Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FERGU > Week 4 Lectures > Flashcards

Week 4 Lectures Flashcards

1
Q

What is the most common cause of PSA elevation?

A

BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Of all nodules felt on digital rectal exam, what percentage are cancer?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why would you do a Trans Rectal Ultrasound (TRUS)?

A

Only to help guide a prostate biopsy (or to help estimate size of prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do you order a prostate biopsy?

A

BEST indication is a PSA velocity rising at 0.75/year or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are two characteristics of prostate cancer?

A

Multifocal and heterogenous (heterogeneity is unusual to this degree in a primary tumor–more common in metastasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does prostate cancer’s heterogeneity and multifocal nature mean for treatment plans?

A

These two factors mean you can’t target a single area in prostate cancer for treatment–thus there is no focal treatment for prostate cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most powerful prognostic tool for prostate cancer

A

Gleason score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the gleason score

A

Two numbers: A + B
A = most common cell type seen on slide
B = second most common
Add the two numbers together to get the Score
Score 1-6 = low risk (active surveillance)
Score 7 = intermediate risk
Score 8 and above = high risk
Score 7 and above requires treatment
60-70% of diagnosed prostate cancer is low risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does “high risk” prostate cancer mean?

A

Gleason score of 8 or above; higher risk of treatment failure, higher chance of metastasis, more aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What areas of the prostate are of most concern for cancer (location)?

A

apex and base of prostate because these areas are close to the bladder and the urinary systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the stage of the most common prostate cancers detected in men?

A

T1c (tumor found only on biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the treatment outcomes for localized prostate cancer? Metastatic?

A

Localized: treat to cure
Metastatic: non curable (fatal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why would you do surgery through perineum for prostate cancer?

A

Not done anymore except maybe for obese patients because less fat on the perineum so easier to reach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common radiation therapy for prostate cancer?

A

Brachytherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What radiation therapy would you use for more aggressive prostate cancers (gleason 8-9)? What about localized cancers?

A

Aggressive: External beam therapy (because dont want to miss any of the cancer)
Localized: Brachytherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is active surveillance in prostate cancer treatment?

A

Periodic PSA, periodic rectal exams, periodic biopsies (to make sure there is no progression of the cancer) – 20-25% will progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When would you use chemotherapy in prostate cancer?

A

only for patients with metastatic disease who have been treated with hormone therapy already but continue to have progressing diease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What chemo drug is used most often in prostate cancer?

A

Docetaxel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug is used before chemo in metastatic prostate cancer?

A

Abiraterone–a SIP 17 inhibitor
(used in castration resistant prostate cancer with metastasis before chemo)
–may also use Enzaltemide (androgen receptor antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the treatment for localized prostate cancer?

A

Surgery or radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment for advanced prostate cancer?

A

Hormone therapy (and eventually chemo if unresponsive or continues progressing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most likely cause of painless hematuria

A

Neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most likely cause of hematuria + renal colic

A

stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most likely cause of chills, fever, sepsis

A

infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most likely cause of increase urinary frequency, nocturia, reduced flow, anuria

A

BPH, neurogenic bladder, urethral strictures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of urinary tract obstruction

A

Stones
BPH
Tumors (TCC, Bladder, Prostate, lymphadenopathy, pelvic neoplasms)
Congenital (UPJ, UVJ, post. urethral valves, ureterocele)
Inflammatory (RPF, abscess, urethral stricture)
Pregnancy–gravid uterus may compress ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why use a radiograph KUB in UTO?

A

Best to follow progress of known stone to see if it will pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why would you use IVP?

A

almost NEVER use if CT is available

Fairly good for stones, presence/absence of obstruction, congenital variants; less sensitive for RCC unless large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Advantages of Ultrasound

A

Risk free–no radiation or contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Disadvantages of US

A

ureter not seen unless dilated, therefore not good for ureteric stone or tumour; may see hydronephrosis but not the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Reasons to use US

A

Good for renal parenchyma (i.e masses, atrophy), renal stones, REALLY good for hydronephrosis

Can also look at bladder, prostate, assess post-void residual volue in bladder, all of which may be abnormal in BPH or other causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is CT-IVP used for

A

delayed images of the collecting system used to see EXCRETION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the cost of CT versus MRI

A

CT is less expensive than MRI (CT machine is expensive but the actual scan is not)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Radiation levels of CT

A

relatively high–be judicious in how many a patient gets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is an advantage of CT over US

A

CT is good for comparing images which is harder for US because a lot of US depends on techniqe of the administrating clinician

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which imaging method is best for stones

A

CT-KUB is exquisite for stones–virtually all stones are radioopaque on CT, even uric acid stones, whereas they are luscent on plain films–“procedure of choice for renal calculi”

CT-KUB–>NOT for transitional cell carcinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a disadvantage to a CT-KUB

A

cant get any functional info about the kidney (+ radiation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Why would you do a CT with contrast

A

Shows renal parenchymal enhancement–therefore can identify TUMORS, ABSCESSES, INFARCTS, some functional info

can add delayed views of collecting system at cost of more time and radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Disadvantages of CT with contrast

A

Stones may be obscured by contrast

Contrast can be nephrotoxic

Often higher dose of radiation than CT-KUB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is direct pyelography

A

direct injection of contrast into collecting system (as opposed to IV)

Retrograde = via cystoscope into bladder, inject into ureters

Antegrade = via nephrostomy tract from back to kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why would you do a direct pyelography imaging exam

A

Excellent depiction of calyces, renal pelvis, ureters

Retrograde can be therapeutic–remove stones, biopsy masses, place stents, evacuate bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When are urethrograms done?

A

Done done very often.

Retrograde urethrograms are done to assess urethral strictures, trauma (inject from meatus)

Voiding urethrograms done to assess for reflux, obstruction due to Posterior Urethral VAlves etc…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Are MRIs frequently done for urinary tract obstruction?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Advantages of MRI

A

No radiation (comparatively); gadolinium contrast is less nephrotoxic than iodinated contrast in CT; excellent anatomic depiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a particular use for MRI in urinary tract obstruction diagnosis

A

in pregnancy if US not diagnostic can do MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Disadvantages of MRI

A

expensive, less readily available, rare toxicity of gadolinium especially in renal failure (nephrogenic systemic fibrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are nuclear medicine renograms used for?

A

to assess % function from each kidney

no nephrotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What guides choice on imaging modalities for urinary tract obstruction?

A

Hx, physical, lab results–what do you expect to find?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which tests have:

  1. most radiation?
  2. least radiation?
  3. highest cost?
  4. lowest cost?
  5. most toxicity?
  6. highest accuracy?
  7. mid-accurate?
  8. least accurate?
A
  1. CT
  2. US, MRI
  3. Nuclear medicine, MRI
  4. CT-KUB, KUB plain film
  5. IVP, CT with contrast
  6. CT, MRI
  7. NM, CT-KUB, US, IVP
  8. KUB plain film
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Which imaging tests are nearly always the initial tests in urinary tract obstruction

A

US and CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Imaging test for hydronephrosis

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Imaging test for stones

A

CT (i.e present with renal colic)

finds other cause in up to 1.3 of patients (i.e appendicitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

First line test in children or pregnant women

A

US–if shows hydronephrosis, next line most likely voiding cystourethrogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Imaging if suspect BPH

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Causes of “surgical” renal failure

A 
Bladder outlet obstruction (BPH, maybe tumor)
Urethral stricture
Neurogenic bladder
SImgle kidney with hydronephrosis
Bilateral ureteric obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Best tests for painless hematuria

A

Cystoscopy = best test for bladder
Retrograde pyelogram for ureters (done together)

Painless hematuria likely a tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Most common congenital urinary tract obstruction

A

UPJ obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

If a patient presents with fever, chills and renal colic or chronic obstructive symptoms, what must be done?

A

URGENT evaluation–medical emergency.

Blood, urine cultures; electrolytes
Catheterize (Foley) if think lower tract obstruction
CT or US to see if stone/mass/hydro
Urgent drainage by percutaneous nephrostomy, or less often by cystoscopy and retrograde stent insertion

59
Q

Reasons to do a percutaneous nephrostomy

A

for drainage of obstructed kidney

60
Q

What condition is associated with rising creatinine, Hx of frequency, nocturia, weak stream?

A

BPH–>Ultrasound

61
Q

Source of sympathetic nerves

A

T1-L2

62
Q

Source of parasympathetic nerves

A

S2, 3, 4 and cranial nerves

63
Q

How do the afferent nerves of the ANS reach their cell bodies in the posterior root ganglion?

A

Via the white ramus communicans

64
Q

Source of

  1. greater splanchnic
  2. lesser splanchnic
  3. least splanchnic
A
  1. T5-T9
  2. T10-T11
  3. T12
65
Q

What nerves are responsible for the sympathetic innervation of the urinary system?

A

Splanchnic nerves (T5-T12)

66
Q

White ramus communicans

A

carry myelinated axons of preganglionic fibers from the spinal nerve to the paravertebral ganglia of the sympathetic trunk

67
Q

Gray ramus communicans

A

Carry postganglionic nonmyelinated axons to the spinal nerves from sympathetic trunk

68
Q

Why are the sphlanchnic nerves unusual?

A

They pass through the sympathetic trunk without synapsing–leave myelinated and pass the diaphragm to take part in formation of the abdominal autonomic plexi

69
Q

Name the cranial nerves that form part of the efferent parasympathetic nervous system

A

III, VII, IX, X

oculomotor, facial, glossopharyngeal, vagus

70
Q

Name the sacral nerves that are involved in the parasympathetic systm

A

S2, 3, 4–the pelvic splanchnic nerves

71
Q

What stimulates the afferent neurons of the ANS?

A

Stretch and lack of O2 (i.e ischemia)–NOT heat or touch

72
Q

Where are the parasympathetic ganglia located?

A

Close to or within the walls of the organs

73
Q

What plexus gives rise to the renal, testicular/ovarian, and ureteric plexi?

A

intermesenteric plexus (part of aortic plexus of nerves between superior and inferior mesenteric arteries)

74
Q

How do the postganglionic nerves travel to the organs? (or preganglionic in the case of parasympathetic)

A

with the blood vessels

75
Q

Kidney innervation

  1. Sympathetic
  2. Parasympathetic
A
  1. T10-L1–vasoconstrict renal arteries within kidney

2. vagus–vasodilate renal arteries

76
Q

Ureter innervation

  1. Sympathetic
  2. Parasympathetic
A
  1. T11-L2–convey pain sensation, i.e resulting from obstruction and consequent distention
  2. S2, 3, 4
77
Q

What is the only organ that receives preganglionic nerve fibers from the SNS

A

medulla of the adrenal cortex–because itself acts as a ganglion

78
Q

Urethra innervation

  1. Sympathetic
  2. Parasympathetic
A
  1. L1, L2–tightens internal urethral sphincter (alpha 1)

2. S2, 3, 4–releases internal urethral sphincter

79
Q

Urinary bladder innervation

  1. sympathetic
  2. parasympathetic
A
  1. T11/L2–in males, strong action of the internal urethra sphincter around the neck (Beta 2)
  2. S 2, 3, 4–contracts bladder (muscarinic)–also in charge of sensing STRETCH receptors and PAIN within the bladder
80
Q

What is the dermatome that would be involved if bladder stretched too much (site of referred pain)?

A

external genitalia (because S 2, 3, 4)

81
Q

What is the function of the SNS in the pelvis

A
  1. contraction of internal urethral sphincter in men; internal anal sphincter in both sexes
  2. smooth muscle contraction in association with reproductive tract with accessory glands of the reproductive system
  3. moving secretions from epididymis and associated glands to the urethra to form semen
82
Q

What is the function of the parasympathetic system in the pelvis

A
  1. vasodilation (kidneys)
  2. bladder contraction
  3. stimulates erection
83
Q

Describe the physiology of normal filling of the bladder

A
  1. bladder stretches (elastic properties)–>leads to SYMPATHETIC reflex–>ALPHA adrenergic receptors at bladder neck activated and increase resistance at bladder neck (“tightens it”)
  2. Beta 3 receptors are also activated in the detrusor, inhibiting contraction
  3. Direct inhibition of the detrusor muscle motor neurons in the sacral spinal cord
  4. as urethral pressure increases due to filling, the pudendal nerve (S234) fires which activates the external sphincter (tightens it) forming a seal
84
Q

Describe the physiology of normal bladder emptying

A
  1. increased bladder stretching/filling produces more pressure causing sensation of distention
  2. the PMC coordinates: the firing of the PNS pathway (contraction of the detrusor and relaxation of the urethral smooth muscle); inhibition of the sympathetic pathways (smooth sphincter relaxation); inhibition of the pudendal nerve firing (external sphincter relaxes)

bladder emptying

85
Q

What does PMC stand for

A

pontine micturition center

86
Q

From where does the PMC receive input?

A

GU afferents as well as areas in the brain (cerbellum, cerebrum, basal ganglia)

87
Q

What does the PMC do?

A

coordinates micturition by turning off the sympathetic signals and turning on the parasympathetic signals

allows for contraction of detrusor and relaxation of bladder outlet + external urethral sphincter

88
Q

Causes of transient urinary incontinence

A

DIAPERS

Delerium
Infection
Atrophic vaginitis/urethritis
Pharmacologic
Excess urine output
Restricted mobility
Stool impaction
89
Q

List general classifications of urinary incontinence

A 
Transient incontinence (DIAPERS)
Overflow Incontinence
Stress incontinence
Total incontinence
Urgency/Urge incontinence
90
Q

What is overflow incontinence

A

uncontrollable leakage of small amounts of urine from a bladder that does not empty well

91
Q

What is the mechanism behind the clinical pathology of urinary incontinence

A

retention of urine in a bladder that does not empty well causes an increase in pressure causing small amounts to dribble out

bladder becomes overfilled due to obstruction, weak bladder contraction or medications

92
Q

What might be some obstructions associated with overflow incontinence

A

stones, urethral stricture, BPH, constipation

93
Q

What might a cause other than obstruction be for overflow incontinence

A
  1. weak bladder contractions due to detrusor muscle hyporeflexia secondary to a lower motor neuron (sacral spinal cord damage or peripheral nerve damage i.e diabetes mellitus, surgery or radiation therapy)
  2. chronic dilation of the bladder
  3. anticholinergics (TCAs, SSRIs, antipsychotics), Opiods, and Beta blockers (Beta 3 receptors) can interfere with bladder contraction
  4. alpha 1 antagonists promote internal sphincter contraction (i.e cold/sinus meds)
94
Q

Treatment for overflow incontinence

A

treat underlying problem

  1. BPH–alpha antagonists, 5 alpha reductase inhibitors, TURP
  2. urethral stricture–dilation with catheter, urethrotomy
  3. catheterization to drain bladder
95
Q

What is stress incontinence

A

uncontrollable loss of small amounts of urine due to sudden increases in abdominal pressure caused by coughing, sneezing, laughing, lifting, during valsalva, or other changes in position

96
Q

what population most experiences stress incontinence

A

young and middle aged women

97
Q

what are some causes of stress incontinence

A
  1. weakness of urinary sphincter (from trauma, childbirth, pelvic surgery, or an abnormal position of the urethra or uterus in women)
  2. lack of estrogen (causes deterioration of the urethral mucosal lining, thereby reducing resistance)
  3. Obesity (extra weight places increased stress on the bladder)
  4. damage to upper part of urethra or bladder neck
98
Q

What meds can exacerbate stress incontinence

A

ACE inhibitor due to coughing side effect

use of alpha 1 antagonists

99
Q

treatment for stress incontinence

A
  1. kegel exercises + biofeedback to ID muscles that are being exercised
  2. pessaries
  3. alpha 1 agonists for internal sphincter contraction
  4. estrogen to increase mucosal lining, increasing resistance
  5. sling procedures–transvaginal tape procedure is most common
  6. injection of bulk forming agents such as collagen around urethra
  7. artificial urinary sphincter
100
Q

what is total incontinence

A

complete inability to store or control urinary leakage, independent of activity

101
Q

what is the most common cause of total incontinence

A

damage to nerves controlling bladder (i.e congenital, post surgical, childbirth, pelvic disease, radiation therapy)

102
Q

What are other causes of total incontinence (other than nerve damage)

A
  1. fistulas between ureters or bladder with vagina or rectum

2. scarring of the urethra in women preventing sphincter constriction

103
Q

treatment for total incontinence

A

treat underlying problem

surgically close fistula
artificial urinary sphincter if applicable

104
Q

what is urgency/urge incontinence

A

involuntary loss of urine following a strong desire to void–bladder contractions overwhelm cerebral inhibitions

bladder muscles are usually over-reactive–contraction before bladder is full

increase in frequency of urination in day and night

105
Q

possible causes of urgency/urge incontinence

A
  1. constipation
  2. diuretics
  3. detrusor hyper-reflexia secondary to upper motor neuron lesions (cerebral injury, basal ganglia disease like Parkinsons’s, suprasacral spinal cord damage)
  4. most common in elderly
106
Q

treatment for urgency/urge incontinence

A
  1. fluid and dietary restriction–no caffeine, ETOH, acidic/spicy foods or fluids
  2. scheduled voiding
  3. treat constipation
  4. kegel exercises
  5. estrogen in females to increase urethral resistance
  6. anticholinergics to relax bladder
  7. improve home environment for continence–bedside urinal
107
Q

When is a chronic urethral catheter used for incontinence?

A

only as a last resort

  • use in patient with unresponsive incontinence with skin complications despite barrier creams and absorbent pads inside diapers
  • change every 4-6 weeks
  • increased risk of UTIs and therefore bladder and renal stones
108
Q

What is the physiological basis for the voiding dysfunction seen in men with obstructive uropathy (BPH)

A

BPH causes urinary incontinence through a few different mechanisms leading to a common outcome

  • enlargement of the prostate through the mechanism of BPH causes impingement of the prostatic portion of the urethra and the bladder uvula–>causes an obstruction to urine flow out of the bladder; this in turn (if present chronically) will lead to thickening of the bladder wall (normal response produced by the PMC)–>this means that there is a combo of both urge incontinence (an increased spasticity of the bladder) along with overflow incontinence (b/c of increased amounts of urine present in bladder)
  • over time, the bladder wall may become fatigued and will be less able to propel urine out of the bladder while it is full (a form of overflow incontinence)
109
Q

What situations complicate the voiding issues seen as a result of BPH

A

may be complicated by stasis or the urine in the bladder

stasis may lead to an increased chance of having urinary tract infections within the bladder and potentially up to the kidneys

this causes an increased sensitivity of the bladder, and leads to spasm of the bladder wall (again leading to urge incontinence)

110
Q

Is BPH progressive?

A

yes–worsening of clinical parameters over time

111
Q

List complications of BPH

A
  1. urinary retention–acute (AUR) or chronic
  2. renal failure–due to hydronephrosis–>pyelonephrosis–>pyelonephritis
  3. recurrent UTIs–due to urine stasis
  4. bladder stones
  5. need for surgery–for AUR or symptoms relief
112
Q

alarm symptoms with BPH

A

hematuria
UTI
bladder stones
renal failure

113
Q

How might prostate cancer present clinically

A

usually asymptomatic (most are detected with an abnormal PSA or abnormal DRE)

if locally extensive/large however, it can cause obstructive voiding symptoms because it compresses the urethra/bladder neck

if it has metastasized (commonly to axial skeleton) it can cause back pain

114
Q

How might BPH present clinically?

A

can either cause obstructive or irritative symptoms

115
Q

describe the obstructive symptom presentation of BPH

A 
hesitancy
decreased force and caliber of stream
sensation of incomplete bladder emptying
double voiding
straining
post void dribbling

due to prostatic enlargement, which causes obstruction of the urine outlet pathway

116
Q

How can the obstructive symptoms of BPH be further subdivided?

A

into “mechanical” and “dynamic” obstruction

117
Q

what is BPH “mechanical” obstruction?

A

intrusion of the tumor into the urethral lumen or bladder neck, causing higher bladder output resistance

118
Q

what is BPH “dynamic” obstruction?

A

due to autonomic stimulation of the prostate, which causes elevated tone and therefore constriction

119
Q

describe the irritative symptoms clinical presentation of BPH

A

due to secondary response of the bladder to the increased outlet resistance

bladder outler obstruction–>detrusor muscle hypertrophy and hyperplasia, collagen deposition–>decreased bladder compliance

120
Q

what are the symptoms of prostatitis?

A

urinary: dysuria, frequency, urgency
constitutional: fever, chills, malaise, perineal/back/rectal pain

irritative symptoms are due to inflammatory processes occurring close to the bladder neck

121
Q

In general, what conditions are associated with frequency?

A

either due to increased urinary output or decreased functional bladder capacity which may result from

a) bladder outlet obstruction (increased residual urine volume results in lower functional capacity)
b) neurogenic bladder disorders
c) extrinsic bladder compression
c) psychological factors

122
Q

List a differential diagnosis for a prostatic nodule

A 
prostate cancer (30%)
BPH
prostate calculus
prostate infarct
prostatitis (infection)
prostate cyst
TB prostatitis (chronic granulomas)
previous TURP or biopsy
123
Q

what is the most effective method for early detection of prostate cancer?

A

combined use of DRE and serum PSA testing

124
Q

How useful is the DRE in screening for prostate cancer?

A
  • palpable areas of induration, or asymmetric firmness of the gland, suggest the presence of prostate cancer, but these findings can also be caused by prostate inflammation (especially granulomatous prostatitis), by BPH, and by prostatic stones
  • DRE hasonly fair reproducibility in the hands of experienced examiners
  • DRE misses 23-45% of the cancers that are subsequently detected by prostate biopsies done for elevated serum PSA
  • prostate cancers detected by DRE are at an advanced pathological stage (>T2) in more than 50% of men
125
Q

How useful is PSA in screening for prostate cancer?

A

it is not recommended for screening unless there is a risk factor for prostate cancer or patient agrees to monitor PSA velocity starting from age 50

126
Q

what does an abnormal PSA entail?

A
  • absolute levels >4 (lower for asian males)
  • > 10 is strong indication of CaP (between 4-10 is grey zone)
  • if in the grey zone, look at free-PSA to PSA ratio (rations >25% are at significantly lower risk of CaP)
127
Q

what are some risk factors that would push you towards testing PSA?

A

african american descent
family Hx of CaP
previous abnormal biopsy

128
Q

What other conditions can cause an elevated PSA?

A 
prostatitis
BPH
infarction
instrumentation
inflammation

(test has poor specificity)

129
Q

Will CaP always present with high PSA?

A

no sometimes it can present with low PSA

therefore test has poor sensitivity as well

130
Q

list drugs commonly used to treat problems with bladder function

A

alpha agonists
alpha antagonists
beta agonists
beta antagonists

131
Q

mechanism of action of alpha agonists

A

used to facilitate storage by increasing outlet resistance via sphincter constriction

132
Q

alpha agonists potential SEs

A

hypertension due to vasoconstriction

133
Q

alpha antagonists mechanism of action

A

used to facilitate emptying of the bladder by decreasing outlet resistance via sphincter relaxation

134
Q

alpha antagonists potential SEs

A

retrograde ejaculation

135
Q

beta agonists mechanism of action

A

used to facilitate storage by decreasing bladder contractility (smooth muscle relaxation)

bind beta-3 receptors on bladder to promote relaxation

136
Q

beta agonists potential SEs

A

increased HR and contractility

137
Q

beta antagonists mechanism of action

A

will apparently cause urinary retention due to increase in sphincter resistance–probably due to presence of beta-3 Rc on sphincter–if blocked, no urination

138
Q

Treatment options for prostate cancer: local disease

A
  1. radical prostatectomy –open retropubic; perineal–if retropubic approach is contraindicated (good for obese men); laparoscopic
  2. radiotherapy–brachytherapy (has to be low/intermediate stage); external beam (3D conformal, conventional, IMRT)
139
Q

complications of radical prostatectomy

A
  1. intraoperative: bleeding, rectal injury, damage to obturator nerve, damage to ureters
  2. postoperative: incontinence (10% require 1 pad/day for stress incontinence at year 1), improves for up to 2-3 years; erectile dysfunction (2 nerves spared–50-60%; 1 nerve spared–20-30%)
140
Q

complications for radiotherapy

A
  1. radiation exposure to bladder and rectum
  2. nerves may be damaged, cause ED
  3. urinary incontinence
141
Q

treatment for locally advanced/metastatic prostate cancer

A

hormonal therapy

  1. LHRH analogue–causes initial hormone flare which can cause bad effects by sudden enlargement of prostate, so need to lair this with antiandrogen
  2. LHRH antagonist
  3. estrogen–not used much in canada because causes thromboembolic toxicity, CVS toxicity, prominent feminizaton
  4. steroidal antiandrogen, non steroidal antiandrogen–not used as monotherapy, used with GNRH analogue to prevent initial hormone flare
142
Q

indications for hormone therapy

A
  1. neoadjuvantly–before radiation/prostatectomy (rarely used)
  2. primary therapy for advanced prostate cancer
  3. adjuvantly (during/after radical therapy)
  4. failures after radical therapy
143
Q

treatment for castrate resistant prostate cancer

A

aka hormonal resistant prostate cancer

  1. docetaxel + prednisone is the only therapy shown to work–is the standard of care for HRPC with metastatic disease
  2. new agents in development: abriratone, ipilumimab, OGX-011, ZD4054

FERGU (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions