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Urology > Disease Table Notes: > Flashcards

Disease Table Notes: Flashcards

1
Q

Aetiology prostate cancer

A 
commonest male cancer
older
African Caribbean 
Western countries 
FH
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2
Q

Pathology prostate cancer

A

Mostly adenocarcinomas

Affecting peripheral zone

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3
Q

Signs prostate cancer

A

PSA

Mass on PR

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4
Q

Symptoms prostate cancer

A

Often asymptomatic
Prostatic symptoms
Weight loss
Lethargy

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5
Q

Prostatic symptoms

A

Hesitancy
Poor stream
Termina dribbling

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6
Q

Symptoms locally invasive prostate cancer

A 
Haematuria 
Suprapubic pain 
Anuria 
Weight loss 
Lethargy 
Incontinence 
Impotence
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7
Q

Symptoms distant mets prostate cancer

A

Bone pain
Sciatica
Paraplegia
LN enlargement

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8
Q

Investigations prostate cancer

A 
PSA 
PR 
Transrectal US + biopsy 
CT 
MRI
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9
Q

Rx for prostate cancer

A

Watchful waiting
Radical prostatectomy
Hormone therapy
Active surveillance

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10
Q

What is PSA

A

Protease produced by semen

Many leaked into serum

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11
Q

when do you not measure PSA?

A

after PR

ejaculation

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12
Q

What can causes elevations in PSA?

A

UTI
Chronic prostatitis
BPH
Prostate cancer

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13
Q

Risk factors testicular cancer

A 
Young males 
Infertility 
Atrophic testis 
Previous cancer in contralateral testis 
FH
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14
Q

2 types of testicular cancer

A

Seminoma

Non-seminomatous:

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15
Q

Commonest type of testicular cancer

A

Germ cell tumour

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16
Q

Testicular cancer tumour markers

A

Alpha fetoprotein
Beta HCG
LDH/lactase dehydrogenase

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17
Q

Symptoms testicular cancer

A

Painless lump
Trauma often brings people to notice lumps
Pain

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18
Q

Symptoms lung mets in testicular cancer

A

Dyspnoea

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19
Q

Investigations testicular cancer

A

MSSU
Testicular USS

Mets:
CXR
CT chest/abdo/pelvis

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20
Q

Rx testicular cancer

A

Orchidectomy

Radiotherapy

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21
Q

Rx testicular cancer metastases

A

Chemotherapy

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22
Q

Common mets site testicular cancer

A

Para-aortic LN
Chest
Bone

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23
Q

Risk factors renal cancer

A 
M
FH 
Smoking 
Anti-hypertensives
OBesity 
End-stage renal disease
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24
Q

Subtypes renal cancer

A

Clear cell
Papillary
Chromophobe

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25
Q

Classic triad renal cancer

A

Flank pain
Haematuria
Mass

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26
Q

Symptoms renal cancer

A

Haematuria
Loin pain
Weight loss
Anorexia

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27
Q

Investigations for renal cancer

A 
U&E's 
FBC
US 
CT 
MRI
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28
Q

RX renal cancer

A

radical nephrectomy

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29
Q

How does RCC respond to chemo and radio?

A

Resistant to both

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30
Q

2 benign lesions of kidneys

A

Oncocytoma

Angiomyolipoma

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31
Q

Risk factors TCC bladder cancer

A

Smoking

Aromatic amines

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32
Q

Risk factors squamous cell carcinoma

A

Schistosomiasis
Chronic cystitis
Recurrent UTI
Pelvis radiotherapy

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33
Q

What do most RCC arise from

A

TCC

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34
Q

Symptoms of bladder cancer

A

Frank haematuria
Recurrent UTI
Dysuria

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35
Q

Investigations for bladder cancer

A

Cystoscopy + biopsy
CT urogram
USS

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36
Q

Investigations for bladder cancer staging

A

CT
MRI
Bone scan if suspected mets

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37
Q

RX for grade non-muscle invasive bladder cancer

A

TURBT

Followed by chemo

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38
Q

Rx for High grade non-invasive bladder cancer

A

BCG therapy

Radical surgery

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39
Q

RX muscle invasive bladder cancer

A

Radical cystectomy

Radiotherapy

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40
Q

Follow up bladder cancer

A

Regular cystoscopy

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41
Q

Common mets bladder cancer

A

Iliac LN
Para-aortic LN
Liver
Lungs

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42
Q

Risk factors UTI

A 
F (short urethra)
Sexual activity 
DM
Pregnancy 
Renal cysts
Renal stones 
Catheterisation 
Instrumentation (cystoscopy)
BPH
Loss of bladder sensation (stasis of urine)
Congenital
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43
Q

Common UTI organisms

A

E.coli
Proteus sp.
Staph saprophyticus

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44
Q

Symptoms UTI

A 
Dysuria 
Frequency 
Urgency 
Polyuria 
Haematuria 
Suprapubic pain
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45
Q

Investigations for UTI

A

MSSU:
>105
Catheter:
Collected from catheter sampling port

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46
Q

Uncomplicated UTI treatment

A

3d course:
Trimethoprim
Nitrofurantoin
eGFR >30

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47
Q

RX Men UTI

A

7d course
Trimethoprim
Nitrofurantoin
eGFR>30

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48
Q

RX UTI in pregnancy

A

Nitrofurantoin

NOT trimethoprim

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49
Q

Who should be screened for UTI

A

Pregnant W

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50
Q

What might recurrent UTI in young males be a sign of?

A

Chlamydia

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51
Q

What is acute polynephritis

A

Acute kidney infection

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52
Q

Symptoms of acute polynephritis

A

Fever
Rigors
Loin pain
Urinary symptoms

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53
Q

Rx for acute polynephritis

A

Ciproflaxin

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54
Q

Commonest kidney stone type

A

Calcium oxalate

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55
Q

Are more M or F affected with urothliasis

A

M

56
Q

Symptoms of kidney stone?

A

Loin tenderness
Dysuria
Haematuria
UTI

57
Q

Commonest presentation of kidney stones

A

Loin pain

58
Q

Imaging for kidney stones

A

CT KUB
KUB x-ray
USS

59
Q

Investigations for kidney stones

A 
FBC
U&E's
Creatinine 
Albumin 
Calcium 
Phosphate
60
Q

Rx for kidney stones

A

Analgesics: NSAIDS
ESWL
PCNL
Ureteroscopy

61
Q

When is ESWL not effective for renal stones?

A

> 2cm
Cystine stones
In pregnancy

62
Q

Indications for PCNL

A

Large stones

PUJ stenosis

63
Q

What is AKI

A

Sudden episode of kidney failure or kidney damage that occurs within hrs/days
Increase in Serum Creatinine by ≥26.5 umol/l
Or
≥1.5x baseline
Urine output <0.5ml/kg/hr for 6 hrs

64
Q

Who is AKI common in

A

Hospitalised patients

65
Q

Risk factors for AKI

A 
Age>75
Previous AKI 
HF
Liver disease 
CKD 
DM 
Vascular disease
Common hospitalised patients
66
Q

Pre-renal causes AKI

A 
Hypovolaemia 
Arterial occlusion 
ACE inhibitors 
Haemmorhage 
Hypotension (shock)
67
Q

Renal causes AKI

A 
Toxin related (NSAIDS, aminoglycosides)
Acute interstitial nephritis 
Acute tubular necrosis 
Acute GN
Vasculitis
68
Q

Which drugs are notoriously renal toxic?

A

Gentamicin
NSAIDs
Aminoglycosides

69
Q

Post renal causes AKi

A 
Obstruction 
Stones 
Malignancy 
Stricture 
Fibrosis
70
Q

Investigations AKI

A 
Serum creatinine 
Urine output 
Potassium 
ECG 
USS 
Renal biopsy 
Proteinuria?
Haematuria?
71
Q

ECG signs hyperkalaemia

A

Tall tented T waves

Increased PR interval

72
Q

Rx fluid balance AKI

A

Volume resuscitation
Optimised BP
Stop ACE inhibitors

73
Q

Rx toxicity AKI

A

Stop nephrotoxic drug

74
Q

RX for hyperkalaemis

A

Calcium gluconate
IV insulin + glc
Salbutamol

75
Q

Consequences AKI

A 
Acidosis 
Electrolyte imbalance 
Intoxication 
Fluid overload 
Uraemia symptoms: gout
76
Q

Definition of CKD

A

Defined by either the presence of kidney damage
Or
eGFR <60ml/min that is present 3 months

77
Q

Causes of CKD

A 
Hypertension 
DM
GN
Renovascular disease
Polycystic kidney disease
Chronic exposure to toxins
78
Q

Define stage 1 CKD

A

GFR>90

79
Q

Define stage 2 CKD

A

GFR 60-89

80
Q

Define stage 3 CKD

A

GFR 30-59

81
Q

Define stage 4 CKD

A

15-29

82
Q

Define stage 5 CKD

A

<15

83
Q

Blood investigations CKD

A 
U&amp;E’s
K+
Urea 
Creatinine 
Bicarb
Albumin 
Calcium 
LFT’s
84
Q

Urine investigations CKD

A

Blood
Protein
PCR
24hr collection

85
Q

Histology investigations CKD

A

Biopsy

Clotting factors

86
Q

Radiology investigations CKD

A

USS
Plain radiograph
CT
MRI

87
Q

Rx hypertension CKD

A

Look diuretics

88
Q

RX CKD

A 
Manage the underlying cause 
Establish good DM control 
Treat hypertension 
Erythropoietin 
Sodium bicarbonate 
Restrict fluid and salt intake 
Loop diuretics 
Activated vitamin D analogues 
RRT 
Kidney Tx
89
Q

When is RRT required for CKD

A

Stage 5

<15 GFR

90
Q

Long term complications of CKD

A 
Acidosis 
Renal bone disease
Death and dialysis 
Uraemic complications
Hypertension
91
Q

Examples of uraemic complications in AKI and CKD

A

Pericarditis
Encephalopathy
Gout

92
Q

How does CKD lead to anaemia

A

Kidneys are responsible for erythropoietin production
Which stimulate production of RBC from bone marrow
So in CKD:
Reduced erythropoietin production
Lower production of RBC
Anaemia

93
Q

Treatment for anaemia in CKD

A

Rx give erythropoietin

94
Q

Describe bone disease in CKD

A

Loss or renal tissue leads to lack of activated Vit D3
Indirect reduction in calcium absorption from gut
Leads to hypocalcaemia
PTH is released causing the bones to lose calcium
Over time this resorption of calcium from the bones leads to brittle bones

95
Q

Describe serum calcium and phosphate levels in CKD

A

High serum phosphate

Low serum calcium

96
Q

Describe acidosis in CKD

A

Worsen hyperkalaemia

97
Q

Describe hyperkalaemia in CKD

A

K+ normally secreted with exchange for Na+ absorption in distal tubule
Reduced deliver of Na+ to distal tubule as GFR falls
Therefore, retain potassium
Leading to hyperkalaemia

98
Q

What can K+ >7mmol/L cause

A

Fatal cardiac arrhythmia

99
Q

Which zone does BPH typically affect?

A

Transitional zone

100
Q

What is BPH common with?

A

Increasing age

101
Q

Which score is used for prostate symptoms?

A

International prostate symptoms score

102
Q

What are the voiding symptoms of BPH

A

Hesitancy
Poor stream
Terminal dribbling
Incomplete emptying

103
Q

What are storage symptoms of BPH

A

Frequency
Nocturia
Urgency
Urge incontinence

104
Q

Investigations for BPH

A 
PSA 
MSSU 
Flow rate study 
Urea 
Creatinine 
Flexible cystoscopy 
Renal USS 
Prostate biopsy
105
Q

Medical therapy for BPH

A

Alpha blocker

5 alpha reductase inhibitors

106
Q

Surgical treatment for BPH

A

Transurethral resection of prostate

TURP

107
Q

Potential side effect of TURP

A

Impotence

108
Q

Complications of BPO

A 
Progression of LUTS
Acute or chronic urinary retention 
Urinary incontinence 
UTI 
Bladder stone 
Renal failure due to hydronephrosis
109
Q

Characteristics of nephritis syndrome

A

Haematuria
Hypertension
Little proteinuria
Low urine vol.

110
Q

Pathology of IgA nephropathy

A

IgA deposits in the mesangium
Causing increased proliferation in mesangial cells
Irritates mesangial cells and causes them to proliferate and produce more matrix
IgA becomes stuck in mesangium and becomes clogged with antibody

111
Q

Symptoms of IgA nephropathy

A

Haematuria
Proteinuria <1g
Hypertension

112
Q

Investigations for IgA nephropathy

A

Renal biopsy

113
Q

Rx IgA nephropathy

A

ACEi/ARB

Corticosteroids

114
Q

What does post infective nephritis commonly follow?

A

Pharyngitis
Impetigo
Streptococcal infection

115
Q

How long after infection does post infective nephritis occur?

A

10-21 days

116
Q

Rx for post-infective nephritis

A

Antibiotics for infection

117
Q

Pathology of post infective nephritis

A

Streptococcal antigen deposits in the glomerulus leading to immune complex formation and inflammation

118
Q

Triad of nephrotic syndrome

A

Heavy proteinuria
Oedema
Hypoalbuminaemia

119
Q

Treatment for oedema

A

Furosemide

120
Q

3 main nephrotic syndromes

A

Minimal change disease
Membranous Nephropathy
Focal Segmental Glomerulonephritis

121
Q

3 main Nephritic Syndormes

A

IgA Nephropathy
Post infective Nephritis
Cresentic Glomerulonephritis

122
Q

Who is minimal change disease most commonly seen in?

A

Children

123
Q

Symptoms minimal change disease

A

Sudden onset oedema
Proteinuria
Hyperlipidaemia

124
Q

Treatment for minimal change disease

A

Corticosteroids:

Prednisolone

125
Q

Does minimal change disease cause renal failure?

A

No

126
Q

Investigations for minimal change disease

A

Urinanalysis
24hr protein urine
Serum albumin levels
Urine protein/creatinine reation

127
Q

Pathology membranous glomerulonephritis

A

Thickened glomerular basement membrane
Diffusely thickened due to sub epithelial deposits of IgG
Activates compliment C3 which punches holes in the membrane
Glomerular membrane thickened by leaky
Allowing albumin to be filtered (oedema)

128
Q

Signs of membranous glomerulonephritis

A

Oedema
Hypoalbuminaemia
Heavy proteinuria

129
Q

Which antibody is seen in membranous glomerulonephritis

A

PLA2R

130
Q

Which three areas does glomerulonephritis with polyangitis commonly affect

A

Kidney
Lungs
Nose

131
Q

What can membranous glomerulonephritis be secondary to?

A

Malignancy
Infection
Rheumatoid Arthritis
Drugs

132
Q

Pathology of focal and segmental glomerulosclerosis

A

Scar tissue formation in segments of some glomeruli

Segmental sclerosis and hyalinosis

133
Q

Symptoms/signs of focal and segmental glomerulosclerosis

A

Proteinuria
Hypoalbuminaemia
Hyperlipidaemia
Oedema

134
Q

Does focal and segmental glomerulosclerosis pose a risk of CKD?

A

yes

135
Q

Rx for focal and segmental glomerulosclerosis

A

ACEi/ARB
Furosemide
Rutiximab

Urology (13 decks)

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