Exam 3 Flashcards by Sara Clements

is lethargy a late sign of prostate cancer?

yes

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is constipation a late sign of prostate cancer?

yes

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is rectal pain a late sign of prostate cancer?

yes

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is anemia a late sign of prostate cancer?

yes

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is back or hip pain radiating to the testicular area a late sign of prostate cancer?

yes

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is lymphedema a late sign of prostate cancer?

yes

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is lymphadenopathy a late sign of prostate cancer?

yes

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should you routinely screen for prostate cancer using the PSA?

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should you routinely screen for prostate cancer using the DRE?

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what must occur before PSA screening for prostate cancer?

shared decision making

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should you ever perform prostate cancer sreening w/ PSA on men over 70?

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is PSA prostate specific?

yes

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is PSA cancer specific?

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what happens to the PSA normal range with age?

increases

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what age should you start screening for prostate cancer in african american male?

45 years

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what age should you start screening for prostate cancer if father, brother, or son with cancer before age 65?

45 years

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when should higher risk patients start having screening for prostate cancer?

40 years

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what is an abnormal PSA in men 40-50?

> 2.5

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what is the median PSA in men 40-50?

0.6 to 0.7

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what is an abnormal PSA in men in their 60s?

> 4

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what is the median PSA in men in their 60s?

1.0 to 1.5

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can a PSA score be considered abnormal if it rises a certain amount in a single year?

yes

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if a PSA score rises more than WHAT within a year, you should refer to urology?

more than 0.35

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what age group has the strongest evidence for benefit of PSA screening?

55 to 69 years

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what lab is elevated with prostate cancer mets?

serum alk phos

imaging? Assess size of prostate and assess pelvic lymph nodes for staging

when would you do an MRI and bone scan re prostate cancer?

PSA > 20

is prostatitis a ddx for prostate cancer?

yes

is BPH a ddx for prostate cancer?

yes

are prostatic nodules (benign) a ddx for prostate cancer?

yes

are prostate stones a ddx for prostate cancer?

yes

can chemotherapy definitively cure prostate cancer once it has spread beyond the gland

can immunotherapy definitively cure prostate cancer once it has spread beyond the gland?

what should you do with positive findings on DRE and PSA?

refer to urologist for definitive diagnosis (biopsy) and staging

what is the definitive diagnostic test for prostate cancer?

biopsy

what is an emerging therapy for prostate cancer?

androgren replacement post tereatments

class? Lupron

gonadotropin-releasing hormone agonist

condition? Arises from a systemic hormonal alteration, which may or may not act in combination with growth factors that stimulate stromal or glandular hyperplasia

BPH

functioning leydig cells are a risk factor for what?

BPH

when do patients report symptoms of BPH?

earlier than the appearance of clinical evidence

25% of patients at age 55 years with BPH describe what?

a change in their voiding pattern

what is the main impact of BPH?

quality of life

what do symptoms of BPH depend on?

type and degree of obstruction

a combo of what kind of symptoms are seen with bph?

obstructive and irritative voiding

obstructive or irritative? Decreased force of urinary stream

obstructive

obstructive or irritative? Urinary hesitancy

obstructive

obstructive or irritative? Postvoid dribbling

obstructive

obstructive or irritative? Incomplete bladder emptying

obstructive

obstructive or irritative? Overflow incontinence

obstructive

obstructive or irritative? Inability to stop urinary stream

obstructive

obstructive or irritative? Urinary retention

obstructive

obstructive or irritative? Double voiding

obstructive

obstructive or irritative? Straining during urination

obstructive

obstructive or irritative? Nocturia

irritative symptoms

obstructive or irritative? Urinary frequency

irritative symptoms

obstructive or irritative? Urgency

irritative symptoms

obstructive or irritative? Dysuria

irritative symptoms

obstructive or irritative? Urge incontinence

irritative symptoms

are symptoms usually specific to BPH?

what is the AUASI questionnaire designed to do?

uncover degree of symptomatology

what should you score before starting bph treatment?

AUASI questionnaire

are AUASI scores diagnostic?

does prostate size always correlate with BPH sx severity?

what is the normal size of the prostate?

2 to 3 cm across

what is the normal weight of the prostate?

20 g

score of slightly enlarged prostate?

1+ (3 fingerbreadths across)

score of four fingerbreadths of prostate?

should you do a focused neuro exam with bph?

yes

gross hematuria possible with bph?

yes

what age will you often see gross hematuria with bph?

over 60

can urinary retention increase the PSA?

yes

can prostatitis elevate the PSA?

yes

is elevated PSA alone diagnostic of bph?

is elevated PSA alone diagnositic of prostate cancer?

when will you see increased serum creatinine with bph?

with obstructive uropathy

what is considered the most conservative and most appropriate management approach for BPH?

watchful waiting

what is the recommended bph treatment when BPH has little or no impact on quality of life?

watchful waiting

what is the primary risk factor for developing bph?

aging

what percentage of men have bph by age 80?

90 percent

at what age may changes in urinary patterns occur?

by age 50

bph must be differentiated from WHAT unless life expectancy is less than 10 years?

prostate cancer

how should silodosin be taken?

with a meal

condition? One of several inflammatory and/or painful conditions affecting the prostate gland

prostatitis

what condition accounts for about 25% of all office visits by male patients?

prostatitis

what percentage of males will experience prostatitis in their lifetime?

50 percent

what is the most common type of prostatitis?

chronic nonbacterial prostatitis

how much more common is chronic nonbacterial prostatitis than bacterial prostatitis?

eight times

what pt population is more likely to have bacterial prostatitis?

HIV

acute bacterial prostatitis is always associated with WHAT?

a UTI

what is a major cause of recurrent bacteruria?

chronic bacterial prostatitis

which prostatitis is a/w a history of recurrent UTI?

chronic bacterial prostatitis

why is chronic bacterial prostatitis a/w a hx of recurrent UTI?

repeated seeding of the urinary tract by an infected prostate

condition? Presents with s/s of prostatitis but without evidence of inflammation

prostatodynia

which prostatitis? Fever, chills, low back pain, malaise, arthralgia, myalgia

acute bacterial prostatitis

which prostatitis? Frequency, urgency, dysuria, nocturia, bladder outlet obstruction

acute bacterial prostatitis

which prostatitis? Warm, tense, boggy, very tender prostate

acute bacterial prostatitis

which prostatitis? Sx often absent, perineal pain, low back pain, lower abdominal pain, scrotal pain, penile pain, pain on ejaculation

chronic bacterial prostatitis

which prostatitis? Dysuria, irritative voiding

chronic bacterial prostatitis

which prostatitis? Normal, boggy, or focally indurate prostate

chronic bacterial prostatitis

which prostatitis? Pelvic pain

nonbacterial prostatitis and prostatodynia

which prostatitis? Irritative voiding, abnormal flow

nonbacterial prostatitis and prostatodynia

which prostatitis? Similar to chronic bacterial prostatitis, tender on palpation

nonbacterial prostatitis and prostatodynia

is the prostate usually swollen or boggy in chronic prostatitis?

what should you do with an extremely ill patient with bacterial prostatitis?

hospitalize

should you hospitalize a prostatitis patient with urosepsis?

yes

what must you do with a patient with acute bacterial prostatitis?

keep very well hydrated

what class of drugs should be used for prostatitis only when no other treatment options exist?

fluoroquinolones

what class of antibiotics is associated with tendinitis and tendon rupture?

fluoroquinolones

what is the etiology of nonbacterial prostatitis?

uncertain

what is the nature of treatment for nonbacterial prostatitis?

generally supportive

can you treat nonbacterial prostatitis with NSAIDs, muscle relaxants, anticholinergic agents, warm sitz baths, and nontraumatic sexual activity with regular ejaculation?

yes

what kind of catheter may be needed for patients with prostatitis with severe urinary retention?

suprapubic

what are the only source of glycoprotein PSA?

epithelial cells of prostate gland

prostate cancer is rare before what age?

40 years

what is the age of onset for prostate cancer?

50 to 60 years

symptoms of prostate cancer are similar to those of what condition?

bph

how are patietns over 70 with prostate cancer treated?

conservatively

when should you screen for prostate cancer with PSA in high risk patients?

at age 40

condition? Believed to result from a sequential accumulation of genetic abnormalities affecting the androgen receptors on prostatic tissue

prostate cancer

what is the jewett system used for?

to stage prostate cancer malignancy

what lobes of the prostate are most predisposed to malignant transformation?

left and right posterior lobes

where do carcinomas of the prostate usually extend?

to the base of the bladder

the lethality of malignant prostate cancers is a direct function of what?

the heterogeneity in their cellular composition

how to antitestosteron therapies for prostate cancer work?

by suppressing androgen

sx of patients with prostate cancer early in the disease process?

usually asymptomatic

can patients with prostate cancer be asymptomatic in late stages of disease?

yes

latent symptoms of what? Bone pain, weight loss, anemia, SOB, lymphedema, lymphadenopathy

prostate cancer

condition? Dre shows palpable, hard prosate that may be localized or diffuse

prostate cancer

condition? Several hard prostate areas may be noted, or nodules may be limited to one hardened area

prostate cancer

early or late? Hematuria and hemospermia with prostate cancer

late

why is PSA NOT cancer specific?

because it is contained in the cytoplasm of both benign and malignant prostatic cells

why is the effectiveness of using psa in screening for prostate cancer questioned?

due to the lack of evidence that routine screening for elevated psa levels can improve quality and quantity of life for the overall adult male population

what is the predominant age range for the onset of prostate cancer?

50 to 60 years

is there a PSA level below which prostate cancer can be definitively ruled out?

the risk of prostate cancer does WHAT as the PSA level increases?

increases

what is the first ddx that the provider must consider in patient with suspected prostate cancer?

bph

scale? Prostate tumors are classified according to this system in which an initial grade (score) is applied to the architectural pattern of the cancer in the largest segment of the specimen

gleason system

gleason score? Indicates a well-differentiated cancer that is likely to be slow growing

1 to 4

gleason score? Indicates a moderately differentiated cancer

5 to 7

gleason score? Indicates a poorly differentiated cancer that is likely to be aggressive and rapidly growing

8 to 10

patients with prostate cancer older than what age are usually offered conservative treatment as an alternative to surgery?

70 years

if a patient is younger than WHAT with prostate cancer, curative surgery is often recommended?

younger than 70

condition? Having to wake at night one more more times to void, each time being preceded and followed by sleep

nocturia

as males age, nocturia is usually sign of what?

prostatic problem

detrusor muscle instability may cause what two symptoms?

urinary incontinence and nocturia

can methyldopa, phenothiazines, diazepam, excess vitamin D, and diuretics cause nocturia?

yes

can alpha adrenergic agents cause urinary retention?

yes

can androgens cause urinary retention?

yes

can ephedrine and pseudoephedrine cause urinary retention?

yes

can urinary retention lead to nocturia and incontinence?

yes

can nocturia result from primary disease of the urinary tract?

yes

can nocturia result from metabolic diseases?

yes

can nocturia be related to CV disorders?

yes

what is viral to the diagnosis of nocturia?

documentation of the pattern of urination during a 24 hr period

term? A desire to urinate

urgency

urinary urgency is frequently the result of what?

prostatic disease or bladder infection

term? Involuntary loss of urine during physical activity/exertion

stress incontinence

term? Difficulty initiating a urinary stream

hesitancy

term? Decrease in urinary output

oliguria

can dribbling be symptomatic of disease? Y

yes

what two conditions commonly cause dribbling?

urethral stricture and prostatic obstruction

what does nocturia treatment depend on?

identifying the cause

should you r/o UTI with nocturia?

yes

condition? Syndrome that usually consists of urogenital pain, lower urinary tract symptoms, and/or sexual dysfunction

chronic pelvic pain syndrome

condition? Testicular pain, groin, and/or low back pain

chornic pelvic pain syndrome

is there a unifying cause of CPPS?

what age groups mostly have CPPS?

young and middle aged males

describe treatment of CPPS?

multimodal, pased on type of symptoms

what class is used to treat voiding sx with CPPS?

alpha blockers

class? Medications that reduce bladder neck and urethral spasms

alpha blockers

condition? An isolated symptom- a fullness or heaviness of the scrotum

testicular pain

what is testicular pain often directly related to?

anatomic causes

is testicular torsion an emergency?

yes

are most spermatoceles painful?

when do testosterone levels peak?

adolescence and early adulthood

by how much do testosterone levels decline per year after age 30?

1 percent

what hormone rises as males age?

follicle stimulating hormone

what does FSH control?

sperm production

what hormone controls testosterone production?

luteinizing hormone

what are normal testosteron levels in men aged 18 to 69?

300 to 1100

when are testosterone levels best assessed?

between 7 and 10 am

what is the normal range of free testosterone levels?

46 and 224

can testosterone decline be a function of normal aging?

yes

can testosterone decline be due to hypogonadism?

yes

can stress and obseity suppress testosterone levels?

yes

can tobacco and alcohol use suppress testosterone levels?

yes

can OSA, DM, and illness suppress testosterone levels?

yes

does low T affect multiple bodily systems?

yes

can low T cause dyslipidemia?

yes

can low T cause HTN?

yes

is low T a/w t2dm?

yes

what is the first line treatment for symptomatic patients with low T levels?

testosterone replacement therapy

condition? The sudden and rapid deterioration of renal function resulting in the inability to maintain acid-base, fluid, and electrolyte balance and accumulation of nitrogenous wastes

acute kidney injury

aki- serum creatinine rises to WHAT or greater within 48 hours?

0.3

condition? 1.5 fold or greater increase in serum creatining from the reference value within 1 week

acute kidney injury

condition? Urine output less than 0.5 ml/kg/hr for more than 6 consecutive hours

acute kidney injury

what is the reference serum creatinine for aki?

the lowest value recorded within 3 months of the event

what is the most common type of cause of aki?

intrarenal injury

what are aki symptoms most often attributed to?

uremia or underlying cause

arae there usually profound neuro and MS disorders with aki?

does aki have a high mortality rate?

yes

what percentage of all hospitalized pts develop aki?

between 2 and 5 percent

what percentage of aki in hospitalized patients is iatrogenic?

50 percent

what is a major risk factor for older patients for aki?

surgery

is aki a risk of open heart surgery?

yes

any problem that causes WHAT can lead to aki?

decreased blood flow to the kidneys

can anaphylactic shock cause aki?

yes

what are the three major groups of aki?

prerenal, intrarenal, or postrenal

what determines the classification of aki?

anatomical nature of the lesion

which aki? Any condition that leads to an overall decrease in renal perfusion

prerenal azotemia

which aki? Hypovolemia, renovascular disease, liver disease with portal HTN, decreased CO, systemic vasodilation, renal vasoconstriction, and impairment of autoregulation of blood flow (aceis or NSAIDs)

prerenal azotemia

which aki? Includes disorders that affect the renal parenchyma itself

intrarenal azotemia

which aki? Glomerulonephritis, acute tubular necrosis

intrarenal azotemia

what is ATN often caused by?

ischemic insult or nephrotoxic drugs

which aki? Any etiology that might lead to an obstruction of urine flow from the kidneys

postrenal azotemia

which aki? BPH, bladder or prostate cancer

postrenal azotemia

can patients have a combo of aki types?

yes

is metabolic acidosis a complication of aki?

yes

is intravascular volume overload a complication of aki?

yes

is anemia a complication of aki?

yes

condition? Nausea, vomiting, anorexia, pericarditis

uremic syndrome

which aki? Fluid and electrolyte depletion

prerenal aki

which aki? Hemorrhage

prerenal aki

which aki? Septicemia

prerenal aki

which aki? Cardiac failure

prerenal aki

which aki? Liver failure

prerenal aki

which aki? Heat stroke

prerenal aki

which aki? Burns

prerenal aki

which aki? Ischemia

intrarenal aki

which aki? Toxins, radiocontrast agents

intrarenal aki

which aki? Hemoglobinuria, myoglobinuria

intrarenal aki

which aki? Acute glomerulonephritis

intrarenal aki

which aki? Arterial or venous obstruction

intrarenal aki

which aki? Tubulointerstitial nephritis

intrarenal aki

which aki? Pyelonephritis

intrarenal aki

which aki? Prostatism (hypertrophy or malignancy)

postrenal aki

which aki? Bladder, pelvic, or retroperitoneal tumor

postrenal aki

which aki? Renal calculi

postrenal aki

what causes prerenal azotemia?

decreased blood flow to the kidneys

term? Mechanisms attempt to shunt blood to undamaged nephrons

adaptive hyperfiltration

what causes intrarenal azotemia?

injury to renal tissue

what is the most common cause of intrarenal azotemia?

ATN

which aki? Bilateral or distal postrenal obstruction impedes urine flow and results in oliguria or frank anuria

postrenal azotemia

symptoms of aki are not usually present until the gfr falls to what?

10 to 15 percent of normal

what causes the most common symptoms of aki?

accumulation of toxic metabolites such as urea

term? Approximately 400 ml or less of urine production per day

oliguria

what can give clues to the etiology of aki?

detailed history

what are the four stages of aki?

initiating, oliguria, diuretic, and recovery

when does the initiating stage of aki begin?

when kidney is injured

how long does the aki oliguric stage last?

5 to 15 days

phase of aki? Defined as beginning when urine output increases to greater than 400 ml/day and bun begins to fall

diuretic stage

phase of aki? Extends from the time BUN stabilizes and urine output returns to normal to the day patient returns to normal activity

recovery phase

the objective manifestations of aki depend on what?

the stage of the disorder

signs of fluid depletion with aki point to what etiology?

prerenal etiology

severe proteinuria from renal losses may lead to what?

anasarca

elevation of what two labs assist in establishing the diagnosis of aki?

bun and creatinine

what lab are often used as an estimate of renal function?

direct serum creatinine levels

eosinophiluria is characteristic of what?

allergic interstitial nephritis due to renal toxic drugs

muddy brown granular casts and epithelial cell casts are strongly associated with what?

atn

which aki? Indicated by high urinary specific gravity and osmolality

prerenal problems

urinary sodium with prerenal problems?

low

urinary sodium tends to be less than WHAT in prerenal disease?

what formula is helpful in distinguishing prerenal azotemia from ATN?

FENa

a FENa greater than WHAT usually reflects ATN?

2 percent

condition? Characterized by the inability to concentrate urine

atn

what is the most accurate way to measure proteinuria?

24 hour urine collection

a protein loss of more than 3 to 2.5 g every 24 hours indicates what?

a glomerular lesion

test? Commonly used to assess kidney size and r/o hydronephrosis

renal ustrasound

what test is helpful to determine exact location of urinary tract obstruction?

what is the main diagnostic challenge with aki?

determine the underlying cause

condition? Characterized by altered renal ability to conserve dosium

atn

condition? Results form interference with the flow of urine from the kidneys and is a/w obstruction or diruption of the urinary tract

postrenal azotemia

approximately what percentage of patients with aki are nonoliguria?

50 percent

condition? Stones (renal calculi) originate in the kidney

nephrolithiasis

what is the most common substance of kidney stones?

calcium salts

what percentage of stones are calcium salts?

75 to 85 percent

what percentage of stones are struvite?

10 to 15 percent of normal

what percentage of stones are uric acid?

7 percent

what percentage of stones are cystine?

1 to 2 percent

condition? Stones often cause acute episodes of urinary tract obstruction, infection, and severe pain in adults

nephrolithiasis

what age range is the peak incidence of renal calculi?

20 to 30 years

what is the lifetime prevalence of renal calculi?

15 to 25 percent

what kind of lifestyle does a typical kidney stone patient have?

sedentary

what kind of occupational exposure is a/w kidney stones?

high environmental temperatures

males or females? More often have calcium oxalate stones

males

are struvite stones more common in males or females?

females

can renal stones be d/t obstruction or urinary stasis?

yes

can renal stones be d/t infection?

yes

can renal stones be d/t dehydration and urinary concentration?

yes

can renal stones be d/t increased consumption of calcium or vitamin C or D?

yes

can renal stones be d/t excessive excretion of uric acid?

yes

can renal stones be d/t vitamin A deficiency?

yes

can hereditary factors predispose patients to kidney stone formation?

yes

calcium oxalate and calcium phosphate stones account for what percentage of all cases of renal calculi?

65 to 85 percent

diet high in salt, animal fat, animal protein, and oxalate from leafy green vegs predispose to what kind of stones?

calcium oxalate and calcium phosphate

is a low calcium diet a risk factor for calcium stones?

yes

is vasectomy a risk factor for calcium stones?

yes

struvite stones are associated with what condition?

UTIs

struvite stones occur with alkaline or acidic urine?

alkaline

struvite stones occur with a ph greater than what?

struvite stones occur when what kind of organism is present?

a urea splitting organisms

what are two urea-splitting organisms?

proteus or klebsiella

which stones? Formed from an increase in uric acid production or ineffective elimination of uric acid

uric acid stones

which stones? May result from dietary intake of foods high in uric acid

uric acid stones

what kind of ph can lead to uric acid stones?

acidic ph

uric acid stones account for what percentage of all renal stone cases?

15 to 20 percent

which stones? Created because of a rare autosomal recessive disorder called cystinuria

cystine stones

which stones? Formed when there is a metabolic error that causes a decrrease in tubular reabsorption in the kidney, leading to urinary cystine concentrations greater than 250

cystine stones

condition? Occurs when normally soluble mineral substances supersaturate the urine and deposite out of solution as crystals, which serve as nuclei for stone-forming substances

nephrolithiasis

do many patients have renal stones of mixed etiology?

yes

what color are calcium stones?

light

which stones? Crystals characteristically resemble RBCs in shape and size or may have larger dumbbell form

calcium stones

which stones? Flat and consist of hexagonally shaped crystals that are radiopaque

struvite stones

which stones? Often form secondary to UTI caused by p mirabilis

struvite stones

staghorn calculi are more likely to be what kind of stones?

struvite stones

which stones? Radiolucent and red orange in color, with a teardrop or flat suqare shape

uric acid stones

which stones? Lemon yellow, hexagonal, and sparkle under light microscopy

cystine stones

which stones? Causes: idiopathic, hypercalciumia, or increased levels of uric acid

calcium stones

which stones? Mgmt: thiazide diuretics, diet, cholestyramine, surgery

calcium stones

which stones? Causes: alkaline urine, infection with urea-splitting organisms such as pseudomonas

struvite stones

which stones? Management: antibiotic therapy, surgery

struvite stones

which stones? Causes: increased uric acid production, high uric acid intake, regional enteritis, UC, or idiopathic

uric acid stones

which stones? Mgmt: allopurinol, fluid replacement, diet, surgery

uric acid stones

which stones? Mgmt: force fluids, d-penicillamine, tiopronin

cystine stones

what is the incidence of recurrence of certain stones within 5 years?

40 to 50 percent

when can complications occur with renal stones?

when stone obstructs flow of urine

can stones predispose patient to UTI and hematuria?

yes

what determines the signs and symptoms of a stone?

location, size, and type of stone

what is the usual onset of renal stone pain?

sudden

term? Type of flank pain that is not relived by changes in position or other measures

renal colic

condition? Pain may present with a referral pattern that originates in the flank or kidney area and radiates across the abdomen down into the groin, perineal area, and inner thigh

nephrolithiasis

nausea and vomiting possible with renal stones?

yes

urinary frequency, dysuria, hematuria, diaphoresis, and weakness possible with renal stones?

yes

condition? Abdominal distention, guarding on palpation, flank tenderness on percussion, decreased or absent bowel sounds

nephrolithiasis

when might fever be present with nephrolithiasis?

if there is acute infection r/t obstruction

why might BP be elevated with renal stones?

because of pain

what should start the workup for renal stones?

UA, CBC, chemistry

what UA finding is seen in the majority of renal stone cases?

gross or microsopic hematuria

gross/microscopic hematuria may be absent in up to what percentage of renal stone cases?

30 percent

what is important for the appropriate renal stone treatment to be started?

id the type of stone formation

what kind of CT for renal stone workup?

noncontrast (potential for renal toxicity)

RBCs on UA with renal stones?

yes

WBCs on UA with renal stones?

yes

casts on UA with renal stones?

yes

minerals, bacteria, pus, abnormal ph with renal stones?

yes

what might be seen with creatinine on 24 hour urine?

increased

why would serum BUN be elevated with renal stones?

due to urinary tract obstruction

why might creatinine be elevated with renal stones?

secondary to damage to the kidney

condition? Tentative diagnosis is made from H&P findings showing increased intensity of renal colic with flank pain or a pattern of referred pain coupled with flank tenderness

nephrolithiasis

what may be the only presenting sign of stone formation?

hematuria

how is the diagnosis of renal stones confirmed?

ua that is positive for blood and visualization of the renal system by radiography or ultrasound

what are the treatment goals of renal stones?

decrease the symptoms and complications and prevent recurrence

what should be decreased in mgmt of renal stones?

concentration of stone-forming substances in the urine

how much water should be consumed with renal stones?

six to eight 8-ounce glasses per day

how long should the high fluid intake continue with renal stones?

indefinitely

most stones smaller than what size pass spontaneously?

5 mm

spontaneous passage of renal stones larger than what size is highly unlikely?

10 mm

what is the initial priority with renal stone mgmt?

pain management

what doses of oral NSAIDs would be used with renal stone management?

600 to 800 mg TID

can 60 mg IM ketorolac be effective for renal stone pain?

yes

most studies have demonstrated that what class of drugs is as effective as opiates for renal stone pain?

NSAIDs

what class of drugs have been shown to relax ureteral smooth muscle re renal stones?

*NSAIDS*

do antispasmodics have anticholinergic effects?

yes

can antispasmodics lead to urinary retention?

yes

what class of drugs can help reduce calcium excretion?

thiazide diuretics

what drug helps reduce uric acid production by inhibiting xanthine oxidase?

allopurinol

what drug affects the excretion of cystine?

d-penicillamine

what drugs increase calciuria and typically worsen renal stone formation?

loop diuretics and triamterene

what kind of interventions may be necessary if the stone does not pass spontaneously?

noninvasive or invasive surgical interventions

what is the least invasive surgical technique for renal calculi?

extracorporeal shock-wave lithotripsy

how long should NSAIDs be avoided before ESWL?

at least 3 days (re bleeding risk)

what kind of measures should be taken to reduce the incidence of recurrence of renal stones?

preventive measures

how much fluid intake per day to reduce the occurrence of calcium-based stones?

greater than 2 L per day

what kind of diet promotes calcium excretion?

an acidic diet higher in meat content

what kind of diet may prevent oxalate stones?

a low-oxalate diet

how can struvite stone production be decreased?

by preventing UTIs through patient education and self care

should patients with renal stones monitor I and O and strain urine for stones?

yes

should you take supplements with phosphorus or calcium, antacids, and vitamin D3 with renal stones?

does inactivity contribute to renal stone formation?

yes

how does inactivity contribute to renal stone formation?

calcium shifts and urinary stasis

should caffeine, beer, and wine be avoided with renal stones?

yes

what are these foods high in? beets, black tea, chocolate, lamb, nuts, rhubarb, spinach

oxalate

what kind of diet is often effective in reducing stones formed from excess uric acid?

low-purine diet

what are these foods high in? organ meats, red meats, seafood, poultry, legumes, whole grains, and alcohol

purines

what effect does alcohol have on uric acid clearance?

decreased

condition? The involuntary loss of urine from the bladder

urinary incontinence

is urinary incontinence an unavoidable consequence of aging?

there seems to be a strong association between UI and what psych disorder?

major depression

are males or females more likely to have incontinence?

females

the incidence of UI does what with age?

icreases

which UI? Characterized by sudden onset; several causes, including delirium, infection, drugs, underlying systemic illness, and restricted mobility

transient UI

what organs mediate bladder emptying?

parietal lobes and the thalamus

what happens to bladder capacity with aging?

decreased

what happens to postvoid residual urine volume with aging?

increased

what is considered an increased postvoid residual urine volume?

> 50 ml

what happens to disinhibition of bladder contractions with aging?

increased (i.e., OAB)

what happens to nocturnal sodium and fluid excretion with aging?

increased

condition? Results from increased urethral resistance in males r/t benign prostatic hypertrophy and weakness of the pelvic floor in females

urinary overflow phenomenon

condition? Can result in decreased competence of the internal and external sphincters via atrophy of the urethral mucosal epithelium, resulting in atrophic urethritis, loss of compliance, and a diminished urethral mucosal seal

postmenopausal estrogen deficiency

which UI? Cause: leakage of urine d/t hypermobility of the bladder neck, intrinsic sphincter deficiency, or neurogenic spincter deficiency

stress incontinence

which UI? Cause: medications: Sedatives, hypnotics, antispasmodics

stress incontinence

which UI? Urine leakage with cough or sneeze

stress incontinence

which UI? History of vaginal deliveries; evidence of urine loss

stress incontinence

which UI? Pad tess, stress test, UA with culture and sensitivity; video-urodynamics, cystometrogram

stress incontinence

which UI? Mgmt: pelvic floor reeducation with biofeedback (Kegels), weight loss if obese

stress incontinence

can hormone replacement therapy (estrogen) be used to treat stress incontinence?

yes

what drug class to treat stress incontinence?

alpha adrenergic agonist

can periurethral bulking injections be used to treat stress incontinence?

yes

can surgical correction of hypermobile bladder neck be used to treat stress incontinence?

yes

which UI? Cause: leakage due to UTI; vaginitis; bladder stones and tumors

urge incontinence

which UI? Cause: cortical, subcortical, and suprasacral lesions; CVA; dementia; MS; parkinsons

urge incontinence

which UI? Cause: medications- diuretics, narcotics

urge incontinence

which UI: history of dysuria, frequency, urgency, hematuria, or nocturia?

urge incontinence

which UI? Evidence of a large amount of urine loss

urge incontinence

which UI? Evidence of unstable detrusor function with decreased capacity

urge incontinence

which UI? Assess perineal hygiene

urge incontinence

which UI? Mgmt: antimicrobial agents, antiseptics, topical estrogen, anticholintergics, smooth muscle relaxants, TCs

urge incontinence

which UI? Failure to empty bladder due to underactive detrusor activity, outlet obstruction, or DM

overflow incontinence

which UI? Cause: medications- anticholinergics, disopyramide, antihistamines, CCBs

overflow incontinence

which UI? History of urinary hesitancy, dribbling, decreased stream, feeling of incomplete bladder emptying, constipation

overflow incontinence

which UI? Mgmt: scheduled toileting, Crede's maneuver, treatment of underlying conditions

overflow incontinence

which UI? Mgmt: urinary collection devices (intermittent or suprapubic)

overflow incontinence

which UI? Causes: delirium, fecal impaction, lack of manual dexterity, or decreased mobility

functional incontinence

which UI? Causes: medications- diuretics, hypnotics, alcohol, narcotics, decongestants

functional incontinence

which UI? Fecal impaction; assess sleep patterns, mental state, hearing, vision, pysical dexterity and functional ability

functional incontinence

which UI? Mgmt: remove barriers to rapid toileting; provide barrier-free environment

functional incontinence

term? Includes the date of incontinence onset, # times per day or night the pt voids, amt of urine voided each time, fluid intake history, and characteristics of UI

voiding history

what is the aim of physical exam with UI?

identify the underlying pathophysiological causes (can be multiple)

is a neuro assessment important in UI?

yes

what two abilities should be assessed in UI neuro exam?

functional and cognitive ability

should you do an abdominal exam with UI?

yes

should you do a pelvic exam with UI?

yes

should you do a rectal exam with UI?

yes

should you do a prostate exam with UI?

yes

can incontinence cause skin breakdown?

yes

what percentage of pts with CHF experience incontinence?

50 percent

test? Allow direct observation of urine loss with a full bladder

cough stress test

how long should the patient/caregiver keep a voiding record?

3 to 7 days

test? For pts with questionable hx of UI; involves having pt take pyridium and then wear a pad that can be checked at invervals for staining

pad test

should UA and c&s be done for UI?

yes

should you check BMP with UI?

yes

a urine cath to assess postvoid residual volume is important unless a reliable measurement can be obtained by what?

bladder scan

are UA results often normal with UI?

yes

patients with what condition may have glucosuria?

diabetes

pts with glomerular disease may have what UA finding?

proteinuria

nitrites or bacteria on a UA are signs of what?

infection

a urine culture that is positive for a predominant bacterial species (i.e. other than mixed or normal flora) indicates what?

infection

local irritation and bladder or outflow obstructions may lead to which UI?

urge incontinence

the bladder and lower GU tract must be able to WHAT and empty properly for normal micturition to occur?

store urine

laxity of pelvic floor muscles, bladder outlet or sphincter weakness may lead to which UI?

stress incontinence

increased intraabdominal pressure can precipitate which UI?

stress incontinence

are mixed types of incontinence common?

yes

effective treatment of UI is largely driven by what?

the pathophysiological basis of its etiology

which UI? The involuntary loss of urine resulting from increased intraabdominal pressure

stress incontinence

which UI? Bladder is unable to retain urine because of hypermobility of the bladder neck

stress incontinence

which UI? Aka detrusor instability

urge incontinence

which UI? The involuntary leakage of urine resulting from an inability to delay voiding

urge incontinence

which UI? The patient has the sensation of a full bladder but is unable to store the urine long enough to reach the toilet

urge incontinence

the term overactive bladder is often used interchangeably with what term?

urge incontinence

are OAB and urge incontinence the same condition?

condition? A syndrome of sx that include urgency, frequency, and nocturia, all of which are s/w involuntary contractions of the detrusor muscle

overactive bladder

condition? The sudden intense urge to urinate and an involuntary loss of urine

urge incontinence

can urge incontinence be a feature of OAB?

may or may not

what fraction of patients with OAB have urge incontinence?

one-third

can OAB occur as a component of other types of UI?

yes

what plays an important role in the management of OAB?

pharmacotherapy

which UI? The involuntary leakage of small amounts of urine

overflow incontinence

which UI? Incontinence that occurs with a normally functioning urinary system

functional urinary incontinence

which UI? The leakage of urine is caused by factors outside the lower urinary tract and can be transient in nature

functional urinary incontinence

in older patients, WHAT is a key contributor to iatrogenic UI?

polypharmacy

condition? Occurs when the normally sterile environment of the urinary tract system is invaded by pathogenic bacteria

lower UTI

where can infections of the lower urinary tract occur?

urethra, bladder, and the prostate

infection of what two structures usually occur together?

urethra and bladder

term? Infection of the urethra

urethritis

term? Infection of the urinary bladder

cystitis

condition? Chronic inflammation of the baldder wall

interstitial cystitis

condition? Infection of the prostate gland

prostatitis

acute LUTIs are characterized by what?

onset of UTI in a previously symptom-free individual

when is a UTI considered recurrent?

when it occurs again within two weeks of the original infection

can a complicated UTI be acute?

yes

can a complicated UTI be chronic?

yes

condition? UTI that is either an acute or chronic infection that is accompanied by factors that predispose a patient to the infection or make treatment more difficult

complicated UTI

condition? UTI that can be resolved without addressing additional factors and is localized to the lower urinary tract

uncomplicated UTI

what percentage of females experience lower UTI each year?

20 percent

what is the lifetime incidence of lower UTI in females?

50 to 60 percen t

what patient population has a higher prevalence of UTI?

sexually active adults, very young children, or frail older adults

males older than what age have approximately double the rate of UTI compared to the overall female population?

65 years

can lower UTI be the result of other conditions within the renal system?

yes

a urethral obstruction can create WHAT providing a medium for bacterial growth?

stasis of urine

condition? Can occur as a result of poor or nonsterile catheterization technique, poor hygiene etc

UTI

IC is primarily found in what gender?

females

condition? Cause unknown, theory that an abnormality in the bladder surface allows potassium and urea to leak into the bladder interstitium

interstitial cystitis

is interstitial cystitis an infectious condition?

does IC respond to antibiotics?

the prevalence of UTI does what with age?

increaess

do older adults always have symptoms of UTI?

what are two risk factors for UTI in males?

prostatic hypertrophy and diabetes

what is the usually cause of lower UTIs?

contamination from patients own GI tract

alkaline or acidic urine is a common complication of DM?

alkaline urine

in DM, WHAT of the urine creates a medium in which bacteria can more readily grow and proliferate?

elevated ph

renal stones can create an environment re UTI that promotes what?

bacterial growth

in female patients, approximately 80 to 90 % of cases of uncomplicated UTI are the result of what bacterium?

e coli

is E coli gram positive or gram negative?

negative

what shape of bacteria is e coli?

rod

what is the second most common cause of uncomplicated bacterial UTI?

staph saprophyticus

is staph saprophyticus gram positive or gram negative?

gram positive

can fungi be a causative agent in a complicated UTI that fails to respond to antibiotic therapy?

yes

why is cystitis rare in males?

because increased length and drier environment around the urethra contribute to less frequent bacterial colonization

does prostatic fluid have inherent antibacterial properties?

yes

when this condition occurs in males, it is often a/w abnormal urethral anatomy or inadequate treatment of prostatitis?

UTI

do most abx penetrate the prostatic tissue?

might female patients with UTI present with urethritis and cystitis simultaneously?

yes

what is the most frequently report sx in both male and female patients with UTI?

dysuria

urinary frequency or urgency with UTI?

yes

nocturia with UTI?

yes

hematuria with UTI?

yes

low back or suprapubic pain with UTI?

yes

cloudy, foul-smelling urine with UTI?

yes

what may be the sole manifestation of UTI and should create a high level of suspicision in older adults?

altered mental status

is urethritis in males common?

vaginal discharge in female patients and urethral discharge in male patients may suggest what?

STI

purulent urethral discharge may reflect what infection?

n gonorrhoeae

whitish-mucoid urethral discharge may reflect what infection?

chlamydia

what kind of urine sample should be submitted for UA?

clean catch midstream

cloudy urine appearance on UA with UTI?

yes

alkaline ph on UA with UTI?

yes

hematuria on UA with UTI?

yes

elevated nitrites on UA with UTI?

yes

leukocyte esterase on UA with UTI?

yes

what does leukocyte esterase detect on UA?

pyruia

bacterial overgrowth on UA with UTI?

yes

urinary sediments of RBCs, WBCs, and mucus on UA with UTI?

yes

what kind of bacteria convert urinary nitrates to nitrites?

enterobacteriaceae

do staph converte urinary nitrates to nitrites?

false-positive urinary nitrite tests may result from what medication?

pyridium

what test may be ordered to speciate and determine the sensitivity of the UTI causative organism to specific antibiotic therapy?

urine culture and sensitivity

diagnosis of what? Made based on the subjective complaints of the patient and a clean-catch midstream urine sample showing the presence of bacteria

lower UTI

what amount of bacteria of the same morphology suggests UTI?

100000

condition? Currently defined as a urine sample with greater than 1,000 organisms/ml in the presence of characteristic clinical symptoms

UTI

whe WHAT also influences interpretation of the urine culture because the sterility of commonly performed clean-catch techniques is heavily dependent on the patient's ability to self-clean around the urethra before voiding?

METHOD

are alcohol swabs adequate for UA collection?

what is the most reliable way to collect a UA?

straight cath using sterile technique

what is the gold standard with the greatest sensitivity for lab confirmation of UTI?

urine culture and sensitivity

what test with UTI typically indicates pyuria and often the presence of RBCs?

urinalysis

how is pyuria quantified on a lab test?

greater than 10 neutrophils/hpf on microscopic exam

term? Greater than 10 neutrophils/hpf on microscopic exam

pyuria

is hematuria common with UTI?

yes

is hematuria common with urethritis?

is hematuria common with vaginitis?

is blood in the urine a marker of complicated UTI?

UTIs may be treated with WHAT based on knowledge of the most common bacterial etiologies?

empiric antibiotic therapy

what testing will aid in definitively identifying the UTIs infecting microorganism and the appropriate antibiotic therapy?

urine culture and antibiotic sensitivity testing

IC is primarily a diagnosis of what?

exclusion

what is a potential diagnostic tool for IC?

potassium sensitivity test

what do WBC casts in the urine reflect?

passage of neutrophils through the renal tubules

why might patients with IC present with the need to urinate frequently?

because of reduced bladder capacity

what is the mainstay of lower UTI treatment?

antimicrobial management

what is the first line treatment of choice for uncomplicated lower UTI?

nitrofurantoin x 5 days

what is the dosing for TMP-SMX for lower UTI?

160/800 mg one tablet BID x 3 days

what is the dosing for nitrofurantoin for UTI?

100 mg BID x 5-7 days

what is the dosing for amox-clav for UTI?

500 mg/125 mg BID x 10 days

what is the dosing for amoxicillin for UTI?

500 mg BID x 10 days

what is the dosing for cefuroxime for UTI?

250 mg-500 mg BID for 5-10 days

is nitrofurantoin effective against many gram positive cocci?

yes

gram positive or gram negative? Enterococcus faecalis

gram positive

nitrofurantoin should be used as empirical therapy for what only?

uncomplicated UTI

drug? A broad-spectrum antibiotic used to empirically treat uncomplicated UTI, given as a single dose

fosfomycin

what is indicated as a first-line treatment in complicated UTI in female patients who are not pregnant?

tmp-smx

what should be considered when slecting an antibiotic for UTI?

local resistance patterns

what class of drug shohuld be reserved for UTI when no other antibiotic agents are appropriate?

fluoroquinolones

class? Ciprofolxacin

fluoroquinolones

empirical treatment of UTI in male patients (i.e., a complicated UTI) should be extended for how long?

at least 7 days

should you use nitrofurantoin for a male UTI?

should you use beta lactams for a male UTI?

treatment of UTI during pregnancy is especially important because an established link between UTI and WHAT?

premature delivery

drug? Tends to reduce bladder wall inflammation in IC

polysulfate sodium (elmiron)

UTI that is secondary to other pathological conditions will not resolve until what?

the primary causative factor is addressed

when should you consider prophylactic therapy for UTI?

if UTI recurs frequently (e.g., monthly)

how much fluid should you drink with UTI?

eight to ten 8-ounce glasses of water per day

condition? An infection of the kidney that is characterized by infection within the renal pelvis, tubules, or interstitial tissue that may be unilateral or bilateral

pyelonephritis

can pyelonephritis be acute or chronic?

yes

condition? Chronic version leads to changes in the kidney that create atrophy and scarring of the kidney and calyceal deformity that may eventually lead to renal failure

pyelonephritis

is pyelo more common in males or females?

females

is ureterovesical reflux a predisposing factor for pyelo?

yes

is urinary obstruction a predisposing factor for pyelo?

yes

is stress incontinence a predisposing factor for pyelo?

yes

are multiple or recurrent UTIs a predisposing factor for pyelo?

yes

are renal disease and kidney trauma predisposing factors for pyelo?

yes

is pregnancy a predisposing factor for pyelo?

yes

is prostatic enlargement a predisposing factor for pyelo?

yes

are metabolic disorders like DM a predisposing factor for pyelo?

yes

is an indwelling catheter a risk factor for pyelo?

yes

condition? Most commonly an ascending infection from the bladder

pyelonephritis

does lower UTI always precede pyelo?

unclear

do many patients with pyelo present without clinical evidence of prior cystitis?

yes

condition? Bacteria believed to enter through the urethral meatus and ascend upward from the lower urinary tract to one or both kidneys via the ureters, bloodstream, or lymph system

pyelonephritis

condition? In female patients, typically caused by fecal flora that colonize the vaginal introitus and subsequently ascend along the urinary tract to the kidneys

pyelonephritis

what is the most comon gram negative causative agent re pyelo?

e coli

are p mirabilis, klebsiella, and pseudomonas gram negative causes of pyelo?

yes

what percentage of pyelo cases are caused by gram positive organisms?

between 5 and 10 percent

what is the second most common cause of pyelo in young females?

s saprophyticus

condition? Swelling of the renal parenchyma occurs as a result of the patchy distribution of the acute infectious process throughout the kidney

acute pyelonephritis

condition? Chronic- usually caused by a recurrent or chronic bacterial infection of the kidney, often to the presence of instrumentation

chronic pyelonephritis

what is the classic triad of acute pyelo?

fever, CVA pain, nausea and/or vomiting

how high can fever get with acute pyelo?

103

how long can fever last with acute pyelo?

hours or days

condition? May present with shaking, chills, N/V, unilateral flank or localized back pain over the affected kidney, fatigue, diarrhea, or other symptoms resembling those of gram negative sepsis

acute pyelonephritis

acute pyelo presentation can mimic what?

pelvic inflammatory disease

condition? May present with the patient c/o fatigue, nausea, decreased appetite with weight loss, nocturia, and/or polyuria

chronic pyelonephritis

condition? Exam will elicit marked tenderness on deep abdominal palpation and/or percussion of the affected flank and back overlying the affected kidney (CVA) tenderness

acute pyelonephritis

when is chronic pyelo usually first diagnosed?

when the patient presents with impaired renal function caused by dmaage to the kidneys

how is diagnosis of pyelo confirmed?

urinalysis

pyelo UA shows bacteria?

yes

pyelo UA shows proteinuria?

yes

pyelo UA shows leukocyte esterase?

yes

pyelo UA shows nitrites?

yes

pyelo UA shows hematuria?

yes

pyelo UA hows pyuria?

yes

what do WBC casts on UA mean?

passage of neutrophils through the renal tubules

pyelo UA shows WBC casts?

yes

what does urine culture demonstrate with pyelo?

> 100,00

blood cultures may be positive in what percent of mild to moderate pyelo cases?

10 to 20 percent

it can be difficult to differentiate pyelo from what condition?

cystitis

what finding is diagnostic for pyelo?

presence of WBC casts

in female patients w/ pyelo, WHAT should be performed to rule out an alternative or additional diagnosis such as pelvic inflammatory disease?

pelvic examination

is hematuria common with upper UTI?

yes

is hematuria common with lower UTI?

yes

is hematuria common with vaginitis?

is hematuria common with urethritis?

what kind of therapy is needed to prevent permanent damage to kidneys with pyelo?

aggressive

what is more important in pyelo management than serum or urine drug levels?

tissue penetration of antibiotics into the renal medulla

what makes a case of acute pyelo mild?

absence of N/V or signs of sepsis

can you give oral abx for mild pyelo?

yes

how long should treatment course last for mild to moderate pyelo?

7 to 10 days

how long should treatment course last for severe pyelo cases?

14 days

what drug can be used as second-line therapy for pyelo?

ceftriaxone 1 g IV daily

condition? Characterized by abnormal tissue formations on or around the kidney that may cause or contribute to renal disease

renal tumors

can renal tumors be primary?

yes

can renal tumors be secondary?

yes

what is a secondary renal tumor?

results from malignant spread

are renal adenomas malignant?

are renal adenocarcinomas malignant?

yes

what is the typical age of renal cancer onset?

55 and 70 years

what is the average age of renal cancer diagnosis?

64 years

renal cell carcinomas originating in the WHERE are most common?

renal cortex

what percentage of renal tumors originate in the renal cortex?

85 percent

what percentage of renal cell carcinomas are clear cell?

75 to 85 percent

what percentage of renal cell carcinomas are chromophilic or papillary?

15 percent

what percentage of renal cell carcinomas are chromophobic?

5 percent

what percentage of renal cancers are transitional cell carcinomas?

5 to 8 percent

what structure do transitional cell carcinomas commonly affect?

bladder

what percentage of renal cell carcinomas are curable if they are superficial and/or localized in the renal pelvis or ureter?

90 percent

what is the percentage of cure for invasive renal tumors?

10 to 15 percent

what is the common renal tumor in children?

nephroblastoma

what is another name for nephroblastoma in children?

wilms tumor

is obesity a risk factor for renal cell carcinoma?

yes

is exposure to asbestos a risk factor for renal cell carcinoma?

yes

is cadmium and/or gasoline exposure a risk factor for renal cell carcinoma?

yes

is use of phenacetin a risk factor for renal cell carcinoma?

yes

are NSAIDs a risk factor for renal cell carcinoma?

yes

are aspiring-containing analgesics a risk factor for renal cell carcinoma?

yes

is chronic HD for acquired polycystic kidney disease a risk factor for renal cell carcinoma?

yes

cigarette smoking has what percentage correlation with the development of renal cell carcinoma?

25 to 30 percent

is hypertension a risk factor for renal cell carcinoma?

yes

what kind of epithelium lines the urinary system?

transitional cell

are transitional cell epithelial tumors often symptomatic?

are renal tumors usually encapsulated?

yes

where are renal tumors usually located?

near the cortex unilaterally

can renal neoplasms be benign?

yes

can renal neoplasms be malignant?

yes

where do primary renal neoplasms originate?

in the kidney

where do secondary renal neoplasms originate?

originating or spread from another source

where do primary renal malignancies usually spread through?

lymph nodes

where do primary renal malignancies usually met to?

lungs, liver, bone

is metastatic disease that spreads to the kidney, usually from the lung, more common than primary renal neoplasm?

yes

where does secondary renal cancer usually come from?

the lung

should benign renal neoplasms be removed?

yes

renal cancer symptoms vary depending on what?

the size of the tumor

early signs of renal tumor growth are char as what?

silent

approximately WHAT percentage of the time, asymptomatic patients with renal cancer present with gross hematuria as the only outward complaint?

60 percent

approx 60% of the time, patients with renal cancer are asymptomatic and p/w WHAT as the only outward complaint?

gross hematuria

what % of patients with renal cancer report dull, achy flank pain, or an abdominal mass?

30 percent

what is the classic triad of renal cancer?

flank pain, hematuria, and an abdominal mass

does the classic triad of renal cancer indicate late disease?

yes

general signs of advanced renal cancer include what two things?

weight loss and fatigue

condition? Intermittent fever not associated w/ infection and palpable abdominal mass

renal tumor

does metastasis of renal cancer indicate a poor prognosis?

yes

how is the dx of a renal mass initially confirmed?

IVP with nephrotomography

is urine cytology reliable for diagnosing renal tumors?

which renal cancer stage? Defined as a tumor confined within the kidney capsule; treated by nephrectomy

stage I

which renal cancer stage? Defined as the invasion of the renal capsule that is confined within the Gerota's fascia encapsulating the kidney and adrenal gland; treated by nephrectomy

stage II

which renal cancer stage? Defined as involvement of the regional lymph nodes ipsilaterally, the renal vein, or the vena cava

stage III

which renal cancer stage? Defined as distant metastasis

stage IV

approx what percentage of patients with renal tumors have metastatic disease at diagnosis?

30 percent

what is the most common site of renal cancer mets?

lung (50-60%)

what percentage of renal cancer mets are to bone?

30 to 40 percent

what percentage of renal cancer mets are to regional lymph nodes?

15 to 30 percent

what percentage of renal cancer mets are to the lung?

50 to 60 percent

what percentage of renal cancer mets are to the brain?

10 percent

how is a renal cyst differentiated from a renal tumor?

by biopsy

should you r/u renal calculi and infarction with renal tumor?

yes

treatment of renal cancer requires immediate what?

referral to a urologist

condition? Abnormal tissue masses that occur in the bladder wall lining

bladder tumors

what is the bladder lining composed of?

transitional cell epithelium (urothelium)

do bladder tumors commonly recur despite aggressive treatment?

yes

WHAT are the most common cancer of the urinary system?

bladder tumors

what is the 6th most common neoplasm in the US?

bladder cancer

bladder cancer occurs in men how much more often than women?

90% of new bladder cancer dx occur in what age group?

>= 55 y/o

what is the average age for bladder cancer dx?

73 years

what ethnicity is at higher risk for bladder cancer?

non-hispanic whites

is there a sig correlation b/w bladder tumors and cigarette smoking?

yes

is there a sig correlation b/w bladder tumors and presence of renal tumors?

yes

is exposure to aromatic amine dyes (arylamines) and arsenic a risk factor for bladder tumors?

yes

is chronic use of phenacetin-containing analgesics a risk for bladder tumors?

yes

is use of saccharin a risk for bladder tumors?

yes

is chronic lower UTI a risk for bladder tumors?

yes

is recurrent nephrolithiasis a risk for bladder tumors?

yes

condition? Primarily transitional cell carcinomas that arise from the transitional cell uroepithelium

bladder tumors

can bladder tumors be squamous cell carcinomas?

yes

can bladder tumors be adenocarcinomas?

yes

which type of bladder tumors have the most favorable prognosis?

transitional cell carcinomas

what are the two classes of bladder tumors (description)?

papillary or nonpapillary

what percentage of bladder tumors are papillary?

90 percent

what percentage of bladder tumors are nonpapillary?

10 percent

which type of bladder lesions form as a small protuberance attached to a stalk?

papillary bladder lesions

which type of bladder lesions are more invasive and have a poorer prognosis?

nonpapillary bladder lesions

to what 4 places does primary bladder cancer tend to met to?

lymph nodes, liver, lungs, bones

can bladder cancer be secondary?

yes

is there genetic predisposition for bladder cancer?

yes

which kind of bladder cancer is typically associated with an underlying inflammatory process, such as chronic UTI and renal calculi; deeply invasive, poor prognosis

squamous cell carcinoma

patients w/ a bladder tumor are frequently WHAT until they have an episode of hematuria?

asymptomatic

can hematuria w/ bladder tumor be microscopic?

yes

can hematuria w/ bladder tumor be gross?

yes

can hematuria w/ bladder tumor be intermittent?

yes

can hematuria w/ bladder tumor be continuous?

yes

dysuria, frequency, chills, low grade fever, weight loss, urinary urgency- with bladder tumors?

yes

UA with bladder tumor tends to show what?

trace to gross hematuria

anemia possible on CBC with bladder tumor?

yes

how is a dx of bladder tumor confirmed?

by visualization of the lesion through transurethral resection of the bladder tumor

can positive urine cytology for transitional cell cancer confirm bladder cancer diagnosis?

yes

does negative urine cytology always rule out the possibility of bladder cancer?

WHAT evaluation can be used re bladder cancer to confirm the dx, determine location of the tumor, and aid in staging the tumor?

cystoscopy

what should cysto include re bladder tumor?

bladder washing for cytology and mucosal biopsy

what can be useful for determining the metastatic progress of bladder cancer?

abdominal or pelvic CT

bladder cancer stage? Tumors are confined to the mucosa

stage 0

bladder cancer stage? Tumors invade the lamina propria

stage I

bladder cancer stage? Tumors invade the muscular layer

stage II

bladder cancer stage? Tumors extend to the peripelvic fat or renal parenchyma

stage III

bladder cancer stage? Metastatic disease

stage IV

can urine marker tests detect recurrent bladder tumors?

yes

does bladder cancer often present with painless hematuria?

yes

treatment of bladder cancer depends on what?

type, size, and degree of invasion of the bladder tumor

what are the three treatment categories/extents of bladder cancer?

superficial, invasive, or metastatic

what two stages of bladder cancer are considered superficial?

stages 0 and I

which category of bladder tumor? Involve the bladder mucosa and submucosa

superficial

how are superficial bladder tumors treated?

endoscopic or laser resection

do superficial bladder tumors tend to recur?

yes

how often should you check a patient with recent superficial bladder tumor?

every 6 months

which category of bladder tumor? Involve the muscle and/or perivesical fat around the bladder

invasive tumors

what two bladder cancer stages are involved with invasive tumors?

stages II and III

how are invasive bladder tumors treated?

radical cystectomy or with radiation/chemo

which category of bladder tumor? Involve spread to the lymph nodes, bone, or other viscera

metastatic tumors

which stage of bladder tumors are in the metastatic class?

stage IV

how are metastatic bladder tumors treated?

radiation and/or chemotherapy

for most bladder tumors, WHAT is the treatment of choice?

surgical resection

should all pts w/ bladder cancer be referred to a urologist?

yes

why should a UA and cysto be done every 3-6 months with bladder cancer?

b/c of significant risk of recurrence

which stage bladder tumor (TNM)? Noninvasive papillary carcinoma; cancer has grown from urothelium toward hollow center of bladder but not into connective tissue or muscle of bladder wall; has not spread to lymph nodes or distant sites

stage 0

which stage bladder tumor TNM? Cancer hase grown into the layer of connective tissue under the urothelial lining, but has not reached the muscular layer of the bladder wall; has not spread to lymph nodes or distant sites

stage I

which stage bladder tumor TNM? Cancer has grown into the thick muscular layer of the bladder wall, but has not passed through the muscle to reach the fatty tissue surrounding the bladder; has not spread to lymph nodes or distant sites

stage II

which stage bladder tumor TNM? Cancer has grown into the fatty tissue around the bladder; may have spread to prostate, uterus, or vagina, but not growing into pelvic or abdominal wall; has not spread to lymph nodes or distant sites

stage III

which stage bladder tumor TNM? Cancer has grown through the bladder wall and into pelvic or abdominal wall; may have spread to nearby or distant lymph nodes or to sites such as the bones, liver, or lungs

stage IV

smoking cessation education w/ bladder cancer?

yes

condition? The inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance

erectile dysfunction

condition? Can also manifest as a lack of sexual desire or an inability to ejaculate

erectile dysfunction

most cases of ED are in males over what age?

40 years

is ED vastly underreported?

yes

which ED class? If patient fails to achieve a satisfactory erection in 2 out of 10 attempts

mild

ED class? If all attempts at satisfactory erection fail

severe

transient, limited episodes of impotence occur in about what portion of all adult males at some point in their lives?

one-half

does aging affect sexual functioning?

yes

more than what percentage of men by age 55 have ED?

33 per

do most cases of ED have an identifiable, physical cause?

yes

the rate of ED does WHAT as the rate of CV disease increases?

increases

can ED result from a failure to generate the nerve impulse required to initiate an erection?

yes

can ED be the result of failure to adequately fill the penile blood vessels?

yes (arteriogenic)

can ED result from failure to retain blood in the penis?

yes (veno-occlusive)

are meds a common cause of ED?

yes

are SSRIs known to cause ED?

yes

can testicular failure cause ED?

yes

can hyperprolactinemia cause ED?

yes

can phenothiazines cause ED?

yes

can thioridazine cause ED?

yes

can imipramine cause ED?

yes

can methyldopa cause ED?

yes

can guanethidine cause ED?

yes

can reserpine cause ED?

yes

can spironolactone cause ED?

yes

can alcohol cause ED?

yes

can heroin cause ED?

yes

can methadone cause ED?

yes

can estrogen cause ED?

yes

can betablockers cause ED?

yes

can thiazide diuretics cause ED?

yes

can antihypertensives cause ED?

yes

continual high blood flow into the vascular system of the penis is needed to maintain what?

erect state

can male sexual dysfunction manifest in many ways?

yes

it is essential in terms of ED to determine if patient has WHAT, particularly during sleep or early in the morning?

normal erections

if patient able to achieve erection normally at times, what is most likely NOT the cause of ED?

organic cause

what percentage of ED cases are caused by medications?

25 percent

should you perf genital exam in ED?

yes

testes less than what length should cue for hypogonadism?

4 cm

should you palpate the penile pulse when assessing for ED?

yes

should you perf a neuro exam when working up ED?

yes

should you do lab tests to r/o various causes of ED?

yes

should you r/o diabetes with ED?

yes

should you check TSH with ED?

yes

a testosterone level below what warrants a serum prolactin level?

< 300

what is the most useful specialized test with ED?

nocturnal penile tumescence and rigidity test

what test is useful to assess patient's physical ability to achieve erection?

nocturnal penile tumescence and rigidity test

when during sleep do males usually have erections?

during REM sleep

what kind of cause of ED is indicated if there is an absence or impairment of erection during sleep?

physiological cause

what two medical conditions cause ED in sexual situations but normal activity during NPTR?

pelvic steal syndrome and disruption of afferent nerves

condition? Involves partial blockage of iliac vessels

pelvic steal syndrome

condition? Produce an indurated area that may be identified by careful palpation along the penile urethra

urethral strictures

if organic causes of ED cannot be found, what will pts benefit from?

behavioral based sex therapy

can fluoxymesterone be used for ED?

yes

can methyltestosterone be used for ED?

yes

can transdermal testosterone be used for ED?

yes

can testosterone implantable pellets be used for ED?

yes

can sildenafil be used to treat ED?

yes

can vardenafil be used to treat ED?

yes

can tadalafil be used to treat ED?

yes

can avanafil be used to treat ED?

yes

can alprostadil be used to treat ED?

yes

what is the ED tx of choice for patients w/ documented testosterone deficiency and do not have prostate cancer, BPH, breast cancer, or CV disease?

testosterone therapy

should testosterone therapy be used in pts with HTN?

should testosterone therapy be used in patients with clotting disorders?

can testosterone therapy increase the severity of sleep apnea?

yes

can vacuum constriction devices be used for ED?

yes

how do vasoactive drugs work for ED?

decrease the breakdown of 5 c GMP

what is the intracellular second messenger of nitric oxide?

Cgmp

what is the primary vasodilator and NT involved in erectile response?

cgmp

what was the first c gmp drug?

sildenafil

what is the brand name for sildenafil?

viagra

what kind of drug is sildenafil?

an orally active cgmp-specific phosphodiesterase inhibitor

drug? Results in increased blood flow necessary for succesful penile erection

sildenafil

what is the standard dose of sildenafil?

50 mg by mouth at least 1 hours before sexual activity

what is a contraindication for sildenafil?

severe hypotension

do PDE5 inhibitors affect libido?

do PDE5 inihibitors initiate an erection without sexual stimulation?

have vasoactive prostaglandins been shown to be an effective treatment for ED?

yes

can penile prostheses be used to treat ED?

yes

can penile revascularization be used to treat ED?

yes

males younger than 45 years whose impotence is caused by severe pelvic trauma are the best candidates for what surgery?

penile revascularization surgery

can low-intensity shock wave therapy be used to treat ED?

yes

what is the primary role of education in patient with ED?

stress importance of management of chronic conditions

counseling should be done for psychogenic ED?

yes

condition? Inflammation of the epididymis

epididymitis

structure? Coiled structure connecting the sperm-producing rete testis to the vas deferens that allows for maturation of sperm

epididymitis

condition? Inflammation results in scotal pain, swelling, and induration of the posterior-lying epididymis w/ eventual scrotal wall edema and involvement of the adjacent testicle

epididymitis

can epididymitis have reactive hydrocele formation?

yes

condition? Concurrent involvement of ipsilateral testicle results in painful inflammatory epididymal-testicular complex

epididymo-orchitis

increased risk for epididymitis when patient has unprotected intercourse?

yes

risk for epidydmitis when there is hx of UTI w/ dysuria?

yes

risk for epididymitis when hx of urethral discharge?

yes

can epididymitis sx occur after heavy lifting or straining?

yes

what patient populations most commonly present with epididymitis?

younger sexually active or older males with Uti

does epididymitis occur often in prepubertal males?

rarely

epididymitis in a prepubertal male likely heralds what?

a structural abnormality in the GU tract

what are the causes of epididymitis in patients younger than 35 years?

STIs (chlamydia or gonorrhea)

chlamydia infection produces what kind of discharge?

serous

gonorrhea produces what kind of discharge?

purulent

causes of epidymitis in patients 35 years of age and older include what?

coliform bacteria

what is the most common bacterial cause of epididymitis over 35 years?

e coli

can pseudomonas aeruginosa cause epididymitis?

yes

can staph aureus cause epididymitis?

yes

epididymitis is often associate with WHAT in pts older than 35 years or w/ coliform infections in males engaging in insertive anal intercourse?

distal urinary tract obstruction

what type of epididymitis will present with sterile pyuria and nodularity of the vas deferens and pain?

tuberculous epididymytis

do UTI and prostatis predispose to development of epididymitis?

yes

can indwelling catheters cause epididymitis?

yes

can urinary instrumentation cause epididymitis?

yes

condition? Caused by STIs is transmitted through the urethra and may be accompanied by symptomatic or asymptomatic urethritis

epididymitis d/t STIs

what is the major complaint of patients with epididymitis?

scrotal pain

where does scrotal pain radiate with epididymitis?

along the spermatic cord or to the flank

do many patients with epididymitis have pain at the tip of the penis?

yes

frequency of urination, dysuria, cloudy urine, or hematuria with epididymitis?

yes

what will elevation of the testes and epididymis do with epididymitis?

relieve the discomfort

what patients with epididymitis may onnly have minimal pain despite severe infections or abscesses?

diabetes mellitus patients

fever and chills w/ epididymitis ocnly occur with what?

severe infection or abscess formation

scrotal swelling with epididymitis?

yes

scrotum wall will be WHAT with epididymitis?

thick and indurated

can reactive hydrocele occur with epididymitis?

yes

patients with the nonsexually transmitted epididymitis will have what urine finding?

pyuria

tender prostate with epididymitis?

yes

pyuria on UA with epididymitis?

yes

leukocytosis on UA with epididymitis?

yes

are n gonorrhoaea gram positive or gram negative?

gram negative

if no organisms are visible on the urethral smear with epididymitis, but WBCs are evident, what is the usual diagnosis?

nongonococcal urethritis (chlamydia)

what might CBC show w/ epididymitis?

increased WBCs with left shift

what test can confirm the diagnosis of epididymitis?

scrotal ultrasound

what is the initial treatment of epididymitis?

bedrest, scrotal elevation and ice packs, appropriate abx therapy

in pts younger than 35 yrs with sex transmitted epididymitis, what is treatment?

one time dose of ceftriaxone- 250 mg IM + doxycycline 100 mg BID x 10 days

if pt w/ epididymitis is allergic to cephalosporins or tetracyclines, what class of drug can be used?

fluoroquinolones

should sexual partner be tx with sex transmitted epididymitis?

yes

what is tx for pts with nonsex transmitted forms of epididymitis?

cipro 750 mg PO BID, ofloxacin 200 to 300 mg PO BID, or Bactrim SD BID for 2-3 weeks

should noninfectious epididymitis tx include NSAIDs, rest, and scrotal support?

yes

can infertility result from epididymitis?

yes

can recurrent epididymitis occur?

yes

can abscess formation occur w/ epididymitis?

yes

condition? Fulminant necrotizing fasciitis of the perineum and/or genitalia

fournier's gangrene

should activity be limited with epididymitis?

yes

should scrotal contents immobilize with epididymitis?

yes

can wearing an athletic supporter help with epididymitis?

yes

condition? Twisting or rotation of the testes, resulting in acute ischemia

testicular torsion

is testicular torsion a uro emergency?

yes

what range in degrees can happen with testicular torsion?

90 to 360 degrees about the spermatic cord

condition? A small vestigial remnant of the mullerian duct located on the anterosuperior portion of the testis twists about its base

appendiceal torsion

term? Testis that fails to descent into the scrotal sac

cryptorchid

what type of testis is most prone to torsion?

cryptorchid

can testicular torsion occur at any age?

yes

two-thirds of testicular torsion cases occur between what ages?

10 and 20 years

what age is the peak incidence of testicular torsion?

14 years

is testicular torsion common in older males?

torsion of the appendix testis is more common in children in what age range?

7 to 14 years

is testicular torsion usually an idiopathic and spontaneous occurrence?

yes

what percentage of test torsion cases have a hx of trauma?

20 percent

what portion of pts with test torsion have prior episodic testicular pain?

one-third

condition? One initiating factor appears to be contraction of the cremaster muscle

testicular torsion

what percentage of patients may have contraction of the cremaster muscle during sleep?

50 percent

can contraction of the cremaster muscle be stimulated by trauma, exercise, and sex stimulation?

yes

is test torsion more common in winter months?

yes

are paraplegics at high risk for test torsion?

yes

why are paraplegic patients at high risk for developing test torsion?

constant pressure while sitting

condition? Arterial inflow compromised, venous outflow obstructed leading to ischemia; exquisitely painful

testicular torsion

can test torsion lead to necrosis if not treated emergently?

yes

how fast can irreversible cellular damage occ w/ test torsion?

6 to 12 hours

what is the most common symptom of test torsion?

acute onset pain with swelling

pain onset with torsion of the appendix testis?

more gradual

what is the most common clinical sign of test torsion?

absence of the cremasteric reflex

condition? Testicle may be high in the scrotum, with a transfers, rather than longitudinal lie

testicular torsion

condition? Bell clapper deformity

testicular torsion

does elevation of testicles with torsion relieve pain?

term? Small lump palpable on superior pole of the testis, may appear blue if skin pulled tightly

blue dot sign

what causes the blue dot sign in test torsion?

infarction and necrosis of the appendix testis

how is test torsion diagnosed?

hx and presenting manifestations

for how long is doppler US reliable in test torsion?

first 12 hours

compression of the testicular vessels leads to ischemic necrosis of the testes within how long?

6 hours

failure to recognize the torsion and intervene immediately results in loss of the tesicle in what percent of cases?

80 percent

can manual reduction be used for test torsion in the ED?

yes

procedure? Gentle external rotation of the testis toward the thigh

manual reduction of the testis

within what timeframe should surgery be done for test torsion?

within 4 hours of sx to preserve testicle

testicular salvage is directly related to WHAT?

duration of torsion

what is the salvage rate for torsion less than 6 hours?

85 to 90 percent

the salvage rate becomes less than 10% if the torsion is greater than how long?

24 hours

WHAT occurs in 80 to 94% of pts and may be related to duration of testicular ischemic injury?

depressed spermatogenesis

what portion of testes salvaged may atrophy in the first 2 to 3 years post-torsion?

two thirds

condition? Collection of peritoneal fluid within the scrotum around the testes

hydrocele

condition? Fluid between the parietal and visceral layers of the tunica vaginals

hydrocele

structure? Two layered sac that surrounds the testis and spermatic cord

tunica vaginalis

condition? Forms when secretion of fluid into this potential space exceeds its reabsorption

hydrocele

condition? Collections may range from only a few mm of fluid to enormous volumes measured in liters

hydrocele

what is the incidence rate of hydroceles in adults males?

1 percent

most hydroceles occur in males over what age?

40 years

can nonspecific acute epididymitis cause hydrocele?

yes

can tuberculous epididymitis cause hydrocele?

yes

can trauma to the tests cause hydrocele?

yes

can tumor of the testes cause hydrocle?

yes

condition? Protrusion of the bladder through abdominal wall

exstrophy of bladder

can exstrophy of bladder increase risk for hydrocele formation?

yes

rapidly forming hydroceles may result from what?

reactive inflammatory processes

condition? May result from gradual fluid accumulation within the tunica vaginalis ni young males

chronic hydrocele

condition? Swelling in the scrotum or inguinal

hydrocele

condition? If size of the scrotum fluctuates

communicating hydrocele

are hydroceles usually painful?

heaviness of scrotum possible w/ hydrocele?

yes

where might hydrocele pain radiate?

lower back

what color might trapped fluid w/ hydrocele appear with transillumination?

light pink, yellow, or red

do the testes themselves transilluminate?

do hematomas transilluminate?

can you see swelling in the groin or upper scrotum with hydrocele?

yes

if a hydrocele cannot be confirmed, what kind of US should be done?

inguinoscrotal ultrasound

test? Can distinguish the presence or absence of bowel within the inguinal ring

inguinoscrotal ultrasound

condition? Inflamamtion or infection of the testes

orchitis

condition? An inflammatory process that can produce sx that mimic those of a hydrocele

epididymitis

condition? Mass of varicose veins in the spermatic cord within the scrotum

varicocele

no treatment of a hydrocele is required unless what?

complications are present

condition? An abnormal degree of venous dilation of the pampiniform plexus in the spermatic cord above the testes which can cause pain and engorgement of the testis

varicocele

what is the overall incidence rate for varicocele?

8 to 20 percent

what is the rate of varicocele in pts eval for infertility?

30 to 40 percent

what is the leading cause of varicoceles?

weakened vessel wall in the spermatic vein or excessive pressure

condition? A weakened vessel wall in the spermatic vein or excessive pressure in these vessels

varicocele

condition? Results from vascular engorgement of the internal spermatic vein

varicocele

where does a varicocele almost always appear?

on the left or bilaterally

why are varicoceles usually on the left or bilaterally?

left spermatic vein empties into the left renal vein

where does the left spermatic vein empty into?

left renal vein

where does the right spermatic vein empty?

inferior vena vaca

condition? Pt may present w/ pain and engorgement of testes

varicocele

the recognition of a varicocele is usually secondary to a problem with what?

fertility

condition? Often describes sensation of palpation scrotum as feeling like a bag of worms

varicocele

how might pt w/ varicocele sit?

upright position

how far up might engorged veins extend up with varicocele?

external inguinal ring

how can you increase venous dilation with varicocele?

valsalva maneuver in recumbent position

varicocele grade? Only palpable when patients performs valsalva

grade 1

varicocele grade? Palpable when patient is standing

grade 2

varicocele grade? May be assessed with light palpation and visual inspection

grade 3

how often are sperm count and motility decreased in pts with varicocele?

65 to 75 percent

is there evidence of a progressive decline in fertility in patients with varicoceles?

yes

can scrotal US help confirm dx of varicocele?

yes

in an older patient, can the development of a varicocele be a late sign of renal tumor?

yes

should you refer to surgeon with varicocele?

yes

condition? Surgical treatment involves ligation of the internal spermatic vein

varicocele

is infertility a complication of varicocele?

yes

is testicular atrophy a complication of varicocele?

yes

condition? Neoplasms may arise from any testicular or adnexal cell component

primary testicular neoplasms

tumors of the germ cells and the seminiferous tubules are the most common testicular WHATs?

carcinomas

testicular cancers comprise only WHAT percent of all neoplasms in males?

1 to 2 percent

testicular cancer is more/less common in African Americans?

less

in adult males, germ cell cancers comprise what percent of all testicular cancers?

90 to 95 percent

what is the peak onset age of testicular cancer?

between 20 and 40 years

what is the average age of testicular cancer dx?

33 years

what is the only undisputed risk factor for testicular cancer?

prior cryptorchidism

what percentage of testicular tumors are a/w prior cryptorchidism?

10 percent

is fam hx of testicular cancer an increased risk for testicular cancer?

yes

a primary testicular neoplasm may arise from any testicular WHAT?

adnexal cell component

what are the two divisions of testicular tumors?

germinal and nongerminal

what percentage of test cancers are germinal?

90 to 95 percent

except for spermatocytic seminomas, all germ cell tumors may be precented by what premalignant condition?

intratubular germ cell neoplasia of unclassified type (testicular carcinoma in situ)

term? Genetic mutations lead to gonadal dysfunction and subsequent malignancy over a large area of tissue

field defect

at least 1/2 of cases of untreated ITGCNU will progress to invasive malignant disease within how long?

5 years

where do test cancers predictably spread to?

retroperitoneal draining lymph nodes

patients with a hx of WHAT are recommended to have an empiric testicular bx between the ages of 18 and 20

cryptorchidism

condition? Pt presents w/ hard lump or nodule on the testis that is felt while forming a self exam

testicular cancer

how does test cancer generally present?

painless enlargement of the testis

condition? A scrotal nodule or swelling detected

testicular cancer

describe the mass with test cancer?

firm, nontender mass

condition? Firm, nontender mass within tunica albuginea palpable and distinct from sperm cord structures

testicular cancer

acute/chronic epididymitis may result in delay of test cancer dx in what percent of cases?

10 percent

what sx may be present in 5% of patients w/ testicular malignancies?

gynecomastia

can hydroceles dev secondary to testicular cancer?

yes

as many as what percent of patients with test cancer will be asymptomatic?

10 percent

what percentage of test cancer patients will present with signs of mets?

10 percent

when are biomarkers useful re test cancer?

following disease progression or remission after treatment

what are the two biomarkers used re test cancer?

alpha-fetoprotein and human chorionic gonadotropin

can heavy marijuana smoking elevate AFP?

yes

levels of hcg with test cancer are elevated by all WHATs?

choriocarcinomas

test? Useful diagnostic tool for testicular cancer because mass can usually be seen clearly originating within the testes

scrotal ultrasound

how can a definitive diagnosis of testicular cancer be made?

transinguinal scrotal exploration and biopsy

what is the main princple of mgmt for test cancer?

radical orchiectomy

what is the MAJOR diagnostic tool for test cancer?

radical orchiectomy

is test cancer highly treatable?

yes

does test cancer tx leave high chance of infertility?

yes

nonseminoma germ cell stage? Lesion confined to testis

stage A

nonseminoma germ cell stage? Regional lymph node involvement in retroperitoneum

stage B

nonseminoma germ cell stage? Distant metastasis

stage C

seminoma stage? Lesion confined to testis

stage I

seminoma stage? Spread to retroperitoneal lymph nodes

stage II

seminoma stage? Supradiaphragmatic nodal or visceral involvement

stage III

what Is extremely important for patients with test cancer?

follow up

condition? Characterized by a progressive loss of functional nephrons, eventually leading to ESRD

chronic kidney disease

when do s/s renal failure appear?

as functional reserve of kidneys is lost

CKD most often develops as a complication of what?

chronic systemic disease

what is the timeframe for development of CKD?

months to years

men are how much more likely than women to have ESRD?

1.3 to 1.4 x

what is the peak age of onset of ESRD?

65 and 75 years

african americans are how much more likely to have esrd?

3.9 x

can renal disease be d/t many age-related illness?

yes

what % of ESRD cases are caused by DM and primary HTN?

70 percent

can NSAID overuse cause CKD?

yes

can cigarette smoking increase r/f CKD?

yes

can collagen vascular diseases increase r/f CKD?

yes

can AIDS-related nephropathies increase r/f CKD?

yes

can cirrhosis increase risk for CKD?

yes

can congenital diseases increase r/f CKD?

yes

hypertension is present in at least WHAT percent of CKD patients?

85 percent

hypertensive and diabetes related CKD are forms of what?

microvascular end-organ damage

the patho of renal failure depends on what?

the underlying cause

what are the three most common causes of CKD?

diabetic nephropathy, hypertensive nephropathy, and Gn

what is the most common cause of ESRD?

diabetic nephropathy

are glomerular hyperfiltration and hypertension implicated in DM/ESRD?

yes

ultimately, it is WHAT that mediates progressive nephronal destruction with DM?

glomerular hypertension

what is the second most common cause of renal failure?

hypertensive nephropathy

renal tubular changes corrlate with the degree of reduction in WHAT?

renal blood flow

condition? Occurs when the renal artery and its branches become thickened, stiff, and narrow due to atheromatous plaques or fibromuscular dysplasia

renal artery stenosis

what is the 3rd most common cause of renal failure?

glomerulonephritis

what percentage of ESRD cases is due to GN?

25 to 30 percent

condition? An inflammatory process that primarily affects the glomerular capillaries

glomerulonephritis

what are the two main categories of glomerular injury?

nephritis and nephrosis

condition? Characterized by glomerular inflammation and/or necrosis

nephritis

condition? Characterized by abnormal permeability of the glomerular membrane

nephrosis

what is the hallmark of nephrosis?

increased permeability of the glomerular capillary wall to macromolecules, including serum proteins

sx of CKD generally do not appear until renal function (as measured by GFR) declines to WHAT percent of normal?

10 to 15 percent

at WHAT percent of normal GFR, biochemical evidence of renal failure may be apparent?

30 to 40 percent

is anorexia an early prominent symptom in renal failure?

yes

is lassitude an early prominent symptom in renal failure?

yes

is fatigability an early prominent symptom in renal failure?

yes

is weakness an early prominent symptom in renal failure?

yes

condition? Caused by the inability of the kidneys to perform their normal excretory, metabolic, and endocrine functions

uremia

pruritis and dry skin with CKD?

yes

nausea, vomiting, hiccups with CKD?

yes

emotional lability or depression with CKD?

yes

insomnia, fatigue (esp on exertion), confusion, headache, seizures, and coma with CKD?

yes

characteristic uremic frost with CKD?

yes

hyperpigmentation of skin with CKD?

yes

condition? Hand-flapping on hyperextension of the wrists with complete forward extension of the upper extremities

asterixis

can peripheral neuropathy happen with CKD?

yes

can AMS happen with CKD?

yes

what causes peripheral edema and ascites with CKD?

proteinuria and resulting hypoalbuminemia

elevated BP with CKD?

yes

should you do biochemical monitoring if a patient is predisposed for CKD?

yes

what constitutes biochemical monitoring with CKD?

BUN, creatinine, and creatinine clearance

what lab can track the progression of CKD?

serum creatinine

how high can gfr be in healthy adults?

up to 130 ml/min

what is the gfr normally well above?

90 ml/min

accurate measurement of GFR is based on experimental calculations of what?

renal inulin clearance

substance? A polymer of fructose secreted from the blood exclusively via renal glomeruli w/ no tubular reabsorption

inulin

what formula can be used to estimate gfr in ml/min?

cockcroft-gault formula for creatinine clearance

what is a far more informative diagnostic tool as a measure of renal function?

creatinine clearance

what two things are often used to stratify CKD patients by disease severity?

GFR and proteinuria

CKD stage? Persistent albuminuria w/ normal GFR > 90 ml/min

stage 1

CKD stage? Albuminuria w/ a GFR between 60-90 ml/min

stage 2

CKD stage? A GFR between 30 and 59 ml/min

stage 3

CKD stage? A GFR between 15 and 29 ml/min

stage 4

CKD stage? ESRD, a GFR < 15 ml/min

stage 5

why would a patient w/ CKD have anemia?

erythropoietin deficiency

monitoring what test can detect increasing proteinuria?

urinalysis

what kind of anemia can be seen in CKD?

normocytic and normochromic anemia

what happens to HCT in CKD?

decreased

what happens to bleeding time in CKD?

increased

capillary fragility in CKD?

yes

thombocytopenia in CKD?

yes

what happens to immune responsiveness in CKD?

decreased

what happens to vitamin D in CKD?

decreased

what happens to ammonia in CKD?

increased

what happens to BUN in CKD?

increased

what happens to creatinine in CKD?

increased

what happens to uric acid in CKD?

increased

what happens to potassium in CKD?

increased

what happens to phosphate in CKD?

increased

what happens to parathyroid hormone in CKD?

increased

what happens to glucose levels in CKD?

increased

insulin resistance in CKD?

yes

hyperlipidemia in CKD?

yes

what lipids are esp elevated in CKD?

triglycerides

the greater the proteinuria in CKD, the more WHAT the progression of CKD?

rapid

coarse granular casts in CKD?

yes

proteinuria in CKD?

yes

what test is performed at baseline when impaired renal function is first noted?

renal ultrasound

what is the goal of ddx of CKD?

identify underlying cause of renal failure

management of what? 1) determine and control underlying cause; 2) monitor changes in renal function; 3) conservative tx of physio effects of CKD; 4) more aggressive treatment as appropriate

CKD

in ckd, must strictly control what in diabetic patients?

glucose levels and hypertension

what is the target a1c in diabetic CKD patients?

< 7%

what is the target BP for any patient with proteuria of more than 1 gram per day?

125/75

what is the goal BP for a pt with proteinuria < 1 g/day?

no more than 130/80

given the importance of maintaining renal perfusion, systolic BPs lower than what should be avoided?

110

what classes of meds should be used for BP control in patients with DM (renoprotective effects)?

ACE Is or ARBS

what two classes of meds have renoprotective effects?

ACE Is and ARBS

what should be added if monotherapy of ACE or ARB is insuffiencient?

diuretic

what two drugs are the last two additions in CKD for BP control?

CCB or beta blocker

what is definitive treatment for renal artery stenosis?

angioplasty or surgical repair to stent or reconstruct the stenotic vessels

which CKD stage? Decreased renal reserve

stage 1

which CKD stage? Kidney damage

stage 2

which CKD stage? Renal insufficiency

stage 3

which CKD stage? Severe renal insufficiency

stage 4

which CKD stage? End-stage kidney disease or kidney failure

stage 5

GFR stage 1 ckd?

> 90 ml/min

GFR stage 2?

60 to 89 ml/min

GFR stage 3a?

45- 59 ml/min

GFR stage 3b?

30-44 ml/min

GFR stage 4?

15 to 29 ml/min

GFR stage 5?

< 15 ml/min

CKD stage? Asymptomatic, mild HTN

stage 1

CKD stage? Mild HTN, increased PTH, early bone disease, increased BUN and creatinine

stage 2

CKD stage? Hypertension; anemia d/t decreased erythropoietin, increased BUN/creatinine, risk for CV events

stage 3

CKD stage? Moderate htn, anemia, hyperphosphatemia, increased trigs, metabolic acidosis, hyperkalemia, water/salt retention, increased BUN/creatinine

stage 4

CKD stage? Severe hypertension, anemia, hyperphosphatemia, uremia

stage 5

what is a cornerstone of conservative management of CKD?

dietary therapy

what is the goal serum sodium concentration with CKD?

135-145

should you restrict fluid intake and sodium intake in CKD?

yes

what is the restricted goal of sodium intake w/ CKD?

2 grams per day

what is the fluid restricted goal of fluid intake per day?

2 L per day

what is the protein intake rec for CKD?

0.6 to 0.8 g/kg/day

what is the rec'd caloric intake for CKD?

40 to 50 cal/kg/day

is malnutrition a common complication of CKD?

yes

what are the most effectively utilized source of nitrogen in ckd?

foods rich in essential amino acids

what is the dietary phosphate restriction in ckd?

800 mg/day

what med may be used as a potassium-binder for hyperkalemia in CKD?

kayexalate

what is the kayexalate dosing?

5 mg 1-3x/day with meals

type of ckd drug? Calcium carbonate

oral phosphate binder

type of ckd drug? Calcium acetate

oral phosphate binder

type of ckd drug? Sevelamer

oral phosphate binder

are oral phosphate binders taken w/ meals?

yes

when do you start oral phosphate binders w/ ckd?

gfr < 30 ml/min

what drug is used when CKD is complicated by iatrogenic hypercalcemia?

sevelamer

why should aluminum and magnesium containing salts be avoided in ckd?

cumulative toxicity

what drug should be taken in ckd due to reduced ability to synthesize activated vitamin D in CKD and propensity for subsequent hypocalcemia and renal osteodystrophy?

calcitriol 0.25 mg daily

should ckd use renal specific multivitamin?

yes

what are the first class of diuretics to be tried in ckd?

thiazide diruretics

thiazide diuretics in ckd have an additive effect when used with what?

a loop diuretic

should potassium-sparing diuretics be given in ckd?

why should potassium-sparing diuretics be avoided in ckd?

kidneys' reduced ability to excrete potassium

how should ckd anemia be treated?

erythropoietin

what is the usual dosing of EPO in ckd?

10,000 units per week

what should be taken by ckd patients with iron-deficiency anemia?

ferrous sulfate 325 mg by mouth 1-3 x daily with meals

is CKD a coronary artery disease risk equivalent?

yes

should patients w/ high cholesterol and ckd be treated with a statin?

yes

what is the LDL goal in CKD?

< 100

hypovolemia and renal toxic drugs can do what to CKD?

exacerbate

how should metabolic acidosis be treated in CKD?

sodium bicarbonate 600 mg twice daily

what should you titrate serum bicarb level to?

16 to 20

what ckd gfr indicates more aggressive therapy?

< 10 ml/min

a serum creatinine level nearing what in ckd requires more aggressive therapy?

a bun greater than what in CKD require more aggressive therapy?

100

term? Subjective experience of pain or burning sensation on urination

dysuria

term? Slow, painful urination

strangury

dysuria is most commonly a/w what?

lower UTI

can SSRIs cause dysuria?

yes

can citalopram cause dysuria?

yes

can escitalopram cause dysuria?

yes

can paroxetine cause dysuria?

yes

can fluoxetine cause dysuria?

yes

can opiates cause dysuria?

yes

can scopolamine cause dysuria?

yes

dysuria is most often associated with problems of what structure?

bladder

when caused by bladder problems, WHAT usually occurs secondary to diminished bladder capacity or w/ pain when the bladder becomes distended?

urinary frequency

can urinary frequency be a manifestation of urinary incontinence?

yes

in males, dysuria frequently reflects WHAT?

an infection

what is the easiest, least invasive, and most economical way to ID UTIs and other renal problems?

urinalysis

term? Blood in the urine

hematuria

term? Visible blood in the urine

gross hematuria

term? Microscopic blood in the urine

occult

why should positive dipstick results be confirmed with microscopic exm?

b/c of false-positive dipstick test result

term? On micro exam, char by more than 3 rbcs per hpf

hematuria

what is the normal urinary excretion of RBCs?

2,000,000 cells per day

urine will appear what color with between 20 and 30 rbcs/hpf?

pink

at what # rbcs does urine become red?

100 rbcs per hpb

there is a direct relationship between the quantity of blood found in the urine and the likelihood of WHAT?

pathology

these cause what urine appearance? DI, diuretics, fluid overload

colorless

what urine color? Hematuria, malignancy, stones, acidic urine

dark

urine color? UTI, hematuria, bilirubin, mucus

cloudy

urine color? Hematuria, hemoglobin, myoglobin, beets, rhubarb, senna, food coloring

pink/red

urine color? Pyridium, bile pigments

orange/yellow

urine color? Rifampin

red/orange

urine color? Myoglobinuria, hemoglobinuria, bile pigments, melanin, cascara, iron preps

reddish-brown/brown/black

urine color? Bile pigments, methylene blue, propofol, amitriptyline, indigo carmine

green

urine color? Proteinuria, bile salts

foamy

inc/dec spec gravity? Dehydration, congestive heart failure, adrenal insuff, DM, nephrosis, increased ADH

increased

inc/dec spec gravity? DI, pyelonephritis, glomerulonephritis, excess fluid intake

decreased

acidic or alkaline ph? Diet, meds, acidosis, ketoacidosis, COPD

acidic

acidic or alkaline ph? Diet, sodium bicarbonate, vomiting, metabolic alkalosis, UTI

alkaline

positive bilirubin with jaundice and hepatitis?

yes

positive blood with kidney stones, tumors, kidney disease, trauma, infection, injury from instrumentation, coag problems, menses?

yes

glucose in urine with DM, pancreatitis, cushing's disease, shock, burns, corticosteroids, renal disease, hyperthyroidism, cancer

yes

positive ketones with starvation, dieting, ketoacidosis, vomiting, diarrhea, pregnancy?

yes

are nitrates positive in urine with infection?

yes

positive urine protein with nephrotic syndrome?

yes

positive leukocyte esterase with infection (urine)?

yes

positive reducing substance in urine signifes presence of what?

glucose, fructose, galactose, lactose, or pentose

which hematuria occurs on a single occasion?

transient hematuria

which hematuria occurs on two or more consecutive voidings?

persistent hematuria

can both transient and persistent hematuria be a sign of serious underlying disease?

yes

pus in the urine indicates what?

bacterial infection somewhere along urinary tract

even transiet hematuria in males over 50 years may be an indication of what?

serious disease

there is a greater positive correlation b/w underlying malignancy and WHAT hematuria, especiall in pts w/ hx of cig smoking?

gross hematuria

of males older than 50 years, what percentage w/ hematuria have urinary tract malignancies? Typ transitional cell carcinoma

2.4 percent

in males over 60 years, the incidence of urinary tract malignancy increases to what percent?

9 percent

in older males with gross hematuria, the rate of associated malignancy is as high as what percent?

20 percent

the causes of hematuria are grouped according to what?

anatomical site of the blood source

which hematuria? May be due to bleeding anywhere from the renal pelvis to the urethra, but is rarely caused by a systemic disease

isolated hematuria

RBC casts in urine usually indicate inury to what?

nephron

are RBC casts diagnostic of hematuria of renal origin?

yes

intact uniform RBCs w/ no casts suggest hematuria originating where?

lower urinary tract

presence of bacteria in the urine is diagnostic of what origin?

infectious

acute cystitis and urethritis produce what kind of hematuria?

gross hematuria

the presence of both proteinuria and hematuria is suggestive of what?

glomerular or interstitial nephritis

why is a drug history important with hematuria?

many drugs can cause hematuria

condition? Can result in destruction of nephrons and subsequently lead to impaired renal function and hematuria

nephritis

is menstrual hx important in female w/ hematuria?

yes

suprapubic tenderness is suggestive of what etiology?

bladder

hematuria accompanied by colicky flank pain suggests what?

ureteral stone

what is the most important diagnostic tool in cases of hematuria?

urinarlysis

what test should be done on all patients with hematuria?

urine culture and sensitivity

dysmorphic RBCs on UA may indicate what?

glomerular disease

condition? Primary proteins found in urine

proteinuria

what are the primary proteins found in urine?

globulin and albumin

proteinuria is usually indicative of what kind of pathology?

renal

can proteinuria be functional as a result of acute illness, emotional stress, or excessive exercise?

yes

can proteinuria reflect serious disease?

yes

abnormalities in the glomerular basement membrane produce what?

glomerular proteinuria

condition? Proteinuria characterized by free monoclonal light chain components of immunoglobulin proteins

bence jonces proteinuria

can bence jones proteinuria be a/w lymphosarcoma, hodgkins, and leukemia?

yes

is intermittent proteinuria most often symptomatic?

does urine dipstick detect bence jones proteins?

a 24 hour urine with more than how much protein is considered abnormal?

> 150 mg protein

a 24 hour urine collection w/ more than how much protein indicates a nephrotic process?

> 3.5 g

a urine albumin to urine creatinine ratio of less than what is considered normal?

< 0.2

condition? Nodular hyperplasia of the prostate

benign prostatic hyperplasia

condition? One of the most common conditions affecting men older than age 40 years

benign prostatic hyperplasia

what is the prevalence of BPH in men by age 40?

8 to 20 percent

what is the prevalence of BPH in men by age 80 and above?

70 to 90 percent

at what prostate size does BPH occur?

greater than 30 ml

what is the decreased urinary flow rate with BPH?

less than 15 ml per second

what is the signficant post void residual bladder volume with BPH?

greater than 50 ml

what does AUASI stand for?

american urologic association symptom index

what AUASI score is mild BPH sx?

0 to 7

what AUASI score is moderate BPH sx?

8 to 19

what AUASI score is severe BPH sx?

20 or greater

is an increased AUASI score diagnostic of BPH?

what does an increased AUASI score mean for me?

need to gather a detailed HPI of urinary symptoms

is nocturia an irritative symptom of BPH?

yes

is urinary frequency an irritative sx of BPH?

yes

is urgency an irritative sx of BPH?

yes

is dysuria an irritative sx of BPH?

yes

is urge incontinence an irritative sx of BPH?

yes

what happens to force of urinary stream with BPH?

decreased

hesitancy with BPH?

yes

post-void dribbling with BPH?

yes

sensation of incomplete bladder emptying with BPH?

yes

overflow incontinence with BPH?

yes

inability to voluntarily stop the urinary stream with BPH?

yes

urinary retention with BPH?

yes

double voiding with BPH?

yes

straining with BPH?

yes

what is double voiding?

voiding a second time within 2 hours

what is the purpose with DRE with BPH?

to determine enlargement of the prostate gland

what size is enlarged with prostate on DRE?

walnut size

gross hematuria in men > 60 years with BPH?

yes

weak stream in BPH?

yes

what constitutes bladder distention with BPH?

> 150 ml

what constitutes increased PVR with BPH?

> 100 ml

why do a UA with BPH?

to exclude infection and hematuria

is serum creatinine recommended for eval of BPH?

why is urinary PH increased with BPH?

chronic increased residual

why would you do a sleep study with BPH eval?

to rule out OSA and nocturnal polyuria

what is the most important differential dx to r/o before diagnosing BPH?

prostate cancer

what is the PSA usually with BPH?

< 10 ng/ml

why are urine cultures sometimes positive for bacteria in BPH?

because of chronic residual volume

when should urine cytology be done with BPH?

especially with hematuria

what can urine cytology rule out with BPH?

carcinoma

what part of the prostate does cancer have a propensity for?

posterior and apical zone

why can you palpate many cases of prostate cancer through the rectal wall?

cancer's propensity for the gland's posterior and apical peripheral zone

what should you suspect if prostate is nodular and unusually firm?

prostate cancer

what is the intervention for mild to moderate BPH sx?

watchful waiting

what should be avoided re oral intake with BPH?

caffeine, alcohol, highly seasoned foods

when should BPH medication be initiated?

moderate symptoms

when should you start more rigorous treatment for BPH?

high AUASI symptom score, urinary retention, complications of BPH

when would a BPH patient require inpatient management?

dehydration and electolyte imbalances due to signficant urinary obstruction

when should lifestyle changes be started with BPH re AUA score?

over 7

is caffeine a bladder irritant?

yes

is alcohol a bladder irritant?

yes

are highly seasoned foods bladder irritants?

yes

what should be ruled out before starting BPH medications?

prostate cancer

what do selective alpha1-adrenergic agonists do re BPH?

relax bladder neck

class? Prazosin

selective alpha1-adrenergic agonist

class? Terazosin

selective alpha1-adrenergic agonist

class? Doxazosin

selective alpha1-adrenergic agonist

class? Silodosin

selective alpha1-adrenergic agonist

what is the dosing for prazosin?

1 to 5 mg BID

what is the dosing for terazosin?

1 to 10 mg daily

what is the dosing for doxazosin?

1 to 8 mg daily

what is the dosing for silodosin?

4 to 8 mg daily

titration with silodosin?

titration with prazosin?

yes

titration with terazosin?

yes

titration with doxazosin?

yes

class? Tamsulosin

subtype alpha1a-adrenergic blockers

class? Alfuzosin

subtype alpha1a-adrenergic blockers

titration with tamsulosin?

titration with alfuzosin?

tamsulosin dosing?

0.4 or 0.8 mg daily

alfuzosin dosing?

10 to 15 mg daily immediately after the same meal each day

does finasteride reduce prostate size?

yes

does dutasteride reduce prostate size?

yes

class? Finasteride

5 alpha reductase inhibitor

class? Dutasteride

5 alpha reductase inhibitor

how long do 5 alpha reductase inhibitors take to reduce prostate size?

6 months

what three classes of OTC drugs can cause acute urinary retention?

alpha agonists, anticholinergic agents, antihistamines

is coffee a bladder irritant?

yes

how often should BPH patients void to reduce possibility of UTI?

every 2 hours

how often should BPH patients be seen for follow up?

every 1 to 6 months

does the ACS recommend routine PSA screening in BPH patients?

how long does acute bacterial prostatitis occur?

less than 2 months

how long does chronic bacterial prostitis last?

more than 3 months

what is the most common type of prostatitis?

chronic nonbacterial prostatitis

condition? Acute inflammation condition of the prostate usually associated with systemic symptoms like fever, malaise, chills

acute bacterial prostatitis

might patient have UTI sx with acute bacterial prostatitis?

yes

abdominal pain with prostatitis?

yes

rectal pain with prostatitis?

yes

ejaculatory pain with prostatitis?

yes

what is the etiology of prostatitis?

translocation of bacteria up the urethra and the reflux of infected urine in the prostate

condition? Caused by the translocation of bacteria up the urethra and the reflux of infected urine in the prostate

prostatitis

acute prostatitis is most common in what patient population?

sexually active men between ages 30 and 50 years

in what age group is chronic bacterial prostatitis more common?

older than 50 years

can athletes who run long distances and have vigorous exercise regimens be predisposed to prostatitis?

yes

what age is a risk factor for prostatitis?

older than 50 years

is history of prostatic calculi a risk factor for prostatitis?

yes

is history of a previously diagnosed UTI a risk factor for prostatitis?

yes

chronic prostatitis is associated with a history of recurrent WHAT, presumably due to repeated seeding of the urinary tract by the infected prostate

UTI

is acute bacterial prostatitis associated with UTI?

yes

onset speed of acute bacterial prostatitis?

abrupt

acute bacterial prostatitis- treat empirically for WHAT until culture results?

gram-negative organisms

what two conditions are both caused by an infection that originates from the ascending urethral flexion or from the reflux of urine into the prostatic ducts?

acute and chronic bacterial prostatitis

what type/category of organism is most commonly involved in prostatitis?

aerobic, gram negative bacteria

klebsiella with prostatitis?

yes

pseudomonas with prostatitis?

yes

enterobacter with prostatitis?

yes

e coli with prostatitis?

yes

proteus mirabilis with prostatitis?

yes

n gonorrhea with prostatitis?

yes

what are the two most common gram positive bacteria w/ prostatitis?

strep faecalis and s aureus

gram negative e coli are responsible for what percentage of chronic bacterial prostatitis cases?

75 to 80 percent

with what condition might you see tenesmus?

prostatitis

condition? A spasmodic contraction of the anal sphincter

tenesmus

term? Persistent desire to empty the bowel or bladder accompanied by involuntary, ineffective straining efforts

tenesmus

weak urine stream with prostatitis?

yes

incomplete bladder emptying with prostatitis?

yes

terminal dribbling with prostatitis?

yes

what kind of symptoms are common in both chronic bacterial prostatitis and prostatodynia?

irritative symptoms

do patients with prostatodynia typically have a history of recurrent UTI?

yes

are obstructive symptoms common with acute bacterial prostatitis?

yes

are obstructive symptoms common with prostatodynia?

yes

are patients with prostatitis usually willing to have DRE?

describe the prostate with acute prostatitis?

warm, very tender, boggy

describe the prostate with chronic prostatitis?

painful and tender, NOT swollen or boggy

what condition can happen due to vigorous manipulation of the prostate?

septicemia

what will a CBC show with acute bacterial prostatitis?

leukocytosis and a left shift

what will a UA show with acute bacterial prostatitis?

bacteriuria, pyuria, possibly hematuria

what must you culture to confirm a diagnosis of chronic bacterial prostatitis?

expressed prostatic secretions

type of prostatitis? Urine sample will show presence of WBCs, but urine culture will be negative

nonbacterial prostatitis

what is the diagnostic test to eval for prostatic malignancy or abscess?

transrectal ultrasonography (TRUS)

is cystitis a differential diagnosis for prostatitis?

yes

is urethritis a differential diagnosis for prostatitis?

yes

is pyelonephritis a differential diagnosis for prostatitis?

yes

is epididymitis a differential diagnosis for prostatitis?

yes

is prostatic abscess a differential diagnosis for prostatitis?

yes

is malignancy a differential diagnosis for prostatitis?

yes

is obstructive calculi a differential diagnosis for prostatitis?

yes

is acute urinary retention a differential diagnosis for prostatitis?

yes

is STI a differential diagnosis for prostatitis?

yes

the manifestations of acute prostatitis can mimic those of what GI condition?

acute diverticulitis

in what setting shold you manage prostatitis in the absence of a fever?

outpatient

when might hospitalization for prostatitis be considered?

suspected urosepsis, abscess, or immunocompromise

should patients with acute bacterial prostatitis stay extremely well hydrated?

yes

what is the legnth of the antibiotic course for acute prostatitis?

5 days

what is the levaquin dosing for acute bacterial prostatitis?

500 to 700 mg daily

what is the cipro dosin for acute bacterial prostatitis?

500 mg PO q 12 hours

can trimetoprim and sulfamethoxazole be used for acute bacterial prostatitis?

yes

for how long can prostatitis treatment be extended if patient with prostatitis remains symptomatic?

an additional 2 weeks

what drug has the best cure rate for chronic bacterial prostatitis?

levofloxacin

what is the eradication rate of levofloxacin for chronic bacterial prostatitis?

75 percent

can ofloxacin be effective for chronic bacterial prostatitis?

yes

can moxifloxacin be effective for chronic bacterial prostatitis?

yes

can TMPSMX be effective for chronic bacterial prostatitis?

yes

can azithromycin be effective for chronic bacterial prostatitis?

yes

can fosfomycin be effective for chronic bacterial prostatitis?

yes

when should fluoroquinolones be used for acute bacterial prostatitis?

only if no other effective antibiotic choices

how long do you treat patients with chronic bacterial prostatitis with ABX?

4 to 6 weeks

for how long can you extend chronic bacterial prostatitis antibiotic treatment?

additional 4 to 6 weeks if first course results in only a partial symptomatic response

can nonbacterial prostatitis be an occult infection?

yes

when do you use antibiotics re nonbacterial prostatitis?

only with inflammatory prostatic secretions

can you use erythromycin 250 mg QID with nonbacterial prostatitis?

yes

can you use TMP SMX 1 tab QD for nonbacterial prostatitis?

yes

can you use nitrofurantoin 100 mg daily with nonbacterial prostatitis?

yes

prostatitis patient with hematuria or significantly elevated PSA should what?

receive prompt urology referral

when should patients with acute/chronic bacterial prostatitis receive a follow up UA and culture?

30 days after beginning treatment

what is the most common cancer found in American men?

prostate cancer

what ethnicity is at highest risk for prostate cancer?

african american

are men w/ family hx of prostate cancer at higher risk?

yes

what kind of fat is implicated in prostate cancer risk?

animal fat

a high fat diet is a/w what cancer?

prostate cancer

in what two continents is prostate cancer highest?

north america and europe

what type of cancer ranks second in number of cancer deaths?

prostate cancer

before what age is prostate cancer rare?

before age 40 years

what is the average age of prostate cancer diagnosis?

66 years

what percentage of men are diagnosed with prostate cancer ate 66 yrs or older?

60 percent

approximately what percentage of males over 80 years have prostate cancer?

67 percent

is there genetic susceptibility for prostate cancer?

yes

are there occupational and environmental risk factors for prostate cancer?

yes

what element is associated with prostate cancer?

cadmium

is smoking an important risk factor for prostate cancer?

yes

what happens to prostate cancer risk relative to # of cigarettes smoked?

increases

does increased testosterone level increase prostate cancer risk?

yes

is prostate cancer usually symptomatic?

is prostate cancer usually asymptomatic?

yes

can PSA be normal with prostate cancer?

yes

a PSA over what is seen usually with prostate cancer?

what range of PSA will usually receive a biopsy?

4 to 9.9

PSA over what generally necessitates a biopsy?

over 10

should you pay attention to PSA fluctuations even within a normal range from year to year?

yes

nocturia- early or late sign of prostate cancer?

earlier

normal or abnormal? Prostate boggy, rubbery, soft, symmetric, with smooth groove down the middle

normal

normal or abnormal? Palpable prostate nodules, hardened and asymmetrical, induration

abnormal

can urinary sx happen with prostate cancer?

yes

can UTI happen with prostate cancer?

yes

is weight loss a late sign of prostate cancer?

yes

what sodium level defines hyponatremia?

< 135

what sodium level defines hypernatremia?

> 145

what potassium level defines hypokalemia?

< 3.5

what potassium level defines hyperkalemia?

> 5

condition? Present when urine production during 8 hours of sleep is > 33% of 24-hour urine production

noctural polyuria

WHAT abnormalities are common among older adults as a consequence of age-related functional changes in the kidney in addition to multiple comorbidities and polypharmacy?

fluid and electrolyte abnormalities

age-related changes in water and sodium metabolism make older adults more vulnerable to what kind of disorders?

sodium disorders

do older adults have an impaired ability to excrete water and dilute urine?

yes

what happens to the # of functioning nephrons with age?

decreased

what happens to renal blood flow with age?

decreased

in older adults with impaired cardiac, renal, or hepatic function, WHAT is a common etiology of hyponatremia?

excessive water retention

excessive water retention causes what kind of hyponatremia?

hypervolemic

what happens as a result of increased antidiuretic hormone secretion?

water retention

salt depletion with or without loss of extracellular fluid can cause what kind of hyponatremia?

hypovolemic hyponatremia

what kind of hyponatremia is caused by vomiting, diarrhea, or laxative abuse?

hypovolemic hyponatremia

can restricted sodium intake cause hypovolemia hyponatremia?

yes

what kind of hyponatremia is caused by SIADH?

euvolemic hyponatremia

the primary sx of sodium disorders are WHAT?

neurologic

anorexia, nausea, vomiting, headache with hyponatremia?

yes

weakness, loss of coordination, muscle cramps with hyponatremia?

yes

a urine sodium of WHAT suggests SIADH?

> 40

electrolyte imabalance? Older adults have a decreased ability to concentrate urine and a reduced sensation of thirst

hypernatremia

condition? Serum sodium > 145

hypernatremia

is hypernatremia associated with high mortality?

yes

WHAT electrolyte imbalance usually results from the excessive loss of body water relative to the loss of sodium?

hypernatremia

condition? A syndrome characterized by hypotonic polyuria from either inadequate ADH secretion or inadequate renal response to ADH

diabetes inspidus

confusion, restlessness, hyperreflexia, progressive obtundation, and coma possible with hypernatremia?

yes

what is the main goal of hypernatremia treatment?

admin dilute fluids to replace the water deficit and to limit further water loss

electrolyte imabalance? Usually a result of depletion of serum potassium form extrarenal losses, intrarenal losses, or iatrogenic causes

hypokalemia

where do extrarenal losses of potassium occur?

GI tract

what electrolyte imbalance can happen with chronic diarrhea?

hypokalemia

intrarenal losses of potassium occur as a result of what?

conditions that directly affect the kidney

what is the most common cause of hypokalemia in older adults?

medications

what does treatment of hypokalemia involve?

replacement of potassium

electrolyte imbalance? The result of underlying physiologic and pathophysiologic changes that commonly occur in older adults that predispose to elevated potassium levels

hyperkalemia

what is the primary cause of hyperkalemia in older adults?

medications

weakness, ascending paralysis, respiratory failure, muscle cramping w/ hyperkalemia?

yes

peaked t waves with hyperkalemia?

yes

flattened p waves with hyperkalemia?

yes

symptoms r/t CKD may not occur until disease is WHAT?

advanced

sleep disturbance, decreased attentiveness possible with CKD?

yes

condition? The presence of reduced GFR or evidence of kidney damage for at least 3 months

chronic kidney disease

the prevalance of CKD is highest among what age group?

older adults

among older adults, is serum creatining a good marker of kidney function?

is older age a risk factor for CKD?

yes

is obesity a risk factor for CKD?

yes

is smoking history a risk factor for CKD?

yes

is family history a risk factor for CKD?

yes

is hx of CVD a risk factor for CKD?

yes

can CKD develop as a consequence of AKI?

yes

WHAT is an independent risk factor for progression of kidney disease as well as for mortality?

proteinuria

what two classes of meds are recommended as first-line treatment for proteinuria?

ACEIs or ARBS

delirium, falls, or functional decline are atypical symptoms of UTIs in older adults?

yes

what is the most common overdiagnosed bacterial infection?

urinary tract infection

is asymptomatic bacteriuria common in older adults?

yes

does asymptomatic bacteriuria in older adults require treatment?

condition? Pyuria and positive urine culture

asymptomatic bacteriuria

condition? Pyuria and positive urine culture in a person with sx that localize to the GU tract

urinary tract infection

is prostatic hyperplasia with retention a RF for UTI?

yes

is hx of recurrent UTIs a rf UTI?

yes

is the loss of the protective effect of estrogen on bladder mucosa a RF UTI?

yes

is cognitive impairment a RF UTI?

yes

Exam 3 Flashcards

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