Urology Review Questions & Elaborate solutions 2024/2025

Urology Review Questions & Elaborate solutions 2024/2025 Q1: What is the next best step in evaluating a patient with blood at the tip of the urethral meatus besides catheterizing? a. inserts foley catheter b. suprapubic catheter c. scrotal US d. DRE e. CT of the penis - ANSWER-D Blood at the tip of the urethral meatus may indicate: - ANSWER-urethral injury Q2: DRE in a patient with a high riding (non-palpable prostate) may suggest this: - ANSWER-urethral injury Q3: You raise your suspicion for urethral injury to the trauma surgeon and want to hold off on foley catheter until urethral injury is disproven. Meanwhile, an Xray of the pelvic is performed and shows that the patient has a pubic shear/pelvic fracture. What is the best step in evaluating the patient? A. Diagnostic foley placement B. IV pyelogram C. Retrograde urethrogram (RUG) D. CT cystogram E. Transrectal U/S - ANSWER-C (blood at meatus = RUG) What 3 layers of fascia are ruptured in anterior urethral injuries? - ANSWER-Scarpa's Colle's Dartos Do MVCs, pelvic fractures, blood at the meatus, and inability to void suggest an anterior or posterior urethral injury? - ANSWER-posterior straddle injuries + penile trauma + perineal (butterfly) hematomas suggest an anterior or posterior urethral injury? - ANSWER-anterior Q4. In the setting of pelvic trauma, what GU injury is *most likely* to cause bladder rupture and visible contrast on scan in the peritoneum? a. renal pelvis avulsion b. extraperitoneal bladder injury c. ureteral transection d. intraperitoneal bladder injury e. urethral injury - ANSWER-D (full bladder = you will see contrast in the peritoneum) (extraperitoneum = NO contrast in peritoneum, the white stuff/contrast will be around and below the bladder) Q5. These happens when you have a *full bladder at the time of trauma*: a. renal pelvis avulsion b. extraperitoneal bladder injury c. ureteral transection d. intraperitoneal bladder injury e. urethral injury - ANSWER-D Q6. These happens when you have an* empty/compressed bladder at the time of trauma*: a. renal pelvis avulsion b. extraperitoneal bladder injury c. ureteral transection d. intraperitoneal bladder injury e. urethral injury - ANSWER-B (*e*empty = *e*extraperitoneal) How should an intraperitoneal bladder injury be managed? - ANSWER-surgery (immediate cystography) + foley catheter for 2 weeks How should an extraperitoneal bladder injury be managed? - ANSWER-catheter for 2 weeks Difference in tx from intraperitoneal and extraperitoneal bladder injury? - ANSWER-instar = surgery + catheter extra = just catheter Q7. A 45-year-old male presents to the emergency room with scrotal pain and swelling for one week, but worsening over the past 24 hours. He has a PMH significant for uncontrolled DM. He is ill appearing. Temperature is 102.4. WBC is 28. Glucose is 427. Physical exam revealed on the following slide. Severely erythematous, necrotic appearing scrotum and perineum. Crepitus in upper thighs, scrotum, escutcheon. Extremely foul odor emanating from wound. What disease process is illustrated? a. Cellulitis b. Rectal perforation c. Fournier's Gangrene d. Hernia e. Spider Bite - ANSWER-C How do we treat Fournier's Gangrene? - ANSWER-broad spectrum abx aggressive debridement strict blood glucose control delayed wound closure and skin grafting Q8. A 40-year-old male with history of erectile dysfunction treated with Viagra (sildenafil) presents with a painful, persistent erection for the previous 18 hours. What is the next step? a. cold compress b. alpha-blocker therapy c. beta-blocker therapy d. aspiration + drainage of erection e. tourniquet - ANSWER-d Continues...