Genitourinary Flashcards
Causes of chronic kidney disease
Diabetes
HTN
Glomerulonephritis
Things to discuss in history for CKD
SOB Nausea vomitting Bone pain Confusion, depression Ankle swelling Gout Recurrent UTIs SLE/scleroderma
Which medications to ask about in CKD?
ACEi
Erythropoetin
Steroids/immunosuppresant
Key examination findings in CKD
Hyperventilation Pigmentation and purpura Asterixis BP AV fistula for dialysis Anaemia/jaundice Balot kidneys Renal bruits Gout
Bloods for CKD?
eGFR, creatinine, plasma creatinine/urea level
Electrolytes, phosphate, uric acid, calcium, albumin
FBC
Imaging for CKD?
Renal ultrasound CT scan Cystoscopy Renal artery doppler Renal biopsy
Complications of CKD
Anaemia Bone disease Dry skin Decreased gastric emptying Gout Carpal tunnel Restless leg syndrome Pericarditis Heart failure
Lifestyle management of CKD
Smoking cessation
Physical activity
Diet(reduce fats and monitor salt and water balance)
Cardiovascular management of CKD
ACEi (if diabetic take even if normal BP)
Statins for lipids
Aspirin low dose
Renal management CKD
Erythropoeitin if CKD <3 and HB <100
Correct iron deficiency first
If renal bone disease: calcitriol/calcitab
If restless legs: gabapentin
Indications for dialysis
Acute renal failure Fluid overload despite mx Uraemic symptoms despite mx Creatinine >1000 Hyperkalemia Electrolyte abnormalities Drugs eg dabigatran
Complications of dialysis
Bone disease Infection Protein malnutrition CVD Amyloid, arythralgia Malignancy
Define nephrotic syndrome
Proteinuria, hypoalbubinaemia, severe oedema and hyperlipidaemia
Define nephritic syndrome
Proteinuria, haematuria, oliguria, hypertension
Common causes of nephrotic syndrome
Minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis, diabetes, myeloma
Common causes of nephritis syndrome
IgA nephropathy Post strep Goodpastures's syndrome SLE myeloma
Investigations for glomerulonephritis
Urinalysis-albumin creatinine ratio more accurate than dipstick eGFR and creatinine Bloods Autoantibodies Renal ultrasound +- biopsy
Things to ask in prostate history
Urgency Frequency Dysuria Feeling of incomplete emptying Hesitancy Nocturia Terminal dribbling Haematuria
Investigations of prostate issues
PSA CR U+Es MSU IPSS Abdo ultrasound Voiding studies Biopsy
Lifestyle management of BPH
Avoid caffeine and alcohol
Physiotherapy
Medical management of BPH
a-blockers: doxazoxin, tamulosin
5a-reductase inhibitors: Finasteride
Surgical management of BPH
if prostate <100g TURP (transurethral resection of the prostate)
if >100g HOLEP (holmium laser enucleated prostate)
What is TURP syndrome?
Hyponatremia due to excessive irrigation fluid during a TURP operation
Complicated UTI vs uncomplicated
Complicated: abnormal renal tract, voiding difficulty, reduced renal function or virulent organism eg staph aureus
Uncomplicated: normal renal tract and function
Differentiate between pyelonephritis, cystitis, and prostatitis
Pyelo: fever, rigors, loin pain
Cystitis: frequency, dysuria, urgency, haematuria
Prostatitis: Flu-like symptoms, back ache, enlarged prostate
Risk factors for breast cancer
obesity
smoking
estrogen exposure
family history (BRCA-1 breast and ovarian)
Questions to ask about breast cancer presentation
Painless lump Peau d'orange Paget's disease of the nipple Nipple discharge Tethering Asymmetry
Investigation for breast cancer
Triple assessment
Examination
Imaging: Ultrasound (+mammogram if over 35)
Biopsy: FNA (C2 benign, C5 maligant)
Most common types of breast cancer
Ductal carcinoma 80%
Lobular carcinoma 20%
Management of breast cancer
Surgery: Partial mastectomy, total mastectomy +- sentinel node biopsy or axillary node clearance
Radiation
Chemotherapy if high risk
Tamoxifen or herceptin if HER2
