Urology

Question 1

what is the threshold for diagnosis of a UTI

Answer 1

> 10^5 colony forming units per millilitre of urine

Question 2

what are the common causative organisms of UTIs

Answer 2

E. coli - 68%
proteus mirabilis
staph saprophyticus
Klebsiella
Enterococcus faecalis

Question 3

what dipstick findings suggest UTI?

Answer 3

+ve for nitrites and/or leukocytes

microscopic haematuria

Question 4

treatment for UTI is?

Answer 4

Trimethroprim
Nitrofurantoin
short course, 3-5 days
for resistant cause, co-amoxiclav, ciprofloxacin

Question 5

what is acute pyelonephritis?

Answer 5

infection within renal pelvis/parenchyma

fever, loin pain, tenderness, significant bacteriuria

Question 6

what medication can be used to treat pyelonephritis in pregnancy

Answer 6

tetracycline, trimethoprim, sulphonamides, quinolones must be avoided

amoxicillin, nitrofurantoin and cephalosporins ok

Question 7

common causes of hydronephrosis

Answer 7

urinary tract obstruction

BPH, cancer, stones

Question 8

presentation of hypdronephrosis

Answer 8

dull ache/pain in back, flanks, worse after drinking alot
microscopic haematuria
urinating less often, weak stream

Question 9

how is AKI defined

Answer 9

increase in creatinine:
>0.3ml within 48hrs
>1.5x baseline within 7 days
urine volume <0.5ml/kg/hr for 6 hours

Question 10

pre-renal causes of AKI

Answer 10

hypoperfusion, due to:

hypovolaemia, hypotension, sepsis, CCF, cirrhosis, renal artery stenosis

Question 11

Intrinsic renal causes of AKI

Answer 11

tubular- acute tubular necrosis, nephrotoxins
Glomerular - glomerulonephritis
Interstitial - acute interstitial nephritis
Vascular - vasculitis, thrombus

Question 12

post-renal causes of AKI

Answer 12

Obstruction

stones, clots, malignancy, BPH

Question 13

why is it important to do an urgent ABG and ECG in AKI?

Answer 13

check for hyperkalaemia, which can lead to arrhythmias

Question 14

management of AKI

Answer 14

treat the underlying cause
replenish fluid, remove obstruction
dialysis if necessary

Question 15

how is chronic kidney disease (CKD) classified

Answer 15

presence of kidney damage (proteinuria, haematuria etc) or decreased kidney function (eGFR <60) for 3 months or more

Question 16

causes of chronic kidney disease

Answer 16

PCKD, glomerulonephritis, hypertension, tubointerstitial nephritis, pelvic tumours, diabetes

Question 17

symptoms of severe CKD

Answer 17

anorexia, N+V, fatigue, oedema, dyspnoea, polyuria, anuria/oliguria

Question 18

management of CKD

Answer 18

stop nephrotoxic drugs, treat underlying cause, treat oedema, anaemia
diet - Na, K+, protein restriction
if necessary, prepare for dialysis or transplant

Question 19

how long does it take to recover renal function after an AKI

Answer 19

2-3 weeks

Question 20

at what point do symptoms tend to become apparent in CKD

Answer 20

when urea >40mmol/L

when eGFR drops suddenly or below 15

Question 21

what is the presentation of BPH

Answer 21

incomplete emptying, frequency, urgency, weak stream, straining, nocturia, intermittency

Question 22

how is BPH diagnosed

Answer 22

PR exam
MSU, U+Es, PSA (carry out before PR)
USS, biopsy if suspected malignancy

Question 23

Name some alpha blockers used in BPH

Answer 23

Doxazocin, tamsulosin, alfuzosin, terazosin

Question 24

what treatment options are there for BPH

Answer 24

lifestyle
indwelling catheter
alpha blockers
finasteride
Surgery - transurethral resection of the prostate (TURP), prostatectomy

Question 25

what do PSA values indicate?

Answer 25

<4 = normal
4-10 = can be BPH
10+ = cancer in 50% of cases

Question 26

what findings would prostate cancer have on PR

Answer 26

hard, irregular, asymmetrical, nodular, lack of mobility

loss of smooth surface

Question 27

characteristic of bladder cancer

Answer 27

Transitional cell carcinoma (90%)
50% caused by smoking
bladder cancer 50x more likely than those of ureter/renal pelvis

Question 28

how is bladder cancer investigated?

Answer 28

cystoscopy
urine microscopy
CT urogram
MRI/lymphangiography

Question 29

what additional signs might renal cell carcinoma cause?

Answer 29

Hypertension due to secretion of renin by tumour

anaemia due to depression of erythropoietin

Question 30

presentation of kidney stones

Answer 30

renal colic - spasms loin to groin, more painful if stone is moving
haematuria, anuria, N+V
patient often writhing in pain

Question 31

most sensitive investigation for kidney stones

Answer 31

non-contrast CT kidney, ureter, bladder (KUB) - 99%
Xray KUB - 80%
ultrasound to spot hydronephrosis

Question 32

management of kidney stones

Answer 32

analgesia, Abx if infection, surgery, prevention

medical expulsion therapy

Question 33

what are the options for medical expulsion therapy

Answer 33

Alpha blockers - tamsulosin
CCBs - nifedipine
Extracorporeal shockwave lithotripsy (ESWL)
surgery