renal and urological emergencies

Question 1

what is acute urinary retention a common complication of

Answer 1

BPH

Question 2

why can anticholinergic drugs cause urinary retention

Answer 2

inhibit parasympathetic activity on detrusor muscle and its inhibitory effects on the bladder sphincters

Question 3

management of acute urinary retention

Answer 3

catheterisation

Question 4

what happens in testicular torsion

Answer 4

testicle twists around the spermatic cord leading to obstruction of blood flow to the testicle

Question 5

who typically presents with testicular torsion

Answer 5

teenage boys

Question 6

what is a predisposing factor for testicular torsion

Answer 6

bell clapper deformity - testes aren’t attached properly to the tunica vaginalis

Question 7

clinical presentation of testicular torsion

Answer 7

sudden pain - woken up from sleep !!
N+V associated, pyrexia and redness of overlying area

Question 8

2 clinical signs of testicular torsion

Answer 8

reduced or absent cremasteric reflex
testis may be higher than normal

Question 9

what is the cremasteric reflex

Answer 9

gentle pinching or stroking of the medial thigh causes elevation of the ipsilateral testicle

Question 10

name some risk factors for testicular torsion

Answer 10

family history, previous history, undescended testes

Question 11

surgical correction of undescended testes

Answer 11

bilateral orchiopexy

Question 12

what is epididymo-orchitis

Answer 12

inflammation of the epididymis and testes

Question 13

most common cause of epididymo-orchitis in young males

Answer 13

STIs

Question 14

most common cause of epididymo-orchitis in patients over 35

Answer 14

e.coli from GI tract

Question 15

classic finding of epididymo-orchitis

Answer 15

alleviation of pain upon elevation of the testes

Question 16

management of epididymo-orchitis in patients over 35

Answer 16

ofloxacin and analgesia

Question 17

what is paraphimosis

Answer 17

inability to replace foreskin to its original position after its been retracted

Question 18

what is phimosis

Answer 18

foreskin is too tight to be retracted over the glans of the penis

Question 19

what can often precede paraphimosis

Answer 19

catheterisation or cystoscopy
staff member forgets to replace it to its natural position

Question 20

management of paraphimosis

Answer 20

manual compression
dorsal slit if needed

Question 21

what is priapism

Answer 21

prolonged unwanted erection

Question 22

what are the 2 main categories of priapism

Answer 22

ischaemic (low-flow) and non-ischaemic (high-flow)

Question 23

what is the most common type of priapism

Answer 23

ischaemic

Question 24

what causes ischaemic priapism

Answer 24

lack of venous drainage from the corpus cavernosa

Question 25

what conditions are ischaemic priapism linked to

Answer 25

sickle cell, malignancy

Question 26

what is the most common cause of non-ischaemic priapism

Answer 26

trauma

Question 27

pathophysiology of non-ischaemic priapism

Answer 27

unregulated cavernous arterial inflow

Question 28

what syndrome is ischaemic priapism an example of

Answer 28

compartment syndrome !!

Question 29

investigation of priapism and positive result

Answer 29

aspirate blood from corpus cavernosum + do ABG ischaemic: low O2, high CO2 non-ischaemic: normal arterial blood

Question 30

management pathway of priapism

Answer 30

aspiration + irrigation with saline injection of phenylephrine or adrenaline surgical shunt

Question 31

what is fournier's gangrene

Answer 31

rapidly progressive necrotising fasciitis of the perineum

Question 32

name some predisposing factors for fournier's gangrene

Answer 32

diabetes, local trauma, perianal infection

Question 33

what diagnostic test can be used to confirm fournier's gangrene

Answer 33

imaging to see if any evidence of gas in soft tissues

Question 34

what is a perinephric abscess

Answer 34

collection of pus due to a bacterial infection in the perinephric fat and fascia surrounding the kidney

Question 35

diagnostic imaging in suspected perinephric abscess

Answer 35

CT

Question 36

clinical presentation of a perinephric abscess

Answer 36

fevers, night sweats and psoas irritation causing an antalgic gait

Question 37

what is a bladder injury commonly associated with

Answer 37

pelvic fracture

Question 38

name some renal indications for a CT with contrast

Answer 38

frank haematuria occult haematuria in a child haematuria and really low BP haematuria following penetrating injury

Question 39

imaging used in suspected bladder injury

Answer 39

CT cystogram

Question 40

where along the urethra is most vulnerable to trauma

Answer 40

bulbomembranous junction

Question 41

investigation to assess urethral injury

Answer 41

retrograde urethrogram

Question 42

most common situation for a penile fracture

Answer 42

intercourse

Question 43

clinical presentation of a penile fracture

Answer 43

cracking/popping sound, followed by pain, rapid detumescence

Question 44

imaging of choice for testicular injury

Answer 44

ultrasound