23/5 Flashcards
How does acute interstitial nephritis present?
Triad
- fever
- rash
- eosinophilia
Often triggered by penicillins
How is bacterial conjuncitivitis managed?
- Self care - regular bathing and cleaning of the eyelids (typcially takes 5-10days to clear)
- Topical chloramphenicol (sometimes delayed prescription given)
What is haemoatocrit?
Ratio of RBC to the volume of water (increases in dehydration as water is lost)
How much adenosine is given in each bolus in SVT?
6mg (max of 30mg)
ADENOSine = 6 letters = 6mg
Symptoms of Gilbert’s syndrome
Autosomal recessive condition which causes reduced activity of enzyme which conjugates bilirubin
Asymptomatic apart from periodical jaundice triggered by physical or psychological stress
VIVA for bladder cancer
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
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
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)
How is nephrotic syndrome investigated and managed?
Urine dipstick - proteinuria
Urinalysis - raised creatine:albumin ratio
Management = high dose steroids
What does brown urine suggest?
Conjugated bilirubin accumulation = biliary obstruction
Who should not get urine dipstick used and just go straight to MSU to lab?
Women >65 (dipstick becomes more unreliable as get older) and catheterised patients (can be cross contamination)
What abx are used in last trimester in pregnancy?
Amoxicillin and celefexin
Can you have a UTI if just nitrites ?
Can you have a UTI if just leukocytes?
Can if just nitrites NOT if just leukocytes
What party drug is associated with bladder problems?
Ketamine
