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Phase 2 > Kidney & GU > Flashcards

Kidney & GU Flashcards

1
Q

Name an upper UTI

A

Pyelonephritis

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2
Q

Name the lower UTIs

A

Cystitis
Prostatitis
Urethritis
Epidydmo-orchitis

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3
Q

Causes of UTI

A

BACTERIAL!
KEEPS

Klebsiella
E.coli - (uropathogenic E.coli = 80% of UTIs)
Enterobacter
Proteus
Staph. spp - coag neg e.g. saprophiticus

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4
Q

Ix for ALL UTIs

A

1st - urine dipstick
+ve leukocytes
+ve nitrites
+/-ve haematuria

GS : Midstream (MCS)
Confirms UTI, identifies pathogen

–
Prostatitis has its own GS, Mid MCS is used for its 1st line

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5
Q

What does MCS stand for?

A

Microscopy
Culture
Sensitivity

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6
Q

Where do the bacteria adhere to in UTI?

A

Urothelium
Vaginal epithelium
Vaginal mucus

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7
Q

When is a UTI complicated?

A

Pregnant
Males
Catheterised Pxs
Recurrent/persistent infection
Immunocomp
Structural abnormality
Urosepsis

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8
Q

What is Pyelonephritis?

A

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

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9
Q

Key presentation of Pyelonephritis

A

TRIAD OF :
1. Loin/flank pain
2. Fever
3. Pyuria

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10
Q

What other symptoms might present in Pyelonephritis?

A

Back pain
Severe headache
N+V
Associated cystitis symptoms

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11
Q

What other Ix might you do for a patient with Pyelonephritis?

A

URGENT US to detect stones, obstruction or incomplete bladder emptying

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12
Q

Tx Pyelonephritis

A

Hydration / Fluid replacement

IV Abx -
broad spectrum e.g. oral co-amoxiclav, oral ciprofloxacillin
if severe - IV gentamicin or IV co-amoxiclav
If pregnant - cefalexin

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13
Q

What is Cystitis?

A

Infection of the bladder

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14
Q

Cystitis occurs in whom?

A

Children
Females
Pregnancy
People w catheters

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15
Q

Why are women more susceptible to Cystitis?

A

Shorter urethra
∴ short proximity to anus
∴ allows bacteria transfer

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16
Q

Key Presentation of Cystitis

A

HD FUSS

Haematuria
Dysuria
Frequency
Urgency
Suprapubic pain
Smelly urine

+ confusion in elderly

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17
Q

Tx Cystitis

A

Trimethoprim/Nitofurantoin
(3 day course for women, 7 day for men/complicated women)

In pregnancy
Trimeth cannot be used in 1st tri
Nitrofurantoin cannot be used in 3rd tri
∴ amoxicilin, cefalexin can both be used

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18
Q

What is Urethritis?

A

Urethral inflammation due to infectious or non-infectious causes

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19
Q

Causes of Urethritis

A

Sexually acquired disease!

N. Gonorrhoea
Chlamydia

Trauma
Urethral stricture
Irritation
Urinary calculi

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20
Q

Key presentation of Urethritis

A

Dysuria +/- discharge, blood or pus
Skin lesion
Urethral pain
Penile discomfort/pruritus

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21
Q

What other Ix can be done for Urethritis?

A

NAAT (Nucleic Acid Amplification Test) - detects STI type for treatment

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22
Q

How is a NAAT taken?

A

Females - self-collected vaginal swab
endo-cervical swab
first void urine

Males - first void urine

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23
Q

Tx Urethritis

A

N. Gonorrhoea - IM ceftriaxone and oral azithromycin

Chlamydia trachomatis - Azithromycin or doxycycline

–
Partner notification

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24
Q

Major complication of Urethritis

A

Reactive Arthritis

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25
Q

What is Epididymo-orchitis?

A

Inflammation of epididymis extending to tests, usually due to cystitis or urethritis

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26
Q

Key presentation of Epididymo-Orchitis

A

Unilateral scrotal pain and swelling
Pain relieved with elevating tests - Pos Prehn’s sign!
Cremaster reflex INTACT

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27
Q

What is Prehn’s sign?

A

Relief when testes is lifted

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28
Q

What is important to rule out with Epididymo-Orchitis? Why?

A

Testicular torsion! bc urological emergency!!

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29
Q

What other Ix can you do with Epididymo-Orchitis?

A

NAAT - detest STI type for treatment

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30
Q

Tx Epididymo-Orchitis

A

Depends on where

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31
Q

What are features that suggest testicular torsion rather than Epididymo-Orchitis?

A

Short duration of pain - very acute, sudden
Associated nausea, abdo pain
High-riding/bell-clapper testis
Scrotal elevation only relieves pain in epididymitis, NOT IN TORSION (i.e. torsion = Prehn’s sign -ve)

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32
Q

Tx Epididymo-Orchitis

A

N. Gonorrhoea - IM ceftriaxone and oral azithromycin

UTI - Trimethoprim/Nitofurantoin
(3 day course for women, 7 day for men/complicated women)

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33
Q

Cause of Epididymo-Orchitis

A

Under 35 years - Urethritis
Over 35 years - Cystitis

Mumps
Trauma
In elderly - catheter!!

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34
Q

What is prostatitis associated with?

A

LUTS

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35
Q

Causes of Prostatitis

A

Acute :
Strep. faecalis
E. coli
Chlamydia

Chronic :
Bacterial ^
Non-bacterial e.g. ↑ Prostatic pressure, pelvic floor myalgia

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36
Q

DDx Epididymo-Orchitis

A

Testicular torsion !!!!!!!!!!!!!
Hydrocele
Trauma
Abscess formation

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37
Q

Presentation of Prostatits

A

Systemically unwell + Significant voiding LUTs

Chronic is above > 3 months

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38
Q

Describe voiding LUTs

A

Straining
Poor stream
Hesitancy
Incomplete emptying
Post micturition dribbling
Dysuria

39
Q

Ix for Prostatitis

A

GS : DRE !!!!!
prostate is tender or hot, hard from calcification

40
Q

Tx Prostatitis

A

Acute :
1st - gentamycin + IV co-amoxiclav
2nd - trimethoprim

Chronic :
4-6 week course of quinolone e.g. ciprofloxacin
+/- a-blocker - Tamsulosin

41
Q

What is BPH?

A

Benign proliferation of transitional zone of prostate, WITHOUT MALIGNANCY

42
Q

Function of prostate

A

Testosterone and Dihydrotestosterone production
Seminal fluid production
Regulation of urine flow

43
Q

RF BPH

A

Age > 60!
Fhx
DM
Heart disease
Obesity

44
Q

Key presentation of BPH

A

LUTS (freq, urgency, dribbling, weak stream, nocturia)

45
Q

Ix BPH

A

DRE - smooth and enlarged prostate
Prostate specific antigen
Urine test

46
Q

Tx BPH

A

Tamsulosin, FInasteride

47
Q

Nephrotoxic drugs

A

NSAIDs
Acei
Gentamicin
Amphotericin
Metformin

48
Q

Types of Prostate cancer

A

Adenocarcinoma
Transitional cell carcinoma
Small cell prostate cancer

49
Q

RF Prostate cancer

A

Mean age = 72
High testosterone levels
FHx
Obesity

50
Q

Where does prostate cancer usually arise from?

A

Peripheral zone - far away from urethra
∴ can grow signif before affects anything

51
Q

What do granular casts indicate?

A

Active renal disease

52
Q

Ix prostate cancer

A

DRE - hard, irregular prostate
PSA (non-specific)
Ultrasound & MRI (trans-rectal ultrasound scann - TRUSS)

GS : BIOPSY!
+ Gleason grading!

53
Q

Describe Gleason Grading

A

Histological grades of 2 cell patterns
Add 2 most common together
Higher score = more aggressive

1 - Small, uniform glands
2 - More space between glands
3 - Distinct infiltration of cells from glands at margin
4 - Irregular masses of neoplastic cells, few glands
5 - Lack of/Only occassional glands, sheets of cells

54
Q

Tx Prostate cancer

A

Radical prostatectomy (surgery)
Radio/Chemotherapy

Hormonal therapy :
GnRH agonist - Zoladex

55
Q

RF Bladder cancer

A

55+
FHx
Smoking = 2-4x risk
Bladder stones
Occupational risk - carcinogen exposure
Male

56
Q

Key presentation of bladder cancer

A

Painless haematuria
Frequency
Back pain

57
Q

Ix bladder cancer

A

Urinalysis

GS :
Cytoscopy and biopsy
CT urogram - allows staging

Other : CT, MRI, bone scan

58
Q

Tx Bladder cancer

A

Depends on staging

NON-muscle invading bladder cancer :
T1 - transurethral resection (TURBT) or local diathermy

Muscle invasion :
T2-3 - radical cystectomy
T4 - palliative chemo and radiotherapy

59
Q

What is Hydrocele?

A

Build up of fluid in the tunica vaginalis

60
Q

Key presentation of Hydrocele

A

Soft, non-tender lump
Painless swelling

61
Q

Ix Hydrocele

A

Shine light through sctorum
FBC - check for infection

62
Q

Tx Hydrocele

A

Usually resolves spontaneously
Surgical drainage

63
Q

What is Varicocele?

A

Enlargement of testicular veins
“Bag of worms”

64
Q

Key presentation of Varicocele

A

Dull ache, scrotal heaviness, mass
“Bag of worms”

65
Q

Ix Varicocele

A

Venography
Colour doppler ultrasound

66
Q

Tx Varicocele

A

Surgery if pain, infertility or testicular atrophy

67
Q

What is testicular torsion?

A

Medical emergency!!
Twisting of spermatic cord

68
Q

Presentation of Testicular torsion

A

Acute, severe pain
Unilateral and swollen
Prehn’s sign -ve
Abd pain
N+V

69
Q

Ix Testicular torsion

A

DO NOT DELAY SURGERY
Doppler ultrasound
Urine test

70
Q

Tx Testicular torsion

A

Surgical intervention!
The quicker, higher the salvage rate

71
Q

What is epididymitis?

A

Inflammation of epididymis

72
Q

Causes of epididymitis

A

Infection
STI
Trauma

73
Q

Presentation of epididymitis

A

Acute pain
Unilateral
Prehn’s sign +ve

74
Q

Ix epididymitis

A

STI screening
Ultrasound
Bloods
Urine testing

75
Q

Tx epididymitis

A

Abx - IM Ceftriaxone and doxycycline

76
Q

At what age do epididymal cysts usually occur?

A

~ 40 years

77
Q

Where are epididymal cysts positioned in regards to the tests?

A

Lie above and behind

78
Q

Key presentation of epididymal cysts

A

Lumps - often multiple
Can be bilateral
Are transluminate (bc fluid-filled)

79
Q

How can you differentiate between epididymal cyst and hydrocele?

A

Transillumination
Testes palpable separately from cysts in epididymal cyst

80
Q

Ix epididymal cyst

A

Transillumination
Scrotal ultrasound

81
Q

Tx epididymal cyst

A

Usually not necessary
Surgery if painful and symptomatic

82
Q

What is the most common cancer in males 15 - 44?

A

Testicular cancer

83
Q

Key presentation of Testicular cancer

A

LUMP! (can be painless/painful) in testicle
Heaviness
Dull ache
Swelling
Gynecomastia
Back pain

84
Q

What does cough and dyspnoea indicate with testicular cancer?

A

Lung metastases

85
Q

Testicular torsion can lead to ischaemia. What cells are the most susceptible to ischaemia?

A

Germ cells

86
Q

With testicular torsion, when should you aim to perform surgery?

A

Within 6 hours of presentation

87
Q

Which testis is more commonly affected with testicular torsion?

A

Left

88
Q

DDx of Testicular torsion

A

Epididymo-Orchitis !
But px tends to be older and symptoms of UTI are also present
More gradual onset of pain

89
Q

Cause of Torsion of testicular appendage

A

Surge in gonadotrophins that signal onset of puberty
∴ usually occurs in boys between 7-12 years

90
Q

How does testicular appendage torsion present?

A

Less pain than testicular torsion
Small blue nodule under scrotum

91
Q

BPH is

A

A histological diagnosis

92
Q

BPE (benign protastic enlargement)

A

A clinical diagnosis

93
Q

Ix Testicular Cancer

A

Ultrasound
Biopsy and histology - fried-egg cells

Serum tumour markers - AFP (alpha feto-protein) and/or B-hCG)
Lactate dehydrogenase

Normal AFP - seminoma
↑ AFP & ↑ B-hCG - non-seminoma germ cell tumours

94
Q

Types of Testicular cancer

A

96% germ cells -
Seminomas - most common! 25 - 40, 60+
Teratomas - infancy

Non-germ cells
Leydig cell tumours
Sertoli cell tumours
Sarcomas

Phase 2 (24 decks)

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