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Urology > Urology > Flashcards

Urology Flashcards

1
Q

What are the etiology for Acute Pyelonephritis?

A
  • E. coli
  • Proteus
  • Klebsiella
  • Enteobacter 7
  • Pseudomonas
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2
Q

What are the S/Sx for Acute Pylelonephritis?

A

fever
-flank pain*
-shaking chills*
-urgency*
-frequency*
dysuria
+/- N/V
costovertebral tenderness

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3
Q

What are the cbc lab findings for Acute Pyelonephritis?

A

+ leukocytosis with left shift

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4
Q

What are the urinalysis findings in Acute Pyelonephritis?

A
  • pyuria

- WBC casts

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5
Q

What is the Tx for Acute Pyelonephritis?

A
  • Cipro
  • Oflxacin
  • Bactirm (oral)

-ampicillin & Gentamicin (IV)

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6
Q

What is Acute Cystitis?

A

-a bladder infection

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7
Q

What are the Etiology for Acute Cystitis?

A
  • Eschericia coli* (tx with Fluoroquinolone)

- enterococci (Klebsiella and Proteus) ( tx with ampicillin or Vanc)

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8
Q

How do the bugs get to the bladder?

A

-ascending from the urethra

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9
Q

What are the S/Sx of Acute Cystitis?

A
  • frequency
  • urgency
  • dysuria
  • suprapubic discomfort
  • —Women may have hematuria
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10
Q

What are the lab findings for Acute Cystitis?

A

Urine ; +nitrates, +leukocyte esterase

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11
Q

What is the Tx for Acute Cystitis?

A

3-day antibiotic

–Flouroquinolones or nitrofurantion

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12
Q

Which sex is affected more by kidney/urinary stones?

A

-Men (3:1)

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13
Q

What are the RF for kidney/urinary stones?

A
  • diet

- dehydration

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14
Q

What are the S/Sx for kidney/urinary stones?

A

-N/V

severe colic pain often in flank any radiate to ipsilateral testis or labium

-pain causes patients to frequently move

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15
Q

What are the lab findings for kidney/urinary stones?

A
  • gross hematuria

- send for 24 hr urine analysis

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16
Q

What is the Tx for kidney/urinary stones?

A 
-fluids
\+/- ****alpha blockers****
-CCB
-steroids lithotripsy
-stone extraction
-stent placement
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17
Q

What percent of kidney/urinary stones are Radiopaque?

A

-85% white (Calcium and Struvite)

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18
Q

What percent of kidney/urinary stones are Radiolucent (black) ?

A

-15% black (uric acid, Dihydroxyadenine, triamterene and xanthine)

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19
Q

What are the 2 types of Radiopaque kidney/urinary stones?

A
  • Calcium stones

- Struvite stones

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20
Q

What are the 2 types of Calcium kidney/urinary stones?

A
  • Calcium Oxalate,

- Calcium Phosphate

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21
Q

What it is the Tx for Calcium kidney/urinary stones?

A

-decrease dietary calcium intake
-cellulose phosphate (gut)
-thiazides (kidney)
+/- allopurinol

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22
Q

Which type of kidney urinary stones do women get which is common with UTI’s and Abx therapy?

A

-Struvite with a Staghorn Calculi*

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23
Q

What are the characteristics of Struvite kidney/urinary stones?

A
  • ph > 7.2

- Urease forming organisms : proteus and pseudomonas

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24
Q

What are the 2 types of Radiolucent kidney/urinary stones?

A
  • Uric acid

- Cystine

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25
Q

What are the characteristics of Uric acid kidney/urinary stones?

A
  • pH > 5.5

- if hyperuricemia is present, Tx with allopurinol

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26
Q

What are the characteristics of Cystine kidney/urinary stones?

A
  • ph < 5.5

- hard to manage

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27
Q

What is the Tx for Cystine kidney/urinary kidney/urinary stones?

A

-alkalinization of urine above 7.5

+/- penicillamine (is cystine binding to prevent kidney stones), tiopronin

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28
Q

What is Interstitial Cystitis?

A

-pain with bladder filling that is relieved by empying

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29
Q

What is the etiology of cystitis?

A
  • unknown

- this is a Dx of exclusion

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30
Q

What are the S/Sx of Interstitial Cystitis (Frequency and Urgency Syndrome?

A

+/- urgency

  • frequency
  • nocturia
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31
Q

What are the lab findings with Interstitial Cystitis?

A

-urine cultures and cytology must be negative

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32
Q

What is the Tx for Interstitial Cystitis?

A
  • Amitriptyline* (block pain arousal )

- nifedipine (calcium channel antagonist which inhibits smooth muscle contraction and cell-mediated activity)

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33
Q

What are the diseases associated with Interstitial Cystitis?

A
  • irritable bowel disease

- inflammatory bowel disease

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34
Q

What is Urinary Incontinence?

A

-the involuntary leakage of urine that causes social, and or hygienic concerns

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35
Q

What is urge incontinence?

A

urge incontinence is sudden uncontrollable urge that leads to leakage

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36
Q

What is the etiology of urge incontinence?

A

-inflammatory or neurogenic conditions

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37
Q

What are the post-void residuals like with urge incontinence?

A

-low post-void residuals

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38
Q

What is the Tx for urge incontinence?

A
  • tolteidine (Detrol, works selectively for urinary bladder over salivary glands)
  • oxubutynin (Dirtropan, causes direct smooth muscle relaxation of the bladder and has local anesthetic properties)
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39
Q

What is Stress Incontinence?

A

stress incontinence is leakage with cough, sneeze or exertion

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40
Q

What is the cause of stress in continence?

A

-due to laxity of pelvic floor musculature

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41
Q

What is the post-void residual like with stress incontinence?

A

-low post-void residuals

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42
Q

What is the Tx for Stress Incontinence?

A
  • kegal exercises*
  • estrogen
  • anticholinergics
  • surgical repair
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43
Q

What is overflow incontinence?

A

overflow incontinence is urinary retention with intermittent leakage form over distended bladder

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44
Q

What is the post-void residual like with overflow incontinence?

A

-high post-void residual

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45
Q

What is the Tx for overflow incontinence?

A

-foley catheter is both diagnostic and therapeutic

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46
Q

In a urinalysis should glucose be present?

A

-glucose is negative in a N urinalysis

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47
Q

What does a urinalysis positive for Nitrate mean?

A

+ UTI

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48
Q

In a UA what do RBC casts indicate?

A

-Glomerulonephritis

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49
Q

What do WBC casts indicate in a UA?

A

-Pyelonephritis

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50
Q

What do tubular casts indicate in a UA?

A

-Acute Tubular Necrosis

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51
Q

What do Muddy brown casts indicate in a UA?

A

-Acute Tubular Necrosis

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52
Q

What types of casts are typically seen in a UA when the patient has Acute Tubular Necrosis?

A

-Tubular casts and Muddy brown casts

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53
Q

What type of casts in a UA are seen with Chronic Renal Failure?

A

-Waxy/Broad casts

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54
Q

What type of condition is seen with Hyaline casts?

A

-Hyaline casts are normal

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55
Q

What is Hypospadias?

A

-when the meatus is located on the ventral aspect of the penis, scrotum, or perineum

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56
Q

What is Phinosis?

A

-foreskin connote be retracted over the glans

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57
Q

A patient has painful swelling of the foreskin distal to the phimotic ring. The most likely Dx is?

A

-Paraphimosis

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58
Q

What does Paraphimosis result in?

A

-results in painful engorgement and edema of the glans

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59
Q

Failure to reduce the paraphimosis (retracted painful swelling of the foreskin) can lead to what?

A

-can lead to ischemic of glands penis

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60
Q

-A patient presents with complaints of curvature of his penis with erection. What is the most likely Dx?

A

-Peyronie’s Disease

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61
Q

Where is the abnormality with Peyronies’s Disease?

A

-scarring of the tunica albuginea

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62
Q

What is the etiology for Peronies’s Disease?

A

-unknown

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63
Q

What percent of men have Peronies’s Disease?

A

-3%

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64
Q

What type of abnormal curvature is usually present with Peyronie’s Disease?

A

-usually dorsal curvature

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65
Q

What is the Tx for Peyronie’s?

A
  • Vitamin E
  • injection therapy
  • surgery
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66
Q

A patient presents with complaints of not being able to maintain an erection. What is the likely Dx?

A

-Erectile Dysfunction

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67
Q

What type of patient usually gets erectile dysfunction?

A

Diabetes*

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68
Q

What are the etiology for erectile dysfunction?

A
  • diabetes*
  • vascular disease
  • neurogenic
  • endocrine
  • pelvic surgery
  • medications
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69
Q

What medications can cause erectile dysfunction?

A
  • Betablockers
  • cimetidine
  • spirolactone
  • SSRI
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70
Q

What are the lab findings with erectile dysfunction?

A
  • normal tesosterone
  • normal prolactin
  • normal LH/FSH
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71
Q

What is the Tx for erectile dysfunction?

A
  • Hormone therapy is needed
  • vasoactive therapy: PDE-5
  • injectible protaglandins
  • Penile prostheses
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72
Q

How to Phosphodiesterase Inhibitors work in erectile dysfunction?

A

-inhibits the enzyme PDE-5 from breaking down cGMP and keeps an erection

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73
Q

What are the Phosphodiesterase Inhibitor drugs?

A
  • Sildenafil (Viagra)
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)
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74
Q

What are the side effects of the Phosphodiesterase Inhibitor drugs used to Tx erectile dysfunction?

A

Wh-Hypotension

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75
Q

What are the contraindications of the Phosphodiesterase Inhibitors use to Tx ED ?

A

-contraindicated with the concurrent use of nitroglycerine or nitrates

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76
Q

What is Priapism?

A

-a painful erection lasting longer than 4 hours

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77
Q

What are the two types of Priapism?

A

Low-flow (veno-occlusive, ischemic)

High-flow (traumatic-ateriocavernosal fistula)

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78
Q

What is the etiology for Priapism?

A

Conditions: sickle cell, leukemia

Meds: psychotropics, trazadone, alcohol

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79
Q

What is the Tx for Priapism?

A

-injections or surgery

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80
Q

What are the bugs (etiology) that cause Acute Bacterial Prostatitis?

A

E. coli & Pseudomonas

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81
Q

What are the S/Sx of Acute Bacterial Prostatitis?

A
  • Perineal pain
  • sacral or suprapubic pain
  • fever
  • irritative voiding complaint
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82
Q

What is the Lab for Acute Bacterial Prostatitis?

A

-leukocytosis with left shift

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83
Q

What is the UA like in Acute Bacterial Prostatitis?

A

-pyuria

+/- hematuria

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84
Q

What is the Tx for Acute Bacterial Prostatitis?

A

-ampicillin & amino glycoside initially, then quinolines x 4-6 weeks

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85
Q

What is contraindicated in Acute Bacterial Prostatitis?

A

-prostatic massage

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86
Q

What is the etiology for Chronic Bacterial Prostatitis?

A

-Gram neg rods & Enterococcus

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87
Q

What are the S/Sx for Chronic Bacterial Prostatitis?

A
  • Some patients are symptomatic
  • they may have irritative voiding symptoms
  • they may have low back pain and perineal pain
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88
Q

What does the UA show in a patient with Chronic Bacterial Prostatitis?

A

-UA is normal

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89
Q

What are the lab findings in Chronic Bacterial Prostatitis?

A

-Prostatic secretions–leucocytosis

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90
Q

What is the Tx for Chronic Bacterial Prostatitis?

A

-Difficult– 6-12 weeks of Bactrim > quinolines, erythromycin

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91
Q

What is the most common Prostatitis?

A

-Nonbacterial Prostatitis

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92
Q

What is the etiology for Nonbacterial Prostatitis?

A
  • unknown
  • ? Chlamydia
  • mycoplasma
  • ureaplasma
  • viruses
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93
Q

What are the S/Sx of Nonbacterial Prostatitis?

A

-same as other Prostatitis

  • irritive voiding
  • low back pain
  • perineal pain
  • suprapubic discomfort
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94
Q

What is the lab for Nonbacterial Prostatitis?

A

-cultures are negative but +leukocytes on prostatic secretions

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95
Q

What is the Tx for Nonbacterial Prostatitis?

A

-Erythromycin x 3-6 weeks

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96
Q

What is the most common benign tumor in men?

A

-Benign Prostatic Hyperplasia

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97
Q

Who gets Benign Prostatic Hyperplasia?

A

-50% of patients are > 75 years old

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98
Q

What is the etiology of Benign Prostatic Hyperplasia?

A

-unknown

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99
Q

What are the obstructive S/Sx of Benign Prostatic Hyperplasia?

A

-Obstructive :

  • hesitancy
  • decreased force
  • incomplete bladder emptying
  • straining
  • post void dribbling
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100
Q

What are the Irritative S/Sx of Benign Prostatic Hyperplasia?

A
  • urgency
  • frequency
  • nocturia
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101
Q

What is the Lab findings for Benign Prostatic Hyperplasia?

A

-PSA often checked negative

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102
Q

What is the medical/nonsurgical Tx for Benign Prostatic Hyperplasia?

A

Alpaha blockers and 5-alpha-Reductaase inhibitors

  • Prozosin
  • terazosin
  • doxazosin
  • alfuzosin
  • tamsulosin
  • phenoxbenzamine
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103
Q

What are the side effects of the Alpha Blockers used to Tx Benign Prostatic Hyperplasia?

A
  • orthostatic hypotension
  • dizziness
  • tiredness
  • retrograde ejaculation
  • rhinitis
  • headache
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104
Q

What are the two 5 alpha-Reductase inhibitors?

A
  • Finasteride
  • dutastiride

(finasteride–Proscar, Propecia)

(dutastiride–Acvodart)

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105
Q

What OTC meds can be used to Tx Benign Prostatic Hyperplasia?

A

-saw palmetto

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106
Q

What are the Surgical Tx for Benign Prostatic Hyperplasia?

A

-TURP : transuretheral resection of the prostate
SE : retrograde ejaculation, impotence

  • TUIP : transurethral excision of the prostate
  • TUNA : transurethral needle ablation of the prostate
  • Laser therapy : coagulative necrosis
  • Prostatectomy
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107
Q

What are the causes of Scrotal Swelling?

A
  • hydrocele
  • varicocele
  • epididymitis
  • testicular torsion
  • hernia
  • adenexal mass (epididymal cyst / spermatocele)
  • testicual mass = tumor
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108
Q

A male patient presents with complaints of a dull ache and heaviness of his testicles, and scrotal swelling? Physical exam shows a scrotal mass which transilluminates confirming a fluid filled mass. What is the Dx and how is should this be treated?

A

-Dx is a Hydrocele

Tx : no intervention is usually needed, +/- surgery

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109
Q

What is a Hydrocele?

A

-collection of fluid between two layers of tunical vaginalis

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110
Q

What is the etiology of a Hydrocele?

A
  • congenital or acquired

- may be secondary to lymphatic obstruction

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111
Q

What are the S/Sx of a Hydrocele?

A
  • Dull ache

- heaviness

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112
Q

How is a Hydrocele Dx?

A

-transilluminate to confirm mass is fluid filled

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113
Q

What is the Tx for a Hydrocele?

A

-no intervention is usually needed

+/- surgery

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114
Q

What causes Acute Epididymitis in men < 40 years old?

A

-STDs : Chlamydia, Neisseria

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115
Q

What causes Acute Epididymitis in men > 40 years old?

A

-Gram neg rods (E. coli)

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116
Q

What are the S/Sx of Acute Epididymitis?

A 
-urethritis
\+/- cystistis
-pain along spermatic cord
-fever
-scrotal swelling
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117
Q

What are the Physical Exam findings for Acute Epididymitis?

A

** + phren’s sign (elevation of the scrotum improves pain**

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118
Q

What are the lab findings for Acute Epididymitis?

A

-Neisseria = intracellualar diplococci

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119
Q

What is the Tx for Acute Epididymitis?

A
  • non STD’s are treated for 21-28 days of appropriate antibiotics
  • STD’s : ceftriaxone and doxycylcine
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120
Q

When is Testicular Torsion most common?

A

-testicular torsion is most common in early puberty

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121
Q

What are the S/Sx’s of testicular torsion?

A
  • scrotal swelling
  • erythema of skin
  • high riding testis
  • loss of cremaster reflex*
  • horizontal plane of testis
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122
Q

How is testicular torsion Dx?

A

-color flow Doppler ultrasound

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123
Q

What is the Tx for Testicular Torsion?

A
  • prompt surgical exploration with detorsion

- orchiectomy if gonad is infarcted

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124
Q

What are the urology & Nephrology malignancies?

A
  • Adenocarcinoma of the prostate
  • Transitional cell cancer of the urinary bladder
  • Renal cell carcinoma
  • Testicular cancer
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125
Q

What is the most common noncutaneous cancer in adult US males?

A
  • Prostate Cancer, 1 in 6 men
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126
Q

Which race is at higher risk for prostate cancer?

A

-African Americans

127
Q

What are the S/Sx of prostate cancer?

A
  • usually none

- Detected on biopsy for abnl DRE or increased PSA

128
Q

What is the lab findings for Prostate Cancer?

A

-PSA : normal is 0.4.0, > 4.0 in Prostate Cancer

129
Q

What is the Tx for Prostate Cancer?

A
  • radical prostatectomy
  • cryosurgical prostate ablation
  • hormone therapy
  • radiation therapy
130
Q

Which sex gets bladder Cancer?

A

Males (3:1)

131
Q

What type of Cancer is bladder cell cancer?

A

Transitional cell carcinoma > 90 %**

132
Q

What are the RF for Bladder Cancer?

A

Smoking

133
Q

What are the S/Sx of Bladder Cancer?

A
  • Hematuria

- irritative voiding symptoms

134
Q

How is Bladder Cancer Dx?

A

-cystoscopy with + biopsy

135
Q

What is the Tx for Bladder Cancer?

A

-resection
+/- chemotherapy (BCG, doxorubicin)
-radiation

136
Q

What is the most common renal cell tumor?

A

-Renal cell carcinoma

137
Q

What are the RF for Renal cell carcinoma?

A

-smoking

138
Q

What are the S/Sx of Renal cell cancer?

A

-Usually asymptomatic

  • Gross or microscopic hematuria
  • Flank pain or abdominal mass
139
Q

How is Renal cell cancer Dx?

A

-CT or MRI

140
Q

What is the Tx for Renal Cell cancer?

A

-radical nephrectomy vs partial nephrectomy for smaller lesions

141
Q

What is the most common solid tumor in males age 15-34?

A

-testicular tumors

142
Q

What are the risk factors for testicular tumors?

A

-cryptorchidism (absence of one or both testicles from the scrotum)

143
Q

What percentage of testicular tumors are germ cell tumors?

A

-95% are germ cell tumors

144
Q

What are the types of testicular germ cell tumors?

A
  • Semioma, 40%
  • teratoma
  • choricarcinoma
  • yolk-sac
145
Q

What are the S/Sx of testicular tumors?

A

-painless enlargement of the testis

146
Q

What are the lab findings for testicular tumors?

A
  • beta-HCG
  • AFP
  • LD
147
Q

How are Testicular tumors Dx?

A

+ needle biopsy

148
Q

What is the Tx for testicular tumors?

A

-radical orchiectomy

+/- radiation

149
Q

What is the most common type of kidney stone?

A
  • calcium

- it makes up 85% of all kidney stones

150
Q

What is the most specific imaging modality for Dx kidney stones?

A

-CT

151
Q

Will a spermatocele transilluminate?

A

-yes

152
Q

A kidney stone of less than what size will likely pass on its own?

A

-less than 5 mm

153
Q

List three possible Tx for stress incontinence?

A
  • Kegels
  • estrogen therapy
  • surgical placement of a urethral sling
154
Q

A 65 y.o. male presents with frequency. On digital rectal exam you feel an elastic moderately enlarged prostate. What is the most likely Dx?

A

-BPH

155
Q

A PSA above what level should start to make you concerned?

A

> 4.0

156
Q

Give 2 major risk factors for erectile dysfunction?

A
  • diabetes
  • hypertension
  • depression
  • coronary artery disease
157
Q

List one risk factor for bladder cancer?

A

-smoking

158
Q

Define paraphimosis.

A

-foreskin is retracted and connot be reduced

159
Q

Which condition is an emergency phimosis or paraphimosis?

A

-Paraphimosis

160
Q

What is the name of the condition that involves fibrous scar tissue in the penis causing a curvature of the erect penis?

A

-Peyronie’s disease

161
Q

Both testicles should be descended by what age?

A

-3 months

162
Q

Feeling a bag of worms in the scrotum should make you think of what Dx?

A

-varicocele

163
Q

A fluid filled painless mass found in the scrotum which transilluminates should make you think of what Dx?

A

-Hydrocele

164
Q

What is the first line Tx for a Hydrocele?

A

-watchful waiting unless there is a question of fertility

165
Q

Name the sign which is defined as decreased pain with scrotal elevation?

A

-Prehn’s sign

166
Q

Maltese crosses in the urine should make you think of what Dx?

A

-Nephrotic syndrome

167
Q

What is the imaging study of choice if you suspect bladder cancer?

A

-Cystoscopy and biopsy

168
Q

What is the most likely Dx for a free floating, painless, cystic mass found posterior and superior to the testis?

A

-Spermatocele

169
Q

What age range is typically associated with testicular torsion?

A

-10-20 years old

170
Q

Where is the epididymis found?

A

-found at the posterior upper pole

171
Q

What is the best imaging to rule out testicular torsion?

A

-Doppler/ultrasound for decreased blood flow to the testes

172
Q

What are the two most common causes of epididymitis?

A

-Neisseria gonorhea and chlamydia

173
Q

What medication classes are prescribed in order to help prevent chronic renal failure in diabetic patients?

A

-ACEIs and ARBs

174
Q

Will epididymitis feel better with scrotal elevation?

A

-yes

175
Q

What is the normal level of serum bicarbonate (HCO3) ?

A

24 mEq/L

176
Q

What is the tx for epididymitis?

A

-Ceftriaxone and doxycycline

177
Q

What is the first line Tx for Cystitis?

A

-Bactrim

178
Q

What is the most common organism that causes a bladder infection?

A

-E. coli

179
Q

Tenderness at the costovertebral angle should make you think of what DX?

A

-Pyelonephritis

180
Q

What is the condition where the urethral meatus is not at the tip of the penis?

A

-Hypospadias and in far fewer cases epispadias

181
Q

What is the most common organism responsible for prostatits?

A

-E. coli

182
Q

What is the first line antibiotic for prostatitis?

A

-Bactrim 4-6 weeks

183
Q

List two risk factors for prostate cancer?

A
  • advancing age
  • African american
  • positive family history
  • high fat diet
184
Q

What might you feel on a digital rectal exam of a patient with prostate cancer?

A
  • Enlarged prostate

- hard nodules within the prostate

185
Q

Define priapism?

A

-painful persistant erection

186
Q

A prostate biolpsy consists of how many samples?

A

6-12

187
Q

Painless hematuria should make you think of what Dx?

A

-bladder cancer

188
Q

What is the most common bladder cancer?

A

-Transitional cell cancer

189
Q

Define phimosis?

A

-foreskin can not be retracted

190
Q

Name the condition in which the head of the penis curves downward or upward, at the junction of the head and shaft of the penis. (hint: it is often assoc with hypospadias) .

A

-Wilms tumor

191
Q

List three possible causes of pre renal failure?

A
  • CHF
  • severe dehydration
  • hemorrhage
192
Q

What is the most common cause of post renal renal failure?

A
  • BPH

- postrenal renal failure is secondary to an outflow obstruction

193
Q

Muddy brown sediment in the urine should make you think of what Dx?

A

-Acute tubular necrosis

194
Q

Tea colored urine with red cell casts should make you think of what Dx?

A

-Glomerulonephritis

195
Q

What are the two most common predisposing factors in the development of chronic renal failure?

A
  • HTN

- DM

196
Q

A sponge like prostate on digital rectal exam should make you think of what Dx?

A

-Prostatitis, but be careful. You can cause sepsis with a digital rectal exam.

197
Q

Will serum potassium be decreased or elevated in renal failure?

A

-elevated

198
Q

A urine protein of > 3.5 grams/day should make you think of what Dx?

A

-Nephrotic syndrome

199
Q

What hereditary pattern does polycystic kidney disease follow?

A

-Autosomal dominant

200
Q

What is the normal pH of the blood?

A

7.35 - 7.45

201
Q

What is the most accurate way to Dx urethritis?

A

-urine PCR

202
Q

What is considered a normal PCO2 ?

A

40 mmHG

203
Q

An ABG shows a pH of 7.2, a bicarb of 25 and a PCO2 of 50. Is this respiratory or metabolic acidosis?

A

-Respiratory – CO2 is elevated

204
Q

White blood cell casts should make you think of what Dx?

A

-Pyelonephritis

205
Q

What area of the prostate is affected by BPH?

A

-the transitional zone

206
Q

What area of the prostate is the primary site for prostate cancer?

A

-the peripheral zone

207
Q

An involuntary loss of urine during coughing or laughing is what type of incontinence?

A

-stress incontinence

208
Q

A patient who has normal bladder function, but can not get to the bathroom is what type of incontinence?

A

-overflow incontinence, the bladder cannot empty sufficiently

209
Q

At what age do you begin screening patients of prostate cancer?

A

-age 50, an annual digital rectal exam and a PSA are recommended

210
Q

Often caused by chlamydia what is the syndrome characterized by urethritis (or cervicitis), arthritis and conjunctivitis?

A

-Reiter’s syndrome

211
Q

What is the most common type of testicular cancer?

A

-Nonseminoma

212
Q

A 60 y.o. male presents with c/o nocturia. PE of the prostate shows him to have an enlarged and firm prostate generally in the middle lobe. Urine culture is negative. PSA is 3. What is the dx and how do you tx?

A
  • BPH
  • behavior modifications, no fluids before bed, decrease alc and caffeine, routine voiding schedule
  • meds by script
213
Q

What Alpha blockers would you use for BPH in a 60 y.o. male? What is the major side effect of these meds?

A
  • prazosin and terazosin

- may cause hypotension

214
Q

What 5 alpha reductase inhibitors could you use in a 61 y.o. with BPH?

A
  • Finasterid and or Dusasteride

- these meds block the production of DHT which causes BPH

215
Q

A 55 y.o. male presents for a routine PE. Prostate exam shows him to have a firm nodule. What dx are you concerned with, what testing is needed, and how do you tx if tests are positive?

A
  • get a PSA, normal is below 4
  • biopsy 6-12 samples
  • MRI/CT
  • CA of the prostate is the concern
  • Tx considerations include watchful waiting, radiation, Brachytherapy, radical prostatectomy
216
Q

A 18 y.o. presents with aching in the scrotum. Exam shows him to have what feels like a bag of worms and will not transilluminate. What is the Dx and how is this tx?

A

-Dx is a varicolcele

  • may contribute to infertility by decreased sperm count
  • if fertility is a problem consider surgical removal
217
Q

21 y.o. presents with a small painless (sometimes unfortable) lump on his testis. This mass transilluminates. What is the Dx and what is the Tx?

A
  • Spermatocele
  • usually left alone
  • surgery/spermatocelectomy if needed
218
Q

18 y.o. presents with scotum swelling which transilluminates. What is the usual tx?

A

-surgical removal

219
Q

PE on an infant male shows him to have an undecended testis. What is the recommended tx?

A
  • need to address within 12 months
  • hCG injections may cause a rise in testosterone and is often an effective tx

-Surgery/orchioplexy

220
Q

A 46 y.o diabetic male presents for routine PE. You directly ask about his erections. He desires to have sex with his wife but has been unable. How do you tx?

A
  • exercise
  • Phosphodiesterase inhibitors
    • tadalfil (Cialis)
    • Vardenafil (Levitra)
  • Alprostadil
  • Penile implants
221
Q

To Dx the type of incontinence what is the work up?

A
  • good Hx
  • U/A for possible infection
  • U/S for post-void residual volume
  • Full bladder standing cough test
  • possible cystoscopy
222
Q

A 55 y.o. female presents for routine PE and you ask specifically about urine leakage. The patients describes significant leakage with coughing, sneezing and laughing. What type of urinary incontinence is this and how do you tx?

A
  • This is stress incontinence, often due to urethral incompetence
  • Tx includes, regular bladder emtyping, reduce caffeine and alc, DC anticolinergic meds, Kegel ex, straight catheter, suprapubic pressure

Meds: topical extrogens for females

Surgery: urethal sling

Alpha blockers if this was a male.

223
Q

A 55 y.o. presents with c/o sudden feeling of urgency and loss of urine. What type of incontinence is this?

A

-Urge incontinence, may be due to neurological disease

224
Q

A 65 y.o. male presents describes a reduces urinary stream and leakage. What type of incontinence is this and what might be causing this?

A
  • Overflow incontinence

- outlet obstruction (BPH) or possibly an underactive detrusor muscle

225
Q

A 65 y/o male presents with Sx of Overflow incontinence and BPH? What would be a good first line Tx?

A

-Alpha blockers for BPH which may cause obstruction

226
Q

What sex gets kidney stones (urolithiasis)?

A

-men, twice more than women

227
Q

What are most kidney stones composed of?

A

-calcium

228
Q

What is a Staghorn calculi?

A

-a kidney stone shaped like the horns of a stag

229
Q

A 48 y.o. male presents with sudden onset of severe flank pain, nausea and vomiting, and he appears extremely restless. He has noted to have hematuria. What is the Dx and Tx?

A

-Dx, is Urolethiasis

  • Tx, pain meds, allow stone to pass,
  • Meds: alpha blockers, NSAID’s, corticosteroids help stone to pass
  • Ureteroscopic stone extraction
  • Extracorporeal shock wave lithotripsy
230
Q

You just cathed a guy and now an hour later he complaines of penis pain. What do you do? and What is the Dx

A
  • reduce the foreskin
  • cut the foreskin if it cannot be reduced, EMERGENT
  • Dx is Paraphimosis
231
Q

An 8 y.o. male presents with not being able to retract the foreskin over the glans of the penis. What do you do?

A
  • nothing this normal into adolescents

- Dx is Phimosis

232
Q

A 15 y.o. male presents to the ER with sever ab pain, and nausea. He has groin and scrotum pain also. His cremasteric reflex is absent on the right side. What is the Dx and how do you tx?

A
  • you could obtain a U/S with Doppler of the testis
  • this is consistent with testicular torsion of the rt testis
  • Manual detorsion of the testis is indicated, do this like opening a book
  • Surgery if unable to reduce
233
Q

What are the sx of epididymitis?

A
  • scrotum hurts
  • swollen scrotum
  • urethral discharge
  • pain with voiding
  • fever
234
Q

What is a positive Prehn’s sign?

A

-elevating the scotum/lifting the balls provides pain relief of epidimitis

235
Q

with epididimitis a gram stain with intracellular diplococcici —?

A

-N. gonorrhoeae

236
Q

With epididimitis no visible organism but lots of WBC’s ===?

A

-Chlamydia

237
Q

Tx of epdidimitis N. gonorrhoeae and Chlamydia are tx with what antibiotics?

A
  • Macrolides–azithromycin
  • Cephalosporins–Cefixime

-Tx all partners

238
Q

Name the 3 organisms that cause Orchitis?

A
  • Chlamydia
  • gonorrhea
  • Mumps
239
Q

Tx of Orchitis includes?

A
  • scrotal elevation and ice
  • NSAIDS
  • Opiates
  • antibiotics if chlamydia or gonorrhoea
240
Q

What bugs cause acute prostatitis?

A
  • E. coli

- Pseudomonas

241
Q

What bugs cause Chronic Prostatitis?

A
  • gram neg rods

- Enterococcus

242
Q

A patient presents with fever, pain with voiding and perineal pain. He is tender with rectal exam. Urine culture is positive for E. coli? What is the DX?

A

-acute prostatitis

  • Tx: TMP/SMZ 160/800 po BID for 6 weeks or
    - Ciprofloxacin 500 mg BID for 6 weeks
243
Q

What are the antibiotics for tx of chronic prostatitis?

A

-Fluoroquinolones, penetrate well into the prostate and are choice, tx for 4 wks, if resistant use cotrimoxazole for 3 months

244
Q

A patient presents with a boggy prostate and back ache. what is the Dx?

A

-chronic prostatitis

245
Q

What antibiotics do you choose for chronic prostatitis?

A

-Fluoroquinolones, erythromycin

246
Q

What bug is the No 1 cause of Cystitis?

A

-E. coli, then enterococci

247
Q

Should men get Cystitis?

A

-cystitis in men is a sign of other pathology like bladder CA

248
Q

What about catheters and cystitis?

A

-use catheters sparingly and for as short a time as possible, pull as soon as you can after surgery

249
Q

A 65 y.o. female presents with c/o “it hurts when i pee” (dysuria), urgency and now with hematuria. What test do you run and how do you treat?

A
  • UA and urine culture

- Tx with Reflex, fluoroquinolones, Bactrim

250
Q

A male patient presents with purulent urethral discharge , painful voiding and frequency? What is your work up and how do you treat? What is your Dx?

A
  • urethral swab
  • sounds like gonnacoccal urethritis
  • ceftriaxone, 125 mg IM for the gonorrhea
  • azithromycin, 100 mg q day for 7 days for Chlamydia
  • Doxycycline, 100 mg bid for 7 days for Chlamydia
251
Q

32 y.o. female presents with fever, radiating flank pain, dysuria, ab pain, N/V. She has costovertebral tenderness. UA shows pyuria and white cell casts. What is the work up and how do you tx? What is the dx?

A
  • dx is pylonephritis
  • UA, urine culture, (KUB) x-ray of kidney’s, ureter and bladder
  • US , CT if needed
  • antibiotic tx
252
Q

What is the most common bug to cause peylonephritis and what is the antibiotic tx?

A
  • E. coli most commonly causes pylonephritis
  • antibiotic tx depends on culture, options include
    • fluoroquinolones
    • cephalosporins
    • aminogylcosides
    • bactrim
253
Q

A 56 y.o male presents with c/o of bloody urine. He is a 30 year 1 pk a day smoker? What is the work up, Dx and tx?

A
  • UA will show hematuria
  • U/S, CT, MRI
  • Cytology
  • cystoscopy and biopsy
  • Dx is Bladder Carcinoma
  • Tx, surgical, bladder resection by scope (TURBT), partial or radical cystectomy and adjuvant chemotherapy and radiation may be used
254
Q

What is the most common cancer in men and what are the risk factors?

A
  • Prostate cancer -African american
  • family hx
  • high fat diet
255
Q

What are the sx of prostate ca?

A

-none, it is found on rectal exam usually at a routine PE

256
Q

What are the PE findings and work up for ca of the prostate?

A
  • nodules on PE of the prostate
  • PSA >4
  • multiple samples from 3 zones of the prostate
  • oMRI
  • Bone scan for mets
257
Q

What is the tx for ca of the prostate?

A
  • radical prostatectomy
  • radiation
  • watchful waiting
258
Q

What are the Risk Factors for Renal Cell carcinoma?

A
  • smoking

- males > females

259
Q

What are the Sx of renal cell cancer?

A
  • blood in urine
  • flank pain
  • palpable abdominal mass

-sometimes found on routine exam

260
Q

What is the work up for renal cell CA?

A
  • UA shows hematuria
  • U/S
  • CT/MRI
261
Q

What is the tx for renal cell ca?

A
  • partial nephrectomy

- radical nephrectomy

262
Q

What are 3 things to know about testicular carcinoma?

A
  • one of the highest rates of cures for all cancers
  • may be related to cryptorchidism
  • more than 90% of testicular tumors are germ cell tumors which includes summons and nonseminomas
263
Q

A 19 y.o. male presents with c/o feeling of heaviness or at in the scortum and he has noted a lump on his testicle. Exam shows him to have a firm nodule on testis exam? What is the work up and what is the tx?-

A
  • Dx is to r/o testicular ca
  • work up includes blood/lab for hcg, alpha fetoprotein, and locate dehydrogenase
  • Complete orchiectomy is necessary for dx. Do not biopsy this increases risk of cancer spreading into the scrotum

Tx is radical orchiectomy along with adjuvant chemotherapy may be required

264
Q

A 7 y.o. presents with mother and she says this kid has a mass in his abdomen, fever and blood in his urine? PE shows him to have a swollen abdomen and a palpable mass? What is the work up, Dx and how do you tx?

A
  • U/S
  • CT/MRI

Tx is nephrectomy and adjuvant chemotherapy

265
Q

With epididimitis and no visible organism but lots of WBC’S what is the likely bug?

A

-Chlamydia

266
Q

What is tx for chronic bacterial prostatitis?

A
  • 6-12 weeks of Bactrim, quinolones, erythromycin

- your tx Gram neg rods & Enterococcus

267
Q

What bugs cause acute bacterial prostatitis?

A

-E. coli & Pseudomonas

268
Q

How do you tx Acute Bacterial Prostatitis?

A

-ampicillin & amino glycoside (like gentimycin) initially, then quinolones for 4-6 week

269
Q

What conditions can cause priapism?

A
  • sickle cell anemia

- leukemia

270
Q

What meds can cause priapism?

A
  • psychotropics
  • trazadone
  • alcohol
271
Q

What are the contraindications for treating ED with PDE-5 meds?

A

-concurrent use of nitroglycerine or nitrates

272
Q

What are the meds used for ED?

A
  • seldenafil (Viagra)
  • Vardenafil (Levitra)
  • Tadalafil (Cialis)
273
Q

Who most commonly gets ED?

A

-Diabetics

274
Q

What is the tx for Peyronie’s Disease?

A
  • (idiopathic erectile curvature due to scarring of the tunic albuginea)
  • Vit E, injection therapy, surgery
275
Q

Paraphimosis?

A
  • retracted painful swelling of the foreskin distal to phimotic ring
  • results in painful engorgement and edema of the glans
  • failure to reduce can lead to ischemia of the glans penis
276
Q

Phimosis?

A

-foreskin cannot be retracted over the glans

277
Q

Hypospadias?

A

-the meatus is located on the ventral aspect of the penis, scrotom, or perineum

278
Q

Tell me about Casts on a UA?

A
  • RBC Casts : glomerulonephritis
  • WBC Casts : pyelonephritis
  • Tubular Casts : acute tubular necrosis
  • Muddy Brown Casts : acute tubular necrosis
  • Waxy/Broad Casts : chronic renal failure
  • Hyaline Casts : normal
279
Q

Tx of Interstitial Cystitis?

A

amitriptyline, nifedipine

280
Q

Describe interstitial cystitis and how to tx?

A
  • pain with bladder filing that is relieved by emptying
  • tx with amitriptyline
  • assoc with irritable bowel disease
281
Q

Tx for Radiopaque kidney stones?

A
  • mostly are calcium (with oxalate or phosphate)
  • tx by decreasing dietary calcium, take thiazides, +/-allopurinol
  • if Struvite: ph > 7.2, you might see a Staghorn* calculus
282
Q

55 % of Acute Renal Failure is caused by what?

A

-prerenal, shock to the kidneys due to hypoperfusion to the kidneys

283
Q

45 % of Acute Renal Failure is cause by what?

A
  • Renal issues themselves
    • acute tubular necrosis
    • acute interstitial nephritis
    • glomerulonephritis
284
Q

The last 5-10 % of Acute Renal failure is caused by what?

A
  • Post renal things

- BPH, tumor

285
Q

Prerenal causes of Acute Renal Failure is with inadequate renal perfusion, by what causes?

A
  • Decrease Renal Persusion from
    • decreased intrasvascular volume
      • hemorrhage, GI losses, dehydration, burns, trauma
    • change is vascular resistance
      • sepsis, anaphylaxis, anesthesia
    • Low cardiac output
      • CHF, pulmonary embolism, tamponade
286
Q

An elevated BUN/Crt, > 20/1 (due to increased urea reabsorption) and Fractional excretion Sodium **

A
  • Acute renal failure (of the prerenal type)
  • Tx
    • maintain euvolemia
    • avoid nephrotoxic drugs
    • NSAIDS, +/- ACE inhibitors, Digoxin
287
Q

85 % of intrinsic acute kidney injury in acute renal failure is due to Acute Tubular Necrosis? Due to what ?

A
  • tubular damage from ischemia or nephrotoxins

- prolonged hypotension or hypoxia

288
Q

What drugs are Nephrotoxins and damage the tubules of the kidney?

A
  • Aminoglycosides: Gentamicin > tobramycin
  • amphotericin B
  • vancomycin
  • Radiographic contrast media N-acetylcysitne
  • Cyclosporine toxicity
  • hmMyoglobinuria, hemolysis, hyperuricemia
289
Q

A patient presents with in elevated BUN/Crt, along with hyperkalemia, hyperphospatemia and UA with Muddy Brown Casts* . What is the Dx and Tx?

A

-Acute Renal Failure from Acute Tubular Necrosis

  • Tx
    • avoid volume overload and hyperkalemia
    • +/- diuretics and Dopamine
    • protein restriction
    • +/- Dialysis
290
Q

A patient presents with fever, rash, and arthralgias. She has has Strep infection and tx was with penicillin. Lab CBC shows eosinophilia and UA shows eosinophiluria, RBC and WBC casts and hematuria. What is the Dx and Tx?

A

-Acute renal failure from Acute Interstitial Nephritis

-Tx good prognosis over weeks
+/- short course of steroids
+/- short term dialysis

291
Q

A patient presents with Hypertension and edema. UA shows hematuria, proteinuria, and RBC casts. Patient has had a recent sore throat/possible strep infection. What other lab do you order and how do you tx?

A
  • Acute renal failure from Glomerulonephritis
  • order ASO titer, anti-GBM titer, ANCA, ANA

TX is steroids and possible plasma exchange

292
Q

What is the likely etiology of Glomerulonephritis?

A
  • **IGA nephropathy (Berger disease)*

- **Postinfectious strep glomerulonephritis*

293
Q

When renal failure is due to postrenal causes describe the possible etiology?

A
  • benign prostatic hyperplasia*
  • Bladder dysfunction Anticholinergic drugs*
  • urethral obstruction or bladder obstruction
294
Q

A 56 y.o. male presents with lower abd pain. He is known to have BPH. Lab shows increased BUN/Crt. How do you further Dx and how do you tx?

A
  • bladder US

- tx : catheter, stent or surgery

295
Q

A 55 y.o. diabetic presents with c/o fatigue, pruritus, DOE, anorexia, N/V, and restless legs. UA shows elevated BUN and Creatinine. Blood works shows anemia, metabolic acidosis, hypocalcemia, *hyperkalemia and hyperphosphatemia. US shows small echogenic kidneys

A
  • Dx is chronic kidney disease
  • Tx
    • protein restriction diet
    • salt and water restriction
    • restriction of potassium, phosphorus and magnesium
    • dialysis
    • transplant
296
Q

What are the complications of Chronic Kidney Disease?

A
  • hypertension : ACE-I or ARB
  • pericarditis
  • congestive heart failure / atherosclerosis
  • Anemia : normochromic/normocytic
    - due to decreased erythropoietin production
  • coagulopathy : from platelet dysfunction
  • encephalpathy / neuropathy
  • osteomalacia
297
Q

55 y.o. male presents with HTN and has been tx with meds but remains HTN. What do you suspect? How do you work up and tx?

A
  • suspect renal artery stenosis (from atherosclerosis)
  • order renal angiogram : Gold Standard

Tx: angiogplasty +/- stenting

298
Q

Patient presents with peripheral edema, and hyper coagulable. Labs show:

  • hypoalbuminemia
  • heavy proteinuria > 3.5 g/24 hr
  • hyperlipidemia
  • Physical exam with edema

*APPLE

What is the Dx?

A

-you note APPLE

Dx is Nephrotic Syndrome

299
Q

Why are alpha blockers used to Tx Kidney Stones?

A

-relaxes the muscles in the ureter, helping to pass the stone more quickly and with less pain

300
Q

How do anticholinergic drugs work in treating Urinary Incontinence?

A

-these drugs inhibit the binding of acetylcholine to the cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. They also increase the urine volume at which the first involuntary bladder contraction occurs, decrease the amplitude of the involuntary bladder contraction, and increase bladder capacity.

301
Q

20 y.o. male presents with a painless enlarged testicle. You suspect testicular CA. What labs would you order?

A
  • beta HCG
  • LDH
  • AFP
302
Q

A scrotum mass that does not transluminate and feels like a bag of worms.?

A

-vericocele

303
Q

What is glomerulonephritis?

A
  • inflammation of the kidney by typically by immune response, after infection like strep throat
  • affects the glomeruli which filter the blood of wastes
304
Q

What is interstitial nephritis?

A
  • a form of nephritis involving the interstitial area between the kidney tubules, spaces between the tubules gets inflamed/swollen
  • often a reaction to medications such as antibiotics or nsaids
305
Q

What is acute tubular necrosis

A
  • death of tubular epithelial cells that form the renal tubules of the kidney. Common causes are hypotension and nephrotoxic drugs.
  • prognosis is good as tubule cells constantly replace themselves, tx with hydration and remove the offending drug
306
Q

What is Berger disease?

A

occurs when the antibody immunoglobulin A (IGA) lodges in the kidneys. Results in local inflammation that, over time may affect the kidneys ability to filler waste, excess water and electrolytes from the blood.

307
Q

What is nephrotic syndrome?

A

-a kidney disorder that causes your body to excrete too much protein in the urine. Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels (capillary walls of the glomerulus) in the kidney that filter waste and excess water from the blood.

308
Q

Describe the pathology of the glomerulus in nephrotic syndrome.

A

-the small pores in the podocytes, large enough to permit proteinuria (and subsequently hypoalbuminemai, less than 25g/L), because some of the protein albumin has gone from the blood to the urine) but not enough to allow cells through (hence no hematuria).

309
Q

What occurs in nephritic syndrome?

A

-in nephritic syndrome red blood cells pass though the podocyte pores and cause hematuria.

310
Q

What 3 things characterize nephrotic syndrome?

A
  • proteinurea
  • hypoalbuminemia
  • edema
311
Q

What is metabolic acidosis?

A
  • occurs when the body produces excessive amounts of acid or when the kidneys are not removing enough protein (increased hydrogen ion concentration in the blood)
  • blood ph less than 7.35
  • there is increased production of hydrogen ions or inability of the kidneys to form bicarbinate (HCO3)
312
Q

What is acidosis?

A

-metabolic acidosis together with respiratory acidosis is one of two general causes of acidemia

313
Q

What is metabolic alkalosis?

A

-ph is elevated above 7.45. Is a result of decreased hydrogen ion concentration, leading to increased bicarbonate

Urology (1 decks)

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