Urinary and reproductive Flashcards
(137 cards)
1
Q
organisms causing UTIs in immunosuppressed (otherwise is E coli)
A
- klebsiella
- candida
- pseudomonas
- proteus vulgaris
2
Q
when to do urine MC&S in UTI
A
- always in men
- > 65
- not required if symptomatic in non-pregnant women
- if failed to respond to treatment
- haematuria
3
Q
when to do 2 week wait in UTI
A
- 45+ and unexplained visible haematuria
- 60+ and unexplained non-visible haematuria and dysuria/raised WCC
4
Q
antibiotics to give in pyelonephritis (empirical before culture results)
A
oral ciprofloxacin 7-10 days
or co-amoxiclav 7 days
5
Q
when to give antibiotic prophylaxis for pyelonephritis
A
- women with 3 symptomatic infections a year
- prophylaxis in children with VUR, recurrent infections or scarring on imaging
6
Q
drugs causing prostatic acute urinary obstruction
A
- anticholinergics
- opioids
- alpha agonists
- benzos
- CCB
- NSAIDs
- TCAs
- antihistamines
7
Q
what do you find in urinalysis in pyelonephritis
A
white cell casts in urine
8
Q
what confirms diagnosis of prostatic acute urinary obstruction on bladder USS
A
> 300cc
9
Q
what to offer 2 days before catheter removal in prostatic acute urinary obstruction
A
alpha blocker (then TWOC following alpha blocker commencement e.g. tamsulosin)
10
Q
prostatic surgeries carried out for prostatic acute urinary obstruction
A
- TURP
- HoLEP (becoming more common)
11
Q
long term medical treatment for BPH
A
- 5-alpha reductase inhibitors (finasteride)
- +/- alpha blockers
12
Q
definition of severe hyperkalaemia
A
> 6.5
13
Q
drugs causing hyperkalaemia
A
- ACEi
- ARBs
- spironolactone
- beta blockers
- LMWH
14
Q
when is immediate treatment required for hyperkalaemia
A
- > 6 with ECG changes or
- >6.5
15
Q
drugs used to treat hyperkalaemia
A
CIGS
- calcium gluconate IV (10ml 10%)
- insulin/dextrose infusion (10 units act rapid in 50ml 50% glucose over 20 mins)
- salbutamol nebs (5mg back to back over 10-20 mins)
also 15g oral calcium resonium/loop diuretics/dialysis to remove potassium from body
16
Q
definite management of testicular torsion
A
immediate surgery = contralateral testis should also be fixed - 50% chance of torsion if not treated
17
Q
when can you do expectant management of an ectopic
A
- if <30mm, unruptured, asymptomatic, no foetal heartbeat
- serum <200 and declining
closely monitor patient over 48 hours and perform intervention if hCG levels rise/symptoms then perform intervention
18
Q
when can you do medical management of an ectopic
A
- hCG <1500 and falling
- if <35mm, unruptured, no pain, no foetal heartbeat
- not suitable if also an intrauterine pregnancy
19
Q
medical management of ectopic
A
methotrexate IM - takes 4-6 weeks to completely resolve
20
Q
how do recurrent attacks of genital herpes occur
A
reactivation of latent virus in sacral ganglia - may be triggered by:
- stress
- sex
- menstruation
21
Q
gold standard diagnostic test for genital herpes
A
viral PCR of vesicle fluid
22
Q
treatment of first episode of genital herpes
A
saline baths
lignocaine gel
analgesia
acyclovir 400mg TDS (need to start within 5 days)
some patients with frequent exacerbations may benefit from longer term acyclovir
23
Q
what to do if first episode of genital herpes is in last stages of pregnancy (>28 weeks)
A
consider C/S to avoid dissemination (neurological effects/death)
24
Q
test for HIV which can be done 3-4 weeks after infection
A
4th generation test - combination of antibody and antigen (p-24 antigen detected after 3-4 weeks but antibody takes 4-8 weeks to develop)
25
type of rash in HIV seroconversion illness (3-12 weeks after exposure)
maculopapular, on trunk
26
when does AIDs occur after infection with HIV
around 8 years after - death within 2 years without treatment
27
what is oral hairy leukoplakia indicative of
HIV
28
main indicator of risk of opportunistic infections in HIV
CD4 cell count
29
when do you start to get symptoms for CKD
stage 4 and 5 (otherwise often an incidental finding)
30
ACR levels and when to refer for CKD
if 3-70 repeat in 3 months
if >70 refer to nephrologist
31
what to do if eGFR <60
repeat within 2 weeks
32
criteria for diagnosis of CKD stages
- tests >3 months shown a reduction in kidney function or the presence of proteinuria
- eGFR is persistently <60 and/or urine ACR is persistently >3
33
do you have CKD if your eGFR is >60 and you have no other evidence of kidney damage
no - only stages 1 and 2 if:
1 = >90 and other evidence of damage
2 = 60-89 and other evidence of damage
34
BP targets for CKD
if ACR <70 - 140/90
if ACR >70 - 130/80
give ACEi to manage
35
medication to give in CKD
- ACEi
- atorvastatin 20mg
- anti platelet
- vaccines
avoid nephrotoxic drugs
36
criteria for detecting AKI
- rise in serum creatinine of 26+ in 48 hours
- 50% or greater rise in serum creatinine in past 7 days
- drop in urine output to 0.5ml/kg/hr for 6 hours in adults
37
when is RRT indicated in AKI
- pulmonary oedema
- persistent high potassium
- pH <7.15
- encephalopathy, pericarditis, drug overdose
38
if surgery is needed for stress incontinence what is carried out
tension-free vaginal tape (TVT)
39
triad of features in nephrotic syndrome
- proteinuria (>3)
- hypoalbuminaemia (<30)
- oedema
40
why can nephrotic syndrome result in thrombosis e.g. renal vein thrombosis
loss of antithrombin-III, proteins C and S and associated rise in fibrinogen
41
why does nephrotic syndrome increase the risk of infection
urinary immunoglobulin loss
42
why does nephrotic syndrome cause hypocalcaemia
vitamin D and binding protein lost in urine
43
management of non-muscle invasive bladder cancer
transurethral resection od bladder tumour
44
management of invasive bladder cancer
radical cystectomy/radiotherapy, neoadjuvant chemotherapy
45
genes associated with prostate cancer
BRCA2
| pTEN
46
first line investigation for hydronephrosis
USS
47
treatment of acute vs chronic UUT obstruction
acute = nephrostomy tube
chronic = ureteric stent/pyeloplasty
48
why can renal carcinoma cause a varicocele
occlusion of left testicular vein
49
will U&Es always be abnormal in renal carcinoma
no - if one kidney is functioning well renal function will be normal
50
potential FBC findings of renal carcinoma
anaemia
| polycythaemia (may secrete EPO)
51
most common site of mets of renal carcinoma
lungs - cannon ball secondaries is almost diagnostic
52
what can be used to reduce tumour size and treat mets in renal carcinoma
alpha interferon and interleukin 2
53
type of urinary stones associated with chronic infections
struvite stones
54
why does an ileostomy increase the risk of urinary stones
loss of bicarb and fluid = acidic urine = uric acid precipitation
55
type of diuretics which can increase the risk of and decrease the risk of urinary stones
loop diuretics can increase
thiazide diuretics can decrease calcium stones
56
imaging to do for urinary stones
CT KUB within 14 hours of admission (immediately if fever, solitary kidney or uncertain diagnosis - may need to exclude AAA)
57
drugs which can be used to facilitate stone passage
CCBs or alpha blockers
58
size of urinary stones which usually pass spontaneously
<5mm
can do lithotripsy, nephrolithotomy in severe cases
usually pass in 4 weeks
59
treatment of urinary stones 5mm-2cm
extracorporeal shock wave lithotripsy
if PREGNANT = uretoscopy
60
drugs to prevent uric acid stones
allopurinol
61
type of polycystic kidney disease presenting in childhood
recessive
dominant presents in adulthood
62
extra renal signs of ADPKD
- polycystic liver disease (reflux, dyspnoea, early satiety, haemorrhage)
- infertility in men
- pancreatitis
- aneurysms
63
imaging for urethral stricture
cystoscopy
64
diagnosis of VUR
micturating cystourethrogram
DMSA scan to look for renal scarring
65
4 types of glomerulonephritis
- minimal change (children, nephrotic syndrome)
- diffuse (all glomeruli)
- focal (only some glomeruli)
- segmental (parts of affected glomerulus)
66
type of glomerulonephritis which may be associated with HIV
focal
67
when to give PEP for HIV
anyone who has had unprotected sexual contact/condom failure with a high-risk source within last 72 hours
take for 28 days
high risk source = known HIV positive or unconfirmed HIV status but MSM, from country high HIV prevalence or IVDU
68
AIDS-related malignancies
- Kaposi's sarcoma
- non-Hodgkin's lymphoma
- invasive cervical carcinoma
all patients with non-Hodgkin's lymphoma should be screened for HIV
69
what to give to newborn of HIV positive mother
PEP for 4 weeks after birth
70
gonorrhoea - type of bacteria
gram-negative diplococcus
71
treatment of gonorrhoea
ceftriaxone 500mg IM
72
hepatic consequence of gonorrhoea
perihepatitis
73
issues of gonorrhoea in pregnancy
- conjunctivitis within 3 days of birth
- can cause joint problems - rarely septicaemia
- preterm rupture of membranes
- chorioamnionitis
74
complications of chlamydia
- PID, endometritis, salpingitis
- tubal infertility
- ectopic pregnancy
- sexually acquired reactive arthritis (SARA)
- perihepatitis
75
what is Fitz-Hugh Curtis syndrome
perihepatitis due to chlamydia - infection reaches up around liver capsule
76
what are condylomata lata
painless warty lesions on genitalia - sign of secondary syphilis
77
type of rash in secondary syphilis
widespread mucocutaneoux
can affect palms and soles
78
neurological conditions in secondary syphilis
- acute meningitis
- cranial nerve palsies
- uveitis
- optic neuropathy
- delusions of grandeur
- interstitial keratitis and retinal involvement
79
features of neurosyphilis
tabes dorsalis
| dementia
80
features of cardiovascular syphilis
aortic root
gummata
ascending aortic aneurysms
81
blood test for screening of syphilis
RPR test
82
what is a Jarisch Herxheimer reaction
reaction to treatment in syphilis - similar to anaphylaxis but no wheeze/hypotension
don't need treatment - just antipyretics if needed
83
bacteria commonly causing acute bacterial prostatitis
- E. coli - gram negative bacteria entering prostate gland via urethra
- chlamydia
84
most consistent finding in chronic prostatitis
chronic pelvis pain
85
when to refer for prostatitis
diabetes
immunocompromised
pre-existing urological condition
chronic
86
antibiotics for acute prostatitis
14 days ciprofloxacin PO
87
infections associated with balanitis
strep and staph infections
candida in about 20%
88
what can circinate balanitis be associated with
reactive arthritis
89
investigations in balanitis
- DM testing (risk factor)
- swab of discharge
- STI testing
90
management of balanitis
- cleaning
- STI screening
- bacterial = fluclox
- candida = clotrimazole
- circumcision if recurrent/pathological phimosis present
91
what is phimosis vs paraphimosis
phimosis = foreskin can't be retracted
paraphimosis = foreskin pulled back but can't be returned to original position
92
what is balanitis xerotica obliterans associated with
whitish plaque on glans - associated with phimosis in adults
93
most common cause of paraphymosis
not replacing foreskin after inserting catheter
94
complication of paraphymosis
ischaemia of glans (if not treated)
95
drugs which can cause erectile dysfunction
SSRIs
| beta blocker
96
management of erectile disjunction
- control risk factors (weight, smoking, alcohol)
| - PDE-5 inhibitors (viagra)
97
what type of drug is sildenafil
viagra - PDE-5 inhibitor
98
common cause of epididymo-orchitis in people <35
gonorrhoea
other causes = mumps, UTI, trichomoniasis, HIV, TB
99
drug which can cause epididymo-orchitis
amiodarone
100
treatment of epididymo-orchitis if caused by gonorrhoea
treat as for gonorrhoea
101
treatment of epididymo-orchitis if caused by enteric bacteria (e.g. E. coli)
ofloxacin
102
what are elevated in testicular germ cell tumours (cancer)
AFP elevated in 60%
| LDH elevated in 40%
103
most common type of breast cancer
infiltrating/invasive ductal carcinoma
104
when to do BRCA1/BRCA2 testing in someone with breast cancer
women under 50
triple negative breast cancer (ER/PR/HER2)
105
what to do about lymph nodes during surgery for breast cancer
- if axillary node involvement = axillary clearance
| - if no evidence of involvement = sentinel node biopsy
106
when to do neoadjuvant chemotherapy for breast cancer
- initial surgery not possible due to tumour size
- to allow for breast conservation
- HER2 positive or triple negative
107
when to give hormonal therapy to people with breast cancer
in ER/PR positive disease = Tamoxifen
in HER2 positive disease = Herceptin (trastuzumab)
aromatase inhibitors = superior efficacy to tamoxifen in post-menopausal women
108
complication of using tamoxifen
increases risk of endometrial cancer
109
risk factor for breast fibroadenoma
HRT
110
investigation for fibroadenoma
triple assessment:
- examination (USS if <40, mammogram if older)
- needle biopsy (might not be required)
111
when to do a biopsy in fibroadenoma
>4cm - core biopsy to exclude phyllodes tumour
112
when to consider a breast abscess
if infection doesn't clear after 1 course of antibiotics - therefore would need to incise and drain with antibiotics
113
how to diagnose adenomyosis
MRI
114
antibiotics for PID
doxycycline
ceftriaxone
metronidazole
115
what to give to partner of someone with PID
doxycycline
OR ofloxacin and metronidazole
116
what can lichen sclerosus et atrophicus develop into
vulval carcinoma
117
most common type vulval cancer
squamous cell
118
what size ovarian cyst should have yearly USS follow up
5-7cm
>7cm = consider MRI
119
when to do a laparoscopic cystectomy for an ovarian cyst
>10cm, solid or complex, fixed, bilateral, ascites
120
moat common type of ovarian cyst
follicular (physiological)
121
what can cause pseudomyxoma peritonea
if a mutinous cystadenoma ruptures
122
type of ovarian cyst associated with Meig's syndrome (benign ovarian cyst, pleural effusion, ascites)
fibromas
123
what can cause a haemorrhagic degeneration of fibroids
progestins
clomifene
pregnancy
124
potential renal complication of fibroids
hydronephrosis
125
what can be used to temporarily shrink fibroids
GnRH agonists
126
pH of discharge in trichomoniasis
>4.5
127
management of mycoplasma genitalium
azithromycin
moxifloxacin
penicillins WONT work as no cell walls
128
pH of discharge in BV
>4.5 (same as trichomoniasis)
129
pH of discharge in candida
<4.5
130
what can you find on histology in BV
clue cells
131
management of bacterial vaginosis
metronidazole
132
medical management of miscarriage
mifepristone - misoprostol 2 days later
133
LH and FSH levels in PCOS
LH chronically elevated
FSH chronically suppressed
134
Rotterdam criteria for PCOS
2/3 required of:
- polycystic ovaries (12+ follicles or ovarian volume >10cm3 on USS)
- hyperandrogegism
- oligo/anovulaiton
135
prolactin level in PCOS
normal
136
when can undescended testes increase the risk of testicular cancer
if intra-abdominal - risk of malignant degeneration
137
at what age should undescended testes be considered
from 3 months old - unlikely to descend spontaneously from 6 months old
majority of surgeries performed around 1 year
