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Phase 2a Ru > Genito Urinary > Flashcards

Genito Urinary Flashcards

1
Q

What is nephrolithiasis

A

Kidney stones

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2
Q

What is the most common type of kidney stone

A

Calcium-based (80%) calcium

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3
Q

What are the risk factors for nephrolithiasis

A

Chronic dehydration, kidney primary diseases, hyperPTH, UTIs, History of previous stone

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4
Q

What are the signs/ symptoms are nephrolithiasis

A

Unilateral loin to groin pain that is colicky
Patient cant lie still
Haematuria+ dysuria

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5
Q

What is the first line investigation for suspected renal stones

A

KUB XR

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6
Q

What is the GS investigation for Kidney stones

A

Non contrast CT KUB

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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

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8
Q

Are calcium oxalate or calcium phosphate stones more common

A

Calcium phosphate

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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.

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10
Q

What type of stone usually forms a staghorn calculus

A

Struvite

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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)

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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

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13
Q

What is the surgical management for renal stones

A

Extracorporeal shock wave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Ureteroscopy and laser lithotripsy

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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

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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

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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.

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17
Q

When would you use ESWL vs PCNL

A

ESWL when stones are 5-10mm
PCNL when stones are 20mm+

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18
Q

What are the characteristics of an AKI

A

Increased serum creatinine + urea
Decreased urine output

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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

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20
Q

How much urine does someone need to urinate to be classed as an AKI

A

<0.5ml/kg/hr for 6< hours

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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)

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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)

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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)

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24
Q

What can cause Acute Interstitial Nephritis

A

Drugs (Beta-lactam Atb, PPI)
Sarcoidosis, amyloidosis
Systemic Lupus Erythematosus
Sjordens Syndrome
Infections

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25
Q

What are the causes of a post-renal AKI

A

Stones
BPH
Drugs (anticholinergics, CCBs)
Occuled catheter

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26
Q

What are risk factors for an AKI

A

Age, comorbidities, hypovolemia, nephrotoxic drugs, decreased blood filtration and urine output
Diabetes
Liver disease

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27
Q

What is the pathology of an AKI (what substances build up)

A

Usually excreted substances build-up
K+ (arrhythmias)
Urea (pruritis, confusion if severe)
Fluid (oedema)
H+ (Acidosis)

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28
Q

What are the top 3 causes of an AKI

A

Sepsis
Cardiogenic shock
Major surgery

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29
Q

What can hyperuricemia lead to

A

Encephalopathy
Pericarditis
Skin manifestations

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30
Q

What is the staging classification used for AKI

A

KDIGO

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31
Q

What tests would you order in suspected AKI

A

U+E, FBC, CRP

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32
Q

How would you investigate suspected intrarenal AKI

A

Renal biopsy

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33
Q

What is the 1st line treatment for an AKI

A

Treat complications
K+ calcium gluconate
Acidosis- sodium bicarbonate
Fluid overload:- diretics

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34
Q

What is the last resort treatment for an AKI

A

Renal replacement therapy
Haemo dialysis indicated in acidosis, fluid overload, uremia and hyperkalemia

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35
Q

What are the urea: creatinine ratios in pre, intra and postrenal aki

A

Pre:- >100:1
Intra:- <40:1
Post:- 40-100:1

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36
Q

What classifies a CKD

A

eGFR <6Oml/min/1.73m^2 for 3+ months

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37
Q

What are the 5 CKD stages

A

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

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38
Q

What stage CKD does metformin become contraindicated

A

Stage 4 (GFR<30)

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39
Q

What are the risk factors for CKD

A

DM + HTN (MC)
Glomerulonephritis
PKD
Nephrotoxic drug

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40
Q

Explain the pathology of CKD

A

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.

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41
Q

What are the complications of CKD

A

Anemia:- decreases EPO
Osteodystrophy:- Decreased vitamin D activation
Neuropathy + encephalopathy
CVD (highest mortality complication)

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42
Q

What investigation do you do for CKD

A

FBC, U+E, urine dip, Ultrasound

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43
Q

Differences between AKI and CKD

A

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

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44
Q

What albumin creatinine ratio indicates significant proteinuria

A

Albumin: creatinine > 3

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45
Q

What is treatment for CKD

A

Treat complications
Anaemia:- Fe then EPO
Osteodystrophy:- Vit D supplements
CVD:- ACEi + statins
Oedema:- diuretics

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46
Q

What is treatment for stage 5 CKD

A

Renal Replacement therapy (dialysis)

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47
Q

What is the treatment for end-stage renal failure

A

Renal transplant

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48
Q

What are the risk factors for benign prostate hyperplasia

A

Age, ethnicity (Afro-Caribbean, increased testosterone)
Castration is protective of benign prostate hyperplasia

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49
Q

What zone of the prostate proliferates in BPH

A

Inner transitional zone (muscular, gland)

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50
Q

What are the signs/ symptoms of BPH

A

LUTS:- mostly voiding symptoms
Storage:- frequency, urgency, nocturia, incontinence
Voiding:- poor stream, dribbling, incomplete emptying, straining, dysuria

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51
Q

What do you diagnose benign prostate hyperplasia

A

Digital rectal exam:- BPH is smooth and enlarged (cancer is hard and irregular)
Also, rule out other causes such as stones/ UTI

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52
Q

Does PSA raise in BPH

A

Yes but more so in cancer

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53
Q

What is the 1st line pharmological treat for BPH

A

Alpha-blocker (tamsulosin):- relaxes bladder neck

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54
Q

What is the second line pharmacological treatment for BPH

A

5-alpha-reductase inhibitors (finasteride)
decreases testosterone production

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55
Q

What dietary changes should someone with BPH make

A

Less caffine

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56
Q

What is the last resort treatment for BPH

A

Transurethral resection of the prostate (TURP)

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57
Q

What is the most common complication of transurethral resection of the prostate

A

Retrograde ejaculation

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58
Q

What is the most common renal cancer

A

Renal cell carcinoma

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59
Q

What are the 3 most common renal cell carcinomas including most common

A

Clear cell 80%
Papillary 15%
Chromophobe 5%

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60
Q

What are the risk factors for Renal cell carcinoma

A

Smoking, obesity, hypertension, end-stage renal failure, hereditary
Von Hippel-Lindau Disease

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61
Q

What is Von Hippel-Lindau disease

A

Autosomal dominant loss of tumour suppressor gene

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62
Q

What % of renal cell carcinoma cases have already metastasised at presentation

A

25%

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63
Q

What are the signs/ symptoms of renal cell carcinoma

A

Triad:- Flank pain, haematuria, abdominal mass
may also have left sided varicocele

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64
Q

What is the 1st line investigation for renal cell carcinoma

A

Ultrasound scan

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65
Q

What is the GS investigation for renal cell carcinoma

A

CT chest/ abdo/ pelvis

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66
Q

What is the staging system used for renal cell carcinoma

A

Robson staging 1-4

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67
Q

What is the treatment for renal cell carcinoma (also what if metastasised)

A

Nephrectomy
If metastisized give IFN-alpha

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68
Q

What is the most common place for renal cell carcinoma to metastasise to

A

Lung (cannonball metastases)

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69
Q

What are the complications of renal cell carcinoma

A

Polycythemia (unregulated production of EPO)
Hypercalcemia (secretion of a hormone that mimics the action of PTH)
Hypertension (increased renin production)
Stauffers syndrome

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70
Q

What is Stauffer’s syndrome

A

Abnormal liver function tests seen in renal cell carcinoma, without liver metastases)

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71
Q

What are the 4 stages of renal cell carcinoma

A

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

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72
Q

What is Gerota’s fascia

A

The renal fascia that encapsulates the kidney and adrenal glands

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73
Q

If a patient is not suitable for surgery what can the management options be for renal cell carcinoma

A

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

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74
Q

What is a Wilms tumour

A

Renal mesenchymal stem cell tumour seen in children under 5.

75
Q

What is the most common bladder cancer

A

Transitional cell carcinoma 95%

76
Q

What is the other type of bladder cancer other than TCC

A

Squamous cell carcinoma 5%
Adenocarcinoma 2%

77
Q

What disease do patients have that makes them more likely to have squamous cell bladder cancer of transitional cel

A

Schistosomiasis

78
Q

What are the risk factors for bladder cancer

A

Occupational exposure to dye/ paints/ rubber (aromatic amines)
Smoking
Chemo/ radiotherapy
Age
Male

79
Q

What is the classical presentation of bladder cancer

A

Painless haematuria

80
Q

What is the gold standard investigation for bladder cancer

A

Flexible cystoscopy+ biopsy

81
Q

What is the treatment for bladder cancer

A

Medical:- Chemo/ radiotherapy
Surgery:- transurethral resection of bladder tumour

82
Q

What zone of the prostate does prostate cancer affect

A

Outer zone of peripheral prostate

83
Q

What are the risk factors for Prostate Cancer

A

Genetic factors
Age
Afro-Caribbean ethnicity
Family history

84
Q

What genes make a person susceptible to prostate cancer

A

BRCA2, HOXB13

85
Q

What are the symptoms of Prostate cancer

A

LUTS- like BPH but with systemic cancer symptoms:- weight loss, fatigue, night pain
Bone pain (lumbar)

86
Q

Where does prostate cancer typically metastasise to

A

Bone (thick sclerotic lesion)
Liver, lung Brain

87
Q

What is the gold standard investigation for prostate cancer

A

Transrectal ultrasound + biopsy

88
Q

What is the grading system for prostate cancer

A

Gleason score (based on biopsy)

89
Q

How is the Gleason score calculated

A

1st and 2nd most prevalent pattern in biopsy
8 is high risk

90
Q

What is the treatment for prostate cancer

A

Local:- Prostatectomy
Metastatic:- hormone therapy, radio/ chemo

91
Q

How does hormone therapy treat metastasis of prostate cancer

A

Decrease testosterone
GnRH agonist (supresses HPG axis) (ED)
Bilateral orchiectomy (remove testes)

92
Q

What are the 2 types of testicular cancer

A

Germ cell 90% or non-germ cell 10%

93
Q

What are the germ cells affected in germ cell testicular cancer

A

Seminoma+ teratoma

94
Q

What are the non-germ cells affected in testicular cancer

A

Sertoli, leydig, sarcoma

95
Q

What are risk factors for testicular cancer

A

Cryptorchidism, infertility, family history

96
Q

What are the signs/ symptoms of testicular cancer

A

Painless lump in a testicle which does not transilluminate

97
Q

What is the most common hormone-sensitive cancer

A

Prostate

98
Q

What investigations do you perform in suspected testicular cancer

A

Scrotal ultrasound
Tumour markers AFP, beta-hCG, LDH

99
Q

What does a raised alpha-fetoprotein suggest

A

Teratoma testicular cancer

100
Q

What is the treatment for testicular cancer

A

Urgent orchidectomy (offer sperm storage)

101
Q

What organisms can cause UTIs

A

KEEPS
Klebsiella 10%
Enterobacter
E. coli 80%
Proteus mirabilis 5%
S. saphrophyticus 5-10%

102
Q

What is the first line investigation in a suspected UTI and what do you see

A

Urine dipstick
+ve leukocytes
+ nitrates (bacteria break down nitrates to nitrites)
+/- haematuria

103
Q

What is the GS investigation for UTI

A

Midstream urine sample

104
Q

What is the treatment for UTI

A

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
Q

What antibiotics do you avoid and when in pregnancy for treatment fo UTI

A

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
Q

What is pyelonephritis

A

Infection of the renal parenchyma and upper ureter

107
Q

What are risk factors for pyelonephritis

A

Urine stasis (stones), renal structural abnormalities, catheters

108
Q

What are the signs/ symptoms of pyelonephritis

A

Triad:- loin pain, fever, pyuria

109
Q

What is the first line investigation for pyelonephritis

A

Urine Dipstick

110
Q

What is the gold standard investigation for pyelonephritis

A

Urine microscopy, culture and susceptibility
(MC+ S)

111
Q

What is the treatment for pyelonephritis

A

Analgesia; paracetamol
Ciprofloxacin or co-amoxiclav

112
Q

What antibiotic do you give to someone with pyelonephritis who is also pregnant

A

Cefalexin

113
Q

What is cystitis

A

Infection of bladder

114
Q

RF for cystitis

A

Urine stasis, bladder lining damage, catheters

115
Q

Sx of cystitis

A

Suprapubic tenderness + discomfort, increased frequency+ urgency, visible haematuria

116
Q

1st line investigation for cystiris

A

Urine Dip

117
Q

GS investigation for cystitis

A

Urine microscopy, culture and susceptibility test

118
Q

Treatment for cystitis

A

Trimethoprim or nitrofurantoin

119
Q

Treatment for cystistis if pregnent

A

Amoxicillin

120
Q

What is urethritis

A

Urethral inflammation +/- infection

121
Q

Most common cause of urethritis

A

Sexually acquired

122
Q

2 types of urethritis

A

Infective, non infective (trauma)

123
Q

2 types of infective urethritis with MC
and causative organisms

A

Gonococcal (Niesseria gonorrhoea)
Non-gonococcal (Chlamydia trachomatis) MC

124
Q

Sx of urethritis

A

Dysuria +/- urethral discharge (blood/ pus)
Urethral pain

125
Q

What type of bacteria is Neisseria gonorrhoea

A

Gram -ve diplococcus

126
Q

What test to detect STI vs UTI

A

STI; Nucleac acid amplification test)
UTI; Urine microscopy, culture and susceptibility test

127
Q

Treatment for Neisseria gonorrhoea Urethritis

A

IM ceftriaxone + azithromycin

128
Q

Treatment for chlamydia trachomatis urethritis

A

Azithromycin or doxycycline

129
Q

Most common cause of Epididymo-orchitis in males over 35 vs under

A

<35 urethritis (STI)
>35 Cystiis (KEEPS extension)

130
Q

Sx of Epidiymo-orchitis

A

Unilateral scrotal pain + swelling
Pain released with elevating testes (+ve Prehn’s sign)

131
Q

What investiagtions in epididymo-orchtitis

A

NAAT, urine dip, mc+s

132
Q

Sx of nephrotic syndrome

A

Proteinuria
Hypoalbumineruia
Hyperlipidemia
Hypogammaglobulinaemia
Hypercoagulable blood
Weight gain

133
Q

Sx of nephritic syndrome

A

Haematuria
Oliguria
Hypertension
Oedema

134
Q

What is most common cause of primary nephrotic syndrome in children vs adults

A

Children:- Minimal change disease
Adult:- Focal segmental glomerulosclerosis

135
Q

Most common cause of secondary nephrotic syndrome

A

Diabetes (nephropathy)

136
Q

What is seen in light microscopy + e- microscopy in minimal change disease

A

Light; no change
E-; Podocyte effacement + fusion

137
Q

What is seen on light microscopy in focal segmental glomerulosclerosis

A

Segmental sclerosis (but less than 50% affected)

138
Q

What do you see on light microscopy and electron microscopy in membranous nephropathy

A

Light; Thickend GBM
Electron; Subpodocyte immune complex deposition (spike + dome appearance)

139
Q

Treatment for nephrotic syndrome

A

Glucocorticoids
Minimal change responds well others less so

140
Q

What is the most common cause of nephritic syndrome

A

IgA nephropathy (Berger’s disease)

141
Q

Causes of nephritic syndrome

A

IgA nephropathy T2
Post strep glomerulonephritisT2
SLE T2
Goodpastures syndrome T3

142
Q

Presentation of IgA nephropathy

A

Visible haematuria 1-2 days after tonsilitis or viral infection

143
Q

Investigation in IgA nephropathy and what does it show

A

Immunofluorescence microscopy shows
IgA complex deposition

144
Q

Treatment for IgA nephropathy

A

Non-curable
Blood pressure control with ACEi

145
Q

Presentation for Post strep glomerulonephritis

A

Visible haematuria 2 weeks after pharyngitis from group A beta haemolytic strep (Strep pyogenes)

146
Q

Investigations for post-strep glomerulonephritis

A

Light microscopy; Hypercellular glomeruli
Electron Microscopy; subendothelial immune complex deposition
Immunofluorescence shows starry sky appearance

147
Q

How can SLE cause nephritic syndrome

A

Lupus nephritis due to ANA deposition in endothelium

148
Q

Treatment for Lupus nephritis

A

Steroids, hydroxychloroquine, immunosuppressants

149
Q

What antibodies in Goddpastures cause a nephritic syndrome

A

Anti-GBM

150
Q

Treatment for goodpastures syndrome

A

Steroids + plasma exchange

151
Q

How does haemolytic uremic syndrome cause nephritic syndrome

A

5 days post-infection antibodies against Shiga toxin (e. coli, shigella)

152
Q

What can haemolytic uremic syndrome cause

A

Haemolytic anaemia, AKI (glomerulonephritis), thrombocytopenia

153
Q

What is rapidly progressing glomerulonephritis

A

A subtype of glomerular nephritis that progresses to end-stage renal failure very fast

154
Q

What is present in Rapidly progressing glomerulonephritis

A

Inflammatory crescents in Bowman’s space

155
Q

What can cause Rapidly progressing glomerulonephritis

A

Wegner’s granulomatosis, Goodpasture’s

156
Q

What protein is affected in the mutation causing autosomal dominant polycystic kidney diseases

A

PKD1 polycystin-1 85%
PKD2 polycyctin-2 15%

157
Q

What is the pathology of ADPKD

A

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
Q

Presentation of ADPKD

A

Bilateral flank/ back or abdo pain +/- Htn and haematuria

159
Q

Complication of ADPKD

A

Extrarenal cysts particularly in the circle of Willis leading to berry aneurysm (SA haemorrhage)

160
Q

Diagnsotic test for ADPKD

A

Kidney ultrasound showing enlarged bilateral kidney with multiple cysts

161
Q

What is an epididymal cyst

A

extra testicular cyst above + behind testes that will transilluminate

162
Q

What is a hydrocele

A

Fluid collection in tunica vaginalis
Cyst that testicle sits in that will transilluminate

163
Q

How to diagnose epididymal cyst + hydrocele

A

Scrotal Ultrasound

164
Q

What is a varicocele

A

Distended pampiniform plexus due to increased left renal vein pressure causing reflux

165
Q

Presentation of varicocele

A

Bag of wors on LHS mostly typically painless

166
Q

Complication of varicocele

A

Infertility

167
Q

What is testicular torsion

A

Spermatic cord twists on itself occluding the testicular artery causing ischemia. Can lead to gangrene of testis if not dealt with

168
Q

RF for testicular torsion

A

Bell clapper deformity; horizontal lie of the testes

169
Q

What are Symptoms of testicular torsion

A

Severe uni-testicular pain (hurts to walk), abdo pain, N+V, no pain relief with elevating testes

170
Q

What reflex is lost in testicular torsion

A

Cremaster reflex
Sroek inner thigh, and ipsilateral testicle should elevate

171
Q

Treatment for testicular torsion

A

Urgent surgery within 6h is always 1st line

172
Q

What is orchidopexy or orchidectoimy

A

Orchidopexy is fixation
Orchidectomy is the removal of the testis

173
Q

Incontinence more common in male or female

A

Female

174
Q

Types of incontenance

A

Stress (sphincter weakness)
Urge (detrusor muscle overactivity)
Spatic paralysis (neurological UMN lesion); overactive reflexes + hypertonia of detrusor

175
Q

Treatment for incontinence

A

Surgery or anticholinergic drugs

176
Q

Is retention more common in males or females

A

Males

177
Q

Causes of retention

A

Stones, BPH, Neurological flaccid paralysis
LMN lesion (hypotonia of detrusor)

178
Q

LUTS storage symptoms

A

FUNI
Frequency
Urgency
Nocturia
Incontinence

179
Q

LUTS voiding symptoms

A

SHID
poor Stream
Hesitancy
Incomplete emptying
Dribbling

180
Q

What is 1st line treatment for CKD

A

ACEi

181
Q

What medications are given to patients with ANCA positive diseases

A

Cortico steroids + Ritixumab

182
Q

Sx of CKD

A

Itching
Loss of appetite
Nausea
Oedema
Muscle cramps
Pallor
Hypertension

183
Q

What is the A score

A

Used in CKD. Albumin creatinine ratio
A1= <3mg/mmol
A2=3-30mg/mmol
A3=>30mg/mmol

Phase 2a Ru (10 decks)

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