Gu Em

Front 1

GU EMERGENCIES

Back 1

GU EMERGENCIES

Front 2

Define Meatus:

Back 2

A passage or opening.
Lithiasis: 1. The formation of stones. 2. Uric acid diathesis

Front 3

Define Micturition:

Back 3

Urination

Front 4

Define Dysuria:

Back 4

Painful or difficult urination, symptomatic of numerous conditions

Front 5

Define Calyx:

Back 5

Any cuplike organ or cavity. 2. A cuplike extension of the renal pelvis that encloses the papilla of a renal pyramid; urine from the papillary duct is emptied into it.

Front 6

Define Nocturia:

Back 6

Excessive or frequent urination after going to bed.

Front 7

Define Hematuria:

Back 7

Blood in the urine

Front 8

Define Oliguria:

Back 8

Urinary output of less than 400 ml/day.

Front 9

Define Pyuria:

Back 9

Pus in the urine

Front 10

Define Phimosis:

Back 10

Stenosis or narrowness of the preputial orifice so that the foreskin cannot be pushed back over the glans penis

Front 11

Define Paraphimosis:

Back 11

Strangulation of the glans penis due to retraction of a narrowed or inflamed foreskin

Front 12

What diagnostic is gold standard for evaluating renal colic

Back 12

Intravenous pyelography (IVP)

Front 13

What is the potential significance of blood at the meatus.

Back 13

Blood at the meatus is associated with urethral injuries. Pelvic Fx

Front 14

How would you evaluate blood at the meatus due to trauma

Back 14

retrograde urethrogram mandatory in this setting in order to make dx and minimize long-term complications of urethral transection (i.e. urethral strictures and urinary incontinence)

Front 15

What should be avoided while evaluating blood at meatus in trauma

Back 15

urinary catheter should not be placed to prevent conversion of partial urethral laceration to complete transection. Eval of GU should be performed in retrograde fashion: RO urethral injury before bladder, then bladder before urethral or renal injury

Front 16

What imaging technique is mandatory in the trauma setting?

Back 16

retrograde urethrogram

Front 17

Explain the meaning of a finding of superiorly displaced prostate.

Back 17

indicates disruption of posterior urethra. Anterior urethral injuries associated with straddle injuries and instrumentation

Front 18

Define what initial hematuria is suggestive of:

Back 18

suggests injury to the distal system (i.e., urethra or prostate).

Front 19

Define microscopic hematuria

Back 19

Microscopic hematuria is defined as more than five red blood cells (RBCs) per high-power field.

Front 20

Define what terminal hematuria is suggestive of:

Back 20

Terminal hematuria suggests bladder neck injury.

Front 21

Define what continuous hematuria is suggestive of:

Back 21

Continuous hematuria suggests upper renal system (bladder, ureter, or kidney) injury

Front 22

8. Understand why the lack of hematuria does not rule out injury to the renal system in penetrating injuries and how to further for renal injury

Back 22

10% pts w/renal injury related to stab wounds may not manifest hematuria. CT w/contrast is primary imaging for penetrating trauma to kidneys. usually shows appropriate detail of injury to inform mgt decisions

Front 23

Explain the significance of renal contusion.

Back 23

relatively minor injury includes renal parenchymal ecchymosis, minor lacerations & subcapsular hematomas w/intact renal capsule. IVP usually normal. CT may reveal edema w/microextravasation of contrast material within renal parenchyma. Subcapsular hematoma appears as flattened portion of renal cortex compressed by hematoma under renal capsule

Front 24

Contrast cortical versus corticomedullary lacerations of the kidney.

Back 24

Renal lacerations classified as minor cortical lacerations not involving medulla or collecting system or major renal lacerations extending deep in corticomedullary junction or collecting system. perirenal hematoma may fill perirenal space before its tamponaded by Gerota fascia. imaging studies show disruption of renal outline, perirenal hematoma, & possibly extravasation of contrast material adjacent to kidney

Front 25

Expain a grade I renal injury and treatment

Back 25

Contusion (microscopic or gross hematuria, with normal urologic study results)
Subscapular, nonexpanding hematoma without laceration. Observation, spontoneous resolution

Front 26

Explain a grade II renal injury and treatment

Back 26

Parenchymal laceration <1.0 cm depth limited to cortex, no extravasation
Nonexpanding hematoma, confined to retroperitoneum Observation, spontoneous resolution

Front 27

Explain a grade III renal injury and treatment

Back 27

Parenchymal laceration >1 cm depth with extravasation or collecting system rupture. Observation or surgery

Front 28

Explain a grade IV renal injury and treatment

Back 28

Laceration extending through to collecting system
Vascular pedical injury, hemorrhage contained. Surgery

Front 29

Explain a grade V renal injury and treatment

Back 29

Shattered kidney
Avulsed hilum (devascularized kidney). Surgery

Front 30

Explain the treatment options for a zipper injury to the penis

Back 30

skin of penis or scrotum can get caught in movable part or between teeth of zipper. (Beans above the Frank) Gentle manipulation after local infiltration with 1% lidocaine is most successful way to release entrapment. Release of skin can be achieved by cutting median bar of movable part of zipper with bone-cutting plier. If all procedures fail, removal under general anesthesia or circumcision by the urologist may be required

Front 31

Describe how a simple scrotal abscess of a hair follicle is managed

Back 31

I&D of abscess or circumferential excision of roof of abscess followed by wound care and sitz baths

Front 32

Describe Phimosis and how its managed

Back 32

inability to retract foreskin proximally & posterior to glans. May be due to infection poor hygiene or previous injury w/scarring. Tx: circumcision, topical steroids applied 4-6 wks is effective 70-90% time

Front 33

Describe Paraphimosis and how its managed

Back 33

inability to reduce proximal edematous foreskin distally over glans in natural position. Resulting edema can lead to arterial compromise & gangrene. true urologic emergency. Can reduced by compression of glans for several mins allowing reduction of foreskin back. Or several sm puncture wounds w/22-25g needle allows expression of edema fluid

Front 34

Describe Fournier’s gangrene and how its managed

Back 34

polymicrobial synergistic necrotizing infection of perineal subQ fascia & male genitalia originating from skin urethra or rectum. Stars benign infection or simple abscess that quickly becomes virulent leading to end-artery thrombosis in subQ tissue promoting widespread necrosis of tissue. TX: Aggressive fluid resuscitation; gram+(-)& anaerobic abx & surgical debridement, hyperbaric O2 therapy

Front 35

Describe Orchitis and how its managed

Back 35

inflammation of testicle (rare), usually in conjunction w/systemic infection (mumps, EB, varicella). Usually unilateral followed by contralateral involvement in 1-9d. Almost always associated w/epididymitis. Tx symptomatic & disease specific

Front 36

Describe Priapism and how its managed

Back 36

uruologic emergency presenting as persist, px, erection where corpora & cavernosa engorged w/stagnant bl. glans & corpus spongiosum usually soft & uninvolved; may involve urinary retention. May result in impotence. Often rx related to intracavernosal injection of vasoactive substances for impotence, oral agents for HTN or mental disorders. children due to hematologic disorders (sickle cell). Classified high-flow (non-ischemic) & low-flow (ischemic). Tx: analgesia, terbutaline subq. Pseudoephedrine maybe effective w/1st 4 hrs. Corporal aspiration & irrigation if persistent

Front 37

Describe testicular torsion, the common age group, how it is diagnosed and treatment considerations

Back 37

fixation between enveloping tunica vaginalis & posterior scrotal wall. Peaks in puberty but may occur any age. Often involve hx of athletic event, strenuous activity, trauma prior to onset px. Can occur during sleep. Px in lower abd, inguinal canal or testis; constant or intermittent but not positional. Involved testis is firm tender often higher in scrotum when standing. Emergent urologic consultation & surgery. If dx uncertain, US & radionuclide scintigraphy maybe used. Consider manual detorsion of testis as emergent or pre-op tx

Front 38

Explain how the onset of pain differs in epididymitis from that of torsion. Contrast the most common cause in patient under 40 patient versus the patient over 40.

Back 38

Onset px more gradual because of inflammation in epididymitis vs ischemic in torsion. Most common cause <40 STDs or complications (stricture) young boys due to coliform bacteria, often w/congenital anomalies of lower GU tract causing reflux. >40 common urinary pathogens (e. coli, klebsiella) Px relieved by opioid; scrotal support; tx infection w/abx

Front 39

Identify possible causes of urinary retention.

Back 39

chronic systemic medical illnesses or carcinomas w/ sensory or motor neurogenic side effects or complications; medications; inconvenient/infrequent voiding (car trips); meatal stenosis; urethral stricture; bladder neck stricture; benign prostatic hypertrophy; infrequent ejaculation w/prostatic congestion; silent prostatism

Front 40

IDentify how urinary retention can be relieved in the emergency department and additional treatment and followup

Back 40

urethral catheter w/lidocaine jelly; leave cath in place & connect portable drainage bag, instruct family in care & how d/c; abx if evidence of UTI. Admit to hospital or arrange follow up w/urologist

Front 41

Identify Risk factors for kidney and renal stones

Back 41

male sex; 3-5 decade of life; hereditary; people who in mt, desert, tropical regions; sedentary jobs; warmest 3 mo yr; inadequate H2O intake; certain meds; previous hx stones

Front 42

Identify Presentation of renal stones

Back 42

acute onset severe episodic visceral px & little tenderness. Px in flank radiate anteroinferiorly around abd progresing to ipsilateral testicle/labia. NV, diaphoresis, no comfortable position; anxious, pacing, reluctant to lie still (“writhing”)

Front 43

Identify where renal stones lodge and why

Back 43

passage may halt in areas of anatomic narrowing or bending. Common areas: renal calyx, renal ureteropelvic jnx, where ureter passes over pelvic brim & iliac vessels, UVJ (smallest diam & common location). women, common location is posterior pelvis

Front 44

Identify types of renal stones

Back 44

75% calcium oxalate, phosphate, or both
10% magnesium- ammonium-phosphate (struvite).
10% uric acid- uroliths
5% cystine and other uncommon minerals

Front 45

What factors determine whether a stone will pass spontaneously or not

Back 45

size and location—see table 96-2 in book