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Internal Medicine > Week 14- Genitourinary System 2 > Flashcards

Week 14- Genitourinary System 2 Flashcards

1
Q

The process of micturition (voiding or bladder-emptying) and continence involves a complex interplay of…

A

-Nerves (cortex of brain, brainstem, parasympathetic, and preganglionic sympathetic)
-Detrusor smooth muscle of the bladder
-Internal urethral sphincter (involuntary smooth muscle)
-External urethral sphincter, part of the pelvic floor muscles (voluntary skeletal muscle); innervated by the pudendal nerves

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2
Q

The pelvic floor has ___ layers

A

3

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3
Q

Complaint of involuntary urine loss

A

Urinary incontinence

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4
Q

Only _____% of incontinent adults seek medical care

A

20-50

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5
Q

Urinary incontinence is related to…

A

-Falls in older adults
-Pressure sores
-Skin breakdown
-UTIs
-Institutionalization
-Depression
-Isolation

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6
Q

True or false: Many people have more than one type of incontinence

A

True

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7
Q

Complaint of involuntary loss of urine on effort or physical exertion, or on sneezing or coughing

A

Stress urinary incontinence (SUI)

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8
Q

Stress urinary incontinence occurs during activities that increase _______________

A

Intraabdominal pressure

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9
Q

Pathogenesis of SUI

A

-Weakness or loss of tone in PFM
-Internal urethral sphincter failure
-Hypermobility of the ureterovesical junction
-Damage to the pudendal nerve (e.g., infection, tumor, childbirth)

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10
Q

Complaint of involuntary loss of urine associated with urgency

A

Urgency urinary incontinence (UUI)

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11
Q

Urgency urinary incontinence I is related to…

A

Detrusor instability (the bladder contracts at small volumes)

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12
Q

Urgency urinary incontinence (UUI) often happens in response to ____________

A

Triggers

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13
Q

Inflammation of the prostate gland can be…

A

-Acute/chronic
-Bacterial/nonbacterial
-Symptomatic/asymptomatic

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14
Q

True or false: All categories of prostatitis have inflammation

A

False

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15
Q

Category ____ of prostatitis is more commonly seen in the PT clinic

A

III

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16
Q

Bacterial infection of the prostate gland as a result of GU infection (bacteria or virus), sexually transmitted infections (STIs)

A

Acute bacterial prostatitis (category I)

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17
Q

Acute bacterial prostatitis has ___________ voiding and __________ voiding

A

-Irritative
-Obstructive

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18
Q

Type of pain associated with acute bacterial prostatitis

A

Suprapubic, rectal, sacral, low back, perineum

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19
Q

Systemic symptoms associated with acute bacterial prostatitis

A

Fever, chills, nausea, emesis, arthralgia, myalgia, and malaise

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20
Q

Recurrent infection of the prostate

A

Chronic bacterial prostatitis (category II)

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21
Q

-Low-grade symptoms as for category I
-Flare-ups of pelvic pain
-Voiding problems
-Sexual dysfunction

A

Chronic bacterial prostatitis (category II)

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22
Q

Pain and urinary dysfunction with inflammation but without infection

A

IIIA

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23
Q

Pain and urinary dysfunction without inflammation or infection
Previously known as chronic nonbacterial prostatitis

A

IIIB

24
Q

-GU, lower abdominal/pelvic, and low back pain (worse by sitting, squatting, and bending)
-Irritative voiding and obstructive voiding
-Sexual dysfunction
-Disturbed quality of life

A

Chronic prostatitis/chronic pelvic pain syndrome

25
Q

-No symptoms
-WBCs and inflammatory markers are found in semen or prostate tissue
-Usually being diagnosed when looking for causes of infertility or when testing for prostate cancer

A

Asymptomatic inflammatory prostatitis (category IV)

26
Q

Non-malignant enlargement of the prostate gland

A

Benign prostatic hyperplasia (BPH)

27
Q

BPH has a prostate volume of _____ mL

A

> 30 mL

28
Q

BPH occurs with lower __________ symptoms and __________

A

-Urinary tract
-Bladder outlet obstruction

29
Q

____% of men ≥ 50 y/o experienced BPH symptoms

A

70

30
Q

BPH risk factors

A

-Age over 40
-Family history of BPH
-Diabetes
-Heart disease with use of beta blockers
-Obesity

31
Q

True or false: As men age, the ratio of new prostate cells to old prostate cells shifts in favor of lower cell death

A

True

32
Q

Pathogenesis of BPH

A

-The increased growth of new prostate cells (hyperplasia, not hypertrophy) occurs primarily inward, encroaching on the urethra (benign prostate obstruction)
-As the prostate enlarges, the urethra becomes obstructed, interfering with the normal flow of urine, resulting in urine backing up the ureters and pooling in the kidney

33
Q

BPH symptoms

A

-Painful urination
-Blood in the urine
-Unexplained lower back, pelvis, hip, or upper thigh pain
-Sexual dysfunction

34
Q

Common BPH assessments

A

-Digital rectal exam (DRE)
-Prostate specific antigen (PSA) blood test

35
Q

PSA is secreted by ___________

A

Prostatic epithelia cells

36
Q

True or false: PSA rises slowly with aging

A

True

37
Q

PSA is strongly correlated to ____________

A

Prostate volume

38
Q

Norm for PSA blood test

A

< 4 ng/mL

39
Q

BPH PT implications

A

-Identify the presence of obstructed voiding (4 questions on next slide)
-Medical referral may be required
-Lifestyle education and pelvic physical therapy
-Sides effects from the medications to treat BPH
-Screening questions

40
Q

Side effects from the medications to BPH

A

-General muscle weakness, drowsiness, dizziness, tachycardia, and postural orthostatic hypotension
-Erectile dysfunction (ED) and loss of libido
-Gynecomastia (enlargement of a man’s breasts)
-Possibility of falls from dizziness and loss of balance

41
Q

The most common cancer in American men

A

Prostate cancer

42
Q

Prostate cancer is the ____ most common cause of male death from cancer

A

2nd

43
Q

___ in ___ American men will develop prostate cancer!!!

A

1
6

44
Q

______________ (glandular cells) accounts for 98% of primary prostatic tumors

A

Adenocarcinoma

45
Q

Prostate cancer usually starts in the outer portion of the prostate and spreads ____________

A

Inwardly

46
Q

True or false: The relationship between testosterone/androgens and prostate cancer fully understood

A

False

46
Q

True or false: We know the precise cause of prostate cancer

A

False

46
Q

______________ influences the normal growth and development of the prostate

A

Testosterone

47
Q

Most prostatic adenocarcinomas are characterized by small- to moderate-size disorganized glands that infiltrate the _________ of the prostate

A

Stroma

48
Q

True or false: Prostate cancer invades adjacent local structures and includes lymphatic metastasis

A

True

49
Q

Obstructive symptoms of prostate cancer

A

-Urinary urgency, frequency, hesitancy, dysuria, hematuria, difficulty initiating or continuing the urine stream, and decreased urine stream
-Similar to BPH typically present in later stages

50
Q

True or false: Bony metastasis occurs more often to appendicular skeleton than to the axial skeleton

A

False

(axial, appendicular)

51
Q

True or false: Bony metastasis may come in the form as sacral and lumbar pain

A

True

52
Q

Clinical manifestation of prostate cancer

A

A dull, vague ache may be noted in the rectal, sacral, or lumbar spine region, and the individual may have difficulty walking

53
Q

PT implications for prostate camcer

A

-Screening for referral
-Complications of medical treatment
-Pre-hab and rehab for prostate surgery

Internal Medicine (25 decks)

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