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ClinMedEx 4 > Ross GUT > Flashcards

Ross GUT Flashcards

1
Q

Renal stones (renal colic) is often misdiagnosed as what?

A

AAA

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2
Q

What are signs of AAA that get confused with renal colic?

A
  1. Stones don’t usually present for the first time in people over the age of 60
  2. don’t usually present with hypotension
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3
Q

What are symptoms of renal colic?

A

flank pain that radiates to the groin or CV angle and lateral ab pain

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4
Q

Does renal colic produce rebound, guarding, or abdominal tenderness?

A

No

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5
Q

Risk factors for nephrolithiasis?

A

obesity, diabetics, gout, immobilization, family hx and inflammatory bowel disease

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6
Q

What is the imaging of choice for nephrolithiasis?

A

Non contrast CT

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7
Q

If we want to know about kidney function, what is the imaging of choice?

A

IVP

-Signs of a stone on IVP are delayed filling and dilation of the affected collecting system.

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8
Q

What are the two types of stones?

A

Calcium oxalate and phosphate

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9
Q

What is the mc site of a stone impaction?

A

Uteropelvic junction is the most common location of obstructed stone, the pelvic brim (ureter crosses the iliac vessels) and the uterovesical junction.

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10
Q

On CT, these are signs of what?

stranding of perinephric fat, hydronephrosis and nephromegaly

A

kidney stone

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11
Q

Stones greater than ____ mm are unlikely to pass on their own and will need a urology consult.

A

8

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12
Q

Basic tx for kidney stones?

A

IV lidocaine, nsaids and narcaotics

Also antiemetic (ondansteron) as well as IV hydration

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13
Q

T/F: You can have an increased leukocytosis w/ a stone without infection (look for a band shift)

A

True

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14
Q

Do you need to image uncomplicated nephrolithiasis?

A

If no infection, no hydronephrosis, normal Cr, then you can send the patient home with a f/u

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15
Q

What is a pregnant patient has stones? What imaging do you do?

A

Start with U/S then if hydro, do a low dose CT or MRI

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16
Q

Can you give NSAIDs to a pregnant woman with nephrolithiasis?

A

No

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17
Q

Anyone with an infected stone needs a ________ _____

A

urine culture

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18
Q

Treatment for infected stone?

A

Cefuroxime or FQ

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19
Q

UTI (positive UA) with a stone: infected stone treatment?

A

Cipro 500 mg PO x 14 days

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20
Q

What is medical expulsive therapy for kidney stones?

A

Stones that are larger than 6 mm can have trial of CCB (Nifedipine x 8 weeks) or Tamsulosin x 3 weeks

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21
Q

Fever, flank pain and + UA

A

pyelonephritis

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22
Q

You will see an increased _______ in urosepsis (infection in the urinary tract)

A

lactate

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23
Q

Treatment for pregnant woman with UTI?

A

Macrobid

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24
Q

Treatment for UTI if not pregnant?

A

FQ

25
Q

What is the rule of 2 for pyelonephritis?

A
  • 2 L of NS
  • 2 g ceftriaxone
  • 2 mg morphine
26
Q

How long do you treat an uncomplicated UTI for?

A

3-5 days

27
Q

How long do you treat pyelo for?

A

14 days

28
Q

Tx for asymptomatic bacturia in pregnancy? (treat as UTI)

A

Macrobid or Keflex

29
Q

This will transilluminate

A

hydrocele

30
Q

Imaging for hydrocele?

A

U/S

31
Q

Difference between epididymitis and orchitis?

A

Epididymitis is swelling or pain in the back of the testicle in the coiled tube (epididymis) that stores and carries sperm. Orchitis is swelling or pain in one or both testicles, usually from an infection or virus.

32
Q

Imaging for epididymitis?

A

U/S

33
Q

Treatment for epididymitis?

A

Ceftriaxone IM then doxy x 10 days

34
Q

Treatment for a partner with epididymitis?

A

Floxacin (ofloxacin or levofloxacin)

35
Q

How do we treat orchitis?

A

Same as epididymitis because often in conjunction

36
Q

A patient presents with prostate bogginess and pain, what is the most likely dx?

A

acute prostatitis

37
Q

Treatment for acute prostatitis?

A

Fluroquinolones

38
Q

A patient >65 years old presents with painful urination, discharge from penis, and pain. What imaging should be done?

A

U/S for Epididymitis/epididymo-orchitis

39
Q

In patients <35 who present with symptoms of Epididymitis/epididymo-orchitis what could be the cause and what test should you consider?

A

Gonorrhea/chlamidya and get a urine culture

40
Q

A patient presents with discharge from penis, UA may be positive for wbc. What is the most likely diagnosis?

A

Urethritis: typically STI

Make sure to look for Herptic lesions.

Can be either gonococcal or non-gonococcal

41
Q

A patient presents with perineal and or low back pain and fever. WHat is the first test you should do?

A

Urine culture

42
Q

What is the tx for prostatitis?

A

Treat with fluoroquinolones or cephalosporins for more than 28 days.

43
Q

painful inguinal mass + empty scrotum =

A

testicular torsion

44
Q

14 yr old male presents with one hour of scrotal pain and vomiting. There is no fever or urinary sxs. On his exam his cremasteric reflex is absent and the painful testicle has a horizontal lie. What is the appropriate management?

A

Call urology and order U/S

45
Q

With a testicular torsion, the cremasteric reflex is present or absent?

A

absent

46
Q

What is a blue dot sign?

A

In testicular torsion- the ischemic necrotic appendix.

47
Q

What are two RF of fournier’s gangrene?

A

diabetics and alcohol abusers

48
Q

What lab is helpful to dx fournier’s gangrene?

A

Lactate level

49
Q

Be suspicious of this when you see any bullae on the sctroum or groin intense pain associated with fever.

A

fournier’s gangrene

50
Q

Imaging for fournier’s gangrene?

A

If stable a CT with contrast of abdomen and pelvis is the imaging modality of the initial assessment.

51
Q

What is the tx for fournier’s gangrene?

A

Pip-taz IV or meropenem IV plus vanco

Addition to either regimen = ADD clindamycin IV

52
Q

Foreskin pulled back and entrapping the glans.

A

Paraphimosis and entrapment

53
Q

Treatment of paraphimosis and entrapment?

A

reduce it forward because can cause gangrene if not

54
Q

prolonged erection of the penis that is usually painful. The persistent erection continues hours beyond or isn’t caused by sexual stimulation

A

Priapism

55
Q

Non-invasive treatment for priapism?

A

Terbutaline PO or pseudoephedrine PO

56
Q

If non-invasive tx for priapism doesn’t work (terbutaline or pseudoephedrine), what is the next step?

A

Injection of lidocaine and injection of epi or phenylepherine into the corpus cavernosum

57
Q

What procedure needs to be done for a GU trauma?

A

Tears in the tunica albuginea and or corpus cavernosa are associated with direct blunt trauma. The problem is that these are often associated with urethral tears and will need a retrograde urethrogram (inject dye into the urethra and take xrays to see where it goes).

58
Q

If you suspect a UTI in a neonate, what should you do?

A

Need to get a cath urine if can’t get a clean catch with a bag

ClinMedEx 4 (16 decks)

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