Block 34 Week 8 Flashcards

Question

scrotal pain?

Answer 1

* Testicular torsion - this is a urological emergency * rare prob in pts over 30 yrs * only test is exploration * ideally up to 6 hrs but can be salvagable upto 24 hrs

Answer 2

blue dot sign

Answer 3

* chlamydia most causative organisism * under 35-> refer to GUM clinic

Answer 4

* Doxy for chylamdyia * Ciprofloxacin for Gonorrhoea

Answer 5

* Acute inability to pass urine’ * Can lead to acute renal failure * Catheterise

Answer 6

* Record the volume of urine drained. No urine = consider renal failure * Urine for culture if suspicion of infection & cover with antibiotics – check local antibiotic policy * FBC, U&E. Is the creatinine deranged from the patient’s normal baseline? * don't check PSA - raised in retention and by catheterization * rectal examination * tamsulosin then TWOC

Answer 7

* UROLOGICAL EMERGENCY * Resuscitate * Drain the kidney – nephrostomy or stent * Antibiotics + urine culture * Delayed surgical intervention

Answer 8

* cancer - bladder, kidney, ureter, prostate * stones - kidney, ureter, bladder * inflammation - interstitial cystitis, cyclophosphamide * infections * trauma - kidney, bladder, urethra, pelvic fracture

Answer 9

VH than non visible

Answer 10

* urine culture * renal US * urine cytology * CT, MRI, renography

Answer 11

bladder cancer

Answer 12

high pressure chronic retention - drain after catheterisation

Answer 13

* neurological disease/ SC/ cauda equina compression - back pain, sciatica, ejaculatory dist, sensory dist in legs, feet, perineum

Answer 14

* acute loin pain more likely to be due to obstruction e.g. stone * chronic loin pain suggests disease within kidney or renal pelvis

Answer 15

* commonest cause of sudden onset severe flank pain is the passage of a stone down through the ureter

Answer 16

- down through the ureter * ureteic stone pain characteristically starts v suddenly (within minutes), is colicky in nature and radiates to the groin as the stone passes into the lower ureter * ppt can't get comfy, often roll around in agony

Answer 17

* if the ppt has pain/ discomfort in the penis and a strong desire to void, suggests that the stone has moved into the intramural part of the ureter

Answer 18

* acute loin pain is less likely to be due to a ureteric stone in women and ppts at the extremes of age * tends to be disease of men (and women) at 20-60yrs

Answer 19

- clot or tumour colic - loin pain and haematuria - PUJ obst - Pyelo

Answer 20

* PUJ obstruction - may present acutely w flank pain severe enough to mimic a ureteric stone * CT demonstrates hydronephrosis with normal ureter below the PUJ and no stone

Answer 21

* high fever - >38 but ureteric stone ppts don't unless there is infection with the obts * ppts tend to be systemically v unwell

Answer 22

* ppts ureteric colic often move around the bed in agony whilst those w peritonitis lie still * signs of peritonitis - abd tenderness, guarding

Answer 23

* examine for abd mass - pulsatile and expansile - leaking AAA * in women do a preg test * examine back chest and testicles

Answer 24

* involuntary leakage of urine on effort, exertion, sneezing or coughing

Answer 25

* involuntary leakage of urine accompanies by or immediately preceded by urgency

Answer 26

* comb of SUI and UUI

Answer 27

* 25% of over 20s have UI, 50% have SUI

Answer 28

* occurs due to bladder neck/ uretheral hypermotility and/or NM defects causing intrinsic sphincter def (sphincter weakness incontinence) * urine leaks whenever uretheral resistance is exceeded by an inc in abd pressure occuring e.g. exercise or coughing

Answer 29

* may be due to bladder overactivity or less commonly due to pathology that irritates the bladder (infection, tumour, stone) * symptoms from involun detrustor contractions may be difficult to distinguish from those due to sphincter weakness * in some ppts detrustor contractions can be provoked by coughing making it diff to distinguish between UUI and SUI

Answer 30

* suggests fistulous communication between the bladder and vagina e.g. due to surgical injury at the time of hysterectomy or C section or rarely presence of an ectopic ureter draining into the vagina - urine leak is usually low in volume but lifelong

Answer 31

* bc retroperitoneal (kidneys, ureters) or pelvic organs are relatively inaccessible, for the kidneys and bladder to be palpable implies a fairly advanced disease state

Answer 32

* arises out of the pelvis * dull to percussion * pressure of examining hand may cause a desire to void

Answer 33

* foetus - smooth firm mass, dull to percussion * flatus - hyper-resonant - may be visible peristalsis if intestinal obstruction * faeces - palpable in the flanks and across the epigastrium, firm, may be sep masses in the line of the colon * fat * fluid (ascites) - fluid thrill, shifting dullness

Answer 34

- mass lies in the paracolic gutter, moves w res, dull to percussion - can be felt bimanually - can be ballotted - renal carcinoma, hydronephrosis, pyelo, perinephric abcess, polcystic disease

Answer 35

- mass descends from under right costal margin - moves w resp - dull to percussion - sharp or rounded edge

Answer 36

- infection - congestion - HF, HV obstruction - infilitration - amyloid - space occupying lesions - hepatic cancer, mets, hydatid cyst - cirrhosis

Answer 37

- under left costal margin - firm, smooth, may have palpable notch

Answer 38

- infection - congestion - infiltration - space occupying lesions

Answer 39

* most common type of kidney tumour * type of adenocarcinoma that arises from the renal tubules

Answer 40

haematuria, flank pain, palpable mass

Answer 41

* Clear cell (around 80%) * Papillary (around 15%) * Chromophobe (around 5%)

Answer 42

* Wilms tumour is a specific type of tumour affecting the kidney in children under 5

Answer 43

* Haematuria * Vague loin pain * Non-specific symptoms of cancer (e.g., weight loss, fatigue, anorexia, night sweats) * Palpable renal mass on examination

Answer 44

* Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI

Answer 45

* tends to spread to tissues around the kidney with Gerota's fascia * often spreads to the renal vein then to the IVC

Answer 46

* “Cannonball metastases” in the lungs are a classic feature of metastatic renal cell carcinoma. * Cannonball mets can also occur from choriocarcinoma (cancer in the placenta) and, less commonly, with prostate, bladder and endometrial cancer.

Answer 47

- polycythemia - EPO - Hypercalcaemia - PTHr - HTN - Stauffers syndrome - cushings

Answer 48

due to various factors, including increased renin secretion, polycythaemia and physical compression

Answer 49

abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis

Answer 50

* surgery is first line: partial/ radical nephrectomy * when surgery can't be done: * arterial embolisation * percutaneous cryotherapy * radiofreq ablation

Answer 51

Consider a Wilms tumour in a child under the age of 5 years presenting with a mass in the abdomen. The parents may have noticed the mass

Answer 52

* Abdominal pain * Haematuria * Lethargy * Fever * Hypertension * Weight loss

Answer 53

* initial Ix is US * CT/ MRI for staging * biopsy needed for definitive diagnosis

Answer 54

* transurethral resection of bladder tumour (TURBT) - cornerstone of management - providing diagnosis, staging and initial Tx

Answer 55

* intravesical therapy: for high risk NMIBC or carcinoma in situa - BCG immunotherapy * Maintenance therapy: BCG maintenance therapy may improve outcomes in high-risk patients.

Answer 56

* neoadjuvant chemo - cisplatin based * radical cystectomy * bladder sparing approaches - TURBT, radiotherapy, chemotherapy * adjuvant chemo

Answer 57

* first line therapy - platinum based * immune checkpoint inhibitors like pembrolizumab

Answer 58

* Surgery main - partial nephrectomy for t1 * radical nephrectomy in T2

Answer 59

* Radical nephrectomy + lymph node dissection is the standard of care * Neo-Adjuvant Therapy: Tyrosine kinase inhibitors (TKIs) or immunotherapy can be considered to downsize the tumour before surgery.

Answer 60

* mainstray of treatment is systemic therapy * Low risk patients: VEGF inhibitors such as sunitinib, bevacizumab or pazopanib. * Intermediate and high risk patients: dual immunotherapy with ipilimumab and nivolumab

Answer 61

* digital rectal examination: asymmetrical, hard, nodular enlargement with loss of median sulcus * hard, lumpy

Answer 62

- Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination. - Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the age‑specific reference range.

Answer 63

* any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or * erectile dysfunction or * visible haematuria.

Answer 64

* protein produced by prostate epithelial cells * PSA is produced by normal prostate tissue, however levels in the blood tend to increase in malignancy.

Answer 65

* PSA testing can be discussed with men over 50, and should be offered to those men over 50 who request it

Answer 66

* Active or recent UTI (last 6 weeks) * Recent ejaculation, anal sex or prostate stimulation * Engaged vigorous exercise for 48 hours * Had a urological intervention in the past 6 weeks

Answer 67

* Lower urinary tract symptoms (e.g. nocturia, frequency, hesitancy, urgency or retention) * Visible haematuria * Unexplained symptoms that may be explained by advanced prostate cancer (e.g lower back pain, bone pain, weight loss) * Erectile dysfunction

Answer 68

* can detect prostate cancer at early stage -> earlier treatment -> better outcomes

Answer 69

* PSA testing can result in false positives -> unecessary biopsies, anx for patients * PSA can be elevated from other conditions such as BPH

Answer 70

* 95% are adenocarcinomas * majority arise in the peripheral zone of the prostate, with 10-20% arising from the central zone and 10-20% arising from the transitional zone.

Answer 71

* bone pain - mets? * weight loss * fatigue * urinary symptoms * neurological symptoms - spread to SC or nerves

Answer 72

* It predominantly affects younger men aged 15-35 years and has a higher incidence in Caucasian populations

Answer 73

serminomas (40-60%) and non-seminomatous germ cell tumours (30-50%)

Answer 74

embryonal carcinoma, yolk sac tumour, choriocarcinoma, and teratoma.

Answer 75

* Infertility (increases risk by a factor of 3) * Cryptorchidism * Family history * Klinefelter's syndrome * Mumps orchitis

Answer 76

painless lump

Answer 77

- Pain - lmpotence - hydrocele - gynaecomastia

Answer 78

- AFP in 60% - LDH in 40%

Answer 79

* Seminomas: hCG may be elevated in around 20%

Answer 80

* testicular cancer in men if they have a non‑painful enlargement or change in shape or texture of the testis. * Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms.

Answer 81

US first line

Answer 82

* Treatment depends on whether the tumour is a seminoma or a non-seminoma * Orchidectomy * Chemotherapy and radiotherapy may be given depending on staging and tumour type

Answer 83

* Nocturia * Frequency * Hesitancy * Urgency * Dribbling * Overactive bladder * Retention

Answer 84

(e.g haematuria, blood in semen, lower back pain/bone pain secondary to bony metastasis, weight loss, anorexia)

Answer 85

* Visible haematuria * Abnormal DRE (hard, nodular, enlarged, asymmetrical)

Answer 86

* Multiparametric MRI is now commonly the first line investigation in the diagnosis of prostate cancer. * MRI influenced prostate biopsy - guided biopsy offered to patients w a Likert score of above 3

Answer 87

- option in low-risk localised prostate cancer. - It involves regular PSA measurements, digital rectal examinations and multiparametric MRIs. - It is used as many with low-risk localised disease

Answer 88

* Radical prostatectomy: is a definitive treatment option for localised prostate cancer. It involves the removal of the entire prostate gland and surrounding tissues

Answer 89

definitive Tx for localised prostate cancer

Answer 90

urinary incontinence and erectile dysfunction (though less than radical prostatectomy) as well as bowel symptoms (e.g. faecal incontinence).

Answer 91

urinary incontinence and ED

Answer 92

* aims to lower androgen levels - can be given to those with intermediate or high-risk localised disease (normally if receiving radical radiotherapy) or in metastatic disease to slow progression.

Answer 93

include a loss of libido, erectile dysfunction, loss of ejaculation and osteoporosis.

Answer 94

* GnRH agonist: chemical castration - reduced LH/FSH release * e.g. goserelin * Bicalutamide (an anti-androgen) * Bilateral orchidectomy (castration)

Answer 95

* Active surveillance * Radical prostatectomy * Radical radiotherapy

Answer 96

a choice of active surveillance, radical prostatectomy or radical radiotherapy can be offered.

Answer 97

NICE advises offering radical prostatectomy or radical radiotherapy. They advise considering active surveillance in those declining radical therapy.

Answer 98

NICE advises offering radical prostatectomy or radical radiotherapy. They do not advise active surveillance in high-risk disease.

Answer 99

Patients are typically managed with prostatectomy and radiotherapy. Docetaxel chemotherapy may be used

Answer 100

* Docetaxel chemotherapy and androgen deprivation therapy are often used. Bilateral orchidectomy can be offered as an alternative to androgen deprivation therapies.

Answer 101

* 96% survive one year * 86% survive 5 yrs after diagnosis

Answer 102

- orchidectomy * should be performed in virtually all cases * both diagnostic and therapeutic

Answer 103

* Orchidectomy must be performed via an inguinal approach. This is to avoid crossing lymph networks - the testicles lymph drain to para-aortic nodes whilst the scrotal skin drains to the inguinal nodes.

Answer 104

* Stage I Seminoma (low risk): Standard treatment options include surveillance (active monitoring without immediate treatment) or adjuvant radiotherapy to the retroperitoneal lymph nodes.

Answer 105

Options may include surveillance, adjuvant radiotherapy, or adjuvant chemotherapy.

Answer 106

Treatment typically involves chemotherapy, such as a combination of bleomycin, etoposide, and cisplatin (BEP regimen).

Answer 107

Treatment usually involves radical inguinal orchiectomy (removal of the affected testicle). Adjuvant treatments such as chemotherapy or radiotherapy may be considered

Answer 108

Treatment often involves chemotherapy, typically with a regimen such as BEP (bleomycin, etoposide, cisplatin) or EP (etoposide, cisplatin).

Answer 109

* renal stones are also referred to as renal calculi, urolithiasis, nephrolithiasis * hard stones that form in the renal pelvis * commonly get stick at the vesico-ureteric junction

Answer 110

* Obstruction leading to acute kidney injury * Infection with obstructive pyelonephritis

Answer 111

calcium based - raised calcium and low urine output are key factors

Answer 112

* 2 types of calcium stones: calcium oxalate (most common) and calcium phosphate

Answer 113

* dehydration * hypercalciuria, hyperparathyroidism, hypercalcaemia * cystinuria * high dietary oxalate * renal tubular acidosis * medullary sponge kidney, polycystic kidney disease * male sex * infection

Answer 114

* gout * ileostomy: loss of bicarbonate and fluid results in acidic urine, causing the precipitation of uric acid

Answer 115

* drugs that promote calcium stones: loop diuretics, steroids, acetazolamide, theophylline

Answer 116

* thiazides can prevent calcium stones (increase distal tubular calcium resorption

Answer 117

not visible on XR

Answer 118

produced by bacteria, therefore, associated with infection

Answer 119

associated with cystinuria, an autosomal recessive disease

Answer 120

* where the stone forms in the shape of the renal pelvis, giving it a similar appearance to the antlers of a deer stag. * The body sits in the renal pelvis with horns extending into the renal calyces. * They may be seen on plain x-ray films.

Answer 121

* Most commonly, this occurs with stones made of struvite. - In recurrent upper urinary tract infections, the bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite.

Answer 122

* Unilateral loin to groin pain that can be excruciating (“worse than childbirth”) * Colicky (fluctuating in severity) as the stone moves and settles * Patients often move restlessly due to the pain.

Answer 123

- renal colic * Haematuria * Nausea or vomiting * Reduced urine output * Symptoms of sepsis, if infection is present

Answer 124

* urine dipstick - usually shows haematuria, helpful to exclude infection * blood tests - signs of infetion and identify hypercalcaemia * abd X ray - will show calcium based stones but uric acid stones won't show up - radiolucent

Answer 125

* CT KUB - initial Ix for diagnosing stones - within 24 hrs * US KUB in children and pregnant women

Answer 126

* NSAIDs - IM diclofenac, IV paracetamol

Answer 127

* watchful waiting for stones less than 5mm

Answer 128

* antiemetics for nausea and vomiting - cyclizine e.. * ab if infection

Answer 129

* tamsulosin - to aid w spontaneous passage of stones

Answer 130

* surgical interventions - required in large stones (10mm or larger), stones that do not pass spontaneously or where there is complete obstruction or infection.

Answer 131

* Extracorporeal shock wave lithotripsy (ESWL) - shock waves directed at stones to break them up

Answer 132

camera inserted and stone broken up using lasers

Answer 133

* Percutaneous nephrolithotomy - camera inserted, stones broken up * open surgery

Answer 134

reduce the intake of oxalate-rich foods (e.g., spinach, beetroot, nuts, rhubarb and black tea)

Answer 135

reduce the intake of purine-rich foods (e.g., kidney, liver, anchovies, sardines and spinach)

Answer 136

* Avoiding excess salt * Good oral hydration (and adding lemon juice to drinking water) * Avoiding carbonated drinks * A balanced diet * Healthy weight loss * potassium citrate * thiazide diuretics

Answer 137

* urine dip * urine culture * 24 hr urine collection to measure calcium, oxalate, citrate, uric acid

Answer 138

* advancing age * previous pregnancy and childbirth * high body mass index * hysterectomy * family history

Answer 139

detrusor overactivity

Answer 140

leaking small amounts when coughing or laughing, related to increased intra-abd pressure

Answer 141

due to bladder outlet obstruction, e.g. due to prostate enlargement, overflow after retention

Answer 142

* bladder diaries should be completed for a minimum of 3 days * vaginal examination to exclude pelvic organ prolapse and ability to initiate voluntary contraction of pelvic floor muscles ('Kegel' exercises) * urine dipstick and culture * urodynamic studies

Answer 143

* weakening of pelvic floor muscles: * Age * Pregnancy & vaginal delivery * Constipation * Obesity * Family history

Answer 144

* characterised by the urge to pass urine associated with involuntary leakage. * It occurs secondary to an overactive bladder * due to detrusor muscle overactivity -> involuntary contractions of the bladder

Answer 145

* mostly idiopathic but can occur secondary to neurological disorders

Answer 146

* when someone can't fully empty their bladder with overflow occuring when the bladder becomes v full or secondary to stress/ urge * can occur secondary to physical obstruction or underactivity of the detrusor muscle:

Answer 147

* bladder outlet obst e.g. prolapse, fibroids, following pelvic surgery

Answer 148

* detrusor underactivity: leads to retention and leakage

Answer 149

* This occurs with advancing age, in those with peripheral neuropathy, spinal cord pathologies (e.g. MS) and secondary to medications (e.g. antimuscarinics)

Answer 150

* shame and embarassment -> social withdrawal * low self esteem * anxiety * social isolation - fear or leakage or odor * reduced QOL - fear of accidents * financial burden - purchase of absorbent products

Answer 151

* skin irritation and infection - rash, ulcers * UTIs * sleep disturbances due to nocturia * sexual dysfunction

Answer 152

* arises from neurological conditions like SC injury, MS, PD, stroke

Answer 153

* damage to nerves disrupts co-ordination between the detrusor muscle, and sphincter muscles * -> urinary retention, overactive bladder

Answer 154

* disruption of voluntary control over bladder function -> detrusor overactivity and increased bladder pressure * there may also be detrusor-sphincter dyssynergia, where the detrusor muscle contracts while the sphincter remains closed, leading to urinary retention

Answer 155

* These lesions disrupt the reflex arc responsible for bladder emptying and can lead to detrusor areflexia or hyporeflexia, decreased bladder contractility, and urinary retention. * Overflow urinary incontinence may occur due to bladder overdistension and leakage around the incompetent sphincter.

Answer 156

* decreased awareness of bladder fullness or urgency * delayed recognition of the need to void/ inability to sense when the bladder is full -> retention/ incontinence

Answer 157

* incontinence * retention * overactivity * distension * hydronephrosis

Answer 158

* stress and anxiety * depression * self esteem * social withdrawal

Answer 159

* dysuria w unexplained non visible haematuria age 60 and over * Haematuria (visible and unexplained) either without urinary tract infection or that persists or recurs after successful treatment of urinary tract infection, age 45 years and over * Haematuria (non-visible and unexplained) with dysuria or raised white cell count on a blood test, age 60 years and over * White cell count raised on a blood test with unexplained non-visible haematuria, age 60 years and over

Answer 160

* ED * haematuria * LUTS

Answer 161

* prostate feels malignant * PSA > reference ranges

Answer 162

* alpha blockers like doxazosin or tamsulosin for moderate to severe LUTS

Answer 163

* anticholinergic for overactive bladder

Answer 164

* 5-AR inhibitor like finasteride for LUTS with enlarged prostate

Answer 165

loop diuretic

Answer 166

* immediately catheterise for acute retention * offer alpha blocker * measure creatinine and image upper urinary tract for chronic retention

Answer 167

* persisting bladder or urethral pain * palpable bladder on bimanual or abdominal examination after voiding * clinically benign pelvic masses * associated faecal incontinence * suspected neurological disease * symptoms of voiding difficulty * suspected urogenital fistulae * previous continence surgery * previous pelvic cancer surgery * previous pelvic radiation therapy.

Answer 168

* caffiene reduction for overactive bladder * weight loss

Answer 169

pelvic floor therspy

Answer 170

* bladder training for urgency/ mixed incontinence

Answer 171

duloxetine

Answer 172

- Tension free vaginal tape - autologous sling procedures - colposuspension - intramural urethral bulking

Answer 173

- when the stress incont is caused by neuro disorder or when other surgical interventions fail - involves a pump inserted into the labia that inflates and deflates a cuff around the urethra allowing women to control continence manually

Answer 174

- bladder retraining - anticholinergics - oxybutinin - mirabegron

Answer 175

- botox in bladder wall - pec sacral nerve stimulation - augmentation cystoplasty - urinary diversion

Answer 176

Discontinue SAMA (switch to SABA) if commencing LAMA

Answer 177

tension pneumothorax

Answer 178

- ALL: most common children - AML: mostly in adults, auer rods - CLL - smudge cells, most common overall - CML - Philadelphia chromosome, imatinib

Answer 179

- high K - high P - low calc

Answer 180

howell jolly bodies due to hypospelnism

Answer 181

- HTN - Raised JVP - afebrile - s3 present

Answer 182

- hypotension - pyrexia - normal/ unchanged JVP

Answer 183

- HTN - oedema - hameaturia - olig

Answer 184

- focal segmental glomeruloscl - minimal change - membranous nephropathy - diabetic nephropathy - amyloidosis

Answer 185

- post-strep GN - IgA nephropathy - Alport - membarnoproliferative GN - rapidly progressive GN

Answer 186

- Most common NS in african & hispanic - assoc w sickle cell and HIV

Answer 187

effacement of foot podocytes

Answer 188

- most common Neph S in children - assoc w recent infection - rarely assoc w hodgkin lymphoma

Answer 189

effacement/ fusion of podocyte foot processes

Answer 190

ab against phospholipase A1

Answer 191

- infections - hep B and C - SLE - meds - NSAIDs, penicillamine, gold

Answer 192

- spike and dome appearance - thickened BM and cap

Answer 193

- common in ESRD - usually w other comps like retinopathy

Answer 194

glycosylation of vascular BM -> hyaline arteriosclerosis -> hyperfiltration at the efferent arteriole

Answer 195

Kimmelstein wilson nodules: eosinophilic nodule w central acellular region

Answer 196

- most commonly afffects kidneys - assoc w TB, MM and RA

Answer 197

- AA = chronic inflAAmation - AL amyloid - multipAL myleoma

Answer 198

- apple green on EM - congo red stain

Answer 199

- Usually kids - 2-4 weeks after URTI

Answer 200

- anti-strep ab - O titre

Answer 201

Granular/ starry sky

Answer 202

- goodpastures - microscopic polyangitis - diffuse proliferative GN - granulomastosis w polyangitis

Answer 203

Crescents - when we see the crescent we rapidly prepare for Eid

Answer 204

- haematuria - haemoptysis

Answer 205

- type 2 hypersen - anti-GBM disease - affects type IV collagen

Answer 206

- Wegener's - vasculitis - C-anca - when w C granulomatosis w polyangitis u cry

Answer 207

- haematuria - haemoptysis - nasal involvement - rhinosinusitis

Answer 208

- small vessel nectrotising vasculiutis - Sim to wegeners but no nasal involvement

Answer 209

- assoc w SLE - wire loops seen Dif-LUPUS proliferative GN

Answer 210

- TIV collagen defect

Answer 211

- sensorineural deafness - GN - lens dislocation/ retinopathy

Answer 212

basket weaving

Answer 213

- Assoc w hep C and hep B - most likely to co-occur w neph S

Answer 214

- Tram-track appearance of GBM - i get 2 MPG on the tram-track

Answer 215

- PTH and Ca high - Phosphate low

Answer 216

- High PTH - low/ normal Ca - phosphate High - Vit D low

Answer 217

Parathyroid gland hyperplasia occurs as a result of low calcium, almost always in a setting of chronic renal failure

Answer 218

- Ca normal or high - PTH high - phos normal/ low - ALP high

Answer 219

Occurs as a result of ongoing hyperplasia of the parathyroid glands after correction of underlying renal disorder, hyperplasia of all 4 glands is usually the cause

Answer 220

cortisol and ACTH suppressed

Answer 221

cortisol is not suppressed but ACTH suppressed

Answer 222

ectopic ACTH

Answer 223

double hydro keep fludro the same

Answer 224

sodium bicarb

Answer 225

inc in granulocytes at diff stages of maturation and thrombocytosis

Answer 226

- glossitis - hyperseg neutrophils = anaemia

Answer 227

* Pallor * Persistent fatigue * Unexplained fever * Unexplained persistent infections * Generalised lymphadenopathy * Persistent or unexplained bone pain * Unexplained bruising * Unexplained bleeding

Answer 228

acute wheeze, hypotension and no fever, presents acutely → expiratory wheeze

Answer 229

hypotension, not so acute presentation, non-cardiogenic pulmonary oedema → bilateral coarse crackles

Answer 230

can transform to high-grade lymphoma (Richter's transformation) making patients suddenly unwell - NHL

Answer 231

1.Low Lymphocytes -> the answer should be AML or CML 2. WBC > 100 -> Chronic causes so Consider CML (rule out AML) 3. Presence of bands cell -> confirm CML

Answer 232

- *blast -> Acute *bands -> Chronic

Answer 233

- A sudden anemia and a low reticulocute count indicates parvovirus. - Acute sequestration and haemolysis causes a high reticulocyte count.

Answer 234

sequestration crisis

Answer 235

sickle cell

Answer 236

- Aka large multinucleate cells with eosinophilic nucleoli - Aka mirror image nucleoli

Answer 237

- STaph epidermis - also the most common cause of peritonitis from dialysis

Answer 238

* analgesia e.g. opiates * rehydrate * oxygen * consider antibiotics if evidence of infection

Answer 239

* indications include: acute vaso-occlusive crisis (stroke, acute chest syndrome, multiorgan failure, splenic sequestration crisis * rapidly reduce the percentage of Hb S containing cells

Answer 240

* indications include: severe or symptomatic anaemia, pregnancy, pre-operative * do not rapidly reduce the percentage of Hb S containing cells

Answer 241

- Cold weather is MMMiserable = cold AIHA -> IgM + caused by Mycoplasma or infectious Mononucleosis (glandular fever)

Answer 242

Warm weather is Great = warm AIHI -> IgG + caused by CLL or SLE

Answer 243

Aplastic crises in sickle cell disease are associated with a sudden drop in haemoglobin - low reticulocyte coutn seen

Answer 244

The triad of angioedema, hypotension, and wheezing suggests an anaphylactic reaction rather than acute haemolysis.

Answer 245

Fever, abdominal pain, hypotension during a blood transfusion → acute haemolytic reaction

Answer 246

* high ferritin * high iron * high transferrin saturation

Answer 247

* basophilic stippling of red blood cells

Answer 248

* Prussian blue staining will show ringed sideroblasts

Answer 249

sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas can trigger haemolysis

Answer 250

* anti-malarials: primaquine * ciprofloxacin * sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

Answer 251

verparmil can cause cardiac arresy

Answer 252

S3 is most commonly caused by heart failure which is the result of a dilated, compliant ventricle

Answer 253

hypothermis

Answer 254

* double aortic contour * widened mediastinum

Answer 255

Small cell: ACTH and ADH Squamous: PTH

Answer 256

Chronic diabetic nephropathy will have large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys

Answer 257

Replace magnesium before correcting hypokalaemia. Hypomagnesemia prevents potassium absorption

Answer 258

The urea to creatinine ratio is high, as it is above 100, indicating that the cause of acute kidney injury is pre-renal - high urea makes it pre-renal e.g. dehydratoon

Answer 259

Irradiated blood products are used to avoid transfusion-associated graft versus host disease by destroying T cells

Answer 260

GDP6 deficiency

Answer 261

* anaemia: lethargy * weight loss and sweating are common * splenomegaly may be marked → abdo discomfort * an increase in granulocytes at different stages of maturation +/- thrombocytosis

Answer 262

Ritcher's transformation occurs when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin's lymphoma. Patients often become unwell very suddenly.

Answer 263

* lymph node swelling * fever without infection * weight loss * night sweats * nausea * abdominal pain

Answer 264

* Higher sugar loss and higher fluid loss, extreme dehyration * Head change - neuro: confusion * No abd pain and No ketones * Slower onset and stable potassium

Answer 265

* treat hydration first: 0.9% normal saline * Stabilise sugar w insulin

Answer 266

treated with beta blockers, propylthiouracil and hydrocortisone. Iv propanolol first line

Answer 267

Iron / calcium carbonate tablets can reduce the absorption of levothyroxine - should be given 4 hours apart

Answer 268

The diagnostic criteria for HHS include hypovolaemia, hyperglycaemia (blood sugar > 30mmol/L) and a serum osmolality > 320mosmol/kg.

Answer 269

weight gain

Answer 270

In De Quervain's thyroiditis there is globally reduced uptake of iodine-131 during thyroid scintigraphy

Answer 271

normocytic anaemia, leukopenia and thrombocytopenia = aplastic anaemia.

Answer 272

* Diffuse large B cell most common

Answer 273

* Burkitt lymphoma typically affects young or immunosuppressed patients.

Answer 274

* Follicular lymphoma is a fairly common subtype of NHL (16% of cases) however it is low grade and usually very slow growing with symptoms developing over months to years.

Answer 275

A raised ESR and osteoporosis represents multiple myeloma unless proven otherwise

Answer 276

* basal insulin * sulfonylrurea - glicazide * for v symptomatic ppts

Answer 277

- All patients with diabetes who are treated with insulin must notify the DVLA. For the DVLA to license an insulin-treated individual with a Group 1 licence, they must meet all the following criteria: * Adequate hypoglycaemia awareness * No more than 1 episode of severe hypoglycaemia while awake in the preceding 12 months AND the most recent episode occurred more than 3 months ago * Practises appropriate glucose monitoring * Not regarded as a likely risk to the public while driving * Meets the visual standards for acuity and visual field * Under regular review

Answer 278

* Hyponatraemia * Hyperkalaemia * Hypoglycaemia

Answer 279

Giving insulin in hyperosmolar hyperglycaemic state may provoke sudden and dramatic fluid shift between compartments, which may result in central pontine myelinolysis

Answer 280

- young females - mets to cervical LNs

Answer 281

papillary and follicular thyroid cancer

Answer 282

generally women >50 years old. Metastasis to lung and bones.

Answer 283

- parafollicular cells which produce calcitonin so this can be used as a tumour marker - MEN2

Answer 284

Elderly patient. Very poor prognosis

Answer 285

might present with dysphagia or stridor

Answer 286

GASTROPARAESIS

Answer 287

Leads V1 and V2 showing tall R waves is characteristic of a posterior MI

Answer 288

- Treating hypernatreamia too fast -> cerebral odema - treating hypo too fast -> Central pontine myelinolys

Answer 289

* increased risk of breast and cervical cancer

Answer 290

- ovarian - endometrial cancer

Answer 291

volume (ml) * ABV / 1,000

Answer 292

pTU in T1, switch to carbimazole in T2 and T3 - pTU has higher risk of hepatitis

Answer 293

1. IGF-1 2. OGTT: confirm diagnosis

Answer 294

hypernatreamia and hypokalamia

Answer 295

Rupture of the papillary muscle due to a myocardial infarction → acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema

Answer 296

Recent sore throat, rash, arthritis, murmur → ?rheumatic fever

Answer 297

An implantable cardioverter-defibrillator can be inserted to reduce the risk of sudden cardiac death in HOCM

Answer 298

undiagnosed bilateral renal artery stenosis

Answer 299

- gallop rhythm - HF and severe AS

Answer 300

caused by a prolonged PR, severe mitral stenosis or mitral regurgitation

Answer 301

- his is an extra sound causes by atrial contraction against a stiff ventricle. - It is associated with hypertrophic obstructive cardiomyopathy and hypertension

Answer 302

cytoscopy is Ix of choice

Answer 303

PIO-glitazone risks: - Pee: Bladder cancer - Ischaemic (not quite but helps me): Heart failure - Osteo: Fractures

Answer 304

- Chronic urinary retention is classed as high pressure urinary retention if renal function is impaired or if there is hydronephrosis - Low pressure chronic urinary retention presents with a painless distended bladder, but no associated hydronephrosis or renal impairment.