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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
What does the prostate do?
Produces testosterone and dihydrotestosterone | Produces PSA - liquefies semen
26
What is BPH?
Benign enlargement of prostate
27
How does BPH present?
LUTS - storage and voiding
28
How do you investigate BPH?
DRE and PSA
29
How is BPH managed?
Tamulosin (or finasteride)
30
What is prostate cancer?
Adenocarcinoma
31
How does prostate cancer present?
LUTS symptoms | Metastasis - haematuria, back pain
32
How is localised prostate cancer treated?
Radical prostatectomy
33
How is advanced prostate cancer treated?
Zoladex (GnRH agonist)
34
What is varicocele?
Abnormal enlargement of testicular veins - 'bag of worms'
35
How is varicocele investigated?
US and doppler
36
How is varicocele treated?
Conservative
37
What is hydrocele?
Fluid in tunica vaginalis in scrotum
38
How does hydrocele present?
Soft, non-tender transluminous swelling
39
How is hydrocele treated?
Conservative
40
What is testicular torsion?
Twisting of spermatic cord
41
How does testicular torsion present?
Acute, severe pain | Unilateral, swollen, tender, retracted upwards
42
How is testicular torsion investigated?
Prehn's sign negative | pain not relieved by lifting scrotum
43
How is testicular torsion treated?
De-torsion
44
How does epididymitis present?
Acute pain | Unilateral
45
How is epididymitis investigated?
Prehn's sign positive
46
How is epididymitis treated?
Stat IM ceftriaxone if organism unknown plus doxycycline
47
What is the most common cause of scrotal swelling?
Epididymal cyst
48
How does epididymal cyst present?
Lump found in posterior aspect of testicle
49
How is epididymal cyst investigated?
US
50
How is epididymal cyst treated?
Dissolve in 10 days
51
How does testicular cancer present?
Painless lump Hydrocele Gynaecomastia
52
How is testicular cancer investigated?
US
53
How is testicular cancer treated?
Chemo/radio | Orchidectomy
54
What is nephritic syndrome?
Inflammation within kidney
55
What are the features of nephritic syndrome?
Haematuria - reflects inflammation of kidney Oliguria - reduced GFR Proteinuria - <3g/24 hours HTN - fluid overload
56
What causes nephritic syndrome?
Inflammatory disease affecting kidney - can arise from both systemic disease and renal limited disease
57
What are the systemic causes of nephritic syndrome?
SLE Post strep GN Small vessel vasculitis Goodpasture's/anti-GMB disease
58
What are the renal causes of nephritic syndrome?
IgA nephropathy
59
How is nephritic syndrome investigated?
Diagnostic = kidney biopsy Urinalysis Bloods
60
How is nephritic syndrome managed?
Treat underlying cause ACEi/ARB Corticosteroids
61
What are the NICE guidelines for diagnosing AKI (urine output)?
Fall in urine output <0.5ml/kg/hour >6 hours in adults (8 in children)
62
What does urinalysis of nephritic syndrome show?
Haematuria
63
What do bloods for nephritic syndrome show?
Raised ESR and CRP | May be anaemia

Phase 2a (25 decks)

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