Term
| collection of fluid between the two layers of the tunica vaginalis |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what scrotal masses transilluminate? |
|
Definition
|
|
Term
|
Definition
| watchful waiting, can refer for surgery if symptomatic. |
|
|
Term
| what should never be done to a hydrocele? |
|
Definition
|
|
Term
| what diagnostic test should you do if you unsure about the state of a testicle? |
|
Definition
|
|
Term
| engorgement of the internal spermatic veins above the testis, results from incompetence of the venous valves of the internal spermatic venous system |
|
Definition
|
|
Term
|
Definition
left side
if soley on the right side consider retroperitoneal or renal mass. |
|
|
Term
|
Definition
|
|
Term
| where do the L and R spermatic veins empty? |
|
Definition
L = L renal vein
R = inferior vena cava |
|
|
Term
| what happens to a varicocele when the pt is supine? |
|
Definition
| it should diminish or disappear |
|
|
Term
| can a unilateral varicocele affect both testes? |
|
Definition
|
|
Term
| complication of varicocele |
|
Definition
|
|
Term
|
Definition
reassurance esp if asx, left sided, and has had for a long time.
watchful waiting.
surgery if associated with infertility or pain. |
|
|
Term
|
Definition
|
|
Term
| increased risk of what with cryptorchidism? |
|
Definition
| infertility and testicular malignancy (seminoma) |
|
|
Term
|
Definition
surgery by 1 yo,
according to urology notes most will descend by 3 months. |
|
|
Term
| most cases of epididymitis are? |
|
Definition
|
|
Term
| MCC of epididymitis in pts < 40? > 40? |
|
Definition
< 40 = STD due to chlamydia or gonorrhea
> 40 = non STD, gram negative rod/UTI |
|
|
Term
| urethritis (pain and discharge), cysitis (frequency, urgency, dysuria), fever, scrotal swelling |
|
Definition
|
|
Term
|
Definition
supportive: bed rest, scrotal eval
abx: STD = ceftriaxone, doxy x 10-21d
non STD = bactrim, erythro, flouroquinalone x 21-28d |
|
|
Term
| inflammation of the prostate gland |
|
Definition
|
|
Term
| difference between acute and chronic prostatitis |
|
Definition
acute = bacterial infection
chronic = presents as intermittent UTI's |
|
|
Term
|
Definition
| coxsackie B, mumps, trauma |
|
|
Term
| MC complications after mumps in adolescents and adults |
|
Definition
|
|
Term
| typically follows parotitis infx within 8 days, abrupt onset fever, chills, nausea, abd pain, testicle becomes swollen and tender |
|
Definition
|
|
Term
|
Definition
| supportive with pain control, 1/3 of affected testicles will atrophy, infertility is rare |
|
|
Term
| hernia within the scrotum is usually a |
|
Definition
|
|
Term
| always document what about hernias? |
|
Definition
| if they are reducible or not |
|
|
Term
|
Definition
surgery, support belt
refer to GU/general surgery
educate the pt |
|
|
Term
| twisting of the testis and spermatic cord resulting in ischemia |
|
Definition
|
|
Term
| peak ages for testicular torsion |
|
Definition
|
|
Term
| difference between intravaginal and extravaginal testicular torsion |
|
Definition
intravaginal = within tunica vaginalis
extravaginal = involves twisting testis, cord, and processes vaginalis (often in newborns) |
|
|
Term
| diagnostic test for testicular torsion |
|
Definition
|
|
Term
|
Definition
|
|
Term
| diagnostic indicator of acute cystitis |
|
Definition
| UA = pyuria, bacteriuria, varying degrees of hematuria |
|
|
Term
| pt loses urine at all times and in all positions |
|
Definition
|
|
Term
|
Definition
|
|
Term
| loss of urine associated with activites that result in an increase in intra-abdominal pressure |
|
Definition
|
|
Term
| does a pt with stress incontinence leak urine when supine? |
|
Definition
|
|
Term
| what type of incontinence is most common in multiparous women or status post pelvic surgery |
|
Definition
|
|
Term
| what is the position of the bladder on lateral stress cystogram for a pt with stress incontinence? |
|
Definition
| bladder neck will descend below the midportion of the pubic symphysis |
|
|
Term
| tx of stress incontinence |
|
Definition
surgery "sling" (highest cure rate)
kegal exercises
post menopausal = estrogen cream |
|
|
Term
| overactive bladder is also known as |
|
Definition
|
|
Term
| uncontrolled loss of urine that is preceded by a strong, unexpected urge to void |
|
Definition
|
|
Term
| is urge incontinence related to position or activity |
|
Definition
|
|
Term
| what conditions are commonly associated with urge incontinence (2) |
|
Definition
| inflammatory conditions, neurogenic bladder |
|
|
Term
|
Definition
anticholinergic meds (oxytuinin, tolterodine, darifenacin, trospoum chloride, festerodine fumarate, solifenacin succinate)
tricyclic antidepressants (imipramine)
botulism toxin
toilet re-training |
|
|
Term
| results from chronic urinary retention |
|
Definition
|
|
Term
| causes of urinary retention (4) |
|
Definition
BPH
urethral strictures
neurogenic bladder
meds (psychotropics) |
|
|
Term
| tx of overflow incontinence |
|
Definition
| placement of urethral catheter (dx and therapeutic), further tx directed at underlying disease |
|
|
Term
|
Definition
| < 20 million sperm/ml of ejactulate |
|
|
Term
|
Definition
|
|
Term
| how long should you wait between semen analysis? |
|
Definition
|
|
Term
| how long does spermatogenesis take? |
|
Definition
|
|
Term
| consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse |
|
Definition
|
|
Term
|
Definition
|
|
Term
| if the pt wakes up with an erection what is the cause of his ED? |
|
Definition
|
|
Term
| orgnanic causes of ED (3) |
|
Definition
| smoking, alcohol, diabetes |
|
|
Term
| endocrine causes of ED (3) |
|
Definition
| hypogonadism, hyperthyroidism, elevated prolactin |
|
|
Term
| neurological causes of ED (3) |
|
Definition
| spinal cord lesions, MS, autonomic neuropathy |
|
|
Term
| pelvic surgery causes of ED (2) |
|
Definition
|
|
Term
| radiotherapy causes of ED (5) |
|
Definition
PVD
renal/hepatic fialure
BPH
penile abnormalities (post priapism)
Peyronie's disease |
|
|
Term
| causes of drug induced ED (8) |
|
Definition
antihypertensives (BB, diuretics)
digoxin
major tranquilizers
alcohol
estrogen
antidepressants
cimetidine
steroids |
|
|
Term
|
Definition
males over age 40, DM, dyslipidemia, HTN
psychological conditions
neurologic disease
renal failure
previous prostate cancer tx
previous groin trauma
hormonal d/o (thyroid, adrenal, pituitary)
drug use, smokers, alcoholics
obesity, sedentary lifestyle |
|
|
Term
| meds associated with ED (9) |
|
Definition
BB
thiazide diuretics, spirinolactone
clonidine
doxazosin, terazosin
antidepressants
cimetidine
ketoconazole |
|
|
Term
|
Definition
|
|
Term
| what test is done to differentiate between organic and psychologic ED? |
|
Definition
| nocturnal tumescence testing = injection of alprostadil |
|
|
Term
|
Definition
| behaviorally oriented sex therapy |
|
|
Term
| tx for ED pts with venous disorder of the penis who fail to achieve erection with vasoactive substance injection |
|
Definition
| vacuum constriction device |
|
|
Term
| how long should PDE-5 inhibitors be taken before sex? |
|
Definition
|
|
Term
| contraindications to PDE-5 inhibitors |
|
Definition
|
|
Term
|
Definition
| sildenafil, vardenafil, tadalafil, yohimbine |
|
|
Term
| what BPH and ED meds can be taken together? |
|
Definition
| tamsulosin (flomax) and tadalafil (cialis) |
|
|
Term
| SE of PDE-5 inhibitors (5) |
|
Definition
hypotension
temporary color vision disturbances
mild HA
facial flushing
priapism |
|
|
Term
| what are the basics of ED tx (5) |
|
Definition
regular exercise
healthy diet
smoking cessation
decrease alcohol intake
limit long distance cycling or change seat |
|
|
Term
| what is often the first indication of renal disease? |
|
Definition
|
|
Term
| what leads to increased urinary levels of urobilinogen and billirubin |
|
Definition
| hemolytic processes, or hepatic disease |
|
|
Term
| if urine is positive for glucose what do you do next? |
|
Definition
|
|
Term
| what can cause false positive urine test for ketones? |
|
Definition
| fasting, post exercise, pregnancy |
|
|
Term
| what do nitrites in the urine mean? |
|
Definition
bacteruria
many gram negative bacteria can reduce nitrates to nitrites |
|
|
Term
| most reliable urine for sample to test for nitrites |
|
Definition
|
|
Term
| what do leukocytes in the urine indicate? |
|
Definition
|
|
Term
| what can cause a false postive urine leukocyte esterase test? |
|
Definition
|
|
Term
| what should you do if urine is positive for blood? |
|
Definition
|
|
Term
|
Definition
| released by the posterior pituitary in response to several stimuli, acts on the collecting tubules to promote resorption of free water |
|
|
Term
| what stimulates release of ADH? |
|
Definition
increased plasma oncotic pressure
left atrial distention
exercise
certain emotional states |
|
|
Term
|
Definition
diabetes insipidus = kidney can't concentrate urine.
sxs = polyuria, polydipsia |
|
|
Term
|
Definition
central (lack of ADH)
neprhogenic (periphreal resistance to ADH) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| resportion of excessive amounts of free water with resultant hyponatremia. |
|
|
Term
|
Definition
| hyponatremia, cerebral edema, and resultant neurologic dysfunction |
|
|
Term
| normal electrolyte values: sodium, potassium, chloride, bicarb, anion gap |
|
Definition
sodium: 135-145
potassium: 3.5-5.0
chloride: 95-110
bicarb: 20-32
anion gap: 8-14 |
|
|
Term
|
Definition
| nausea, generalized weakness, mental confusion, seizures |
|
|
Term
| causes of hypovolemic hyponatremia (4) |
|
Definition
loss of fluid with hypotonic replacement
thiazide diuretics
K depletion in cells
aldosterone deficiency |
|
|
Term
| causes of euvolemic hyponatremia (5) |
|
Definition
SIADH
severe hyperglycemia
polydipsia
diuretics
hypothyroidism |
|
|
Term
| causes of hypervolemic hyponatremia (5) |
|
Definition
CHF
hepatic cirrhosis
overhydration
nephrotic syndrome
renal failure |
|
|
Term
| major defense agaisnt hypernatremia |
|
Definition
|
|
Term
|
Definition
tremors
irritability
ataxia
confusion
coma |
|
|
Term
|
Definition
| hypovolemic hypernatremia |
|
|
Term
| causes of hypovolemic hypernatremia (3) |
|
Definition
dehydration
profuse sweating
vomiting or diarrhea |
|
|
Term
| causes of hypovolemic hypernatremia (2) |
|
Definition
|
|
Term
| what electrolye disturbances are caused by DI? DM? |
|
Definition
DI = hypernatremia
DM = hyponatremia |
|
|
Term
| causes of hypervolemic hypernatremia (3) |
|
Definition
hypertonic saline/sodium bicarb tx
hyperaldosteronism
Curhsing's syndrome |
|
|
Term
| causes of hypokalemia (6) |
|
Definition
decreased dietary intake
diuretics
insulin
alkalosis
hypomagnesemia
hyperaldosteronism |
|
|
Term
|
Definition
|
|
Term
| causes of hyperkalemia (7) |
|
Definition
excess intake
acidosis
insulin deficiency
drugs (heparin, digoxin, cyclosporin)
ACEI
K sparing diuretics
decreased excretion (renal failure, hypoaldosteronism) |
|
|
Term
|
Definition
muscle weakness
cardiac arrhythmias/arrest
often fatal if not corrected |
|
|
Term
| ECG abnormality associated with hyperkalemia |
|
Definition
|
|
Term
| hyperchloremia parallels what? |
|
Definition
|
|
Term
| causes of hyperchloremia (3) |
|
Definition
dehydration
hyperventilation
excess loss of bicarb (via GI loss, renal tubular acidosis) |
|
|
Term
| causes of hypochloremia (3) |
|
Definition
prolonged vomiting
metabloic alkalosis
pyelonephritis |
|
|
Term
| know acid/base disorders, simple/mixed, and compensation appropriateness |
|
Definition
|
|
Term
|
Definition
AG = Na - (Cl + HCO3)
normal = 12 |
|
|
Term
| causes of high anion gap acidosis |
|
Definition
Methanol
Uremia
DKA/AKA
Paraldehyde
INH
Lactic acidosis
Ethylene Glycol
Salicylate (starvation) |
|
|
Term
| MC conditions of the urinary tract (3) |
|
Definition
1 = pathologic conditions of the prostate
2 = UTI
3 = urinary calculi |
|
|
Term
| when do kidney stones usually present? men or women more? |
|
Definition
3rd - 4th decade
MC in men |
|
|
Term
| 5 major types of kidney stones |
|
Definition
calcium oxylate, calcium phosphate
cystine
struvite
uric acid |
|
|
Term
| only kidney stone that is radiolucent |
|
Definition
|
|
Term
|
Definition
|
|
Term
| who is at increased risk of kidney stones? |
|
Definition
pts in hot, humid environments esp. during the summer months
decreased fluid intake
gastric bypass
HTN, obesity, DM
excessive PT
meds that crystalize the urine (indinavir, acyclovir, triamterene) |
|
|
Term
| gold standard for dx of kidney stones |
|
Definition
|
|
Term
| what size stones usually pass spontaneously? |
|
Definition
|
|
Term
|
Definition
| most can be tx conservatively with hydration, analgesics, and anti-emetics |
|
|
Term
| when is lithotripsy recommended for kidney stones? |
|
Definition
| smaller radiolucent stones < 1cm |
|
|
Term
| when is percutaneous nephrolithotomy recommended for stones? |
|
Definition
larger renal stones > 2 cm
proximal ureteral stones > 1cm |
|
|
Term
| urology referral indications for kidney stones (7) |
|
Definition
intractable pain
obstruction
stone > 5mm
infection
pt with a single kidney
pregnant pt
PMH of severe renal disease |
|
|
Term
| compliations of kidney stones (6) |
|
Definition
renal failure
ureteral stricture
infection, sepsis
urine extravasation
perinephric abscess
xanthogranulomatosus pyelonephritis |
|
|
Term
| what type of stone most commonly causes staghorn calculi? |
|
Definition
|
|
Term
| essentials of dx for acute glomerulonephritis (3) |
|
Definition
|
|
Term
| prevention of kidney stones (6) |
|
Definition
hydrate, hydrate, hydrate
watch diet (decrease salt/animal protein)
don't skip meals
be aware of your climate
preventative meds
stay active |
|
|
Term
| pt c/o dark "cola colored" urine, decreased urine volume, edema (periorbital, scrotal), HTN |
|
Definition
|
|
Term
| tx of acute glomerulonephritis |
|
Definition
goal = reduce inflammation
most cases = admit pt
aggressive reduction of HTN and fluid overload (salt & water restriction, diuretic therapy, possible dialysis).
may require corticosteroids, cytotoxic agents |
|
|
Term
| who has a better prognosis with acute glomerulonephritis |
|
Definition
|
|
Term
| heavy proteinuria, hypoalbuminemia, edema, hypercholesterolemia |
|
Definition
|
|
Term
| essentials of dx for nephrotic syndrome |
|
Definition
urine protein > 3.5g/24 hrs
hypoalbuminemia < 3g/dL
peripheral edema = hallmark! |
|
|
Term
| 1/3 of adult pts with nephrotic syndrome also have |
|
Definition
| systemic renal disease (DM, amyloidosis, SLE) |
|
|
Term
| 4 MCC of nephrotic syndrome |
|
Definition
minimal change disease (kids)
membranous nephropathy
focal glomerular sclerosis
membranoproliferative GN |
|
|
Term
|
Definition
monitor protein loss and intake (tx proteinuria with an ACEI or ARB)
tx edema (salt restriction, diuretics = thiazide or loop)
tx hyperlipidemia (diet, exercise, statin)
consider anticoagulation |
|
|
Term
| what can lead to hypercoagulability with nephrotic syndrome |
|
Definition
| serum albumin < 2g/dL --> prone to renal vein thrombosis, DVT, etc |
|
|
Term
|
Definition
|
|
Term
| causes of pre-renal failure (3) |
|
Definition
decreased perfusion from:
decreased intravascular volume
change in vascular resistance
low cardiac output |
|
|
Term
| causes of volume depletion in pre-renal failure |
|
Definition
| hemorrhage, GI loss, dehydration, excessive diuresis, pancreatitis, burns, trauma, peritonitis |
|
|
Term
| least common cause of ARF |
|
Definition
|
|
Term
| cause of post-renal failure |
|
Definition
| urinary flow from both kidneys or a single functioning kidney is obstructed (usually a urologic problem) |
|
|
Term
| MCC of post-renal failure |
|
Definition
|
|
Term
| what kind of drug puts you at risk for post renal failure? |
|
Definition
|
|
Term
| causes of post renal failure (6) |
|
Definition
urethral obstruction
bladder dysfunction/obstruction
obstruction of both ureters/renal pelvisies
bladder/prostate/cervical cancer
retroperitoneal processes
neurogenic bladder |
|
|
Term
| sites of injury in intrinsic renal failure |
|
Definition
| tubules, interstitium, vasculature, glomeruli |
|
|
Term
| causes of intrinsic renal failure (3) |
|
Definition
acute tubular necrosis
acute interstitial nephritis
acute glomerulonephritis |
|
|
Term
|
Definition
seen in concentrated urine, febrile disease, following strenuous exercise, during the course of diuretic therapy.
not specific for renal disease |
|
|
Term
|
Definition
| intraparenchymal bleeding, hallmark of GN |
|
|
Term
|
Definition
| pyelonephritis, interstital nephritis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| ATN, GN, tubulointerstitial disease |
|
|
Term
|
Definition
| form in tubules that have become dilated and atrophic due to chronic parenchymal disease. Frequently seen in CRF |
|
|
