Urology/Renal Flashcards
What is the most common bacterial cause of acute bacterial prostatitis?
What is the most common route of infection?
E. coli
Ascending urethral infection
What is the hallmark symptom of acute bacterial prostatitis?
Perineal pain, fever, and dysuria
Which physical exam finding is associated with acute bacterial prostatitis?
Tender, boggy, and swollen prostate on digital rectal exam (DRE)
What is the first-line antibiotic therapy for acute bacterial prostatitis in an outpatient setting?
What is the recommended duration of treatment?
Fluoroquinolones (e.g., ciprofloxacin) or trimethoprim-sulfamethoxazole (TMP-SMX)
4-6 weeks
A 58-year-old man presents with fever, dysuria, and difficulty urinating. DRE reveals a tender and swollen prostate. What procedure should be avoided in this patient?
A. Urine culture
B. Prostate-specific antigen (PSA) testing
C. Prostatic massage
D. Transrectal ultrasound
Prostatic massage
Prostatic massage is contraindicated in acute bacterial prostatitis due to the risk of bacteremia or sepsis
A 40-year-old man is diagnosed with acute bacterial prostatitis. His urinalysis shows pyuria, and his urine culture is pending. What is the most appropriate initial empiric antibiotic therapy for an outpatient?
A. Nitrofurantoin
B. Ciprofloxacin
C. Amoxicillin-clavulanate
D. Doxycycline
Ciprofloxacin
Fluoroquinolones, such as ciprofloxacin, or TMP-SMX are the first-line empiric treatments for acute bacterial prostatitis due to their excellent prostatic tissue penetration.
A 70-year-old man with acute bacterial prostatitis presents with high fever, confusion, and hypotension. What is the best next step in management?
A. Oral ciprofloxacin
B. Intravenous piperacillin-tazobactam
C. Watchful waiting
D. Prostate biopsy
Intravenous piperacillin-tazobactam
This patient is septic and requires broad-spectrum IV antibiotics, such as piperacillin-tazobactam or ceftriaxone, for initial treatment
When evaluating acute renal failure, the ratio of BUN/creatinine is helpful for the identification of the underlying cause. Ratios of < 10:1 are suggestive of what kind of problem?
What do ratios higher than 10 indicate?
Intrinsic Renal Problems
* Tubular
* Interstitial
* Glomerular injuries
Flow Obstruction (neurogenic bladder, mass, stricture, large prostate)
An older man is brought from the nursing home for evaluation of altered mental status. On laboratory testing he is found to have acute kidney failure with a BUN of 75 mg/dL and creatinine of 5.0 mg/dL. Which of the following is most likely to be elicited on history or physical examination?
A) Cystitis
B) Diuretic use
C) Urinary retention
D) Vomiting
Urinary retention
What are some pre-renal causes of acute kidney injury?
What is the BUN/creatinine ratio likely to be in pre-renal cases?
- Cardiogenic shock
- Hemorrhage
- Sepsis
> 20:1
What laboratory ratio is typically elevated in prerenal AKI?
BUN:Creatinine ratio >20:1
What is the most common cause of intrinsic AKI?
What urinary finding is characteristic?
Acute tubular necorsis (ATN)
Muddy brown granular casts
What is the primary cause of postrenal AKI?
Urinary obstruction (BPH, stones, etc.)
What imaging modality is often used to evaluate for obstruction in postrenal AKI?
Renal Ultrasound
What electrolyte imbalance is most commonly associated with AKI?
Hyperkalemia
A 70-year-old man with a history of congestive heart failure presents with fatigue, reduced urine output, and orthostatic hypotension. Labs reveal BUN 60 mg/dL and creatinine 2.0 mg/dL, with a BUN:Creatinine ratio of 30:1. Urinalysis is bland. What is the most likely cause of his AKI?
A. Prerenal AKI
B. Intrinsic AKI
C. Postrenal AKI
D. Chronic kidney disease
Prerenal AKI
Elevated BUN:Creatinine ratio (>20:1) and bland urinalysis are classic findings in prerenal AKI, often due to hypoperfusion
A 65-year-old man with a history of benign prostatic hyperplasia (BPH) presents with lower abdominal discomfort and no urine output for the past 12 hours. Physical exam reveals a distended bladder. What is the next best step in management?
A. Start IV fluids
B. Obtain a renal biopsy
C. Place a Foley catheter
D. Order a CT scan of the abdomen and pelvis
Place a Foley catheter
Postrenal AKI due to BPH is managed initially by relieving the obstruction with a Foley catheter
A 50-year-old woman with AKI secondary to rhabdomyolysis presents with weakness and palpitations. Labs reveal potassium 6.5 mEq/L, creatinine 4.0 mg/dL, and peaked T waves on ECG. What is the most appropriate initial treatment?
A. Furosemide
B. Calcium gluconate
C. Sodium bicarbonate
D. Hemodialysis
Calcium gluconate
Calcium gluconate stabilizes cardiac membranes in the presence of hyperkalemia. Other measures, such as insulin and dialysis, follow
What is the gold standard test to diagnose acute cystitis?
Uncomplicated acute cystitis can be treated with what abx?
Urine Culture - the results won’t be available during the ED visit
trimethoprim-sulfamethaxozole for 5 days
A healthy 30-year-old man presents to the emergency department for a prolonged erection. He reports using cocaine last night while partying, and the erection has been present for 6 hours. Examination reveals tachycardia to 110 bpm and a rigid penile shaft with soft glans penis. Penile blood gas has a pH of 7.10. Which of the following is the most appropriate management of this patient?
A) Aspiration of the glans penis
B) Intracavernosal phenylephrine
C) Intravenous terbutaline
D) Observation for spontaneous resolution
Intracavernosal phenylephrine
This patient’s presentation is consistent with ischemic priapism, a urologic emergency. Priapism is generally defined as a prolonged erection lasting longer than 4 hours without sexual stimulation. Ischemic priapism is most commonly caused by side effects of medications, including erectile dysfunction injections, neuroleptic medications such as trazodone, blood pressure medications including prazosin and calcium channel blockers, and recreational sympathomimetic drugs.
A 28-year old man who has sex with other men presents with difficulty starting his urinary stream, dysuria, and urgency. He appears acutely ill, is febrile, and reports chills. He has pelvic pain as well as pain at the tip of his penis. What is the most likely exam finding in this patient?
A) Costovertebral angle tenderness
B) Left lower quadrant pain
C) Scrotal swelling and tenderness
D) Tender, warm, swollen prostate
Tender, warm, swollen prostate
This patient has acute bacterial prostatitis. The most common finding on exam is a swollen and tender prostate.
