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Emergency Medicine > Urologic Emergencies > Flashcards

Urologic Emergencies Flashcards

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1
Q

Differential Diagnosis of Acute Scrotal Pain

A

Testicular torsion
Appendiceal torsion
Epididymitis
Testicular rupture

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2
Q

History of Acute Scrotal Pain

A 
Good pain history
Fever/chills
Dysuria/hematuria
Discharge
H/O trauma
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3
Q

Describe a Positive Prehn’s Sign

A

Lifting of testicle on affected side relieves pain

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4
Q

Physical Exam Inclusions

A 
Abdominal exam
Exam of testes, epididymis, cord, and scrotal skin
Exam of inguinal region
Cremasteric reflex
Possible DRE to check prostate
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5
Q

Work Up of Acute Scrotal Pain

A

UA and culture

Color doppler ultrasound

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6
Q

History of Testicular Torsion

A

Sudden onset

Possible inciting event or occur spontaneously

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7
Q

Symptoms of Testicular Torsion

A

Lower abdominal pain, inguinal canal or testes

N/V (+/-)

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8
Q

Physical Exam Findings for Testicular Torsion

A 
High-riding testis on affected side
Significant swelling
Epididymis may be displaced and not found in normal position
Testicle is firm
Exquisite tenderness
Cremasteric reflex absent
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9
Q

Diagnostic Evaluation of Testicular Torsion

A

Color doppler US of testicle

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10
Q

Treatment of Testicular Torsion

A

Emergent urologic consultation
Manual detorsion
Orchiopexy

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11
Q

Describe Manual Detorsion

A

Twist laterally “like opening a book”

May need to twist 720 degrees

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12
Q

Acute Epididymitis

A

Less than 6 weeks
Swelling of epididymis with exquisite tenderness
+/- inguinal lymphadenopathy
Systemic symptoms: fever/chills, irritative voiding symptoms
+/- acute prostatitis

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13
Q

Chronic Epididymitis

A

6+ weeks
Subtle epididymal induration and tenderness
No irritative voiding symptoms
+/- inguinal lymphadenopathy

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14
Q

Physical Exam Findings in Epididymitis

A

Tenderness posterior and lateral to the testis
DRE to evaluate prostate
Acute: reactive hydrocele
Positive Prehn’s sign

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15
Q

Work Up of Epididymitis

A

UA and urine culture
+/- GC and chlamydia
Urethral swab if discharge present
Rule out other causes of scrotal pain

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16
Q

Etiology of Epididymitis in Men Younger than 35 Years Old

A

Gonococcal

Clamydia

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17
Q

Treatment of Epididymitis in Men Younger than 35 Years Old

A

Ceftriaxone 250 mg IM +

Doxycycline 100 mg BID x 10 days

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18
Q

Etiology of Older Men or History of BPH, Urethral Stricture, or Chronic UTI

A

Enteric gram negative bacteria

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19
Q

Treatment of Older Men or History of BPH, Urethral Stricture, or Chronic UTI

A

Levaquin 500 mg QD x 10 days

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20
Q

Symptomatic Treatment of Epididymitis

A

NSAIDs
Scrotal elevation
Ice

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21
Q

Risk Factors for Inflammatory Epididymitis

A 
Medication reaction
Prolonged sitting
Vigorous exercise
Trauma
Autoimmune disease
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22
Q

Presentation of Inflammatory Epididymitis

A

Progressive, gradual onset of pain

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23
Q

Treatment of Inflammatory Epididymitis

A

Scrotal elevation
Warm baths
NSAIDs

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24
Q

Define Appendix Testis

A

Small appendage of normal tissue that is usually located on the upper portion of the testis

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25
Q

Symptoms of Appendiceal Testis

A

Gradual onset of pain
Reactive hydrocele (transilluminate)
Localized tenderness
Classic “blue dot” sign

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26
Q

Diagnosis of Appendiceal Testis

A

US shows tossed appendage as a lesion of low echogenicity with central hypoechogenic area

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27
Q

Conservative Treatment of Appendiceal Testis

A 
Rest
Ice
NSAIDs
Slow recovery with discomfort
Infarcted tissue usually reabsorbed
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28
Q

Surgical Treatment of Appendiceal Testis

A

Excision of appendix testis

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29
Q

Define Testis Rupture

A

Rip or tear in the tunica albuginea resulting in extrusion of testicular contents

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30
Q

Main Symptoms of Testis Rupture

A

Scrotal swelling
Severe pain
Ecchymosis

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31
Q

Diagnostics for a Testis Rupture

A

Scrotal US

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32
Q

Treatment of Testis Rupture

A

Referral to urologist for scrotal exploration
Pain management
IV

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33
Q

Other Causes of Scrotal Pain

A 
Trauma
Strangulated hernia
Post-vasectomy problems
Mumps
Testicular cancer
Kidney stone
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34
Q

Define Priapism

A

Erection unrelated to stimulation lasting typically longer than 4 hours

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35
Q

Pathophysiology of Priapism

A

Trapping of blood in the erectile bodies which can result in ischemia and infarction

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36
Q

Ischemic Priapism

A

Most common

Painful

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37
Q

Non-Ischemic Priapism

A

Rare
Painful
Usually development of traumatic A/V fistula between cavernosal artery and corpus cavernosum

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38
Q

Etiology of Priapism

A 
Idiopathic
Sickle cell anemia
Leukemia
Thalassemia
MM
TTP
Spinal shock
Metastatic cancers
Perineal, pelvic, or penile trauma
Iatrogenic
Drugs
Infection
Metabolic disorders
39
Q

Drug Classes that can Cause Priapism

A 
Anticoagulants
Anti-hypertensives
Anti-depressants
PDE5 inhibitors
Intracavernous injections
Alpha-blockers
Cocaine
40
Q

Metabolic Disorders that can Cause Priapism

A 
Gout
Hemodialysis
High lipid content
Total parenteral nutrition
DM
Amyloidosis
41
Q

History of Priapism

A

Presence of pain
Duration, role of antecedent factors, prior episodes
Existence of etiological conditions
Existence of erectile function status

42
Q

Physical Exam Findings of Priapism

A

Extent of tumescence and presence and extent of tenderness

Abdominal, perirenal, and rectal exams can reveal signs of trauma or malignancy

43
Q

Diagnosis of Priapism

A

CBC
Color doppler US to distinguish ischemic from non-ischemic
Evaluation of aspirated blood

44
Q

Treatment of Priapism

A

Pain management

Urgent urological consultation

45
Q

Treatment of Ischemic Priapism

A

Evacuation of blood

Intracavernous injection of alpha-adrenergic sympathomimetic agent

46
Q

Treatment of Non-Ischemic Priapism

A

Observation

Urological consult

47
Q

Define Penile Fracture

A

Rupture of one or both of the tunica albuginea that covers the corpora cavernosa

48
Q

Cause of a Penile Fracture

A

Rapid blunt force to an erect penis
Vaginal intercourse
Aggressive masturbation

49
Q

Signs and Symptoms of Penile Fracture

A

Popping or cracking sound
Severe pain
Immediate loss of erection

50
Q

Diagnostics of a Penile Fracture

A

Retrograde urethrogram (RUG)

51
Q

Treatment of a Penile Fracture

A

Surgical correction

52
Q

Complications of a Penile Fracture

A

ED
Penile curvature
Pain

53
Q

Describe Paraphimosis

A

Foreskin in uncircumcised or partially circumcised male is retracted behind the glans penis, develops venous and lymphatic congestion and cannot be returned to its normal position

54
Q

History with a Paraphimosis

A

Swelling of penis and penile pain
Cause of irritability in preverbal infant
Recent penile exam, foley insertion, cystoscopy

55
Q

Physical Findings with a Paraphimosis

A 
Ensure no constricting FB
Edema and tenderness of the glans
Painful swollen retracted foreskin
Penile shaft unaffected
Ischemic: blue or black, firm
56
Q

Non-Invasive Techniques for Reduction of a Paraphimosis

A 
Ice
Compression bandages
Osmotic agents
Manual compression and reduction
Traction with forceps
57
Q

Invasive Techniques for Reduction of a Paraphimosis

A

Glans penis aspiration

Dorsal slit procedure

58
Q

Define Urinary Retention

A

Inability to voluntarily pass urine

59
Q

3 Factors Causing Retention

A

Outflow obstruction
Neurologic impairment
Inefficient detrusor muscle

60
Q

Diagnosing Urinary Retention

A 
H&P
Bladder US
Catheter insertion
UA/culture
Creatinine level
61
Q

Treatment of Urinary Retention

A

Catheter

Alpha-blocker meds

62
Q

Alpha-blocker Medications that help in Urinary Retention

A

Tamsulosin (Flomax)

Doxazosin (Cardura)

63
Q

Complications of Urinary Retention

A

Hematuria

Postobstructive diuresis

64
Q

Labs to Diagnose Dysuria

A

UA

Urine culture

65
Q

Pyuria on UA can be seen with what infections?

A

UTI
Chlamydia urethritis
Gonococcal urethritis

66
Q

Hematuria + Pyuria on UA Rules Out

A

STI

67
Q

Painless Hematuria Potentially Indicates

A

Cancer

68
Q

When is a urine culture recommended with dysuria?

A

Men with pyelonephritis

Women with a complicated UTI

69
Q

Presentation of Pyelonephritis

A 
Flank pain
Abdominal pain
Pelvic pain
N/V
Fever >99.8
May have CVA tenderness
\+/- cystitis symptoms
70
Q

Labs for Pyelonephritis

A

UA
CBC
Pregnancy test

71
Q

Treatment of Mild to Moderate Pyelonephritis

A

Rehydrate and give parenteral dose of antibiotics in ED
Observe for 8-12 hours
IV ceftriaxone
Oral fluoroquinolone x 7 days

72
Q

Treatment of Severe Pyelonephritis

A 
Hospitalization
High fever
Pain
Marked debility
Inability to maintain oral hydration or take oral meds
Pregnancy
Concerns about patient compliance
73
Q

Presentation of Nephrolithiasis

A

Colicky flank pain

Hematuria

74
Q

Diagnostics of Nephrolithiasis

A

Abdominal plain films
Usually non-contrast helical CT scan
US: patient who need to avoid radiation

75
Q

Conservative Treatment of Nephrolithiasis

A

Pain medication
Stone less than 10 mm, tamsulosin (Flomax)
Hydration
Strain urine

76
Q

When is an urgent urological consult warranted?

A

Urosepsis
Acute renal failure
Anuria
Unyielding pain, N/V

77
Q

Epidemiology of Blunt Trauma to the Urogenital Region

A

MVA
Falls from heights
Direct blows to the torso or external genitalia
Injuries to the female genitalia (pelvic fractures, physical or sexual assault)
Testicular injuries

78
Q

Initial Management of Genitourinary Trauma

A

Identification and stabilization of life-threatening injuries
Rarely life-threatening

79
Q

Secondary Survey of GU Trauma for Both Genders

A

Inspect perineum and external genitalia
Blood on underwear
Folds of buttocks for perineal lacerations (pelvic fracture)
Rectal exam

80
Q

What are we looking for with a rectal exam in a GU trauma?

A

Sphincter tone
Presence of blood
Position of prostate

81
Q

Secondary Survey of GU Trauma for Males

A

Examine scrotum for bruising or testicular rupture

Look for blood at penile meatus

82
Q

Secondary Survey of GU Trauma for Females

A

Vaginal introitus for lacerations or hematoma
Bimanual exam if suspicion of pelvic trauma, hematoma, or bruising
Any sign of vaginal blood, need a speculum exam to look for vaginal laceration

83
Q

When should you suspect a urethral injury?

A 
Blood at urethral meatus
Gross hematuria
Inability to void
Absent or abnormally positioned prostate
Ecchymosis or hematoma of penis, scrotum or perineum
Plain films reveal a pelvic fracture
84
Q

What must be done prior to insertion of a foley catheter in GU trauma?

A

Retrograde urethrogram (RUG)

85
Q

When should you evaluate for bladder rupture?

A

Foley catheter has been placed and there is gross hematuria or pelvic fracture with microscopic hematuria

86
Q

What tests can evaluate for a bladder rupture?

A

Retrograde cystography

Retrograde CT cystography

87
Q

Define Bladder Contusion

A

Partial thickness injury to the bladder wall without rupture

88
Q

When does an intraperitoneal rupture occur?

A

Blunt force injury to the lower abdomen with a full bladder

89
Q

What does an intraperitoneal rupture result in?

A

Rupture of the bladder dome followed by extravasation of urine into the peritoneal cavity

90
Q

When does an extraperitoneal rupture occur?

A

In association with pelvic fractures

91
Q

When should you suspect renal injuries?

A 
Bruising, pain, or tenderness of the flank or abdomen
Posterior rib or spine fractures
Hematuria (gross or microscopic)
Shock
Fever, flank mass
92
Q

Work Up of Renal Injuries

A

UA

Renal imaging

93
Q

Indications for Renal Imaging

A

Penetrating trauma
Lower rib fracture
Gross hematuria
Blunt trauma with microscopic hematuria plus shock
Clinical signs indicating abdominal organ injury or significant deceleration injury

Emergency Medicine (17 decks)

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