Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery Subspecialties > Urology > Flashcards

Urology Flashcards

1
Q

What are the 5 types of incontinence?

A
  • stress
  • urge
  • overflow
  • functional
  • mixed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of incontinence in ppl >75yo?

A

urge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

S/Sx of urge incontinence? (3)

A
  • frequency
  • urgency
  • nocturia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Common etiologies of urge incontinence? (3)

A
  • usually idiopathic
  • overactive bladder
  • detruser hyperactivity w/impaired bladder contractility (DHIC)
    Nb. can also be d/t cystitis, tumor, stones, PD, dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx for urge incontinence (4)

A
  • Timed voiding
  • dietary manipulations to avoid irritants, weight loss
  • kegels
  • Meds: anticholinergics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes stress incontinence? (2)

A
  • leakage d/t lack of pelvic supports

- intrinsic sphincter deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe how lack of pelvic supports leads to stress incontinenc). What would usually cause this?

A
  • usually hypermobility of the bladder neck (85%)

- 2/2 aging, hormonal changes, multiple vaginal births, pelvic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What would cause intrinsic sphincter deficiency (stress incontinence)?

A

pelvic radiation, trauma, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx for stress incontinence? (4)

A
  • pelvic floor exercises
  • Meds: alpha agonists, imipramine
  • quit smoking
  • surgery - bladder sling for support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the cause of overflow incontinence?

A
  • detrusor underactivity
  • bladder outlet obstruction
  • Elevated PRV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What could cause detrusor under activity (overflow incontinence)? (5)

A

DM, MS, lumbar stenosis, spinal cord injury, meds (anticholinergics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What would cause bladder outlet obstruction (overflow incontinence)? (3)

A

ureteral stricture, BPH, cystocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the s/sx of overflow incontinence

A

small but continuous urine leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tx for overflow incontinence (2)

A

TURP, or intermittent catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

functional incontinence doesn’t involve _____

A

the lower urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

functional incontinence results from _______

A

cognitive or functional impairments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mixed incontinence (stress and urge) is most common in what population?

A
  • older women (65% w/stress incontinence have urgency)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tx of mixed incontinence

A

imipramine (anticholinergic and alpha agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 3 P’s you should assess for in the history of someone with incontinence? What should you also inquire about or suggest?

A
  • Position of leakage (standing, sitting, supine)
  • Protection (pads per day, wetness of pads)
  • problem (quality of life)
  • voiding diary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different modalities you can use to diagnose incontinence? (4)

A
  • UA
  • PRV
  • pad weight
  • urodynamics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What other meds can be used to treat incontinence in addition to the aforementioned meds, lifestyle modifications, exercises, and bladder training?

A
  • alpha adrenergic stimulators
  • oral estrogen
  • cymbalta (duloxetine) - increases urethral sphincter contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When do you screen for prostate cancer?

A
  • high risk groups/AAs: 45 yrs
  • Others: 50 yrs
  • stop at 75 or <10 yr survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RFs for prostate cancer (5)

A
  • AA>white>Asians
  • FMH
  • Diet
  • age
  • environmental exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you determine someone’s gleason score?

A
  • first # = majority of the tissue
  • second # = 2nd most common
    (4+3 is worse than 3+4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What gleason score is the cut off for high grade?

A

> 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PSA

A
  • a serine protease from the prostate that breaks down products in semen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ULN for PSA

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

PSA is used mostly for _____

A

disease RECURRENCE more than screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What things can elevate PSA? (8)

A
  • ejaculation
  • infection
  • cancer
  • instrumentation
  • inflammation
  • prostatitis
  • BPH
  • irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does PSA free:bound ratio tell us

A

decreased free:increased bound means a greater cancer risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is PSA velocity? How do we measure it? What is this used for?

A
  • the change in one’s PSA values over time
  • 3 measurements over 2 years is best
  • PSA 4 - threshold is 0.75 ml/yr increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is PSA density?

A
  • density of PSA/total prostate fluid volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the threshold for PSA density at which you’d biopsy?

A

> 0.15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the MOST COMMON cause of PSA elevation?

A
  • aging!!! consider BPH in older men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Where in the prostate does PCa occur?

A

peripherally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Why is PCa often asx?

A

Since it usually occurs in the periphery of the prostate it doesn’t cause obstructive sx until later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If someone is newly dx’ed with PCa what should you look for?

A

BONE METS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When is watchful waiting indicated in PCa pts? (2) How does watchful waiting work?

A
  • when they have <10 yr predicted survival
  • low grade, low volume dz
  • follow dz with 6 mos. PSA screening and biopsy if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 important outcomes after radical prostatectomy?

A
  • nerve sparing for erections

- incontinence a major problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

AEs a/w Ext beam radiation tx for PCa? (2)

A
  • 40% ED

- radiation proctitis(?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

AE a/w cryosurgery? How does the use of this compare with ext beam XRT in the setting of PCa?

A
  • 50-60% incontinence rate

- used more after XRT failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What hormonal drugs are used to treat PCa? (3)

A
  • Leuprolide - GHRH agonist
  • Flutamide - testosterone antagonist
  • Ketoconazole - adrenal gland test blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

SEs a/w hormonal tx for PCa? (6)

A
  • decreased libido
  • hot flaslhes
  • impotence
  • increased body fat
  • loss of muscle
  • loss of bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

When is hormonal tx used for PCa? Why?

A
  • in setting of metastatic dz to control growth bc tumor will eventually become hormonally resistant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Prevalence of BPH

A

50% @ 50; 80% @ 80

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How does BPH present?

A

LUTS (lower UT sx)

  • obstruction
  • irritation
  • urethral stricture/bladder outlet obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are obstructive BPH sx? (5)

A
  • weak stream
  • hesitancy
  • straining
  • nocturia
  • incomplete emptying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are irritative BPH sx? (3)

A
  • urgency
  • frequency
  • dysuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the different types of bladder ca?

A
  • TCC (90%)
  • Squamous
  • Adeno
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How does BCa present?

A
  • painless, gross hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the diagnostic work up for BCa? (3)

A
  • cytology (specific but not sensitive)
  • cystoscopy
  • TURBT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How does staging work for BCa?

A

Ta-T1: no muscle invasion

T2-T4: muscle invaded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Tx of BCa (localized and invasive respectively)

A
  • localized: TURBT, then surveillance + intravescle immuno/chemotherapy
  • invasive: radical cystectomy +/- chemo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What causes BPH?

A
  • androgens effect on periurethral (transitional) zone which constricts the urethra
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the steps for a diagnostic workup of BPH? (6)

A
  • UA - r/o infection
  • Cr - check renal fxn
  • DRE - for masses
  • PSA
  • PVR
  • Question survey for sx severity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Medical tx for BPH and their fxns? (3)

A
  • finasteride (5-alpha reductase inhibitor) - shrinks prostate
  • Terazosin/doxazosin/tamsulosin/alfuzosin - alpha adrenergic blockers (latter 2 are specific)
  • Combination of the 2 - most effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are the SEs of alpha blockers for BPH? (4)

A
  • orthostasis
  • impotence
  • decreased libido
  • retrograde ejaculation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the SEs of 5-alpha R inhibitors for BPH? (3)

A
  • impotence
  • decreased libido
  • decreased semen ejaculatory volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is a drawback to using medications for BPH vs. surgery?

A
  • 30-40% d/c tx w/in 12 mos. d/t unwanted SEs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Indications for surgery in setting of BPH? (5)

A
  • urinary retention
  • recurrent UTI
  • persistent hematuria
  • bladder stones
  • renal insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What’s the gold standard procedure for prostate removal d/t BPH? What does it accomplish?

A
  • TURP

- removes just the transitional zone of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When would you do an open prostatectomy? (2)

A
  • When the prostate is >100 g

- bladder stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which group most commonly has kidney stones?

A

white males who have previously had a stone (50% chance of recurrence at 10 yr post-stone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How many kidney stones pass on their own? In what length of time?

A

80%

4 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

80% of stones are < ____mm

A

4 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the indications for treatment of a kidney stone?

A
  • > 5 mm
  • persistent pain/bleeding
  • chronic infection
  • partial/complete obstruction
  • causing parenchymal damage
  • intractable N/V
  • patient preference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Most kidney stones are _____ which form from ____ _____ _____

A

calcium oxalate

Randall’s plaque nidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Causes of ca oxalate stones (4)

A
  • idiopathic hypercalciuria
  • primary hyperparathyroidism
  • cancer
  • sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Tx for pts w/ca oxalate/phosphate (4)

A
  • thiazides
  • hydration
  • protein restriction
  • Na restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Describe struvite stones

A

form in the calyces of the renal pelvis = stag horn calculi; 2/2 urease producing bugs that alkalinize the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are the urease producing bacteria (4)

A

PROTEUS
klebsiella
enterobacter
pseudomonas

72
Q

With what conditions do you tend to see uric acid stones? (3)

A
  • gout
  • xanthine oxidase deficiency
  • high purine turnover states (chemo)
73
Q

Describe the conditions (kidney/urine) that give rise to uric acid stones and how you diagnose them

A
  • acidic urine; RTA Type I

- CT NOT x-ray - these are radiolucent

74
Q

how do you treat uric acid stones

A

alkalinize the urine with CITRATE

75
Q

What causes cysteine stones?

A

COLA transport deficiencies - cysteine, ornithine, lysine, arginine

76
Q

What do the cysteine crystals/stones look like

A
  • hexagonal crystals

- ground glass appearance on x-ray

77
Q

those with cysteine stones have a positive ______ test

A

urinary cyanide nitroprusside test

78
Q

cysteine stones do NOT respond to _____ tx

A

shockwave TEST QUESTION

79
Q

T/F - Indinavir stones are radiopaque?

A

False - radiolucent

80
Q

Decreased GFR in the setting of a kidney stone leads to elevated pressures, decreased blood flow and therefore _______

A

ischemia

81
Q

kidney stone presentation may mimic ____ as the stone approaches the UVJ

A

cystitis

82
Q

Hematuria occurs in ___% of pts w an active kidney stone

A

90

83
Q

How do you dx a kidney stone? What is they’re pregnant?

A

CT abdomen/pelvis

  • KUB if no CT (75-90%) of stones are radioopaque
  • If pregnant: US
84
Q

What is the medical management of kidney stones? (4)

A
  • Analgesia: NSAIDs, narcotics
  • DDAVP for renal colic
  • metabolic stone eval for recurrent stones w/24 hr urine, serum electrolytes
  • facilitate passage w/alpha blockers, CCBs
85
Q

How do you work up recurrent stones? (3)

A

metabolic stone eval:

  • 24 hr urine
  • serum electrolytes
  • stone composition
86
Q

What are 2 modalities that can be used for stones that require removal (<3cm)?

A

ESWL, laser lithotripsy

87
Q

What are the indications for stone removal vs. passage? (3)

A
  • obstruction + infection
  • renal deterioration
  • refractory pain/nausea
88
Q

What happens with the vasculature during an erection? (3)

A
  • relaxation of the cavernous arteries
  • filling of the venous sinusoidal spaces
  • constriction of the subtunical venous plexus
89
Q

What vascular conditions can give rise to ED? (5)

A
  • HTN
  • HLD
  • DM
  • smoking
  • radiation
90
Q

Which of the following drugs can cause ED?

  • antipsychotics
  • antidepressants
  • antihistamines
  • central anti-hypertensives
  • BBs
  • spironolactone
  • small amts of alcohol
  • large amts of alcohol
A
  • antipsychotics: YES
  • antidepressants: YES
  • antihistamines: NO
  • central anti-hypertensives: YES
  • BBs: YES
  • spironolactone: YES
  • small amts of alcohol: NO - stimulatory!
  • large amts of alcohol: YES
91
Q

What type of ED is most common - organic or psychogenic?

A

Mixed

92
Q

ED could be the presenting symptom of which conditions? (6)

A
  • DM
  • CAD
  • HLD
  • HTN
  • SC compression
  • pit tumor
93
Q

What does the workup for ED involve?

A
  • UA
  • fasting glu
  • CBC
  • Cr
  • lipids
  • testosterone (prolactin, LH, free test for low T)
94
Q

What are some medical modalities (medication or otherwise) used to treat ED? (7)

A
  • PDE5 inhibitors
  • psychotherapy
  • Testosterone (if low T)
  • intracavernosal injections
  • intraurethral injections
  • vacuum erection devices
  • penile surgery
95
Q

What are the 3 different intracavernosal injections used for ED and what are the risks a/w this tx modality?

A
  • papverine, phentolamine, alprostadil

- risk of scars and priapism

96
Q

How many degrees of rotation must the spermatic cord endure to become ischemic (testicular torsion)

A

720

97
Q

What is the most common cause of testis loss in the US?

A

testicular torsion

98
Q

Bell clapper deformity

A

extended tunica vaginalis resulting in horizontal lie of the testicle
- in 12% of males

99
Q

How does testicular torsion usually present? (4)

A
  • Negative Prehn’s sign (pain stays constant with elevation of the testes)
  • loss of cremasteric reflex
  • <30 yo
  • intense acute onset pain
100
Q

____ is used to dx testicular torsion; however it can distinguish between this and ______. In order to do this you must look at TESTICULAR PERFUSION

A
  • US

- epididymitis

101
Q

How do you treat testicular torsion?

A
  • SURGICAL EMERGENCY (detorsion in 6 hrs = almost 100% salvage, 20% is 12 hrs)
  • Detorsion w/orchidoplexy of affected and unaffected testicle
102
Q

Appendiceal torsion

  • what does it mimic?
  • natural hx?
  • what does duplex US show?
  • whats a characteristic physical finding?
A

mimics testicular torsion except the testis is palpable with normal lie

  • self limited, atrophies with time
  • hypervascularity to region
  • Blue dot sign - seen through the skin
103
Q

(T/F) As a rule, penetrating trauma to the scrotum should be explored

A

T

104
Q

What are the bugs responsible for epididymitis in the young and old?

A

young: GC
old: gram -s (UTI bugs) - like E. coli

105
Q

What’s the presentation of epididymitis

  • age
  • which sign is +
  • what’s tender
  • describe the scrotum
  • how is the urine affected
A 
>30 yrs old
\+ Prehn's sign
epididymal tenderness
scrotal thickening, erythema
- pyuria
106
Q

How do you dx epididymitis?

A
  • UA
  • culture
  • duplex - increased blood to testes
107
Q

How do you treat epididymitis?

A

Abx x 3 wks: textracyclines, fluoroquinolones

pain management

108
Q

Acute orchitis

tx?

A

testicular inflammation/tenderness

- same as epididymitis (tetracyclines, flouros)

109
Q

testicular abscess tx

A

I&D

110
Q

Fournier’s gangrene

what populations do you usually see this in?

A

a fasciitis leading to gangrene of the perineum

  • rapidly progressive, life threatening
  • usually see this in DM, immunocompromised
111
Q

What are 2 inflammatory processes involving the testes/scrotum?

A
  • Henoch-Schonlein purpura vasculitis

- fat necrosis

112
Q

Presentation of hydrocele (2)

A
  • usually asx

- will transilluminate

113
Q

How do you treat hydrocele?

A
  • you don’t unless there’s a hernia or if it presents beyond 12-18 mos. of age
114
Q

Hydrocele arises from fluid in what layer of the scrotum?

A
  • tunica vaginalis
115
Q

Bag of worms is the nickname for _____

A

varicocele

116
Q

varicocele is dilatation of the _____ plexus and it’s seen in __% of men

A
  • pampiniform

- 15%

117
Q

varicocele usually affects which side more than the other and why?

A
  • L

- drains into the L renal vein

118
Q

varicocele (does/doesn’t) transilluminate

A

doesnt

119
Q

how do you treat varicocele?

A

surgically only if sx

120
Q

What are the 2 types of hernia?

A
  • incarcerated

- strangulated

121
Q

What are the most common bugs that cause UTI?

A

SEEKS PP

  • Serratia
  • E. coli (80%)
  • Enterobacter
  • Klebsiella
  • S. Saprophyticus (5-15%)
  • Proteus mirabilis
  • Pseudomonas
122
Q

What are 3 pathogenic factors of UTI bacteria

A
  • PILI w/phase variation that allows them to avoid phagocytosis - implicated in pyelo
  • K antigen
  • hemolysin
123
Q

What are the host defenses against UTIs? (7)

A
  • normal flora of the periurthra
  • urea in urine
  • high osmolarity
  • acidity
  • genetic predisposition
  • mucosa
  • antibody in kidney
124
Q

What physiologic factors affect colonization of normal flora in females? (3)

A
  • changes in estrogen
  • low vaginal pH
  • cervical IgA
125
Q

____ in the urine may facilitate infection

A

glucose

126
Q

Bladder epithelium has _____ to recognize bacteria, recruit WBCs and induce exfoliation

A

TLRs

127
Q

Uncomplicated UTI

A

UTI in a normal, healthy patient (acute cystitis/pyelo)

128
Q

complicated UTI

A

infection in a pt w/conditions predisposing to infection (BPH, hyronephrosis, stones, neurogenic bladder, systemic illness like DM, pregnancy, anal intercourse, FB in tract)

129
Q

recurrent UTI

A

occurs after a documented infection that has resolved

130
Q

reinfection of UTI

A

a new event w/reintroduction of bacteria to GU

131
Q

persistent UTI

A

recurrent UTI caused by same bacteria

- stones, chronic prostatitis, infected kidney, ectopic ureter, foreign body, cysts, abscess

132
Q

UTIs are mostly from the periurethral area, but may be ______ in immunocompromised patients or neonates. In these cases the common bugs are ____(3)

A
  • hematogenous

- staph, candida, TB

133
Q

Generally speaking, what are 2 RFs for UTI development?

A
  • reduced urine flow (OBSTRUCTION, VUR)

- altered defense (PREGNANCY, spinal cord injury)

134
Q

How do you diagnose UTIs and why are the respective modalities effective? (3)

A
  • Dipstick: LE highly sensitive and specific, nitrite specific but not very sensitive, pyuria is very sensitive (95%)
  • Cx: >100K colonies diagnostic
  • Imaging: for pets who don’t respond to treatment, looking for anatomic abnormality
135
Q

How do you treat UTIs?

A

hydration, relief of obstruction, foreign body (FB) removal, abx

136
Q 
Put the following abx in order of highest urine concentration --> lowest concentration:
cipro
amoxicillin
bactrim
cabrenicillin
cephalexin
nitrofurantoin
A 
cabrenicillin
cephalexin
amoxicillin
bactrim
cipro
nitrofurantoin
137
Q

When and how do you treat uncomplicated UTIs? What if the person has DM, is pregnant, greater than 65 yrs, or has hx of pyelo?

A
  • ONLY when they’re symptomatic
  • fluoroquinolones x 3 d (use if >10-20% R to bactrim); bactrim x 3 d
  • DM/pregnant/>65yo/pyelo hx: 7-10 d of tx
138
Q

When and how do you empirically treat complicated UTIs (abnormal tract, immunocompromised, MDR)

A
  • treat even when they’re asx

- parenteral ampicillin, aminoglycosides (vanc if allergic) x 14 d, switch to PO at 48 hrs

139
Q

blood cultures are positive in ____% of people with complicated UTIs

A

20-40%

140
Q

Which UTI abx are safe to use in pregnancy and which aren’t?

A
  • safe: nitrofurantoin

- not safe: fluoroquinolones - tendon malformation in infants

141
Q

How long do you treat acute prostatitis w/abx? Chronic prostatitis?

A
  • 4 wks

- 6-12 wks

142
Q

In which cases would you want to repeat cultures for a UTI so you can test for the appropriate cure? (3)

A
  • pregnancy
  • pyelo
  • relapsing UTI
143
Q

who has a greater risk of UTI thoughout childhood, boys or girls? What is their respective prevalence? What about during the first year of life?

A

girls: 8%
boys: 2%
- in first year of life boys get them more (10x increase in uncircumcised)

144
Q

children tend to present with UTIs w/ _____ symptoms

A

nonspecific - poor feeding, irritability, lethargic, vomiting, diarrhea, distension

145
Q

_____ are the 2nd most common cause of nosocomial UTI in children and can spread systemically with the high potential to become _____ in the NICU

A
  • Fungi

- invasive candidiasis

146
Q

Fungi can give rise to ____ in the kidney. A renal and bladder US can diagnose these

A

fungus balls

147
Q

Viral cystitis is usually caused by ____(4) and is usually self limited

A
  • HSV
  • flu
  • adenovirus
  • polyoma
148
Q

____ and ____ kids are at greater risk for viral cystitis

A
  • transplant

- immunocompromised

149
Q

The most common serious sequelae from pyelonephritis in a child is _____

A

renal scarring

150
Q

Pyelonephrosis in a child requires _____ for treatment.

A

urgent PCNT placement and abx

151
Q

recurrent pyelo in a child may lead to ______ and _____

A

reflux nephropathy

ESRD

152
Q

how do you diagnose a UTI in children?

A
  • dipstick
  • UCx
  • BCx
    (std is 10^5 colonies/ml)
153
Q

Under what circumstances and when do you image a child with a UTI? What imaging modalities?

A

FEBRILE infant OR child 2 mos. - 2 yrs w/1st UTI
- RBUS: anytime
only for voiding cystourethrogram: as soon as the child is infection free
- renal and bladder US, voiding cystourethrogram

154
Q

In children, ____ is the most commonly isolated bug with uncomplicated cystitis and can be treated with _______

A
  • enterobacter

- nitrofurantoin and bactrim

155
Q

40% of children with UTI have ______ which is a congenital cause of UTIs

  • can be detected with ___
  • natural hx: ____
A
  • VUR
  • voiding cystourethrogram (VCUG)
  • generally self resolves
156
Q

60% of children with congenital hydronephrosis have ______

  • this is d/t ______
  • natural hx: ____
A
  • UPJ obstruction
  • poor peristalsis or anatomic abnormality
  • may resolve or requires pyeloplasty
157
Q

When a child has a UTI in the first few months of life you think of _____
- you diagnose this by looking for the _____ sign on US

A
  • ureteroceles

- drooping lily sign

158
Q

Ectopic ureter is a congenital abnormality that may present as ___ or ___ in girls; or ____ or ____ in boys

A
  • girls: UTI, incontinence

- boys: UTI, epididymo-orchitis

159
Q

Neuropathic bladder in children is usually due to ____ or ____

A

spina bifida

trauma

160
Q

posterior urethral valve is the most frequent cause of congenital ________

  • US shows ____
  • 1/3-1/2 also have ___ or ___
A
  • bladder outlet obstruction
  • thick bladder, b/l hydronephrosis
  • VUR or renal dysplasia
161
Q

Prune belly syndrome

A

deficiency of the abdominal wall, dilatation of the ureters, bladder, urethra, w/b/l cryptorchidism

162
Q

In neonates w/a constant wet umbilicus you think of _____

A

urachal remnants

163
Q

Stones occur in children who have _____

  • Most of these stones are located where?
  • how do you treat them?
A

metabolic d/os

  • in the kidney
  • 50% pass spontaneously w/in 2 wks
164
Q

What are 3 acquired causes of UTIs in children?

A
  • stones
  • sexual abuse
  • dysfunctional voiding syndrome
165
Q

Dysfunctional voiding syndrome

A

lack of coordination between detrusor and external sphincter activity in children

166
Q

In cases of hematuria, dipstick is ____% sensitive and ___% specific. You should also confirm with _____

A
  • 95%
  • 75%
  • microscopic examination
167
Q

microhematuria is defined as ___ RBCs/HPF on ___ (#) specimens

A

> 3

2/3

168
Q

RFs for hematuria include:

  • age?
  • sex?
  • smoking hx?
  • exposures? which ones?
  • previous ____, _____
  • specific sx…
A
  • > 40
  • M
  • yes
  • chemicals - cyclophosph, benzenes, mitotane
  • pelvic radiation, urologic dz
  • irritative voiding
169
Q

the likelihood of malignancy in someone with hematuria is __%. Which malignancy is most common?

A

10%

- TCC

170
Q

What are the main causes of glomerular hematuria? (3)

A
  • IgA nephropathy/Bergers*
  • thin BM disease
  • hereditary nephritis (alports)
171
Q

What are the main non-glomerular causes of hematuria:

  • upper tract (5)
  • lower tract (5)
A
  • upper: stones, pyelo, RCC, TCC, obstruction

- lower: UTI, BPH, exercise, TCC, instrumentation

172
Q

What impact does excessive anticoagulation have on hematuria?

A
  • does NOT lead to de novo hematuria but may worsen current hematuria
173
Q

What is the w/u for non-high risk hematuria?

A
  • UA

- culture if infection suspected, then treat, then repeat UA

174
Q

What is the w/u for high risk hematuria (any of the RFs, or gross hematuria) (7)

A
  • evaluation of upper and lower UT
  • US,
  • cytology
  • contrast CT
  • cystoscopy
  • retrograde ureterogram
  • bladder wash
175
Q

What if the w/u for hematuria in a high risk patient turns up negative?

A

re-evaluate in 48-72 mos. 3% will develop malignancy

176
Q

NO EBM RECS FOR SCREENING ASX PTS FOR HEMATURIA

A

-

Surgery Subspecialties (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions