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1. Fellowship Written - SAQ > Urology > Flashcards

Urology Flashcards

1
Q

What is the most likely organism in a post prostat biopsy infection?

What antibiotic will you use

A

E.Coli for urosepsis

IV gent and Amoxicillin

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2
Q

How may US help in urosepsis?

A

IVC filling?
cannula
cardiac function
hydronephrosis

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3
Q

Risk factors for fourniers

A

DM
alcoholism
obestiy
cirrhosis
malignancy
Immunosuppresion

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4
Q

left sided abdo pain
diagnosis and thy

A

left small VUJ stone with hydronephrosis

fat stranding around kidney
enlarged ureter
stone evident

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5
Q

with renal stones what are the two main investigtations and why (excluding CT for diagnosing)

A

bloods - to see for infection or impaired renal function
urine dip - ?infection

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6
Q

what are the criteria for discharge of renal stone

A

eating and drinking
pain under control
no infection
FU planned

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7
Q

swollen left tender testicle
investigations and why

Most likely diagnosis

A
  1. urine disptick - ?infection
  2. urine PCR - STD
  3. renal function - ?impaired also for abx (gent)
  4. US - ?abscess

Epidydymoorchitis

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8
Q

what are the indications for admission in epidydymoorchitis

A
  1. Septic
  2. pain not controlled
  3. complications eg abscess
  4. social eg homeless
  5. unable to arrange adequate FU
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9
Q

abx treatment for epididymoorchitis

A

trimethoprin 300mg nocte 7/7
ceftrixone 500mg IM
2 week apart azithro doses - 500mg oral

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10
Q

What are the complications of priapism

A

erectile dysfunction
disfigurement of the penis

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11
Q

what is the role of cavernosal gas in priapism?

A

ischamic v non ischamic because ischaemic needs urgent drainage.

Cut of is PH 7.25

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12
Q

what ix may you do in priapism other than cavernosum gas

A
  1. FBC/blood film for causes eg malaria thallasemia
  2. biochem - causes eg gout diabetes
  3. malaria films
  4. doppler for ischaemic v non ischaemic
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13
Q

what is the emergency management of priapism?

A
  1. Ice blocks and local pressure
  2. analgesia
  3. aspirate 50ml blood from each corpus cavernosum
  4. +/ inject adrenaline and apply pressure
  5. consult urology
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14
Q

what are the common causes of priapism

A
  • Drugs - sildenafil, prazocin
  • Haem - malaria, sickle cell, CML
  • Neurogenic- spinal cord injury, redback spider bite
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15
Q

what are the two key factors in determining outcome of priapism

A

ischaemic v non ischaemic

duration - risk of impotence starts at 4 hours, 100% by 72 hours

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16
Q
A
17
Q

left loin pain and haematuria

A
18
Q
A
19
Q

what are the immediate management priorities for testicular torsion

A

analgesia
uro consult or urgent transfer for exploration
NBM

20
Q

2 year old
list two abnormalities and diagnosis

A

paraphymosis
oedematous foreskin
engorged glans with high risk of ischaemia

21
Q

what are the methods for foreskin reduction in paraphymosis

A
  1. manual traction - circumfrential pressure and distal pulling ?sugar to act as osmotic agent
  2. aspiration via block
  3. surgical - dorsal slit
22
Q

how do you do a penile block in paraphymosis

A

Consent
* Sterile technique
* Local anaesthetic: Bupivicaine 0.25% 0.1ml/kg
* Injection site:
o Dorsal nerves of penis
o Pull penis downwards
o Inject perpendicular to the skin at 10:30 & 01:30 0.5-1cm lateral to and
caudal to the pubic symphysis.
o Caution with regards to dorsal penile vessels

23
Q

diagnosis

A

urinary retention

24
Q

causes of urinary retention from different catagories

A
  1. infective - UTI
  2. medication - anticholinergic
  3. neurological - cauda equina
  4. structural - BPH
    5.
25
Q

how is urinary retention diagnosed

A

difficulty voiding and over 300ml in bladder

26
Q

what are the steps in inserting SPC

A

Confirm and bladder position with bedside US
* Position supine / Prep and drape / sterile gloves
* Infiltrate local anaesthesia 2cm above pubic symphysis
o insert needle until aspirate urine
o direction ~perpendicular (more cephalad in children, more caudal in adults
* Core steps
o Needle to bladder / introduce wire / scalpel to skin / dilator / catheter / split away
sheath
o Scalpel incision / firm pressure into bladder with trocar, remove trochar / insert
catheter / split away sheath
* Post-procedure: Attach collection bag / dress skin / cares and follow up organised

27
Q
A

1. Fellowship Written - SAQ (27 decks)

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