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GUM Flashcards

1
Q

What are the functions of the urinary tract?

A
  1. To collect urine produced continuously by kidneys
  2. Store collected urine safely
  3. Expel urine when socially acceptable
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2
Q

Where do stones tend to form in the ureters?

A
  1. Pelvic ureter junction
  2. Where it crosses iliac vessels
  3. Where it enters trigone of bladder
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3
Q

What nerves supply the bladder?

A
  1. Pelvic nerve
  2. Hypogastric plexus
  3. Pudendal nerve
  4. Afferent pelvic nerve
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4
Q

What is the origin of pelvic nerves?

A

S2 to S4 (keeps the pee of the floor)

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5
Q

What is the normal capacity of the bladder?

A

400-500ml

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6
Q

When is first sensation felt in the bladder?

A

100-200ml

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7
Q

Why does bladder pressure remain low when volume increases?

A

Receptive relaxation and detrusor muscle compliance

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8
Q

What is the reflex when voiding is inappropriate?

A

Guarding reflex

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9
Q

What is the role of the detrusor muscle?

A
  1. Relaxes during storage

2. Contracts during voiding

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10
Q

What is the role of the distal sphincter muscle?

A
  1. Contracts during storage

2. Relaxes during voiding

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11
Q

What are the storage LUTS?

A
  1. Frequency
  2. Nocturia
  3. Urgency
  4. Urgency incontinence
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12
Q

What are the voiding LUTS?

A
  1. Hesitancy
  2. Straining
  3. Poor/intermittent stream
  4. Incomplete emptying
  5. Post-micturition dribbling
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13
Q

What are the red flag LUTS?

A
  1. Haematuria

2. Dysuria

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14
Q

What is benign prostatic hyperplasia (BPH)?

A

Increase in epithelial and stroll cell numbers in periurethral area of prostate

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15
Q

What can cause BPH?

A
  1. Increase in cell number
  2. Decrease apoptosis
  3. Combination of both
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16
Q

What is a requirement for BPH?

A

Androgens

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17
Q

What is used to score LUTS symptoms?

A

International Prostate Symptom Score (IPSS)

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18
Q

What are the examinations done in LUTS pt.?

A
  1. General examination
  2. Abdomen examination
  3. External genitalia
  4. DRE
  5. Focussed neurological exam
  6. Urinalysis
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19
Q

What investigations are done in LUTS/BPH?

A
  1. Flow rates and residual volume
  2. Frequency volume chart
  3. Renal biocehmistry
  4. PSA
  5. TRUSS
  6. Flexible cystoscopy
  7. Urodynamics
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20
Q

What can cause reduction of flow rate?

A
  1. Obstruction within lower urinary tract

2. Detrusor underactivity

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21
Q

What is normal post void residual (PVR)?

A

<12ml

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22
Q

What are the complications of benign prostatic enlargement (BPE)?

A
  1. Symptom progression
  2. Infections
  3. Stones
  4. Haematuria
  5. Retention
  6. Interactive obstructive uropathy
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23
Q

What are the clinical features of acute retention of urine (AUR)?

A
  1. Painful
  2. 600ml-1L residual urine
  3. Normal U&E
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24
Q

What is the Rx for AUR?

A
  1. Catheterisation
  2. Alpha blockers - tamsulosin
  3. ISC
  4. Bladder outflow surgery
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25
Q

What are the clinical features of interactive obstructive uropathy?

A
  1. Nocturnal enuresis
  2. Residual volume 4L
  3. High CRP
  4. Diuresis
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26
Q

What is the Rx for interactive obstructive uropathy?

A
  1. IV fluids
  2. TURP
  3. Indwelling catheter
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27
Q

What is the Rx for BPH?

A
  1. Observation
  2. Medical treatment
  3. Surgical treatment
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28
Q

What is the medical treatment for BPH?

A
  1. Alpha adrenergic antagonists e.g. tamsulosin
  2. 5a-reductase inhibitors e.g. finasteride
  3. Combination therapy
  4. Anti-cholinergics
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29
Q

What are the indications for surgery in BPH?

A

RUSHES

  1. Retention
  2. UTIs
  3. Stones
  4. Haematuria
  5. Elevated creatinine due to BOO
  6. Symptom deterioration
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30
Q

Give 4 surgical treatments for BPH

A
  1. Bladder neck incision
  2. TURP
  3. Bipolar
  4. Greenlight laser
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31
Q

Give 4 complications of TURP

A
  1. Sepsis
  2. Haemorrhage
  3. Clot retention
  4. Erectile dysfunction
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32
Q

What is incontinence?

A

Involuntary loss of urine (failure of storage)

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33
Q

What is overactive bladder (OAB)?

A

Urgency with frequency, with or without nocturia, when appearing in absence of local pathology

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34
Q

What is the Rx for OAB?

A
  1. Behavioural therapy
  2. Anti-muscarinic agents
  3. B3 agonists
  4. Botox
  5. Sacral neuromodulation
  6. Surgery
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35
Q

Why does birth cause stress incontinence in females?

A
  1. Denervation of pelvic floor and urethral sphincter

2. Weakening of fascial support of bladder and urethra

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36
Q

How is stress incontinence managed in females?

A
  1. Pelvic floor physiotherapy
  2. Duloxetine
  3. Surgery
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37
Q

What causes stress incontinence in males?

A
  1. Neurogenic

2. Prostatectomy

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38
Q

How is stress incontinence managed in males?

A
  1. Artificial sphincter

2. Male sling

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39
Q

What is most in spastic spinal cord injury?

A
  1. Coordination

2. Completion of voiding

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40
Q

What are the features of spastic spinal cord injury?

A
  1. Reflex bladder contractions
  2. Detrusor sphincter dyssynergia
  3. Poorly sustained bladder contraction
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41
Q

What is lost in flaccid spinal cord injury?

A
  1. Reflex bladder contraction
  2. Guarding reflex
  3. Receptive relaxation
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42
Q

What are the features of flaccid spinal cord injury?

A
  1. Areflexic bladder
  2. Stress incontinence
  3. Risk of poor compliance
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43
Q

What is autonomic dysreflexia?

A

Overstimulation of sympathetic nervous system below level of lesion in response to a noxious stimulus

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44
Q

What are the symptoms of autonomic dysreflexia?

A
  1. Headache
  2. Severe HTN
  3. Flushing
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45
Q

What are the risk factors for unsafe bladder?

A
  1. Raised bladder pressure
  2. Vesico-ureteric reflux
  3. Chronic infection
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46
Q

What is an unsafe bladder?

A

One that puts kidneys at risk

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47
Q

What causes raised bladder pressure?

A

Prolonged detrusor contraction causing loss of compliance

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48
Q

What is the result of raised bladder pressure?

A

Problems with drainage of urine from kidneys and ultimately hydronephrosis and renal failure

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49
Q

What are the routes for reflex bladder?

A
  1. Harness reflexes to empty bladder into incontinence device
  2. Suppress reflexes converting bladder to flaccid type and then empty regularly
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50
Q

What are the management for paraplegic bladder?

A
  1. Suprapubic catheter
  2. Convene
  3. Suppress reflexes or poorly compliant bladder converting bladder to safe type and then regularly empty using ISC
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51
Q

What can be used to suppress reflex bladder contractions?

A
  1. Anticholinergics
  2. Mirabegron
  3. Intravesical botulinum toxin
  4. Posterior rhizotomy
  5. Cystoplasty
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52
Q

What is the mean age for prostate cancer?

A

72

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53
Q

What type of cancer are most prostate cancers?

A

Adenocarcinoma

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54
Q

What are the sites for prostate cancer?

A
  1. Peripheral zone (70%)
  2. Transitional zone (20%)
  3. Central zone (10%)
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55
Q

How are prostate cancers graded?

A

Gleason scale

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56
Q

Which organs does prostate cancer spread to?

A
  1. Bone
  2. Lung
  3. Liver
  4. Kidneys
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57
Q

How does prostate cancer spread locally?

A

Through prostate capsule

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58
Q

What are the biomarkers for prostate cancer?

A
  1. Tissue
  2. PSA
  3. PSMA
  4. PCA3
  5. Gene fusion products
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59
Q

When is PSA elevated?

A
  1. Benign prostate enlargement
  2. UTI
  3. Prostatitis
  4. Prostate cancer
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60
Q

What are 5 symptoms of prostate cancer?

A
  1. Weight loss
  2. Hesitancy
  3. Frequency
  4. Nocturia
  5. Urgency
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61
Q

What is seen on examinations for prostate cancer?

A
  1. DRE
  2. Neurological exam
  3. Overdistended bladder
  4. Bony tenderness
  5. Lymphadenopathy
  6. DVT
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62
Q

What does DRE check for in prostate cancer?

A

A nodule, asymmetry, difference in texture and bogginess

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63
Q

What are the investigations for prostate cancer?

A
  1. PSA
  2. MRI prostate
  3. Prostate biopsy
  4. CT abdomen
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64
Q

What is normal PSA level?

A

<3ng/ml

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65
Q

What are the Rx for prostate cancer?

A
  1. Active surveillance
  2. Radical prostatectomy
  3. Radiotherapy
  4. Hormone therapy
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66
Q

What hormone therapies are used for prostate cancer?

A
  1. Orchiectomy
  2. LH-releasing hormone agonists e.g. goserelin
  3. Anti-androgens e.g. flutamide
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67
Q

What are the side effects of hormone therapies?

A
  1. Impotence
  2. Depression
  3. hot flushes
  4. Lethargy
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68
Q

What are the Rx for metastatic prostate cancer?

A
  1. Chemotherapy e.g. docetaxel
  2. Biphosphonates
  3. Radiotherapy
  4. TURP
  5. Nephrostomy
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69
Q

What is used to Dx prostate cancer?

A
  1. LUTS
  2. PSA
  3. Transrectal USS
  4. Prostate biopsy
  5. Prostate cancer grading
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70
Q

What are the benefits of PSA testing?

A
  1. Early diagnosis of localised disease

2. Early Rx of advanced disease

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71
Q

What are the risks of PSA testing?

A
  1. Overdiagnosis of insignificant disease

2. Harm caused by investigation/Rx

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72
Q

What is the peak age for kidney cancer?

A

85-90

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73
Q

What is the mortality for kidney cancer?

A

35%

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74
Q

What are the risk factors for kidney cancer?

A
  1. Smoking
  2. Environment e.g. petroleum
  3. Occupation e.g. leather tanners
  4. Hormonal e.g. obesity
  5. Genetic e.g. VHL
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75
Q

What is the classic triad of kidney cancer?

A
  1. Mass
  2. Haematuria
  3. Pain
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76
Q

What are the blood signs of kidney cancer?

A

Raised PTH, EPO, PLC

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77
Q

What are the investigations for kidney cancer?

A
  1. USS renal

2. CT renal

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78
Q

What are the histological types in kidney cancer?

A
  1. Clear cell
  2. Papillary
  3. Chromophobe
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79
Q

What are the Rx for kidney cancer?

A
  1. Nephrectomy
  2. Radiotherapy
  3. Cryotherapy
  4. Tyrosine kinase inhibitors
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80
Q

Where is bladder cancer more common?

A
  1. Industrialised areas

2. Schistosomiasis endemic areas

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81
Q

Give 4 risk factors for bladder cancer

A
  1. Smoking
  2. Tanner
  3. Dye worker
  4. Hairdresser
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82
Q

What is the presentation of bladder cancer?

A
  1. Painless haematuria
  2. Irritative LUTS
  3. Flank pain
  4. Weight loss
  5. Pelvic mass
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83
Q

What type of cancer is most common in bladder?

A

Transitional cell carcinoma

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84
Q

What are the investigations for bladder cancer?

A
  1. CT

2. Cystoscopy

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85
Q

What is the Rx for bladder cancer?

A
  1. TURBT
  2. Chemotherapy
  3. Immunotherapy
  4. Cystectomy
  5. Radiotherapy
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86
Q

What is the most common age for testicular cancer?

A

20-35

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87
Q

What are the risk factors for testicular cancer?

A
  1. Cryptorchidism
  2. Previous cancer
  3. HIV
  4. Klinefelter’s syndrome
  5. Maternal oestrogen exposure
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88
Q

What is the pathology of most testicular cancer?

A

Germ cell tumours - seminomatous and non-seminomatous

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89
Q

Where do testicular cancers metastasise to?

A
  1. Epididymis
  2. Spermatic cord
  3. Scrotal wall
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90
Q

What is the presentation of testicular cancer?

A
  1. Scrotal lump
  2. Scrotal pain
  3. Weight loss
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91
Q

What is the DDx for testicular cancer?

A
  1. Hydrocele
  2. Epididymal cyst
  3. Indirect inguinal hernia
  4. Varicocele
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92
Q

What are the investigations for testicular cancer?

A
  1. USS testes
  2. CT CAP
  3. CT brain/spine
  4. Tumour markers - AFP, LDH, hCG
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93
Q

What is the Rx for testicular cancer?

A
  1. Orchidectomy
  2. Sperm banking
  3. RPLND
  4. Radiotherapy
  5. Chemotherapy
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94
Q

What are the complications of glomerulitis?

A
  1. Haematuria
  2. Proteinuria
  3. High BP
  4. Renal impairment
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95
Q

What is the presentation of acute nephritic syndrome (ANS)?

A
  1. Acute kidney injury
  2. Haematuria
  3. Proteinuria
  4. Oliguria
  5. HTN
  6. Fluid overload
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96
Q

Give 3 causes of ANS

A
  1. ANCA associated vasculitis
  2. SLE
  3. Goodpasture’s disease
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97
Q

What is the important diagnostic method for glomerular disease?

A

Urine dipstick

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98
Q

What does renal vasculitis involve?

A

Necrotising small vessel vasculitis involving capillaries, venues, arteriolar and small arteries

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99
Q

When does renal vasculitis usually occur?

A

5th to 7th decade

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100
Q

What are the symptoms of renal vasculitis?

A
  1. Headache
  2. Flu-like symptoms
  3. Bloody discharge
  4. Tender nodules
  5. Wheeze
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101
Q

What are the investigations for renal vasculitis?

A
  1. ANCA
  2. Urine dipstick
  3. Bloods
  4. BP
  5. CRP
  6. Biopsy
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102
Q

What are the stages of treatment for renal vasculitis?

A
  1. Induced remission

2. Maintenance Rx

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103
Q

What is the induced remission treatment for renal vasculitis?

A
  1. Steroids
  2. Cyclophosphamide
  3. Plasma exchange
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104
Q

What is the maintenance treatment for renal vasculitis?

A
  1. Azathioprine

2. Rituximab

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105
Q

What are the complications of renal vasculitis?

A
  1. Declining renal function
  2. Hypertension
  3. Proteinuria
  4. Osteoporosis
  5. Malignancy
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106
Q

What is the pathophysiology of IgA nephropathy?

A

Mesangial proliferative glomerulonephritis (GN) with diffuse mesangial IgA deposits

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107
Q

When does most IgA nephropathy occur?

A

2nd or 3rd decade

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108
Q

What is the Dx for IgA nephropathy?

A
  1. Biopsy

2. Diffuse mesangial IgA deposits

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109
Q

What is the supportive Rx for IgA nephropathy?

A
  1. RAAS inhibitors
  2. Diet
  3. Lower cholesterol
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110
Q

What is the immunosuppressive Rx for IgA nephropathy?

A
  1. Steroids
  2. Cyclophosphamide
  3. Azathioprine
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111
Q

What is the presentation of nephrotic syndrome?

A
  1. Heavy proteinuria
  2. Hypoalbuminaemia
  3. Oedema
  4. Hypercholesterolaemia
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112
Q

What is nephrotic syndrome?

A

Metabolic consequences are hypoalbuminaemia, hypercoagulability, loss of binding proteins needing drug dose adjustments and risk of infections

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113
Q

Give 5 causes of nephrotic syndrome

A
  1. Minimal change
  2. Membranous
  3. Focal segmental glomerulosclerosis
  4. DM
  5. Amyloid
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114
Q

What are the investigations for nephrotic syndrome?

A
  1. Bloods
  2. Urinalysis
  3. Urine protein creatinine ratio
  4. ANA, DNA
  5. Antiphospholipase A2 receptor antibody
  6. HepB Ag
  7. Renal biopsy
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115
Q

Where is renal biopsy taken from and why?

A

Lower pole of kidney as its least vascular region

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116
Q

What is the Rx for nephritic syndrome?

A
  1. Manage complications e.g. diuretics, ACEI
  2. Treat underlying cause
  3. Statins
117
Q

What is the pathophysiology of membranous GN?

A
  1. Thickening of glomerular capillary wall

2. IgG complement deposit in sub epithelial surface causing leaky glomerulus

118
Q

What causes secondary membranous GN?

A
  1. Autoimmune conditions
  2. Viruses
  3. Drugs
  4. Tumours
119
Q

What are the clinical features of membranous GN?

A
  1. Nephrotic syndrome

2. Benign urinary sediment

120
Q

What is the Dx for membranous GN?

A
  1. Serum PLA2 Ab

2. Renal biopsy

121
Q

What is the Rx for membranous GN?

A
  1. Steroids
  2. Cyclophosphamide
  3. CNI
  4. Rituximab
  5. Supportive Rx
122
Q

What is the presentation of minimal change disease?

A
  1. Nephrotic syndrome

2. Benign urine sediment

123
Q

What is the Dx for minimal change disease (MCD)?

124
Q

What is the Rx for MCD?

A
  1. Steroids
  2. Cyclophosphamide
  3. Cyclosporine
125
Q

What are common causes of asymptomatic abnormalities?

A
  1. IgA

2. Thin membrane disease

126
Q

What is chronic kidney disease (CKD)?

A

Progressive decline in kidney function with abnormal dipstick

127
Q

What causes CKD?

A
  1. IgA nephropathy
  2. Membranous GN
  3. DM
  4. Mesangiocapillary GN
  5. HIV associated nephropathy
128
Q

What is the physiology of erections?

A
  1. Cavernosal nerve stimulation with NO release
  2. Smooth muscle relaxation
  3. Compression of venous outflow
  4. Increased cavernosal pressure and contraction of ischiocavernosus muscle
  5. Rigid erection
129
Q

What is the physiology of ejaculation?

A
  1. Stimulation via pudendal nerve
  2. Emission: peristaltic contraction of epididymus, vas deferent and seminal vesicles with simultaneous bladder neck contraction and external sphincter relaxation
  3. Expulsion: rhythmic contraction of bulbospongiosus muscle
130
Q

What is erectile dysfunction (ED)?

A

Persistent inability to attain and maintain an erection sufficient for satisfactory sexual performance

131
Q

Give 5 causes of ED

A
  1. DM
  2. Smoking
  3. HTN
  4. Hypercholesterolaemia
  5. Obesity
132
Q

What is the presentation of non-organic ED?

A
  1. Relationship difficulties
  2. Performance anxiety
  3. Normal morning erections and non-coital erections
133
Q

What is the Hx of ED?

A
  1. Early morning erections
  2. Masturbation
  3. Libido difficulties
  4. Ejaculation dysfunciton
  5. Anatomical difficulties
134
Q

What are the examinations for ED?

A
  1. External genitalia
  2. DRE
  3. CV exam
  4. Gynaecomastia
  5. Neurological exam
135
Q

What are the investigations for ED?

A
  1. FBC, BGL, LH/FHS, TFTs
  2. Validated questionnaire (IIEF or SHIM)
  3. Penile doppler USS
  4. Nocturnal penile tumescence
136
Q

What are the management options for ED?

A
  1. Lifestyle changes
  2. Optimise medication
  3. Correct hormone imbalance
  4. Counselling
  5. Vacuums device
137
Q

What medications can be used for ED?

A
  1. PDE5 inhibitors

2. Alprostadil

138
Q

Give 2 examples of PDE5 inhibitors

A
  1. Sildenafil

2. Tadalafil

139
Q

What are the SE of PDE5 inhibitors?

A
  1. Headache
  2. Flushing
  3. Nasal congestion
  4. Impaired colour vision
  5. Priapism
140
Q

What are the SE of alprostadil?

A
  1. Urethral pain
  2. Hypotension
  3. Priapism
  4. Pain
  5. Penile fibrosis
141
Q

What are the risks of penile prosthesis?

A
  1. Urethral perforation
  2. Cold glans
  3. Concorde glans
  4. Malfunction
  5. Infection
  6. Erosion
142
Q

What is premature ejaculation?

A

Ejaculation which always occurs prior to or within 1 min of vaginal penetration and the inability to delay and negative consequences of distress, frustration or avoidance of sexual intimacy

143
Q

What is the management for premature ejaculation?

A
  1. Counselling
  2. Quiet vagina technique
  3. Squeeze technique
  4. Topical local anaesthetic
  5. SSRIs
144
Q

What is Peyronie’s disease?

A

Fibrotic plaque causing bend on erection

145
Q

What can cause Peyronie’s disease?

A
  1. Dupuytren’s contracture
  2. Alcohol excess
  3. DM
146
Q

What is the presentation of Peyronie’s disease?

A
  1. Pain on erection
  2. Deformity
  3. Inability to have penetrative sex
147
Q

What is the Rx for Peyronie’s disease?

A
  1. Nesbit’s plication
  2. Lue’s procedure
  3. Penile prosthesis
148
Q

What is the pathophysiology of penile fracture?

A

Rupture of tunica albuginea

149
Q

What is the presentation of penile fracture?

A
  1. Sudden pain
  2. Immediate detumescence
  3. Inability to gain erection
150
Q

What is the Dx for penile fracture?

A
  1. Aubergine penis on exam
  2. USS
  3. MRI
151
Q

What is the Rx for penile fracture?

A

Surgery for exporation and repair

152
Q

What is priapism?

A

Prolonged, often painful, erection of penis in absence of sexual desire or stimulation lasting > 4 hr

153
Q

What is the peak age for priapism?

154
Q

What are the risk factors for priapism?

A
  1. SCD
  2. Prior trauma
  3. ED medications
  4. Recreational drug use
155
Q

What are the investigations for priapism?

A
  1. FBC, U&E
  2. Sickle cell screen
  3. Cavernosal blood gas analysis
  4. Colour duplex USS
156
Q

What is the Rx for priapism?

A
  1. Analgesia
  2. Ice pack
  3. Aspiration +/- irrigation
  4. Intracavernosal phenylephrine
  5. Surgical shunts
  6. Penile prosthesis
157
Q

What are the functions of the kidneys?

A
  1. Filter or secrete waste
  2. Retain albumin, cells
  3. Reabsorption
  4. Control BP, fluids
  5. Activate vit D
  6. Synthesise EPO
158
Q

What are the complications of CKD?

A
  1. Anaemia

2. Bone disease

159
Q

Which drugs inhibit creatinine secretion?

A
  1. Trimethoprim
  2. Cimetidine
  3. Ritonavir
160
Q

What are the features of Fanconi syndrome?

A
  1. Glycosuria
  2. Acidosis with failure of urine acidification
  3. Phosphate wasting (rickets/osteomalacia)
  4. Aminoaciduria
161
Q

Where is K most filtered and reabsorbed?

A

Proximal tubule and loop of Henle by Na/K cotransporter

162
Q

What governs renal potassium control?

A
  1. Distal delivery of Na

2. Aldosterone

163
Q

What drugs teat hypokalaemia?

A
  1. Loop diuretics

2. Thiazide diuretics

164
Q

What drugs treat hyperkalaemia?

A
  1. Spironolactone
  2. Amiloride
  3. ACEI
  4. ARBs
165
Q

What drugs are used for distal tubule?

166
Q

What drugs are used for aquaporins?

A

Vasopressin antagonists

167
Q

What drugs are used for collecting duct?

A

Aldosterone antagonist

168
Q

What drugs are used for loop of Henle?

A

Loop diuretics

169
Q

What is the role of prostaglandin on arterioles?

A

Preferentially dilates afferent arteriole

170
Q

What is the role of angiotensin II on arterioles?

A

Preferentially constricts efferent arteriole

171
Q

What is indicated in proteinuric CKD?

A

ACEI and ARB

172
Q

What are the signs of nephrogenic diabetes insipidus?

A
  1. Hypercalcaemia
  2. Hypokalaemia
  3. Lithium
  4. Genetic link
173
Q

What are the roles of calcitriol?

A
  1. Increases Ca and phosphate absorption from gut

2. Suppresses PTH

174
Q

What does calcitriol deficiency cause?

A

Secondary hyperparathyroidism

175
Q

What are the signs of secondary hyperparathyroidism?

A
  1. Rugger jersey spine
  2. Brown tumours
  3. Radial border of phalanges
  4. Salt and pepper skull
176
Q

What is used to measure kidney function?

A
  1. Creatinine
  2. eGFR
  3. Proteinuria
  4. Albuminuria
177
Q

What excretes creatinine?

178
Q

What produces creatinine?

A

Muscle metabolism

179
Q

What is the aetiology of CKD?

A
  1. DM
  2. HTN
  3. Chronic glomerulonephritis
  4. Obstructive uropathy
  5. Cystic disease
  6. AKI
180
Q

How is CKD classified?

A

GFR category (normal to kidney failure) vs albuminuria increase

181
Q

What are the risk factors for CKD?

A
  1. Age
  2. Male
  3. HTN
  4. Smoking
  5. LV hypertrophy
  6. DM
  7. Dyslipidaemia
182
Q

Why is BP control important in CKD?

A

It reduces decreases in GFR

183
Q

What BP medications are used in CKD?

A

ABCDs

  1. ACEI/ARBs
  2. BB
  3. CCB
  4. Diuretics
184
Q

What is the Rx for CKD?

A
  1. Manage BP
  2. Manage DM
  3. Statins
185
Q

Why is anaemia a complication of CKD?

A

Liver makes hepcidin which is normally filtered by kidneys, so get build up which reduces EPO production

186
Q

What are the renal replacement therapies (RRT) specific managements for CKD?

A
  1. Haemodialysis
  2. Peritoneal dialysis
  3. Transplant
187
Q

How is a haemodialysis machine connected to blood supply?

A

AV fistula or tunnelled line

188
Q

How does haemodialysis work?

A
  1. Blood pumped out of fistula into blood line
  2. Heparin added to prevent clots
  3. Blood flows to dialysed, where impurities, salt and excess fluid are drawn into dialysis fluid
  4. Clean blood returned
189
Q

How does peritoneal dialysis work??

A

Infuses a sugary solution into abdomen which draws off toxins

190
Q

What are the early complications of kidney transplant?

A
  1. Delayed function
  2. Surgical complications
  3. Infection
  4. Rejection
191
Q

What happens if a transplanted kidney doesn’t function straight away?

A

Pt. is put on dialysis

192
Q

How is fluid status assessed?

A
  1. Ankle oedema
  2. Pulmonary oedema or crackles
  3. High jugular venous pressure
  4. High BP
193
Q

What is the Rx for dehydration?

194
Q

What is the Rx for overhydration?

195
Q

What is the epidemiology of chlamydia?

A

Higher in females, drops off after 25

196
Q

What is the epidemiology of gonorrhoea?

A

Higher in males, diagnoses common in range of ages

197
Q

What bug causes chlamydia?

A

Chlamydia trachomatis

198
Q

What bug causes gonorrhoea?

A

Neisseria gonorrhoeae

199
Q

Where does chlamydia infection effect?

A
  1. Urethra
  2. Endocervical canal
  3. Rectum
  4. Pharynx
  5. Conjunctiva
200
Q

What are the symptoms of chlamydia and gonorrhoea for males?

A
  1. Pain passing urine
  2. Urethral discharge
  3. Asymptomatic 50%
201
Q

What is the incubation for chlamydia for males?

202
Q

What are the complications of chlamydia for males?

A
  1. Epididymoorchitis

2. Reactive arthritis

203
Q

What is the incubation in gonorrhoea for males?

204
Q

What are the symptoms of chlamydia and gonorrhoea for females?

A
  1. Discharge
  2. Menstrual irregularity
  3. Dysuria
205
Q

Give 5 complications of chlamydia and gonorrhoea in females

A
  1. Tubal factor infertility
  2. Ectopic pregnancy
  3. Conjunctivitis
  4. Atypical pneumonia
  5. Fitz Hugh Curtis syndrome
206
Q

How is chlamydia diagnosed?

A

Nucleic acid amplification test (NAAT)

207
Q

What is the prevalence of chlamydia in asymptomatic <25 year olds?

208
Q

What is the Rx for chlamydia?

A
  1. Partner management
  2. Test for other STIs
  3. Doxycycline
  4. Erythromycin
209
Q

What is used instead of erythromycin in pregnancy?

A

Azithromycin

210
Q

How is gonorrhoea diagnosed?

A
  1. Near patient test
  2. Microscopy
  3. NAAT
211
Q

What is the Rx for gonorrhoea?

A
  1. Partner notification
  2. Test for other STIs
  3. Check Abx sensitivity
  4. Ceftriaxone
212
Q

Why is partner notification important?

A
  1. Prevent re-infection of index pt.

2. Prevent complications in asymptomatic contacts

213
Q

What bug causes syphilis?

A

Treponema pallidum

214
Q

When do women tend to get syphilis?

A

Reproductive age

215
Q

What is the incubation for primary syphilis?

A

21-35 days

216
Q

What is the development of syphilis ulcers?

A
  1. Dusky macule
  2. Papule
  3. Indurated clean based non-tender ulcer
217
Q

What is the most common presentation in secondary syphilis?

A

Maculosquamous rash

218
Q

How is syphilis diagnosed?

A
  1. Early moist lesions - ID motile spirochetes

2. Serology from genital ulcer or rash

219
Q

What are the serological tests for syphilis?

A
  1. Screening EIA
  2. TPPA
  3. Non-treponemal test
220
Q

What is the Rx for syphilis?

A
  1. Penicillin injection

2. Partner notification

221
Q

What is the presence of bacteria in urine called?

A

Bacteriuria

222
Q

What is pyuria?

A

Presence of leukocytes in urine

223
Q

Who does uncomplicated UTIs effect?

A

Non pregnant women

224
Q

What is the most common cause of UTI?

225
Q

What are the symptoms of a lower UTI?

A

Dysuria, frequency

226
Q

What are the symptoms of an upper UTI?

A

Pyrexia, haematuria

227
Q

How are UTIs diagnosed?

A
  1. Urine dipstick
  2. Microscopy
  3. Culture
  4. Sensitivity
228
Q

What is seen on microscopy for UTIs?

A
  1. WBC
  2. RBC
  3. Casts
  4. Bacteria
  5. Epithelial cells
229
Q

What is the Rx for uncomplicated UTI?

A
  1. Abx 3 days
  2. Increase fluid intake
  3. Void pre-post intercourse
  4. Hygiene
230
Q

What is the first line Abx for UTIs?

A

Nitrofurantoin

231
Q

What other Abx can be used for UTIs?

A
  1. Fosfomycin

2. Pivmecillinam

232
Q

What are the complications of long term catheters?

A
  1. UTI/pyelonephritis
  2. Stones
  3. Obstruction
  4. Chronic inflammation
233
Q

How are UTIs diagnosed in pregnancy?

234
Q

What is pyelonephritis?

A

Infection of renal parenchyma and soft tissues of renal pelvis/upper ureter

235
Q

Who is affected by pyelonephritis?

236
Q

What is associated with pyelonephritis?

A

Sepsis and systemic upset, rigors

237
Q

What are the symptoms of pyelonephritis?

A
  1. Loin pain
  2. Fever
  3. Pyuria
238
Q

What are the investigations for pyelonephritis?

A
  1. Abdominal exam
  2. Bloods incl. cultures
  3. USS
  4. MSU
239
Q

What is the Rx for pyelonephritis?

A
  1. Fluid replacement
  2. IV Abx - coamoxiclav
  3. Drain obstructed kidney
  4. Catheter
  5. Analgesia
240
Q

What are the complications of pyelonephritis?

A
  1. Renal abscess

2. Emphysematous pyelonephritis

241
Q

What is the commonest age for urolithiasis (stones)?

242
Q

What is the most common cause of stones?

A

Dehydration

243
Q

How can stones be prevented?

A
  1. Overhydration
  2. Low salt diet
  3. Normal dairy intake
  4. Healthy protein intake
  5. Reduce BMU
  6. Active lifestyle
244
Q

How can cystine stones be prevented?

A
  1. Excessive overhydration
  2. Urine alkalisation
  3. Cysteine binders e.g. captopril
245
Q

What are the symptoms of stones?

A
  1. Loin pain
  2. Renal colic
  3. UTI symptoms
  4. Recurrent UTIs
  5. Haematuria
246
Q

What is renal colic?

A

Pain results from upper urinary tract obstruction

247
Q

What are the signs of renal colic?

A
  1. Unilateral loin pain
  2. Rapid onset
  3. Unable to get comfortable
  4. Radiation to groin and ipsilateral testis/labia
  5. Nausea/vomiting
  6. Spasmodic/colicky
248
Q

What is the investigation of ureteric colic?

A
  1. Urinalysis, MSU
  2. FBC, U&E, Ca, uric acid
  3. NCCT-KUB
  4. KUB XR
  5. USS
249
Q

What is the DDx for ureteric colic?

A
  1. Ruptured AAA
  2. Diverticulosis
  3. Appendicitis
  4. Ectopic pregnancy
  5. Testicular torsion
250
Q

What imaging technique is used for ureteric colic in pregnancy?

251
Q

What is the Rx for ureteric colic?

A
  1. Analgesia (NSAIDs/opiates)
  2. Antiemetics
  3. IV fluids
  4. Observe for sepsis
  5. IV Abx if indicated
252
Q

What are the methods of kidney drainage?

A
  1. Nephrostomy

2. Ureteric stent

253
Q

What is the Rx of urosepsis?

A
  1. Medical
  2. Lithotripsy
  3. Surgical
254
Q

What are the consequences of renal stones?

A
  1. Renal or ureteric colic
  2. Abscess
  3. Fistula
  4. Xanthogranulomatous pyelonephritis
255
Q

What are the Rx for kidney stones?

A
  1. EWSL
  2. Ureteroscopy (laser)
  3. PCNL
  4. Nephrectomy
256
Q

What is the pathophysiology of AKI?

A

Renal function decreased to point where body accumulates waste products and is unable to maintain homeostasis

257
Q

What are the symptoms of AKI?

A
  1. Oedema
  2. Little urine
  3. Fatigue
  4. SOB
  5. Confusion
258
Q

What is the Dx for AKI?

A
  1. Raise serum creatinine

2. Fall urine output

259
Q

What is the Rx for AKI?

A
  1. Temporary haemodialysis
  2. Diuretics
  3. IV fluids
  4. Ca infusion
  5. Polystyrene sulfonate
260
Q

What is acute renal failure?

A

Kidneys suddenly become unable to filter waste products from blood

261
Q

What are the symptoms of acute renal failure?

A
  1. Decreased urine output
  2. Oedema
  3. SOB
  4. Fatigue
  5. Confusion
262
Q

What is cystitis?

A

Inflammation of bladder

263
Q

What is the usual cause of cystitis?

A

Bladder infection

264
Q

What are the symptoms of cystitis?

A
  1. Urgency
  2. Burning when urinating
  3. Haematuria
  4. Pelvic discomfort
  5. Fever
265
Q

What is the Ix for cystitis?

A
  1. Urinalysis
  2. Cystoscopy
  3. USS pelvis
266
Q

What is the Rx for cystitis?

A
  1. Abx
  2. Bladder distention
  3. Surgery
  4. Nerve stimulation
267
Q

What is prostatitis?

A

Inflammation of prostate gland

268
Q

What are the symptoms of prostatitis?

A
  1. Severe pain in pelvic region
  2. Pain when urinating
  3. Not able to urinate
  4. Malaise
  5. Pain on ejaculation
269
Q

What is the Ix for prostatitis?

A
  1. Urinalysis
  2. Bloods e.g. FBC, WCC
  3. Post-prostatic massage
  4. CT pelvis
270
Q

What is the Rx for prostatitis?

A
  1. Abx
  2. Alpha blockers
  3. NSAIDs
271
Q

What are the symptoms of urethritis?

A
  1. Dysuria
  2. Haematuria
  3. Discharge from penis
  4. Hesitation
272
Q

What are the causes of urethritis?

A
  1. Gonorrhoea
  2. Chlamydia
  3. Bacteria in stool
273
Q

What is the Dx for urethritis?

A
  1. Physical exam
  2. STI tests
  3. Microscopy
274
Q

What is the Rx for urethritis?

A
  1. Azithromycin
  2. Doxycycline
  3. Ceftriaxone
275
Q

What is the pathophysiology of polycystic kidney disease (PKD)?

A
  1. Clusters of cysts develop in kidneys

2. Kidneys enlarge and lose function

276
Q

What are the symptoms of PKD?

A
  1. Abdo pain
  2. Haematuria
  3. Frequency
  4. UTI
  5. Pain in sides
277
Q

What are the Ix for PKD?

A
  1. Renal USS
  2. CT abdo/pelvis
  3. MRI abdo/pelvis
  4. Urinalysis
278
Q

What is the Rx for PKD?

A
  1. ACEIs
  2. Analgesia
  3. Abx
  4. Dialysis
279
Q

What are the symptoms for epididymal cyst?

A
  1. Dull pain scrotum
  2. Heaviness in scrotum
  3. Redness scrotum
  4. Increased pressure penis
280
Q

What is the Ix for epididymal cyst?

A
  1. Physical examination

2. USS

281
Q

What is the Rx for epididymal cyst?

A

Drainage via needle

282
Q

What is the pathophysiology of hydrocele?

A

Swelling in scrotum that occurs when fluid collects in sheath surrounding testicle

283
Q

What are the symptoms of hydrocele?

A
  1. Painless swelling of testicles

2. Pain in scrotum

284
Q

How is hydrocele diagnosed?

A
  1. Physical exam
  2. Urinalysis
  3. Bloods
  4. USS
285
Q

What is the Rx for hydrocele?

A
  1. Surgical removal

2. Surgical drainage

286
Q

What is varicocele?

A

Enlargement of veins within scrotum

287
Q

What are the symptoms of a varicocele?

A
  1. Lump in testicle
  2. Swelling in scrotum
  3. Enlarged or twisted veins in scrotum
  4. Dull, recurring pain in scrotum
288
Q

What is the Ix for varicocele?

A
  1. Physical exam

2. Scrotal USS

289
Q

What is the Rx for varicocele?

A
  1. Varicocele repair

2. Percutaneous embolisation

Phase 2a Medicine (15 decks)

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