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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
Q

Management of CKD

A
  • treat DM, HTN, glomerulonephritis
  • reduce risk of CVD → atorvastatin
  • manage complications
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26
Q

Managing complications of CKD

A
  • mineral bone disease → low vitD
  • HTN
  • proteinuria
  • anaemia → ESA
  • RRT
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27
Q

When should renal replacement therapy be considered?

A
  • ESRF
  • acidosis not responsive to bicarb
  • persistent electrolyte disturbances
  • persistent oedema
  • severe symptoms of uraemia
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28
Q

What are the types of RRT?

A
  • haemodialysis
  • peritoneal dialysis
  • renal transplant
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29
Q

Physiology of prostate

A
  • produces testosterone and dihydrotestosterone

- production of PSA → liquefies semen

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30
Q

What is BPH?

A
  • hyperplasia of inner transitional zone of prostate gland
  • partially blocks urethra
  • normal part of ageing for men
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31
Q

Presentation of BPH

A

LUTS

storage

  • frequency
  • urgency
  • nocturia
  • urgency incontinence

voiding

  • poor/intermittent stream
  • post-micturition dribbling
  • straining
  • incomplete emptying
  • hesitancy
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32
Q

Investigations for BPH

A
  • DRE → smooth but enlarged prostate
  • PSA → not very accurate
  • bladder diaries
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33
Q

Management of BPH

A
  • 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,

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34
Q

Features of prostate cancer

A
  • most common male malignancy

- most slow growing but can be aggressive/malignant

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35
Q

Risk factors for prostate cancer

A
  • Afro-Caribbean
  • family history/genetics
  • increasing age
  • anabolic steroids
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36
Q

Presentation of prostate cancer

A
  • LUTS
  • weight loss
  • fatigue
  • night sweats
  • bone pain
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37
Q

Whee does prostate cancer metastasise to?

A
  • bone → sclerotic bony lesions
  • brain
  • liver
  • lung
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38
Q

Investigations for prostate cancer

A
  • community → DRE, PSA
  • DIAGNOSTIC = transrectal USS and biopsy
  • gleason grading system
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39
Q

Management of prostate cancer

A

local

  • prostatectomy <70
  • active surveillance >70, low risk
  • radiotherapy

metastatic

  • chemo
  • radiotherapy
  • bilateral orchidectomy
  • goserelin
  • palliative care to relieve symptoms
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40
Q

What is urethritis?

A
  • uretheral inflammation due to infectious or non-infectious cause
  • non-gonococcal uretheritis more common than gonococcal
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41
Q

Causes of urethritis

A
  • N.gonorrhoea
  • chlamydia
  • trauma
  • urethral stricture
  • urinary calculi
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42
Q

Presentation of urethritis

A
  • skin lesion
  • dysuria +/- discharge (blood/pus)
  • urethral pain
  • penile discomfort/pruritus
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43
Q

Investigations for urethritis

A
  • STI testing
  • M&C urethral discharge
  • bood cultures
  • urine dipstick
  • urethral smear
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44
Q

Management of urethritis

A
  • management of underlying cause → Abs, partner notification
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45
Q

What condition is important to think about with urethritis?

A

reactive arthritis

  • conjunctivitis
  • urethritis
  • arthritis

can’t see, can’t pee, can’t climb a tree

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46
Q

What is cystitis?

A
  • infection of urinary bladder

- most common in sexually active young women

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47
Q

Risk factors of cystitis

A
  • history of UTI
  • diabetes
  • pregnancy
  • catheterisation
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48
Q

Microorganisms that cause cystitis

A

KEEPS

  • klebsiella
  • E.coli → most common
  • enterococci
  • proteus species
  • staph aureus
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49
Q

Presentation of cystitis

A
  • dysuria
  • frequency
  • urgency
  • suprapubic pain
  • haematuria and polyuria
  • incontinence
  • confusion in elderly
  • cloudy smelly urine
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50
Q

Investigations for cystitis

A
  1. urine dipstick → high leukocytes/nitrates, blood

GOLD STANDARD = mid-stream MC&S

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51
Q

Management of cystitis

A
  • trimethoprim/nitrofurantoin → 3 days (f), 7 days (m)

- in pregnancy → amoxicillin, cefalexin

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52
Q

What is variocele?

A
  • abnormal dilation of testicular veins in pampiniform venous plexus
  • left side more commonly affected
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53
Q

Presentation of variocele

A
  • feels like a bag of worms

- dragging/soreness/heaviness of scrotum

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54
Q

Management of variocele

A
  • conservative

- surgical repair if pain infertility, testicular atrophy

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55
Q

Diagnosis of variocele

A

US and Doppler

56
Q

What is testicular torsion?

A
  • medical emergency

- twisting of spermatic cord with rotation of testicle

57
Q

Presentation of testicular torsion

A
  • acute severe pain
  • unilateral, swollen, tender
  • retracted upwards
58
Q

Diagnosis of testicular torsion

A

examination

  • firm swollen testicle
  • rotation → epididymis is not in normal posterior position
  • Prehn’s -ve

can do US but not essential → whirlpool sign

59
Q

Management of testicular torsion

A

de-torsion → orchiopexy

60
Q

What is nephrotic syndrome?

A

issue with filtration barrier

61
Q

What is the characterising triad in nephrotic syndrome?

A
  • proteinuria >3
  • hypoalbuminaemia → loss of albumin in urine
  • oedema → loss of oncotic pressure
62
Q

Presentation of nephrotic syndrome

A
  • frothy urine
  • infection
  • xanthelasma
  • xanthomata
  • athersclerosis
  • fatigue
  • dyspnoea
  • leukonychia
63
Q

Pathophysiology of nephrotic syndrome

A
  1. inflammation
  2. damage to podocytes → protein leakage
  3. increased liver activity → increases albumin and then cholesterol, coag factors
  4. reduced oncotic pressure
64
Q

Causes of nephrotic syndrome

A

occurs due to renal disease disrupting kidney function

  • minimal change disease
  • focal segmental glomerulosclerosis
  • membranous nephropathy
65
Q

Secondary causes of nephrotic syndrome

A
  • diabetic nephropathy
  • SLE
  • amyloidosis
  • hepB,C
  • HIV
66
Q

Investigations of nephrotic syndrome

A
  • 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
Q

Management of nephrotic syndrome

A
  • fluid/salt resuscitation
  • treat cause → 12 weeks prednisolone
  • treat complications
  • protein loss → ACEi/ARBs
68
Q

Treatment of complications in nephrotic syndrome

A
  • oedema → loop diuretics
  • hyperlipidaemia → statins
  • VTE → heparin
  • infection → Abs
69
Q

Minimal change disease

A
  • mainly kids
  • unclear cause → immune mediated
  • normal appearance in microscopy but abnormal function
  • diagnosis = biopsy → EM = loss of podocytes
70
Q

Membranous glomerulonephritis

A

more common in adults

causes

  • antibodies again PLA2R
  • SLE
  • NSAIDs
  • HBV/HCV

diagnosis = renal biopsy EM → thickened glomerular basement membrane

71
Q

Focal segmental glomerulosclerosis

A

adults

causes

  • idiopathic
  • HIV
  • sickle cell
  • heroin

diagnosis = presence of scarring on glomeruli

72
Q

Risk factors of testicular cancer

A
  • 20-45
  • male
  • caucasian
  • cryptorchidism
  • previous testicular cancer
  • HIV
  • family history
73
Q

Presentation of testicular cancer

A
  • palpable lump within the testis
  • non-transilluminable
  • haematospermia
  • often found on self-examination
74
Q

Investigations for testicular cancer

A
  • urgent US of testes
  • chest xay for pulmonary mets
  • tumour markers → not always raised
75
Q

Management of testicular cancer

A
  • urgen radical inguinal orchidectomy +/- testicular prosthesis
  • semen cryopreservation
  • treat metastatic disease → chemo, radiotherapy, lymph node dissection
76
Q

Features of kidney cancer

A
  • most common type is RCC → malignant cancer of PCT epithelium
  • often asymptomatic and discovered incidentally
  • 25% have metastasis at presentation
77
Q

Risk factors of kidney cancer

A
  • haemodialysis
  • smoking
  • HTN
78
Q

Presentation of kidney cancer

A

classic triad

  • haematuria
  • flank pain
  • palpable abdominal mass
  • classic cancer symptoms
  • may present with varicocele
79
Q

Investigations for kidney cancer

A
  1. US

CT chest/abdomen/pelvis

DIAGNOSTIC = renal biopsy

80
Q

Management of kidney cancer

A
  1. full/partial nephrectomy

- mayo prognostic risk score → predict survival, guide treatment

81
Q

Complications of kidney cancer

A
  • polycythaemia
  • HTN
  • hypercalcaemia
  • Cushings
82
Q

Features of bladder cancer

A
  • most common GU tract malignancy

- most common type = transitional cell carcinoma of bladder

83
Q

Risk factors of bladder cancer

A
  • 50-80
  • male
  • caucasian
  • smoking
  • pelvic radiation
  • bladder stone due to chronic inflammation
  • exposure to dye/rubber/leather/textiles/paint → hairdresser, painter
84
Q

Presentation of bladder cancer

A
  • painless haematuria → visible or non-visible
  • urgency
  • suprapubic/pelvis mass/pain
  • recurrent UTI without bacteriuria
  • systemic symptoms
85
Q

Investigations for bladder cancer

A

haematuria clinic

  • urinalysis → sterile pyuria
  • CT urogram → staging
  • bloods
  • DIAGNOSTIC = flexible cystoscopy
86
Q

Treatment for bladder cancer

A
  • chemo
  • radiotherapy
  • symptomatic relief
  • transurethral resection of bladder tumour
  • cystodiathermy
  • cystectomy
87
Q

What is pyelonephritis?

A
  • 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
Q

Presentation of pyelonephritis

A
  • triad of loin pain, fever, pyuria
  • costovertebral joint pain
  • severe headache
  • N&V
  • septic shock if advanced
89
Q

Investigations of pyelonephritis

A
  1. urine dipstick → WBC, microscopic haematuria
  • bloods → inflammatory markers
  • urgent US → stones, obstruction

GOLD STANDARD = mid-stream MC&S → diagnosis of causative agent

90
Q

Treatment of pyelonephritis

A

Abs

  • cefalexin 7-10 days
  • trimethoprim/amoxicillin if sensitive

analgesia → PCM

91
Q

What is prostatitis?

A
  • inflammation and swelling of prostate gland

- most common cause = e.coli

92
Q

Presentation of prostatitis

A
  • very tender prostate → seen on DRE
  • systemic symptoms → fever, chills, malaise
  • voiding symptoms
93
Q

Investigations for prostatitis

A
  • U&C → blood and WBCs, bacteria

- bloods cultures if patients febrile

94
Q

Management of prostatitis

A

Abs

- ciprofloxacin/levofloxacin 14 days

95
Q

Which Abs should you avoid in pregnancy?

A
  • trimethoprim = teratogenic

- nitrofurantoin → avoid at full term

96
Q

Features of UTIs

A
  • presence of microorganisms in the urinary tract
  • name depends on location
  • can occur from untreated urolithiasis
97
Q

What are the 5 most common pathogens causing UTIs

A

KEEPS

  • klebsiella
  • e.coli → most common
  • enterococci
  • proteus
  • staph coagulase -ve
98
Q

Presentation of UTIs

A

voiding symptoms = FUND

  • frequency
  • urgency
  • nocturia
  • dysuria
99
Q

What is an epididymal cyst?

A
  • 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
Q

Investigation for epididymal cyst

A
  • lump found in posterior aspect of testicle
  • can palpate cyst and testis separately
  • US

no treatment needed → dissolve in 10 days

101
Q

Epididymitis

A
  • acute pain, unilateral
  • could be due to previous infection
  • Prehn’s sign +ve
  • treatment = IM ceftriaxone (organism unknown) and doxycycline
102
Q

What is hydrocele?

A
  • abnormal collection of fluid in tunica vaginalis
103
Q

What are the two types of hydrocele?

A
  • simple = overproduction of fluid

- communicating = peritoneal fluid and scrotum are connected

104
Q

Presentation of hydrocele

A
  • non tender smooth cystic swelling
  • painless unless infected
  • transluminates
105
Q

Treatment of hydrocele

A
  • most resolve spontaneously

- similar to testicular cancer → rule out

106
Q

What is nephritic syndrome?

A

syndrome presenting as inflammation within the kidney

107
Q

Key features of nephritic syndrome

A
  • haematuria → kidney inflammation
  • oliguria → decreased GFR
  • proteinuria
  • HTN → fluid overload
108
Q

Causes of nephritic syndrome

A
  • SLE
  • post strep glomerulonephritis
  • small vessel vasculitis
  • Goodpasture’s
  • IgA nephropathy
109
Q

Investigations for nephritic syndrome

A

DIAGNOSTIC = kidney biopsy → cause

  • urinalysis → haematuria
  • bloods → high ESR, CRP
110
Q

Management of nephritic syndrome

A
  • treat underlying cause
  • ACEi/ARB → reduced proteinuria, preserves renal function
  • corticosteroids → reduce inflammation
111
Q

What is IgA nephropathy

A
  • AKA Berger disease

- deposition of IgA into mesangium of kidney → inflammation and damage

112
Q

Presentation of IgA nephropathy

A
  • asymptomatic

- microscopic haematuria

113
Q

Diagnosis of IgA nephropathy

A
  • biopsy

- same management as nephritic syndrome

114
Q

What is post strep GN?

A
  • nephritic syndrome following infection 3-6 weeks before

- deopsition of atrep antigen in glomeruli → inflammation and damage

115
Q

Presentation of post strep GN

A
  • haematuria
  • acute nephritis

diagnosed by evidence of strep infection

116
Q

Treatment of post strep GN

A
  • Abs to clear strep

- supportive care

117
Q

What is Goodpasture’s

A
  • autoantibodies to type4 collagen in glomerular and alveolar membrane
  • can cause rapidly progressing glomerulonephritis → renal failure
118
Q

Presentation of Goodpasture’s

A
  • SOB

- oliguria

119
Q

Diagnosis of Goodpasture’s

A

anti-GBM autoantibodies in bloods and biopsy

120
Q

Management of Goodpasture’s

A
  • plasma exchange
  • steroids
  • cyclophosphamide → immune suppression
121
Q

What is PKD

A
  • clusters of cysts develop within kidneys
  • autosomal dominant
  • PKD1 and PKD2 genes on Cr16
122
Q

Pathophysiology of PKD

A
  1. cysts develop and grow over time in tubular part of nephron
  2. compression of renal architecture and vasculature
    3 progressive impairment
123
Q

Risk factors of PKD

A
  • family history of PKD/CVS events
  • male
  • caucasian
124
Q

Presentation of PKD

A
  • HTN
  • abdominal/flank pain
  • headaches
  • LUTS
  • palpable cysts
125
Q

Investigations for PKD

A

renal US then biopsy

  • <30 → 2 cysts
  • 30-59 → 2 cysts in each kidney
  • > 60 → 4 cysts in each kidney
126
Q

Management of PKD

A
  • treat HTN
  • infected - Abs, drain
  • surgical removal → nephrectomy
  • chronic → dialysis/transplant
127
Q

Complications of PKD

A
  • berry aneurysms → rupture causes sub-arachnoid haemorrhage
  • cysts on other organs
  • ventricular hypertrophy
128
Q

What is chlamydia?

A
  • most common bacterial STI

- caused by chlamyrdia trachomatis

129
Q

Presentation of chlamydia

A

men

  • testicular pain
  • voiding synptoms, dysuria
  • 50% asymptomatic

women

  • vaginal discharge and dysuria
  • white/yellow/green discharge
  • 70% asymptomatic
130
Q

Diagnosis of chlamydia

A

nucleic acid amplification testing

131
Q

Management of chlamydia

A
  • avoid sex until treatment finished
  • contact tracing
  • single dose azithromycin
  • 7 days doxycycline
132
Q

What is gonorrhoea?

A
  • caused by Neisseria gonorrhoea

- second most common STI

133
Q

Presentation of gonorrhoea

A
  • more likely to be asymptomatic
  • men → dysuria, frequency , discharge
  • women → vaginal discharge, dysuria, pelvic pain
134
Q

Investigations for gonorrhoea

A
  • NAAT
  • microscopy → gram =ve diplococci
  • culture → all infected areas with a swab
135
Q

Treatment of gonorrhoea

A
  • single ceftriaxone IM dose

Phase 2a Resits (10 decks)

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