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Genitourinary > MDT's Part 3 > Flashcards

MDT's Part 3 Flashcards

1
Q

What is testicular torsion?

A

Testi torse (twist) on the spermatic cord, potentially producing ischemia from reduced arterial inflow and venous flow obstruction

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2
Q

What does testicular torsion require?

A

Emergent diagnosis to salvage testicle

- treat within 6-8 hours to salvage testi

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3
Q

Who does testicular torsion usually affect and how?

A
  • Young men, rare in men older than 30

- Usually rotates medially

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4
Q

What are some signs and symptoms of testicular torsion?

A
  • Acute scrotal pain
  • Profound tenderness and swelling
  • Nausea/vomiting
  • Negative cremasteric reflex
  • Bell clapper deformity (high-riding testi oriented transversely)
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5
Q

Imaging for testicular torsion?

A

Scrotal U/S (with color flow doppler)

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6
Q

Treatment for testicular torsion?

A
  • Manual detorsion

- Surgical detorsion

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7
Q

What is the etiology of penile trauma?

A
  • Diverse mechanisms

- 25% injuries to external genitalia require RBC transfusion due to blood loss

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8
Q

What are some self-inflicted injuries associated with penile trauma?

A
  • Amputation
  • Vacuum injuries
  • Zipper injuries
  • Constriction/strangulation injuries
  • Degloving injuries
  • Penetrating injuries
  • Contusions
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9
Q

Treatment of penile trauma?

A
  • Conservative treatment
  • Analgesics/NSAIDS
  • Rest
  • Ice packs
  • Elevation
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10
Q

Imaging for penile trauma?

A
  • Retrograde urethrogram

- Scrotal/penile U/S

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11
Q

Immediate urological consult for surgical intervention with penile trauma?

A
  • Urethral injury
  • Amputations
  • Degloving
  • Penetrating injuries
  • Penile trauma

MEDEVAC

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12
Q

If there is penile trauma with associated urethral injury, what is contraindicated?

A

Foley Catheter

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13
Q

What is Phimosis?

A

Fibrous constriction of the foreskin preventing retraction

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14
Q

What can phimosis be a result of?

A
  • Balanitis

- Balanoposthitis

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15
Q

What is Balanitis?

A

Inflammation of glans penis

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16
Q

What is balanoposthitis?

A

Inflammation of glans penis and prepuce

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17
Q

Can phimosis cause urinary retention and what can be done?

A

Yes

  • Foley catheter for urinary retention unless it cannot be passed
  • Suprapubic catheterization if Foley cannot be passed
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18
Q

What is the most common infectious cause of underlying balanoposthitis in phemosis?

A

Candidal infection

  • Treat iwith good hygiene and topical antifungal
  • Clotrimazole, Miconazole
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19
Q

What is Paraphimosis?

A
  • True urologic emergency

- Occurs when retracted foreskin develops a fixed constriction proximal to glans

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20
Q

What are some manual reductions of paraphimosis?

A
  • Compress glans firmly for 5-10 minutes
  • tightly wrap glans with 2 inch bandage
  • Ice
  • Dorsal nerve block (must discuss with MO prior)
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21
Q

If manual reduction of paraphimosis does not work, what can be done?

A
  • Dorsal slit of the foreskin
  • Discuss with Physician Sup prior
  • Incision of band will allow for foreskin retraction
  • Referral to urology for elective circumcision
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22
Q

What is the result of Acute Kidney Injury?

A
  • Sudden decrease in kidney function

- Inability to maintain acid-base, fluid, and electrolyte balance and to excrete nitrogenous waste

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23
Q

Acute Kidney Injury (AKI) can be divided into what 3 categories?

A
  • Pre-renal
  • Intrinsic Kidney disease
  • Post renal
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24
Q

What is the first step in treating AKI?

A

Identifying the cause

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25
Q

General considerations for pre-renal AKI?

A
  • Most common etiology
  • If reversed quickly, renal blood flow damage to kidneys does not occur
  • Hypoperfusion can lead to secondary intrinsic kidney injury
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26
Q

How does decreased renal perfusion occur?

A
  • Decreased intravascular volume (blood loss, GI loss, dehydration)
  • Change in vascular resistance (Sepsis, anaphylaxis)
  • Low cardiac output (Cardiogenic shock, heart failure, PE)
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27
Q

General considerations for post-renal AKI?

A
  • Least common cause

- Important to detect because it’s reversable

28
Q

Causes of post-renal AKI?

A
  • Urethral obstruction
  • Bladder dysfunction/obstruction
  • Obstruction of both ureters/pelvis
  • Benign Prostatic hypertrophy
  • Cancer
29
Q

General considerations for intrinsic AKI?

A
  • Up to 50% of cases

- Considered after rule out of pre and post renal

30
Q

Sites of injury for intrinsic AKI?

A
  • Tubules
  • Interstitium
  • Vasculature
  • Glomeruli
31
Q

Signs and symptoms of AKI?

A
  • Non-specific signs (N/V, malaise, pericarditis)
  • Pericardial effusion
  • Arrythmias
  • Rales in hypervolemia
  • Abdominal pain
32
Q

Lab findings for AKI?

A
  • Blood urea nitrogen
  • Creatinine
  • Urinalysis
33
Q

Imaging for AKI

A

Renal U/S

34
Q

Treatment of pre-renal AKI?

A
  • Depends on cause
  • Achieve renal perfusion
  • Avoiding nephrotoxic drugs
35
Q

Treatment of post-renal AKI?

A
  • Bladder catheterization

- Relieve underlying cause

36
Q

Treatment of intrinsic AKI?

A
  • Usually self-limited

- Managed by nephrology

37
Q

Follow up and referral for AKI?

A
  • Most patients will be MEDEVAC
  • Pre-renal: Emergency medicine, Cardiology, Internal medicine
  • Post-renal: Urology for obstruction
  • Intrinsic: Nephrology
38
Q

General considerations for Hyponatremia?

A
  • Serum sodium levels <135 mEq/L
  • Most common electrolyte abnormality
  • Usually reflects excess water-retention relative to sodium
39
Q

Evaluation for hyponatremia starts with?

A
  • New medications
  • Changes in fluid intake
  • Fluid output
40
Q

Mild symptoms of hyponatremia?

A
  • Usually asymptomatic
  • Nausea
  • Malaise
41
Q

Moderate symptoms of hyponatremia?

A
  • HA
  • Lethargy
  • Disorientation
42
Q

Severe symptoms of hyponatremia?

A
  • Respiratory arrest
  • Seizure
  • Coma
  • Permanent brain damage
  • Brainstem herniation
  • Death
43
Q

Treatment of hyponatremia?

A
  • Restriction of free water and hypotonic solution initial step
  • Free water intake should be less than 1-1.5L/day
44
Q

Hospitalization for hyponatremia?

A
  • Severe and symptomatic hyponatremia for:
  • monitoring fluid balances and weights
  • treatment
  • frequent sodium checks
45
Q

General considerations for hypernatremia?

A
  • Sodium concentration >145 mEq/L
  • Typically hypovolemic
  • Intact thirst mechanism and access to water are primary defense
46
Q

Symptoms in a dehydrated hypernatremia patient?

A
  • Orthostatic hypotension

- Oliguria (small amounts of urine)

47
Q

Early signs of hypernatremia?

A
  • Lethargy
  • Irritability
  • Weakness
48
Q

Severe signs of hypernatremia?

A
  • Na >158
  • Hyperthermia
  • Delirium
  • Seizures
  • Coma
49
Q

Treatment of hypernatremia?

A
  • Correcting cause of fluid loss
  • Replacing water
  • Replacing electrolytes as needed
  • Fluids should be administered over a 48 hour period (serum Na correction of approx 1mEq/L/Hr)
50
Q

Who requires hospitalization for hypernatremia?

A

Symptomatic hypernatremia

51
Q

Natermia vs kalemia?

A

Sodium vs Potassium

52
Q

General considerations for hypokalemia?

A

Serum potassium <3.5mEq/L

- Severe may induce arrythmias or rhabdo

53
Q

What can hypokalemia result from?

A
  • Insufficient dieetary potassium intake
  • Intracellular shifting of potassium from extracellular space
  • Blocked by alpha-adrenergic stimulation
54
Q

What is the most common cause of hypokalemia?

A

GI loss from infectious diarrhea

* intestinal secretion is 10x higher than gastric secretion

55
Q

Signs of mild to moderate hypokalemia?

A
  • Muscular weakness
  • Fatigue
  • Muscle cramps
56
Q

Signs of severe hypokalemia?

A
  • <2.5mEq/L
  • Flaccid paralysis
  • Hyporeflexia
  • Hypercapnia
  • Tetany
  • Rhabdomyolysis
57
Q

Imaging for hypokalemia?

A
  • ECG may show
  • Decreased amplitude and broadening of T waves
  • Premature ventricular contractions
  • Depressed St segments
58
Q

Treatment for hypokalemia?

A

Oral potassium supplementation is quickest and easiest

59
Q

Follow up for hypokalemia?

A

Unexplained or refractory hypokalemia referred to Endocrinology or Nephrology

60
Q

General considerations for hyperkalemia?

A
  • Serum K level >5.0 mEq/L (repeat to rule out false hyperkalemia)
  • ECG may be normal
  • Usually occurs in Pts with advanced kidney disease
  • Acidosis causes intracellular potassium to shift extracellularly
61
Q

Hyperkalemia may develop in Pts taking?

A
  • ACE inhibitors
  • Angiotensin-receptor blockers
  • Potassium sparing diuretics
62
Q

Signs of hyperkalemia?

A
  • Muscle weakness
  • Flaccid paralysis
  • Ileus
63
Q

Imaging for hyperkalemia?

A
  • ECG may reveal
  • Bradycardia
  • PR interval prolongation
  • Peaked T waves
  • QRS widening
64
Q

Treatment of hyperkalemia?

A
  • Withhold exogenous K
  • Identify cause
  • Review medication and dietary K intake
  • Insulin, bicarbonate, and beta-agonist
  • Loop diuretics
65
Q

Emergent treament for hyperkalemia when?

A
  • Cardiac toxicity
  • Muscle paralysis
  • Severe hyperkalemia ( K level >6.5)
66
Q

Follow up for hyperkalemia?

A

Severe hyperkalemia sent to ED

Genitourinary (6 decks)

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