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AKT > Kidney and Urology > Flashcards

Kidney and Urology Flashcards

1
Q

Recommended duration of antibiotic treatment for acute prostatitis?

A

14 days and then review-may stop at 14 days or continue for a further 14 days.

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2
Q

1st line antibiotic treatment for acute prostatitis?

A

ciprofloxacin 500mg BD or ofloxacin 200mg BD, if unsuitable the trimethoprim 200mg BD.

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3
Q

Recommended further treatment post TURBT for bladder carcinoma in situ?

A

intra vesical BCG to improve local control (high risk of becoming muscle invasive) and reduce incidence of progression.

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4
Q

What is Prehn sign?

A

relief of pain with elevation of testes

positive in epididymo-orchitis

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5
Q

Pharmacological tx of epididymo-orchitis if you suspect STI cause?

A

IM 1g Ceftriaxone STAT + doxycycline 100mg PO BD for 10-14/7
OR PO ofloxacin 200mg BD for 14/7
if thought to be due to chalmydia or other non gonococcal cause treat with doxycycline or ofloxacin

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6
Q

Pharmacological tx of epididymo-orchitis if you suspect UTI cause/enteric organism?

A

Ofloxacin 200mg PO BD for 14/7 OR
Levofloxacin 500mg PO OD for 10/7

if quinolone CI e.g. due to hx of seizures or tendon disorders, then tx with co-amoxiclav 500/125 TDS for 10/7

if UTI is confirmed as cause patient should be r/f to urology for investigation for underlying structural abnormality or urinary tract obstruction

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7
Q

How is eGFRcystatinC used to help reduce over diagnosis in early CKD?

A

Use at initial diagnosis if eGFR is 45-59, sustained for at least 90 days, and no proteinuria (ACR<3) or other marker of kidney disease.
CKD should not be diagnosed if eGFR as as above and eGFRcystatinC >60 and no other marker of kidney disease.

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8
Q

Which patients with CKD require referral for specialist assessment?

A
  • eGFR<30 (stage 4 or 5)
  • ACR 70 or more (unless known to be caused by DM and already appropriately treated)
  • ACR 30 or more with haematuria
  • accelerated progression-sustained decrease in GFR of 25% or more and change in GFR category or sustained decrease of 15ml/min or more within 1 yr-note progression is assessed by repeating eGFR 3 times over at least 3 months
  • known/suspected genetic or rare cause
  • HTN poorly controlled despite at least 4 anti-HTN drugs at therapeutic doses
  • suspected renal artery stenosis
  • suspected complication of CKD e.g. renal disease, renal mineral and bone disorder
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9
Q

Target BP in those with CKD?

A

<140/90
if also diabetic aim <130/80
also if ACR 70 or more aim <130/80

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10
Q

Use of ACEIs/AngII blockers for BP control in patients with CKD?

A

Offer if:

  • diabetic and ACR 3 or more
  • HTN and ACR of 30 or more
  • ACR 70 or more

do not routinely offer if pre treatment potassium >5

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11
Q

Change in eGFR and creatinine that should prompt stopping of ACEI?

A

if eGFR change 25% or more, or change in serum creatinine 30% or more, and no other cause for renal deterioration found

if changes less than this rpt U+Es in 1-2 weeks

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12
Q

When should patients with CKD have calcium, phosphate and PTH levels monitored?

A

if eGFR<30

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13
Q

2ww referral criteria to urology for suspected bladder Ca for patients with visible haematuria?

A

aged 45 and over with unexplained visible haematuria without UTI or visible haematuria that persists or recurs after successful tx of UTI

(also same criteria as 2ww referral for renal cancer)

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14
Q

2ww referral criteria to urology for suspected bladder Ca for patients with non visible haematuria?

A

aged 60 and over with unexplained non visible haematuria and either dysuria or raised WCC on blood test

non-urgent referral if aged 60 or over with recurrent or persistent unexplained UTI

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15
Q

Which men should get a PSA and DRE to assess for prostate cancer?

A
  • any lower urinary tract sx e.g. nocturia, urinary frequency, hesitancy, urgency or retention OR
  • visible haematuria OR
  • erectile dysfunction
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16
Q

2ww referral criteria for penile Ca?

A

penile ulcerated lesion/mass, where STI has been excluded as cause OR persistent penile lesion after tx for STI completed

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17
Q

1st choice PO Abx for pyelonephritis?

A

cefalexin
could consider co-amoxiclav or trimethroprim if culture results available and sensitive
if needs IV Abx 1st line=co-amoxiclav, cefuroxime if pregnant

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18
Q

How is risk stratified in localised prostate cancer?

A

Based on PSA, Gleason score and staging:
low risk-PSA <10 and gleason 6 or less and stage T1-2a
intermediate-PSA 10-20 OR gleason 7 OR stage T2b
high (locally advanced prostate Ca)-PSA >20 PR gleason 8-10 OR stage T2c or more

Gleason score (2-10)=sum of gleason grade (1-5) of the 1st and 2nd most common tumour patterns.

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19
Q

Tx for low risk localised prostate cancer?

A

active surveillance OR watchful waiting OR radical prostatectomy OR radical radiotherapy (note small increased risk of colorectal cancer)

each tx no difference in mortality from prostate cancer BUT disease progression more likely with active surveillance
urinary continence problems and ED more likely if radical prostatectomy, short term bowel problems more likely with radiotherapy

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20
Q

Tx for intermediate or high risk localised prostate cancer?

A

offer radical prostatectomy or radical radiotherapy, consider active surveillance if person chooses not to have immediate radical tx if intermediate risk (watchful waiting also an option for any risk group)
if radical radiotherapy for intermediate or high risk localised also offer 6 months of androgen deprivation therapy

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21
Q

How often should PSA be measured in patients with localised prostate cancer who are having radical treatment?

A

no earlier than 6 weeks after tx

at least every 6 months for the 1st 2 years then at least once a year

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22
Q

Tests if patient with localised prostate cancer chooses active surveillance?

A

in 1st year, check PSA every 3-4 months, DRE at 1 year and MRI at 12-18 months
after 1 years check PSA every 3-6 months and DRE every 6-12 months for 3 years then PSA every 6 months and DRE every 12 months.

*in contrast to watchful waiting-pt has repeat clinical assessments and PSA testing at least annually but no DRE/MRI

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23
Q

When is a 2ww referral required for a man aged 50-69 who has had a PSA test?

A

if PSA 3 or higher

note PSA sample must reach the lab within 16 hours

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24
Q

Most common type of testicular cancer?

A

germ cell tumours

types: seminoma-peak 35 years and non seminomas e.g. teratoma-peak 25 years

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25
Q

How are varicoceles classified?

A

graded I-III
I=only palpable during valsalva
II=palpable with or without valsalva
III-visualised aswell as easily palpable

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26
Q

Tx of a subclinical/grade I varicocele in adult?

A

reassure and observe

if concerns re fertility offer semern analysis

27
Q

Tx of grade II/III asymptomatic varicocele with normal semen analysis?

A

observe with semen analysis every 1-2 yrs

28
Q

Tx of grade II/III symptomatic varicocele or abnormal semen analysis?

A

refer for surgery`

29
Q

Which conditions are on the selected list scheme (SLS) for NHS prescription of branded viagra for erectile dysfuntion?

A 
CKD requiring dialysis or transplant
DM
prostate Ca
prostatectomy
spina bifida
parkinsons disease
polio
spinal cord injury
severe pelvic injury
single gene neuro disease
30
Q

What should men with bothersome urinary tract symptoms be asked to complete?

A

a urinary frequency-volume chart for at least 3 days

31
Q

How can baseline LUTS be assessed in men considering any treatment for LUTS?

A

International Prostate Symptom Score (IPSS)

32
Q

1st line management for voiding symptoms in men?

A
  • active surveillance
  • conservative measures-advice on fluid intake and diet, pelvic floor muscle training and bladder training, containment devices
33
Q

Management of LUTS in men where active surveillance not appropriate and conservative tx fails, and moderate to severe voiding symptoms (IPSS 8 or more)?

A
  • offer an alpha blocker e.g. tamsulosin, review at 4-6 weeks then every 6-12 months
  • if man has an enlarged prostate and is considered at high risk of progression e.g. older, higher PSA, worse sx, poorer urine flow, offer a 5 alpha reductase inhibitor e.g. finasteride. Review at 3-6 months then every 6-12 months.
  • if combination of voiding sx and enlarged prostate consider both drugs in combination
34
Q

What can be added to an alpha blocker for men with moderate to severe voiding symptoms and storage symptoms persisting?

A

anti muscarinic

35
Q

Management of man with overactive bladder cause of LUTS?

A
  • refer for supervised bladder training
  • if sx persist offer an anti-muscarinic
  • if still persisting offer mirabegron
  • if still tx fails refer to urology
36
Q

Define nocturnal polyuria in men?

A

passing more than 35% of urine at night

37
Q

Management of nocturnal polyuria in men?

A
  • limit fluid intake in late afternoon/evening
  • if not helped consider a loop diuretic in late afternoon
  • if still bothersome either refer to urology or consider seeking specialist advice about switching to oral desmopressin to be taken at bedtime
38
Q

Management of stress urinary incontinence in man NOT caused by a prostatectomy?

A

refer for specialist assessment to confirm the cause

if caused by a prostatectomy refer for supervised pelvic floor muscle training

39
Q

Investigations for all men presenting with erectile dysfunction?

A
  • HbA1c/fasting plasma glucose
  • lipid profile
  • total testosterone, if indicated measure free testosterone and if borderline or low check FSH, LH and prolactin aswell as repeating the testosterone measurement, if these are abnormal consider referral to endocrine
40
Q

Which men with ED are classified as high cardiovascular risk and should be referred for cardiac assessment and tx before resuming sexual activity?

A

unstable angina
uncontrolled HTN
recent MI without intervention (in last 2 weeks)
LVD/CHF NYHA IV
HOCM
moderate to severe valvular disease e.g. AS
high risk arrhythmia

41
Q

When can a man be classified as a non responder to a phosphodiesterase 5 inhibitor?

A

if they have received 6-8 doses at max dose with sexual stimulation

42
Q

What advice should be given to patients before checking their U+Es in assessment for CKD?

A

Not to eat meat for 12 hours beforehand

43
Q

Predisposing factors to testicular torsion?

A
  • testicular tumour
  • testes with horizontal lie
  • previous undescended testes
  • spermatic cord with long intra scrotal portion
44
Q

Most common testicular malignancy in men over the age of 50?

A

non-hodgkins lymphoma

45
Q

Most common cause of scrotal pain in adults?

A

epididymitis

46
Q

When should an urgent US of the scrotum be requested for men presenting with scrotal swelling?

A
  • a hydrocele detected in men aged 20-34 (due to risk of testicular Ca)
  • body of the testis cannot be distinguished
  • not evident whether swelling is testicular or extra testicular
  • a haematocele does not follow trauma or is chronic
  • hx of trauma and scrotal pain or persistent testicular sx
  • diagnostic uncertainty
47
Q

Management of an infant or young boy with suspected inguinal hernia?

A

urgent referral to paediatric surgeon (preferably to be seen within 2 weeks)

48
Q

Management of patient with persistent scrotal swelling at 2 weeks having completed Abx treatment for epididymo-orchitis?

A

urgent OP appointment with urologist to r/o underlying testicular cancer

49
Q

When should a congenital hydrocele resolve by?

A

2 years of age

50
Q

Type of chronic prostatitis?

A
  • chronic bacterial prostatitis (<10% of cases), suggested by recurrent or relapsing UTIs or episode of acute prostatitis in the least 1 year
  • chronic prostatitis/chronic pelvic pain syndrome (>90%)-no proven bacterial infection
51
Q

Most common bacteria implicated in chronic bacterial prostatitis?

A

E coli

52
Q

Investigations in suspected chronic prostatitis?

A
  • urine dip and MSU-send for culture, note may be normal in men with chronic bacterial prostatitis and no acute UTI, look back at previous cultures
  • creatinine and eGFR if recurrent UTIs, chronic urinary retention or hx of renal stones
  • STI screen-first pass urine, and urethral swab for trichomoniasis
  • consider a PSA
53
Q

Tx for men with chronic prostatitis/chronic pelvic pain syndrome?

A
  • analgesia-paracetamol +/- NSAID
  • alpha blocker e.g. tamsulosisn for 4-6/52 if significant LUTS
  • targeted CBT, counselling and antidepressants if significant psychosocial sx
  • single course of Abx if sx have been present less than 6 months e.g. trimethoprim or doxycycline for 4-6 weeks
  • stool softener if defecation painful
  • acupuncture
  • r/f to urology if severe sx, sx persist or diagnostic uncertainty
54
Q

Management of chronic bacterial prostatitis?

A
  • r/f to urology
  • whilst awaiting referral prescribe single course of Abx treatment
  • analgesia
  • stool softener if defecation painful
55
Q

F/u of men with acute prostatitis commenced on PO Abx?

A
  • review at 48hrs to check response to tx and urine culture results, +urgent r/f to GUM if STI identified
  • following recovery, refer for investigation to exclude structural abnormality of urinary tract
56
Q

Most common type of prostate cancer?

A

adenocarcinoma

57
Q

What specific referral is needed for men with prostate cancer starting bicalutamide (anti androgen) long term monotherapy (more than 6 months)?

A

due to risk of gynaecomastia offer referral for prophylactic radiotherapy to both breast buds within the 1st month of tx, if unsuccessful consider weekly tamoxifen

58
Q

When should a urine be sent for culture in women with a suspected UTI?

A
  • if pregnant, with repeat at 7 days following tx
  • age over 65 years
  • visible or non visible haematuria
  • recurrent UTI
  • persistent sx or treatment fails
  • catheterised or recently catheterised
  • RFs for complicated or resistant UTI e.g. renal impairment, hospitalisation for more than 1 week in last 6 months
59
Q

Typical urinary ACR seen with nephrotic syndrome?

A

more than 220 mg/mmol

60
Q

If ongoing RFs for CKD but patient not diagnosed with CKD how should they be f/u?

A

annual review of serum creatinine, eGFR, ACR and urine dipstick testing

61
Q

In the investigation of possible CKD how should a person’s CVS risk factors be assesed?

A
  • BMI
  • nutritional status
  • BP
  • HbA1c
  • lipid profile
62
Q

Frequency of eGFR monitoring for patients with CKD and ACR of >30?

A

if eGFR less than 60-twice a year (more than this then once a year)
if eGFR less than 30-three times a year
if ESRD-4 times a year (same irrespective of ACR)

63
Q

Definition of recurrent UTI in women?

A

2 or more episodes in 6 months or 3 or more in 1 year

64
Q

When should Abx prophylaxis be considered in management of recurrent UTI in women?

A

if underlying cause has been investigated and behavioural/personal hygiene measures and vaginal oestrogen are ineffective or inappropriate.

Initial tx: consider single dose Abx prophylaxis when exposed to trigger e.g. nitrofurantoin 100mg or trimethoprim 200mg

If no improvement or no identifiable triggers then trial of daily prophylaxis: trimethoprim 200mg ON or nitrofurantoin 50-100mg ON

F/u within 3-6 months

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