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Phase 2A HT > GU > Flashcards

GU Flashcards

1
Q

What is the most common cause of hypercalcaemia leading to renal stone formation?

A

Hyperparathyroidism

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2
Q

What 3 main places do renal stones get stuck?

A

Pelviureteric junction, Pelvic brim and Vesicoureteric junction

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3
Q

Pre-renal causes of AKI?

A 
FRIST
F- failure --> heart/liver/skin
I- infection/sepsis, intrarenal haemodynamics
R- red cell haemorrhage
S- sick --> gi losses, stenosis
T- thrombosis
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4
Q

Define AKI

A

= abrupt DETERIORATION in parenchymal renal function which is usually but not invariably REVERSIBLE over a period of days or weeks

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5
Q

Define CKD

A

= LONG STANDING and usually PROGRESSIVE DECLINE in renal fucntion

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6
Q

3 main causes of rapidly progressive GN?

A
  1. background of acute nephritic syndrome
  2. antiglomerular BM disease (Goodpastures if w. lung involvement)
  3. ANCA-assoc. vasculitis
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7
Q

Triad of features seen in nephrotic syndrome?

A

proteinuria, hypoalbuminaemia and oedema

may also get hyperlipidaemia

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8
Q

why do pts get recurrent infections in nephrotic syndrome?

A

Due to decreased IgG levels as they are lost in urine/deposited in glomerular BM

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9
Q

why do pts get hyper-coagulability symptoms in nephrotic syndrome and give an example

A

–> venous/arterial thrombosis due to loss of proteins and clotting factors in the urine

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10
Q

most common causes of chronic kidney disease

A

DM
HTN
Atherosclerotic renal vascular disease
(=most common causes in european countries)

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11
Q

RF for CKD

A

CVD, proteinuria, HTN, DM, AKI, recurrent UTIs

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12
Q

How do you distinguish between AKI and CKD?

A

normochromic anaemia, small kidneys on US and presence of renal osteodystrophy favour chronic process

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13
Q

What GFR level is considered as established renal failure?

A
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14
Q

3 possible causes of severe fluid losses

A

burns
diarrhoea/vomiting
virus/fever

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15
Q

Advantages of renal transplant rather than dialysis (4)

A
  • survival advantage
  • QoL advantage
  • economic advantage
  • enable successful pregnancy
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16
Q

Why are women with CKD less likely to conceive

A

women normally stage 4/5 CKD when they reach CBA and often develop anaemia –> decrease likelihood of conception

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17
Q

Complications of kidney transplant

A
  • malig and inf much more common due to immunosuppressant therapy
    Others: CVD, cerebrovascular disease and tx withdrawal
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18
Q

indications for dialysis in AKI

A 
hyperK
metabolic acidosis (DKA)
pulm. oedema
uraemic pericarditis
severe uraemia (can --> neurological complications
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19
Q

Wha are the criteria for absolute exclusion of transplant (renal)

A 
malig
HIV
active infection
not fit for general anaesthesia
life expectancy
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20
Q

inhibitors of creatinine secretion?

A

trimethoprin, cimetidine, ritonavir

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21
Q

Albumin levels in urine & their interpretation:

A 
300mg = macro-(proper)-albuminuria
>1g = heavy, golemrular pathology likely
>3g = nephrotic range (--> hypoalbuminaemia --> periph. oedema)
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22
Q

where do thiazide diuretics work?

A

distal tubule

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23
Q

medication causing hypokalaemia

A 
loop diuretics (furosemide, bumetanide)
thiazide diuretics (bendoflumethiazide)
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24
Q

medication causing hyperkalaemia

A

spironolactone (= aldosterone antag)
amiloride (= potassium sparing diuretic)
ACEIs (ramipril, lisinopril, perindopril)
ARBs (trimethroprin and calcineurin inhibitors) - eg losartan, irbesartan

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25
Q

calcitriol actions

A
  • increases calcium and phosphate absorption from the gut

- suppressed PTH

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26
Q

EPO=?

A

= eryhtropoietin, a hormone secreted by the kidney that stimulates RBC production by bone marrow

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27
Q

What do polycystins do and what is their relation to PKD?

A

PKD1 & 2 cause mutations in polycystins 1 and 2
polycystins regulate tubular and vascular development in kindneys
also in other organs, incl. liver, brain, arterial blood vessels and pancreas –> casuing extra-renal manifestations of PKD

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28
Q

what is a varicocoele?

A

= abnormal dilation of the testicular veins in the pampiniform plexus, caused by venous reflux

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29
Q

2 complications of varicocoeles

A
  • reduced testicular function

- male infertility

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30
Q

when is surgery indicated in varicocoele

A

pain
infertility possibility
possible testicular atrophy

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31
Q

typical presentation of testicular torsion

A

sudden, severe pain in one testes, makes walking uncomfortable
may spread to lower abdo
comes on during sport or exercise

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32
Q

How do you differentiate between testicular torsion and epididymo-orchitis?

A

torsion = sudden onset pain, younger pt
EO = slower onest of symps in an older pt (often assoc with STD)
both have inflamed and painful testis

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33
Q

histological appearance of benign prostatic hyperplasia

A

cell hyperplasia and reduced apoptosis

34
Q

What would DRE find in benign prostatic hyperplasia

A

smooth enlargement of prostate, often asymmetrical across lateral lobes

35
Q

4 factors involved in UT obstruction in prostatic hyperplasia

A
  1. hyperplastic nodules compress and stretch prostatic urethra
  2. involvement of periurethral zone interferes with sphincter mechanism
  3. contraction of hyperplastic SM in stroma
  4. inflam cell infiltration
36
Q

role of dihydrotestosterone

A

enlargement of the prostate gland and seminal vesicles (in puberty)

37
Q

Where in prostate does benign hyperplasia occur

A

Transitional zone (lateral lobes)

38
Q

Where in prostate does prostate cancer occur?

A

Peripheral zone

39
Q

5 cancers that metastasise to bone

A 
breast
lung
kidney
thyroid 
prostate
40
Q

What is PSA

A

= prostate specific antigen, an protease responsible for the liquefaction of semen
will be raised in any prostatic disease

41
Q

Pros of screening for prostate cancer

A
  • saves lives (decreases mortality 30%)
  • earlier detection = better prognosis
  • commonest cancer of men
  • 4th most common cause of cancer death
42
Q

Cons of screening for prostate cancer

A
  • goes against ‘do more good than harm’ –> detect cancer where tx won’t help –> pt anxiety
  • overdx of insignificant disease
  • negative implications fo dx/tx
  • uncertain natural history
43
Q

presentation of renal cell carcinoma

A

classic triad:

haematuria, loin pain, loin mass (in flank)

44
Q

What is Wilms tumour

A

= undifferentiated mesodermal tumour of the intermediate cell mass
Most common intra-abdo tumour of CHILDHOOD (20% of all childhood malig)

45
Q

What cell line do most testicular tumours arise from?

A

> 96% from germ cells

46
Q

3 physiological examples of dipstick +ve haematuria

A 
menstruation
sport (muscle breakdown)
sexual intercourse
47
Q

why is Von Hippel Lindau premalignant

A

pts are predisposed to forming cysts, an then lose their normal gene to inhibit this, leading to multiple cysts forming which can develop into cancerous lesions

48
Q

indicators of psychological aetiology of ED?

A

sudden onset
good nocturnal/early morning erections
situational ED
young patient

49
Q

examples of drugs with negative effect on ED

A

ACEI
B-blockers
diuretics
(ang. II receptor blockers may have positive effect)

50
Q

why are UTIs more common in women

A

short urethra & its proximity to anus facilitates transfer of bowel organisms to bladder

51
Q

what is the most common cause of UTI and where does it arise from?

A

E. coli, usually arises from pt’s own bowel flora (bacteria colonise urethral orifice and ascend urinary tract

52
Q

5 main bacterial causes of UTI

A 
E.COLI (70%), 
Proteus Mirabilis, 
Staph saprophyticus/epidermis, 
Klebsiella, 
Enterococcus faecalis
53
Q

Definition of UTI

A

> 10^5 organisms per ml (or for dx 10^2 with pyruia)

54
Q

RF for UTI

A

Female, sex/new sexual partner, immunosuppression/DM, pregnancy and catheter, any abnormality in urinary tract or internal/external obstruction, age

55
Q

Normal host defences preventing bacterial colonisation of UT (preventing UTI)

A 
pH of urine
flow of urine washes out bacteria
commensals
tamm-harsfall protein (from kidney)
GAG layer
56
Q

definition of recurrent UTI

A

> 2 episodes in 6m OR

>3 episodes in 12m

57
Q

definition of complicated UTI

A

= UTI in the presence of:

  • structurally/functionally abnormal UT (w. or w/o host compromise
  • poor renal function
  • outflow obstruction
  • virulent organisms
58
Q

indications for ix of UTIs

A

recurrent episodes
signif LUTS
haematuria
men/children

59
Q

abnormalities that encourage cystitis

A

UT obstruction/stasis
previous damage to bladder epi
bladder stones
poor emptying

60
Q

symptoms of UTI (lower)

A

frequency, dysuria, strangury, haematuria, suprapubic pain

61
Q

signs of UTI

A

fever
abdo/loin tenderness
foul smelling urine

62
Q

Tx of UTI

A

trimethoprim (empirical)
nitrofurantoin
ADVICE: increase fluids, urinate often (& void pre and post intercourse)

63
Q

S&S of acute pyelonephritis (=inflam of kidneys)

A

rigors, pyrexia, N&V, loin pain & tenderness

64
Q

uncomplicated UTI = ?

A

UTI in otherwise healthy, non-pregnant woman with functionally normal UT

65
Q

pyelonephritis = ?

A

neutrophil infiltration of parenchyma, (small cortical abscesses and streaks of pus in renal medulla often present)

66
Q

vesicoureteric reflux = ?

A

incompetent valve between bladder and ureter, allowing reflux of urine up ureters during bladder contraction and voiding
(usually ceases by ~ puberty but normally damage is already done by then)

67
Q

epididymo-orchitis = ?

A

syndrome consisting of pain swelling and inflam of epididymus ± inflam of testes

68
Q

Most common aetiology in epididymo-orchitis

A

35yrs = mostly G -ve enteric organisms, eg E. coli, pseudomonas

69
Q

RF for epididymo-orchitis

A

previous infection
indwelling catheters
anal intercourse
structural/functional abnormalities of UT

70
Q

typical presentation fo epididymo-orchitis

A

UNILATERAL scrotal pain and swelling of ACUTE ONSET, with UTI symps

71
Q

presentation of prostatitis

A

fever, malaise, myalgia, rigors
(plus UTI symptoms)
pain in low back/abdomen
pain on ejaculation

72
Q

tx of prostatitis

A 
analgesia, 
suprapubic catheter (if retention), 
parenteral ABX, 
flouroquinolones - eg ciprofloxacin - 4 wks
2nd line - trimethoprim/macrolides
73
Q

presentation of urethritis

A

urethral pain, dysuria ± discharge

NB primarily sexually acquired

74
Q

presentation of pyelonephritis

A

Classic triad: loin pain, fever and pyuria

75
Q

why does dairy consumption reduce chance of UT stone formation?

A

it doesnt impact calcium in urine, BUT it binds to oxalate removing it from gut and urine, hence decreasing stone formation

76
Q

give 4 preventative measures for reducing stone formation

A 
decrease salt in diet
overhydration
normal dietary intake/healthy protein intake
physical activity/regular exercise
reduce BMI
77
Q

what condition is classically described by pain thats 12/10 or ‘worse than labour’

A

Renal colic

78
Q

what is gold standard for dx of renal stone?

A

NCCT KUB - v. rapid, 99% sens for stones

79
Q

mx of ureteric colic

A

analgesia - NSAID suppository, opiates
antiemetics
± admit and IV fluids
observe for sepsis

80
Q

whats the most common cause of stress incontinence (in women)

A

childbirth –> denervation of pelvic floor and urethral sphincter

81
Q

what medication do you give in renal colic and when

A

if stone is >5mm give tamsulosin (=a blocker) - relaxes smooth muscle allowing the stone to pass OR nifedipine (CCB)

82
Q

RF for AKI

A

PMH - DM, CKD, prostate cancer

elderly

Phase 2A HT (11 decks)

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