Renal + Urology emergencies

Question 1

What is the criteria of malignant hypertension

Answer 1

Systolic pressure > 180
or Diastolic pressure > 120
+ signs of organ damage

Question 2

Malignant hypertension can lead to

Answer 2

Acute renal failure
Papilloedema
Encephalopathy
Cardiac failure

Question 3

Benign prostate hyperplasia can lead to

Answer 3

acute urinary retention - inability to urinate with increasing pain

Question 4

Management of acute urinary retention

Answer 4

Catheter

Question 5

What is testicular torsion

Answer 5

When the testicle rotates and twist the spermatic cord that brings blood to the scrotum -> ischaemia and necrosis

Question 6

Which age group is most commonly affected by testicular torsion

Answer 6

10-30 years old, peak at 13-15

Question 7

Symptoms of testicular torsion

Answer 7

Acute severe pain at groin and lower abdomen
Nausea, vomiting
Swollen tender testis
Testis higher than normal position
Cremasteric reflex is reduced

Question 8

What is cremasteric reflex

Answer 8

Stroking / pinching medial thigh causes contraction of cremaster muscle which elevates the testis

Question 9

What nerves are responsible for cremasteric reflex

Answer 9

genitofemoral nerve

Question 10

How do you differentiate between testicular torsion and epididymitis

Answer 10

In testicular torsion, pain is not relieved by elevating the testis

Question 11

Management of testicular torsion

Answer 11

Urgent surgical exploration - fix both testis

Question 12

What is epididymo-orchitis

Answer 12

Infection of the epididymis (epididymitis) and testis

Question 13

Common pathogens causing epididymo-orchitis

Answer 13

N. gonorrhoea
Chlamydia
E. coli

Question 14

E. coli as a cause of epididymo-orchitis is more common in

Answer 14

Older adults with low-risk sexual history

Question 15

STI as a cause of epididymo-orchitis is more common in

Answer 15

Younger adults <35

Question 16

Symptoms of epididymo-orchitis

Answer 16

Acute sever testicular pain
May have history of dysuria and urethral discharge (sign of STI)
Warm, hot swollen testis
Pain RELIEVES on elevation of the testes

Question 17

Management of epididymis-orchitis

Answer 17

If STI is the most likely cause - refer to local sexual health clinic -> ceftriaxone

If enteric organisms are the most likely cause -
1. send MSU
2. oral quinolone (ofloxacin)

Question 18

What is priapism

Answer 18

Unwanted persistent penile erection > 4 hrs not associated to sexual arousal

Question 19

2 types of causes of priapism

Answer 19

Ischaemic
Non-ischaemic

Question 20

What is the ischaemic cause of priapism

Answer 20

Due to impaired vasorelaxation -> reduced vascular outflow -> congestion of blood in corpus cavernosum

Question 21

What is corpus cavernosum

Answer 21

Spongy tissue of the penis that fills up with blood to cause erection

Question 22

What is the non-ischaemic cause of priapism

Answer 22

due to high arterial inflow e.g. fistula formation

Question 23

Which type of priapism is more urgent

Answer 23

Ischaemic cause of priapism - it is a compartment syndrome which can cause necrosis

Question 24

What are the causes of priapism

Answer 24

Idiopathic
Sickle cell disease
Erectile dysfunction medication
Trauma
Drugs

Question 25

What drugs can cause priapism

Answer 25

Anti-hypertensives Anti-coagulants Cocaine Cannabis Ecstasy

Question 26

What are the erectile dysfunction medications that can cause priapism

Answer 26

intracavernosal papaverine Sildenafil PDE-5 inhibitors

Question 27

Symptoms of priapism

Answer 27

Persistent erection > 4hrs Pain at penis May be non-painful -> suggests non-ischaemic

Question 28

Investigations for priapism

Answer 28

Cavernosal blood gas analysis Doppler / duplex USS - shows high/low blood flow

Question 29

What may cavernosal blood gas analysis show for priapism

Answer 29

If ischaemic - pO2 and pH reduced, pCO2 increased If non-ischaemic - normal

Question 30

Management of ischaemic priapism

Answer 30

1. Aspiration of blood + injection of saline 2. intracavernosal injection of vasoconstrictive agent 3. surgery

Question 31

Why is injection of saline used in ischaemic priapism

Answer 31

To wash out viscous blood

Question 32

What vasoconstrictive agent is used for priapism

Answer 32

alpha agonist - Phenylephrine

Question 33

Management of non-ischaemic priapism

Answer 33

Observation, not a medical emergency

Question 34

What is Fournier's gangrene

Answer 34

necrotising facilities around the penis

Question 35

type 1 necrotising fasciitis is most commonly caused by

Answer 35

mixed anaerobes and aerobes

Question 36

type 2 necrotising fasciitis is most commonly caused by

Answer 36

Streptococcus pyogenes

Question 37

which type of necrotising fasciitis is the most common

Answer 37

type 1 - common post-surgery in diabetics

Question 38

Risk factors of necrotising fasciitis

Answer 38

Recent trauma/burns Diabetes - use of SGLT2 IV drug use Immunosuppression

Question 39

Symptoms of Fournier gangrene

Answer 39

rapidly worsening cellulitis swelling and crepitus of scrotum dark purple areas - necrosis

Question 40

Management of Fournier gangrene

Answer 40

Urgent surgical debridement IV antibiotics

Question 41

What is paraphimosis

Answer 41

Painful swelling of the foreskin, happens after foreskin retracted for catheterisation or cystoscopy and staff member forgets to replace it in its natural position