Infections

Question 1

What is pyonephrosis

Answer 1

Pus within renal pelvis

Question 2

Investigations for pyonephrosis

Answer 2

Blood and urine cultures

ABG

Question 3

Immediate management of pyonephrosis

Answer 3

Oxygen
IV fluids
IV antibiotics - gentamicin and co-amoxiclav
Contact ITU

Question 4

Options for drainage of pyonephrosis

Answer 4

Percutaneous under LA

Internal under GA

Question 5

Typical history in acute pyelonephritis

Answer 5

Gradual onset
Flank pain
Radiates to iliac fossa or suprapubic region
UTI
Systemically unwell, fever and chills

Question 6

Investigations for acute pyelonephritis

Answer 6

Bedside: temperature/baseline obs and urinalysis
Bloods: FBC, Us and Es, blood cultures
Imaging: US to exclude pyonephrosis
Special tests: urine MCS

Question 7

Management for acute pyelonephritis

Answer 7

Analgesia 
Antibiotics - 14 days co-amoxiclav
Fluids
Antiemetics
DVT prophylaxis

Question 8

Aetiology of epididymorchitis between different demographics

Answer 8

20-40: STI (usually chlamydia)

40+: UTI (usually Ecoli)

Question 9

Antibiotics for epididymorchitis and why

Answer 9

14 days ciprofloxacin as targets STI and UTI causative organisms and penetrates epididymis

Question 10

History of epididymorchitis

Answer 10

Gradual onset
Unilateral testicular pain
LUTS
Ask about mumps vaccinations!

Question 11

Examination findings in epididymorchitis

Answer 11

Erythematous scrotum
Tender testis
Fluctuance - possible abscess 
May have hydrocele
Rarely can have Fourniers gangrene (necrosis of scrotal skin) - need emergency debridement and ABx

Question 12

Management of epididymorchitis

Answer 12

ABx
Analgesia
Follow up STI clinic?