The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint
- 9 types of GU tract conditions
- 6 types of infectious and inflammatory conditions
- 5 types of GU neoplastic diseases
- 7 types of renal diseases
- 2 types of fluid and electrolyte disorders
- Acid Base Disorders
Total: 30 conditions
GU Blueprint Course
GU Tract Conditions (PEARLS)The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint includes 9 GU tract conditions |
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Benign prostatic hyperplasia | In men with BPH, avoid use of anticholinergic and antihistamines
PSA is often ↑ in BPH - correlate with risk of symptom progression
Treat with 5-α reductase inhibitors - finasteride and dutasteride (androgen inhibitor - inhibits conversion of testosterone to dihydrotestosterone suppressing prostate growth, and reducing bladder outlet obstruction) has positive effect on clinical course of BPH α-1 blockers - tamsulosin (flomax) most uroselective provides rapid symptom relief - smooth muscle relaxation of prostate and bladder neck decreases urethral resistance and obstruction which increases urinary flow can cause dizziness and orthostatic hypotension as well as retrograde ejaculation |
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Congenital abnormalities | Vesicoureteral reflux (VUR) is retrograde passage of urine from the bladder back into the ureter and collecting system - diagnosed with VCUG
Hypospadias and Epispadias urethra opens onto the underside/topside of the penile shaft |
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Cryptorchidism (ReelDx) | If testicles non-palpable at 6 mo well-child exam, refer to urology/surgery for evaluation and possible orchiopexy, ↑ Risk in premature infants 30%, if not repaired risks infertility | |||||||||||||||
Erectile dysfunction | Phosphodiesterase 5 inhibitors: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), do not use with nitrates may cause hypotension | |||||||||||||||
Hydrocele/varicocele (ReelDx) | (+) transillumination - hydrocele
Bag of worms in scrotum - varicocele (made worse when patient is upright and improves when patient is supine) |
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Incontinence | Stress incontinence - results from activity such as laughing or coughing
Urge incontinence - results from an overactive detrusor muscle |
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Nephrolithiasis/urolithiasis (ReelDx) | Extracorporeal shock wave lithotripsy is indicated in patients with stones greater than 6 mm in size or intractable pain.There are four major types of stones:
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Paraphimosis/phimosis | Paraphimosis - Inability to return foreskin to normal position causes tourniquet effect, is a medical emergency
Phimosis - Inability to retract the foreskin, usually resolves by age 5, betamethasone topically, if no improvement circumcision |
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Testicular torsion | Asymmetric high riding testicle “bell clapper deformity”, Negative prehn's sign (lifting of testicle will not relieve pain) | |||||||||||||||
GU Infectious and Inflammatory Conditions (PEARLS)The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint includes 6 infectious and inflammatory conditions |
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Cystitis | Cystitis is an infection of the bladder and is characterized by dysuria without urethral discharge, E. coli (M/C)
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Epididymitis | + Prehn's sign = relief with elevation of the scrotum is a classic sign | |||||||||||||||
Orchitis | > 25 % are associated with MUMPS, swollen testicle with erythema and shininess of the overlying skin, age <35 or sexually active postpubertal males (cover for GC/Chlamydia) | |||||||||||||||
Prostatitis | Etiology is based on patient's age and risk factors
If you suspect acute prostatitis do not massage the prostate this can lead to sepsis! |
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Pyelonephritis | Fever + flank Pain + nausea and vomiting + CVA tenderness + white blood cell casts in urine, 7 days of cipro or levaquin | |||||||||||||||
Urethritis | Urethritis is an infection of the urethra with bacteria (or with protozoa, viruses, or fungi) and occurs when organisms that gain access to it acutely or chronically colonize the numerous periurethral glands in the bulbous and pendulous portions of the male urethra and in the entire female urethra | |||||||||||||||
Neoplastic Diseases of the Genitourinary System (PEARLS)The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint includes 5 GU neoplastic diseases |
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Bladder cancer | Painless hematuria in a smoker, transitional cell carcinoma is the most common type | |||||||||||||||
Prostate cancer | PSA is considered normal < 4
PSA > 4 think BPH, prostate CA and prostatitis What is the recommended age to start annual prostate screening? White male average risk: 50 years old - Black male, + FMHX or + BRCA mutations: 40 years old |
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Renal cell carcinoma | Classic triad of flank pain + hematuria + painless abdominal/renal mass
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Testicular cancer | Firm, painless, nontender testicular mass, seminoma is the most common type (60%), Risk factors include history of cryptorchidism | |||||||||||||||
Wilms tumor (ReelDx) | Child with painless, unilateral abdominal mass with no other signs of symptoms, also known as nephroblastoma | |||||||||||||||
Renal Diseases (PEARLS)The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint includes 7 types renal diseases |
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Acute renal failure (ReelDx) |
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Chronic kidney disease | CKD is progression of ongoing loss of kidney function (GFR) defined as less than 60 mL/min/1.73 m² or presence of kidney damage (proteinuria, glomerulonephritis or structural damage from polycystic kidney disease) for > 3 months
Measurement of GFR is the gold standard - The Cockcroft - Gault formula (requires age, body weight and serum creatinine) or Modification of Diet in Renal Disease equation Management includes Blood pressure control < 130/80, ACE or ARB, A1c 6.5-7.5% Patients with chronic renal failure typically present with hypocalcemia, hyperphosphatemia, and metabolic acidosis |
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Glomerulonephritis (Nephritic Syndrome) | Immune-mediated glomerular inflammation results in glomerular damage which results in urinary protein and RBC loss
Several etiologies of acute glomerulonephritis
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Hydronephrosis | Often the result of obstruction or infection, treat underlying cause | |||||||||||||||
Nephrotic syndrome (ReelDx) | Glomerular damage results in increased urinary protein loss
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Polycystic kidney disease | Associated with cerebral aneurysms, autosomal dominant genetic disorder, no cure, treat with BP control | |||||||||||||||
Renal vascular disease | Renal arteriography = GOLD STANDARD for diagnosis, renal artery bruit, patient placed on ACE who develops renal failure think renal artery stenosis | |||||||||||||||
Fluid and Electrolyte Disorders (PEARLS)The NCCPA™ PANCE and PANRE Genitourinary Content Blueprint requires includes 2 fluid and electrolyte disorders |
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Hypervolemia - disorders of water excess (hyponatremia)
Increased free water = decreased serum sodium = hyponatremia |
Plasma sodium concentration of less than 135 mEq/L (Hyponatremia), serum Na should be corrected slowly—by ≤ 10 mEq/L over 24 h to avoid osmotic demyelination syndrome
Peripheral and presacral edema, pulmonary edema, JVD, hypertension, decreased hematocrit, decreased serum protein, decreased BUN:CR |
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Hypovolemia disorders of water deficiency (hypernatremia)
Decreased free water = increased serum sodium = hypernatremia |
Poor skin turgor, dry mucous membranes, flat neck veins, hypotension, increased BUN/CR ratio > 20:1 **decrease of flow to kidneys means more bound urea in the blood which means ↑ BUN
plasma sodium will be greater than 145 mEq/L Diabetes insipidus - Low urine sodium and polyuria usually indicate DI
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Hyperkalemia | Peaked T waves | |||||||||||||||
Hypokalemia | Flattening of T waves, U wave | |||||||||||||||
Hypocalcemia | Long QT interval | |||||||||||||||
Hypercalcemia | Short QT interval | |||||||||||||||
Hypomagnesemia | Tall T wave | |||||||||||||||
Hypermagnesemia | Prolonged PR, Widened QRS | |||||||||||||||
Acid/Base Disorders (PEARLS) |
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Three Step Approach to Acid Base Disorders
Table comparing types of acid base disorders:
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