pace your MRCP-PACES

👉 *IMPORTANT 521* 👈 *Catheterized patients and UTI* All catheterized patients are bacteriuric. Send MSU only if symptomatic. Symptoms of UTI may be non-specific/atypical. Possible symptoms include fever, flank suprapubic pain, change in voiding pattern, vomiting, confusion, sepsis. Change long-term catheter before starting an antibiotic. Refer to local guidelines for initial antibiotic choice. Where possible use a narrow-spectrum antibiotic according to culture sensitivity. Good Luck

👉 *IMPORTANT 520* 👈 Avoid using ciprofloxacin, trimethoprim in 1st trimester and nitrofurantoin in 3rd trimester while managing UTI in pregnancy Good Luck

👉 *IMPORTANT 519* 👈 Please Do not use antibiotics for the treatment of asymptomatic bacteriuria in non-pregnant women, men, and adults with catheters. Good Luck

👉 *IMPORTANT 518* 👈 *Causes of sterile pyuria* *Non infection related* Calculi Renal tract tumour Papillary necrosis Tubulointerstitial nephritis Chemical cystitis Polycystic kidney Recent catheter Pregnancy SLE Drugs, eg steroids Good Luck

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr Ahmed mohamed* *Dr Aqsa Khan* *Dr Nabil* *Dr Usman* *Dr Hina Ali* For passing *MRCP UK PART 2* They have been keen member of our part 2 group. We wish them the best for their future.

👉 *IMPORTANT 517* 👈 *Causes of sterile pyuria* *Infection related* TB Recently treated UTI Inadequately treated UTI Fastidious culture requirement Appendicitis Prostatitis Chlamydia Good Luck

👉 *IMPORTANT 516* 👈 Aetiology of AKI can be divided according to site as: • pre-renal: decreased perfusion to the kidney. • renal: intrinsic renal disease. • post-renal: obstruction to urine. Good Luck

👉 *IMPORTANT 515* 👈 *Sterile pyuria* Increased numbers of white cells in urine but sterile on standard culture Good Luck

👉 *IMPORTANT 514* 👈 *Common organisms in UTI* Usually anaerobes and Gram-negative bacteria from bowel and vaginal flora. E. coli is the main organism (75–95% in community ). Staphylococcus saprophyticus (a skin commensal) in 5–10%. Other enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumonia. Good Luck

👉 *IMPORTANT 513* 👈 Please Do not rely on classical symptoms and signs of UTI in a catheterized patient. Good Luck

👉 *IMPORTANT 512* 👈 *Few signs in urinary tract infections* Fever Abdominal or loin tenderness Check for a distended bladder Enlarged prostate. If vaginal discharge, consider PID Good Luck

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *March 2023 online course ( 15 days ) for PACES MRCP (UK).* We will start from *15 March and finish on 31 March.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

👉 *IMPORTANT 511* 👈 *Few symptoms of urinary tract infection :* • *Cystitis:* Frequency, dysuria, urgency, supra pubic pain, polyuria, haematuria. • *Acute pyelonephritis:* Fever, rigor, vomiting, loin pain/tenderness, costovertebral pain, associated cystitis symptoms, septic shock. • *Prostatitis:* Pain: perineum, rectum, scrotum, penis, bladder, lower back. Fever, malaise, nausea, urinary symptoms, swollen or tender prostate on PR Good Luck

👉 *IMPORTANT 510* 👈 *Few risk factors for UTI* • increased Bacterial inoculation: Sexual activity, urinary incontinence, faecal incontinence, constipation. • Reduced binding of uropathogenic bacteria: Spermicide use, decreased oestrogen, menopause. • Decreased Urine flow: Dehydration, obstructed urinary tract. • Increased bacterial growth: DM, immunosuppression, obstruction, stones, catheter, renal tract malformation, pregnancy. Good Luck

👉 *IMPORTANT 509* 👈 *Few pearls about urine microscopy* *Crystals:* Crystals are common in old or cold urine and may not signify pathology. They are important in stone formers. • Uric acid—uric acid stones, tumour lysis syndrome. • Calcium oxalate—stones, high oxalate diet, ethylene glycol poisoning. • Cystine—seen in cystinuria. Good Luck

👉 *IMPORTANT 508* 👈 *Few pearls about urine microscopy* *Casts:* Casts are cylindrical bodies formed in the lumen of distal tubules. They are formed of Tamm-Horsfall protein combined with cells. • Hyaline cast —seen in normal urine. • Red cell cast —signify an inflammatory process in the glomerulus, eg glomerulonephritis. • White cell cast —pyelonephritis, interstitial nephritis , glomerulonephritis. • Granular cast —formed from degenerated tubular cells, seen in any chronic kidney disease. Good Luck

👉 *IMPORTANT 507* 👈 *Few pearls about urine microscopy* *Cells:* *Squamous epithelial cells:* Often seen, not pathological. Good Luck

👉 *IMPORTANT 506* 👈 *Few pearls about urine microscopy* *Cells:* *White blood cells:* >10 white cells/mm³ in an unspun specimen is abnormal. Causes include UTI, glomerulonephritis, tubulointerstitial nephritis, renal transplant rejection, and malignancy. Good Luck

ANNOUNCEMENT Hello n salam everyone We are pleased to announce admissions for our *March 2023 online course ( 15 days ) for PACES MRCP (UK).* We will start from *15 March and finish on 31 March.* *Active slots available on first come--first served basis.* Listener slot available too. *Atleast 90 Important exam cases ( including recent diets cases ) will be practiced and discussed as we do in our weekly Sunday sessions.* After the performance a detailed feedback will be given to elaborate the weak skills. It is equally beneficial for those who are beginners or have exam in coming diet. Interested candidates may send a personal message for details. WhatsApp No: 00923346036496. Email: drtanzeelbukhari@gmail.com GOOD LUCK.

👉 *IMPORTANT 504* 👈 *Famous CAGE Questionaire for Alcholism* C: Have you ever felt you should Cut down on your drinking? A: Have people Annoyed you by criticizing your drinking? G: Have you ever felt bad or Guilty about your drinking? E: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)? Two "yes" responses indicate that the possibility of alcoholism should be investigated further. In that situation, it would be nice to offer help as referring to (Alcohol cessation clinic/ Rehabilitation for alcoholism). Good Luck