Renal calculi -Important points

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■ Abdominal examination is
most rewarding after ensuring
adequate analgesia.
■ Plain KUB has a sensitivity of
only 45-59% and a specificity
as low as 77% – it cannot be
used to rule in or rule out the
diagnosis of ureteric calculi.
■ Infection with obstruction
mandates urgent
decompression.
■ There is evidence of
permanent nephron loss within
72 hours of complete
obstruction.
■ The likelihood of spontaneous
stone passage is determined
by stone size and position.
■ Fifteen to twenty per cent of
all patients with ureteric
calculi will require intervention
using ESWL, ureteroscopy or
percutaneous nephrolithotomy.

Renal calculi -indictions for early intervention

1.Obstruction with evidence of infection-urgent decompression.
2.larger calculi -more than 6mm
3.Bilateral obstruction.
4.An obstructed solitary or transplanted kidney.
5.Renal impairment.(review the definition of renal impairment)
6.Ongoing unacceptable discomfort.

Haematuria

Haematuria

(usually
microscopic but sometimes
frank)
occurs in 95% of
patients with renal colic on day
one and 65% by day three,
but
up to 87% of patients with
AAA rupture will also have
haematuria.

TINNITUS IMPORTANT POINTS

■ Tuning fork testing is especially
important when otoscopy and
systemic examinations are
unremarkable.
■ It is vital to recognise the
possible causes of seemingly
innocuous tinnitus (especially
sudden onset) and institute
early appropriate treatment.
■ There is great variation in how
people react to tinnitus –
some cope well with little
disturbance while others feel
anxious or depressed.
■ Treating underlying anxiety
and depression improves
outcomes.
■ Many patients report their
tinnitus-related stress started
when their doctor told them
“nothing could be done”.
■ Most people will habituate
naturally to tinnitus, as long
as they regard the sound as
meaningless.

GRADING OF BURNS AND HF ACID BUURNS

sKIN burns can be graded into three categories.
Grade 1 has redness or white marking only,
grade 2 has oedema and blistering and grade 3 burns are associated with necrosis.
HF acid burns Appearance
Grade 1 white burn mark and/or erythema and pain
Grade 2 white burn mark and/or erythema and pain
PLUS oedema and blistering
Grade 3 white burn mark and/or erythema and pain
PLUS oedema and blistering
PLUS necrosis