GU/GYN emergencies Flashcards
If there is going to be a delay in intervention for testicular torsion what treatment should you try first?
manual detorsion
A positive phren sign is classic for what condition?
epididymitis
The majority of kidney stones are composed of what?
calcium
What pain med would you give for testicular torsion?
morphine
don’t go to ketorolac because patient will need to go to surgery
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?
penile fracture
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
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
How is Fournier’s gangrene diagnosed?
clinically diagnosed
confirmed with CT scan where you see free air
A “blue dot” sign is classic for what condition?
torsion of the appendix testis
What is the most important initial test to obtain in a penile fracture?
- urinalysis to assess the patient’s ability to urinate
In a patient who presents with flank pain you should always exam this system.
GU system
What is the only successful treatment method for Fournier’s gangrene?
surgical debridement
mortality is 100% without surgical debridement
Loss of cremasteric reflex is classic for what GU emergency?
testicular torsion
When should you consult urology for a nephrolithiasis? (4)
- infected kidney stone
- acute kidney injury
- failed trail of passage or uncontrolled pain/vomiting
- > 10mm
What is the management for nephrolithiasis? (5)
- 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
What size do we lose the ability to pass stone?
> 5mm we lose the ability to pass stone exponentially
What imaging study would you get for a first-time nephrolithiasis?
CT scan without contrast
get U/S in patient with Hx of kidney stone
What are good patient education tips for nephrolithiasis? (3)
- don’t fly on airplane until stone passes
- stay away from red meats and soda
- stone can take days to weeks to pass
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?
kidney stone
What antibiotics are prescribed for Fournier’s gangrene?
- broad spectrum + CLINDAMYCIN
what is the best definitive management for testicular torsion?
surgical detorsion and fixation
What rollercoaster at disney helps pass a kidney stone the most?
big thunder
What part of the penis is ruptured in a “penile fracture”?
tunica albuginea
What is the best treatment for penile fracture?
surgical repair
non-surgical repair results in >50% chance of erectile dysfunction and deformity
