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FA17 Nephrology > GU Emergencies > Flashcards

GU Emergencies Flashcards

(82 cards)

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1
Q

twisting of spermatic cords

A

testicular torsion

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2
Q

testicular torsion

clinical features

A

young men (16-18)

sudden onset of UNILATERAL testicular pain

scrotal swelling/erythema

abdominal pain

bell clapper deformity

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3
Q

bell clapper deformity

A

affected testicle moves to horizontal plane

testicular torsion

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4
Q

immediate testicular torsion workup

A

Testicular U/S

urologic surgical consult

detorsion attempted

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5
Q

interim testicular torsion tx

A

de torsion maneuver (open book)

infarct occurs within 6 hrs

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6
Q

clinical pearls of testicular torsion

A

absent cremasteric reflex

history will have less severe episodes

50% occur during sleep

bimodal age presentation (infancy and adolescence)

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7
Q

twisting of appendix

A

Torsion of Testicular or Epididymal Appendix

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8
Q

clinical features of testicular torsion appendix

A

common among boys 10-16 (any age)

sudden onset of pain

inflammation and necrosis occurs

early- firm, tender
late- generalized edema and pain

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9
Q

appendix

A

embryological remnants

found on superior part of testicle or epididymis

no function

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10
Q

diagnosing appendix testicular torsion

A

Doppler U/S

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11
Q

treatment of testicular torsion appendix

A

immediate urological consult

necrotic appendages can be excised

analgesics and rest

calcifies in 1-2 weeks

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12
Q

pathognomonic testicular torsion appendix

A

Blue-Dot Sign

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13
Q

blue dot sign

A

stretching skin over necrotic nodule

during transillumination

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14
Q

clinical features of SUPERFICIAL scrotal abscess

A

indurated - can evolve

progressive pain and surrounding erythema

supercritical layer of scrotal wall

fever is usually absent (localized not systemic)

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15
Q

distinguishing between superficial abscess and Fournier’s gangrene

A

in gangrene - pt appears very ill

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16
Q

Treatment of superficial scrotal abscess

A

local anesthesia + incision and drainage

bactrim, clindamycin, doxycycline

sitz bath, wound care

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17
Q

Fournier’s gangrene

clinical features

A

ill out of proportion to exam

severe abdominal pain progressing to scrotum

fevers, tachycardia, hypotension

tense scrotal edema, blisters, bulla

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18
Q

those at risk for Fournier’s gangrene

A

middle aged, DM males

indwelling foley catheter

IV drug users

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19
Q

treatment of Fournier’s gangrene

A

aggressive fluid resuscitation

CBC, lactic acid, BMP, UA, C&S, CT scan

early surgical debridement and drainage

early broad spectrum ABx

hyperbaric O2 chamber

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20
Q

clinical features of orchitis

A

variable onset (mild- severe)

viruses - mumps (4-7 days after parotid)

scrotal pain/edema

unilateral

constitutional symptoms (malaise, HA, myalgia)

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21
Q

what should always be on your differential in orchitis?

A

testicular cancer (reactive hydrocele)

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22
Q

treatment of orchitis

A

supportive care
analgesics
cold pack
scrotal elevation

bacterial cause - epididymitis

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23
Q

testicular ultrasound orchitis

A

can distinguish viral or bacterial cause

viral: proceeding or concurrent parotid swelling supports mumps, orchitis
bacterial: large, boggy, tender epididymus

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24
Q

testicular tumor

clinical presentation

A

painless, firm testicular mass

complains of heaviness

distinctly palpable from testicle (early)

reactive hydrocele - late

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25
treatment of testicular tumor
referral to urologist for surgical exploration
26
testicular tumor
acute hydroceles and hematocele should prompt consideration of a tumor supraclavicular lymph node, abdominal mass, or chronic nonproductive cough
27
hydrocele
collection of peritoneal fluid b/t parietal and visceral layer of tunica vaginalis
28
communicating hydrocele
usually develops as a result of failure of processes vaginalis to close during develop peritoneal fluid common in newborns (congenital)
29
noncommunicating hydrocele
no connection to the peritoneum fluid comes from mesothelial lining of tunica vaginalis epididymitis, orchitis, testicular torsion, trauma, tumor
30
clinical features of hydrocele
asymptomatic soft, fluid filled scrotum transilluminated
31
hydrocele workup
directed toward discovering underlying cause transilluminate, u/s urology referral
32
hydrocele treatment
child under 1/neonate of age is usually supportive (typically resolve spontaneously) surgical repair for communicating beyond 1 yr or idiopathic and symptomatic hydrocele
33
scrotal edema
scrotal skin becomes taunt with pitting edema associated with CHF or nephrotic syndrome
34
clinical features of epididymitis
onset over hours ipsilateral (pain on same side, inguinal canal, lower quadrant of abdomen) tender, indurated, edematous epididymis scrotal swelling, pain UA = WBCs, pyuria, bacteriuria fevers
35
differential diagnosis of epididymitis
testicular torsion - U/S to distinguish testicular cancer
36
epididymitis treatment
<35 y/o = treat like STD >35 35 y/o = treat like UTI febrile patients, consider IV abx and admission
37
epididymitis ABX used
<35 - STD (ceftriaxone, doxycycline) >35 (ciprofloxin/olfloxacin/Bactrim)
38
pathopneumonic epididymitis
Prehn sign relief of pain with elevation of scrotum
39
bacterial inflammation of the prostate gland
acute prostatitis
40
acute prostatitis clinical features
low back pain perineal pain subrapubic pain obstructive lower urinary tract perineal pain with ejaculation fever, chills
41
acute prostatitis risk factors
anatomic or neurophysiological lower UTI acute epididymitis anal intercourse phimosis intraprostatic ductal reflux indwelling urethral catheter
42
causative organisms acute prostatitis
MC = E. Coli pseudomonas, Klebsiella, enterobacter, serrate, staphylococcus
43
clinical findings of acute prostatitis
perineal tenderness rectal sphincter spasm prostatic tenderness and bogginess
44
diagnosis of acute prostatitis
digital rectal exam or prostatic massage is CI urethral swab cultures, first void urine
45
acute prostatitis treatment not STI cause
Cipro x 14 days Bactrim DS x 14 days (alternative) f/u w/PCP
46
treatment of acute prostatitis STI cause
(age <35) ceftriaxone (Rocephin) IM dose + doxycycline (Vibramycin)
47
acute prostatitis disposition
abnormal vital signs = admit + Zosyn
48
urethritis
STD males = dysuria with discharge females = vaginal discharge/irritation
49
urethritis chlamydia infection suspected when
vaginal discharge or irritation history of partner with urethritis cervicitis pyruria
50
urethritis clinical features
dysuria urethreal discharge vaginal discharge
51
diagnosis of urethritis
clinical | UA
52
urethritis infectious pathogens
chalmydia trachmoatis neisseria gonorrhoae trichomonsa vaginalis
53
urethritis treatment
ceftriaxone (Rocephin) azithromycin or doxycycline
54
entrapment of retracted forskin around penis
can't be reduced, true emergency paraphimosis
55
paraphimosis clinical features
pain, swelling, erythema venous encouragement (which can lead to occlusion and tissue necrosis)
56
paraphimosis ER tx
analgesics/sedative reduction technique (reduction firmly for 5 min to reduce swelling and foreskin) local anesthesia and incision of constricting band + circumcision
57
inability to retract foreskin proximally and posterior to glans penis
phimosis
58
phimosis
normal in uncircumcised boys caused by poor hygiene can cause urinary retention infection (ABX) + topical steroids, circumcision
59
infection and inflammation of glans penis
Balanitis also involves overlaying foreskin
60
balanitis
pain, tenderness, pursuits lesions on glans (ulcerated or scaly) may cause urinary retention AA and hispanic males MC
61
etiologies of Balanitis
poor hygiene + uncircumcised candidate infections allergic/contact dermatitis STDs
62
Balanitis diagnosis
avoid retraction, evaluate presence of urethral meatus and inspect for discharge illicit history of immunosuppression and Reiter syndrome
63
treatment Balanitis
warm soaks 2x day candidal infection clotrimazole and miconazole treat STD accordingly mini STRAIGHT cath urology consult
64
hair tourniquet
hair or filament wraps around penis - surgical emergency edema and arterial compromise and amputation young children, penile rings suspected in unconsolable crying infant
65
hair tourniquet ER tx
immediate release of constriction relieves pain and restores circulation must be taken not to further injury try cold packs to decrease swelling and visualize hair
66
penile zipper injuries
foreskin becomes entrapped in teeth of zipper as zipper is opened tx = remove zipper and free foreskin penile block at base of penis to ease removal ensure intact urethra
67
penile fracture
trauma during intercourse report sudden snapping sound usually swollen and angulated at fracture, caused by tear of tunica albuginea
68
treatment of penile fracture
retrograde urethrogram emergent surgical repair
69
urethral rupture
trauma anterior: local infection/sepsis, straddle injury posterior: pelvic fracture, blood from urethral meatus, can't void, perineal bruising
70
ER tx of urethral rupture
urethrogram evidence of urethral rupture = supra-pubic catheterization, no foley catheterization
71
clinical pearls of urethral rupture
foley catheter CI consider in trauma patient: unable to void, blood at meatus, perineal trauma cause scrotal swelling in males
72
straddle injuries
pain, swelling, ecchymosis, hematoma of perineum or scrotum dysuria and urinary retention caused blunt trauma
73
straddle injuries treatment
supportive - ice packs and elevation, mini cath can obscure perineal laceration (swelling if careful exam not performed) and pelvic radiographs
74
priapism clinical features
persistant painful erection presents within several hours to days engorgement of corpora cavernosus (glans penis, corpus spongiosum( arterial (trauma) and venous causes (ED, sickle cell, leukemia)
75
treatment of priapism
Ice packs terbutaline pseudoephedrine aspiration of corpus cavernosusm phenylephrine or epinephrine
76
urinary retention
painful urologic emergency - sudden inability to pass urine mc in elderly men with benign prostate hypertrophy can use a catheter to remove urine from the bladder
77
hematospermia
blood in sperm benign condition (ass. with trauma) CAN indicate infection or cancer
78
GU foreign bodies tx, complications, clinical features
genital pricing, constrictive devices and uretheral foreign bodies s/s: swelling, edema, pain, dysuria and urinary retention comp: UTI, urethral rupture, contact dermatitis, vascular compromise (Constrictive)
79
hernia
protrusion of any viscous from it surrounding tissue walls classified by anatomic location and status
80
direct hernia
inguinal men >40 origin above inguinal ligament, rarely courses into scrotum hernia badges anteriorly, not felt in inguinal canal
81
indirect hernia
mc of all hernias, all ages origin above inguinal ligament, courses into scrotum hernia bulges into canal and touches finger tips
82
femoral inguinal hernias
least common women>men below inguinal ligament, never scrotum

FA17 Nephrology (13 decks)

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