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Phase 2a med mine > GU > Flashcards

GU Flashcards

1
Q

Describe the pathophysiology of nephrotic syndrome

A

Podocyte injury/scarring

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2
Q

What is the main difference between nephrotic and nephritic syndrome?

A

Nephrotic: proteinuria >3.5g/day
Nephritic: haematuria

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3
Q

Describe the symptoms of nephrotic syndrome

A

Proteinuria: >3.5g/day
Hypoalbuminaemia->oedema
Hyperlipidaemia
Hypogammaglobuniaemia
Hypercoagulability

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4
Q

How does nephrotic syndrome result in hyperlipidemia?

A

Liver increases synthesis of lipids in response to low albumin

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5
Q

How does nephrotic syndrome result in hypogammaglobulinemia?

A

Loss of Ig’s in urine

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6
Q

How does nephrotic syndrome result in hypercoagulability?

A

Loss of antithrombin 3 and proteins C and S in urine

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7
Q

How is nephrotic syndrome diagnosed?

A

Biopsy
Light/electron microscopy

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8
Q

What are the 3 main conditions that result in nephrotic syndrome?

A

Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy

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9
Q

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

A

Minimal change disease

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10
Q

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

A

Focal segmental glomerulosclerosis

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11
Q

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

A

Membranous nephropathy

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12
Q

What would you see in light microscopy in a patient with minimal change disease?

A

Nothing

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13
Q

What would you see in electron microscopy in a patient with minimal change disease?

A

Podocyte effacement and fusion

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14
Q

What would you see in light microscopy in a patient with focal segmental glomerulosclerosis?

A

Segmental sclerosis

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15
Q

What would you see in electron microscopy in a patient with focal segmental glomerulosclerosis?

A

Podocyte effacement

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16
Q

What would you see with light microscopy in a patient with membranous nephropathy?

A

Thickened glomerular basement membrane

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17
Q

What would you see in electron microscopy in a patient with membranous nephropathy?

A

Subpodocyte immune complex deposition
Spike and dome appearance

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18
Q

Describe the pathophysiology of nephritic syndromes

A

T3 hypersensitivity reactions
Apart from Goopasture’s-Type 3
GBM breaks: inflammation and Bowman crescents

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19
Q

Describe the symptoms of nephritic syndrome

A

Haematuria
Hypertension
Oedema
Oliguria

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20
Q

Name the conditions that commonly cause nephritic syndrome

A

IgA nephropathy
Post-strep glomerulonephritis
Goodpasture’s syndrome
SLE nephropathy
(Haemolytic uremic syndrome)

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21
Q

What is IgA nephropathy also called?

A

Berger’s syndrome

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22
Q

Name 2 conditions that can present as both nephrotic and nephritic

A

Diffuse proliferative glomerulonephritis
Membrano-proliferative glomerulonephritis

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23
Q

Name 2 risk factors for developing IgA nephropathy

A

Asian(greater incidence in Asian populations)
HIV

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24
Q

How do patients with IgA nephropathy usually present?

A

Visible haematuria(Ribena/coke) 1-2 days post viral infection (URTI-pharyngitis/tonsilitis/gastroenteritis)

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25
Q

How is IgA nephropathy diagnosed?

A

Biopsy:
Immunofluorescence microscopy shows IgA complex deposition in mesangium(supportive cells of Bowman’s capsule)

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26
Q

Describe the treatment for IgA nephropathy

A

Non-curative: 30% progress to ESRF
BP control: ACE-i 1st line control

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27
Q

Name a differential diagnosis for a patient presenting with IgA complex deposition in the kidneys

A

Could be :
IgA nephropathy
Henoch Schonlein purpura

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28
Q

What is Henoch Schonleun purpura?

A

AKA IgA vasculitis
Alos shows IgA complex deposition in kidneys

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29
Q

How can you distinguish between Henoch Schonlein purpura and IgA nephropathy?

A

IgA nephropathy: IgA deposition only in kidneys
Henoch Schonlein: systemic deposition-kidneys, skin ,liver

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30
Q

Describe how patients with post-strep glomerulonephritis commonly present

A

Visible haematuria (ribena/coke)
2 weeks after pharyngitis from group A,Beta haemolytic strep (S pyogenes)

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31
Q

Which bacteria is responsible for post-strep glomerulonephritis?

A

S pyogenes

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32
Q

How is post-strep glomerulonephritis diagnosed?

A

Biopsy then light/electron/immunofluorescence microscopy

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33
Q

What would you find in a patient with post strep glomerulonephritis with light microscopy?

A

Hypercellular glomeruli

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34
Q

What would you find in a patient with post-strep glomerulonephritis with electron microscopy?

A

Subendothelial immune complex deposition

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35
Q

What would you find in a patient with post strep glomerulonephritis with immunofluorescence microscopy?

A

Starry sky appearance
IgG, IgM and C3 deposition along GBM and mesangium

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36
Q

Describe the treatment for post strep glomerulonephritis

A

Usually self limiting
Can progress to RPGN(rapidly progressing glomerulonephritis)

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37
Q

Describe the cause of SLE nephropathy

A

ANA desposition in endothelium

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38
Q

How is SLE nephropathy diagnosed?

A

ANA positive
anti dsDNA positive

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39
Q

Describe the treatment for SLE nephropathy

A

Steroids
Hydroxychloroquine
Immunosuppressants: cyclophosphamide

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40
Q

Describe the pathophysiology of Goodpasture’s

A

Autoantibodies: anti-GBM that cause pulmonary+alveolar haemorrhage and glomerulonephritis

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41
Q

How is Goodpasture’s syndrome diagnosed?

A

Immunofluorescence: Linear deposition of IgG along glomerular capillaries

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42
Q

Describe the treatment for Goodpasture’s syndrome

A

Steroids and plasma exchange

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43
Q

Which nephritic syndrome can lead to rapidly progressing glomerulonephritis?

A

Post strep glomerulonephritis

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44
Q

How do patients with haemolytic uremic syndrome commonly present?

A

5 days post infection with shiga toxin
E coli, shigella

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45
Q

Name 2 micro bacteria that can cause haemolytic uremic syndrome

A

E coli, shigella

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46
Q

Name the consequences of haemolytic uremic syndrome

A

Haemolytic anaemia
AKI(glomerulonephritis) and uremia
Thrombocytopenia

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47
Q

How is haemolytic anaemia treated?

A

Mostly self-limiting
Present as a medical emergency-supportive fluids and antibiotics

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48
Q

What is rapidly progressing glomerulonephritis

A

Subtype of glomerulonephritis that progresses to ESRF very quickly-weeks to months

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49
Q

How is rapidly progressing glomerulonephritis diagnosed?

A

Inflammatory crescents in Bowman’s space

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50
Q

Name the causes of rapidly progressing glomerulonephritis

A

Wegener’s granulomatosis
MPA
Good pastures

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51
Q

Name 2 conditions that can present as both nephritic and nephrotic?

A

Diffuse proliferative glomerulonephritis
Membranoproliferative glomerulonephritis

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52
Q

What is polycystic kidney disease?

A

Cyst formation throughout renal parenchyma leading to bilateral enlargement and damage

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53
Q

How is polycystic kidney disease inherited?

A

Familial
Can be autosomal dominant-most common
Or autosomal recessive

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54
Q

Which gene mutations are involved in autosomal dominant PCKD?

A

85%: PKD1
15%: PKD2

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55
Q

What groups of people do autosomal dominant PCKD tend to affect?

A

Males
Present at 20-30 years

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56
Q

Is autosomal recessive or dominant PCKD more common?

A

Autosomal dominant more common

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57
Q

When do patients with autosomal recessive PCKD commonly present?

A

Disease of infancy or prebirth
High mortality

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58
Q

Name some congenital abnormalities associated with autosomal recessive PCKD?

A

Potter’s sequence: flattened nose, clubbed feet

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59
Q

Which kind of PCKD inheritance is associated with congenital abnormalities?

A

Autosomal recessive

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60
Q

Describe the normal physiology of PKD1+2 genes

A

Code for polycystin (Ca2+ channel)
When filtrate passes cilia of nephron, they move and polycystin(Ca2+ channels)open
Ca2+ influx->inhibits excessive growth of cilia

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61
Q

Describe the pathophysiology of PCKD

A

PKD mutations lead to decreased Ca2+ influx so excessive growth of cilia->cysts
Many cysts-polycystic

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62
Q

Describe the common presentation of a patient with polycystic kidney disease

A

Bilateral flank/back/ abdo pain
Can have hypertension and haematuria
Can also cause extra-renal cysts which can rupture and cause haemorrhage

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63
Q

Name a common location of extra renal cysts

A

Circle of Willis: Berry aneurysm

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64
Q

Name a complication that can arise from a ruptured berry aneurysm

A

Subarachnoid haemorrhage

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65
Q

How is PCKD diagnosed?

A

Kidney US
Genetic testing and fHx of PCKD

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66
Q

What findings would you expect on the ultrasound of someone with PCKD?

A

Enlarged bilateral kidneys with multiple cysts

67
Q

Describe the treatment of PCKD

A

Non curative
Manage symptoms:
Acei-hypertension
RRT/transplant for ESRF

68
Q

What MUST you rule out when investigating a scrotal mass?

A

Cancer until proven otherwise

69
Q

What is an epididymal cyst?

A

Extra testicular cyst(above and behind testes) that will transilluminate

70
Q

How is an epididymal cyst diagnosed?

A

US scrotum

71
Q

What is a hydrocele?

A

Fluid collection in tunica vaginalis
Cyst
Will transilluminate

72
Q

How can you diagnose a hydrocele?

A

US scrotum

73
Q

What is a varicocele?

A

Distended pampiniform plexus due to increased left renal vein pressure causing reflux

74
Q

Describe the common presentation of a patient with a varicocele

A

Bag of worms on exam
Usually LHS
Typically painless but can be painful when larger and more severe

75
Q

Name a complication of a varicocele

A

Infertility

76
Q

What is testicular torsion?

A

Spermatic cord twists it on itself causing occlusion of testicular artery->ischaemia->can lead to gangrene of testes if untreated

77
Q

Name a risk factor for developing testicular torsion

A

Bell clapper deformity
Testes lie horizontally instead of vertical

78
Q

How do patients with testicular torsion commonly present?

A

Severe uni testicular pain (hurts to walk)
Abdominal pain
Nausea and vomiting
Cremasteric reflex lost
No pain relief when elevating testes.

79
Q

What is the cremasteric reflex?

A

Stroke inner thigh: ipsilateral testicle should elevate(retract upwards)

80
Q

How is testicular torsion diagnosed?

A

US to check testicular blood flow
1ST: Surgical exploration if high risk

81
Q

Describe the treatment of testicular torsion

A

Urgent surgery within 6 hours
All cases require bilateral orchiopexy
If testes viable: orchipexy
If testes not viable: Orchidectomy

82
Q

What is orchiopexy surgery?

A

Fixing of testes to scrotal sac to overcome Bell clapper deformity

83
Q

What are the 2 categories LUTS can be characterised as?

A

Storage symptoms
Voiding symptoms

84
Q

Are storage or voiding symptoms more common in men or women?

A

Storage: more common in women
Voiding: more common in men

85
Q

When do storage symptoms occur?

A

Occurs when the bladder should be storing urine (need to pee)

86
Q

When do voiding symptoms occur?

A

Occur when bladder outlet is obstructed (hard to pee)

87
Q

Name the LUTS storage symptoms

A

FUNI
Frequency
Urgency
Nocturia
Incontinene

88
Q

Name the LUTS voiding symptoms

A

SHID
poor Stream
Hesitancy
Incomplete emptying
Dribbling

89
Q

Name the GU related red flag symptoms

A

Haematuria
Dysuria

90
Q

Is incontinence commonly seen in males or females?

A

Females

91
Q

What are the 3 types of incontinence?

A

Stress
Urge
Spastic paralysis

92
Q

What is stress incontinence?

A

Pee leaks out due to increase in intra abdominal pressure->causes sphincter weakness
Post pregnancy trauma

93
Q

What causes urge incontinence?

A

Detrusor muscle overactivity

94
Q

What causes spastic paralysis incontinence?

A

Neuro urological UMN lesion
Overactive reflexes and hypertonia of detrusor

95
Q

What is the treatment for incontinence?

A

Surgery
Anticholinergic drugs

96
Q

Is retention commonly seen in males or females?

A

Males
‘Overflow incontinence’

97
Q

What is urinary retention?

A

Inability to pass urine even when bladder full (>500mL)

98
Q

Name some causes of urinary retention

A

Obstruction: stones, BPH, neurological flaccid paralysis

99
Q

What is the treatment for urinary retention?

A

Catheterisation

100
Q

What is benign prostate hyperplasia?

A

Non malignant prostate hyperplasia-normal with ageing

101
Q

Name some risk factors for developing BPH

A

Increasing age
Ethnicity(Afrocaribbeans have higher testosterone)

102
Q

Name something that is protective against BPH

A

Castration

103
Q

Describe the pathophysiology of BPH

A

Proliferation of inner transitional zone of prostate->narrows urethra

104
Q

How do patients with BPH typically present?

A

LUTS (mostly voiding)
Poor stream dribbling, incomplete emptying, straining, dysuria, nocturia, urgency
Anuria if totally occluded urethra->hydronephrosis, UTI, stones

105
Q

What is the difference between BPH and prostate cancer?

A

BPH: proliferation of inner transitional zone
Prostate cancer: Outer zone proliferation

106
Q

Name some consequences of a totally occluded urethra from BPH

A

Retention->
Hydronephrosis!!!!
UTI
Stones

107
Q

How is BPH diagnosed?

A

DRE-rectal exam: smooth and enlarged
PSA: rule out prostate cancer but unreliable
Bladder diary, rule out other causes

108
Q

What differences would you expect in the rectal exam of a patient with BPH vs prostate cancer?

A

PBH: smooth enlarged
Prostate cancer: Hard and irregular

109
Q

How is PSA useful?

A

Very unreliable-can be raised in both BPH and prostate cancer but can be used to rule out prostate cancer

110
Q

Describe the treatment for BPH

A

Lifestyle changes: decrease caffeine-may eventually need catheter
Medications: tamsulosin, finasteride
Surgery as last resort: TURP

111
Q

Describe the medications used to treat BPH

A

1st line: alpha blocker-tamsulosin
2nd line: 5 alpha reductase inhibitor-finasteride

112
Q

How are alpha blockers useful in treating BPH?

A

Relax baldder neck

113
Q

How are 5 alpha-reductase inhibitors useful in treating BPH?

A

Decrease testosterone production so decrease prostate size

114
Q

Name a surgery used for BPH treatment

A

TURP-trans urethral prostate resection-remove prostate tissue to reduce size

115
Q

Name a complication from a TURP procedure

A

Retrograde ejaculation

116
Q

What is obstructive uropathy and what complication can it lead to?

A

Blockage of urine flow, can affect one or both kidneys depending on the level of obstruction->obstructive nephropathy

117
Q

Name some causes of obstructive uropathy

A

BPH
Stones
(Things that cause obstructions)

118
Q

Describe the pathophysiology of obstructive uropathy

A

Obstruction-> increased retention and increased KUB pressure->reflexing/backlogged urine in renal pelvis (hydronephrosis)->dilated renal pelvis which is more infection prone

119
Q

Describe the typical presentation of a patient with obstructive uropathy

A

Signs of an obstruction
Might be asymptomatic if only 1 kidney is affected

120
Q

How is obstructive uropathy treated?

A

1)Relieve kidney pressure->catheteris urethra, ureteral stent
2)Treat BPH or stones (underlying cause)

121
Q

What are the components of the upper urinary tract

A

Kidneys and ureters

122
Q

What are the components of the lower urinary tract

A

Bladder and urethra

123
Q

What is a UTI in the upper urinary tract called?

A

Pyelonephritis-kidney infection

124
Q

Which UTIs occur in the lower urinary tract?

A

Cystitis-UPEC infection of bladder
Prostatitis-inflammation of prostate
Urethritis
Epididymo orchiditis

125
Q

Which organisms commonly cause UTIs?

A

KEEPS
Kliebsiella
Enterobaccter
E.Coli
Proteus
S.saprophyticus

126
Q

Which organism is responsible for 80% of UTIs?

A

Uropathogenic E.Coli

127
Q

What is the difference between a complicated and non-complicated UTI?

A

Uncomplicated-non pregnant women
COmplicated-anything else

128
Q

Why are females more affected by UTIs than men?

A

Females have shorter urethras so closer to anus and easier for bacteria to colonise

129
Q

What is the first line test for diagnosing UTIs?

A

Urine dipstick!
Positive leukocytes
Positive nitrites
Might or might not have haematuria

130
Q

What is the gold standard test for diagnosing UTIs?

A

Midstream urine sample-confirm UTI and ID pathogen

131
Q

What is pyelonephritis?

A

Infection of renal parenchyma and upper ureter
Ascending transurethral spread
Usually UPES but can be other KEEPS

132
Q

Which groups tend to be affected by pyelonephritis?

A

Females
<35

133
Q

Name some risk factors for developing pyelonephritis

A

Urine stasis(stones)
Renal structure abnormalities
Catheters

134
Q

How do patients with pyelonephritis typically present?

A

Triad of:
Loin pain
Fever
Pyuria

135
Q

What is pyuria?

A

Pus and WBC’s in urine

136
Q

How is pyelonephritis diagnosed?

A

1st line: urine dipstick
Gold standard: microscopy culture and sensitivities
Also investigate for stones if suspected

137
Q

Describe the treatment for pyelonephritis?

A

Analgesia, paracetemol
Antibiotics: ciprofloxacin or co-amoxiclav
Cefalexin if pregnant

138
Q

Which antibiotic should be used for pyelonephritis in pregnant patients?

A

Cefalexin

139
Q

What is the official triad of pyelonephritis symptoms?

A

Nausea and vomiting
Fever
Loin pain
(No pyuria as would need to be investigated to show it)

140
Q

What is cystitis?

A

UPEC infection of bladder

141
Q

Name some risk factors for developing cystitis

A

Urine stasis
Bladder lining damage
Catheters

142
Q

Is cystitis predominantly seen in males or females?

A

Females

143
Q

Describe the presentation of a patient with cystitis

A

Suprapubic tenderness and discomfort
Increased frequency and urgency
Visible haematuria
Confusion in elderly

144
Q

How is cystitis diagnosed?

A

1st line: urine dipstick
GS: microscopy cultures and sensitivity

145
Q

How is cystitis treated?

A

Abx: trimethoprim or nitrfurantoin
Amoxicillin if pregnant

146
Q

What antibiotic should be used to treat cystitis in pregnant patients?

A

Amoxicillin

147
Q

What is urethritis?

A

Inflammation with/without infection of urethra
Most commonly a sexually acquired condition

148
Q

Name the infective causes of urethritis

A

Gonococcal(Neisseria gonorrhoea)
Non-gonococcal (Chlamydia trachomatus)

149
Q

What is the most common cause of urethritis?

A

Neisseria gonorrhoea

150
Q

Name a non infective cause of urethritis

A

Trauma

151
Q

Name some risk factors for urethritis

A

MSM
Unprotected sex

152
Q

Describe how patients with urethritis commonly present

A

Dysuria with/without urethral discharge (blood/pus)
Urethral pain

153
Q

How is urethritis diagnosed?

A

NAAT(nucleic acid amplification test)->detect gonorrhoea or chlamydia)
Urine dip(positive if infective, UTI indicated)
MC+s-detect and ID pathogen if UTI

154
Q

Name a gram-negative diplococcus bacteria that could cause urethritis

A

Gonorrhoea

155
Q

How is urethritis treated?

A

Neisseria gonorrhoea: IM ceftriaxone + azithromycin
Chlamydia trachomatis: azithromycin (or doxycycline)

156
Q

Name the triad of reactive arthritis

A

‘Can’t see, can’t pee, can’t climb a tree’
Conjunctivitis, urethritis, arthritis

157
Q

What kind of bacteria is chlamydia

A

Obligate intracellular gram-negative aerobe (bacillus)

158
Q

What is epididymo-orchitis?

A

Inflammation of epididymis, extending to testes

159
Q

What are the 2 main causes of epididymo-orchitis?

A

Urethritis (STI) <35yrs
Cystitis(KEEPS in bladder)

160
Q

How do patients with epididymo-orchitis

A

Unilateral scrotal pain and swelling
Pain relieved with elevating testes(Prehn’s sign)
Intact cremaster reflex

161
Q

Name a differential diagnosis for epididymo-orchitis

A

Testicular torsion
More acute, nausea and vomiting, cyptochordism(BellClapper)1

162
Q

How is epididymo-orchitis diagnosed?

A

NAAT-STI
Urine dip
MC+S

163
Q

Describe the treatment for epididymo-orchitis

A

Dependent on STI/UTI
NG: ceftriaxone + azathioprine
CT: azithromycin

Phase 2a med mine (11 decks)

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