Urology Flashcards
Balanitis
glans penis becomes inflamed
in what population is balanitis MC
uncircumsized men
most common cause of balanitis
Candidal infections
sx balanitis
pain, tenderness, or pruritus of the glans penis
PE balanitis
candidal balanitis: white, cottage cheese-like exudate on the glans penis
Bacterial balanitis: thick, foul-smelling purulent exudate
Circinate balanitis: associated with reactive arthritis and will present with shallow ulcers on the glans
tx candidal balanitis
topical imidazole (e.g., clotrimazole, miconazole), nystatin cream, or oral fluconazole
tx bacterial balanitis
topical metronidazole, oral amoxicillin-clavulanate, or clindamycin topical cream if an anaerobe is suspected
Mupirocin cream, oral dicloxacillin, or oral cephalexin may be used if streptococcal or staphylococcal infection is suspected
Benign prostatic hyperplasia (BPH)
proliferation of the fibrostromal tissues of the prostate that results in prostatic urethral compression and urinary outlet obstruction
most common benign tumor in men
BPH
obstructive BPH sx
hesitancy, decreased force/caliber of urine, postvoid dribbling, a sensation of incomplete emptying, double voiding, straining to urinate
irritative BPH sx
dysuria, frequency, urgency, nocturia
DRE BPH
smooth, firm, elastic enlargement of the prostate
If the induration of the prostate is palpated, prostate cancer should be excluded by further testing
medical therapy for BPH
using alpha-blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 inhibitors, combination therapy, phytotherapy
Alpha-1 adrenergic antagonists for BPH
- Terazosin
- Doxazosin
- Tamsulosin
- Alfuzosin
- Silodosin
5-alpha reductase inhibitors for BPH
- Finasteride
- Dutasteride
Anticholinergic agents for BPH
- Tolterodine
- Oxybutynin
- Darifenacin
- Solifenacin
- Fesoterodine
- Trospium
Phosphodiesterase type 5 inhibitors for BPH
- Tadalafil
MC cause of epididymitis in a patient younger than 35 years
chlamydia
most common cause of scrotal pain
epididymitis
sx epididymitis
painful, swollen scrotum
frequency, urgency, and dysuria,
PE epididymitis
tenderness to palpation over the superior-posterior aspect of the testicle where the epididymis is located
erythematous scrotum
positive prehn sign
intact cremasteric reflex
dx epididymitis
urine culture
UA
urine nucleic acid amplification testing
tx epididymitis for patients under the age of 35 and patients who are at increased risk of STIs
ceftriaxone 500 mg intramuscular injection for one dose and doxycycline 100 mg orally twice daily for 10 days
tx epididymitis for pts 35 years of age and older and patients who are at low risk of STIs
levofloxacin 500 mg orally once daily for 10 days
common cause of urethritis
Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium
repeat testing urethritis
3 months after treatment because of a high rate of reinfection
test of cure urethritis
3 weeks after treatment is completed is only indicated in patients who are pregnant, have persistent symptoms, or receive an antibiotic regimen with inferior cure rates.
What pear-shaped protozoan has four flagella at its anterior end and can be seen on urine microscopy?
Trichomonas vaginalis
Acute uncomplicated cystitis
bacterial infection of the bladder and is much more common in women than in men due to the shorter length of the female urethra
sx acute uncomplicated cystitis
dysuria, frequent urination, lower abdominal pain, and urgency
may have gross hematuria
dx acute uncomplicated cystitis
leukocytes, nitrites, and blood on urine dipstick.
tx acute uncomplicated cystitis
sulfamethoxazole-trimethoprim twice daily for 3 days or nitrofurantoin 100 mg twice daily for 5 days
glomerulonephritis
hematuria, mild proteinuria, and red blood cell casts secondary to glomerular inflammation
Glomerulonephritis with proteinuria of 1–3.5 g/day is categorized as
nephritic syndrome
nephritic syndromes
poststreptococcal glomerulonephritis, IgA nephropathy, Alport syndrome, membranoproliferative glomerulonephritis, and rapidly progressive glomerulonephritis (e.g., Goodpasture syndrome, microscopic polyangiitis, granulomatosis with polyangiitis)
protrusion or bulge of an organ, part of an organ, or tissue through an opening in the anatomical structure that is supposed to hold it in
hernia
most common site for a hernia
abdomen
most common type of hernia
inguinal hernia
indirect inguinal hernia
occurs through the deep inguinal ring, which is lateral to the inferior epigastric artery
direct inguinal hernia
protrudes through the weakened posterior wall of the inguinal canal, which is medial to the epigastric artery
RF hernia
previous hernia, male sex, chronic cough, chronic constipation, abdominal wall injury or surgery, older age, and smoking
imaging hernia
When imaging is needed to clarify the diagnosis, ultrasound is the most appropriate initial modality
definitive tx hernia
surgery
which type of inguinal hernia is MC
indirect
urease producing bacteria MC
proteus mirabilis
what can urease producing bacteria cause
magnesium ammonium phosphate crystals –> nephrolithiasis secondary to struvite stones
preferred diagnostic test for nephrolithiasis
Noncontrast CT of abdomen and pelvis
US preferred in pregnant pts
Kidney stones are most commonly formed from
calcium oxalate
Other types of stone composition
calcium phosphate, uric acid, struvite, and cysteine
Struvite stones are associated with urinary tract infections secondary to
Proteus and Klebsiella species
sx nephrolithiasis
paroxysms of severe flank pain, pain with urinating akin to “passing gravel,” or inability to urinate altogether (suggestive of an acute obstruction).
Pain that radiates to the groin is suggestive of a stone in the lower ureter.
Other associated symptoms include hematuria, nausea, and vomiting.
UA nephrolithiasis
hematuria
stones that are what size will not pass spontaneously
> 5 mm
what med can be given to facilitate expulsion of stone
Tamsulosin
Prostatitis MC caused by
E coli
sx prostatitis
fever, irritative voiding symptoms, and perineal, sacral, or suprapubic pain. Urinary retention may also be present
DRE prostatitis
warm, edematous, exquisitely tender prostate
what should be removed in pt w prostatitis
indwelling catheter
tx prostatitis
intravenous administration of ampicillin and an aminoglycoside (e.g., gentamicin) in hospital
Patients who are afebrile for 48 hours may be transitioned to a 6-week course of oral antibiotics (e.g., trimethoprim-sulfamethoxazole, ciprofloxacin).
what is present on UA for pyelo
pyuria (pus in pee)
WBC casts
Outpatient therapy pyelo
ceftriaxone 1 g intramuscular with the addition of trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, a cephalosporin, or a fluoroquinolone, all of which can be given orally for 10–14 days (with the exception of the fluoroquinolones, which are given for 5–7 days).
inpatient tx pyelo
antipseudomonal carbapenem (imipenem, meropenem, doripenem) and vancomycin may be used for patients with critical illness, urinary tract obstruction, and high risk of multidrug-resistant organisms. For patients with no risk factors for multidrug-resistant organisms, ceftriaxone or piperacillin-tazobactam is used.
failure to respond to therapy within what amount of hours warrants imaging in pyelo
48 hours
MC neoplasm in men btwn 15 and 35 yo
testicular CA
MC type of testicular CA tumor
germ cell tumors
Major RF for testicular CA
cryptorchidism
sx of testicular CA
painless enlargement of the testis or sensation of heaviness
PE testicular CA
nontender, discrete mass or diffuse testicular enlargement
sx of testicular CA that indicate metastatic dz
lower extremity edema (vena cava obstruction), back pain (retroperitoneal metastases), and cough (pulmonary metastases)
labs associated w testicular CA
elevations in human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase
definitive dx testicular CA
inguinal orchiectomy
MC cause orchitis
viral - mumps (paramyxovirus)
gram stain Neisseria gonorrhoeae
gram negative intracellular diplococci
gram stain chlamydia
> /= 2 WBCs/hpf and no organisms seen in suggestive of nongonococcal urethritis
