20/06 Flashcards by Lucy Allan

tx of acute bacterial prostatitis

14 days quinolone eg ciprofloxacin

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muddy brown casts in the urine

acute tubular necrosis

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acute vs chronic urinary retention

painful vs painless

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BPH mx

alpha 1 antagonists eg tamsulosin
5 alpha reductase inhibitors eg finasteride
both
TURP

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alpha 1 antagonists eg tamsulosin SEs

dizziness
postural hypotension
dry mouth
depression

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5 alpha reductase inhibitors eg finasteride SEs

erectile dysfunction
reduced libido
ejaculation problems
gynaecomastia

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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

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lump separate from the body of the testicle
found posterior to the testicle

epididymal cyst

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ED normal libido

organic cause

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ED decreased libido

psychogenic cause

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oung man who has always had difficulty achieving an erection

refer to urology

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which hydroceles are common in newborns

communicating -> usually resolves within first few months

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Chronic upper urinary tract obstruction

ureteric stent or a pyeloplasty

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urethral injury invx

ascending urethrogram

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mx urethral injury

suprapubic catheter placed surgically

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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

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Predominately overactive bladder

moderate fluid intake and bladder retraining
antimuscarinic eg oxybutynin, tolteridone
mirabegron

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nocturia

moderating fluid intake at night
furosemide 40mg in late afternoon
desmopressin

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priapism invx

Cavernosal blood gas analysis to differentiate between ischaemic and non-ischaemic

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mx priapism

> 4 hrs - aspiration of blood from the cavernosa
injection of phenylnephrine
surgery

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prostate cancer hormonal tx

LHRH analogues and anti androgens

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prostate cancer low risk

active surveillance

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prostate cancer INVX

multiparamic MRI

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prostate cancer tx

radical prostatectomy
radiotherapy: external beam and brachytherapy

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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

1. Proteinuria (> 3g/24hr) causing 2. Hypoalbuminaemia (< 30g/L) and 3. 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