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24 Cards in this Set
- Front
- Back
what are the 4 zones of the prostate? what 2 zones can you feel during a prostate exam?
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4 zones- transition, central, peripheral, and anterior fibromuscular stroma
2 zones: peripheral and central zone |
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what percentage of adenocarcinomas and prostatitis are found in each zone?
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transition- majority of BPH and 20% of adenocarcinoma
central: 1-5% of adenocarcinoma peripheral: 90% of all prostatitis, 70% of adenocarcinomas fibromuscular--- negligable |
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What are the three causes of prostatitis? what does it cause that can confuse it w/ a prognosis more worrisome? what population is effected most by prostatitis?
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3 causes: infection, trauma, or stasis (feels pain or bogginess of rectal exam)
-causes an increased PSA blood levels number 1 urologic dx in men <50 |
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what are the two subcategories of chronic nonbacterial prostatitis? how do you distinguish between them?
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inflammatory- WBCs in semen
noninflammatory- no WBCs in semen |
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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
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Dx: acute bacterial prostatitis
may also show bladder distention tx: hospitalization w/ IV abx. if not N/V give orals w/ G- coverage. |
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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 have him do a UA and it comes back 10 x WBC in the VB-3. dx and tx
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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
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dx: chronic nonbacterial prostatitis (inflammatory)
tx: warm baths, prostatic massage for infrequent ejaculators and NSAIDs. 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?
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dx: Chronic nonbacterial prostatitis (noninflammatory)- prostatodynia
tx: warm baths, prostatic massage for infrequent ejaculators and NSAIDs. Abx are controversial, but used. PLUS alpha blockers (to relax the smooth muscle capsule of the prostate and the detrusor muscle increasing urination ease) and antidepressants (to alter pain pathway) |
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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
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Nephrolithiasis
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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?
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pop: 20-45 y/o men in developed countries
hallmarks: intense pain and hematuria w/ or w/o pyruria (WBCs) reccurence: each successive stone you have has a 50% chance addition. 2nd stone- 75% chance of having another one |
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what type of stone is the only one that cannot be seen on plain film?
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uric acid
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how do you distinguish pyelonephritis from nephrolithiasis?
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Lots of RBCs w/ lil WBCs- nephrolithiasis
lots of WBCs w/ lil RBCs- pyelonephritis |
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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?
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calcium- 75%
calcium oxalate- 50% (acidic pH) calcium phosphate stones require alkaline urine |
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At what level are you considered to have hypercalciuria? what is the number 1 cause of hyerpcalciuria?
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>4 mg/kg/24 hr
#1 cause- increased intake |
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how do you prevent calcium stones?
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increase fluid and fiber intake
use thiazide diuretics to increase distal tubular reabsorption of Ca+ |
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how do you tx hyperoxaluruia? how do you tx hypercalciuria?
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hyperoxaluria: tx w/ Mg and Ca supplements to bind oxalate in the gut. (calcium oxalate)
hypercalciuria: Decrease intake of Ca+ or use thiazide diuretics ALWAYS TX UNDERLYING CAUSE! |
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how do you tx uric acid stones?
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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.
You can use ECSL to break up the stone |
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35 year old female presents to your office complaining of stone like pain. She has a PMH including multiple UTI's d/t proteus and subsequential antibiotic tx. Dx, tx and what would you see on xray?
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DX: triple phosphate stone - Magnesium ammonium phosphate
d/t ammonium phosphate traps Ca and Mg resulting in those stones. xray: Staghorn: Horns sticking off the stones tx: UNDERLYING CAUSE. |
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You look at an xray an notice hexagonal shaped crystals in the kidney. Dx and tx
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DX: cystine stones
TX: increased volume intake and alkalinization of urine. Ultrasonic lithotripsy is used. |
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when does the pt feel pain when passing a kidney stone?
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only when the stone is moving.
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what is the diagnostic tests of choice for stones?
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IV pyelogram
can also use: Xray and US do not use CT (only good for hydronephrosis) |
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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 2/3rs of the ureter?
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4 and 7mm-- 50%
ECSWL for proximal 1/3 of ureteral or renal pelvis stones US lithotripsy- distal 2/3 of ureter |
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WHat do you do to your pt in order to prevent new stones from forming?
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catch the stone and perform a metabolic workup:
24 hr urine collection for volume pH creatinine urea Na ca phosphate urate oxalate citate cystine |
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what is the string sign?
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stone at the base by the bladder that obstructs the dye in the ureter causes the ureter to look like a string.
normal ureter: will have paristalsis which will not all the dye to concentrate in the ureter, but will have a spotted effect. |