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Conditions Flashcards

1
Q 
Torsion of spermatic cord 
age group?
cremasteric reflex absent or present?
Ix?
Rx?
A

puberty
reflex absent
ix = doppler US
rx: prompt exploration to prevent ischaemia. 2-3 point fixation. must fix other side! remove if testis is necrotic

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2
Q

blue dot sign

A

torsion of appendix testis

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3
Q

Rx for appendix testis torsion

A

resolves spontaneously

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4
Q

Signs of and Rx for epididymitis

A

Pyuria
Doppler US shows swollen epidydimis and ^ blood flor
Rx: Ofloxacin

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5
Q

Priapism - prolonged erection > ? hrs
dark blood - low or high flow?
rx for ischamic / non ischaemic?

A

4 hrs
dark blood = low flow/ischaemic
Rx
- ischaemic: aspiration +/- irrigation with saline, inject alpha agonist every 5-10 mins, surgical shunt
- non ischaemic: observe, may resolve itself / selective arterial embolisation

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6
Q

swelling and crepitus of scrotum, marked toxicity out of proportion to clinical findings

A

Fournier’s gangrene

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7
Q

Ix and Rx for fournier’s gangrene

A

Ix: plain xray/US > gas in tissues
Rx: Abx and surgical debridement

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8
Q

Who usually gets emphysematous pyelonephritis

what does it usually require?

A

diabetics

usually requires nephrectomy

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9
Q

imaging for urethral injury

A

retrograde urethrogram

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10
Q

pharmacological therapy for urge incontinence

A

antimuscarinics e.g. oxybutynin

beta - 3 - adrenergic e.g. mirabegron

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11
Q

1st line for treating stress incontinence

A

pelvic floor exercises

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12
Q

foot process fusion

A

minimal change glomerulonephritis

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13
Q

treatment for minimal change glomerulonephritis

responsive?

A

1st line = oral steroids - 94% complete remission

2nd line = cyclophosphamide

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14
Q

what can FSGS be 2y to

A

HIV, heroin use, obesity, reflux nephropathy

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15
Q

what is FSGS assoc with

A

suPAR levels

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16
Q

glomerular crests on biopsy

A

rapidly progressive glomerulonephritis

NB. potential to cause ESRF within DAYS

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17
Q

treatment for RPGN

A

IV methyprednisolone 3 days then oral prednisolone
Cyclophosphamide
may need plasma exchange

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18
Q

what do most cases of IgA nephropathy present with

A

micro or macro proteinuria

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19
Q

what is IgA nephropathy assoc with

A

Henoch-Schonlein purpura

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20
Q

Anti GBM disease - auto antibodies to ??

A

type 4 collagen

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21
Q

2y causes of membranous glomerulonephritis

A 
Hep B 
gold
penicillamine 
SLE 
malignancy
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22
Q

post streptococcal glomerulonephritis
usually present with nephrotic or nephritic syndrome?
rx?

A

nephritic

rx = supportive

23
Q 
nephrotic syndrome
3 features?
damage to what?
proliferative?
normal or abnormal renal function usually?
A

proteinuria >3g per day
hypoalbuminaemia
oedema
(also, assoc with hypercholesterolaemia)

damage to podocytes

non proliferative

usually normal renal function

24
Q

type of oedema in nephrotic syndrome

A

periorbital

25
what is damaged in nephritic syndrome
endothelial or mesangial cells
26
what can cause tubular injury
gentamicin rhabdomyolysis contrast ischaemia
27
Renal AKI what might anaemia make you think of? what might low platelets make you think of?
anaemia > CKD? myeloma? low platelets > HUS?
28
life threatening if K is over ?
6.5
29
medical treatment for hyperkalaemia
calcium gluconate (10 mls, 10%) insulin with 50 mms 50% dextrose (actrapid) salbutamol nebulised - 90 mins calcium resonium - to prevent absorption from GI tract
30
drug used for bone disease in CKD | what is it?
alfacalcidol | hydroxylated form of vitamin D
31
examples of phosphate binders
calcium carbonate | calcium acetate
32
why do you get anaemia in CKD?
erythropoietin production by the kidneys declines
33
correcting anaemia in CKD
IV iron | Epo subcut injections
34
CKD stages
1. > 90 + other evidence of kidney damage 2. 60-89 + other evidence of kidney damage 3. a. 45 - 59 ; b. 30 - 44 4. 15 - 29 5.
35
``` ADPKD pkd1 / 2 - chromosomes? (which one results in ESRF earlier) large or small kidneys? is there pain? extra renal features ```
``` pkd1 - chromosome 16 - ESRF earlier ): pdk2 - chromosome 4 large kidneys pain extra renal manifestations: - hepatic cysts are most common - in 1/3: cysts in the liver, pancreas, lung (no functional effect) - berry aneurysms > subarachnoid haemorrhage - cardiac disease - valve prolapse - diverticular disease - hernias ```
36
ADPKD Ix - are cysts bilateral or unilateral? Rx
Ix: - USS > multiple, bilateral cysts - CT/MRI if unclear on US - genetic linkage/mutation analysis Rx: - rigorous control of hypertension - ACEI - hydration - proteinuria reduction - TOLVAPTAN reduces cyst volume
37
``` ARPKD assoc with ? lesions gene on chromosome ? renal involvement bilateral or unilateral? are kidneys usually palpable? slow or fast decline in GFR? ```
``` assoc with hepatic lesions gene on chromosome 6 bilateral kidneys always palpable slow decline in GFR - less than 1/3 reach dialysis ```
38
ARPKD Ix prognosis
US/CT/MRI infants who survive the neonatal period have a mortality rate of 9-24% in the first year survival after first year > 80% survival beyond 15 yrs
39
Alports syndrome mutations in the ? gene (leads to deficient what?) characteristic feature? what is seen later and how does this affect prognosis? extra renal features typical feature on biopsy treatment
mutations in the COL4A5 gene (leads to deficienct collagen - type 4- matrix) characteristic feature = haematuria proteinuria is seen later and confers bad prognosis extra renal: - SN deafness - ocular - anterior lenticonus - leiomyomatosis of the oesophagus/genitilia - rare biopsy: thickened GBM + 'splitting' Rx = non specific - standard aggressive tx of BP, proteinuria
40
``` Who gets Anderson Fabrys disease? Inborn error if ? gene leading to deficiency in ??? clinical features - renal failure - cutaneous? - cardiac? - neuro? ```
X linked > males inborn error of GLA gene leading to deficiency in alpha galactosidase A - cutaneous: angiokeratomas - cardiac: cardiomyopathy, valvular disease - neuro: stroke, acroparaesthesia
41
anderson fabrys whats seen on biopsy? treatment?
concentric lamellar inclusions with lysosomes fabryzyme
42
``` medullary cystic kidney aut dom or rec? where are the cysts? Ix? rx? ```
aut dom cysts are at corticomedullary junction Ix: fam hx, CT rx: renal transplant
43
``` medullary sponge kidney what happens to the collecting ducts? what do the cysts contain? increased risk of ? renal failure? ```
dilation calculi UTI renal failure unusual :)
44
most common cause of renovascular hypertension
renal artery stenosis
45
when are ACEI contraindicated
bilateral renal artery stenosis
46
Myeloma - percentage with renal impairment at presentation? - hyper or hypo calcaemia? - features - renal manifestations - renal amyloidosis: +ve ??? stain showing ??? birefringence
50% hypercalcaemia - bone pain, weight loss, anaemia, amyloidosis, recurrent infections, fatigue - AKI secondary to hypercalcaemia - monoclonal immunoglobulin deposition disease - cast nephropathy - renal amyloidosis showing +ve congo red stain showing apple green birefringence
47
multiple myeloma is cancer of ? cells | most cases also involve ?
cancer of plasma proteins | most cases also involve paraprotein
48
rouleax formation cells
myeloma
49
myeloma - lytic or sclerotic lesions?
lytic
50
in myeloma, what can be done to remove light chains
plasma exchange
51
renal involvement is most common in GPA/MPA/EGPA ??
GPA and MPA
52
Lupus nephritis - most often proteinuria or haematuria? - up to ? % of lupus patients will have renal involvement at presentation
proteinuria | up to 50%
53
urgent indications for haemodialysis
K > 7 or > 6.5 and unresponsive to medial therapy urea > 40, pericardial rub/effusion pH

Renal (9 decks)

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