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Emergency Medicine > Lecture 12.5: LE + Male Genitalia Lecture > Flashcards

Lecture 12.5: LE + Male Genitalia Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Erysipelas MC organism is…

A

GAS

Upper dermis only

The GAS tank is Empty

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2
Q

Cellulitis MC organism is…

A

Staph

Skin and SQ tissue

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3
Q

Cellulitis has () borders, while erysipelas has () borders.

A
  • Cellulitis = Ill-defined borders
  • Erysipelas = Well-defined/Demarcated borders

Exact borders, Crappy borders

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4
Q

Cellulitis & Erysipelas

  • Concerned for abscess? Order a ()
  • Concerned for DVT? Order a ()
  • Concerned for osteomyelitis? () or ()
  • Concerned for systemic infection/bite? order a set of ()
A
  • Abscess: US
  • DVT: Venous Doppler US
  • Osteomyelitis: XR or CT
  • Systemic: Serologies (CBC, CMP, cultures)
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5
Q

Cellulitis & Erysipelas

Outpatient management of NO MRSA RISK

A

Keflex or Clinda

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6
Q

Cellulitis & Erysipelas

Outpatient management of MRSA RISK

A

Bactrim, Doxy, Clinda

BCD!

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7
Q

Cellulitis & Erysipelas

You should follow up after starting outpatient abx in () to () hours

A

48-72 hours

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8
Q

Cellulitis & Erysipelas

Inpatient admit + IV ABX via Rocephin, Ancef, or Clinda +/- Vanco/daptomycin are indicated if you meet at least 2 of these sepsis criteria:

  • Temp > ()
  • HR > ()
  • RR > ()
  • WBC < () or > ()
  • SBP < ()
  • AMS
  • Lactic acid > 2
  • Immunocompromised
A
  • Temp > 100.4F/38C
  • HR > 90
  • RR > 20
  • WBC < 4k or > 12k
  • SBP < 100

Pretty much SIRS criteria

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9
Q

MC pathogen for a cutaneous abscess

A

Staph

bc it comes from cellulitis

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10
Q

T/F: Cutaneous abscesses can spontaneously drain

A

True

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11
Q

T/F: You need diagnostics to evaluate a cutaneous abscess

A

False.

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12
Q

Prior to doing an I&D on an abscess, you need…

A

Informed consent

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13
Q

After I&D and packing a cutaneous abscess, you should follow up in ()

A

2-3 days

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14
Q

ABX prophylaxis is indicated prior to I&D of a cutaneous abscess if the patient is at high risk for what cardiac condition? What is the ABX?

A
  • High risk for endocarditis
  • Must use IV clinda or vanco 30-60 mins prior.
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15
Q

ABX prophylaxis is indicated in severe cutaneous abscess presentations, such as immunocompromised or septic patients. The ABX used primarily are (), and if they show signs of sepsis, you must add on () or ().

A
  • IV vanco, linezolid, or clinda
  • Add on Zosyn or meropenem

MC Abscess = staph, severe = MRSA so use vanco.
Zosyn is an antipseudomonal

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16
Q

A moderate to severe cutaneous abscess is indicated by this criteria:

  • Lesion > () cm
  • Multiple abscesses
  • Surrounding ()
  • immunosuppression
  • Signs of ()
A
  • Lesion > 2cm
  • Surrounding cellulitis
  • Signs of systemic infection
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17
Q

Oral therapy using (3 options) can be used for abscesses with risk of MRSA as long as it is a moderate presentation and the patient is ()

A
  • Bactrim, doxy, clinda
  • Patient must be immunocompetent

BCD!!!

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18
Q

Patient education for a cutaneous abscess discharge include:

  • Keeping the wound (wet/dry)
  • Removing the dressing after 2-3 days at home (yes/no)
A
  • Keep wound dry
  • DO NOT REMOVE dressing (come back to ED/PCP to remove)
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19
Q

Most useless physical exam test for DVT

A

Homan’s sign

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20
Q

You should suspect DVT in someone with ()lateral extremity swelling that is greater than () cm in difference when measured 10 cm below the tibial tubercle.

A

Unilateral swelling >= 2 cm in diff.

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21
Q
  • Phlegmasia alba dolens describes a large DVT that is (color).
  • Phlegmasia cerulea dolens describes a large DVT that is (color)
A
  • Alba dolens = white/pale
  • Cerulea dolens = dusky blue
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22
Q

Well’s DVT scores of 2 or less = order a ()

A

D-dimer

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23
Q

High bleeding risk in a DVT is the presence of () or more risk factors.

A

2

I wrote that you just need to know # of RFs, not the actual RFs

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24
Q

A proximal DVT with NO limb ischemia can be treated with () if high bleeding risk, or () if mod-low bleeding risk.

A
  • High bleed risk = IVC filter
  • Mod-low bleed risk = DOAC or LMWH
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25
Q

A proximal DVT + limb ischemia with high bleeding risk is treated via (), whereas a mod-low bleeding risk is treated via ()

A
  • High risk = thrombectomy + IVC filter
  • Mod-low = Catheter thrombolysis + AC

Limb ischemia = take out clot!

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26
Q

A distal-only DVT with high bleeding risk is treated via ()

A distal-only symptomatic DVT with mod-low bleeding risk is treated via ()

A
  • High risk distal = IVC filter
  • Symptomatic low-mid distal = DOAC (preferred) or LMWH

Same as a proximal DVT without limb ischemia

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27
Q

In a distal-only asymptomatic DVT, you should treat it with () if there is concern for proximal extension, but if not, you should treat it via ()

A
  • Risk of proximal spread = DOAC (preferred) or LMWH
  • No risk = Serial proximal compressive US Qweekly for 2-4 weeks
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28
Q

T/F: A proximal DVT should always be admitted.

A

Trueee

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29
Q

Chronic PAD is characterized by:

  • (classic symptom)
  • Atypical leg pain (ischemic rest)
  • () healing wounds
  • () skin changes
A
  • Claudication
  • Non-healing wounds
  • Hyperpigmented skin changes
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30
Q

The 6 Ps of acute arterial occlusions are:

A
  • Pain
  • Pallor
  • Poikilothermia
  • Paresthesias
  • Paralysis
  • Pulselessness

At least one will be present

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31
Q

ABI < () is indicative of PAD

A

0.9

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32
Q

The initial imaging modality for arterial limb ischemia is…

A

Duplex US

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33
Q

Venous doppler can no longer pick up pulses starting at what Rutherford acute limb ischemia classification? (I, IIa, IIb, III)

A

III - nonviable

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34
Q

At what rutherford stage(s) do you do diagnostic vascular imaging before treating?

A

Stage I and IIa

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35
Q

The initial pharm tx once rutherford classification is determined for acute limb ischemia is…

A

UFH bolus followed by maintenance

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36
Q

Testicular torsion MC occurs as a () or during ()

A

Neonate or puberty

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37
Q

The affected testicle in testicular torsion is (), (), and (), lying ()

A

Firm, tender, elevated, and lying transverse (Bell Clapper)

38
Q

You would expect a () cremasteric reflex with testicular torsion

A

Negative reflex

39
Q

The initial imaging modality of choice for Testicular Torsion

A

Duplex US showing diminished blood flow to affected testis.

40
Q

The goal to detorsion for testicular torsion is within () hours of onset

A

6 hours after

41
Q

Manual detorsion is done via a () to () direction, and you still need to do surgical detorsion afterwards!!

A

Medial to lateral direction

42
Q

The MC torsed testicular appendage is…

A

Appendix epididymis

43
Q

The pathognomonic sign of a testicular appendage torsion is…

A

Blue dot sign

44
Q

Doppler US of a testicular appendage torsion shows () blood flow to the testis.

A

Confirms blood flow to testis.

Normal torsion has decreased blood flow

45
Q

The management for a testicular appendage torsion is…

A

Discharge and take some pain meds

46
Q

Viral Orchitis is MC due to…

A

Mumps

Mumps is all the -itis

47
Q

Epididymitis is MC due to…

A

Bacteria

Young men = G/C
Anal or older = KLUBBing + E. Coli = klebsiella

48
Q

Epididymitis shows a () cremasteric reflex and () prehn sign

A

Positive for both

49
Q

The affected testis in epididymitis is (higher/lower) in the scrotum

A

Lower

50
Q

Generally, the initial lab you want to get in epididymitis/orchitis is…

A

UA w/ C&S

51
Q

Outpatient tx of epididymitis that you suspect is NOT due to Gono/Chla is () or ()

If you think its due to G/C, then the tx is () + ()

Anal: () + ()

A
  • UTI: Levofloxacin or Bactrim
  • G/C: Rocephin + Doxy/azithro
  • Anal: Rocephin + Levo

Admit tx is essentially the same, just IV

52
Q

A superficial scrotal abscess occurs due to infection of a (), while the other form is an extension of intrascrotal infections

A

Infection of a hair follicle

53
Q

The preferred imaging study for a scrotal abscess is a ()

A

US

54
Q

For intrascrotal abscesses, you must do ()

A

Surgical drainage.

Do not just I&D if its intrascrotal

55
Q

A necrotizing fasciitis of the perineal, genital, or perianal anatomy that originated as a benign infection/simple infection is known as…

A

Fournier’s Gangrene

Microthrombosis of small SC vessels.

56
Q

You suspect fournier’s gangrene but you’re not super sure. You should order a () showing air along fascial planes or deep tissue involvement.

A

CT w/ IV con

57
Q

The broad spectrum ABX for Fournier’s Gangrene is..

A

Zosyn

Also do resuscitation tx; cause pseudomonas probs?

58
Q

If you have a high clinical suspicion of Fournier’s Gangrene, your immediate next action should be…

A

Getting an urgent urology consult before more imaging.

59
Q

Inflammation of both the glans and foreskin is..

A

Balanoposthitis

60
Q

The usual tx for balanoposthitis is topical…, but severe presentations require oral…

A
  • Topical nystatin/clotrimazole
  • Oral fluconazole

If bacterial, use bacitracin or mupirocin in children

61
Q

You have a balanoposthitis patient that stays symptomatic despite proper tx. Your next step in management is to…

A

Obtain fungal/bacterial specimen swabs

62
Q

Paraphimosis has a () sign and is an ()

A

Donut sign = emergency

63
Q

Initial management of paraphimosis is to..

A

Reduce the glans via anesthesia and compression

64
Q

Your manual reduction of paraphimosis fails. You should now use…

A

Make small punctures into the glans so it leaks fluid

65
Q

Paraphimosis

You attempt reduction which fails. Puncturing the glans also failed. There is now arterial compromise and urology is unavailable for consultation. Your next step is to…

A

Dorsal incision of foreskin, reduction, suture

Follow up in 3 days

66
Q

Phimosis can interefere with urine retention. The temporary tx for it is… but the definitive treatment is…

A

Temporary: hemostatic dilation
Definitive: Circumcision

67
Q

Your patient with phimosis does not want to get circumcised. You recommended () with daily manual () to reduce the need.

A
  • Topical steroid therapy
  • Daily manual retraction
68
Q

Priaprism lasts longer than () hours, and causes irreversible damage after () hours.

A

> 4 hours, irreversible damage after 24hrs.

69
Q

Ischemic priaprism is () flow and MC in (). A coagulopathy () is the MCC if it occurs in children.

A
  • Low flow.
  • MC in adults
  • Sickle cell disease for children
70
Q

ABG from low-flow/ischemic priapism will show…

A

Hypoxemia

Black blood when aspirating.

71
Q

ABG of non-ischemic/high flow priapism will show ()

A

Normal blood.

72
Q

The MCC of non-ischemic/high flow priapism is…

A

Traumatic fistula

73
Q

Ischemic/low-flow priapism is treated via () block, () aspiration, instillation of ().

A
  1. Dorsal block
  2. Coporal aspiration
  3. Phenylephrine
74
Q

The first step in treating a trapped penis due to ring/hair/wire is…

A

Compression and cooling

75
Q

A penile fracture refers to rupture of the () of 1 or both corpus cavernosa due to direct trauma

A

Tunica albuginea

76
Q

MCC of penile fracture

A

Sex

77
Q

You hear an audible snap when having sex. Your penis becomes discolored and swollen. This describes a…

A

Penile fracture

78
Q

First step in penile fracture management is…

A

Consult urology + do a pre-op retrograde urethrogram

79
Q

Fibrotic plaques within the () of the penis that make it curved describe Peyronie’s

A

Tunica albuginia

80
Q

The following are seen in clinical presentation of peyronie’s:

  • Hx of () dysfunction
  • () pain
  • ()
  • ()
  • () deformity during erection
A
  • Hx of sex dysfunction
  • Penile pain
  • Indentation
  • Curvature
  • Shortening deformity during erection
81
Q

The two patient populations with the highest risk for urethral foreign bodies are…

A

Children and mentally unstable

82
Q

T/F: After Pelvis XR you can remove a urethral foreign body

A

No consult urology

is what i have written down

83
Q

Initial management of urethral strictures is via…

A

14 or 16 Fr foley straight tip catheter

After, try a 12 Fr Coude with lubricant

84
Q

You should consult urology regarding urethral strictures after () failed attempts to cath.

A

3 failed attempts

3 strikes

85
Q

You failed to cath a urethral stricture 3 times and urology is unavailable. You perform an emergent ()

A

Suprapubic cystostomy with catheter placement.

86
Q

The MC patient to complain of urinary retention is…

A

Old guy with BPH

87
Q

Your first diagnostic test in evaluating urinary retention is…

A

Post void residual US showing more than 50 cc

88
Q

Management of urinary retention with hematuria is..

A

3-way foley

89
Q

Just like for urethral strictures, if urology is unavailable and you need them, you have to do an emergent ()

A

Suprapubic catheter

90
Q

Bladder spasms can be treated with ()

A

Oxybutynin

91
Q

Most urinary retention pts can go home with a catheter in place for 3-7 days. However, you should admit them if they demonstrate post-obstructive () or post-obstructive ()

A
  • Renal failure
  • Diuresis

Emergency Medicine (29 decks)

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