Renal & Urinary FCM Flashcards
What symptoms suggest BPH? (3 marks)
Nocturia,
Urinary hesitancy
Reduced flow
What is BPH?
Benign Prostatic Hyperplasia
Enlargement of prostate due to natural growth with age
How would you investigate for BPH? (3 marks)
Urinalysis - rule out UTI
PSA & DRE
US - urinary retention
What is the medical management for BPH and when would you review this medication?
Tamsulosin
Review at 4 weeks
Aside Tamsulosin, what other medication would you give if there is a high risk of BPH progression?
Finasteride
What is the difference between a moving renal colic and renal obstruction?
Kidney stone - constant, dull
Obstruction - episodic, sharp
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
What imaging would you request for a pregnant patient presenting with symptoms suggestive of renal colic?
US kidneys, ureters and bladder
Name 4 causes of acute urinary retention in men
BPH Prostate cancer Paraphimosis Penile trauma (constipation)
Name 4 causes of acute urinary retention in females
Prolapse
Ovarian cyst
Uterine Fibroid
Constipation
What medication is contraindicated in the first trimester of pregnancy for a UTI?
Trimethoprim
What is the first line treatment for a UTI and can be given to pregnant women?
Nitrofurantoin
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
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
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
Why would you give a patient with hyperkalemia calcium gluconate
Protect the cardiac membrane has high potassium can lead to arrhythmias
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?
