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S7- Differential Diagnosis > Week 10- Urogenital & Gynecologic Disease > Flashcards

Week 10- Urogenital & Gynecologic Disease Flashcards

1
Q

PART 1

A

PART 1

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2
Q

Common areas of pain that are secondary to renal/urologic origin? (3)

A
  • flank
  • low back
  • pelvic
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3
Q
  • Parts of the Upper Urinary Tract? (2)

- Parts of the Lower Urinary Tract? (2)

A
  • Kidneys, Ureter

- Bladder, Urethra

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4
Q

S/Sx related to genitourinary disease divided into what (3) areas?

A
  • Constitutional
  • MSK
  • Urinary
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5
Q

Genitourinary Constitutional S/Sx. (3)

A
  • Fever, chills
  • Fatigue, malaise
  • Anorexia, weight loss
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6
Q

Genitourinary MSK S/Sx. (3) ***

A
  • Unilateral costovertebral tenderness
  • Low Back, pelvic, flank, inner thigh, or leg pain
  • Ipsilateral shoulder pain
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7
Q

Genitourinary Urinary S/Sx. (8)

A
  • Dysuria (painful/difficult urination)
  • Nocturia (wake up due to need to urinate)
  • Feelings of incomplete voiding, but unable to urinate more
  • Hematuria (blood in urine)
  • Dribbling at the end of urination
  • Frequent urination
  • Hesitancy (weak/interrupted urine stream)
  • Proteinuria
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8
Q 
Other S/Sx (Men):
-Difficulty starting/continuing \_\_\_\_\_\_\_\_\_\_\_\_.
Discharge from penis.
-Penile \_\_\_\_\_\_\_.
-\_\_\_\_\_\_/\_\_\_\_\_\_\_ pain.
-\_\_\_\_\_\_/\_\_\_\_\_\_ in groin.
-\_\_\_\_\_\_\_\_ dysfunction.
A
  • stream of urine
  • lesions
  • testicular/penile pain
  • swelling/mass
  • sexual dysfunction
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9
Q

Other S/Sx (Women):

  • Abnormal vaginal _________.
  • Painful menstruation (____________).
  • Changes in menstrual pattern.
  • Pelvic masses/lesions.
  • Pain during intercourse (____________).
  • May refer pain to what areas?
A
  • bleeding
  • (dysmenorrhea)
  • (dyspareunia)
  • low back, sacral, pelvic, shoulder, or abdomen
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10
Q

Genitourinary Risk Factors. (6)

A
  • Age >60
  • Hx diabetes or HTN
  • Hx kidney disease, heart attack, or stroke
  • Hx kidney stones, UTI, lower urinary tract obstruction
  • Hx autoimmune disease
  • AA, Hispanic, Pacific Island, Native American
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11
Q

PART 2

A

PART 2

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12
Q

What are (3) specific things we can break down renal and urologic pain into?

A
  1. ) Upper Urinary Tract Pain
  2. ) Pseudorenal Pain
  3. ) Lower Urinary Tract Pain
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13
Q

Upper Urinary Tract:

  • What are the 2 structures of the Upper Urinary Tract?
  • Site of pain generally corresponds to dermatomes ___-___.
  • How is this pain described? (3)
  • Both dysfunction in the kidneys and ureters can result in abdominal muscle spasms with rebound tenderness on the _________ side.
A
  • Kidneys, Ureters
  • T10-L1
  • Aching, dull, boring
  • same side
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14
Q

Pseudorenal Pain:

  • What does this mean?
  • Occurs secondary to what (2) things?
  • Most common sites are ___ and ___.
  • Usually an _______ onset associated with ______.
  • What is one way we can tell the difference between this and true renal pain?
A
  • Mimics renal and/or ureteral pain.
  • Radiculitis or irritation of costal nerves.
  • T10 and T12
  • acute onset associated with trauma
  • Pseudorenal pain is usually affected by BODY POSITION (true renal pain is seldom affected by position).
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15
Q

What is the pain pattern of pseudorenal pain? (2)

A
  1. ) Back and/or flank pain occurs at same level as kidney.
  2. ) Affected by changing position. (lying on involved side increases, prolonged sitting increases, reproduced with movements of spine, costovertebral angle tenderness on palpation)
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16
Q
  • Are pseudorenal S/Sx associated with urinary S/Sx?

- Will these patients have a + or - kidney percussion test?

A
  • No

- Negative

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17
Q

Lower Urinary Tract:

  • What are the 2 structures of the Lower Urinary Tract?
  • Where is pain generally reported where? (3)
  • Pain is described as _______.
  • How is it characterized? (4)
A
  • Bladder, Urethra
  • pubis or lower abdomen, back
  • sharp
  • urinary urgency, sensation to void, dysuria, mild stinging to intense burning with urination
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18
Q

What would we perform if we note cluster of S/Sx associated with genitourinary or gynecologic?

A

Review of Systems

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19
Q

PART 3: UROGENITAL PATHOLOGIES

A

PART 3: UROGENITAL PATHOLOGIES

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20
Q

List of Urogneital Pathologies. (15)

A
  • Upper Urinary Tract Inflammation/infection
  • Lower Urinary Tract Inflammation/infection
  • Renal or Ureteral Stones
  • Renal Cancer
  • Prostatitis
  • Benign Prostatic Hyperplasia
  • Prostate Cancer
  • Incontinence
  • Renal Failure
  • Bladder Cancer
  • Testicular Cancer
  • Endometriosis
  • Ovarian Cysts
  • Ectopic Pregnancy
  • Ovarian Cancer
21
Q

Upper vs Lower UTI:

  • Structures of Upper and Lower Urinary Tracts?
  • Which urinary tract inflammation is considered to be more serious and why?
  • Which is more common in women and why?
  • UTIs are more common in older adults (men and women) and have non specific symptoms such as what? (3)
  • Staph infection of urinary tract may cause _________ in the vertebrae.
A
  • Upper (kidney, ureter), Lower (bladder, urethra)
  • Upper UTI more serious due to potential damage to renal tissue itself.
  • Lower UTI more common in women due to; short female urethra, proximity of urethra to vagina/rectum, rate of occurrence increases with age and sexual activity.
  • ALTERED MENTAL STATUS***, loss of appetite, N/V/ab pain
  • osteomyelitis
22
Q

Upper UTI S/Sx. (7)

A
  • Unilateral costovertebral tenderness***
  • Ipsilateral shoulder pain***
  • Flank pain
  • Fever and chills
  • Skin hypersensitivity**
  • Hematuria, Pyuria, or Bacteriuria
  • Nocturia
23
Q

Lower UTI S/Sx. (5)

A
  • LBP
  • Pelvic/lower abdominal pain
  • Urinary frequency/urgency
  • Dysuria, hematuria, pyuria, bacteriuria
  • Pain with intercourse
24
Q

Lower UTI Risk Factors:

  • _____
  • Gout
  • HTN
  • _______ urinary problems
  • Medical procedures requiring urinary __________
A
  • DM
  • obstructive
  • urinary catheterization
25
Q

What is the biggest sign we are looking for indicating a patient has a Lower UTI?

A

ALTERED MENTAL STATUS

26
Q

Renal Calculi (Kidney Stones):

  • Decreased urine flow results in ________.
  • This can then result in stone formation (calculi). Where do calculi primarily form?
  • Do stones remain in kidney or travel downstream?
A
  • stagnation
  • kidney
  • Either remain in kidney or move downstream
27
Q

Ureteral Stones:

  • _____ painful.
  • If stone blocks urine, pressure builds upstream in the kidney causing it to ______ (_____________).
  • Can it cause permanent kidney damage?
  • Most characteristic symptom is ______/_______/______ pain that originates deep in the ______ area and radiates around side and into ________.
A
  • Most painful
  • swell (hydronephosis)
  • Yes
  • SUDDEN/SHARP/SEVERE pain originating deep in LUMBAR area and radiating around side and into GENITALS.
28
Q

Kidney/Ureteral Stones S/Sx. (11)

A
  • Pain (acute/spasmodic/radiating, mild/dull flank pain, LUMBAR DISCOMFORT)***
  • Hyperesthesia of dermatomes (T10-L1)***
  • Abdominal muscle spasms***
  • Acute ureteral/renal blockage reported as excruciating, spasmodic, radiating pain with severe N/V***
  • N/V
  • Palpable flank mass
  • Hematuria
  • Fever/chills
  • Urge to urinate frequently
  • Renal impairments
  • Sudden/acute in development
29
Q

Renal Cancer:

  • Renal tumors may be detected as flank mass combined with what (3) things?
  • What is the primary symptom of urinary tract neoplasm?
  • Is it more common in males or females?
A
  • Unexplained weight loss, fever, hematuria
  • Hematuria (blood in urine ALWAYS requires MD referral)
  • Males
30
Q

Renal Cancer Risk Factors. (5)

A
  • Smoking
  • Obesity
  • HTN
  • Long-term dialysis
  • Most common in males
31
Q

Renal Cancer S/Sx. (7)

A
  • Hematuria (blood in urine)***
  • Flank/side pain***
  • Painful urination
  • Urinary frequency
  • Weight loss
  • Fever
  • General fatigue
32
Q

What test can we perform if there concern for problem with kidneys causing patient symptoms?

A

Kidney Fist Percussion Test

33
Q

Prostatitis:

  • What is it?
  • Happens in ___% of the adult male population.
  • ______ pain and discomfort.
  • Patients have ______ complaints.
A
  • Relatively common inflammation of the prostate causing enlargement.
  • 10%
  • chronic pain/discomfort
  • voiding complaints (difficulty stopping/starting urine flow)
34
Q

Prostatitis S/Sx. (11)

A
  • Low back, inner thigh, and perineal pain***
  • Sudden moderate-high fever
  • Chills
  • Nocturia
  • Dysuria
  • Weak or interrupted stream
  • Unable to completely empty bladder
  • Sexual dysfunction
  • General malaise
  • Arthralgia
  • Myalgia
35
Q

Benign Prostatic Hyperplasia (BPH):

  • What is it?
  • Common occurrence in men >___yo.
  • Prostate enlarges and squeezes into _______.
  • Interferes with _______/________ function.
  • If the prostate is greatly enlarged, chronic _________ may occur.
A
  • Defined as enlarged prostate.
  • > 50yo
  • urethra
  • urinary/sexual function
  • constipation
36
Q

BPH S/Sx. (7)

A
  • Low back or upper thigh pain/stiffness***
  • Bladder palpable above pubic symphysis
  • Urinary problems (hesitancy, weak, dribbling, frequency, nocturia)
  • Lower abdominal discomfort w/ feeling need to void
  • Suprapubic/pelvic pain
  • Erectile dysfunction
  • Blood in urine/semen
37
Q

What are some BPH follow-up questions?

A
  • Does it feel like your bladder is not empty when you finish urinating?
  • Do you have to urinate again less than 2 hours after the last time you emptied your bladder?
  • Do you have a weak stream of urine or find you have to start and stop urinating several times when you go to the bathroom?
  • Do you have to push or strain to start urinating or keep the urine flowing?
  • Do you have any leaking or dribbling of urine?
  • Do you get up more than once at night to urinate?
38
Q

Prostate Cancer:

  • __/__ of all men by age ___.
  • Present in 50-75% of all men by age ___.
  • _____ pain and _______ can be caused by cancer metastasis.
  • Tumors tend to be _________ vs __________.
A
  • 1/3 by age 50
  • 5–75% by age 75
  • back pain and sciatica
  • osteoblastic (bone forming) vs osteolytic (bone lysing)
39
Q

Prostate Cancer Risk Factors. (3)

A
  • Family Hx
  • More common in AA compared to caucasian or hispanic
  • Diet high in animal fat/meat
40
Q

Prostate Cancer S/Sx. (5)

A
  • Bone pain
  • Anemia
  • Weight loss
  • Lymphedema of the LEs and scrotum
  • Neurological changes associated with spinal cord compression
41
Q

What are the (5) types of incontinence?

A
  1. ) Stress
  2. ) Urge
  3. ) Mixed
  4. ) Overflow
  5. ) Functional
42
Q

Stress Incontinence:

  • Primarily related to ______ or _________ weakness, ligamentous and fascial laxity.
  • Pressure applied to bladder from coughing, sneezing, laughing, lifting, or physical exertion that increases ________ _________.
A
  • urethral or pelvic floor weakness

- increases abdominal pressure

43
Q

Urge Incontinence:

  • Commonly called “_______ _______”
  • Involuntary contraction of the _________ muscle with a strong desire to void.
  • Often _________ but can be caused by meds, alcohol, bladder infections/tumor, neurogenic bladder, bladder outlet obstruction.
  • High prevalence in what population?
A
  • “overactive bladder”
  • detrusor muscle
  • female elite athletic population
44
Q

Mixed Incontinence:

-Combination of ______ and ______ incontinence.

A

-urge and stress

45
Q

Overflow Incontinence:

  • _____________ of the bladder and it cannot empty completely.
  • Urine ______/_________
  • Client does not have any sensation of _______/________.
  • Caused by acontractile or deficient _________ muscle.
A
  • overdistention
  • leaks/dribbles
  • fullness/emptying
  • detrusor muscle
46
Q

Functional Incontinence:

  • Occurs when bladder is _______, but mind/body are not working together.
  • Occurs secondary to mobility or access difficulty.
A

-normal

47
Q

Incontinence Risk Factors. (10)

A
  • Advanced age
  • Overweight/obese
  • Chronic cough
  • Chronic constipation
  • Hx UTI
  • Diabetes
  • Neurologic Disorders
  • Medications
  • Caffeine, alcohol
  • Female Gender
48
Q

Incontinence Female (5) vs. Male (3) Risk Factors.

A

Female

  • Pregnancy
  • Vaginal birth or C-section
  • Pelvic Trauma/Radiation
  • Bladder/Bowel prolapse
  • Menopause

Male:

  • Enlarged prostate
  • Prostate/pelvic surgery
  • Radiation

S7- Differential Diagnosis (15 decks)

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