culture is not always necessary. If done, diagnosis by culture requires demonstration of significant bacteriuria in properly collected urine
  • Nucleic acid amplification test allows for the specific identification of N. gonorrhoeae, C. trachomatis, M genitalium

EOR - Family Med (5 decks)

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