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EOR Exam - Family Medicine > Urology and Renal > Flashcards

Urology and Renal Flashcards

1
Q

Define balanitis.

A

Inflammation of the foreskin and head of the penis.

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2
Q

What S/S are most commonly associated with balanitis?

A

Patient will be uncircumcised male c/o itching and burning of penis presenting with erythema, inflammation, and scant white discharge.

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3
Q

What is the most common pathogen that causes balanitis?

A

Candida

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4
Q

What is the typical treatment for balanitis?

A

Improved hygiene, topical antifungal or abx.

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5
Q

What patients are more susceptible to balanitis and how are they treated?

A

Diabetics –> hygiene, glucose control, clotrimazole

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6
Q

Describe the pathophysilogical process leading to benign prostatic hyperplasia (BPH).

A

proliferation of fibrostromal prostate tissue –> urethral compression –> obstruction of urinary outlet

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7
Q

What clinical features will be indicative of BPH?

A

Slightly elevated PSA, enlarged prostate on DRE, hesitancy and straining, post-void dribbling, nocturia, urgency, frequent UTIs.

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8
Q

What are treatment options for BPH?

A

Behavioral: imit fluids before bed
Pharm: alpha antagonists (prazosin), PDE-5 inhibitors (tadalafil), Anti-Ach agents
Procedures: balloon dilation, microwave irradiation, stent placement, transurethral resection/incision

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9
Q

What is the most common cause of non-gonococcal urethritis?

A

Chlamydia

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10
Q

Differentiate urethritis caused by chlamydia from that of gonorrhea.

A

IN chlamydia, discharge is usually watery and less painful than in gonorrhea.

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11
Q

What is the typical presentation of chlamydia in females and what is the risk of disease progression?

A

Usually asymptomatic –> progress to PID, cervicitis, salpingitis

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12
Q

What is the most common cause of female infertility?

A

Chlamydia

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13
Q

How is the diagnosis of chlamydia made?

A

Typically presumptive based on symptoms –> bacteria is gram negative on testing

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14
Q

What is the treatment for chlamydia?

A

Doxycycline, azithromycin, erythromycin –> preferred in pregnancy

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15
Q

Define cystitis and state the most common cause and progression of the disease.

A

Bladder infection. Usually E. Coli that ascends from urethra –> often appears in women after sexual intercourse.

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16
Q

What clinical features are consistent with a diagnosis of cystitis?

A

H&P: Frequency, urgency, dysuria, maybe suprapubic tenderness.
UA: Pyuria, bacteriuria, may have hematuria –> urine culture will be positive for offending organism

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17
Q

What imaging is used to diagnose cystitis?

A

None needed unless suspected pyelonephritis, recurrent infections, or abnormal anatomy.

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18
Q

What is used in the treatment of cystitis?

A

Sx relief: hot sitz baths, phenazopyriadine (aka “azo”)

Abx: Bactrim, nitrofurantoin, fluoroquinolones if severe or recurrent.

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19
Q

What type of drug is phenazopyriadine and what is its primary AE?

A

Urinary analgesic –> turns urine orange

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20
Q

Describe the pathogenesis and causative agents in epididymitis.

A

Retrograde spread of organism through the vas deferens. YOunger than 35, organism is usually G/C –> older than 35 is E. Coli.

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21
Q

Describe S/S consistent with epididymitis.

A

Dull ache in scrotum that can radiate up ipsilateral flank, swollen epididymis, fever, chills.

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22
Q

Describe Prehn’s sign and its finding in epididymitis.

A

Positive when scrotal pain is relieved with elevation of the scrotum –> positive sign indicates epididymitis.

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23
Q

What urinalysis findigns are consistent with epididymitis?

A

Pyuria, bacteriuria –> urine culture will be positive for offending organism

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24
Q

What is the treatment for epididymitis?

A

< 35 yoa: ceftriaxone + doxycycline

> 35 yoa: ciprofloxacin

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25
Q

Define and describe glomerulonephritis.

A

Deposition of inflammatory proteins in glomerular membranes as result of immunologic response

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26
Q

What is the prognosis in glomerulonephritis?

A

Excellent in kids, worse in adults - especially with pre-existing renal disease.

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27
Q

What are the most common causes of glomerulonephritis?

A

hematuria, Henoch-schonlein purpura, postinfectious GN, IgA nephropathy, hereditary nephritis

28
Q

What S/S are associated with glomerulonephritis?

A

tea/cola colored urine, oliguria, edema of the face and eys in the AM and feet/ankles at night, HTN

29
Q

What is the most common cause of glomerulonephritis and what would be diagnostic of this condition?

A

Prior strep infection –> increased antistreptolysin-O titer

30
Q

What urinalysis and serum lab findings are indicative of glomerulonephritis?

A

UA: hematuria, RBC casts, proteinuria
Labs: dec GFR, dec serum complement

31
Q

What is the treatment of glomerulonephritis?

A

Steroids and other immunosuppressants to control the inflammatory response.
Decrease fluid and salt intake
ACEIs in chronic glomerulonephritis
Treat HyperK, HTN, edema, and acidosis PRN

32
Q

Define azotemia and how it is treated when present in glomerulonephritis.

A

Azotemia: elevated BUN and serum creatinine

Symptomatic azotemia in glomerulonephritis indicates a need for dialysis

33
Q

What is the incubation period for gonorrhea?

A

2-8 days after exposure

34
Q

What S/S are most commonly associated with gonorrhea?

A

Men: burning with urination, milky/yellow discharge
Women: Often asymptomatic –> may have frequency, urgency, purulent urethral discharge

35
Q

What complications may present if gonorrhea is untreated?

A

Men: prostatitis, epididymitis, chronic infection
Women: vaginitis, cervicitis, PID, infertility

36
Q

What are the S/S of gonococcal bacteremia?

A

Peripheral skin lesions, septic arthritis of the knee, ankle, or wrist.

37
Q

What will a culture show when gonorrhea is present?

A

Gram negative intracellular diplococci

38
Q

What is the treatment for gonorrhea?

A

IM ceftriaxone

Treat chlamydia as coinfection with doxycycline (previously azithromycin)

39
Q

Define hernia.

A

Protrusion of organ or structure through wall that normally contains it

40
Q

Describe and state the treatment for various types of hernias.

A

Umbilical: congenital –> often resolves on its own but may require surgery
Hiatal: Protrusion of stomach trhough esophageal hiatus. Treat with acid reducers or surgery.
Inguinal: passage of intestine through external inguinal ring. Treatment is surgery
Ventral: passage through a weakness in the anterior abdominal wall. If treated, requires surgery.

41
Q

Describe the three types of inguinal hernias.

A

Indirect: Intestine passes through inguinal canal and may enter scrotum.
Direct: Intestine passes through Hesselbach’s triangle and rarely enters the scrotum.
Femoral: Intestine passes through the femoral ring

42
Q

Which type of inguinal hernia is most and least common?

A

Most common: indirect

Least common: femoral

43
Q

What structures make up the boundaries of Hesselbach’s triangle?

A 
Rectus abdominus (medial)
Inferior epigastric vessels (lateral)
Inguinal ligament (inferior)
44
Q

What are the common causes of kidneys stones (nephrolithiasis)?

A

Saturation of urine with Ca, oxalate, other solutes or lack of inhibitors to crystal formation (citrate).

45
Q

List types of stones from most common to least common.

A

Ca –> uric acid –> cystine –> struvite

46
Q

Describe S/S associated with nephrolithiasis.

A

Unilateral, colicky flank pain, hematuria, dysuria, frequency, fever, chills, N/V

47
Q

What diagnostic evaluatins are consistent with nephrolithiasis?

A

Normal serum labs (possible leukocytosis)
UA: hematuria, leukocytes, crystals
CT without contrast: detect stones as small as 1mm
Renal US: can ID stones in kidney, ureter, or ureterovesicular junction

48
Q

What is the treatment for nephrolithiasis?

A

5mm or less: inc fluids and analgesia
5-10 mm: fluid, analgesia, lithotripsy or ureteroscopy with stone basket extraction
10+ mm: ureteral stent (percutaneous nephrostomy) is gold standard. Vigorous hydration and analgesia

49
Q

Define orchitis and state the common pathophysiology.

A

Inflammation of one or both testicles. Commonly caused by ascending infection from urinary tract.

50
Q

What infection in post-pubertal males is often followed by orchitis?

A

Mumps

51
Q

What S/S are commonly associated with orchitis?

A

Unilateral swelling and tenderness, fever, tachycardia

52
Q

What findings on urinalysis are consistent with orchitis?

A

pyuria and bacteriuria with bacterial infection

53
Q

Define pyuria.

A

Pus in the urine caused by inc WBCs

54
Q

What is treatment for orchitis?

A

If mumps, treat mumps. If bacterial, same treatment as epididymitis …
< 35 yoa: ceftriaxone + doxycycline
> 35 yoa: ciprofloxacin

55
Q

Define prostatits.

A

Ascending infection of gram-negative rods into prostatic ducts

56
Q

What S/S are commonly associated with prostatits?

A

Frequency, urgency, dysuria, fever, chills, low back pain, tender and swollen prostate.

57
Q

What does a urinalysis typically show in prostatitis and what is/are the common causative pathogens?

A

UA: pyuria, hematuria, bacteriurua

58
Q

How is prostatitis treated?

A

Fluoroquinolones or Bactrim –> FQs preferred in chronic. IV FQs if hospitalization necessary. Add NSAIDs and/or alpha-1 blocker if lower urinary tract symptoms present.

59
Q

How should prostatitis be treated if fever persists more than 36 hours after abx treatment?

A

Consult urology for suspected abscess

60
Q

Define pyelonephritis and state in which population it is more common.

A

Infection involving parenchyma and renal pelvis. More common in diabetics and elderly women.

61
Q

What S/S are commonly associated with pyelonephritis?

A

fever, flank pain, chills, irritative voiding symptoms, N/V/D, abdominal pain in kids, pronounced CVA tenderness in adults.

62
Q

What diagnostic evaluations are used to evaluate pyelonephritis and what are the results?

A

CBC: leukocytosis with left shift
UA: pyuria, bacteriuria, hematuria, WBC casts
US: hydronephrosis s/p obstruction

63
Q

What is the treatment for outpatient and inpatient pyelonephritis?

A

In: FQs or Bactrim for 1-2 weeks
Out: IV –> FQs, ceftazidime/cefepime (3rd/4th gen), ES PCNs (zosyn), or gentamycin

64
Q

What is the most common malignancy in young men (age 15-35) and what are risk factors?

A

Testicular cancer –> r/f: Hx of cryptorchidism or previous testicular CA

65
Q

What is the most common clinical feature of testicular cancer?

A

painless, solid testicular swelling

EOR Exam - Family Medicine (15 decks)

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