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Phase 2a Revision > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Kidney function

A

→ Water / Hormone homeostasis

→ Removal of waste

→ RBC production

→ Activate vit. D

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2
Q

AKI & CKD & Risk Factors

A 
AKI = Sudden loss of kidney function.
CKD = Gradual loss of Kidney function.
Risks:
→ Age > 65
→ Diabetes
→ High BP
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3
Q

AKI Diagnostic Criteria

A
  • Rise in creatinine of >= 26umol /L in 48 hrs
  • > = 50% rise in creatinine over 7 days
  • Fall in urine output to less than 0.5ml/kg/hr for more than 6hrs in adults (8 in kids)
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4
Q

Aetiology & characteristic for Pre-renal

A
  • Hypovolaemia Secondary to diarrhoea & vomiting (Dehydration)
  • Sepsis
  • NSAIDs / Diuretics

→ Normal Na+, Raised urea & creatinine. Responds well to Fluid therapy.

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5
Q

Aetiology & Characteristic for Intrinsic / Intra-renal

A
  • Post - strep. infection
  • Acute Tubular Necrosis
  • Rhabdomyolysis

→ T2DM & HTN, low urine osmolality, High urine Na+, High blood k+.

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6
Q

Aetiology & Characteristic for Post - renal

A
  • kidney stone in ureter / bladder
  • Benign Prostatic Hyperplasia
  • bladder cancer

→ Loin → Groin acute colicky pain, Microscopic haematuria.

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7
Q

AKI Management

A
  • Fluid balance
  • Stop Nephrotoxic Drugs
  • Treat hyperkalaemia → risk of arrythmias
  • Renal Replacement Therapy
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8
Q

Nephrotoxic drugs

A
  • NSAIDs
  • ACE-I & ARBs
  • Aminoglyclides e.g. Gentamicin
  • Loop diuretics
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9
Q

CKD management

A

ACE-I / ARB
→ Ramipril / Candesartan

Reduce risk of CVD
→ Atorvastatin

Anaemia
→ Erythropoietin

Reduce swelling
→ Chlorothiazide

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10
Q

CKD complications

A
  • Mineral bone diseases - low vit. D
  • HTN
  • Proteinuria
  • Anaemia
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11
Q

Benign Prostatic Hyperplasia (BPH)

A

Hyperplasia of stromal & epithelial cells of the Prostate. Presents in men > 50 yrs

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12
Q

BPH symptoms

A

Mainly LUTs Symptoms

  • Hesitancy - weak urine flow
  • Urgency
  • Frequency
  • Intermittency
  • Straining
  • Nocturia
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13
Q

BPH Investigations

A
  • Digital Rectal Examination
  • Prostate - Specific antigen
  • Prostate examination (abnormal transitional zone)
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14
Q

BPH management

A
  • Alpha-blockers [ Tamsulosin ]
  • 5 - alpha reductase inhibitors [ Finasteride ]
  • Transurethral Resection of Prostate (TURP)
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15
Q

Lower Urinary Tract Infections (LUTS]

A

Infection (mainly E.coli) in the bladder causing cystitis.

They can spread to kidneys & cause pyelonephritis

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16
Q

LUTS Symptoms

A
  • fever & Dysuria
  • Discomfort & Suprapubic pain
  • Frequency
  • Urgency
  • Incontinence
  • Cloudy & Smelly urine
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17
Q

LUTS investigations

A
  • Urinanalysis

- Urine dipstick - Nitrites → Gram -ve bacteria break down nitrates into nitrites.

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18
Q

Most common cause of UTI

A
  • E. Coli
  • Klebsiella
  • Enterococcus
  • Candida
  • Staphylococcus
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19
Q

UTI Management

A
  • Nitrofurantoin
  • Cefalexin
  • Trimethoprim or Amoxicillin if sensitive
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20
Q

Hydrocele

A

Fluid in tunica vaginalis - secondary to trauma/ infection

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21
Q

Hydrocele examinations & cause

A
  • testicle is Palpable
  • Transilluminated

→ Idiopathic

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22
Q

Hydrocele management

A
  • Watch & wait
  • Surgery (if inguinal hernia is seen)
  • Aspiration
  • Sclerotherapy
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23
Q

Varicocele

A

Veins in the Pampiniform Plexus which drains into the testicular Vein become Swollen.

Due to increased resistance in the testicular vein.

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24
Q

Testicular vein drainage

A

Right Testicular vein = drains into infcrior vena cava

Left Testicular vein = drains into the left renal vein

Most varicocele occurs in Left due to increased resistance

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25
Q

Varicocele Symptoms

A
  • Throbbing / dull pain or discomfort, worse on Standing
  • dragging sensation
  • ‘Bag of worms’
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26
Q

Varicocele investigations

A
  • Ultrasound with Doppler imaging
  • Semen analysis
  • Hormonal test ( FSH & testosterone)
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27
Q

varicocele Management

A
  • Surgery

- Endovascular embolisation - for testicular atrophy / infertility

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28
Q

Testicular torsion

Sx:

Ix:

Mx:

A

= twisting of cord that supply testicle

Sx: - severe pain, hot, red & swollen
- Unilateral, Swollen, Tender, Retracted upwards

Ix: Imaging - Prehn’s sign -ve

Mx: De - torsion

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29
Q

Epididymitis

Sx:

Ix:

Mx;

A
  • Inflammation in tube that’s at back of testicle carrying sperm
  • Gradual unilateral pain
  • Prehn’s sign + ve
  • start IM Ceftriaxone + Doxycycline
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30
Q

Epididymal Cyst

Ix:

Mx:

A
  • Common cause of Scrotal swelling
  • painless lump found in Posterior aspect of testicle (epididymus)
  • Clear/ milky fluid
  • Transillumination & Ultrasound
  • Analgesia
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31
Q

Cystitis

A

Infection of the urinary bladder due to E. coli

  • common in young sexually active women
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32
Q

Cystitis Risks

A
  • History of UTI
  • Diabetic
  • Frequent sex
  • Pregnancy
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33
Q

Cystitis Symptoms

A
  • Dysuria - discomfort, pain, burning on urination
  • Frequency
  • Urgency
  • cloudy smelly urine
  • Suprapubic tenderness
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34
Q

Cystitis Investigations

A
  • Urine dipstick - if + ve then UTI

Gold - Urine culture & sensitivity

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35
Q

Cystitis management

A
  • Antibiotic = Trimethoprim / NitrofurantoinI avoid in 3rd trimester)
36
Q

Prostate cancer
Sx:
Ix:
Tx:

A
  • Adenocarcinoma in peripheral zone
  • LUTS symptoms
  • Metastasis - haematuria, back pain
  • MRI
  • Give Goserelin (GnRH agonist), Radiotherapy
37
Q

Nephritic Syndrome

A

Inflammation within the kidney.

38
Q

Features that define Nephritic Syndrome

A

→ Haematuria - reflects inflammation of kidney

→ Dysuria - due to less GFR

→ Proteinuria - less than 3g/ 24 hrs

→ Hypertension - due to fluid overload

39
Q

Systemic Causes of Nephritic Syndrome

A
  • SLE
  • Post strep GN
  • Small vessel vasculitis
  • Goodpasture’s /anti-GMB disease
40
Q

Renal cause of Nephritic Syndrome

A

lgA nephropathy

41
Q

Nephritic Syndrome investigations

A
  • Kidney biopsy
  • Urinalysis - blood & Protein
  • Bloods - high ESR & CRP & eGFR
42
Q

Nephritic Syndrome Management

A
  • Blood pressure control - ACE-I / ARB

- Corticosteroids

43
Q

IgA Nephropathy

A

Deposition of lgA into the Mesangium of the kidney. This results in inflammation & damage.

It presents asymptomatically with microscopic haematuria.

44
Q

IgA Nephropathy Investigations

A

Biopsy

45
Q

lgA Nephropathy Management

A
  • Corticosteroids
  • Rituximab
  • Give fish oil
46
Q

Goodpasture’s Disease

A

Caused by autoantibodies to Type lV collagen in glomerular & alveolar membrane.

47
Q

Goodpasture ‘s Disease Symptoms

A
  • Dyspnoea
  • Oliguria

→ due to resp & renal damage

48
Q

Goodpasture’ s disease Investigations

A
  • Anti-GBM antibodies in bloods & biopsy
49
Q

Goodpasture’s Disease Management

A
  • Plasma exchange
  • steroids
  • Cyclophosphamide (for immune suppression)
50
Q

Nephrotic Syndrome

A

Issue with the filtration barrier, with podocytes being primarily implicated, which results in leaking of Protein into the urine.

51
Q

Features of Nephrotic Syndrome

A
  • Proteinuria - >3g/24 hr
  • Hypalbuminaemia - due to Ioss of albumin in urine
  • Oedema - loss of of oncotic pressure, this can be rapid & severe
52
Q

Symptoms of Nephrotic Syndrome

A
  • Oedema

- Frothy Urine - Shows Proteinuria

53
Q

Nephrotic Syndrome Investigations

A
  • Urinalysis
  • Urine protein: Creatinine ratio
  • Blood tests - renal function, elevated lipids
  • Renal biopsy
54
Q

Nephrotic Syndrome Management

A
  • Corticosteroids (prednisolone)
  • Low salt diet
  • Diuretics
  • Antibiotic Prophylaxis
55
Q

Nephrotic Syndrome Complications

A

Hyperlipidaemia - loss of albumin increases cholesterol formation.

  • Manage with Statins

VTE - due to increased clotting factors.

  • Give heparin
56
Q

Causes of Nephritic Syndrome

A

→ lgA nephropathy

→ Goodpasture’s disease

→ Post Streptococcal glomerulonephritis

57
Q

Causes of Nephrotic Syndrome

A

→ Minimal change disease

→ Focal segmental glomerulosclerosis

→ Membranous Nephropathy

58
Q

Minimal Change Disease

Diagnosis

Treatment

A

Normal appearance upon microscopy but there’s abnormal Function. Most common in children

  • Biopsy = Presentation is nephrotic (Periorbital oedema, ankle oedema, frothy urine)
  • Treatment = High dose steroids → Prednisolone
59
Q

Focal Segmental Glomerulosclerosis

Diagnosis

Treatment

A

Can be idiopathic or Secondary to HIV, Heroin & Lithium.

  • Diagnosed by presence of scarring of glomeruli i.e. Focal sclerosis
  • Give steroids idiopathic disease
  • Give ACE-I / ARB ) → Blood pressure control
60
Q

Membranous Nephropathy

Diagnosis

Treatment

A
  • Immunologically mediated - small vessels in glomeruli get inflammed.
  • Diagnosed by renal biopsy → Shows thickened glomerular basement membrane.
  • Anti Phospholipase A2 receptor antibody

→ Give ACE-I / ARB for all.
→ Prednisolone + Cyclophosphamide

61
Q

Renal colic (Nephrolithiasis/ Urolithiasis)

A
  • Renal stones that form in the renal pelvis, where urine collects before travelling to ureters.

Sites:
→ Pelviureteric junction
→ Pelvic brim
→ Vesicoureteric junction

62
Q

Renal colic Complications

A

→ Obstruction = leading to A.K.I

→ Infection = with Obstructive Pyelonephritis

63
Q

Types of renal colic

A
  • Calcium - based stones:
    → Calcium Oxalate
    → Calcium Phosphate
  • Having a raised Serum calcium (hypercalcium) and a low urine output.

Other types:

  • Uric acid
  • Struvite
  • Cystine
64
Q

Renal Colic Symptoms

A
  • Unilateral loin to groin pain
  • Colicky
  • Haematuria
  • Nausea & vomiting
  • Reduced urine output
65
Q

Renal colic Investigations

A
  • Kidney, Ureter, Bladder (KUB) X-Ray =1st line
  • NCCT - KUB = Gold Standard
  • Ultrasound
66
Q

Cause of renal Stones/ colic

A
  • Hypercalcaemia
67
Q

Renal colic Management

A
  • NSAIDs (analgesics) - e.g. IM diclofenac, IV Paracetamol
  • Anti-emetics - e.g. Metoclopramide (for nausea & vomiting)
  • Tamsulosin ( alpha-blocker - aid Passage of Stones)
  • Antibiotics - for infections
68
Q

Management to reduce risk of renal stone reoccurrence

A

→ Potassium Citrate

→ Thiazide diuretics (eg. Indapamide)

69
Q

Polycystic Kidney Disease

A

Genetic Condition where kidneys develop multiple fluid filled cysts.
- There is Autosomal dominant (more common) & Autosomal recessive type

70
Q

Types of PKD

A
  • Autosomal Dominant:
    PKD-1
    PKD- 2
  • Autosomal Recessive:
    Gene on Chromosome 6
71
Q

Autosomal Dominant Manifestations

A
  • Cerebral aneurysms
  • Hepatic, Splenic, Pancreatic, Ovarian & Prostatic cysts
  • Cardiac valve disease (mitral regurgitation)
  • Colonic diverticula
72
Q

Autosomal Dominant PKD Complications

A
  • Chronic loin pain
  • Hypertension
  • Cardiovascular disease
  • Renal stones
  • Haematuria
73
Q

Autosomal Recessive PKD

A
  • Oligohydramnios in Pregnancy → low amniotic fluid
  • which leads to underdevelopment of the lungs → results in resp. failure
  • underdeveloped ear cartilage, flat nasal bridge, end- stage renal failure
74
Q

PKD management

A

Tolvaptan (vasopressin receptor antagonist) - Slow renal failure in autosomal dominant PKD.

  • Antihypertensives
  • Analgesia for renal colic
  • Antibiotics for infection
  • Dialysis
  • Renal transplant
75
Q

Bladder Cancer
Ix
Tx

A

Ix = Flexible Cystoscopy

Tx =
Transurethral Resection of the Bladder Tumour
Mitocycin C → given with TURBT
BCG → For higher risk, non- muscle invasive cancers
Methotrexate, Vinblastine, Cisplatin → Muscle- Invasive Cancers

76
Q

?Post Streptococcal Glomerulonephritis Diagnosis

A

Urinalysis - has protein & blood (infection)

Kidney Biopsy

77
Q

Bladder cancer

Symptom

Type of cancer

A

Haematuria
Lethargy
Usually present with history of schistosomiasis

→ Squamous cell carcinoma

78
Q

Gonorrhoea

Symptoms

Diagnosis

Treatment

A

Neisseria gonorrhoea
Gram - ve diplococci bacteria

Man= Urethral discharge, dysuria, Epididymo-orchitis
Women= Abnormal vaginal discharge, Painful sex

Nucleic acid amplification test = swab

TX= Ceftriaxone & Azithromycin

79
Q

Pyelonephritis

Symptoms

Diagnosis

Tx

A

Inflam. of kidney due to bacteria. Usually E. Coli. & Klebsiella

Fever, Loin pain, Polyuria

Ix: Midstream Urine sample

Tx = Cefalexin, Co-amoxiclav, Trimethoprim, Ciprofloxacin

80
Q

Bladder nerve supply

A

Sympathetic = Hypogastric nerves (T12-L2)

Parasympathetic = Pelvic nerve (S2-S4) - Contraction of detrusor muscle (when urinating)

Somatic = Pudenal nerve (S2-4) - Innervates external urethral sphincter

81
Q

Testicular Cancer

A

Symptoms = Gynaecomastia, Testicular discomfort, feeling of mass in testis.

Dx = Raised Serum alpha-fetoprotein

82
Q

Renal cancer (Renal cell carcinoma)

Sx:

Ix:

Tx:

A

SX: Weight loss, loin pain, Painless haematuria, Loin mass

Ix: CT /MRI

Tx: Chemo., Transplant

83
Q

Why does Person have hypertension with renal cancer?

A

Renin secretion → Increase in BP due to Raas system

84
Q

Diuretics & their mechanism

A

→ Thiazide = Inhibit of Na+ & CI-

→ Loop diuretic = Inhibit Na+ / k+ / CI

→ K+ Sparing diuretic = Inhibits Na+ reabsorption & k+ secretion

85
Q

Hypercalcaemia Presentations

A
  • Stones
  • Groans
  • Bones
  • Moans
86
Q

Erectile Dysfunction

  • Associated conditions
  • Management
A
  • Diabetes, MI, Renal failure, Liver disease

- > Phosphodiesterase e.g. Sildenafil

Phase 2a Revision (9 decks)

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