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Dysuria and LUTS Flashcards

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1
Q

Microalbuminuria vs proteinuria

A

Microalbuminuria: Not detected by normal urine dipstick, need special tests in high-risk groups

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2
Q

Causes of proteinuria

A

Vascular: Hypertension, CCF

Infectious: UTI, haeumolytic uraemic syndrome

Trauma: Postural (in adolescents)

Autoimmune: SLE, vasculitis, glomerulonephritis

Metabolic: DM

Neoplastic:Pregnancy (PRE-ECLAMPSIA), myeloma

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3
Q

Causes for microalbuminuria

A

Diabetes Mellitus

Arteriopathy

COPD

Malignancy

Acute illness

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4
Q

Definition of nephrotic syndrome

A

Proteinuria

Oedema

Hypoalbuminaemia

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5
Q

Definition of nephritic syndrome

A

Haematuria

Proteinuria

Oliguria

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6
Q

Causes of nephrotic syndrome

A

Glomerulonephritis

Diabetes

SLE, amyloid

Neoplasms

Endocarditis

Sickle cell, malaria

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7
Q

Complications of nephrotic syndrome

A

Hypovolaemia

Thromboembolism

Hypercholesterolaemia

Infx (esp pneumococcal)

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8
Q

What is strangury

A

‘Tenesmus’ of the urine - desire to pass something that will not pass

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9
Q

Epidemiology of renal stones

A

M>F

Peak age 20-50y

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10
Q

Risk factors for renal stone formation

A

Chronic UTI

Structural kidney abnormality

Hypercalcaemia, gout, cystinuria

Dehydration

Immobilisation

Family history

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11
Q

Presentation of renal stones

A

Pain + nausea/vomiting

Loin pain: Renal stone

Renal colic: Ureteric stone, may refer to testis/penis/labia majora

Strangury: Bladder stone

Interrupted flow: Urethral stone

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12
Q

Management of renal stones

A

Usually resolve spontaneously

Urine dipstick to check for haematuria

Investigate with X-ray/USS (90% radio-opaque)

Diclofenac for pain + anti-emetic

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13
Q

Indications for hospital admission with renal stones

A

Fever

Oliguria

Pregnancy

Lives alone

Poor fluid intake

Symptoms >24h

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14
Q

Differential for renal stones

A

Ruptured AAA

Appendicitis, cholecystitis, pancreatitis

Diverticulitis

Pyelonephritis

Strangulated hernia, testicular torsion

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15
Q

Investigation of haematuria

A

MC&S of MSU

Bloods: creatinine, eGFR, U&E

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16
Q

Differential causes for haematuria

A

Renal: Tumour, stones, interstitial nephritis, infection

Bladder: Stones, tumour, UTI

Prostate: Prostatitis, tumour

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17
Q

Criteria for urgent referral of haematuria

A

Painless macroscopic haematuria any age

Any pt with abdominal mass ?related to renal tract

>40y w/ persistent UTI assoc w/ haematuria

>50 w/ unexplained microscopic haematuria

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18
Q

Criteria for non-urgent referral of haematuria

A

<50 with microscopic haematuria

Proteinuria, high creatinine, low eGFR > renal

Otherwise urology

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19
Q

Differential for sterile pyuria

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A

Infective: Inadequately treated UTI, renal TB, non-cultured organism

Inflammatory: Interstitial nephritis/cystitis, prostatitis

Neoplasm: Bladder

Renal: polycystic kidney, calculi

20
Q

Risk factors of bladder cancer

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A

M>F

Smoking

Chemical, textile industry

Schistosomiasis (SCC)

Chronic UTI

Urinary stasis

21
Q

Presentation of bladder cancer

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A

Haematuria - painless or painful

Less common:

  • Recurrent UTI
  • Frequency
  • Loin pain
  • Pelvic pain
  • Bladder outflow obstruction
22
Q

Risk factors for UTI

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A

Female

DM

Prev infection

Stones, stasis

Pregnancy, menopause

Dehydration, catheterisation

23
Q

Presentation of cystitis

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A

Frequency, urgency,

suprapubic pain, dysuria,

haematuria, cloudy/offensive urine

incontinence/retention

24
Q

Presentation of pyelonephritis

Study These Flashcards
A

Fevers, malaise, rigors

Loin-to-groin pain

N+V

Haematuria

25
Differential for dysuria
UTI STI (esp chlamydia) Vulvovaginitis - consider eczema, infection Interstitial cystitis Tumour, stone
26
Differential for urinary frequency
**External pressure:** Fibroids, pregnancy, prostatism **Internal space:** Stones, tumour, fibrosis (post-radiotherapy) **Inflammation:** Cystitis **Neuro:** e.g. MS **Other:** DM, drugs
27
Indications for urine MC&S
* Pregnant * Uncatheterised man * Catheterised + symptomatic UTI * Unresolving UTI * Recurrent UTI * Child * ?Pyelonephritis
28
When to treat UTI w/o dipstick
Severe and/or \>=3 symptoms in a woman
29
NPV of non-cloudy urine
97% - consider alt dx
30
Common causative organisms for UTIs
E. coli (most common!) Proteus Pseudomonas Strep Staph
31
Leucocyte and nitrite dipstick interpretation
Both +ve - 92% PPV Both -ve - 76% NPV Nitrite more specific for infx but may miss non-EC infx
32
Management of uncomplicated UTI
3d course of nitrofurantoin 100mg m/r BD **OR** 50 mg i/r QDS Potassium citrate or Na bicarbonate to ease symptoms Increase fluid intake
33
What is a complicated UTI
Man Immunosuppression Structural GU abnormality Recurrent/relapsed UTI Pregnancy 7d not 3d course of abx
34
Management of UTI in pregnancy
MSU MC&S 100mg m/r nitrofurantoin BD or 50mg i/r qds 7d course
35
Chlamydia testing samples
Endocervical swab if female First void urine if male
36
Prevalence of BPH
10-30% of men in 70s
37
Symptoms of prostatism
Frequency, urgency, dysuria terminal dribbling, hesitancy Incomplete emptying, straining Intermittent stram
38
Differential for prostatism
UTI Detrusor instability Urethral stricture Stone, tumour Hypercalcaemia, uraemia
39
Conservative management of prostatism
Change med timings (Esp diuretics) Avoid alcohol, caffeine, high fluid esp in evenings Avoid constipation Pelvic floor/bladder retraining exercises
40
Drug therapy for prostatism
**a-adrenoreceptor antagonists:** e.g. doxazocin, prazosin - caution for postural hypotension **5a-reductase inhibitors:** e.g. finasteride
41
Criteria for referral of prostatism
Complicated prostatism (e.g. acute retention) Raised/rising PSA Nodular/firm prostate on DRE
42
Presentation of acute bacterial prostatitis
Swollen, tender prostate UTI symptoms Fever, myalgia, arthralgia Low back, perineal, penile, rectal pain
43
Contraindications for PSA test (confounders)
Ejaculation within 48h Exercise within 48h Prostate examination within 1wk UTI within 1mo Biopsy/instrumentation within 6w
44
Indications for PSA and DRE ?prostate cancer
Erectile dysfunction Haematuria Low back pain Weight loss Inflammatory/obstructive LUTS in old age!
45
Effect of having PSA test
6-8 y earlier Dx 1 in 1000 reduction in death (from 5 to 4) No effect on life expectancy Treatment + investigation: ED, incontinence, pain
46
Issues with prostate cancer screening
Unknown natural history Commonly occurs in old age - unclear survival benefit Common autopsy incidental (75% over 75) - unclear effect of treatment on survival Lack of good test
47
False positive and negative rate of PSA
70% false positive 15% false negative

Primary care (8 decks)

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