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24 Cards in this Set
- Front
- Back
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what are the 4 zones of the prostate? what 2 zones can you feel during a prostate exam? |
4 zones- transition, central, peripheral, and fibromuscular stroma |
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Which zone is the most common for prostatitis? |
peripheral |
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What are the three causes of prostatitis?
How is it diagnosed? |
3 causes: infection, trauma, or stasis
dx: -feels pain or bogginess of rectal exam -use prostatic massage to collect expressed prostatic secretions (EPS) |
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what are the two subcategories of chronic nonbacterial prostatitis? how do you distinguish between them? |
inflammatory- WBCs in semen (may also be asymptomatic inflammatory prostatitis- usually dont tx this)
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36 year old male presents to your office w/ fever, chills, low back pain and N/V. On PE you feel a warm, tender prostate w/ induration. Dx and tx |
Dx: acute bacterial prostatitis |
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40 year old male presents to your office complaining of pain in the groin region, dysuria, ejacylodynia (pain on ejaculation) and nocturia. On PE you notice a normal prostate. You have him do a UA and it comes back 10 x WBC in the VB-3. dx and tx |
dx: chronic bacterial prostatitis
tx: gram- coverage for 6 weeks |
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40 year old male presents to your office complaining of pain in the groin region, dysuria, ejacylodynia and nocturia. On PE you notice a normal prostate. You do a UA and it comes back normal, the EPS comes back w/ WBCs, but no growth. DX and tx |
dx: chronic nonbacterial prostatitis (inflammatory) Abx are controversial, but used. |
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25 year old man presents to your office complaining of pain in the groin region, dysuria, ejacylodynia and nocturia. On PE you notice a normal prostate. UA, EPS and DRE are all normal. TX and Dx? |
dx: Chronic nonbacterial prostatitis (noninflammatory)- prostatodynia Abx are controversial, but used. * PLUS alpha blockers (to relax the smooth muscle capsule of the prostate) and antidepressants (to alter pain pathway), & heat |
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35 year old male pt presents to your ER complaining of colicky flank pain radiating to abdomen and then to the groin. He also mentioned that he had blood in the urine. Dx |
Nephrolithiasis
(kidney stones) |
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what population is most commonly effected by nephrolithiasis? what are the hallmarks of nephrolithiasis? what is the issue of stones concerning recurrence? |
pop: 20-45 y/o men in developed countries
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what percentage of stones are calcium stones in nephrolithiasis? what percentage of those are calcium oxalate? which type of calcium stones require alkaline urine? |
calcium- 75% |
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At what level are you considered to have hypercalciuria?
what is the number 1 cause of hyerpcalciuria? |
>4 mg/kg/24 hr |
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how do you prevent calcium stones? |
increase fluid and fiber intake |
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how do you tx hyperoxaluruia (high oxalate)? how do you tx hypercalciuria? |
hyperoxaluria: tx w/ Mg and Ca supplements to bind oxalate in the gut. (calcium oxalate) |
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what type of stone is the only one that cannot be seen on plain film? |
uric acid |
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how do you tx uric acid stones? |
increased volume intake and alkalinization of urine w/ po NaHCO3 and diamox at night time. then redo the 24 hr urine test to see if you made a difference. |
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35 year old female presents to your office complaining of stone like pain. She has a hx including multiple UTI's d/t proteus (urease producer) & subsequential antibiotic tx. Dx, tx and what would you see on xray? |
DX: triple phosphate stone - Magnesium ammonium phosphate - struvite |
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You look at an xray an notice hexagonal shaped crystals in the kidney. Dx and tx |
DX: cystine stones d/t hypercystinuria
Ultrasonic lithotripsy can also be used if stones don't resolve |
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when does the pt feel pain when passing a kidney stone? |
only when the stone is moving. |
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what is the diagnostic tests of choice for stones?
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Spiral CT |
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what percentage of stones will pass when between 4 and 7 mm?
How do you tx stones that are 8mm or < in the proximal third of ureteral or renal pelvis?
what about them being located in the distal 2/3rds of the ureter? |
4 and 7mm-- 50%
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What is the tx if hydronephrosis (obstructed kidney) is present w/ stone? |
surgery- use stint to drain kidney, then remove stone |
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WHat do you do to your pt in order to prevent new stones from forming? |
catch the stone and perform a metabolic workup:
(find cause to prevent future stone) |
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what is the string sign?
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stone that obstructs the dye in the ureter causes the ureter to look like a string. |
