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Year 5 notes > Urinary and reproductive > Flashcards

Urinary and reproductive Flashcards

1
Q

organisms causing UTIs in immunosuppressed (otherwise is E coli)

A
  • klebsiella
  • candida
  • pseudomonas
  • proteus vulgaris
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2
Q

when to do urine MC&S in UTI

A
  • always in men
  • > 65
  • not required if symptomatic in non-pregnant women
  • if failed to respond to treatment
  • haematuria
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3
Q

when to do 2 week wait in UTI

A
  • 45+ and unexplained visible haematuria

- 60+ and unexplained non-visible haematuria and dysuria/raised WCC

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4
Q

antibiotics to give in pyelonephritis (empirical before culture results)

A

oral ciprofloxacin 7-10 days

or co-amoxiclav 7 days

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5
Q

when to give antibiotic prophylaxis for pyelonephritis

A
  • women with 3 symptomatic infections a year

- prophylaxis in children with VUR, recurrent infections or scarring on imaging

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6
Q

drugs causing prostatic acute urinary obstruction

A
  • anticholinergics
  • opioids
  • alpha agonists
  • benzos
  • CCB
  • NSAIDs
  • TCAs
  • antihistamines
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7
Q

what do you find in urinalysis in pyelonephritis

A

white cell casts in urine

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8
Q

what confirms diagnosis of prostatic acute urinary obstruction on bladder USS

A

> 300cc

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9
Q

what to offer 2 days before catheter removal in prostatic acute urinary obstruction

A

alpha blocker (then TWOC following alpha blocker commencement e.g. tamsulosin)

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10
Q

prostatic surgeries carried out for prostatic acute urinary obstruction

A
  • TURP

- HoLEP (becoming more common)

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11
Q

long term medical treatment for BPH

A
  • 5-alpha reductase inhibitors (finasteride)

- +/- alpha blockers

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12
Q

definition of severe hyperkalaemia

A

> 6.5

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13
Q

drugs causing hyperkalaemia

A
  • ACEi
  • ARBs
  • spironolactone
  • beta blockers
  • LMWH
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14
Q

when is immediate treatment required for hyperkalaemia

A
  • > 6 with ECG changes or

- >6.5

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15
Q

drugs used to treat hyperkalaemia

A

CIGS

  • calcium gluconate IV (10ml 10%)
  • insulin/dextrose infusion (10 units act rapid in 50ml 50% glucose over 20 mins)
  • salbutamol nebs (5mg back to back over 10-20 mins)

also 15g oral calcium resonium/loop diuretics/dialysis to remove potassium from body

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16
Q

definite management of testicular torsion

A

immediate surgery = contralateral testis should also be fixed - 50% chance of torsion if not treated

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17
Q

when can you do expectant management of an ectopic

A
  • if <30mm, unruptured, asymptomatic, no foetal heartbeat
  • serum <200 and declining

closely monitor patient over 48 hours and perform intervention if hCG levels rise/symptoms then perform intervention

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18
Q

when can you do medical management of an ectopic

A
  • hCG <1500 and falling
  • if <35mm, unruptured, no pain, no foetal heartbeat
  • not suitable if also an intrauterine pregnancy
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19
Q

medical management of ectopic

A

methotrexate IM - takes 4-6 weeks to completely resolve

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20
Q

how do recurrent attacks of genital herpes occur

A

reactivation of latent virus in sacral ganglia - may be triggered by:

  • stress
  • sex
  • menstruation
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21
Q

gold standard diagnostic test for genital herpes

A

viral PCR of vesicle fluid

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22
Q

treatment of first episode of genital herpes

A

saline baths
lignocaine gel
analgesia
acyclovir 400mg TDS (need to start within 5 days)

some patients with frequent exacerbations may benefit from longer term acyclovir

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23
Q

what to do if first episode of genital herpes is in last stages of pregnancy (>28 weeks)

A

consider C/S to avoid dissemination (neurological effects/death)

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24
Q

test for HIV which can be done 3-4 weeks after infection

A

4th generation test - combination of antibody and antigen (p-24 antigen detected after 3-4 weeks but antibody takes 4-8 weeks to develop)

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25
Q

type of rash in HIV seroconversion illness (3-12 weeks after exposure)

A

maculopapular, on trunk

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26
Q

when does AIDs occur after infection with HIV

A

around 8 years after - death within 2 years without treatment

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27
Q

what is oral hairy leukoplakia indicative of

A

HIV

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28
Q

main indicator of risk of opportunistic infections in HIV

A

CD4 cell count

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29
Q

when do you start to get symptoms for CKD

A

stage 4 and 5 (otherwise often an incidental finding)

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30
Q

ACR levels and when to refer for CKD

A

if 3-70 repeat in 3 months

if >70 refer to nephrologist

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31
Q

what to do if eGFR <60

A

repeat within 2 weeks

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32
Q

criteria for diagnosis of CKD stages

A
  • tests >3 months shown a reduction in kidney function or the presence of proteinuria
  • eGFR is persistently <60 and/or urine ACR is persistently >3
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33
Q

do you have CKD if your eGFR is >60 and you have no other evidence of kidney damage

A

no - only stages 1 and 2 if:

1 = >90 and other evidence of damage

2 = 60-89 and other evidence of damage

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34
Q

BP targets for CKD

A

if ACR <70 - 140/90

if ACR >70 - 130/80

give ACEi to manage

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35
Q

medication to give in CKD

A
  • ACEi
  • atorvastatin 20mg
  • anti platelet
  • vaccines

avoid nephrotoxic drugs

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36
Q

criteria for detecting AKI

A
  • rise in serum creatinine of 26+ in 48 hours
  • 50% or greater rise in serum creatinine in past 7 days
  • drop in urine output to 0.5ml/kg/hr for 6 hours in adults
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37
Q

when is RRT indicated in AKI

A
  • pulmonary oedema
  • persistent high potassium
  • pH <7.15
  • encephalopathy, pericarditis, drug overdose
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38
Q

if surgery is needed for stress incontinence what is carried out

A

tension-free vaginal tape (TVT)

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39
Q

triad of features in nephrotic syndrome

A
  • proteinuria (>3)
  • hypoalbuminaemia (<30)
  • oedema
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40
Q

why can nephrotic syndrome result in thrombosis e.g. renal vein thrombosis

A

loss of antithrombin-III, proteins C and S and associated rise in fibrinogen

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41
Q

why does nephrotic syndrome increase the risk of infection

A

urinary immunoglobulin loss

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42
Q

why does nephrotic syndrome cause hypocalcaemia

A

vitamin D and binding protein lost in urine

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43
Q

management of non-muscle invasive bladder cancer

A

transurethral resection od bladder tumour

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44
Q

management of invasive bladder cancer

A

radical cystectomy/radiotherapy, neoadjuvant chemotherapy

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45
Q

genes associated with prostate cancer

A

BRCA2

pTEN

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46
Q

first line investigation for hydronephrosis

A

USS

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47
Q

treatment of acute vs chronic UUT obstruction

A

acute = nephrostomy tube

chronic = ureteric stent/pyeloplasty

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48
Q

why can renal carcinoma cause a varicocele

A

occlusion of left testicular vein

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49
Q

will U&Es always be abnormal in renal carcinoma

A

no - if one kidney is functioning well renal function will be normal

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50
Q

potential FBC findings of renal carcinoma

A

anaemia

polycythaemia (may secrete EPO)

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51
Q

most common site of mets of renal carcinoma

A

lungs - cannon ball secondaries is almost diagnostic

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52
Q

what can be used to reduce tumour size and treat mets in renal carcinoma

A

alpha interferon and interleukin 2

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53
Q

type of urinary stones associated with chronic infections

A

struvite stones

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54
Q

why does an ileostomy increase the risk of urinary stones

A

loss of bicarb and fluid = acidic urine = uric acid precipitation

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55
Q

type of diuretics which can increase the risk of and decrease the risk of urinary stones

A

loop diuretics can increase

thiazide diuretics can decrease calcium stones

56
Q

imaging to do for urinary stones

A

CT KUB within 14 hours of admission (immediately if fever, solitary kidney or uncertain diagnosis - may need to exclude AAA)

57
Q

drugs which can be used to facilitate stone passage

A

CCBs or alpha blockers

58
Q

size of urinary stones which usually pass spontaneously

A

<5mm

can do lithotripsy, nephrolithotomy in severe cases

usually pass in 4 weeks

59
Q

treatment of urinary stones 5mm-2cm

A

extracorporeal shock wave lithotripsy

if PREGNANT = uretoscopy

60
Q

drugs to prevent uric acid stones

A

allopurinol

61
Q

type of polycystic kidney disease presenting in childhood

A

recessive

dominant presents in adulthood

62
Q

extra renal signs of ADPKD

A
  • polycystic liver disease (reflux, dyspnoea, early satiety, haemorrhage)
  • infertility in men
  • pancreatitis
  • aneurysms
63
Q

imaging for urethral stricture

A

cystoscopy

64
Q

diagnosis of VUR

A

micturating cystourethrogram

DMSA scan to look for renal scarring

65
Q

4 types of glomerulonephritis

A
  • minimal change (children, nephrotic syndrome)
  • diffuse (all glomeruli)
  • focal (only some glomeruli)
  • segmental (parts of affected glomerulus)
66
Q

type of glomerulonephritis which may be associated with HIV

A

focal

67
Q

when to give PEP for HIV

A

anyone who has had unprotected sexual contact/condom failure with a high-risk source within last 72 hours

take for 28 days

high risk source = known HIV positive or unconfirmed HIV status but MSM, from country high HIV prevalence or IVDU

68
Q

AIDS-related malignancies

A
  • Kaposi’s sarcoma
  • non-Hodgkin’s lymphoma
  • invasive cervical carcinoma

all patients with non-Hodgkin’s lymphoma should be screened for HIV

69
Q

what to give to newborn of HIV positive mother

A

PEP for 4 weeks after birth

70
Q

gonorrhoea - type of bacteria

A

gram-negative diplococcus

71
Q

treatment of gonorrhoea

A

ceftriaxone 500mg IM

72
Q

hepatic consequence of gonorrhoea

A

perihepatitis

73
Q

issues of gonorrhoea in pregnancy

A
  • conjunctivitis within 3 days of birth
  • can cause joint problems - rarely septicaemia
  • preterm rupture of membranes
  • chorioamnionitis
74
Q

complications of chlamydia

A
  • PID, endometritis, salpingitis
  • tubal infertility
  • ectopic pregnancy
  • sexually acquired reactive arthritis (SARA)
  • perihepatitis
75
Q

what is Fitz-Hugh Curtis syndrome

A

perihepatitis due to chlamydia - infection reaches up around liver capsule

76
Q

what are condylomata lata

A

painless warty lesions on genitalia - sign of secondary syphilis

77
Q

type of rash in secondary syphilis

A

widespread mucocutaneoux

can affect palms and soles

78
Q

neurological conditions in secondary syphilis

A
  • acute meningitis
  • cranial nerve palsies
  • uveitis
  • optic neuropathy
  • delusions of grandeur
  • interstitial keratitis and retinal involvement
79
Q

features of neurosyphilis

A

tabes dorsalis

dementia

80
Q

features of cardiovascular syphilis

A

aortic root
gummata
ascending aortic aneurysms

81
Q

blood test for screening of syphilis

A

RPR test

82
Q

what is a Jarisch Herxheimer reaction

A

reaction to treatment in syphilis - similar to anaphylaxis but no wheeze/hypotension

don’t need treatment - just antipyretics if needed

83
Q

bacteria commonly causing acute bacterial prostatitis

A
  • E. coli - gram negative bacteria entering prostate gland via urethra
  • chlamydia
84
Q

most consistent finding in chronic prostatitis

A

chronic pelvis pain

85
Q

when to refer for prostatitis

A

diabetes
immunocompromised
pre-existing urological condition
chronic

86
Q

antibiotics for acute prostatitis

A

14 days ciprofloxacin PO

87
Q

infections associated with balanitis

A

strep and staph infections

candida in about 20%

88
Q

what can circinate balanitis be associated with

A

reactive arthritis

89
Q

investigations in balanitis

A
  • DM testing (risk factor)
  • swab of discharge
  • STI testing
90
Q

management of balanitis

A
  • cleaning
  • STI screening
  • bacterial = fluclox
  • candida = clotrimazole
  • circumcision if recurrent/pathological phimosis present
91
Q

what is phimosis vs paraphimosis

A

phimosis = foreskin can’t be retracted

paraphimosis = foreskin pulled back but can’t be returned to original position

92
Q

what is balanitis xerotica obliterans associated with

A

whitish plaque on glans - associated with phimosis in adults

93
Q

most common cause of paraphymosis

A

not replacing foreskin after inserting catheter

94
Q

complication of paraphymosis

A

ischaemia of glans (if not treated)

95
Q

drugs which can cause erectile dysfunction

A

SSRIs

beta blocker

96
Q

management of erectile disjunction

A
  • control risk factors (weight, smoking, alcohol)

- PDE-5 inhibitors (viagra)

97
Q

what type of drug is sildenafil

A

viagra - PDE-5 inhibitor

98
Q

common cause of epididymo-orchitis in people <35

A

gonorrhoea

other causes = mumps, UTI, trichomoniasis, HIV, TB

99
Q

drug which can cause epididymo-orchitis

A

amiodarone

100
Q

treatment of epididymo-orchitis if caused by gonorrhoea

A

treat as for gonorrhoea

101
Q

treatment of epididymo-orchitis if caused by enteric bacteria (e.g. E. coli)

A

ofloxacin

102
Q

what are elevated in testicular germ cell tumours (cancer)

A

AFP elevated in 60%

LDH elevated in 40%

103
Q

most common type of breast cancer

A

infiltrating/invasive ductal carcinoma

104
Q

when to do BRCA1/BRCA2 testing in someone with breast cancer

A

women under 50

triple negative breast cancer (ER/PR/HER2)

105
Q

what to do about lymph nodes during surgery for breast cancer

A
  • if axillary node involvement = axillary clearance

- if no evidence of involvement = sentinel node biopsy

106
Q

when to do neoadjuvant chemotherapy for breast cancer

A
  • initial surgery not possible due to tumour size
  • to allow for breast conservation
  • HER2 positive or triple negative
107
Q

when to give hormonal therapy to people with breast cancer

A

in ER/PR positive disease = Tamoxifen

in HER2 positive disease = Herceptin (trastuzumab)

aromatase inhibitors = superior efficacy to tamoxifen in post-menopausal women

108
Q

complication of using tamoxifen

A

increases risk of endometrial cancer

109
Q

risk factor for breast fibroadenoma

A

HRT

110
Q

investigation for fibroadenoma

A

triple assessment:

  • examination (USS if <40, mammogram if older)
  • needle biopsy (might not be required)
111
Q

when to do a biopsy in fibroadenoma

A

> 4cm - core biopsy to exclude phyllodes tumour

112
Q

when to consider a breast abscess

A

if infection doesn’t clear after 1 course of antibiotics - therefore would need to incise and drain with antibiotics

113
Q

how to diagnose adenomyosis

A

MRI

114
Q

antibiotics for PID

A

doxycycline
ceftriaxone
metronidazole

115
Q

what to give to partner of someone with PID

A

doxycycline

OR ofloxacin and metronidazole

116
Q

what can lichen sclerosus et atrophicus develop into

A

vulval carcinoma

117
Q

most common type vulval cancer

A

squamous cell

118
Q

what size ovarian cyst should have yearly USS follow up

A

5-7cm

> 7cm = consider MRI

119
Q

when to do a laparoscopic cystectomy for an ovarian cyst

A

> 10cm, solid or complex, fixed, bilateral, ascites

120
Q

moat common type of ovarian cyst

A

follicular (physiological)

121
Q

what can cause pseudomyxoma peritonea

A

if a mutinous cystadenoma ruptures

122
Q

type of ovarian cyst associated with Meig’s syndrome (benign ovarian cyst, pleural effusion, ascites)

A

fibromas

123
Q

what can cause a haemorrhagic degeneration of fibroids

A

progestins
clomifene
pregnancy

124
Q

potential renal complication of fibroids

A

hydronephrosis

125
Q

what can be used to temporarily shrink fibroids

A

GnRH agonists

126
Q

pH of discharge in trichomoniasis

A

> 4.5

127
Q

management of mycoplasma genitalium

A

azithromycin
moxifloxacin

penicillins WONT work as no cell walls

128
Q

pH of discharge in BV

A

> 4.5 (same as trichomoniasis)

129
Q

pH of discharge in candida

A

<4.5

130
Q

what can you find on histology in BV

A

clue cells

131
Q

management of bacterial vaginosis

A

metronidazole

132
Q

medical management of miscarriage

A

mifepristone - misoprostol 2 days later

133
Q

LH and FSH levels in PCOS

A

LH chronically elevated

FSH chronically suppressed

134
Q

Rotterdam criteria for PCOS

A

2/3 required of:

  • polycystic ovaries (12+ follicles or ovarian volume >10cm3 on USS)
  • hyperandrogegism
  • oligo/anovulaiton
135
Q

prolactin level in PCOS

A

normal

136
Q

when can undescended testes increase the risk of testicular cancer

A

if intra-abdominal - risk of malignant degeneration

137
Q

at what age should undescended testes be considered

A

from 3 months old - unlikely to descend spontaneously from 6 months old

majority of surgeries performed around 1 year

Year 5 notes (10 decks)

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