Urology and Rheumatology Quiz

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Questions and Answers

What is a common symptom of urolithiasis or nephrolithiasis?

Loss of appetite

Frequent urination

Painless hematuria

Colicky pain (correct)

Which assessment finding is typical of benign prostatic hyperplasia (BPH)?

Increased urinary flow

Difficulty starting urine flow (correct)

Painless hematuria

High cholesterol levels

Which of the following medications is categorized as a DMARD for managing rheumatoid arthritis?

Acetaminophen

Aspirin

Calcitonin

Methotrexate (correct)

What is a primary diagnostic procedure for urinary bladder cancer?

Cystoscopy Signup and view all the answers

What is the primary role of calcitonin in the management of bone health?

To decrease calcium levels in the blood Signup and view all the answers

Which of the following is NOT a management option for urolithiasis/nephrolithiasis?

Surgical removal of gallbladder Signup and view all the answers

Which of the following is NOT considered an early complication of fractures?

Delayed healing Signup and view all the answers

What is a risk factor for developing prostate cancer?

Age and ethnicity Signup and view all the answers

Which treatment option may be used for urinary bladder cancer?

BCG vaccine Signup and view all the answers

Which assessment finding is characteristic of osteoarthritis?

Inflammation and crepitus Signup and view all the answers

Which type of traction involves a pulling force that is in a straight line with the body part resting on the bed?

Straight/running traction Signup and view all the answers

What conditions can result from untreated BPH?

Urinary stasis and UTI Signup and view all the answers

Which of the following statements regarding continuous bladder irrigation (CBI) after TURP is correct?

It is used to prevent clot formation. Signup and view all the answers

What is a key nursing intervention for patients with fractures in the early stages of care?

Administer pain relief as needed Signup and view all the answers

Which assessment symptom is indicative of a fracture?

Ecchymosis Signup and view all the answers

What symptom indicates a potential complication following a hysterectomy?

Vaginal bleeding Signup and view all the answers

What dietary components are essential to facilitate fracture healing?

Calcium and Vitamin D Signup and view all the answers

Which condition is characterized by a sudden onset of neurological deficits that last less than 24 hours?

Transient ischemic attack Signup and view all the answers

Which of the following is a common reason for the inability to heal a fracture properly?

Inadequate nutrition Signup and view all the answers

How should the affected limb be managed if compartment syndrome is suspected?

Maintain the limb at heart level Signup and view all the answers

Which of the following is a symptom of Cholecystitis or Cholelithiasis?

RUQ pain radiating to the shoulder Signup and view all the answers

What is the first-line diagnostic tool for diagnosing Crohn's Disease?

Barium studies Signup and view all the answers

In managing a patient with diverticulitis, which dietary change is recommended during exacerbation?

NPO to clear liquids, then low fiber Signup and view all the answers

Which of the following conditions is associated with Curling's ulcer?

Burns Signup and view all the answers

What is an appropriate nursing intervention for a patient experiencing dumping syndrome?

Position the patient on their left side after meals Signup and view all the answers

Which type of ulcer is common in patients with brain trauma?

Cushing's ulcer Signup and view all the answers

During an intestinal obstruction, which symptom is specific to a small bowel obstruction?

Visible peristaltic waves Signup and view all the answers

Which medication is often used prophylactically to prevent ulcer formation in at-risk patients?

Famotidine Signup and view all the answers

In managing patients on Total Parenteral Nutrition (TPN), which complication is essential to monitor?

Sepsis Signup and view all the answers

What is a common treatment for severe malabsorption in patients who need GI rest?

NPO status Signup and view all the answers

Which medication is used to control hypertension and prevent vasospasm in hemorrhagic stroke management?

Nimodipine Signup and view all the answers

What is the primary goal of oral care in patients with increased intracranial pressure (ICP)?

Prevent aspiration Signup and view all the answers

Which dietary consideration is crucial when managing Parkinson's Disease with Levodopa?

Low protein diet Signup and view all the answers

What is the most appropriate position for feeding a patient with swallowing difficulties?

Upright with head and neck flexed forward Signup and view all the answers

Which characteristic is NOT commonly associated with Open-Angle glaucoma?

Rapid onset of symptoms Signup and view all the answers

What is an important post-operative consideration following an arthroscopy procedure?

Ice application for vasoconstriction Signup and view all the answers

Which condition does NOT indicate a need for immediate surgery in the context of hemorrhagic stroke management?

Transcranial Doppler monitoring Signup and view all the answers

In patients with dense osteoporosis, which diagnostic method is most effective to assess bone density?

Bone densitometry (DXA) Signup and view all the answers

Which symptom is NOT commonly associated with Angle-Closure glaucoma?

Gradual visual field loss Signup and view all the answers

What is the primary purpose of administering mitotics like Pilocarpine in glaucoma management?

Decrease intraocular pressure (IOP) Signup and view all the answers

Which of the following is considered a risk factor for developing osteoporosis?

Sedentary lifestyle Signup and view all the answers

In managing seizures, which of the following is NOT considered a common cause?

High potassium levels Signup and view all the answers

Which statement about the '6 Ps' of compartment syndrome is incorrect?

Pulselessness suggests adequate circulation Signup and view all the answers

What is a primary goal of post-operative care following hip arthroplasty?

Prevent hip dislocation Signup and view all the answers

Which of the following is an appropriate post-operative instruction for a patient who has undergone knee arthroplasty?

Utilize a CPM machine for mobility Signup and view all the answers

What symptom is most indicative of appendicitis when assessing pain in the abdomen?

Right lower quadrant pain Signup and view all the answers

Which post-operative precaution should be taken for a patient who has undergone cervical discectomy?

Use a neck brace as needed Signup and view all the answers

What dietary adjustment is recommended for a patient with gastroesophageal reflux disease (GERD)?

Avoid irritants such as caffeine Signup and view all the answers

What is a common cause of gastritis?

Use of nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

Which surgical procedure is commonly performed to treat peptic ulcer disease?

Vagotomy Signup and view all the answers

What is a primary complication related to peptic ulcer disease?

Perforation of the GI wall Signup and view all the answers

Which symptom is most commonly observed in a patient with erosive gastritis?

Abdominal burning pain Signup and view all the answers

What type of imaging is considered first-line for diagnosing gallstones?

Ultrasound Signup and view all the answers

During the assessment of a patient with degenerative disc disease, what symptom is commonly noted?

Loss of sensory and motor control Signup and view all the answers

What is the recommended position for a patient undergoing an upper GI endoscopy?

Left side lying Signup and view all the answers

After which type of surgery might patients experience a high risk of blood clots (DVT/VTE)?

Hip arthroplasty Signup and view all the answers

What is a significant concern during post-operative care after a spinal surgery?

Neurovascular assessment Signup and view all the answers

Study Notes

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.

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Description

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.