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GU Flashcards

1
Q

What does haematuria in the urine at different parts of the stream indicate? Start/end/throughout?

A 
start = urethral disease
end = prostate/bladder base bleeding
throughout = source above bladder
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2
Q

What is macroscopic and microscopic haematuria?

A

Blood in urine
Macroscopic = visible
Microscopic = dipstic +ve

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3
Q

Transient causes of haematuria?

A

UTI, menstruation, vigorous exercise, sex

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4
Q

Causes of haematuria?

A

cancer of urinary tract, stones, BPH, prostatitis, urethritis, IGA nephropathy, nephritic syndrome

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5
Q

Ix of haematuria?

A

exclude transient causes, urine microscopy
Plasma Cr (calculate eGFR), protein/creatinine ratio
renal tract imaging, cystoscopy

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6
Q

What is the triad of nephrotic syndrome?

A

proteinuria, hypoalbuminaemia, oedema

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7
Q

name 2 causes of nephrotic syndrome?

A

minimal changes disease, membranous nephropathy

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8
Q

What are some causes of membranous nephropathy?

A

Drugs - penicillame, gold, NSAIDS
Autoimmune - SLE
Neoplastic - lung, colon, breast
Infection - hep B & C

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9
Q

How do you diagnose minimal changes disease?

A

electron microscopy of kidney biopsy - shows fusion of podocytes

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10
Q

How do you manage nephrotic syndrome?

A

Oedema - salt restriction and a thiazide diuretic
Proteinuria - ACEi
DVT prophylaxis

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11
Q

Ix of Nephrotic/Nephritic synd?

A

eGFR, urinary protein, serum UEs, serum albumin, urine microscopy (red casts?), strep throat swab, BG, CXR, US kidneys, renal biopsy
Abs - ANA, DNA, ANCA, GMM, Hep B and C, HIV

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12
Q

Complications of nephrotic syndrome?

A 
Thrombosis - loss of clotting factors in urine
Sepsis - loss of Igs
AKI
hyperlipidaemia
CKD
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13
Q

Triad of nephritic syndrome?

A

Haematuria, Proteinuria, Hypertension

+/- oliguria, uraemia

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14
Q

causes of nephritic syndrome?

A

post-strep glomerulonephritis, infective endocarditis, SLE, HSP

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15
Q

how do you manage nephritic syndrome?

A

HTN - loop diuretic, Na restriction

Monitor fluid balance

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16
Q

Commonest cause of a UTI?

A

E.Coli

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17
Q

What increases the risk of a UTI?

A

female, urinary obstruction and stasis, previous bladder damage, bladder stones, reduced bladder emptying

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18
Q

UTI symptoms?

A

frequency, dysuria, suprapubic pain, tenderness, haematuria, smelly urine

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19
Q

Pyelonephritis symptoms?

A

loin pain, tenderness, N&V, fever

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20
Q

What makes a UTI complicated?

A

abnormal tract (stone/obstruction), systemic disease invovling kidney (DM/sickle cell), men, pregnancy

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21
Q

Ix for UTI?

A

urine dipstick (leucocytes and nitrates)
urine microscopy and culture
renal tract imaging

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22
Q

Management of a UTI?

A

Nitrofuratoin, Trimethoprim = first line

high fluid intake, search cause if it is an underlying infection

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23
Q

What is renal HTN?

A

Narrowing of the renal arteries due to atheroma. This causes reduced renal perfusion and renal ischaemia. The reduced pressure in afferent glomerular arterioles causes activation of RAAS.

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24
Q

How do you investigate renal HTN?

A

renal arteriography, doppler US, CT + IV contrast

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25
Q

Management for renal HTN?

A

treat atherosclerosis - exercise, stop smoking, statins, antiplatelets, control `bp
Stent if necessary

26
Q

Comonest type of renal calculi?

A

Calcium oxalate

27
Q

Causes of hypercalcaemia?

A

hyperparathyroidism, increased dietary intake, increased bone resporption (cancer/immobilisation)

28
Q

Causes of hyperoxaluria?

A

high oxalate diet (spinach/rhubarb)

enzyme deficiencies

29
Q

What condition is associated with hyperuricaemia?

A

gout

30
Q

what GI condition is associated with uric acid stones?

A

ileostomy, due to loss of carbonate

31
Q

which UTI organisms are associated with infection - induced calculi? Why do they increase the risk?

A

proteus, klebsiella. The bacteria produces urea which converts to ammonia and increases the pH of the urine which favours stone formation.

32
Q

Renal calculi symptoms?

A 
colicky pain (loin to groin)
N&V, sweating, UTI, pyelonephritis, bladder outflow obstruction, haematuria
33
Q

Ix for renal calculi?

A

urine dipstick and culture, serum UE, Cr, Ca, urate

FBC, CRP, non contrast CT KUB

34
Q

management of renal calculi?

A

PAIN RELIEF - Diclofenac

  • <5mm stones usually pass spontaneously
    REMOVAL - shock wave lithotripsy, ureteroscopy, open surgery
35
Q

how to prevent recurrence of renal calculi?

A

normal Ca diet, high fluid intake
Allopurinol for uric stones
cystine stones - need to drink 5L water a day

36
Q

Common causes of an urinary tract obstruction?

A

LUMEN - calculi, tumour, blood clot
WALL - congenital abnormality, stricture, neuropathic bladder
OUTSIDE PRESSURE - BPH, prostate or pelvic tumour, phimosis

37
Q

Symptoms of a upper urinary tract obstruction?

A

dull ache in flank, anuria

38
Q

Symptoms of a bladder outlet obstruction?

A

hesitancy, poor stream, terminal dribbling, felling of incomplete emptying

39
Q

What is an AKI?

A

sustained rise in urea and creatinine due to a rapid decline in GFR leading to loss of normal water and solute homeostasis

40
Q

Causes of AKI?

A

PRE-RENAL - hypovolaemia, reduced BP, reduced cardiac pump efficiency, renal stenosis
RENAL - NSAIDS, ACEi, acute tubular necrosis
POST RENAL - enlarged prostate or pelvic masses

41
Q

Ix for AKI?

A

Bloods - FBC, ESR, cultures, Ca, Ph, uric acid
Urine dipstick - MS&C, culture, urinary electrolytes
renal US/CT
ANCA Ab/complement levels
Hep/HIV Abs

42
Q

What is CKD?

A

progressive renal impairment over >3 months

43
Q

Causes of CKD?

A 
diabetic nephropathy
Chronic glomerulonephritis (SLE)
chronic pyelonephritis
HTN
Schistomiasis
44
Q

Features of CKD and why?

A

ANAEMIA - reduced EPO production by diseased kidney and haematuria means more losses
BONE DIS - due to tertiary hyperparathyroidism. renal Ph retention means reduced Ca and increased PTH
NEURO - polyneuropathy
CVD - increased risk of MI/HF/CVA due to HTN and dyslipidaemia

45
Q

How do you manage CKD?

A

Renoprotect (optimise BP) - usual pathway
Reduce CVS RF - optimise BP, statins, smoking, diabetes, normal protein diet.
Treat complications;
1. HYPERKALAEMIA - dietary restriction, stop spironolactone
2. dietary phosphate restriction, synthetic Vit D
3. Recombinant EPO for anaemia
4. Sodium bicarbonate for acidosis
5. Infections - influenza and pneumococcal vaccine

46
Q

What is dialysis and how does it work?

A

uraemic toxins are removed from blood by diffusion across semipermeable membrane towards low concentrations in dialysis fluid. Gradient maintained by replacing dialysis fluid.

47
Q

What is autosomal dominant PKD?

A

multiple cysts throughout kidneys, the cysts increase with age causing destruction of kidney tissue and reduced renal function.

48
Q

mutations in which gene cause ADPKD?

A

PKD1/PKD2

49
Q

Features of ADPKD?

A 
acute loin pain if haemorrhage
abdo discomfort
HTN
progressive renal impairment
REMEMBER: liver cysts, SAH, MV prolapse
50
Q

Ix for ADPKD?

A

Exam - large irregular kidneys, HTN, hepatomegaly
US kidneys
family history

51
Q

mangement of ADPKD?

A

monitor BP, control
Measure creatinine regularly
dialysis
offer US to family members

52
Q

Where does renal cell carcinoma normally arise?

A

proximal tubular epithelium?

53
Q

Features of RCC?

A

haematuria, loin pain, mass in flank

+/- malaise, fever, weight loss

54
Q

Ix for renal tract cancers

A

US, CT KUB, bloods, PET scan, prostate exam

55
Q

Where do urothelial tumours usually arise?

A

transitional cell epithelium

56
Q

What is BPH?

A

hyperplasia of the glandular and connective tissue of the prostate

57
Q

Features of BPH

A

frequency, nocturia, delayed initiation, post void dribble, acute retention

58
Q

Ix for BPH

A

US, examination, serum UE, PSA

59
Q

Name 2 medications and their classes used to treat BPH? name some adverse effects for each

A

A1 antagonist - Tamsulosin
A/E - dizzy, postural hypotension, dry mouth

5a reductase inhibitors - Finasteride
A/E = ED, reduced libido, ejaculation problems

60
Q

Features of Prostate cancer?

A

the same as BPH, bone pain, weight loss, malaise, bladder outflow obstruction

61
Q

Ix for bladder cancer?

A

transrectal US of prostate, PSA levels, MRI to stage tumour

62
Q

Mx of prostate cancer? Name 2 drugs and their action

A

radical prostatectomy
LH analogues e.g. goserelin
antiandrogens - Cyproterone acetate

Finals (21 decks)

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