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nicks phase 2a flaschards > GU and renal > Flashcards

GU and renal Flashcards

1
Q

where to kidney stones most commonly get deposited?

A
  • pelivureteric junction
  • pelvic brim
  • vesicoureteric junction
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2
Q

what is the most common type of kidney stone?

A

calcium oxalate

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3
Q

why does kidney stone formation occur?

A

occurs when normally soluble material supersaturates the urine and begin to form crystals

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4
Q

how do kidney stones present clinically?

A

FEVER, NAUSEA, ACUTE FLANK PAIN

- also haematuria, proteinuria and anuria

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5
Q

how would you diagnose kidney stones?

A
  • urine dipstick
  • urine PH
  • 24h urine for biochemistry
  • non-contrast CT
    kidney, ureter and bladder XR
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6
Q

how are kidney stones treated?

A
  • analgesia
  • antibiotics- gentamicin
    ureteroscopy
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7
Q

what can cause urinary tract obstruction?

A 
Prostatic obstruction – hypertrophy or tumour
Gynaecological cancers
Caliculi
Hypercalcaemia
Renal tubular acidosis
Primary hyperoxaluria
Medullary sponge kidney
Tuberculosis
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8
Q

how would you treat and upper urinary tract obstruction?

A

nephrostomy or ureteric stent

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9
Q

how would you treat a lower urinary tract obstruction?

A

urethral or suprapubic catheter

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10
Q

what is AKI?

A

a spectrum of damage to the kidney from a mild deterioration in function to severe injury requiring renal replacement therapy

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11
Q

what is the diagnostic criteria for AKI?

A
  • Rise in creatinine >26μmol/L in 48hrs
  • Rise in creatinine >1,5 x baseline
  • Urine output <0.5mL/kg/h for >6 consecutive hours
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12
Q

what are the pre-renal causes of AKI?

A

hypotension
renal artery stenosis
basically hypoperfusion of the kidney

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13
Q

what are the intrinsic renal causes of AKI?

A
  • acute tubular necrosis
  • glomerularonephritis
  • interstitial- drugs, infection
  • vascular- vasculitis, malignant hypertension
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14
Q

what is the main post-renal cause of AKI?

A

urinary tract obstruction

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15
Q

how would you treat AKI?

A
  • stop nephrotic drugs
  • pre-renal- correct volume -depletion with fluids
  • intrinsic renal- refer
  • post-renal- catheterise and treat obstruction via a stent
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16
Q

what is CKD?

A

Impaired renal function for >3 months based on abnormal structure or function

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17
Q

what can cause CKD?

A 
•type 2 Diabetes
•Glomerulonephritis
- IgA nephropathy 
- systemic disorders, SLE, vasculitis
• idiopathic
•Hypertension
•Renovascular disease
•Pyelonephritis
•Reflux nephropathy
•polycystic kidney disease
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18
Q

how does a patient with CKD present clinically?

A
  • asymptomatic until late stage
  • anaemia
  • renal osteodystrophy
  • neurological complications- postural hypotension, weakness
  • MI, cardiac failure, stroke
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19
Q

how would you treat CKD?

A
  • treat cause
  • lifestyle modifications
  • lower BP
  • aspirin and statins to reduce CV risk
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20
Q

what happens during haemodialysis?

A

blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction

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21
Q

what is peritoneal dialysis?

A

a catheter is inserted into the peritoneal cavity and fluid is infused, allowing solutes to slowly diffuse across

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22
Q

what are contraindications of renal transplantation?

A

active infection
cancer
severe comorbidity

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23
Q

what are the signs of autosomal dominant polycystic kidney disease (ADPKD)?

A 
renal enlargement w/ cysts
abdo pain
haematuria
renal caliculi
hypertension
progressive renal failure
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24
Q

how would you treat ADPKD?

A
  • ACE inhibitors to treat hypertension

- dialysis

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25
Q

how would you treat IgA nephropathy?

A

BP control with an ACE inhibitor

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26
Q

what are the features of Henoch-Schonlein purpura?

A

purpuric rash on extensor surfaces
flitting polyarthritis
abdo pain
nephritis

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27
Q

what does SLE cause?

A

vascular, glomerular tubulointerstitial damage

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28
Q

what disease presents with auto-antibodies of type IV collagen?

A

anti-glomerular membrane disease- Goodpasture’s

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29
Q

what is nephrotic syndrome?

A

inflammation causes loss of podocytes- allowing proteins to pass into the nephron

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30
Q

what is the key triad of symptoms in nephrotic syndrome?

A
  • proteinuria
  • hypoalbuminaemia
  • oedema
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31
Q

what can cause nephrotic syndrome?

A
  • primary- minimal change disease, membranous nephropathy

- secondary- hepatitis B/C, SLE, diabetic nephropathy

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32
Q

what is the treatment of nephrotic syndrome?

A
  • reduce oedema- loop diuretics
  • reduce proteinuria via ACE/ ARB
  • reduce risk of complication- anticoagulant
  • treat underlying cause
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33
Q

what is minimal change disease?

A

commonest cause of nephrotic syndrome in children

34
Q

What is the major cause of urinary incontinence in men?

A

enlarged prostate

35
Q

what can cause incontinence in women?

A
  • functional
  • stress
  • urge
36
Q

what can cause erectile dysfunction?

A
  • smoking, diabetes, alcohol
  • endocrine- hypogonadism
  • neurological- cord lesions
  • pelvic surgery
  • prostatic hyperplasia
37
Q

how can erectile dysfunction be treated?

A
  • counselling
  • oral phosphodiesterase
  • vacuum aids
  • intracavernosal injections
38
Q

what are epididymal cysts?

A

smooth extravesicular, spherical cysts found in the epididymis

39
Q

what is hydrocele?

A

fluid within the tunica vaginalis

40
Q

what is varicocele?

A

dilated veins of the pampiniform plexus

41
Q

why is the left side more affected in varicocele?

A

the left testicular vein drains into the left Renal vein, whereas on the right side it drains straight into the IVC

42
Q

What are the symptoms of testicular torsion?

A

sudden onset pain in one testis
makes walking uncomfortable
pain in abdomen
nausea and vomiting

43
Q

how does benign prostate hyperplasia present?

A

LUTS- nocturia, frequency, urgency, post-micturition dribbling, hesitancy, haematuria, UTI

44
Q

how can BPH be treated?

A
  • lifestyle- avoid caffeine and alcohol, void twice in a row, bladder training
  • drugs- alpha blockers and 5alpha reductase inhibitors
  • surgery- TURP, TUIP
45
Q

where does a renal cell carcinoma arise from?

A

proximal renal tubular epithelium

46
Q

how does a renal cell carcinoma present clinically?

A

haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss

47
Q

how can RCC be diagnosed?

A
  • high BP due to renin secretion
  • FBC- polycythaemia due to Epo secretion
  • urine- haematuria
  • imaging- US, CT, MRI, CXR
48
Q

how would you treat a RCC?

A

radical nephrectomy

49
Q

what is the most common type of bladder tumour?

A

transitional cell carcinoma

50
Q

what are risk factors for bladder cancer?

A

smoking, working in the rubber industry- aromatic amines, chronic cystitis, schistosomiasis

51
Q

how does a bladder tumour present clinically?

A

painless haematuria, recurrent UTI’s and voiding irritability

52
Q

how can you diagnose prostate cancer?

A
  • DRE- hard-irregular prostate
  • raised PSA
  • transracial USS and biopsy
  • bone scan and CT to check for mets
53
Q

how would you treat prostate cancer?

A
  • radical prostatectomy
  • radical radiotherapy
  • hormone therapy
54
Q

what are the 4 types of testicular tumour?

A
  • seminoma
  • non-seminomatous germ cell tumour
  • mixed germ cell tumour
  • lymphoma
55
Q

differential diagnosis of testicular tumour

A
  • Inguinoscrotal hernia
  • Epididymal cyst
  • Varicocele
  • Hydrocele
  • Haematocele
  • Orchitis
56
Q

how would you treat a testicular tumour?

A
  • radical orchidectomy

- seminomas are very radiosensitive

57
Q

how would you treat prostatitis?

A

analgesia and oral levofloxacin

58
Q

what can cause epididymo-orchitis?

A 
o	Chlamydia (if <35yrs)
o	E. coli
o	Mumps
o	N. gonorrhoea
o	TB
59
Q

how is epididymo-orchitis treated?

A 
o	Doxycycline – if <35, to cover chlamydia
o	Ceftriazone, ciprofloxacin 
o	Analgesia
o	Scrotal support
o	Drain any abscess
60
Q

what are the most common UTI-causing organisms?

A

E.coli
proteus mirabilli
klebisella pneumonia
staphylococcus saprophyticus

61
Q

how does acute pyelonephritis present clinically?

A

flank pain, vomiting and fever

62
Q

how is a UTI treated?

A
  • fluids
  • trimethoprim, amoxicillin
  • if upper UTI, IV co-amoxiclav
63
Q

what are some risk factors of developing kidney stones?

A

high protein/salt diet, male gender, obesity, dehydration, medications- antacids, FH

64
Q

what are the risk factors of acute kidney injury?

A
  • age over 75
  • CKD
  • drugs
  • sepsis
  • history of urinary symptoms
65
Q

how is a bladder tumour treated?

A

radical cystectomy

66
Q

how does prostate cancer present clinically?

A
  • nocturia
  • hesitancy
  • poor stream
  • terminal dribbling
  • obstruction
67
Q

how does a testicular tumour present clinically?

A
  • painless testis lump

- pain

68
Q

how can a testicular tumour be diagnosed?

A
  • CXR/ CT

- excision biopsy

69
Q

what is benign prostatic hyperplasia?

A

non-neoplastic enlargement of the prostate gland

70
Q

how can BPH be diagnosed?

A
  • frequency volume chart
  • renal biochemistry
  • imaging
  • PSA- prostate specific antigen test
  • TRUSS- trans-rectal ultrasound scan
  • flexible cystoscopy
71
Q

what are some complications of benign prostatic enlargement?

A
  • infections
  • stones
  • haematuria
  • symptomatic progression
72
Q

how does cystitis present clinically?

A

frequency, dysuria, urgency and haematuria

73
Q

how does prostatitis present clinically?

A

flu-like symptoms, low backache

74
Q

what are the clinical signs of a UTI?

A
  • fever
  • loin tenderness
  • foul-smelling urine
75
Q

what diagnostic test is done in a patient with a suspected UTI?

A

urine dipstick

76
Q

what can cause nephritic syndrome?

A

Goodpasture’s disease
Henoch-Schonlein Purpura
SLE
IE

77
Q

how does nephritic syndrome present clinically?

A

proteinuria
haematuria
anaemia
hypertension

78
Q

how is nephritic syndrome managed?

A

ACE inhibitors

79
Q

how is a hydrocele treated?

A

aspiration and surgery

80
Q

how can a suspected diagnosis of testicular torsion be diagnosed?

A

doppler USS

81
Q

how can testicular torsion be corrected?

A

surgery

testes fixed to scrotum

nicks phase 2a flaschards (15 decks)

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