TNS - Genitourinary trauma Questions
with Accurate Answers
a patient enters your ED after a straddle injury. he presents with perineal tenderness,
blood at the meatus, and a high riding prostate. Which GU injuries might this patient
have sustained? (3) - ANSWERS(1) posterior urethra injuries
(2) fracture of pelvic ring or pubic diastasis
(3) bladder injury
which tests/assessments should the resuscitation team use to rule in (or rule out) the
above injuries? (3) - ANSWERS(1) retrograde urethrogram
(2) cystogram
(3) pelvic x-ray
a patient has sustained a fracture of the anterior pelvis. your assessment reveals
slightly bloody urine, suprapubic pain, and tenderness on palpation. a retrograde
urethrogram and retrograde cystogram were both performed, and extravasation of
contrast is noted in the pelvis. The urethra is noted to be intact. which injury is
suspected? - ANSWERSbladder rupture
a patient is involved in a high-speed car crash and needed extrication from the vehicle.
small bowel disruption is noted on CT scan. A UA reveals microscopic blood. the patient
is slightly tachycardic - HR 100, BP 148/88, and skin is warm and dry. which injuries
might be suspected based on mechanism and clinical finding? (2) what additional
radiographic exams should be anticipated? - ANSWERSureteral injury
kidney injury
CT
one shot IVP
which GU injury should a TNS suspect when identifying the following on assessment:
pelvic instability to palpation (2) - ANSWERSposterior urethral injury
bladder injury
which GU injury should a TNS suspect when identifying the following on assessment:
blood at the urethral meatus - ANSWERSanterior urethral injury
which GU injury should a TNS suspect when identifying the following on assessment:
boggy or high-riding prostate - ANSWERSposterior urethral injury
which GU injury should a TNS suspect when identifying the following on assessment:
bruising at the umbilicus or flank - ANSWERSrenal/kidney injury
, if one notes any of the following: pelvic instability, blood at urethral meatus, or
boggy/high-riding prostate, what intervention is contraindicated? - ANSWERSplacement
of a urinary catheter
what test must be done prior to insertion of a urinary catheter for patients presenting
with pelvic trauma? (2) - ANSWERS(1) retrograde urethrogram
(2) preliminary KUB that demonstrates no evidence of pelvic fx
what is the type of bladder rupture most common in children? why is this different from
adults? - ANSWERSintraperitoneal rupture - more common due to anatomical position
of the bladder outside of the pelvis
where does the bladder most commonly tear in patients with pelvic fractures? -
ANSWERSextraperitoneal
the dome - the weakest/most mobile tissue of the bladder
what is the most common injury associated with bladder rupture? - ANSWERSpelvic
fracture
an adult arrives after having been struck by a front loader and thrown 5 feet from the
vehicle. CT scans of the chest, abdomen, and pelvis were completed with a finding of
both intraperitoneal and extraperitoneal bladder rupture. Why is this a significant
finding? what concerns should u have about care and outcome for this patient? -
ANSWERSthis injury requires a significant force
concern for pelvic fracture - ALSO combined bladder rupture is usually caused by
penetrating trauma - may need surgical exploration
what test is best for diagnosing bladder injury? - ANSWERSCT retrograde cystography
which injury is more common in children due to hyper-mobility of the vertebral column? -
ANSWERSureteropelvic junction dysfunction
*ureteral injury*
why should the initial, immediate urine return in a Foley catheter be examined (as
opposed to looking in the collection bag)? - ANSWERSto ensure accurate indication of
hematuria
if you wait and examine the collection bag, the sample will be diluted
what kind of renal injury patient would qualify for non-operative management? -
ANSWERS36 F with grade II renal injury, VSS, with hematuria
with Accurate Answers
a patient enters your ED after a straddle injury. he presents with perineal tenderness,
blood at the meatus, and a high riding prostate. Which GU injuries might this patient
have sustained? (3) - ANSWERS(1) posterior urethra injuries
(2) fracture of pelvic ring or pubic diastasis
(3) bladder injury
which tests/assessments should the resuscitation team use to rule in (or rule out) the
above injuries? (3) - ANSWERS(1) retrograde urethrogram
(2) cystogram
(3) pelvic x-ray
a patient has sustained a fracture of the anterior pelvis. your assessment reveals
slightly bloody urine, suprapubic pain, and tenderness on palpation. a retrograde
urethrogram and retrograde cystogram were both performed, and extravasation of
contrast is noted in the pelvis. The urethra is noted to be intact. which injury is
suspected? - ANSWERSbladder rupture
a patient is involved in a high-speed car crash and needed extrication from the vehicle.
small bowel disruption is noted on CT scan. A UA reveals microscopic blood. the patient
is slightly tachycardic - HR 100, BP 148/88, and skin is warm and dry. which injuries
might be suspected based on mechanism and clinical finding? (2) what additional
radiographic exams should be anticipated? - ANSWERSureteral injury
kidney injury
CT
one shot IVP
which GU injury should a TNS suspect when identifying the following on assessment:
pelvic instability to palpation (2) - ANSWERSposterior urethral injury
bladder injury
which GU injury should a TNS suspect when identifying the following on assessment:
blood at the urethral meatus - ANSWERSanterior urethral injury
which GU injury should a TNS suspect when identifying the following on assessment:
boggy or high-riding prostate - ANSWERSposterior urethral injury
which GU injury should a TNS suspect when identifying the following on assessment:
bruising at the umbilicus or flank - ANSWERSrenal/kidney injury
, if one notes any of the following: pelvic instability, blood at urethral meatus, or
boggy/high-riding prostate, what intervention is contraindicated? - ANSWERSplacement
of a urinary catheter
what test must be done prior to insertion of a urinary catheter for patients presenting
with pelvic trauma? (2) - ANSWERS(1) retrograde urethrogram
(2) preliminary KUB that demonstrates no evidence of pelvic fx
what is the type of bladder rupture most common in children? why is this different from
adults? - ANSWERSintraperitoneal rupture - more common due to anatomical position
of the bladder outside of the pelvis
where does the bladder most commonly tear in patients with pelvic fractures? -
ANSWERSextraperitoneal
the dome - the weakest/most mobile tissue of the bladder
what is the most common injury associated with bladder rupture? - ANSWERSpelvic
fracture
an adult arrives after having been struck by a front loader and thrown 5 feet from the
vehicle. CT scans of the chest, abdomen, and pelvis were completed with a finding of
both intraperitoneal and extraperitoneal bladder rupture. Why is this a significant
finding? what concerns should u have about care and outcome for this patient? -
ANSWERSthis injury requires a significant force
concern for pelvic fracture - ALSO combined bladder rupture is usually caused by
penetrating trauma - may need surgical exploration
what test is best for diagnosing bladder injury? - ANSWERSCT retrograde cystography
which injury is more common in children due to hyper-mobility of the vertebral column? -
ANSWERSureteropelvic junction dysfunction
*ureteral injury*
why should the initial, immediate urine return in a Foley catheter be examined (as
opposed to looking in the collection bag)? - ANSWERSto ensure accurate indication of
hematuria
if you wait and examine the collection bag, the sample will be diluted
what kind of renal injury patient would qualify for non-operative management? -
ANSWERS36 F with grade II renal injury, VSS, with hematuria
