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Phase 2 - Marc's Genitourinary > Genitourinary Lectures > Flashcards

Genitourinary Lectures Flashcards

1
Q

Define glomerular filtrate rate.

A

Fluid volume filtered through glomeruli per time unit.

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2
Q

List 3 normal GFRs.

A

1) 120ml/min
2) 7200ml/hr
3) 170L/day

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3
Q

What percentage of cardiac output do the kidneys receive?

A

20%.

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4
Q

What does eGFR predict?

A

Creatinine generation.

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5
Q

List 3 factors that affect eGFR.

A

1) age
2) gender
3) race

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6
Q

List the 3 sites for sodium reabsorption.

A

1) PCT - 70%
2) loop of Henle - 25%
3) DCT - 5%

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7
Q

What part of the kidney is most vulnerable to damage and what type?

A

PCT, ischaemic injury.

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8
Q

What transporters are found in the loop of Henle?

A

Na2KCl cotransporters.

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9
Q

Where do loop diuretics work?

A

Thick ascending limb of loop of Henle.

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10
Q

Where do thiazide diuretics work?

A

DCT.

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11
Q

What is the juxtaglomerular apparatus? (2)

A

1) organ that senses solute concentration

2) release renin when GFR is low

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12
Q

What is aldosterone’s function? (3)

A

1) increased eNac channel in collecting duct
2) sodium reabsorbed
3) potassium excreted

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13
Q

Where is potassium mostly reabsorbed? (2)

A

1) PCT

2) loop of Henle

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14
Q

List 2 hormones that increase potassium reabsorption.

A

1) insulin

2) catecholamines (e.g. DA, NA, A)

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15
Q

List 2 medications that cause hypokalaemia.

A

1) loop diuretics

2) thiazide diuretics

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16
Q

List 5 medications that cause hyperkalaemia.

A

1) spironolactone (aldosterone antagonist)
2) ACEi
3) ARB
4) amiloride (acts on eNac, i.e. collecting duct)
5) trimethoprim (acts on eNac, i.e. collecting duct)

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17
Q

Where is water concentration detected?

A

Hypothalamus.

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18
Q

Describe erythropoietin.

A

Hormone produced by kidneys in response to tissue hypoxia. Increases haemoglobin production.

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19
Q

What is MAP.

A

Mean arterial pressure, 60-70mmHg

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20
Q

Describe the change in glomerular filtrate pressure along the nephron. (2)

A

1) 60-70mmHg at Bowman’s capsule (MAP)

2) 3-10mmHg at collecting duct

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21
Q

What spinal nerve roots control urinating.

A

S3-S5 (PNS).

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22
Q

What spinal nerve roots control urine storage.

A

T10-L2 (SNS).

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23
Q

What is the volume of the bladder?

A

500ml.

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24
Q

What epithelium is found in the bladder?

A

Urothelium - transitional epithelium, 3-7 cells thick, completely impermeable.

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25
Q

What gender is more likely to develop retention?

A

Male, longer urethra so greater voiding pressure required.

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26
Q

What gender is more likely to develop incontinence?

A

Female, shorter urethra, lower voiding pressure to overcome.

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27
Q

List 3 common narrowings where renal calculi occur.

A

1) pelviureteric junction
2) pelvic brim
3) vesicoureteric junction

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28
Q

Define hydronephrosis.

A

Urine filled dilation of renal pelvis as ureter is blocked.

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29
Q

What are infection induced renal calculi composed of? (3)

A

Struvite (magnesium ammonium phosphate, NH₄MgPO₄·6H₂O).

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30
Q

What is the difference between nephrolithiasis, renal calculi and renal colic? (3)

A

1) nephrolithiasis - formation of kidney stones
2) renal calculi - kidney stones
3) renal colic - pain due to kidney stones

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31
Q

Define stranguria.

A

Burning dysuria in frequent small volumes despite urgency (i.e. inc. dysuria, oliguria, urgency)

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32
Q

What is another name for acute kidney injury?

A

Acute renal failure.

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33
Q

What is AKI characterised by? (2)

A

1) high serum urea creatinine
2) low urine output

i.e. decreased GFR

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34
Q

What percentage of hospital patients have AKI?

A

18%.

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35
Q

What percentage of ITU patients have AKI?

A

50%

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36
Q

List 5 types of renal replacement therapy.

A

1) haemodialysis
2) peritoneal dialysis
3) haemofiltration
4) haemodiafiltration
5) kidney transplant

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37
Q

List indications for dialysis.

A

1) symptomatic uraemia (e.g. pericarditis)
2) uncontrolled hyperkalaemia
3) metabolic acidosis
4) fluid overload

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38
Q

List 3 complications of renal replacement therapy.

A

1) CVD (e.g. MI)
2) infection
3) amyloidosis

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39
Q

Define hepatorenal syndrome.

A

AKI in patients with cirrhosis or fulminant liver failure.

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40
Q

List 4 types of kidney cancer.

A

1) renal cell carcinoma (85%)
2) transitional cell carcinoma (10%)
3) sarcoma
4) nephroblastoma (Wilms’ tumour)

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41
Q

What percentage of renal cell carcinoma present with metastasis?

A

25%.

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42
Q

What age group does Wilms’ tumour affect?

A

0-3 years old.

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43
Q

What percentage of transitional cell carcinomas occur in the bladder?

A

50%.

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44
Q

List 4 organs lined by transitional epithelium.

A

1) kidney (renal calyces, renal pelvis)
2) ureter
3) bladder
4) urethra

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45
Q

What should any patient over 40 years old with haematuria be assumed to have?

A

Transitional cell carcinoma (bladder).

46
Q

What’s the most common cancer in 15-44 year old males?

A

Testicular cancer.

47
Q

What is the most common male cancer?

A

Prostate cancer.

48
Q

What percentage of PSAs are normal in cancer patients?

A

30%.

49
Q

What score is used to diagnose prostate cancer using a transrectal ultrasound guided prostate biopsy?

A

Gleason score.

50
Q

What is the treatment of prostate cancer dependent on?

A

The projected survival of the patient, i.e. more years likely to live more likely to carry out a radical prostatectomy.

51
Q

List 4 storage lower urinary tract symptoms (LUTS).

A

1) nocturnal
2) frequency
3) urgency
4) incontinence

52
Q

List 6 voiding lower urinary tract symptoms.

A

1) hesitancy
2) poor intermittent stream
3) straining
4) dysuria
5) haematuria
6) after dribble (post micturition or terminal)

53
Q

Define post micturition dribble.

A

Involuntary loss of urine a few minutes after passing urine (often after leaving toilet).

54
Q

Define terminal dribble.

A

Difficulty in stopping passing urine.

55
Q

What is protective against benign prostatic hyperplasia?

A

Castration.

56
Q

List 3 things not caused by benign prostatic hyperplasia.

A

1) infertility
2) erectile dysfunction
3) prostate cancer

57
Q

How do α1 blockers treat benign prostatic hyperplasia?

A

Smooth muscle relaxation in bladder neck and prostate decreases obstructive LUTS.

58
Q

When should α1 blockers not be prescribed?

A

Postural hypertension.

59
Q

What is the function of 5α reductase?

A

Testosterone —> dihydrotestosterone (active form).

60
Q

How do 5α reductase inhibitors treat benign prostatic hyperplasia? (2)

A

1) block conversion of testosterone to dihydrotestosterone

2) prevents prostatic growth

61
Q

What are the complications of transurethral resections of prostate (TURPs)? (3)

A

1) impotence (14%)
2) erectile dysfunction (10%)
3) incontinence (1%)

62
Q

List 2 things find in UTI urine.

A

1) bacteria (bacteriuria)

2) pus (pyuria)

63
Q

List 5 pathogens that cause UTIs in primary settings.

A

1) Klebsiella
2) Enterococci
3) Escherichia coli
4) Proteus
5) Staphylococci

64
Q

In what setting is there a broader range of UTI causes?

A

Hospital.

65
Q

Define uncomplicated UTI.

A

UTI in healthy non-pregnant woman with normally functioning urinary tract.

66
Q

Define complicated UTI.

A

UTI in patients with abnormal urinary tract (e.g. stones) or systemic disease involving kidneys (e.g. diabetes mellitus).

67
Q

What is the likelihood of a woman getting a UTI in her lifetime?

A

1/3.

68
Q

List 3 virulence factors that increase uropathogenic Escherichia coli’s virulence in UTIs.

A

1) P pilli - urethral ascent
2) aerobactin - iron intake
3) haemolysin - pore formation

69
Q

What often precedes pyelonephritis?

A

Cystitis.

70
Q

What is the common presentation triad of pyelonephritis? (3)

A

1) loin pain
2) fever
3) pyuria

71
Q

What is the most common male UTI?

A

Prostatis.

72
Q

When does prostatis usually present?

A

<35 years old.

73
Q

What is urethritis primarily?

A

STI.

74
Q

What is the first test for urethritis (STI)?

A

Nucleic acid amplification test (NAAT).

75
Q

What is the most common STI?

A

Chlamydia.

76
Q

What is more common in men chlamydia or gonorrhoea?

A

Gonorrhoea.

77
Q

What is more common in women chlamydia or gonorrhoea?

A

Chlamydia.

78
Q

How does chlamydia gram stain?

A

Negative.

79
Q

How does gonorrhoea gram stain?

A

Negative.

80
Q

Define epididymo-orchitis.

A

Inflammation of epididymis and testis.

81
Q

List 2 causes of epididymo-orchitis.

A

1) STI (<35 years old)

2) UTI (>35 years old)

82
Q

List 4 histological changes found in diabetes mellitus caused chronic kidney disease.

A

1) mesangial expansion and proliferation
2) podocytopathy
3) glomerular basement thickening
4) glomerulosclerosis

83
Q

What is the ‘best’ form of renal replacement therapy?

A

Kidney transplant.

84
Q

What is the most commonly used RRT?

A

Haemofiltration.

85
Q

Describe how haemofiltration works. (4)

A

1) dual lumen catheter placed in vein (jugular, subclavian, femoral)
2) blood pump draws/returns blood from/to lumen
3) ultrafiltrate continuously removed
4) replacement infusion continuously infused

86
Q

Describe how haemodialysis works.

A

1) atrioventricular fistula draws/returns blood into a vein

2) blood passed over semi-permeable membrane with counter current dialysis fluid

87
Q

List 3 disadvantages of haemodialysis.

A

1) time consuming (3 times a week for 4 hours)
2) large solutes not cleared
3) requires haemodynamically stable unatherosclerotic patient

88
Q

List 6 complications of haemodialysis.

A

1) hypotension
2) chest pain
3) infection (dialysis catheter)
4) nausea
5) headaches
6) fever/rigours

89
Q

What is the main form of RTT used in CKD?

A

Peritoneal dialysis.

90
Q

Describe how peritoneal dialysis works.

A

Peritoneum used as a membrane for fluid and solute exchange.

91
Q

List 4 complications of peritoneal dialysis.

A

1) infection (e.g. peritonitis)
2) abdominal hernia
3) bowel perforation
4) loss of peritoneum membrane function (over time)

92
Q

How much protein is lost via urine in nephrotic syndrome?

A

> 3.5g/day.

93
Q

Why is there a hypercoagulable state in nephrotic syndrome?

A

Loss of antithrombin III.

94
Q

List 3 features of erection.

A

1) carvernosal smooth muscle relaxation
2) increased sinusoidal blood flow
3) occlusion of venous outflow

95
Q

What initiates and maintains erections?

A

Nitric oxide.

96
Q

What spinal nerve roots control erections?

A

S2-S4 (PNS).

97
Q

What spinal nerve roots control ejaculation?

A

T11-L2 (SNS).

98
Q

How is a flaccid state maintained?

A

Constant sympathetic tone.

99
Q

List the 3 triggers of erection.

A

1) psychogenic (sensory stimulation)
2) reflexogenic (genital stimulation)
3) nocturnal (REM sleep)

100
Q

Describe how an erection forms. (6)

A

1) S2-S4 pudendal nerve stimulation
2) NO release
3) GTP —> cGMP (guanylate cyclase)
4) protein kinase G closes L-type Ca2+ channels
5) fall in cytoplasmic Ca2+
6) smooth muscle relaxation

101
Q

What percentage of 40 year olds have erectile dysfunction?

A

2%.

102
Q

What percentage of 65 year olds have erectile dysfunction?

A

25%.

103
Q

What percentage of patients with radical prostatectomy have erectile dysfunction?

A

80%.

104
Q

List 4 side effects of phosphodiesterase-5 inhibitors.

A

1) headaches
2) flushing
3) dyspepsia
4) runny nose

105
Q

How do phosphodiesterase-5 inhibitors treat erectile dysfunction? (2)

A

1) inhibit breakdown of cGMP

2) prolonged smooth muscle relaxation

106
Q

What percentage of end stage renal failure is caused by glomerulonephritis?

A

25%.

107
Q

Define glomerulonephritis.

A

Broad term of inflammation of glomeruli and nephrons.

108
Q

List 4 ways glomerulonephritis can present.

A

1) nephritic syndrome
2) nephrotic syndrome
3) acute kidney injury
4) chronic kidney disease

109
Q

List 4 things glomerulonephritis can cause.

A

1) haematuria
2) proteinuria
3) compensatory hypertension
4) acute kidney injury

110
Q

When do epididymal cysts generally develop?

A

Around 40 years old.

111
Q

What side is more commonly affected in varicocele?

A

Left side, due to the angle left testicular vein enters left renal vein.

Phase 2 - Marc's Genitourinary (9 decks)

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