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👉 *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. paceUrMRCP.

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

✌️✌️ HEARTIEST CONGRATULATIONS ✌️✌️ To Dr Riyaz For passing PACES MRCP ( UK ) from India. We wish him the best for his future.

👉 *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 paceUrMRCP.

👉 *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 paceUrMRCP.

👉 *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. paceUrMRCP.

👉 *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. paceUrMRCP.

👉 *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. paceUrMRCP.

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

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👉 *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. paceUrMRCP.

👉 *IMPORTANT 505* 👈 *Few pearls about urine microscopy* *Cells:* *Red blood cells:* >2 red cells/mm³ is abnormal. Can come from anywhere in the urinary tract. Isomorphic red cells are similar to circulating red cells and may suggest bleeding from a genitourinary or external source. Dysmorphic red cells are abnormal in size/shape. Although they may in dicate bleeding from the glomerulus (especially in exam questions!), assessment is subjective and dysmorphism also occurs due to changes in pH, osmolality, protein, and due to tubular passage. paceUrMRCP.

👉 *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). paceUrMRCP.

👉 *IMPORTANT 503* 👈 *Few General Symptoms Symptoms for history taking* Rise in body temperature Tiredness Lumps or Bumps Weight loss/Gain Pallor Hair Loss, Excessive Hair GrowthRash Sleep Sweating Mood Appetite paceUrMRCP.

👉 *IMPORTANT 502* 👈 *Few Genito-Urinary Symptoms for history taking* Hesitancy, straining, poor flow, dribbling and sense of incomplete evacuation (Males) Passing less/more urine than usual (Polyuria/Oliguria) Burning pains with your water works (Dysuria) Change in color or smell of your water works Abnormal discharge from private areas What about your periods? Regular? Any problems? Problems with amounts or timings? When did you first start to have periods? Using any methods of contraception? Are you using the pill? (Females) paceUrMRCP.

👉 *IMPORTANT 501* 👈 *Few Rheumatological Symptoms for history taking* Joint pains; Analyze Joint Pains Number: No. Of Joint affected Deformity: present or absent Stiffness: Present or absent, if present for how long & when Swelling Symmetry Skin rash, Bruising, Acne Oral sores Morning stiffness of joints Skin tightness Muscle pains Muscle weakness paceUrMRCP.

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