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Phase 2a > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are the CKD stages?

A 
1
2
3a
3b
4
5
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2
Q

What is CKD stage 1?

A

GFR > 90ml/min

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3
Q

What is CKD stage 2?

A

GFR = 60-90ml/min with some sign of kidney damage

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4
Q

What is CKD stage 3a?

A

GFR = 45-59ml/min, a moderate reduction in kidney function

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5
Q

What is CKD stage 3b?

A

GFR = 30-44ml/min, a moderate reduction in kidney function

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6
Q

What is CKD stage 4?

A

GFR = 15-29ml/min, severe reduction in kidney function

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7
Q

What is CKD stage 5?

A

GFR < 15ml/min, established kidney failure (dialysis or transplant may be needed)

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8
Q

What are the NICE criteria for AKI diagnosis (creatinine)?

A

Rise in creatinine of > 26µmol/L in 48 hours

or

> 50% rise in creatinine over 7 days

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9
Q

What is AKI stage 1?

A

Increase in creatinine 1.5-1.9 times baseline

or

Reduction in urine output to <0.5ml/kg/hour for ≥ 6 hours

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10
Q

What is AKI stage 2?

A

Increase in creatinine to 2.0 to 2.9 times baseline

or

Reduction in urine output to <0.5ml/kg/hour for ≥ 12 hours

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11
Q

What is AKI stage 3?

A

Increase in creatinine to ≥ 3.0 times baseline

or

Increase in creatinine to ≥ 353.6µmol/L

or

Reduction in urine output to <0.3ml/kg/hour for ≥24 hours

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12
Q

What are CKD and AKI?

A

Reduced kidney function (acute or chronic)

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13
Q

What is the function of the kidneys?

A

Water/hormone homeostasis
Removal of waste/toxins
RBC production
Activate vitamin D

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14
Q

What are the risk factors for CKD and AKI?

A 
Emergency surgery i.e. risk of sepsis or hypovolaemia
CVD risk
CKD - eGFR < 60
DM
HF
Age >65
Liver disease
Use of nephrotoxic drugs
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15
Q

How does intrinsic AKI present?

A

T2DM and HTN, low urine osmolality, high urine Na+, high blood K+

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16
Q

How does pre-renal AKI present?

A

Normal Na+, raised urea and creatinine. Responds well to fluid therapy

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17
Q

How does post-renal AKI present?

A

Loin > groin acute colicky pain, microscopic haematuria

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18
Q

What are the pre-renal causes of AKI?

A

Hypovolaemia secondary to diarrhoea/vomiting

Renal artery stenosis

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19
Q

What are the intrinsic causes of AKI?

A 
Glomerulonephritis
Acute tubular necrosis (ATN)
Acute interstitial nephritis (AIN)
Rhabdomyolysis
Tumour lysis syndrome
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20
Q

What are the post-renal causes of AKI?

A

Kidney stone in ureter or bladder
BPH
External compression of the ureter

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21
Q

How is AKI managed?

A 
Fluid balance
Stop nephrotoxic drugs
Treat hyperkalaemia (risk of arrhythmia)
Treat underlying cause
RRT if not responding to medical treatment
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22
Q

What drugs are nephrotoxic?

A 
NSAIDs
Aminoglycosides
ACEi
ARB
Loop diuretics
Metformin
Digoxin
Lithium
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23
Q

How is CKD managed?

A

Slow the progression of disease
20mg atorvastatin (reduce risk of CVD)
Manage complications

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24
Q

What complications of CKD need to be managed?

A 
Mineral bone disease - low vitamin D
HTN
Proteinuria
Anaemia > ESA
RRT - haemodialysis, peritoneal dialysis, transplant
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25
Q

What does the prostate do?

A

Produces testosterone and dihydrotestosterone

Produces PSA - liquefies semen

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26
Q

What is BPH?

A

Benign enlargement of prostate

27
Q

How does BPH present?

A

LUTS - storage and voiding

28
Q

How do you investigate BPH?

A

DRE and PSA

29
Q

How is BPH managed?

A

Tamulosin (or finasteride)

30
Q

What is prostate cancer?

A

Adenocarcinoma

31
Q

How does prostate cancer present?

A

LUTS symptoms

Metastasis - haematuria, back pain

32
Q

How is localised prostate cancer treated?

A

Radical prostatectomy

33
Q

How is advanced prostate cancer treated?

A

Zoladex (GnRH agonist)

34
Q

What is varicocele?

A

Abnormal enlargement of testicular veins - ‘bag of worms’

35
Q

How is varicocele investigated?

A

US and doppler

36
Q

How is varicocele treated?

A

Conservative

37
Q

What is hydrocele?

A

Fluid in tunica vaginalis in scrotum

38
Q

How does hydrocele present?

A

Soft, non-tender transluminous swelling

39
Q

How is hydrocele treated?

A

Conservative

40
Q

What is testicular torsion?

A

Twisting of spermatic cord

41
Q

How does testicular torsion present?

A

Acute, severe pain

Unilateral, swollen, tender, retracted upwards

42
Q

How is testicular torsion investigated?

A

Prehn’s sign negative

pain not relieved by lifting scrotum

43
Q

How is testicular torsion treated?

A

De-torsion

44
Q

How does epididymitis present?

A

Acute pain

Unilateral

45
Q

How is epididymitis investigated?

A

Prehn’s sign positive

46
Q

How is epididymitis treated?

A

Stat IM ceftriaxone if organism unknown plus doxycycline

47
Q

What is the most common cause of scrotal swelling?

A

Epididymal cyst

48
Q

How does epididymal cyst present?

A

Lump found in posterior aspect of testicle

49
Q

How is epididymal cyst investigated?

A

US

50
Q

How is epididymal cyst treated?

A

Dissolve in 10 days

51
Q

How does testicular cancer present?

A

Painless lump
Hydrocele
Gynaecomastia

52
Q

How is testicular cancer investigated?

A

US

53
Q

How is testicular cancer treated?

A

Chemo/radio

Orchidectomy

54
Q

What is nephritic syndrome?

A

Inflammation within kidney

55
Q

What are the features of nephritic syndrome?

A

Haematuria - reflects inflammation of kidney
Oliguria - reduced GFR
Proteinuria - <3g/24 hours
HTN - fluid overload

56
Q

What causes nephritic syndrome?

A

Inflammatory disease affecting kidney - can arise from both systemic disease and renal limited disease

57
Q

What are the systemic causes of nephritic syndrome?

A

SLE
Post strep GN
Small vessel vasculitis
Goodpasture’s/anti-GMB disease

58
Q

What are the renal causes of nephritic syndrome?

A

IgA nephropathy

59
Q

How is nephritic syndrome investigated?

A

Diagnostic = kidney biopsy
Urinalysis
Bloods

60
Q

How is nephritic syndrome managed?

A

Treat underlying cause
ACEi/ARB
Corticosteroids

61
Q

What are the NICE guidelines for diagnosing AKI (urine output)?

A

Fall in urine output <0.5ml/kg/hour >6 hours in adults (8 in children)

62
Q

What does urinalysis of nephritic syndrome show?

A

Haematuria

63
Q

What do bloods for nephritic syndrome show?

A

Raised ESR and CRP

May be anaemia

Phase 2a (25 decks)

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