GU Flashcards
1
Q
What are 3 functions of the kidney?
A
Filter or secrete waste
Retain albumin
Reabsorb glucose, bicarbonates
Control BP and electrolytes
Erythropoietin synthesis
Activates 25-hydroxy vitamin D
2
Q
Define golmerular filtration rate (GFR)
A
Volume of fluid filtered from glomeruli to Bowman’s space per minute
3
Q
What is normal GFR?
A
120ml/min
7.2L/hour
170L/day
4
Q
What percentage of CO does each kidney receive?
A
20%
5
Q
What part of the kidney is most vulnerable to damage?
A
PCT
6
Q
What is reabsorbed in the Loop of Henle?
A
25% Na+
7
Q
What transporters are most active in the ascending LOH?
A
Na2KCl
8
Q
Where do loop diuretics mainly work?
A
Ascending LOH
9
Q
Where do thiazide diuretics work?
A
Distal convoluted tubule
10
Q
What detects high solutes/low GFR?
A
Juxtaglomerular apparatus
11
Q
What is released in response to low GFR?
A
Renin
12
Q
Outline the angiotensinogen pathway
A
Angiotensinogen -> angiotensin -> angiotensin II -> aldosterone release
13
Q
Where is renin released from?
A
Kidney
14
Q
What is the function of renin?
A
Converts angiotensinogen -> angiotensin
15
Q
Where is ACE released from?
A
Lungs
16
Q
What is the function of ACE?
A
Converts angiotensin -> angiotensin II
17
Q
What are the effects of angiotensin II?
A
Aldosterone production
Vasoconstriction
18
Q
What is the function of aldosterone?
A
Sodium and water absorbed
Potassium excreted
19
Q
Where does aldosterone primarily act?
A
Collecting duct
20
Q
What occurs in the collecting duct?
A
Secretes K+ and H+ into urine
Water handling
Salt handling
21
Q
What regulates water handling in the collecting duct?
A
Vasopressin
22
Q
What is water absorbed through in the collecting duct?
A
Aquaporin 2 channels
23
Q
Where is K+ mostly reabsorbed?
A
PCT/LOH
24
Q
What 2 organs make up the upper urinary tract?
A
Kidneys
Ureters
25
What 4 parts make up the lower urinary tract?
Bladder
Bladder neck
Prostate gland
Urethra
26
What muscle controls urinating (bladder contraction)?
Detrusor muscle contraction
27
What nerves control voiding?
Parasympathetic
S3, S4, S5
28
What nerves control urine storage?
Sympathetic
T10, L1, L2
29
What lines the bladder?
Urothelium
30
Why are women more likely to develop incontinence?
Shorter urethra with lower resistance
31
What is the other name for nephrolithiasis?
Renal stones
32
Define nephrolithiasis
Calculi form in collecting ducts and can be deposited anywhere from renal pelvis to urethra
33
What are the 3 MC sites of stones?
Pelvic brim
Pelviureteric junction (PUJ)
Vesicoureteric junction (VUJ)
34
What are 5 types of renal stones?
Calcium oxalate (MC)
Calcium phosphate
Uric acid
Struvite- infection
Cysteine
35
Who affected by renal stones?
10-15% of people
20-40
Males>
36
What is the recurrence rate of renal stones?
>50%
37
What are the risk factors of renal stones?
Dehydration
Obesity
Primary renal disease
Infection
Recurrent UTI
38
Outline the pathophysiology of renal stones/nephrolithiasis
Excess solute in CD -> supersaturated urine -> crystallisation -> outflow obstruction -> may cause hydronephrosis
39
What are the symptoms of renal colic?
Rapid onset
Comes in waves (colicky) of extreme pain
Groin to loin pain
Often can not lie still
40
What are the symptoms of nephrolithiasis?
Renal colic
Fluid/diuretics make it worse
Haematuria
Dysuria (hard to wee)
FEVER IS RED FLAG (infection)
41
What are 2 differential diagnoses of renal stones?
Vascular incident (AAA)
Diverticulitis
Ectopic pregnancy or ovarian cyst torsion
Testicular torsion
42
How is nephrolithiasis diagnosed?
GS: NC-CT of KUB
Urinalysis, FBC, U+E
43
How are renal stones/nephrolithiasis treated?
Small = diclenofac (NSAIDs)
Larger stones = medical expulsion therapy (tamulosin)
Not working = ESWL (small) /PCNL (large)
44
What is ESWL?
Extracorporeal shockwave lithotripsy
Ultrasound waves break up stone
45
What is PCNL?
Percutaneous nephrolithotomy
Keyhole surgery to remove large stones
46
How are renal stones/nephrolithiasis prevented?
Low sodium diet
Overhydrate
Reduce BMI
Reduce animal protein
Increase citrus
Thiazides for hypercalcuria
47
What are the complications of nephrolithiasis?
Hydronephosis (outflow obstruction)
Abcess
Chronic damage
Pyonephrosis
48
What occurs when renal stones are infected?
Pyonephrosis
49
How is pyonephrosis treated?
IV Abx
Drain
Oxygen
50
Define acute kidney injury/AKI
Abrupt (hour-days) decline in kidney function characterised by a rise in serum creatine and urea and decline in urine output
51
How is AKI classified?
KIDIGO classification
52
What are the 3 criteria for AKI diagnosis?
Rise in creatine >26 micomol/L in 48 hours
Or
Rise in creatine >1.5x baseline
Or
Urine output <0.5ml/kg/h for > 6 hours
53
What are 3 risk factors of AKI?
Increased age
Comorbidities
Hypovolaemia
Nephrotoxic drugs
54
How common is AKI?
18% hospital patients
1/4 with sepsis and 50% with septic shock
55
What are the 3 classifications of causes of AKI?
Prerenal (MC)
Renal
Postrenal
56
What are 3 Prerenal causes of AKI?
Renal hypoperfusion
Hypovolaemia
Shock
Hypotension
Low CO
57
What are 3 renal causes of AKI?
Glomerulonephritis
Renal parenchymal damage
Necrosis (MC)
Thrombosis
58
What are 3 post-renal causes of AKI?
UT obstruction at ureter, bladder, prostate
Luminal (eg stones)
BPH
Occluded catheter
Malignancy
59
What are the symptoms of AKI?
Can be asymptomatic
Hyperkalaemia: arrhythmia, muscle weakness
Oilguria
High urea/uraemia: fatigue, weakness, N+V, confusion
Oedema
Acidosis
60
How is AKI diagnosed?
Intrarenal = biopsy
Postrenal = renal USS
Urea:creatine ratio
Exclude infection
Check for infection
ECG for hyperkalaemia
61
What are the signs of hyperkalaemia on ECG?
Tall tented T wave
Flat P wave
Wide QRS
Prolonged PR
62
How is AKI treated?
Treat complications (hyperkalaemia, fluid excess, acidosis)
Treat underlying cause
Stop nephrotoxic drugs
Last line= RRT
63
How is hyperkalaemia in AKI treated?
Calcium gluconate
Insulin
64
How is acidosis treated in AKI?
Sodium bicarbonate
65
How is excess fluid managed in AKI?
Diuretics
66
What are 2 nephrotoxic drugs?
NSAIDs
ACE-inhibitor
Gentamicin
Amphotericin
67
What are 3 indications for RRT in AKI?
AEIOU
Acidosis
Electrolyte imbalance (persistent hyperkalaemia)
Intoxication (poisoning)
Oedema (refractory pulmonary oedema)
Uraemia (encephalopathy or pericarditis).
68
What does a urea:creatine ratio of >100:1 indicate in AKI?
Prerenal cause
69
What does a urea:creatine ratio of <40:1 indicate in AKI?
Renal cause
70
What does a urea:creatine ratio of 40-100:1 indicate in AKI?
Postrenal cause
71
Define CKD
Gradual progressive irreversible decline in kidney function present for >3 months
72
Define CKD in terms of GFR
<60ml/min/1.73m^2 for 3+ months
73
What is used to stage CKD?
eGFR
74
What eGFR indicates stage 1 CKD?
>90 with renal signs
75
What eGFR indicates stage 5 CKD?
<15
Worst- not working or close to failure
76
What unit is used for eGFR?
mL/min/1.73m2
77
What are 3 risk factors of CKD?
DM
HTN
Old age
CVD
SLE
Recurrent UTI
BAME
Chronic NSAID use
78
What are 3 causes of CKD?
Idiopathic
DM
HTN
Polycystic kidneys
Tuberous sclerosis
AKI
FHx
79
What 4 parameters are used to stage CKD?
Creatine
Age
Gender
Ethnicity
80
Outline the pathophysiology of CKD
Nephrons fail -> filtration done by fewer functional nephrons -> increased flow in remnant nephrons -> increased pressure causes nephron failure -> can be detected as increased proteinuria -> ESRF
81
What are the symptoms of CKD?
Asymptomatic for a while
Accumulation of metabolites (eg urea)
Anaemia
Haematuria
Nephropathy
82
What are 4 complications of CKD?
Anaemia of chronic disease
Bone disease
Neurological issues (postural HTN, weakness)
CVD
83
How is CKD diagnosed?
Anaemia of chronic disease
Low eGFR
USS usually shows small kidneys (bilateral atrophy)
84
How is CKD treated?
Irreversible so prevent progression and prevent complications
BP: ace inhibitor, angiotensin blocker, CCB
Calcitrol and Ca2+
Lower cholesterol
ESRF: RRT or transplant
85
What type of dialysis is usually used for CKD?
Peritoneal
86
Define UTI
Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteriuria and pyuria
87
What level of organisms defines UTI?
>10^5 organisms/ml fresh mid stream urine
88
What 5 pathogens cause UTI?
KEEPS
Klebsiella
E.coli (MC)
Enterococcus
Proteus
Staph Saprophyticus
89
What are the 2 classifications of UTI location?
Upper urinary tract = kidneys
Lower urinary tract = bladder onwards
90
What is one upper UTI?
Pyelonephritis
91
What causes 80% of UTIs?
Uropathogenic strains of E.coli (UPEC)
92
Why are UTIs more common in females?
Shorter urethra
Closer to anus so easier for bacteria to colonise
93
What are 4 host defence mechanisms against UTI?
Antegrade fushing of fluid (forward flushing)
Tamm-Horsfall protein (antimicrobial)
Low urine pH and high osmolality
Urinary IgA
94
What are 4 lower UTIs?
Cystitis
Prostatitis
Epididymo-orchitis
Urethritis
95
What is the 1st line test for UTI?
Urine dipstick
- positive leukocytes
- positive nitrites
- positive/ negative haematuria
96
Define uncomplicated UTI
UTI in healthy, non-pregnant woman with functionally normal urinary tract
97
Define complicated UTI
Infection in patients with abnormal urinary tract (eg. Stones, DM, virulent organism)
Complications and treatment failure more likely
Most UTIs in men are complicated
98
What is the GS of UTI diagnosis?
Midstream microscopy, culture, and sensitivity
99
Define pyelonephritis
Infection of the renal parenchyma and upper ureter
100
How is pyelonephritis contracted?
Ascending transurethral spread
Usually UPEC
101
Who is primarily affected by pyelonephritis?
Women <35
Associated with sepsis or systemic upset
102
What are 3 risk factors of pyelonephritis?
Calculi
Pregnancy
Catheter
DM
Structural abnormalities
103
What are the symptoms of pyelonephritis?
Classic triad:
- Loin pain
- Fever
- Pyuria (pus in urine)
104
What additional investigation is carried out for pyelonephritis?
Urgent ultrasound to detect stones or obstruction
105
How is pyelonephritis treated?
Analgesia
Ciprofloxacillin or co-amoxiclav (IV if severe)
106
What is given to pregnant women with pyelonephritis?
Cefalexin
107
Define cystitis
Urinary infection of the bladder
107
What are the risk factors of cystitis?
Urinary obstruction -> urinary stasis
Damage to bladder epithelium
Bladder stones
Poor emptying
Catheter
108
What are the symptoms of cystitis?
Suprapubic pain and discomfort
Increased frequency and urgency
Offensive smelling/ cloudy urine
Incontenence
109
How is cystitis treated?
Trimethoprim or nitrofurantoin (3 weeks to 7 if complex)
110
What is given to pregnant women with cystitis?
Amoxicillin
111
Define prostatitis
Infection and inflammation of the prostate gland
112
Who is affected by prostatitis?
Mc UTI in men <50
Usually presents >35
113
What are the MC causes of prostatitis?
Strep. Faecalis
E. Coli
Chlamydia
114
What are 3 risk factors of prostatitis?
STI
Indwelling catheter
Post biopsy
Increased age
115
What are the symptoms of prostatitis?
Systemically unwell
Fever, rigours, malaise
Pain on ejaculating
Can be chronic (>3 months)
116
How is prostatitis diagnosed?
Prostate tender and hard
Dipstick
PSA
TRUSS
117
How is prostatitis treated?
Gentamicin+ co-amoxiclav
118
Define urethritis
Urethral inflammation due to infectious or non-infectious causes
119
How is urethritis usually transmitted?
Sexually transmitted
120
What are the 2 main causes of urethritis?
Gonococcal (nessiseria gonorrhoea)
Non gonococcal: MC chlamydia trachomatis
121
What are 3 risk factors of urethritis?
Sexually active
Unprotected sex
Male-male sex
122
What type of bacteria is chlamydia?
Obligate intracellular gram negative aerobic bacillus
123
What type of bacteria is Neisseria?
Gram negative diplococcus
124
How is urethritis diagnosed?
NAAT (Nucleic Acid Amplification Test)
- female = self collected vaginal swab, male = first void
Dipstick and other normal stuff
125
How is chlamydia (CT) treated?
doxycycline and azithromycin
126
How is gonorrhoea treated?
IM Ceftriaxone
127
Define epididymo-orchitis
Pain, swelling and inflammation of the epididymis that can extend to the testes usually due to urethritis or cystitis
128
What condition is associated with urethritis?
Reactive arthritis
129
What is the MC cause of epididymo-orchitis in men <35?
Chlamydia
N. Gonorrhoea
130
What is the MC cause of epididymo-orchitis in men >35?
KEEPS
Elderly= catheter
131
What are the risk factors of epididymo-orchitis?
Previous infections
Catheter
Anal intercourse
132
What are the symptoms of epididymo-orchitis?
Unilateral scrotal pain and swelling
Positive Pren’s sign
Cremaster reflex intact
133
What is Pren’s sign?
Pain relieved by elevating testes
134
How is epididymo-orchitis diagnosed?
NAAT
Normal stuff
135
How is epididymo-orchitis treated?
Ceftiaxone and doxycycline
136
How is testicular torsion differentiated from epididymo-orchitis?
epididymo-orchitis = positive Phrens sign
TT = negative
Pain elevated by lifting testes
137
Define glomerulonephritis
Group of parenchymal diseases resulting in inflammation of the golmeruli and nephrons
138
What percentage of CKD is caused by glomerulonephritis?
25%
139
What is injured in nephrotic syndrome?
Podocyte food processes
140
What is injured in nephritic syndrome?
Disruption of glomerular basement membrane due to inflammation
141
What are the symptoms of nephrItic syndrome?
Haematuria
Oliguria
HTN
142
What are 2 conditions that can present as both nephrotic and nephritic syndrome?
Diffuse proliferative glomerulonephritis
Membrane proliferate glomerulonephritis
143
What are the symptoms of nephrOtic syndrome?
Proteinuria (frothy urine)
Hypoalbuminaemia
Oedema
Also usually severe Hyperlipidaemia
144
What is the MC cause of nephritic syndrome?
IgA nephropathy
145
What are 3 primary causes of nephrotic syndrome?
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
146
What is the MC cause of nephrotic syndrome in children?
Minimal change disease
147
What is the MC cause of nephrotic syndrome in adults?
Focal segmental glomerulosclerosis
148
What is the MC secondary cause of nephrotic syndrome?
Diabetes
149
How is minimal change disease (nephrotic) diagnosed?
Biopsy then E-microscopy shows podocyte effacement and fusion
150
How is focal segmental glomerulosclerosis diagnosed?
Biopsy and microscopy shows scarring (segmental sclerosis)
151
How is membranous nephropathy diagnosed (3 things)?
Biopsy shows BM thickening
Subpodocyte immune complex deposition
Anti phospholipase A2 receptor antibodies present
152
How is nephrotic syndrome treated?
Treat oedema: thiazide diuretics, loop diuretics
ACEi/ARB
Immunosuppressants
Steroids
153
Which cause of nephrotic syndrome responds best to steroids?
Minimal change disease
154
What is the major clinical difference between nephrotic and nephritic syndrome?
Nephritic = Inflammation
Nephrotic = oedema
155
What are 5 causes of nephritic syndrome?
IgA nephropathy/ Berger’s
Post strep glomerulonephritis
SLE
Goodpastures
Haemolytic uremic syndrome
156
What are the complications of nephrotic syndrome?
Hyperlipidaemia
Thrombolytic events
Susceptibility to infection
157
What is the only non-type 3 hypersensitivity reaction cause of nephritic syndrome?
Goodpastures - T2
158
What are the symptoms of IgA nephropathy?
Visible haematuria 1-2 days after viral infection (tonsillitis or gastroenteritis) due to IgA deposition in the meseangium of the kidney
159
How is IgA nephropathy diagnosed?
Immunofluorescence microscopy shows IgA complex deposition
160
How is IgA nephropathy treated?
Non-curative (30% = ESRF)
BP control
Fish oil and steroids if present >3 months
161
What are the symptoms of post strep glomerulonephritis?
Visible hamematuria 2 weeks after pharyngitis from group A beta haemolytic strep (pyrogenes)
162
How is post strep glomerulonephritis diagnosed?
Evidence of strep infection
Immunofluoresence shows starry sky appearance due to antigen deposited in glomerulus
163
How is post strep glomerulonephritis treated?
Usually self limiting
Antibiotics
164
How is SLE nephritic syndrome diagnosed?
ANA posited
Anti dsDNA positive
165
How is SLE nephritis treated?
Steroids
Hydroxychloroquine
Immunosuppressant
166
What is Goodpastures?
Pulmonary and alveolar haemmorage with glomerulonephritis due to autoantibodies
167
How is Goodpastures diagnosed?
Anti-GBM present
168
How is Goodpastures treated?
Steroids
Plasma exchange
Immunosuppressants (cyclophosphamide)
169
What are the symptoms of Goodpastures?
SOB
Ogliouria
170
When does haemolytic uremic syndrome occur?
Around 5 days post infection of shiga toxin (e. Coli or shigella)
171
What are 3 functions of the prostate?
Produces 80% of seminal fluid
Testosterone and DTH production
Regulates urine flow
172
Define benign prostate hyperplasia (BPH)
Increase in the size of prostate without presence of malignancy
173
What are the risk factors of BPH?
40% of men >60
Afro carribeans
Obesity
Heart disease
FHx
174
Outline the pathophysiology of BPH
Benign modular or diffuse proliferation -> grows bigger -> can squeeze or partially block urethra -> problems with urinating
175
What are the symptoms of BPH?
FUNI- need to wee
Frequency, Urgency, Nocturia ,Incontenence
SHID- hard to wee
Poor Stream ,Hesitant, Incomplete emptying ,Dribbling
176
How is BPH diagnosed?
DRE (digital rectal exam) shows enlarged but smooth prostate
PSA may be high
Urine test to exclude infection
177
How is BPH treated?
Lifestyle factors: avoid caffeine and alcohol
1. Alpha 1 antagonist (tamulosin)
2. 5-alpha reductase inhibitor (finasteride)
Not responding or massive = TURP/ TUIP (transurethral resection/incision of prostate)
178
How does tamulosin/alpha 1 antagonists work?
Relax smooth muscle in bladder neck and prostate producing increase in urine flow rate
179
What are the side effects of tamulosin?
Drowsiness
Dizziness
Ejactulatory failure
Weight gain
180
When is tamulosin contraindicated?
Postural HTN
181
How does finasteride work?
Blocks conversion of testosterone to its active form (dihydrotestosterone) which causes prostatic growth
182
What are the side effects of finasteride?
Impotence
Decreased libido
183
What are the complications of untreated BPH?
Bladder calculi
UTI
Haemaruria
Acute retention
184
What is the MC male malignancy?
Prostate cancer
185
Where do prostate cancers usually occur?
Peripheral zone of prostate gland
186
What is the MC type of prostate cancer?
Adenocarcinoma
187
Where does prostate cancer most commonly metastasise?
Lymph and bone through prostate capsule
188
What are the risk factors of prostate cancer?
FHx
Genetics
Black
Increased age
189
What are 2 genes that increase the risk of prostate cancer?
HOXB13
BRCA2
190
What are the symptoms of prostate cancer?
LUTS: nocturia, hesitancy, poor stream, terminal dribbling
Erectile dysfunction
Weight loss
191
How is prostate cancer diagnosed?
DRE: hard, irregular prostate
Raised PSA
GS: TRUS and biopsy
192
How is prostate cancer treated?
Radical prostatectomy (<70)
Radiotherapy and hormone therapy
LHRH agonists
Androgen receptor blocker
193
What are 2 LHRH agonists?
Leuprorelin
Goserelin
194
What is an androgen receptor blocker?
Bicalutamide
Flutamide
195
How is prostate cancer graded?
Gleason score- higher = worse prognosis
196
Who is commonly affected by testicular cancer?
20-40 year old men
197
Where do most testicular cancers arise from?
Germ cells (seminomas)
198
What are the risk factors of testicular cancer?
Undescended testes (Cryptorchidism)
Infertility
FHx
HIV
Kleinfelters
199
What are the symptoms of prostate cancer?
Painless lump in testicles
Testicular and abdo pain
Hydrocele (scrotum swelling)
Gynaecomastia (man boobs)
200
What are 2 differential diagnoses of testicular cancer?
Testicular torsion
Lymphoma
Hydrocele
201
How is testicular cancer diagnosed?
Doppler ultrasound (GS)
raised AFP and B-hCG
CT staging
202
How is testicular cancer treated?
Radical inguinal orchidectomy (ball removal)
Chemotherapy
Store sperm!
203
What is bladder cancer an example of?
Transitional cell carcinoma (TCC)
204
Who is most commonly affected by bladder cancer?
Men
>55
205
What are 3 risk factors of bladder cancer?
Smoking
Occupational exposure: dyes (hairdresser) paint, other carcinogens
Chronic inflammation of UT
FHx
206
What are the symptoms of bladder cancer?
Painless haematuria
Back pain
Voiding inability
207
What are 2 differential diagnoses of bladder cancer?
UTI
Urethral trauma
Haemmoragic cystitis
Renal cancer
208
How is bladder cancer diagnosed?
Flexible cystoscopy with biopsy
CT urogram (also staging)
Urinalysis
209
How is bladder cancer treated surgically?
TURBT (transurethral removal of bladder tumour)
Radical cystectomy
- extenteration in women: bladder, womb
- cystoprostatectomy in men: bladder, prostate
210
What are 2 types of kidney cancer?
Renal cell carcinoma (RCC)
Wilms tumour/nephroblastoma
211
Where does RCC arise from?
Proximal convoluted tubule epithelium
212
Who is most commonly affected by RCC?
Males>females
Usually around 55
Czech Republic
213
What are the risk factors of RCC?
Smoking
Obesity
HTN
Haemodialysis
VHL syndrome
214
What gene increases the risk of RCC?
Von Hippel Linadu syndrome (VHL)
- Autodom mutation on chromosome 3
215
What are the symptoms of RCC?
Often asymptomatic
Haematuria
Loin pain
Abdo mass
Variocele if left(rare)
Polycythaemia
216
How is RCC diagnosed?
1. USS abdo
GS: CT chest and abdomen with contrast
217
What is the name of the staging used in RCC?
Robson staging
218
How is RCC treated?
Localised = nephrectomy (full/partial)
Untolerable for surgery: cryoalbation
Can need adrenalectomy
219
Define Wilms tumour
Childhood tumour of primitive renal tubules and mesenchymal cells (<3)
220
How many people >50 have renal cysts?
50%
221
Define Polycystic kidney disease
Cyst formation in renal parenchymal causing bilateral enlargement and damage
222
What is the MC inherited kidney disease?
Autodom Polycystic disease
223
What are the 2 types of Polycystic kidney disease?
Autodom (MC)
Autorec
224
What genes are mutated in Autodom PKD?
PKD1 on chromosome 16
Or
PKD2 on chromosome 4
225
When is ESRF reached if PKD1 is mutated?
50s
226
When is ESRF reached if PKD2 is mutated?
70s
227
Outline the pathophysiology of Autodom PKD
PKD1 + 2 code for polycystin (calcium channel) -> normally Ca2+ influx inhibits growth of cilia so lack of = excessive cilia growth -> cysts
228
What are the symptoms of Autodom PKD?
Usually occurs >20
Loin pain
Haematuria
HTN
Polycystic liver
Berry aneurysms
229
What thrombotic event is associated with PKD?
Berry aneurysm rupture -> subarachnoid haemorrhage
230
How is PKD diagnosed?
Ultrasound of kidney shows echogenic spaces
FHx
BP raised
231
How is Autodom PKD treated?
1. Transplant
Non curative
BP control
RRT
Tolvaptan
232
What gene is mutated in autorec PKD?
PKHD1 mutation on chromosome 6
233
Who does autorec PKD commonly occur in?
Infants- increased fetal mortality
234
What are the symptoms of autorec PKD?
Abdo mass and renal failure in childhood
235
How is autorec PKD diagnosed?
Prenatal USS
Kidney biopsy
236
What is the MC STI?
Chlamydia
237
What is the proper name for gonorrhoea?
Neisseria gonorrhoea
238
What is the real name for chlamydia?
Chlamydia trachomatis
239
What is the incubation period of chlamydia?
7-21 days
240
What is the incubation period of gonorrhoea?
2-5 days
241
What is the primary site of STI infection in males?
Urethra
242
What is the primary site of STI infection in females?
Cervix
243
What are 3 complications of STIs?
Pelvic inflammatory disease
Neonatal transmission
Ectopic pregnancy
Fitz Hugh Curtis syndome
244
What are the symptoms of chlamydia in men?
50% asymptomatic
Voiding symptoms
Dysuria
245
What are the symptoms of chlamydia in women?
70% asymptomatic
Vaginal discharge
Dysuria
246
What are the symptoms of gonorrhoea in males?
Dysuria
Increased frequency
Discharge
247
What are the symptoms of gonorrhoea in women?
Vaginal discharge
Dysuria
Pelvic pain
248
Define epididymal cyst
Smooth extratesticular spherical cyst in the head of the epididymis
249
What does an epididymal cyst contain?
Spermatocele fluid (clear and milky)
250
What are the presentations of epididymal cysts?
Lump above and behind testes
Transilluminate as fluid filled
Testes palpable separately from the cyst (unlike hydrocele)
251
How is an epididymal cyst diagnosed?
Scrotal ultrasound
252
How are epididymal cysts treated?
Usually fine
If painful can be removed surgically
253
Define hydrocele
Abnormal collection of fluid in the tunica vaginalis
254
Who is hydrocele common in?
Usually in younger men
255
What are the 2 types of hydrocele?
Simple hydrocele
Communicating hydrocele
256
Define simple hydrocele
Overproduction of fluid in tunica vaginalis
257
Define communicating hydrocele
Processus vaginalis fails to close allowing peritoneal fluid to communicate freely with the scrotal portion
258
What are the symptoms of hydrocele?
Scrotal enlargement with non-tender, smooth swelling
Not usually painful unless infected
Testes can be hard to palpate
Anterior and below to testes
Transilluminate
259
What is the difference in position between hydrocele and epididymal cyst?
Hydrocele: anterior and below
Cyst: inferior and behind
260
How is hydrocele diagnosed?
Scrotal ultrasound
261
How is hydrocele treated?
Usually fine
Infants fine within 2 years
If bad, aspiration or surgical removal
262
Define varicocele
Abnormal dilation of testicular veins in the venous plexus, caused by venous reflux
263
What side is more likely to be affected by varicocele?
Left
264
What are the symptoms of varicocele?
Distended scrotal veins “BAG OF WORMS”
Dull ache or heaviness
Hangs lower on site of varicocele
265
How is varicocele diagnosed?
Venography
Colour doppler USS
266
What is the complication of varicocele?
Infertility
267
When is surgery needed in varicocele?
Pain
Infertility
Testicular atrophy
268
Define testicular torsion
Twisting of the testes around spermatic cord causing occlusion of blood vessels, causing ischemia and infarction and POTENTIAL LOSS OF TESTES
269
What time period should surgery be performed in testicular torsion?
<6 hours
270
Who does testicular torsion commonly occur in?
Adolescent boys or young men
11-30
271
What are the symptoms of testicular torsion?
Sudden onset of pain in one testes
Abdo pain, N+V
Negative phrens sign
Cremasteric reflex lost
272
What is the cremasteric reflex?
stroking inner thigh → cremaster muscle contracts and pulls ipsilateral testicle towards inguinal canal
273
What is a risk factor of testicular torsion?
Belt clapper deformity- testes not fully fixed to scrotum
274
What are 2 differential diagnoses of testicular torsion?
Epididymo orchitis (test phrens sign- TT= negative)
Acute hydrocele
Idiopathic scrotal oedema
275
How is testicular torsion diagnosed?
Doppler USS
Surgical exploration
276
How is testicular torsion treated?
Surgery to untwist and expose testes
If too late…. Orcihdectomy (remove testes)
orchiplexy (fixation)
277
What are 3 types of incontinence in females?
Stress (sphincter weakness)
Urge (detrusor overactivity)
Spastic paralysis
278
How is incontinence treated?
Surgery
Anti muscarinic (oxybutynin)
279
Define retention
Males
Inability to pass urine even when bladder is full
280
What are 3 causes of retention in males?
Stones
BPH
Neurological flaccid paralysis
281
What are 4 storage symptoms?
FUNI- need to wee
Frequency
Urgency
Nocturia
Incontenence
282
What are 4 voiding symptoms?
SHID- hard to wee
Poor Stream
Hesitant
Incomplete emptying
Dribbling
283
What is the function of the detrusor muscles?
Relaxes in storage
Contracts in voiding
284
What nerves control detrusor muscles?
Parasympathetic cholinergic control
S3, S4, S5
285
What is the function of distal sphincter?
Contracts in storage
Relaxes in voiding
286
What are some factors that cause an increase in PSA?
prostate hyperplasia or cancer
prostatis
recent ejaculation
UTI
age
287
What drugs should be stopped in AKI?
DAAMN
diuretics
Ace-I/ARB
Aminoglycosides
Metformin
NSAIDs
288
What is minimal change disease associated with?
Upper respiratory tract infection
289
What is a group a beta haemolytic strep?
Strep pyogenes
290
What are the symptoms of haemolytic uremic glomerulonephritis?
Haemolytic anaemia
AKI
Thrombocytopenia
291
What is the testicular appendage?
Small functionless piece of tissue above the testicle
292
What are the symptoms of testicular appendage torsion?
Similar to TT
Small blue dot at top of testes
293
How is testicular appendage torsion treated?
NOT A SURGICAL EMERGENCY
rest + analgesia
294
How is erectile dysfunction treated?
Sildenafil (viagra)
295
How does sildenafil work?
Phosphodiesterase inhibitor- causes smooth muscle relaxation and vasodilation
296
What are the side effects of Sildenafil?
Hypotension
Inc risk of stroke
297
Where do potassium soaring diuretics work?
Collecting duct
298
What eGFR indicates stage 2 CKD?
89-60
299
What eGFR indicates stage 3a CKD?
59-45
300
What eGFR indicates stage 3b CKD?
44-30
301
What eGFR indicates stage 4 CKD?
29-16
302
When is trimethoprim contraindicated?
Pregnancy
303
What is the triad of haemolytic uraemia syndrome?
Thrombocytopenia
Haemolytic anaemia
AKI
