6 things NOT to miss

Question 1

_____ w/ fever

• 3 associated findings

Answer 1

Obstructive stone

• infected urine UPSTREAM of obstruction
• unable to drain infection
• abscess

Question 2

2 Tx for obstructive stone w/ fever?

Answer 2

Requires drainage

• nephrostomy tube
• ureteral stent

IV abx

Question 3

Testicular Torsion

• MC age of presentation is __-___ yrs old, but can occur at any age
• Acute onset of _____
• ____ deformity
• Absent ______

Answer 3

• 12 - 18
• severe testicular pain
• bell clapper
• cremaster

Question 4

PE findings of Testicular Torsion

• _____ testicle
• ____ riding
• _____ lie
• Absent _____
• No pain w/ _____ (_____)
• Thick or ____ spermatic cord
• Epididymis _____

Answer 4

• tender and firm
• high
• horizontal
• cremaster
• elevation of testis (Phren’s sign)
• knotted
• NOT posterior to testis

Question 5

What other condition would be on Ddx when evaluating Testicular Torsion?

• What 3 studies would you order?

Answer 5

Epididymis

• Dopper US
• Nuclear scan
• Phren’s Sign

Question 6

Tx of testicular torsion?

Answer 6

• Detorsion (open the book)
• Surgical : Scrotal exploration, detorsion and orchidopexy (unilateral/bilateral)

Question 7

What is this?

• Necrotizing fasciitis of male genitalia and perineum
• Involves mainly subcutaneous tissues
• Infection advances rapidly, over ____

Answer 7

Fournier’s Gangrene

• minutes

Question 8

3 risk factors of Fournier’s Gangrene

Answer 8

• Diabetes
• Alcohol abuse
• Immunocompromsed states

Question 9

• Painful swelling and induration of penis, scrotum, or perineum
• Cellulitis
• ____
• Necrosis
• Ecchymosis
• _____
• ______
• ______
• ____ absent if immunocompromised

Answer 9

Fournier’s Gangrene

• Eschar
• Crepitus
• Cutaneous anesthesia
• foul odor
• fever

Question 10

Imaging of Fournier’s Gangrene will show gas in the ____ tissues

Answer 10

Gas

Question 11

Tx for Fournier’s Gangrene

• Abx to cover ___ and ____
• Surgical _____
• _____ dressings
• ____ therapy
• HBO (hyperbaric oxygen)

Answer 11

• aerobic & anaerobic
• debridement
• wet - dry
• whirlpool

Question 12

2 causes of Acute Urinary Retention

Answer 12

• BPH
• Anticholinergic medications

Question 13

Acute Urinary Retention

• Normal _____
• Bladder scan (____)
• ___ gel / lubrication
• What 2 catheters?
• ____ tube

Answer 13

• bladder capacity
• Ultrasound
• lidocaine
• foley & coude
  
  • coude is curved
• Suprapubic

Question 14

Persistent penile erection that continues hours beyond or is unrelated to sexual stimulation and lasts greater than 4 hours duration

Answer 14

Priapism

Question 15

4 causes of Priapism

Answer 15

• Sickle cell trait & disease
• Trazodone
• Cocaine
• ED treatments
  
  • Papverine/Prostaglandin E1/Phentolamine
  • PDE-5 inhibitors

(SECT)

Question 16

3 sequelae of Priapism

Answer 16

• Ischemia / hypoxia
• Progressive cavernosal fibrosis
• ED

Question 17

Tx for priapism (3 steps)

Answer 17

• 18 guage needle into corpus cavernosum / corpora cavernosa
• Aspiration
• Instillation of phenylephrine
• If not successful, proceed to shunts…

Question 18

Foreskin (prepuce) gets stick proximal to corona and glans

Answer 18

Paraphimosis

Question 19

Tx for paraphimosis

Answer 19

• Compress edema
• May need a block
• Index and long finger on either side (peace)
• Thumbs on glans
• Then push and pull

Question 20

What are the 6 things to not miss?

Answer 20

1. Obstruction w/ fever
2. Testicular Torsion
3. Fournier’s Gangrene
4. Acute Urinary Retention
5. Priapism
6. Paraphimosis

PAP TOF