Uro/Nephro

Question 1

Causes of HTN

Answer 1

H- hyperthyroidism
Y - why? unknown/idiopathic
P- pheo
E- eats too much - obesity
R- renal
T- thrombosis
E- Endo: CAH, hyperpara, aldosteronism
N- ICP, GBS, NF
S- Stenosis. (renal artery, coarct, supravalv AS)
I- Ingestion (cocaine, steroids, OCP, decongestants)
O- Obs (eclampsia)
N- neuroblastoma

Question 2

What renal injuries are possible without hematuria?

Answer 2

Renal Artery injury (laceration or avulsion)

Question 3

Scrotal TRAUMA: Indications for surgery

Answer 3

1. Testicular rupture
2. Large hematoceles
   3.Testicular laceration ( if tunica albuginea NOT intact)

Question 4

SCROTAL TRAUMA: complications

Answer 4

1. Testicular rupture
2. Injury to the spermatic cord
3. Large Hematocele ( Blood within the tunica vaginalis – may suggest severe injury)
4. Intratesticular hematoma or laceration of the tunica albuginea
5. Traumatic epidydimitis
6. Scrotal avulsion

Question 5

SCROTAL TRAUMA: complications of not surgically correcting

Answer 5

1. Unsalvageable (ruptured) testis
2. Missed testicular torsion ( Spurious history of trauma)
3. Infection/poor healing of testicular hematocele or if penetrating trauma
4. Compression of testis by hematoma or large hematocele

Question 6

Urinary retention: possible causes

Answer 6

– Infection (UTI): Urethritis and urethral edema, leading to acute urinary retention
– Constipation: fecal impaction
– Obstruction: Flow of urine is impeded by outflow obstruction from mechanical, structural or dynamic factors
– Neurologic impairment: Secondary to the interruption of sensory/motor nerve innervation to the detrusor muscle, incomplete relaxation of the urinary sphincter mechanism or inefficient detrusor muscle contraction
– Medications lead to acute urinary retention through a variety of mechanisms (e.g., anticholinergic medications decrease bladder sensation and reduce detrusor contractility)

Question 7

Signs of urethral injury (trauma)

Answer 7

Blood at meatus
Retention
hematuria

Question 8

Test for urethral injury

Answer 8

Retrograde urethrogram

Question 9

Balanitis : management

Answer 9

1. Urinalysis
2. Sitz baths (warm soaks) 3-4 times per days, void in bath if too painful to void
3. PO Cephalexin and or cover for STIs in teen
4. Needs FU: Exam post acute infection to ensure that there isn’t a true phimosis if unable to retract foreskin and consider circumcision if true phimosis (or recurrent infections)

Question 10

Most important sign of renal injury.
Who to image?

Answer 10

Hematuria.
Image if:
- gross hematuria
- microscopic hematuria: >50 RBCs/hpf (blunt) or >5 if penetrating
- microscopic hematuria with shock
- clinical findings indicative of renal injury: bruising/FF on POCUS

Question 11

Renal injuries classification/grading:

Answer 11

I: Contusion or non expanding subcapsular hematoma
II: Hematoma confined to retroperitoneum or Laceration <1cm depth , no urinary extravasation
III: Laceration into perinephric fat >1cm , no extravasation
IV: Deep lac into collecting system/vascular, contained hematoma
V: Fractured/completely shattered kidney, or avulsed from renal pedicle , avascular

Question 12

Diagnostic test of choice for renal injuries:
- stable pt
- Unstable pt

Answer 12

CT with contrast