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FCM > Renal / GU > Flashcards

Renal / GU Flashcards

1
Q

What aids the diagnosis of UTI in a woman under 65 years

A
  1. Urine Dipstick
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2
Q

When do you send a urine sample for culture in UTI to confirm diagnosis.

A
  1. recurrent UTI, or possibility of antibiotic resistance.
  2. only positive for leukocyte.
  3. Have visible or non visible haematuria on UTI
  4. Older than 65
  5. Pregnant
  6. Has a catheter
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3
Q

Do you routinely perform a sub-preputial swab to confirm diagnosis of balantitis?

A

No - only if you suspect candida or bacterial culture

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4
Q

What do you use to support the initial diagnosis of renal colic?

A

Urine dipstick - the presence of haematuria supports renal or ureteric colic.

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5
Q

What do you use to confirm the diagnosis of suspected renal and ureteric colic?

A

Urgent imaging within 24 hours - Low dose non-contrast CT.

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6
Q

What do you do for asymptomatic renal stones that are less than 5mm

A

Watchful waiting. Can also do this if it is larger that 5mm.

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7
Q

What ECG changes do you notice in Hyperkalaemia

A
  1. Tall peaked (tented) T waves
  2. Loss of P wave
  3. widened QRS with tall T wave
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8
Q

What is the investigation used for Acute urinary retention

A

post-void bedside bladder scan - will show the volume of retained urine.

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9
Q

How is hydronephrosis diagnosed?

A

Ultrasound

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10
Q

Investigations for BPH ( Bladder problems (frequency, urgency, nocturia) and obstructive flow problems (hesitancy, terminal dribbling, intermittent flow, incomplete urine sensation from bladder (vesical tenesmus)

A
  1. Urinalysis (Hematuria)
  2. PSA (cannot differentiate between prostate cancer or BPH)
  3. DRE (assess the size and shape, surface of the prostate)
  4. IPPS (questionnaire on how it effects life, 0 best 5/6 worst)
  5. u&e’s to see the effect on the kidney damage
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11
Q

Cystitis - UTI (Lower urinary tract - urethra & bladder)

A

Urinalysis - leukocytes PLUS NITRITES
Culture (E.coli, klebsiella,
Cystoscopy (unsure why - looks into the bladder and the urethra)

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12
Q

Investigations for acute acute prostatitis?

A 
MSU midstream specimen of urine (culture, microscopy, sensitivity)
Blood cultures
DRE
FBC
STI screening
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12
Q

Investigations for acute acute prostatitis?

A 
MSU midstream specimen of urine (culture, microscopy, sensitivity)
Blood cultures
DRE
FBC
STI screening
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13
Q

Investigations for urethritis (Gonococcal or non-gonocchochal)

A

Urethral swab

NAAT

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14
Q

What do you test for epididymitis (commonly due to Gonorrhoea or chlamydia, enteric organisms) and what are the symptoms?

A

Urine dipstick
urine culture
swollen, red, warm, painful testicle (can be 1 or both), possible discharge from penis, blood in semen and pain in suprapubic region.

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15
Q

How do you diagnose AKI?

A
  1. creatinine rise by 26mmol/l within the last 48 hours
  2. 50% rise from baseline over 7 days
  3. less that 0.5 ml/kg per hour for more than 6 hours
16
Q

What is defined as oliguria?

A

urine output of less than - 0.5ml/kg/hr

17
Q

How is AKI detected symptomatically?

A
  1. decrease urine output 0.5ml/kg/hour
  2. fluid overload (pulmonary and peripheral oedema)
  3. increase in metabolites that are usually kept in control by kidneys, potassium (arrythmias), urea (features of uremia, encephalitis, pericarditis) and creatinine.
18
Q

How is AKI detected?

A

U & E’s (sodium, potassium, urea and creatinine)
Urinalysis
Imagining renal US - if no detectable cause found within 24 hours.

19
Q

What are the investigations for renal calculi (nephrolithiasis)

A

Urine dipstick (blood ++)
Non-contrast CTKUB
IV Urogram
US if pregnant

20
Q

When would you intervene for a renal calculi?

A

<5mm watchful waiting
<2cm lithotripsy and uteroscopy in pregnancy
Complex or staghorm calculi (Staghorn stones are large and branching stones that fill part or all of the pelvicalyceal system) may lead to nephrectomy

21
Q

what are the indications of 24 hr urinary collection?

A

Kidney stones - stone risk assessment 48 hrs.
Pheochromocytoma - 24 hr free metanephrines
Cushing syndrome - 24 hr free urinary cortisol

22
Q

When do you do a CT in the urinary tract?

A

Staging of cancer
Metastatic disease
Frank haematuria
upper and lower tract disease

23
Q

What is a urogram?

A

Imaging and contrast used to take images in the:
1. nephrogenic phase (will light up white, for masses and cysts)
2. excretory phase (once adminstered the contrast, can watch urination and see defects in this process.
Helps detect causes for frank haematuria, renal masses.

24
Q

what is a cystoscopy

A

helps to view the lUT, causes of haematuria, obstruction, and detected bladder cancer. Can take biopsy and put in stents and remove bladder stones.

25
Q

What does doppler ultrasound show you?

A

DOPPLER = always used to show blood flow.
In the kidneys, hypertension, dysplasia, fibromuscular problems can cause renal artery stenosis, renal bruits (Treated by angioplasty) and obstructions.

26
Q

When would you do renal ultrasound?

A

Hydronephrosis, hematuria, loin pain, erectile dysfunction

27
Q

What does a raised urobiligin indicate?

A

Hemolytic anemia

malaria

28
Q

What does bilirubin the urine indicate?

A
  1. high - liver disease

2. low - blockage in the gall bladder.

29
Q

What is prostatitis, how is it diagnosed and when would your urgently refer?

A

UTI symptoms + obstructive voiding symptoms + acute retention + penile pain, and pain during sex/ejaculation, back pain.

Urine culture and examination - swollen, tender and warm.

Urgent referral if patient is immunocompromised, has diabetes or has BPH would require specialist referral.

30
Q

Always arrange follow up in how many hours for prostatitis?

A

48 hours and to check urine culture - that you are on the correct antibiotics.

14 days to check if they are getting better and to continue antibiotics for a further 14 days.

refer for investigation after recovery for structural abnormalities of the urine tract.

31
Q

When would you arrange an ultrasound for scrotal swelling?

A

NOT if its acute.
only if there is uncertainty in the diagnosis
hematocele without trauma
hydrocele (in 18-30 year olds)

32
Q

What would you do for a patient that has acute epidiymo-orchities, testicular torsion or strangulated inguinal hernia?

A

Urgent hospital admission/referral

FCM (13 decks)

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