GU/GYN emergencies

Question 1

If there is going to be a delay in intervention for testicular torsion what treatment should you try first?

Answer 1

manual detorsion

Question 2

A positive phren sign is classic for what condition?

Answer 2

epididymitis

Question 3

The majority of kidney stones are composed of what?

Answer 3

calcium

Question 4

What pain med would you give for testicular torsion?

Answer 4

morphine

don’t go to ketorolac because patient will need to go to surgery

Question 5

35-year-old male presents to the ED complaining of penile pain. He was having intercourse when he heard a “crack” and developed severe pain. Aside from being extremely embarrassed, he has no other complaints. What is the diagnosis?

Answer 5

penile fracture

Question 6

What is the treatment for epididymitis in the following populations:

a. age 35 or under
b. age 35 or above
c. patient who practices insertive anal intercourse

Answer 6

a. consider STI = ceftriaxone 500mg IM + doxycycline 200mg per day
b. consider UTI = levofloxacin 500 mg per day for 10 days
c. ceftriaxone 500mg IM + levofloxacin 500mg per day

10 day course

Question 7

How is Fournier’s gangrene diagnosed?

Answer 7

clinically diagnosed

confirmed with CT scan where you see free air

Question 8

A “blue dot” sign is classic for what condition?

Answer 8

torsion of the appendix testis

Question 9

What is the most important initial test to obtain in a penile fracture?

Answer 9

• urinalysis to assess the patient’s ability to urinate

Question 10

In a patient who presents with flank pain you should always exam this system.

Answer 10

GU system

Question 11

What is the only successful treatment method for Fournier’s gangrene?

Answer 11

surgical debridement

mortality is 100% without surgical debridement

Question 12

Loss of cremasteric reflex is classic for what GU emergency?

Answer 12

testicular torsion

Question 13

When should you consult urology for a nephrolithiasis? (4)

Answer 13

• infected kidney stone
• acute kidney injury
• failed trail of passage or uncontrolled pain/vomiting
• > 10mm

Question 14

What is the management for nephrolithiasis? (5)

Answer 14

• IV fluids
• pain management (toradol 15-30mg IV)
• anti-emetics (zofran 4mg IV)
• alpha blockers (tamsulosin 0.4 mg once a day)
• ask patient to strain urine

Question 15

What size do we lose the ability to pass stone?

Answer 15

> 5mm we lose the ability to pass stone exponentially

Question 16

What imaging study would you get for a first-time nephrolithiasis?

Answer 16

CT scan without contrast

get U/S in patient with Hx of kidney stone

Question 17

What are good patient education tips for nephrolithiasis? (3)

Answer 17

• don’t fly on airplane until stone passes
• stay away from red meats and soda
• stone can take days to weeks to pass

Question 18

40-year-old male presents to the emergency department complaining of flank pain. His pain was sudden onset 1 hour ago, 8/10, waxing and waning, with associated nausea and vomiting. He cannot find a comfortable position. No fevers, diarrhea, dysuria, hematuria. What is the diagnosis?

Answer 18

kidney stone

Question 19

What antibiotics are prescribed for Fournier’s gangrene?

Answer 19

• broad spectrum + CLINDAMYCIN

Question 20

what is the best definitive management for testicular torsion?

Answer 20

surgical detorsion and fixation

Question 21

What rollercoaster at disney helps pass a kidney stone the most?

Answer 21

big thunder

Question 22

What part of the penis is ruptured in a “penile fracture”?

Answer 22

tunica albuginea

Question 23

What is the best treatment for penile fracture?

Answer 23

surgical repair

non-surgical repair results in >50% chance of erectile dysfunction and deformity