Renal and Urology

Question 1

4 main causes of epididymo-orchitis

Answer 1

E. coli
chlamydia trachomatis
N.gonorrhoea
Mumps

Question 2

Key features of epidydimo-orchitis presentationn

Answer 2

• gradual onset (mins-hrs), unilateral, testicular pain
• Dragging/ heavy sensation
• swelling of testicle & epididymis
• pain relieves when testicle lifted

Question 3

3 featuers suggesting STI cause of epididymo-orchitis

Answer 3

1. <35yo
2. increased sexual partners in last 12 months
3. urethral discharge

Question 4

epididymo-orchitis mannagement

Answer 4

if STI most likely- urgent GUM referral
- if organism unknown: ceftriaxone 500mg IM stat & doxycycline 100mg PO BD 10-1days

if enteric organisms most likely
- send an MSU
- oral quinolone for 2 weeks (e.g. ofloxacin)

Question 5

4 risk factors for pyelonephritis

Answer 5

• Female sex
• Structural urological abnormalities
• Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
• Diabetes

A 45-year-old WOMAN presents to her GP with severe, lower back pain, which is making her extremely nauseous. Two times during the consultation, she excused herself to urinate. Observations are taken, which reveal a heart rate of 102/min, a blood pressure of 123/78mmHg, and a temperature of 39.5 ºC. She has a past medical history of type 2 DIABETES and a herniated lumbar disc, for which she takes regular metformin and codeine phosphate.

Most likely dx - pyelonephritis

Question 6

what is the most common cause of pyelonephritis

Answer 6

E.Coli

Question 7

typical features of pyelonephritis

Answer 7

Fever, loin pain, nausea and vomiting → acute pyelonephritis

Question 8

in investigating pyelonephritis, when should a midstream urine be performed

Answer 8

before Abx

Question 9

pyelonephritis

Answer 9

• 1st line Abx for 7-10 (tx in the community)
  o Cefalexin
  o Co-amoxiclav (if culture results are available)
  o Trimethoprim (if culture results are available)
  o Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)

Question 10

what Abx should be given to a female patient with UTI
PMHx RA
Meds - methotrexate

Answer 10

Nitrofurantoin

1st line for UTI = nitrofurantoin & Trimethoprim

BUT trimethoprim + methotrexate = risk of bone marrow suppression