Genitourinary

Question 1

what is loin to groin pain likely to be

Answer 1

pyelonephritis

Question 2

how would you investigate LUTS?

Answer 2

flowmeter
dipstick
international porstate symptom score
PSA and creatinine
frequency volume chart

Question 3

causes of polyuria

Answer 3

behavioural

poorly controlled diabetes

Question 4

nocturia causes

Answer 4

habit

congestive cardiac failure (ANP)

Question 5

what is conservative treatment for BPE?

Answer 5

alpha blocker like tamulosin, they decrease smooth muscle tone, may lead to retrograde ejaculation

Question 6

what can BPE complicate into?

Answer 6

UTI
acute urinary retention
urinary incontinence
haematuria
bladder caliculi

Question 7

what is acute urinary retention?

Answer 7

inability to voluntarily pass urine, caused by spinal cord compression, BPE, prostate cancer. Patient will have normal U&E

Question 8

how is obstruction treated

Answer 8

fluid resus
pain management
antibiotics
restore flow using stents

Question 9

causes of obstruction

Answer 9

PKD
ureter strictures
phimosis
BPE

Question 10

voiding symptoms

Answer 10

dribbling
hesitancy
poor flow
intermittent stream

Question 11

storage symptoms

Answer 11

urgency

nocturia

Question 12

what does sidenafil inhibit?

Answer 12

phosphodiesterase

Question 13

what makes up the lower urinary tract?

Answer 13

bladder
bladder neck (only in men)
urethra
urethral sphincter

Question 14

what does Onuf’s nucleus do?

Answer 14

it stimulates storage, contracts the urethral sphincter, causes the guarding reflex

Question 15

what do pontine centres control

Answer 15

detrusor nucleus

Question 16

what is the sympathetic supply of the bladder?

Answer 16

hypogastric T10-S2

Question 17

what is the parasympathetic supply of the bladder?

Answer 17

pelvic nerve S3-5

Question 18

list some functions of angiotensin II

Answer 18

constricts efferent arteriole so increases GF pressure (so ACEi and ARBs can decrease renal function)
stimulates aldosterone secretion

Question 19

4 functions of the kidney

Answer 19

filter and secrete
EPO production
activate 1,25 dihydroxyvitamin D
control blood pressure

Question 20

what is resorbed in the proximal tubule?

Answer 20

all by active transport
glucose
amino acids
HCO3
Na

Question 21

what happens in the loop of Henle?

Answer 21

countercurrent multiplication system

Question 22

where does aldosterone have its effect

Answer 22

collecting duct, increases plasma Na and decreases K and H, if very high then get hypokalaemic acidosis

Question 23

what transporter is in the distal tubule?

Answer 23

Na/Cl

Question 24

what transporter is in the ascending limb

Answer 24

Na/K

Question 25

what can loop and thiazide diuretics cause?

Answer 25

alkalosis, hypokalaemia

Question 26

what drugs can cause hyperkalaemia

Answer 26

``` spironolactone amiloride ACE-is ARBs calcineurin inhibitors ```

Question 27

what does hyperparathyroidism cause and increase in?

Answer 27

phosphate

Question 28

what is the difference between calcitonin and calcitriol

Answer 28

calcitonin causes an increase in plasma calcium levels, it is secreted from thyroid calcitriol is active vitamin D so it inhibits PTH, increases phosphate and calcium absorption so also increases plasma calcium levels

Question 29

how does CKD cause decreased bone density

Answer 29

less hydroxylation of calcitriol so secondary hyperparathyroidism so hyperphosphataemia

Question 30

what usually causes pyelonephritis

Answer 30

uropathogenic E coli

Question 31

how is stress incontinence treated?

Answer 31

artificial urinary sphincter | sling

Question 32

what is the osmolarity of normal saline?

Answer 32

similar to extracellular fluid which is 150mmol/L Na and Cl so 300

Question 33

where are kidneys transplanted into?

Answer 33

iliac fossa

Question 34

what might immunosuppression complicate into

Answer 34

infection | neoplastic risk

Question 35

what metabolic problem could CKD patients have?

Answer 35

metabolic acidosis with hypocalcaemia and hyperkalaemia

Question 36

why is there hyperlipidaemia in nephrotic syndrome?

Answer 36

the liver is activated

Question 37

what does not happen in nephrotic syndrome?

Answer 37

kidney failure

Question 38

treatment of nephrotic syndrome

Answer 38

ACEi diuretics underlying cause: DM, steroids

Question 39

how is PKD treated?

Answer 39

monitor U&Es | treat hypertension and end stage renal disease, infections

Question 40

most common nephropathy causes which syndrome?

Answer 40

IgA causes nephritic-because inflammation

Question 41

what metabolic problems are CKD patients at risk of?

Answer 41

acidosis hyperkalaemia hypocalcaemia

Question 42

causes of nephrotic syndrome

Answer 42

amyloidosis minimal change nephropathy DM hepatitis

Question 43

how is amyloidosis detected

Answer 43

cOngO red stain, amylOidOsis, nephrOtic syndrome

Question 44

treatment for urate stones

Answer 44

allopurinol

Question 45

medical treatment for urotheliasias attack

Answer 45

diclofenac ABC antiemetic

Question 46

where should stones be treated

Answer 46

ureters because they may lead to sepsis

Question 47

options for urotheliasias

Answer 47

alpha blocker-tamulosin percutaneous lithotomy extracorporeal shock wave lithotripsy ESWL nephrectomy

Question 48

how are STIs diagnosed

Answer 48

nuclei acid amplification tests from vaginal swab in women or first pass urine in men

Question 49

first sign of syphilis

Answer 49

chancre, a painless ulcer

Question 50

ADPKD symptoms?

Answer 50

hypertension pain haematuria

Question 51

what are renal cell carcinomas?

Answer 51

adenocarcinomas

Question 52

what inherited disease can cause renal cell carcinoma

Answer 52

von Hippel Lindau

Question 53

how are renal cysts classified

Answer 53

Bozniak classification

Question 54

what might varicocele be a sign of

Answer 54

renal cell carcinoma

Question 55

what can tyrosine kinase inhibitors be used for

Answer 55

CML | renal cel carcinoma

Question 56

symptoms of hypovolaemia

Answer 56

thirst and dizziness

Question 57

who is at risk of hypovolaemia

Answer 57

elderly ileostomy short bowel syndrome on diuretics

Question 58

how much of extracellular fluid is intravascular

Answer 58

20%, rest is interstial-of a third

Question 59

where do renal stones form

Answer 59

on the papilla

Question 60

how much urine should one pass in a day

Answer 60

less than 2.7 litres

Question 61

how do you decrease detrusor activity-as in urgency incontinence

Answer 61

anticholingergic agents like oxybuynin or botulinum toxin A

Question 62

what does UMN lesion lead to in the bladder

Answer 62

reflex bladder, reflexes lead to involuntary urination

Question 63

what does LMN lesion lead to in the bladder?

Answer 63

areflexic bladder, will overflow

Question 64

how does MS affect the bladder

Answer 64

overactive and incomplete emptying

Question 65

what cancers will cause haematuria

Answer 65

kidney and bladder

Question 66

heart failure treatment in black men

Answer 66

hydralazine and isosorbate dinitirate

Question 67

causes of renal kidney injury

Answer 67

from acute tubular necrosis (haemorrhage, burns, pancreatitis), glomerulonephritis,

Question 68

some nephrotoxic drugs

Answer 68

amoidarone lithium gentamycin NSAIDs

Question 69

what effect will Henoch-Schoenlein purpura have on the kidneys?

Answer 69

nephritic syndrome

Question 70

when is pANCA postitive

Answer 70

in Primary sclerosing cholangitis, PBC has +ve AMA

Question 71

when is cANCA positive?

Answer 71

in Goodpasture's

Question 72

what can pyelonephritis complicate into?

Answer 72

emphysematous pyelonephritis abscess sepsis

Question 73

what is pyelonephritis

Answer 73

inflammation of renal pelvis and parenchyma

Question 74

most common testicular cancer

Answer 74

seminomatous

Question 75

what is testicular torsion?

Answer 75

twisting of spermatic cord causing testis to become ischaemic

Question 76

differentials of testicular lump

Answer 76

hydrocele spermatocele varicocele

Question 77

risk factor for testicular torsion

Answer 77

bell clapper deformity

Question 78

causes of acute tubular necrosis

Answer 78

``` haemorrhage burns pancreatitis diuretics nephrotoxins RENAL CAUSE ```

Question 79

most common cause of renal AKI

Answer 79

acute tubular necrosiss

Question 80

what causes infectious mononucleosis

Answer 80

epstein barre

Question 81

pre renal causes of AKI?

Answer 81

``` skin/liver/heart failure infection haemorrhage dehydration thrombosis renal artery stenosis ```

Question 82

why are nephrotic syndrome patients prone to infection?

Answer 82

IgGs lost in urine | steroids used for treatment

Question 83

how is post strep glomerulonephritis treated?

Answer 83

blood pressure control diuretics salt restriction

Question 84

renal complication of infective endocarditis

Answer 84

acute nephritic syndrome

Question 85

features of nephritic syndrome

Answer 85

haematuria hypertension oliguria

Question 86

pyelonephritis antibiotic?

Answer 86

co amoxiclav

Question 87

where does renal carcinoma usually occur

Answer 87

proximal convoluted tubule

Question 88

what are the signs of pyonephrosis and what should you do?

Answer 88

fever, infective markers, raised creatinine (signs of sepsis) needs immediate decompression

Question 89

what kind of renal stones are the most dense

Answer 89

calcium phosphate-can be seen on AXR

Question 90

which renal stones are hard to see on X ray

Answer 90

cysteine

Question 91

what drugs predispose someone to stones

Answer 91

chemo | endinavir

Question 92

how are stones treated

Answer 92

ESWL or Percutaeneous nephrolithotomy

Question 93

what is suggested by symptoms of renal stones with creatinine not raised?

Answer 93

only partial obstruction

Question 94

what does testosterone treatment increase?

Answer 94

hyperplasia of prostate and it raises PSA but doesn't increase risk of prostate ca

Question 95

what would you advise a patient with irritable bladder?

Answer 95

keep drinking plenty (conc urine irritates) | decrease caffeine

Question 96

what constitutes a wet overactive bladder

Answer 96

associated incontinence

Question 97

what UTI antibiotics can be used in pregnancy

Answer 97

amoxicillin, nitrofuantoin, (trimethoprim after 12 weeks)

Question 98

when can't you use nitrofuantoin?

Answer 98

renal impairment

Question 99

what is mirabegron

Answer 99

beta 3 agonist to treat overactive bladder