23/5

Question 1

How does acute interstitial nephritis present?

Answer 1

Triad
- fever
- rash
- eosinophilia

Often triggered by penicillins

Question 2

How is bacterial conjuncitivitis managed?

Answer 2

1. Self care - regular bathing and cleaning of the eyelids (typcially takes 5-10days to clear)
2. Topical chloramphenicol (sometimes delayed prescription given)

Question 3

What is haemoatocrit?

Answer 3

Ratio of RBC to the volume of water (increases in dehydration as water is lost)

Question 4

How much adenosine is given in each bolus in SVT?

Answer 4

6mg (max of 30mg)

ADENOSine = 6 letters = 6mg

Question 5

Symptoms of Gilbert’s syndrome

Answer 5

Autosomal recessive condition which causes reduced activity of enzyme which conjugates bilirubin

Asymptomatic apart from periodical jaundice triggered by physical or psychological stress

Question 6

VIVA for bladder cancer

Answer 6

Most likely transitional cell Ca (90%)

Hx
Painless frank haematuria

Shx - smoker, industrial dyes

Invx
Bedside
- abdo exam
- dipstix

Bloods
- not indicated

Imagining
Cytoscopy
2 week referral if:
>45 with visible haematuria and no UTI or post-UTI treatment
>60 non-visible haematuria AND dysuria/raised WCC

Management
- graded with TNM (T2 = muscle, T4 = mets) work out the rest

Non-muscle invasive
- chemo and immunotherapy
transurethral resection of the bladder tumour

Muscle invasive
radial cystectomy with unirary diversion

Question 7

DDx and following investigation/management for the following urinalysis results:
- haematuria
- glucose
- raised specific gravity
- nitrites and leukocytes

Detail about UTI investigation and management depending on pt

Answer 7

Haematuria
- UTI, renal calculi
- cancer of the urinary tract (in particular bladder)
- nephritic syndrome (GN, IgA, PSGN, goodpasture’s)
- trauma to the urinary tract
- menstruation

Dependant on sx - CT KUB, cytoscopy, microscopy and culture (UTI), U+Es (GN)

Glucose
- ? diabetes
- capillary blood glucose + HbA1c

Raised specific gravity
- dehydration

Nitrites and leukocytes on dipstick = UTI
Women = 3 days nitrofuratonin/trimethomprim
Men + pregnant women + children = MSU

Men + preggers = 7 day course = nitro (expect for last trimester = amoxicillin/cefelexin)

Question 8

How is nephrotic syndrome investigated and managed?

Answer 8

Urine dipstick - proteinuria
Urinalysis - raised creatine:albumin ratio

Management = high dose steroids

Question 9

What does brown urine suggest?

Answer 9

Conjugated bilirubin accumulation = biliary obstruction

Question 10

Who should not get urine dipstick used and just go straight to MSU to lab?

Answer 10

Women >65 (dipstick becomes more unreliable as get older) and catheterised patients (can be cross contamination)

Question 11

What abx are used in last trimester in pregnancy?

Answer 11

Amoxicillin and celefexin

Question 12

Can you have a UTI if just nitrites ?
Can you have a UTI if just leukocytes?

Answer 12

Can if just nitrites NOT if just leukocytes

Question 13

What party drug is associated with bladder problems?

Answer 13

Ketamine