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Phase 2a - Jemima > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What is nephrolithiasis

A

kidney stones

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2
Q

what are kidney stones made up of

A

calcium oxalate stones

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3
Q

where are kidney stones deposited

A

in the collecting duct

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4
Q

where can kidney stones be deposited

A

anywhere in the renal pelvis to the urethra

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5
Q

what are 90% of the kidney stones in the form of

A

radio opaque stones

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6
Q

other than radio opaque stones what other types of kidney stones are there

A

struvite
calcium phosphate
uric acid
cysteine

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7
Q

what are risk factors of nephrolithiasis

A

chronic dehydration
kidney inherited disease
hyperPTH (hypercacaemia)
UTIs
history of previous renal stones

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8
Q

what is the pathophysiology of nephrolithiasis

A

there is an excess of solute in the collecting ducts which causes super saturated urine. This favours crystalisation. The stones forms then cause regular outflow obstruction and hydronephrosis

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9
Q

how do you treat hydronephrosis

A

surgical decompression ASAP

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10
Q

what does obstruction of regular renal outflow cause

A

dilation and obstruction of the renal pelvis, increasing damage and infection risk

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11
Q

what is the presentation of nephrolithiasis

A

loin to groin pain that is colicky - peristaltic waves
the patient cant lie still
haematuria
dysuria
can have a fever is a suprarenal infection is present

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12
Q

what is a differential diagnosis for nephrolithiasis

A

peritonitis - same symptoms except there is rigidity

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13
Q

how do you diagnose nephrolithiasis

A

1st line = Kidney, ureters, bladder X-RAY (80% specific)
GOLD = CT kidney, ureters, bladder (99% specific) and therefore diagnostic
bloods: FBC, U&E and urine dipstick

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14
Q

how do you treat nephrolithiasis

A

if symptomatic = hydrate, analgesia (didofenac) IV for severe pain
Abx if UTI present (gentamycin)
Stones normally pass spontaneously if small enough (<5mm)
elective surgical Tx is too big to pass and causing pain

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15
Q

how do you surgically remove a kidney stone

A

Endoscopic sound wave Lithotripsy
Percutaneous nephrolithotomy (keyhole)

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16
Q

what is acute kidney injury

A

Abrupt decline in kidney infection (hrs to days) characterised by an increase in serum creatinine and urea and a decreased urine output

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17
Q

what is the classification of acute kidney injury

A

KDIGO
Serum creatinine increase 26umol/L within 48hrs OR 1.5X baseline in 7 days
Urine output <0.5ml/kg/hr for 6hrs consecutive

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18
Q

how do you stage acute kidney injury

A

use AKIN
stage 1, 2, 3, and the higher the stage the reduced likelihood of kidney injury

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19
Q

what are the three causes of acute kidney injury

A

pre-renal
renal
post-renal

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20
Q

what are the renal causes acute kidney injury

A

nephron and parenchyma damage
- tubular - acute tubular nephrosis
- interstitial cell death - fever, rashes eosinophilia
- glomerular
- toxins (sepsis)

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21
Q

what are pre-renal causes of AKI

A

Hypoperfusion
total body - decreased cardiac output (shock)
liver failure - hepatorenal syndrome
Renal artery stenosis or blockage
drugs - NSAIDs, ACE-i (decrease GFR)
IV contrast

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22
Q

what are causes of post renal AKI

A

obstructive uropathy
stones
BPH - common in elderly men
Drugs - anticholinergics, CCBc
Occluded indwelling

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23
Q

what are risk factors for AKI

A

increased age, comorbidities, hypovolemia of any cause, nephrotoxicity drugs, decreased blood filtration and urine output

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24
Q

What is the pathophysiology of acute kidney injury

A

there is an accumulation of usually excreted substances
- K+ causing arrhythmias
- Urea causes pruritis, uremic frost, confusion if severe
- fluid causes oedema
- H+ causes acidosis

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25
Q

why does ACEi cause nephrotoxicity

A

causes constriction of afferent arterioles and therefore decreases perfusion to the glomerulus

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26
Q

what is the presentation of acute kidney injury

A

as a result of substance accumulation:
uremia causes encephalopathy, pericarditis, skin manifestations
fluid overload causes oedema or hypovolemic shock
H+ causes metabolic acidosis
K+ causes arrhythmias

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27
Q

how does hyperkalaemia present on an ECG

A

tall tented T waves
P wave flattening
Wide QRS

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28
Q

how do you diagnose AKI

A

establish the cause pre/utra/post with KDIGO classification - serum creatinine and urine output
- check K+, H+, urea, creatinine, FBC and CRP
- renal biopsy and USS for post renal

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29
Q

how do you treat acute kidney injury

A

treat the complications (hyperkalaemia, metabolic acidosis, fluid overload)
treat underlying cause
last resort - RRT and haemodialysis

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30
Q

how do you differentiate between a pre-renal, renal or post-renal cause of AKI using the urea: creatinine ratio

A

Urea: creatinine
>100:1 = prerenal
<40:1 = renal
40-100 = postrenal

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31
Q

what is chronic kidney disease

A

eGFR is less than 60mL/min/1.73m^2 for over three months (normal = 120)

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32
Q

what are the 5 stages of chronic kidney disease

A

1) 90+ with renal signs
2) 60-89 with renal signs
3)a 45-59, b 30-44
4) 25-29
5) <15

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33
Q

what are the 4 parameters used to determine chronic kidney disease

A

creatinine
age
gender
ethnicity

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34
Q

what are risk factors for chronic kidney disease

A

diabetes mellitus and hypertension
also glomerulonephritis, PKD, nephrotoxic drugs such as NSAIDs

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35
Q

what is the pathophysiology behind CKI

A

there is a decrease in GFR due to damage. this leads to an increased burden and therefore compensatory RAAS to help increase the GFR. This increases the transglomerular pressure causing shearing and loss of BM selectivity causing proteinurea and haematuria

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36
Q

what are the symptoms of chronic kidney disease

A

early on asymptomatic
symptoms then start as substances accumulate and there is renal damage
anaemia
osteodystrophy
neuropathy and encephalopathy
CVD

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37
Q

how do you diagnose CKD

A

FBC - anaemia of chronic disease
U+E
urine dip for proteinurea
USS
GFR function staging 1-5
albumin: creatinine ratio

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38
Q

what is the differences between AKI and CKI

A

in AKI there is an increase in serum creatinine with decreased urine output and CKI is reduced GFR
AKI is shorter with no anaemia and the ultrasound is often normal

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39
Q

how do you treat CKI

A

there is no cure so you have to treat the complications
- Anaemia: EPO and Fe
- osteodystrophy: Vitamin D supplements
- CVD: ACEi and statins
- oedema: diuretics

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40
Q

When GFR is in stage 5 what has to happen

A

dialysis and ultimately renal transplant will be used as a cure

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41
Q

what is benign prostate hyperplasia

A

non malignant prostate hyperplasia which is normal with aging

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42
Q

what are risk factors for benign prostate hyperplasia

A

an increase in age
ethnicity - Afro-Caribbean
family history
cigarette smoking
male pattern baldness

castration is protective

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43
Q

what is the pathophysiology of benign prostate hyperplasia

A

inner transitional zones of the prostate (muscular, gland) proliferates and narrows the urethra

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44
Q

What is the presentation of benign prostate hyperplasia

A

Storage = frequency, urgency, nocturia, incontinence
Voiding = poor stream, dribbling, incomplete emptying, straining, dysuria
ariuria if the urethra is totally occluded leading to retention issues such as UTI, stones and hydrophores

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45
Q

how do you diagnose benign prostate hyperplasia

A

DRE- rectal exam - smooth and enlarged
PSA - rule out prostate cancer however this can be quite unreliable

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46
Q

how do you treat benign prostate cancer

A

lifestyle: reduce caffeine
Drugs: 1st line is alpha blocker (tamsulosin) and 2nd line is 5 alpha reductase inhibitors (finasteride)
last resort is surgery (transurethral resection of prostate)

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47
Q

what is the action of tamsulosin

A

it relaxes the bladder neck

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48
Q

what is the action of finasteride

A

it reduces testosterone production and therefore the size of the prostate

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49
Q

what is renal cell carcinoma

A

it is a proximal convoluted tubule epithelial carcinoma

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50
Q

what are the risk factors for renal cell carcinoma

A

smoking
haemodialysis
hereditary: Von hippel lindau

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51
Q

what is Von Hippel lindau disease

A

it is an autonomic dominant loss of a tumour suppressor gene
- can cause bilateral renal and pancreas cysts
- can cause cerebellum cancers

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52
Q

what are are symptoms of renal cell cariconoma

A

it is often asymptomatic
Triad: flank pain, haematuria, abdominal mass
may have left left sided varicocele
patients may also have anaemia due to low EPO and hypertension as the tumour releases renin

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53
Q

how do you diagnose renal cell carcinoma

A

1st line - USS (ultrasound)
Gold - CT chest/abdominal/pelvis (more sensitive)

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54
Q

how do you stage renal cell carcinoma

A

staging - Robinson staging 1-4

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55
Q

what is the treatment for renal cell carcinoma

A

nephrectomy (full or partial if blocked)

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56
Q

what is a Wilms tumour

A

it is a renal mesenchymal stem cell tumour seen in children under the age of three (rare)
- nephroblastoma

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57
Q

what type of cancer is bladder cancer

A

it is a transitional cell carcinoma of the cancer

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58
Q

what are the risk factors of developing bladder cancer

A

occupational exposure to dyes/paints/rubber
painter, hairdresser, mechanic
smoking
chemotherapy and radiotherapy
age (mean age is about 33)
male

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59
Q

what type of bladder cancer is a patient more likely to have if they have schistosomiasis

A

squamous cell carcinoma rather than transitional

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60
Q

what are the symptoms of bladder cancer

A

painless haematuria (micro/macroscopic)
UTI symptoms without bacteriuria

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61
Q

How do you diagnose bladder cancer

A

flexible cystoscopy (gold standard)
urinalysis
biopsy
CTT urogram - allows staging

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62
Q

how do you treat bladder cancer

A

conservative - support
medical - chemo or radiotherapy
surgery - TURBT - transurethral resection of bladder tumour or cystectomy as a last resort

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63
Q

what type of cancer is bladder cancer

A

it is a cancer of the outer zone of the peripheral prostate
- adenocarcinoma
- shows neoplastic malignant proliferation

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64
Q

what are risk factors for developing prostate cancer

A

Genetic - BRCA2 and HOXB13
increase in age
Afro-Caribbean ethnicity

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65
Q

what are the symptoms of prostate cancer

A

lower urinary tract symptoms
systemic cancer symptoms - weight loss, fatigue, pain, bone pain

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66
Q

where does prostate cancer typically metastisise to

A

bone, liver, lung, brain

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67
Q

how do you diagnose prostate cancer

A

DRE - prostate exam
PSA test
transrectal USS and biopsy is diagnostic
use the gleason score for grading where the higher the score the worse the prognosis

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68
Q

how do you treat prostate cancer

A

local - prostatectomy
metastatic - hormone therapy to reduce testosterone, bilateral orchidectomy and GnRH receptor agonis leading to suppression of HPG axis (goserelin)

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69
Q

what is a side effect of Goserelin

A

erectile dysfunction and libido loss

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70
Q

what is the most hormone sensitive cancer

A

prostate cancer

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71
Q

what are the two types of testicular cancer

A
  1. Germ cell (90%) - seminoma teratoma
  2. Non germ cell - sertoli, leydig sarcoma
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72
Q

what are the risk factors for testicular cancer

A

cryptorchidism = undescended testis
infertility
family history

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73
Q

what is the symptoms of testicular cancer

A

painless lump in the testicle which does NOT transilluminate

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74
Q

how do you diagnose testicular cancer

A

urgent (doppler) USS tests (90% diagnostic)
Tumour markers such as AFP and BhCG

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75
Q

what types of testicular cancer is AFP and BhCG raised in

A
  1. AFP is raised in teratoma
  2. bHCG is raised in seminomas
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76
Q

what is the treatment for testicular cancer

A

urgent radical orchidectomy (+offer sperm storage) always
as an extra can have chemo or radiotherapy

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77
Q

what is obstructive uropathy

A

it is a blockage of urine flow and can affect one or both kidneys depending on the level obstruction

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78
Q

what are the causes of obstructive uropathy

A

benign prostatic hypertrophy - obstructions
stones

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79
Q

what is the pathophysiology of obstructive uropathy

A

obstruction causes retention and therefore an increase in kidney, ureter, bladder pressure. This causes refluxing of the urine into the renal pelvis and causes hydronephrosis (dilated renal pelvis)

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80
Q

what are the symptoms of obstructive uropathy

A

With the obstruction
difficulty passing urine.
a slowed stream, sometimes described as a “dribble”
a frequent urge to urinate, especially at night (nocturia)
the feeling that your bladder isn’t empty.
decreased urine output.
blood in your urine

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81
Q

what is the treatment for obstructive uropathy

A

relieve kidney pressure - catherterise and ureteral stent
treat the benign prostate hyperplasia or the stones (plus infection if that has occured)

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82
Q

what are the different locations for UTI

A

Upper (kidney) - pyelonephritis
Lower (bladder onward) - cystitis, prostatitis, urethritis, epidydymo-orchiditis

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83
Q

what organisms cause UTI

A

KEEPS
Klebsiella
Enterobacter
E.coli
Proteus
S. Saprophytic

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84
Q

what is the most common bacterial cause of UTI

A

E.Coli

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85
Q

How do you diagnose UTI

A

1st line: urine dipstick
- leukocytes, nitrites and haemoturia
Gold standard: Midstream MC+S to confirm the UTI and the pathogen causing it

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86
Q

what is pyelonephritis

A

it is infection of the renal parenchyma and upper ureter.

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87
Q

what type of spread does pyelonephritis have

A

ascending transurethral spread

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88
Q

what is the usual cause of pyelonephritis

A

uropathic E.Coli

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89
Q

what are the risk factors of pyelonephritis

A

urine status - stones
renal structural abnormalities
catheters

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90
Q

what is the presentation of pyelonephritis

A

Triad
loin pain
fever
pyuria (pus containing urine)

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91
Q

how do you diagnose pyelonephritis

A

1st line: urine dipstick
gold: MC+S (microscopy, culture, sensitivity)

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92
Q

what is the treatment for pyelonephritis

A

Analgesia, paracetamol
antibiotics: ciprofloxacin or co-amoxiclav

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93
Q

what is cystitis

A

uropathic E.coli infection of the bladder

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94
Q

what are risk factors for cystitis

A

Frequent sexual intercourse
History of UTIs
Congenital abnormality
Urinary catheter
Asymptomatic bacteruia
DM
Spinal cord injuries
Pregnancy
Immunodeficiency
Older age
Lack of circumcision

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95
Q

what are the symptoms of cystitis

A

suprapubic tenderness and discomfort
increased frequency and urgency
visible haematuria
can cause confusion in elderly

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96
Q

how do you diagnose cystitis

A

urine dip stick
urine culture and sensitivity - gold standard for diagnosis

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97
Q

how do you treat cystitis

A

Antibiotics - 3 days of trimethoprim or nitrofurantoin (amoxicillin if the patient is pregnant)

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98
Q

what is Urethritis

A

it is urethral inflammation plus or minus infection

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99
Q

what is the most common way of getting urethritis

A

Sexually acquired infection

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100
Q

what infections can cause urethritis

A

Gonococcal - Neisseria gonorrhoea
Non - gonococcal - Chlamydia trachomatis

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101
Q

what are non infective causes of urethritis

A

trauma

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102
Q

what are risk factors for urethritis

A

unprotected sex
MSM

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103
Q

what are symptoms of urethritis

A

dysuria +/- urethral discharge (blood or pus
urethral pain
orchalgia

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104
Q

how do you diagnose urethritis

A

nucleic acid amplification test to detect STI
Urine dip
MC+S - will detect pathogen ID if UTI

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105
Q

how do you treat urethritis

A

Neisseria - IM ceftriaxone and azithromycin
Chlamydia - Doxycycline (or azithromycin)

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106
Q

what type of bacteria is chlamydia

A

obligate intracellular gram negative aerobe (bacillus)

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107
Q

What type of bacteria is Neisseria

A

gram negative diplococcus

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108
Q

What disorder is urethritis associated with

A

reactive arthritis
- conjunctivitis
- urethritis
- arthritis

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109
Q

what is epididymo-orchitis

A

it is inflammation of epididymis extending to the testis. Usually due to urethritis (STI) or cystitis extension

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110
Q

What ages is urethritis or cystitis causing epididymo-orchitis more common in

A
  1. Urethritis - more in under 35
  2. Cystitis - more in over 35
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111
Q

what are the symptoms of Epididymo-orchitis

A

unilateral scrotal pain and swelling
pain is relieved with elevating testes
cremaster reflex is intact
positive prehns sign

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112
Q

how do you diagnose Epididymo-orchitis

A

Nucleic acid amplification test
urine dip
MC + S

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113
Q

what is the treatment for Epididymo-orchitis

A

dependent of its an STI or UTI
STI - Ceftriaxone and azithromycin or azithromycin

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114
Q

what are the two types of Glomerulopathology

A

Nephrotic or nephritic

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115
Q

what are the signs of nephrotic Glomerulopathy

A

proteinuria
hypoalbuminemia
oedema - due to 3rd spacing
hyperlipidemia
hypogammaglobulinemia (low Ig)
hypercoagulable blood - due to loss of antithrombin 3

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116
Q

what are signs of nephritic glomerulopathology

A

Haematuria
oliguria - little urine: salt and water retention
hypertension
oedema - due to fluid overload

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117
Q

what causes nephritic glomerulopathology

A

when there is breakdown of the glomerular basement membrane
- inflammation
- bowman crescents

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118
Q

what can present as both nephrotic and nephritic glomerulopathology

A

diffuse proliferative glomerulonephritis
membrano-proliferative glomerulonephritis

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119
Q

what are primary causes of nephrotic syndrome

A

minimal change disease (MC in children)
focal segmental glomerulosclerosis
membranous nephropathy

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120
Q

what are secondary causes of nephrotic syndrome

A

diabetic nephropathy

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121
Q

what are symptoms of nephrotic syndrome

A

proteinuria
hypoalbuminemia
oedema
hyperlipidemia with wt gain

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122
Q

how do you diagnose nephrotic syndrome - minimal change disease

A

light microscopy - no change
electron microscopy - podocyte effacement and fusion

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123
Q

how do you diagnose focal segmental glomerulosclerosis

A

light microscopy - segmental sclerosis; less than 50% glomeruli affected

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124
Q

how do you diagnose membranous nephropathy

A

light microscopy - thickened glomerular basement membrane
electron microscopy - sub podocyte immune complex deposition, spike and dome appearance

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125
Q

how do you treat nephrotic syndrome

A

steroids with variable response
- minimal change disease responds well
- FSG and MN responds less well

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126
Q

what are causes of nephritic syndrome

A

IgA nephropathy (Berger’s syndrome)
Post strep glomerulonephritis
SLE
Goodpasture’s syndrome
haemolytic uremic syndrome

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127
Q

what are the symptoms of IgA nephropathy

A

visible haematuria - looks like ribena or coke
-normally occurs 1-2 days after tonsilitis viral infection (or gastroenteritis)

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128
Q

how do you diagnose IgA nephropathy

A

immunofluorescence
microscopy shows IgA complex deposition

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129
Q

what is the treatment for IgA nephropathy

A

non curative: 30% progresses to ESFR
BP control (ACEi)

130
Q

what are the symptoms of post strep glomerulonephritis

A

visible proteinuria
- 2 weeks after pharyngitis from Group A, B hemolytic strep (S.Pyogenes)

131
Q

how do you diagnose post strep glomerulonephritis

A

light microscopy - hypercellular glomeruli
electron microscopy - subendothelial immune complex deposition
immunofluorescence shows stary sky appearance - IgG, IgM and C3 deposit along the GBM

132
Q

what is the treatment for post strep glomerulonephritis

A

self limiting usually
sometimes may progress to rapidly progressive glomerulonephritis

133
Q

what is a differential diagnosis for IgA nephropathy

A

Henoch schonlein purpura - small cell vasculitis
diagnosis gives the same result but the difference is that IgA is only kidney deposition, and HSP is systemic (kidney, liver, skin)

134
Q

How do you diagnose SLE

A

ANA+ve and anti dsDNA positive

135
Q

how do you treat SLE

A

steroids
hydroxychloroquine
immunosuppressants

136
Q

how does SLE cause nephritic syndrome

A

lupus nephritis - ANA deposition in the endothelium

137
Q

how does goodpastures cause nephritic syndrome

A

there is pulmonary and alveolar haemorrhage as well as glomerulonephritis due to autoantibodies (anti-GBM)

138
Q

how do you treat Goodpastures syndrome

A

steroids and plasma exchange

139
Q

what are causes of haemolytic uremic nephritis

A

normally about 5 days post infection vs shiga toxin (E.coli, shigella)
- hameolytic anaemia
- AKI causing uremia
Thrombocytopenia

140
Q

how do you treat haemolytic uremic nephritis

A

mostly self limiting - but symptoms mean a medical emergency so support with fluids and antibiotics

141
Q

what is rapidly progressing glomerulonephritis

A

it is a subtype of glomerulonephritis which progresses to ESRF very fast (weeks to months)

142
Q

how do you diagnose RPGN

A

inflammatory crescents in bowmans space

143
Q

what are causes of rapidly progressing glomerulonephritis

A

wegner’s granulomatosis (GPA)
MPA (pANCA positive)
Goodpastures (c-ANCA positive)

144
Q

what is polycystic kidney disease

A

there is cyst formation throughout the renal parenchyma causing bilateral enlargement and damage

145
Q

what are the types of polycystic kidney disease

A

FAMILIAL INHERITED
Auto rec - less common, disease of infancy or prebirth with increased mortality
Auto dom - mutated PKD1 (85%) or PKD2

146
Q

what is the pathophysiology of polycystic kidney disease

A

PKD1+2 code for polycystin (calcium channel)
When filtrate passes through nephron cilia move and the polycystin on the cilia open.
calcium influx inhibits excessive growth
In the mutation there is less calcium influx and therefore there is excessive cilia growth leading to cyst formation

147
Q

what are the symptoms of polycystic kidney disease

A

Bilateral flank/ back or abdominal pain
could have hypertension and haematuria
extrarenal cysts - particularly in the circle of willis leading to berry aneurysms

148
Q

How do you diagnose polycystic kidney disease

A

kidney ultrasound - enlarged bilateral kidneys with multiple cysts
genetic testing
family history of PKD

149
Q

what is the treatment of polycystic kidney disease

A

Non curative
manage the symptoms
- Hypertension (ACEi)
- ESRF (RRT transplant)

150
Q

if you find a scrotal mass what do you assume it is until you prove otherwise

A

Cancer until proved otherwise

151
Q

what is an epididymal cyst

A

it is an extratesticular cyst (above and beyond testis) that will transilluminate
- smooth, extratesticular spherical cyst

152
Q

how do you diagnose an epididymal cyst

A

ultrasound the scrotum

153
Q

what is hydrocele

A

it is fluid collection in the tunica vaginalis
- cyst that testicle sits within that will transilluminate

154
Q

how do you diagnose hydrocele

A

ultrasound scrotum

155
Q

what is varicocele

A

distended pampiniform plexus due to increased left renal vein pressure causing reflux
-typically painless

156
Q

how do you diagnose varicocele

A

clinical examination

157
Q

what is testicular torsion

A

the spermatic cord twists on itself causing occlusion of the testicular artery - ischemic and gangrene of testis if not delt with

158
Q

is testicular torsion a medical emergency

A

YES

159
Q

what is a risk factor for testicular torsion

A

Bell clapper deformity

160
Q

what are the symptoms of testicular torsion

A

severe unitesticular pain
abdominal pain
nausea and vomiting
cremasteric reflex is lost
no pain relief with elevating testis

161
Q

How do you diagnose testicular torsion

A

ultrasound to check testicular bloodflow
surgical exploration if there is increased risk

162
Q

what is the treatment for testicular torsion

A

urgent surgery within 6 hours
- surgical exploration always 1st line if clinical suspicion of testicular torsion

163
Q

how do you overcome the bell clapper deformity

A

all cases require bilateral orchiopexy (fixing of testis to scrotal sac)

164
Q

what are types of incontinence

A

stress
urge
spastic paralysis

165
Q

what is stress incontinence

A

it is due to sphincter weakness
- pee leaks with intraabdominal pressure rise

166
Q

what is urge incontinence

A

it is detrusor muscle overactivity

167
Q

what is spastic paralysis incontinence

A

neurological upper motor neuron lesion
- overactive reflexes plus hypertonia of detrusor

168
Q

is incontinence more common in females or males

A

females

169
Q

what is the treatment for incontinence

A

surgery
anticholinergic drugs

170
Q

what is retention

A

it is the inability to pas urine even when bladder full
- overflow incontinence

171
Q

what are causes of retention

A

obstruction
- stones
- BPH
- neurological flaccid paralysis

172
Q

what is the treatment for retention

A

catheterize

173
Q

is retention common in males or females

A

males

174
Q

what are the storage symptoms (lower urinary tract symptoms)

A

Urgency
Frequency
Incontinence
Nocturia

175
Q

why do storage symptoms occur (lower urinary tract symptoms)

A

they occur when the bladder should be storing urine and therefore you need to pee

176
Q

what are voiding symptoms (lower urinary tract symptoms)

A

poor stream
incomplete emptying
dribbling
hesitancy

177
Q

why do voiding symptoms occur

A

when the bladder outlet is obstructed and therefore it makes it hard to pee

178
Q

what are risk factors for CKD and AKI

A

emergency surgery i.e risk of sepsis or hypovolemia
CVD risk
CKD -eGFR <60
diabetes mellitus
heart failure
age >65 years
Liver disease
use of nephrotoxic drugs

179
Q

what are the different stages of CKD

A

1, 2, 3a, 3b, 4, 5

180
Q

what is CKD stage 1

A

GFR is > 90ml/min

181
Q

What is CKD stage 2

A

GFR range is 60-90
some sign of kidney damage

182
Q

what is CKD stage 3a

A

45-59ml/min
moderate reduction in kidney function

183
Q

what is CDK stage 3b

A

30-44 ml/min
moderate reduction in kidney disease

184
Q

what is CDK stage 4

A

15-29ml/min
severe reduction in kidney function

185
Q

what is CKD stage 5

A

less than 15ml/min
established kidney failure - dialysis of kidney transplant may be needed

186
Q

what is the NICE diagnostic guideline for kidney injury

A

rise in creatinine of equal to or over 26umol in 48 hour
over 50% rise in creatinine over 7 days
fall in urine output to less than 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children)

187
Q

what are signs of intrinsic kidney injury

A

type 2 diabetes mellitus
hypertension
low urine osmolarity
high urine sodium
high blood potassium

188
Q

what are levels of sodium, urea and creatinine in pre-renal kidney injury

A

normal sodium
raised urea
raised creatinine
responds well to fluid therapy

189
Q

what are signs of post-renal kidney injury

A

loin to groin acute colicky pain
microscopic haematuria

190
Q

what are causes of pre-renal kidney injury

A

hypovolaemia secondary to diarrhoea and vomiting
renal artery stenosis

191
Q

that are intrinsic causes of kidney injury

A

glomerulonephritis
acute tubular necrosis
acute interstitial nephritis
rhabdomyolysis
tumour lysis syndrome

192
Q

what are post renal causes of kidney injury

A

kidney stone in ureter or bladder
benign prostatic hyperplasia
external compression of the ureter

193
Q

what is stage 1 of AKI

A

increase in creatinine to 1.5-1.9 times the baseline
or
reduction in urine output to <0.5 ml/kg/hour for equal to or over 6 hours

194
Q

whats stage 2 of AKI

A

increase in creatinine to 2.0 to 2.9 times the baseline
or
reduction in urine output to <0.5mL/kg/hour for equal to or over 12 hours

195
Q

what is stage 3 of AKI

A

increase in creatinine to equal to or over 3 times baseline
or
increase in creatinine > 353.6 umol/l
or
reduction in urine output to <0.3 mL/kg/hour for over 24 hours

196
Q

what are examples of nephrotoxic drugs

A

NSAIDs
Aminoglycosides
ACE-i
ARB
loop diuretics
metformin?
Digoxin?
lithium?

197
Q

how do you reduce the risk of CVD in CDK management

A

Atorvastatin - 20mg

198
Q

what is the physiology of the prostate

A

produces testosterone and dihydrotestosterone
production of PSA - liquefies semen

199
Q

what type of cancer is prostate cancer

A

adenocarcinoma

200
Q

what is the management of benign prostatic hyperplasia

A
  1. tamsulosin
  2. finasteride
201
Q

what is the treatment for prostate cancer

A

localised - radial prostatectomy
advanced - zoladex (GnRH agonist)

202
Q

what is hydrocele

A

it is fluid in the tunica vaginalis
soft, non-tender transluminous swelling

203
Q

what are varicocele

A

it is abnormal enlargement of the testicular veins

204
Q

what are signs of testicular torsion

A

unilateral
swollen
tender
retracted upward
prehns sign negative

205
Q

how do you treat epididymitis

A

IM ceftriaxone plus doxycycline

206
Q

what is the most common cause of scrotal swelling

A

epididymal cyst

207
Q

what are signs of testicular cancer

A

a painless lump with hydrocele and gynacomastia

208
Q

what is nephritic syndrome

A

it is inflammation within the kidney

209
Q

what are features which defines nephritic syndrome

A

haematuria
oliguria
proteinuria
hypertension

210
Q

what causes nephritic syndrome

A

an inflammatory disease affecting the kidney - it can arise from both systemic and renal limited disease

211
Q

what investigations are done for nephritic syndrome

A

kidney biopsy - diagnostic
urinalysis
bloods - elevated ESR and CRP

212
Q

how do you manage nephritic syndrome

A

treat underlying cause
blood pressure control - ACE-i/ARB
corticosteroids

213
Q

why does goodpasture’s disease cause glomerulonephritis

A

because there are autoantibodies to type IV collagen in the glomerular and alveolar membrane

214
Q

how does Goodpasture’s present

A

shortness of breath
oliguria

215
Q

how do you manage Goodpasture’s disease

A

plasma exchange
steroids
cyclophosphamide

216
Q

why does IgA nephropathy cause glomerulonephritis

A

there is deposition of IgA into the mesangium of the kidney leading to inflammation and damage

217
Q

what is the most common cause of nephritic syndrome in high income families

A

IgA nephropathy

218
Q

how does IgA nephropathy present

A

asymptomatically with microscopic haematuria

219
Q

what is the pathophysiology behind post streptococcal glomerulonephritis

A

This is nephritic syndrome following an infection, 3-6 weeks prior. This is due to deposition of strep antigens in the glomeruli leading to inflammation and damage.

220
Q

how does a patient with post streptococcal glomerulonephritis present

A

with haematuria
can also present with acute nephritis

221
Q

what is Henoch Schoenlein purpura

A

it is a small vessel vasculitis that affects the kidney and joints due to IgA deposition

222
Q

how does Henoch Schoenlein purpura present

A

Presents with a purpuric rash on legs, nephritic symptoms, and joint pain due to IgA deposition

223
Q

how do you treat Henoch Schoenlein purpura

A

Managed with corticosteroids and ACE-I/ARB

224
Q

what is nephrotic syndrome

A

this is where there is an issue with the filtration barrier, with the podocytes being primarily implicated, which results in leaking of protein into the urine

225
Q

what is the triad which characterises nephrotic syndrome

A

proteinuria - >3g/24 hours
hypoalbuminaemia - loss of albumin in urine
Oedema - loss of oncotic pressure

226
Q

what are the primary causes of nephrotic syndrome

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

227
Q

what are some secondary causes of nephrotic syndrome

A

diabetes
drugs
autoimmune
neoplasia
infection

228
Q

how does nephrotic syndrome present

A

oedema
frothy urine

229
Q

what investigations are done for nephrotic syndrome

A

Urinalysis
Urine Protein: creatinine ratio- to quantify the degree of proteinuria
Blood tests- renal function, elevated lipids
Renal biopsy- gives cause

230
Q

what is the management for nephrotic syndrome

A

Management
Fluid and salt restriction
Loop diuretics- to manage oedema
Treat cause
ACE-I/ARB to reduce protein loss
Manage complications

231
Q

what are the complications of nephrotic syndrome

A

hyperlipidaemia - loss of albumin increases cholesterol formation = treat with statins
VTE - due to increased clotting factors = treat with heparin

232
Q

how do you treat minimal change disease

A

high dose steroids such as prednisolone

233
Q

what can focal segmental glomerulosclerosis be secondary to

A

HIV
Heroin
Lithium

234
Q

what should all patients with focal segmental glomerulosclerosis receive

A

ACE-i or ARBs to control blood pressure

235
Q

how do you manage membranous nephropathy

A

Managed with ACE-I/ARB in all. In patients with high risk of progression, prednisolone and cyclopshosphamide.

236
Q

what antibody is found in 70-80% of membranous nephropathy patients

A

Anti phospholipase A2 receptor antibody

237
Q

what are the differences between nephritic and nephrotic syndrome

A

nephritic has slight proteinuria, hypertension and haematuria, with oedema, low GFR and can have a rash, abdominal pain and N&V

nephrotic has high proteinuria, hypoalbuminaemia and high level of oedema. It can have a reduced or normal GFR and hyperlipidaemia

238
Q

what percentage of nephrotic syndrome shows no visible change on biopsy

A

25% of cases

239
Q

what is the most common GU tract malignancy

A

bladder cancer

240
Q

what is the most common bladder cancer

A

90% are urothelial carcinomas

241
Q

where does urothelial carcinoma spread to

A

the iliac and para-aortic nodes and then to the liver and the lungs

242
Q

what are risk factors for bladder cancer

A

Smoking increases risk 2-4 times, accounts for half of male cases of bladder cancer
Age over 55
Pelvic radiation
Exposure to occupational carcinogens
Bladder stone- due to chronic inflammation

243
Q

what is the management for bladder cancer

A

T1 - transurethral resection or local diathermy
T2-3 - radical cystectomy
T4 - palliative chemotherapy and radiotherapy

244
Q

where are 90% of renal cancers found to be arising from

A

proximal tubular epithelium (carcinomas)

245
Q

what is the epidemiology of renal cancer

A

mean age of diagnosis is 55
2:1 male to female diagnosis ratio

246
Q

where does renal cancer spread to

A

bone
liver
lungs

247
Q

what are risk factors for renal cancer

A

haemodialysis
smoking
hypertension

248
Q

how does renal cancer present

A

Classic triad of symptoms: haematuria, flank pain, palpable abdominal mass

249
Q

what investigations are done for renal cancer

A

Bloods: polycythaemia from erythropoietin secretion
Raised BP: due to renin secretion
Ultrasound
CT/MRI
CXR- shows cannon ball mets

250
Q

what score is used to predict survival in renal cancer

A

Mayo prognostic risk score

251
Q

what are the 4 stages of the mayo prognostic risk score

A

Stage I: partial or radical nephrectomy
Stage II: radical nephrectomy
Stage III: radical nephrectomy and adrenalectomy
Stage IV: systemic treatment

252
Q

what is the definition of a UTI

A

Defined as the presence of microorganisms in the urinary tract which produces clinical features. It can affect the lower tract causing cystitis (bladder), urethritis and prostatitis, and the upper causing pyelonephritis. It can also occur from untreated urolithiasis

253
Q

what are the 5 most common UTI causing pathogens

A

The 5 most common pathogens can remembered with KEEPS:
Klebsiella
E coli- most common causing >50% of cases
Enterococci
Proteus
Staphylococcus coagulase negative

254
Q

what is the treatment for pyelonephritis

A

Antibiotics: cefalexin for 7-10 days. Trimethoprim or amoxicillin if sensitive.
Analgesia- paracetamol

255
Q

what is prostatitis most commonly caused by

A

E.coli

256
Q

what are risk factors for cystitis

A

History of UTI
Diabetes
Frequent sexual intercourse
Pregnancy

257
Q

what is the presentation of prostatitis

A

Very tender prostate: on DRE intensely tender prostate gland
Systemic Sx: fever, chills, malaise
Voiding Sx

258
Q

what investigations are done for prostatitis

A

Urinalysis and culture- shows blood and WBCs, and bacteria
Blood cultures- in patients who are febrile

259
Q

what is prostatitis

A

inflammation and swelling of the prostate gland

260
Q

how do you manage prostatitis

A

ciprofloxacin or levofloxacin for 14 days

261
Q

what is the most common bacterial STI

A

chlamydia trachomatis

262
Q

how does chlamydia present in men

A

Men- testicular pain
voiding symptoms, dysuria
50% are ASX

263
Q

how does chlamydia present in women

A

Women- vaginal discharge and dysuria
white, yellow or green discharge
70% are ASX

264
Q

how do you diagnose STIs

A

nucleic acid amplification test

265
Q

how do you manage chlamydia

A

avoid sex until the treatment is finished
contact tracing
single 1g dose of azithromycin plus 7 days of doxycycline

266
Q

what is the second most common STI in the UK and what is it caused by

A

Gonorrhoea and its caused by neisseria gonorrhoea

267
Q

what is the presentation of gonorrhoea

A

more likely to be ASX
Men: dysuria, frequency, discharge
Female: vaginal discharge dysuria, pelvic pain

268
Q

what investigations are done for gonorrhoea

A

NAAT
Microscopy: shows gram-negative diplococci
Culture: all infected areas with a swab

269
Q

how do you treat gonorrhoea

A

single ceftriaxone IM dose

270
Q

what is urolithiasis

A

it is the presence of crystalline stones in the urinary tract

271
Q

where are the three places youre most likely to find crystalline stones in urolithiasis

A

pelvicoureteric junction
pelvic brim
vesicouretral junction

272
Q

what are the stones made from in urolithiasis

A

supersaturated urine - mostly formed of calcium oxalate

273
Q

what are the risk factors of urolithiasis

A

Dehydration
High salt intake
Obesity- lowers pH
Congenital horseshoe kidney
Oxalate rich diet
Gout- uric acids stones

274
Q

how does urolithiasis present

A

Most are asymptomatic
Causes severe colicky unilateral pain from loin to groin
Associated with nausea and vomiting
Haematuria- 85% of cases
Assume ruptured AAA until proven otherwise!

275
Q

what investigations are done for urolithiasis

A

KUBXR- first line and diagnostic for 80% of stones
Non contrast CTKUB- gold standard
Urine dip stick- for haematuria
Blood tests- raised calcium and phosphate

276
Q

what is the management for urolithiasis

A

Strong analgesia- diclofenac
Antibiotics
Tamsulosin/nifedipine- relaxes smooth muscle and helps expulsion
Percutaneous nephrolithotomy- used to expulse stones over 10mm

277
Q

what can be given to help prevent urolithiasis

A

thiazide diuretics- this helps with recurrent stones by reducing calcium levels
Hydration, reduce salt and oxalate intake

278
Q

what type of cancer is kidney cancer

A

renal cell carcinoma - arises from the renal parenchyma or cortex

279
Q

what are the risk factors for kidney cancer

A

Smoking
Male sex
>55yo
Black/Native American ethnicity
Obesity
Hypertension
Family history

280
Q

what are the signs and symptoms of kidney cancer

A

More than 50% asymptomatic
Haematuria
Flank pain
Palpable abdo mass
Non-specific systemic symptoms
Signs of hepatic dysfunction
Myoneuropathy
Lower limb oedema
Scrotal varicocele
Derm manifestations/vision loss

281
Q

how do you diagnose kidney cancer

A

Elevated creatinine (reduced clearance)
Haematuria and/or proteinuria
Abdo/pelvic US (mass)
CT abdo/pelvis (mass)
MRI abdo/pelvis (mass)

282
Q

what is the differential diagnosis for kidney cancer

A

Benign renal cyst
Ureteric cancer
Bladder cancer
Upper urinary tract urothelial tumour
Angiomyolipoma
Oncocytoma
Secondary mets
Congenital renal parenchymal abnormalities
Renal infarction
Renal infection

283
Q

how is kidney cancer managed

A

surgery

284
Q

what are the complications of kidney cancer

A

Anaemia
Hypercalcaemia
Erythrocytosis
SIADH
Hepatic dysfunction

285
Q

what are the symptoms of prostate cancer

A

Nocturia
Urinary frequency
Urinary hesitancy
Dysuria
Abnormal digital rectal examination
PSA more widely used
Asymmetrical, nodular prostate
Haematuria
Weight loss/anorexia
Lethargy
Bone pain
Palpable lymph nodes

286
Q

how do you diagnose prostate cancer

A

raised PSA
prostate biopsy

287
Q

what are the differential diagnosis for prostate cancer

A

BPH
Chronic prostatitis

288
Q

how do you manage prostate cancer

A

Active surveillance
Androgen deprivation therapy
External-beam radiotherapy
Brachytherapy
Radical prostatectomy

289
Q

what are risk factors for testicular cancer

A

Cryptochidism
Gonadal dysgenesis
Family/personal history
Testicular hypertrophy
White ethnicity
HIV infection

290
Q

what are signs of testicular cancer

A

Lump/enlargement of one testicle
Feeling of heaviness in the scrotum
Dull ache in the abdomen or groin
Sudden collection of fluid in the scrotum
Pain or discomfort in a testicle or the scrotum
Enlargement/tenderness of the breasts
Back pain

291
Q

what are the complications of testicular cancer

A

infertility

292
Q

what is the differential diagnosis for testicular cancer

A

Testicular torsion
Epididymo-orchitis
Scrotal hernia
Hydrocele
Epididymal cyst
Haematomas
Spermatocele
Intratesticular benign cysts
Syphilitic gumma

293
Q

what are complications of benign prostatic hyperplasia

A

UTI
renal insufficiency
bladder stones
haematuria
sexual dysfunction
acute urinary retention
overactive bladder

294
Q

what are possible complications of pyelonephritis

A

renal failure
sepsis
renal abscess formation
emphysematous pyelonephritis
parenchymal renal scarring
recurrent UTIs

295
Q

what is the pathophysiology behind chronic pyelonephritis

A

there is a slow progressive renal damage due to chronic inflammation or infection.
This causes thinning of the adrenal cortex with scarring
The scarring can be in one or both kidneys and it often causes atrophic tubules with no glomeruli

296
Q

what is the most common mechanism of renal scarring in chronic pyelonephritis

A

vesicoureteral reflux

297
Q

what are causes of chronic pyelonephritis

A

Recurrent infections resulting from anatomical abnormalities
Vesiculoreteral reflux
Inadequate treatment/recurrence of acute pyelonephritis

298
Q

what are risk factors for chronic pyelonephritis

A

Acute pyelonephritis
Vesicoureteral reflux
Obstruction
Renal caliculi
DM

299
Q

what are signs or symptoms of chronic pyelonephritis

A

Nausea
Elevated blood pressure
Weight loss
Fatigue
Malaise
Cloudy urine
Fever
Back/flank pain + tenderness

300
Q

How is chronic pyelonephritis diagnosed

A

renal function tests
electrolyte panel
FBC
renal ultrasound
kidney-ureter-bladder X ray
CT abdomen

301
Q

what is a differential diagnosis for chronic pyelonephritis

A

Acute pyelonephritis
Renal caliculi
Renal cancer

302
Q

how is chronic pyelonephritis managed

A

no specific treatment available
renal damage isnt reversible
can help to repair anatomical or functional problems

303
Q

what are the possible complications of chronic pyelonephritis

A

AKI
Hyperparathyroidism
Acute pyelonephritis
Obstruction
CKD

304
Q

what are the symptoms of cystitis

A

Dysuria
Urgency
Frequency
Suprapubic pain
Abdo pain
Fever
Vaginal discharge
Vaginal pruritis
Dyspareunia (painful intercourse)
Structurally or functionally abnormal bladder

305
Q

what are the possible complications of cystitis

A

Pyelonephritis
Preterm delivery
Urinary retention
Recurrent UTIs

306
Q

what are risk factors of prostatitis

A

UTI
benign prostatic enlargement
urinary tract instrumentation or manipulation

307
Q

what are possible complications of urethritis

A

Chronic non-gonococcal urethritis
Genitourinary abscess
Urethral stricture/fistula
Reactive arthritis
Disseminated gonococcal infection
Epididymitis
Acute conjuctivitis
Pneumonia

308
Q

what are causes of urethritis

A

N gonorrhoeae (gonococcal urethritis)
C trachomatis
M genitalium
U urealyticum

309
Q

what are the differential diagnosis of urethritis

A

UTI
Candida balanitis or vaginitis
Non-infectious urethritis
Nephrolithiasis
Interstitial cystitis
Reactive arthritis
Chronic prostatitis

310
Q

what is the pathophysiology behind nephritic syndrome

A

Largely triggered by immune-mediated injury exhibiting both humoural and cellular components

A variety of non-immunological metabolic, haemodynamic and toxic stress can also induce glomerular injury

311
Q

what are signs and symptoms of Polycystic kidney disease

A

Renal cysts
Hypertension
Abdo/flank pain
Haematuria
Palpable kidney/abdo mass
Headaches
Dysuria
Urgency to pee
Suprapubic pain
Fever
Cardiac murmur
Abdo hernia or rectus abdominis diastasis
Hepatomegaly

312
Q

what drug can be given to help slow progression of cysts in polycystic kidney disease

A

Tolvaptan

313
Q

what are possible complications of PKD

A

Cardiac complications
GORD
Ruptured intracranial aneurysm
sepsis
complications during pregnancy

314
Q

what are the signs and symptoms of a epididymal cyst

A

Lump
Multiple, may be bilateral
May be painful if large
Well defined and will transluminate since fluid
filled
Testis palpable separate to the cyst

315
Q

what is a communicating hydrocele

A

patent processus vaginalis connects the peritoneum with the tunica vaginalis, allowing peritoneal fluid to flow freely between both structures. Risk of inguinal herniation

316
Q

what is a non communicating hydrocele

A

processus vaginalis closed, more fluid produced by tunica vaginalis than is being absorbed

317
Q

what are risk factors for hydrocele

A

Male sex
Prematurity/low birth weight
Infant (<6mths)
Late descent of testes
Increased intraperitoneal fluid/pressure
Inflammation/injury within scrotum
Testicular cancer
Connective tissue disorders

318
Q

how do you manage hydrocele

A

surgery if large or uncomfortable
aspiration can be considered

319
Q

what are possible complications of hydrocele

A

Haematoma
Inguinal hernia
Pain in inguinal area radiating to abdomen
Lower extremity oedema
Testicular atrophy
Hydronephrosis
Infertility

320
Q

what is varicocele associated with

A

Abnormal gonadotropin levels
Impaired spermatogenesis
Histological changes to sperm
Infertility

321
Q

Describe the lower neural pathways involved with filling of the urinary bladder, including the nerve root levels involved

A

there is sympathetic innervation via hypogastric nerve (T10-L2) which causes relaxation of detrusor muscle via the beta 1 receptors .There is also contraction of the IUS via alpha 1 receptors

322
Q

what is the nerve responsible for somatic control of micturition including the nerve root

A

S2-4 - pudendal nerve

Phase 2a - Jemima (11 decks)

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