Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3. E Med & Surgery > 2- Urologic Emergencies > Flashcards

2- Urologic Emergencies Flashcards

1
Q

At what size does a kidney stone become symptomatic w/ pain and obstruct the ureter?

A

≥ 2-3 mm in size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common composition of a kidney stone? Are they radiolucent or radiopaque?

A

Calcium salts

Radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Struvite stones indicate what? Are they radiolucent or radiopaque?

A

Infection

Radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How will a pt w/ renal colic present?

A

Sudden onset colicky unilateral flank pain w/ radiation to groin as stone passes into lower ureter (pain equal to labor), N/V, urinary frequency, hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the imaging of choice for evaluating renal colic?

A

Non-contrast CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What imaging is used in pregnant, children or pt w/ previous hx of stones?

A

Renal US (identifies hydronephronis, +/- stone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The majority of what size kidney stones will pass spontaneously?

A

Usually pass if < 5 mm, will not pass if > 8 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the tx for renal colic?

A

Pain relief, anti-emetic, ABX, alpha 1 blocker, watchful waiting

Admit if “sick”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are definitive txs for a ureteric stone (intractable pain, fever, renal function, 4 wks)?

A

ESWL (lithotripsy)
PCNL (nephilithotomy)
Ureteroscopy
Open surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

For what size stones will medical explusion therapy (CCB, a-blocker, flowmax) have an effect?

A

5-10 mm => increased passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If pt is not able to pass a stone what can provide temporary relief?

A

JJ stent

Percutaneous nephrostomy tube (common in pregnant pts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Renal colic is aka what?

A

Urolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a painful inability to void w/ relief of pain following drainage of bladder by cath?

A

Acute urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common causes of obstructive urinary retention in men > 50 yo?

A

Prostatic Hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the general causes of urinary retention? (4)

A

Obstructive
Pharmacologic
Inflammatory
Neurogenic (spinal cord trauma/tumor, MS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the exam findings for pt w/ urinary retention?

A

Abdominal/bladder distention

Large amount urine in post void residual (PVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What volume of urine is concerning for urinary retention?

A

> 100-150 ml

  • <50-100 ml = normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the initial management for acute urinary retention?

A

Urethral cath/Suprapubic cath
Continuous bladder irrigation if blood clots
Monitor pt for 24 hrs post decompression and d/c home w/ drainage bag and urology f/u in 3-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the late management for acute urinary retention?

A

Tx underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common pathogen of uncomplicated cystitis?

A

E. coli (due to fecal flora colonization)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If pt presents w/ urinary sx but has no vaginitis or cervicitis on exam, are they likely to have UTI?

A

Yes! 90% likelihood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If pt presents w/ urinary sx and has cloudy urine, are they likely to have UTI?

A

Yes 96% likelihood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

T or F: Cystitis is a clinical dx supported by UA, culture and hx/PE.

A

TRUE!

Always order UA if 
Sx not clear
Male, back pain, looks sick
IMC
HX multi course ABX
Hx of ABX resistance
HX of mult drug allergies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the infectious disease society of American guidelines for when to tx cystitis?

A

Urine culture ≥ 100,000 CFU/ml

+ leukocyte ester & nitrates (Pyuria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When should pelvic exam be performed in pt w/ suspected cystitis?
Vaginal d/c, sick, return visit
26
What should be included on PE for pt w/ suspected UTI?
CVA percussion
27
Are Culture and imaging indicated for dx of routine UTI?
Not usually
28
What is the ABX tx for cystitis?
``` Macrobid X 5 days Bactrim DS > 3 days (don't use if high e. coli resistant strains) Fosfomycin 3g single dose Cephalosporins X 7 days Aumentin x 7 days ```
29
What ABXs are NOT allowed in the tx of UTI?
Fluoroquinolone (Cipro) - black box warning (only use if no other tx options for uncomplicated UTI) - Concern for tendon rupture (especially older pts w/ concomitant steroid use) Amoxicillin - too much resistant
30
Who is at risk for complicated UTI?
``` Men Elderly Hospital acquired Pregnancy Indwelling urinary cath/recent instrumentation Children Recent ABX use DM/IMC ```
31
A complicated UTI is evaluated/tx similar to what?
Pyelonephritis. Labs and longer ABX
32
What is an ascending infectious inflammatory process involving the kidney parenchyma and renal pelvis?
Pyelonephritis
33
A pt w/ pyelonehpritis will present w/ lower UTI sx + what?
Fever, chills, rigors OR N/V OR Diaphoresis OR Flank and/or abdominal pain
34
What do you specifically expect to look for on UA of pt w/ suspected pyelonephritis?
WBC casts
35
What ABX is NOT used in the TX of pyelonephritis?
Macrobid
36
Empiric therapy options for pyelonephritis include what?
Cipro 500 mg BID x 7 day Levo 750 QD x 5 days Bactrim DC x 14 days Cephalosporins 3rd > 1 st gen for 10-14 days
37
When would you admit a pt w/ pyelonephritis?
``` Obstruction (stones, tumor) Urologic surgeries/instrumentation Pregnancy DM Unable to tolerate POs Compliance risk ```
38
Are pts w/ asymptomatic bacteriuria often tx?
No. Want to prevent antimicrobial resistance and C. diff
39
When do you tx pt w/ asymptomatic bacteriuria?
Pregnant, sxs, undergoing urologic procedure
40
If pt w/ cystitis/pyelo sx and positive blood on UA. What rare complication do you want to be sure to R/O?
AAA Often present w/ "and" complaints - CP, ABD/neck/head/leg pain, renal failure, CVA
41
In pts < 35 yo that are dx w/ acute prostatitis, what is the most common bacterial etiology?
N gonorrhoeae and chlamydia
42
In pts > 35 yo that are dx w/ acute prostatitis, what is the most common bacterial etiology?
E. coli
43
How will a pt w/ prostatitis present?
Fever, chills, myalgia Pain to low back, rectum, perineum +/- urinary retention, dysuria
44
What will DRE show for pt w/ prostatitis?
Tender boggy prostate.
45
What should be avoided on DRE in Pt w/ suspected prostatitis?
Do not massage prostate => Bacteremia
46
Is imaging typically required for evaluation of prostatitis?
Only if toxic appearing
47
What will UA show for pt w/ prostatitis?
Pyuria (pus in the urine)
48
What is the tx for prostatitis?
> 35 yo - Cipro or Lev > 2-4 wks | < 35 yo - TX GC/Chlamydia
49
What is urosepsis?
Severe illness that occur when a UTI spread systemically
50
DX of urosepsis requires 2+ sx. What are the sx?
``` Temp > 100.4 or <96.8 WBC > 12K or <4K w/ 10% bands Tachycardia Tachypnea AMA (elevated lactate > 4 mmol/L) ```
51
Urosepsis in common in what pts?
Nursing home resident Recent/persisting UTI, pyelonephritis, prostatitis Recent urological procedures
52
How will a pt w/ urosepsis present?
Weakness, confusion, dehydration
53
What is the tx for urosepsis?
Fluids, ABX, tx shock, admit
54
When pt presents to ED w/ hematuria. What three dx must you work up/ rule out?
Obstruction Coagulopathy Rhabdomyolysis
55
If pt w/ gross hematuria or RBC > 5 what is the workup?
Check labs, med list, LMP, Uro eval
56
What lab will help determine if pt is in Rhabdo?
CK
57
If pt w/ gross hematuria or RBC > 3 and normal vitals what is the workup?
If normal vitals => urine work up
58
If pt w/ gross hematuria or RBC > 3 and abnormal vitals/labs/pain what is the workup?
- Renal US, CT abd pelvic w/ contrast - Bladder US, +/- foley if retention, continuous bladder irrigation - Tx any found cause
59
If testicular torsion is detorsed by 6 hrs what is the salvage rate?
80-100%
60
Pt w/ suspected testicular torsion presents in extreme abdominal pain and N/V. Exam for pt may show what?
High riding testis w/ transverse lie (bell clapper deformity) Blue dot sign +/- loss of cremasteric reflex
61
What is blue dote sign in a pt w/ testicular torsion?
Torsion of the appendix testis
62
What dx is needed immediately for pt w/ suspected testicular torsion?
Doppler US
63
What is the tx for testicular torsion?
Urology STAT => testicular fixation (even if detorsed in ED) Definitive tx: Manual detorsion (medial to lateral/ "opening of book" technique)
64
What is retrograde spread of infected urine down the vas deferens?
Epididymitis
65
What is the most common cause of epididymitis in M < 35 yo?
GC, Chlamydia
66
What is the most common cause of epididymitis in M > 35 yo?
E. coli, Enterococci, Pseudomonas, Proteus
67
Pt presents w/ scrotal pain and swelling, lower abdominal/perineal pain, +/- fever, UTI sx. You suspect epididymitis. What exam findings would support your dx?
Pain is relieved w/ testicle elevation Cremastric reflex is intact Inguinal lymphadenopathy
68
What labs/imaging are needed for evaluated epididymitis?
UA Test GC/Chlamydia Doppler US to r/o torsion or tumor CBC/admit if systemic sx
69
What is the tx for epididymitis?
``` Bedrest Scrotal elevation w/ ice ABX Analgesics Stool softeners ```
70
For acute epididymitis most likely caused by GC/chlamydia (<35 y/o) what is the ABX tx?
Ceftriaxone IM x1 + | Doxycycline x 10 days
71
For acute epididymitis most likely caused by GC/chlamydia AND enteric organisms (MSM) what is the ABX tx?
Ceftriaxone IM x1 + | Levofloxacin x 10 days
72
For acute epididymitis most likely caused by enteric organisms (>35 yo) what is the ABX tx?
Levofloxacin x 10 days
73
What is foreskin that becomes retracted behind the glans of penis and can't be replaced over the glans?
Paraphimosis
74
Is paraphimosis or phimosis an emergency?
Paraphimosis b/c possible arterial compromise *Think "Para" as in Paramedic
75
How will paraphimosis present?
Pain, tenderness, redness to retracted foreskin and glans
76
What is the tx for paraphimosis?
- Attempt manual gland compression (reduce by pushing on glans while pulling on foreskin) - If unsuccessful sugar lidocaine wrap, emergent dorsal slit in foreskin - Urology Stat
77
Balanoposthitis/blantitis are due to infection of the glands most commonly in uncircumcised men. Which is describes an infection in peds vs adults?
``` Balanoposthitis = peds Balantitis = adults ```
78
What is a persistent erection of the penis > 4 hrs that is NOT accompanied by sexual desire?
Priapism
79
Acute low flow causes of priapism are most common. Pt presents w/ fully rigid penis (glans soft), +/- painful. What are possible causes?
Drugs, blood disorders (sickle cell), spinal trauma, idiopathic
80
High flow causes of priapism are RARE. Pt presents w/ partially rigid penis that is painless. What are possible causes?
Trauma
81
What antidepressant causes priapism?
Trazadone *Antidepressants and antipsychotics are most common drugs to cause priapism)
82
What is the risk associated w/ priapism?
Impotence and fibrosis
83
What is the tx for priapism?
- Terbuatline SQ (decrease inflow of blood to penis) - Aspirate corpus cavernosa w/ butterfly needle (3 & 9 o' clock position) - Phenylephrine injection in corpora cavernosa - Urology
84
What is necrotizing fasciitis infection of the perineum involving the penis, scrotum, perineum, and abdominal wall?
Fourniers gangrene
85
What are the most common pathogens of fourniers gangrene
Staph Strep E. coli Clostridium
86
What is the common RF for Fourniers gangrene?
``` DM (most common) Alcoholism/liver disease IMC Trauma Preexisting perineal/rectal infections ```
87
Pt presents w/ fever, toxic appearing and perineal POOP. You suspect fourniers gangrene. What exam findings would support your dx?
Localized pain, swelling, discoloration to affected area Redness next to port of entry Subcutaneous crepitation over affected areas Putrid odor
88
What is the work up for Fourniers gangrene?
``` Septic work up Surgery consult NPO & IVF IV ABX Contrast CT ```
89
What is the tx for Fourniers gangrene?
Surgical debridement

3. E Med & Surgery (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions