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Clin Therapeutics II (Spring 2018) > Exam 2: GU emergencies > Flashcards

Exam 2: GU emergencies Flashcards

1
Q

Which condition is a painful inability to void (pee)?

A

Acute Urinary Retention

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2
Q

MC cause of Acute Urinary Retention in men?

A

BPH

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3
Q

Classes of meds which can cause Acute Urinary Retention?

A 
Anticholinergics
Alpha-stimulants
Anesthetics
Narcotics
EtOH
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4
Q

How can a clot cause Acute Urinary Retention?

A

Cuts off urethera. In both men and women.

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5
Q

Increased uretheral resistance causes an obstruction where?

A

Bladder outlet obstruction

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6
Q

What does low bladder pressure do to the bladder’s contractility?

A

Lowers bladder contractility making it hard to pee

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7
Q

What will interruptions of sensory and motor innversation to the bladder do?

A

Can’t pee

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8
Q

How to DX Acute Urinary Retention?

A

Bladder U/S

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9
Q

Initial tx of Acute Urinary Retention if not due to trauma?

A

Uretheral catheter to decompress the bladder

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10
Q

Initial tx of Acute Urinary Retention due to trauma?

A

Suprapubic catheter

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11
Q

Late treatment of Acute Urinary Retention needs to be targeted at what?

A

the underlying cause

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12
Q

Surgical treatment of BPH?

A

TURP. Removes tissue to relieve obstruction.

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13
Q

What class of meds for BPH? WHat do they do to prostate?

A

Alpha-1-blockers. Relaxes prostate to let the urine make it out.

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14
Q

Terazosin and Doxazosin do what to BP?

A

Can reduce BP (alpha-1-blockers)

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15
Q

Which alpha-1-blocker has higher incidence of ejaculatory dysfunction?

A

Tamsulosin

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16
Q

Finasteride does what? How long to work?

A

Shrinks prostate. Takes 6 months to work.

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17
Q

When to do a voiding trial in Acute Urinary Retention?

A

3-7 days after catheter decompression

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18
Q

What condition can occur if more than 1000ml urine withdrawn and Cr 3+

A

Post-Obstructive Diuresis

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19
Q

How to treat Post-Obstructive Diuresis?

A

Inpatient. Monitor urine output 200ml/hr for 3 consecutive hours (3L/24h)

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20
Q

What to monitor in Post-Obstructive Diuresis?

A

Serum and urine lytes

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21
Q

Who should follow up with urology after decompressing Acute Urinary Retention?

A

All

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22
Q

What is nephrolithiasis?

A

Kidney stone

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23
Q

MC type of nephrolithiasis?

A

Calcium Oxalate

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24
Q

3 risk factors for calcium oxalate nephrolithiasis?

A
  1. Dehydration
  2. Hypercalcemia
  3. Hyperoxalsomething
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25
Q

Uric Acid Stones happen when pH is below what?

A

<5.5

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26
Q

Struvite Stones aka

A

Magnesium ammonium phosphate stones (MAPS)

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27
Q

What increases risk of Struvite Stones?

A

UTIs w/urease-producting bacteria

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28
Q

What the heck is Proteus?

A

Proteus mirabilis is a Gram-negative, facultatively anaerobic, rod-shaped bacterium

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29
Q

Proteus causes what type of kidney stone?

A

Struvity stones

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30
Q

When are Staghorn Calculi found?

A

After recurrent infections

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31
Q

Staghorn Calculi from which type of kidney stone?

A

Sturvite

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32
Q

Highest mortality and morbidity with nephrolithiasis when what 2 things happen in combo?

A
  1. Upper tract obstruction

2. Upper UTI

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33
Q

How to generally prevent kidney stones?

A

2L/day fluid intake, low salt intake, moderate animal protein to regulate uric acid, moderate calcium to bind to oxalate

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34
Q

How to prevent Calcium Oxalate stones?

A

2 TBLS pure lemon juice per day. Decreased CaOx deposits.

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35
Q

Pure lemon juce prevents which type of kidney stone?

A

Calcium Oxalate only!

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36
Q

What type of pain with kidney stones?

A

Colicky pain

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37
Q

Severe flank pain and ipsilateral lower abdomen pain is kidney stone where?

A

Ureteral stone

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38
Q

Where can Ureteral stone radiate to?

A

Testicles and vulvar areas

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39
Q

Mid-ureter stone radiates in which direction?

A

Anteriorally

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40
Q

Stone in RIGHT mid-ureter can mimic what?

A

Appendicitis

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41
Q

Stone in LEFT mid-ureter can mimic what?

A

Diverticulitis

42
Q

Gold Standard for kidney stone dx?

A

CT abdomen and pelvis without contrast

43
Q

Dx of kidney stone is preggers?

A

Ultrasound

44
Q

What kind of stone can’t KUB detect?

A

Uric Acid stone

45
Q

What size can’t stones pass on own?

A

≥6mm

46
Q

Goal of kidney stone treatment?

A

Shorten time to pass stone

47
Q

Meds to shorten time of stone passing?

A
  1. Alpha blockers
  2. Analgesics
  3. Lots of fluids >2L/day
48
Q

What to do when stone passes?

A

Strain urine to check makeup of stone

49
Q

Which stone can be dissolved?

A

Uric Acid only

50
Q

How to dissolve Uric Acid stone?

A

Potassium citrate to alkalize urine

51
Q

ESWL when stone is smaller than what?

A

<3cm

52
Q

WHat does ESWL do?

A

Breaks stones into smaller fragments

53
Q

Treatment of stone stuck in ureter?

A

Uterscopy with laser lithotrist to break up

54
Q

Tx of large stone stuck at staghorn calculi?

A

Percutaneous nephrolithotomy

55
Q

When to admit PT with kidney stone?

A
  1. Upper obstructruction w/infx or sepsis
  2. Renal deterioration
  3. Bilateral hydronephrosis
  4. Pain refractory to analgesia
  5. Stone in solitary kidney
56
Q

Which condition is a synergistic polymicrobial necrotizing fascitis of the perineum and genetalia?

A

Fourner’s Gangrene

57
Q

MC microbe in Fourner’s Gangrene?

A

E Coli

58
Q

How many organisms found in culture from Fourner’s Gangrene

A

Usually 3

59
Q

Fourner’s Gangrene how many times more common in men than women?

A

10X

60
Q

What is the causal event of Fourner’s Gangrene?

A

Breakdown in urethera or colon

61
Q

S/Sx of Fourner’s Gangrene

A

Severe scrotal pain, edema, erythema, necrotic tissue

62
Q

Dx for Fourner’s Gangrene

A

Clinical H&P

63
Q

What sort of stat consult for Fourner’s Gangrene?

A

Surgical. Need to debrid necrotic tissue.

64
Q

Which 3 abx combo in Fourner’s Gangrene?

A

Clindamycin + Vanco + Zosin (CVZ…like CVS, everyone’s favorite drug store)

65
Q

Testicular Torsion is a twist of what?

A

720º twist of spermatic cord

66
Q

What sort of emergency is Testicular Torsion?

A

True vascular emergency! Compromised blood flow to testis!

67
Q

Pain in Testicular Torsion?

A

Rapid onset of severe scrotal pain

68
Q

What does whole scrotum appear as at 12-24h in Testicular Torsion?

A

Confluent mass

69
Q

UA and WBC in Testicular Torsion?

A

Normal

70
Q

Fever or voiding issues in Testicular Torsion?

A

No fever, no voiding issues

71
Q

Dx for Testicular Torsion?

A

Ultrasound

72
Q

What sort of flow to use on ultrasound for Testicular Torsion?

A

Doppler flow to assess testicular blood flow

73
Q

Who to consult for Testicular Torsion?

A

Urology

74
Q

Can preserve teticle if tx done in how long from onset?

A

4-6 hurs

75
Q

What is a pathological erection called?

A

Priapism

76
Q

What is happening with both corpora cavernosa in Priapism? What’s impaired?

A

Engorged with stadnant blood. Impaired drainage and relaxation.

77
Q

Priapism results when there is what?

A

Impaired drainage and relaxation

78
Q

Many cases of Priapism due to what?

A

Intracavernosal injection of vasoactive impotence meds

79
Q

Two types of Priapism?

A
  1. Ischemic

2. Non-ischemic

80
Q

Increased arterial blood flow in ischemic priapism causes what?

A

Hypoxia, acidosis, and penile compartment syndrome

81
Q

3 major diseases/things which can cause ischemic priapism?

A
  1. Sickle cell
  2. Drugs
  3. Neurogenic shock
82
Q

Ischemic Priapism has what type of arterial blood flow? (Hint: increased or decreased)

A

Increased arterial blood flow

83
Q

Increased arterial blood flow in priapism causes what chemical issues?

A

Hypoxia, acidosis, penile comparment syndrome

84
Q

Non-ischemic priapism due to fistula where?

A

Between cavernosal artery and corpus cavernosum

85
Q

What does fistula in non-ischemic priapism consistently cause?

A

High inflow of blood

86
Q

Common causes of non-ischemic priapism?

A

Needly injury, trauma, congenital arterial malformation

87
Q

Aspiration for priapism? (hint: gotta remove blood)

A

5ml Corporal aspiration w/18g at 3 or 9 o’clock

88
Q

What to inject after aspiration for priapism?

A

Diluted Phenylepherine 1mL/19mL saline q15-20min

89
Q

Tx of sickle-cell priapism?

A

Exhange transfusion, hydrate, analgesia

90
Q

Penile fracture due to rupture of what?

A

Tunica albuniea from direct trauma or erect penis

91
Q

How percent of Penile fracture can cause partial or complete urethral rupture?

A

18%

92
Q

MC cause of Penile fracture?

A

Sexual intercourse

93
Q

What does penis look like in Penile fracture?

A

Acutely swollen, discolored, tender penis

94
Q

How to assess urethera in Penile fracture?

A

Retrograde urethrogram

95
Q

Tx for Penile fracture?

A

Surgery to remove hematoma and suture tunica albulinea

96
Q

Foreskin retracted behind coronal sulcus of glans penis causes what?

A

Paraphimosis

97
Q

What 2 things obstructed in Paraphimosis

A

Venous and lymphatic flow

98
Q

3 major problems from Paraphimosis?

A
  1. Skin necrosis
  2. Gangrene
  3. Autoamputation
99
Q

Tx for Paraphimosis?

A

Try manual retraction of foreskin. If doesn’t work then surgery.

100
Q

What to give for pain with Paraphimosis? What NEVER to give?

A

Lidocaine for pain. NEVER GIVE EPI!!!!

Clin Therapeutics II (Spring 2018) (11 decks)

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