Renal & Urinary FCM Flashcards by Adele French

What symptoms suggest BPH? (3 marks)

Nocturia,
Urinary hesitancy
Reduced flow

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What is BPH?

Benign Prostatic Hyperplasia

Enlargement of prostate due to natural growth with age

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How would you investigate for BPH? (3 marks)

Urinalysis - rule out UTI

PSA & DRE

US - urinary retention

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What is the medical management for BPH and when would you review this medication?

Tamsulosin

Review at 4 weeks

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Aside Tamsulosin, what other medication would you give if there is a high risk of BPH progression?

Finasteride

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What is the difference between a moving renal colic and renal obstruction?

Kidney stone - constant, dull

Obstruction - episodic, sharp

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What imaging would you request if someone is presenting with symptoms depicting renal colic?

CT-KUB

Non-contrast CT scan of kidneys, ureters and bladder

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What imaging would you request for a pregnant patient presenting with symptoms suggestive of renal colic?

US kidneys, ureters and bladder

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Name 4 causes of acute urinary retention in men

BPH 
Prostate cancer
Paraphimosis
Penile trauma 
(constipation)

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Name 4 causes of acute urinary retention in females

Prolapse
Ovarian cyst
Uterine Fibroid
Constipation

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What medication is contraindicated in the first trimester of pregnancy for a UTI?

Trimethoprim

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What is the first line treatment for a UTI and can be given to pregnant women?

Nitrofurantoin

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What other investigation should you send if a patient presents with a UTI and why?

Mid-stream urine for MC&S to detect bacteria to know which antibiotics

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What should you check in a patients blood when prescribing nitrofurantoin and in what 2 cases should you avoid it?

Renal function - eGFR

Avoid:
Last term of pregnancy
eGFR <45

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What investigations would you do to investigate hyperkalaemia? (3 marks)

ABG/VBG - look for raised potassium and metabolic acidosis

Serial U&Es

12 Lead ECG - Tall tented t waves and flat p waves

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Why would you give a patient with hyperkalemia calcium gluconate

Protect the cardiac membrane has high potassium can lead to arrhythmias

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Why would you give a patient with hyperkalamia insulin-glucose IV infusion?

Insulin acts as a potassium binder and shifts potassium into cells to lower serum levels

Why would you give a hyperkalaemic patient salbutamol nebs?

Shifts potassium into cells

What medications should be stopped in AKI?

D.A.M.N

D - Diuretics
A - ACEi, ARB,
M - Metformin
N - NSAIDS

Why is metformin stopped in AKI?

It is normally excreted from the kidneys - can cause build-up

What 4 things should you consider in a patient with an AKI?

Hyperkalaemia

Optimise fluid balance

Stop nephrotoxic drugs

Consider for dialysis

What is Epididymitis and what is the most common cause?

Pain, swelling and inflammation of the epididymis and posterior scrotum

STI <35

What causes epididymitis in men over 35? (2 marks)

BPH

E.coli

What is prostatitis?

Infection/inflammation of the prostate gland

Name 3 causes of prostatitis

UTI Phimosis (unable to retract foreskin) Urethral stricture

How does prostatitis present? (4 marks)

Dysuria, urgency and hesitancy Pain at base of penis Tender, boggy prostate Systemic features

How would you investigate for prostatitis? (4 marks)

Bloods - inflammatory markers Urine - Urinalysis to check for infection - Urine culture to assess cause STI screen

When would you refer a man to hospital for prostatitis in regards to their PMHx?

Immunocompromised | DM

What is the first line medical management for prostatitis?

Ciprofloxacin 500mg BD for 14 days

How does testicular torsion present? ( 4 marks)

Presents <6 hours from symptom onset History of trauma Previous attacks of pain Vomiting

What is the management of suspected testicular torsion?

Urgent surgery

Does testicular torsion cause pain to the whole scrotum?

Yes

How does epididymitis-orchitis present? (3 marks)

Dull pain Pain and swelling of posterior scrotum Patient sexually active

Is the pain and tenderness relieved by elevating the scrotum in testicular torsion or epididymo-orchitis? (positive phren's sign)

Epididymo-orchitis

Name 3 instances where you would also send off a urine culture in a patient presenting with a LUTI?

Pregnant Recurrent UTI Haematuria

What is rhabdomyolysis?

Results from skeletal muscle breakdown releasing urate, potassium and creatine kinase into the blood

What scenarios would rhabdomyolysis present? (3 marks)

Long duration on the floor (elderly, fall) Trauma to site for long duration Long distance running

Name two important complications of rhabdomyolysis

Hyperkalaemia | AKI

Name 3 investigations you should do in a patient presenting with rhabdomyolysis

ECG Potassium levels Urinalysis

What condition is Nitrofurantoin contra-indicated in and why?

Glucose-6-phosphate deficiency (G6PD) as it can cause haemolytic anaemia

What is Balanitis?

Inflammation of the glans penis

Name 4 signs and symptoms of balanitis

Penile ulcerations Dysuria Non-retractable foreskin Lymphadenopathy Discharge?