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medicine phase 2 a > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are the NICE criteria for an AKI?

A

rise in creatinine >25micromols/L in 48 hrs
rise in creatinine >50% in 7 days
urine output <0.5ml/kg/hr

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2
Q

What are the most common causes of AKI?

A

pre-renal causes

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3
Q

What are the pre-renal causes of AKI?

A

due to inadequate perfusion of the kidney
- hypotension
- heart failure
- dehydration

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4
Q

What are the renal causes of AKI?

A

glomerulonephritis
interstitial nephritis
acute tubular necrosis
rhabdomyolosis
tumour lysis syndrome

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5
Q

what are the post-renal causes of AKI?

A

obstruction of outflow:
- kidney stones
- abdo/pelvic masses (cancer)
- urethral/ureter strictures
- BPH, prostate cancer

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6
Q

What is the first line investigation for AKI?

A

urinalysis - protein, blood, leukocytes, nitrites, glucose

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7
Q

What would positive leukocytes and nitrites in urinalysis suggest?

A

infection

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8
Q

What would protein and blood in urine suggest?

A

acute nephritis (may also be positive in infection)

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9
Q

What would glycosuria be suggestive of?

A

diabetes

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10
Q

what is the first line management for AKI?

A

rehydration - IV
stop nephrotoxic drugs
relive obstruction e.g. insert catheter for post-renal causes

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11
Q

What are the nephrotoxic drugs?

A

Diuretics
ACEi/ARBs
metformin
NSAIDs

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12
Q

What could uraemia as a result of AKI lead to?

A

encephalopathy or pericarditis

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13
Q

What are the complications of AKI?

A

hyperkalaemia
fluid overload - heart failure/pulmonary oedema
metabolic acidosis
uraemia

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14
Q

What are some of the causes of CKD?

A

diabetes
hypertension
NSAIDs, PPIs, lithium
polycystic kidney disease
glomerulonephritis

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15
Q

What signs/symptoms could be present in CKD?

A

pruritus
nausea
peripheral neuropathy
oedema
loss of appetite
muscle cramps
pallor

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16
Q

What are the first line investigations for CKD?

A

eGFR - using U&Es
ACR
urine dipstick - haematuria

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17
Q

What investigation can be used in patients with accelerated CKD?

A

renal ultrasound (polycystic kidney disease)

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18
Q

How is CKD diagnosed with eGFR?

A

an eGFR <90 on two occasions three months apart

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19
Q

What two scores are used to determine the stage of kidney disease?

A

G score - eGFR
A score - ACR

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20
Q

What are some of the complications of CKD?

A

anaemia
renal bone disease
dialysis related problems
cardiovascular disease
peripheral neuropathy

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21
Q

What is the first line treatment for patients with CKD?

A

ACEi to treat hypertension

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22
Q

What should be monitored in patients with CKD on ACEi?

A

potassium
both CKD and ACEi cause hyperkalaemia

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23
Q

What are the aims of management of CKD?

A

slow progression of disease
Reduce cardiovascular risk
reduce risk of complications
treat complications

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24
Q

How would you treat metabolic acidosis?

A

oral sodium bicarbonate

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25
Q

How would you treat renal bone disease?

A

Vit D supplementation
low phosphate diet
bisphosphonates

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26
Q

What active form of Vit D are given in renal bone disease?

A

calcitriol, alfacalcidol

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27
Q

What are the treatments for end stage renal failure?

A

dialysis and renal transplant

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28
Q

How would you treat anaemia in CKD?

A

iron supplementation or exogenous erythropoietin

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29
Q

In what ways does CKD cause bone disease?

A

less metabolism of Vit D to active form
secondary hyperparathyroidism due to low calcium - more osteoclast activity

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30
Q

What are the symptoms of prostate cancer?

A

LUTS, haematuria, ED
evidence of metastases

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31
Q

What are some of the treatments for prostate cancer?

A

radical prostatectomy
radiotherapy
hormone blockers

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32
Q

Give an example of a GnRH agonist used to treat advanced prostate cancer

A

relugolix

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33
Q

What are the two grading systems used for prostate cancer?

A

Gleason grading
TNM (Tumour, lymph Nodes, Metastases)

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34
Q

How does the gleason grading system work?

A

looks at the degree of differentiation from cells from a prostate biopsy

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35
Q

How would you treat BPH?

A

alpha blockers
5-alpha reductase inhibitor

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36
Q

Give and example of an alpha blocker

A

tamsulosin, doxazosin

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37
Q

Give an example of a 5-alpha reductase inhibitor

A

finasteride

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38
Q

What is a variocele?

A

abnormal enlargement of the testicular veins

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39
Q

What is a hydrocele?

A

fluid in the tunica vaginalis

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40
Q

What are the key presentations of testicular torsion?

A

unilateral acute testicular pain
swelling
tenderness

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41
Q

What deformity can be a cause of testicular torsion?

A

bell-clapper deformity, there is not fixation of the testicle to the tunica vaginalis

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42
Q

What is the treatment for testicular torsion?

A

analgesia
orchiopexy (correction of position)
orchidectomy if necrosed

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43
Q

What are the key presentations of epididymitis?

A

unilateral acute testicular pain

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44
Q

What are the causes of epididymitis?

A

STI pathogens
E. coli
mumps

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45
Q

What is it called when epididymis spreads to the testes?

A

epididymo-orchitis

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46
Q

What are some of the investigation you could do for epididymitis?

A

urine microscopy
nucleic acid amplification testing (gonorrhoea/chlamydia)
salival (mumps) /charcoal swabs (discharge)

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47
Q

What antibiotics would you use for epididymitis where it is caused by and enteric organism (e.coli)

A

doxycycline
OR
ofloxacin
OR
ciprofloxacin

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48
Q

What combination of antibiotics would you use for epididymitis caused by a sexually transmitted infection?

A

IM ceftriaxone (gonorrhoea)
doxycycline (chlamydia)

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49
Q

Give an example of (fluoro)quinolone antibiotics

A

ofloxacin
levofloxacin
ciprofloxacin

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50
Q

What type of antibiotic are quinolone antibiotics?

A

powerful broad spectrum, gram negative cover

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51
Q

What is ofloxacin commonly used to treat?

A

UTIs, pyelonephritis, epididymo-orchitis and prostatitis

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52
Q

What are the side effects of quinolone antibiotics?

A

tendon damage/rupture
lower seizure threshold (caution in patients with epilepsy)

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53
Q

Where do epididymal cysts occur?

A

the head of the epididymis

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54
Q

What is the treatment for uncomfortable or painful epididymal cysts?

A

removal

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55
Q

What are the two types of testicular cancer?

A

seminomas
non-seminomas (mainly teratomas)

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56
Q

What are the presentations of testicular cancer?

A

non-tender, hard, irregular lump with no transillumination
rarely: gynaecomastia

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57
Q

What is the initial investigation for suspected testicular cancer?

A

scrotal ultrasound

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58
Q

What serum tumour marker may be present in teratomas?

A

alpha fetoprotein

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59
Q

What serum tumour marker may be present in both seminomas and teratomas?

A

beta-hCG

60
Q

What staging system is used for testicular cancer?

A

Royal Marsden staging system

61
Q

What surgical procedure can be used to treat testicular cancer?

A

radical orchidectomy

62
Q

What are the features of someone with nephritic syndrome?

A

haematuria
oliguria
proteinuria <3g/24hrs
fluid retention

63
Q

What are the criteria for a patient to have nephrotic syndrome?

A

peripheral oedema
proteinuria >3g/24hrs
serum albumin <25g/L
hypercholesterolaemia

64
Q

What are the presentations of someone with nephrotic syndrome?

A

oedema
frothy urine (proteinuria)

65
Q

What is interstitial nephritis?

A

inflammation between the cells and tubules in the kidney

66
Q

What are the two specific diagnoses of interstitial nephritis?

A

acute interstitial nephritis and chronic tubulointerstitial nephritis

67
Q

What is glomerulosclerosis?

A

scarring of the tissue in the glomerulus

68
Q

What can cause glomerulosclerosis?

A

any type of glomerulonephritis or obstructive uropathy

69
Q

How is glomerulonephritis normally treated?

A

steroids (prednisone)
ACEi - to lower bp

70
Q

What is the most common cause of nephrotic syndrome in children?

A

minimal change disease

71
Q

What is the most common cause of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis

72
Q

What is the most common cause of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis

73
Q

How is nephrotic syndrome normally treated?

A

steroids - prednisone

74
Q

What is the most common cause of primary glomerulonephritis?

A

IgA nephropathy

75
Q

How would you diagnose IgA nephropathy?(bergers disease)

A

histology - IgA deposits in mesangium

76
Q

What is the most common cause of glomerulonephritis?

A

membranous glomerulonephritis

77
Q

What are the causes of membranous glomerulonephritis?

A

idiopathic
secondary to malignancy, NSAIDS, rheumatoid disorders

78
Q

What would biopsy show in membranous glomerulonephritis?

A

IgG and complement deposits in basement membrane

79
Q

How does post-streptococcal glomerulonephritis (diffuse proliferative glomerulonephritis) present?

A

nephritic syndrome 1-3 weeks after strep infection

80
Q

What causes goodpasture sydrome?

A

Anti-GBM (glomerular basement membrane) attacks glomerulus and pulmonary basement membranes

81
Q

What are the key presentations of Goodpasture syndrome?

A

glomerulonephritis, pulmonary haemorrhage

will present with AKI and haemoptysis (coughing up blood)

82
Q

How would patients with Wegeners granulomatosis (granulomatosis with polyangiitis) present?

A

AKI, haemoptysis, wheeze, sinusitis, saddle shaped nose

83
Q

What are some of the risk factors for bladder cancer?

A

smoking, exposure to aromatic amines - used to be used in dye and rubber manufacture

84
Q

What are the two most common types of bladder cancer?

A

transitional cell carcinoma (90%)
squamous cell carcinoma (5% - often caused by schistosomiasis)

85
Q

What is the key symptom of bladder cancer?

A

painless haematuria

86
Q

What are the NICE guidelines on suspected bladder cancer in over 45 yr olds?

A

2 week wait referral if:
haematuria without UTI or persisting after UTI treatment

87
Q

What are the NICE guidelines on suspected bladder cancer in over 60 yr olds?

A

2 week wait referral if:
haematuria +
dysuria (painful/difficult urination) OR raised WCC

88
Q

What investigation is used for bladder cancer?

A

cystoscopy

89
Q

What staging system is used for bladder cancer?

A

TNM (tumour, nodes, metastases)

90
Q

What surgical procedure can be used to treat non-muscle invasive bladder cancer?

A

transurethral resection of bladder tumour (TURBT)

91
Q

What more drastic surgical treatment may be used for bladder cancer?

A

radical cystectomy

92
Q

What intravesical treatments are there for bladder cancer?

A

intravesical chemotherapy and BCG

93
Q

What is the most common procedure to have done after a cystectomy?

A

urostomy with ileal conduit

94
Q

What is the classic triad of symptoms associated with renal cell carcinoma?

A

haematuria, flank pain and palpable mass

95
Q

Where is a common site for renal cancers to metastasise?

A

lungs - cannonball metastases

96
Q

What paraneoplastic features may be present with renal cell carcinoma?

A

polycythaemia - increased EPO
hypercalcaemia - tumour mimics parathyroid
hypertension - renin increase
Stauffers syndrome - abnormal LFTs without liver metastases

97
Q

What staging system is used in renal cell carcinoma?

A

TNM or numbered system (stages 1-4)

98
Q

What surgical procedures are used for renal cell carcinoma?

A

radical nephrectomy
partial mephrectomy

99
Q

What other, less invasive treatments are used for renal cell carcinoma?

A

arterial embolisation - cut off blood supply
percutaneous cryotherapy
radiofrequency ablation

100
Q

What are the 5 most common pathogens that cause UTIs? (KEEPS)

A

Klebsiella
E. coli
enterococcus
proteus
staphylococcus coagulase negative

101
Q

What are the extra symptoms a patient might present with in pyelonephritis?

A

fever, loin/back pain, nausea/vomiting

102
Q

What would urinalysis show in UTIs/pyelonephritis?

A

nitrites, leukocytes, blood

103
Q

What is the main investigation for UTIs/pyleonephritis?

A

midstream urine (MSU) for microscopy, culture and sensitivity testing

104
Q

What is the treatment for UTIs/pyelonephritis?

A

cefalexin (pyelonephritis)
nitrofurantoin (UTIs)

105
Q

What should be immediately done for patients arriving in the hospital with sepsis?

A

sepsis six
3 tests
3 treatments

106
Q

What are the three tests that should be done in patients with sepsis?

A

blood lactate and cultures
urine output

107
Q

What are the three treatments that should be done for patients with sepsis?

A

oxygen to maintain sats at 94-98%
empirical broad spectrum abx IV
IV fluids

108
Q

what could be the problem in a patient with suspected pyelonephritis who is not responding to treatment?

A

renal abscess
kidney stone obstructing ureter

109
Q

What are the presentations of cystitis?

A

dysuria, cloudy, smelly urine, frequency and urgency

110
Q

how would you investigate cystitis (bladder pain syndrome)?

A

urinalysis
cytoscopy
swabs (STIs)
DRE

111
Q

What are the key presentations of prostatitis?

A

tender prostate on DRE
systemic symps - fever, chills, malaise

112
Q

What antibiotics are used for prostatitis?

A

ciprofloxacin or ofloxacin or trimethoprim

113
Q

What test is used to diagnose chlamydia and gonorrhoea?

A

nucleic acid amplification test (swab)

114
Q

What is the antibiotic used for chlamidyia?

A

doxycycline 100mg twice daily for a week

115
Q

What type of swab would be taken to allow for microscopy and cultures?

A

charcoal swab

116
Q

What is the 1st line treatment for gonorrhoea?

A

IM ceftriaxone

117
Q

Where do kidney stones commonly get stuck?

A

vesico-ureteric junction

118
Q

What are most kidney stones made of?

A

calcium oxalate

119
Q

Name two risk factors for developing kidney stones

A

hypercalcaemia and low urine output

120
Q

What is type of kidney stone is usually seen in patients with recurrent UTIs?

A

struvite

121
Q

What is it called when a kidney stone forms in the shape of the renal pelvis?

A

staghorn calculus

122
Q

What are the typical presentations of kidney stones?

A

unilateral loin to groin pain
colicky (as the stone moves)

123
Q

What would a urine dipstick show in kidney stones?

A

haematuria

124
Q

What is the initial investigation to diagnose kidney stones?

A

non contrast CT kidney, ureters and bladder (CTKUB)

125
Q

What three things could cause kidney stones?

A

calcium supplementation, hyperparathyroidism, cancer (myeloma, breast/lung cancer)

126
Q

What is the most effective analgesia to use for kidney stones?

A

NSAID - IM diclofenac

127
Q

What alpha blocker can be used to help spontaneous passing of kidney stones?

A

tamsulosin

128
Q

Above what size of kidney stones are surgical interventions often necessary?

A

10mm

129
Q

What surgical interventions can be used to remove kidney stones?

A

extracorporeal shock wave lithotripsy (ESWL)
ureteroscopy and laser lithotripsy

130
Q

What preventative medications can be given to patients with recurring calcium oxalate stone?

A

potassium citrate
thiazide diuretics (indapamide)

131
Q

What is the first line treatment for chronic kidney disease?

A

ACEi - ramipril

132
Q

How can diabetes effect the kidneys?

A

high levels of glucose cause scarring of the glomerulus - glomerulosclerosis

133
Q

What substances can directly damage the kidneys?

A

radiology contrast dye
gentamycin
NSAIDs

134
Q

What might cause ischaemia secondary to hypoperfusion in the kidney?

A

sepsis
shock
dehydration

135
Q

What would be found in urinalysis that is indicative of renal tubular necrosis?

A

muddy brown casts

136
Q

What is the most common cause of renal tubular acidosis?

A

type 4 - reduced aldosterone

137
Q

Why might aldosterone be reduced?

A

Addisons, ACEi, spironolactone, SLE, diabetes, HIV

138
Q

How would you treat renal tubular acidosis?

A

fludrocortisone

139
Q

What is haemolytic uraemic syndrome (HUS)?

A

thrombosis in the small vessels of the body causing thrombocytopenia
AKI causing uraemia
haemolytic anaemia

140
Q

What is the usual cause of HUS?

A

shiga toxin, produced by E. coli

141
Q

What is rhabdomyolysis?

A

skeletal muscle breakdown and release of breakdown products in blood

142
Q

What do muscles release when broken down?

A

myoglobin
potassium
phosphate
creatine kinase

143
Q

What can cause rhabdomyolysis?

A

prolonged immobility
vigorous exercise beyond person capability
crush injuries
seizures

144
Q

what is the first line management for rhabdomyolysis?

A

IV fluids

145
Q

How is polycystic kidney disease diagnosed?

A

ultrasound and genetic testing

146
Q

What inheritance patterns can PKD be?

A

autosomal dominant or recessive

147
Q

What medication can slow the progression of autosomal dominant PKD?

A

tolvaptan (vasopressin receptor antagonists)

medicine phase 2 a (10 decks)

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