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MD2 lectures > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are the obstructive urinary symptoms?

A

Poor flow, hesitancy, intermittency, terminal dribbling

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2
Q

What are the irritative urinary symptoms?

A

Frequency, nocturia, urgency, incontinence

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3
Q

What is the main difference between acute and chronic urinary retention?

A

Pain

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4
Q

What are the causes of acute urinary retention in females?

A
  • Reflex AUR: urethritis/UTI
  • Intrinsic compression, meatal stenosis/stricture, tumour, urethral diverticulum/stone
  • Extrinsic compression: severe prolapse, pelvic space occupying lesions
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5
Q

What defines obstructive nephropathy?

A

Elevated creatinine, bilateral hydronephrosis

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6
Q

What 3 blood tests should you perform if testicular cancer is suspected?

A

alpha-FP, beta-HCG and LDH

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7
Q

What is a common presentation of testicular torsion?

A

Acute onset severe pain ± swelling, with a high riding testicle on examination

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8
Q

What is the treatment of epididymo-orchitis?

A
  • Elevation
  • Analgesia
  • Empiric Abx for GNB and STI coverage
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9
Q

What are the 4 main functions of the kidney?

A
  • Excretion of solutes and waste products
  • Acid/base homeostasis
  • Na/water balance
  • Endocrine functions (EPO, vitamin D)
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10
Q

What is the normal rate of eGFR?

A

10ml/min/1.73m2 per decade beyond the age of 40yo

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11
Q

How do you define CKD?

A

GFR 3 months

OR

Evidence of kidney damage for >3 months: microalbuminuria, proteinuria, glomerular haematuria, pathological abnormalities, anatomical abnormalities

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12
Q

What are the basic principles of management of ALL patients with CKD?

A
  • Identify and treat the cause
  • Reduce further progression
  • Reduce CV risk
  • Early detection and management of metabolic complications
  • Avoid renally excreted or nephrotoxic medications
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13
Q

What are the metabolic complications of CKD?

A
  • Anaemia
  • Metabolic acidosis
  • Calcium, phosphate and PTH management
  • Dyslipidaemia
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14
Q

What are the 4 categories of intrinsic AKI?

A
  1. Tubular injury (common): ischaemia, toxins
  2. Interstitial nephritis (common); drugs, infection, infiltration
  3. Glomeruli: GN, thrombosis
  4. Vascular disease: vasculitis, occlusion
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15
Q

Explain the clinical evaluation of AKI

A
  1. Is the renal impairment acute or chronic?
  2. Has obstruction been excluded?
  3. What is the patient’s volume status?
  4. Is there evidence of other intrinsic renal disease apart from ATN?
  5. Has a major vascular occlusion occurred?
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16
Q

What is the main difference between pre-renal AKI and ATN?

A

Fraction excretion of sodium = 2 in ATN

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17
Q

What is the acute workup for a renal stone?

A
  • FBE, UEC
  • Serum Ca2+ and uric acid
  • MSU
  • CT-KUB (or CT-IVP)
  • Plain KUB
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18
Q

What are the indications for intervention with a renal stone?

A
  • Infection/sepsis
  • Renal impairment
  • Bilateral obstructing calculi
  • Solitary kidney
  • Inability to control symptoms (refractory pain)
  • Prolonged obstruction
  • Unlikely to pass spontaneously
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19
Q

What are the differentials for an elevated PSA?

A

Prostate cancer, prostatitis, BPH

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20
Q

What is the Gleason score?

A
  • Pathological grading (rating out of 10): architectural assessment
  • Numerical terminology
  • 6 = low risk disease, 7 = intermediate risk, >8 = high risk
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21
Q

What are some management options in prostate cancer?

A
  • Androgen deprivation therapy
  • Orchidectomy
  • Chemotherapy
  • Palliative care
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22
Q

How do you stage prostate cancer?

A
  • TNM
  • Bone scan
  • CT ± MRI
  • Assess fitness for treatment
23
Q

What is the often “first hit” in Indigenous people that leads to CKD?

A

Low nephron number in low birth weight children

24
Q

What is the main pathological process in minimal change disease?

A

Podocyte foot processes are absent or distorted, resulting in proteinuria

25
Q

What is the most common glomerular cause of haematuria?

A

IgA disease

26
Q

If a biopsy is p-ANCA positive, what disease process is occurring?

A

Microscopic polyangiitis

27
Q

What is the renal biopsy threshold in DM?

A

Proteinuria of at least 1g/day

28
Q

If a biopsy is c-ANCA positive, what disease process is occurring?

A

Wegener’s granulomatosis

29
Q

What is the characteristic renal biopsy finding in DM?

A

Kimmelstein-Wilson disease

30
Q

What conditions predispose to carcinoma of the bladder?

A

Smoking, Schistosomas, urinary calculus, urinary diverticula, congenital abnormalities

31
Q

How do patients with bladder cancer present clinically?

A

Bleeding, pain or infection if obstructive, hydronephrosis or with metastases

32
Q

What are common types of testicular tumours?

A
  • Embryonal carcinoma
  • Choriocarcinoma
  • Teratoma
33
Q

What are the findings in Gleason 3?

A

Infiltration of cells from glands at margins

34
Q

What are the findings in Gleason 4?

A

Irregular masses of cells with few glands

35
Q

What are the findings in Gleason 5?

A

Lack of glands, sheets of cells

36
Q

What are the features of a nephrotic syndrome?

A

Swelling, low serum albumin and proteinuria

37
Q

Renal disease: Most common in children and young people, then another peak in elderly. There is a reduced Renal function. Will respond well to steroids and be treated completely. Will not need to biopsy. There may be relapses.

A

Minimal change disease (nephrotic)

38
Q

Renal disease: biopsy for diagnosis (some tissue looks normal, some tissue doesn’t). Doesn’t respond as well as to steroids.

A

Focal segmental glomerular sclerosis (nephrotic)

39
Q

Renal disease: middle to late ages (50-70yrs), normal renal function, doesn’t completely resolve when you treat it so ongoing problem. Treatment requires more immunosuppression so cyclophosphamide and prednisolone.

A

Membraneous (nephrotic)

40
Q

What are the features of a nephritic syndrome?

A

Acute deterioration in renal function with sodium and water retention, and haematuria

41
Q

Renal disease: normal antibody in body usually associated with mucous membranes. URTI infection/mucosal infection IgA gets up in body and lands in the kidney. Abnormal IgA deposition in the kidney. This sets up an inflammatory reaction. Staining: IgA and complement

A

IgA nephropathy (nephritic)

42
Q

Renal disease: 3 weeks after throat infection, autoantibodies against, proliferation of endothelial and mesangial cells, cytokines to call in neutrophils. Ix: look for previous infection with strep, staining will show IgG, IgA, complement

A

Post-infectious GN (nephritic)

43
Q

Renal disease: mixed nephritic/nephrotic picture

A

Membranoproliferative disease

44
Q

What are the two medications used to treat BPH?

A
  • 5alpha reductase inhibitors (decrease DHT)

- Alpha receptor antagonists (SMC relaxation)

45
Q

How do you define AKI?

A

1.5x increase from most recent baseline creatinine or 6 hours of oliguria

46
Q

How do you manage AKI?

A
  • Discontinue offending agents or nephrotoxins
  • Meticulous attn to volume status
  • Monitor UECs and venous bicarbonate
  • Daily weihts, fluid chart, regular observations and regular fluid assessments
  • Investigations: urine dipstick, urine PCR, renal US, LFTs, CRP, CK, platelets
  • Review and adjust all drug doses accordingly
  • Treat metabolic complications: volume overload, hyperkalaemia, metabolic acidosis, infection, nutrition
47
Q

What are the STOP causes in AKI?

A
  • Sepsis and hypoperfusion
  • Toxicity
  • Obstruction
  • Parenchymal disease
48
Q

What are indications for invention in renal stones?

A
  • Infection/sepsis
  • Renal impairment
  • Bilateral obstructing calculi
  • Solitary kidney
  • Inability to control Sx
  • Prolonged obstruction
  • Unlikely to pass spontaneously
49
Q

When is expectant management appropriate?

A
  • Size
50
Q

What medical therapy can be used to pass renal stones?

A
  • Alpha blockers most effective
  • CCB and steroids are not as effective
  • Urinary alkalinsation if uric acid
51
Q

What are the surgical treatment options for renal stones?

A
  • JJ stent
  • Ureteroscopy and lithotropsy (laser, pneumatic)
  • Shock wave lithotripsy
52
Q

When should a renal stone be followed up and how?

A

Within 1-2 weeks with plain KUB

53
Q

Which imaging is gold standard in haematuria?

A

CT-IVP

54
Q

What are some precipitants of AUR?

A
  • Medications (anticholinergics)
  • UTI
  • Diuresis (alcohol)
  • Post-operative (pain, anaesthetic, analgesics)

MD2 lectures (13 decks)

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