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Genitourinary > Ch 4 Male MDT > Flashcards

Ch 4 Male MDT Flashcards

1
Q

Hematuria visible to the naked eye

A

Gross Hematuria

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2
Q

Hematuria only detectible by examination of the urine sediment by microscopy, or urinalysis

A

Microscopic

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3
Q

Both gross and microscopic hematuria require:

A

Evaluation

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4
Q

An upper urinary tract source (kidneys and ureters) can be identified in __% of patients with gross or microscopic hematuria

A

10%

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5
Q

Hematuria

Stone disease accounts for __%

A

40%

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6
Q

Hematuria

__% caused by kidney disease

A

20%

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7
Q

Hematuria

__% from renal cell carcinoma

A

10%

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8
Q

Hematuria

__% caused by urothelial cell carcinoma of the ureter or renal pelvis

A

5%

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9
Q

The lower tract source of gross hematuria is most commonly from:

A

Urothelial carcinoma of the bladder

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10
Q

Microscopic hematuria in the male is most commonly from:

A

Benign prostatic hyperplasia

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11
Q

Gross hematuria

What may help localize the disease?

A

Description of timing

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12
Q

The presence of blood at the beginning of the urinary stream that clears during the stream, implies an anterior penile urethral source

A

Initial hematuria

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13
Q

The presence of the blood at the end of the urinary stream, implies a bladder neck or prostatic urethral source

A

Terminal hematuria

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14
Q

The presence of blood through the urinary stream, implies a bladder or upper tract source

A

Total hematuria

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15
Q

Hematuria associated with renal colic suggests:

A

Ureteral stone

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16
Q

Irritative voiding symptoms in a young woman may suggest:

A

Acute bacterial infection and associated cystitis

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17
Q

In the absence of other symptoms, gross hematuria may be more indicated of:

A

Tumor

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18
Q

Labs:

Hematuria

A

UA

Urine Culture

BUN and Creatinine

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19
Q

Imaging:

Hematuria

A

CT scan of the upper tract w/o contrast

Cystoscopy

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20
Q

Indicated in patients with gross hematuria or those over 35 years with asymptomatic hematuria

A

Cystoscopy

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21
Q

Treatment for hematuria

A

Depends on the underlying disease process

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22
Q

Hematuria UA

Proteinuria and casts suggest:

A

Renal Origin

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23
Q

What kind of bacteria are responsible for most of the UTIs?

A

Coliform bacteria (E. Coli)

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24
Q

Most common route for UTI

A

Ascending infection from the urethra

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25
Q

Infection of the bladder

A

Cystitis

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26
Q

Cystitis is most commonly caused by:

A

Coliform bacteria
-E. Coli

Gram-positive bacteria
-Enterococci

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27
Q

Uncomplicated cystitis in men is rare and suggests:

A

Infection from stones

Prostatitis

Chronic urinary retention

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28
Q

Signs and symptoms:

  • Irritative voiding symptoms
  • Suprapubic discomfort
  • Women have hematuria after sex
  • Usually afebrile
  • Exam may elicit suprapubic tenderness with palpation
A

Cystitis

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29
Q

Noninfectious cystitis can be caused by:

A

Pelvic irradiation

Chemotherapy

Bladder carcinoma

Interstitial cystitis

Voiding dysfunction disorders

Psychosomatic disorders

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30
Q

Cystitis UA may reveal

A

Pyuria

Bacteriuria

Various degrees of hematuria

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31
Q

Treatment for cystitis

A

Antimicrobial therapy

  • Ciprofloxacin
  • Nitrofurantoin
  • Trimethoprim/sulfamethoxazole (Bactrim)

Urinary analgesics
-Phenazopyridine

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32
Q

Women who have more than __ episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy

A

3

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33
Q

The three most commonly used oral agents for Cystitis prophylaxis

A

Trimethoprim-sulfamethoxazole (40/200mg) daily

Nitrofurantoin (100mg) daily

Cephalexin (250mg) daily

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34
Q

Infectious inflammatory disease involving the kidney parenchyma and renal pelvis

A

Pyelonephritis

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35
Q

Most common causative agents that cause pyelonephritis

A

Gram-negative bacteria:

  • Klebsiella
  • Proteus
  • E Coli
  • Enterobacter
  • Pseudomonas
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36
Q

Bacteria commonly seen in pyelonephritis

A

Gram-positive

  • Enterococcus faecalis
  • Staphylococcus
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37
Q

What bacteria causes Pyelonephritis from a hematogenous route?

A

Staph Aureus

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38
Q

Signs and symptoms

  • Fever
  • Flank pain
  • Irritative voiding symptoms (urgency, frequency, dysuria)
  • Shaking chills
  • Associated nausea & vomiting
  • Diarrhea
  • Tachycardia
  • Costovertebral angle tenderness is usually pronounced
A

Pyelonephritis

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39
Q

Pyelonephritis lab findings

A

CBC: Leukocytosis & Left Shift

UA: Pyuria, bacteriuria, hematuria, white cell casts

Urine Culture: Heavy growth of offending organism

Blood culture may be positive

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40
Q

Imaging for pyelonephritis

A

Renal Ultrasound

-May show hydronephrosis (stone/obstruction)

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41
Q

Treatment for pyelonephritis

A

Antibiotic therapy (2-week therapy)

  • Ampicillin & Gentamicin IV
  • Ciprofloxacin PO
  • Levofloxacin PO
  • Trimethoprim-sulfamethoxazole PO

Urinary Analgesics
-Phenazopyridine

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42
Q

Pyelonephritis

IV antibiotics are continued for __ hours after the fever resolves and oral antibiotics are then given to complete the 14 day course of therapy

A

24 hours

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43
Q

Pyelonephritis

Fevers may persist for up to __ hours even with appropriate antibiotics

A

72

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44
Q

Inflammation and infection of the prostate gland

A

Acute Prostatitis

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45
Q

Prostatitis is usually caused by:

A

Gram negative

  • E Coli
  • Pseudomonas Species
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46
Q

Prostatitis is less commonly caused by:

A

Gram-positive

-Enterococci

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47
Q

Most likely routes for infection of prostatitis

A

Ascent up the urethra

Reflux of infected urine into the prostatic ducts

(Lymphatic and hematogenous routes are rare)

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48
Q

Signs and symptoms

  • Perineal, sacral, or suprapubic pain
  • High fever
  • Irritative voiding symptoms
  • Obstructive symptoms, urinary retention
  • Warm and often exquisitely tender prostate (gentle exam)
A

Prostatitis

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49
Q

Laboratory findings in prostatitis

A

CBC: Leukocytosis and left shift

UA: Pyuria, bacteriuria, hematuria

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50
Q

Treatment for prostatitis

A

Antibiotics (4-6 weeks)

  • Ampicillin & Gentamicin IV
  • Ciprofloxacin PO
  • Levofloxacin PO
  • Trimethoprim-sulfamethoxazole PO

Tylenol

NSAIDs

Stool softeners

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51
Q

Prostatitis

IV Antibiotics are continued for ___ hours after the fever resolves and oral antibiotics are given to complete the ___ week course therapy

A

24-48 hours

4-6 weeks

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52
Q

May evolve from acute bacterial prostatitis

Many men have no history of acute infection

A

Chronic bacterial prostatitis

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53
Q

What organism is associated with chronic bacterial prostatitis infection?

A

Gram Neg Rods (MOST COMMON)

Enterococcus (Gram Positive)

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54
Q

Prostate may be:

A

Normal

Boggy

Indurate

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55
Q

Chronic bacterial prostatitis

Pelvic radiographs or transrectal U/S may show:

A

Prostatitis calculi

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56
Q

Treatment for Chronic bacterial prostatitis

A

Antimicrobials (6-12 weeks Therapy)

  • Trimethoprim-sulfamethoxazole PO
  • Ciprofloxacin PO
  • Levofloxacin PO

NSAIDs

Sitz Baths

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57
Q

Chronic bacterial prostatitis optimal duration of antibiotic therapy length

A

6-12 weeks

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58
Q

Inflammation and/or infection of the epididymis

A

Epididymitis

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59
Q

Sexually transmitted forms of epididymitis usually occur in men under:

A

40

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60
Q

Sexually transmitted epididymitis is caused by:

A

Chlamydia trachomatis

Neisseria gonorrhoeae

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61
Q

Non-sexually transmitted forms of epididymitis occur in:

A

Older men

Associated with UTI and Prostatitis

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62
Q

Non-sexually transmitted epididymitis is typically caused by:

A

Gram-negative rods

  • E coli
  • Klebsiella
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63
Q

Signs and symptoms

  • May follow acute physical strain, trauma, or sex
  • Associated Sx: Urethritis, Cystitis
  • Pain in the scrotum, may radiate to flank
  • Fever
  • Scrotal swelling
A

Epididymitis

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64
Q

Physical findings

Early course of epididymitis:

A

The epididymis may be distinguishable from the testes

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65
Q

Later course of epididymitis

A

The teste and epididymis appear as one enlarged tender mass

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66
Q

Elevation of the scrotum above the pubic symphysis improves pain from epididymitis

A

Prehn sign

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67
Q

Epididymitis

A

Inflammation of the epididymis

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67
Q

Epididymitis

Testing for suspected chlamydia and gonorrhoeae

A

NAAT (Nucleic acid amplification testing)

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68
Q

Imaging for epididymitis

A

Ultrasound

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69
Q

Treatment for sexually transmitted epididymitis

A

Ceftriaxone IM & Doxycycline PO

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70
Q

Treatment for non-sexually transmitted epididymitis

A

Trimethoprim/sulfamethoxazole

Ciprofloxacin

Levofloxacin

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71
Q

Complications of epididymitis that is delayed or inadequate treatment may result in:

A

Epididymo-orchitis (Testicle Inflammation)

Decreased fertility

Abscess formation

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72
Q

Epididymitis

Refer to urology when:

A

Persistent symptoms and infection despite antibiotic therapy

Signs of sepsis or abscess formation

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73
Q

Renal calculi is also known as:

A

Urolithiasis

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74
Q

Men are more effected by urolithiasis than women by:

A

2.5:1

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75
Q

How many major types of urinary stones are there?

A

5

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76
Q

Most common type of urinary stone

A

Calcium (85%)

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77
Q

Weather

Contributing factors of renal calculi

A

High humidity & elevated temperatures

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78
Q

Higher incidence rates of renal calculi are associated with what disease processes?

A

Sedentary lifestyle

Hypertension

Carotid calcification

Cardiovascular disease

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79
Q

Diet that is associated with renal calculi

A

High protein and salt intake

Inadequate hydration

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80
Q

Signs and symptoms:

  • Pain often occurs suddenly in the flank
  • Nausea and vomiting
  • Constantly moving to find a comfortable position
  • May be episodic
A

Renal calculi

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81
Q

Urinalysis findings in renal calculi

A

Hematuria (90%)

Urinary pH

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82
Q

Imaging for Renal Calculi

A

Plain abdominal radiograph (Kidney, Ureter and Bladder)

Renal U/S

Spiral CT in prone position

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83
Q

Renal calculi

KUB with renal U/S can diagnose up to __% of stones

A

80%

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84
Q

Renal calculi

What has increased sensitivity and specificity over other tests?

A

Spiral CT

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85
Q

Stones smaller than ____mm in diameter on a plain abdominal radiograph usually pass spontaneously

A

5-6 mm

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86
Q

Renal Calculi

Medications that can increase the rate on spontaneous stone passage

A

Alpha-blockers (Tamsulosin)

NSAIDs

-With or without a low dose oral corticosteroid

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87
Q

Stones that require surgical removal include those that are showing signs of:

A

Obstruction or infection

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88
Q

Procedures for stone removal include:

A

Ureteroscopy stone extraction

Extracorporeal shock wave lithotripsy

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89
Q

The greatest importance in reducing stone recurrence

A

Increased fluid intake

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90
Q

Renal calculi

Increasing fluid intake to ensure a voided volume of:

A

2.5 L/day

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91
Q

Stones

Patients are encouraged to ingest fluids during meals, __ hours after each meals, and prior to sleep

A

2 hours

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92
Q

Renal calculi

Sodium intake should be restricted to:

A

150 mEq/day

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93
Q

Renal calculi

Protein intake should be:

A

Spread out through the day

Limited to 1g/kg/day

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94
Q

Disposition

Obstructing stone with associated infection is a:

A

MEDEVAC

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95
Q

Renal calculi

Signs/symptoms of infection:

A

Fever

Tachycardia

Elevated WBC

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96
Q

Referral to urology is warranted if the stone fails to pass within:

A

4 weeks

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97
Q

Two types of erectile tissue

A

Corpus cavernosa

Corpus spongiosum

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98
Q

Normal male erection is a neurovascular event relying on:

A

Intact autonomic and somatic nerve supply

Arterial blood flow

Smooth and striated musculature of the corpora cavernosa and pelvic floor

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99
Q

Erection is caused and maintained by:

A

Increase in arterial flow

Relaxation of the smooth muscle

Increase in venous resistance

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100
Q

The key transmitter that initiates and sustains erections

A

Nitric oxide

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101
Q

The consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance

A

Erectile dysfunction (ED)

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102
Q

ED has what kind of etiologies?

A

Organic and psychogenic

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103
Q

Organic erectile dysfunction may be an early sign of:

A

Cardiovascular disease

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104
Q

Loss of libido may indicate:

A

Androgen deficiency

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105
Q

Loss of erections may result from:

A

Arterial

Venous

Neurogenic

Hormonal

Psychogenic

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106
Q

The most common cause of erectile dysfunction is:

A

Decrease in arterial flow resultant from progressive vascular disease

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107
Q

The ability to attain but not maintain an erection may be the first sign of:

A

Endothelial dysfunction and further Cardiovascular risk

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108
Q

What medications are associated with erectile dysfunction?

A

Antihypertensive

Antidepressant

Opioids

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109
Q

Fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity

A

Peyronie disease

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110
Q

The loss of seminal emission

A

Anejaculation

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111
Q

Anejaculation may result from

A

Androgen deficiency

Sympathetic denervation as a result of spinal cord injury

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112
Q

Labs for erectile dysfunction:

A

Lipid profile (dyslipidemia)

Glucose (diabetes)

Testosterone

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113
Q

Free testosterone must be drawn at what hours?

A

8-10 am

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114
Q

Treatment for ED:

A

Lifestyle modification (smoking, alcohol, diet, exercise)

Hormonal replacement

Oral agents (phosophodiesterase-5 inhibitors)

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115
Q

ED

Men with psychogenic component benefit from:

A

Sexual health therapy or counseling

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116
Q

Occurrence of penile erection lasting longer than 4 hours

A

Priapism

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117
Q

Ischemic injury of the corpora cavernosa from venous congestion and cessation of arterial inflow

A

Priapism

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118
Q

Initial treatment for priapism

A

Aspiration of blood from the penis and injection of sympathomimetic drugs (epinephrine/phenylephrine)

119
Q

Benign prostatic hyperplasia (BPH) is a hyperplastic process, meaning:

A

There is an increased number of cells

120
Q

Most common benign tumor in men and its incidence is age related

A

BPH

121
Q

At age 55, __% of men report obstructive voiding symptoms

A

25%

122
Q

At age __, 50% of men report decrease in the force and caliber of the urinary stream

A

75

123
Q

BPH symptoms can be related to what two things?

A

1) OBSTRUCTIVE component of the prostate

2) IRRITATIVE, secondary response of the bladder to the outlet resistance

124
Q

Hesitancy

Decreased force and caliber of stream

Sensation of incomplete bladder empyting

Double voiding (urinating 2 times within 2 hours)

Straining to urinate

Postvoid dribbling

A

Obstructive BPH symptoms

125
Q

Urgency

Frequency

Nocturia

A

Irritative BPH Symptoms

126
Q

Most important tool used in the evaluation of patients with BPH

A

American Urological Association (AUA) symptom index

127
Q

AUA symptom index

Number of questions & scale

A

7 questions

Severity of 0-5

128
Q

BPH DRE exam normal findings

A

Smooth firm elastic enlargement of the prostate

129
Q

DRE findings that should alert you for possible prostate cancer

A

Induration

130
Q

Labs for BPH

A

UA: to exclude infection/hematuria

Prostate specific antigen test (PSA)

131
Q

BPH

Only recommended to assist in determining the surgical approach

A

Cystoscopy

132
Q

BPH

CT or renal Ultrasound is recommended only:

A

Concomitant urinary tract disease or complications

133
Q

Treatment for BPH patients with mild symptoms

A

Watchful waiting

134
Q

Medical therapy for BPH

A

Alpha-blockers

5-alpha-reductase-inhibitors

Phsophdiesterase-5 inhibitors

135
Q

Act against bladder outlet obstruction by relaxing smooth muscle in the bladder neck, prostate capsule, and prostatic urethra

A

Alpha-blockers

136
Q

Act by reducing the size of the prostate gland and in turn improves symptoms

A

5-alpha-reductase inhibitors

137
Q

Used in patients with erectile dysfunction with mild or moderate symptoms

A

Phosphdiesterase-5 inhibitors

138
Q

BPH

Absolute surgical indications:

A

Refractory urinary retention (failing one catheter removal)

Large bladder diverticula

Sequelae of benign prostatic hyperplasia

139
Q

Conventional surgeries for BPH

A

Transurethral resection of the prostate (TURP)

Transurethral incision of the prostate (TUIP)

Open simple prostatectomy

140
Q

Minimally invasive surgeries for BPH

A

Laser therapy

Transurethral needle ablation of the prostate (TUNA)

Transurethral elect vaporization of the prostate

Hyperthermia

Implant, to open prostatic urethra

141
Q

Refer to urology with an AUA score of:

A

> 7

142
Q

Most common non-cutaneous cancer in American men and second leading cause of cancer related death in men

A

Prostate Cancer

143
Q

A 50 year old American man has a lifetime risk of:

__% latent cancer

__% clinically apparent cancer

__% death due to prostatic cancer

A

40%

16%

2.9%

144
Q

Risk factors of prostate cancer

A

African American race

Family history

History of high dietary fat intake

145
Q

Most prostate cancers are detected because of:

A

Elevations in serum PSA

146
Q

Obstructive symptoms of the prostate is most often due to:

A

BPH

147
Q

Prostate cancer

Metastases commonly occurs in:

A

Lower extremity lymphedema

Axial skeleton (Most Common)

148
Q

__% if men with intermediate elevation between 4.1-10 ng/mL will have prostate cancer

__% of men with elevations greater than 10 ng/mL will have prostate cancer

A

8-30%

50-70%

149
Q

Labs for prostate cancer

A

PSA

BUN & Creatinine

Alkaline phosphatase and calcium

CBC

150
Q

Standard method for detection and confirmation of prostate cancer

A

Prostate biopsy

151
Q

Imaging for prostate cancer

A

Transrectal U/S

MRI

Bone Scan

152
Q

PSA testing baseline testing is offered at what age with no risk factors?

A

50

153
Q

PSA testing for 40-45 year old’s with risk factors that include:

A

African American men

Family history of prostate cancer

BRCA1 or BRCA2 mutations

154
Q

Prostate cancer possible therapies

A

Active surveillance

Radical prostatectomy

Radiation therapy

Cryosurgery

Androgen deprivation therapy for advanced disease

155
Q

All patients with a focal nodule or induration on DRE or elevated PSA MUST be:

A

Referred to Urology

156
Q

What is responsible for the infrequent rate of injury to the testis?

A

Mobility of the testicle

Cremasteric muscle

Tough capsule of the testes

157
Q

What is a part of the spermatic cord?

A

Vas deferens

Cremasteric muscle

Artery

Vein

Nerves

158
Q

Scrotal laceration/avulsion should be:

A

Explored and debrided

Managed by housing the testicle in the remaining scrotal skin

159
Q

Blunt testicular injury usually occurs secondary to a direct blow to the testes impinging against the:

A

Pubic symphysis (Bicycle injury)

160
Q

Sac fills with blood and appears as a large blue tender scrotal mass

A

Blunt testicular injury

161
Q

Labs for testicular trauma

A

CBC

UA

162
Q

Imaging for scrotal trauma

A

Scrotal and testicular US

163
Q

What studies can help delineate the extent of testicular involvement and evaluate for testicular rupture?

A

Colored Doppler

164
Q

Blunt and penetrating testicular injuries require:

A

MEDEVAC to Urology

165
Q

Treatment for lacerations or avulsions just involving the skin of the scrotum

A

Closed primarily by independent provider

166
Q

Necrotizing fasciitis of the subcutaneous tissues of the perineum often involving the scrotum

A

Fournier’s Gangrene

167
Q

Typically begins as a benign infection or simple abscess that quickly leading to widespread necrosis of otherwise previously healthy tissue

A

Fournier’s Gangrene

168
Q

You must maintain a high suspicion of what, if the patient presents with scrotal, rectal or any genitalia pain out of proportion to their physical exam findings

A

Fournier’s Gangrene

169
Q

Signs and symptoms:

  • Tense edema of scrotum and other involved skin
  • Blisters/bullae
  • Crepitus
  • Fever
  • Pain out of proportion to physical exam
  • Tachycardia
  • Hypotension
A

Fournier’s Gangrene

170
Q

Imaging for Fournier’s Gangrene

A

CT

MRI

171
Q

Treatment for Fournier’s Gangrene

A

Aggressive surgical exploration and debridement

Broad spectrum antibiotics
-Ertapenem

Fluids

MEDEVAC

172
Q

Complications from Fournier’s gangrene.

Patients may ultimately need:

A

Cystostomy

Colostomy

Orchiectomy

173
Q

Malignancy is often:

A

Painless

174
Q

Dilation of the pampiniform plexus of spermatic veins and is generally left sided

A

Varicocele

175
Q

Symptoms:

  • Asymptomatic mass, may have mild pain
  • Mass is separate from testes
  • Feels like a “bag of worms”, especially upright
  • Size increased with Valsalva
A

Varicocele

176
Q

Right sided varicocele should raise suspicion of:

A

Inferior vena cava and intraabdominal pathology

177
Q

Sudden left sided varicocele should raise suspicion for:

A

Left renal vein obstruction

Renal tumor

178
Q

Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord

A

Hydrocele

179
Q

Gradually enlarging painless cystic mass that transilluminates

May indicate tumor

A

Hydrocele

180
Q

Fluid filled cyst at the head of the epididymis that may contain nonviable sperm

A

Spermatocele

181
Q

Painless

Palpated as distinct from the testes

Typically transilluminates as cystic in nature

A

Spermatocele

182
Q

Diagnostic imaging of choice for scrotal and testicular abnormalities

A

Ultrasound

183
Q

Most common neoplasm in men aged 20-35

A

Testicular cancer

184
Q

Testicular cancer

What is necessary for diagnosis?

A

Orchiectomy

185
Q

Testicular cancer

___ cases per 100,00 males each year

A

5-6

186
Q

__% of testicular cancer develop in patients with a history of cryptorchism

A

5%

187
Q

Symptoms:

  • Painless enlargement of the testis
  • Sensation of heaviness
A

Testicular cancer

188
Q

Testicular cancer

__% Asymptomatic

__% Metastatic disease symptoms

__% Gynecomastia

A

10%

10%

5%

189
Q

An incorrect diagnosis is made at the initial examination in up to __% of patients with testicular tumors

A

25%

190
Q

If this test is positive, you should have a high suspicion of testicular cancer

A

HCG

191
Q

Imaging for testicular cancer

A

Scrotal US
-Determine intra/exta-testicular

Chest, abd, and pelvic CT after diagnosis is made

192
Q

__% of testicular cancer diagnosis is made by inguinal orchiectomy

A

75%

193
Q

Testicular cancer

5-year disease free survival for patients with stage I-III are ___%

A

90-100%

194
Q

Testicular Cancer

Patients with disseminated disease have a 5-year disease free survival rate at __%

A

55-80%

195
Q

Testicular torsion may occur after:

A

Trauma

Spontaneously

196
Q

Urgency to diagnose and treat testicular torsion with __ hours to prevent loss of the testis

A

6 hours

197
Q

Testicular torsion tends to occur in:

A

Young men

198
Q

Which testicle is more prone to torsion?

A

Left

199
Q

Testicular torsions usually rotate:

A

Medially

200
Q

Symptoms:

  • Acute scrotal pain (several hours after activity)
  • Profound tenderness and swelling
  • Nausea and vomiting
  • Negative cremasteric reflex
A

Testicular torsion

201
Q

High riding testis oriented transversely

A

Bell clapper deformity

202
Q

Imaging for testicular torsion

A

Scrotal US with color flow Doppler

203
Q

Manual Detorsion

A

Grasping the testicle and rotating it within the scrotum outward (Lateral to Medial) one to two full 360 degree turns

204
Q

If there is no improvement from testicle detorsion you should:

A

Rotate it in the opposite direction (lateral to medial)

205
Q

_____ of torsed testicles may have lateral rotation

A

One-third

206
Q

Disposition for testicle torsion

A

MEDEVAC

Needs surgical exploration and detorsion regardless of result of manual detorsion

207
Q

Testicle salvage

___% at 6-8 hours
___% at 12 hours

A

80-100%

0%

208
Q

___% of patients sustaining injury to the external genitalia require RBC transfusion due to blood loss from genital injury alone

A

25%

209
Q

Blunt trauma to the erect penis may cause rupture of the:

A

Corpus cavernosum

210
Q
  • Immediate pain
  • Deforming hematoma (eggplant)
  • “Cracking sound”
  • Immediate detumescence
  • May cause urethral injury
A

Penile rupture or fracture

211
Q

Can occur secondary to clothing being trapped by heavy machinery

A

Amputation

212
Q

Treatment zipper injuries

A

Local anesthetic is injected and then unzip after mineral oil lubrication

213
Q

Treatment for penile contusions

A

Analgesics/NSAIDs

Cold packs

Rest

Elevation

214
Q

Imaging for penile trauma

A

Retrograde urethrogram

Scrotal/Penile US

215
Q

Treatment for penile trauma

A

MEDEVAC

Immediate urological consultation for surgical repair

216
Q

Urethral injury is suspected if:

A

Blood in the urethra meatus

Perineal hematoma

High riding prostate on DRE

217
Q

Fibrous constriction of the foreskin preventing retraction

A

Phimosis

218
Q

Inflammation of the glans penis

A

Balanitis

219
Q

Inflammation of the glans penis and the prepuce

A

Balanoposthitis

220
Q

If Foley catheter cannot be inserted, what is indicated?

A

Suprapubic catheterization

221
Q

Most common infectious cause of underlying balanoposthitis

A

Candidal infection

222
Q

Treatment for Phimosis

A

Good hygiene and topical antifungal

223
Q

Phimosis

Urologist can perform this procedure to temporarily fix the problem

A

Dorsal slit circumcision

224
Q

Two conditions that can be the result from phimosis

A

Balanitis

Balanoposthitis

225
Q

A true urologic emergency

Retracted foreskin develops a fixed constriction proximal to the glans

A

Paraphismosis

226
Q

Treatment for paraphimosis

A

Manual reduction
-Compress glans firmly for 5-10 minutes to reduce its size
-Icing
Move the prepuce distally while the glans is pushed proximally

227
Q

Treatment

Manual reduction fails for paraphimosis

A

Dorsal slit of the foreskin

228
Q

Disposition

Paraphismosis

A

Referral to urology for circumcision to reduce recurrence

229
Q

Results in a sudden decrease in kidney function

A

Acute Kidney Injury (AKI)

230
Q

Labs

AKI is characterized as:

A

Increase in serum creatinine

231
Q

The inability to maintain acid-base, fluid, and electrolyte balance and to excrete nitrogenous wastes

A

AKI

232
Q

Three categories of AKI

A

Prerenal

Intrinsic

Post renal

233
Q

Most common etiology of AKI

A

Prerenal (40-80%)

234
Q

Prerenal AKI

Continuous hypoperfusion can lead to:

A

A secondary intrinsic kidney injury

235
Q

Decreased renal perfusion occurs by:

A

Decrease in intravascular volume

Change in vascular resistance

Low cardiac output

236
Q

Least common cause (5-10%) of AKI

A

Postrenal

237
Q

Postrenal AKI

Important to detect because etiologies are:

A

Reversible

238
Q

Postrenal causes

A

Urethral obstruction

Bladder dysfunction or obstruction

Obstruction of both ureters/renal pelvises

BPH

Cancer (Bladder, prostate, and cervical)

239
Q

Most common cause of postrenal AKI in males

A

BPH

240
Q

Up to 50% of AKI

A

Intrinsic

241
Q

Consider intrinsic AKI after:

A

Prerenal and postrenal causes are ruled out

242
Q

Sites of intrinsic AKI injury

A

Tubules

Interstitium

Vasculature

Glomeruli

243
Q

Symptoms:

  • Buildup of waste products (nausea, vomiting, altered sensorium, pericarditis, malaise)
  • Pericardial effusion leading to tamponade and friction rub
  • Arrythmias
  • Rales in hypervolemia
  • Diffuse abdominal pain and ileus
A

Acute Kidney Injury

244
Q

Labs for AKI

A

Blood Urea Nitrogen (BUN)

Creatinine

UA

245
Q

AKI

Can help determine prerenal, postrenal or intrinsic

A

Creatinine (Cr)

246
Q

Imaging for AKI

A

Renal US

247
Q

Treatment for prerenal AKI

A

Achieving euvolemia

Restoring renal perfusion

248
Q

Treatment for postrenal AKI

A

Bladder catheterization

Relieve underlying cause

249
Q

Treatment for AKI

A

Usually self-limited

Managed by nephrology

250
Q

Complications of AKI

A

Dialysis

Arrhythmias secondary to electrolyte abnormalities

Bleeding/clotting disorders

Encephalopathy

Cardiac Tamponade

251
Q

Disposition for AKI

A

MEDEVAC

Prerenal: ER, Cardiology, Internal Medicine

Postrenal: Urology referral to relieve obstruction

Intrinsic: Nephrologist

252
Q

Hyponatremia is defined as:

A

Less than 135 mEq/L

253
Q

Most common electrolyte abnormality in hospitalized patients often caused by hypotonic fluids

A

Hyponatremia

254
Q

Hyponatremia is usually caused by:

A

Excess water-retention

255
Q

Mismanagement of hyponatremia can result in:

A

Neurologic catastrophes from cerebral osmotic demyelination

256
Q

Evaluation for hyponatremia

A

New medications

Changes in fluid intake

Fluid output

257
Q

Mild hyponatremia

A

130-135 mEq/L

Nausea

Malaise

258
Q

Moderate hyponatremia symptoms

A

Headache

Lethargy

Disorientation

259
Q

Severe symptoms of hyponatremia

A

Respiratory arrest

Seizure

Coma

Permanent brain damage

Brainstem herniation

Death

260
Q

Treatment for hyponatremia

A

Restriction of free water and hypotonic fluid

Less than 1-1.5 L/day

261
Q

Hyponatremia

What may be necessary in patients with negative free water clearance?

A

Hypertonic saline

262
Q

Most serious complication of hyponatremia is iatrogenic cerebral osmotic demyelination from:

A

Overly rapid sodium correction

263
Q

Symptomatic and severe hyponatremia generally require:

A

Hospitalization for

  • Monitoring of fluid balance and weights
  • Treatment
  • Frequent sodium checks
264
Q

Hypernatremia is classified as:

A

Sodium concentration greater than 145 mEq/L

265
Q

Hypernatremia is typically due to:

A

Free water loss

266
Q

Primary defense against hypernatremia

A

Intact thirst mechanism and access to water

267
Q

Signs and symptoms:

  • Dehydration (hypotension, oliguria)
  • Lethargy
  • Irritability
  • Weakness
A

Hypernatremia

268
Q

Severe signs of Hypernatremia (>158)

A

Hyperthermia

Delirium

Seizures

Coma

269
Q

Treatment for hypernatremia

A

Correcting the cause of fluid loss

Replacing water

Replacing electrolytes

270
Q

Hypernatremia

Fluids should be administered over a _____ period

A

48-hour

271
Q

Hypernatremia

Aiming for serum sodium correction of approximately

A

1 mEq/L/h

272
Q

Rapid correction of hypernatremia may cause:

A

Cerebral edema

Severe neurologic impairment

273
Q

Hypokalemia is classified as:

A

<3.5 mEq/L

274
Q

Severe hypokalemia may induce:

A

Arrhythmias and rhabdomyolysis

275
Q

Hypokalemia can result from:

A

Insufficient dietary potassium intake

Intracellular shifting

276
Q

The most common cause of hypokalemia is:

A

GI loss from infectious diarrhea

277
Q

The potassium concentration in intestinal-secretion is __ times higher than in gastric secretions

A

10 times

278
Q

Symptoms

Mild to moderate hypokalemia

A

Muscular weakness

Fatigue

Muscle cramps

279
Q

Severe hypokalemia

A

<2.5mEq/L

280
Q

Signs and symptoms of severe hypokalemia

A

Flaccid paralysis

Hyporeflexia

Hypercapnia

Tetany

Rhabdomyolysis

281
Q

Imaging for hypokalemia

A

ECG

  • Decreased and broadening of T waves
  • PVCs
  • Depressed ST segments
282
Q

Treatment for hypokalemia

A

Oral potassium supplementation

-40-100 mEq/day for days to weeks

283
Q

Complications of hypokalemia

A

Cardiac arrhythmias

Rhabdomyolysis

284
Q

Hyperkalemia

A

> 5.0 mEq/L

285
Q

Hyperkalemia may develop in patients taking:

A

ACE inhibitors
Angiotensin-receptor blockers
Potassium-sparing diuretics

286
Q

Hyperkalemia usually occurs in patients with:

A

Advanced kidney disease

287
Q

Hyperkalemia

_____ causes intracellular potassium to shift extracellularly

A

Acidosis

288
Q

Hyperkalemia impairs neuromuscular transmission, causing:

A

Muscle weakness

Flaccid paralysis

Ileus

289
Q

Can causing a raise in potassium concentration by 1-2 mEq/L by causing acidosis and potassium shift from cells

A

Fist clenching during venipuncture

290
Q

ECG changes in hyperkalemia include

A

Bradycardia

PR interval prolongation

Peaked T waves

QRS widening

Conduction disturbances (bundle branch block, AV block)

V-Fib and cardiac arrest

291
Q

Treatment for hyperkalemia

A

Withholding exogenous potassium

292
Q

Hyperkalemia

Emergent treatment is indicated when:

A

Cardiac toxicity

Muscle paralysis

Severe hyperkalemia (>6.5)

293
Q

Shifts potassium intracellularly within minutes of administration

A

Insulin (give with glucose)

Bicarbonate

Beta-agonists

294
Q

Intravenous _____ may be given to antagonize the cell membrane effects of potassium

A

Calcium

295
Q

Medications for hyperkalemia

A

Loop diuretics

  • Furosemide
  • Bumetanide
296
Q

Complications of hyperkalemia

A

V-fib

Cardiac arrest

Genitourinary (8 decks)

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