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Phase 2a Resits > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A
  • kidney stones

- slightly more common in men → testosterone = increased oxalate

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2
Q

What are kidney stones made of?

A
  • calcium oxalate → radio-opaque
  • uric acid → radio-lucent
  • struvite → radio-opaque
  • cystine
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3
Q

Risk factors for nephrolithiasis

A
  • chronic dehydration
  • obesity
  • high protein/salt diet
  • recurrent UTIs
  • hyperparathyroidism → hypercalciuria
  • congenital abnormalities
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4
Q

Presentation of nephrolithiasis

A

renal colic

  • severe unilateral abdominal pain
  • starts in loin, radiates to ipsilateral groin/testicle/labia
  • sudden onset early in morning
  • restlessness
  • N&V
  • haematuria
  • dysuria
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5
Q

Investigations for nephrolithiasis

A
  • dipstick → haematuria, leukocutes, nitrites
  • bloods → FBC, CRP, U&E

GOLD STANDARD = non-contrast CT KUB

  • US in pregnancy
  • radio-opaque only visible on US
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6
Q

Management of nephrolithiasis

A
  • symptomatic relief → hydration, NSAIDs, opioids
  • small pass spontaneously

if too big:

  • EWSL → break stone into smaller fragments using shockwaves
  • uteroscopy
  • PCNL → percutaneous access, use nephroscope to remove stone

lifestyle advice

  • decrease Na and protein
  • increase citrus fruit
  • adequate fluid intake
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7
Q

When should treatment be provided immediately for nephrolithiasis?

A
  • intolerable pain/vomiting

- signs of obstruction/infection/AKI

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8
Q

What are the functions of the kidney?

A
  • water/hormone homeostasis
  • waste/toxin removal
  • RBC production
  • activated vitD
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9
Q

Risk factors of CKD and AKI

A
  • emergency surgery → risk of sepsis/hypovolaemia
  • CVD risk
  • diabetes
  • HF
  • age >65
  • liver disease
  • use of nephrotoxic drugs
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10
Q

Which drugs are nephrotoxic?

A
  • NSAIDs
  • aminoglycides
  • ACEi
  • ARBs
  • loop diuretics
  • metformin
  • digoxin
  • lithium
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11
Q

What is AKI?

A
  • sudden decline in renal function

- determined by increased serum creatinine +/- decreased urine output

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12
Q

Causes of pre-renal AKI

A
  • hypovolaemia secondary to D&V

- renal artery stenosis

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13
Q

Causes of intrinsic AKI

A
  • glomerulonephritis
  • acute tubular necrosis ATN
  • acute interstitial nephritis AIN
  • rhabdomyolysis
  • tumour lysis syndrome
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14
Q

Causes of post-renal AKI

A
  • kidney stone in ureter or bladder
  • BPH
  • external compression of ureter
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15
Q

Presentation of pre-renal AKI

A
  • normal Na+
  • raised urea and creatinine
  • responds well to fluid therapy
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16
Q

Presentation of intrinsic AKI

A
  • T1DM
  • HTN
  • low urine osmolality
  • high urine Na+
  • high blood K+
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17
Q

Presentation of post-renal AKI

A
  • acute colicky pain radiating from loin to groin

- microscopic haematuria

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18
Q

Diagnosis of AKI

A
  • rise in creatinine to 1.5-1.9 times baseline
  • > 50% rise in creatinine over 7 days
  • fall in urine output to less than 0.5 for >6hrs in adults (8hr in kids)
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19
Q

Management of AKI

A
  • fluid balance
  • remove nephrotoxic drugs
  • treat hyperkalaemia → risk for arrythmia
  • treat underlying cause
  • RRT if no response to medical treatment
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20
Q

Complications of AKI

A
  • end stage renal failure
  • metabolic acidosis
  • uraemia
  • CKD
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21
Q

What is CKD

A
  • abnormal kidney structure/function

- present for >3 months with implications for health

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22
Q

Causes of CKD

A
  • diabetes
  • HTN
  • glomerulonephritis
  • PDK
  • VHL
  • persistent pyelonephritis
  • obstruction → stones, BPH, tumours
  • nephrotoxic drugs
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23
Q

Presentation of CKD

A
  • often asymptomatic until ESRF
  • fluid retention → oedema, raised JVP
  • oliguria
  • uraemia → pruritus, uraemic frost, yellow-grey complexion, reduced appetite
  • cardiac arrythymias
  • fatigue
  • pallor
  • bone pain
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24
Q

Diagnosis of CKD

A
  • eGFR <60
  • eGFR <90, signs of renal damage
  • albuminuria >30, albumin:creatinine >3
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25
Management of CKD
- treat DM, HTN, glomerulonephritis - reduce risk of CVD → atorvastatin - manage complications
26
Managing complications of CKD
- mineral bone disease → low vitD - HTN - proteinuria - anaemia → ESA - RRT
27
When should renal replacement therapy be considered?
- ESRF - acidosis not responsive to bicarb - persistent electrolyte disturbances - persistent oedema - severe symptoms of uraemia
28
What are the types of RRT?
- haemodialysis - peritoneal dialysis - renal transplant
29
Physiology of prostate
- produces testosterone and dihydrotestosterone | - production of PSA → liquefies semen
30
What is BPH?
- hyperplasia of inner transitional zone of prostate gland - partially blocks urethra - normal part of ageing for men
31
Presentation of BPH
LUTS storage - frequency - urgency - nocturia - urgency incontinence voiding - poor/intermittent stream - post-micturition dribbling - straining - incomplete emptying - hesitancy
32
Investigations for BPH
- DRE → smooth but enlarged prostate - PSA → not very accurate - bladder diaries
33
Management of BPH
- lifestyle → reduce caffeine/alcohol, relax when voiding 1. alpha blockers eg tamsulosin 2. 5-alpha reductase inhibitors eg finasteride - consider surgery if no response to drugs GOLD STANDARD = TURP - required if acute urinary retention, gross haematuria,
34
Features of prostate cancer
- most common male malignancy | - most slow growing but can be aggressive/malignant
35
Risk factors for prostate cancer
- Afro-Caribbean - family history/genetics - increasing age - anabolic steroids
36
Presentation of prostate cancer
- LUTS - weight loss - fatigue - night sweats - bone pain
37
Whee does prostate cancer metastasise to?
- bone → sclerotic bony lesions - brain - liver - lung
38
Investigations for prostate cancer
- community → DRE, PSA - DIAGNOSTIC = transrectal USS and biopsy - gleason grading system
39
Management of prostate cancer
local - prostatectomy <70 - active surveillance >70, low risk - radiotherapy metastatic - chemo - radiotherapy - bilateral orchidectomy - goserelin - palliative care to relieve symptoms
40
What is urethritis?
- uretheral inflammation due to infectious or non-infectious cause - non-gonococcal uretheritis more common than gonococcal
41
Causes of urethritis
- N.gonorrhoea - chlamydia - trauma - urethral stricture - urinary calculi
42
Presentation of urethritis
- skin lesion - dysuria +/- discharge (blood/pus) - urethral pain - penile discomfort/pruritus
43
Investigations for urethritis
- STI testing - M&C urethral discharge - bood cultures - urine dipstick - urethral smear
44
Management of urethritis
- management of underlying cause → Abs, partner notification
45
What condition is important to think about with urethritis?
reactive arthritis - conjunctivitis - urethritis - arthritis can't see, can't pee, can't climb a tree
46
What is cystitis?
- infection of urinary bladder | - most common in sexually active young women
47
Risk factors of cystitis
- history of UTI - diabetes - pregnancy - catheterisation
48
Microorganisms that cause cystitis
KEEPS - klebsiella - E.coli → most common - enterococci - proteus species - staph aureus
49
Presentation of cystitis
- dysuria - frequency - urgency - suprapubic pain - haematuria and polyuria - incontinence - confusion in elderly - cloudy smelly urine
50
Investigations for cystitis
1. urine dipstick → high leukocytes/nitrates, blood GOLD STANDARD = mid-stream MC&S
51
Management of cystitis
- trimethoprim/nitrofurantoin → 3 days (f), 7 days (m) | - in pregnancy → amoxicillin, cefalexin
52
What is variocele?
- abnormal dilation of testicular veins in pampiniform venous plexus - left side more commonly affected
53
Presentation of variocele
- feels like a bag of worms | - dragging/soreness/heaviness of scrotum
54
Management of variocele
- conservative | - surgical repair if pain infertility, testicular atrophy
55
Diagnosis of variocele
US and Doppler
56
What is testicular torsion?
- medical emergency | - twisting of spermatic cord with rotation of testicle
57
Presentation of testicular torsion
- acute severe pain - unilateral, swollen, tender - retracted upwards
58
Diagnosis of testicular torsion
examination - firm swollen testicle - rotation → epididymis is not in normal posterior position - Prehn's -ve can do US but not essential → whirlpool sign
59
Management of testicular torsion
de-torsion → orchiopexy
60
What is nephrotic syndrome?
issue with filtration barrier
61
What is the characterising triad in nephrotic syndrome?
- proteinuria >3 - hypoalbuminaemia → loss of albumin in urine - oedema → loss of oncotic pressure
62
Presentation of nephrotic syndrome
- frothy urine - infection - xanthelasma - xanthomata - athersclerosis - fatigue - dyspnoea - leukonychia
63
Pathophysiology of nephrotic syndrome
1. inflammation 2. damage to podocytes → protein leakage 3. increased liver activity → increases albumin and then cholesterol, coag factors 4. reduced oncotic pressure
64
Causes of nephrotic syndrome
occurs due to renal disease disrupting kidney function - minimal change disease - focal segmental glomerulosclerosis - membranous nephropathy
65
Secondary causes of nephrotic syndrome
- diabetic nephropathy - SLE - amyloidosis - hepB,C - HIV
66
Investigations of nephrotic syndrome
- urinalysis - urine protein:creatinine → degree of proteinuria - blood tests → renal function, elevated lipids GOLD STANDARD = needle biopsy and microscopy - looks for changes in glomerulus - gives cause
67
Management of nephrotic syndrome
- fluid/salt resuscitation - treat cause → 12 weeks prednisolone - treat complications - protein loss → ACEi/ARBs
68
Treatment of complications in nephrotic syndrome
- oedema → loop diuretics - hyperlipidaemia → statins - VTE → heparin - infection → Abs
69
Minimal change disease
- mainly kids - unclear cause → immune mediated - normal appearance in microscopy but abnormal function - diagnosis = biopsy → EM = loss of podocytes
70
Membranous glomerulonephritis
more common in adults causes - antibodies again PLA2R - SLE - NSAIDs - HBV/HCV diagnosis = renal biopsy EM → thickened glomerular basement membrane
71
Focal segmental glomerulosclerosis
adults causes - idiopathic - HIV - sickle cell - heroin diagnosis = presence of scarring on glomeruli
72
Risk factors of testicular cancer
- 20-45 - male - caucasian - cryptorchidism - previous testicular cancer - HIV - family history
73
Presentation of testicular cancer
- palpable lump within the testis - non-transilluminable - haematospermia - often found on self-examination
74
Investigations for testicular cancer
- urgent US of testes - chest xay for pulmonary mets - tumour markers → not always raised
75
Management of testicular cancer
- urgen radical inguinal orchidectomy +/- testicular prosthesis - semen cryopreservation - treat metastatic disease → chemo, radiotherapy, lymph node dissection
76
Features of kidney cancer
- most common type is RCC → malignant cancer of PCT epithelium - often asymptomatic and discovered incidentally - 25% have metastasis at presentation
77
Risk factors of kidney cancer
- haemodialysis - smoking - HTN
78
Presentation of kidney cancer
classic triad - haematuria - flank pain - palpable abdominal mass - classic cancer symptoms - may present with varicocele
79
Investigations for kidney cancer
1. US CT chest/abdomen/pelvis DIAGNOSTIC = renal biopsy
80
Management of kidney cancer
1. full/partial nephrectomy | - mayo prognostic risk score → predict survival, guide treatment
81
Complications of kidney cancer
- polycythaemia - HTN - hypercalcaemia - Cushings
82
Features of bladder cancer
- most common GU tract malignancy | - most common type = transitional cell carcinoma of bladder
83
Risk factors of bladder cancer
- 50-80 - male - caucasian - smoking - pelvic radiation - bladder stone due to chronic inflammation - exposure to dye/rubber/leather/textiles/paint → hairdresser, painter
84
Presentation of bladder cancer
- painless haematuria → visible or non-visible - urgency - suprapubic/pelvis mass/pain - recurrent UTI without bacteriuria - systemic symptoms
85
Investigations for bladder cancer
haematuria clinic - urinalysis → sterile pyuria - CT urogram → staging - bloods - DIAGNOSTIC = flexible cystoscopy
86
Treatment for bladder cancer
- chemo - radiotherapy - symptomatic relief - transurethral resection of bladder tumour - cystodiathermy - cystectomy
87
What is pyelonephritis?
- infection of kidneys/upper ureter - most commonly acquired by ascending transurethral spread - can be via blood or lympatics - majority caused by uropathic e.coli
88
Presentation of pyelonephritis
- triad of loin pain, fever, pyuria - costovertebral joint pain - severe headache - N&V - septic shock if advanced
89
Investigations of pyelonephritis
1. urine dipstick → WBC, microscopic haematuria - bloods → inflammatory markers - urgent US → stones, obstruction GOLD STANDARD = mid-stream MC&S → diagnosis of causative agent
90
Treatment of pyelonephritis
Abs - cefalexin 7-10 days - trimethoprim/amoxicillin if sensitive analgesia → PCM
91
What is prostatitis?
- inflammation and swelling of prostate gland | - most common cause = e.coli
92
Presentation of prostatitis
- very tender prostate → seen on DRE - systemic symptoms → fever, chills, malaise - voiding symptoms
93
Investigations for prostatitis
- U&C → blood and WBCs, bacteria | - bloods cultures if patients febrile
94
Management of prostatitis
Abs | - ciprofloxacin/levofloxacin 14 days
95
Which Abs should you avoid in pregnancy?
- trimethoprim = teratogenic | - nitrofurantoin → avoid at full term
96
Features of UTIs
- presence of microorganisms in the urinary tract - name depends on location - can occur from untreated urolithiasis
97
What are the 5 most common pathogens causing UTIs
KEEPS - klebsiella - e.coli → most common - enterococci - proteus - staph coagulase -ve
98
Presentation of UTIs
voiding symptoms = FUND - frequency - urgency - nocturia - dysuria
99
What is an epididymal cyst?
- smooth extra testicular spherical cyst at the epididymis - contains clear and milky fluid - may be multiple and bilateral - painful if large - most common cause of scrotal swelling
100
Investigation for epididymal cyst
- lump found in posterior aspect of testicle - can palpate cyst and testis separately - US no treatment needed → dissolve in 10 days
101
Epididymitis
- acute pain, unilateral - could be due to previous infection - Prehn's sign +ve - treatment = IM ceftriaxone (organism unknown) and doxycycline
102
What is hydrocele?
- abnormal collection of fluid in tunica vaginalis
103
What are the two types of hydrocele?
- simple = overproduction of fluid | - communicating = peritoneal fluid and scrotum are connected
104
Presentation of hydrocele
- non tender smooth cystic swelling - painless unless infected - transluminates
105
Treatment of hydrocele
- most resolve spontaneously | - similar to testicular cancer → rule out
106
What is nephritic syndrome?
syndrome presenting as inflammation within the kidney
107
Key features of nephritic syndrome
- haematuria → kidney inflammation - oliguria → decreased GFR - proteinuria - HTN → fluid overload
108
Causes of nephritic syndrome
- SLE - post strep glomerulonephritis - small vessel vasculitis - Goodpasture's - IgA nephropathy
109
Investigations for nephritic syndrome
DIAGNOSTIC = kidney biopsy → cause - urinalysis → haematuria - bloods → high ESR, CRP
110
Management of nephritic syndrome
- treat underlying cause - ACEi/ARB → reduced proteinuria, preserves renal function - corticosteroids → reduce inflammation
111
What is IgA nephropathy
- AKA Berger disease | - deposition of IgA into mesangium of kidney → inflammation and damage
112
Presentation of IgA nephropathy
- asymptomatic | - microscopic haematuria
113
Diagnosis of IgA nephropathy
- biopsy | - same management as nephritic syndrome
114
What is post strep GN?
- nephritic syndrome following infection 3-6 weeks before | - deopsition of atrep antigen in glomeruli → inflammation and damage
115
Presentation of post strep GN
- haematuria - acute nephritis diagnosed by evidence of strep infection
116
Treatment of post strep GN
- Abs to clear strep | - supportive care
117
What is Goodpasture's
- autoantibodies to type4 collagen in glomerular and alveolar membrane - can cause rapidly progressing glomerulonephritis → renal failure
118
Presentation of Goodpasture's
- SOB | - oliguria
119
Diagnosis of Goodpasture's
anti-GBM autoantibodies in bloods and biopsy
120
Management of Goodpasture's
- plasma exchange - steroids - cyclophosphamide → immune suppression
121
What is PKD
- clusters of cysts develop within kidneys - autosomal dominant - PKD1 and PKD2 genes on Cr16
122
Pathophysiology of PKD
1. cysts develop and grow over time in tubular part of nephron 2. compression of renal architecture and vasculature 3 progressive impairment
123
Risk factors of PKD
- family history of PKD/CVS events - male - caucasian
124
Presentation of PKD
- HTN - abdominal/flank pain - headaches - LUTS - palpable cysts
125
Investigations for PKD
renal US then biopsy - <30 → 2 cysts - 30-59 → 2 cysts in each kidney - >60 → 4 cysts in each kidney
126
Management of PKD
- treat HTN - infected - Abs, drain - surgical removal → nephrectomy - chronic → dialysis/transplant
127
Complications of PKD
- berry aneurysms → rupture causes sub-arachnoid haemorrhage - cysts on other organs - ventricular hypertrophy
128
What is chlamydia?
- most common bacterial STI | - caused by chlamyrdia trachomatis
129
Presentation of chlamydia
men - testicular pain - voiding synptoms, dysuria - 50% asymptomatic women - vaginal discharge and dysuria - white/yellow/green discharge - 70% asymptomatic
130
Diagnosis of chlamydia
nucleic acid amplification testing
131
Management of chlamydia
- avoid sex until treatment finished - contact tracing - single dose azithromycin - 7 days doxycycline
132
What is gonorrhoea?
- caused by Neisseria gonorrhoea | - second most common STI
133
Presentation of gonorrhoea
- more likely to be asymptomatic - men → dysuria, frequency , discharge - women → vaginal discharge, dysuria, pelvic pain
134
Investigations for gonorrhoea
- NAAT - microscopy → gram =ve diplococci - culture → all infected areas with a swab
135
Treatment of gonorrhoea
- single ceftriaxone IM dose

Phase 2a Resits (10 decks)

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