Term
| where is the most common site of bacterial infection? |
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Definition
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Term
| what is the most common infection in sexually active females? |
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Definition
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Term
| what is the most common abdominal mass in newborns? |
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Definition
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Term
| what is the most common CA in men overall? in men 15-40 yrs old? |
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Definition
| prostate CA and testicular CA respectively. GU CA makes up 40% of all CA in men. |
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Term
| where is the most common site of congenital anomalies in the body? |
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Definition
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Term
| what % of nursing home pt does urinary incontinence affect? |
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Definition
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Term
| which ribs protect the kidneys? what trauma is associated with their fracture and kidney injury? |
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Definition
| ribs 9-12 - which MVAs commonly can fracture |
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Term
| how can fracture/dislocation of the spine affect urinary function? |
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Definition
| fracture/dislocation of the spine can lead to voiding dysfunction |
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Term
| what does the pelvis protect? |
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Definition
| the bladder, prostate and urethra (also vulnerable to MVA) |
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Term
| what do the kidneys lie anterior to? |
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Definition
| the psoas major muscles and 10-12 ribs |
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Term
| what is the innervation to the bladder? |
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Definition
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Term
| what portion of the bladder is covered by the peritoneum? |
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Definition
| the dome and posterior surface - if perforation of bladder (such as in trauma or iatrogenically) urine will be found in abdominal cavity and cause peritonitis (if perforation occurs where there is not peritoneum, the urine will stay localized) |
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Term
| can the prostatic urethra and prostate gland be separated? |
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Definition
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Term
| what is often associated with ED? |
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Definition
| CAD (aging produces atherosclerosis) |
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Term
| why is it important to know that the autonomics of the GI and upper urinary tract are the same? |
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Definition
| b/c the symptoms may be the same, for ex: n/v |
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Term
| what is an easy way to indirectly assess the innervation to the external urinary sphincter? |
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Definition
| evaluation of the external anal sphincter - which shares innervation with the external urinary sphincter |
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Term
| what is the venous drainage for either testicular vein and the related possible pathological implications? |
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Definition
| the *L testicular vein empties into the L renal vein, and if it becomes occluded, can result in varicocele - *most common cause of male infertility*. the R testicular vein empties into the vena cava, obstruction of which can produce bilateral lower extremity edema. renal CA can also extend into the renal vein/vena cava. |
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Term
| what role do abdominal lymphatics play in urogenital CA dxes? |
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Definition
| abdominal lymphatics are important in staging/evaluating the extent of malignancy. prostate and bladder cancers spread to pelvic lymph nodes and kidney tumors spread to para aortic and paravertebral nodes. in bladder cancer and prostate cancer, removal of nodes often increases curability |
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Term
| what characterizes kidney pain? |
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Definition
| dull-severe, constant, unrelenting pain at the costovertebral angle *unaffected by movement* which occurs w/sudden distention of the renal capsule. (radiculitis may mimic this - but is affected by movement). |
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Term
| what usually characterizes ureteral pain? |
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Definition
| ureteral pain is severe, crescendo-like, radiating down from the kidney and may extend to the testicle/labia. the *most common cause is passage of a kidney stone.* ureteral pain, like kidney pain is unaffected by movement/body position. |
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Term
| what characterizes vesical/bladder pain? |
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Definition
| vesical/bladder pain usually occurs w/over-distention and is associated with extreme urgency. if an infection is involved, burning sensations are usually experienced w/urination. |
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Term
| what characterizes prostate pain? |
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Definition
| prostate pain presents as discomfort in the peritoneal area, low back or rectum and is almost always associated with urinary symptoms. |
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Term
| what characterizes testicular and epidymal pain? |
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Definition
| testicular and epididymal pain can be dull or very severe and may radiate to the RLQ (could mimic appendicitis). |
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Term
| what are symptoms related to urination? |
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Definition
| urgency, increased frequency, dysuria, nocturia, hematuria, enuresis, incontinence, and pneumaturia |
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Term
| what is increased urinary frequency? causes? |
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Definition
| urination greater than 3-5x daily which may be due to increased oral fluids/diuretics, incomplete emptying (common w/enlarged prostate), systemic disease (DM), neurological disease (multiple sclerosis), and reduced bladder capacity. the 2 functions of the bladder are storage/evacuation of urine. |
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Term
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Definition
| the sudden compelling desire to pass urine which is difficult to defer. urinary urgency may occur with *inflammatory conditions involving the lower urinary tract, *neurogenic bladder dysfunction, and *loss of voluntary inhibition of bladder contraction. incontinence occurs when urgency is severe enough. |
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Term
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Definition
| painful urination, a burning sensation related to inflammation of the bladder, prostate, or urethra. dysuria is usually associated with increased urgency and frequency (triad of inflamed bladder). |
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Term
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Definition
| a very common complain, characterized by the pt waking up in order to urinate. it may occur in the absence of disease (increased fluids/diuretics) or with inflammation, increased 3rd compartment fluid (CHF/venous insufficiency - check for pitting edema), incomplete bladder emptying (BPH), neurogenic bladder dysfunction, and decreased bladder capacity. |
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Term
| why is hematuria so important? |
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Definition
| it is the most common symptom of urethral CA. the most common cause of hematuria however is infection. hematuria is also present in almost every stone pt. the blood in the urine may be microscopic or gross, and more than 3 RBCs per high powered field 2x is significant. |
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Term
| how can the different presentations of hematuria direct your dx? |
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Definition
| color: bright red = active bleeding, pink = no active/aggravated cause, rust/wine = old blood. clots: if present, pt should be hospitalized due to significant bleeding. time of appearance during urination: red urine entire urination (total gross) = bladder/upper tracts affected, red urine only at start of urination = distal prostate/ant. urethra, and red urine only at end of urination = prostatic urethra. |
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Term
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Definition
| any involuntary loss of urine, if it occurs at night, it is qualified w/"nocturnal". noctural enuresis is a normal occurrence in children up until age 4 and may be functional or due to delayed maturation of the micturation center. when occurring during the day, enuresis may be associated with more severe pathology requiring a complete evaluation. |
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Term
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Definition
| involuntary loss of urine with or w/o sense of urgency of which there are several kinds: *stress incontinence - weakness of sphincter w/coughing etc, *urge incontinence - inability to voluntarily inhibit detrusor contraction, *paradoxical/overflow incontinence - involuntary loss of urine b/c bladder due to pressure, and *mixed incontinence - combination of urge/stress incontinence. |
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Term
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Definition
| gas passage in urine, which is uncommon and usually due to a gas forming infection (rare) or rectal/sigmoid fistula (more common) |
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Term
| what characterizes urethral discharge? |
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Definition
| usually due to an STD, chlamydia being the most common, followed by gonorrhea. urethral discharge may also be due to nonbacterial prostitis and is usually associated with burning. |
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Term
| what are symptoms of obstruction to bladder outlet? |
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Definition
| slowing of stream (usually progressive, normal flow should be 20ml/sec), hesitancy, straining, triad of frequency/urgency/incontinency, feeling of incomplete emptying, nocturia, and inability to void (acute and chronic) |
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Term
| where are important places to look in terms of the entire body of a GU pt for possible signs of pathology? |
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Definition
| head/neck: face, nodes, masses. chest: breasts/axillary nodes. abdomen/flank: masses, tenderness, organomegaly. external genitalia: masses, tenderness (palpate, transilluminate, inspect). prostate: size, consistency, symmetry, tenderness, masses (massage). the lower extremities: edema. |
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Term
| if the scrotum does transilluminate, what is a possible dx? |
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Definition
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Term
| how should the abdomen and external genitalia be examined? |
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Definition
| in the *upright and *supine position, b/c a hernia and varicocele may be missed in the supine position |
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Term
| what is the most common cause of male infertility? |
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Definition
| varicocele, which is dilated veins in the scrotum and only palpable when the pt is standing |
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Term
| how should the DRE be performed? |
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Definition
| in the knee chest or upright bent over position w/360 degree rotation |
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Term
| what is the morphology of the prostate? |
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Definition
| ~4 cm in diameter (chestnut size). the prostate has lateral sulci which deepen and a median furrow which obliterates w/gland enlargement. consistency of the prostate is similar to the thenar eminence and it should be slightly mobile, starting laterally and moving posteriorly. |
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Term
| does consistency change with BPH? |
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Definition
| no, it shouldn't. the median sulcus however will flatten as the gland enlarges. |
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Term
| how is CA of the prostate palpated? |
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Definition
| as a change in consistency more than a distinct lump |
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Term
| how are the abdomen and flanks examined? |
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Definition
| bimanually w/the pt lying down, one hand pushes down and the other pushes up, starting light and moving to deeper palpation. if the pt is complaining of increased urinary frequency/urgency, the bladder should be palpated as an empty bladder should not be palpable. if pressure on the bladder increases the pt's urge to urinate, even after they have previous to the exam, this is referred to as *voidance. inguinal nodes, hernias (standing position), tenderness, guarding, and palpable masses should be assessed. |
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Term
| what should be assessed when evaluating the male penis? |
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Definition
| if there is a prepuce and whether it is retractable, stenotic, fissured, ulcerated, free of lesions (condyloma acuminata - HPV), if there is a phimosis (narrowing of distal prepuce - common in DM pts), stenosis/lesions of urethral meatus, and if the presence of fibrosis in the shaft (peyronie's disease). |
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Term
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Definition
| a redundant prepuce which is somewhat stenotic which makes it hard to retract so you cannot observe the penis underneath |
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Term
| what should be assessed when evaluating the male scrotum/scrotal contents? |
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Definition
| the skin should be inspected for lesions (condyloma acuminata), the testes should be palpated bimanually for size/consistency (hardness/mass: consider malignant), check for absence of testes (cryptorchidism - undescended testicle - more likely to develop CA), transilluminate to differentiate fluid/solid tumors, and palpate cord structures/epididymus |
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Term
| what is an incarcerated hernia? |
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Definition
| a hernia too large to be squeezed back into the abdomen - can strangulate and become necrotic segment of bowel if not fixed |
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Term
| how does a hydrocele occur congenitally? |
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Definition
| the descending testicle drags the peritoneum along with it through the inguinal ring, where it should fuse and create the tunica vaginalis - but if it doesn't and remains patent, fluid or bowels may eventually pass through the space and create hydrocele (most common scrotal enlargement). |
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Term
| what needs to be evaluated on the female vagina and introitus? |
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Definition
| the labia, vaginal mucosa, urethral meatus, hymenal ring and clitoris. r/o bladder/urethral prolapse, palpate urethra/pelvic structures bimanually, and check for vaginal discharge. |
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Term
| what is a cystourethrocele? |
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Definition
| bladder prolapse. the bladder and urethra should be parallel to the floor, but they can drop down lower. generally pts w/this will present with stress incontinence. if the bladder extends beyond the introitus, this is referred to as a 3rd degree cystocele and the pt is that much more susceptible to UTIs due to inefficient emptying. |
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Term
| what does the GU neurologic exam consist of? |
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Definition
| evaluation of: deep tendon reflexes (particularly with frequency/urgency/incontinence), the bulbocavernosus reflex (common innervations to clitoris/glans penis - squeezing/pinching either should contract anal sphincter), the sensation of perianal skin, and urodynamic examination (more complicated voiding problems) |
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