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Phase 2A revision > GU to work on > Flashcards

GU to work on Flashcards

1
Q

what are the risk factors for testicular cancer?

A
  1. Cryptorchidism (undescended testes)
  2. Family history
  3. previous testicular cancer
  4. HIV
  5. age 20-45
  6. Caucasian
  7. infant hernia
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2
Q

How do you manage nephritic syndrome?

A

Treat underlying cause

Blood pressure control- ACE-I/ARB. This reduces proteinuria and preserves renal function

Corticosteroids- this is to reduce the inflammation causing damage to the kidney

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3
Q

What can nephrotic syndrome be secondary to?

A
  1. DM
  2. SLE
  3. Amyloidosis
  4. Infection
  5. Drugs
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4
Q

How is minimal change disease treated?

A

High dose corticosteroids = prednisolone

  • Frequent relapse or steroid-dependent disease is treated with CYCLOPHOSPHAMIDE or CICLOSPORIN/TACROLIMUS
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5
Q

How would you diagnose membranous nephropathy?

A

Serum anti-PLA2R antibodies

Renal biopsy = thickened glomerular basement membrane (sub epithelial IgG and C3 complement deposits)

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6
Q

What is the management of membranous nephropathy?

A

Managed with ACE-I/ARB in all.

In patients with high risk of progression, prednisolone and cyclopshosphamide.

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7
Q

Describe the treatment for nephrotic syndrome

A

Fluid and salt restriction

Loop diuretics- to manage oedema

Treat cause

ACE-I/ARB to reduce protein loss

Manage complications

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8
Q

Give 3 complications of nephrotic syndrome

A
  1. Infections (Ig loss, complement activity decrease)
  2. Thromboembolism (more clotting factor) manage with heparin
  3. Hyperlipidaemia - loss of albumin increases cholesterol formation. Manage with statins
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9
Q

What is the treatment for IgA nephropathy?

A
  • BP control - ACEi / ARB

- steroids if renal function declines

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10
Q

Give 5 potential causes of urinary tract stones

A
  1. Congenital abnormalities - horseshoe kidney, spina bifida
  2. Hypercalcaemia/high urate/high oxalate
  3. Hyperuricaemia
  4. Infection
  5. Trauma
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11
Q

When are urinary tract stone removed?

A

<5mm = watch and wait

> 5mm:

  • Oral nifedipine (CCB) or alpha blocker (tamsulosin)
  • Extracorporeal shock wave lithotripsy (ESWL) - break stone into smaller fragment using shockwaves
  • Ureteroscopy (laser/basket)
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12
Q

What investigations might you do to find out what is causing someone’s renal colic?

A
  1. Bloods - including calcium, phosphate, urate
  2. Urinalysis
  3. MSU MCS (mid-stream urine microscopy, culture & specificity)
  4. NCCT-KUB (non-contrast CT scan of kidney, ureter and bladder) = gold standard
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13
Q

What is the GFR?

A

Volume of fluid filtered from the glomeruli into Bowman’s space pre unit time

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14
Q

What is the effect of NSAIDs on the afferent arteriole of glomeruli?

A

NSAIDs inhibit prostaglandins and so lead to afferent arteriole vasoconstriction = reduced GFR

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15
Q

What is the effect of AECi on the efferent arteriole of glomeruli?

A

ACEi cause efferent arteriole vasodilation = reduced GFR

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16
Q

How is CKD diagnosed?

A
  • eGFR < 60,
    or:
  • eGFR < 90 + signs of renal damage,
    or:
  • Albuminuria > 30mg/24hrs (Albumin:Creatinine > 3mg/mmol)
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17
Q

Briefly describe the pathophysiology causes CKD

A

Hyper-filtration for nephrons that work –> glomerular hypertrophy and reduced arteriolar resistance –> raised intraglomerular capillary pressure and strain –> accelerates remnant nephron failure (progressive)

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18
Q

Name 4 cause of CKD

A
  1. DM - 24% of patients
  2. Hypertension
  3. Glomerulonephritis
  4. Congenital - polycystic kidney disease
  5. Urinary tract obstruction
  6. drugs - NSAIDs, ACEi, antidepressants, many antibiotics
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19
Q

Give 3 signs of CKD

A

Often asymptomatic until very low kidney function

  • Fluid retention
  • oedema and raised JVP
  • Oliguria - 0.5 mL/kg/h or <500mL/day
  • Effects of uraemia
    - pruritus = ureamic frost, yellow/grey complexion, nausea, reduced appetite
  • cardiac arrhythmias - hyperKa
  • Fatigue, pallor - anaemia
  • Bone pain - hyperphosphatemia (CKD-MBD)
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20
Q

What investigations might be done in someone who has CKD?

A

FBC = anaemia
U+Es = raised phosphate, uric acid, urea, creatine and decreased Calcium
Urine dipstick = haematuria and proteinuria
GFR Imaging - USS, CT KUB, ECG, Xrays

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21
Q

Describe the management of CKD

A

Slow progression of disease

  • DM treatment
  • HTN treatment
  • Glumeronephritis treatment

Reduce risk of CVD
- Atorvastatin- 20mg

Manage complications

  • Mineral bone disease- low Vit D
  • HTN
  • Proteinuria
  • Anaemia-> ESA
  • RRT- haemodialysis, peritoneal dialysis, transplant
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22
Q

Give 5 potential complications of haemodialysis

A
  1. Hypotension
  2. Cramps
  3. Nausea
  4. Chest pain
  5. Fever
  6. Blocked or infected dialysis catheter
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23
Q

Give 4 potential complications of peritoneal dialysis

A
  1. Infection (peritonitis/catheter exit site infection)
  2. Peri-catheter leak
  3. Abdominal wall herniation
  4. Intestinal perforation
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24
Q

Give 3 contraindications for renal transplant

A
  1. ABO incompatibility
  2. Active infection
  3. Recent malignancy
  4. Morbid obesity
  5. Age >70
  6. AIDS
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25
Q

Define Acute Kidney Injury (AKI)

A

Sudden decline in renal function determined by increased serum creatinine +/- ↓ urine output.
Results in imbalance in electrolytes and azotaemia (↑ creatinine / nitrates)

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26
Q

Give 5 risk factors for AKI

A
  1. Increasing age
  2. CKD
  3. HF
  4. DM
  5. Nephrotoxic drugs - NSAIDs, ACEi
  6. hypertension
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27
Q

How does AKI present?

A
  1. Uraemia (high urea) = fatigue, weakness, vomiting, seizures
  2. Acidosis
  3. Arrhythmias
  4. Oliguria
  5. Oedema
  6. high creatinine
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28
Q

What is the diagnostic criteria for AKI?

A

1/3 = diagnostic

  1. Rise in CR >26 mmol/L in 48 hours
  2. Rise in Cr >50% in 48 hours
  3. Urine output fall to < 0.5 ml/kg/h for 6 hours
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29
Q

Give 4 risk factors of UTI’s

A
  1. Catheter
  2. Female
  3. Prostatic hypertrophy (obstructs)
  4. Low urine volume
  5. Urinary tract stones
  6. Pregnancy
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30
Q

Give 3 bacterial virulence factors that aid their ability to cause UTI’s

A
  1. Fimbriae/pili that adhere to urothelium
  2. Acid polysaccharide coat resists phagocytes
  3. Toxins (e.g. UPEC releases cytotoxins)
  4. Enzyme production (e.g. urease)
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31
Q

Give 3 host defence mechanisms against UTIs

A
  1. Antegrade flushing of urine
  2. Tamm-horsfall protein
  3. GAG layer
  4. Low urine pH
  5. Commensal flora
  6. Urinary IgA
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32
Q

Describe the management for someone who is having recurrent UTIs

A
  1. Increase fluid intake
  2. Regular voiding
  3. Void pre and post intercourse
  4. Abx prophylaxis
  5. Vaginal oestrogen replacement
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33
Q

what are the risk factors for cystitis?

A
  1. Urinary obstruction
  2. Previous damage to bladder epithelium
  3. Poor bladder emptying
  4. bladder stones
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34
Q

what are the symptoms of cystitis?

A
  1. Dysuria
  2. Frequency and urgency
  3. Suprapubic pain
  4. Offensive smelling/cloudy urine
  5. Haematuria
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35
Q

What is the treatment for cystitis?

A

1st line = Trimethoprim or nitrofurantoin (avoid trimethoprim in pregnancy -> teratogenic)

2nd line = ciprofloxacin or Co-amoxiclav

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36
Q

what are the causes of prostatitis?

A

acute:

  • streptococcus faecalis
  • e.coli
  • chlamydia

chronic:

  • bacterial (as above)
  • non-bacterial - elevated prostatic pressure, pelvic floor myalgia
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37
Q

Give 4 symptoms of acute prostatitis

A
  1. Fever
  2. Rigors
  3. Malaise
  4. Voiding LUTS
  5. Pelvic –> anal pain
  6. pain on ejaculation

very tender prostate

38
Q

Give 3 symptoms of chronic prostatitis

A
  1. Recurrent UTI’s
  2. Pelvic –> anal pain
  3. acute symptoms
    Symptoms for > 3 months
39
Q

What investigations might you do in someone with prostatitis?

A
  1. Urinalysis and MSU = blood, WBC and bacteria
  2. DRE = boggy, tender and hot to touch
  3. STI screen
  4. Microbiology = uropathogens in urine
  5. Imaging - TRUSS +/- CT abdo/pelvis
40
Q

How would you treat prostatitis?

A

Quinolone (ciprofloxacin) or trimethoprim (if unable to take quinolones) for 4-6 weeks
Treat pain = paracetamol/ibuprofen

41
Q

what are the causes of urethritis?

A
  • N. gonorrhoea
  • chlamydia
  • trauma
  • urethral stricture
  • irritation
  • urinary calculi
42
Q

what are the symptoms of urethritis?

A
  • skin lesion
  • dysuria +/- discharge (blood/pus)
  • urethral pain
  • penile discomfort/Pruritis
43
Q

what is the treatment for urethritis?

A

STI treatment = Abx - ceftriaxone and doxycycline

partner notification

44
Q

What investigations might you do in someone with pyelonephritis?

A
  1. urine dipstick (1st line)
  2. mid-stream urine MC+S (gold standard)
  3. urgent USS to detect stones, obstruction or incomplete bladder emptying
45
Q

Describe the treatment for pyelonephritis

A

Antibiotics: cefalexin for 7-10 days. Trimethoprim or amoxicillin if sensitive.
Analgesia- paracetamol

46
Q

what is the management for urinary tract stones?

A
  • Strong analgesia- diclofenac
  • Antibiotics
  • Tamsulosin/nifedipine- relaxes smooth muscle and helps expulsion
  • Percutaneous nephrolithotomy- used to expulse stones over 10mm
47
Q

what are the risk factors for urinary tract stones?

A
  • chronic dehydration
  • obesity
  • high protein/salt diet
  • recurrent UTIs
  • hyperparathyroidism (hypercalcaemia)
  • congenital abnormalities
48
Q

what is the pathophysiology of intra-renal AKI?

A
  • glomerular - glomerulonephritis
    o this causes barrier damage and protein leakage
    o this decreases oncotic pressure which decreases GFR- tubular
  • necrosis
    o complex blood supply causes cells to infarct, break away and plug tubules
    o this decreases hydrostatic pressure and decreases GFR
  • vascular - vasculitis
    o damaged vasculature decreases O2 which causes necrosis
  • interstitial - acute interstitial nephritis
    o inflammation and immune cells cause damage
49
Q

what are the risk factors for prostate cancer?

A
  • family history
  • increasing age
  • black
  • genetic
  • HOXB13, BRCA2
50
Q

what are the investigations for varicocele?

A

● Venography

● Colour doppler ultrasound to see blood flow

51
Q

what are the investigations for testicular torsion?

A
  • doppler ultrasound - lack of blood flow to testis
  • urinalysis - exclude infection and epididymis
  • prehn’s sign = negative (raising scrotum exacerbates pain)
  • DO NOT DELAY SURGICAL EXPLORATION
52
Q

what are the risk factors for pyelonephritis?

A
  • renal structural abnormalities
  • calculi (stones)
  • catheterisation
  • pregnancy
  • diabetes
  • immunocompromised
53
Q

what are the risk factors for prostatitis?

A 
STI
UTI
indwelling catheter
post-biopsy
increasing age
54
Q

what are the investigations for hydrocele?

A
  • USS

- serum alpha-fetoprotein and hCG to exclude malignant teratomas and germ cell tumours

55
Q

what are the clinical features of nephritic syndrome that is specific to SLE?

A
  • rash
  • arthralgia
  • kidney failure
  • neurological symptoms
  • pericarditis
  • pneumonitis
56
Q

what is the treatment for nephritic syndrome caused by SLE?

A
  • immunosuppression
  • steroids
  • cyclophosphamide
  • rituximab
57
Q

what are the investigations for urethritis?

A
  • STI testing
  • microscopy and culture of urethral discharge
  • urine dipstick
  • urethral smear
  • ?flexible cystoscopy
58
Q

what are the causes membranous nephropathy?

A
  • idiopathic
  • drugs - penicillamine, gold, NSAIDs
  • autoimmune - SLE, thyroiditis
  • infection, hep B or C, schistosomiasis
  • cancer - lung, colon. stomach, breast
59
Q

what are the causes of focal segmental glomerulosclerosis?

A
  • idiopathic

secondary

  • HIV
  • sickle cell anaemia
  • heroin
  • interferon treatment
60
Q

what are the investigations for focal segmental glomerulosclerosis?

A

needle biopsy = focal sclerosis and GBM thickening

61
Q

what is the pathophysiology of focal segmental glomerulosclerosis?

A
  • Scarring that is focal and only some glomeruli involved and segmental (only part of glomerulus affected)
  • CD80 in podocytes resulting in increased permeability in glomeruli and thus proteinuria and haematuria
  • Secondary hypertension and renal impairment
62
Q

what is the treatment for nephrotic syndrome caused by focal segmental glomerulosclerosis?

A

Give steroids in idiopathic disease

All patients should receive ACE-I/ARB blood pressure control

63
Q

what are the risk factors/causes of minimal change disease in nephrotic syndrome?

A
  • can be idiopathic
  • atopy - allergic reaction can trigger
  • drugs - NSAIDs, lithium, antibiotics, bisphosphonates, sulfasalazine
  • hep C, HIV, TB
  • associated with hodgkins lymphoma
64
Q

what is the clinical presentation of minimal change disease?

A
  • Proteinuria
  • Oedema, predominantly around the face
  • Fatigue
  • Frothy urine
65
Q

what are the risk factor for autosomal dominant polycystic kidney disease?

A
  • family history of ADPKD- ESRF

- hypertension

66
Q

what is the clinical presentation of autosomal dominant polycystic kidney disease?

A
  • hypertension
  • abdo/flank pain (haemorrhage)
  • LUTS (dysuria, urgency, pain)
  • palpable
67
Q

what are the investigations for autosomal dominant polycystic kidney disease?

A

Renal USS then renal biopsy for genes
<30yrs – at least 2 unilateral or bilateral cysts
30-59yrs – 2 cysts in each kidney
>60yrs – 4 cysts in each kidney

68
Q

what is the treatment for autosomal dominant polycystic kidney disease?

A
  • Treat hypertension – lifestyle, ACEi (ramipril)
  • Infected – Abx or drain
  • Surgical – removal (nephrectomy)
  • Chronic – dialysis or transplant
69
Q

what are the complications of polycystic kidney disease?

A

berry aneurysms
cysts on other organs
50% have ventricular hypertrophy
pre-malignant

70
Q

what is the clinical presentation of autosomal recessive polycystic kidney disease?

A
  • variable
  • many present in infancy with multiple renal cysts and congenital hepatic fibrosis
  • enlarged polycystic kidneys
  • 30% develop kidney failure
71
Q

what is the specific clinical presentation of pre-renal AKI?

A
  • hypotension (D&V, syncope, pre-syncope)

- signs of liver or heart failure (oedema)

72
Q

what is the specific clinical presentation of intra-renal AKI?

A

infection, signs of underlying disease (vasculitis, glomerulonephritis, DM)

73
Q

what is the specific clinical presentation of post-renal AKI?

A

LUTS (BPH)

74
Q

what are the complications of AKI?

A

end stage renal failure
metabolic acidosis
uraemia
CKD

75
Q

how does hypertension cause CKD?

A

thickening of afferent arteriole leading to ischaemia. Further fluid overloading due to activation of RAAS

76
Q

what is the treatment for urinary tract stones?

A
  • strong analgesic (IV diclofenac)
  • antibiotics if infection (IV cefuroxime or IV gentomycin)
  • antiemetics
  • stone removal
77
Q

which drugs are classed as nephrotoxic?

A
  • NSAIDs
  • aminoglycosides
  • ACEi
  • ARB
  • loop diuretics
  • metformin
  • digoxin
  • lithium
78
Q

what is the management for epididymitis?

A
  • IM ceftriaxone (if organism is unknown) + doxycycline
79
Q

what is the clinical presentation of goodpastures disease?

A

Presents with SOB and oliguria due to respiratory and renal damage

80
Q

what is the management for goodpasture’s disease?

A

plasma exchange
steroids
cyclophosphamide (for immune suppression)

81
Q

what is the clinical presentation of post strep glomerulonephritis?

A

Presents with haematuria. Can present with acute nephritis

82
Q

what are the secondary causes of nephrotic syndrome?

A 
DDANI
diabetes
drugs
autoimmune
neoplasia
infection
83
Q

where does bladder cancer spread to?

A

spreads to the iliac and para-aortic nodes, and to the liver and lungs

84
Q

what are the causes/risk factors of bladder cancer?

A
  • Smoking = increases risk 2-4 times, accounts for half of male cases of bladder cancer
  • Age over 55
  • Pelvic radiation
  • Exposure to occupational carcinogens
  • Bladder stone- due to chronic inflammation
85
Q

what is the presentation of bladder cancer?

A
  • Painless haematuria- this is the most common presenting symptom for bladder cancer, assume pt has urothelial tumour till proven otherwise
  • Ask about RF in history
  • UTI symptoms without bacteriuria
86
Q

what are the investigations for bladder cancer?

A

Urinalysis- sterile pyuria
Cystoscopy and biopsy- diagnostic
CTT urogram- allows staging

87
Q

what is the management for bladder cancer?

A

T1: transurethral resection or local diathermy
T2-3: radical cystectomy
T4: palliative chemotherapy and radiotherapy

88
Q

what is the equation for net filtration pressure for the glomerulus?

A

NFP = GHP - (GCOP + CHP)

NFP = net filtration pressure
GHP = glomerular hydrostatic pressure
GCOP = glomerular colloid oncotic pressure
CHP = capsular hydrostatic pressure
89
Q

what is the innervation of the external urinary sphincter?

A

pudendal nerve S2-S4

90
Q

what is the innervation of internal urinary sphincter?

A

pelvic splanchnic nerve S2-S4

91
Q

what is the innervation of the bladder?

A 
sympathetic = sympathetic chain T11-L2
parasympathetic = pelvic splanchnic S2-S4

Phase 2A revision (38 decks)

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