GU Flashcards
common presentations of a renal colic?
acute loin pain that comes and goes, can’t get comfortable and radiates to groin
what is the gold standard investigation for a renal colic?
non-contrast CT of kidney, ureter and bladder
what is the complication that may occur when obtaining a contrast CT?
risk of anaphylaxis
what is the first line investigation for a renal colic?
XR of kidney, ureter and bladder - isn’t as specific as CT
What is the most common composition of renal stones?
calcium oxalate
what is most common presentation in bladder cancer?
painless haematuria
what storage symptoms occur in BPH?
Frequency, Urgency, Nocturia
what voiding symptoms occur in BPH?
Straining, Hesitancy, Incomplete emptying, Poor stream, Post-micturition dribbling
how does tamsulosin work in respect to BPH?
- it is a selective alpha 1-adrenenergic receptor antagonist
- relaxes the smooth muscle in the bladder neck and prostate -> increasing urinary flow rate -> improves obstructive symptoms
what are potential side effects of alpha 1 adrenoceptors, e.g. tamsulosin?
postural hypotension, dizziness and syncope (due to alpha 1 adrenoceptors also being found in smooth muscle of blood vessels, therefore can also lower vascular resistance)
list the most common organisms to cause a UTI
KEEPS - Klebsiella, E. Coli, Enterococcus, Proteus/Pseudomonas, Staphylococcus saprophyticus
how do you define minimal change disease?
Proteinuria (>3.5g/day), Hypoalbuminaemia, Oedema (periorbital and arms), Hyperlipidaemia and lipiduria
why does proteinuria occur in minimal change disease?
damaged glomerulus is more permeable → more protein come across from blood into nephron → proteinuria
why does oedema occur in minimal change disease?
oncotic pressure falls due to less protein in blood → lower osmotic pressure → water driven out of vessels into tissues
why does Hyperlipidaemia and lipiduria occur in minimal change disease?
loss of protein = less lipid synthesis → more lipids in blood → more in urine
why do potassium levels need to be regulated in AKI?
failed kidney function -> inability to excrete potassium -> builds up in blood -> hyperkalaemia -> medical emergency / cardiac arrest
describe the stages of CKD in relation to GFR
- Stage 1 > 90 ml/min with evidence of renal damage
- Stage 2 60-89 ml/min with evidence of renal damage
- Stage 3a 45-59 ml/min with or without renal damage
- Stage 3b 30-44 ml/min with or without renal damage
- Stage 4 15-29 ml/min with or without renal damage
- Stage 5 <15 ml/min, established renal failure
describe furosemide’s pharmacology
a loop diuretic which acts on the ascending limb of the loop of Henle and inhibits the NKCC2 channels
which tumour marker is most likely to be raised in suspected testicular cancer?
alpha feto-protein (AFP)
what is the gold standard investigation for transitional cell carcinoma?
cystoscopy
what is the name of the staging system used for prostate cancer?
Gleason scoring
those with ADPKD have a 10-15% chance of suffering with a what?
intercranial aneurysm e.g. subarachnoid haemorrhage
what is released from where in response to decreased renal perfusion (e.g. hypovolaemia)?
renin from juxtaglomerular cells in kidney
how can you determine between nephrotic and nephritic syndrome in a q?
nephritic = haematuria
nephrOtic = nO haematuria
what is acute tubulointerstitial disease? what can cause it?
- presence of inflammatory cell infiltrate in the interstitium of the kidney
- common cause is allergic reaction to drug (e.g. NSAIDs)
what causes a UTI to be deemed complicated?
pregnancy, males, children, recurrent UTIs, elderly, abnormal urinary tract (e.g. catheter)
list the common symptoms of pyelonephritis
fever, rigor, vomiting, loin pain/tenderness, costovertebral pain, associated cystitis pain, septic shock, loss of appetite, headache, oliguria
what antibiotic is used to treat chlamydia trachomatis?
1g azithromycin or 100mg doxycycline
what class of drugs is the first line treatment for BPH?
A-blockers
symptoms of renal cell carcinoma?
- weight loss/anorexia
- loin pain
- varicocele
- enlarged lymph nodes
- bilateral ankle oedema
- pyrexia
what causes hypertension in renal cell carcinoma?
increased renin secretion causes increased bp due to increased RAAS activation
What scoring system is used to stage renal cell carcinoma?
TNM for malignancy
Name an investigation that would be used to stage RCC
CT/MRI
define hydrocele
abnormal collection of fluid within the remnants of the proceus vaginalis
what is treatment for a hydrocele?
watch and wait, surgery if inguinal hernia appears
investigations for testicular torsion?
clinical/physical exam - no time for imaging
first line treatment for testicular torsion?
surgery called manual distorsion
complication for testicular torsion?
testicular ischaemia / infarction
What is the name of the form of incontinence y when coughing or laughing?
stress
In urge incontinence the detrusor muscle is overstimulated. What class of medication can be used to counteract this?
antimuscarinics
name 3 types of nephrotic syndrome
minimal change disease, membranous adenopathy, amyloidosis, advanced renal disease, focal segmental glomerulosclerosis
What is the most common form of nephrotic syndrome in children?
Wilm’s tumour
What is the mainstay treatment for nephrotic syndrome?
glucocorticoids
how do thiazide diuretics work?
inhibition of Na+ and Cl- cotransporter in the distal tubule
how to loop diuretics work?
inhibition of the Na+/K+/Cl- contransporter in the loop of henle
how do K+ sparring diuretics work?
inhibition of Na+ reabsorption and K+ secretion in the distal tubule ad collecting duct
how do osmotic diuretics work?
inhibition of water and Na+ reabsorption in the proximal tubule, loop of Henle and collecting duct
how do carbonic anhydrase inhibitors work?
inhibition of bicarbonate reabsorption in the proximal tubules
Name 5 risk factors for chronic kidney disease
increasing age, hypertension, DM, AKI, microalbuminaemia, proteinuria, obesity, smoking, alcohol, drugs
As CKD progresses kidney function begins to reduce, what hormone secretion might begin to reduce?
vit D / EPO
What is the first line treatment in CKD? Give an example
ACEi e.g. ramipril
first line treatment for HTN?
> 55yo or Afro-Carribean, it is calcium channel blocker, Otherwise give ACE-i
What does a positive PKD 2 gene mutation indicate?
high risk of developing PKD, more severe form, rarer than PKD1
List 3 some signs & symptoms picked up from a patient with chronic kidney disease
oedema, pruritis, fatigue, polyuria
presentations of hypercalcaemia?
stones, bones, groans, moans
What ratio would be used to monitor renal function?
urea:creatinine ratio
what is diagnostic of IgA nephropathy?
presence of IgA deposits within the glomerulus and mesangial cells under immunofluorescence
ANCA positive blood tests in glomerulonephritis points to which condition?
vasculitis / pauci-immune necrotising glomerulonephritis
What medications are given to patients with ANCA positive disease?
corticosteroids + rituximab
What are the three most common areas for a renal stone to become lodged?
- Pelviureteric junction/ureteropelvic junction – where the renal pelvis connects to the ureter
- Pelvic brim – where the ureter crosses over the pelvic brim and the bifurcation of the common iliac arteries
- Vesicoureteric junction/ureterovesicular junction – where the ureter connects to the urinary bladder
Give 4 risk factors that would make someone more susceptible to renal stone formation
- dehydration
- infection
- hypercalcaemia, hyperoxaluria, hypercalciuria, hyperuricaemia
- primary renal disease
- drugs (diuretics, antacids, corticosteroids, aspirin, allopurinol, vitamin c, vitamin d)
- diet (chocolate, tea, strawberries, rhubarb)
- gout
- family history
- anatomic abnormalities that predispose to stone formation
Give 3 examples of what you could do to prevent the recurrence of renal stone formation.
- maintain hydration
- low calcium intake in the diet
- eat green leafy veg
- low salt diet e.g. reduce the levels of processed meat, ready meals, reduce animal protein intake, - reduce BMI, be active/exercise
Name 2 investigations you could conduct to diagnose BPH
- DRE – smooth enlarged prostate
- Serum Prostate Specific Antigen (PSA) – blood test
What triad of symptoms most commonly present in someone with pyelonephritis?
loin pain, polyuria, fever
What is the gold standard investigation for Pyelonephritis?
midstream urine sample
Name 2 bacteria that you would expect to find in pyelonephritis
KEEPS!!
- Klebsiella spp.
- E.coli
- enterococcus spp.
- Proteus spp.
- coag negative staphylococcus spp
what type of bacteria is neisseria gonorrhoeae?
gram negative diplococci
What antibiotic would you give to treat the Neisseria gonorrhoeae?
ceftriaxone and azithromycin
what is the first line treatment for an uncomplicated UTI? when is it contraindicated in pregnancy?
nitrofurantoin
- avoided at term pregnancy due to neonatal haemolysis
painless haematuria is the typical finding of which cancer?
bladder
what is the first choice antibiotic for pregnant women with acute pyelonephritis?
cefalexin
What is the second most common mineral composition of renal calculi?
magnesium ammonium phosphate
what is Prehn’s sign?
clinical sign in which there is relief of pain upon elevation of the left scrotum.
first line treatment for diabetic neuropathy?
ACE-i e.g. ramipril
Where does the left testicular (gonadal) vein drain into?
left renal vein
what drug class is diclofenac?
NSAID
where is aldosterone produced?
zona glomerulosa
What is the first line test for diagnosing renal stones and what is the gold standard diagnostic test for them?
1st line = Kidney, ureter, bladder ultrasound. Gold standard = Non-contrast computerised tomography (NCCT) of kidney, ureter, and bladder
If a patients renal stone is less than 5mm what treatment should be given to them?
Watch and wait for spontaneous passage/ give a strong analgesic (IV diclofenac)
what type of virus is HIV?
Reterovirus subgroup lentivirus
what CD4 count is the defining level for an AIDs diagnosis?
<200/ul
What is the overall name for treatment given to HIV patients and what sub-groups of medication are given – write in full
- HAART (highly active antiretroviral therapy)
- NRTI (nucleoside reverse transcriptase inhibitors)
What test would be performed to confirm an STD and how would a sample be collected?
First void urine and NAAT/culture OR swab urethral secretions and microscopy
A patient is found to have Gonorrhoea. Describe the appearance of this bacteria on microscopy?
Gram negative diplococci
what is usual function of PSA?
liquifies semen
which cells produce PSA?
luminal cells
A biopsy shows two histological findings consistent with prostate cancer, what could these be?
infiltrative medium sized glands, nuclear enlargement, prominent nuclei
What would electron microscopy show in IgA nephropathy?
immune deposits in mesangium
Name a condition that shows the same signs as IgA nephropathy on microscopy but can affect more than just the kidneys.
Henoch-Scholein purpura
What type of hypersensitivity reaction is IgA nephropathy?
type III
What causes IgA nephropathy?
Galactose deficient IgA antibodies are not recognised as foreign so accumulate. Anti-glycan IgG antibodies bind forming immune complexes. These immune complexes deposit in the kidney
What can IgA nephropathy progress to?
kidney failure
How do corticosteroids prevent immune complex formation in IgA nephropathy?
They prevent production of IgA and anti-glycan IgG
What is the gold standard of investigations for a UTI?
mid-stream urine microscopy, culture and sensitivity
Give an example of an antibiotic used to treat a UTI
Nitrofurantoin, Trimethoprim, Amoxicillin (co- amoxiclav), Cefalexin
Where is the excess fluid located within the testis?
tunica vaginalis
Name 3 causes of Hydrocele
trauma, infection, testicular torsion, patent processus vaginalis
Give 2 differential diagnoses of Hydrocele
testicular torsion, strangulated hernia
Name 1 test that would be done to exclude a malignant teratoma and confirm Hydrocele
- Serum alpha-fetoprotein
- Serum hCG (human chorionic gonadotropin)
Give 2 treatment options for Hydrocele
- watch and wait - will resolve spontaneously
- surgical removal of hydrocele
Name 2 ways the doctor confirm the diagnosis of kidney stones, and the positive result of them.
- Urine dipstick, haematuria/protein/glucose
- NCCT-KUB, visualisation of stone
What type of drug would the doctor prescribe for renal colic, and give an example of this drug?
analgesic - IV diclofenac
What type of stone will only form in acidic urine?
uric acid stones
Which ethnicity is more severely affected by BPH, and suggest a reason why.
afro-caribbean men, higher levels of testosterone
What hormone is essential for the BPH? And thus, what procedure protects individuals against developing BPH?
testosterone, removal of testes
Why would a mid-stream urine sample help you exclude from your differential diagnoses?
infection
What protein can sometimes be raised in the blood of someone with BPH?
prostate specific antigen
what parasite can cause bladder cancer?
schistosomiasis
what antibiotic is used to treat cystitis?
trimethoprim
classic triad of symptoms of renal cell cancer?
loin/flank pain, haematuria, palpable mass
give 3 functions of the kidney
- excretion of water/waste material
- ultrafiltration
- maintains circulating fluid balance
- produces EPO
what is the definition of erectile dysfunction?
the inability to gain and maintain an erection long enough to achieve sexual satisfaction
give 3 causes of nephritic syndrome
IgA nephropathy, ANCA, post strep infection, SLE, Goodpastures disease
what pharmacological treatment is given for stress incontinence?
duloxetine
what surgical treatment is given for stress incontinence?
sling, artificial urinary sphincter
give 4 risk factors for CKD
diabetes, family history, old age, recurrent UTIs
Which organism is the most common cause of pyelonephritis?
E. Coli
characteristics of chronic prostatitis?
pelvic/perineal pain lasting longer than 3 months, RF: trauma causing nerve damage in LUT
what is significant about trimethoprim?
- used to treat UTIs
- TERATOGENIC
what does Budd-Chiari syndrome present with?
abdo pain, ascites and hepatosplenomegaly
what is Reiter’s syndrome aka?
reactive arthritis
which artery plays an important role in erectile dysfunction?
internal pudendal artery
What anatomical differences between men and woman make stress incontinence more likely in women?
women only have one sphincter and it is shorter
what are the 5 types of incontinence?
stress, urgency, mixed, continuous, overflow
what test rules out prostate cancer?
serum PSA
list 4 fisk factors of prostatitis
increasing age, STIs, UTIs, DRE, catheters
2 features felt on prostate exam in prostatitis?
warm, tender, nodular / normal
Describe 2 treatments for acute bacterial prostatitis
ciprofloxacin, analgesia, catheter
describe the pathogenesis of CKD
- scarred nephrons fail ->
- burden of filtration falls to remaining healthy nephrons ->
- glomerular hypertrophy
- increased glomerular capillary pressure and strain and damage remaining nephrons
what is the most common cause of an AKI?
sepsis
what eGFR is used to diagnose CKD?
<60ml/min/1.73m^2>3months
What is the commonest type of renal cell carcinoma?
clear cell
name 1 drug and action for prostate cancer
Goserelin - GnRH agonist
What is the first-line management for maintaining remission in Crohn’s disease?
1st line is Azathioprine or mercaptopurine. (2nd line = Methotrexate)
what is treatment/investigations for testicular torsion?
if low pain score - US, if high surgical exploration and untwisting if required
give the triad of symptoms that make up nephrotic syndrome
hypoalbuminaemia, oedema, proteinuria
what haematological cancer is associated with amyloidosis
non-hodgkins lymphoma
What does the L in AL amyloidosis stand for
light chain
Name 2 cardiac complications of amyloidosis
Restrictive cardiomyopathy, arrhythmia, angina
What colour would you expect amyloid to stain on Congo Red staining?
red
oral melphalan for amyloidosis. How does this drug work?
damages DNA in plasma cells that create light chains
what is amyloidosis
caused by a build-up of an abnormal protein amyloid in organs and tissues throughout the body
define CKD
GFR < 60mL/min/1.73 m2 for more than 3 months
Why would CKD cause anaemia?
reduced erythropoietin production
