Lecture 12.5: LE + Male Genitalia Lecture Flashcards
1
Q
Erysipelas MC organism is…
A
GAS
Upper dermis only
The GAS tank is Empty
2
Q
Cellulitis MC organism is…
A
Staph
Skin and SQ tissue
3
Q
Cellulitis has () borders, while erysipelas has () borders.
A
- Cellulitis = Ill-defined borders
- Erysipelas = Well-defined/Demarcated borders
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)
5
Q
Cellulitis & Erysipelas
Outpatient management of NO MRSA RISK
A
Keflex or Clinda
6
Q
Cellulitis & Erysipelas
Outpatient management of MRSA RISK
A
Bactrim, Doxy, Clinda
7
Q
Cellulitis & Erysipelas
You should follow up after starting outpatient abx in () to () hours
A
48-72 hours
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
9
Q
MC pathogen for a cutaneous abscess
A
Staph
10
Q
T/F: Cutaneous abscesses can spontaneously drain
A
True
11
Q
T/F: You need diagnostics to evaluate a cutaneous abscess
A
False.
12
Q
Prior to doing an I&D on an abscess, you need…
A
Informed consent
13
Q
After I&D and packing a cutaneous abscess, you should follow up in ()
A
2-3 days
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.
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
16
Q
A moderate to severe cutaneous abscess is indicated by this criteria
A
- Lesion > 2cm
- Surrounding cellulitis
- Signs of systemic infection
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
18
Q
Patient education for a cutaneous abscess discharge include:
- Keeping the wound (wet/dry)
- Removing the dressing after 2-3 days
A
- Keep wound dry
- DO NOT REMOVE dressing (come back to ED/PCP to remove)
19
Q
Most useless physical exam test for DVT
A
Homan’s sign
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.
21
Q
- Phlegmasia alba dolens describes a large proximal DVT that is (color).
- Phlegmasia cerulea dolens describes a large proximal VT that is (color)
A
- Alba dolens = white/pale
- Cerulea dolens = dusky blue
22
Q
Well’s DVT scores of 2 or less = ()
A
D-dimer
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
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
25
A proximal DVT + limb ischemia with high bleeding risk is treated via (), whereas a mod-low bleeding risk is treated via ()
* High risk = thrombectomy + IVC filter
* Mod-low = Catheter thrombolysis + AC
26
A distal-only DVT with high bleeding risk is treated via ()
A distal-only symptomatic DVT with mod-low bleeding risk is treated via ()
* High risk distal = IVC filter
* Symptomatic low-mid distal = DOAC (preferred) or LMWH
27
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 ()
* Risk of proximal spread = DOAC (preferred) or LMWH
* No risk = Serial proximal compressive US Qweekly for 2-4 weeks
28
T/F: A proximal DVT should always be admitted.
Trueee
29
Chronic PAD is characterized by:
* (classic symptom)
* Atypical leg pain (ischemic rest)
* () healing wounds
* () skin changes
* Claudication
* Non-healing wounds
* Hyperpigmented skin changes
30
The 6 Ps of acute arterial occlusions are:
* Pain
* Pallor
* Poikilothermia
* Paresthesias
* Paralysis
* Pulselessness
| At least one will be present
31
ABI < () is indicative of PAD
0.9
32
The initial imaging modality for arterial limb ischemia is...
Duplex US
33
Venous doppler can no longer pick up pulses starting at what Rutherford acute limb ischemia classification? (I, IIa, IIb, III)
III - nonviable
34
At what rutherford stage(s) can you just do diagnostic vascular imaging before treating?
Stage I and IIa
35
The initial pharm tx once rutherford classification is determined for acute limb ischemia is...
UFH bolus followed by maintenance
36
Testicular torsion MC occurs as a () or during ()
Neonate or puberty
37
The affected testicle in testicular torsion is (), (), and (), lying ()
Firm, tender, elevated, and lying transverse (Bell Clapper)
38
You would expect a () cremasteric reflex with testicular torsion
Negative reflex
39
The initial imaging modality of choice for Testicular Torsion
Duplex US showing diminished blood flow to affected testis.
40
The goal to detorsion for testicular torsion is within () hours of onset
6 hours after
41
Manual detorsion is done via a () to () direction, and you still need to do surgical detorsion afterwards!!
Medial to lateral direction
42
The MC torsed testicular appendage is...
Appendix epididymis
43
The pathognomonic sign of a testicular appendage torsion is...
Blue dot sign
44
Doppler US of a testicular appendage torsion shows () blood flow to the testis.
Confirms blood flow to testis.
| Normal torsion has decreased blood flow
45
The management for a testicular appendage torsion is...
Discharge and take some pain meds
46
Viral Orchitis is MC due to...
Mumps
| Mumps is all the -itis
47
Epididymitis is MC due to...
Bacteria
48
Epididymitis shows a () cremasteric reflex and () prehn sign
Positive for both
49
The affected testis in epididymitis is be (higher/lower) in the scrotum
Lower
50
Generally, the initial lab you want to get in epididymitis/orchitis is...
UA w/ C&S
51
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: () + ()
* UTI: Levofloxacin or Bactrim
* G/C: Rocephin + Doxy/azithro
* Anal: Rocephin + Levo
| Admit tx is essentially the same, just IV
52
A superficial scrotal abscess occurs due infection of a (), while the other form is an extension of intrascrotal infections
Infection of a hair follicle
53
The preferred imaging study for a scrotal abscess is a ()
US
54
For intrascrotal abscesses, you must do ()
Surgical drainage.
| Do not just I&D if its intrascrotal
55
A necrotizing fasciitis of the perineal, genital, or perianal anatomy that originated as a benign infection/simple infection is known as...
Fournier's Gangrene
| Microthrombosis of small SC vessels.
56
You suspect fournier's gangrene but you're not super sure. You should order a () showing air along fascial planes or deep tissue involvement.
CT w/ IV con
57
The broad spectrum ABX for Fournier's Gangrene is..
Zosyn
| Also do resuscitation tx
58
If you have a high clinical suspicion of Fournier's Gangrene, your immediate next action should be...
Getting an urgent urology consult before more imaging.
59
Inflammation of both the glans and foreskin is..
Balanoposthitis
60
The usual tx for balanoposthitis is topical..., but severe presentations require oral...
* Topical nystatin/clotrimazole
* Oral fluconazole
| If bacterial, use bacitracin or mupirocin in children
61
You have a balanoposthitis patient that stays symptomatic despite proper tx. Your next step in management is to...
Obtain fungal/bacterial specimen swabs
62
Paraphimosis has a () sign and is an ()
Donut sign = emergency
63
Initial management of paraphimosis is to..
Reduce the glans via anesthesia and compression
64
Your manual reduction of paraphimosis fails. You should now use...
Make small punctures into the glans so it leaks fluid
65
# 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...
Dorsal incision of foreskin, reduction, suture
| Follow up in 3 days
66
Phimosis can interefere with urine retention. The temporary tx for it is... but the definitive treatment is...
Temporary: hemostatic dilation
Definitive: Circumcision
67
Your patient with phimosis does not want to get circumcised. You recommended () with daily manual () to reduce the need.
* Topical steroid therapy
* Daily manual retraction
68
Priaprism lasts longer than () hours, and causes irreversible damage after () hours.
>4 hours, irreversible damage after 24hrs.
69
Ischemic priaprism is () flow and MC in (). A coagulopathy () is the MCC if it occurs in children.
* Low flow.
* MC in adults
* Sickle cell disease for children
70
ABG from low-flow/ischemic priapism will show...
Hypoxemia
| Black blood when aspirating.
71
ABG of non-ischemic/high flow priapism will show ()
Normal blood.
72
The MCC of non-ischemic/high flow priapism is...
Traumatic fistula
73
Ischemic/low-flow priapism is treated via () block, () aspiration, instillation of ().
1. Dorsal block
2. Coporal aspiration
3. Phenylephrine
74
The first step in treating a trapped penis due to ring/hair/wire is...
Compression and cooling
75
A penile fracture refers to rupture of the () of 1 or both corpus cavernosa due to direct trauma
Tunica albuginea
76
MCC of penile fracture
Sex
77
You hear an audible snap when having sex. Your penis becomes discolored and swollen. This describes a...
Penile fracture
78
First step in penile fracture management is...
Consult urology + do a pre-op retrograde urethrogram
79
Fibrotic plaques within the () of the penis that make it curved describe Peyronie's
Tunica albuginia
80
The following are seen in clinical presentation of peyronie's:
* Hx of () dysfunction
* () pain
* ()
* ()
* () deformity during erection
* Hx of sex dysfunction
* Penile pain
* Indentation
* Curvature
* Shortening deformity during erection
81
The two patient populations with the highest risk for urethral foreign bodies are...
Children and mentally unstable
82
T/F: After Pelvis XR you can remove a urethral foreign body
No consult urology
| is what i have written down
83
Initial management of urethral strictures is via...
14 or 16 Fr foley straight tip catheter
| After, try a 12 Fr Coude with lubricant
84
You should consult urology regarding urethral strictures after () failed attempts to cath.
3 failed attempts
| 3 strikes
85
You failed to cath a urethral stricture 3 times and urology is unavailable. You perform an emergent ()
Suprapubic cystostomy with catheter placement.
86
The MC patient to complain of urinary retention is...
Old guy with BPH
87
Your first diagnostic test in evaluating urinary retention is...
Post void residual US showing more than 50 cc
88
Management of urinary retention with hematuria is..
3-way foley
89
Just like for urethral strictures, if urology is unavailable and you need them, you have to do an emergent ()
Suprapubic catheter
90
Bladder spasms can be treated with ()
Oxybutynin
91
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 ()
* Renal failure
* Diuresis
