urological problems and the kidney

Question 1

what is nephrolithiasis ?

Answer 1

formation or the disease of stones in the kidneys

Question 2

what are the risk factors for developing urinary stones ?

Answer 2

male
white
obese
diabetic

Question 3

what are the conditions associated with urinary stone disease ?

Answer 3

primary hypertension
sarcoidosis
CF

Question 4

what is the nature of the pain associated with urinary stones ?

Answer 4

acute colicky flank pain radiating to the groin

Question 5

what are the required workup for urinary stones ?

Answer 5

rule out medication induced stones
CT can be used
MRI if the patient is pregnant
urine culture to identify the type of stone

Question 6

what are the different types of urine stones/crystals ?

Answer 6

calcium oxalate 
calcium phosphate 
uric acid 
struvite 
cystine

Question 7

what are the associated conditions with calcium oxalate crystals ?

Answer 7

hypercalciuria

Question 8

what are the associated conditions with calcium phosphate crystals ?

Answer 8

distal renal tubular acidosis

Question 9

what are the associated conditions with uric acid crystals?

Answer 9

hyperurecemia
gout
DM
obesity

Question 10

what are the associated conditions with struvite crystals ?

Answer 10

alkaline crystals due to chronic urinary tract infection

Question 11

what are the associated conditions with cystine crystals ?

Answer 11

cystinuria

Question 12

what is the most important intervention when it comes to treatment of renal stones ?

Answer 12

markedly increase fluid intake

Question 13

what can be given in cases of hypercalciuria ?

Answer 13

thiazide diuretics

Question 14

what can be given in cases of hyperuricosuria ?

Answer 14

allopurinol or potassium citrate

Question 15

what can be given for hypocitraturia ?

Answer 15

potassium citrate

Question 16

what size of stones should pass spontaneously ?

Answer 16

less than 4 mm

Question 17

when is urological intervention required ?

Answer 17

evidence of :

• infection
• acute kidney injury
• intractable nausea or pain
• stones that fail to pass

Question 18

what are the urological intervention options ?

Answer 18

shock wave lithotripsy
percutaneous nephrolithotomy
rigid and flexible ureteroscopy

Question 19

which urological intervention can be used for proximal ureteric stones ?

Answer 19

shock wave lithotripsy

Question 20

when is percutaneous nephrolithotomy indicated ?

Answer 20

anatomic abnormalities such as horse shoe kidney

Question 21

what is the treatment of choice for middle and distal ureteric stones ?

Answer 21

rigid and flexible uterescopy

Question 22

what are the classifications of UTIs in adults ?

Answer 22

asymptomatic bacteriuria 
acute uncomplicated cystitis in females 
recurrent cystitis in females 
acute uncomplicated pyelonephritis in females 
complicated UTI

Question 23

what is asymptomatic bacteriuria ?

Answer 23

presence of uropathogens without any evidence of systemic infection

Question 24

which group of people are at a much higher risk at acquiring acute uncomplicated cystitis ?

Answer 24

sexually active women mostly between the ages of 15-45 y/o

Question 25

what is the most common causative organism of uncomplicated UTI ?

Answer 25

e.coli | staph aureus

Question 26

who is at risk of a complicated UTI ?

Answer 26

- post menopausal women - males - patients with structural or functional abnormalities of the urinary tract - catheters in situ - patients with comorbidities ( DM)

Question 27

what may asymptomatic bacteriuria in young children indicate ?

Answer 27

underlying vesicoureteral reflux

Question 28

what is the clinical picture of uncomplicated cystitis in females ?

Answer 28

acute onset of dysuria frequency suprapubic pain or new urine incontinence

Question 29

what are the differential diagnosis of uncomplicated cystitis in females ?

Answer 29

vaginitis urethritis

Question 30

what are the investigations for uncomplicated cystitis ?

Answer 30

urine analysis : heamturia common inn UTI but not vaginitis/urethritis bacteruria required for a definitive diagnosis urine cultures are not indicated

Question 31

in a case of suspected uncomplicated cystitis if the urine analysis showed negative for pyuria what would that suggest ?

Answer 31

strongly suggests an alternative diagnosis

Question 32

what must be considered if there is a recurrence of attacks within 1 to 2 weeks in recurrent acute cystitis?

Answer 32

consider infection with ab-resistant antibiotic obtain urine culture treat according to culture

Question 33

if there is recurrence within 2 weeks to 6 months of initial infection what is the next best step in management ?

Answer 33

use a different antibiotic

Question 34

if recurrence occurs after 6 months of the initial infection what is the next best thing to do ?

Answer 34

use the same antibiotic

Question 35

what is the clinical presentation of pyelonephritis ?

Answer 35

fever chills costophrenic angle pain nausea and vomiting pyuria is almost always present

Question 36

what investigations should be done in cases of pyelonephritis ?

Answer 36

urine cultures

Question 37

what is the most important factor in the development of catheter associated bacteriuria ?

Answer 37

the duration of the catheterization

Question 38

what are the complications of long term catheterization ?

Answer 38

bacteremia antibiotic resistance flora cystitis/pyelonephritis catheter obstruction

Question 39

what is the clinical picture of catheter associated bacteriuria ?

Answer 39

asymptomatic

Question 40

when do we give antibiotics in UTI ?

Answer 40

only in symptomatic cases to avoid antibiotic resistant bacteria

Question 41

what can we do to reduce the incidence of symptomatic UTI in patients with spinal cord injury ?

Answer 41

hydrophilic-coated catheter

Question 42

what is the pathogenesis of prostatitis ?

Answer 42

reflux of infected urine from the urethra into the prostatic duct

Question 43

what is the treatment fro prostatitis ?

Answer 43

fluoroquinolone

Question 44

what should the broad spectrum ab given in UTI cover ?

Answer 44

staph aureus

Question 45

what is emphysematous pyelonephritis ?

Answer 45

fulimant necrotizing life threatening form of acute pyelonephritis

Question 46

how should the efficacy of treatment be evaluated ?

Answer 46

urine culture