Genito Urinary Flashcards
1
Q
What is nephrolithiasis
A
Kidney stones
2
Q
What is the most common type of kidney stone
A
Calcium-based (80%) calcium
3
Q
What are the risk factors for nephrolithiasis
A
Chronic dehydration, kidney primary diseases, hyperPTH, UTIs, History of previous stone
4
Q
What are the signs/ symptoms are nephrolithiasis
A
Unilateral loin to groin pain that is colicky
Patient cant lie still
Haematuria+ dysuria
5
Q
What is the first line investigation for suspected renal stones
A
KUB XR
6
Q
What is the GS investigation for Kidney stones
A
Non contrast CT KUB
7
Q
Why is a non-contrast CT used when a patient has suspected kidney disease
A
The contrast must be excreted by the kidneys
8
Q
Are calcium oxalate or calcium phosphate stones more common
A
Calcium phosphate
9
Q
What is a staghorn calculus
A
When a stone forms in the shape of the renal pelvis. Body sits in renal pelvis with horns extending into the renal calyces.
10
Q
What type of stone usually forms a staghorn calculus
A
Struvite
11
Q
What are the 3 most common sites for a renal stone obstruction
A
Pelvo ureteric junction (where renal pelvis becomes the ureter)
Pelvic brim (where iliac vessels travel across the ureter)
Vesicoetric junction (where the ureter enters the bladder)
12
Q
What is the treatment for renal stones (non surgical)
A
NSIADs most effective for analgesia
Antiemetics for N+V
Antibiotics if infection (gentamycin for pyelonephritis)
Stones usually pass if less 5mm
13
Q
What is the surgical management for renal stones
A
Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Ureteroscopy and laser lithotripsy
14
Q
What is Extracorporeal shock wave lithotripsy (ESWL)
A
A machine that generates shock waves using XR guidance to break stones into smaller pieces
15
Q
What is percutaneous nephrolithotomy (PCNL)
A
A nephroscope is inserted via a small incision in the back. The scope is inserted kidney to asses ureters. Stone can be broken and removed
16
Q
What is ureteroscopy and laser lithotripsy
A
A camera is inserted via the urethra, bladder and ureter. Stone is identified and broken up using targeted lasers.
17
Q
When would you use ESWL vs PCNL
A
ESWL when stones are 5-10mm
PCNL when stones are 20mm+
18
Q
What are the characteristics of an AKI
A
Increased serum creatinine + urea
Decreased urine output
19
Q
How much do the creatinine levels need to rise to be an AKI
A
Increase of 26 micro mol/l in 48hours or 1.5X bassline over 7 days
20
Q
How much urine does someone need to urinate to be classed as an AKI
A
<0.5ml/kg/hr for 6< hours
21
Q
What are causes for pre-renal AKI
A
Reduced cardiac output (c.h.f, cardio shock)
Liver failure (hepatorenal syndrome)
Renal artery blockage
Drugs (NSAIDS + ACEi)
22
Q
What are the causes of an intrarenal AKI
A
Acute tubular necrosis (ATN) MC
Acute interstitial Nephritis (AIN)
Glomerular Nephritis
Thrombotic microangiopathy (thrombosis due to endothelial injury)
23
Q
What can cause acute tubular necrosis
A
Drugs (Antibiotics, Vancomycin) Contrast dye
Low blood flow for a long period of time
High levels of haemoglobin (lots of haemolysis)
Rhabdomyolysis (Lots of myoglobin)
Uric acid from the death of cancer cells
Multiple myeloma (Bence Jones Proteins)
24
Q
What can cause Acute Interstitial Nephritis
A
Drugs (Beta-lactam Atb, PPI)
Sarcoidosis, amyloidosis
Systemic Lupus Erythematosus
Sjordens Syndrome
Infections
25
What are the causes of a post-renal AKI
Stones
BPH
Drugs (anticholinergics, CCBs)
Occuled catheter
26
What are risk factors for an AKI
Age, comorbidities, hypovolemia, nephrotoxic drugs, decreased blood filtration and urine output
Diabetes
Liver disease
27
What is the pathology of an AKI (what substances build up)
Usually excreted substances build-up
K+ (arrhythmias)
Urea (pruritis, confusion if severe)
Fluid (oedema)
H+ (Acidosis)
28
What are the top 3 causes of an AKI
Sepsis
Cardiogenic shock
Major surgery
29
What can hyperuricemia lead to
Encephalopathy
Pericarditis
Skin manifestations
30
What is the staging classification used for AKI
KDIGO
31
What tests would you order in suspected AKI
U+E, FBC, CRP
32
How would you investigate suspected intrarenal AKI
Renal biopsy
33
What is the 1st line treatment for an AKI
Treat complications
K+ calcium gluconate
Acidosis- sodium bicarbonate
Fluid overload:- diretics
34
What is the last resort treatment for an AKI
Renal replacement therapy
Haemo dialysis indicated in acidosis, fluid overload, uremia and hyperkalemia
35
What are the urea: creatinine ratios in pre, intra and postrenal aki
Pre:- >100:1
Intra:- <40:1
Post:- 40-100:1
36
What classifies a CKD
eGFR <6Oml/min/1.73m^2 for 3+ months
37
What are the 5 CKD stages
GFR
1:- 90+ w/ renal signs
2:- 60-89 w/ renal signs (if no signs no CKD)
3A:- 45-59
3B:- 30-44
4:- 15-29
5:- <15
38
What stage CKD does metformin become contraindicated
Stage 4 (GFR<30)
39
What are the risk factors for CKD
DM + HTN (MC)
Glomerulonephritis
PKD
Nephrotoxic drug
40
Explain the pathology of CKD
Many of the nephrons are damaged increasing the burden on the remaining nephrons. Compensatory RAAS activation increases GFR but the increase in trans glomerular pressure leads to loss of BM selective permeability. Leads to proteinuria/ haematuria.
Angiotensin 2 upregulates TGF-beta and plasminogen activator-inhibitor 1 causing mesangial scarring.
41
What are the complications of CKD
Anemia:- decreases EPO
Osteodystrophy:- Decreased vitamin D activation
Neuropathy + encephalopathy
CVD (highest mortality complication)
42
What investigation do you do for CKD
FBC, U+E, urine dip, Ultrasound
43
Differences between AKI and CKD
AKI:- based on serum creatinine + urine out put. CKD:- decreased eGFR
AKI:- shorter symptom onset CKD:- 3 month+
AKI:- no anemia CKD:- anemia
Ultrasound:- AKI normal, CKD:- bilateral small kidneys
44
What albumin creatinine ratio indicates significant proteinuria
Albumin: creatinine > 3
45
What is treatment for CKD
Treat complications
Anaemia:- Fe then EPO
Osteodystrophy:- Vit D supplements
CVD:- ACEi + statins
Oedema:- diuretics
46
What is treatment for stage 5 CKD
Renal Replacement therapy (dialysis)
47
What is the treatment for end-stage renal failure
Renal transplant
48
What are the risk factors for benign prostate hyperplasia
Age, ethnicity (Afro-Caribbean, increased testosterone)
Castration is protective of benign prostate hyperplasia
49
What zone of the prostate proliferates in BPH
Inner transitional zone (muscular, gland)
50
What are the signs/ symptoms of BPH
LUTS:- mostly voiding symptoms
Storage:- frequency, urgency, nocturia, incontinence
Voiding:- poor stream, dribbling, incomplete emptying, straining, dysuria
51
What do you diagnose benign prostate hyperplasia
Digital rectal exam:- BPH is smooth and enlarged (cancer is hard and irregular)
Also, rule out other causes such as stones/ UTI
52
Does PSA raise in BPH
Yes but more so in cancer
53
What is the 1st line pharmological treat for BPH
Alpha-blocker (tamsulosin):- relaxes bladder neck
54
What is the second line pharmacological treatment for BPH
5-alpha-reductase inhibitors (finasteride)
decreases testosterone production
55
What dietary changes should someone with BPH make
Less caffine
56
What is the last resort treatment for BPH
Transurethral resection of the prostate (TURP)
57
What is the most common complication of transurethral resection of the prostate
Retrograde ejaculation
58
What is the most common renal cancer
Renal cell carcinoma
59
What are the 3 most common renal cell carcinomas including most common
Clear cell 80%
Papillary 15%
Chromophobe 5%
60
What are the risk factors for Renal cell carcinoma
Smoking, obesity, hypertension, end-stage renal failure, hereditary
Von Hippel-Lindau Disease
61
What is Von Hippel-Lindau disease
Autosomal dominant loss of tumour suppressor gene
62
What % of renal cell carcinoma cases have already metastasised at presentation
25%
63
What are the signs/ symptoms of renal cell carcinoma
Triad:- Flank pain, haematuria, abdominal mass
may also have left sided varicocele
64
What is the 1st line investigation for renal cell carcinoma
Ultrasound scan
65
What is the GS investigation for renal cell carcinoma
CT chest/ abdo/ pelvis
66
What is the staging system used for renal cell carcinoma
Robson staging 1-4
67
What is the treatment for renal cell carcinoma (also what if metastasised)
Nephrectomy
If metastisized give IFN-alpha
68
What is the most common place for renal cell carcinoma to metastasise to
Lung (cannonball metastases)
69
What are the complications of renal cell carcinoma
Polycythemia (unregulated production of EPO)
Hypercalcemia (secretion of a hormone that mimics the action of PTH)
Hypertension (increased renin production)
Stauffers syndrome
70
What is Stauffer's syndrome
Abnormal liver function tests seen in renal cell carcinoma, without liver metastases)
71
What are the 4 stages of renal cell carcinoma
Stage 1:- less than 7cm (confined to kidney)
Stage 2:- more than 7cm (confined to kidney)
Stage 3:- Local spread to nearby tissues or veins but no beyond Gerota's fascia
Stage 4:- Spread beyond Gerota's fascia, including metastasis
72
What is Gerota's fascia
The renal fascia that encapsulates the kidney and adrenal glands
73
If a patient is not suitable for surgery what can the management options be for renal cell carcinoma
Arterial embolisation:- cutting off the blood supply to the affected kidney
Percutaneous cryotherapy:- injecting liquid nitrogen to freeze and kill the tumour cells
Radiofrequency ablation:- putting a needle in the tumour and using an electrical current to kill the tumour cells
74
What is a Wilms tumour
Renal mesenchymal stem cell tumour seen in children under 5.
75
What is the most common bladder cancer
Transitional cell carcinoma 95%
76
What is the other type of bladder cancer other than TCC
Squamous cell carcinoma 5%
Adenocarcinoma 2%
77
What disease do patients have that makes them more likely to have squamous cell bladder cancer of transitional cel
Schistosomiasis
78
What are the risk factors for bladder cancer
Occupational exposure to dye/ paints/ rubber (aromatic amines)
Smoking
Chemo/ radiotherapy
Age
Male
79
What is the classical presentation of bladder cancer
Painless haematuria
80
What is the gold standard investigation for bladder cancer
Flexible cystoscopy+ biopsy
81
What is the treatment for bladder cancer
Medical:- Chemo/ radiotherapy
Surgery:- transurethral resection of bladder tumour
82
What zone of the prostate does prostate cancer affect
Outer zone of peripheral prostate
83
What are the risk factors for Prostate Cancer
Genetic factors
Age
Afro-Caribbean ethnicity
Family history
84
What genes make a person susceptible to prostate cancer
BRCA2, HOXB13
85
What are the symptoms of Prostate cancer
LUTS- like BPH but with systemic cancer symptoms:- weight loss, fatigue, night pain
Bone pain (lumbar)
86
Where does prostate cancer typically metastasise to
Bone (thick sclerotic lesion)
Liver, lung Brain
87
What is the gold standard investigation for prostate cancer
Transrectal ultrasound + biopsy
88
What is the grading system for prostate cancer
Gleason score (based on biopsy)
89
How is the Gleason score calculated
1st and 2nd most prevalent pattern in biopsy
8 is high risk
90
What is the treatment for prostate cancer
Local:- Prostatectomy
Metastatic:- hormone therapy, radio/ chemo
91
How does hormone therapy treat metastasis of prostate cancer
Decrease testosterone
GnRH agonist (supresses HPG axis) (ED)
Bilateral orchiectomy (remove testes)
92
What are the 2 types of testicular cancer
Germ cell 90% or non-germ cell 10%
93
What are the germ cells affected in germ cell testicular cancer
Seminoma+ teratoma
94
What are the non-germ cells affected in testicular cancer
Sertoli, leydig, sarcoma
95
What are risk factors for testicular cancer
Cryptorchidism, infertility, family history
96
What are the signs/ symptoms of testicular cancer
Painless lump in a testicle which does not transilluminate
97
What is the most common hormone-sensitive cancer
Prostate
98
What investigations do you perform in suspected testicular cancer
Scrotal ultrasound
Tumour markers AFP, beta-hCG, LDH
99
What does a raised alpha-fetoprotein suggest
Teratoma testicular cancer
100
What is the treatment for testicular cancer
Urgent orchidectomy (offer sperm storage)
101
What organisms can cause UTIs
KEEPS
Klebsiella 10%
Enterobacter
E. coli 80%
Proteus mirabilis 5%
S. saphrophyticus 5-10%
102
What is the first line investigation in a suspected UTI and what do you see
Urine dipstick
+ve leukocytes
+ nitrates (bacteria break down nitrates to nitrites)
+/- haematuria
103
What is the GS investigation for UTI
Midstream urine sample
104
What is the treatment for UTI
3 days simple women
5-10 days women who are immunosuppressed or have abnormal kidney function
7 days for men, pregnant or catheter-related
Nitrofurantoin/ trimethoprim
105
What antibiotics do you avoid and when in pregnancy for treatment fo UTI
Nitrofurantoin:- avoided in the third trimester as linked with haemolytic anaemia in newborn
Trimethoprim is avoided in the first trimester as affects folic acid
106
What is pyelonephritis
Infection of the renal parenchyma and upper ureter
107
What are risk factors for pyelonephritis
Urine stasis (stones), renal structural abnormalities, catheters
108
What are the signs/ symptoms of pyelonephritis
Triad:- loin pain, fever, pyuria
109
What is the first line investigation for pyelonephritis
Urine Dipstick
110
What is the gold standard investigation for pyelonephritis
Urine microscopy, culture and susceptibility
(MC+ S)
111
What is the treatment for pyelonephritis
Analgesia; paracetamol
Ciprofloxacin or co-amoxiclav
112
What antibiotic do you give to someone with pyelonephritis who is also pregnant
Cefalexin
113
What is cystitis
Infection of bladder
114
RF for cystitis
Urine stasis, bladder lining damage, catheters
115
Sx of cystitis
Suprapubic tenderness + discomfort, increased frequency+ urgency, visible haematuria
116
1st line investigation for cystiris
Urine Dip
117
GS investigation for cystitis
Urine microscopy, culture and susceptibility test
118
Treatment for cystitis
Trimethoprim or nitrofurantoin
119
Treatment for cystistis if pregnent
Amoxicillin
120
What is urethritis
Urethral inflammation +/- infection
121
Most common cause of urethritis
Sexually acquired
122
2 types of urethritis
Infective, non infective (trauma)
123
2 types of infective urethritis with MC
and causative organisms
Gonococcal (Niesseria gonorrhoea)
Non-gonococcal (Chlamydia trachomatis) MC
124
Sx of urethritis
Dysuria +/- urethral discharge (blood/ pus)
Urethral pain
125
What type of bacteria is Neisseria gonorrhoea
Gram -ve diplococcus
126
What test to detect STI vs UTI
STI; Nucleac acid amplification test)
UTI; Urine microscopy, culture and susceptibility test
127
Treatment for Neisseria gonorrhoea Urethritis
IM ceftriaxone + azithromycin
128
Treatment for chlamydia trachomatis urethritis
Azithromycin or doxycycline
129
Most common cause of Epididymo-orchitis in males over 35 vs under
<35 urethritis (STI)
>35 Cystiis (KEEPS extension)
130
Sx of Epidiymo-orchitis
Unilateral scrotal pain + swelling
Pain released with elevating testes (+ve Prehn's sign)
131
What investiagtions in epididymo-orchtitis
NAAT, urine dip, mc+s
132
Sx of nephrotic syndrome
Proteinuria
Hypoalbumineruia
Hyperlipidemia
Hypogammaglobulinaemia
Hypercoagulable blood
Weight gain
133
Sx of nephritic syndrome
Haematuria
Oliguria
Hypertension
Oedema
134
What is most common cause of primary nephrotic syndrome in children vs adults
Children:- Minimal change disease
Adult:- Focal segmental glomerulosclerosis
135
Most common cause of secondary nephrotic syndrome
Diabetes (nephropathy)
136
What is seen in light microscopy + e- microscopy in minimal change disease
Light; no change
E-; Podocyte effacement + fusion
137
What is seen on light microscopy in focal segmental glomerulosclerosis
Segmental sclerosis (but less than 50% affected)
138
What do you see on light microscopy and electron microscopy in membranous nephropathy
Light; Thickend GBM
Electron; Subpodocyte immune complex deposition (spike + dome appearance)
139
Treatment for nephrotic syndrome
Glucocorticoids
Minimal change responds well others less so
140
What is the most common cause of nephritic syndrome
IgA nephropathy (Berger's disease)
141
Causes of nephritic syndrome
IgA nephropathy T2
Post strep glomerulonephritisT2
SLE T2
Goodpastures syndrome T3
142
Presentation of IgA nephropathy
Visible haematuria 1-2 days after tonsilitis or viral infection
143
Investigation in IgA nephropathy and what does it show
Immunofluorescence microscopy shows
IgA complex deposition
144
Treatment for IgA nephropathy
Non-curable
Blood pressure control with ACEi
145
Presentation for Post strep glomerulonephritis
Visible haematuria 2 weeks after pharyngitis from group A beta haemolytic strep (Strep pyogenes)
146
Investigations for post-strep glomerulonephritis
Light microscopy; Hypercellular glomeruli
Electron Microscopy; subendothelial immune complex deposition
Immunofluorescence shows starry sky appearance
147
How can SLE cause nephritic syndrome
Lupus nephritis due to ANA deposition in endothelium
148
Treatment for Lupus nephritis
Steroids, hydroxychloroquine, immunosuppressants
149
What antibodies in Goddpastures cause a nephritic syndrome
Anti-GBM
150
Treatment for goodpastures syndrome
Steroids + plasma exchange
151
How does haemolytic uremic syndrome cause nephritic syndrome
5 days post-infection antibodies against Shiga toxin (e. coli, shigella)
152
What can haemolytic uremic syndrome cause
Haemolytic anaemia, AKI (glomerulonephritis), thrombocytopenia
153
What is rapidly progressing glomerulonephritis
A subtype of glomerular nephritis that progresses to end-stage renal failure very fast
154
What is present in Rapidly progressing glomerulonephritis
Inflammatory crescents in Bowman's space
155
What can cause Rapidly progressing glomerulonephritis
Wegner's granulomatosis, Goodpasture's
156
What protein is affected in the mutation causing autosomal dominant polycystic kidney diseases
PKD1 polycystin-1 85%
PKD2 polycyctin-2 15%
157
What is the pathology of ADPKD
PKD1+2 code for polycystin in the Ca++ channel on the cilia of the nephron. When filtrate passes cilia move and polycystin open. Ca+ influx prevents excessive growth.
PKD mutation leads to a decreased calcium influx so cilia grow excessively
158
Presentation of ADPKD
Bilateral flank/ back or abdo pain +/- Htn and haematuria
159
Complication of ADPKD
Extrarenal cysts particularly in the circle of Willis leading to berry aneurysm (SA haemorrhage)
160
Diagnsotic test for ADPKD
Kidney ultrasound showing enlarged bilateral kidney with multiple cysts
161
What is an epididymal cyst
extra testicular cyst above + behind testes that will transilluminate
162
What is a hydrocele
Fluid collection in tunica vaginalis
Cyst that testicle sits in that will transilluminate
163
How to diagnose epididymal cyst + hydrocele
Scrotal Ultrasound
164
What is a varicocele
Distended pampiniform plexus due to increased left renal vein pressure causing reflux
165
Presentation of varicocele
Bag of wors on LHS mostly typically painless
166
Complication of varicocele
Infertility
167
What is testicular torsion
Spermatic cord twists on itself occluding the testicular artery causing ischemia. Can lead to gangrene of testis if not dealt with
168
RF for testicular torsion
Bell clapper deformity; horizontal lie of the testes
169
What are Symptoms of testicular torsion
Severe uni-testicular pain (hurts to walk), abdo pain, N+V, no pain relief with elevating testes
170
What reflex is lost in testicular torsion
Cremaster reflex
Sroek inner thigh, and ipsilateral testicle should elevate
171
Treatment for testicular torsion
Urgent surgery within 6h is always 1st line
172
What is orchidopexy or orchidectoimy
Orchidopexy is fixation
Orchidectomy is the removal of the testis
173
Incontinence more common in male or female
Female
174
Types of incontenance
Stress (sphincter weakness)
Urge (detrusor muscle overactivity)
Spatic paralysis (neurological UMN lesion); overactive reflexes + hypertonia of detrusor
175
Treatment for incontinence
Surgery or anticholinergic drugs
176
Is retention more common in males or females
Males
177
Causes of retention
Stones, BPH, Neurological flaccid paralysis
LMN lesion (hypotonia of detrusor)
178
LUTS storage symptoms
FUNI
Frequency
Urgency
Nocturia
Incontinence
179
LUTS voiding symptoms
SHID
poor Stream
Hesitancy
Incomplete emptying
Dribbling
180
What is 1st line treatment for CKD
ACEi
181
What medications are given to patients with ANCA positive diseases
Cortico steroids + Ritixumab
182
Sx of CKD
Itching
Loss of appetite
Nausea
Oedema
Muscle cramps
Pallor
Hypertension
183
What is the A score
Used in CKD. Albumin creatinine ratio
A1= <3mg/mmol
A2=3-30mg/mmol
A3=>30mg/mmol
