Urology

Question 1

What can be used to treat chronic bacterial prostatitis?

Answer 1

Levofloxacin or Bactrim

Question 2

The MC causes of hematuria are:

Answer 2

URI, nephrolithiasis, neoplasms, BPH, glomerulonephritis, and schistosomiasis

• In the ED, consider strenuous exercise, poststreptococcal infection (in younger patients), and life threats including malignant hypertension, eroding abdominal aortic aneurysm, coagulopathy, foreign body, immune-mediated disease, sickle cell disease complications, and renal vein thrombosis

Question 3

Life threatening causes of incontinence not miss in the ED include:

Answer 3

o Cauda equina syndrome
o Spinal cord compression
o Paraspinal abscess → think bacterial abscess if → fever

Question 4

Stones measuring <5mm often pass spontaneously. Most stones pass within __ to __ weeks of symptom onset.

Answer 4

2-4 weeks

Question 5

Stones 5-10mm should be managed by:

Answer 5

Fluids, analgesics, AND

Elective lithotripsy or ureteroscopy

Question 6

Stones >10mm

Answer 6

Vigorous hydration!

Ureteral stent or percutaneous nephrostomy should be used if renal function is jeopardize

Question 7

For the BIG stones…

Answer 7

Urgent treatment with extracorporeal shock wave lithotripsy can be used for renal stones of less than 2 cm or for ureteral stones of less than 1 cm. Ureteroscopic fragmentation also may be used. Percutaneous nephrolithotomy can be used for stones of greater than 2 cm

Question 8

_____ is a surgical emergency!!! It is more common in men < 30y. Acute onset unilateral scrotal pain is the hallmark symptom.

Answer 8

Testicular torsion

Question 9

Symptoms and signs of testicular torsion are:

Answer 9

-N/V, Scrotum is red and swollen, testis is tender and high-riding

Question 10

The most sensitive finding for testicular torsion is the absence of the _____.

Answer 10

Cremasteric reflex!!

*Doppler US may be helpful in dx but this is a clinical dx

Question 11

____ is the MC cause of cystitis.

Answer 11

E. coli

Question 12

UA of someone w/ cystitis often shows:

Answer 12

Pyuria, bacteriuria, and varying degrees of hematuria

-leukocyte esterase and nitrates

Question 13

Suggested regimen for treating cystitis is:

Answer 13

Bactrim x 3-5 days or fluoroquinolone x 3-5 days

Nitrofurantoin during pregnancy!! –> should treat asymptomatic bacteriuria in pregnancy

Question 14

In men younger than 35-40y ____ and ____ are the MC organisms to cause Epididymitis.

Answer 14

GC/Chlam

Question 15

In men older than 35-40y ____ is the MC organism.

Answer 15

E. coli

Question 16

Clinical manifestation of epididymitis include:

Answer 16

Swelling, VERY tender to touch, eventually get a warm and enlarged scrotal mass

-Patient may have fever/chills

Question 17

The ____ sign is a classic sign of epididymitis but it is not very reliable.

Answer 17

Prehn’s- relief of pain with scrotal elevation

Question 18

Treatment for epididymitis is:

Answer 18

1. Men <35y= Cetriaxone + Doxy for 10 days
2. Men >35y= Ciprofloxacin for 10-14 days
   * If toxic appearing admit for IV antibiotics–> ceftriaxone or Bactrim IV

Question 19

____ occurs in 25% of postpubertal males who have mumps infection.

Answer 19

Orchitis

Question 20

Clinical manifestations of orchitis include:

Answer 20

• Testicular swelling and tenderness, usually unilateral
• Fever and tachycardia
• UA revealing pyuria and bacteriuria

*US most useful if abscess or tumor is suspected!!

Question 21

Chronic nonbacterial prostatitis is the most common of the prostatitis syndromes, and its cause is unknown.

Answer 21

fyi

Question 22

All forms of prostatitis present with irritative bladder symptoms such as:

Answer 22

frequency, urgency, dysuria

Question 23

The four-glass localization test is the classic means of distinguishing a chronic prostate infection from another UTI. How does it work?

Answer 23

Urine samples are taken at initial void, midstream, and after prostatic massage. Prostatic secretions account for the fourth sample. Assessment of the samples helps to localize the nidus of infection. This test should be avoided in a patient suspected to have acute prostatitis

Question 24

Treatment of prostatitis typically involves what class of medication?

Answer 24

Fluoroquinolone for a total of 30 days

*Hospitalization may be indicated in acute cases with administration of IV gentamycin and ampicillin

**Chronic, recurrent, or resistant prostatitis with or without prostatic calculi may require TURP for ultimate resolution

Question 25

Signs and Symptoms of pyelonephritis include:

Answer 25

• Fever, flank pain, shaking chills, irritative voiding symptoms.
• Nausea, vomiting, and diarrhea are not uncommon
• Tachycardia, pronounced costovertebral angle tenderness
• UA shows pyuria, bacteriuria, and varying degrees of hematuria. WBC casts may be seen.

Question 26

Treatment of pyelonephritis involves…

Answer 26

1. Outpatient–> Quinolones or Bactrim 1-2 weeks.
2. Hospital admission in more severe cases–> IV fluoroquinolones or ampicillin and gentamicin, then PO cipro for 2 weeks

Question 27

______ classically presents as acute urethral discharge following unprotected sex.

Answer 27

Urethritis

Question 28

Urethritis is treated like GC/Chlam

Answer 28

Ceftriaxone + Azithromycin

Question 29

What is Reiter’s Syndrome?

Answer 29

Urethritis, arthritis, conjunctivitis, and mucocutaneous lesions

Question 30

Acute renal failure can lead to:

Answer 30

Volume overload, hypertension, pulmonary edema, mental status changes or neurologic symptoms, nausea and vomiting, bone and joint problems, anemia, and increased susceptibility to infection (a leading cause of death) can occur as patients develop more chronic uremia

Question 31

3 categories of renal failure are:

Answer 31

1. Prerenal
2. Renal
3. Postrenal

Question 32

Some findings in acute renal failure

Answer 32

o Normal urinary sediment may be seen in prerenal and postrenal failure, hemolytic-uremic syndrome, and TTP

o The presence of albumin may indicate glomerulonephritis or malignant hypertension

o Granular casts are seen in acute tubular necrosis

o Albumin and red blood cell casts are found in glomerulonephritis, malignant hypertension, and autoimmune disease

o White blood cell casts are seen in interstitial nephritis and pyelonephritis

o Crystals can be present with renal calculi and certain drugs (sulfa, ethylene glycol, radiocontrast agents)

Question 33

______ is the radiologic procedure of choice in most patients with renal failure when upper tract obstruction and hydronephrosis is suspected.

Answer 33

Renal US

Question 34

What causes PRErenal failure?

Answer 34

Conditions that decrease renal perfusion and is the most common cause of community-acquired acute renal failure (70% of cases)

Question 35

Common causes of PRErenal failure are:

Answer 35

o Common causes of prerenal failure → hypovolemic states (vomiting/diarrhea, diuretics and other antihypertensives, reduced intake), fluid sequestration (cirrhosis, pancreatitis, burns, septic shock, others), blood loss, or decreased cardiac output from cardiac dysfunction

o Effective intravascular volume should be restored with isotonic fluids (NS or LR) at a rapid rate. Volume resuscitation is the first priority

o If cardiac failure is causing prerenal azotemia, cardiac output should be optimized to improve renal perfusion, and reduction in intravascular volume (i.e., with diuretics) may be appropriate

Question 36

_____ causes most cases of intrinsic renal failure.

Answer 36

Ischemic renal injury–> Acute tubular necrosis (ATN) = AKI

*Nephrotoxic agents are 2nd on the list

Question 37

____ MC cause of hospital acquired renal failure.

Answer 37

ATN or AKI

*Use caution with renally excreted drugs- digoxin, magnesium, sedatives, narcotics

Question 38

_______ occurs primarily in elderly men with high-grade prostatic obstruction.

Answer 38

POSTrenal azotemia

• strictures are also causes
• *Permanent loss of renal function occurs over 10-14 days with complete obstruction and worsens with UTI
• **If treatment of underlying cause fails to improve renal fxn then hemodialysis or peritoneal dialysis should be considered

Question 39

About 60% of cases of glomerulonephritis are in children 2-12y. Prognosis is ____ (good/bad) in this group.

Answer 39

Good! :)

Question 40

What are signs and symptoms of glomerulonephritis?

Answer 40

Urine is often tea or cola colored

Oliguria or anuria present

Edema of the face and eyes present in AM, and edema of feet and ankles in PM

Question 41

A common cause of GN is _____.

Answer 41

Post-streptococcal infx. PSGN

Question 42

Treatment of GN involves:

Answer 42

o Steroids and immunosuppressive drugs may be used to control the inflammatory response which is responsible for the damage. These are usually not needed in PSGN

o Dietary management → salt and fluid intake should be decreased

o Dialysis should be performed if symptomatic azotemia is present

o Medical therapy:
• ACE inhibitors are renoprotective (reduce urinary protein loss) in chronic GN
• Use medications as appropriate for hyperkalemia, pulmonary edema, peripheral edema, acidosis, and hypertension

Question 43

Hypoalbuminemia, edema, hyperlipidemia, coagulation abnormalities with increased risk for DVT and renal vein thrombosis is associated with _____ syndrome.

Answer 43

Nephrotic

Question 44

CKD can lead to:

Answer 44

Volume overload, hyperkalemia, metabolic acidosis, hypertension, anemia, and bone disease.

Question 45

Hemoptysis and kidney disease:

Answer 45

• Most commonly caused by anti-GBM (Goodpasture) disease due to pulmonary alveolar hemorrhage.
• ANCA-associated vasculitis with glomerulonephritis and pulmonary capillaritis (Wegener’s disease)

Question 46

Renal dermal syndromes include:

Answer 46

• SLE, Henoch Schönlein Purpura (HSP), cryoglobulinemia, and ANCA-associated vasculitis
• Palpable purpura (HSP), necrotic dermal inflammation, ulcers, or nodules

Question 47

Treatment of GN involves:

Answer 47

o Supportive care with fluid and electrolyte management
o Poststreptococcal → antibiotics
o Nephrosis →control proteinuria with ACE-I and ARBs
o Diabetics → control blood pressure and glycemic disease
o Severe edema → sodium and water restriction and careful use of loop diuretics
o Immunosuppressive agents → Goodpasture syndrome, Wegener granulomatosis, and polyarteritis. Can limit disease in idiopathic nephrotic syndrome, lupus nephritis, and idiopathic RPGN. Can be considered in IgA-nephropathy and amyloidosis.