20/06 Flashcards
tx of acute bacterial prostatitis
14 days quinolone eg ciprofloxacin
muddy brown casts in the urine
acute tubular necrosis
acute vs chronic urinary retention
painful vs painless
BPH mx
alpha 1 antagonists eg tamsulosin
5 alpha reductase inhibitors eg finasteride
both
TURP
alpha 1 antagonists eg tamsulosin SEs
dizziness
postural hypotension
dry mouth
depression
5 alpha reductase inhibitors eg finasteride SEs
erectile dysfunction
reduced libido
ejaculation problems
gynaecomastia
what is indicated if the patient has a significantly enlarged prostate and is considered to be at high risk of progression
5 alpha reductase inhibitors eg finasteride but takes 6 months to work
lump separate from the body of the testicle
found posterior to the testicle
epididymal cyst
ED normal libido
organic cause
ED decreased libido
psychogenic cause
oung man who has always had difficulty achieving an erection
refer to urology
which hydroceles are common in newborns
communicating -> usually resolves within first few months
Chronic upper urinary tract obstruction
ureteric stent or a pyeloplasty
urethral injury invx
ascending urethrogram
mx urethral injury
suprapubic catheter placed surgically
voiding symptoms
conservative measures: pelvic floor muscle training, bladder training, prudent fluid intake and containment products
alpha blocker if mod-severe
5alpha reductase if high risk of progression
voiding + storage - antimuscarinic
Predominately overactive bladder
moderate fluid intake and bladder retraining
antimuscarinic eg oxybutynin, tolteridone
mirabegron
nocturia
moderating fluid intake at night
furosemide 40mg in late afternoon
desmopressin
priapism invx
Cavernosal blood gas analysis to differentiate between ischaemic and non-ischaemic
mx priapism
> 4 hrs - aspiration of blood from the cavernosa
injection of phenylnephrine
surgery
prostate cancer hormonal tx
LHRH analogues and anti androgens
prostate cancer low risk
active surveillance
prostate cancer INVX
multiparamic MRI
prostate cancer tx
radical prostatectomy
radiotherapy: external beam and brachytherapy
anti-androgen therapy prostate cancer
GnRH agonists e.g. Goserelin (causes tumour flare)
most common renal cell cancer
clear cell
calcium oxalate stones
Hypercalciuria
radio opaque
cystine stones
inherited AR disorder
radio dense
uric acid
low urinary pH
malignancy
children with inborn errors of metabolism
radiolucent
calcium phosphate
renal tubular acidosis
radio-opaque (the most)
struvite
formed from magnesium, ammonium and phosphate
assoc with chronic infections
slightly radio-opaque
alkaline urine
Stone burden of less than 2cm in aggregate
lithotripsy
Stone burden of less than 2cm in pregnant females
uterescopy
Complex renal calculi and staghorn calculi
Percutaneous nephrolithotomy
Ureteric calculi less than 5mm
manage expectantly
cremasteric reflex is lost
elevation of the testis does not ease the pain (Prehn’s sign)
testicular torsion
ank spond xray findings
subchondral erosions
sclerosis
squaring of lumbar vertebrae
most likely inherited cancer
gastric
acute interstitial nephritis cause
drugs
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
sterile pyuria
white cell casts
acute interstitial nephritis
exceptions to bilaterally small kidneys in ckd
autosomal dominant polycystic kidney disease
diabetic nephropathy (early stages)
amyloidosis
HIV-associated nephropathy
feature suggesting CKD > AKI
hypocalcaemia
definition oliguria
urine output of less than 0.5 ml/kg/hour
creatinine AKI criteria
a rise in serum creatinine of 26 or greater within 48 hours
a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
imaging in AKI
renal USS
removal of potassium from the body
- Calcium resonium (orally or enema)
- Loop diuretics
- Dialysis
microscopic haematuria/ renal failure
sensorineural deafness
retinitis pigmentosa
alports syndrome (x linked)
renal biopsy: splitting of lamina densa seen on electron microscopy
alports syndrome
Congo red staining: apple-green birefringence
amyloidosis
pulmonary haemorrhage
rapidly progressive glomerulonephritis
anti-gbm
renal biopsy: linear IgG deposits along the basement membrane
anti-gbm
factors which affect egfr
eating red meat
muscle mass
pregnancy
anti-hypertensives in CKD
ACEi
furosemide
ckd mineral bone disease mx
reduced dietary intake of phosphate
phosphate binders
vitamin D: alfacalcidol, calcitriol
parathyroidectomy
mx of proteinuria in CKD
ACEi or ARB
SGLT2
AMPLE
A llergies
M edications
P ast medical history
L ast meal or other intake
E vents leading to presentation
copd abx prophylaxis
azithromycin
which cardiac drug can worse glucose tolerance
thiazides eg indapamide
CI to peritoneal dialysis
IBD
what is needed prior to discharge following an acute asthma attack
PEF >75% of best or predicted
what determines the HIV transmission risk following a needle stick injury
viral load
eczema herpeticum cause
herpes simplex 1
what type of DI does haemochromatosis cause
cranial
tx of nephrogenic DI
thiazides
low salt/protein diet
central diabetes insipidus tx
desmopressin
monitoring of diabetic nephropathy
ACR ratio from early morning specimen
focal and segmental sclerosis and hyalinosis on light microscopy
effacement of foot processes on electron microscopy
focal segmental glomerulosclerosis
haemolytic uraemic syndrome triad
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
HSP
IgA mediated small vessel vasculitis
mx of hyperkalaemia
stablise cardiac membrane - IV calcium gluconate
shift K from ECF - ICF - insulin + dextrose infusion, neb salbutamol
removal of potassium from body - calcium resonium, loop diuretic, dialysis
nephrotic syndrome in adults
Membranous glomerulonephritis
Membranous glomerulonephritis tx
ACEi or ARB
steroid
nephrotic syndrome in kids
minimal change disease
minimal change disease mx
steroid
nephrotic syndrome
- Proteinuria (> 3g/24hr) causing
- Hypoalbuminaemia (< 30g/L) and
- Oedema
confirmation of strep infection for post-strep glomerulonephritis
raised anti-streptolysin O titre
formation of epithelial crescents in the majority of glomeruli
rapidly progressive glomerulonephritis
red cell casts
nephritis syndrome
ongoing jaundice and pain after cholecystectomy
gallstones in the common bile duct
venous leg ulcers loc
above the ankle
deep venous insufficiency
prev DVT
superficial venous insufficiency
varicose veins
majolins ulcer
squamous cell carcinoma occuring at sites of chronic inflammation
arterial ulcers loc
toes and heels
deep punched out ulcer
arterial
neuropathic ulcer loc
plantar surface of metatarsal head and plantar surface of hallux
mx of neuropathic ulcers
cushioned shoes to reduce callous formation
pyoderma gangrenosum
ulcer assoc with IBD/RA
can occur at stoma sites
acute limb threatening ischaemia invx
handheld doppler exam
if signals present -> ABPI
pre-existing claudication with sudden deteriorationand widespread evidence of vascular disease
thrombus
sudden onset of painful leg with no pre-existing claudication or vascular disease
embolus
what is given to prevent thrombus propagation
intravenous unfractionated heparin
rest pain in foot for more than 2 weeks
ulceration
gangrene
critical limb ischaemia
6 PS
acute limb ischaemia
peripheral arterial disease meds
statin and clopidogrel
peripheral arterial disease tx
stop smoking
exercise training
short segment stenosis (e.g. < 10 cm), aortic iliac disease and high-risk patients
endovascular revascularisation
long segment lesions (> 10 cm), multifocal lesions, lesions of the common femoral artery and purely infrapopliteal disease
surgical revascularisation
Patients with clinical signs of superficial thrombophlebitis affecting the proximal long saphenous vein
uss to exclude concurrent DVT
superficial thrombophlebitis tx
anti-embolism stockings
prophylactic doses of LMWH for up to 30 days or fondaparinux for 45 days (or NSAIDs)
varicose veins invx
venous duplex USS
this will demonstrate retrograde venous flow
varicose veins tx
graduated compression stockings
if pt is having PCI for stemi what meds should be given
prasugrel + aspirin
if already on anticoag, clopidogrel
refractory anaphlaxis
IV adrenaline (under expert guidance) + IV fluid bolus
maintaining remission in crohns
Azathioprine or mercaptopurine
kussmauls sign (jvp doesnt fall with inspiration)
dyspnoea
peripheral oedema
constrictive pericarditis
what does the BCG protect against
TB meningitis and disseminated TB in children
PUVA
squamous cell cancer
MASSIVE PE AND HYPOTENSION
THROMBOLYSE
which cardiac drug exacerbates gout
thiazides
low lying placenta at 20 week scan
rescan at 32 weeks
ejection systolic murmur louder on inspiration
atrial septal defect
stage IA cervical cancer
cone biopsy
housebond pt
vit D
vomiting/aspiration
metabolic alkalosis
raised ESR and osteoporosis
?myeloma
most common cause of primary hyperparathyroidism
A solitary parathyroid adenoma
