Urology Flashcards
(109 cards)
1
Q
prostate
🧠 What are the common complications of transurethral resection of the prostate (TURP)?
A
🔹 Bleeding
🔹 Post-TURP syndrome (hyponatremia from
glycine absorption)
🔹 UTI
🔹 Urinary incontinence
🔹 Urethral stricture
🧠🕵 Mnemonic for you :
“5 U’s of TURP”
🪄Urine (retention/incontinence)
🪄UTI
🪄Urethral stricture
🪄Unexpected bleeding
🪄Unbalanced sodium (Post-TURP syndrome)
2
Q
prostate
What causes Post-TURP syndrome (Postprostatectomy syndrome)?
A
🔹 Systemic absorption of hypotonic irrigation fluid (e.g., glycine), leading to hyponatremia and fluid overload
3
Q
prostate
What electrolyte disturbance is most associated with transurethral resection of the prostate TURP?
A
🔹 Hyponatremia
due to absorption of hypotonic irrigation fluids like glycine (Post-TURP syndrome)
4
Q
prostate
How has the risk of Post-transurethral resection of the prostate syndrome been reduced in modern practice?
A
🔹 By using isotonic saline instead of glycine as irrigation fluid during the procedure
5
Q
Erectile Dysfunction
🧠 What is Erectile Dysfunction (ED)?
A
persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance
6
Q
Erectile Dysfunction
What are the common causes of ED?
A
- Vascular: Atherosclerosis, hypertension
- Neurological: Diabetes-induced neuropathy,
- Endocrine: Hypogonadism, thyroid disorders
- Psychological: Depression, anxiety
- Medications: Antihypertensives, antidepressants
7
Q
Erectile Dysfunction
What is the Main treatment for ED?
A
Phosphodiesterase type 5 inhibitors (PDE5i), such as sildenafil, tadalafil, and vardenafil.
8
Q
Erectile Dysfunction
How do PDE5 inhibitors facilitate erections in the treatment of erectile dysfunction?
A
cause penile smooth muscle relaxation and increased perfusion.
9
Q
Erectile Dysfunction
Why should PDE5 inhibitors Not be
co-administered with nitrates?
A
is absolutely contraindicated due to the risk of life-threatening hypotension.
💡Nitrates & PDE5I. ↑nitric oxide levels⇉ ms relax.⇉ V.D ⇉Hypotention
10
Q
Erectile Dysfunction
What are the next steps when PDE5 inhibitors fail to improve erectile dysfunction symptoms?
A
Try another non-surgical treatment options as
1. vaccum-penile pump to achieve erection
2. injection of prostaglandins into the penis
11
Q
Erectile Dysfunction
What is intracavernosal injection therapy?
A
the injection of vasodilators directly into the corpora cavernosa to induce an erection like : Prostaglandin E1.
12
Q
Erectile Dysfunction
What are the surgical treatment options for erectile dysfunction, and when are they indicated?
A
Indicate when conservative treatments fail.
The primary surgical options include
1. Penile Prosthesis Implantation
2. Penile Revascularization Surgery
13
Q
erectile dysfunction
Are topical steroid creams effective treatments for (ED) ??
A
❌ NO , not effective
14
Q
Erectile Dysfunction
Why is ED common in diabetic patients?
A
Diabetes can lead to:
Neuropathy: Damaging nerves involved in erection.
Vascular Damage: Impairing blood flow to the penis.
Hormonal Changes: Affecting testosterone levels
15
Q
prostate
Are other electrolyte disturbances (besides hyponatremia) commonly seen after transurethral resection of the prostate ?
A
🔹 No
other electrolyte disturbances are not typically associated with TURP
16
Q
priapism
🧠 What is the Priapism?
A
Definition: Priapism is a prolonged, often painful, penile erection lasting more than 4 hours without sexual stimulation .
17
Q
priapism
What are the two main types of priapism ?
A
Ischemic
Non-ischemic
18
Q
priapism
The causes of Ischemic Priapism ?
A
sickle cell disease
Hematologic disorders (Leukemia, Thalassemia)
Drugs( Antidepressants/Antipsychotics)
P: Penile injections.
19
Q
priapism
When should intervention be considered in cases of priapism?
A
🔹 If priapism lasts more than 4 hours
20
Q
priapism
What is the first-line treatment for non-ischemic priapism caused by pelvic/genital trauma?
A
🔹 Perineal compression ⇒ used to close off the arteriovenous fistula .
21
Q
priapism
What is the next step if perineal compression fails to resolve non-ischemic priapism?
A
🔹Selective angioembolization⇒ to occlued AV fistula by using reversible agents like Gelfoam.
22
Q
priapism
What is the initial managment of ischemic priapism ?
A
🔹 By needle aspiration of the corpora cavernosa and irrigation with saline
23
Q
priapism
What is the stepwise treatment for ischemic priapism?
A
- Needle aspiration of corpora cavernosa
- Saline irrigation
- Alpha-adrenergic agonist injection (e.g., phenylephrine)
- Surgical shunt if no response
24
Q
🧠 nephrolithiasis
🧱 What are the four main types of Renal stones?
A
🔹 Calcium stones (most common)
🔹 Uric acid stones
🔹 Struvite stones
🔹 Cystine stones
25
# nephrolithiasis
Which type of nephrolithiasis is linked to a genetic defect?
**Cystine stones** ↪ **Autosomal Recessive**
26
# nephrolithiasis
Which amino acids are affected by the genetic defect in cystinuria, leading to stone formation?
excessive urinary excretion of 4 amino acids, particularly cystine , Ornithine, Lysine, Arginine
**🧠 Mnemonic: COLA🍾**
C – Cystine
O – Ornithine
L – Lysine
A – Arginine
27
# nephrolithiasis
The most common Nephrolithiasis is ?
Calcium Stones
28
# nephrolithiasis
Which kidney stones are not visible on standard X-rays?
**Uric acid stones**
that formed in low PH
29
# nephrolithiasis
What are struvite stones composed of?
**magnesium ammonium phosphate**
especially in the presence of urinary tract infection
30
# nephrolithiasis
why **struvite stones** are **called infection stones**?
It Cause in response to UTIs by **urease-producing bacteria** (e.g., Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus,staph epidermidis )
31
# nephrolithiasis
What are the typical **characteristics of struvite stones**?
* often large
* form rapidly
* staghorn calculi
* radio opaque
| staghorn calculI: Is branching kidney stone
32
# nephrolithiasis
💊 What are the treatment strategies for struvite stones?
Treatment involves **antibiotic therapy** to eradicate the underlying infection and surgical removal of the stones.
| struvite stones cused by infectious bacteria
33
# nephrolithiasis
When should patients with nephrolithiasis be referred for surgical intervention?
➯When patients have **continuous symptoms**
➯ and **unable to pass the stone spontaneously.**
34
# nephrolithiasis
What is shock wave lithotripsy (SWL) and how is it performed?
Is a transcutaneous procedure **done with fluoroscopy** to guide treatment length and location.
utilizes it in **fragmentation of the targeted stones**
35
# nephrolithiasis
What are possible complications of SWL?
🔹 Hypertension
🔹 Renal injury
🔹 Steinstrasse (**stone street**) ➱ obstructed fragments in ureter
🔹 Chronic kidney disease (CKD)
🧠🕵️ **Mnemonic for you :**
**(HTN+3Renal)**
36
# nephrolithiasis
Which kidney stones **should not be treated** with shock wave lithotripsy (SWL)?
**1. Non radiopaque stones**: Can’t be seen on X-ray → can’t target accurately.
**2. Stones >2 cm in size:** Difficult to fully fragment → ↑ risk of failure & complications like (Steinstrasse).
**3. Distal ureteral stones**: Hard to localize & treat with shock waves → ureteroscopy preferred.
37
# urinary incontinence
🧠 What is **urge incontinence?**
🚽 incontinence due to a sudden urge to urinate
💧 caused by **overactive bladder** or **detrusor instability**→ ↑ bladder muscles contract → leakage before reaching the restroom.
| detrusor ms: is smooth muscle in the u. bladder. store &expel the urine
38
# urinary incontinence
What is the **primary pharmacological treatment for urge incontinence?**
**Anticholinergic (antimuscarinic) agents**
MOA:by inhibiting involuntary bladder contractions.
| MOA: mechanism of action
39
# urinary incontinence
What is the **mechanism of action of anticholinergic agents in treating overactive bladder?**
🔬 They **block muscarinic receptors** in the bladder detrusor muscle → reducing involuntary contractions and increasing bladder capacity.
40
# urinary incontinence
What are **common side effects of anticholinergic medications**?
1. blurred vision(mydriasis ) زغلولة
2. dry mouth ناشفة
3. constipation حبست
4. urinary retention حبست
5. glucoma جوزها
6. tachycardia ابو سريع
🧠🕵 **Mnemonic for you :**
( زغلولة ناشفة حبست جوزها ابو سريع 🪿 )
| mydriasis: dilated pupil
41
# urinary incontinence
In which condition should **anticholinergic agents be avoided**?
👁️ **Narrow angle-closure glaucoma**
these drugs can precipitate acute angle-closure by inducing **mydriasis** and increasing intraocular pressure
| .
42
# urinary incontinence
🏃 What is **stress incontinence?**
* 🏃 incontinence during physical activities that **increase abdominal pressure**, such as coughing, sneezing, laughing, or exercising.
*
* 🏃 occurs when the **pelvic floor muscles and urinary sphincter are weakened or damaged.**
43
# urinary incontinence
💧 What is **overflow incontinence**?
🚽 involuntary leakage of urine **due to an overdistended bladder that cannot empty completely**.
results from impaired detrusor muscle contractility or bladder outlet obstruction
44
# 🧠 Prostate Cancer
Screening for Prostate Cancer done by ??
by Prostate-Specific Antigen (PSA test)
45
# Prostate Cancer
What are the American Urological Association (AUA) recommendations for PSA screening?
* Age **55–69**
* Screen every 2 years if chosen
* **No routine screening outside this age range**
46
# Prostate Cancer
Why is PSA screening for prostate cancer controversial?
* Cost-effectiveness concerns
* High false-positive rate
* Overdiagnosis and overtreatment
| ⚡ Many global health authorities no longer recommend routine screening.
47
# Prostate Cancer
What are the key initial steps in evaluating a patient with suspected **prostate cancer**?
📌 **Digital rectal exam (DRE)**
📌 **Serum PSA level**
If any of them abnormal ➱ **Transrectal ultrasound-guided biopsy**
48
# Prostate Cancer
How many biopsy samples are typically taken during a transrectal ultrasound (TRUS)-guided prostate biopsy?
📌 12 samples
49
# Prostate Cancer
What is the **Gleason score** in prostate cancer?
* 12 samples are taken from the prostate by (TRUS)
* Grades prostate biopsy samples from (1–5)
* **Gleason score** = sum of the two most common patterns of biopsy samples (range 2–10)
* Higher score = more aggressive tumor
| ⚡ the Gleason score determined during a (TRUS)-guided prostate biopsy
50
# Prostate Cancer
what is the clinical importantance of Gleason score in prostate cancer ?
📌 Determines **prognosis** and **make treatment decisions** (e.g., surveillance vs. surgery or hormone therapy)
51
# Prostate Cancer
Which imaging studies are used to stage prostate adenocarcinoma?
🔹 **Abdominopelvic CT scan** ➱ for lymph node involvement
🔹 **Bone scan**➱ for skeletal metastases
52
# Prostate Cancer
What are the treatment options for **localized prostate adenocarcinoma ?**
🔹 Observation and follow-up
🔹 Radical prostatectomy
🔹 Radiotherapy or brachytherapy
53
# Prostate Cancer
What factors determine the **treatment approach** for prostate adenocarcinoma?
Treatment depends on:
1. **Extent of disease:**
▪️ Localized → Local treatment
▪️ Metastatic →Systemic therapy (e.g. hormone therapy)
2. **Patient’s age and general health:**
▪️ Elderly or frail patients → conservative management
▪️ Younger, fit patients → definitive treatment
54
# Transitional Cell Carcinoma
🧠 the **most prevalent** type of bladder cancer ?
**Transitional Cell Carcinoma** (TCC), also known as **urothelial carcinoma**
55
# Transitional Cell Carcinoma
What is Transitional Cell Carcinoma (TCC)?
🧪 Is a cancer **originates from the urothelial cells lining the bladder.**
🧪 the **most common type** of bladder cancer
56
# Transitional Cell Carcinoma
The **main risk factor** for TCC is ??
| **Transitional Cell Carcinoma** (TCC)
🚭 **Smoking** 🚭
57
# Transitional Cell Carcinoma
The **most common presentation** of TCC?
| **Transitional Cell Carcinoma** (TCC)
🩸 **painless hematuria**
58
# Transitional Cell Carcinoma
What is the **gold standard** for diagnosing bladder cancer?
🔍**Cystoscopy with biopsy**
59
# Transitional Cell Carcinoma
What is **the standard treatment** for **small**, **papillary** **non-muscle-invasive** TCC tumors?
| **Transitional Cell Carcinoma** (TCC)
**Transurethral** **Resection of Bladder Tumor (TURBT)**
60
# Transitional Cell Carcinoma
What is **carcinoma in situ** (CIS) of the bladder?
🧫 CIS is a **high-grade**, **flat**, **non-muscle-invasive** bladder cancer **confined to the mucosal layer**.
🧫 It's considered aggressive due to its potential for progression and recurrence.
| **carcinoma in situ** (CIS)
61
# Transitional Cell Carcinoma
What is the primary treatment for bladder CIS?
| **carcinoma in situ** (CIS)
transurethral **resection of the tumor** + intraurethral instillation of Bacillus Calmette-Guérin **(BCG) therapy** is the standard treatment.
* **BCG** stimulates the immune system to target and destroy cancer cells, reducing recurrence and progression risks.
62
# Transitional Cell Carcinoma
When is **neoadjuvant( chemotherapy OR radiation) indicated in TCC** of the bladder?
| 🤓 " **Neo** means before " & "**adjuvant** means something additional."
**before a large operation (such as radical cystectomy with urinary diversion)** to
1. non-metastatic tumors
2. Tumors **invading the bladder's muscular layer**.
3. **Large tumors** occupying a significant portion of the bladder.
4. Tumors **infiltrating adjacent organs** or the **abdominal wal**l (local infiltration)
| 🤓Neoadjuvant therapy given to a patient before surgery to shrink tumor
63
# Transitional Cell Carcinoma
In which scenarios is neoadjuvant chemotherapy **NOT recommended** for TCC?
| **Transitional Cell Carcinoma** (TCC)
1. **Metastatic disease**
2. **History of pelvic irradiation:** Increased risk of complications.
3. **Severe comorbidities:** as advanced age, due to potential chemotherapy toxicity
64
# Transitional Cell Carcinoma
What is the **standard treatment** for **metastati**c bladder Transitional Cell Carcinoma (TCC)?
🩺 **platinum-based chemotherapy**
65
# Renal Cell Carcinoma
🧠 What imaging modality is preferred for initial evaluation of a **suspected renal mass**?
**Contrast-enhanced CT** or **MRI** of the abdomen
66
# Renal Cell Carcinoma
At what tumor size is renal cell carcinoma (RCC) highly suspected?
📌 **If >3 cm**
| ⚡ Most renal tumors >3 cm are presumed to be RCC until proven otherwise.
67
# Renal Cell Carcinoma
When is **active surveillance** appropriate for renal masses?
📌 For small (<3 cm) slow-growing masses with low metastatic potential
68
# Renal Cell Carcinoma
What is the expected **growth rate of small renal tumors under surveillance?**
Approximately **0.5 cm per year**.
69
# Renal Cell Carcinoma
What defines a **T1** renal tumor in Renal cell caercinoma(RCC) staging?
📌 Tumor **confined to kidney** and **≤7 cm** in greatest dimension.
70
# Renal Cell Carcinoma
the **treatment of choice** in cases of a **small**, **well-circumscribed, superficial tumor ( T1 stage ) .**
📌 **Partial nephrectomy**
| ⚡ Partial nephrectomy helps preserve kidney function
71
# Renal Cell Carcinoma
Indications for **Radical Nephrectomy**
🔹 Large tumors (>7 cm),
🔹 Central location,
🔹 Multifocal disease, or
🔹 High risk with partial nephrectomy (as, bleeding)
72
# Renal Cell Carcinoma
Is **adrenalectomy** routinely performed during radical nephrectomy?
**No, adrenal gland is preserved** unless there is clear evidence of invasion (<10% of cases).
| Adrenal gland involvement less than 10% of cases
73
# Renal Cell Carcinoma
What is the best management for a 10 cm enhancing renal mass in the central kidney ?
📌**Radical nephrectomy**
| Adrenal gland is usually preserved unless there is direct invasion.
74
# Fournier’s gangrene?
🧠 What is the most likely diagnosis in a diabetic patient with **scrotal swelling, skin changes, and crepitus**?
**Fournier’s gangrene** – a necrotizing fasciitis of the perineum and genital area.
75
# Fournier’s gangrene?
What are the major **risk factors** for developing Fournier’s gangrene?
🪄 Diabetes mellitus
🪄 immunosuppression.
🪄 peripheral vascular disease
🪄 alcoholism
76
# Fournier’s gangrene?
What is the initial treatment approach for Fournier’s gangrene?
🚨 **supportive measures** (fluids, broad-spectrum antibiotics, hemodynamic support) ➕ urgent **surgical debridemen**t to remove necrotic tissue
77
# Fournier’s gangrene?
What is the **cornerstone of treatment** for Fournier’s gangrene, in addition to antibiotics?
🚨 Urgent **surgical debridement** of all necrotic tissue.
78
# testicular cancer
🧠 the **classic presentation** of a testicular tumor ??
A firm, **painless** testicular mass
79
# testicular cancer
Is a **Painless testicular mass** in a young man considered danger?
📌 yes , should always be considered **testicular cancer until proven otherwise.**
| ⚡ Testicular Mass = Cancer Until Proven Otherwise
80
# testicular cancer
The **First-line test** of choice for Painless testicular mass ??
➡️ **Scrotal/Testicular** **Ultrasound**
81
# testicular cancer
What **NOT to Do** for testicular masses ??
❌❌ **Avoid Biopsy**
🧠🕵 Mnemonic:
"Don't poke the tumor!"
| ⚡ Percutaneous biopsy is contraindicated due to risk of tumor seeding
82
# testicular cancer
What are the **tumor markers** for testicular masses ❓
🧪 AFP (Alpha-Fetoprotein)
🧪 β-hCG (Beta-Human Chorionic Gonadotropin)
🧪 LDH (Lactate Dehydrogenase)
83
# testicular cancer
Are testicular tumor markers used in **diagnosis**of testiculer cancer ? If not, why are they used?”
🚫 **NO**
Used for
1. 📊 Prognosis
2. 🔁 Monitoring treatment response
| ⚡ Physical examination & US findings of a mass ⇨sufficient for diagnosis
84
# acute testicular pain
🧠What are the **D.D**. of acute testicular pain?
| D.D. = Differential Diagnosis
1. **Testicular Torsion**
2. **Inguinal Hernia**
3. **epididymitis**
5. **Fournier's Gangrene**
6. **Trauma**
7. **Others**
| Fournier’s gangrene a necrotizing fasciitis of the perineum and genitali
85
# acute testicular pain
The **Definition** of Testicular torsion ??
✅ ischemic emergency
✅ as a result of a **congenital defect** that results in impaired fixation of the testicle inside the scrotum ⇒ permit the torsion of the testicle around the spermatic cord pedicle.
✅ requires immediate intervention to prevent irreversible damage
86
# acute testicular pain
comparing the onset and characteristics of pain in **Testicular Torsion and Epididymitis** ❓
1. **Onset of the pain:**
* Torsion : Sudden, **severe**
* in Epididymitis : Gradual, aching,
2. **Associated Symptoms:**
* in torsion: Nausea, vomiting, abdominal pain
* in epididymitis: Urinary symptoms, fever
| Urinary symptoms (as urgency, frquency, dysuria)
87
# acute testicular pain
What is the **test of choice** for evaluating an acute scrotal pain ?
🧷 **Scrotal (Testicular) Doppler Ultrasound**
To Differentiates ischemic (torsion) vs inflammatory (epididymitis) processes
88
# acute testicular pain
How can you **distinguish testicular torsion from epididymitis** on Doppler ultrasound?
**1. by intratesticula Blood Flow :**
Absent or significantly decreased in testicular torsion , but normal or Increased blood flow (hyperemia) in the epididymitis.
**2. Testicular Position:**
High-riding testis in testiculer torsion,
but within Normal position in epdidymitis.
89
# acute testicular pain
if Testicular **doppler US shows normal blood flow** in **gradual** scrotal **pain** and **mild** redness , what is the **diagnosis and treatment**
Epididymitis
💊 **Antibiotics**
| 💡 normal us , no sever pain → exclude testiculer torsion
90
# testicular torsion
🧠 What is the **critical time window for testicular torsion**?
* ⏳ **< 6 hours** from pain onset →(~90% testis salvage)
* Drops to (~10%) if >24 hours
91
# testicular torsion
What is the **definitive management** for testicular torsion?
🚨 **Detorsion + bilateral orchiopexy**
92
# allograft rejection
🧠 what is the three classic types of allograft rejection after transplantation **according to the time** ?
1. **hyperacute rejection** (within minutes to hours) after transplantation
2. **Acute Rejection** (within the first few weeks to months)
3. **Chronic Rejection** (over months to years)
93
# allograft rejection
Rejection occurs within the **first few weeks to months** of transplantation?
Acute Rejection
94
# allograft rejection
when **Chronic Rejection** occurs ?
**over months to years.**
95
# allograft rejection
what is the **predominant****immune mechanisms** for each type of allograft rejection ?
1. Hyperacute rejection : by **preformed antibody**
2. Acute rejection: by **T cells**
3. Chronic Rejection: not fully understood It is thought to be secondary to chronic immunologic injury from both T and B cell–mediated processes
96
# allograft rejection
Does **Acute Rejection** is irreversible ?
🔬 **NO** , its reversable in 70% of transplants
by T cell–specific immunosuppressive therapies, such as monoclonal antibodis
| When acute rejection occurs, these treatments can reverse the rejection
97
# ischemic orchitis
🧠What is **ischemic orchitis**, and how does it present post-inguinal hernia repair?
🕒 Ischemic orchitis is a **rare complication following inguinal hernia repair**
🕒 presenting **2–5 days postoperatively**
🕒 manifests as a **tender, swollen testicle**.
98
# ischemic orchitis
What is the **recommended treatment** for ischemic orchitis ??
💊 **analgesics** and anti-inflammatory drugs such as **NSAIDs**.
99
# Benign Prostatic Hyperplasia
🧠What is **Benign Prostatic Hyperplasia** (BPH)?
***non-cancerous enlargement** of the prostate gland
* It can **compress the urethra **
* cause lower urinary tract symptomsmay
* cause urinanry stone
100
# Benign Prostatic Hyperplasia
What is **the first-line treatment for Benign Prostatic Hyperplasia (BPH)?**
💊 **Alpha-blockers**
* They relax the smooth muscle in the bladder neck and prostate, improving urine flow
101
# Benign Prostatic Hyperplasia
What are the **indications for surgical treatment of BPH**?
🔹 **Ineffective conservative** treatment
🔹 **Continuous symptoms**
🔹 **Recurrent UTI**
🔹 **Bladder stone**
102
# Benign Prostatic Hyperplasia
What is the best management for a patient with **BPH and** **bladder stone unresponsive to medical therapy**?
✅ **Transurethral lithotripsy & Transurethral prostatectomy**
treats **both** the bladder stone and underlying BPH.
| BPH inducer the formation of bladder stones so remove it .
103
# Benign Prostatic Hyperplasia
Why is advising increased hydration **not appropriate** in case of BPH and bladder stone ?
The **urinary outflow obstruction from BPH prevents the stone from passing** so fluids won’t help.
104
# Benign Prostatic Hyperplasia
Why is extracorporeal shock wave lithotripsy **not enough**in a patient with bladder stone and BPH?
It **doesn’t address the underlying obstruction** caused by BPH, so the stone may recur or persist.
105
# pyelonephritis
Patient mitted with aminal pain and **fever of 38.5°C.** Physical examination shows** right flank tenderness.** Lab parameters: **leukocytes count is 20,000**, likely diagnosed by ?
| normal leukocytes count : (4000-11,000)
**pyelonephritis**
105
# pyelonephritis
🧠What is the **imaging of choice** in a patient with suspected **pyelonephritis** and impaired kidney function?
**Non-contrast CT of the abdomen and pelvis**
* To identify urinary tract obstruction (e.g. stone, stricture)
105
# pyelonephritis
What key **clinical features** differentiate pyelonephritis from lower urinary tract infection (UTI)?
**1. Pyelonephritis features:**
* Fever ≥ 38°C
* Flank pain tenderness
* Systemic symptoms (chills, fatigue)
**2. Lower UTI (e.g., cystitis) features:**
* Dysuria
* Urinary frequency & urgency
* Suprapubic discomfort
* Usually no fever or systemic symptoms
105
# pyelonephritis
What is the best next step in a patient with **pyelonephritis, worsening kidney function, and signs of sepsis?**
Start **IV fluids** + broad-spectrum **antibiotics** AND perform**non-contrast CT to assess for obstruction** or complications
105
# pyelonephritis
Why is **imaging** urgent in pyelonephritis with sepsis?
To **identify urinary tract obstruction** (e.g. stone, stricture) that may**need urgent drainage**, especially if antibiotics aren't effective.
