2. Which one of the following regarding percutaneous SPC
is false?
A. Hx of previous lower abode surgery or irradiation is a
contraindication to SPC insertion
B. Recognised complications include extraperitoneal extravasation,
haematuria and injury to the bowel
C. Indications include trauma to the urethra, phimosis with urinary
retention and pelvic trauma
D. It is less likely to cause bacteriuria than urethral catheterisation
3. False = C. Indications include trauma to the urethra,
phimosis with urinary retention and pelvic trauma
• A poorly defined bladder is a contraindication, the other stuff places
them at greater risk of bowel perf as it may have resulted in bowel
adherence to the abode wall.
• Other contraindications
• coagulopathies
• pelvic trauma
4. Complications
• bowel perf
• intraperitoneal extravasation
• extrperitoneal extravasation
• infection of space of Retzius
• catheter obstruction
• haematuria
• infection
• haematoma
• bypassing
5. indications for SPC
• When IDC is indicated but unsuccessful
• Urethral trauma/disruption
• urethral stricture
• urinary retention secondary to phimosis
• gynaecological malignancies
• false passages
6. Regarding investigation of a patient with renal colic,
which one of the following is true?
A. Most stones cannot be visualised with magnetic resonance
urography
B. Nearly all stones are radiolucent
C. Haematuria is not present in 40% of patients
D. A urinary pH of <5 suggests struvite stones
7. True = A. Most stones cannot be visualised with
magnetic resonance urography
• Around 90% of stones are radio-opaque
• MRI can show anatomically features and the consequences of
stones but generally not the stones themselves
• Up to 20% of patients with proven stones don’t have hameturia
• No relationship between degree of obstruction and
presence/absence of haematuria
8. • UTIs from urea splitting organisms such as:
• Proteus
• Klebsiella
• Pseudomonas
• Staph
• Can cause struvite stones
• A urinary pH of >7.5 is suggestive of a urine infection from these bacteria
• A pH <5 is associated with UA calculi
NH4MgPO4·6H2O
9. Which one of the following patients should be referred for
admission?
A. A patient with a single kidney who has a distal ureteric 3 mm stone
with a low degree obstruction and is now pain free
B. An 82yo man who presents with macroscopic haematuria with
passage of blood clots per urethra
C. An adolescent with fever, riggers, white cell casts in the urine with
normal vital signs and no vomiting
D. A 13yo boy with gradual onset of pain over 1-2 days in the upper
pole of the right testis and a blue dot sign is visible on examination
10. Should be admitted = B. An 82yo man who presents with
macroscopic haematuria with passage of blood clots per urethra
• High risk of clot retention and obstruction
• Criteria for admission for patients with renal colic
• one functioning kidney with a moderate-high degree of obstruction
• infected obstructed kidney
• ongoing pain (>4hrs) despite adequate analgesia
• Proximal stone >5mm in size*
11. Size matters
• 4mm stone 90% chance of passing
• 8mm stone 5% chance of passing
12.
13. Regarding the Mx priapism of in the ED which one of the
following statements is the most correct?
A. For low flow priapism, administer analgesia and apply ice to the shaft
for 4 hours
B. If thrombosis is the cause, administer IV fluids, oxygen and
analgesia, commence exchange blood transfusion and request
urological review
C. Prescribe analgesia, insert a urethral catheter if the patient is in
retention and provide reassurance
D. If the patient has high flow priapism perform a penile block, insert an
18g into one of the corpus cavernosum and inject phentolamine
14. Most correct = C. Prescribe analgesia, insert a urethral
catheter if the patient is in retention and provide reassurance
15. Priapism
• High flow vs low flow
• Low flow is most common and is true emergency
• Rx <4hrs
• due to reduced venous outflow
• high flow is really rare, usually due to an AVM post trauma
16. Causes of high flow
• Intracavernosal injection of papaverine, phentolamine, PGE1, etc
• sickle cell disease (23% adult and 63% paediatric)
• other haemoglobinopathies
• Leukaemia
• hyper coagulable states
• Fabry’s disease
• Immunosuppressive disorders
• Other medications - SSRIs, phenothiazines, prazosin hydrazine
• Cocaine, alcohol, THC
• Trauma
deficiency of an enzyme that causes
a buildup of glycoproteins
19. Treatment
• If due to sickle cell then fluid, oxygen, analgesia and exchange transfusion
• Otherwise
• LA - penile block
• Aspirate blood from the corpus cavernosum with a 16-18g butterfly, positioned perpendicularly
to the base, until bright red blood is aspirated
• Irrigate with NS (controversial)
• 1 ml phenylephrine, that has been diluted in normal saline at a ratio of 100–500 μg/ml
• Injections can be repeated every 3–5 minutes until detumescence occurs, with a maximum of
1mg administered within one hour
• ?cold and flu tabs
21. Regarding testicular torsion, which one of the following
statements is true?
A. It is mostly due to lateral rotation of the spermatic cord
B. The cremasteric reflex is always absent
C. It can be readily excluded with scrotal USS
D. It can be associated with a fever
22. True = D. It can be associated with a fever
• Usually medial rotation
• peak age 12-16yo
• many occur spontaneously, particularly at night
• N & V
• fever in 20%
• The testis can be salvaged up to 12hrs post onset
• ideally 6hrs post onset
• Chance of testis survival at 24hrs is near zero
• USS has 80% sensitivity for testicular torsion
23. Regarding Fourniers gangrene, which one of the
following statements is true?
A. It is a polymicrobial necrotising infection confined to the scrotal skin
that originates from the skin
B. It may slowly progress to involve the buttocks and thighs
C. Hyperbaric oxygen is an adjunctive treatment
D. The antibiotic of choice is IV metronidazole
24. True = C. Hyperbaric oxygen is an adjunctive treatment
• FG is polymicrobial infection of the perineum
• originates from the skin, urethra or rectum
• RF: DM, imunosuppression, perianal trauma, perianal disease and
UTIs
• Hyperbaric oxygen Rx is an adjunct to debridement
• ABs: Meropenam 1g TDS, and clindamycin 600mg TDS
25. AAAs are at risk of rupture. Which one of the following
statements is most correct?
A. Risk of rupture s increased in women, non-smokers and increasing
age
B. Most patients with rupture present with all of: hypotension, pain and
a pulsatile mass
C. Rupture can present with gastrointestinal bleeding
D. Tenderness on palpation is a sign of rupture
26. True = C. Rupture can present with gastrointestinal
bleeding
• An aortoenteric fistula can cause GI bleeding
• Known AAA, age >50, fistula should be considered
• The size of the AAA is the strongest RF for rupture
• if AAA <5cm then 1%
• if AAA >5cm then 17%
• Risk is also higher in women, smokers, HTN
27. A patient with known cholelithiasis presents to the ED. Which one
of the following patients does not have a complication of gallstones
A. A patient with RUQ pain, T 39.1, jaundice, HR 124, hypotension and
dilated intrahepatic ducts on ultrasound
B. A patient with vomiting, RUQ pain, and tenderness and T 36.6
C. A patient with crampy abdo pain, bile stained vomiting, mild abdo
distension and HR 118
D. A patient with epigastric pain, vomiting, diaphoresis and a HR 52
28. Does not have a complication of gallstones = D. A patient
with epigastric pain, vomiting, diaphoresis and a HR 52
• A Cholangitis
• B Biliary colic
• C SBO from gallstone ilieus
• D inferior MI
• RUQ pain, fever, jaundice is classic for cholangitis - Charcot’s triad
30. Which one of he statements regarding hernias is the
most correct?
A. Incisional hernias have a narrow origin and complications are
uncommon
B. umbilical hernias resolve spontaneously in children
C. Direct inguinal hernias occur more frequently in the older age group,
extend into the scrotum and can become strangulated requiring
surgery
D. Indirect inguinal hernias occur due to a defect in the transversals
fascia and anterior abdominal wall; they may become strangulated
and require surgery
31. Most correct = B. umbilical hernias resolve
spontaneously in children
• Umbilical hernias in children are congenital and rarely become
incarcerated
• Usually resolve spontaneously unlike in adults
• Incisional hernias - the origin is normally wide and complications are rare
• Direct inguinal hernias pass medial to the inferior epigastric artery and are
due to weakness in the transversals fascia and ant. abdo wall - less
complications than indirect
• Indirect - more frequent in males, more frequent on right side
