Enlargement of the prostate. nodules on the urethra and resistance to urine flow. PSA elevated. voiding symptoms, hesitancy, poor flow, storage symptoms, frequency, nocturia, noctournal incontinence, urgencyDoes not lead to cancerTx: alpha blockers, 5-alpha-reductase
Benign Prostatic Hyperplasia
BPH complications:
Acute urinary retentionurinary tract infectionsbladder stonesbladder damagekidney damagehydronephrosis
Gold standard for surgical intervention for BPH
Trans-urethral Resection of the Prostate (TURP). Laser Vaporization of the prostate is also popular
Bladder exposed on the abdominal wall, pelvic bones widely separated, abnormal formation of the prostate, penis or female genitaliacongenital
Bladder Exstrophy
oligohydramnios (reduced amniotic fluid) causes renal agenesisSupernumerary or Duplicated Kidney
Potter's Syndrome (Potter's Sequence)
obstruction prevents flow of urine from the cyst
hydronephrossis
Exposed spinal cord enclosed in a sac on the child's back, nerve difficulties emptying the bladder
Spina Bifida
absence of one of both testes from the crotum.. seen at birth4-40 fold increase in testicular cancer
cryptorchidism
Venous plexus in the scrotumsee with transillumination. 15-30 yo can get this from abdominal ascities
Varicocele
Fluid around the testicle, from peritoneum wrapped around the testicle, called the tunica vaginalis
Hydrocele
Loss of support of the urethra due to damage to pelvic support structures as a result of childbirthLeaking small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and liftingdue to insufficient strength of the pelvic floor muscles to prevent the passage of urine
Stress urinary incontinence
Uninhibited contractions of the detrusor muscleLeaking of large amounts of urine with insufficient warning to get to in timeexercisinginvoluntary loss of urine occurring for no apparent reason while suddenly feeling the need to urge to urinate kegels helps
Urge Urinary incontinence
Pain is renal colic and comes in waves, symptoms include, nausea, vomiting, fever, blood in the urine and painful urination
Kidney stones
Most common kidney stone...shows up on x-ray
calcium oxalate
most common cause of kidney stones
dehydration
infection stones", often in the presence of infection by urea-splitting bacteria
Struvite stones
tx for uric acid kidney stones
allopurinol
muzzle"inability to retract foreskin from the glands of the penis (dital to proximal)non-emergent
phimosis
inability to replace the cover of the glans with the foreskinemergentthe foreskin becomes trapped behind the glans penis, and cannot be reduced to its normal position covering the glans peniscannot be pulled back over the glans into normal anatomical position
paraphymosis
opening of urethra is small
meatal stenosis
spermatic cord twists, cutting off testicle's blood supply, rapid onsetirreversible ischemia begins after 6 hourssudden, severe, testicular pain, and nausea
testicular torsion
bell-clapper deformity
congenital testicular torsion testis is inadequately affixed to the scrotum allowing it to move freely on its axis
Most common type of bladder cancer
transitional cell carcinoma
Pain during urination, frequent urination, urge to urinate
suspect bladder cancer
most common contributor to urinary bladder cancer
tobacco smoke30% workplace carcinogens
Usually no symptoms, but eventually symptoms include, frequent urination, nocturia, difficulty starting stream, hematuria and dysuria...agent orange
suspect prostate cancer
evaluation of prostate cancer
rectal ultrasound
two types of prostate cancer
adenocarcinoma and glandular cancer
Most common cancer in males aged 20-39 years, the most common to start, rarely seen before the age of 15 yearsFirst sign cancer is a lump or swelling in the testes
suspect testicular cancer
evaluation of testicular cancer
ultrasoundCT scansinguinal Do not perform biopsy-increases the risk of spreading into the scrotum
True or false if you suspect testicular cancer you should biopsy it
False. this can lead to it spreading into the scrotum
most common type of kidney cancer in adults
Renal Call Carcinoma
Symptoms include, blood in the urine (40%), flank pain (40%), mass in the abdomen or flank (25%), weight loss (33%), fever (20%), high blood pressure (20%), night sweats
suspect renal cell carcinoma
Classic Triad, Hematuria, Flank Pain and Abdominal Mass
Renal cell carcinoma
Risk factors for renal cell carcinoma
obesitysmokinghypertension
these patients are 30 times more likely than the general public to develop renal cell carcinoma
acquired cystic disease of the kidney
Typically occurs in childrenthe most common kidney tumor in kidsunilateralpainless abdominal tumor that can be easily felt
Wilms' Tumor (nephroblastoma)
bilateral Wilms' tumor
Denys-drash syndrome
Pelvic Pain and Abdominal Swelling (Bloating and Distention)hormone therapy after menopause, fertility medication and obesity
Ovarian cancer
suspect ovarian cancer
perform a laparoscopy
bleed, pain, rupturemost are benignclassified according to whether they are a variant of the normal menstrual cycle, called a Functional Cyst, or they are not normal
ovarian cysts
large vs giant ovarian cysts
large- over 5 cmgiant- over 15 cm
while large ovarian cysts are not usually prone to _____ they more commonly _____
rupturetwist
most common type of Ovarian Cyst (2 cm)
Follicular Cyst
common type of giant ovarian cysts
dermoid cyst
Amenorrhea with Infertility, Hirsutism and Enlarged Polycystic Ovaries
Polycystic Ovary Syndrome (PCOS), or Stein-Leventhal Syndrome
A String of Pearls" (on ultrasound) , abnormally large number of eggs, irregular or no periods or heavy periods, excess body and facial hair, acne, pelvic pain, trouble getting pregnant and patches of thick velvety skin
PCOS
most common from of vulvovaginitis
irritant vaginitis
biggest problem with osteoporosis
fractures
type of osteoporosis common in women after Menopause, due to the decrease in estrogen production after menopause
primary type 1
type of osteoporosis occurs after age 75 and is seen in females and males at a ratio of 2:1
Primary Type 2, Senile Osteoporosis
type of osteoporosis at any age equally, chronic predisposing medical problems, or prolonged use of medications such as glucocorticoids
secondary osteoporosis, Steroid-Induced Osteoporosis
risk factors for breast cancer
obesity, alcohol, hormone replacement therapy during menapause, ionizing radiation, early age at first menstruation, having children late or not at all
screening recommendations for breast cancer
Recommends screening every two years in women 50 to 74 years old
type of breast cancer with Peau d'orange
inflammatory breast cancer
type of breast cancer resemble eczema and redness
Paget's Disease
lumps in breast that cause discomfort
fibrocystic breast disease
Non-cancerous tumors composed of fibrous and glandular tissuebreast mice because they move around a lot, cause a lot of pain
fibroadenomas of the breast
the most common organism responsible for mastitis
S. aureaus
breast diseasefever, pain, erythema, rapid onset of symptomsEarly Stages, present with local pain, redness, swelling and warmthLater Stages, systemic symptoms like fever and abscess and develop very quickly without any warning
Mastitis
Non-puerperal Mastitis, lesions of the breast occurring unrelated to pregnancy and breastfeedingBreast tenderness or warmth to the touchSwelling of the breastPain Skin redness, often in a wedge-shaped patternFever of 101 F (38.3 C) or greaterShivering and chills
Mastitis
Non-puritic red rash palms and solesno scarring
secondary syphilis
granulomatous gummae on skin looks like SCC, also cardio and neuro symptoms
tertiary syphilis
when can treponemes (syphilis) cross the placenta?what can it cause in the infant?
10-15 weekskeratitis, malfromed teeth, facial deformation (saddle nose), CNS abnormalities
What type of cells does neisseria like to colonize?
mucosal non-ciliated, columnar epithelia cells
how soon after infection do gonorrhea appear?
2-7 days
Test for gonorrheaTX?
nucleic acid amplification testgram stain of dischargeIM ceftriazone + oral azithromycin or doxycycline
how does chlamydia affect women?Men?
Women- >80% asymptomatic, can ascend to upper genital tract and cause PID which can lead to tubal infertilityMen- most commonly Urethritis, asymptomatic in 30-40%rarely spreads upwards to epidymitis or prostate
Which STD can present with Reiters syndrom?
Chlamydia
Wet mount of vaginal discharge or urethral exudate in men reveals jerky, parasite cell movements
Trichomonas vaginalis
What is the most common cause of neonatal conjunctivitis in the US?
chlamydia
This contreceptive does not increase the risk for arterial and venous diseae.
DMPA, m
Implantation anywhere besides __________ is considered an ectopic pregnancy
endometrial lining
stomach pain in a woman suspect ______ 1st
ectopic pregnancy
premature separation of the placenta from its implantation site before delivery is a know risk factor for it is:
placenta abruptionhypertension
abnormally adherent placenta that has invaded into or beyond endometrium
placenta accreta
plaenta implants over the internal cervical os
placenta previa
how do you diagnose endometrial cancer?
Dilation and Curettage (D&C)pap smear is not sufficient
estrogen alone increases or decreases endometrial cancerestrogen plus progesterone increases or decreases endometrial cancer
increasesdecreases
tx for endometrial cancer
bilaterasalpingo-oophorectomy (total abdominal hysterectomy)
most common reason for a hysterectomy in the USalso most common benign tumor in females during middle and late reproductive years
uterine fibroid (leiomyoma)
uterine fibroid origninates from the _____ layer of the uterus
myometrium
if these ligaments rupture you have a high chance of having uterine prolapse most common caus3
Uterosacral ligamentstrauma during childbirth
true or false endometriosis is a risk factor for ovarian cancer
True
most common type of ovarian cyst
follicular cyst
most common endocrine disorder among women between 18 and 44
Polycystic ovary syndrome
How do you diagnose PCOS
Rotterdam criteria: (at least 2)no ovulation, high androgen levels, ovarian cysts
endometriosis improves or gets worse with menopause
improves
major cause of Cervical intraepithelial neoplasia
infection of the cervix with HPV 16, 18, 31, and 33
How often and at what age should pap smears be done?
every 3 years ages 21-65
most common type of Cervical cancer
SCC-90%Adenocarcinoma- 10%
what percentage of cervical cancers can be prevented with the HPV vaccine?what strains of hpv cause the most cervical cancer?
90%16 and 18 - 75%
What is the name of the HPV vaccines?what age is it give to?
Gardasil Cervarix9-26
most common causes of cervicitis
chalamydia-40%gonorrheaother infections
what device repairs serious cystoceles
pessary- holds the bladder in place
2 main causes of rectocele
childbirth hyesterectomyq
most vulva cancer is what type of cell
Squamous cell -90%2nd most common is melanoma (50-80 yo)
3 main types of vaginitis
Bacterial vaginosis- Gardnerellavaginal Candidiasis- CandidiasisTrichomoniasis
gold standard for surgical treatment of BPH
Trans-urethral Resection of the Prostate (TURP)Holmium Laser Enucleation of the Prostate up and coming
most common birth defect of male genitalia
cryptorchidism
Which one of these reasons would you not correct an undescended testicle herniapaintumortorsion fertility
pain
Kegel exercise will help which type of incontinencestressurge
stress
pain from a kidney stone can be confused with pain from ________
retroperitoneal abdominal aortic aneurysm
men with bell clapper deformity are more susceptible to
testicular torsion
in which one of these is the cremasteric reflex typically presenttesticular torsionepididymitis
epididymitis
testicular torsion results in the surface of the testicle being rotated toward or away form the midline
towards
most common type of bladder cancer is know as _____ cell carcinoma aka _____ cell carcinoma
transitionalurothelial
how do you diagnose bladder cancer?most common symptom?
biopsy during systoscopyhematuria
which of these is not a risk factor for prostate cancerobesityred meat consumptionfamily historysmokingracemilk productshigh blood pressure
...
which of these is not a common symptom of testicular cancer?strotal heavinesslow back paindysuriagyenocomastia
dysuria
tumor markers for tsticular cancer
AFPHcgLDH-1
most testicular cancers arise fromgerm cellsleudig cells sertoli cells
germ cells
most common cancer in men age 20-40most common kidney cancer in adults
testicular cancerRenal Cell Carcinoma
which of these is not a sign of Renal Cell carcinomaAbdominal mass Flank painblood in the urineincreased urgencyfeverhigh blood pressure
increased urgency
Triad of Renal Cell Carcinoma
Abdominal massFlank painHematuria
why do patients with RCC develop anemia
depression of eerythropoietin
protytipal patient with wilm's tumor
adolesenet without developmental abnormalitiesunilateral nephroblastomas
true or false you biopsy a Wilm's tumor
False
Which of these is not indicative of renal failureoliguriahematuriasudden increase in creatine and BUNdecrease in kidney function
hematuria
what is the major complication with acute tubular necrosis
Hyperkalemia
classic triad of interstitial nephritis
feverrasharthralgia
triad of nephritic syndromeusually result form what bacteria
oliguriahypertension edemastrep pyogens not involving the kidney
blood in the urine, decrease in amount of urine, presence of HTN
Nephritic syndrome
acute post strep glomerulonephritis results from a strept infection of the kidney
Falseusually 1-4 weeks after pharyngeal infection
triad of glomerulonephritis
oliguriaedemahypertension
What test can show all of theseinfectionformed elementshematuria proteinuria
...
This urine cast is not indicative of renal diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
hyaline casts
This urine cast is present after strenuous exercise and ferbile diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
hyaline casts
This cast is indicative of glomerulonephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
red cell casts
This cast is indacative of pyelonephritis or interstitial nephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
White cell casts
These indicate acute tubular necrosis or interstitial nephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
renal tubular cell casts
these are indicative of chronic kidney diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts
broad waxy casts
gold standard for evaluating gfr
cockcroft-gault equationccr=(130-age)weight(kg)/Pcr72)pcr is serium creatineccr is creatine clearance
which one of these would you not see an elevated BUNHeart failureGi bleedPredinose useCentral DIRenal artery stenosisLiver diseaseSIADH
Central DI
most common cause of intrinsic acute kidney injury
acute tubular necrosis
membranous neuropathy makes us suspicious of what
hep b and carcinoma
most common cause of end stage renal disease in the US
diabetic neuropathy
when would you start dialysis on a patient with ESRD
when gfr is 10 ml/min/1.73m2when gfr is 10-15 with uremic sx, fluid overload not responsive to diuresis, and refractory hyperkalemia