Formative Questions Flashcards
What are the functions of the kidney and what are the implications of kidney damage on them?
- Controlling acid-base balance
- Controlling water balance
- Maintaining electrolyte balance
- Removing toxins and waste products from the body
- Controlling blood pressure
- Producing hormone - erythropoetin
- Activating vitamin D
Implications of kidney damage, HTN, bone problems, anaemia, toxic build up in body, electrolyte imbalances, dehydration or water retention, acidosis or alkalosis.
Define glomerulonephritis. What is the difference in presentation between nephrotic syndrome and nephritic syndrome?
Glomerulonephritis is any of a group of diseases that injure the part of the kidney that filters blood (glomeruli)
Nephrotic syndrome: finding oedema in a person with proteinuria due to podocyte pathology and increased fat in the blood.
Nephritic syndrome: haematuria (especially red cell casts with dysmorphic RBCs) due to inflammatory change and a decrease in the amount of urine in the presence of HTN
Name the medical emergency most associated with acute kidney injury – what ECG changes can this commonly cause?
Hyperkalaemia
Broadened QRS complexes, tall tented T waves, increased PR interval, small or absent P wave.
What are the 4 most common types of urinary tract stones? Name 5 common symptoms of renal tract stones.
- Calcium oxalate stones (75%)
- Struvite stones (10%)
- Uric acid stones (10%)
- Cystine stones (1%)
5 common symptoms
- Asymptomatic
- Haematuria (v and nv)
- Loin to groin pain
- Renal colic
- UTI symptoms - dysuria, strangury, urgency, frequency
- Recurrent UTIs
What are the criteria for a 2 week wait referral for suspected bladder cancer?
Aged over 45 and
- unexplained visible haematuria without urinary tract infection or
- visible haematuria that persists or recurs after successful treatment or UTI
- aged 60 and over and unexplained nonvisible haematuria and either dysuria or raised WCC on blood test
List five symptoms common with lower urinary tract obstruction in men.
- Hesitancy
- Dribbling
- Poor stream
- Haematuria
- Straining
- Frequency
- Nocturia
- Urgency
- Incontinence
What are the two groups of drugs commonly used in symptomatic benign prostatic hypertrophy?
- alpha blockers (tamsulosin)
2. 5a reductase inhibitors (finasteride)
What issues are there which prevent the Prostate Specific Antigen (PSA) test being used routinely for screening?
- It is not cancer specific – it can be raised in benign prostatic hypertrophy, UTI, prostatitis
- 6% of men with a normal PSA will have prostate cancer whilst 70% of men with a raised PSA will not have prostate cancer
What is the commonest presentation of testicular cancer? What differentiates it as a true scrotal mass?
Painless, palpable lump within the testis is the most common presentation - may be hard and craggy and does not transiluminate
A true scrotal lump you can palpate above it (rather than one arising from the inguinal canal where you cannot)
Name five medical conditions associated with erectile dysfunction? What is the first line medical treatment for erectile dysfunction in those with a normal testosterone?
- Liver disease and alcohol
- Trauma - pelvic fracture
- DM
- Heart disease - MI or HTN
- Renal failure
- Iatrogenic - prostatectomy 75%
Oral phosphodiesterase-5 inhibitors (sildenafil or tadalafil)
Which sexually transmitted infection is the most commonly diagnosed? How is it tested for and treated?
- Chlamydia (46%)
- Women can be tested on a self-taken vaginal swab or first void urine sample
- Men are tested on a first void urine sample
Management has several factors
- Partner management
- Test for other STIs
- Doxycycline 100mg bd for 7 days
- Erythromycin 500mg bd for 14 days or Azithromycin in pregnancy
How is Urinary tract infection defined? What constitutes an uncomplicated urinary tract infection? What are the implications of UTI in possible bladder cancer?
Inflammation of the urinary tract following bacterial invasion.
Uncomplicated UTI: otherwise normal urinary tract in female.
Complicated UTI: occurring in an abnormal or male urinary tract.
NICE now recommends that those aged 60 and over with recurrent or persistent unexplained urinary tract infection are referred non-urgently due to possibility of bladder cancer
What is the classic triad of symptoms in pyelonephritis? How does its antibiotic treatment differ from a lower urinary tract infection?
Pyelonephritis: fever, loin pain, nausea and vomiting
In lower tract infection broad spectrum antibiotics should be avoided whereas in upper urinary tract infections they are used first line.
Treatment for pyelonephritis: oral ciprofloxacin for 7 days.
Treatment for UTI: 3 days of nitrofurantoin.
