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FA17 Nephrology > GU Emergencies > Flashcards

GU Emergencies Flashcards

1
Q

twisting of spermatic cords

A

testicular torsion

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2
Q

testicular torsion

clinical features

A

young men (16-18)

sudden onset of UNILATERAL testicular pain

scrotal swelling/erythema

abdominal pain

bell clapper deformity

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3
Q

bell clapper deformity

A

affected testicle moves to horizontal plane

testicular torsion

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4
Q

immediate testicular torsion workup

A

Testicular U/S

urologic surgical consult

detorsion attempted

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5
Q

interim testicular torsion tx

A

de torsion maneuver (open book)

infarct occurs within 6 hrs

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6
Q

clinical pearls of testicular torsion

A

absent cremasteric reflex

history will have less severe episodes

50% occur during sleep

bimodal age presentation (infancy and adolescence)

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7
Q

twisting of appendix

A

Torsion of Testicular or Epididymal Appendix

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8
Q

clinical features of testicular torsion appendix

A

common among boys 10-16 (any age)

sudden onset of pain

inflammation and necrosis occurs

early- firm, tender
late- generalized edema and pain

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9
Q

appendix

A

embryological remnants

found on superior part of testicle or epididymis

no function

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10
Q

diagnosing appendix testicular torsion

A

Doppler U/S

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11
Q

treatment of testicular torsion appendix

A

immediate urological consult

necrotic appendages can be excised

analgesics and rest

calcifies in 1-2 weeks

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12
Q

pathognomonic testicular torsion appendix

A

Blue-Dot Sign

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13
Q

blue dot sign

A

stretching skin over necrotic nodule

during transillumination

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14
Q

clinical features of SUPERFICIAL scrotal abscess

A

indurated - can evolve

progressive pain and surrounding erythema

supercritical layer of scrotal wall

fever is usually absent (localized not systemic)

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15
Q

distinguishing between superficial abscess and Fournier’s gangrene

A

in gangrene - pt appears very ill

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16
Q

Treatment of superficial scrotal abscess

A

local anesthesia + incision and drainage

bactrim, clindamycin, doxycycline

sitz bath, wound care

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17
Q

Fournier’s gangrene

clinical features

A

ill out of proportion to exam

severe abdominal pain progressing to scrotum

fevers, tachycardia, hypotension

tense scrotal edema, blisters, bulla

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18
Q

those at risk for Fournier’s gangrene

A

middle aged, DM males

indwelling foley catheter

IV drug users

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19
Q

treatment of Fournier’s gangrene

A

aggressive fluid resuscitation

CBC, lactic acid, BMP, UA, C&S, CT scan

early surgical debridement and drainage

early broad spectrum ABx

hyperbaric O2 chamber

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20
Q

clinical features of orchitis

A

variable onset (mild- severe)

viruses - mumps (4-7 days after parotid)

scrotal pain/edema

unilateral

constitutional symptoms (malaise, HA, myalgia)

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21
Q

what should always be on your differential in orchitis?

A

testicular cancer (reactive hydrocele)

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22
Q

treatment of orchitis

A

supportive care
analgesics
cold pack
scrotal elevation

bacterial cause - epididymitis

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23
Q

testicular ultrasound orchitis

A

can distinguish viral or bacterial cause

viral: proceeding or concurrent parotid swelling supports mumps, orchitis
bacterial: large, boggy, tender epididymus

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24
Q

testicular tumor

clinical presentation

A

painless, firm testicular mass

complains of heaviness

distinctly palpable from testicle (early)

reactive hydrocele - late

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25
Q

treatment of testicular tumor

A

referral to urologist for surgical exploration

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26
Q

testicular tumor

A

acute hydroceles and hematocele should prompt consideration of a tumor

supraclavicular lymph node, abdominal mass, or chronic nonproductive cough

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27
Q

hydrocele

A

collection of peritoneal fluid b/t parietal and visceral layer of tunica vaginalis

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28
Q

communicating hydrocele

A

usually develops as a result of failure of processes vaginalis to close during develop

peritoneal fluid

common in newborns (congenital)

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29
Q

noncommunicating hydrocele

A

no connection to the peritoneum

fluid comes from mesothelial lining of tunica vaginalis

epididymitis, orchitis, testicular torsion, trauma, tumor

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30
Q

clinical features of hydrocele

A

asymptomatic
soft, fluid filled scrotum

transilluminated

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31
Q

hydrocele workup

A

directed toward discovering underlying cause

transilluminate, u/s

urology referral

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32
Q

hydrocele treatment

A

child under 1/neonate of age is usually supportive (typically resolve spontaneously)

surgical repair for communicating beyond 1 yr or idiopathic and symptomatic hydrocele

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33
Q

scrotal edema

A

scrotal skin becomes taunt with pitting edema

associated with CHF or nephrotic syndrome

34
Q

clinical features of epididymitis

A

onset over hours

ipsilateral (pain on same side, inguinal canal, lower quadrant of abdomen)

tender, indurated, edematous epididymis

scrotal swelling, pain

UA = WBCs, pyuria, bacteriuria

fevers

35
Q

differential diagnosis of epididymitis

A

testicular torsion - U/S to distinguish

testicular cancer

36
Q

epididymitis treatment

A

<35 y/o = treat like STD

> 35 35 y/o = treat like UTI

febrile patients, consider IV abx and admission

37
Q

epididymitis ABX used

A

<35 - STD (ceftriaxone, doxycycline)

> 35 (ciprofloxin/olfloxacin/Bactrim)

38
Q

pathopneumonic epididymitis

A

Prehn sign

relief of pain with elevation of scrotum

39
Q

bacterial inflammation of the prostate gland

A

acute prostatitis

40
Q

acute prostatitis clinical features

A

low back pain

perineal pain

subrapubic pain

obstructive lower urinary tract

perineal pain with ejaculation

fever, chills

41
Q

acute prostatitis risk factors

A

anatomic or neurophysiological lower UTI

acute epididymitis

anal intercourse

phimosis

intraprostatic ductal reflux

indwelling urethral catheter

42
Q

causative organisms acute prostatitis

A

MC = E. Coli

pseudomonas, Klebsiella, enterobacter, serrate, staphylococcus

43
Q

clinical findings of acute prostatitis

A

perineal tenderness

rectal sphincter spasm

prostatic tenderness and bogginess

44
Q

diagnosis of acute prostatitis

A

digital rectal exam or prostatic massage is CI

urethral swab cultures, first void urine

45
Q

acute prostatitis treatment

not STI cause

A

Cipro x 14 days
Bactrim DS x 14 days (alternative)

f/u w/PCP

46
Q

treatment of acute prostatitis

STI cause

A

(age <35)

ceftriaxone (Rocephin) IM dose + doxycycline (Vibramycin)

47
Q

acute prostatitis disposition

A

abnormal vital signs = admit + Zosyn

48
Q

urethritis

A

STD

males = dysuria with discharge

females = vaginal discharge/irritation

49
Q

urethritis chlamydia infection suspected when

A

vaginal discharge or irritation

history of partner with urethritis

cervicitis

pyruria

50
Q

urethritis clinical features

A

dysuria
urethreal discharge
vaginal discharge

51
Q

diagnosis of urethritis

A

clinical

UA

52
Q

urethritis infectious pathogens

A

chalmydia trachmoatis

neisseria gonorrhoae

trichomonsa vaginalis

53
Q

urethritis treatment

A

ceftriaxone (Rocephin)

azithromycin or doxycycline

54
Q

entrapment of retracted forskin around penis

A

can’t be reduced, true emergency

paraphimosis

55
Q

paraphimosis clinical features

A

pain, swelling, erythema

venous encouragement (which can lead to occlusion and tissue necrosis)

56
Q

paraphimosis ER tx

A

analgesics/sedative

reduction technique (reduction firmly for 5 min to reduce swelling and foreskin)

local anesthesia and incision of constricting band + circumcision

57
Q

inability to retract foreskin proximally and posterior to glans penis

A

phimosis

58
Q

phimosis

A

normal in uncircumcised boys

caused by poor hygiene

can cause urinary retention

infection (ABX) + topical steroids, circumcision

59
Q

infection and inflammation of glans penis

A

Balanitis

also involves overlaying foreskin

60
Q

balanitis

A

pain, tenderness, pursuits lesions on glans (ulcerated or scaly)

may cause urinary retention

AA and hispanic males MC

61
Q

etiologies of Balanitis

A

poor hygiene + uncircumcised

candidate infections

allergic/contact dermatitis

STDs

62
Q

Balanitis diagnosis

A

avoid retraction, evaluate presence of urethral meatus and inspect for discharge

illicit history of immunosuppression and Reiter syndrome

63
Q

treatment Balanitis

A

warm soaks 2x day

candidal infection clotrimazole and miconazole

treat STD accordingly

mini STRAIGHT cath

urology consult

64
Q

hair tourniquet

A

hair or filament wraps around penis - surgical emergency

edema and arterial compromise and amputation

young children, penile rings

suspected in unconsolable crying infant

65
Q

hair tourniquet ER tx

A

immediate release of constriction relieves pain and restores circulation

must be taken not to further injury

try cold packs to decrease swelling and visualize hair

66
Q

penile zipper injuries

A

foreskin becomes entrapped in teeth of zipper as zipper is opened

tx = remove zipper and free foreskin

penile block at base of penis to ease removal

ensure intact urethra

67
Q

penile fracture

A

trauma during intercourse

report sudden snapping sound

usually swollen and angulated at fracture, caused by tear of tunica albuginea

68
Q

treatment of penile fracture

A

retrograde urethrogram

emergent surgical repair

69
Q

urethral rupture

A

trauma

anterior: local infection/sepsis, straddle injury
posterior: pelvic fracture, blood from urethral meatus, can’t void, perineal bruising

70
Q

ER tx of urethral rupture

A

urethrogram

evidence of urethral rupture = supra-pubic catheterization, no foley catheterization

71
Q

clinical pearls of urethral rupture

A

foley catheter CI

consider in trauma patient: unable to void, blood at meatus, perineal trauma

cause scrotal swelling in males

72
Q

straddle injuries

A

pain, swelling, ecchymosis, hematoma of perineum or scrotum

dysuria and urinary retention

caused blunt trauma

73
Q

straddle injuries treatment

A

supportive - ice packs and elevation, mini cath

can obscure perineal laceration (swelling if careful exam not performed) and pelvic radiographs

74
Q

priapism clinical features

A

persistant painful erection

presents within several hours to days

engorgement of corpora cavernosus (glans penis, corpus spongiosum(

arterial (trauma) and venous causes (ED, sickle cell, leukemia)

75
Q

treatment of priapism

A

Ice packs

terbutaline

pseudoephedrine

aspiration of corpus cavernosusm

phenylephrine or epinephrine

76
Q

urinary retention

A

painful urologic emergency - sudden inability to pass urine

mc in elderly men with benign prostate hypertrophy

can use a catheter to remove urine from the bladder

77
Q

hematospermia

A

blood in sperm

benign condition (ass. with trauma)

CAN indicate infection or cancer

78
Q

GU foreign bodies

tx, complications, clinical features

A

genital pricing, constrictive devices and uretheral foreign bodies

s/s: swelling, edema, pain, dysuria and urinary retention

comp: UTI, urethral rupture, contact dermatitis, vascular compromise (Constrictive)

79
Q

hernia

A

protrusion of any viscous from it surrounding tissue walls

classified by anatomic location and status

80
Q

direct hernia

A

inguinal

men >40

origin above inguinal ligament, rarely courses into scrotum

hernia badges anteriorly, not felt in inguinal canal

81
Q

indirect hernia

A

mc of all hernias, all ages

origin above inguinal ligament, courses into scrotum

hernia bulges into canal and touches finger tips

82
Q

femoral inguinal hernias

A

least common

women>men

below inguinal ligament, never scrotum

FA17 Nephrology (13 decks)

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