Ross - About the Flow Flashcards by Alice Richards

characteristics of renal colic

abrupt flank pain

CVA tenderness

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renal colic begins in the __

and radiates to the __

lateral abd

genitals

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symptoms NOT characteristic of renal colic (3)

rebound

guarding

abd tenderness

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rf for renal colic (6)

obesity

gout

immobilization

fam hx

IBD

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tx for 1st instance of renal colic

imaging → non contrast CT

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pt’s w. guarding or rebound tenderness likely don’t have renal cause, but still may need imaging… if this is the case, who may need imaging

fever

signs of obstructing stone

elderly (>65 yo)

omg is she serious with this study guide

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CT has replaced __ as preferred diagnostic test for renal pain, but does not show

delayed filling

dilation of collecting system

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US is not sensitive to diagnose

renal calculi

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imaging of choice for renal calculi

IVP?

I think? this is very confusing on the study guide

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2 types of renal stone

calcium

struvite

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calcium stones include

oxalate

phosphate

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less common type of renal stones

uric acid

cysteine

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mc location ob obstructed stone

uterovesicular junction → pelvic brim uteropelvic junction

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where does the ureter cross the iliac vessels

uterovesicular junction

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what do you think when you see a CT w. stranding of perinephric fat, hydronephrosis, and nephromegaly

signs of obstruction

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what imaging should be used to look for blood, crystals, and signs of infxn

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bacteria in obstructed collecting system causes (3)

abscess

renal destruction

sepsis

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what pt’s need urology consult

high grade obstructions

large stones

infected stones

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basic tx for renal stones

analgesia

antiemetic

IV hydration

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what analgesics are 1st line for renal stones

IV lidocaine

nsaids

narcotics

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indications for admit/urology consult for renal stones (5)

complicated stones:

high obstructions

stones > 8 mm

intractable pain

e.o UTI

transplanted/solitary kidney

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indication for medical expulsion therapy for stones

< 10 mm

no risk of infxn

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stones > __ are unlikely to pass on their own and need consult

8 mm

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condition involving retraction of foreskin and entrapment of the glands

paraphimosis and entrapment

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complications of paraphimosis/entrapment

edema gangrene

tx for paraphimosis/entrapment

reduce incise if can't reduce physically (GU will do this)

phimosis is mc and less complicated in \_\_

nenoates

sign of complicated phimosis in neonate

urine outflow obstruction

phimosis in neonate may require

dorsal slit in foreskin

2 types of priaprism

high flow low flow

mc type of priaprism

low flow

3 meds that can cause priaprism

neuroleptics hydralazine CCB

if you see a young or pre pubescent pt w. priaprism, consider

sickle cell dz

tx for priaprism

1. try non invasive first 2. if this doesn't work → need to be drained

how do you drain (3 steps) a priaprism

1. injxn of epi or phenylephrine into corpus cavernosa 2. aspiration of blood thru a 18 g needle 3. if no relief → urology consult

what size needle to drain priaprism

18 g *i feel like she would ask this*

direct blunt GU trauma are associated w. tears in the (2)

tunica albuginea corpus cavernosa

if GU trauma involves a urethral tear, you need to order

retrograde urethrogram → inject dye into urethra

maldevelopment of normal fixation of testes that occurs btw enveloping tunica vaginalis and posterior scrotal wall

testicular torsion

when you see “bell clapper” deformity, think

testicular torsion

mc pt population for testicular torsion (2)

neonate preadolescence

testicular torsion is mc associated w. __ method of injury

trauma stenuous effort

PE findings of testicular torsion

firm tender testes aligned on horizontal axis absent cremasteric reflex

tx for testicular torsion

can try manual detorsion all need urology consult

should you wait for US results to consult urology if you suspect testicular torsion

no!

\_\_% of pt's have bell clapper deformity on both sides

sx of epididymal torsion

less pain than tt point tenderness

what does a blue dot sign make you think

ischemic necrotic appendix

polymicrobial GU infxn w. similar pathology to necrotizing fasciitis

fournier gangrene

2 mc pathogens in fournier gangrene

e. coli bacterioides (anaerobe)

rf for fournier gangrene (2)

DM etoh

lab to order if you suspect fournier's gangrene

lactate

what do you think when you see, bullae in scrotum or groin, intense pain, fever

fournier gangrene

imaging for fournier gangrene

CT w. contrast of abd and pelvis

fournier gangrene infection is located

w.in fascial planes

tx steps for fournier gangrene

1. **emergent surgical consult** 2. CT

epididymitis/epididymo-orchitis mc affects __ yo and is usually associated w. **\_\_**

35 STI

consider treating pt \< 35 w. epididymitis for (2)

chlamydia ghonorrhea

if pt \>35 presents w. epididymitis, consider what 3 pathogens

e. coli klebsiella pseudomonas

for teenagers w. epididymitis, consider \_\_

infected reflux

pt's \> 65 w. epididymitis, consider

urinary outlet obstruction → enlarged prostate STI

tx for epididymitis in pt \> 65 yo

US GU referral

cause of epididymitis in young unvaccinated adult

mumps

sx of epididymitis related to mumps

salivary gland enlargement

urethritis is mc caused by

STI → gonococcal or non-gonococcal

sx of urethritis

penile d.c +/- WBC on UA look for herpetic lesions

tx for prostatitis is determined by

acute vs chronic

possible sx of prostatitis

perineal and/or lower back pain fever

tests to order for prostatitis

UA culture

AVOID __ in prostatitis dx

catheter prostate massage

pharm for prostatitis

fluoroquinolones or cephalosporins \> 28 days

sx of chronic prostatitis (3)

back pain scrotal pain painful ejaculation

what is NOT a common sx of chronic prostatitis

fever

sx of prostatitis can be present for __ or more months

do symptoms need to be continuous for dx of chronic prostatitis

no → can be recurrent

length of duration of tx for chronic prostatitis

2-3 mo *non emergent urology referral*

UTI + fever in neonate is mc

pyelonephritis

for urine collection in neonate, you can try \_\_ but will probably need \_\_

bag specimen catheterize