GYN/GU emergencies Flashcards
What is a deterioration of renal function leading to waste accumulation in blood & electrolyte abnormalities;
acute kidney injury
What lab test and calculation will help you figure out if a kidney issue is pre, post, or intrarenal?
FENa
The most common cause of this type of acute kidney injury is hypovolemia or low blood flow to kidneys. Name the condition and treatment?
Pre-renal kidney injury
replenish volume and send home when stable
The most common cause of this AKI is pre-renal kidney injury?
renal or intrinsic
What is acute tubular necrosis
damage to tubule cells of kidneys
What is the treatment for intrarenal AKI?
give volume or vasopressors for renal perfusion & consult with nephrology
A 40y/o male presents with painless hematuria and has a 25 year hx of smoking. What should be highest on our differentials?
cancer
This is an obstruction or injury along the UT system after the kidneys; Blockage of urine flow;
post renal AKI
The most common cause of post renal AKI? Treatment
BPH with urinary retention
Treat with Foley catheter and drainage of urine
This is a catheter that can flush clots from bladder?
Murphy catheter
A 32y/o male presents with dysuria & urethral discharge, & swelling of the penis; what is the likely dx, cause, labs and tx?
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
What is the term for inflammation of the urethra?
urethritis
What is inflammation of prostate usually caused by E. coli from preceding GU tract infection?
prostatitis
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?
Prostatitis
Labs: UA, STI, CBC (for infection level); blood culture (infection level); CMP
Treat empirically with Bactrim & ciprofloxacin or levofloxacin x 4 weeks
These are three indication for admitting a patient with a kidney stone whos been given pain medications?
- pain is uncontrolled despite medication
- cannot take anything PO
- has a fever
What drugs are used to help expulsion of kidney stones between 5-10 mm?
Alpha blockers
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?
testicular torsion
one testicle might be higher up
Cremaster reflex will be negative
tx is detorsion and urology consult
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?
Orchitis or inflammation of the testicle
Treatment is NSAIDS and ABX
A 35y/o patient present with posterior scrotal px, inguinal and lower ABD px, and +/- urethral discharge. What is the likely dx?
epididymitis
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?
E.coli & Klebsiella in ages >35
G/C in ages <35
treat with empirical ABX, NSAID for pain, and stool softener
A positive ____ sign indicates a patient has epididymitis. What is the sign called and what is the definition?
Phren’s sign
lifting the testicle and feeling relief of px
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?
varicocele
This scrotal condition is caused by fluid between layers of the tunica vaginalis, & the pain is proportionate to the size?
Hydrocele
What is the dx sign for hydrocele?
transilluminated testicle
A patient presents to the ED with a round, tender testicular mass that causes chronic pain and is not illuminated by the pen light?
ependymal cyst
What is the tx for priapism?
Within 24H of presentation remove blood from corpus cavernosum and inject phenylephrine or do surgery
This condition is a necrotizing infection of subcutaneous tissue in the scrotal area common in immunocompromised & diabetes?
Fournier gangrene
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?
Fournier gangrene
A butterfly hematoma in the male groin region is indicative of what?
testicular rupture
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?
non-ruptured Ovarian cyst
Give NSAIDS and f/u with GYN
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?
ovarian torsion
What is the tx for ovarian torsion?
GYN consult and laparoscopic surgery for de-torsion
A 34y/o female patient Presents with acute unilateral pelvic px; PE shows adnexal mass, fullness, tenderness; Positive hCG; what is the likely dx?
ectopic pregnancy
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?
tubo-ovarian abscess
Consult GYN to have it drained
Give ABX (ceftriaxone or doxy)
manage sepsis
