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Q1: What is the next best step in evaluating a patient with blood at the tip of the urethral meatus besides catheterizing? . 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) QS. 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. A45-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 prolonged high grade unilateral obstruction Q10. An 18-year-old male with no PMH presents with acute onset of severe pain in his groin radiating into his testicle as well as nausea and vomiting. On physical exam, *he has an elevated, tender left testicle with a horizontal lie*: a. clonus in left plantar reflex b. hypoactive cremasteric reflex c. diminished penile pulses d. hyperactive cremasteric reflex e. tender, boggy prostate - ANSWER-B (suggests a torsion) What is the next best study to confirm diagnosis of a testicular torsion? - ANSWER-US how do we treat a testicular torsion? - ANSWER-detorsion of testicles with bilateral orchidopexy 33M with no PMHx presents to the clinic after noticing his scrotum to be enlarged on one side. He denies any other complaints such as pain or fevers. Palpable, "bag-of- worms-like" mass in left spermatic cord. Palpable, firm, nodular left testicle Normal right hemiscrotum, normal palpation of right testicle and spermatic cord. What should you think? - ANSWER-varicocele (b/c bag of worms. Differentials also include hydrocele, testicular mass) (important) Q11. What is the most common type of hydrocele in an ADULT? a. communicating b. non-communicating c. drooping d. incarcerated e. infected - ANSWER-B (adult = non-communicating) What is the most common type of hydrocele in a CHILD? a. communicating b. non-communicating c. drooping d. incarcerated e. infected - ANSWER-a (patent tunica vaginalis) Patients with this may have a hard time palpating the testicle. Light will *transilluminate* the scrotum. - ANSWER-hydrocele Q12. What side does a varicocele more commonly occur on: left, right or equal on both? - ANSWER-left (unlike the right side, wherein the gonadal vein drains directly into the IVC, the left gonadal vein enters the renal vein which must then cross the aorta to reach the IVC) Q13. What is the MOST common form of testicular cancer in young men? . Sertoli Cell . Seminoma . Leydig Cell . Choriocarcinoma . Teratoma - ANSWER-B oao0o0n What is the most common testicular malignancy to cause bilateral malignancies in older men? - ANSWER-lymphoma Q14. 54F presents to the clinic with complaint of intermittent blood in her urine. Additionally, she complains of urinary frequency, urgency, and dysuria. She reports a 40-year 1ppd smoking habit. What is the first test you should run? a. CT of abdomen/pelvis b. Bladder US c. Urine culture d. Empiric antibiotic e. Pap smear - ANSWER-C (point: in microscopic hematuria, first you must check the urine, and then you check for cancer) What is the triad for renal cell carcinoma? - ANSWER-flank pain flank mass hematuria Q15. What is the most common subtype of RCC? a. Papillary b. Medullary c. Clear Cell d. VHL Syndrome - ANSWER-C Gold standard for managing RCC? - ANSWER-Partial Nephrectomy (stressed this) Q16. Patient presents with Gross hematuria, and admits to have been swimming in the Nile. What disease do they have? What type of cancer may they develop? - ANSWER- Schistosomiasis (SCC) 
