Exam 4 Urologic Emergencies Flashcards Preview

Q4 EM Surg > Exam 4 Urologic Emergencies > Flashcards

Flashcards in Exam 4 Urologic Emergencies Deck (56):
1

Renal Colic is?

Nephrolithiasis Urolithiasis (stones)

2

Common stone types?

Calcium (most C) - radiopaque
Struvite (from infection) - radiopaque
Uric Acid (gout) - radiolucent
Cystine (rare)

3

Renal Colic presentation?

Sudden pain moving from flank to groin
N/V
Freq urine, dark colored

4

Renal Colic labs? (4)

CBC
UA (U blood)
BMP (BUN/Cr)
Pregnancy

5

Renal Colic imaging? (3)

KUB
Non-cont CT (most specific)
US if preggo or kid (not as specific)

6

Renal Colic tx? (5)

8mm won't pass
Pain meds
ABX
α1-block
Removal

7

Acute Urinary Retention caused by?

Obstructive U = prostatic hyperplasia
Inflamm
Neuro (cord lesion, MS)
Rx (antihist/cholinergics, narcotics)

8

Acute Urinary Retention presentation?

Painful inability to void
Abd and bladder distention
Relief w/ drain

9

Acute Urinary Retention labs?

BMP = renal fail
UA = infection

10

Acute Urinary Retention tx?

Decompress w/ catheter
Monitor 4-6hrs
D/C w/ bag and F/U 1-3 days

11

Cystitis etiology? (4)

E coli
Staph saprophyticus
Klebs
Proteus

12

Cystitis presentation? (6)

Dysuria
Polyuria
Urgency
Suprapubic/Abd pain
Dark urine (blood or dehydration)
Low back pain

13

Cystitis labs? (2)

Dip: False + possible
LE (pyuria)
Nitrite (G-)

Urine micro:
6-20 WBC

14

Cystitis tx?

Fluoroquin x 3days
Macrobid x 5days
Cephalo x 7-10days
Phenazopyridine for pain

15

Complicated Cystitis differ from uncomplicated how?

Present the same
W/U the same
Longer tx w/ close F/U

16

Complicated Cystitis seen in who/from what? (11)

Male
Elderly
Kids
Preggos
DM
Catheter
Hospital-acquired
Recent procedure
Recent ABX
Fxn'l abnormality
Sxs > 7 days

17

Pyelonephritis is?

Kidney infection involving kidney parenchyma and renal pelvis

18

Pyelonephritis etiology?

E coli (>90%)
Enterobacter
Kleb

19

Pyelonephritis presentation?

Fever/chills/rigors
N/V
Diaphoresis
Flank/abd pain
+ cystitis sxs

20

Pyelonephritis labs? (6)

UA = LE, nitrites, pyuria, bacteruria, hematuria, WBC CASTS
Urine C&S
Blood Cx
CBC
Preg test
BMP for e-

21

Pyelonephritis imaging?

CT
US

22

Pyelonephritis in-pt tx when? (7)

Can't tolerate PO
Compliance risk
Uncertain dx
High fever
Uncontrolled pain
Look very sick
Complication risks

23

Pyelonephritis risk factors for complications?

Obstruction/tumor/stone
Recent urologic procedure
Preggo
DM

24

Pyelonephritis tx?

10-14 days
DOC: Cephalosporins
2nd: Fluoro
NO Bactrim or Macrobid

25

Acute Prostatitis is?

Etiology?

Bacterial infection of prostate

< 35 yo = honor/chlamy
> 35 yo = E coli

26

Acute Prostatitis presentation? (4)

Fever/chills
Myalgia
Pain in low back, rectum, perineum
P urine retention, dysuria

27

Acute Prostatitis exam? (3)

Abd = tender
GU = perineal tender
Rectal = boggy, tender prostate

28

Acute Prostatitis: Avoid manipulation of prostate, why?

May cause bacteremia

29

Acute Prostatitis labs?

Imaging?

UA = pyuria
CBC = P ↑ WBC

None unless toxic

30

Acute Prostatitis tx? (6)

Cipro > 35 yo
Ceftri + Doxy < 35 yo

Hydrate
Pain
Rest
Stool soft

31

Urosepsis is?

Presentation? (4)

Severe illness from spread of UTI

P hx of UTI, stones, prostatitis
Persistent sxs of above
Weak/confused
Dehydration

32

Urosepsis exam findings? (5)

Systemic Inflammatory Response Syndrome (SIRS):

Temp > 100.4 or < 96.8
WBC > 12K or < 4k or 10% bands
↑ Plasma Lactate > 4
Tachycardia > 90
Tachypnea > 20

33

Urosepsis labs? (5)

CBC
UA w/ Cx
Blood Cx
BMP
Lactate

34

Urosepsis imaging?

CT r/o stone, abscess, ddx

35

Urosepsis tx?

Fluids
ABX
Tx shock
Admit

36

Testicular Torsion presentation? (5)

Sudden testicular pain
w/ or w/o prior event
P w/ sleep or exertion
Swelling
P abd pain, N/V

37

Testicular Torsion exam? (5)

Sedate pt (pain too much for exam w/o)
Swollen, firm, tender hemiscrotum
High-riding testis w/ transverse line
P cremaster reflex ABSENT
Blue Dot Sign (appendix testis torsion)

38

Testicular Torsion imaging?

STAT doppler US = ↓ or no blood flow

39

Testicular Torsion tx?

STAT Urology for surgery
Medial to lateral detorsion

40

Epididymitis is?

Inflamm of epididymis from back-flow of infected urine down vas deferens

41

Epididymitis etiology?

< 35 yo = gon/chylam
> 35 yo = e coli

42

Epididymitis presentation? (4)

Scrotal pain, swell, tender
RELIEVED w/ elevation of testicle
Low abd/perineal pain
P d/c, UTI sxs, fever/chills

43

Epididymitis exam findings?

Red, swollen, warm testicle
Testicular lump
Inguinal LAD
Cremaster reflex INTACT

44

Epididymitis labs? (3)

CBC is systemic sxs
UA
Gon/Chylam test

45

Epididymitis imaging?

Doppler US r/o torsion or tumor

46

Epididymitis tx? (6)

Scrotal elevation
Ice
If STD Ceftri + Doxy
If UTI Cipro
Pain
Stool soft

47

Paraphimosis is?

Unretractible foreskin
Compromised blood flow to glans

48

Paraphimosis most C in who?

C caused by?

Old/very young

Catheters
Poor hygiene

49

Paraphimosis tx?

Attempt reduction
STAT Urology
Dorsal slit in foreskin

50

Priapism is?

U seen in who?

Erection > 4 hrs

30-40yo

51

Priapism tx? (4)

Pseudoephedrine (Sudafed) PO
Terbutaline SQ (β2-agonist)
Aspirate corpora (till bright red blood)
Phenylephrine (α1-agonist) into corpora

52

Fourniers Gangrene is?

Etiology? (4)

Necrotizing infection of perineum, penis, scrotum, abd wall

Staph
Strep
E coli
Clostridium

53

Fourniers Gangrene a/w what? (6)

DM (most C)
EtOH
Immunocomp
Liver dz
Trauma to area
Prior infection of area

54

Fourniers Gangrene presentation? (7)

Slow or rapid onset
Redness next to point of entry ->
Pain, swell, discoloration
Fever
Toxic appearance
SQ crepitation (crackling) over area
Putrid odor

55

Fourniers Gangrene labs? (6)

Septic W/U:
CBC w/ diff
CMP
Coag
Lactate
UA
Wound Cx

56

Fourniers Gangrene imaging?

Tx?

Contrast CT

STAT surgery