GU conditions Flashcards
1
Q
where do kidney stones (nephroliathiasis) form and what are 90% of them made of
A
stones form in renal pelvis + travel down to ureters
90%= calcium oxalate stones (radio-opaque)
other types=
calcium phosphate
uric acid (radiolucent therefore not seen on x-ray)
struvite (made by bacteria)
cystine
2
Q
list 8 risk factors for kidney stones
A
male
chronic dehydration
obesity
high protein/salt diet
recurrent UTIs
low urine output
hyperparathyroidism/hypercalcaemia
Hx of previous stone
3
Q
pathology of kidney stones
A
excess solute in dehydration= supersaturated urine> favours crystallisation
-stones cause regular outflow obstruction= hydronephrosis
-dilation + obstruction of renal pelvis= damage
4
Q
presentations of kidney stones
A
pain originating @ loin, radiating 2 groin that is colicky, peristaltic waves
patient can’t lie still
haematuria
n+v
decreased urine output
5
Q
1st line investigations for kidney stones (4)
A
urine dipstick- haematuria, leukocytes, nitrates
FBC- CRP (infection)
U&Es- hypercalcaemia
abdo x-ray- Ca stones (no uric acid stones as radiolucent)
6
Q
gold standard investigation for kidney stones
A
non-contrast CT KUB (kidney, ureter, bladder)- presence of stones
non-contrast bc contrast needs to be excreted by kidneys and therefore is harmfulf is there is a renal obstruction
7
Q
symptomatic management of kidney stones
A
symptomatic relief= hydration, NSAIDS (diclofenac), antiemtics, Abxs if UTI eg gentomycin
watchful waiting- stones <5mm norm pass spontaneously
8
Q
elective treatment of kidney stones
A
elective treatment if stones= too big
-extracorpeal shock wave therapy (ESWL- break stones into smaller fragments using shock waves)- smaller stones <20mm
-percutaneous nephrolithotomy (PCNL- use nethoscope to remove stone) larger than 20mm+
-ureteroscopy & laser lithotripsy
9
Q
lifestyle modifications for managing kidney stones
A
decrease sodium & protein intake
increase citrus fruit
adequate fluid intake
10
Q
define an acute kidney injury (AKI)
A
AKI= sudden decline in kidney function determined by increased serum creatinine and decreased urine output
11
Q
what is the KDIGO classification for AKI
A
rise in creatinine of >26 micromol/L within 48 hrs
OR
rise in creatinine of >50% from baseline within 7 days
OR
urine output of <0.5 ml/Kg/hr for >6hrs
12
Q
what is pre renal AKI and what causes it
A
prerenal= inadequate blood supply to the kidneys
causes:
dehydration
hypotension (shock)
heart failure
renal artery blockage
drugs (NSAIDS + ACEi)
decreased blood vol> decreased perfusion> decreased GFR + creatinine clearance
13
Q
what is intra renal AKI and what are its causes
A
intrinsic disease/damage to the kidney causing reduced filtration
causes:
acute tubular necrosis
glomerulonephritis
interstitial nephritis
toxins (sepsis)
kidney damage> decreased oncotic + hydrostatic pressure = decreased GFR
14
Q
what is post renal kidney disease and what are its causes
A
obstruction to outflow of urine= back pressure + decreased function (obstructive uropathy)
causes:
kidney stones
cancerous masses
ureter/urethra strictures
enlarged prostate/prostate cancer
drugs (anticholinergic, CCBs)
obstruction>back pressure 2 kidney> decrease in hydrostatic pressure> decrease in GFR
15
Q
a decrease in GFR leads to a build of which normally excreted products (5)
A
creatinine
K+ (arrhythmias)
urea (confusion, uraemia)
fluid (oedema)
H+ (acidosis)
16
Q
list 5 risk factors for an AKI
A
increasing age
co-morbidities (HTN, T2DM, chronic heart failure)
hypovolemia
nephrotoxic drugs (ACEi. NSAIDS)
cirrhosis/already have kidney problems
17
Q
presentation of an AKI
A
due 2 substance accumulation:
increase in creatinine, decreased urine output
hyperkalaemia (arrhythmias, musc weakness)
uraemia (pericarditis, n+v. encelopathy)
fluid overload (pulmonary + peripheral oedema, hypovolemic shock, orthopnoea)
HTN
sepsis/acute illness
18
Q
list signs of an AKI for pre, intra and post renal
A
pre= hypotension, syncope, d+v
intra= infection, signs of underlying disease
post= LUTS + low urine output
19
Q
list symptoms of an AKI
A
n + v
fever + dizziness
altered mental state
20
Q
investigations for an AKI
A
establish cause (pre/intra/post) + diagnose using KDIGO classification
use urea:creatinine ratio
pre= >100:1
intra= >40:1
post= 40-100:1
metabolic panel and urine output monitoring
-check K+, H+, urea, creatinine w U&Es
urinalysis: leukocytes + nitrites= infection
renal biopsy> to confirm intrarenal cause
USS for post renal
21
Q
1st line management of an AKI
A
1st=
treat underlying causes
stop nephrotoxic drugs (ACEi + NSAIDS)
treat comps:
-hyperkalemia= Ca gluconate
-metabolic acidosis= Na bicarb
-fluid overload= diuretics
22
Q
management of severe AKI
A
severe=
renal replacement therapy
-haemodialysis
indicated in AFUK
Acidosis
Fluid overload
Uremia
K+ >6.5/ECG changes
23
Q
define chronic kidney disease (CKD)
A
chronic reduction in kidney function which is permanent + progressive >3months
24
Q
what are the diagnostic criteria for CKD
A
eGFR <60 ml/min/1.73m2 for 3+ months (norm= 120)
OR
eGFR <90ml/min/1.73m2 + signs of renal damage
OR
albuminuria (albumin in urine)>30mg/24hrs
25
list 4 risk factors for CKD
DM + HTN (mc)
male
increasing age
smoking
26
describe the pathology of CKD
many nephrons damaged= a decrease in GFR- this increases the burden on the remaining nephrons
- compensatory RAAS to increase GFR
BUT:
increase in transglomerular pressure= shearing + loss of basement membrane permeability- causes proteinuria/haematuria
27
list 5 signs of CKD
asymptomatic until end stage
Sxs due to substance accumulation + renal damage
haematuria
proteinuria
peripheral neuropathy
HTN
oedema
28
list 6 symptoms of CKD
pruritis
loss of appetite
nausea
musc cramps
pallor
fatigue
29
investigations for CKD (4)
FBC- anaemia of chronic disease
U&E- GOLD for estimated eGFR function. (diagnostic)
urine dip (proteinuria)
GFR func. staging 1-5
30
describe eGFR function staging 1-5
uses 4 parameters:
creatine, age, gender, ethnicity
1. 90+ w. renal signs
2. 60-90 w. renal signs
3. a. 45-59 b. 30-44
4. 15-29
5. <15
highest score= well functioning kidneys
lowest= most severe kidney damage
31
management of CKD
no cure so treat comps:
-anaemia= ferrous sulphate + erythropoietin
-oedema= diuretics
-metabolic acidosis= Na bicarb
-osteodystrophy= vit D supps
-CVD= ACEi + statins
end stage= renal replacement therapy (eGFR<15) dialysis
eventually- kidney transplant= cure
32
AKD vs CKD
AKD=
-increase in serum creatinine + decrease in urine output
-shorter Sx onset
-no anaemia
-USS= normal
CKD=
-decrease in eGFR
-3+ months Sx onset
-anaemia of CKD
-USS= bilateral, small, abnormal kidneys
33
describe benign prostate hyperplasia (BPH)
non-malignant hyperplasia of stromal + epithelial cells of prostate- causes enlarged prostate which partially blocks urethra
34
list 5 risk factors for BPH
increasing age
increase in testosterone (castration= protective)
FHx
smoking
non-asian
35
presentation of BPH
| what is used to assess these symptoms
LUTS- lower urinary tract symptoms
STORAGE:
frequency, urgency, incontinence, nocturia
VOIDING:
dysuria, poor/intermittent stream, dribbling, straining, incomplete emptying, hesitancy
IPSS (international prostate symptom score) used to assess severity of LUTS
36
investigations for BPH (including GOLD)
GOLD= DRE- smooth but enlarged prostate (prostate cancer= hard + irregular)
-prostate specific antigen raised (v. unreliable as can be raised in cancer as well)
-urine frequency volume chart
-urine dipstick (rule out infection)
37
management of BPH
lifestyle- reduce caffeine/alcohol intake
1st= alpha blockers eg tamsulosin (relaxes smooth musc in bladder neck + prostate)
2nd= 5-alpha reductase inhibitors eg finasteride (blocks conversion of testosterone to dihydrotestosterone which decreases prostate size)
surgery= last resort- TURP, transurethral resection of prostate
38
describe renal cell carcinoma + list 4 risk factors for it
adenocarcinoma rising from PCT
mc. of renal cancer
RFs:
smoking
obesity
hereditary
von hippel-lindau (autodom loss of tumour suppressor gene)
39
presentations of renal cell carcinoma (including a triad)
triad=
1. haematuria
2. flank pain
3. palpable mass
may have L varicocele
cancer symptoms= wt. loss, fatigue, anorexia, night sweats
40
1st line and gold standard investigations for renal cell carcinomas
1st=
bloods= increased: RBCs, Ca, LDH (lactate dehydrogenase)
abdo/pelvis USS
GOLD= CT chest/abdo/pelvis
41
management of renal cell carcinomas
nephrectomy/partial nephrectomy
42
define bladder cancer and give the mc. subtype of bladder cancer
cancer in bladder arising from urothelium
mc. subtype= transitional cell carcinoma
43
Risk factors for bladder cancer
occupational exposure to dyes/paints/rubber (aromatic amines)
-painter
-hairdresser
-mechanic working w. tyres
-dye factory worker
age 65+
male
caucasian
smoking
pelvic radiation
44
presentations of bladder cancer
painless haematuria (macro or microscopic)
urgency
dysuria
suprapubic/pelvic mass
pelvic pain
recurrent UTI
signs of metastases: bone pain, wt. loss
45
1st line and GOLD investigations for bladder cancer
1st=
urinalysis 4 microscopy + culture
bladder USS
GOLD= flexible cystoscopy + biopsy
46
management of bladder cancer
conservative= support eg specialist nurse
medical= chemo/radio
surgical= TURBT (transurethral resection of bladder tumour)
last resort= cystectomy (bladder removal)1
47
where does prostate cancer develop
peripheral zone of the prostate
-mc. cancer in men + v. slow growing
48
list 5 risk factors for prostate cancer
genetic- BRCA2, HOXB13
FHx
increasing age
afro-caribbean
anabolic steroids
49
what are lower urinary tract symptoms (LUTS)
STORAGE: need to pee
-frequency
-urgency
-nocturia
-incontinence
VOIDING: hard 2 pee
-poor stream
-incomplete emptying
-hesitancy
-need 2 pee
50
presentation of prostate cancer
| where does it typically metastasise to
LUTS (like BPH) but w. systemic cancer symptoms (wt. loss, fatigue, night pain) + bone pain
haematuria
erectile dysfunction
typically metastasises to bone (thick sclerotic lesions), liver, lungs & brain
51
1st line investigations for prostate cancer
DRE + prostate exam- firm + hard + asymmetrical + rough
test for prostate specific antigen in community setting - increased
52
gold standard investigation for prostate cancer + grading system
transrectal USS + biopsy
Gleason grading system- based on biopsy
- higher score= worse prognosis
53
management of prostate cancer in a local setting
prostatectomy if <70
active surveillance if 70+
external beam radiotherapy
brachytherapy
54
management of prostate cancer that has metastasised
chemo/radio
bilateral orchidectomy (GOLD hormonal treatment)
androgen deprivation therapy
palliative care 2 relieve symptoms eg TURP
55
where does testicular cancer arise from and list the germ and non-germ cell cancers
cancer arising from germ cells in the testes
-90% germ cell cancers (semimomas, teratomas)
-10% non-germ cell cancers (leydig, sertoli, lymphoma)
56
list 5 risk factors for testicular cancer
undescended testes (cryptorchidism)
male infertility
FHx
tall
HIV
57
presentation of testicular cancer
palpable painless lump in testicle- which does NOT TRANSILLUMINATE
haematospermia (blood in semen)
gynecomastia
58
investigations for testicular cancer
urgent USS (doppler) of testes
tumour markers:
-alpha fetoprotein (AFP)= increased in teratomas
-beta HCG= increased in seminomas + teratomas
lactate dehydrogenase= non-specific raised
59
management of testicular cancer
urgent radical orchidectomy- offer sperm storage (semen cryopreservation
metastatic lymph node removal, chemo, radio
60
what is obstructive neuropathy
blockage of urinary flow
- can affect 1 (urine output + serum creatinine may remain the same) or both kidneys
61
what are 2 causes of obstructive neuropathy and describe the pathology of an obstruction
renal stones
BPH
obstruction= urinary retention> increase in kidney or ureter or bladder pressure > refluxing of urine into renal pelvis= hydronephrosis (dilated renal pelvis which is more infection prone)
62
list 3 presentations of a renal obstruction
flank pain
LUTS
fever
-may be asymptomatic of only one kidney affected
63
investigations for obstructive neuropathy (4)
urinary dipstick
renal USS
urea & creatinine
FBC
64
management of an obstructive neuropathy
1st= relieve pressure on the kidneys: urethral catheter, ureteric stent, nephrostomy tube
treat underlying cause: renal stones, BPH, infection
65
list 1 upper kidney UTI and 4 lower (bladder onward) UTIs
upper= pyelonephritis
lower=
cystitis
prostatitis
urethritis
epididymo-orchiditis
66
list the organisms that cause UTIs (KEEPS)
Kiebsella
Enterobacter
E. coli
Proteus
S. saprophyticus
80% of cases= uropathogenic E.coli
67
what is the first line investigation for all types of UTIs and what are the results
urine dipstick
-positive 4 leukocytes
-positive 4 nitrites (bacteria break down nitrates into nitrites)
-+/- haematuria
68
what is the gold standard investigation for all types of UTIs
midstream microscopy + serology
-confirm UTI + identify pathogen
69
describe pyelonephritis
upper UTI
inflammation of kidney renal pelvis caused by bacterial infection (mc. enteropathogenic E.coli)
-mostly acquired via ascending transurethral spread
70
list 4 risk factors for pyelonephritis
female
urinary stasis (BPH, stones, cancer)
vesicoureteral reflux
catheter
71
presentations of pyelonephritis (including a triad)
triad of: loin pain, fever, pyuria (increased levels of WBCs or pus in urine)
+
urgency
frequency
dysuria
suprapubic pain
n+v
back pain
headache
72
management of pyelonephritis
analgesia- paracetamol
Abxs- ciprofloxacin or co-amoxiclav
- if pregnant, cefalexin
73
describe cystitis
lower UTI causing an inflamed bladder
m.c caused by enteropathogenic E.coli
74
list 5 risk factors for cystitis
female
urine stasis (BPH, stones, cancer)
frequent sex
catheter
bladder lining damage
75
presentations of cystitis (4)
suprapubic tenderness + discomfort
increased frequency + urgency
haematuria + polyuria
confusion in elderly
76
management of cystitis
Abxs: trimethoprim/nitrofurantoin
preggo=
no trimethoprim in 1st trimester (inhibits folate synthesis)
no nitrofutantoin in 3rd trimester
use amoxicillin, cefalexin instead
77
describe urethritis
lower UTI
urethral inflammation +/- infection
mc. sexually acquired condition
78
what are the 2 types of bacteria that cause infective urethritis
gonococcal- neisseria gonorrhoea
non-gonococcal- chlamydia trachomatis
79
list 3 risk factors for urethritis
female
MSM
unprotected sex
80
1st line investigations for urethritis
urine dipstick + microscopy & culture
NAAT- nucleic acid amplification test- detect UTI (chlamydia/gonorrhoea)
81
gold standard investigation for urethritis
urethral discharge gram stain
- decrease in polymorphonuclear leucocytes confirms urethritis
presence of gram negative cocci= gonorrhoea
82
management of urethritis
Neisseria gonorrhoea- 1g IM ceftriaxone + 1g azithromycin
chlamydia trachomatis- 100mg doxycycline or azithromycin
83
describe epidiymo-orchitis
lower UTI
inflammation of epididymis + testes
- usually due 2 UTI (gonorrhoea, chlamydia) or by enteric pathogens (E.coli)
84
list 3 risk factors for epidiymo-orchitis
unprotected sex
bladder outflow obstruction (BPH, stones, cancer)
catheter
85
presentation of epidiymo-orchitis
gradual onset of unilateral scrotal pain + swelling
pain relieved w. elevated testis (positive prehn's sign)
cremaster reflex intact
urethral discharge
LUTS
DDx= rule out testicular torsion (much more acute, n+v , no cremaster reflex)
86
1st line + gold investigations for epidiymo-orchitis
1st= urine dipstick= leukocytes + nitrites + blood
GOLD=
NAAT (nucleic acid amplification test)
urine microscopy + cultures
other= USS 2 rule out testicular torsion
87
management of epidiymo-orchitis
neisseria gonorrhoea= 1g IM ceftriaxone + 1g azithromycin
chlamydia trichomatis= 100mg doxycycline or azithromycin
E.coli= 500mg levofloxacin
88
what do nephr0tic syndromes cause
group of conditions which cause glomerular basement membrane 2 become permeable to protein
89
list 4 common characteristics of nephr0tic syndrome
proteinuria
peripheral oedema
hypoalbuminemia
hypercholesterolemia
90
what are 3 primary causes of nephr0tic syndrome
minimal change disease (mc. in kids, unknown cause, immune mediated)
membranous glomerularnephritis (adults)
focal segmental glomerulosclerosis (causes= HIV, sickle cell, mc. in adults)
91
what is a secondary cause of nephr0tic syndrome
diabetic nephropathy
92
presentations of nephr0tic syndrome
proteinuria (>3.5g/24hrs)
-frothy, apple juice urine + infection
hypoalbuminemia (<30g/L)
peripheral oedema
hypercholestrolaemia
haematuria
hyperlipidaemia + wt. gain
HTN
93
1st line investigations for nephr0tic syndrome
bloods eg decreased albumin
mid-stream urinalysis + dip stick
kidney USS
94
gold standard investigation for nephr0tic syndrome and what would you see with each primary cause
needle biopsy + microscopy
minimal change disease:
light microscopy= no change
electron microscopy= podocyte loss
membranous glomerulonephritis:
light microscopy= thickened capillary wall
electron= subpodocyte immune complex deposition (spike + dome appearance)
focal segmental glomerulosclerosis:
light= segmental sclerosis
95
management of nephr0tic syndrome
high does steroids - 12 weeks prednisolone
treat comps:
oedema= diuretics
hyperlipidaemi= statins
hypercoagulable state= anticoagulant eg warfarin
infection= Abxs
96
describe nephritic syndrome
group of glomerulonephritis pathologies that cause inflammation of the kidneys
-increased permeability of glomeruli allows movement of RBCs into filtrate= haematuria + proteinuria
97
list 5 causes of nephritic syndrome
IgA neuropathy (Berger's disease, mc.)
SLE
post-streptococcal glomerulonephritis
good pasture's syndrome
haemolytic uraemic syndrome
98
what are the causes of nephritic syndrome (apart from good pastures) all examples of
type 3 hypersensitivity reactions
(goodpastures= type 2)
99
IgA nephropathy (Sx, Dx, Tx) and what is a DDx
Sx= visible haematuria 1-2 days after viral infection- coke/ribena urine
Dx= immunofluroscence microscopy- IgA complex deposition
Tx= non-curative, BP control (ACEi)
DDx= Henloch schonlein purpura
-Sxs are exactly same
diff=
IgAn- only kidney deposition
HSP- systemic deposition
100
post streptococcal glomerulonephritis (Sx, Dx, Tx)
Sx= visible haematuria- coke/ribena urine
-2 weeks after pharyngitis from group A,B haemolytic strep
Dx=
light microscopy= hypercellular glomeruli
electron microscopy= subendothelial immune complex deposition
immunofluorescence- 'starry sky' appearance
Tx= usually self limiting - penicillin
101
SLE (Dx, Tx)
lupus nephritis secondary 2 SLE (ANA deposition in endothelium)
Dx= ANA positive, anti dsDNA positive
Tx= hydroxychloroquine + cyclophosphamide
102
good pasture's (Dx, Tx)
pulmonary + alveolar haemorrhage
Dx= anti-GBM autoantibodies
Tx= steroids + plasma exchange
103
describe polycystic kidney disease
fluid filled cysts form within renal parenchyma (cortex + medulla)
104
what are the 2 types of polycystic kidney disease
auto-dom= mutated PKD-1 chromosome (85%) or PKD-2 (15%)
auto-rec= gene on chromosome 6 (L.C, prebrith/infancy w. high mortality)de
105
describe the pathology of polycystic kidney disease
cysts grow + develop overtime into tubular portion of nephron= compression of Rena architecture + vasculature
progressive impairment- gets bigger + worse w age
106
presentation of polycystic kidney disease
bilateral flank/back or abdo pain (+/- haematuria & HTN)
LUTS
palpable kidneys
extra-renal manifestations:
cerebral aneurysms (esp Berry- if ruptured= subarachnoid haemorrhage)
hepatic, splenic, pancreatic, ovarian and prostatic cysts
abdo hernia
107
investigations for polycystic kidney disease
kidney USS- enlarged bilateral kidneys w. multiple cysts
15-39 @ least 3 cysts uni or bilateral
40-59 @ least 2 in each kidney
60+ @ least 4 in each kidney
other= genetic testing + FHx of PKD
108
management of polycystic kidney disease
non-curative
Tolvaptan (ADH receptor antagonist)- slows development of cysts + progression of renal failure
supportive= antihypertensives, Abxs if infected, drainage + surgical removal of cysts
dialysis + transplant (ESRF)
109
name 4 non-cancerous scrotal conditions/diseases
epididymal cyst
hydrocele
varicocele
testicular torsion
110
what is a epididymal cyst, where is it normally located and what does it contain (will it transilluminate)
smooth intra testicular spherical cyst @ top of testicle
-contains clear + milky fluid - WILL TTRANSILLUMINATE
111
investigations and management of epididymal cysts
Dx= USS of scrotum
Tx= none, surgery if causing pain
112
describe hydrocele including simple and communicating
hydrocele= abnormal collection of fluid in tunic vaginalis
simple= overproduction of fluid
communicating= peritoneal fluid + scrotum are connected
113
presentation of hydrocele (will it transilluminate)
non-tender, smooth scrotal swelling
WILL transilluminate
114
investigations + management of hydrocele
Dx= clinical diagnosis + USS of scrotum
Tx= observation or surgery/aspiration 4 larger, symptomatic hydroceles
115
describe varicocele and what are 2 things that can cause it
abnormal dilation of testicular veins in pampiform venous plexus
caused by either increased resistance in testicular vein or incompetent valves causing reflux
116
which testicle is mc affected in varicocele and how can it lead to infertility
L side mc affected due 2 angle L testicular vein enters L renal vein
infertility can occur bc pampiform plexus regulates temp of blood entering testes- varicocele can disrupt this
117
presentation of varicocele (4)
scrotal mass that feels like a bag of worms
dragging + heaviness of scrotum
throbbing/dull pain
worse on standing
118
investigations + management for varicocele
Dx=
clinical diagnosis
other= USS w. doppler
semen analysis for fertility
Ix= surgical repair if pain, infertility, atrophy
119
what happens in testicular torsion and what can happen if it is not dealt with ASAP
spermatic cord twists on itself - causes occlusion of testicular artery + ischaemia
- gangrene of testes if not dealt with
surgical emergency
120
what is a risk factor for testicular torsion
bell clapper deformity- horizontal lie of testes
121
presentation of testicular torsion
severe, unilateral testicular pain
hurts 2 walk
cremasteric reflex lost (stroke inner thigh- ipsilateral testicle elevates)
no pain relief w elevating testes (negative phren sign)
firm + swollen testicle
abdo pain
n + v
122
1st line and gold investigations for testicular torsion
1st= immediate surgical exploration if there is high risk
gold= scrotal USS- whirlpool sign (spiral appearance of spermatic cord + blood vessels
123
management of testicular torsion
urgent surgery within 6hrs
orchiopexy (corrections position of testicles)
orchidectomy (remove testicle)
124
what are 3 types of incontinence and management
stress -sphincter weakness due to trauma/post preggo
urge- detrusor musc overactivity
spastic paralysis
Tx= surgery + anticholinergic drugs
125
what is retention, give 4 causes of retention and management
inability 2 pass urine even when bladder full (500ml)
causes= obstruction
-BPH
-stones
-neurological flaccid paralysis
Tx= catheterise
126
what are storage symptoms of LUTS
LUTS= lower urinary tracts symptoms
storage= need 2 pee
-frequency
-nocturia
-urgency
-incontinence
127
what are voiding symptoms of LUTS
voiding= hard 2 pee
-poor stream
-incomplete emptying
-hesitancy
-need 2 pee
128
what are red flag LUTS
dysuria + haematuria
129
presentations of chlamydia trachomatis (including Sxs in women VS men)
chlamydia trachomatis= gram negative bacteria (mc. UTI in UK)
Sxs:
women=
abnormal vaginal discharge
vaginal bleeding
cervical inflammation
painful sex + urination
men=
painful urination
penis discharge
130
investigations for chlamydia trachomatis
nucleic acid amplification test (NAAT)
-swabs check directly for DNA or RNA organism
swabs= endocervical, vulvovaginal, 1st catch urine sample, men= urethral
131
management of chlamydia trachomatis
doxycycline 100mg x2 daily for 7 days
CI= preggo + breast feeding
instead use clarithromycin, amoxicillin, azithromycin
132
what does neisseria gonorrhoea affect
neisseria gonorrhoea= gram negative diplococcus
- infects mucous membranes w. columnar epithelium
133
presentations of neisseria gonorrhoea (men vs women- 3 each)
women=
odourless purulent discharge (green/yellow)
painful urination
pelvic pain
men=
odourless purulent discharge (green/yellow)
painful urination
testicular pain/swelling (epididymis-orchitis)
134
1st line and gold investigations for neisseria gonorrhoea
1st= charcoal swab for microscopy, culture and antibiotic sensitivity
gold= NAAT- checks for DNA/RNA of organism
swabs= endocervical, vulvovaginal, 1st catch urine, men= urethral
135
management of neisseria gonorrhoea
IM ceftriaxone (cephalosporin)- 1g if sensitivity not known
oral ciprofloxacin- 500mg if sensitivities are known
136
what is syphilis caused by
Syphilis= STI caused by treponema palladium- spirochaete bacterium which gets thru skin + mucous membranes
137
presentations of primary, secondary and tertiary syphilis
primary=
painless genital ulcer
lymphadenopathy
2ndary=
maculopapular rash
condylomata lata (grey wart-like lesions around genitals)
fever
lymphadenopathy
tertiary=
gummatous lesions (granulomatous lesions on skin, organs, bones)
AAA
138
presentations of neurosyphilis
headache
altered behaviour
dementia
tremor
paralysis
139
investigations for neurosyphilis
IM benzathine benzylpenicillin
CI penicillin allergy= ceftriaxone, amoxicillin, doxycycline (doxycycline CI in breast feeding + pregnancy)
