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105 Cards in this Set
- Front
- Back
I. What is good for looking for renal obstruction or stones?
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1. IVU
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a. KUB=
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Kidney, Ureter, Bladder plain film xray of the abdomen
b. Limited in scope |
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What is one concern with use of IVU?
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allergic reaction to IV contrast
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What is a risk in using a retrograde ureterogram?
advantage? |
If there is a stone, you can dislodge it or move it up the urinary tract
No risk of alergic reaction, you putting the dye in directly to the ureter |
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what will give you a good picture of the bladder? What will this study help you see?
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VOIDING CYSTOURETHROGRAM (VCUG)
diagnostic of vesicoureteral reflux |
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What is best for seeing a renal mass versus cyst?
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Ultrasound
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what can measure post void residual CC in the bladder?
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Ultrasound
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what do you use to diagnose renal calculi?
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Non contrast spiral CT used to locate renal calculi.
again no risk of allergic rxn |
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renal masses, pathology, and to delineate btw renal mass and cyst...not ultrasound
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CT
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What gives clear deliniation of masses, if you can't tell what something is on CT?
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MRI
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narrowing of the glans penis, normally found in newborns, can be due to trauma. What is this?
Can be a cause of in little kids? |
urethral meatal stenosis
can cause obstruction so they cannot void...thus after using the bathroom little kids still have urine in them, so when they go to bed, they wet it |
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. Inflammation of prepuce (foreskin) associated with the inability to retract the prepuce over the glans penis =
What is this associated with? tx? |
PHIMOSIS
Often associated with balanitis – inflammation of the glans penis circumcision |
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what is PEYRONIE’S DISEASE
what is the pathology behind it? |
Angulation of penis during erection
. Pathology – fibrosis of the tunica albuginea of the corpus cavernosum, the tunica can then no longer stretch, causing the angulation |
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Dude goes to bone a chick. He slangs his thang out and is like, yeah bitch, thats whats up. As he starts to get an erection his dong hooks and he can't insert. The girl laughs, and he tries to explain that he simply has...
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Peyronie's disease
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POTABA and large doses of Vit E will help treat what?
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Peyronies (hooked dick)
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this is a STD that grows in warm moist places (like foreskin). Looks like the dude dipped his wang in cauliflower. What is this? What caused it? Tx?
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CONDYLOMATA ACUMINATA
Caused by HPV Laser surgery |
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this is usually caused by syphilis and is painless. Can be found on the glans penis, it will not have a purulent exudate
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Syphylitic (Hard Chancre)
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this is usually very painful, the base of the chancre is usually purulent. Due to what?
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Chancroid (Soft chancre)
Hemophylis ducreyi |
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TPA can help you find what?
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spirochetes in Hard Chancres
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what can be a distinguishing feature btw hard and soft chancres?
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soft May have painful inguinal lymphadenopathy
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in order to diagnose gonococcal urethritis, what must you see?
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Gonorrhea IN THE CYTYOPLASM OF THE CELL
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what is the clap?
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gonorrhea
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which form of urethritis is more common: gonococcal or non?
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nongonococccal
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Thick yellow purulent discharge is associated with what urethritis?
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Gonococcal
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Pt may not even know they have a discharge, but could have dysuria or clear discharge...what type of urethritis?
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Nongonococcal
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If you diagnose either Nongonococcal or Gonococcal or even Syphilis, what do you need to do?
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examine the sexual partner(s)
you dirty human |
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URETHRAL MEATAL STENOSIS in females may cause what?
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recurrent UTI
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In young males may be what can be a cause of enuresis
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Urethral meatal stenosis
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most common site of urethral meatal stenosis?
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Bulbous urethra – most common site
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in congenital meatal stenosis, what can be a cause of this obstruction? 2
which is more common |
posterior urethral valves :more common
anterior urethral valves these are near the urethral sphcinter, and they are remnants from a structure that should have been removed after birth, but remains, and can lead to bed wetting/retention |
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this will cause urine to leak out of the tear, leading to difficulty in voiding, can cause scrotum swelling and lower abdominal pain
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Total avulsion of the urethra
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What do you make sure you NEVER do for a partial urethral avulsion?
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NEVER CATHETERIZE. May convert partial to total avulsion
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dude comes in with after a motorcycle injury and has swelling in the scrotum, lower abdominal swelling, and blood from the urrethral meatus....
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Total urethral avulsion
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What are the 2 types of prostatitis? which is most common
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bacterial
non-bacterial- most common |
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pt comes in with dysuria, frequency, fever, hesitancy, and perineal discomfort.. What are you thinking? what feature of this problem distinguishes it from another type?
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Bacterial prostatitis
bacterial will have high temp |
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pt has a clear white discharge with minimal dysuria, frequency, hesitancy, and perineal discomfort.. What do they have?
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Non-bacterial prostatitis (the white charge is due to the prostatic secretions)
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how do you treat someone with non-bacterial prostatitis?
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Stop alcohol and caffeine use
hot tub baths Cipro (or Bactams) |
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which form of prostatitis will be loaded with white blood cells?
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Bacterial
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if you suspect bacterial prostatitis what should you NOT do
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OMIT THE DIGITAL RECTAL EXAM
that thing is super tender, also, can spread the bacteria and lead them to be septic |
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what leads to BPH
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long time testosterone
age |
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What is BOOS? what is it seen in commonly?
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Bladder outlet obstruction symtoms
BPH |
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a 60 year old man comes to your office complaining of having to urinate frequently, decreased urinary stream, have to get up at night, when he finishes he still feels like he has to go...what does he likely have?
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BPH
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what do you need to do to look for carcinoma of the prostate?
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Digital rectal exam and PSA
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PSA < 4.0
PSA >4.0 |
PSA < 4.0 : benign
PSA >4.0: carcinoma |
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what is Free PSA? when do you do it?
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PSA that is not conjugated with a protein
When a person has a large prostate and high regular PSA...it will help you distinguish carcinoma or not less free PSA is associated with Carcinoam |
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Free PSA >25-29%
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benign disease
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Free PSA <7%
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carcinoma
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tx for BPH?
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alpha blockers and 5 alpha reductase inhibitor
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typical symptoms of carcinoma of the prostate?
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BOING
usually assymptomatic |
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if you are black, what age do you start getting PSA? white? family history of cancer?
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black: 40 annually
white: 50 annually history: 40 annually |
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you are doing a digital rectal exam and feel a rock hard prostate..what is likely going on?
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Carcinoma of the prostate
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hyperechocic areas on transrectal ultrasound is suspicious of what?
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prostate Carcinoma
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what must you have before you can treat a pt for with carcinoma?
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tissue positive of cancer...
F'in Obamacare. |
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The higher the PSA the higher the what?
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Malignancy
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Gleason score >8 pt will have what?
** |
recurrent Malignant disease
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if you do a prostatectomy, what are some important post surgical problems?
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could be incontinent (try for less than 1%)
also will not be able to bone (no erection) |
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given the option of radiation or prostectomy, what would you probably try?
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radiation
longevity is about the same procedure is more well tolerated, can be done on an outpatient basis |
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in cystitis, what gets inflammed leading you to feel like you have to pee
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trigone
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why do you do a urine culture and sensitivity for a pt with cystitis?
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grow out the specific bacteria and can treat them with the right ABX
this will stop recurrent infection |
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if a person has recurrent UTIs, what do they require?
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UROLOGICAL CONSULT
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how do you differentiate btw bladder carcinoma and hemorrhagic cystitis
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hemorhaggic: burning on urination
cancer: painless hematuria |
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woman with gross hematuria, painful, getting up at night, miserable, urine loaded with WBC
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HEMORRHAGIC CYSTITIS
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35 year old woman presents with bladder pain as it fills with urine. They get suprapubic pain that is relieved by voiding. Pt also has frequency, urgency, and nocturia (even up to every 20 minutes)
What does she have? What will the urinalysis be like? |
INTERSTITIAL CYSTITIS
Urinalysis will be normal! (sterile urine) |
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what causes INTERSTITIAL CYSTITIS?
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the interstitium becomes inflammed and you get fibrosis of this layer of the bladder
it is no longer elastic and stretchy, as it stretches, you are tearing the interstitial area of the bladder. they will end up having a smaller bladder giving them the need to urinate |
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as you distend the bladder you start to see hemorrhagic areas showing up in the mucosa...what is this called? seen in?
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glomerulations
INTERSTITIAL CYSTITIS |
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what is BCG? what is it a possible tx for?
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initiates immune response in the bladder
interstitial cystitis |
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most common carcinoma of the bladder?
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Transitional Cell Carcinoma (TCC)
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adenocarcinoma will form in what 2 places?
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dome- fetal urachus
or trigone both are glandular |
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Squamous cell carcinoma is the largest cause of bladder cancer where?
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EGYPT
due to schistosomiasis |
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Painless gross hematuria always requires a urological eval... why?
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they could have CARCINOMA
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Biggest cause of Transitional Cell Carcinoma?
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SMOKING
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pt with recurrent transitional cell carcinoma is treated how?
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Instill BCG into the bladder
this initiates an immune response in the bladder that allows them to fight off the cancer aka this is fucking badass |
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if the muscularis is invaded of the bladder, what is the tx? what about adenocarcinoma? what about squamous?
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cystectomy for all
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What normally leads to stone formation?
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bladder obstruction (urine stagnation)
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folley catheter can lead to what problem
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you can have a piece flake off and cause a stone!
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what is the key to treating stones?
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treat the underlying problem
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how do you get a diverticuli?
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weakness in the detrusor muscle that allows a small sack to pouch out off the bladder
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what 2 things can lead 2 bladder diverticuli?
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1) Secondary to bladder outlet (have to push hard to get urine out and blow out the detrusor muscle!)
2) Secondary to neurogenic bladder (get a spastic high pressure bladder) |
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if you see Christmas tree bladder what is going on?
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the bladder has multiple diverticula, normally due to neurogenic bladder
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pt presents with recurrent UTI but is otherwise asymptomatic. this can normally be due to high pressure on the bladder and may have a stone sitting just outside the bladder on xray
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Diverticuli
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what is the normal cause of epidiymitis?
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normally secondary to abacterial prostatitis
the secretions from the prostate and get pumped backwards can be viral or mumps NOT BACTERIAL normally |
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pt comes in with pain in the scrotum. May have some swelling and has fever. What do they have? What can this be secondary to?
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EPIDIYMITIS
post strenuous work (will push on prostate and cause secretions to push back) |
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what is Prehn’s sign?
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elevation of the testie that relieves pain
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how do you rule out torsion of the testis?
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Nuclear scan (will not show up hot)
look for blood flow to the testis |
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Tx for epidiymitis?
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. Bed rest
b. Scrotal support c. Warm soaks or sit baths d. Force fluids e. Antibiotics - Keflex or Doxycycline for 21-28 days f. Anti inflammatory/analgesics |
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what is a non-tender mass on the testis?
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hydrocele
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2 keys to the physical exam for hydrocele?
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transluminate
rule out testicular mass |
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If you transluminate a mass on the teste, what must you do next? What will confirm that you only have a hydrocele?
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Ultrasound of the testis
nice non-echoic mass with nothing in it=hydrocele |
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What causes a spermatocele?
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rete testes or ducts in the epididymis
becomes obstructed and causes a mass |
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What will be different on aspiration of fluid for a hydrocele and a spermatocele?
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Hydrocele:clear fluid
Spermatocele: sperm |
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blockage of a duct conveying sperm=
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spermatocele
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Symmetrical well demarcated mass usually in area of head
of the epididymis (may occur anywhere in epididymis) 2) Usually non tender 3) Transilluminates if large 4) Usually can palpate testis as separate organ |
spermatocele
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why do you NOT cut out spermatoceles?
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people will end up with a painful scar...
get chronic testicular pain |
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what can lead to testicular torsion
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inproper development of the gubernaculum (remember this is what is responsible for pulling the ball down and keeping it in place; without it, you get a bell clapper teste that can let that bad boy slang all over the place)
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man comes in with an acute onset of severe pain in the scrotum. they can't sit still and nothing relieves the pain, lifting the testes does not help. What do they have?
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Torsion
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mother brings in one year old child because he won't stop crying and is writhing around in pain. The child has been crying for sometime with no seeming relief of what is ailing him. The mom is concerned. You are thinking?
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Torsion
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painful ball, one higher than the other and one with swelling. What should you do next?
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Nuclear scan, look for blood flow to the testes
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How long do you have to treat a torsion?
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6-8 hours or you are going to lose that ball
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Tx for torsion of the testes
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orchiopexy (fix the testes in place) of BOTH sides
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what is a positive Prehn's sign
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lift the ball and the pain goes away
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painless hematuria=
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bladder cancer
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Female pt. presents after repeated infection and obstruction of periurethral glands (GC, Normal Vaginal Flora). She complains of having to pee a lot, pain on intercourse, and post micturation dribbling.
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Diverticuli
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N. gonorrhea gram stain and shape?
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Gram -
diplococci |
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Good test to order if you are looking for metastases of Prostate Cancer
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Bonescan
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T/F
Females have a shorter urethra and are therefore more likely to get UTI/Cystitis |
True
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