Trigger - LE and male genitalia

Question 1

How do you prep an abscess

Answer 1

Clean overlying skin w povidone and drape in steril fashion.

Question 2

what are the high risk features for endocarditis? how would this change your plan of care if you were treating a patient for an abscess?

Answer 2

• prosthetic heart valves or prosthetic material
• hx of previous endocarditis
• unrepaired cyanotic CHD
• repaired CHD w prosthetic material
• repaired CHD w residual defects
• Cardiac transplant recipients w valve regurg

give IV clinda or vanc 30-60 min prior to I&D

Question 3

where do you measure for extremity swelling related to a DVT?

Answer 3

10cm below the tibial tubercle

Question 4

A large proximal DVT that is white/pale

Answer 4

phlegmasia Alba dolens

Question 5

A large proximal DVT that is dusky blue

Answer 5

Phlegmasia cerulea dolens

Question 6

what are the risks for MRSA

Answer 6

• recent hospitalization, surgery, or hemodialysis
• HIV infection, drug use, or prior ABX
• incarceration, military
• sharing sports equiptment, needles or razors.

Question 7

When do you use POCUS with a cutaneous abscess

Answer 7

to differentiate a edep abscess from cellulitis

Question 8

For I&D of a drainage you should…
1. use a no. () or () scalpel blade
2. incise over the area of ()
3. incise deep enough to ()
4. express pus w ()
5. insert () into the abscess to ()
6. +/- irrigation of wound w saline

Answer 8

Question 9

For LARGE abscesses what is the management

Answer 9

Send for drainage in the OR

Question 10

which areas are considered areas of cosmetic concern and should be sent for management by a specialist

Answer 10

• palms
• soles
• nasolabial folds

Question 11

How do you treat a mild, moderate and severe abscess

just say all of em, i know you can

Answer 11

• mild - I&D alone! no abx
• Moderate/severe - bactrim, clinda, doxy
• Severe + immunocomp or sepsis - IV (Vanc/linezolid/clinda) + (piptaz or meropenem)

only add pip/taz or meropenem if signs of sepsis

Question 12

What do the Wells test scores for DVT

Answer 12

0 or less = D dimer
1-2 = high sensitivity d dimer
3+ = US

Question 13

what is D dimer

Answer 13

Plasma D-dimer is a product of cloth breakdown, released upon degradation of polymerized crosslinked fibrin. Elevated plasma dimer levels indicate that coagulation has been activated, fiber clot has formed, and clot degradation by plasma has occurred.

Question 14

What are the DOACs

Answer 14

• dabigatran (pradaxa)
• rivaroxaban (Xarelto)
• Apixaban (Eliquis
• Edoxaban (Lixiana, Savaysa)

Question 15

Which DVT types require a surgery consult

Answer 15

• Proximal DVT without limb ischemia w high bleeding risk
• proximal DVT w ischemia

Question 16

When do you use Serial proximal compressive US Qweekly for 2-4 weeks in a DVT

Answer 16

a DVT with distal vein involvement only that has a moderate/low risk of bleeding and is asymptomatic

Question 17

what are the 4 criteria for amission w a DVT

Answer 17

1. proximal DVT
2. Concurrent symptomatic PE
3. High bleeding risk
4. comorbid conditions requiring hospitalization

Question 18

What are the 6 P’s for?

Answer 18

Acute arterial occlusion

Question 19

Which arteries correlate with which parts of the leg for arterial limb ischemia

Answer 19

Question 20

what ABI is suggestive of severe disease

Answer 20

<0.4

Question 21

chart for rutherford classification of ischemia

Answer 21

Question 22

immediate consultation with vascular surgery about revascularization prior to additional diagnostic imaging is the management for which rutherford stage

Answer 22

IIb

Question 23

How do you tx acute limb ischemia

Answer 23

UFH

Question 24

Does pyuria on a UA rule out testicular torsion

Answer 24

no

Question 25

pain localized to the upper pole of the testis

Answer 25

testicular appendage torsion

Question 26

Mumps is the MC viral cause of

Answer 26

orchitis

Question 27

1. men who are <35 and DONT practice anal intercourse - MC etiology is ()
2. Men >35 or those who do practice anal intercourse - MC etiology is ()

epididymitis!!!!

Answer 27

1. gonorrhea and chlamydia
2. urinary pathogens like E. coli and Klebsiella

Question 28

testes in this disease hangs LOWER than normal in the scrotum

Answer 28

epididymitis

Question 29

How do you treat epididymitis in:
1. not gono/chlam
2. + gono/chlam
3. anal intercourse exposure

Answer 29

1. Levo or bactrim
2. rocephin + doxy/azithro
3. Rocephin + Levo

Question 30

what is the treatment for a patient with an intrascrotal abscess

Answer 30

• immediate urology consult for surgical drainage
• broad ABX (zosyn) until cultures are back

Question 31

CT w IV contrast shows air along fascial planes and deep tissue involvement

Answer 31

fournier’s gangrene

Question 32

Tx for fournier’s gangrene

Answer 32

• zosyn
• fluids, opioids, NPO, septic work up.
• Urgent urology consult

Question 33

What are the 3 options of tx for paraphimosis in order

Answer 33

1. try anesthesia and manual reduction
2. small punctures to release fluid (22-25g needle)
3. dorsal slit

Question 34

sickle cell disease is the MCC of () occuring in children

Answer 34

ischemic priapism

This disease is MC in ADULTS!!!! if in peds, sickle cell.

Question 35

MCC of non-ischemic/high flow priapism

Answer 35

traumatic fistula

Question 36

Prior to attempting removal of an object on an entrapped penis, what must you do

Answer 36

corporal aspiration

Question 37

what size foley for urethral strictures

Answer 37

• 14 or 16 Fr straight
• if unsuccessful use 12 Fr Coude w lube

Question 38

what is a positive post void residual bladder scan volume

Answer 38

> 50-150cc