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Q4 EM Surg > Exam 4 Urologic Emergencies > Flashcards

Exam 4 Urologic Emergencies Flashcards

1
Q

Renal Colic is?

A

Nephrolithiasis Urolithiasis (stones)

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2
Q

Common stone types?

A

Calcium (most C) - radiopaque
Struvite (from infection) - radiopaque
Uric Acid (gout) - radiolucent
Cystine (rare)

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3
Q

Renal Colic presentation?

A

Sudden pain moving from flank to groin
N/V
Freq urine, dark colored

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4
Q

Renal Colic labs? (4)

A

CBC
UA (U blood)
BMP (BUN/Cr)
Pregnancy

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5
Q

Renal Colic imaging? (3)

A

KUB
Non-cont CT (most specific)
US if preggo or kid (not as specific)

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6
Q

Renal Colic tx? (5)

A 
8mm won't pass
Pain meds
ABX
α1-block
Removal
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7
Q

Acute Urinary Retention caused by?

A

Obstructive U = prostatic hyperplasia
Inflamm
Neuro (cord lesion, MS)
Rx (antihist/cholinergics, narcotics)

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8
Q

Acute Urinary Retention presentation?

A

Painful inability to void
Abd and bladder distention
Relief w/ drain

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9
Q

Acute Urinary Retention labs?

A 
BMP = renal fail
UA = infection
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10
Q

Acute Urinary Retention tx?

A

Decompress w/ catheter
Monitor 4-6hrs
D/C w/ bag and F/U 1-3 days

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11
Q

Cystitis etiology? (4)

A

E coli
Staph saprophyticus
Klebs
Proteus

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12
Q

Cystitis presentation? (6)

A 
Dysuria
Polyuria
Urgency
Suprapubic/Abd pain
Dark urine (blood or dehydration)
Low back pain
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13
Q

Cystitis labs? (2)

A

Dip: False + possible
LE (pyuria)
Nitrite (G-)

Urine micro:
6-20 WBC

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14
Q

Cystitis tx?

A

Fluoroquin x 3days
Macrobid x 5days
Cephalo x 7-10days
Phenazopyridine for pain

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15
Q

Complicated Cystitis differ from uncomplicated how?

A

Present the same
W/U the same
Longer tx w/ close F/U

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16
Q

Complicated Cystitis seen in who/from what? (11)

A 
Male
Elderly
Kids
Preggos
DM
Catheter
Hospital-acquired
Recent procedure
Recent ABX
Fxn'l abnormality
Sxs > 7 days
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17
Q

Pyelonephritis is?

A

Kidney infection involving kidney parenchyma and renal pelvis

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18
Q

Pyelonephritis etiology?

A

E coli (>90%)
Enterobacter
Kleb

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19
Q

Pyelonephritis presentation?

A 
Fever/chills/rigors
N/V
Diaphoresis
Flank/abd pain
\+ cystitis sxs
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20
Q

Pyelonephritis labs? (6)

A 
UA = LE, nitrites, pyuria, bacteruria, hematuria, WBC CASTS
Urine C&S
Blood Cx
CBC
Preg test
BMP for e-
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21
Q

Pyelonephritis imaging?

A

CT

US

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22
Q

Pyelonephritis in-pt tx when? (7)

A 
Can't tolerate PO
Compliance risk
Uncertain dx
High fever
Uncontrolled pain
Look very sick
Complication risks
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23
Q

Pyelonephritis risk factors for complications?

A

Obstruction/tumor/stone
Recent urologic procedure
Preggo
DM

24
Q

Pyelonephritis tx?

A

10-14 days
DOC: Cephalosporins
2nd: Fluoro
NO Bactrim or Macrobid

25
Q

Acute Prostatitis is?

Etiology?

A

Bacterial infection of prostate

< 35 yo = honor/chlamy
> 35 yo = E coli

26
Q

Acute Prostatitis presentation? (4)

A

Fever/chills
Myalgia
Pain in low back, rectum, perineum
P urine retention, dysuria

27
Q

Acute Prostatitis exam? (3)

A 
Abd = tender
GU = perineal tender
Rectal = boggy, tender prostate
28
Q

Acute Prostatitis: Avoid manipulation of prostate, why?

A

May cause bacteremia

29
Q

Acute Prostatitis labs?

Imaging?

A 
UA = pyuria
CBC = P ↑ WBC

None unless toxic

30
Q

Acute Prostatitis tx? (6)

A

Cipro > 35 yo
Ceftri + Doxy < 35 yo

Hydrate
Pain
Rest
Stool soft

31
Q

Urosepsis is?

Presentation? (4)

A

Severe illness from spread of UTI

P hx of UTI, stones, prostatitis
Persistent sxs of above
Weak/confused
Dehydration

32
Q

Urosepsis exam findings? (5)

A

Systemic Inflammatory Response Syndrome (SIRS):

Temp > 100.4 or < 96.8
WBC > 12K or < 4k or 10% bands
↑ Plasma Lactate > 4
Tachycardia > 90 
Tachypnea > 20
33
Q

Urosepsis labs? (5)

A 
CBC
UA w/ Cx
Blood Cx
BMP
Lactate
34
Q

Urosepsis imaging?

A

CT r/o stone, abscess, ddx

35
Q

Urosepsis tx?

A

Fluids
ABX
Tx shock
Admit

36
Q

Testicular Torsion presentation? (5)

A 
Sudden testicular pain
w/ or w/o prior event
P w/ sleep or exertion
Swelling
P abd pain, N/V
37
Q

Testicular Torsion exam? (5)

A 
Sedate pt (pain too much for exam w/o)
Swollen, firm, tender hemiscrotum
High-riding testis w/ transverse line
P cremaster reflex ABSENT
Blue Dot Sign (appendix testis torsion)
38
Q

Testicular Torsion imaging?

A

STAT doppler US = ↓ or no blood flow

39
Q

Testicular Torsion tx?

A

STAT Urology for surgery

Medial to lateral detorsion

40
Q

Epididymitis is?

A

Inflamm of epididymis from back-flow of infected urine down vas deferens

41
Q

Epididymitis etiology?

A

< 35 yo = gon/chylam

> 35 yo = e coli

42
Q

Epididymitis presentation? (4)

A

Scrotal pain, swell, tender
RELIEVED w/ elevation of testicle
Low abd/perineal pain
P d/c, UTI sxs, fever/chills

43
Q

Epididymitis exam findings?

A

Red, swollen, warm testicle
Testicular lump
Inguinal LAD
Cremaster reflex INTACT

44
Q

Epididymitis labs? (3)

A

CBC is systemic sxs
UA
Gon/Chylam test

45
Q

Epididymitis imaging?

A

Doppler US r/o torsion or tumor

46
Q

Epididymitis tx? (6)

A 
Scrotal elevation
Ice
If STD Ceftri + Doxy
If UTI Cipro
Pain
Stool soft
47
Q

Paraphimosis is?

A

Unretractible foreskin

Compromised blood flow to glans

48
Q

Paraphimosis most C in who?

C caused by?

A

Old/very young

Catheters
Poor hygiene

49
Q

Paraphimosis tx?

A

Attempt reduction
STAT Urology
Dorsal slit in foreskin

50
Q

Priapism is?

U seen in who?

A

Erection > 4 hrs

30-40yo

51
Q

Priapism tx? (4)

A 
Pseudoephedrine (Sudafed) PO
Terbutaline SQ (β2-agonist)
Aspirate corpora (till bright red blood)
Phenylephrine (α1-agonist) into corpora
52
Q

Fourniers Gangrene is?

Etiology? (4)

A

Necrotizing infection of perineum, penis, scrotum, abd wall

Staph
Strep
E coli
Clostridium

53
Q

Fourniers Gangrene a/w what? (6)

A 
DM (most C)
EtOH
Immunocomp
Liver dz
Trauma to area
Prior infection of area
54
Q

Fourniers Gangrene presentation? (7)

A 
Slow or rapid onset
Redness next to point of entry ->
Pain, swell, discoloration
Fever
Toxic appearance
SQ crepitation (crackling) over area
Putrid odor
55
Q

Fourniers Gangrene labs? (6)

A 
Septic W/U:
CBC w/ diff
CMP
Coag
Lactate
UA
Wound Cx
56
Q

Fourniers Gangrene imaging?

Tx?

A

Contrast CT

STAT surgery

Q4 EM Surg (27 decks)

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