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emergency med final > urologic emergencies > Flashcards

urologic emergencies Flashcards

1
Q

most common type of kidney stone

A
  • calcium salts
  • radiopaque
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2
Q

60-90% of kidney stones are radiopaque, which type is radiolucent

A
  • uric acid
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3
Q

List 4 types of kidney stones

A
  • calcium salts
  • struvite - associated with infection
  • uric acid
  • cystine
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4
Q

What imaging should you get to assess renal colic

A

non-contrast CT

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5
Q

What imaging should you get to assess renal colic in a pregnant woman, child, or person with frequent CT scans

A

US

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6
Q

what size of kidney stone will usually pass? what size will usually not pass

A
  • usually pass < 5mm
  • usually not pass > 8 mm
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7
Q

emergency room tx of renal colic

A
  • pain relief
  • Abx?
  • alpha 1 blocker: dilate ureter
  • watchful waiting
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8
Q

what is the most common cause of urinary retention in men > 50

A
  • obstruction from prostatic hyperplasia
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9
Q

what are some classes of medications that can lead to urinary retention

A
  • antihistamine
  • anticholinergic
  • narcotic
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10
Q

what imaging/labs should you get when assessing urinary retention

A
  • bladder US
  • BMP: renal failure
  • UA: infection
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11
Q

initial management of urinary retention

A
  • urethral catheterization
  • subprapubic catheter
  • discharge pt with drainage bad and f/u in 1-3 d
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12
Q

what is cystitis

A
  • pathogens from fecal flora colonize the vaginal introitus, enter the urethra and bladder, and stimulate a host response
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13
Q

which pathogen is the primary cause of cystitis

A

Escherichia coli

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14
Q

in a pt with cystitis, urine dipstick will be positive for

A
  • leukocyte esterase -> pyuria
  • nitrite: gram negative bacteria
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15
Q

what medication is given for analgesia in cystitis

A
  • phenazopyridine (Pyridium)
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16
Q

what conditions make a case of cystitis complicated

A
  • male
  • elderly, children
  • pregnant
  • indwelling urinary catheter
  • anatomic abnormality
  • recent abx use
  • symptoms > 7 days
  • DM, immunosuppression
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17
Q

workup of complicated cystitis

A
  • longer tx
  • culture
  • closer f/u
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18
Q

pyelonephritis

A
  • infectious inflammatory disease involving kidney parenchyma and renal pelvis
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19
Q

number one pathogen associated with pyelonephritis

A

E coli

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20
Q

WBC casts are consistent with

A

pyelonephritis

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21
Q

imaging for pyelonephritis

A
  • con-contrast CT or US
22
Q

risk factors for complications with pyelonephritis

A
  • obstruction - stone, tumor
  • urologic surgeries or instrumentation
  • pregnancy
  • DM
23
Q

length of tx for pyelonephritis

A

10-14 days

24
Q

abx options for pyelonephritis

A
  • cephalosporin
  • fluoroquinolones
    • **NO bactrim, macrobid
25
as a rule of thumb, causes of acute prostatis above age 35 and under age 35 are caused by
* age \> 35: E-coli * age \< 35: N. gonorrhoeae and chlamydia
26
clinical presentation * fever, chills, myalgia * pain in lower back, rectum or perineum * may have urinary retention, dysuria * **tender boggy prostate**
acute prostatis
27
is radiology indicated in acute prostatis
* not unless toxic
28
why should the prostate not be massaged during physical exam if you suspect acute prostatis
* bacteremia
29
tx of acute prostatis
* cipro for E-coli * GC/chlamydia tx
30
urosepsis
* severe illness which occurs when a urinary tract infection spreads systemically
31
list the SIRS (systemic inflammatory response syndrome) criteria
* temperature \> 100.4 or \< 96.8 * WBC count \> 12K or \< 4K or 10% bands * tachycardia \> 90 bpm * tachypnea \> 20/min * severe-altered mental status * lactate \> 4 mmol/L
32
imaging when assessing urosepsis
* CT * r/o stone, abscess, ddx
33
risk factor for testicular torsion
* 10x more common in undescended testis
34
clinical presentation * swollen, firm and tender hemiscrotum * hgih riding testis with transverse lie * possible _loss of cremasteric reflex_
testicular torsion
35
blue dot sign is consistent with
* torsion of appendix testis
36
test of choice when assessing testicular torsion
* testicular US * shows absent or decreased flow to affected side
37
tx of testicular torsion
* call urology stat - needs surgery * sedate pt and attept to manually detorse * turn testicle medially to laterally "opening of a book" technique
38
cause of epididymitis
* retrograde spread of infected urine down the vas deferens = inflammation of epididymis * **\< 35: chlamydia, GC** * \> 35: E-coli
39
clinical presentation * scrotal pain, swelling and tenderness * relieved with testicle elevation * may have urethral discharge * cremasteric reflex intact * testicle red, swollen, warm, tender
epididymitis
40
radiolgy for epididymitis
* US: r/o torsion or tumor * may see increased flow to epididymis
41
tx of epididymitis if STD suspected
* rocephin + doxycycline
42
paraphimosis
* foreskin becomes retracted behind glans of penis and cannot be placed over glans * emergency
43
balanoposthitis
Defined as the inflammation of the foreskin and glans in uncircumcised males
44
Balanitis
inflammation of the glans (the rounded head) of the penis
45
Priapism
* persistent erection of penis for more than 4 hours that is not related or accompanied by sexual desire
46
most common cause of Priapism
* acute low flow
47
important to warn all patients with Priapism of the possibility of
* impotence, fibrosis
48
tx of Priapism
* aspirate corpora with butterfly needle * 2 o'clock and 10 o'clock * aspirate 20-30cc till bright red arterial blood * inject phenylephrine into corpora cavernosa
49
fourniers gangrene
* necrotizing infection of perineum involving penis, scrotum, perineum, abd wall
50
most common risk factors for fourniers gangrene
* DM
51
imaging to assess fourniers gangrene
Contrast CT scan

emergency med final (4 decks)

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