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GME - Residency > Urology > Flashcards

Urology Flashcards

1
Q

A PVR greater than __________ is concerning.

A

100 mL

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2
Q

What five drugs are first line for uncomplicated cystitis?

A

Amoxcillin
Bactrim
Nitrofurantoin
Fosfomycin
Cephalexin

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3
Q

What four drugs treat complicated cystitis?

A

Ciprofloxacin
Levofloxacin
Bactrim
Cefpodoxime

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4
Q

What three drugs treat cystitis in a pregnant woman?

A

Augmentin/amoxicillin
Nitrofurantoin
Cefpodoxime

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5
Q

Review the common causes of urinary retention in women.

A

Postpartum inflammation
HSV inflammation
Bartholin gland cysts/abscesses
Pelvic masses
Neurogenic bladder
Vaginitis

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6
Q

Malignancy typically presents as __________ hematuria.

A

painless

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7
Q

In women, _________ abscess can cause urinary retention.

A

Bartholin’s

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8
Q

There are four categories of causes of urinary retention. Review them and list some examples in each.

A

Obstructive:
- Stone
- Cancer
- Stricture
- Phimosis
- BPH

Infection:
- UTI
- Urethritis
- Vulvovaginitis
- HSV

Neurologic:
- Spinal cord compression/infarction/trauma
- Tabes dorsalis
- MS
- Diabetes

Pharmacologic:
- Anticholinergic
- Antihistamine
- Anti-adrenergic
- Anti-spasmodic

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9
Q

What is Prehn sign?

A

Relief of testicular pain in epididymitis with elevation of the testicle

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10
Q

Which direction should you try first in manual detorsion of a testicle?

A

Medial to lateral (“open the book”)

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11
Q

What agents are acceptable first-line agents for empiric prostatitis?

A

Ciprofloxacin or Bactrim

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12
Q

If a backpacker has red urine but no RBCs on UA, what should you think of?

A

Iodine

Iodinated water tablets can cause red urine.

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13
Q

“Thickened bladder wall” on a prenatal ultrasound is suggestive of _____________.

A

posterior urethral valve

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14
Q

What is the pathophysiology of posterior urethral valve?

A

Abnormal insertion of the Wolffian ducts into the bladder which leads to excess tissue that obstructs the urethra

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15
Q

What feature of a VCUG suggests posterior urethral valve?

A

Dilated proximal urethra on the removal of the catheter

PUV presents with tissue in the proximal part of the urethra. The tissue is usually not at the absolute beginning of the urethra and so the most proximal part of the urethra gets dilated. This will show up with contrast collection on VCUG.

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16
Q

Review the management of priapism.

A

Priapism is worrying if it persists for more than 4 hours.

First, use cold compresses and encourage the patient to urinate to relieve the erection.

If cold compresses and urination fail to relieve it, then aspirate the corpus cavernosa and infuse cold saline.

If the aspiration and saline don’t work, then inject intracavernosal phenylephrine.

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17
Q

The corpus cavernosa is _________ to the corpus spongiosum.

A

posterior

The corpus spongiosum is the part of the penis that is immediately around the urethra and is contiguous with the glans. The corpus cavernosa is the “back” part of the penis that is doral to the spongiosum; the cavernosa are two bodies.

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18
Q

Review the two options for bacterial prostatitis.

A
  • Ciprofloxacin 6 weeks
  • Bactrim 6 weeks
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19
Q

Stress incontinence presents with what?

A

Leakage of urine with anything that increases the intraabdominal pressure: Valsalva, coughing, vomiting.

You need to rule out UTI with a UA. You should also look for hematuria on UA which would warrant a malignancy evaluation.

Beyond the above rule-outs, you can treat with pelvic floor PT, pessary, lifestyle modification, and sling surgery.

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20
Q

How do you differentiate the two types of priapism?

A

Obtain a cavernosal blood gas.

The two kinds of priapism are ischemic and non-ischemic. Ischemic priapism is caused by mechanisms that limit flow. Non-ischemic priapism is caused by increased flow.

On a blood gas, ischemic priapism will have acidosis and with a low O2

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21
Q

What is the movement of detorsing a testicle?

A

Rotate laterally (“open the book”)

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22
Q

What problems can happen with nephrostomy tubes?

A
  • Obstruction (kinking, tube clogs, stopcock malfunction)
  • Dislodgment
  • Infection (superficial or deep)
  • Hematuria (normal in the first 24 hours)
23
Q

How do you flush a nephrostomy tube?

A

Get sterile gloves, sterile saline, and an alcohol swab. Disconnect the tubing, sanitize with alcohol, flush 5-10 mL into the tube, and aspirate back. Reconnect the tubing.

24
Q

As you’re working up nephrostomy obstruction, be sure to treat ____________.

A

dehydration; if they are not passing fluid because of dehydration then you can save yourself a lot of workup

25
Q

How much phenylephrine can you instill in the penis?

A

1000 - 2000 mcg

26
Q

Review the management of priapism.

A
  • Penile nerve block
  • Aspirate the corpus cavernosa
  • Phenylephrine infused
27
Q

What is Trousseau sign?

A

Migratory thrombophlebitis associated with pancreatitis

28
Q

Retroperitoneal bleed sign by belly button?

A

Cullen

29
Q

Retroperitoneal bleed sign on flank?

A

Grey Turner

30
Q

What level of urine from a Foley should make you concerned about electrolyte abnormalities from post-retention diuresis?

A

1,000 mL

31
Q

What is a Prehn sign and what does it suggest?

A

Relief of testicular pain with elevation of the testicle

It suggests epididymitis.

32
Q

What is the difference between phimosis and paraphimosis?

A

Phimosis is inability to retract the foreskin. Paraphimosis is a foreskin that is stuck retracted.

33
Q

Sickle cell patients with priapism may require what treatment that is unique to sickle cell?

A

Exchange transfusion

34
Q

True or false: phimosis (inability to retract the foreskin) needs to be urgently evaluated by a urologist.

A

False

More common in young boys, phimosis usually leads to nothing and spontaneously resolves.

35
Q

What can help reduce paraphimosis?

A

Ice applied to the glans

36
Q

Other than UTI, pyuria can also be from what?

A

Intra-abdominal inflammation

For instance, peri-appendiceal inflammation can cause isolated pyuria.

37
Q

Colony count > _______ in a catheterized sample is diagnostic of UTI.

A

50k

38
Q

Initial detorsion attempts should go to how many degrees of rotation?

A

540

39
Q

Review the management for intraperitoneal and extraperitoneal bladder rupture from blunt trauma.

A

Intraperitoneal occurs at the dome of the bladder and require surgical repair.

Extraperitoneal occur within the pelvis and can be managed non-operatively.

40
Q

Phimosis can be treated with _____________.

A

topical steroids

41
Q

What are first-line abx for outpt pyelo?

A

3rd gen ceph
Cipro
Levo
Bactrim

42
Q

How much (how many degrees) should you attempt to detorse testicles?

A

360º

43
Q

What are some causes of low-flow priapism?

A

Low flow priapism results from decreased venous outflow:
- Sickle cell (clotting)
- ED drugs (overcongestion)

44
Q

What causes high-flow priapism?

A

Increased arterial inflow:
- Neurogenic priapism (SCI)
- Shunt (say, from trauma)

45
Q

True or false: high-flow priapism is painful?

A

False

46
Q

What is the dividing line between anterior and posterior urethral injuries?

A

The urogenital diaphragm

Perineal (“straddle”) injuries and penile fractures cause anterior urethral injuries. Blunt pelvic trauma is more likely to cause posterior urethral injury.

47
Q

What is the preferred imaging modality for penile fracture?

A

US

48
Q

The ______________ (which ruptures in penile fracture) covers the corpus cavernosa.

A

tunica albuginea

49
Q

What medications can cause priapism?

A

Alpha-1 antagonists (e.g., prazocin, tamsulosin, trazodone)

PDE-1 inhibitors (sildenafil, tadalafil)

50
Q

What can you try if a foley balloon will not deflate?

A

Cut off the balloon syringe port and insert a guide wire.

Non-deflating balloons usually happen because the valve is blocked (can be by crystal deposits if saline was used). Wires can dislodge them.

51
Q

What is the difference between congenital and pathologic phimosis?

A

Congenital:
- Occurs in young boys
- Occurs in boys who have either never been able to retract their foreskins or who rarely do so
- No prior history of infections
- No focal adhesions (just a generally tight foreskin)

Pathologic:
- Occurs in adolescents and men
- Acute inability to retract the foreskin
- Focal adhesions

52
Q

What does a positive Prehn sign suggest?

A

Epididymitis and/or orchitis

Elevating the testicle relieves pain = positive Prehn.

53
Q

What are the two times when you need to treat truly asymptomatic bacteriuria?

A

Pregnancy
Anticipated urologic intervention

GME - Residency (112 decks)

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