Flashcards in Pestana Urology Deck (27):
A young boy presents with sudden, severe testicular pain? What will be found on PE (4)? Will the cord be tender? Tests? Treatment?
Testicular torsion. Tender, swollen, high riding, horizontal lie. No. NO TIME FOR TESTS, IT'S AN EMERGENCY! Surgical intervention.
A teenage man presents with sudden severe testicular pain. He is febrile and has experienced pyuria? Will the cord be tender? Tests? Treatment?
Acute epididymitis. Yes. Sonogram (to rule out testicular torsion). IV antibiotics.
A Urology patient who has been sent home to attempt to spontaneously pass a ureteral stone develops chills, flank pain, and a severe fever? Treatment?
Obstruction and Infection of the urinary tract. IV antibiotics and ureteral stent/percutaneous nephrostomy (decompress the urinary tract).
A 30 year old woman presents with increased urinary frequency, dysuria, and cloudy malodorous urine? Treatment?
UTI (cystitis). Empiric antibiotics?
What are two major complications of an intravenous pyelogram (IVP)? What has replaced this test in a urologic workup?
Allergic reaction to dye, contraindicated in patients with renal failure (Creatinine>2). CT and sonogram.
A patient presents with chills, fever, nausea, vomiting, and flank pain. Tests? Treatment?
Pyelonephritis. Urinalysis and cultures, CT and sonogram. IV antibiotics.
An older man presents with chills, fever, dysuria, lower back pain, and an extremely tender prostate on DRE? Treatment? Complications?
Acute bacterial prostatitis. IV antibiotics. Don't do any more DRE - could lead to sepsis!
A newborn baby boy is unable to urinate during the first day of life. He has normal meatal width? Tests? Treatment?
Posterior urethral valves. Voiding cystourethrogram. Endoscopic regurgitation or resection.
On PE of a newborn baby, you note the urethral opening on the ventral side of the penis? Complications? Treatment?
Hypospadias. No circumcision! Plastic reconstruction.
Children who present with UTI symptoms should be assessed via what test?
A child presents with dysuria, increased urinary frequency, perineal pain, flank pain, fever and chills. Tests? Treatment?
Vesicoureteral reflux. CT scan, voiding cystourethrogram, urinalysis and cultures. IV antibiotics (empiric, then culture-guided choice).
A young girl complains of her vagina being wet with urine all of the time. She does not void at inappropriate times and has normal urge to void? Tests? Treatment?
Low implantation of ureter. PE or IVP. Corrective surgery.
A teenager presents with colicky flank pain after his first night drinking in college?
Ureteropelvic junction obstruction (UPJ)
When any patient presents with hematuria, what must you do?
Workup for Cancer - CT scan and cystoscopy (for bladder).
A 60 year old man presents with flank pain, flank mass, and hematuria? What physiologic changes are often noted in this condition (3)? Tests? Treatment?
Renal Cell Carcinoma. Hypercalcemia, erythrocytosis, and elevated liver enzymes. CT scan. Surgery.
Which cancer has the highest correlation with smoking?
A 70 year old man is found to have a rock hard discrete nodule on DRE and a PSA of 10? Tests? Treatment?
Prostate cancer. Sonogram guided Transrectal needle biopsy and CT. Surgery or radiation.
Medical treatment for widespread bone metastases from prostate cancer?
A 25 year old presents with a painless testicular mass? Which serum markers are upregulated with this condition? Tests? Treatment?
Testicular cancer. Biopsy with radical orchiectomy. Alpha fetoprotein and B-human chorionic gonadotropin (B-HCG). Radiation and Chemotherapy (platinum based, ie. cisplatin)
A man with PMH of benign prostatic hypertrophy (BPH) who has recently been taking antihistamines for a bad cold, develops an inability to void and a distended palpable bladder? Medical and Mechanical Treatments?
Acute urinary retention. Indwelling catheter for three days. Alpha blockers or 5-alpha reductase inhibitors (for largest bladders).
How is postoperative urinary retention managed?
Indwelling catheter until retention resolves.
A middle aged woman with many children leaks a small amount of urine when she laughs, sneezes, or bears down. They deny incontinence at night? Cause? Treatments?
Stress incontinence. Weakened pelvic floor with prolapsed bladder neck. Pelvic floor exercises or surgical repair (severe cases).
A patient presents with colicky flank pain that radiates to the inner thigh and genitals? Is intervention always necessary? Treatment? Contraindications? Prevention?
Passage of ureteral stones. No, small stones pass spontaneously (<3cm have 70% chance). Ertracorporeal shock wave lithotripsy (ESWL). Pregnant women, bleeding diathesis, stones that are several centimeters. Drink lots of water.
Most common cause of pneumaturia? Tests? Treatment?
Fistula between bladder and sigmoid colon from diverticulitis. CT scan and sigmoidoscopy (rule out cancer, second most common cause). Surgical therapy.
Psychogenic impotence - Nocturnal Erections? Onset? Treatment?
Does not interfere with nocturnal erections. Sudden (often partner or situation specific). Psychotherapy.
Organic impotence. Sudden vs Chronic causes? Nocturnal erections? Treatment?
Sudden - trauma, pelvic surgery, prostate cancer surgery, Chronic - diabetes, arteriosclerosis. No nocturnal erections. Sildenafil, surgery (for arterial injury), or suction devices/implants.