Urology and Rheumatology Quiz

Urolithiasis/Nephrolithiasis

• Causes/Risk Factors: Supersaturation of urine (calcium, oxalate, uric acid, calcium phosphate), infection (UTI), urine stasis, immobility, hypercalcemia, structural defects.
• Assessment: Colicky pain (primarily in ureter stones), hematuria, pyuria, nausea, vomiting, diarrhea, urinary retention/obstruction.
• Diagnosis: CT scan, IV pyelography (iodine contrast), blood chemistry, 24-hour urine, diet/medication/family history, stone analysis.
• Management: Pain relief (opioids/NSAIDs), moist heat/hot baths, increased fluids, ambulation, dietary modifications (low calcium, low purine, low protein, low oxalate).
• Medical Procedures: Ureteroscopy, ESWL (Extracorporeal Shock Wave Lithotripsy), urethrologic (cutaneous removal; nephrolithotomy).

Urinary Bladder Cancer

• Risk Factors: Age, male gender, race, tobacco use, chronic UTI, high cholesterol, high urine pH, bladder stones.
• Assessment: Painless hematuria, changes in voiding patterns.
• Diagnosis: Cystoscopy, CT, ultrasound, biopsy, bimanual examination.
• Treatment: Transurethral resection or fulguration, BCG vaccine, radiation therapy, chemotherapy, cystectomy with urinary diversion, bladder transplant.

Benign Prostatic Hyperplasia (BPH)

• Mechanism: Obstructs urine flow, causing incomplete bladder emptying and urinary retention.
• Consequences: Gradual dilation of ureters and kidneys, UTIs from urinary stasis.
• Assessment: Frequency, nocturia, urgency, hesitancy, decreased urine stream volume/force, difficulty initiating urination.
• Diagnosis: Digital rectal exam, prostate-specific antigen (PSA), transrectal ultrasound.
• Management: Tamulosin (Flomax) – relaxes bladder outlet; Finasteride (Proscar) – decreases testosterone production.

Prostate Cancer

• Risk Factors: African American race, aging, high-red meat/high-fat dairy diet.
• Assessment: Initially asymptomatic; later, urinary obstruction with symptoms, blood in urine or semen, painful ejaculation.

Surgical Interventions for BPH/Prostate Cancer

• Procedures: TURP (transurethral resection of the prostate); post-op CBI (continuous bladder irrigation), suprapubic/retropubic prostatectomy, perineal prostatectomy, Da Vinci prostatectomy, brachytherapy.

Continuous Bladder Irrigation (CBI)

• Use: Always after TURP
• Assessment: Color and amount of drainage, obstructions.
• Complications: Hemorrhage, infection, DVT, catheter obstruction.
• Post-Op Expectations: Pain relief, positive fluid/electrolyte balance, ambulation, catheter care, avoid straining/heavy lifting, stable vital signs, wound healing, normal urinary elimination.

Hysterectomy

• Procedure: Surgical removal of the uterus (laparoscopic or robotic).
• Indications: Uterine cancer, fibroids, endometriosis, genital prolapse, hypermenorrhea.
• Pre-Op Considerations: Pregnancy test.
• Post-op Considerations: Monitor vaginal bleeding, Foley catheter for 24 hours, monitor VS, breath and bowel sounds, I&O, assess incision, monitor for thromboembolism, labs, and shock/infection.

Cerebrovascular Accident (CVA)/Stroke

• Risk Factors: Cardiovascular risk factors.
• Types: Ischemic (thrombosis/embolism due to atherosclerosis, atrial fibrillation, endocarditis); hemorrhagic (aneurysm); transient ischemic attack (TIA); reversible ischemic neurologic deficit (RIND); stroke in evolution.
• Assessment: Facial symmetry, swallowing reflex, LOC, eye assessment, DTRs, communication loss, progression of symptoms, time of onset.
• Increased ICP (Intracranial Pressure): Early signs: altered LOC, headache, nausea, projectile vomiting; late signs: bradycardia, bradypnea, hypertension.
• Manifestations: Paralysis/weakness; communication loss (expressive, receptive, global); perceptual disturbances; sensory loss (visual changes); agnosia, alexia, agraphia.
• Diagnosis: CT scan, MRI, PET, cerebral angiography (allergy check, kidney function). Post-procedure: Extend affected leg flat; if ICP, slightly raise HOB.
• Management: Airway management, reduce ICP, maintain adequate cardiac output, maintain max blood pressure, oral/eye care; prevent immobility complications (pneumonia, aspiration, pressure sores, contractures, thromboembolism, infection), pain management (amitriptyline, lamotrigine), feeding (upright, head/neck slightly flexed forward, thickened liquids), prevent aspiration.
• Hemorrhagic Stroke Management: NO thrombolytics; prevent vasospasm (IV hydration and nimodipine); control hypertension (beta-blockers, vasodilators); potential surgery (craniotomy, aneurysm coiling/clipping).

Seizure Disorders

• Seizures: Abnormal motor, sensory, autonomic, or psychic activity from sudden excessive discharge from cerebral neurons.
• Epilepsy: Two or more episodes of recurring seizures.
• Causes: Idiopathic (genetic/developmental); acquired (hypoxemia, head trauma, hypertension, CNS infections, metabolic/toxic conditions).

Parkinson’s Disease

• Cause: Decreased dopamine levels due to degeneration of nigrostriatal neurons.
• Symptoms: Tremors, rigidity, bradykinesia/akinesia, postural instability, muscle weakness, dysphagia, muscle GI weakness.
• Diagnosis: History, physical assessment, response to levodopa.
• Management: Levodopa/carbidopa (before meals); deep brain stimulation surgery.

Glaucoma (Open-Angle and Angle-Closure)

• Open-Angle: Increased aqueous humor and decreased outflow.

• Assessment: Headache, mild eye pain, peripheral vision loss, increased IOP.

• Management: Miotics (pilocarpine), timolol, acetazolamide (decreased production); AVOID atropine.

• Education: Avoid activities that increase IOP; do not lie on operative side.

• Angle-Closure: Sudden closure of the angle, causing obstruction.

• Assessment: Rapid onset of increased IOP, decreased/blurred vision, halos.

• Management: Miotics (pilocarpine), timolol, acetazolamide (decreased production); AVOID atropine.

• Education: Avoid activities that increase IOP; do not lie on operative side.

Cataracts

• Description: Cloudiness of the lens, impairing vision.
• Assessment: Decreased visual acuity, blurred vision, diplopia.
• Surgical Management: Mydriatics (atropine sulfate) pre-op, antibiotics, corticosteroids, anti-inflammatory.
• Post-op Management: Monitor for bleeding, infection.
• Education: Wear sunglasses, protective eyewear.

Skeletal Disorders (General Assessment)

• Components: Past health/social/family history, exercise habits, dietary intake (Ca++, Vit. D), concurrent conditions, familial/genetic abnormalities.
• Symptoms: Bone/muscular pain, tenderness, tightness, swelling, paresthesias, muscle spasms.
• Compartment Syndrome "6 Ps": Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia.
• Diagnostics: Imaging (X-ray, CT, MRI, arthrography), bone densitometry/scan; arthroscopy, arthrocentesis; EMG, nerve conduction studies; labs (Ca++, Vit. D, phosphorus, alkaline phosphatase, PTH/calcitonin).
• Arthroscopy: Visualization of joints; more invasive, aseptic technique; pre and post-op antibiotic prophylaxis; pain meds, ice (vasoconstriction).

Osteoporosis

• Description: Metabolic bone disorder often leading to compression fractures; prevention is priority.
• Characteristics: May be asymptomatic; often affects spine (compression = pain), common in postmenopausal women and older adults.
• Risk Factors: Genetics, age, gender, small frame, postmenopause, low calcium/Vitamin D, high phosphate intake, caffeine, alcohol, smoking, sedentary lifestyle, lack of weight-bearing exercise, medications (steroids, antiseizure, heparin, anti-thyroids), comorbidities (anorexia nervosa, renal failure, hyperthyroidism).
• Diagnosis: Bone densitometry, lab work; often undetectable on X-ray until significant demineralization (25-40%).
• Home Care: Identify Ca++ and Vit D rich foods; weight-bearing exercises, modify lifestyle as needed (may discontinue corticosteroids).

Rheumatoid Arthritis

• Description: Autoimmune disease possibly triggered by infections.
• Assessment: Primarily affects the small joints (hands).
• Diagnosis: Increased ESR (20+).
• Medical Management: NSAIDs (with food), steroids (severe swelling), DMARDs (Methotrexate), antimalarial drugs, gold salts/compounds.
• Nursing Management: Decrease movement of stiff joints to decrease pain; morning stiffness.

Osteoarthritis

• Description: Degenerative disease related to aging and “wear and tear.”
• Assessment: Inflammation, crepitus.
• Diagnosis: X-ray, elevated ESR.
• Medical Management: Acetaminophen, NSAIDs, steroids.
• Nursing Management: Weight management, healthy diet, rest, activity restriction.

Fractures

• Types: Closed/simple, open/compound, complete/incomplete, simple, displaced, stress, compression, comminuted, greenstick.

• Causes: Trauma, severe muscle contraction, pathologic conditions.

• Effects: Soft tissue damage, hemorrhage, joint dislocation, tendon/blood vessel/nerve damage.

• Assessment: Pain, muscle spasms, edema, ecchymosis, deformity, shortening, crepitus, loss of function.

• Fracture Healing: Proper immobilization, adequate blood supply, optimal nutrition (Ca++, Vit D), isometric exercises.

• Factors Inhibiting Healing: Extensive trauma, inadequate immobilization, infection, irradiated bone, avascular necrosis, age, corticosteroids.

• Complications (Early): Shock (pelvis, femur, open fractures); DVT (most common); fat embolism (long bones); compartment syndrome (compression)

• Complications (Late): Delayed/mal/non-union, avascular necrosis

• Management: RICE (Rest, Ice, Compression, Elevation), limb elevation (except with compartment syndrome); neurovascular checks; prevent infection (if open fracture); surgery (reduction/ORIF; immobilization with casts/splints/traction)

Traction Management

• Purpose: Minimizes spasms, reduces/aligns/immobilizes fractures, reduces deformity.
• Types: Straight/running, balanced suspension, Buck’s, skeletal.
• Considerations: Continuous force, good body alignment, avoid friction, weight hangs freely. Monitor for complications specific to each type (e.g., skin breakdown; nerve/circulatory impairment with Buck’s).

Orthopedic Surgeries

• Procedures: Open reduction/internal fixation, joint arthroplasty/replacement, meniscectomy, amputation, bone graft, fasciotomy, arthroscopy
• Hip Arthroplasty: Replacement of damaged hip with artificial joint (acetabular cup, femoral head, stem); indicated for DJD, OA, RA. Hip Precautions: Abduction pillow, no crossing legs, bending at waist, pillow between knees.
• Knee Arthroplasty: Metal/acrylic prostheses; indicated for severe pain and functional disability; Precautions: No kneeling, no deep knee bends.

Spinal Injuries/Surgeries

• Degenerative Disc Disease (DDD): Cause of most back problems; a natural aging process and trauma.
• Assessment: Muscle weakness/atrophy; localized/sciatic pain.
• Surgical Procedures: Microdiscectomy, laminectomy, discectomy with fusion, foraminotomy
• Post-Op Spinal Surgery Care: Neurovascular assessment, repositioning and mobility assistance.
• Home Care: Gradually increase activity; avoid driving, heavy lifting, twisting, and bending; follow HCP-prescribed exercises.
• Cervical Discectomy Care: Painful; post-op neck brace. Wound care; proper body mechanics; Modifications in activity – avoid sitting/standing over 30 minutes; twisting/flexing.

Digestive Disorders (General Assessment)

• History: Dietary habits, pain patterns, changes in bowel habits/stool.
• Symptoms: Abdominal pain, nausea, vomiting, indigestion.
• Physical Exam: Inspection, auscultation, percussion, palpation (quadrant method).
• Symptom Localization: RUQ (gallbladder-sharp, colicky; liver-dull), RLQ (appendicitis), LLQ (diverticulitis, ulcerative colitis), LUQ (pancreatitis, Crohn's)

Common Diagnostic Procedures

• Imaging: Endoscopy (EGD, colonoscopy, sigmoidoscopy, proctoscopy), ultrasound, CT, MRI.

Gastroesophageal Reflux Disease (GERD)

• Pathophysiology: Backflow of gastric contents into the esophagus due to incompetent lower esophageal sphincter (LES).
• Assessment: Pyrosis, dyspepsia, dysphagia, odynophagia, epigastric pain.
• Complications: Inflammation, erosion, esophageal cancer.
• Diagnosis: Esophageal pH monitoring, endoscopy, barium swallow.
• Management: Lifestyle changes (low-fat diet, avoid irritants, elevated HOB, adjusted meal timing); medications (antacids, H2 blockers, PPIs, prokinetics); surgery (Nissen fundoplication).

Gastritis

• Types: Acute, chronic; erosive, non-erosive.
• Causes: H. pylori, NSAIDs, alcohol, smoking, caffeine, autoimmune, aging, comorbidities.
• Assessment: Abdominal pain, burning epigastric pain, anorexia, N/V, heartburn, hematemesis, melena.
• Complications: Pernicious anemia, GI perforation.
• Diagnosis: Endoscopy, biopsy (H. pylori), HCl acid analysis.
• Medical Management: Anti-ulcer medications; antibiotics (H. pylori); antidiarrheal/Bismuth salts; prostaglandin analogs (Sucralfate, Misoprostol)
• Surgical Management: Gastric resection; gastrojejunostomy/duodenostomy.
• Nursing Management: NPO, IV fluids, NG tube for decompression. Diet: avoid irritants, small frequent meals; monitor for GI bleeds; report bloody stools.

Peptic Ulcer Disease (PUD)

• Causes: H. pylori, NSAIDs, excess HCl.
• Assessment: Dull, gnawing epigastric pain, indigestion, N/V, melena.
• Complications: Perforation, peritonitis, hemorrhage, pernicious anemia.
• Ulcer Types: Gastric (LUQ, pain after eating, less HCl, less night pain); duodenal (R sided, pain relieved by eating, more HCl, 2-3 hours after eating).
• Diagnosis: EGD (most common), gastric acid analysis, serologic testing for H. Pylori.
• Management: Medications (antibiotics, bismuth salts, PPIs, H2’s, prostaglandin analogs). Surgery (vagotomy, antrectomy, Billroth I/II).
• Nursing Management: Good nutrition, prevent gastric acid irritants, adequate rest, stress reduction, avoid NSAIDs/smoking.
• Stress Ulcers: Curling’s (72 hours after extensive burn); Cushing’s (head injury/brain trauma).

Inflammatory Bowel Disease (IBD)

• Types: Crohn's (small intestine to ileum; all layers affected; RLQ pain); ulcerative colitis (large intestine to rectum; mucosal inflammation; LLQ/LUQ pain).
• Diagnosis: Barium studies (Crohn's), colonoscopy.
• Medical Management: Antibiotics; steroids; immunomodulators (Azathioprine, Methotrexate); anticholinergics; analgesics; B12 injections.
• Surgical Management: Strictureplasty, intestinal transplant, colon resection/hemi-colectomy, total colectomy with ileostomy/colostomy.
• Nursing Management: NPO/TPN for exacerbations; high-protein/high-calorie, low-fiber diet (avoid irritants like cold foods, caffeine, etc.); monitor I&O, electrolytes, ostomy care; stress management.

Diverticulitis/Diverticulosis

• Symptoms: LLQ pain (often sigmoid colon), fever, abdominal distension.
• Complications: Perforation, abscess/fistula formation, bleeding, fluid/electrolyte imbalance.
• Diagnosis: CT scan w/contrast (most common), barium enema, colonoscopy.
• Medical Management: Analgesics (opioids; avoid morphine); antispasmodics; antibiotics; bulk-forming laxatives; stool softeners.
• Dietary Management: NPO/TPN/NGT/IV Fluids during exacerbations; initially NPO, then clear liquids, then low fiber, then gradual increase of fiber and avoid seeds and nuts.

Cholecystitis/Cholelithiasis

• Symptoms: RUQ pain (radiating to right shoulder), nausea, jaundice (calculous presentation).
• Risk Factors: "4 F's" (forty, fat, female, fertile); rapid weight loss.
• Assessment: Fatty food intolerance; N/V; RUQ sharp, colicky pain radiating to right shoulder/midsternum; epigastric distress; fullness.
• Calculous: Jaundice, pruritus, dark urine, light/gray stools.
• Diagnostics: Ultrasound (most common), cholecystography, ERCP, abdominal X-ray. Labs: Alkaline phosphatase, GGT, GGTP, LDH, bilirubin, cholesterol.
• Surgical Management: Laparoscopic cholecystectomy; cholecystostomy; T-tube placement.
• Medical Management: Opioid analgesics, antispasmodics, stone lysis (UDCA, actigall, chenodiol, chenix); vitamin supplements.
• Nursing Management: Low-fat/high-protein/high-carb diet; regular exercise; weight reduction.

Intestinal Obstruction

• Types: Mechanical (adhesions, tumors); non-mechanical (paralytic ileus).
• Mechanism: Blockage preventing normal stool passage.
• Small Bowel: Severe fluid/electrolyte imbalance; visible peristaltic waves, projectile vomiting; dehydration.
• Large Bowel: Minor fluid/electrolyte imbalance; distension; intermittent cramping, diarrhea/ribbon-like stools, leakage.
• Management: Decompression (NGT or rectal tube); NPO; IV fluids; assess bowel sounds; monitor fluid/electrolytes; prokinetics; stool softeners (Colace).

Nutrition Therapy

• Enteral Feeding: Via NGT or PEG tube; Complications: aspiration, diarrhea, hyperglycemia;
• Total Parenteral Nutrition (TPN): For severe malabsorption or GI rest. Central line; Complications: hyperglycemia, infection, sepsis, fluid overload; critical monitoring required.

Test your knowledge on urology and rheumatology topics, including conditions like urolithiasis, benign prostatic hyperplasia, and urinary bladder cancer. This quiz covers common symptoms, diagnostic procedures, and treatment options relevant to both fields.