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Phase 3a > General > Flashcards

General Flashcards

1
Q

How many days should uncomplicated UTI be treated for ?

A

3

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2
Q

How many days should a complicated UTi be treated for

A

7

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3
Q

What medication is used to tx pyleonephritis

A

-IV coamoxiclav +/- gent

+ fluid resus +/- drainage of obstructed kidney

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4
Q

List which Pt are considered to have complicated UTIs

A 
Male 
Pregnant
Children
Catheterised 
Recurrent / persistent 
Urosepsis
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5
Q

What two factors are contraindications to nitrofuratoin in uti tx

A

Third trimester

Poor renal function

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6
Q

What are the causes of pyleonephritis

A

Ascending - catheter / intercourse
Heamatogenous
Lymphatic

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7
Q

What microorganisms can be responsible for UTIs

A

Ecoli (common - coliform , gram -ve bacillus , pink on McConkey agar)

Klebsiella - catheter aq

Proteus - associated with renal stones

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8
Q

Signs and symps of pyleonephritis

A

Lion pain
Pyuria
Pyrexic
RA tenderness

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9
Q

Would you treat assymptomatic 65+

A

No

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10
Q

Complications of catheters

A

Chronic inflam
UTIs
Renal stones

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11
Q

Investigations for pyleonephritis

A

Bloods + culture
MSU
Abdo exam -RA tenderness , exclude tubular, ovarian, appendix
USS

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12
Q

When should urolithesis be surgically removed?

A

Coexisting obstruction

Sepsis

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13
Q

What is the management of urolithesis confirmed by CT

A

Nsaids
Antiemetics
Hydration

(Alpha blocker ie, tamsulosin)

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14
Q

Differentials for renal colic

A 
Bilary colic
Chloecystitis
Peritonitis
Appendicitis 
Endometriosis
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15
Q

Investigations for renal colic

A

CT
Urinalysis

Bloods- FBC, U&E, Cr
Pregnancy test

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16
Q

Surgical treatment for urolithesis

A

Retrograde stent
Percutaneous nephrostomy

Shockwave lithrotripsy

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17
Q

Causes of heamaturea

A 
UTI
Acute pyleonephritis
Bladder cancer
Prostate cancer
BPH
Renal colic 
Mensuration
Recent instrumentation of the urinary tract
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18
Q

Two factors that progression of CKD to ESRF relies on

A

Bp control

Underlying nephropathy

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19
Q

Causes of CKD

A 
Primary Glomerulonephritis
Atherosclerotic vascular disease
PKD
Progression from AKI
SLE
20% idiopathic
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20
Q

RFs for CKD

A 
Female
Age
Hypertension 
Diabetes 
Smoking 
AKI
Chronic use of NSAIDs
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21
Q

What does GFR have to be below for CKD

A

<60ml/min (G3)

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22
Q

Complications of CKD and why

A

Anaemia (herceptin is not excreted so Fe cannot be absorbed from duo)

Heart failure due to fluid overload

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23
Q

5 kidney functions

A 
Nitrogenous waste excretion 
Fluid electrolytes balance
Vitamin D metabolism 
RBC production (erythropoietin synth)
Acid base balance (metabolic compensation)
24
Q

4 nephrotixic drugs

A

Metformin
NSAIDs
Acei
Diuretics

25
Q

Treatment for stress incontinence

A

Pelvic floor exercises

Colposuspension/ sling surgery

26
Q

Treatment for overflow incontinence

A

Tamsulosin

Intermittent catheterisation

27
Q

Tx for OAB/ urge incontinence

A

Bladder training
No caffeine or alcohol
Distraction techniques

Antimuscarinics - oxybutanin / tolterodine
Botox injections

28
Q

Tx of nocturia

A

Desmopressin

29
Q

Two components of urodynamics

A

Flow rate+ residual volume

freq volume chart

30
Q

2 causes of low flow rate

A

Detrusor under-activity

Obstruction

31
Q

Parasympathetic innervation of voiding

  • nerve roots
  • function
A

S2-s4

Detrusor contraction.

32
Q

Sympathetic innervation of voiding

  • nerve roots
  • function
A

T10-L2

Contraction of sphincter, inhibits detrusor contraction

33
Q

Complications of BPE

A 
Stones
Infections
Incontinence 
Retention 
Symptomatic voiding
34
Q

Two components of BPH

A

Static - glandular and Stromal hyperplasia and-hypertrophy

Dynamic - sm contraction of prostrate

35
Q

Incontinence investigations

A

Bloods- PSA, renal func

PR, abdo, genital exam

Urodynamics

MSU

BLADDER SCAN

TRUSS / flexible cystoscopy

36
Q

What is the scoring system used for BPH

A

IPSS

International prostate scoring system

37
Q

What is the normal post void residual volume

A

<12mls

38
Q

What might you see on USS with a post mic residual volume of >250mls?

A

Hydronephresis- dilated ureters

39
Q

What are the treatments for BPH and their SE/ complications

A

Finesteride tackles the static component - 5alpha reductase inhibitor - SE ED

Tamsulosin tackles the dynamic part - alpha adrenergic antagonist -SE postural hypotension, retrograde ejac

TURP- infection, haemorrhage, clots, ED

40
Q

What is the surgical criteria forTURP?

A

RUSHES

Retention
UTI
Stones
Heamaturia
Elevated Cr
Symptoms worsening
41
Q

What is chronic retention+ low pressure a sign of

A

Detrusor failure

42
Q

Pharma Treatment for HfrEF

A

Class 1- ACEI +Beta blocker
Class 2- above / ARB+ aldosterone antagonist
Class 3 - above + isosorbide dinitrate
Class 4- diuretic

43
Q

None pharma tx of HFrEF

A

Refer to advanced HF programs

Refer for possible pacemaker

44
Q

Tx of HFpEF

A

Blood pressure control

Symptom management I.e. diuretics for breathlessness

45
Q

Treatment algorithm for hypertension

A 
ACD
<55:
A
A+Cor D
A+C+D
A+C+D+ MCRA(spirolactone)
>55:
C or D
A2 / A+ C
A+C+D
46
Q

Secondary causes of hypertension

A

Coarctation of the aorta
OCP
Low K+ (underlying Cohns)
Vascular / congenital abnormalities

Renal artery stenosis - increased serum Cr
Thyroid disorder
Aldosteronism (sign= hypocalemia)
Iatrogenic drugs- sertoids, immunoSs, TCAs,

47
Q

Lifestyle changes in hypertension

A 
Low Na diet
Reduce alcohol 
Stop smoking.
Exercise 
Wt reduction
48
Q

What is considered stage 2 hypertension

A

160-179/ 100-109

49
Q

What stages of Hypertension do you treat

A

Stage 2+ or stage 1 if diabetic/ CVA / Hf/ renal probs

50
Q

What symptom+sign in addition to Hx of hypertension requires admission

A

Headache

Papillodema

51
Q

Hypertension investigations

A 
ABPM 
ECG
Urine Dip - ACR , protein/ blood 
fundoscopy 
Bloods= hba1c, LFTs , Cr U&amp;E (end organ damage)
52
Q

Name two thiazide diuretics

A

Bendroflumethiazide.

I dap Amie’s

53
Q

SE of ACEi

A

Dry cough

Detrimental on Renal function, check this before starting in elderly

54
Q

SE of amlodipine

A

ankle swelling

55
Q

SE of diuretics

A

ED!

Thiazide diuretics can cause hyponatremia in the elderly

Phase 3a (7 decks)

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