Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Therapeutics 2 > GU Emergencies > Flashcards

GU Emergencies Flashcards

1
Q

Sx’s of acute urinary retention

A

can’t pee, decreased stream, “dribble”, severe pain in lower abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is acute urinary retention?

A

painful inability to void

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

pathophysiology of acute urinary retention? (HINT: 3 factors)

A

increased urethral resistance
-bladder outlet obstruction

lower bladder pressure
-impaired bladder contractility

interruption of sensory and motor innervations of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what factors can trigger acute urinary retention?

A

Prostatitis, Narcotics, diphenhydramine (anticholinergics), Pseudoephedrine, Oxybutynin/Detrol, ETOH ingestion, anesthesia (paralyzes bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how does prostatitis trigger acute urinary retention?

A

increases bladder outlet obstruction (M/C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do narcotics trigger acute urinary retention?

A

reduce bladder contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does diphenhydramine trigger acute urinary retention? who does it cause retention in?

A

it’s an anticholinergic -> reduces contractility

-causes retention in older people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how does Pseudoephedrine trigger acute urinary retention?

A

it’s a sympathomimetic which stimulates Alpha-receptors in prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how does Oxybutynin/Detrol trigger acute urinary retention?

A

anticholinergic meds for tx of overactive bladder or bladder spasms
-can flip someone into retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

most common cause of acute urinary retention in men?

A

BPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of acute urinary retention in women?

A

pelvic prolapse, urethral stricture, urethral diverticulum, post-surgery, pelvic masses that stop contractility of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

causes of acute urinary retention in both men and women?

A

clot retention (clot off urethra), herpes zoster virus can cause the bladder to not contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the initial management of acute urinary retention?

A

Urethral catheterization (Foley catheter) - to drain bladder

Supra Pubic Catheter (for pts that had trauma to the urethra)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is late management of acute urinary retention?

A

treat the underlying cause (do this after drain the bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what labs do you want to get for acute urinary retention?

A

UA and Cx - want to check Cr, electrolytes, see if there’s an infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the indications for treatment for BPH?

A

incomplete bladder emptying, acute urinary retention, CRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the FIRST LINE medical tx for BPH?

A

Alpha-1 blockers

-Terazosin, Doxazosin, Tamsulosin (M/C), Alfuzosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the MOA of alpha-1 blockers?

A

-relax the muscle of the prostate and bladder neck -> increased urinary outflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when do alpha-1 blockers begin to work?

A

quickly, within 72hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the M/C side effect of alpha-1 blockers?

A

orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

which alpha-1 blockers are more likely to lower BP (cause orthostatic hypotension)? when are they taken?

A

Terazosin and Doxazosin are more likely to lower BP

Taken at Bedtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when can you NOT take terazosin or doxazosin?

A

do not take terazosin or doxazosin with meds for ED like sildenafil, vardenafil, tadalafil, or avanafil

Tamsulosin and Alfuzosin don’t interact with ED meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tamsulosin has a higher incidence of what?

A

ejaculatory dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

do Tamsulosin 0.4mg and Alfusozin need to be pirated up?

A

NO!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are other meds to use to treat BPH?
5-Alpha-reductase inhibitors Finasteride (M/C), Dutasteride
26
MOA of 5-Alpha-reductase inhibitors?
androgen inhibitors -> suppress growth of prostate and can cause it to shrink
27
how long does it take for Finasteride or Dutasteride to work?
6 months -> no indication to start in the AUR phase
28
side effects of Finasteride or Dutasteride? what can they cause? side effects resolve when?
decreased sex drive, difficult with erection or ejaculation, or sx's of depression - can cause pts to stop taking the meds - side effects resolve when the med is stopped
29
what levels decrease by 50% in men who take Finasteride or Dutasteride? why is this important to remember?
PSA levels decrease by 50% | -important to remember if you have PSA testing to screen for prostate cancer
30
complication of acute urinary retention?
Post-Obstructive Diuresis
31
what is the criteria for Post-Obstructive Diuresis?
>200ml/hr for 3 consecutive hrs or 3L/24hrs of urine drained -if >1000cc in bladder and increased Cr, monitor for post-obstructive diuresis
32
pts with post-obstructive diuresis need to be kept as what?
need to be kept inpatient to monitor for urine output and electrolytes
33
tx for post-obstructive diuresis?
IVF at 75% of the cc/hr rate of diuresis probably keep Foley in for 10-14 days
34
all men in urinary retention need what follow-up?
a Urology follow-up
35
what trial should AUR pts get?
a voiding trial in 3-7 days
36
sx's of nephrolithiasis?
writhing in pain - can't sit still unremarkable abdominal exam pain refers to genitals
37
what is the GOLD STANDARD imaging to dx nephrolithiasis?
CT scan of the abdomen and pelvic w/out IV contrast
38
when is U/S used to dx nephrlithiasis?
pregnant pts
39
what stones can KUB X-ray not dx?
uric acid stones
40
sx's of kidney stone at the UPJ?
mild to severe deep flank pain w/out radiation to groin (pain coming from the kidney)
41
sx's of kidney stone in ureter?
Abrupt severe colicky pain in flank and ipsilateral lower abdomen May radiate to testicles or vulvar area, NAUSEA!!!
42
when do you get the radiation of pain to the groin in nephrolithiasis?
when the stone is in the ureter you get radiation of pain to groin area
43
sx's of kidney stone in mid ureter?
Radiates anteriorly - may mimic appendicitis if on right - may mimic diverticulitis if on left
44
sx's of kidney stone in distal ureter and UVJ?
- Pain radiates to groin and testicle in male, labia majora in female - At UVJ may have cystitis symptoms
45
sx's of kidney stone in bladder?
rarely symptomatic, but can cause cystitis like sx's or urinary retention
46
at what size will kidney stones NOT pass on its own?
stones >6mm - stones this size of greater won't pass on its own
47
what is the conservative tx for nephrolithiasis?
- use alpha blockers and analgesics - LOTS OF FLUIDS - 2L/DAY - STRAIN THE URINE - if evidence of UTI, treat with abx
48
risk factors of calcium oxalate stones?
dehydration, hypercalciuria, hyperoxaluria
49
risk factors of uric acid stones?
highly acidic urine, persistent metabolic acidosis, hyperuricemia leading to hyperuricosuria, urine pH < 5.5
50
risk factors of struvite stones?
UTIs with urease-producing bacteria (PROTEUS), Urea -> NH4 + OH- causes urine pH to rise STAGHORN CALCULI - usually found after recurrent infection
51
what type of kidney stones can you dissolve and with what?
uric acid stones -> use Potassium Citrate and try and alkalinize the urine
52
when is ESWL use for tx of kidney stones?
for < 3cm stones in the kidney uses shock wave to break up stone into smaller fragments
53
when is Uretoscopy and Laser Lithotripsy used for tx of kidney stones?
Cystoscopy into Ureter and break up stone with Laser For stone suck in the ureter
54
when is Percutaneous Nephrolithotomy used for tx of kidney stones?
large stones in kidney -> STAGHORN CALCULI
55
when are ureteral stents used for tx of kidney stones?
Used when pt has stone and has infection/sepsis/fever/pyonephrosis and don't want to break up the stone
56
what requires urgent intervention for kidney stones?
- Obstructed upper tract with signs of infection and/or sepsis - Renal deterioration or bilateral hydronephrosis - Intractable N/V - Pain refractory to analgesic - Stone in solitary kidney
57
what is the highest morbidity and mortality with in kidney stones?
with the combination of urinary tract obstruction and upper UTI
58
when do you admit a patient with kidney stones?
- PO analgesics are insufficient - Intractable vomiting - Obstructing in solitary or transplanted kidney - Bilateral ureteral obstruction - Sepsis, Fever, Pyonephrosis - Renal failure - Immunocompromised state
59
what is the management of acute renal stones?
- Placement of a ureteral stent/percutaneous nephrostomy tube to decompress the kidney - Does not involve breaking up the stone as bacteria are often housed w/in the stone and can worsen urosepsis
60
main ways to prevent future kidney stones?
Increased fluid intake (2L/day) and low salt diet For CaOx stones -> Increased dietary citrate - 2 table spoons pure lemon juice a day -citrate can prevent CaOx deposition in the kidney
61
what kidney stones does citrate (2 tblspns pure lemon juice/day) prevent the recurrence of? how do the prevent it?
CaOx stones -> prevents their deposition in the kidney
62
what is Fournier's Gangrene?
a synergistic polymicrobial necrotizing fasciitis of the perineum and genitalia
63
sx's of Fournier's Gangrene?
erythematous, edematous scrotum that is tender to mild palpation + odor, + necrosis on scrotum and penile shaft
64
who should you always inspect the genitals in? checking for?
diabetics, immunocompromised pts checking for Fournier's Gangrene
65
can tx be delayed for Fournier's Gangrene?
NO!!! DO NOT DELAY TX -> HIGH MORTALITY RATE
66
Labs for Fournier's Gangrene?
Sepsis Workup - WBC (high WBC) - CMP (glucose may be high if diabetic) - Lactate - Blood Cx
67
risk factors of Fournier's Gangrene?
- Perineal or genital skin infections - Urethral stricture - Piercing or cocaine injection - STIs - Paraphimosis Causative event is a mucosal breakdown in the urethra or colon
68
what is the M/C organism for Fournier's Gangrene?
E. Coli
69
how many organisms do you usually see from cx for Fournier's Gangrene?
3
70
other organisms for Fournier's Gangrene?
Klebsiella, B. fragilis, Strep, Staph, Pseudomonas, C. Perfringes
71
dx of Fournier's Gangrene?
Clinical DX (have a high clinical suspicion) Surgical Consult Stat!!!! -need debridement of all necrotic tissue ASAP Imaging - good for atypical presentations -X-rays - air in tissues - US - differentiate intrascrotal abnormality, thickening, gas, in scrotal wall - CT or MRI - r/o retroperitoneal or intra-abdominal process
72
what MUST NOT be delayed in dx/tx of Fournier's Gangrene?
Surgical Consult for Early Debridement
73
tx for Fournier's Gangrene?
Surgical Consult for Early Debridement Hemodynamic stabilization - IVF Abx (ZOSYN + VANCO + CLINDAMYCIN) Hyperbaric Oxygen (no clear evidence on effectiveness) PLASTICS
74
what abx treat Fournier's Gangrene?
ZOSYN + VANCO + CLINDAMYCIN Clindamycin targets antitoxin effects of the toxin elaborating strains of strep and staph
75
what does Hyperbaric Oxygen do for tx of Fournier's Gangrene?
No clear evidence on effectiveness Neutralizes anaerobes, increases fibroblast proliferation, promotes angiogenesis
76
high clinical index of suspicion of Fournier's Gangrene in who?
DM, immunocompromised, alcoholics
77
what urologic diseases are Urologic Emergencies?
Testicular Torsion, Priapism, Penile Fracture, Paraphimosis, Fournier's Gangrene
78
sx's of Testicular Torsion? Labs?
Rapid onset of severe pain either from trauma, physical activity or none whatsoever At 12-24 hours, whole scrotum appears as a confluent mass Afebrile, no irritative voiding symptoms Normal UA and WBC
79
what test confirms dx of testicular torsion?
US with Doppler -> assesses arterial flow w/in the affected testis
80
when does Priapism result?
when there is impaired drainage and relaxation of smooth muscle of cavernous arteries and tissues in penis
81
what is Ischemic Priapism?
- Men present with erythematous painful erect corpus cavernosum - The increase arterial flow results in hypoxia, acidosis, and eventually penile compartment syndrome
82
Ischemic Pripism seen in who?
Sickle cell, Drugs, Neurogenic shock
83
what is Non-Ischemic Priapism? Occurs in?
Less common and result of a fistula b/w the cavernosal artery and corpus cavernosum, resulting in consistently high in flow of blood Occurs in: Needle injury, trauma, congenital arterial malformations
84
what is the treatment for Priapism?
- Analgesia - CALL UROLOGY - Corporal aspiration followed by irrigation w/alpha-adrenergic agonists (Phenylephrine)
85
Sick Cell pts with priapism need what tx?
Sickle Cell need exchange transfusion as well as adequate hydration and analgesia
86
what is a penile fracture?
The tunica albuginea of one or both corpus cavernosa ruptures due to direct trauma to the erect penis
87
what is the most common cause of penile fracture? other causes?
sexual intercourse = M/C cause other causes: animal bites, stabbing, bullet wounds, and self-mutilation
88
sx's of penile fracture?
acutely swollen, discolored, and tender penis
89
tx of penile fracture?
CALL UROLOGY Retrograde urethrogram to assess the urethra Surgery to remove hematoma and suture the tunica albuginea
90
tx of paraphimosis?
Pain control, topical lidocaine (NO EPI as can worsen vasoconstriction and ischemia) Urology consult to attempt manual reduction and if not successful, surgical
91
sx's of paraphimosis?
foreskin of uncircumcised male becomes retraced behind the coronal sulcus of the glans of the penis -get venous and lymphatic outflow obstructed, edema worsens, blood flow can become obstructed and result in skin necrosis, gangrene, or even auto-amputation
92
common causes of priapism?
Many cases are pharmacologically related to intracavernosal injection of vasoactive substances for impotence, calcium channel blockers and erectile dysfunction meds

Clinical Therapeutics 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions