Urologic Emergencies

Question 1

Patient presents with sudden onset severe lower abdominal pain, inguinal canal or testes pain that may have N/V. Elevated testis w/significant swelling. Absent cremasteric reflex

Answer 1

testicular torsion

Question 2

The most common cause of scrotal pain in the outpatient setting. It is usually infectious in etiology.

Answer 2

epididymitis

Question 3

Where is the location of pain/tenderness for epididymitis?

Answer 3

posterior and lateral to the testis

Question 4

the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion

Answer 4

phren’s sign

Question 5

Needs to be tested for in work-up of epididymitis due to an infectious etiology

Answer 5

GC and chlamydia

Question 6

Symptomatic treatment of epididymitis

Answer 6

NSAIDs, scrotal elevation, ice

Question 7

Most cases occur between age 7-14YO. Gradual onset of pain. Reactive hydrocoele. Classic blue dot sign and tenderness over anterosuperior testis.

Answer 7

Torsion of the appendiceal testis

Question 8

Safe and quick surgical procedure for torsion of the appendiceal testis if continued pain that’s unresponsive to rest, ice, nsaids

Answer 8

Excision of the appendix testis

Question 9

erection unrelated to stimulation lasting typically longer then 4 h. can result in ischemia and infarction

Answer 9

priapism

Question 10

Which type of priapism is more common and more painful?

Answer 10

ischemic

Question 11

Type of priapism painless, usually from development of a traumatic A/V fistula b/w cavernosal artery and corpus cavernosum

Answer 11

non-ischemic

Question 12

How do you distingush between ischemic and non-ischemic priapism?

Answer 12

ultrasound. And darkly colored blood from corpus cavernosum indicates ischemic whereas bright red indicates non-ischemic

Question 13

What is the treatment for ischemic priapism?

Answer 13

Evacuation of blood then intracavernous injection of phenylephrine

Question 14

Glans and prepuce, excoriated, malodorus and tender suggestive of fungal balantitis. What is the treatment?

Answer 14

Nystatin or clotrimazole

Question 15

Warmth, erythema, edema of the glans, foreskin and penile shaft suggestive of bacterial balantitis. What is the treatment?

Answer 15

first or second generation cephalosporin

Question 16

Difficulty in retracting the foreskin. Normal in newborns and even into adolescence. Etiology of pathologic: lichen sclerosis; scarring; balantitis

Answer 16

phimosis

Question 17

What is the treatment for persistent phimosis?

Answer 17

betamethasone cream for 2-6 weeks

Question 18

Occurs when the foreskin in the uncircumcised male is retracted behind the glans penis, develops venous and lymphatic congestion and cannot be returned to its normal position

Answer 18

paraphimosis

Question 19

Most common cause of dysuria in women and men

Answer 19

UTIs in women and STIs in men

Question 20

Symptoms that when occur together rule out STI as cause of dysuria

Answer 20

hematuria + pyuria

Question 21

done in men and in pts with pyelonephritis or women with complicated UTIs

Answer 21

urine culture

Question 22

First line treatment for uncomplicated cystitis

Answer 22

3 days of TMP-SMX. If allergic us fluoroquinolone

Question 23

Treatment for complicated UTIs except in pregnant patients

Answer 23

fluoroquinolones

Question 24

Treatment for STIs

Answer 24

1g ceftriaxone IM + doxycycline or azithromycin 1g x 1 dose

Question 25

Flank pain, abdominal and pelvic pain. Nausea and vomiting. Fever > 99.8F. May have costovertebral angle tenderness

Answer 25

pyelonephritis

Question 26

Treatment of mild to moderate pyelonephritis

Answer 26

rehydrate and give IV abx (ceftriaxone) in ER and observe for 8-12 hours. d/c on fluroquinalone x 7d

Question 27

Complication of nephrolithiasis

Answer 27

persistent renal obstruction, which could cause permanent renal damage

Question 28

How is nephrolithiasis usually diagnosed?

Answer 28

non contract CT

Question 29

What is the conservative treatment for nephrolithiasis?

Answer 29

pain meds and hydration until stone passes.

Question 30

What does a high riding or boggy prostate on DRE indicate in a trauma assessment?

Answer 30

disruption of the membranous urethra

Question 31

Most common site of urethral injury

Answer 31

weakest point: the bulbomembranous junction

Question 32

Should be done to evaluated any suspicion of pelvic trauma/hematoma/bruising

Answer 32

bimanual exam

Question 33

Necessary to rule out vaginal laceration and should be done with any sign of vaginal bleeding

Answer 33

speculum exam

Question 34

What is the suspected injury if patient presents with: Blood at urethral meatus, Gross hematuria, Inability to void, Absent or abnormally positioned prostate, pelvic fracture?

Answer 34

urethral injury

Question 35

Must be done to evaluate the integrity of the urethra prior to inserting Foley. deferred only if pelvic angiography is being done to control pelvic hemorrhage

Answer 35

retrograde urethrogram

Question 36

What should you do if a Foley catheter has been placed and there is gross hematuria or a pelvic fracture w/ microscopic hematuria (RBCs>25 per HPF)?

Answer 36

evaluate for bladder rupture with retrograde cystography or retrograde CT cystography

Question 37

Occurs from blunt force injury to the lower abdomen w/ a full bladder. Results in rupture of the bladder dome followed by extravasation of urine into the peritoneal cavity

Answer 37

intraperitoneal rupture

Question 38

Occurs in association w/ pelvic fractures. Injury force causes rupture of the anterior or anterior-lateral wall. Sometimes bony fragments impale the bladder

Answer 38

extraperitoneal rupture

Question 39

What should all patients with pelvic fracture or gross hematuria have to rule out bladder rupture?

Answer 39

cystogram