Urology Flashcards
First line treatment for BPH
Alpha blockers when mod-severe symptoms
SOR A
When to use 5-alpha reductase inhibitors
bothersome, mod-severe symptoms and documented enlarged prostate when alpha blocker monotherapy not effective
SOR A
In addition to alpha blockers and 5 alpha reductase inhibitors (Level A). What is a medication whose off label use helps BPH (level B)?
Cialis - mechanism unknown
don’t use with alpha blockers
Empiric antibiotics for Acute bacterial prostatitis (3 choices)
- what are you trying to cover
- cover gram negative enterics. Cover for GC/CHL if sexually active
- Ceftriaxone + Doxy. Ciprofloxacin. Bactrim
- duration 10-14 days
Which labs most accurately predict hypogonadism
AM labs:
- low testosterone
- high FSH
- high LH
What is the diagnostic sequence for primary hypogonadism
- Testosterone level –> low
- repeat free testosterone. Add FSH, LH
- Low T, high FSH, high LH = primary hypogonadism = pituitary is working, the testes are not
What is the diagnostic sequence for secondary hypogonadism
- Testosterone level –> low
- repeat free testosterone. Add FSH, LH
- Low T, low FSH, low LH = secondary hypogonadism = regulatory problem, so look at the pituitary
- prolactin, MRI, TSH, T4
What are concerning side effects of treating with testosterone
increased risk of prostate cancer and breast cancer
worsening BPH
blood clots
sleep apnea
Which populations benefit most from PDE type 5 inhibitors in treatment of ED?
DM, spinal cord injury, antidepressant side effects
SOR A
Who should be screened with PSA?
AAFP does not recommend routine PSA based screening.
For men ages 55-69 who are considering periodic prostate cancer screening –> shared decision making
SOR C
Don’t screen older than 70
SOR D
What lifestyle changes should people with kidney stones make if they have calcium oxalate stones?
- don’t change dietary sodium
- increase fluid intake to at least 2 L per day
SOR B
Which initial image should I get if I suspect kidney stones?
- pregnant, gallbladder dz, or gyn cause suspected –> US
- Hx or radio-opaque stones –> X ray
- Everyone else –> US if not obese, otherwise non contrast CT
How do I manage Kidney stones that are < 4 mm?
98% pass on their own in 1-2 weeks analgesia alpha blockers unlikely to benefit repeat KUB in 1-2 weeks Urology if not passed in 2-4 weeks
How do I manage kidney stones 5-10 mm?
53% pass on their own analgesia alpha blockers unlikely to benefit repeat KUB in 1-2 weeks Intervene if: persisting colic, failure of stone progression, evidence of obstruction
What size kidney stone warrants immediate urology referral?
10 mm
SOR C
