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Yr 4 - ACC > Corrections - Urology > Flashcards

Corrections - Urology Flashcards

1
Q

1st line Abx in pregnant women in 1st trimester?

A

Nitrofurantoin

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2
Q

What test should all pregnant women receive after treatment for a UTI?

A

Test of cure MSU

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3
Q

Management of 2-month-old with suspected UTI?

A

Refer immediately to hospital/paediatrician

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4
Q

What is the investigation of choice to diagnose vesicoureteric reflux?

A

Micturating cystourethrogram –> an imaging test that involves filling the bladder with a contrast material and then taking x-rays while the patient urinates to visualise any reflux of urine back up into the ureters or kidneys.

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5
Q

What is the most common histological subtype of renal cell cancer?

A

Clear cell

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6
Q

What classic triad of features is seen in renal cell cancer?

A

1) haematuria
2) loin pain
3) abdo mass

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7
Q

Features of renal cell cancer?

A

1) classical triad:
- haematuria
- loin pain
- abdominal mass

2) pyrexia of unknown origin

3) endocrine effects:
- may secrete erythropoietin (polycythaemia)
- PTHrP (hypercalcaemia), renin
- ACTH

4) paraneoplastic hepatic dysfunction syndrome

5) varicocele

6) Stauffer syndrome

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8
Q

What is Stauffer syndrome?

A

A paraneoplastic disorder associated with renal cell cancer.

Typically presents as cholestasis/hepatosplenomegaly

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9
Q

What are some possible endocrine effects of renal cell cancer?

A
  • may secrete EPO –> polycythaemia
  • may secrete PTHrP –> hypercalcaemia
  • may secrete ACTH
  • may secrete renin
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10
Q

What test should be done for all women with a suspected UTI if associated with visible or non-visible haematuria?

A

MSU

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11
Q

What MSU result is diagnostic of a UTI?

A

A pure growth of >10^5 organisms/mL

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12
Q

Examples of ‘voiding’ LUTS in men?

A
  • hesistancy
  • poor or intermittent stream
  • straining
  • incomplete emptying
  • terminal dribbling
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13
Q

Examples of ‘storage’ LUTS in men?

A
  • urgency
  • frequency
  • nocturia
  • urinary incontinence
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14
Q

Examples of ‘post-micturition’ LUTS in men?

A
  • Post-micturition dribbling
  • Sensation of incomplete emptying
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15
Q

What scoring system can be used to assess the impact of LUTS on a patients life?

A

International Prostate Symptom Score (IPSS)

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16
Q

Management of predominantly ‘voiding’ LUTS?

A

1) Conservative measures include: pelvic floor muscle training, bladder training, prudent fluid intake and containment products.

2) If ‘mod’ or ‘severe’ symptoms –> add alpha blocker e.g. tamsulosin

3) If if the prostate is enlarged and patient is ‘considered at high risk of progression’ –> offer a 5-alpha reductase inhibitor e.g. finasteride

4) If mixed symptoms of voiding and storage not responding to an alpha blocker then an antimuscarinic drug may be added e.g. oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)

17
Q

What are some management steps to help nocturia in patients with LUTS?

A
  • advise about moderating fluid intake at night
  • furosemide 40mg in late afternoon may be considered
  • desmopressin may also be helpful
18
Q

What is the upper limit of residual urine (i.e. post void volume) in patients:

a) < 65 years old
b) >65

A

a) <50ml is normal

b) <100ml is normal

19
Q

Define chronic urinary retention (in terms of post-voiding volume)?

A

the presence of >500ml within the bladder after voiding.

20
Q

What is a complication of acute urinary retention?

A

Post-obstructive diuresis

21
Q

what is post-obstructive diuresis?

A

The kidneys may increase diuresis due to the loss of their medullary concentration gradient upon catheterisation.

This can take time re-equilibrate
this can lead to volume depletion and worsening of any AKI.

Some patients may therefore require IV fluids to correct this temporary over-diuresis

22
Q

Length of Abx course in women >65?

A

3 days

23
Q

What class of drug is useful for an overactive bladder if conservative measures fail?

A

Antimuscarinics e.g. oxybutynin, tolterodine, darifenacin.

24
Q

In men with a UTI, do you treat with Abx empirically or wait for MSU results?

A

Treat empirically with 7 day course

Yr 4 - ACC (73 decks)

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