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Dysuria and Urinary Frequency Flashcards

1
Q

characterised mainly by urethral and suprapubic
discomfort, indicates mucosal inflammation of the
lower genitourinary tract (i.e. the urethra, bladder
or prostate).

A

Dysuria

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2
Q

_________ difficult and painful micturition with

associated spasm

A

Strangury

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3
Q

________usually causes pain at the onset of

micturition

A

Urethritis

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4
Q

________usually causes pain at the end of

micturition

A

Cystitis

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5
Q

Suprapubic discomfort is a feature of ______

A

bladder infection (cystitis

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6
Q

_______(e.g. prostatic cancer) cause
severe dysuria, pneumaturia and foul-smelling
urine.

A

Vesicocolonic fistulas

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7
Q

Dysuria and frequency are most common in women

aged _______

A

15 to 44 years

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8
Q

Dysuria and discomfort is a common feature

of postmenopausal syndrome, due to __________ The urethra and lower bladder are oestrogen-dependent

A

atrophic urethritis.

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9
Q

Unexplained dysuria could be a pointer to

________

A

Chlamydia urethritis

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10
Q

________ is the most
common cause of dysuria in the adolescent age group
and is a relatively common cause of dysuria in family
practice, estimated at around 15%

A

Vaginitis

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11
Q

Small amounts of blood _________ can

produce macroscopic haematuria

A

(1 mL/1000 mL urine)

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12
Q

Microscopic haematuria includes the presence
of red blood cells (RBC) >8000 per mL of urine
_________ or >2000 per mL of
urine_________ representing the occasional
RBC on microscopic examination

A

(phase contrast microscopy)

light microscopy

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13
Q

Joggers and athletes engaged in very vigorous

exercise can develop_______

A

transient microscopic

haematuria.

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14
Q

What are the 2 types of microscopic hematuria

A

glomerular (from kidney parenchyma):

non-glomerular (urological):

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15
Q

Microscopic hematura:

common causes are IgA nephropathy and thin
membrane disease

A

glomerular

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16
Q

Microscopic hematura:

__________: the common
causes are bladder cancer, benign prostate
hyperplasia and urinary calculi

A

non-glomerular (urological)

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17
Q

Macroscopic haematuria occurs in 70% of people

with________ and 40% with__________

A

bladder cancer

kidney cancer

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18
Q

Massive haematuria is a feature of _______

A

radiation cystitis

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19
Q

______ can occur as a manifestation of nephritis
and may be a feature of bleeding in cancer of the
kidney or polycystic kidney.

A

Loin pain

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20
Q

It is worth noting that _________
secondary to prostatic enlargement located at the
bladder neck, may rupture when a man strains to
urinate.

A

large prostatic veins,

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21
Q

Urine microscopy:
— formed RBCs in true haematuria
— red cell casts indicate _______
— deformed (dysmorphic) red cells indicate glomerular bleeding

A

glomerular bleeding

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22
Q

this test, performed on a urine
sample, may be useful to detect malignancies
of the bladder and lower tract but is usually
negative with kidney cancer

A

Urinary cytology

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23
Q

What are the radiological techniques to assess urinary tract

A

— intravenous urography (IVU); intravenous
pyelogram (IVP)—the key investigation
— ultrasound (less sensitive at detecting LUT
abnormalities)
— CT scanning
— kidney angiography
— retrograde pyelography

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24
Q

In all patients, regardless of the IVU findings,

________is advisable

A

cystoscopy

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25
Q

________indicated if glomerular disease
is suspected, especially in the presence of
dysmorphic red cells on microscopic
examination.

A

Kidney biopsy:

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26
Q

________ is red urine caused by pigments
other than red blood cells that simply stain the
culture red

A

Pseudohaematuria

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27
Q

Causes of pseuohematuria

A

• anthocyanins in food (e.g. beetroot, berries)
• red-coloured confectionery
• porphyrins
• free haemoglobin (e.g. haemoglobinuria)
• myoglobin (red-black colour)
• drugs (e.g. pyridium, phenolphthalein—alkaline
urine)

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28
Q

________ is the passage of a
significant number of red cells in the urine during
or immediately after heavy exercise.

A

Exercise or sports haematuria

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29
Q

What is the theory of the cause of exercise hematuria?

A

largely caused by the posterior wall of the bladder
impacting repetitively on the base of the bladder
during running

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30
Q

Macroscopic haematuria is a common presenting ploy

of people with _________ and ___________simulating kidney colic.

A

Munchausen syndrome

pethidine
addicts

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31
Q

This is a benign granulomatous tumour about the
size of a pea in the distal urethra. Almost exclusive
to post-menopausal women, it is very tender and
bleeds easily.

A

Urethral caruncle

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32
Q

Main Sx of Urethral caruncle

A

The main symptom is haematuria

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33
Q

Dx of Urethral caruncle

A

may require cystoscopy and biopsy for diagnosis

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34
Q

Tx of Urethral caruncle

A

Treatment includes warm salt baths and oestrogen

creams

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35
Q

Bladder cancer is the seventh most common

malignancy, with 90% being_______

A

transitional cell

carcinomas

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36
Q

Most important RF for bladder CA

A

Smoking is the most

common association.

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37
Q

Gold standard for dx of bladder CA

A

IVU is the gold standard

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38
Q

The common bladder carcinoma in situ is treated with
_____________. This 6-week
course and follow-up if necessary leads to
60–75% remission

A

intravesical BCG immunotherapy

39
Q

Other intravesical agents used include various

cytotoxics (___________

A

e.g. mitomycin C)

40
Q

_________ means kidney inflammation

involving the glomeruli

A

Glomerulonephritis

41
Q

____________: oedema + hypertension

+ haematuria

A

nephritic syndrome

42
Q

_______ oedema + hypoalbuminaemia

+ proteinuria

A

nephrotic syndrome:

43
Q

The main causes of glomerulonephritis–nephritic

syndrome are

A 
• IgA nephropathy (commonest)
• thin glomerular basement membrane disease
(has an AD genetic link)
• post-streptococcal glomerulonephritis
• systemic vasculitis
44
Q

Typically presents as haematuria in a young male
adult at the time of or within 1–2 days of a mucosal
infection (usually throat, influenza or URTI) and
persists for several days

A

IgA nephropathy

45
Q

Typically seen in children (>5 years), especially in
Indigenous communities following GABHS throat
infection or impetigo. Presents after a gap of 7–10
days or so.

A

Acute post-streptococcal

glomerulonephritis

46
Q

SSx of PSGN

  • Haematuria: discoloured urine (‘Coke’ urine)
  • Peri-orbital oedema (may be legs, scrotum)
  • Rapid weight gain (from _________)
  • Scanty urine output (oliguria)
  • ________→ may be complications
A

oedema

Hypertension

47
Q

What is the usual course of PSGN

  • Oliguria ______ days
  • Oedema and hypertension ______days
  • Invariably resolves
  • _________prognosis
A

2

2–4

Good long-term

48
Q

Dx of PSGN

A

• GABHS antigens
• Blood urea, creatinine, C 3&4 (complement),
ASOT, DNase B

49
Q

Tx of PSGN

A
  • Strict fluid balance chart
  • Daily weighing
  • Penicillin (if GABHS + ve)
  • Fluid restriction
  • Low protein, high carbohydrate, low salt diet
  • Antihypertensives and diuretics (as necessary)
50
Q

discoloured urine + peri- orbital

oedema + oliguria _________

A

post-streptococcal

glomerulonephritis

51
Q

Proteinuria is an important and common sign of
kidney disease. The protein can originate from the
____________

A

glomeruli, the tubules or the LUT

52
Q

The amount of protein in the urine is normally less

than_______

A

100 mg/24 hours

53
Q

Greater than__________mg/24 hours is abnormal for

children and adults

A

300

54
Q

Proteinuria_________/24 hours indicates a serious

underlying disorder.

A

> 1 g

55
Q

Routine dipstick testing will only detect levels
greater than __________hours and thus has
limitations

A

300 mg/24

56
Q

In diabetics, microalbuminuria is predictive of

nephropathy and an indication for ______

A

early blood

pressure treatment

57
Q

If proteinuria is confirmed on repeated dipstick
testing it should be measured more accurately
by measuring _______ with a
24-hour urine or the ________
which is preferred

A

daily albumin excretion

albumin creatinine ratio (ACR),

58
Q

Nephrotic range proteinuria __________
is due to one or other form of glomerulonephritis in
over 90% of patients.

A

(>3 g/24 hours)

59
Q

_________ is the presence of significant
proteinuria after the patient has been standing
but is absent from specimens obtained following recumbency for several hours, such as an early
morning specimen

A

Orthostatic proteinuria

60
Q

The presence of protein in the urine is a sensitive
marker of ___________ so regular screening
for microalbuminuria in diabetics is regarded as
an important predictor of nephropathy and other
possible complications of diabetes

A

diabetic nephropathy,

61
Q

The use of ________at the microalbuminuria stage may slow

the development of overt nephropathy

A

ACE

inhibitors

62
Q

Gold standard of overt nephropathy

A

The gold

standard is a 24-hour collection

63
Q

While proteinuria is usually simply a marker of
kidney disease, heavy proteinuria in excess of
3 g/24 hours may have severe clinical consequences,
including

A

oedema, intravascular volume depletion,
venous thromboembolism, hyperlipidaemia and
malnutrition

64
Q

_________is the
commonest cause of the nephrotic syndrome in
childhood and accounts for about 30% of adult
nephrotic syndrome

A

Minimal change glomerulonephritis

65
Q

Tx of MCD

A

steroid

66
Q

proteinuria + generalised oedema

+ hypoalbuminaemia

A

nephrotic syndrome

67
Q

Dx of NS

  • Proteinuria________ g/day (3–4 on dipstick)
  • Hypoalbuminaemia _______ g/L
  • Hypercholesterolaemia ______ mmol/L
A

> 3

<30

> 4.5

68
Q

BP of NS

A

N

69
Q

Causes of NS in 2/3 of cases

A

2 in 3 (approx.):
— idiopathic nephrotic syndrome (based on
kidney biopsy)
— minimal change disease (commonest)
— focal glomerular sclerosis
— membranous nephropathy
— membranoproliferative glomerulonephritis

70
Q

Medical Tx of NS

A
  • Diuretics
  • Prednisolone
  • Phenoxymethylpenicillin
  • Aspirin
71
Q

Loss of urine secondary to

factors extrinsic to the urinary tract

A

Functional incontinence

72
Q

(or bed-wetting) Involuntary urine

loss during sleep

A

Nocturnal enuresis

73
Q

The commonest cause of urge incontinence; synonymous
with an irritable or unstable bladder; characterised
by involuntary bladder contractions, resulting in a
sudden urge to urinate

A

Overactive bladder (detrusor instability

74
Q

Escape of urine following poor bladder emptying.

A

Overflow incontinence

75
Q

An urgent desire to void followed by involuntary loss of urine

A

Urge incontinence

76
Q

The involuntary loss of urine during the day or night

A

Urinary incontinence

77
Q

Includes urinary difficulties, detrusor instability and overflow incontinence

A

Voiding dysfunction

78
Q

What is the cause?

Simple stress incontinence (with cough/sneeze

A

Sphincter incompetence

79
Q

What is the cause?

Urge incontinence
Giggle incontinence
Stress and urge incontinence
Enuresis
Complex stress incontinence (with exercise)
A

Unstable bladder, with or without sphincter weakness

80
Q

What is the cause?

Quiet dribble incontinence

A

Sphincter incompetence and unstable bladder or overflow

81
Q

What is the cause?

Continuous leakage

A

Fistula, ectopic ureter, patulous urethra

82
Q

What is the cause?

Reflex incontinence

A

Neuropathic bladder

83
Q

The basic requirements for continence are:

A
  • adequate central and peripheral nervous function
  • an intact urinary tract
  • a compliant stable bladder
  • a competent urethral sphincter
  • efficient bladder emptying
84
Q

The most common contributing factor to urinary incontinence is:

A

weakness of the pelvic floor muscles

85
Q

Drugs that cause Bladder relaxants → overflow incontinence

A
  • anticholinergic agents

* tricyclic antidepressants

86
Q

Drugs that cause Bladder stimulants → urge incontinence

A
  • cholinergic agents

* caffeine

87
Q

Sedatives that cause urge incontinence

A
  • antidepressants
  • antihistamines
  • antipsychotics
  • hypnotics
  • tranquillisers
88
Q

These may be worth a trial for bladder instability or

voiding dysfunction

A
  • solifenacin 5–10 mg (o) daily
  • propantheline 15 mg (o) bd or tds
  • oxybutynin 2.5–5 mg (o) bd or tds
  • tolterodine 2 mg (o) bd
  • imipramine 10–75 mg (o) nocte
89
Q

The main complaint is of ‘heaviness’
in the vagina and a sensation of ‘something coming
down’. Relevant symptoms that are of considerable
distress for the patient and, depending on the type of
prolapse, include voiding difficulties, urinary stress
incontinence, faecal incontinence, incomplete rectal
emptying and recurrent cystitis

A

Uterovaginal prolapse

90
Q

Classification of prolapse:

• ________—bladder descends into vagina
• ________—urethra bulges into vagina
• ________—rectum protrudes into vagina
• ___________—loop of small intestine bulges into
vagina (usually posterior wall)
__________—uterus and cervix descend toward
vaginal introitus:

A

Cystocele

Urethrocele

Rectocele

Enterocele

Uterine

91
Q

What are the degrees of prolapse?

— first degree—__________
— second degree—__________
— third degree (procidentia)—_______

A

cervix remains in vagina

cervix protrudes on
coughing/straining

uterus lies outside vagina

92
Q

Management of prolapse

Pessaries are an option for those who are poor
anaesthetic risks, too frail for surgery, don’t want
surgery, are young and have not completed their
family or are awaiting surgery.

A

Ring pessaries

93
Q

The pessary needs to be cleaned or changed every

_________

A

4–6 months

MC (90 decks)

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