Dysuria and Urinary Frequency

Question 1

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

Answer 1

Dysuria

Question 2

_________ difficult and painful micturition with

associated spasm

Answer 2

Strangury

Question 3

________usually causes pain at the onset of

micturition

Answer 3

Urethritis

Question 4

________usually causes pain at the end of

micturition

Answer 4

Cystitis

Question 5

Suprapubic discomfort is a feature of ______

Answer 5

bladder infection (cystitis

Question 6

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

Answer 6

Vesicocolonic fistulas

Question 7

Dysuria and frequency are most common in women

aged _______

Answer 7

15 to 44 years

Question 8

Dysuria and discomfort is a common feature

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

Answer 8

atrophic urethritis.

Question 9

Unexplained dysuria could be a pointer to

________

Answer 9

Chlamydia urethritis

Question 10

________ 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%

Answer 10

Vaginitis

Question 11

Small amounts of blood _________ can

produce macroscopic haematuria

Answer 11

(1 mL/1000 mL urine)

Question 12

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

Answer 12

(phase contrast microscopy)

light microscopy

Question 13

Joggers and athletes engaged in very vigorous

exercise can develop_______

Answer 13

transient microscopic

haematuria.

Question 14

What are the 2 types of microscopic hematuria

Answer 14

glomerular (from kidney parenchyma):

non-glomerular (urological):

Question 15

Microscopic hematura:

common causes are IgA nephropathy and thin
membrane disease

Answer 15

glomerular

Question 16

Microscopic hematura:

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

Answer 16

non-glomerular (urological)

Question 17

Macroscopic haematuria occurs in 70% of people

with________ and 40% with__________

Answer 17

bladder cancer

kidney cancer

Question 18

Massive haematuria is a feature of _______

Answer 18

radiation cystitis

Question 19

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

Answer 19

Loin pain

Question 20

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

Answer 20

large prostatic veins,

Question 21

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

Answer 21

glomerular bleeding

Question 22

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

Answer 22

Urinary cytology

Question 23

What are the radiological techniques to assess urinary tract

Answer 23

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

Question 24

In all patients, regardless of the IVU findings,

________is advisable

Answer 24

cystoscopy

Question 25

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

Answer 25

Kidney biopsy:

Question 26

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

Answer 26

Pseudohaematuria

Question 27

Causes of pseuohematuria

Answer 27

• 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)

Question 28

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

Answer 28

Exercise or sports haematuria

Question 29

What is the theory of the cause of exercise hematuria?

Answer 29

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

Question 30

Macroscopic haematuria is a common presenting ploy | of people with _________ and ___________simulating kidney colic.

Answer 30

Munchausen syndrome pethidine addicts

Question 31

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.

Answer 31

Urethral caruncle

Question 32

Main Sx of Urethral caruncle

Answer 32

The main symptom is haematuria

Question 33

Dx of Urethral caruncle

Answer 33

may require cystoscopy and biopsy for diagnosis

Question 34

Tx of Urethral caruncle

Answer 34

Treatment includes warm salt baths and oestrogen | creams

Question 35

Bladder cancer is the seventh most common | malignancy, with 90% being_______

Answer 35

transitional cell | carcinomas

Question 36

Most important RF for bladder CA

Answer 36

Smoking is the most | common association.

Question 37

Gold standard for dx of bladder CA

Answer 37

IVU is the gold standard

Question 38

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

Answer 38

intravesical BCG immunotherapy

Question 39

Other intravesical agents used include various | cytotoxics (___________

Answer 39

e.g. mitomycin C)

Question 40

_________ means kidney inflammation | involving the glomeruli

Answer 40

Glomerulonephritis

Question 41

____________: oedema + hypertension | + haematuria

Answer 41

nephritic syndrome

Question 42

_______ oedema + hypoalbuminaemia | + proteinuria

Answer 42

nephrotic syndrome:

Question 43

The main causes of glomerulonephritis–nephritic | syndrome are

Answer 43

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

Question 44

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

Answer 44

IgA nephropathy

Question 45

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.

Answer 45

Acute post-streptococcal | glomerulonephritis

Question 46

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

Answer 46

oedema Hypertension

Question 47

What is the usual course of PSGN * Oliguria ______ days * Oedema and hypertension ______days * Invariably resolves * _________prognosis

Answer 47

2 2–4 Good long-term

Question 48

Dx of PSGN

Answer 48

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

Question 49

Tx of PSGN

Answer 49

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

Question 50

discoloured urine + peri- orbital | oedema + oliguria _________

Answer 50

post-streptococcal | glomerulonephritis

Question 51

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

Answer 51

glomeruli, the tubules or the LUT

Question 52

The amount of protein in the urine is normally less | than_______

Answer 52

100 mg/24 hours

Question 53

Greater than__________mg/24 hours is abnormal for | children and adults

Answer 53

300

Question 54

Proteinuria_________/24 hours indicates a serious | underlying disorder.

Answer 54

>1 g

Question 55

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

Answer 55

300 mg/24

Question 56

In diabetics, microalbuminuria is predictive of | nephropathy and an indication for ______

Answer 56

early blood | pressure treatment

Question 57

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

Answer 57

daily albumin excretion albumin creatinine ratio (ACR),

Question 58

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

Answer 58

(>3 g/24 hours)

Question 59

_________ 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

Answer 59

Orthostatic proteinuria

Question 60

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

Answer 60

diabetic nephropathy,

Question 61

The use of ________at the microalbuminuria stage may slow | the development of overt nephropathy

Answer 61

ACE | inhibitors

Question 62

Gold standard of overt nephropathy

Answer 62

The gold | standard is a 24-hour collection

Question 63

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

Answer 63

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

Question 64

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

Answer 64

Minimal change glomerulonephritis

Question 65

Tx of MCD

Answer 65

steroid

Question 66

proteinuria + generalised oedema | + hypoalbuminaemia

Answer 66

nephrotic syndrome

Question 67

Dx of NS * Proteinuria________ g/day (3–4 on dipstick) * Hypoalbuminaemia _______ g/L * Hypercholesterolaemia ______ mmol/L

Answer 67

>3 <30 >4.5

Question 68

BP of NS

Answer 68

N

Question 69

Causes of NS in 2/3 of cases

Answer 69

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

Question 70

Medical Tx of NS

Answer 70

* Diuretics * Prednisolone * Phenoxymethylpenicillin * Aspirin

Question 71

Loss of urine secondary to | factors extrinsic to the urinary tract

Answer 71

Functional incontinence

Question 72

(or bed-wetting) Involuntary urine | loss during sleep

Answer 72

Nocturnal enuresis

Question 73

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

Answer 73

Overactive bladder (detrusor instability

Question 74

Escape of urine following poor bladder emptying.

Answer 74

Overflow incontinence

Question 75

An urgent desire to void followed by involuntary loss of urine

Answer 75

Urge incontinence

Question 76

The involuntary loss of urine during the day or night

Answer 76

Urinary incontinence

Question 77

Includes urinary difficulties, detrusor instability and overflow incontinence

Answer 77

Voiding dysfunction

Question 78

What is the cause? Simple stress incontinence (with cough/sneeze

Answer 78

Sphincter incompetence

Question 79

What is the cause? ``` Urge incontinence Giggle incontinence Stress and urge incontinence Enuresis Complex stress incontinence (with exercise) ```

Answer 79

Unstable bladder, with or without sphincter weakness

Question 80

What is the cause? Quiet dribble incontinence

Answer 80

Sphincter incompetence and unstable bladder or overflow

Question 81

What is the cause? Continuous leakage

Answer 81

Fistula, ectopic ureter, patulous urethra

Question 82

What is the cause? Reflex incontinence

Answer 82

Neuropathic bladder

Question 83

The basic requirements for continence are:

Answer 83

* adequate central and peripheral nervous function * an intact urinary tract * a compliant stable bladder * a competent urethral sphincter * efficient bladder emptying

Question 84

The most common contributing factor to urinary incontinence is:

Answer 84

weakness of the pelvic floor muscles

Question 85

Drugs that cause Bladder relaxants → overflow incontinence

Answer 85

* anticholinergic agents | * tricyclic antidepressants

Question 86

Drugs that cause Bladder stimulants → urge incontinence

Answer 86

* cholinergic agents | * caffeine

Question 87

Sedatives that cause urge incontinence

Answer 87

* antidepressants * antihistamines * antipsychotics * hypnotics * tranquillisers

Question 88

These may be worth a trial for bladder instability or | voiding dysfunction

Answer 88

* 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

Question 89

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

Answer 89

Uterovaginal prolapse

Question 90

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:

Answer 90

Cystocele Urethrocele Rectocele Enterocele Uterine

Question 91

What are the degrees of prolapse? — first degree—__________ — second degree—__________ — third degree (procidentia)—_______

Answer 91

cervix remains in vagina cervix protrudes on coughing/straining uterus lies outside vagina

Question 92

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.

Answer 92

Ring pessaries

Question 93

The pessary needs to be cleaned or changed every | _________

Answer 93

4–6 months