GYN/GU emergencies

Question 1

What is a deterioration of renal function leading to waste accumulation in blood & electrolyte abnormalities;

Answer 1

acute kidney injury

Question 2

What lab test and calculation will help you figure out if a kidney issue is pre, post, or intrarenal?

Answer 2

FENa

Question 3

The most common cause of this type of acute kidney injury is hypovolemia or low blood flow to kidneys. Name the condition and treatment?

Answer 3

Pre-renal kidney injury
replenish volume and send home when stable

Question 4

The most common cause of this AKI is pre-renal kidney injury?

Answer 4

renal or intrinsic

Question 5

What is acute tubular necrosis

Answer 5

damage to tubule cells of kidneys

Question 6

What is the treatment for intrarenal AKI?

Answer 6

give volume or vasopressors for renal perfusion & consult with nephrology

Question 7

A 40y/o male presents with painless hematuria and has a 25 year hx of smoking. What should be highest on our differentials?

Answer 7

cancer

Question 8

This is an obstruction or injury along the UT system after the kidneys; Blockage of urine flow;

Answer 8

post renal AKI

Question 9

The most common cause of post renal AKI? Treatment

Answer 9

BPH with urinary retention
Treat with Foley catheter and drainage of urine

Question 10

This is a catheter that can flush clots from bladder?

Answer 10

Murphy catheter

Question 11

A 32y/o male presents with dysuria & urethral discharge, & swelling of the penis; what is the likely dx, cause, labs and tx?

Answer 11

urethritis caused by G/C

Get UA and STI testing

TX empirically with Ceftriaxone 500IM & doxycycline 100 BID x7 days; to cover both G/C

Question 12

What is the term for inflammation of the urethra?

Answer 12

urethritis

Question 13

What is inflammation of prostate usually caused by E. coli from preceding GU tract infection?

Answer 13

prostatitis

Question 14

A 44y/o male presents with dysuria, hematuria, fever, suprapubic, groin, and low back px; PE shows tender perineum, tender, boggy prostate. What is the likely dx, labs, and tx?

Answer 14

Prostatitis

Labs: UA, STI, CBC (for infection level); blood culture (infection level); CMP

Treat empirically with Bactrim & ciprofloxacin or levofloxacin x 4 weeks

Question 15

These are three indication for admitting a patient with a kidney stone whos been given pain medications?

Answer 15

• pain is uncontrolled despite medication
• cannot take anything PO
• has a fever

Question 16

What drugs are used to help expulsion of kidney stones between 5-10 mm?

Answer 16

Alpha blockers

Question 17

A patient presents to the ED with severe testicular pain that woke him from sleep. What is the likely dx, exam findings, specific test and results, and treatment?

Answer 17

testicular torsion

one testicle might be higher up

Cremaster reflex will be negative

tx is detorsion and urology consult

Question 18

A 6 year old child presents to the ED with unilateral, large tender testicular mass. It is determined to be bacterial in origin. What is the name of this condition, and what is the treatment?

Answer 18

Orchitis or inflammation of the testicle

Treatment is NSAIDS and ABX

Question 19

A 35y/o patient present with posterior scrotal px, inguinal and lower ABD px, and +/- urethral discharge. What is the likely dx?

Answer 19

epididymitis

Question 20

A 35y/o patient present with posterior scrotal px, inguinal and lower ABD px, and +/- urethral discharge. Its determined that they have epididymitis, what is the likely etiology and treatment?

Answer 20

E.coli & Klebsiella in ages >35

G/C in ages <35

treat with empirical ABX, NSAID for pain, and stool softener

Question 21

A positive ____ sign indicates a patient has epididymitis. What is the sign called and what is the definition?

Answer 21

Phren’s sign
lifting the testicle and feeling relief of px

Question 22

A male patient presents with dull ache in the scrotum and reports that upon self examination they felt a bunch of spaghetti like structures in the testicle. What is the dx?

Answer 22

varicocele

Question 23

This scrotal condition is caused by fluid between layers of the tunica vaginalis, & the pain is proportionate to the size?

Answer 23

Hydrocele

Question 24

What is the dx sign for hydrocele?

Answer 24

transilluminated testicle

Question 25

A patient presents to the ED with a round, tender testicular mass that causes chronic pain and is not illuminated by the pen light?

Answer 25

ependymal cyst

Question 26

What is the tx for priapism?

Answer 26

Within 24H of presentation remove blood from corpus cavernosum and inject phenylephrine or do surgery

Question 27

This condition is a necrotizing infection of subcutaneous tissue in the scrotal area common in immunocompromised & diabetes?

Answer 27

Fournier gangrene

Question 28

This condition presents with abrupt severe px in perineal region, rapid progression to anterior abdominal px and glute px; physical exam will show crackling under tissue?

Answer 28

Fournier gangrene

Question 29

A butterfly hematoma in the male groin region is indicative of what?

Answer 29

testicular rupture

Question 30

A 29y/o female presents to the ED with acute unilateral lower quadrant pain that is tender to palpation. On bimanual exam you note fullness or a mass. Her hCG & STI tests are negative. What is the likely dx and tx?

Answer 30

non-ruptured Ovarian cyst
Give NSAIDS and f/u with GYN

Question 31

A 35y/o female presents with acute, unilateral severe pelvic pain, with N/V after EXERTION; PE shows hypertensive, tachycardia, tenderness in abd. The patient is not pregnant, what is the likely dx?

Answer 31

ovarian torsion

Question 32

What is the tx for ovarian torsion?

Answer 32

GYN consult and laparoscopic surgery for de-torsion

Question 33

A 34y/o female patient Presents with acute unilateral pelvic px; PE shows adnexal mass, fullness, tenderness; Positive hCG; what is the likely dx?

Answer 33

ectopic pregnancy

Question 34

A 40y/o patient presents with acute lower ABD px, fever, chills, vaginal discharge. CBC shows leukocytosis with Left shift, pelvic US shows adnexal mass; what is the dx and treatment?

Answer 34

tubo-ovarian abscess

Consult GYN to have it drained

Give ABX (ceftriaxone or doxy)

manage sepsis