10. GU Flashcards
1
Q
what r nephroliathiasis and what are they made of and where do they form
A
kidney stones
calcium oxolate
collecting duct
2
Q
explain the pathophysiology of nephroliathiasis
A
- excess solute in collecting ducts leads to crystallisation of urine
- these obstruct the outflow of urine
3
Q
what is a complication of nephroliathiasis and explain what this is and how this this treated
A
hydronephrosis- dilation of the renal pelvis in response to obstruction
surgical decompression
4
Q
what 2 risks increase with obstruction and dilation of the renal pelvis
A
- infection risk
- obstruction causes prostaglandin release which results in natural diuresis risk
5
Q
what r the 3 most common obstruction sites for nephroliathiasis
A
- PUJ pelvo-ureteric junction
- pelvic brim (where ureter crosses over iliac blood vessels)
- VUJ vesico-urethral junction
6
Q
presentation of nephroliathiasis 4
A
- unilateral, colicky pain from loin to groin which comes in peristaltic waves
- patient cannot lie still
- haematuria
- dysuria
7
Q
1st line and GS/ diagnostic for nephroliathiasis and give their pros and cons (2, 3)
A
1st line: kidney, ureter and bladder X ray
-> 80% specific for stones
-> cheap and easy
GS: Non contrast CT KUB -> 90% specific for stones
-> rapid
-> background radiation
8
Q
with urinary symptoms what test is important to take if the presenting patient is female
A
pregnancy test
9
Q
treatment of nephrothialiasis 4
A
- watch and wait for stones smaller than 5mm as they spontaneously pass
- medium stones require either endoscopic sound wave lithotripsy (breaks up the stones)
- large stones require percutaneous nephrolitherectomy (keyhole surgery)
- analgesia- IV diclofenac
10
Q
what is acute kidney injury and what 3 things characterise it
A
abrupt decline in kidney function (hours-days)
1. increased serum creatinine
2. increased urea
3. decreased urine output
11
Q
explain the classification criteria for acute kidney injury 3
A
KDIGO:
1. serum creatinine above 26 micromol/L within 48 hours - needs a baseline
OR
2. 1.5 times the baseline in 7 days (increase of 50%)
3. urine output <0.5ml/kg/hour for 6 or more consecutive
12
Q
how to determine the type of acute kidney injury 1 and what value determines each type 3
A
urea: creatinine ratio
>100:1= pre renal
<40:1= renal
40-100= post renal
13
Q
what is the staging method for acute kidney injury, what r the stages and what does a higher stage mean
A
AKIN
stage 1-3
higher stage= decreased likelihood of kidney recovery
14
Q
what r the top 3 causes of AKI
A
sepsis, cardiogenic shock, MAJOR SURGERY
15
Q
what are the 4 pre renal causes of AKI and what is the general trend
A
- decrease in CO: heart failure or shock
- liver failure
- renal artery stenosis
- drugs: NSAIDs, ACEi, IV contrast
-> all to do with hypoperfusion
16
Q
what are the 4 renal causes of AKI and what is the general trend
A
- tubular (acute tubular necrosis)
- interstitial
- glomerular (inflammation)
- toxins (sepsis)
-> nephron and parenchyma damage
17
Q
what r the 3 post renal causes of AKI and what is the general trend
A
- stones (ureteral, bladder or urethra)
- BPH
- drugs (ANTICHOLINERGICS, calcium channel blockers)
-> obstructive uropathy
18
Q
risk factors of AKI 2
A
elderly
nephrotoxic drugs
19
Q
which substances accumulate due to AKI 4 and what do they lead to 4
A
K+= arrythmias
H+= acidosis
urea= pruritis due to urea deposites in the skin
fluid= odema
20
Q
symptomatic presentation of AKI 3
A
- oedema- swelling of limbs and abdomen
- oligouria/ haematuria/ proteinuria (changes to urine)
- ENCEPHALOPATHY/ MENTAL CONFUSION
21
Q
investigations for AKI 1 AND 2 WAYS OF DETERMINING CAUSES
A
- establish cause with urea: creatinine ratio
- FBC: K+, H+, urea and creatinine
- RENAL CAUSE- RENAL BIOPSY
- POST RENAL- KUB US
22
Q
treatment of AKI 3 and what is the last resort treatment
A
treat complications:
1. high K+- calcium gluconate
2. metabolic acidosis- sodium bicarbonate
3. oedema= diuretics
last resort= renal replacement therapy
23
Q
what indicates haemo-dialysis in AKI 5
A
Acidodid (pH <7.1)
Fluid overload (odema)
Uremia (symptomatic)
K+ >6.4
ECG changes due to K+
AFUKE
24
Q
what is CKD
A
eGFR of <60mL/min/1.73m2 for 3 or more months
25
what r the best readings to quantify CKD 2
eGFR and albumin: creatinine ratio
26
what r the stages of CKD 5 and their values
stage 1: >90mL/min eGFR
stage 2: 60-89 mL/min eGFR
stage 3A: 45-59mL/min eGFR
stage 3B: 30-44mL/min eGFR
stage 4: 15-29mL/min eGFR
stage 5: less than 15mL/min eGFR (end stage CKD)
27
what r the 2 most common risk factors for CKD
1. diabetes mellitus
2. hypertension
28
what is the pathophys of CKD 4 and explain why proteins and blood can get into urine
1. low GFR due to damaged nephrons
2. this increases burden on remaining nephrons
3. this also increases RAAS activation to increase GFR but this increases pressure
4. this causes loss of basement membranes selective permeability= blood and protein in urine
29
why is CKD initially asymptomatic 1 and why does CKD become symptomatic 1
asymptomatic- lots of nephrons as a reserve
symptomatic- due to substance accumulation
30
what r the investigations for CKD 3
FBC and U&Es Creatinine, albumin, anaemia
Urinalysis - haematuria, proteinuria, glycosuria
Renal ultrasound
31
treatment for CKD 4
(what is the aim of treatment, example, when to refer and last resort treatment)
Irreversible so treat to prevent progression of disease and symptom control:
eg Oedema - fluid and sodium restriction furosemide
1. Referral to nephrology if eGFR < 30 (stage 4) or A:CR>70
last resort- renal replacement therapy
32
compare AKI and CK presentation time
AKI: shorter symptom onset
CKD: 3+ months presentation
33
compare if there is anaemia or no anaemia in CKD and AKI
AKI: no anaemia
CKD: anaemia of chronic kidney disease
34
compare ultrasound results for AKI and CKD
AKI: USS is normal
CKD: USS shows bilateral small atrophied kidneys
35
what is benign prostatic hyperplasia and when is this classified as normal
non malignant prostate hyperplasia
normal with ageing
36
risk factors for BPH 2
age
African caribbean origin
37
what is protective against BPH
castration (removal of testicles)
38
pathophysiology of BPH
inner transitional zone of prostate (muscular and gland) proliferate and narrows the urethra
39
what r the two issues caused by BPH, which is more common
issues with storage and voiding
voiding more common
40
name 4 aspects of storage
frequency, urgency, nocturia, incontinence
FUNI
41
name 4 aspects of voiding
poor stream, dribbling, incomplete emptying, hesitency
SHID
42
what r the symptoms of retention 4 and when does this occur
anuria, UTI, stones, hydronephrosis
when the urethra is completely occluded
43
what r the two investigations for BPH and what is an issue with one of them
DRE (rectal exam)- smooth enlarged mass
prostate specific antigen (used rule out prostate cancer but can be raised in both)
44
treatment for BPH 3 approaches, 4
1. lifestyle- reduce caffeine intake
2. medications
-> 1st line tamsulosin alpha blocker which relaxes bladder neck
-> 2nd line finasteride alpha reductase inhibitor which decreases testosterone production
3. surgery
transurethral resection of prostate
45
complication of transurethral resection of prostate
retrograde ejaculation
46
what r the 5 GU cancers
-> renal cell carcinoma
-> wilms tumour
-> bladder cancer
-> prostate cancer
-> testicular cancer
47
what is renal cell carcinoma and what age does it occur in
proximal convoluted tubule epithelium carcinoma
over 40s
48
risk factors of renal cell carcinoma 2
smoking
hereditary
49
presentation of renal cell carcinoma 3
often asymptomatic (25%)
triad- flank pain, haematuria, abdominal mass
50
1st line and GS investigation for renal cell carcinoma and what is the advantage of the GS
1st line: USS
GS: CT chest/ abdo/ pelvis (more sensitive)
51
treatment for renal cell carcinoma 1
nephrectomy (full/ partial depending if bilateral)
52
what is wilms tumor and what ages does it occur
renal mesenchymal stem cell tumour
seen in children under 3
53
what is bladder cancer
transitional cell carcinoma of bladder
54
unique risk factor for bladder cancer 1
occupational exposure to dyes/paint/rubber (painter, hairdressers, mechanic working with tyres)
55
presentation of bladder cancer 1
painless haematuria
56
investigation for bladder cancer 1
flexible cystoscopy GS
57
treatment for bladder cancer 3 approaches (4)
conservative= support eg specialist nurse
medical= chemo/radiotherapy
surgery= TURBT (transurethral resection of bladder tumour) or last resort CYSTECTOMY
58
what is prostate cancer
proliferation of outer peripheral zone of prostate (adenocarcinoma)
59
risk factors for prostate cancer 4
genetic BRCA1/2 and HOXB13 and lynch syndrome
elderly
family history
A/C origin
60
presentation of prostate cancer 2
LUTS like BPH (voiding and storage issues) but with systemic cancer symptoms eg weight loss, fatigue, night pain and bone pain
61
where does prostate cancer typically metastasise to and what is the effect of this
typically metastasises to bone= sclerotic lesions, typical lumbar back pain
also metastasises to liver, lung and brain
62
investigations for prostate cancer (community 2, GS/ diagnostic)
DRE is hard and irregular and PSA in community
GS/ diagnostic:
transrectal USS and biopsy
63
how is prostate cancer staged 1 and what is a higher score indicative of 1
use GLEASON score to grade- based on biopsy (the higher it is, the worse the prognosis)
64
4 treatment approaches for prostate cancer
1. prostatectomy
2. radio/chemotherapy
3. hormone therapy Gonadotrophin receptor agonist- goserelin
4. bilateral orchidectomy/ castration
65
explain hormone therapy treatment for prostate cancer (example name, how does it work and 2 side effects)
GnRH receptor agonist eg goserelin
increases LH and FSH but results in suppression of HPG axis= less testosterone
side effects= libido loss, erectile dysfunction
66
what r the two categories of testicular cancer
germ cell (90%) or non germ cell (10%) tumour
67
what r the causes of germ cell testicular cancer 2
seminoma, teratoma
68
what r the causes of non-germ cell testicular cancer 3
sertoli, leydig, sarcoma
69
what is the most common cancer in young men and what age is this
testicular cancer
20-45
70
risk factors for testicular cancer 3
undescended testes
infertility
family history
71
presentation for testicular cancer 2
painless lump in testicle which doesn’t transilluminate (often self found)
may show lung metastases signs eg cough (consider chest x ray)
72
investigations for testicular cancer 2
urgent doppler USS testes (90% diagnostic)
tumour marks AFP and BhCG (+ LDH which is raised non specifically in tumours)
73
when r the 2 tumour markers raised in testicular cancer and what do they indicate 1 each
AFP- raised in teratoma
BhCG- raised in seminomas
74
treatment for testicular cancer 2 and what should always be offered
always 1st line: urgent radical orchiectomy
adjacent chemo or radio
offer sperm storage
75
what r the two locations for UTIS and what is each called
upper- kidney
lower- bladder and down
76
what r the upper UTIs 1
pyelonephritis
77
what r the lower UTIs 4
cystitis, prostatitis, urethritis, epididymo-orchiditis
78
what r the organisms of UTI
KEEPS
klebsiella, enterbacter, E.coli, proteus, s. saphrophyticus
79
what is the main cause of UTIs and in how many of the cases
UPEC- uropathogeinc E coli
80
80
why r females more likely to get a UTI
they have a shorter urethra, therefore closer to anus which makes it easier for bacteria to colonise
81
explain the investigations for all UTIs (1st, GS) and results
1st line: urine dipstick
-positive leukocytes
-positive nitrites
-haematuria
GS: midstream MC + S
82
what is the purpose of midstream MC and S and what does it stand for
confirms UTI and IDs pathogen
midstream microscopy, culture and sensitivity
83
what is obstructive uropathy
block of urine flow
can affect one or both kidney depending on the level of obstruction
84
what is obstruction of one kidney
obstructive nephropathy
85
what is the pathophys of obstructive uropathy and how it leads to hydronephrosis 3
1. obstruction leads to retention
2. causes urine backlog in renal pelvis
3. hydronephrosis= dilated renal plexus which is more infection prone
86
what is the treatment for obstructive uropathy 2
1. relieve kidney pressure- catherise urethra, urethral stent
2. treat cause of obstruction eg BPH/ stones
87
what is pyelonephritis and what organism usually causes it
infection of renal parenchyma and upper ureter
usually UPEC caused, can be other KEEPS
88
how is pyelonephritis acquired and who does it affect
most commonly acquired via ascending transurethral spread
affects females under 35
89
2 things that increase your risk of getting pyelonephritis 2
urine stasis ie stones
catheters
90
presentation of pyelonephritis 3
triad: loin pain, fever and pyuria (pus in urine)
91
investigation for pyelonephritis 1 and what is the reasoning behind this 1
midstream urine sample and do MC+S
to ID the pathogen for the most appropriate antibiotic regime
92
treatment for pyelonephritis 3 one contraindication
1. analgesia- paracetamol
2. antibiotics: cefalexin or co-amoxiclav if results form culture are back and the pathogen IDed is susceptible (CO-AMOXICLAV IS TETAROGENIC)
93
what is cystitis by what organism
UPEC infection of the bladder
94
risk factors for cystitis 3
urine stasis
bladder lining damage
catheters
95
presentation of cystitis 4
suprapubic tenderness and discomfort
increased frequency
urgency
visible haematuria
96
treatment for cystitis 2
antibiotics: trimethoprim or nitrofurantoin
97
what is urethritis and main cause
urethral inflammation with or without infection
main cause is a sexually acquired condition
98
non infective causes of urethritis 1
trauma
99
infective causes of urethritis split into 2 subcategories
gonococcal= neisseria gonorrhoea, less common (gram -ve diplococcus)
non-gonococcal= chlamydia tractiomatis, more common (gram -ve aerobe bacilli)
100
risk factors for urethritis 2
male-male sex
unprotected sex
101
presentation of urethritis 2
dysuria with or without urethral discharge (blood or pus)
urethral pain
102
investigation for urethritis 1
NAAT (nucleus acid amplification test) which detects STIs (NG or CT cause)
103
treatment for urethritis 2
NG: IM ceftriazone and azithromycin
CT: azithromycin (or doxycycline)
104
what is Epididymo-orchitis
inflammation of epididymis, extending to testes
105
what causes epididymo-orchitis 2
STI or UTIs
106
presentation of epididymo-orchitis 3
unilateral scrotal pain and swelling
pain relieved with elevating testes
cremaster reflex is intact
107
investigation for epidiymo-orchitis 1
Nucleic Acid Amplification Tests
108
treatment for epididymo-orchitis 2
depends on infectious cause
NG: IM ceftriazone and azithromycin
CT: azithromycin (or doxycycline)
109
differential for epididymo-orchitis 1 and what r the 3 symptoms for this
testicular torsion
nausea and vomiting and bell clapper sign
110
what can present as both nephrotic and nephritic 2
diffuse proliferative glomerulonephritis
membrano-proliferative glomerulonephritis
111
What is the major clinical difference between nephritic and nephrotic syndrome?
Inflammation (Nephritic) vs Oedema (Nephrotic)
112
if a patient presents with frothy urine and oedema, what syndrome do they have and what is their treatment
nephrotic
ACEi/ARB and loop diuretics
113
what are the characteristics of nephrotic syndrome 5
proteinuria (more than 3.5g/day)= frothy appearance
low serum albumin (<30g/L)
Oedema
Hyperlipidemia
hypertension
114
what are the characteristics of nephritic syndrome 4
Haematuria
Oliguria
hypertension
mild proteinuria (less than 3.5g/day)
115
what is the pathophysiology of nephrotic syndrome 2
podocyte injury= protein leaks into urine
116
pathophysiology of nephritic syndrome 2
inflammation of the kidney= blood leaks into urine
117
what are the causes of nephritic syndrome (systemic 4, 1 renal) and what type of reaction are these
systemic:
SLE
post strep glomerulonephritis
goodpastures
small vessel vasculitits
renal:
IgA nephropathy
ALL examples of type 3 hypersensitivity, except good pastures which is type 2
118
investigation for nephritic and nephrotic syndrome 2
urinalysis: haematuria (nephritic), proteins (nephrotic)
biopsy= DIAGNOSTIC
119
treatment for nephritic syndrome 2
1st line: BP control with ACEi
12 week corticosteroids if continuous haematuria
120
what are the causes of nephrotic syndrome (3 primary, 5 secondary)
primary:
-minimal change disease
-focus segmental glomerulosclerosis
-membranous nephropathy
secondary: DDANI
-diabetes
-drugs
-autoimmune
-neoplasia
-infection
121
investigation results for all causes of nephrotic syndrome
biopsy and microscopy for all
minimal change: podocyte effacement and fusion
focal segmental glomerulosclerosis: segmental sclerosis
membranous nephropathy: subpodocyte immune complex deposition
122
specific test for membranous nephropathy (nephrotic syndrome) 1
anti phospholipase A2 receptor antibody
123
treatment for nephrotic syndrome conditions 2
prednisolone
treat symptoms specifically eg oedema with loop diuretics
124
what is the most common cause of nephritic syndrome in developed countries
IgA nephropathy
125
What is IgA nephropathy and what does it cause
deposition of IgA into the mesangium of the kidney
this causes inflammation and damage
126
presentation of IgA nephropathy 2
asymptomatic
haematuria (ribena/coke)
127
investigation for IgA nephropathy 1
diagnostic= biopsy (IgA complex deposition)
128
treatment for IgA nephropathy 2
1st line: BP control with ACEi
corticosteroids if continuous inflammation
129
differential for IgA nephropathy 1 and how to differentiate 1
Henloch Schonlein purpura
systemic immune complex deposition, not isolated to kidneys
130
what is post strep glomerulonephritis and what doe it cause 1
deposition of strep antigens 3-6 weeks post infection
this causes inflammation
131
presentation of post strep glomerulonephritis 1 and what is this after
visible haematuria (ribena/coke) 3-6 weeks after group A beta haemolytic strep (Strep. pyogenes) infection
132
diagnosis of post strep glomerulonephritis
strep infection evidence
133
treatment for post strep glomerulonephritis 2
antibiotics and supportive care
134
what is often found secondary to SLE and what does it involve
lupus nephritis
ANA deposition in endothelium
135
investigation for SLE 2
ANA positive, anti dsDNA positive
136
treatment for SLE 2
steroids- hydroxycholorquine
immunosuppressants eg cyclophosphamide
137
what is goodpastures 3
anti glomerular basement membrane antibodies (anti GBM) attacks BM in lungs and the kidneys
138
treatment for goodpastures 2
steroids and plasma exchange
139
what is polycystic kidney disease 1 and what does this cause
cyst formation throughout renal parenchyma
enlargement and damage
140
risk factor for polycystic kidney disease 1
family history
141
causes of PKD 2 and which is more common
auto recessive inheritence or auto dominant inhertence
auto dom is more common
142
who is affected in auto recessive and dominant PKD
recessive= infants/ babies
dominant= males 20 year olds
143
name the two mutations and their percentage for auto dom PKD
mutated PKD1 (85%) or PKD (15%)
144
presentation of PKD 3
1. bilateral flank/ back/ abdominal pain
2. with or without hypertension and haematuria
3. extra renal cysts (particularly in circle of Willis)
145
investigation of PKD 2
kidney ultrasound- shows enlarged bilateral kidneys with multiple cysts
genetic testing
146
treatment for PKD 3
1. non curative
2. manage symptoms eg hypertension with ACEi
3. end stage renal failure with renal replacement therapy/ transplant
147
what are scrotal diseases 1 and what is important to note about them clinically 1
non cancerous
BUT assumed to be cancer unless proved otherwise
148
4 types of scrotal diseases
epididymal cyst
hydrocele
varicocele
testicular torsion
149
what is epididymal cyst and does it transilluminate
extratesticular cyst (above and behind testes)
will transilluminate
150
how are scrotal diseases diagnosed 1
USS of scrotum
151
what is hydrocele 2 and does it transilluminate
fluid collection in tunica vaginalis
cyst that testicle sits within
will transilluminate
152
what is variocele 1, why does it occur 1
distension of veins in pampiniform plexus in spermatic cord
due to increased left renal vein pressure
153
presentation of variocele 2
bag of worms
typically painless
154
complication of veriocele 1
infertility
155
what is testicular torsion 1, what does it cause 1 and what does it lead to if not treated 2
spermatic cord twists on itself
causing occlusions of testicular artery
leads to ischaemia and gangrene of testes if not dealt with
156
risk factor of testicular torsion 1
bell clapper deformity (“horizontal lie” of the testes)
157
presentation of testicular torsion 5
server unitesticular pain (hurts to walk)
abdominal pain
nausea and vomitng
cremasteric reflex lost (stroke winner thigh- ipsilateral testicle should elevate and retract upwards)
no pain relief with elevating testes (prehn sign)
158
investigation for testicular torsion 2 what if there is increased risk?
physical exam
USS to check testicular bloodflow
1st physical exam during surgery
159
treatment for testicular torsion 2 and what about if the testicle is non viable
1. urgent surgery bilateral orchiplexy (fixing of testes to scrotal sac to overcome bell clapper deformity)
-> non viable= orchidectomy
160
what gender does incontinence occur mostly in
females
161
two types of incontinence and what are they
stress (sphincter weakness eg post pregnancy trauma)
urge (detrusor muscle overactivity)
162
treatment of incontinence 2
surgery
anticholinergic drugs eg oxybutinin
163
what is retention and what volume does this involve
inability to pass urine even when bladder is full (500+ mls)
164
who does retention affect the most
men
165
causes of retention 2
1. obstruction (stones, BPH, neurological flaccid paralysis)
2. hypotonia of detrusor, as LMN
166
treatment for retention 1
catheter
167
when do storage symptoms occur
occur when bladder should be storing urine and therefore need to pee
168
when do voiding symptoms occur
occurs when bladder outlet is obstructed making it hard to pee
169
what are urinary red flags 2
haematuria
dysuria
