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89 Cards in this Set

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What give urine its normal yellow color?
-caused by various amounts of Urochrome, a product of hemoglobin degradation.
What is the most important color abnormality for Urine?
Red, or reddish brown, which suggests the prescense of erythrocytes, hemoglobin, myoglobin, or pigments derived from medications or or other substances.
-Pt’s urine may change color due to Pyridium. It will change their pee orange and brown
-Difference between colonization and infection. The person with the chronic catheter may have this, a darker or tea-colored urine.
What are the 2 UTI catagories?
1) Simple
2) Complicated
What is a simple UTI?
-structure and fxn normal
-narrow spectrum of pathogens
- includes isolated recurrent bacterial cystitis
-includes acute pyelonephritis in females
Treat uncomplicated UTI for about 1 week
What is a complicated UTI?
-structural/functional impairment that reduces the efficiency of tx
-Refers to UTI in Men
-Freq. multi-drug resistance tx
-Freq. need for urologic eval.
What kind of sample is needed for a abnormal UTI?
Mid stream catch for both men and women.
Mid stream clean catch urine technique to make sure pee is sterile
What is Cystitis?
-Infxn of the bladder most commonly due to coliform bacteria(esp E-coli).
-frequecy, urgency, nocturia, dysuria, voiding, pain. TX: 1-3 days with smx/tmx
Some UTI epidomology facts?
-first year of life, UTI higher in males than females
-increased infxn in boys are associated with congenital abnormalities
- x50 fold more common in women during repro. years
See notes for more
What is the most community acquired UTI?
**E-Coli
What is Bacteriuria?
Bacteria in the urine does not necessarily imply infxn of the urinary tract.
What is Pyuria?
refers to Urine which contains pus. It can
What is Pyuria?
Refers to urine which contains pus. It can be a significant sign of bacterial Urinary Tract Infections**
-indicates infx but not specific to the kidney
What is sterile Pyuria?
-the presence of elevated numbers of white cells in a urine which appears sterile using culture techniques
-WBcs in it and neg culture=think TB**
The UA has WBCs in it. You culture it and it’s negative. You need to then think of Tuberculosis (renal). It can also be from a mild prostatitis (prostate).
Why is the female Urethra more prone to UTI?
Female Urethra (short) has insufficient anatomic barrier to the entry of urethral bacteria which can be massaged easily in the bladder
-possibly bacterial are massaged into the bladder during intercourse
UTI catagories?
-Isolated
-Unresolved
-Recurent infxns
Differentiate between lower/upper UTI. Cystitis vs. pyelonephritis. The kidney infection is more serious and gets treated differently than cystitis. It can be from mild to septic shock. You get called from the nursing home saying Betty is confused. She could be septic from the kidney infection. Most likely organism for adult female is E. coli.
Bacterial Prostatitis: 3 types
-Acute Bacterial
-Chronic Bacterial
-Non bacterial
Lab findings of pyelonephtitis?
-Leukocytosis
-Pyuria
- Normal renal fxn
What about Nitrates?
Nitrates are formed when bacterial reduct the nitrates that are present in normal urine.
Can produce false negatives...
Nitrites mean nothing for symptoms of UTI. They could be positive for UTI even without nitrites.
What is Pyelonephritis?
Infxn and inflammation involving parenchyma and pelvis of kidney.
-Aerobic gram negative (e-coli, etc...)
-Gram positive coagulase negative staph
-Hematogenous spred rare
Pyelonephritis treat 1-2 weeks approx
-considered a upper tract infxn
-*Look for WBC Casts
Complications of Pylelonephritis?
-Uncommon with PROMPT tx

- Septicemia and shock
- Stones
- Emphysematous Pylonephritis
What are some sxms of Pylonephritis?
-Abrupt onset(fever, chills, flank pain, nausea...)
-fever
-flank pain
-irritave voiding sxms
-positive urine culture
What is the most common symptom of Prostatitis?
Pain and Discomfort in the pelvic or perineum.
Acute bacterial Prostatis?
-fever
-irritative voiding sxms
-perineal or suprabubic pain, exquisite tenderness common on rectal exam
-Positive Urine culture
Chronic bacterial and non-bacterial prostatitis look the same. Pedemonte is not sure how they came up with the Dx of bacterial. Maybe they treated him with antibiotics and it got better, so they named it bacterial. Maybe the guy who did not respond to the antibiotics was labeled as nonbacterial prostatitis.
a. Tx: The gland does not have a great volume of blood supply. Treat for 6 weeks. Then do a prostatic massage.
Lab findings with acute bacterial prostatitis?
CBC, leukocytosis, Urinalysis: pyuria, bacteriuria, and varying degrees of hematuria
Definition of Prostatitis?
Chronic abacterial prostatitis is asyndrome characterized by pelvic pain and voiding sxms, which is poorly defined, poorly understood, poorly treated and bothersome
What can you see with Urethritis?
-PMNS
-Localization
-GM stain
-Culture
-Gonocuccus or Chlamydia*
Urethritis?
Male = Cystitis symptonms, discharge, pain

Female= Cysitis symptoms, redness and soreness with walking.
What are some sxms of Prostatitis Type III?
Slow stream, difficulty starting, frequency, nocturia, double voiding, urgency adn urge incontinence.
Chronic non-bacterial Prostatitis?
-irritative voiding sxms
-perineal or suprapubic discomfort, similar to that of chronic bacterial prostatitis
-positive expressed prostatic secretions, but culture is negative.
Epididymitis?

Torsion?
Most causes are infectious and two catagories:
1) Men under 40=sexually transmitted
2) >40 = non sexually transmitted and associated with UTI
Epididymitis vs. Torsion of teste: 10-20 year old. The older person is less likely to have torsion and more likely to have epididymitis.
*Torsion is a medical emergency**
What is the most common cancer in men?
Prostate Cancer

-second leading cause of death in men too!
Epidydymitis signs?
-fever
-irritative voinding sxms
-painful enlargement of epidydimis
-scrotal pain, may follow physical strain
Young= Chlamydia/gonococcus
Older= E-coli/TURP/catheters

Ultrasound to look for abcess
What are prostate cancer risk factors?
-Risk increases with age
-Rare under 40
-80% are 65 years and older
What is the most common sxm of Chronic non-bacterial prostatitis?
Pain or discomfort int he pelvic or perineum lasting for 2 or more months in a 43 year old man.
What are prostate cancer high risk factors?
-Afro-American
-Men who's father or brother has a hx of prostate cancer (2-3 x higher)
What should be done after 40 years old to check for prostate cancer?
-yearly DRE
-Yearly PSA/DRE post age 50, unless you are in a high risk category
-High Risk: yearly PSA after 40-45
What does PSA stand for
Prostate Specific Antigen
PSA=The most helpful SCREENING test*

Most definitive for DX= Prostate Biopsy*
Can Prostate cancer be asymptomatic?
Yes, oftentimes it is
What is the most common site of Prostate Cancer metastasis?
Axial skeleton = lower back pain or pathological fractures
Can dx be based on PSA alone?
No, need biopsy.
70-80% with abnormal PSA may not have prostate cancer*
An elevated PSA does not mean prostate cancer:
a. Just getting older, the prostate grows and it goes up
b. Prostatitis is a higher PSA
What is the cut-off PSA for appropriate early detection in younger men?
2.5-3.5ng/ml
Age dependent PSA levels are critical
What are some effects on PSA?
Finasteride-total PSA reduced by 50%, free PSA not affected
Ejaculation-minimal effect unlikely to be clinically significant after 6 hours
Digital Rectal exam-reports are conflicitng, affects for total and free fraction, wait 24 hours post DRE.
Positive PSA or Postive DRE requires a what to prove the prescence of prostate cancer??
BIOPSY!
80% of prostate cancers occur in the?
Peripheral Zone

20% in the Transition Zone
With biopsies what do you need to look for?
Sampling errors
What is thought to be the strongest factor contributing to reduced rates of mortality?
PSA screening
What are some tx strategies?
-Radical Retropubic Prostatectomy
-Radiation
- Cryotherapy
-Intermittent Androgen Ablation
What are the 2 major risks of all PCa tx?
-Incontinence
-Impotence
Pallative Therapy?
Androgen Deprivation
Decreases PSA in 90% pts
can cause Gynocomastea
What is BPH?
Benign Prostatic Hyperplasia?
-difficulty starting stream
-Weak stream
-Intermittency
-Double voiding
Bladder instability:
BPH: Older guys. He can’t empty his bladder
* Men over 50
* Usually occurs in the Transition Zone
What is the most common benign tumor in men?
BPH-age related

-Obstructive and Irritative complaints
What are kidney stones mostly made of?
Calcium
Can stones be seen on plain film abdomen x-ray?
Yes, 90% of stones are radiopaque* due to Calcium
What else do you see?
Hematuria 80% of the time
What does urolithiasis present with?
-sudden flank pain(severe)
-possibly N&V
-possible urinary freq and urgency
What labs for workup?
-Urinalysis
-urine C&S if infxm suspected
-Screening panel(BUN, Creatinine, Electrolytes and Uric Acid). Also in pts with recurrent stones, as 24 hour urine specimen is indicated*
Stone symptoms are related to?
Position:
1) Caliceal
2) Renal Pelvis
3) Proximal Ureteral
4) Distal Ureteral
Caliceal?
-Usually small
-Usually asymptomatic
-Incidental finding
-Gross Hematuria
-When symptomatic (flank pain, infxn, persistant hematuris)
Renal Pelvis?
-Usu. small
-Renal Pelvis or utero-pelvic jxn
-Intermittent pain (flank or CVA)
-Infxn, obstruction, pylonephritis
Proximal Ureteral?
-Renal Colic
-N&V
-Hematuria
Distal Ureteral?
-Pain is intermittent and sharp
-Radiation to scrotum or labia
-Utero vesical juncture
What is the tx for stones?
-Hydration
-Hydration
-Hydration

and pain relief
Stones that are 5mm or less?
-will pass with supportive tx and wil cause minimal obstruction
When is ESWL indicdated?
upper ureteral stones and renal pelvis stones smaller than 2cm.
Kidney stones > 10mm
Hospitilization and lithotripsy.
Serum Creatinine vs. Glomerular filtration?
A normal serum Creatinine does not necessarily mean they do not have renal failure. Serum Creatinine does not rise until you have lost a lot of kidney function. Glomerular filtration is the true.
What is the most accurate test of GFR? But not used much?
Inulin is the best test because it’s filtered but not secreted or reabsorbed. It will tell you what the GFR is. The problem with it is, that you need a huge lab. Nobody uses it. So we use Creatinine. It’s made at a relatively constant level based on your muscle mass. It’s filtered and some of it is reabsorbed. Don’t make the assumption that the 80 year old has a certain muscle mass. It could be less than the table you use to calculate.
If you suspect the GFR is low, even when the Creatinine is normal?
Watch BP, for infection, etc. Monitor her health. Then when the Creatinine goes up they have to be dialyzed. Avoid sodium, potassium, high protein at that point. Refer to nephrologist.
If the person with slightly higher Creatinine calls with stomach flu and diarrhea?
Need to make sure they are not dehydrated, knocking off more nephrons. May need to admit and IV fluids
A Creatinine clearance test measures?
GFR. It is a hassle, though. You don’t order it very often.
Infection of the prostate that is characterized by pelvic discomfort, dyspareunia, obstructive or irritative sxms, and sterile urine with leukocytosis is?
Chronic nonbacterial prostatitis
Acute bacterial prostatitis presents with?
-sudden onset high fever
-chills
-low back or perineal pain
The most helpful info. to diagnose impotence of a vascular origin is?
Penile brachial pressure index
What tx is the most appropriate for any man with Erectile dsfxn is?
-Psychotherapy
The most likely cause of male infertility after a TURP is?
-Retrograde ejaculation
What is a painless lesion of the penis called?
-A Chancre
Innability to retract the foreskin from the glans penis due to inflamm or infxn is often and indication for circumsicion. What is this condition?
-Phimosis
Which info is most useful in differenting between testicular torsion and epididymitis?
-Negative Nuclear med scan
The most common pathologic form of testicular cancer is?
-Seminoma (gell cell tumors 95%)
What scrotal mass will transilluminate?
-
Casts with entrapped red cells may indicate?
-glomerulonephritis
Epithelial casts in large numbers?
-maybe intrinsic renal dz
and granular casts too
Symptoms of prostate cancer?
a.Signs and symptoms: (Pg. 985 Current)
-some may have focal nodules or areas of induration within the prostate at the time of DRE.
- most are papably normal prostates and are detected on the basis of elevation of the PSA.
- Most obstructions are with BPH, however, large or locally extensive prostatic cancers can cause obstructive voiding symptoms.
- lymph node metastases can lead to lower extremity lymphedema
TUIP?
Tx for BPH: widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
TX for BPH?
Treatment: Patients with mild symptoms should be managed by Watchful Waiting only.
Moderate or severe symptoms: Watchful waiting, Alpha reductase inhibitors,Alpha blockade,
Surgery: TUIP (transurethral incision of the prostate), TURP (transurethral resection of the prostate)
BPH?
Older guys, he can't empty bladder
What 2 things need for BPH to occur?
1)DHT
2)aging
Tx for bacterial prostatitis?
Tx for 6 weeks and do a prostatic massage
what age range for Torsion?
10-20 years old