Osce Review: Genitourinary Male

Front 1

Other names for LUTI

Back 1

cystitis, bladder infxn

Front 2

What are 5 things that make a LUTI complicated?

Back 2

*male, Pg, >65yo, abnl anatomy, immunocompromised

Front 3

*Recurrent LUTI
*Relapse?
*Reinfection?

Back 3

*3 or more/year
*same organism
*new organism

Front 4

MCC cause, 2nd MCC of LUTI

Back 4

E. coli, S. saphrophyticus

Front 5

Risk Factors for LUTI

Back 5

Pg, Female, sex, instrumentation, prev. UTI, incontinence, estrogen deficient, diaphragm/spermicide, abnl anatomy, recent Abx, hygiene

Front 6

Signs/Sx of LUTI

Back 6

*Triad: freq, urgency, dysuria
*Also: suprapubic pain, odor, hematuria

*NO fever/WBC casts (pyelo)

Front 7

Labs for LUTI

Back 7

*UA: specific gravity high (nl: 1.001-1.035), hematuria (>5RBC per HPF (nl 0-2)), turbid urine, nitrates, LE +, >100,000 bacteria/ml (dx), >10 WBC/mm3 (pyuria)

Front 8

When do you culture for LUTI?

Back 8

*complicated: before Abx (+/-) 1-2 after
*Pg: before AND after
*clinical failure: after failure AND 2wks post-tx

Front 9

LUTI
1. Non-pharm Tx
2. Pharm uncomplicated
3. Pharm complicated
4. Prophylaxis

Back 9

1. cranberry juice, hydration, hygiene, void after sex, estrogen replace, yogurt
2. TMP/SMX DS PO BID x3 (resistance - Cipro 250mg BID x 3d)
3. Pg TMP/SMX x7d (avoid 2wks before due date), males = 10-14days
4. 2DS PO @ sx onset, 1DS PO post-coitus

Front 10

Other names for pyelonephritis

Back 10

*upper UTI, kidney infxn

Front 11

How is pyelo different from cystitis?

Back 11

*fever
*WBC casts
-CVA tenderness

Front 12

Signs/Sx of pyelonephritis

Back 12

F, rigors, CVA tenderness, freq, urgency, dysuria, N/V,

Front 13

Labs for pyelonephritis

Back 13

UA - similar to cystitis
****PLUS WBC casts****

Front 14

Risk Factors for pyelonephritis

Back 14

*Pg, UUTI in past yr, DM, instruments, kidney stones, abnl anatomy, old, enlarged prostate, sx >7d, neurogenic conditions, urine reflux

Front 15

Tx of pyelonephritis

Back 15

*Culture
*Uncomplicated: Cipro 500mg PO BID x7d (TMP/SMX DS x14d)
*Complicated: IV until afebrile 24-48hrs (then PO) Cipro x14d

Front 16

Other names for renal calculi

Back 16

*kidney stones
*nephrolithiasis

Front 17

Composition of renal calculi

Back 17

*calcium oxalate (75%)
*struvite (proteus/kleb produce)
*Uric acid

Front 18

Risk Factors for renal calculi

Back 18

*male, age 20-40, dehydration, warm climate, sedentary, white, protein rich diet, diuretics, gout

Front 19

Signs & Sx for renal calculi

Back 19

**walking around (appy = sit still, pancreatitis = lean forward)
*renal colic, flank pain, hematuria, F/tachy, N/V, sweat, freq/urg, anxious

Front 20

Labs for renal calculi

Back 20

UA: blood, RBCs, crystals, pH
Non-contrast CT (test of choice): size of stone & predicts passage of stone
*KUB x-ray w/ stone..serial to show passage

Front 21

Treatment options for renal calculi:
1. Pass on own
2. other things to consider
3. ways to remove stone
4. prevention
5. return to clinic if....

Back 21

1. <4-5mm = pass on own
2. control pain, inc fluids, antiemetic
3. ESWL (lithotripsy), cystoscopy, neprostomy
4. prevent w/ fluids
5. return if inc pain, fever, still vomiting

Front 22

Incontinence:
1. MC in what gender?
2. 4 types

Back 22

1. Females
2. Urge, Stress, Overflow, Functional

Front 23

Urge Incontinence
1. MC in who?
2. Describe
3. S/S
4. Tx

Back 23

1. MC in eldery
2. strong desire to pee, bladder overactive
3. urgency, frequency, lose lots of fluid, triggered by position change
4. Anticholinergic = Oxybutynin (Ditropan) 2.5-5mg PO BID-TID; TCAs (use w/ add'l indications), Topical Estrogen (F w/ urethritis or vaginitis)

Front 24

Stress Incontinence
1. MC in who?
2. Describe
3. S/S
4. Tx

Back 24

1. MC in Females >65
2. urethral underactivity
3. small leaks w/ inc ab pressure (sneeze/cough), predictable/reproducible
4. Kegels, SNRI - duloxetine (Cymbalta 40mg BID), TCA (Imipramine), alpha adrenergic agonist - pseudoephedrine (Sudafed 15-60mg TID), topical estrogen

Front 25

Overflow Incontinence
1. MC in who?
2. Describe
3. S/S
4. Tx

Back 25

1. MC in men (w/ BPH)
2. urethral overactive (+/- bladder underactive), bladder fails to empty properly
3. dribbling, weak stram, hesitant, freq, bladder fullness
4. Cholinomimetics: bethanechol (stims detrusor....NEVER give IV/IM - life threatening GI/CV); self-cath

Front 26

Functional Incontinence
1. describe
2. tx

Back 26

1. physical/cognitive issue prevents from reaching toilet
2. tx: schedule bathroom break, easy access to bathroom

Front 27

1. MC renal CA?
2. S/S
3. Dx
4. Tx

Back 27

1. Renal Cell carinoma
2. hematuria, flank pain, ab/flank mass
3. IVP (intravenous pyelogram - contrast to kidney seen on XR) or CT
4. aggressive/surgery, refractory to chemo

Front 28

Wilm's Tumor (nephroblastoma)
1. MC in who?
2. RFs
3. S/S
4. Dx
5. Tx

Back 28

1. MC in kids (1-5yo, 95% by 10yo)
2. aniridia (lack color in iris), hemihypertrophy, cryptorchidism, hypospadius
3. inc ab size, pain, hematuria, dec appetite
4. US/CT
5. nephrectomy, chemo/rads

Front 29

1.MC malignancy of urinary system?
2. MC type?

Back 29

1. bladder CA
2. transitional cell carcinoma

Front 30

Bladder CA
1. Risks
2. S/S
3. Dx
4. Tx

Back 30

1. Smoking (#1), male, occupational exposures
2. hematuria, dysuria, freq, urgency, ab/pelvic pain, UTI not better
3. Cystoscopy (gold std)
4. surgery (resection), chemo w/ mets

Front 31

Erectile Dysfunction
1. describe
2. causes (2)
3. Tx

Back 31

1. fail to achieve erection
2. organic (vascular, NS, hormones), psychogenic
3. Phosphodiesterase Type 5 Inhibitors: sildenafil (Viagra): 50mg PO x1 (60 min before sex), tadalafil (Cialis) 10mg PO x1 NOTE: PDE5 CI w/ nitrates or CV risk
*PGE1 = Alprostadil (Caverject) 10-20mcg 5-10min before sex

Front 32

Benign Prostatic Hyperplasia (BPH)
1. describe
2. pathology

Back 32

1. enlarged prostate
2. testosterone converted to DHT w/ 5-alpha reductase leads to growth (excessive alpha adrenergic tone) leads to bladder outlet obstruction

Front 33

BPH
1. S/S
2. Dx

Back 33

1. weak stream, hesitantcy, nocturia, urinary retention, overflow, hematuria
2. DRE, PSA, post-void residual

Front 34

BPH Tx
1. mild dz
2. moderate dz
3. moderate dz, prostate >50gm
4. herbal tx

Back 34

1. watchful waiting
2. alpha 1 blocker (zosin): terazosin (Hytrin): 1-10mg PO QHS, alpha 1A blocker (osin): tamsulosin (Flomax)
3. 5 alpha reductase inhibitor (asteride): Finasteride (Proscar) 5mg PO qday
4. saw palmetto

Front 35

Prostatitis
1. describe
2. Cause
3. Sx of acute
4. sx of chronic

Back 35

1. infxn/inflamm of prostate, acute or chronic, usu >30yo
2. MC for acute/chronic: E. coli
3. Acute: F/C, localized pain, malaise, urinary sx
4. recurrent UTI, voiding difficulties, LBP, perineal or suprapubic pain

Front 36

Prostatitis
1. Dx - acute
2. Dx - chronic

Back 36

1. Acute: prostatic massage = CI, sx present, bacteruria, midstream specimen 2. CHRONIC = sequential cultures

Front 37

Prostatitis
1. Tx - acute <35 yo
2. Tx - acute >35 yo

Back 37

1. Ceftriaxone (Rocephin): 250mg IM x 1 (gonorrhea), doxycycline (Adoxa): 100mg PO BID x10d, tx partners
2. Levo or Cipro x 10-14d, adjunct tx: analgesics, stool softner, hydration, bed rest

Front 38

Prostatitis
1. Tx Chronic

Back 38

1. Cipro 500mg BID x4wks (may be longer)
2. surgery if needed

Front 39

Epididymitis
1. MC in who
2. Causes <35?
3. Causes >35

Back 39

1. MC in 19-35 yo
2. gonorrhea/chlamydia
3. E. coli/Pseudomonas

Front 40

Epididymitis
1. Sx
2. Dx

Back 40

1. unilateral pain & swelling, F/C, d/c from urethra, Prehn sign (elevate testes = relief)
2. midstream culture, UA = LE

Front 41

Epididymitis
1. Tx <35
2. Tx >35yo

Back 41

1. Ceftriaxone (gonorrhea): 250mg IM x1, Doxy (chlamydia): 100mg BID x10d, tx partners, scrotal elevation & analgesics
2. Cirpo 500mg PO qday x10-14d, bed rest, scrotal elevation, analgesics

Front 42

Hydrocele
1. describe
2. s/s
3. Dx
4. Tx

Back 42

1. fluid around testicle
2. painless, swelling, heavy
3. transillumination
4. observe, surgery w/ sx

Front 43

Spermatocele
1. describe
2. s/s
3. dx
4. tx

Back 43

1. diverticulum of epidymis, filled w/ sperm/fluid
2. painless, cremaster reflex intact
3. palpate mass = separate from testes, +/- transilluminate
4. watch, surgery w/ pain

Front 44

Varicocele
1. describe
2. s/s
3. dx
4. tx

Back 44

1. Bag of worms, dilated pampiniform plexus (usu L side - drains to renal vein)
2. painless, may affect FERTILITY
3. tortutous mass on surface of scrotum
4. surgery (pain/cosmetics)

Front 45

Testicular Torsion
1. describe
2. s/s
3. dx
4. tx

Back 45

1. Surgical emergency, peak= 14yo, twisting testes - ischemia - infertility
2. acute scrotal pain, lacks cremasteric reflex, N/V, testes ride high
3. Prehn sign (-), US
4. manual reduction (twist awary from midline), orchidoplexy must follow (tacks down)

Front 46

Difference between phimosis and paraphimosis

Back 46

*phimosis: can't retract
*paraphimosis: can't go back to nl non-circumcised position

Front 47

Testicular CA
1. MC in who?
2. Types
3. Risks

Back 47

1. MC in men 15-35yo
2. Germinal (95%; seminomas & non-seminomas), non-germinal
3. cryptorchidism, white, FHx, trauma
3.

Front 48

Testicular CA
1. Sx
2. Dx
3. Tx

Back 48

1. painless lump, heavy, infertile, dull ache
2. US, don't transilluminate
3. orchiectomy (dx/tx), rads/chemo...good prognosis (95% survival)

Front 49

Prostate CA
1. MC in who?
2. Risk Factors

Back 49

1. >50 (2nd MCCOD (CA))
2. >50yo, +FHx, Race (AA inc)

Front 50

Prostate CA
1. S/S
2. Dx
3. Tx

Back 50

1. wt. loss, voiding issue, obstructive sx, hematuria, pelvic discomfort
2. UA, PSA >/= to 4, CT, DRE
3. watchful waiting, chemo/rads, prostatectomy (incontinence/ED)