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Genitourinary Flashcards

1
Q

What is nephrolithiasis?

A

The presence of crystalline stones within the urinary system (Renal colic)

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2
Q

What are the risk factors for nephrolithiasis?

A
  • Dehydration
  • High salt diet
  • White
  • Male
  • Obesity
  • Crystalluria
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3
Q

What are the signs and symptoms of nephrolithiasis?

A
  • Nausea and vomiting
  • Urinary frequency/urgency
  • Haematuria
  • Testicular pain
  • Fever
  • Tachycardia
  • Hypotension
  • Loin pain
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4
Q

How is nephrolithiasis diagnosed?

A
  1. If pregnant/child - renal ultrasound
  2. Non-pregnant adult - Non-contrast CT Kidneys, Ureter, Bladder (NCCT-KUB)
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5
Q

How is nephrolithiasis managed?

A
  1. Symptomatic relief
    - Hydration
    - Analgesia
    - Antiemetics
  2. Watch and wait (if asymptomatic and stone <5mm)
    - Observe for sepsis
  3. Surgery for stones >10mm (or intolerable pain)
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6
Q

What are the methods of drainage for obstructed kidneys?

A
  • Nephrostomy
  • Ureteric stent
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7
Q

What is the surgical management of kidney stones?

A
  • Shock wave lithotripsy
  • Ureteroscopy
  • Percutaneous nephrolithotomy (larger stones)
  • Nephrectomy
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8
Q

What is the management of ureteric stones?

A
  • Conservative management
  • Drainage
  • Medical expulsive therapy
  • Surgical management
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9
Q

What is the management of bladder stones?

A
  • Conservative management
  • Endoscopy
  • Open/laparoscopic surgery (larger stones)
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10
Q

What is acute kidney injury (AKI)?

A

An acute decline in kidney function → rise in serum calcium and/or fall in urine output

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11
Q

What is the pathophysiology of acute kidney injury?

A
  • Pre-renal: impaired kidney perfusion
  • Renal: dysfunction of the kidney
  • Post-renal: blockage of urinary outflow tract
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12
Q

What are the risk factors for AKI?

A
  • Age (>65)
  • Previous AKI
  • Myeloproliferative disorder
  • NSAIDs, ACEi and ARB
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13
Q

What are the signs and symptoms of AKI?

A
  • Hypotension/hypovolaemia
  • Reduced urinary output
  • Lower urinary tract symptoms (LUTS)
  • Nausea and vomiting
  • Haematuria
  • Fever/rash
  • Dizziness
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14
Q

How is AKI diagnosed?

A
  • Urinary output < 0.5ml/kg/hour for more than 6 hours
  • Serum creatinine increased by 1.5x (in past week)
  • Serum creatinine increase by >25µmol/l in 48 hours
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15
Q

What are the differentials for AKI?

A
  • CKD
  • Increased muscle mass
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16
Q

What is the management for AKIs?

A
  • Supportive therapy with monitoring of volume status and electrolytes
  • Treatment of the underlying cause
  • Management of complications
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17
Q

What are the complications of AKI?

A
  • Hyperphosphataemia
  • Uraemia
  • Hyperkalaemia
  • Chronic progressive kidney disease
  • End-stage kidney disease
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18
Q

What is chronic kidney failure?

A
  • Chronic renal failure
  • Abnormalities of kidney structure or function
  • Present for >3 months
  • Health implications
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19
Q

How is CKD defined?

A

GFR <60 ml/min/1.73m^2

Or one of the following:
- Albuminuria/proteinuria
- Urine sediment abnormalities
- Electrolyte abnormalities
- Histological abnormalities
- Structural abnormalities
- Kidney transplant

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20
Q

What are the causes of CKD?

A
  • Diabetes
  • Hypertension
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21
Q

What are the risk factor for CKD?

A
  • Diabetes Mellitus
  • Hypertension
  • Age >50
  • Childhood kidney disease
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22
Q

What are the common signs and symptoms of CKD?

A
  • Fatigue
  • Oedema
  • Nausea (and/or vomiting)
  • Pruritis
  • Anorexia
  • Rashes
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23
Q

What are the less common signs and symptoms of CKD?

A
  • Arthralgia
  • Enlarged prostate
  • Foamy/cola urine
  • Orthopnoea/dyspnoea
  • Seizures
  • Retinopathy
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24
Q

How is CKD diagnosed?

A
  • Renal chemistry (serum creatinine and electrolytes)
  • eGFR
  • Urine analysis (haematuria, proteinuria)
  • Urinary albumin
  • Ultrasound (size, obstruction, renal colic)
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25
What are the differentials for CKD?
- Diabetic kidney disease - Hypertensive nephrosclerosis - Ischaemic neuropathy - Obstructive uropathy - Nephrotic syndrome - Glomerulonephritis
26
What is the management of CKD?
- Slow the progression of loss of kidney function - Prevent need for transplant/renal replacement therapy - Manage underlying cause
27
What are the complications of CKD?
- Anaemia - Renal osteodystrophy - CVD - Protein malnutrition - Metabolic acidosis - Hyperkalaemia - Pulmonary oedema
28
What is the pathophysiology of prostate cancer?
- High-grade prostatic intra-epithelial neoplasm - Cellular proliferation along existing ducts and glands - Cytological changes mimicking neoplasm
29
What are the risk factors for prostate cancer?
- Age >50 - Black - Family history
30
What are the signs and symptoms of prostate cancer?
- Nocturia - Urinary frequency/hesitancy - Dysuria - Abnormal digital rectal examination - Haematuria - Weight loss - Lethargy - Palpable lymph nodes
31
How is prostate cancer diagnosed?
- Raised prostate-specific antigen - Prostate biopsy
32
What are the differentials for prostate cancer?
- Benign prostatic hyperplasia - Chronic prostatitis
33
What is the management of prostate cancer?
- Active surveillance - Androgen deprivation therapy - External-beam radiotherapy - Brachytherapy - Radical prostatectomy
34
What are the risk factors for testicular cancer?
- Cryptochidism - Gonadal dysgenesis - Family/personal history - Testicular hypertrophy - White - HIV infection
35
What are the signs and symptoms of testicular cancer?
- Lump/enlargement of one testicle - Feeling of heaviness in the scrotum - Dull ache in the abdomen or groin - Fluid in the scrotum - Pain or discomfort - Back pain
36
How is testicular cancer diagnosed?
- Ultrasound with colour doppler of testis - Serum beta-human chorionic gonadotrophin - Serum-alpha-fetoprotein - Serum LDH - Histology
37
What are the differentials for testicular cancer?
- Testicular torsion - Epididymo-orchitis - Scrotal hernia - Hydrocele - Epididymal cyst - Haematoma
38
How is testicular cancer managed?
Removal of affected testes.
39
What are the complications of testicular cancer?
Infertility
40
What is the pathophysiology of benign prostatic hyperplasia?
- Hyperplasia of both epithelial and stromal prostatic components - Increased stomal: epithelial ratio - Can result in bladder obstruction
41
What are the risk factors for benign prostatic hyperplasia?
- Age - Family history - Smoking - Male pattern baldness - Metabolic syndrome
42
What are the signs and symptoms of benign prostatic hyperplasia?
1. Storage symptoms - Frequency - Urgency - Nocturia 2. Voiding symptoms - Weak stream - Hesitancy - Intermittency - Straining
43
How is benign prostatic hyperplasia diagnosed?
Prostate-specific antigen (PSA) test.
44
What are the differentials for benign prostatic hyperplasia?
- Overactive bladder - Prostatitis - UTI - Bladder cancer - Neurogenic bladder - Urethral structure
45
How is benign prostatic hyperplasia managed?
- Behavioural management - Medication review - Alpha blockers - Surgery
46
What are the complications of benign prostatic hyperplasia?
- UTI - Renal insufficiency - Bladder stones - Haematuria - Sexual dysfunction - Acute urinary retention - Overactive bladder
47
What is urethritis?
- Usually an STI - Divided into gonococcal and non-gonococcal
48
What is the pathophysiology of urethritis?
- Bacteria generally must attach to human cells to infect them - Antigenic variation arises quickly (can bind to multiple cells and avoid immune system)
49
What causes urethritis?
- N. gonorrhoeae - C. trachomatis - M. genitalium - U. urealyticum
50
What are the risk factors for urethritis?
- 15-24 years old - Female sex - MSM - Low socio-economic status - Multiple/new sexual partners - Prior/current STI - Unprotected sex
51
What are the signs and symptoms of urethritis?
- Urethral discharge - Urethral pruritus/irritation - Dysuria - Orchalgia
52
How is urethritis diagnosed?
- Gram stain of urethral discharge - Nucleic acid amplification test - Culture of urethral discharge
53
What are the differentials for urethritis?
- Candida balanitis or vaginitis - Non-infectious urethritis - Nephrolithiasis - Interstitial cystitis - Chronic prostatitis
54
How is urethritis managed?
- Alleviate acute symptoms and prevent transmission - Sex abstinence - Treat both gonococcal and non-gonococcal until confirmed which it is
55
What are the possible complications of urethritis?
- Chronic non-gonococcal urethritis - Genitourinary abscess - Urethral stricture/fistula - Epididymitis - Disseminated gonococcal infection - Pneumonia
56
What is pyelonephritis?
A severe infectious inflammatory disease of the kidney which can be acute, recurrent or chronic.
57
What is the pathophysiology of acute pyelonephritis?
- A result of ascending UTI - Haematogenous seeding in patients with bacteraemia - Blockage can lead to treatment failure and renal abscess
58
What are the causes of acute pyelonephritis?
- Gram-negative bacteria - E.coli most common
59
What are the risk factors for acute pyelonephritis?
- Hx/FHx of UTIs - Stress incontinence - Diabetes - Catheter/renal stones - Urinary abnormality - Immunosuppression - New sexual partner - Pregnancy
60
What are the investigations for acute pyelonephritis?
1. Urinalysis: - +ve leukocytes - +ve nitrites - Non-visible haematuria - WBC casts 2. Urine culture and sensitivity 3. US to rule out obstruction
61
What are the differentials for acute pyelonephritis?
- LUTI - Cystitis - Acute prostatitis - Urethritis - Chronic pyelonephritis - Pelvic inflammatory disease
62
What is the management of acute pyelonephritis?
- Antibiotics
63
What are the possible complications of acute pyelonepritis?
- Renal failure - Sepsis - Renal abscess formation - Emphysematous pyelonephritis - Parenchymal renal scarring - Recurrent UTIs
64
What are the causes of chronic pyelonephritis?
- Recurrent infections resulting from anatomical abnormalities - Vesicoureteral reflux - Inadequate treatment/recurrence of acute pyelonephritis
65
What are the risk factors for chronic pyelonephritis?
- Acute pyelonephritis - Vesicoureteral reflux - Obstruction - Renal caliculi - Diabetes mellitus
66
How is chronic pyelonephritis diagnosed?
- Renal function tests - Electrolyte panel - FBC - Renal ultrasound - Kidney-ureter-bladder X-ray - CT abdomen
67
What are the differentials for chronic pyelonephritis?
- Acute pyelonephritis - Renal caliculi - Renal cancer
68
How is chronic pyelonephritis managed?
- No specific treatment available - Renal damage is not reversible - Eliminate UTIs - Repair anatomical or functional issues
69
What are the possible complications of chronic pyelonephritis?
- AKI - Hyperparathyroidism - Obstruction - CKD
70
What is the pathophysiology of prostatitis?
- Many ways to develop it - Intraprostatic reflux - Elevated IgG and IgA
71
What causes prostatitis?
E coli
72
What are the risk factors for prostatitis?
- UTI - Benign prostatic enlargement - Urinary tract instrumentation/manipulation
73
What are the signs and symptoms of prostatitis?
- Fever - Chills - Malaise - Tender prostate - <50 - Urinary frequency - Dysuria
74
How is prostatitis diagnosed?
- Urinalysis - Urine culture - Culture of prostatic secretions - Blood cultures
75
What are the differentials for prostatitis?
- BPH - Prostate cancer - UTI - Bladder cancer - Colorectal cancer - Epididimytis/orchiditis
76
How is prostatitis managed?
Antibiotics (quinolone)
77
What are the possible complications of prostatitis?
- Urinary retention - Sepsis - Prostatic abscess - Chronic prostatitis
78
What is the pathophysiology of cystitis?
- E. coli commensal to GIT or vagina can infect the urethra - Can occur due to sex or infection of surrounding tissues
79
What causes cystitis?
E coli
80
What are the risk factors for cystitis?
- Frequent sexual intercourse - History of UTIs - Congenital abnormality - Urinary catheter - Diabetes mellitus - Spinal cord injuries - Pregnancy - Immunodeficiency - Older age
81
What are the signs and symptoms of cystitis?
- Dysuria - Urgency and frequency - Suprapubic pain - Abdo pain - Fever - Vaginal discharge and pruritus
82
What are the investigations for cystitis?
- Urinalysis - Urine microscopy - Urine culture and sensitivity
83
What are the differentials for cystitis?
- Pyelonephritis - Vaginitis - Interstitial cystitis - Chlamydia urethritis
84
What is the management for cystitis?
Antibiotics
85
What are the possible complications of cystitis?
- Pyelonephritis - Preterm delivery - Urinary retention - Recurrent UTIs
86
What is a varicocele?
Abnormal dilation of the internal spermatic veins and pampiniform plexus.
87
What is the pathophysiology of a varicocele?
The exact cause is unknown, thought to be a dysfunction of the countercurrent multiplier system. Associated with: - Abnormal gonadotropin levels - Impaired spermatogenesis - Histological changes to sperm - Infertility
88
What are the signs and symptoms of varicocele?
- Painless scrotal mass - Left-sided signs/symptoms - Small testicle - Infertility
89
How are varicoceles diagnosed?
Clinical examination.
90
What are the differentials for varicoceles?
- Paratesticular mass - Cord hydrocele - Inguinal hernia - Spermatocele
91
How are varicoceles managed?
Surgical repair.
92
What is an epididymal cyst?
A smooth, extratesticular, spherical cyst in the head of the epididymis.
93
What is the pathophysiology of an epididymal cyst?
- Clean and milky (spermatocele) fluid - Lie above the head of the testes
94
What is the clinical presentation of an epididymal cyst?
- Lump - May be painful if large - Well defined - Testis palpable separate to the cyst
95
How is an epididymal cyst diagnosed?
Ultrasound
96
What are the differentials for an epididymal cyst?
- Spermatocele - Hydrocele - Varicocele
97
How is an epididymal cyst managed?
- Treatment normally not required - If painful and symptomatic; excision
98
What is a hydrocele?
A collection of serous fluid between tunica vaginalis that surrounds the testes or along the spermatic cord. Can be communicating and non-communicating.
99
What are the risk factors for hydrocele?
- Male sex - Prematurity/ low birth weight - Infant - Late descent of testes - Increased intraperitoneal fluid/pressure - Inflammation/injury within scrotum - Testicular cancer - Connective tissue disorders
100
What are the signs and symptoms of hydrocele?
- Scrotal mass - Transillumination - Enlargement of scrotal mass following activity - Variation in scrotal mass during the day
101
How are hydroceles diagnosed?
Clinically - no tests are done
102
What are the differentials for hydroceles?
- Inguinal hernia - Testicular cancer - Epididymitis - Epididymo-orchitis - Epididymal cyst - Scrotal oedema - Testicular torsion - Varicocele
103
How are hydroceles managed?
- Surgery if large or uncomfortable - Aspiration can be considered
104
What are the possible complications of hydroceles?
- Haematoma - Inguinal hernia - Pain in inguinal area - Lower extremity oedema - Testicular atrophy - Infertility
105
What is nephritic syndrome?
A collection of signs and symptoms that occur as a result of inflammation in the kidneys. Affects kidney function and causes protein and blood to leak into the urine.
106
What is the pathophysiology of nephritic syndrome?
Largely triggered by immune-mediated injury exhibiting both humoral and cellular components. A variety of non-immunological metabolic, haemodynamic and toxic stress can also induce glomerular injury.
107
What causes nephritic syndrome?
1. Type III hypersensitivity - Post-streptococcal glomerulonephritis - IgA nephropathy - Diffuse proliferative glomerulonephritis 2. Multiple causes - Membranoproliferative glomerulonephritis - Rapidly progressive glomerulonephritis 3. Defect in collagen synthesis - Alport syndrome
108
What are the risk factors for nephritic syndrome?
- Infection - Systemic Lupus Erythematosus - Systemic vasculitis - Neoplasms (lymphoma, lung, colorectal etc) - Haemolytic uraemia syndrome - Drugs
109
What are the signs and symptoms of nephritic syndrome?
Most common: - Haematuria - Sub-nephrotic-range proteinuria - Oedema - Hypertension - Oliguria
110
How is nephritic syndrome diagnosed?
- Bloods (increased creatinine and BUN) - Urinalysis (haematuria and proteinuria) - Renal biopsy
111
What are the differentials for nephritic syndrome?
- Nephrolithiasis - Bladder cancer - Renal cancer - Pre or post-renal failure
112
How is nephritic syndrome managed?
- Reverse renal damage + preserve renal function - Treat systemic cause - Immunosuppression (eg. steroids) - Blood pressure control (ACEi/ARB)
113
What are the possible complications of nephritic syndrome?
- AKI - CKD
114
What is nephrotic syndrome?
Triad of: - Proteinuria - Hypoalbuminemia - Peripheral oedema Hyperlipidaemia and thrombotic disease often comorbid.
115
What is the pathophysiology of nephrotic syndrome?
Glomerular proteinuria develops when components of the filtration barrier are disrupted. The liver compensates the loss of albumin, contributing to the development of lipid abnormalities including hypercholesterolaemia and hypertriglyceridaemia.
116
What causes nephrotic syndrome?
- Can be primary or secondary - Focal segmented glomerulosclerosis - Membrane nephropathy - Diabetic nephropathy - Amyloidosis
117
What are the risk factors for the development of nephrotic syndrome?
- Conditions affecting the kidneys - Drugs (eg. NSAIDs) - Infections (HIV, Hep B/C, malaria)
118
What are the signs and symptoms of nephrotic syndrome?
- Oedema - Foamy urine - Weight gain (fluid retention) - Fatigue - Loss of appetite - Albuminuria - Hyperlipidaemia - Proteinuria
119
How is nephrotic syndrome diagnosed?
- 24h urine collection (protein levels >3.5mg) - Renal biopsy
120
What are the differentials for nephrotic syndrome?
- Minimal change disease - Focal segmental glomerulosclerosis - Membranous nephropathy - Diabetic nephropathy - Multiple myeloma-associated AL amyloidosis - IgA nephropathy
121
How is nephrotic syndrome treated?
- Sodium and fluid restriction - High dose diuretic treatment - Steroids - Blood pressure control
122
What are the possible complications of nephrotic syndrome?
- Infections - Venous thromboembolism - AKI - CKD - Osteitis fibrosa cystica - Osteomalacia
123
What are the 3 main risk factors for renal cancer?
- Smoking - Obesity - Genetic (Also hypertension and dialysis)
124
How does renal cell carcinoma present?
1. Classic triad - Haematuria - Loin pain - Mass Usually diagnosed incidentally from a scan.
125
What investigations are done for renal cell carcinoma?
- US kidneys - CT renal (and chest if enhancing mass) - MRI if extending into vein - Investigate bones and brain for metastatic disease
126
When should a biopsy be considered for renal cell carcinoma?
- Indeterminable mass - Prior to ablation - Metastatic disease systemic therapy
127
What is the management of renal cell carcinoma?
- Active surveillance - Radiofrequency ablation - Partial nephrectomy - Radical nephrectomy - Palliative embolisation - Immunotherapy
128
What are the risk factors for bladder cancer?
- Smoking - Aromatic hydrocarbons - Dyes - Rubber - Industrial exposures (eg. leather workers, hairdressers) - Drugs (most commonly cyclophosphamide)
129
How does bladder cancer present?
- Haematuria (painless visible 85%) - LUTS - Recurent UTIs
130
What investigations are done for bladder cancer?
- Flexible cystoscopy - US - CT urogram
131
What is the management of bladder cancer?
- Transurethral resection - Intravesical therapy (mitomycin or BCG) - Radical cystoprostatectomy - Anterior exentoration (in women) - Radiotherapy (Surgical management for muscle invasive cancers)
132
What is an anterior exentoration?
Removal of the bladder, uterus and ovaries.
133
What are the types of bladder cancer?
- Transitional cell carcinoma (90%) - Squamous cell carcinoma - Adenocarcinoma (rare, poor prognosis)
134
What is bacteriuria?
The presence of bacteria in the urine
135
What is pyuria?
- The presence of leukocytes in the urine - Associated with infection - Can be sterile pyuria
136
What is an uncomplicated UTI?
UTI in non-pregnant women
137
What is a complicated UTI?
- Pregnant women - Men - Catheterised patients - Children - Recurrent/persistent infection - Immunocompromised Any UTI other than in non-pregnant women.
138
What are the most common causes of UTIs?
- E. coli - Proteus - Klebsiella - Enterococci - Staph infection
139
What are the pathogenic causes of UTI?
- Stasis during pregnancy - Ureteric stones - Low urinary volume - Bladder stones or tumour - Obstruction from prostatic hypertrophy - Catheterisation allowing colonisation
140
What are the symptoms of lower urinary tract infection?
- Dysuria - Frequency
141
What are the symptoms of upper urinary tract infection?
- Systemic symptoms eg. fever - Loin pain - Pyuria
142
What investigations are done for UTIs?
Urinalysis and microscopy.
143
What does urinalysis tell us may be present in the urine?
- Blood - Protein - pH - Glucose - Leukocytes - Nitrates - Ketones
144
Give examples of types of urine samples.
- MSU - CSU - Bag urine - Clean catch - SPA aspirate - Early morning (specifically for TB)
145
How is an uncomplicated UTI treated?
3 day course of antibiotics
146
How is a complicated UTI treated?
- Send a sample for culture - 7 day course of antibiotics
147
What are the first line antibiotics used to treat UTIs?
Avoid broad spectrum antibiotics - Nitrofurantoin - Fosfomycin - Pivemcillinam
148
What are the complications of long-term catheters?
- UTI/pyelonephritis - Stones - Obstruction - Chronic inflammaiton
149
What factors increase the prevalence of UTI in pregnancy?
- Age - Parity - Sexual activity - Diabetes - Previous UTI
150
What are the potential complications of pyelonephritis?
- Renal abscess - Emphysematous pyelonephritis
151
What is the innervation of the penis?
- Erection = parasympathetic (S2-4) - Ejaculation = sympathetic (T11-L2) Point and shoot!
152
What can cause erectile dysfunction?
- Hypogonadism - Trauma - Drugs - Psychosomatic
153
What is the pathophysiology of erectile dysfunction?
- Neurogenic = failure to initiate - Arteriogenic = failure to fill (commonest) - Venogenic = failure to store
154
What are the risk factors for erectile dysfunction?
- CVD - Diabetes - Depression - Obesity - Alcohol - Medicaitons - Pelvic surgery
155
What is the management of erectile dysfunction?
- Treat underlying cause - Consider referral to other specialties - Psychosexual counseling
156
What is the medical management of erectile dysfunction?
- PDE-5 inhibitors (viagra) - Intraurethral suppository - Vacuum-assisted device - Implant

Phase 2a (11 decks)

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