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Y2 Renal > Renal + Urology emergencies > Flashcards

Renal + Urology emergencies Flashcards

1
Q

What is the criteria of malignant hypertension

A

Systolic pressure > 180
or Diastolic pressure > 120
+ signs of organ damage

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2
Q

Malignant hypertension can lead to

A

Acute renal failure
Papilloedema
Encephalopathy
Cardiac failure

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3
Q

Benign prostate hyperplasia can lead to

A

acute urinary retention - inability to urinate with increasing pain

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4
Q

Management of acute urinary retention

A

Catheter

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5
Q

What is testicular torsion

A

When the testicle rotates and twist the spermatic cord that brings blood to the scrotum -> ischaemia and necrosis

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6
Q

Which age group is most commonly affected by testicular torsion

A

10-30 years old, peak at 13-15

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7
Q

Symptoms of testicular torsion

A

Acute severe pain at groin and lower abdomen
Nausea, vomiting
Swollen tender testis
Testis higher than normal position
Cremasteric reflex is reduced

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8
Q

What is cremasteric reflex

A

Stroking / pinching medial thigh causes contraction of cremaster muscle which elevates the testis

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9
Q

What nerves are responsible for cremasteric reflex

A

genitofemoral nerve

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10
Q

How do you differentiate between testicular torsion and epididymitis

A

In testicular torsion, pain is not relieved by elevating the testis

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11
Q

Management of testicular torsion

A

Urgent surgical exploration - fix both testis

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12
Q

What is epididymo-orchitis

A

Infection of the epididymis (epididymitis) and testis

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13
Q

Common pathogens causing epididymo-orchitis

A

N. gonorrhoea
Chlamydia
E. coli

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14
Q

E. coli as a cause of epididymo-orchitis is more common in

A

Older adults with low-risk sexual history

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15
Q

STI as a cause of epididymo-orchitis is more common in

A

Younger adults <35

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16
Q

Symptoms of epididymo-orchitis

A

Acute sever testicular pain
May have history of dysuria and urethral discharge (sign of STI)
Warm, hot swollen testis
Pain RELIEVES on elevation of the testes

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17
Q

Management of epididymis-orchitis

A

If STI is the most likely cause - refer to local sexual health clinic -> ceftriaxone

If enteric organisms are the most likely cause -
1. send MSU
2. oral quinolone (ofloxacin)

18
Q

What is priapism

A

Unwanted persistent penile erection > 4 hrs not associated to sexual arousal

19
Q

2 types of causes of priapism

A

Ischaemic
Non-ischaemic

20
Q

What is the ischaemic cause of priapism

A

Due to impaired vasorelaxation -> reduced vascular outflow -> congestion of blood in corpus cavernosum

21
Q

What is corpus cavernosum

A

Spongy tissue of the penis that fills up with blood to cause erection

22
Q

What is the non-ischaemic cause of priapism

A

due to high arterial inflow e.g. fistula formation

23
Q

Which type of priapism is more urgent

A

Ischaemic cause of priapism - it is a compartment syndrome which can cause necrosis

24
Q

What are the causes of priapism

A

Idiopathic
Sickle cell disease
Erectile dysfunction medication
Trauma
Drugs

25
Q

What drugs can cause priapism

A

Anti-hypertensives
Anti-coagulants
Cocaine
Cannabis
Ecstasy

26
Q

What are the erectile dysfunction medications that can cause priapism

A

intracavernosal papaverine
Sildenafil
PDE-5 inhibitors

27
Q

Symptoms of priapism

A

Persistent erection > 4hrs
Pain at penis
May be non-painful -> suggests non-ischaemic

28
Q

Investigations for priapism

A

Cavernosal blood gas analysis
Doppler / duplex USS - shows high/low blood flow

29
Q

What may cavernosal blood gas analysis show for priapism

A

If ischaemic - pO2 and pH reduced, pCO2 increased
If non-ischaemic - normal

30
Q

Management of ischaemic priapism

A
  1. Aspiration of blood + injection of saline
  2. intracavernosal injection of vasoconstrictive agent
  3. surgery
31
Q

Why is injection of saline used in ischaemic priapism

A

To wash out viscous blood

32
Q

What vasoconstrictive agent is used for priapism

A

alpha agonist - Phenylephrine

33
Q

Management of non-ischaemic priapism

A

Observation, not a medical emergency

34
Q

What is Fournier’s gangrene

A

necrotising facilities around the penis

35
Q

type 1 necrotising fasciitis is most commonly caused by

A

mixed anaerobes and aerobes

36
Q

type 2 necrotising fasciitis is most commonly caused by

A

Streptococcus pyogenes

37
Q

which type of necrotising fasciitis is the most common

A

type 1 - common post-surgery in diabetics

38
Q

Risk factors of necrotising fasciitis

A

Recent trauma/burns
Diabetes - use of SGLT2
IV drug use
Immunosuppression

39
Q

Symptoms of Fournier gangrene

A

rapidly worsening cellulitis
swelling and crepitus of scrotum
dark purple areas - necrosis

40
Q

Management of Fournier gangrene

A

Urgent surgical debridement
IV antibiotics

41
Q

What is paraphimosis

A

Painful swelling of the foreskin, happens after foreskin retracted for catheterisation or cystoscopy and staff member forgets to replace it in its natural position

Y2 Renal (12 decks)

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