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clin med > urology > Flashcards

urology Flashcards

1
Q

MC nosocomial infection in hospitals and nursing homes

A

UTI

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2
Q

acute cystits uncomplicated women?

A

Infection of the urothelium (lining or urinary tract)bc bacteria ascends up the urethra

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3
Q

cause of Acute cystitis = bladder infection, uncomplicated women

A

MC e coli
Enterococcus, Klebsiella, proteus
Staph saprophyticus- young sexually active women

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4
Q

Acute cystitis = bladder infection, uncomplicated women

sx

A

Dysuria, frequency, urgency, suprapubic discomfort, foul smelling urine, cloudy urine
NO fever or vaginal discharge

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5
Q

Acute cystitis = bladder infection, uncomplicated women

dx

A

Nitrate + → 90% chance of UTI, but UTI does not r/o - results
Nitrates are converted to nitrite
Leukocyte esterase + → bladder is irritated from pyuria
Good sensitivity
pH → acidic can indicate urolithiasis and basic can indicate urea splitting organism
*Urine culture- gold std; 100,000 organisms midstream catch

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6
Q

Acute cystitis = bladder infection, uncomplicated women

trmt

A

Gold std- macrobid or bactrim DS

Keflex and cipro

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7
Q

Acute cystitis, pregnant women

cause

A 
#1 e coli
#2 strep B
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8
Q

Acute cystitis, pregnant women

dx

A

Urine culture only needs 10,000 organisms

+ UA

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9
Q

Acute cystitis, pregnant women

trmt

A

Treat everyone
Macrobid, ampicillin, Keflex for 7 days
NO fluoroquinolone or sulfonamides

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10
Q

Acute cystitis, men

cause

A

E coli

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11
Q

Acute cystitis, men

sx

A

Dysuria, frequency, urgency, suprapubic discomfort, foul smelling urine, cloudy urine
NO fever or penile discharge

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12
Q

Acute cystitis, men

dx

A

Send all male urines for culture
Meares stamey test
Only need 1-2 WBC to dx

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13
Q

Acute cystitis, men

trmt

A

Cipro or bactrim DS 7-14 days
Tailor trmt once urine cult comes back
Swab for std before getting urine sample

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14
Q

Acute cystitis, complicated

cause

A

E coli MC
Gram - rods Klebsiella, proteus
Gram + bacteria enterococci, staph aureus
Yeasts
Gas forming organism like ones above
*DM are predisposed to emphysematous pyelonephritis

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15
Q

Acute cystitis, complicated

dx

A

CT

Gas in urinary tract with UTI

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16
Q

Acute cystitis, complicated

trmt

A

Elective nephrectomy

Antimicrobial therapy 7-14 days

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17
Q

Pyelonephritis?

A

Acute cystitis spread to the kidney

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18
Q

Pyelonephritis cause

A

Gram - : e coli, proteus, klebsiella, enterobacter, pseudomonas

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19
Q

Pyelonephritis sx

A 
CVA tenderness
Fever
NV
Malaise
tachycardia
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20
Q

Pyelonephritis dx

A 
CBC- leukocytosis
UA- pyuria, bacteriuria, hematuria
Urine culture- heavy growth
US- hydronephrosis (possibly)
Abdomen and pelvis CT with oral and IV contrast- GOLD std
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21
Q

Pyelonephritis trmt

A

IV ampicillin or quinolone

PO fluoroquinolone 14-21 days

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22
Q

Hemorrhagic cystitis

sx

A

Frank hematuria- use wine scale

No fever, CVA tenderness, abdominal mass, tachycardia, appearing acutely ill

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23
Q

Hemorrhagic cystitis

dx

A

+ UA with blood
Send for urine culture
Proteinuria and casts? Renal origin
Bacteriuria and + urine culture? UTI

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24
Q

Hemorrhagic cystitis

trmt

A

Gold std- macrobid or bactrim DS
Keflex and cipro
Keflex and macrobid are in urine
Cipro and bactrim are in tissue

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25
Q

Recurrent cystitis?

A

Women who have over 3 episodes of cystitis in 1 year

Make sure pt does not have stones, reflux, or fistula

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26
Q

Recurrent cystitis

dx

A

Urine culture
PVR- post void residual
Cystoscopy
CT urogram

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27
Q

Recurrent cystitis

trmt

A

Treat infection
Treat stones, reflux, or fistula if present
PPX ATB 30 days-6mo (Bactrim, Macrobid, Keflex)
Postcoital ATB

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28
Q

Catheter associated bacteriuria

cause

A

E coli is MC
Polymicrobial 50%
Candiduria is common

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29
Q

Catheter associated bacteriuria

sx

A

Fever, chills, AP, altered LOC, HoTN, hypo/hyperglycemia

Foul or cloudy urine is NOT an indication of a catheter

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30
Q

dx Catheter associated bacteriuria

A

+ urine culture from the catheter NOT the bag

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31
Q

Catheter associated bacteriuria trmt if caused by bacteria

A

Elective nephrectomy
Antimicrobial therapy 7-14 days
Begin with fluoroquinalone

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32
Q

Catheter associated bacteriuria trmt if caused by fungi

A

If candida infection…
Asymptomatic: remove catheter
Symptomatic: Fluconazole or amphotericin (both antifungals)

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33
Q

Don’t treat unless pregnant, pt is about to have urologic surgery, after renal transplant

A

Asymptomatic bacteriuria

34
Q

OAB cause

A

Detrusor overactivity or early sensation

35
Q 
Overactive bladder (OAB)
 sx
A

Peeing over 8 times a day or over 1 time a night

36
Q 
Overactive bladder (OAB)
 trmt
A
  1. Behavioral modifications
  2. Meds
  3. Alternative trmt
37
Q 
Overactive bladder (OAB)
 meds
A

anticholinergic/antimuscarinic, beta agonist (myrbetriq)

38
Q 
Overactive bladder (OAB)
 alternative therapy
A

Percutaneous nerve stimulation (PTNS)- tibial stimulation thing
Interstim- like bladder pacemaker
Botox

39
Q

Stress Urinary incontinence

cause

A

Bad vesicourethral ligament support

40
Q

Stress Urinary incontinence

sx

A

Incontinence with activity: coughing, lighting, bending, sneezing, intercourse, changing positions

41
Q

Stress Urinary incontinence

PE

A

Q tip test grade 1-4

Assess for cystocele, rectocele, enterocele

42
Q

Stress Urinary incontinence

trmt

A

Repair vesicourethral ligament
MC sling
Pessary

43
Q

Urinary urgency incontinence

cause

A

Detrusor is not stable

44
Q

Urinary urgency incontinence

sx

A

Losing urine right after you feel the need to pee

“Can’t make it in time”

45
Q

Urinary urgency incontinence

trmt

A
  1. Behavioral modification- no caffeine, manage fluid, bladder training, pelvic wall strengthen
  2. Medication
    Anticholinergic 1st line
  3. Alternative trmt
    Percutaneous nerve stimulation (PTNS)- tibial stimulation thing
    Interstim- like bladder pacemaker
    Botox
46
Q

Overflow incontinence

cause

A

Don’t sense pee
Something is blocked so you don’t feel the need to pee
Nerve damage interrupts signal from the brain to bladder so you don’t feel like you need to pee

47
Q

Overflow incontinence

sx

A

Leaking without urgency- not sensing you need to pee

48
Q

Overflow incontinence

dx

A

History, cystoscopy, urodynamics

49
Q

Overflow incontinence

trmt

A

Remove obstruction

Stimulate nerve

50
Q

Urinary retention

cause

A

MC in elderly men bc of BPH
Inc resistance to urine flow or dec detrusor muscle contractility
Enlarged prostate, phimosis, paraphimosis, meatal stenosis

51
Q

what can urinary retention lead to

A

reurrent uti

52
Q

urinary retention sx and PE

A 
Unable to void
Suprapubic and abd pain
Crede- Positional voiding need to lean forward to get pee out
Medications 
abdominal distension on PE
53
Q

Urinary retention

dx

A

US
Cath
CRE/BUN if prolonged

54
Q

Urinary retention

trmt

A

Find the source

Alpha agonist- flomax

55
Q

____ innervate smooth bladder muscle, internal sphincter, and proximal urethra

A

T10-L2

56
Q

Neurogenic bladder

cause

A

MC MS, spinal cord injury, TIA/stroke, parkinsons, DM, ALS, injury to pelvis

57
Q

Neurogenic bladder

sx

A

Don’t feel need to pee
Flooding episodes
Bladder spasm

58
Q

Neurogenic bladder

dx

A

*Urodynamics

59
Q

Neurogenic bladder

trmt

A 
Catheter
Bethanechol- inc tone in detrusor
Interstim
Botox
Cystectomy
60
Q

hematuria sx

A

Blood in urine

61
Q

antyime you have hematuria you should do this for a dx

A

3 C’s
CT urogram
Cytology
Cystoscopy

62
Q

trmt hematuria

A

Find the cause
Infection- hemorrhagic cystitis
Stones
Malignancy- bladder, urethral, ureteral , renal CA
Damage- radiation, cystitis, interstitial cystitis

63
Q

Interstitial cystitis / “painful bladder syndrome”

sx

A

Pain with bladder filling and relieved by emptying

Frequency, urgency, nocturia

64
Q

Interstitial cystitis / “painful bladder syndrome”

PE

A

Check for vaginitis and urethral diverticulum

Pelvic pain usually present

65
Q

Interstitial cystitis / “painful bladder syndrome”

dx

A

UA- normal or hematuria
*K sensitivity test
*Cystoscopy- hunner’s ulcers and patches which are red angry patches in bladder
Biopsy

66
Q

Interstitial cystitis / “painful bladder syndrome”

trmt

A

Hydrodistention- stretch bladder nerves
Meds
Amitriptyline, elmiron, heparin, dimethyl sulfoxide
Dietary changes- ETOH, caffeine, spicy food, acidic food

67
Q

meds for Interstitial cystitis / “painful bladder syndrome”

A

Amitriptyline, elmiron, heparin, dimethyl sulfoxide

68
Q

Vesicoureteral reflux ?

A

Urine goes back into the ureters and kidney

69
Q

Vesicoureteral reflux grades and trmt

A 
Grades 1-5
1 and 2- resolve in infants
3- may resolve
4 and 5- don't resolve 
Need deflux or implant surgery
Adults- none resolve alone
70
Q

TST made where and by who?

A

Made by Leydig cells in seminiferous tubules

71
Q

cause low tst

A

Aging
Dec 1% annually after age 50
Dec libido, male aggression, verbal memory, visuospatial, muscle strength and growth, maturation of sexual organs and penile growth

72
Q

sx low tst

A

Flushes or sweating, breast discomfort or gynecomastia, infertility
Fatigue depression, decline in memory, inc body fat, dec work performance, sleep issues

73
Q

pe low tst

A

Breast tenderness and gynecomastia
Dec in lean body mass
Dec chest hair and skin
Testicular atrophy

74
Q

dx low tst

A

Serum TST lower than 230

Reference ranges not age dependent

75
Q

if TST is low you must get this

A

dexa scan

76
Q

trmt low tst

A

Oral, injectable, transdermal, SQ, buccal

Most popular: transdermal gels → injectables → transdermal patches

77
Q

risks with TST supplements

A 
*Azoospermia
Prostate cancer
BPH
Gynecomastia
Acne
Mood swing
Polycythemia
CV disease
78
Q

monitoring TST

A

Check 1-2 mo after initial trmt
3-6 mo in 1st yr
Annually
DRE, serum PSA, Hg, voiding assessment, liver function

79
Q

when is TST highest and lowest?

A

Highest in am and lowest at 3pm

80
Q

___ and ___ are in urine

____ and ____ are in tissue

A

Keflex and macrobid

cipro and bactrim

clin med (35 decks)

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