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Phase 2a > GU > Flashcards

GU Flashcards

1
Q

Name the two groupings of glomerulonephritis?

Quickly define each of the groupings

A

Nephrotic Syndrome - proteinuria w/ hypoalbuminaemia and oedema (greater than 3.5g/day)

Nephritic Syndrome - haematuria w/ oliguria and HTN (less than 3.5g/day)

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2
Q

What are the 4 primary nephrotic syndrome diseases?

What is the normal race associated with each?

A

Minimal change glomerulonephritis (children & adults)

Focal segmental glomerulosclerosis (black)

Membranous glomerulonephritis (Caucasian)

Membranoproliferative glomerulonephritis (Caucasian)

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3
Q

What are the 5 secondary causes for nephrotic syndrome?
What is the characteristic property of urine with high protein?
What biochemical disorder of the blood is common with nephrotic syndrome?

A 
Diabetes
Amyloidosis
SLE
Infections
Malignancy
(DASIM)

Frothy urine

Hypercholesterolaemia

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4
Q 
Minimal change glomerulonephritis:
Association with what disease?
H&E?
EM?
IF?
Note on prognosis
A

Association with Hodgkin’s lymphoma

Normal on H&E
Effacement of foot processes on EM
No immune complexes - no IF stainined

Children generally respond well to steroids, good prognosis

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5
Q 
Focal segmental glomerulosclerosis:
Association with what 2 diseases and \_\_ use?
H&E?
EM?
Better or worse prognosis than MCD?
A

Association with HIV, sickle cell disease and heroin use

Focal and segmental sclerosis on H&E
Effacement of foot processes on EM
No immune complexes, no IF

Poorer response to steroids, will often progress to CKD

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6
Q

Membranous glomerulonephritis:
H&E?
EM?
IF?

A

Thick glomerular basement membrane on H&E

Spike and dome on EM

Positive granular IF

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7
Q

Membranoproliferative glomerulonephritis:
H&E?
EM?
IF?

Note on T1 vs T2?

A

Thick glomerular basement membrane on H&E

Tram track on EM

Positive granular IF

T1: “tram-tracks”, HBV & HCV, subendothelial
T2: association with C3 nephritic factor, intramembranous

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8
Q

What does RPGN stand for? Associated shape? What are the three possibilities in IF - what does this tell us about the diagnosis?

A

Rapidly progressive glomerulonephritis
Crescent shape on biopsy - macrophages and fibrin

Linear - Goodpasture’s
Granular - glomerulonephritis
Negative (pauci-immune) - ANCA vasculitis

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9
Q

What is Berger disease?
Presents in?
What category of diseases does it come under?

A

IgA nephropathy - deposition of IgA complexes in the mesangium of the kidney

Presents in children

Nephritic syndrome

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10
Q

Acute infections glomerulonephritis:
What is the common bacteria?
What particular protein will these carry?
Treatment is ___?

A

Group A beta-haemolytic strep infection of skin (impetigo) or pharynx

M protein - virulence factor

Treatment is supportive

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11
Q

Which specific cells does a renal cell carcinoma usually arise from?

A

Kidney tubules - specifically, proximal convoluted tubule

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12
Q

How would a renal cell carcinoma look on gross exam and microscopy?

A

Gross - yellow mass

Microscopy - polygonal clear (cytoplasm and lipid filled) cells

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13
Q

What are the two pathways for renal cancer? What population does each present in? What is the presentation in each? Main risk factor in each?

A

HEREDITARY pathway
younger patients, bilateral cancer
Von Hippel-Lindau Disease (also affects the cerebellum) - affecting VHL tumour suppressor gene

SPORADIC pathway
older patients, solitary cancer
Strong association with smoking

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14
Q

What is usual triad in the presentation of renal cell carcinoma?
What other general cancer symptoms could be seen?
What is the staging system in renal cell carcinoma?

A

Haematuria, palpable mass, flank pain - all 3 together is rare

Fever, weight loss and malaise

TNM system

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15
Q

What are examples of the paraneoplastic syndromes often seen in renal cell carcinoma?
A varicocele of what can sometimes be seen in renal cell carcinoma?

A

Production of:
EPO, renin, PTHrP, ACTH

LEFT sided varicocele of testicle - left spermatic vein drains into left renal vein (unlike right spermatic vein)

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16
Q

What is a angiomyolipoma?

Comprised of what 3 things?

A

A common benign tumour of kidneys

Blood vessels, smooth muscle and adipose tissue

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17
Q

What is Wilm’s tumour? - comprised of mostly ___?
Can also have ___ present? (3)
Normal presentation?
Association with what mutation and syndrome?

A

Malignant kidney tumour often affecting young children

Mostly blastema
Also: stroma, tubules, primitive glomeruli

Association with WT1 mutation and WAGR syndrome

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18
Q

Where can a urothelial carcinoma occur? Where does it most commonly occur?
What is the major risk factor? One more risk factor?
Classical presentation?

A

Can occur in urothelial lining of…
BLADDER (most common), RENAL PELVIS, URETER, URETHRA

Major risk factor: cigarette smoke
Also: cyclophosphamide

Classic presentation is haematuria

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19
Q

Two growth pathways in urothelial carcinoma?
Comparitive prognosis of each? p53 involvement?
Why is urothelial carcinoma often multifocal and recurring?

A

Papillary growth - low grade, high grade, invasion - often p53 independent
Flat growth - high grade, invasion (no low grade) - often p53 dependent

Field defect - smoking affects numerous cells

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20
Q

What are the two non-urothelial carncers of the lower urinary tract?
Basic description of each?

A

Squamous cell carcinoma - requires squamous metaplsaia
Chronic cystitis, Schistosoma, Chronic kidney stones

Adenocarcinoma - malignant proliferation of glands
Often arising from urachal remnant (dome of bladder)

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21
Q

What are the three major risk factors for prostate cancer?

A

Increasing Age

Family history - BRCA1 and BRCA2

Ethnicity (Afro-Caribbean increased, Far east uncommon)

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22
Q

What type of cancer is the majority of prostate cancer?

Two other very rare types?

Which are of the prostate does it usually grow in? (3 areas and percentage?)

A

Adenocarcinoma

Transitional cell carcinoma
Small cell prostate cancer

Peripheral (70%), transitional zone (20%), central zone (10%)

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23
Q

How does prostate cancer usually present?
Generic cancer symptoms? (3)
LUTS? (3)
Metastatic disease? (1)

A

Asymptomatic

Malaise, weight loss, anaemia

LUTS: heistancy, poor flow, dysuria, haematuria

Lower back pain from metastatic disease

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24
Q

What is the specific histological grading system for prostate cancer? - briefly describe the scoring

4 basic treatment strategies?

A

Gleason grading system -
2 most common cell patterns are scored from 1-5, and the numbers are added for 2-10 score

Active surveillance - minimise treatment, in low risk patients

Radical prostatectomy - used in fit patients with localised cancer

Radiotherapy - localised and advanced cancer

Hormone therapy (leuprolide) - used to reduce testosterone

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25
Q

Where do most testicular cancers arise from?

How many are seminomas vs non-seminomas?

A

From germ cell tumours

60% seminomas, 40% non-seminomas

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26
Q

How does testicular cancer present? 1 major points, 3 minor points

A

Mass in testicle +/- pain

Dull ache may be present
Post-pubertal gynecomastia
Impotence

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27
Q

Physical exam of testicular cancer would show?
Key point to differentiate it from differentials?
What scan is used?
Two serum markers check for?

A

Physical examination - suspicious masses are often firm and non-fluctuating

Don’t transilluminate -differentiate from Torsion, Epididymitis, Hydrocele

Ultrasound

Serum markers - alphafetoprotein (AFP) and human chorionic gonadotrophin (HCG)

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28
Q

Is a biopsy done on testicular cancer?
What is the general management timelines for testicular cancer?
Prognosis is…?

A

No - might spread the cancer

Radical inguinal orciectomy completed - looked at

Cancer is staged then surveillance and chemotherapy may be done

Good prognosis (5 year survival rate = 95%)

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29
Q

What is the major hormone driving BPH?
Is there an increased risk of cancer in BPH?
What two components of the prostate are enlarged?
What zone is usually enlarged?

A

Dihydrotestosterone (DHT)

No increased risk of cancer

Stroma and glands are increased

Transitional zone - surrounds urethra

30
Q

Mjaor risk factor for BPH? Explain why this risk factor occurs
Another risk factor?

A

Increasing age
5-alpha-reductase increases with age - more DHT

Smoking

31
Q

Using the FUN WISE mneumonic - name the 3 storage symptoms and 4 voiding symptoms of BPH.
What other two urine-related symptoms may be present?

A

Frequency, urgency, nocturia

Weak stream, intermittency, straining, emptying incomplete

Microscopic haematuria and dysuria may be present

32
Q

3 complications of BPH? Why is urinalayis often done with BPH?

A

Hydronephrosis, infections, stones

Can rule out the main ddx - UTI

33
Q

What is the conservative management of BPH?

What is the name of the surgery done?

A

Reduce caffiene and alcohol, bladder retraining

Transurethral resection of prostate

34
Q

What are the 3 medications that can be used for BPH?
Drug name/names?
How do they work?

A

Alpha-1 blockers: relaxes smooth muscle - terazosin, doxazosin

5-alpha-reductase inhibitors: stop DHT formation - finasteride

Anticholinergics may be used for overactive bladder

35
Q 
What are the two major causes of CKD?
Name 3 other kidney related causes?
Name 3 other non-kidney related causes?
What long term medication use?
\_\_\_ can develop into CKD
A

Hypertension, Diabetes

Chronic glomerulonephritis, Cystic disease, Obstructive uropathy

SLE, RA, HIV

NSAIDs

AKI into CKD

36
Q 
How does early CKD present?
Later presentation:
General (2)
Encephalopathy (1)
Haematological (1)
A

Asymptomatic

Nausea, loss of appetite
Asterixis
Anaemia

37
Q

Diagnostic definition of CKD?

What does accelerated CKD mean?

A

GFR <60ml/minute per 1.73m^2, for 3 months or more

Accelerated - 25% or more decrease in GFR within 12 months

38
Q

What are the stages of CKD and related GFR ranges?

What else is used to determine CKD prognosis?

A 
1 = >90 ml/minute/1.72m^2
2 = 60-90 ml/minute/1.72m^2
3a = 45-60 ml/minute/1.72m^2
3b = 30-45 ml/minute/1.72m^2
4 = 15-30 ml/minute/1.72m^2
5 = <15 ml/minute/1.72m^2

Albuminuria is also considered - placed into 3 stages

39
Q

Main principle in CKD management?

Options if ESRF is reached?

A

Treat the cause

Dialysis or Kidney transplant

40
Q

Name the 3 most common bacterial STIs. What bacteria causes each?
4 other viral STIs?

A

Chlamydia - Chlamydia trachomatis

Gonorrhoea - Neisseria gonorrhoeae

Syphillis - Treponema pallidum

Herpes (HSV), Genital Warts (HPV), HIV, Hep B

41
Q

How does chlamydia and gonorrhoea present in males (2) vs females (3)?

A

Males: Dysuria and urethral discharge

Females: Non-specific
Dysuria, discharge, menstural irregularity

42
Q

How is chlamydia diagnosed? Samples are from?

A

Nucleic Acid Amplification Tests (NAAT) e.g, PCR

Females - self-collected vaginal swab
Males - first void urine

43
Q

Normal population for chlamydia vs gonorrhoea? Which of these commonly has asymptomatic carriage?

A

Chlamydia is most common in women & young adults

Gonorrhoea is more common in men & has a wider age range

Asymptomatic carriage of chlamydia is more common than gonorrhoea

44
Q

How is gonorrhoea diagnosed?

Taken from where? (3)

A

Microscopy of gram-stained smears of genital secretions, looking for gram negative diplococci

Male urethra, female endocervix, rectum

45
Q 
Treatment of bacterial STIs:
2 involved in all of them?
Chlamydia?
Gonorrhoea?
Syphilis?
A

Partner management, test for other STIs

Azithromycin or Doxycycline

Azithromycin AND Ceftriaxone

Penicillin (injecion)

46
Q

What are the 2 major stages of syphilis?

What are the 3 big complications of syphilis?

A 
Early infectious syphilis (within 2 years)
Late syphilis (over 2 years)

Gumma, neurosyphilis, cardiovascular complications

47
Q

What are the 3 stages within EARLY SYPHILIS?

What are the symptoms of syphilis and how do these change within early syphilis?

A 
Primary:
Primary chancre (painless) often on genitalia, but depends on transmission route

Secondary: 6-8 weeks after
Non-itchy maculopapular rash
Generalised lymphadenopathy
Mouth ulcers

Latent: (early latent)

48
Q

How can syphilis be transmitted?

What are the diagnosis methods for syphilis?

A

BODY FLUIDS:
Sexual contact, needles, direct contact with lesion
VERTICAL TRANSMISSION:
Can cause congenital syphilis

Diagnosis:
Early moist lesions - sample
Normal diagnosis - serology and particle agglutination test

49
Q

2 classifications of UTIs?

From there can be either ____ or ____?

A

Uncomplicated - non-pregnant women
Complication - pregnant, men, catheters, children, etc…

Asymptomatic or symptomatic

50
Q 
Name the most common cause of UTIs?
Renal stones one?
Hospital one?
Young women one?
2 others?
A 
E. coli >50% of cases
Proteus - renal stone
Klebsiella - hospital/catheter
Staph. saprophyticus - young women
Staph. aureus and Enterococci
51
Q

Symptoms of UTI:
3 lower tract
3 upper tract
What would be found on urine dipstick?

A

Dysuria and frequency, haematuria
Fever and haematuria, possible sepsis?

Nitrate, Leukocytes, Blood?

52
Q

Management of UTI:
Asymptomatic in >65
Uncomplicated - what 2?
Complicated - ?

A

Do not treat

Trimethoprim OR Nitrofurantoin - MSU not needed, dipstick only

Complicated - send MSU sample, longer antibiotic course

53
Q

Risk factors for UTI:

Can you name 5 out of 8?

A 
Female
Frequency sex
Catheter
Pregnancy
Circumcision
Diabetes
Urine retention
Obstruction - eg, BPH
54
Q

Typical population for pyelonephritis?
Triad of symptoms?
Normal treatment?

A

Women younger than 35

Loin pain, fever, pyuria (vomiting?)

Co-amoxiclav for 14 days

55
Q

3 categories of AKI aetiology?

Name 3 examples within each category

A

Pre-renal: Hypovolaemia, Shocks, CHF

Post-renal: BPH, Kidney stones, intra-abdominal tumours

Intra-renal: Acute Tubular Necrosis, Glomerulonephritis, Acute Interstitial Nephritis

56
Q

Name the two groups of medications you can’t give to someone with impaired kidney function. Explain the mechanism behind this

A

NSAIDs- inhibit COX enzymes, stop prostaglandin synthesis needed for vasodilation of the afferent arteriole

ACEi/ARB- stop the RAAS system from maintaining the blood pressure needed to perfuse the kidney

57
Q

Acute Tubular Necrosis:
What part of the nephron does it affect most?
2 causes? Examples from one the of the main causes?
What happens to the damaged cells?

A

Affects PCT the most

Ischaemia
Nephrotoxins - aminoglycosides, lead (heavy metals), anti-freeze, radiocontrast dye

Cells slough off - causes blockages in nephrons and brown spots I the urine

58
Q

Diagnosis of AKI: 3 guidelines. How many of these 3 needed?

A

Any 1 or these 3

  • Rise in Creatinine > 26 micromol/L in 48 hrs
  • Rise in Creatinine < 50% of lowest figure in last 6 months)
  • Urine output < 0.5ml/kg/hr for >6 consecutive hours
59
Q

What is the major emergency in AKI?
ECG findings? How do these progress?
3 different medication managements?

A

Hyperkalaemia - > 6mmol/L

ECG:
First - tall, peaked T waves
Second - small P waves, prolonged PR and QRS
Third - arrhythmia

Insulin + Dextrose
Calcium gluconate
Salbutamol

60
Q

Usual BUN:Cr ratio? How does it change in pre-renal, post-renal and intra-renal AKI?

A

5-20:1

Pre-renal >20:1
Activation of RAAS - more water and salt reabsorption

Intra-renal <20:1
General reabsorption is impaired

Post-renal
>20:1 initially (fluid build-up)
<20:1 later (epithelial cell damage)

61
Q

What is the classic age for kidney stones? But age is getting ____
Males vs Females?
Is recurrence common? Main advice after treatment?

A

Male > Female 2:1

Commonest age is 30-50, but getting younger (teenagers now)

Yes - recurrence is common, drink lots of water

62
Q 
What is the two most common types of renal stones? (how much)
Which is most common?
Colour?
X-ray?
Acidic or alkaline?
A

80% are calcium based

Calcium oxalate: more common, black/dark brown, radiopaque on X-RAY, acidic

Calcium phosphate: less common, dirty white, radiopaque on X-RAY, alkaline

63
Q

Other than calcium stones, name 4 other stones:

10% - name, colour, x-ray

5-10% - name, when, made of, shape, x-ray, colour

1% - name, condition

<1% - name

A

10% uric acid - red-brown, radiolucent

5-10% struvite (infection stones - Mg, Amm, Phos, from urease positive bacteria, staghorn, radiopaque, dirty white)

Cystine (congenital condition - COLA)
Xanthine stones

64
Q

One line description of how renal stones form?
Most common cause of renal stone formation?
Rarer cause?

A

Supersaturation of solutes results in precipitation and crystals forming

Most common cause - idiopathic (probably dehydration)

Rarely hypercalcaemia via primary hyperparathyroidism

65
Q

Name 4 of 6 risk factors for renal stones?

A 
Male, 
20-50, 
Caucasian/Asian, 
High Protein &amp; Salt, 
Family History, 
Oxalate-rich foods
66
Q 
Presentation of renal colic:
Often \_\_?
Pain - site? onset? radiation? character? severe?
2 other symptoms?
Urine may have \_\_\_\_?
What 2 LUTS may be present?
A

Often asymptomatic

Pain is classically sudden onset, waking up patient, radiation to groin, colicky, severe

Fever
Nausea and vomiting

Haematuria (visible or no visible)

LUTS - frequency and urgency

67
Q

What is the gold-standard scan for kidney stones?
What other scans may be done?
Name 3 complications of renal stones?
Main differential to look out for?

A

Non-contrast CT scan - kidney, ureter, bladder
NCCT-KUB

Ultrasound, X-rays

AKI, hydronephrosis, pyonephrosis (pus)

Ruptured AAA

68
Q

4 management stratigies in kidney stone disease?

A

Conservative - many will pass on their own, pain management and anti-emetic

Medical expulsion therapy - CCBs or alpha-blockers

Shockwave lithotripsy

Surgery or stent placement

69
Q 
What is hydronephrosis?
Difference from hydroureter?
General aetiology - hydronephrosis is caused by \_\_\_
4 causes in adults?
2 in antenatal babies?
A

Build-up of urine inside kidney causes swelling

Hydroureter - ureter only
Hydronephrosis - ureter and kidney

Caused by urinary retention

Kidney stones, BPH, Urethral strictures, Cancers

Vesicouretral reflux, congenital ureterpelvic junctin obstruction

70
Q

Testicular/scrotal lump differential:
What is done to confirm diagnosis?
5 differentials w/ description

A

History, Transilluminate, Ultrasound Scan

Testicular cancer - non-tender, from testicle, hard without transillumination, 15-40

Hydrocele - fluid build-up in the tunica vaginalis

Varicocele - swollen, pampiniform venous plexus, “bag of worms”

Epididymal cyst - sac of fluid at the epidydmis

Testicular torsion - emergency, extremely tender, often triggered by activity, needs surgery

71
Q

Two major forms of cystic kidney disease?
Population it affects?
Associated genes?

A

Autosomal Dominant Polycystic Kidney Disease - adults, PKD1 and PKD2 (polycystin)

ARPKD - children, PKHD1

72
Q

How might someone with ADPKD present? (4)

A

Screening - affected relative

Severe loin pain - cyst haemorrhage

Hypertension

Gross haematuria following trauma

Phase 2a (9 decks)

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