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CLCD
Exam Review
| Question | Answer |
|---|---|
| 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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