Ch 133 Genital and Lower Urinary Tract Trauma Flashcards
Primary immediate repair or delayed reconstruction: Anterior urethral injury in a male by low-velocity gunshot trauma
Primary immediate repair
Primary immediate repair or delayed reconstruction: Anterior urethral injury in a male by kitchen knife stab wound
Primary immediate repair
Primary immediate repair or delayed reconstruction: Extraperitoneal bladder injury in a male with bony fragments intravesically
Primary immediate repair
Primary immediate repair or delayed reconstruction: Extraperitoneal bladder injury in a female with pelvic fracture that needs immediate open reduction and fixation
Primary immediate repair
Primary immediate repair or delayed reconstruction: Anterior urethral injury in a male by blunt straddle injury
Delayed reconstruction
Primary immediate repair or delayed reconstruction: Posterior urethral injury in a male by blunt trauma
Delayed reconstruction
Which of the following is an absolute indication for open repair of blunt bladder rupture injury?
A. Significant extraperitoneal bladder rupture with extravasation of contrast agent into the scrotum
B. Significant extraperitoneal bladder rupture with gross hematuria
C. Significant extraperitoneal bladder rupture that has not healed after 3 weeks of Foley catheter drainage
D. Intraperitoneal bladder rupture
E. Significant extraperitoneal bladder rupture associated with pelvic fracture requiring treatment by external fixation
D. Intraperitoneal bladder rupture
In penile fracture, the penile hematoma can be contained within the penile shaft resulting in the typical ‘eggplant’ deformity. Which anatomical disruption allows the hematoma to extend into the scrotum, perineum, and suprapubic regions?
A. Disruption of cavernous venous plexus
B. Disruption of Dartos fascia
C. Disruption of Buck fascia
D. Disruption of the tunica albuginea
E. Disruption of the penile suspensory ligament
C. Disruption of Buck fascia
This is the preferred imaging modality to demonstrate a ruptured tunica albuginea if penile fracture needs to be ruled out in patients with low clinical suspicion
Ultrasonography
The following is TRUE of blunt scrotal trauma that results in testis rupture:
A. It is usually a bilateral process
B. It is often diagnosed by the presence of intratesticular hypoechoic areas on ultrasonography.
C. It has a degree of hematoma that correlates with the extent of injury.
D. It requires conservative management that results in acceptable viability and function.
E. It is definitively diagnosed during physical examination alone in most cases.
B. It is often diagnosed by the presence of intratesticular hypoechoic areas on ultrasonography.
A stress cystography is nearly 100% accurate for bladder injury if the bladder is filled to 350ml. Decreasing filling up to 250 ml only:
A. Will decrease sensitivity of the study from 100% to approximately 80% and will miss small tears
B. Is acceptable as the rate of false negative results will not be affected
C. Is acceptable as long as the patient is asymptomatic and has no pelvic fracture
D. Is acceptable given the patient’s stable condition and as long as the patient will undergo a CT scan anyway
**A. Will decrease sensitivity of the study from 100% to approximately 80% and will miss small tears **
Select the TRUE statement below:
A. Initial management of dog bites includes copious irrigation, debridement, and immediate primary closure along with prophylactic use of a broad-spectrum antibiotic. Human bites, on the other hand, should not be closed primarily.
B. Initial management of dog bites includes copious irrigation, debridement, and staged closure along with prophylactic use of a broad-spectrum antibiotic. Human bites, on the other hand, should be closed primarily.
C. Both human and dog bites can be closed primarily after copious irrigation, debridement, and broad-spectrum antibiotics
D. Both human and dog bites should be allowed to heal by secondary intention after copious irrigation, debridement, and broad-spectrum antibiotics
**A. Initial management of dog bites includes copious irrigation, debridement, and immediate primary closure along with prophylactic use of a broad-spectrum antibiotic. Human bites, on the other hand, should not be closed primarily. **
The following are acceptable techniques performed under a penile block or sedation in managing a zipper injury to the penis, EXCEPT:
A. Adjacent skin can be lubricated by mineral oil followed by multiple robust attempts to unzip and untangle the skin
B. The cloth material adjacent to the zipper can be incised with perpendicular cuts in between each zipper tooth to release the lateral support of the zipper, allowing the device to fall apart
C. A bone cutter or similar tool can be used to cut the median bar of the slider, this allows for separation of upper and lower shields of the slider
D. A screwdriver may be placed between the upper and lower shields and a twisting action separates the two shields from the median bar
E. A circumcising or elliptical skin excision in the area of injury
A. Adjacent skin can be lubricated by mineral oil followed by multiple robust attempts to unzip and untangle the skin
