Note
0.0
(0)
Rate it
Take a practice test
Chat with Kai
Explore Top Notes
Chapter 4: Functional Anatomy of Prokaryotic and Eukaryotic Cells
Note
Studied by 48 people
5.0
(1)
Untitled
Note
Studied by 15 people
5.0
(1)
Current Issues and Future Trends in Health Care in Canada,
Note
Studied by 10 people
5.0
(1)
Ap Government Chapter 2 (Constitution)
Note
Studied by 105 people
5.0
(1)
Chapter 1 - Introduction & Test Strategies
Note
Studied by 45 people
5.0
(2)
Module 2: Understanding the Natural World
Note
Studied by 6 people
5.0
(1)
Home
Bridge Exam 4 – Genitourinary & Oncologic Comprehensive Notes
Bridge Exam 4 – Genitourinary & Oncologic Comprehensive Notes
Testicular Cancer
Risk factors
Cryptorchidism (undescended testis) — even if corrected later, risk persists
Positive family history (especially first-degree male relatives)
Personal history of testicular cancer in contralateral testis
Caucasian ethnicity (incidence >4 times that of African-American men)
Age 15–35 years (peak incidence)
HIV infection (especially seminoma)
Gonadal dysgenesis/Klinefelter syndrome
Exposure to endocrine-disrupting chemicals (estrogens, pesticides) in utero
Infertility / poor semen parameters
Prevention & screening
Monthly testicular self-exam (TSE) beginning at puberty
Prompt evaluation of painless testicular mass or swelling
Scrotal ultrasound followed by serum tumor markers: \alpha-fetoprotein, human chorionic gonadotropin (hCG), lactate dehydrogenase (LDH)
Post-Mastectomy Care (Lymphedema & Arm Precautions)
Do NOT use the affected arm for:
Blood pressure measurements
Venipuncture or IV insertion
Subcutaneous or intramuscular injections
Rationale: minimizes trauma, infection risk, and lymphedema exacerbation
Interventions
Elevate arm above heart level; perform gentle ROM when approved
Compression sleeve or pneumatic device if prescribed
Avoid tight jewelry, sunburn, or heavy lifting > 4–6 kg
Educate on lifelong risk of lymphedema
Pelvic Organ Prolapse
Manifestations
Sensation of vaginal pressure/fullness; “ball” in vagina
Stress urinary incontinence or urinary retention due to kinking of urethra
Constipation; difficulty with bowel evacuation (rectocele)
Low back/pelvic pain, dyspareunia
Visible bulge at introitus during Valsalva
Management
Kegel exercises (strengthen pelvic floor)
Pessary insertion & routine follow-up for fit/cleaning
Estrogen therapy (post-menopausal atrophy)
Surgical: anterior/posterior colporrhaphy, hysterectomy with vault suspension
Benign Prostatic Hyperplasia (BPH)
Pathophysiology
Non-malignant proliferation of peri-urethral (transition-zone) prostate tissue leading to bladder outlet obstruction
Risk factors
Aging (prevalence >50\% at age >60)
Family history, obesity, metabolic syndrome, type 2 diabetes, Black ethnicity (earlier onset)
Manifestations (“LUTS”)
Voiding: weak stream, hesitancy, intermittency, straining, dribbling
Storage: urgency, frequency, nocturia, incomplete emptying
Complications
Acute urinary retention (AUR)
Hydronephrosis → renal insufficiency (post-renal CKD)
Recurrent UTIs, bladder stones, gross hematuria
Diagnostics
Digital rectal exam (smooth, enlarged, rubbery gland)
Serum PSA (rule out prostate Ca; mild elevation possible)
Post-void residual, uroflowmetry, cystoscopy if hematuria or recurrent infections
Tamsulosin
Class: \alpha-1A selective adrenergic blocker (uroselective)
Indication: BPH LUTS; facilitates bladder/urethral smooth-muscle relaxation → improved flow
Side effects / cautions
Orthostatic hypotension, dizziness, syncope (monitor BP, rise slowly)
Ejaculatory dysfunction, retrograde ejaculation
Nasal congestion, headache
Rare floppy iris syndrome during cataract surgery → inform ophthalmologist
Nursing considerations: give at bedtime to minimize dizziness; do not crush; assess LUTS via International Prostate Symptom Score (IPSS)
Prostate-Specific Antigen (PSA)
Glycoprotein produced by prostate epithelium
Normal reference <4\,\text{ng/mL} (age-adjusted ranges exist)
Uses
Screening (controversial) & early detection of prostate cancer
Monitoring response to therapy / recurrence
Elevations also seen in BPH, prostatitis, after DRE or ejaculation; repeat if transient rise
24-Hour Urine Creatinine Clearance (Estimate of GFR)
Purpose: measures endogenous creatinine filtration → approximates glomerular filtration rate (GFR)
Collection
Discard first void, collect all urine for 24 h, keep on ice; draw serum creatinine during collection
Formula (Cockcroft-Gault) for estimate without urine collection:
\text{CrCl} = \frac{(140 - \text{age}) \times \text{weight (kg)}}{72 \times \text{Serum Cr (mg/dL)}} \times (0.85 \text{ if female})
Stress Urinary Incontinence
Cause: urethral sphincter incompetence → leakage with ↑ abdominal pressure (cough, sneeze)
Interventions
Pelvic floor muscle training (Kegels): 3 sets of 10 contractions, TID
Weight loss, smoking cessation, treat chronic cough
Topical estrogen (post-menopause)
Pessary, mid-urethral sling surgery for refractory cases
Urinary Tract Infection (UTI)
Clean-Catch Urine Technique
Wash hands; clean periurethral area front-to-back with antiseptic wipe ×3
Begin voiding, then collect midstream urine into sterile container without stopping flow
Refrigerate or deliver to lab within 30 min
Positive urinalysis (leukocyte esterase, nitrites, >10\,000 CFU/mL) → send urine culture automatically (“reflex culture”)
Primary Causative Organism
\textit{Escherichia coli} (≈ 80–85\%)
Patient Education for Prevention
Hydration: \geq 2–3\,L fluids/day unless contraindicated
Void at least every 3–4 h; post-coital voiding within 15 min
Wipe front-to-back; avoid douches, scented wipes
Cotton underwear, avoid tight synthetic garments
Limit spermicides/diaphragms which ↑ UTI risk
Cranberry (unsweetened juice, capsules) may reduce bacterial adherence
CAUTI (Catheter-Associated UTI) Prevention Guidelines
Use catheter only for appropriate indications; reassess daily
Aseptic insertion, sterile closed drainage
Secure catheter to prevent urethral traction
Maintain unobstructed flow; keep bag below bladder, off floor
Daily perineal hygiene with soap/water, no antimicrobial irrigation
Sample from port with sterile syringe after alcohol swab
Phenazopyridine
Urinary analgesic (azo dye)
Education
Provides symptomatic relief (burning, urgency) — does NOT treat infection
Turns urine, sweat, tears orange-red → stain contacts/clothing
Take with food to ↓ GI upset
Limit to 2 days concurrent with antibiotics (masking symptoms may delay evaluation)
Pyelonephritis
Acute bacterial infection of renal pelvis & parenchyma
Manifestations
High-grade fever, chills, flank/costovertebral angle (CVA) pain
Nausea/vomiting, malaise
LUTS similar to cystitis (dysuria, frequency)
UA: pyuria, bacteriuria, WBC casts, mild proteinuria
Management: IV/PO fluoroquinolones or broad-spectrum β-lactam; hospitalization if severe; hydration
Complications: sepsis, renal scarring → CKD, perinephric abscess
Interstitial Cystitis (Bladder Pain Syndrome)
Chronic sterile inflammatory condition
Clinical picture
Suprapubic pain related to bladder filling, relieved by voiding
Urgency, frequency (up to >60 voids/24 h) without infection
Pain with sexual intercourse
Diagnosis of exclusion; cystoscopy may show petechial hemorrhages (glomerulations)
Management
Dietary avoidance of bladder irritants (caffeine, citrus, spicy food)
Amitriptyline, pentosan polysulfate sodium, antihistamines
Bladder instillations, pelvic floor PT
Urinary Incontinence Types (Comparison)
Stress: outlet incompetence → leak with exertion
Urge (overactive bladder): detrusor overactivity → sudden urge
Overflow
Pathophysiology: impaired detrusor contractility or outlet obstruction → chronic retention, bladder over-distention
Manifestations: constant dribbling, high post-void residual >300\,mL
Management: intermittent self-catheterization, treat BPH/neurogenic causes, cholinergic agonist (bethanechol)
Functional: incontinence due to cognitive, psychological, or mobility barriers despite intact urinary system
Examples: dementia, severe arthritis
Interventions: toileting schedules, assistive devices, environmental modifications
Glomerulonephritis
Complications
Acute hypertension & hypertensive encephalopathy
Nephrotic syndrome (proteinuria >3.5\,g/24 h, edema, hyperlipidemia)
Rapid progression to acute kidney injury (AKI) or chronic kidney disease (CKD)
Pulmonary edema due to fluid overload
Polycystic Kidney Disease (PKD)
Risk factors / etiology
Autosomal dominant inheritance (PKD-1 > PKD-2)
Positive family history in 75\% cases
Manifestations
Bilateral enlarged kidneys with multiple cysts; palpable masses
Flank/abdominal pain, hematuria (ruptured cysts), recurrent UTIs
Hypertension (RAAS activation), nephrolithiasis
Extra-renal: liver cysts, intracranial berry aneurysms, mitral valve prolapse, diverticulosis
Management: BP control (ACE/ARB), tolvaptan (slows cyst growth), dialysis/transplant for ESRD
Chronic Kidney Disease (CKD)
Pathophysiology: progressive nephron loss → adaptive hyperfiltration & sclerosis → GFR decline for >3 months
Risk factors
Diabetes mellitus (#1), hypertension (#2)
Recurrent pyelonephritis, glomerulonephritides, PKD
NSAID overuse, obstructive uropathy, systemic lupus erythematosus
Medications That Decrease Renal Function (Nephrotoxic)
NSAIDs (inhibit prostaglandin-mediated afferent vasodilation)
ACE inhibitors/ARBs (efferent vasodilation — beneficial long-term but may ↓ GFR acutely)
Aminoglycosides (gentamicin), vancomycin
IV contrast (iodinated), amphotericin B
Tenofovir, cisplatin, cyclosporine/tacrolimus, lithium, methotrexate
Glomerular Filtration Rate (GFR)
Definition: volume of plasma filtered across glomerular capillaries per minute — best overall index of kidney function
Normal: \approx 90–120\,mL/min/1.73\,m^2 (declines with age)
Estimated by creatinine-based equations (CKD-EPI, MDRD) or measured by inulin/^{51}\text{Cr} EDTA clearance
Hemodialysis Vascular Access — Arteriovenous (AV) Fistula
Creation: surgical anastomosis of artery (usually radial) to vein (cephalic) in non-dominant arm
Nursing Precautions: NO BP, venipuncture, IV, or constrictive clothing on affected arm; protect from injury
Assessment: “feel the thrill, hear the bruit” each shift
Complications
Thrombosis/stenosis (sudden loss of thrill, ↑ venous pressures)
Infection
Aneurysm formation of venous segment
Steal syndrome (see below)
High-output heart failure (rare)
Steal Syndrome
Pathophysiology: arterial blood diverted (“stolen”) into low-resistance venous fistula → distal limb ischemia
Symptoms: pain, pallor, reduced pulse, numb/cold fingers during dialysis or rest
Management: surgical revision, banding, distal revascularization
Hemodialysis Complications (Systemic)
Hypotension (rapid fluid removal): pause ultrafiltration, Trendelenburg, fluids
Disequilibrium syndrome: cerebral edema from rapid solute shift → headache, nausea, seizures (prevent gradual dialysis)
Muscle cramps, pruritus, anemia, bone disease
End-Stage Renal Disease (ESRD) Diet
Goals: ↓ uremic toxin production, maintain nutrition, control electrolytes/fluids
Recommendations (individualized)
Protein: 1.2–1.3\,g/kg/day when on hemodialysis (higher than pre-dialysis CKD)
Sodium: <2 g/day
Potassium: 2–3\,g/day (avoid high-K foods: bananas, oranges, tomatoes)
Phosphorus: \leq1\,g/day (binders with meals)
Fluid: urine output + 600 mL or 1–1.5\,L/day maximum
Adequate calories from carbohydrates/fats; vitamin D, calcium supplementation
Epoetin Alfa (rHuEPO)
Indication: anemia of CKD (Hb <10\,g/dL)
Administration
IV push at end of dialysis or SC 1–3 ×/week
Target Hb 10–11.5\,g/dL; do NOT exceed 13 due to ↑ stroke/HTN risk
Nursing
Monitor BP (may precipitate/worsen hypertension)
Adequate iron stores essential: ferritin >100 ng/mL, transferrin sat >20\%; supplement PO/IV iron sucrose as needed
ACE Inhibitors
Mechanism of Action
Block conversion of angiotensin I → angiotensin II by inhibiting angiotensin-converting enzyme
↓ Ang II → vasodilation (arterial & efferent arterioles), ↓ aldosterone → natriuresis, ↓ cardiac remodeling
Clinical utility: HTN, diabetic nephropathy (slow CKD); post-MI, heart failure (↓ mortality)
Side effects: cough, hyperkalemia, angioedema, ↑ creatinine (initial), hypotension, contraindicated in pregnancy (teratogenic)
Prostate Cancer
Risk factors
Age >50, African-American race
Family history (first-degree relative, early onset)
BRCA2 gene mutation, Lynch syndrome
High-fat/red-meat diet, low vegetables; obesity
Smoking, chemical exposure (Agent Orange, cadmium)
Most common cancer diagnosed in men; screening: PSA ± DRE starting 45–50 yr depending on risk
BReast CAncer (BRCA)
Most common tumor site: upper outer quadrant (tail of Spence) where glandular tissue dense, lymph drainage to axilla
Risk factors
Female gender, age >50, white ethnicity
Early menarche (
Nulliparity or first birth after 30 yr
Hormone replacement therapy, oral contraceptives long term (>10 yr)
Family history (1st-degree relative), personal history, genetic mutations (BRCA1/BRCA2, p53, PTEN)
Radiation exposure (chest irradiation for Hodgkin’s)
Alcohol (>1 drink/day), obesity (post-menopausal estrogen), sedentary life
Cervical Cancer
Labs/Diagnostics
Pap smear cytology (screening starts 21 yr; 3-yr or 5-yr intervals)
High-risk HPV DNA testing (types 16, 18) co-testing ≥30 yr
Colposcopy with biopsy for abnormal Pap/HPV
Endocervical curettage, cone biopsy (LEEP) for high-grade lesions
Overflow Incontinence (see above)
Breast Cancer Gene
BRCA1 (chromosome 17q) & BRCA2 (13q) tumor-suppressor genes; autosomal dominant; lifetime breast Ca risk up to 65–80\%; ovarian Ca 15–40\%
Counseling, prophylactic mastectomy/oophorectomy, MRI screening
Additional Formulas / Numbers
eGFR staging (KDIGO)
\geq90 (G1) normal/high
60–89 (G2) mild ↓
45–59 (G3a) mild-mod
30–44 (G3b) mod-severe
15–29 (G4) severe
<15$$ or dialysis (G5) kidney failure
Linking Concepts & Ethical Considerations
Cancer screening (PSA, mammography, Pap) requires shared decision-making to balance benefits (early detection) vs. harms (over-diagnosis, anxiety)
Medication nephrotoxicity emphasizes principle of non-maleficence → monitor renal labs, adjust dosing, educate patients on OTC NSAID risks
Dialysis access protection parallels post-mastectomy arm precaution — consistent patient education prevents irreversible harm (ischemia, lymphedema)
Genetic testing (BRCA, PKD) raises confidentiality, insurability issues; provide genetic counseling & informed consent
Note
0.0
(0)
Rate it
Take a practice test
Chat with Kai
Explore Top Notes
Chapter 4: Functional Anatomy of Prokaryotic and Eukaryotic Cells
Note
Studied by 48 people
5.0
(1)
Untitled
Note
Studied by 15 people
5.0
(1)
Current Issues and Future Trends in Health Care in Canada,
Note
Studied by 10 people
5.0
(1)
Ap Government Chapter 2 (Constitution)
Note
Studied by 105 people
5.0
(1)
Chapter 1 - Introduction & Test Strategies
Note
Studied by 45 people
5.0
(2)
Module 2: Understanding the Natural World
Note
Studied by 6 people
5.0
(1)