Urology Flashcards
Umbilical hernias in kids usually resolve by age ___. Surgical repair warranted if persistent by age ____.
Resolve by 2
Repair by 5
Children and neonates are prone to pyelonephritis due to _____ reflux.
Vesicourethral
*E COLI MC etiology
S&S of pyelonephritis include:
Fever, Tachycardia, back/flank pain, (+) CVA tenderness, N/V
UA for UTI shows:
- Pyelonephritis–> WBC casts!
- Dipstick: leukocyte esterase, nitrites, hematuria
- Urine culture: definitive dx! Used for complicated UTI, infants/kids, elderly, males, urologic abnormalities, refractory to tx, and catheterized patients
Treatment options for UTI:
- Uncomplicated: Nitrofurantoin, Cipro, Bactrim
- Complicated: Cipro PO or IV, Aminoglycosides
- Pregnant: Amoxicillin or Nitrofurantoin
- Pyelonephritis: Cipro PO or IV, Aminoglycosides
Inflammation of glomeruli causing PROTEIN and RBC leakage into urine is known as ______.
Glomerulonephritis
What are key S&S of Glomerulonephritis?
HTN, HEMATURIA, DEPENDENT EDEMA (PROTEINURIA), AND AZOTEMIA!!
Common etiologies of Glomerulonephritis include:
- IgA Nephropathy (Berger’s Disease)
- MC CAUSE OF AGN IN ADULTS WORLDWIDE
- Tx: ACEI +/- corticosteroids - Post Infectious
- MC after GABHS
- Scanty, coca-cola colored urine (hematuria and oliguria)
- Dx: increased ASO titers
- Tx: supportive +/- ABX - Membranoproliferative Mesangiocapillary
- SLE, viral Hep - Rapidly Progressive Glomerulonephritis (RPGN)
- Poor prognosis, rapid progression to ESRD
- Good Pasture’s Disease- found with RPGN. Often occurs after URI. KIDNEY FAILURE AND HEMOPTYSIS.
- Linear IgG deposits
- Tx: high dose corticosteroids
**Vasculitis
Glomerulonephritis is usually self-limited with a good prognosis
:)
_____ is MC type of nephrolithiasis.
Calcium oxalate and phosphate
Pain location and stone location related
- Proximal ureter= flank
- Mid-ureter= mid-abdominal
- Distal ureter= groin
Best initial test for kidney stones is ____. However, the gold standard test is _____.
1st= Non-contrast CT
Gold Standard= IV Pyelography (extend of obstruction)
Treatment related to size of stone.
-Stones < 5mm diameter= 80% chance of spontaneous passage. Give fluids, analgesics, antiemetics, and Tamsulosin
- Stones >7mm= 20% chance of passage. Can try:
1. Extracorporeal Shock Wave Lithotripsy
2. Ureteroscopy +/- stent: immediate relief of an obstructed or at-risk kidney
3. Percutaneous nephrolithotomy: for stones >10mm, struvite, or failed other modalities
What are the DRE findings for BPH?
Uniformly enlarged, firm, rubbery prostate
Treatment of BPH involves 2 classes of medication. What are they?
- 5-a Reductase Inhibitors: Finasteride & Dutasteride
- MOA: Inhibits conversion of testosterone to DHT which SUPPRESSES PROSTATE GROWTH and reduces bladder outlet obstruction.
- Does NOT provide immediate relief - a1 Blockers: Tamsulosin (Flomax), and the -Zosins
- MOA: smooth muscles relaxation of prostate and bladder neck
- DOES provide RAPID SYMPTOM RELIEF, but no effect on clinical course of BPH - Surgical: TURP
_____ is prostate inflammation secondary to ascending infection.
Prostatitis
> 35y: MC cause is E coli
<35y: MC cause is GC/Chlam
Kids: Mumps
S&S of acute prostatitis:
Fever/chills, malaise, arthralgias, perineal pain
(also all the other symptoms associated with BPH)
*S&S milder in chronic
PE findings for ACUTE prostatitis?
TENDER, boggy prostate
*AVOID prostatic massage (bacteremia…)
PE findings for CHRONIC prostatitis?
NONtender, boggy prostate
Treatment options for acute and chronic prostatitis?
Acute:
>35y- FQs, Bactrim
<35y- Rocephin + Azithro or Doxy
Chronic:
FQs, Bactrim
TURP if refractory!
Epididymitis is usually ____ (bacterial/viral) and Orchitis is usually _____ (bacterial/viral).
Epididymitis- bacterial
Orchitis- viral
In kids w/ orchitis the MC culprit is mumps. Orchitis usually preceded by ____ (another mumps symptom) by 3-10 days.
Parotitis
PE findings for epididymitis/orchitis:
Epididymal tenderness and induration
- POSITIVE PREHNS SIGN
- POSITIVE (NORMAL) CREMASTERIC REFLEX
Dx for epididymitis/orchitis:
- Scrotal US- enlarged epididymis and INCREASED TESTICULAR BLOOD FLOW
- UA: pyuria (inc. WBCs)
- STD testing: GC/Chlam, RPR, HIV
How do you treat children with acute epididymitis?
Cephalexin or Amoxicillin
_____ is the MC overall bacterial cause of STDs in US
Chlamydia
Reiter’s syndrome is associated with Chlamydia. What is Reiter’s syndrome?
Urethritis, Conjunctivitis/Uveitis, and Arthritis
____ is the MC cause of urethritis in men <30y.
Gonorrhea
*Dissemination: arthritis-dermatitis syndrome
What test is the most sensitive and specific for GC/Chlam?
Nucleic Acid Amplification
Inflammation of the glans penis is known as ____.
Balanitis
- Can be fungal or bacterial in nature
- *Tx- topical creams, if cellulitis–> Ceph or sulfa drug
MC solid tumor in young men 15-40y is _____.
Testicular Ca
_____ leads to a 40x increased risk for testicular cancer and is MC found on the right side.
Cryptochordism
Types of testicular tumors:
- Germinal Cell Tumors (97%)- usually malignant
- Seminoma: men 30-40. Think about the 4 S’s= Simple (lack tumor markers), Sensitive (to radiation), Slower growing, Stepwise spread
-Nonseminomatous: boys <10y. Embyronal cell carcinoma
- Non-Germinal Cell Tumors (3%)- can cause pulm sym
- Leydig cell tumors
- Sertoli cell tumors
- Gonadoblastoma, testicular lymphoma
How is testicular cancer diagnosed?
- Scrotal US
- Alpha-fetoprotein, b-hCG, LDH
*Tx- orchiectomy +/- radiation and chemo (for low to high grade Seminomas)
