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Genitourinary > MDT's Part 3 > Flashcards

MDT's Part 3 Flashcards

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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
General considerations for pre-renal AKI?
- Most common etiology - If reversed quickly, renal blood flow damage to kidneys does not occur - Hypoperfusion can lead to secondary intrinsic kidney injury
26
How does decreased renal perfusion occur?
- Decreased intravascular volume (blood loss, GI loss, dehydration) - Change in vascular resistance (Sepsis, anaphylaxis) - Low cardiac output (Cardiogenic shock, heart failure, PE)
27
General considerations for post-renal AKI?
- Least common cause | - Important to detect because it's reversable
28
Causes of post-renal AKI?
- Urethral obstruction - Bladder dysfunction/obstruction - Obstruction of both ureters/pelvis - Benign Prostatic hypertrophy - Cancer
29
General considerations for intrinsic AKI?
- Up to 50% of cases | - Considered after rule out of pre and post renal
30
Sites of injury for intrinsic AKI?
- Tubules - Interstitium - Vasculature - Glomeruli
31
Signs and symptoms of AKI?
- Non-specific signs (N/V, malaise, pericarditis) - Pericardial effusion - Arrythmias - Rales in hypervolemia - Abdominal pain
32
Lab findings for AKI?
- Blood urea nitrogen - Creatinine - Urinalysis
33
Imaging for AKI
Renal U/S
34
Treatment of pre-renal AKI?
- Depends on cause - Achieve renal perfusion - Avoiding nephrotoxic drugs
35
Treatment of post-renal AKI?
- Bladder catheterization | - Relieve underlying cause
36
Treatment of intrinsic AKI?
- Usually self-limited | - Managed by nephrology
37
Follow up and referral for AKI?
- Most patients will be MEDEVAC - Pre-renal: Emergency medicine, Cardiology, Internal medicine - Post-renal: Urology for obstruction - Intrinsic: Nephrology
38
General considerations for Hyponatremia?
- Serum sodium levels <135 mEq/L - Most common electrolyte abnormality - Usually reflects excess water-retention relative to sodium
39
Evaluation for hyponatremia starts with?
- New medications - Changes in fluid intake - Fluid output
40
Mild symptoms of hyponatremia?
- Usually asymptomatic - Nausea - Malaise
41
Moderate symptoms of hyponatremia?
- HA - Lethargy - Disorientation
42
Severe symptoms of hyponatremia?
- Respiratory arrest - Seizure - Coma - Permanent brain damage - Brainstem herniation - Death
43
Treatment of hyponatremia?
- Restriction of free water and hypotonic solution initial step - Free water intake should be less than 1-1.5L/day
44
Hospitalization for hyponatremia?
- Severe and symptomatic hyponatremia for: * monitoring fluid balances and weights * treatment * frequent sodium checks
45
General considerations for hypernatremia?
- Sodium concentration >145 mEq/L - Typically hypovolemic - Intact thirst mechanism and access to water are primary defense
46
Symptoms in a dehydrated hypernatremia patient?
- Orthostatic hypotension | - Oliguria (small amounts of urine)
47
Early signs of hypernatremia?
- Lethargy - Irritability - Weakness
48
Severe signs of hypernatremia?
- Na >158 - Hyperthermia - Delirium - Seizures - Coma
49
Treatment of hypernatremia?
- 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
Who requires hospitalization for hypernatremia?
Symptomatic hypernatremia
51
Natermia vs kalemia?
Sodium vs Potassium
52
General considerations for hypokalemia?
Serum potassium <3.5mEq/L | - Severe may induce arrythmias or rhabdo
53
What can hypokalemia result from?
- Insufficient dieetary potassium intake - Intracellular shifting of potassium from extracellular space - Blocked by alpha-adrenergic stimulation
54
What is the most common cause of hypokalemia?
GI loss from infectious diarrhea | * intestinal secretion is 10x higher than gastric secretion
55
Signs of mild to moderate hypokalemia?
- Muscular weakness - Fatigue - Muscle cramps
56
Signs of severe hypokalemia?
- <2.5mEq/L - Flaccid paralysis - Hyporeflexia - Hypercapnia - Tetany - Rhabdomyolysis
57
Imaging for hypokalemia?
- ECG may show * Decreased amplitude and broadening of T waves * Premature ventricular contractions * Depressed St segments
58
Treatment for hypokalemia?
Oral potassium supplementation is quickest and easiest
59
Follow up for hypokalemia?
Unexplained or refractory hypokalemia referred to Endocrinology or Nephrology
60
General considerations for hyperkalemia?
- 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
Hyperkalemia may develop in Pts taking?
- ACE inhibitors - Angiotensin-receptor blockers - Potassium sparing diuretics
62
Signs of hyperkalemia?
- Muscle weakness - Flaccid paralysis - Ileus
63
Imaging for hyperkalemia?
- ECG may reveal * Bradycardia * PR interval prolongation * Peaked T waves * QRS widening
64
Treatment of hyperkalemia?
- Withhold exogenous K - Identify cause - Review medication and dietary K intake - Insulin, bicarbonate, and beta-agonist - Loop diuretics
65
Emergent treament for hyperkalemia when?
- Cardiac toxicity - Muscle paralysis - Severe hyperkalemia ( K level >6.5)
66
Follow up for hyperkalemia?
Severe hyperkalemia sent to ED

Genitourinary (6 decks)

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