GU

Question 1

Clinical presentation of epididymitis

Answer 1

Gradual onset pain in flank and suprapubic area progressing to scrotum
Fevers
LUTS
Swollen tender epididymis that may progress to whole testicle if also orchitis
Prehn sign is relief w elevation of scrotum

Cremasteric reflex preserved

Question 2

Treatment of epididymitis

Answer 2

<35 treat gonorrhea chlamydia
>35 treat w fluoroquinolone
Prepubertal give septra

Question 3

What is the deformity that increases your risk of testicular torsion

Answer 3

Tunica vaginalis attaches higher up on spermatic cord leaving some redundant cord and mobile testicle

Question 4

Clinical presentation of testicular torsion

Answer 4

Severe abrupt onset unilateral testicular pain
Loss of cremasteric reflex
Tender firm swollen testicle
Horizontal lie of contralateral testicle

Question 5

Management of testicular torsion

Answer 5

Stat urology
Analgesia
Don’t delay consult for imaging
Attempt manual detorsion open book (medial to lateral) if that doesn’t work then do other way

Question 6

Risk factors for Fournier’s gangrene

Answer 6

Diabetes, immunesuppression, obesity, malignancy, chronic steroid use, chronic alcoholism

Question 7

Bugs most commonly involved in fourniers

Answer 7

E. coli, bacteroides fragilis

Question 8

Treatment of Fournier

Answer 8

Aggressive supportive care
Broad spectrum antibiotics: mero vanco clinda
Emergent surgical debridement

Question 9

Most common cause of Balanitis and balanoposthitis

Answer 9

Candida

Question 10

Clinical presentation of balanitis

Answer 10

Pain, tenderness, itching of glans +- foreskin
Glans is erythematous, can be ulcerated with scaly lesion
Foreskin can be adherent or have purulent discharge when retracted

Question 11

Treatment of balanitis

Answer 11

Topical antifungal x 1-3 weeks
Fluconazole 150 mg po x 1
Abx is cellulitis

Question 12

When is phimosis considered pathological

Answer 12

With difficulty urinating or with sexual dysfunction

Question 13

Treatment of phimosis

Answer 13

Daily cleaning of foreskin
Gentle retraction
Topical steroids
Immediate intervention if outlet obstruction or vascular compromise (dilation of the meatus with forceps)

Question 14

Treatment of paraphimosis

Answer 14

Analgesia, consider dorsal penile block or procedural sedation
Reduce with firm circumferential pressure x 5-10 mins
Can use traction with forceps at 3 and 9 o’clock if no luck

Question 15

Two types of priapism

Answer 15

Ischemic and non ischemic

Question 16

Risk factors for ischemic priapism

Answer 16

Sickle cell disease
Malignancy (leukaemia, multiple myeloma)
Substance abuse (cocaine)
Sildenafil, tadalafil, CCBs, prazosin, trazodone, risperidone
Penile injections for erectile dysfunction (vasodilation agent eg phentolamine, prostaglandin)

Question 17

Blood test to consider if cause of priapism unclear

Answer 17

CBC to screen for heme malignancy

Question 18

Management of ischemic priapism

Answer 18

Analgesia
Trial SQ terbutaline and PO pseudoephedrine
Aspiration of blood from corpus cavernosum w butterfly needle
Injection of vasoconstrictor: phenylephrine bilateral corpus cavernosum

Question 19

Clinical presentation of high flow or non ischemic priapism

Answer 19

Semierect and painless penis

Perineal compression with thumb causes detumescence

Question 20

What is ruptured in penile fracture

Answer 20

Tunica albuginea surrounding corpus cavernosum

Question 21

What should you consider in new r sided varicocele? And left?

Answer 21

Consider vascular compression – IVC if right sided of RCC causing L renal vein compression if left side
Consider CT is suspect vascular compromise

Question 22

What is the blue dot sign in transillumination pathognomonic for

Answer 22

Appendageal torsion of the testicle.

Painful but no effect on fertility or viability

Question 23

Management of appendageal torsion

Answer 23

Rest, analgesia, scrotal elevation
Usually resolves
Surgical in severe cases of pain

Question 24

When should you consult surgery for an inguinal Hernia in the ER

Answer 24

Strangulated, incarcerated, causing obstruction

Question 25

How to reduce an incarcerated Hernia in the ER

Answer 25

Trendelenberg, sedation, gentle pressure

Question 26

Causes of acute urinary retention

Answer 26

Obstruction (penile, urethral, prostate)
Neurogenic causes(diabetes, MS, Cauda equina)
Meds (TCA, anticholinergic, antihistamine, alpha adrenergic)