Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

EMED Unit II > 2 Non Traumatic Urologic Conditions and Emergencies > Flashcards

2 Non Traumatic Urologic Conditions and Emergencies Flashcards

(105 cards)

Start Studying
1
Q

Accumulation of normally dissolved solids from kidney, forming a stone

A

Urolithiasis/Nephrolithiasis (name depends on where it gets stuck)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Once a kidney stone is ______ in size, it becomes symptomatic with pain and obstruction of the ureter

A

2-3 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common type of renal stone

A

Calcium salt

RADIOPAQUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Type of renal stone associated with infection

A

Struvite

RADIOPAQUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type of renal stone associated with gout

A

Uric acid

RADIOLUCENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Rarest kind of renal stone

A

Cystine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the typical history for a patient with renal colic?

A

Unilateral flank pain that is characteristically:
• Very sudden onset (colicky)
•Radiates to the groin as the stone passes into the lower ureter
• May change location, from the flank to the groin
• The patient cannot get comfortable, and may roll around in agony. Pain equal to labor
• Associated with N/V
• Urinary frequency - dark urine (b/c of blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DDx for renal colic

A

Acute pyelonephritis
Papillary necrosis (sickle cell, NSAID abuse)
Appendicitis/biliary colic/bowel obstruction
AAA (if elderly, 1st stone)
GYN emergency (ectopic/ovarian torsion)
Testicular torsion/epididymitis/hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Components of the physical exam for renal colic

A

Exam of abdomen, back, and chest

Male - GU

Female +/- pelvic

Vitals - check temp and BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Labs and Imaging for renal colic

A

CBC, BMP, UA, hCG, NCCT scan or US

BUN/Cr for renal compromise

KUB xray - misses 40% but urology uses these

Non Contrast CT is 94-100% specific

Renal US - use in pregnant women, children, patient with previous hx of stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Renal US sees ____% of stones, and helps identify _______

A

65%

Hydronephrosis

Sensitive (65-96%) and specific (100%) for detection of stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Size of a renal stone predicts…

A

The chance of spontaneous expulsion

1mm or less - spontaneous passage of 87%
2-4mm - 76%
5-7mm - 60%
>9mm - only 25% spontaneously pass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Majority of patients have renal stones that are ____ in size

A

2-4 mm

These have 76% chance of passing spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for renal colic for stones between 5-8mm

A 
Pain relief (NSAIDs)
Anti nausea
Abx
Alpha 1 blockers (ie flomax)
Watchful waiting

Admit if “sick” appearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Temporary relief can be provided to renal colic patients who are not passing the stone on their own by…

A

Insertion of a JJ stent

Percutaneous nephrostomy tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Definitive treatment of a ureteric stone

A

If intractable pain, fever, renal function compromise, or >4 weeks

ESWL (lithotripsy - “shock waves”)
PCNL (nephrolithotomy - 1 cm incision)
Ureteroscopy
Open surgery (very limited)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the utility of medical expulsion therapy for renal stones?

A

CCB or alpha-blockers (Flowmax)

Stones <4-5mm - there is no benefit (but the dumb ass dick doctor will still order it)

Stone 5-10mm - increased passage NNT 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Painful inability to void, with relief of pain following drainage of the bladder by catheterization

A

Acute urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common cause of acute urinary retention in men over 50

A

Obstructive due to prostatic hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the different possible causes of acute urinary retention?

A

Obstructive - BPH, infection of prostate, constipation

Pharmacologic - antihistamine, decongestants, anticholinergics, narcotics

Inflammatory

Neurogenic - spinal cord trauma or tumor, MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SSx of acute urinary retention

A 
Abdominal distension
Bladder US shows distension
Large amount of urine post catheter placement - post void residual (PVR)
BMP +/- renal failure
UA +/- infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Normal capacity of the bladder

A

<50-100 ml

Use clinical judgement if 50-100ml

Abnormal if >100-150ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Initial management of acute urinary retention

A

Urethral catheterization
Suprapubic catheter (SPC)
CBI (continuous bladder irrigation) if blood clots present

Late management - treat the underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do you need to do AFTER treating urinary retention?

A

Monitor pt for 2-4 hrs post decompression
May develop post obstructive diuresis
Discharge pt with drainage bag and follow up 3-5 days (urology)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Pathogens from fecal flora colonize the vaginal introitus, enter the urethra and bladder, and stimulate a host response
Uncomplicated cystitis
26
70-95% of uncomplicated cystitis is caused by...
Escherichia coli ``` Other causes: Klebsiella p. Proteus mirabilis Pseudomonas a. Enterococci Others ```
27
SSx of uncomplicated cystitis
``` Dysuria Frequency Urgency Suprapubic or abdominal pain Dark urine - hematuria-dehydration No vaginitis or cervicitis (=90% likelihood of UTI) Cloudy urine (=96% likelihood of UTI) ```
28
Diagnosis of uncomplicated cystitis is usually ...
A clinical diagnosis U/A and culture to support history and PE
29
UA is needed for cystitis if SSx not clear or....
``` Back pain Looks sick Male Extremes of age Immunocompromised Hx of multiple courses of abx Hx of abx resistance Hx of multi drug allergies ```
30
UA finding indicative of a simple cystitis
Urine culture 100,000 CFU/ml POS Leukocyte esterase and nitrites Pyuria ≥ 10 WBC/hpf
31
Physical exam for cystitis should include...
Temperature Abdominal exam CVA percussion May need pelvic exam (if vaginal d/c, sick, or return visit) to r/o PID
32
DDx for cystitis
Renal calculi Pyelonephritis Vaginitis/vulvitis/HSV Gonorrhea and/or chlamydia (urethritis, cervicitis, PID)
33
Urine microscopy findings for cystitis
>10 wbc/hpf
34
In Dx of cystitis, Urine Dipstick can detect the presence of...
``` Leukocyte esterase (pyuria) Nitrite (gram negative bacteria) ``` Be careful of false negatives and false positives - 10% of UTI’s have normal UA
35
Do you need to do a urine culture or imaging for all cystitis cases?
No - usually not indicated for routine UTIs
36
Treatment for cystitis
``` Abx: • Macrobid x 5 day**** • Cephalosporins (Keflex) x 7 days**** • Bactrim DS x 3 days (Don’t use if high E. coli resistant rates) • Fosfomycin 3g single dose • Augmentin x 7 days ``` Analgesia - Phenazopyridine (OTC Sx relief) Hydration No follow up necessary if asymptomatic after treatment
37
What drugs should you NOT use for cystitis?
Fluoroquinolones (cipro) - FDA black box (should be reserved for use in patients who have no other treatment options) Amoxicillin - too much resistance
38
Serious central nervous system side effects of fluoroquinolones
``` Depression Hallucinations Suicidal thoughts Confusion Anxiety ```
39
Serious side effects of fluoroquinolones involving the tendons, muscles, joints, nerves, and arteries
``` Swelling or inflammation of the tendons TENDON RUPTURE*** Tingling/pricking sensation Numbness in arms/legs or muscle pain Muscle weakness Joint pain Joint swelling AORTIC DISSECTIONS*** ```
40
What patients are more likely to have a complicated cystitis?
``` Males Elderly Hospital acquired Pregnancy Indwelling urinary catheter Recent instrumentation Functional/anatomic abnormality Children Recent antimicrobial use Sx > 7 days DM Immunosuppression ``` All should be evaluated like pyelonephritis - labs and longer treatment
41
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis
Pyelonephritis (Upper UTI) Etiology of pathogens the same as lower UTI
42
Clinical presentation of pyelonephritis
Lower UTI sx - dysuria, urinary frequency, urgency Fever, Chills, Rigors**** N/V Diaphoresis Flank and/or abdominal pain
43
Treatment for pyelonephritis
Empiric therapy - NO macrobid (doesn’t penetrate) ***Cipro 500mg bid x 7 days Levo 750mg qd x 5 days Bactrim DS for 14 days Cephalosporins 3rd gen>1st gen x 10-14 days Fluids UA and Cx Pain meds Follow up if recurrent or still sx
44
Risk factors for pyelonephritis complications
Obstruction (ie stone, tumors) Urologic surgeries or instrumentation Pregnancy DM
45
Indications for inpatient management of pyelonephritis
Inability to maintain oral hydration or take oral meds Compliance risk Uncertainty about dx High fevers, severe disability, or uncontrolled pain Risk factors for complications
46
What do we need to know about asymptomatic bacteriuria?
It’s common and benign - no long term harm Only rarely treated Only get UA if pregnant, Sx, or undergoing urologic procedures Common pitfall - treating nonpregnant pt with abx Rewards - antimicrobial conservation and prevention of C diff
47
Acute bacterial infection of the prostate
Acute prostatitis
48
Acute prostatitis in patients >35 is usually due to...
Gram negative E. coli
49
Acute prostatitis in patients <35 is usually due to...
N. gonorrhoeae or Chlamydia
50
Clinical presentation of prostatitis
Fever, chills, myalgias Pain in lower back, rectum, or perineum May have urinary retention, dysuria
51
Physical exam findings for prostatitis
``` ABD - may be tender GU - perineal are tender Urethral swab should be done Rectal - tender BOGGY prostate (do not massage***) CBC - WBC may be up UA - pyuria Rad - no imaging needed unless toxic ```
52
Treatment for prostatitis
Sx relief - Hydration, analgesics, bed rest, and stool softeners Abx - Cipro or Levoquin if >35 yo (2nd line = bactrim then tetracyclines) x 2-4 weeks If <35 yo, GC/Chlamydia tx If toxic, treat as uroseptic
53
Severe illness which occurs when a urinary tract infection spreads systematically
Urosepsis
54
Clinical presentation of urosepsis
May have hx of recent UTI, pyelonephritis, urolithiasis, or prostatitis Persistent sx of above infections Recent urological procedures Weakness, confusion, dehydration Common with nursing home patients***
55
Urosepsis is diagnosed if a patient meets 2 or more ...
Systemic Inflammatory Response Syndrome (SIRS) criteria * Temp >100.4 or <96.8 * WBC >12K or <4K or 10% bands * Tachycardia >90bpm * Tachypnea >20/min*** * Severe altered mental status * Elevated plasma lactate >4mmol/L
56
How do you work up urosepsis?
Exam as pyelonephritis or acute prostate CBC, blood cultures, BMP, UA, Urine culture, lactate CT w/ contrast - r/o stone, abscess, DDx
57
Treatment for urosepsis
Fluids, abx, tx shock, admit
58
The big three causes of hematuria in the ED
Obstruction Coagulopathy Rhabdomyolysis
59
How do you evaluate gross hematuria or >5RBC in UA?
Need uro eval eventually Hx/Exam UA, CBC, PT/INR, CK, CMP Check med list, LMP
60
How do you evaluate gross hematuria or >3RBC in UA?
If normal vitals/labs, no pain or other c/o —> Uro work up ``` If abnormal vitals/labs or pain —> ED work up • Renal US, CT scan w/ contrast • Bladder US +/- foley if retention, CBI • Tx cause if found • Disposition based on eval ```
61
Rotation of the testis within the tunica —> compromised blood flow
Testicular torsion
62
Testicular torsion is most common in what age group?
12-18 10x more common in pt with hx of undescended testis
63
Clinical presentation of testicular torsion
Sudden onset of testicular pain (may be insidious, may have a prior event, onset may be during sleep or exertion) Swelling May have abdominal pain, N/V Boys may be embarrassed and complain that their stomach hurts rather than talk about their balls
64
Physical exam for testicular torsion
Keep patient NPO cause they’ll need surgery Exam may be difficult due to pain so sedate them Swollen, firm, and tender hemiscrotum High riding testis with transverse lie Possible loss of cremasteric reflex Blue dot sign***
65
Test of choice for testicular torsion
Stat Doppler U/S - shows decreased or absent flow to affected side UA, CBC not helpful acutely but surgeon will need them so do them anyway
66
Treatment for testicular torsion
Stat urology consult for testicular fixation surgery (even if detorsed in ED) Sedate pt, attempt to manually detorse (“opening of book” technique)
67
Retrograde spread of infected urine down the vas deferens
Epididymitis
68
Causes of epididymitis: If <35 yo = _______ If >35 yo = ________
< 35 = Chlamydia/GC > 35 = E. coli, Enterococci, Pseudomonas, and Proteus
69
Clinical presentation of epididymitis
Scrotal pain, swelling, and tenderness - relieved with testicular elevation May have urethral d/c and UTI SSx Lower abd or perineal pain May have fever, chills
70
Physical exam findings for epididymitis
Testicle red, swollen, warm, tender +/- testicular lump Inguinal LAD Cremasteric reflex intact
71
Work up for epididymitis
CBC if systemic signs, going to be admitted UA Test for GC/Chlamydia Doppler US to r/o torsion or tumor**** (may see incr flow to epididymitis)
72
DDx for epididymitis
``` Torsion Orchitis Trauma Tumor Abscess UTI Varicocele Hydrocele ```
73
Treatment for Epididymitis
Bed rest, scrotal elevation w/ ice Abx appropriate for age and sexual activity Pain meds Stool softeners
74
Treatment for acute epididymitis most likely caused by STI (<35 yo)
Ceftriaxone IM single dose PLUS Doxycycline for 10 days
75
Treatment for acute epididymitis most likely caused by STI and enteric organisms (men who practice insertive anal sex)
Ceftriaxone IM in single dose PLUS Levofloxacin for 10 days
76
Treatment for acute epididymitis likely caused by enteric organisms (>35 yo)
Levofloxacin for 10 days
77
Condition in which foreskin becomes retracted behind glans of penis and cannot be placed over glans
Paraphimosis
78
Why is paraphimosis an emergency?
Because arterial compromise to the glans may occur
79
In what patients are you most likely to see paraphimosis?
Elderly or very young patients from frequent catheterization, poor hygiene, or retracted foreskin not replaced Sexual activity or genital piercings increase risk Results in pain, tenderness, and redness to retracted foreskin and glans
80
Treatment for paraphimosis
Attempt to reduce by pushing on glans while pulling on foreskin Glands compression (manual) Sugar lidocaine wrap (sugar acts as osmotic to reduce swelling) Emergent dorsal slit in foreskin Stat urology consult
81
DDx for paraphimosis
Phimosis Balanoposthitis and Balanitis Trauma
82
How would you treat balanoposthitis or balanitis
Antifungal cream + Keflex (b/c the fungal infection is usually coinfected with bacteria)
83
Persistent erection of the penis for more than 4 hours that is not related or accompanied by sexual desire
Priapism Most common in 30-40 yo
84
Most common causes of priapism
Usually due to acute low flow: • Drugs • Blood disorders (ie sickle cell) • Spinal trauma 35% unknown cause High flow = rare (usually from blunt trauma)
85
How to work up priapism
Ask about trauma, new drugs (its a long fucking list) Penile shaft will be firm but glans soft CBC and UA if able
86
How do you treat priapism
Warn pt of possibility of impotence, fibrosis Sudafed PO to decrease inflow Aspirate corpora cavernosa with butterfly needle (at 3 and 9 o’clock) - aspirate 20-100 cc til bright red arterial blood Phenylephrine injected directly into corpora cavernosa (250-500 mcg) Consult urology
87
Necrotizing fasciitis infection of the perineum involving penis, scrotum, perineum, abdominal wall
Fournier gangrene Has a 30% mortality rate Most common etiology = Staph, strep, E. coli, Clostridium
88
Risk factors for Fourniers gangrene
``` DM******* (Most common) Alcoholism Immunosuppression (HIV, cancer) Liver disease Trauma to ano-urogenital/perineal area Pre-existing perineal/rectal infections ```
89
Clinical presentation of fourniers gangrene
Varies from slow to rapid course Starts with redness next to port of entry Localized pain, swelling, discoloration of affected area (POOP, POEM) Fever, lethargy, toxic appearing (SWOS) Subcutaneous crepitation over area Putrid/feculent odor
90
How to work up fourniers gangrene
Septic work up - CBC, CMP, blood culture, coats, wound cultures, UA, lactate Call surgeon Keep NPO IV fluids IV pressers IV Abx Contrast CT
91
Treatment for fourniers gangrene
Surgical debridement
92
What does POOP mean?
Pain out of proportion
93
What does POEM mean?
Pain outside erythemic margins
94
What does SWOS mean?
Sepsis w/o a source
95
Why don’t we give bactrim with an ACE/ARB?
Risk of sudden death
96
What is NEXUS used for?
Spinal cord trauma
97
What is PERC used for?
PE risk
98
What are HEART and TIMI scores used for?
Chest pain
99
What is SIRS used for?
Determining sepsis
100
What is PECARN used for?
Peds head injury (determine need for CT)
101
What is NIHSS?
NIH stroke scale
102
What is CURB-65 used for?
PNA risk
103
What is the Revised Geneva score for?
PE probability
104
What is the FAST score used for?
Trauma ultrasound
105
What is GCS for?
Comas

EMED Unit II (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions