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Exam Review

65 yr and functioning testes are risk factors. pt has hesitancy, strainging, urgency, incomplete voiding, weak stream, and "dribbling" benign prostatic hypertrohpy
PE: digital rectal exam: prostate is enlarged and firm. benign prostatic hypertrophy
BPH - r/o neuropathic bladder (peripheral neuropathy), prostate cancer; diagnosis based on? prostate-specific antigen to r/o cancer. Pressure-flow studies to look at increased bladder pressure relative to uro-flow and r/o neuropathic bladder.
medical treatment for BPH? alpha2-adrenergic blockers AND 5a-reductas inhibitor TO REDUCE SYMPTOMS. SE of Alpha2 are low BP = dizzy, retrograde ejaculation, asthenia. SE of 5a are sexual ejaculatory dysfunction. (meds can decrease PSA levels)
E.Coli, P. Aeruginosa, Klebsiella, proteus, enterococcus acute infection of prostate
E. Coli, P. Aeruginosa, Proteus, Klebsiella, Abacterial: trichomonas, chlamydia, M hominis Chornic infection of prostate
acute symptoms, high fever, chills, malaise, dysuria, frequency, urgency (DFU) prostatitis
PE: very tender prostate is noted on DRE prostatitis
assoc. recurrent UTI, sx are DFU (dysuria, frequency, urgency) and low fever PE: DRE: Normal, swollen, firm, or tender. prostatitis (chronic)
pelvic pain, UTI sx (dysuria, frequency, urgency) and PAIN DURING EJACULTAION or AFTER. prostatitis (abacterial)
Dx for postatitis (acute) clincial findings and postive urine culture (proteus?) (prostate massage and DRE is contrainindicated due to risk of sepsis!!
Dx for chornic bacterial and chornic abacterial prostatitis? four-glass test: culture the initial urine stream, mid-stream, expressed prostate excretions after message, and post-massage urine.
acute bacterial prostatitis tx? Fluoroquinolones and Bacterum (TMP-SMZ) for 4 wks. or for chronic (1-3 mon)
advanced age, pos fhx for prostate ca, AA risk factors. no increased risk with BPH!!! Typically asx early-stage, but develop obstructive voiding symptoms or hematuria. prostate cancer
PE: DRE: prostate nodule may be noted on DRE prostate cancer
elevated prostate-specific antigen testing, >4ng/mL and biopsy. diagnosis made on transrectal US with biopsy. prostate cancer
Treatment for prostate cancer? watchful waiting. androgen deprivation (highrisk). radiacal prostatectomy (low/intermed risk). radiation therapy.
Women tend to get them more often because their urethra is shorter and closer to the anus than in men. why do women get UTIs more than men?
women get this after sexual activity or when using a diaphragn. increased risk after Menopause. what are the risk factors for women with UTI?
Problems emptying bladder completely, sitting prolonged period (biking), what questions ask women with UTI?
cloudy/odor urine, burning, low fever, flank side pain(r/o pylonephritis), kidney stone (radiating flank pain) UTI
abdominal bleeding, wt loss, crampy. change in BM, PAIN Colorectal cancer
hx alcohol, smoking, IBD (more than 8 years) RF for colorectal cancer
age 60-80, first-degree relative with colon cancer, IBD, high in fat diet, low in fiber risk factor for colorectal
screening for CRC Fecal occult blood test, colonoscopy
starting at age ___, avg risk pt should have OFBT annually and colonoscopy every ___ years 50 yrs old, colonoscopy every 10
high risk pts should have colonoscopy for CRC every ____ years colonoscopy every 5 years
anemia, metastatic disease, hepatomegally, Bowel obstruction, pulmonary complaints SE of metastatic CRC
CRC treatment surgical resection; chemo (5-fluorouracil) reduce local and distant. monitor CEA levels (norm <2.5ug/L)
rectal bleeding - what is the workup? list 5 things CEA (cancer), CFBT (anemia, bleeding) colonoscopy (dx/tx polyps, wall tissue changes - contra diverticulitis), CBC/Hb/Hct (anemia), sed rate (inflammation), rectal exam
workup for gut cancer specifically (list 5 things) CT (scan ab/pelvis), FOBT (hidden blood), colonoscopy (tissue samples, dx), tumor markers (CEA), sigmoidoscopy (internal walls of rectum)
PE for GI (list 5 things) abdominal exam (mass, peristalsis) guarding/rebound (tenderness) BS (obstruction)
monitoring CRC CEA (after sugery; should be low) (screen 50-75). after FOLFOX, CEA performed 6 mon, another colonscopy in 6 mon, 1 yr (if norm every 5 years after)
CRC staging is based on ____ biospy, CEA (use Kukes and TNM)
stage 3 CRC tx FOLFOX 6 mon
FOBT screening, Colonoscopy after 50yrs every 1 yr FOBT, every 5 yrs Colonoscopy. right after proceedure 1 yrs until normal (3-5)
FOLFOX drugs fluorouracil (myelosuppression), oxalipiatin (peripheral neuropathy, worsened with cold), leucoxorincalcium folinic acid (neurotoxic)
increased prostate specific antigen can be elevated in BPH, does not signify risk factor for cancer
hx of insomnia, UTI are other complaints of __ BPH
etiology of BPH result of testosterone production can increase likely hood of developement starting in 30s, sx become more real in 50s.
ultrasound used to r/o cancer in testes, prostate, kidneys. blood tests to measure Prostate specific antigen (not dx), rectal exam to feel boggy BPH, BPH
Doxazosin (alpha-blocker) relax smooth muscle in the prostate (SE: dizzy, ejact problems), 5a-reductase (inhibit DHT from converting to testosterone) BPH
WBC, burning, obstructive signs, Fever/chills prostatitis
E.Coli, Klebsiella, Proteus common = C reactive protein and WBC are high prostatitis (medical emergency - hospitalize with IV abX)
prostate massage contraindicated because of sepsis risk prostatitis
ciprofloxacin, doxycycline (strong abx that can penetrate the protate capsule) prostatitis
BUN:Cr >15 postrenal azotemia, blockage of the ureters causing hydronephritis
stone in ureter, pregnancy, hyperplasia, BPH, risk factors for postrenal azotemia
azotemia (BUN) nitrogen-containing compounds (urea, creatinine) in blood (result of decreased GFR)
normal BUN: Cr ratio ~15
decrease in blood flow volume pre-renal (>20) - not the kidney's fault (bleeding, volume loss vomting, heart failure)
uremia result of kidney failure (primary renal) results in parenchymel dz. (glomerularnephritis, tubular necrosis)
uremia BUN;Cr <15 (because what gets filerted is not reabsorbed ie urea = low BUN)
for sx, small kidney stones NSAIDS or opoids first line "watchful waiting"
for midsize, kidney stones second line: lithotripsy
peristaltic contractions of the ureter (waves of 20-60 min painful sx = comes and goes- spasmodic waves), vomiting, restlessness, fever, colicy radiation of pain kidney stones
RF: high protein, high salt, low water, high sguar processed foods, grapefruit juice, apple juice, calcium supplements RF for a kidney stone
KUB film to look at calcium in kidneys, ureter, bladder kidney stones iwth calcium
noncontrast CT scan Dx of choice for kidney stones. dx of kidney stones
ultrasound is best for hydornephrosis dx of kidney stones (when you suspect a blockage)
microscopic exam (RBC, leukocytes, casts, cyrstials), urine culture (organisms?)CBC (infection?) labs for nephrolithisis
painful, difficult urination. purulent discharge (in men) urethritis (either gonorrhea or chlamidia)...sometimes E.coli or CMV
male exam for urehtritis inspect testes, penis for swelling; red urethra by spreading meatus appart; look at prostate (DRE for swelling, lumps)
urethritis is 5 or more granulocytes by smear urethritis dx
metronidazole or doxycycline for treatment of urethritis tx of urethritis
RF Sexual contact, spermicides, contraceptives urethritis
burning with urination and "always have to go" - possible subpubic pain or lower back cystitis
most common cause of cystitis/pyelonephritis after urine culture E.Coli
female anatomy, sexual intercourse (Honeymoon cystitis) and family history, catheters RF for cysititis
RF: cystitis or urethritis generally follows = pyelonephritis
cranberry juice can help with sx cystititis
UA: no nitrates, WBCs, leukocyte esterase. URine microscpy: WBCs, RBCs, bacteria cycstitis workup
Vaginitis = yeast infection. Interstitial cystitis (chronic pain in the bladder)for several UTI symptoms but urine cultures remain negative and not improved with antibiotics. Prostatitis (inflammation of the prostate) ddx for cystitis
prevention: urinate after intercourse, underwear, methods used to wipe after BM, douching prevention for cystitis
Bactrim drug )sulfamethoxdazole/trimoprim (myelosuppression, rash, liver damange) cystitis (UTI) against E. Coli
painful urination, fever, increased HR, tender CVA, pyelonephritis
RF: structural stasis (stones, pregnant, stent, cath,) spermicide use pyelonephritis
urine test strip: nitrites, WBC casts (with sx) dx for peylonephritis
required for treatment: abx sensitivity testing of urine culture, DMSA scan pyelonephritis
cranberry juice reduces pyelonephritis preventative for pyelonephritis
bactrim used for pyelonephritis tx of pyelonephritis
Created by: jamieseals
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