Ross - About the Flow Flashcards
characteristics of renal colic
abrupt flank pain
CVA tenderness
renal colic begins in the __
and radiates to the __
lateral abd
genitals
symptoms NOT characteristic of renal colic (3)
rebound
guarding
abd tenderness
rf for renal colic (6)
obesity
DM
gout
immobilization
fam hx
IBD
tx for 1st instance of renal colic
imaging → non contrast CT
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
CT has replaced __ as preferred diagnostic test for renal pain, but does not show
US
delayed filling
dilation of collecting system
US is not sensitive to diagnose
renal calculi
imaging of choice for renal calculi
IVP?
I think? this is very confusing on the study guide
2 types of renal stone
calcium
struvite
calcium stones include
oxalate
phosphate
less common type of renal stones
uric acid
cysteine
mc location ob obstructed stone
uterovesicular junction → pelvic brim uteropelvic junction
where does the ureter cross the iliac vessels
uterovesicular junction
what do you think when you see a CT w. stranding of perinephric fat, hydronephrosis, and nephromegaly
signs of obstruction
what imaging should be used to look for blood, crystals, and signs of infxn
UA
bacteria in obstructed collecting system causes (3)
abscess
renal destruction
sepsis
what pt’s need urology consult
high grade obstructions
large stones
infected stones
basic tx for renal stones
analgesia
antiemetic
IV hydration
what analgesics are 1st line for renal stones
IV lidocaine
nsaids
narcotics
indications for admit/urology consult for renal stones (5)
complicated stones:
high obstructions
stones > 8 mm
intractable pain
e.o UTI
transplanted/solitary kidney
indication for medical expulsion therapy for stones
< 10 mm
no risk of infxn
stones > __ are unlikely to pass on their own and need consult
8 mm
condition involving retraction of foreskin and entrapment of the glands
paraphimosis and entrapment
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
- try non invasive first
- if this doesn’t work → need to be drained
how do you drain (3 steps) a priaprism
- injxn of epi or phenylephrine into corpus cavernosa
- aspiration of blood thru a 18 g needle
- 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
40
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
- emergent surgical consult
- 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
3
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
