Genitourinary Trauma: Kidneys, Bladder, Urethra, External Genitalia, and Sexual Assault Practice Questions

25 multiple-choice questions on Genitourinary trauma: kidneys, bladder, urethra, external genitalia, and sexual assault for paramedic and EMT students, from Chapter 37 (Abdominal and Genitourinary Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A 6-year-old struck in the flank has blood in his urine. Compared with adults, children are more prone to kidney injury because their kidneys:

   1. A. Are smaller and deeper in the pelvis
   2. B. Are fixed tightly behind the spine
   3. C. Are covered by thick back muscles
   4. D. Have less fat and rib protection
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   Answer: D. Have less fat and rib protection

   A child's kidneys are relatively larger, sit lower, and have less surrounding fat, weaker abdominal and back muscles, and more flexible ribs, so less force can injure them. They are not deeper in the pelvis or better protected than in adults.

2. Urethral injuries are much more common in men than in women mainly because the male urethra is:

   1. A. Wider and more muscular
   2. B. Located inside the bladder wall
   3. C. Longer and less protected
   4. D. Surrounded by the kidneys
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   Answer: C. Longer and less protected

   The long male urethra passes through the prostate and perineum, where pelvic fractures and straddle injuries can tear it. The short female urethra is relatively protected within the pelvis.

3. A 14-year-old boy slipped and fell astride a metal beam. He has perineal bruising and cannot urinate. You should suspect:

   1. A. A urethral injury
   2. B. A renal laceration
   3. C. A splenic rupture
   4. D. A ureteral stone
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   Answer: A. A urethral injury

   Straddle injuries crush the bulbar urethra against the pubic bone, producing perineal or scrotal bruising, blood at the meatus, and inability to void. Renal injury would cause flank pain and hematuria, not urinary retention with perineal bruising.

4. Which signs suggest a urethral injury in a male trauma patient?

   1. A. Kehr sign and left shoulder pain
   2. B. Blood at the meatus and inability to void
   3. C. Cullen sign and periumbilical pain
   4. D. Bilious vomiting with abdominal distension
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   Answer: B. Blood at the meatus and inability to void

   Blood at the meatus, inability to urinate, and perineal or scrotal hematoma are the classic signs of urethral injury. Kehr and Cullen signs point to intra-abdominal bleeding.

5. The urinary bladder is most vulnerable to rupture from a blow to the lower abdomen when it is:

   1. A. Empty and contracted behind the pubis
   2. B. Protected by a properly worn seat belt
   3. C. Inflamed from a urinary infection
   4. D. Full and distended above the pubis
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   Answer: D. Full and distended above the pubis

   A full bladder rises out of the pelvis above the pubic symphysis, its wall becomes thin and stretched, and a sudden blow or belt compression can burst it. An empty bladder sits low behind the pubic bones, where the bony pelvis shields it, so it is injured mainly by pelvic fractures. A properly worn lap belt lies across the bony pelvis, but a distended bladder above it is still exposed and can rupture in a crash. A urinary infection inflames the bladder lining but does not make the wall thin and tense the way distension does. (Caroline 9th ed., bladder injury; ATLS 10th ed.)

6. A 25-year-old who had been drinking was struck in the lower abdomen and now has suprapubic pain and cannot pass more than a few drops of bloody urine. You should suspect:

   1. A. Kidney stone
   2. B. Appendicitis
   3. C. Bladder rupture
   4. D. Testicular torsion
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   Answer: C. Bladder rupture

   Alcohol fills the bladder, and a blow over a distended bladder can rupture it, causing suprapubic pain, hematuria, and inability to void. A kidney stone causes colicky flank pain without a trauma history.

7. Bladder injuries most often accompany which other injury?

   1. A. Pelvic fracture
   2. B. Femur fracture
   3. C. Clavicle fracture
   4. D. Splenic rupture
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   Answer: A. Pelvic fracture

   Bone fragments from a fractured pelvis can lacerate the bladder, and most bladder ruptures occur with pelvic fractures. A pelvic fracture should therefore prompt a search for urinary tract injury.

8. Injury to the ureters is uncommon and is usually caused by:

   1. A. A minor fall
   2. B. A direct punch
   3. C. Penetrating trauma
   4. D. A tightly worn seat belt
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   Answer: C. Penetrating trauma

   The ureters are small, mobile, and deep in the retroperitoneum, so they are rarely injured except by stab or gunshot wounds. Ureteral injury often goes unrecognized at first because hematuria may be absent.

9. A 45-year-old man reports hearing a pop during intercourse followed by immediate pain, loss of erection, and rapid swelling and bruising of the penis. This is most likely:

   1. A. Testicular torsion
   2. B. Priapism from trauma
   3. C. Scrotal hematoma
   4. D. Penile fracture
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   Answer: D. Penile fracture

   Penile fracture is a tear of the tunica albuginea of the erect penis, producing a pop, rapid detumescence, and an eggplant-like swelling. It is a urologic emergency that requires surgical repair.

10. Field care for a penile fracture includes:

    1. A. Firm massage to reduce the swelling
    2. B. Cold packs, analgesia, and transport
    3. C. A tight elastic wrap around the shaft
    4. D. Inserting a catheter to drain urine
    Show answer

    Answer: B. Cold packs, analgesia, and transport

    Cold packs and pain control limit swelling, and the patient needs prompt urologic surgery. Catheterization is avoided because a urethral injury may coexist.

11. A 30-year-old man's penis was partially amputated in an industrial accident. Bleeding is heavy. You should first:

    1. A. Apply direct pressure with sterile dressings
    2. B. Apply a tourniquet around the base of the penis
    3. C. Pack gauze into the urethral opening
    4. D. Clamp the bleeding vessels with hemostats
    Show answer

    Answer: A. Apply direct pressure with sterile dressings

    Bleeding from penile injuries is controlled with direct pressure, and any amputated part is wrapped in moist sterile gauze, bagged, and kept cool. A tourniquet around the penis can cause ischemic injury and is not used.

12. An amputated portion of the penis should be:

    1. A. Placed directly on ice to freeze it quickly
    2. B. Submerged in a cup of sterile saline
    3. C. Left in place at the scene for the police
    4. D. Wrapped in moist gauze, bagged, and cooled
    Show answer

    Answer: D. Wrapped in moist gauze, bagged, and cooled

    As with any amputated part, the penis is wrapped in moist sterile gauze, sealed in a plastic bag, and placed on (not in) ice to slow tissue death. Direct contact with ice causes frostbite that makes reattachment less likely.

13. Two hours after a minor blow to the scrotum, a 15-year-old has rapidly worsening testicular pain and vomiting, and the testis lies high. You should consider:

    1. A. A scrotal hematoma to ice at home
    2. B. Epididymitis needing antibiotics
    3. C. Testicular torsion, an emergency
    4. D. A testicular contusion to observe
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    Answer: C. Testicular torsion, an emergency

    Trauma can trigger testicular torsion, and severe, worsening pain with vomiting and a high-riding testis should not be dismissed as a simple contusion. The testis can be lost within hours, so give analgesia and transport promptly to a facility with urology. A contusion or hematoma does not produce a high-riding testis with escalating pain, and epididymitis develops over days with gradual pain rather than this rapid course.

14. A 6-year-old's penile skin is caught in the slider of his pants zipper. Bleeding is minimal, and your protocol allows field release. The preferred technique is to:

    1. A. Pull the slider down in one quick motion
    2. B. Cut the slider's median bar with cutters
    3. C. Excise the trapped skin with sterile scissors
    4. D. Cover it with ice to shrink the skin
    Show answer

    Answer: B. Cut the slider's median bar with cutters

    The median bar is the small bridge joining the front and back plates of the zipper slider; cutting it with wire, bone, or side cutters lets the plates fall apart and the teeth separate, freeing the skin with little further injury. If release is not possible or your protocol does not allow it, cut the zipper out of the clothing to remove the weight of the garment and transport. Forcing the slider down or back tears more skin. Excising trapped skin is a hospital procedure. Ice on a small child's penis delays release, risks cold injury, and does not free the skin.

15. A 32-year-old woman has a laceration to the labia after a straddle injury and is bleeding steadily. You should:

    1. A. Pack gauze firmly into the vagina
    2. B. Apply a tourniquet across the perineum
    3. C. Irrigate the wound with hydrogen peroxide
    4. D. Apply direct pressure with a sterile pad
    Show answer

    Answer: D. Apply direct pressure with a sterile pad

    The female external genitalia have a rich blood supply and bleed briskly, but direct pressure with a sterile dressing or pad controls most bleeding. Nothing should be packed into the vagina in the field.

16. Bleeding from an injury to the female external genitalia can be heavy because the area:

    1. A. Is supplied directly by the aorta
    2. B. Has little fat padding
    3. C. Has a rich blood supply
    4. D. Is inside the peritoneum
    Show answer

    Answer: C. Has a rich blood supply

    The vulva is highly vascular, so even small lacerations can bleed substantially, although direct pressure usually controls it. Its supply comes from pudendal branches of the internal iliac and femoral arteries rather than directly from the aorta, the heavy bleeding reflects vascularity rather than a lack of fat, and the area lies outside the peritoneum.

17. When caring for a patient who reports a sexual assault, your first priority is to:

    1. A. Collect a detailed sexual history
    2. B. Ensure safety and treat injuries
    3. C. Perform a full genital examination
    4. D. Decide whether the story is true
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    Answer: B. Ensure safety and treat injuries

    Scene safety and life-threatening injuries come first, followed by emotional support and preservation of evidence. A detailed genital exam is done by a trained examiner, not in the field.

18. A 22-year-old woman was sexually assaulted an hour ago and wants to shower before going to the hospital. You should:

    1. A. Explain that showering may destroy evidence
    2. B. Let her shower and change into clean clothes
    3. C. Tell her she cannot be treated after showering
    4. D. Insist that police must decide before she goes
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    Answer: A. Explain that showering may destroy evidence

    Explain that bathing, changing, douching, eating, drinking, or brushing teeth can destroy evidence, while respecting her right to choose. She can be treated regardless of her decision.

19. A man has a gunshot wound to the scrotum. In addition to the genital injury, you should carefully check the:

    1. A. Hands for powder burns and soot
    2. B. Prostate with a rectal exam
    3. C. Thighs and groin for vessels
    4. D. Urine with a dipstick test
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    Answer: C. Thighs and groin for vessels

    A bullet through the scrotum often passes through or near the upper thighs and groin, where the femoral vessels and the urethra may be injured. Look for additional wounds, expanding hematomas, and distal pulses, and control junctional bleeding with direct pressure or packing. Gunshot residue on the hands is a forensic detail rather than a care priority, and rectal exams and urine dipsticks are not field assessments that change prehospital care.

20. A 9-month-old is fussy, and you find a tight hair wrapped around the base of his penis, with swelling beyond it. This is best managed by:

    1. A. Waiting for the hair to loosen by itself
    2. B. Applying a tight bandage over the area
    3. C. Massaging the swelling until it goes away
    4. D. Prompt removal, often in the hospital
    Show answer

    Answer: D. Prompt removal, often in the hospital

    A hair tourniquet can strangle the blood supply and cause tissue loss. If the hair cannot be easily unwound, transport promptly for removal with magnification, depilatory cream, or cutting. Waiting, tight bandaging, and massage worsen ischemia. Unexplained tourniquets also warrant consideration of the child's safety.

21. A 16-year-old girl reports that she was sexually assaulted. Which is most appropriate during your care?

    1. A. Perform a detailed exam of the genitals
    2. B. Limit your exam to injuries needing care
    3. C. Interview her in front of the bystanders
    4. D. Have her empty her bladder before transport
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    Answer: B. Limit your exam to injuries needing care

    The field exam is limited to life-threatening or obvious injuries, and the forensic exam is done by a trained sexual assault nurse examiner. Urinating before evidence collection can destroy evidence.

22. A 48-year-old with a known kidney tumor has gross hematuria and flank pain after a minor fall. Compared with a healthy person, his kidney:

    1. A. Can bleed from much less force
    2. B. Is cushioned by the tumor
    3. C. Needs more force than usual to tear
    4. D. Is less likely to cause hematuria
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    Answer: A. Can bleed from much less force

    Abnormal kidneys, such as those with tumors, cysts, hydronephrosis, or an abnormal location, are injured by forces that would not harm a normal kidney, so significant bleeding after minor trauma is possible. Treat for shock as needed and transport. A tumor makes the kidney more fragile rather than cushioning it, and hematuria remains a common sign of injury to an abnormal kidney.

23. A 41-year-old man has flank pain and gross hematuria after a fall from a ladder. His BP is 92/60 mmHg, P 126/min. The priority is to:

    1. A. Collect a urine sample for testing
    2. B. Insert a catheter to track output
    3. C. Have him drink fluids to flush the kidney
    4. D. Treat for shock and transport rapidly
    Show answer

    Answer: D. Treat for shock and transport rapidly

    A renal laceration can bleed heavily into the retroperitoneum, and his vital signs indicate shock. Collecting urine and fluids by mouth delay definitive care.

24. Testicular rupture after blunt trauma requires:

    1. A. Ice and scrotal support at home
    2. B. Urology follow-up within a week
    3. C. Prompt surgical evaluation
    4. D. Oral antibiotics
    Show answer

    Answer: C. Prompt surgical evaluation

    A ruptured testis needs early surgical repair, ideally within hours, to save the organ. Ice and support at home or an office visit days later delays repair and raises the risk of losing the testicle, and antibiotics do not repair the torn tunica.

25. Degloving of the skin of the penis or scrotum, as in a machinery entanglement, should be managed by:

    1. A. Replacing the skin and suturing it
    2. B. Covering with moist sterile dressings
    3. C. Leaving the area open to the air
    4. D. Firmly applying dry, adherent gauze pads
    Show answer

    Answer: B. Covering with moist sterile dressings

    Exposed tissue is covered with moist sterile dressings to prevent drying, bleeding is controlled with gentle pressure, and the patient is transported for surgical reconstruction. Dry adherent gauze damages tissue when removed.