GU and renal Flashcards
1
Q
where to kidney stones most commonly get deposited?
A
- pelivureteric junction
- pelvic brim
- vesicoureteric junction
2
Q
what is the most common type of kidney stone?
A
calcium oxalate
3
Q
why does kidney stone formation occur?
A
occurs when normally soluble material supersaturates the urine and begin to form crystals
4
Q
how do kidney stones present clinically?
A
FEVER, NAUSEA, ACUTE FLANK PAIN
- also haematuria, proteinuria and anuria
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
6
Q
how are kidney stones treated?
A
- analgesia
- antibiotics- gentamicin
ureteroscopy
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
8
Q
how would you treat and upper urinary tract obstruction?
A
nephrostomy or ureteric stent
9
Q
how would you treat a lower urinary tract obstruction?
A
urethral or suprapubic catheter
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
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
12
Q
what are the pre-renal causes of AKI?
A
hypotension
renal artery stenosis
basically hypoperfusion of the kidney
13
Q
what are the intrinsic renal causes of AKI?
A
- acute tubular necrosis
- glomerularonephritis
- interstitial- drugs, infection
- vascular- vasculitis, malignant hypertension
14
Q
what is the main post-renal cause of AKI?
A
urinary tract obstruction
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
16
Q
what is CKD?
A
Impaired renal function for >3 months based on abnormal structure or function
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
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
19
Q
how would you treat CKD?
A
- treat cause
- lifestyle modifications
- lower BP
- aspirin and statins to reduce CV risk
20
Q
what happens during haemodialysis?
A
blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction
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
22
Q
what are contraindications of renal transplantation?
A
active infection
cancer
severe comorbidity
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
24
Q
how would you treat ADPKD?
A
- ACE inhibitors to treat hypertension
- dialysis
25
how would you treat IgA nephropathy?
BP control with an ACE inhibitor
26
what are the features of Henoch-Schonlein purpura?
purpuric rash on extensor surfaces
flitting polyarthritis
abdo pain
nephritis
27
what does SLE cause?
vascular, glomerular tubulointerstitial damage
28
what disease presents with auto-antibodies of type IV collagen?
anti-glomerular membrane disease- Goodpasture's
29
what is nephrotic syndrome?
inflammation causes loss of podocytes- allowing proteins to pass into the nephron
30
what is the key triad of symptoms in nephrotic syndrome?
- proteinuria
- hypoalbuminaemia
- oedema
31
what can cause nephrotic syndrome?
- primary- minimal change disease, membranous nephropathy
| - secondary- hepatitis B/C, SLE, diabetic nephropathy
32
what is the treatment of nephrotic syndrome?
- reduce oedema- loop diuretics
- reduce proteinuria via ACE/ ARB
- reduce risk of complication- anticoagulant
- treat underlying cause
33
what is minimal change disease?
commonest cause of nephrotic syndrome in children
34
What is the major cause of urinary incontinence in men?
enlarged prostate
35
what can cause incontinence in women?
- functional
- stress
- urge
36
what can cause erectile dysfunction?
- smoking, diabetes, alcohol
- endocrine- hypogonadism
- neurological- cord lesions
- pelvic surgery
- prostatic hyperplasia
37
how can erectile dysfunction be treated?
- counselling
- oral phosphodiesterase
- vacuum aids
- intracavernosal injections
38
what are epididymal cysts?
smooth extravesicular, spherical cysts found in the epididymis
39
what is hydrocele?
fluid within the tunica vaginalis
40
what is varicocele?
dilated veins of the pampiniform plexus
41
why is the left side more affected in varicocele?
the left testicular vein drains into the left Renal vein, whereas on the right side it drains straight into the IVC
42
What are the symptoms of testicular torsion?
sudden onset pain in one testis
makes walking uncomfortable
pain in abdomen
nausea and vomiting
43
how does benign prostate hyperplasia present?
LUTS- nocturia, frequency, urgency, post-micturition dribbling, hesitancy, haematuria, UTI
44
how can BPH be treated?
- lifestyle- avoid caffeine and alcohol, void twice in a row, bladder training
- drugs- alpha blockers and 5alpha reductase inhibitors
- surgery- TURP, TUIP
45
where does a renal cell carcinoma arise from?
proximal renal tubular epithelium
46
how does a renal cell carcinoma present clinically?
haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss
47
how can RCC be diagnosed?
- high BP due to renin secretion
- FBC- polycythaemia due to Epo secretion
- urine- haematuria
- imaging- US, CT, MRI, CXR
48
how would you treat a RCC?
radical nephrectomy
49
what is the most common type of bladder tumour?
transitional cell carcinoma
50
what are risk factors for bladder cancer?
smoking, working in the rubber industry- aromatic amines, chronic cystitis, schistosomiasis
51
how does a bladder tumour present clinically?
painless haematuria, recurrent UTI's and voiding irritability
52
how can you diagnose prostate cancer?
- DRE- hard-irregular prostate
- raised PSA
- transracial USS and biopsy
- bone scan and CT to check for mets
53
how would you treat prostate cancer?
- radical prostatectomy
- radical radiotherapy
- hormone therapy
54
what are the 4 types of testicular tumour?
- seminoma
- non-seminomatous germ cell tumour
- mixed germ cell tumour
- lymphoma
55
differential diagnosis of testicular tumour
* Inguinoscrotal hernia
* Epididymal cyst
* Varicocele
* Hydrocele
* Haematocele
* Orchitis
56
how would you treat a testicular tumour?
- radical orchidectomy
| - seminomas are very radiosensitive
57
how would you treat prostatitis?
analgesia and oral levofloxacin
58
what can cause epididymo-orchitis?
```
o Chlamydia (if <35yrs)
o E. coli
o Mumps
o N. gonorrhoea
o TB
```
59
how is epididymo-orchitis treated?
```
o Doxycycline – if <35, to cover chlamydia
o Ceftriazone, ciprofloxacin
o Analgesia
o Scrotal support
o Drain any abscess
```
60
what are the most common UTI-causing organisms?
E.coli
proteus mirabilli
klebisella pneumonia
staphylococcus saprophyticus
61
how does acute pyelonephritis present clinically?
flank pain, vomiting and fever
62
how is a UTI treated?
- fluids
- trimethoprim, amoxicillin
- if upper UTI, IV co-amoxiclav
63
what are some risk factors of developing kidney stones?
high protein/salt diet, male gender, obesity, dehydration, medications- antacids, FH
64
what are the risk factors of acute kidney injury?
- age over 75
- CKD
- drugs
- sepsis
- history of urinary symptoms
65
how is a bladder tumour treated?
radical cystectomy
66
how does prostate cancer present clinically?
- nocturia
- hesitancy
- poor stream
- terminal dribbling
- obstruction
67
how does a testicular tumour present clinically?
- painless testis lump
| - pain
68
how can a testicular tumour be diagnosed?
- CXR/ CT
| - excision biopsy
69
what is benign prostatic hyperplasia?
non-neoplastic enlargement of the prostate gland
70
how can BPH be diagnosed?
- frequency volume chart
- renal biochemistry
- imaging
- PSA- prostate specific antigen test
- TRUSS- trans-rectal ultrasound scan
- flexible cystoscopy
71
what are some complications of benign prostatic enlargement?
- infections
- stones
- haematuria
- symptomatic progression
72
how does cystitis present clinically?
frequency, dysuria, urgency and haematuria
73
how does prostatitis present clinically?
flu-like symptoms, low backache
74
what are the clinical signs of a UTI?
- fever
- loin tenderness
- foul-smelling urine
75
what diagnostic test is done in a patient with a suspected UTI?
urine dipstick
76
what can cause nephritic syndrome?
Goodpasture's disease
Henoch-Schonlein Purpura
SLE
IE
77
how does nephritic syndrome present clinically?
proteinuria
haematuria
anaemia
hypertension
78
how is nephritic syndrome managed?
ACE inhibitors
79
how is a hydrocele treated?
aspiration and surgery
80
how can a suspected diagnosis of testicular torsion be diagnosed?
doppler USS
81
how can testicular torsion be corrected?
surgery
| testes fixed to scrotum
