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FERGU > Week 4 PBL > Flashcards

Week 4 PBL Flashcards

1
Q

list the questions asked in a focused Hx for urinary incontinence, symptoms of BPH and UTI

A
  1. duration, frequency, urge and severity of UI
  2. amount of fluid consumed daily
  3. associated S/S (dysuria, hematuria, pain)
  4. current meds that might affect UI
  5. past medical Hx that may affect ability to get to washroom/realize urge to urinate (i.e dementia, arthritis)
  6. bowel habits to rule out bowel obstruction that pushes on bladder
  7. social/family Hx to elicit risk factors for infection and cancer
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2
Q

describe the physical exam for urinary incontinence, symptoms of BPH and UTI

A
  1. abdominal exam–assess bladder size, kidney size, CVA tenderness or flank pain, bowel sounds
  2. genitalia examination–assess for abnormalities
  3. rectal exam–anal tone (neuro responses), prostate size and nodules, rectum texture (check for nodules)
  4. neuro exam–perianal sensation, knee and ankle reflexes
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3
Q

what are terazosin and doxazosin?

A

alpha antagonists

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4
Q

terasozin and doxazosin side effects

A
  • decrease BP
  • reflex tachycardia
  • orthostatic hypotension (especially severe in elderly)
  • ejaculatory problems (small risk in terazosin)
  • major interaction with phosphodiesterase inhibitors (VIAGRA)
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5
Q

what are tamulosin and alfuzosin?

A

alpha 1 selective antagonist

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6
Q

SEs of tamulosin and alfuzosin

A

more retrograde ejaculation for tamulosin

less severe side effects compared to terazosin and doxazosin (except for ejaculatory problems)

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7
Q

SEs of 5-alpha reductase inhibitors

A
  • decreased sex drive
  • increased ejaculatory dysfunction (such as a smaller amount of semen ejaculated)
  • difficulty getting an erection
  • breast tenderness or enlargement (even in men)
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8
Q

side effects of anticholinergics, TCAs (which are designed to facilitate storage)

A 
dry mouth
dry eyes
blurred vision
may produce or exacerbate glaucoma
increased HR
dry warm skin/flushing
difficulty emptying bladder
constipation
headaches
confusion
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9
Q

side effects for alpha agonists (designed to facilitate storage)

A 
fatigue
headache
drowsiness
dry mouth
dry nose
increases in BP
many more
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10
Q

list the tests that would be appropriate to order (depending on specific clinical context) in the setting of lower urinary tract obstruction (LUTS)

A 
urinalysis
urine culture
PSA
electrolytes, BUN, creatinine
U/S
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11
Q

rationale for urinalysis in LUTS

A

blood, leukocytes, bacteria, protein, glucose testing

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12
Q

rationale for urine culture in LUTS

A

exclude infection if irritative voiding

usually follows abnormal urinalysis findings

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13
Q

rationale for PSA in LUTS

A

PSA can indicate enlarged prostate; not necessarily indicative of cancer

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14
Q

rational for electrolytes, BUN, creatinine in LUTS

A

screen for chronic renal insufficiency in patients with postvoid residual urine volumes

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15
Q

rationale for ultrasound in LUTS

A

determine bladder, prostate size, degree or hydrinephrosis in patients with urinary retention or signs of renal insufficiancy

TRUS of prostate recommended to determine dimensions (if unsure) of prostate in certain cases

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16
Q

What LUTS symptoms would classify as “complicated” and indicate need for detailed management?

A 
suspicious DRE
hematuria
abnormal PSA
pain
infections
palpable bladder
neuro disease
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17
Q

when is a PSA recommended on presentation of LUTS?

A

when life expectancy is > 10 years and if the diagnosis of prostate cancer can modify the management

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18
Q

what is the difference between complicated and uncomplicated UTI?

A

difference in anatomical

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19
Q

what is an uncomplicated UTI?

A

infection of structurally and neurologically normal urinary tract

genetic and behavioural determinants

most common in young, sexually active females

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20
Q

what is a complicated UTI

A

symptomatic infection of structurally or neurologically abnormal urinary tract (either upper or lower)

men, children and pregnant women

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21
Q

etiology of UTI

A

“KEEPS”

Klebsiella pneumoniae
Enterobacter spp. (E. coli)
Enterococcus spp.
Proteus mirabilis (Pseudomomas in complicated UTI)
Staph. saprophyticus (5-15%, group B strep

22
Q

UTI symptoms in kids

A

nonspecific symptoms (failure to thrive, vomiting, fever)

23
Q

UTI symptoms in kids > 2 years

A

Localized symptoms

frequency, dysuria, abdominal/flank pain

24
Q

Lower UTI symptoms in adults

A

no fever
frequency
painful urination
possible suprapubic pain and possible hematuria

25
Q

Upper UTI symptoms in adults

A

FEVER with possible chills
flank pain
accompanying lower UTI symptoms for 1-2 days

26
Q

symptoms of UTI in elderly

A

often asymptomatic (as frequency, dysuria, hesitancy and incontinence is found in many/most elderly these arent indicative symptoms in this age group)

higher incidence of bactereia

27
Q

Urinalysis: indications of UTI

A
  1. leukocyte esteras positive–alone is not helpful for determining UTI
  2. nitrite positive: probably uTI
  3. LE and nitrite positive: specificity of 96% for UTI
28
Q

Displide: indications of UTI

A
  1. CLED grows only gram negative bacteria

2. EMB grows both gram positive and negative bacteria

29
Q

Culture: indications of UTI

A

significant colony count = indicative of UTI

30
Q

treatment for uncomplicated UTI

A

trimethroprim-sulfamethoxazole (SEPTRA) for 3 days

quinolones for 3 days

nitrofurantoin for 5-7 days

fosfomycin

31
Q

Treatment for complicated UTI

A

quinolones for 7 days

32
Q

treatment of pyelonephritis

A

aminoglycosides IV

33
Q

treatment for UTI in kids

A

may consider amixicillin-clavulinic acid

34
Q

Diagnostic process for prostate cancer

A
  1. screening using DRE + PSA
  2. if highly suspicious of prostate cancer, perform TRUS needle biopsy
  3. gleason score, grade the carcinoma, if present
  4. if suspect metastatic disease, do bone scan
  5. treatment method will vary depending on cancer stage
35
Q

what is currently the gold standard treatment for prostate cancer?

A

surgery–removing the entire prostate and seminal vesicles (radical prostatectomy)

radical retropubic prostatectomy (RRP)
radical perineal prostatectomy (RPP)
laparoscopic radical prostatectomy (LRP)

36
Q

how does radiation treat prostate cancer?

A

high powered xray aimed at tumor region, free radicals form, disruptiono f DNA, decrease cell reproduction and increase scell death

37
Q

what procedure is challenging surgery as new gold standard for prostate cancer therapy?

A

brachytherapy

placement of radioactive source directly into or adjacent to the tumor

suitable for well localized tumor–fast, convenient and has a low risk for serious long term complications

best for low-intermediate risk patients

38
Q

complications of brachytherapy

A

malaise for up to 3 months

39
Q

what are GnRH analogues?

A

analogues to luteinizing hormone releasing hormone–LHRH tells the pituitary to produce more LH which would case the testes to make more testosterone

initially with these drugs testosterone would rise, but chronic use will cause LHRH receptors to downregulate–> reduces testosterone

40
Q

name two GnRH analogues

A

Leuprolide, Goserelin

41
Q

What do GnRH antagonists do?

A

directly inhibit the LHRH receptors that tell the pituitary to produce more LH–rapid reduction in testosterone

may cause release of histamine and thus an allergic reaction

42
Q

what are antiandrogens?

A

molecules that competitively inhibit the binding of DHT (from testosterone) to the androgen receptor that modulates testosterone formation

less prominent side effects

generally used in conjuction with GnRH analogue to reduce the “hormone flare”

43
Q

list lifestyle modifications to manage symptoms related to enlarged prostate

A
  1. decrease fluids, caffeine, alcohol
  2. time diuretics–consuming during the day to prevent nocturia
  3. avoid decongestants which have alpha 1 stimulation
  4. exercise and weight loss
  5. sleep apnea–body normally produces more ADH during sleep but sleep apnea interrupts this process
  6. diet
44
Q

list minimally invasive surgical therapies to manage enlarged prostate

A
  1. interstitial laser coagulation
  2. transurethral microwave therapy
  3. transurethral needle ablation
45
Q

interstitial laser coagulation

A

green light used to vaporize prostate

46
Q

transurethral microwave therapy

A

microwave to heat and destroy excess prostate tissue

requires 2-14 days of catheterization which can lead to UTI

47
Q

transurethral needle ablation

A

delivers low level radio frequency energy to relieve obstruction

can be performed with local aneasthetic in the office in less than 1 hour

low risk of sexual side effects

48
Q

what is the gold standard surgical procedure to deal with enlarged prostate?

A

transurethral resection of the prostate (TURP)

49
Q

Describe the long term “side effects” or TURP

A

recovery is 306 weeks with uncomfortable urination

sexual activity ok after 6 weeks and erections are not affected

70% experience retrograde ejaculation

10% of men will require second TURP within 10-15 years

50
Q

risks of TURP syndrome

A
  • excess absorption of fluids from irrigated scope during surgery–dilutes blood causing hyponatremia and hemolysis
  • can cause leg cramps, heart failure, confusion, seizures, come and death

FERGU (9 decks)

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