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Clin Therapeutics II (Spring 2018) > Exam 2: GU emergencies > Flashcards

Exam 2: GU emergencies Flashcards

(100 cards)

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1
Q

Which condition is a painful inability to void (pee)?

A

Acute Urinary Retention

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2
Q

MC cause of Acute Urinary Retention in men?

A

BPH

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3
Q

Classes of meds which can cause Acute Urinary Retention?

A 
Anticholinergics
Alpha-stimulants
Anesthetics
Narcotics
EtOH
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4
Q

How can a clot cause Acute Urinary Retention?

A

Cuts off urethera. In both men and women.

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5
Q

Increased uretheral resistance causes an obstruction where?

A

Bladder outlet obstruction

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6
Q

What does low bladder pressure do to the bladder’s contractility?

A

Lowers bladder contractility making it hard to pee

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7
Q

What will interruptions of sensory and motor innversation to the bladder do?

A

Can’t pee

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8
Q

How to DX Acute Urinary Retention?

A

Bladder U/S

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9
Q

Initial tx of Acute Urinary Retention if not due to trauma?

A

Uretheral catheter to decompress the bladder

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10
Q

Initial tx of Acute Urinary Retention due to trauma?

A

Suprapubic catheter

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11
Q

Late treatment of Acute Urinary Retention needs to be targeted at what?

A

the underlying cause

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12
Q

Surgical treatment of BPH?

A

TURP. Removes tissue to relieve obstruction.

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13
Q

What class of meds for BPH? WHat do they do to prostate?

A

Alpha-1-blockers. Relaxes prostate to let the urine make it out.

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14
Q

Terazosin and Doxazosin do what to BP?

A

Can reduce BP (alpha-1-blockers)

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15
Q

Which alpha-1-blocker has higher incidence of ejaculatory dysfunction?

A

Tamsulosin

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16
Q

Finasteride does what? How long to work?

A

Shrinks prostate. Takes 6 months to work.

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17
Q

When to do a voiding trial in Acute Urinary Retention?

A

3-7 days after catheter decompression

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18
Q

What condition can occur if more than 1000ml urine withdrawn and Cr 3+

A

Post-Obstructive Diuresis

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19
Q

How to treat Post-Obstructive Diuresis?

A

Inpatient. Monitor urine output 200ml/hr for 3 consecutive hours (3L/24h)

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20
Q

What to monitor in Post-Obstructive Diuresis?

A

Serum and urine lytes

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21
Q

Who should follow up with urology after decompressing Acute Urinary Retention?

A

All

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22
Q

What is nephrolithiasis?

A

Kidney stone

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23
Q

MC type of nephrolithiasis?

A

Calcium Oxalate

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24
Q

3 risk factors for calcium oxalate nephrolithiasis?

A
  1. Dehydration
  2. Hypercalcemia
  3. Hyperoxalsomething
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25
Uric Acid Stones happen when pH is below what?
<5.5
26
Struvite Stones aka
Magnesium ammonium phosphate stones (MAPS)
27
What increases risk of Struvite Stones?
UTIs w/urease-producting bacteria
28
What the heck is Proteus?
Proteus mirabilis is a Gram-negative, facultatively anaerobic, rod-shaped bacterium
29
Proteus causes what type of kidney stone?
Struvity stones
30
When are Staghorn Calculi found?
After recurrent infections
31
Staghorn Calculi from which type of kidney stone?
Sturvite
32
Highest mortality and morbidity with nephrolithiasis when what 2 things happen in combo?
1. Upper tract obstruction | 2. Upper UTI
33
How to generally prevent kidney stones?
2L/day fluid intake, low salt intake, moderate animal protein to regulate uric acid, moderate calcium to bind to oxalate
34
How to prevent Calcium Oxalate stones?
2 TBLS pure lemon juice per day. Decreased CaOx deposits.
35
Pure lemon juce prevents which type of kidney stone?
Calcium Oxalate only!
36
What type of pain with kidney stones?
Colicky pain
37
Severe flank pain and ipsilateral lower abdomen pain is kidney stone where?
Ureteral stone
38
Where can Ureteral stone radiate to?
Testicles and vulvar areas
39
Mid-ureter stone radiates in which direction?
Anteriorally
40
Stone in RIGHT mid-ureter can mimic what?
Appendicitis
41
Stone in LEFT mid-ureter can mimic what?
Diverticulitis
42
Gold Standard for kidney stone dx?
CT abdomen and pelvis without contrast
43
Dx of kidney stone is preggers?
Ultrasound
44
What kind of stone can’t KUB detect?
Uric Acid stone
45
What size can’t stones pass on own?
≥6mm
46
Goal of kidney stone treatment?
Shorten time to pass stone
47
Meds to shorten time of stone passing?
1. Alpha blockers 2. Analgesics 3. Lots of fluids >2L/day
48
What to do when stone passes?
Strain urine to check makeup of stone
49
Which stone can be dissolved?
Uric Acid only
50
How to dissolve Uric Acid stone?
Potassium citrate to alkalize urine
51
ESWL when stone is smaller than what?
<3cm
52
WHat does ESWL do?
Breaks stones into smaller fragments
53
Treatment of stone stuck in ureter?
Uterscopy with laser lithotrist to break up
54
Tx of large stone stuck at staghorn calculi?
Percutaneous nephrolithotomy
55
When to admit PT with kidney stone?
1. Upper obstructruction w/infx or sepsis 2. Renal deterioration 3. Bilateral hydronephrosis 4. Pain refractory to analgesia 5. Stone in solitary kidney
56
Which condition is a synergistic polymicrobial necrotizing fascitis of the perineum and genetalia?
Fourner’s Gangrene
57
MC microbe in Fourner’s Gangrene?
E Coli
58
How many organisms found in culture from Fourner’s Gangrene
Usually 3
59
Fourner’s Gangrene how many times more common in men than women?
10X
60
What is the *causal event* of Fourner’s Gangrene?
Breakdown in urethera or colon
61
S/Sx of Fourner’s Gangrene
Severe scrotal pain, edema, erythema, necrotic tissue
62
Dx for Fourner’s Gangrene
Clinical H&P
63
What sort of stat consult for Fourner’s Gangrene?
Surgical. Need to debrid necrotic tissue.
64
Which 3 abx combo in Fourner’s Gangrene?
Clindamycin + Vanco + Zosin (CVZ...like CVS, everyone’s favorite drug store)
65
Testicular Torsion is a twist of what?
720º twist of spermatic cord
66
What sort of emergency is Testicular Torsion?
True vascular emergency! Compromised blood flow to testis!
67
Pain in Testicular Torsion?
Rapid onset of severe scrotal pain
68
What does whole scrotum appear as at 12-24h in Testicular Torsion?
Confluent mass
69
UA and WBC in Testicular Torsion?
Normal
70
Fever or voiding issues in Testicular Torsion?
No fever, no voiding issues
71
Dx for Testicular Torsion?
Ultrasound
72
What sort of flow to use on ultrasound for Testicular Torsion?
Doppler flow to assess testicular blood flow
73
Who to consult for Testicular Torsion?
Urology
74
Can preserve teticle if tx done in how long from onset?
4-6 hurs
75
What is a pathological erection called?
Priapism
76
What is happening with both corpora cavernosa in Priapism? What’s impaired?
Engorged with stadnant blood. Impaired drainage and relaxation.
77
Priapism results when there is what?
Impaired drainage and relaxation
78
Many cases of Priapism due to what?
Intracavernosal injection of vasoactive impotence meds
79
Two types of Priapism?
1. Ischemic | 2. Non-ischemic
80
Increased arterial blood flow in ischemic priapism causes what?
Hypoxia, acidosis, and penile compartment syndrome
81
3 major diseases/things which can cause ischemic priapism?
1. Sickle cell 2. Drugs 3. Neurogenic shock
82
Ischemic Priapism has what type of arterial blood flow? (Hint: increased or decreased)
Increased arterial blood flow
83
Increased arterial blood flow in priapism causes what chemical issues?
Hypoxia, acidosis, penile comparment syndrome
84
Non-ischemic priapism due to fistula where?
Between cavernosal artery and corpus cavernosum
85
What does fistula in non-ischemic priapism consistently cause?
High inflow of blood
86
Common causes of non-ischemic priapism?
Needly injury, trauma, congenital arterial malformation
87
Aspiration for priapism? (hint: gotta remove blood)
5ml Corporal aspiration w/18g at 3 or 9 o’clock
88
What to inject after aspiration for priapism?
Diluted Phenylepherine 1mL/19mL saline q15-20min
89
Tx of sickle-cell priapism?
Exhange transfusion, hydrate, analgesia
90
Penile fracture due to rupture of what?
Tunica albuniea from direct trauma or erect penis
91
How percent of Penile fracture can cause partial or complete urethral rupture?
18%
92
MC cause of Penile fracture?
Sexual intercourse
93
What does penis look like in Penile fracture?
Acutely swollen, discolored, tender penis
94
How to assess urethera in Penile fracture?
Retrograde urethrogram
95
Tx for Penile fracture?
Surgery to remove hematoma and suture tunica albulinea
96
Foreskin retracted behind coronal sulcus of glans penis causes what?
Paraphimosis
97
What 2 things obstructed in Paraphimosis
Venous and lymphatic flow
98
3 major problems from Paraphimosis?
1. Skin necrosis 2. Gangrene 3. Autoamputation
99
Tx for Paraphimosis?
Try manual retraction of foreskin. If doesn’t work then surgery.
100
What to give for pain with Paraphimosis? What NEVER to give?
Lidocaine for pain. NEVER GIVE EPI!!!!

Clin Therapeutics II (Spring 2018) (11 decks)

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