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JL Renal and Urology > Week 4 (1) > Flashcards

Week 4 (1) Flashcards

1
Q

Is urine normally sterile?

A

Yes

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2
Q

What is the lower end of the urethra colonised by?

A

Coliforms and enterococci from the large bowel

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3
Q

Name some causal organisms of UTI

A 
Coliforms:
E.coli
klebsiella
enterobacter
proteus
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4
Q

What coliform is associated with the formation of stones (calculi)?

A

Proteus

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5
Q

What does proteus smell like?

A

Foul

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6
Q

What does proteus produce?

A

Urease which breaks down urea to form ammonia, which increases urinary pH - precipitation of salts

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7
Q

Name two enterococcus spp. that cause UTI - they are present in hte GI tract

A
  1. Enterococcus faecalis

2. Enterococcus faecium

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8
Q

What organism affects women of child bearing age?

A

Staphylococcus saphrophyticus - coagulase negative staph

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9
Q

What type of organism is pseudomonas aeruginosa?

A

Gram negative bacillus

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10
Q

What is pseudomonas aeruginosa associated with?

A

Catheters and UT instrumentation

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11
Q

What antibioitic treats pseudomonas aeruginosa (orally)?

A

Ciprofloxacin

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12
Q

Give three symtpoms and signs of UTI?

A
  1. Dysuria
  2. Frequency
  3. Haematuria
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13
Q

What is a Boricon container?

A

Contains boric acid (preservative) to stop bacteria multiplying - for urine

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14
Q

How long is there to deliver a urine sample in an sterile universal container?

A

2 hours

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15
Q

What - found of dipstick - ma indicate the presence of leukocytes in the urine?

A

Leukocyte esterase

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16
Q

What do nitrites found on dipstick suggest?

A

Presence of bacteria in urine

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17
Q

When doing microscopy of urine what should be looked for?

A

Presence of polymorphs (pus cells), bacteria and red cells

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18
Q

What is the Kass’s criteria?

A

Descibes the likelihood of UTI from a mid stream urine specimen

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19
Q

What does > 10^5 organisms in urine suggest?

A

Significant/probable UTI

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20
Q

What causes resistance to antibioitics in UTI?

A

ESBL - extended spectrum beta-lactamase

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21
Q

What is ESBL resistant to?

A

ALL cephalosporins and almost all penicillins

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22
Q

Where does ESBL come from?

A

Imported chicken

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23
Q

What antibiotics might be useful in ESBL UTI?

A
  1. Nitrofurantoin
  2. Pivmecillinam
  3. Fosfomycin
  4. Temocillin,. meropenem and ertapenem (IV)
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24
Q

Name organisms resistant to meropenam?

A

Carbapenemase-producing enterobacteriaceae (CPE) - gram negative coliform bacilli

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25
Q

What mediates resistance in CPE and what are they resistant to?

A

ALL current antibiotics and resistance is plasmid-mediated

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26
Q

Name four first line antibiotics for treating a UTI?

A
  1. Amoxicillin
  2. Trimethoprim
  3. Nitrofurantoin
  4. Gentamicin
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27
Q

What antibiotic inhibits bacterial folic acid synthesis?

A

Trimethoprim (oral)

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28
Q

When should trimethoprim be avoided?

A

In first trimester (3months) of pregnancy

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29
Q

What is there a risk of with co-trimoxazole?

A

SJS syndrome from sulphonamide

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30
Q

When should nitrofurantoin be avoided?

A

In late pregnancy (can cause neonatal haemolysis), breast feeding and children

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31
Q

When should gentamicin be avoided?

A

In pregancy. Risk of toxicity causing renal and 8th nerve damage

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32
Q

Does gentamicin treat pseudomonas?

A

Yes - should be prescribed for 3 days only

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33
Q

What antibiotic is 2nd line for UTIs, very betalactamase stable and is esterified form of mecillinam?

A

Pivmecillinam

34
Q

What can cefalexin (broad spectrum) cause?

35
Q

What does ciprofloxacin (C.diff) inhibit?

A

DNA gyrase which prevents supercoiling of bacterial DNA

36
Q

Name the only oral pseudomonas antibiotic?

A

Ciprofloxacin

37
Q

What is the empirical treatment for Female lower UTI?

A

Trimethoprim or nitrofurantoin orally (3days)

38
Q

What is the empitical treatment for uncatheterised male UTI?

A

Trimethoprim or nitrofuratoin orally (7days)

39
Q

What is the empirical treatment for complicated UTI or pyelonephritis?

A

Co-amoxiclav or co-trimoxazole

40
Q

What is the empirical treatment for complicated UTI or pyelonephritis (hospital)?

A

Amoxicillin and gentamicin IV (3 days)

41
Q

Do you treat aysmptomatic bacteriuria?

A

Not if you dont have to, but treat in pregnancy

42
Q

If asymptomatic bacteriuria in pregnancy is not treated - what two complications result?1

A
  1. 20-30% lead to pyelonephritis

2. Intra uterine growth retardation/premature labour

43
Q

What are three causes of abacterial cystitis/urethral syndrome?

A
  1. Early phase of UTI
  2. Honeymoon cystitis
  3. / Chlamydia or gonorrhoea
44
Q

How might abacerial cystitis symtoms be relieved?

A

Alkalising the urine

45
Q

When should you give antibiotics to a catheter related UTI case?

A

ONLY if with fever or symptoms

46
Q

Whast renal tumours are found in renal pelvis?

47
Q

What renal tumours are found in renal parenchyma?

48
Q

Name an embryonic renal tumour?

A

Nephroblastoms (Wilm’s tumour)

49
Q

What causes a central scar on CT?

A

Oncocytoma

50
Q

What is RCC classic triad?

A
  1. Loin pain
  2. Renal mass
  3. Haematuria
51
Q

What staging is used for RCC?

A

Robson - mets: lungs, liver, bone and brain

52
Q

Name two pre-malignanty penile cancer cutaneous lesions?

A
  1. Balanitis xerotica obliterans

2. Leukoplakia

53
Q

What is balanitis xerotica obliterans?

A

White patches, fissuring, bleeding and scarring

54
Q

What is erythroplasia of Queyraty?

A

SCC in situ on glans, prepuce or shaft

55
Q

What are red velvety pathes on peis related to?

A

Zoon’s balanitis

56
Q

What can be used to treat SCC in situ on penis?

A

Topical 5 fluorouracil

57
Q

Give three clinical features of carcinoma of penis?

A
  1. Red raised area penis
  2. Fungating mass, foul smelling
  3. Phimosis
58
Q

What investigation is advisable for primary tumour carcinoma of penis?

A

Ultrasound

59
Q

When is peak incidence of carcinoma of penso?

60
Q

In relation to carcinoma of penis - what lymph nodes might need to be sentinel biopsied or removed?

61
Q

How are testicular tumpurs diagnosed?

A

Ultrasound and markers - AFT, HCG and LDH

62
Q

What does HCG mark?

A

5-10% pure seminoma

60% teratoma

63
Q

What does AFP mark?

A

Never raised in pure seminoma

64
Q

What increases the risk of testicular tumours?

A

X30 with undescended testis

65
Q

What do 100% of trophoblastic teratomas have raised?

66
Q

What does heavy proteinuria present with?

A

Frothy urine

67
Q

Is uraemia with pericarditis serious?

68
Q

What should be examined in the presentation of renal disease?

A

BP and urinalysis

69
Q

What should you mention in a renal systemic enquirey?

A
  1. Dyspepsia
  2. Dyspnoea
  3. Joint pains and arthralgia
  4. Skin rashes
70
Q

What drug is hyperkalcaemia ia side effect of?

A

ACE inhibitors and arbs

71
Q

What type of examinatin can cause acute kidney injury?

A

Radiology contrast

72
Q

What is leukonychia?

A

White bands on nails suggesting hypoalbuminuria

73
Q

What do granular urinary casts suggeset?

A

Indicative of chronic disease

74
Q

What GFR in stage 1 kidney damage?

75
Q

What GFR in stage 2 kidney damage

76
Q

What GFR in stage 3 kidney damage?

77
Q

What GFR in stage 4 kidney damage?

78
Q

What GFR in stage 5 kidney damage?

A

Kidney failure

79
Q

What is the nephrotic syndrome triad?

A
  1. Proteinuria
  2. Hypoalbuminaemia
  3. Oedema
80
Q

What is defined as acute kidney injury, oliguria, oedema, hypertension and active urinary sediment?

A

Nephritic syndrome

JL Renal and Urology (9 decks)

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