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Primary care > Dysuria and LUTS > Flashcards

Dysuria and LUTS Flashcards

1
Q

Microalbuminuria vs proteinuria

A

Microalbuminuria: Not detected by normal urine dipstick, need special tests in high-risk groups

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2
Q

Causes of proteinuria

A

Vascular: Hypertension, CCF

Infectious: UTI, haeumolytic uraemic syndrome

Trauma: Postural (in adolescents)

Autoimmune: SLE, vasculitis, glomerulonephritis

Metabolic: DM

Neoplastic:Pregnancy (PRE-ECLAMPSIA), myeloma

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3
Q

Causes for microalbuminuria

A

Diabetes Mellitus

Arteriopathy

COPD

Malignancy

Acute illness

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4
Q

Definition of nephrotic syndrome

A

Proteinuria

Oedema

Hypoalbuminaemia

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5
Q

Definition of nephritic syndrome

A

Haematuria

Proteinuria

Oliguria

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6
Q

Causes of nephrotic syndrome

A

Glomerulonephritis

Diabetes

SLE, amyloid

Neoplasms

Endocarditis

Sickle cell, malaria

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7
Q

Complications of nephrotic syndrome

A

Hypovolaemia

Thromboembolism

Hypercholesterolaemia

Infx (esp pneumococcal)

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8
Q

What is strangury

A

‘Tenesmus’ of the urine - desire to pass something that will not pass

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9
Q

Epidemiology of renal stones

A

M>F

Peak age 20-50y

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10
Q

Risk factors for renal stone formation

A

Chronic UTI

Structural kidney abnormality

Hypercalcaemia, gout, cystinuria

Dehydration

Immobilisation

Family history

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11
Q

Presentation of renal stones

A

Pain + nausea/vomiting

Loin pain: Renal stone

Renal colic: Ureteric stone, may refer to testis/penis/labia majora

Strangury: Bladder stone

Interrupted flow: Urethral stone

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12
Q

Management of renal stones

A

Usually resolve spontaneously

Urine dipstick to check for haematuria

Investigate with X-ray/USS (90% radio-opaque)

Diclofenac for pain + anti-emetic

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13
Q

Indications for hospital admission with renal stones

A

Fever

Oliguria

Pregnancy

Lives alone

Poor fluid intake

Symptoms >24h

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14
Q

Differential for renal stones

A

Ruptured AAA

Appendicitis, cholecystitis, pancreatitis

Diverticulitis

Pyelonephritis

Strangulated hernia, testicular torsion

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15
Q

Investigation of haematuria

A

MC&S of MSU

Bloods: creatinine, eGFR, U&E

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16
Q

Differential causes for haematuria

A

Renal: Tumour, stones, interstitial nephritis, infection

Bladder: Stones, tumour, UTI

Prostate: Prostatitis, tumour

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17
Q

Criteria for urgent referral of haematuria

A

Painless macroscopic haematuria any age

Any pt with abdominal mass ?related to renal tract

>40y w/ persistent UTI assoc w/ haematuria

>50 w/ unexplained microscopic haematuria

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18
Q

Criteria for non-urgent referral of haematuria

A

<50 with microscopic haematuria

Proteinuria, high creatinine, low eGFR > renal

Otherwise urology

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19
Q

Differential for sterile pyuria

A

Infective: Inadequately treated UTI, renal TB, non-cultured organism

Inflammatory: Interstitial nephritis/cystitis, prostatitis

Neoplasm: Bladder

Renal: polycystic kidney, calculi

20
Q

Risk factors of bladder cancer

A

M>F

Smoking

Chemical, textile industry

Schistosomiasis (SCC)

Chronic UTI

Urinary stasis

21
Q

Presentation of bladder cancer

A

Haematuria - painless or painful

Less common:

  • Recurrent UTI
  • Frequency
  • Loin pain
  • Pelvic pain
  • Bladder outflow obstruction
22
Q

Risk factors for UTI

A

Female

DM

Prev infection

Stones, stasis

Pregnancy, menopause

Dehydration, catheterisation

23
Q

Presentation of cystitis

A

Frequency, urgency,

suprapubic pain, dysuria,

haematuria, cloudy/offensive urine

incontinence/retention

24
Q

Presentation of pyelonephritis

A

Fevers, malaise, rigors

Loin-to-groin pain

N+V

Haematuria

25
Q

Differential for dysuria

A

UTI

STI (esp chlamydia)

Vulvovaginitis - consider eczema, infection

Interstitial cystitis

Tumour, stone

26
Q

Differential for urinary frequency

A

External pressure: Fibroids, pregnancy, prostatism

Internal space: Stones, tumour, fibrosis (post-radiotherapy)

Inflammation: Cystitis

Neuro: e.g. MS

Other: DM, drugs

27
Q

Indications for urine MC&S

A
  • Pregnant
  • Uncatheterised man
  • Catheterised + symptomatic UTI
  • Unresolving UTI
  • Recurrent UTI
  • Child
  • ?Pyelonephritis
28
Q

When to treat UTI w/o dipstick

A

Severe and/or >=3 symptoms in a woman

29
Q

NPV of non-cloudy urine

A

97% - consider alt dx

30
Q

Common causative organisms for UTIs

A

E. coli (most common!)

Proteus

Pseudomonas

Strep

Staph

31
Q

Leucocyte and nitrite dipstick interpretation

A

Both +ve - 92% PPV

Both -ve - 76% NPV

Nitrite more specific for infx but may miss non-EC infx

32
Q

Management of uncomplicated UTI

A

3d course of nitrofurantoin

100mg m/r BD OR 50 mg i/r QDS

Potassium citrate or Na bicarbonate to ease symptoms

Increase fluid intake

33
Q

What is a complicated UTI

A

Man

Immunosuppression

Structural GU abnormality

Recurrent/relapsed UTI

Pregnancy

7d not 3d course of abx

34
Q

Management of UTI in pregnancy

A

MSU MC&S

100mg m/r nitrofurantoin BD or 50mg i/r qds

7d course

35
Q

Chlamydia testing samples

A

Endocervical swab if female

First void urine if male

36
Q

Prevalence of BPH

A

10-30% of men in 70s

37
Q

Symptoms of prostatism

A

Frequency, urgency, dysuria

terminal dribbling, hesitancy

Incomplete emptying, straining

Intermittent stram

38
Q

Differential for prostatism

A

UTI

Detrusor instability

Urethral stricture

Stone, tumour

Hypercalcaemia, uraemia

39
Q

Conservative management of prostatism

A

Change med timings (Esp diuretics)

Avoid alcohol, caffeine, high fluid esp in evenings

Avoid constipation

Pelvic floor/bladder retraining exercises

40
Q

Drug therapy for prostatism

A

a-adrenoreceptor antagonists: e.g. doxazocin, prazosin - caution for postural hypotension

5a-reductase inhibitors: e.g. finasteride

41
Q

Criteria for referral of prostatism

A

Complicated prostatism (e.g. acute retention)

Raised/rising PSA

Nodular/firm prostate on DRE

42
Q

Presentation of acute bacterial prostatitis

A

Swollen, tender prostate

UTI symptoms

Fever, myalgia, arthralgia

Low back, perineal, penile, rectal pain

43
Q

Contraindications for PSA test (confounders)

A

Ejaculation within 48h

Exercise within 48h

Prostate examination within 1wk

UTI within 1mo

Biopsy/instrumentation within 6w

44
Q

Indications for PSA and DRE ?prostate cancer

A

Erectile dysfunction

Haematuria

Low back pain

Weight loss

Inflammatory/obstructive LUTS

in old age!

45
Q

Effect of having PSA test

A

6-8 y earlier Dx

1 in 1000 reduction in death (from 5 to 4)

No effect on life expectancy

Treatment + investigation: ED, incontinence, pain

46
Q

Issues with prostate cancer screening

A

Unknown natural history

Commonly occurs in old age - unclear survival benefit

Common autopsy incidental (75% over 75) - unclear effect of treatment on survival

Lack of good test

47
Q

False positive and negative rate of PSA

A

70% false positive

15% false negative

Primary care (8 decks)

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