Clinical Cases Flashcards

1
Q

1)
A young woman attends the clinic with a 3 day history of peeing more often and discomfort peeing.
What initial tests do you do?

A

Urine Dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1) You find she has blood, protein, leucocytes and nitrites in her urine. What is the likely diagnosis and what would you do next?

A

A UTI

You’d want an MSSU for culture & Sensitivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

1) How would you treat her UTI?

A

Trimethoprim is the standard Abx for UTI. Alternatives exist e.g. nitrofurantoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

1) What else would you want to know before picking an antibiotic for her?

A

If shes pregnant. Trimethoprim is teratogenic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2) A young man presents with red urine and a 2 day history of a sore throat. On exam he hes hypertensive and a dipstick shows blood and protein in his urine. Whats he likely got?

A

The hypertension and blood sounds like Nephrritic syndrome
Could be post-infective GN but that takes 7-14 days after infection not 2.
Most likely its IgA GN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2) How would you confirm your diagnosis?

A

Renal Biopsy

Preceeded by US & Coagulation screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2) How would you treat?

A
ACEI for the hypertension
Supportive Therapy (including monitor progression of disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

3) Elderly male presents with 4 wks of painless frank haematuria. Whats the likely diagnosis?

A

Painless frank haematuria in the elderly is Bladder Cancer until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3) How would you investigate?

A

Cystoscopy:

-> If bladder cancer biopsy to confirm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3) How do you continue if theres no visible bladder canceR?

A

CT-KUB to check for a higher up cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

4) 10 yrd old boy comes in with facial & eyelid swelling, ankle swelling and frothy urine. On urine dipstick he has protein in his urine. Whats the likely diagnosis?

A

Well Oedema & protein in urine indicates nephrotic syndrome.
Nephrotic syndrome in a kid is minimal change disease until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4) how do we confirm/treat the diagnosis?

A

With a renal biopsy (but if were sure we don’t biopsy every 10 yr old)
Steroids for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

5) 71 yr old female presents with 3 wks of fever, anorexia, malaise and rigors. Initial bloods show:
- Low Hb
- High WCC
- High Platelets
- Very High ESR
- High Creatinine
- High Urea
- Low Albumin
- High Alk Phos
Slightly hypertensive

What would be your initial tests?

A

Sigmoidoscopy
Ba Enema
ERCP
CT Thorax/Abdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5) Initial investigations are all normal bar small pleural effusions on CT chest.
How would you respond?

A

Treat with Abx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5) Abx had no effect how would you further investigate?

A

Urinalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

5) Urinalysis shows severe haematuria and proteinuria.

What does this suggest and how do you respond?

A

Coupled with the hypertension and signs of renal insufficiency this suggests nephritic syndrome

Do a renal biopsy

17
Q

5) Renal Biopsy shows Focal Necrotising GN. How do you treat?

A

Cyclophosphamide & Prednisalone