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MRCGP > Kidney + urology > Flashcards

Kidney + urology Flashcards

1
Q

USC criteria urology

A

Urology mass on imaging
Age> 60 with haematuria (non-visible and unexplained) with dysuria or increased blood WCC
Age>60 with recurrent or persistent unexplained UTI.
Age>45 with haematuria (visible and unexplained):
without UTI.
with persistence or recurrence after treatment for UTI.
IDA with haematuria, if GI Ix negative

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2
Q

Management stress incontinence

A

Squeezy app/pelvic floor exercises
Avoid constipation
Reduce caffeine
Continence service

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3
Q

Management urge incontinence

A

Bladder training
1st line- solifenacin succinate 5 mg OD
2nd-line – trospium IR (AEC score 0) 20 mg BD.
3rd-line – mirabegron (AEC score 0) 50 mg OD ££, contraindicated BP>180/110, Caution – QT interval prolongation, stage 2 HTN
If no improvement, gynae ref/continence service

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4
Q

Pre-renal causes AKI

A

Hypovolaemia-dehydration, haemorrhage, GI/stoma losses
↓ cardiac output- sepsis, cardiac failure, liver failure.
Drugs- ACEi, ARB, diuretics, NSAIDs

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5
Q

Renal causes AKI

A

Toxins/meds- abx, contrast, chemotherapy.
Vascular- vasculitis, embolism, dissection.
Glomerular, Tubular, Interstitial e.g. glomerulonephritis, rhabdomyolysis, myeloma.

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6
Q

Post-renal causes AKI

A

Obstruction- stone, BPH, blocked catheter

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7
Q

When should you admit someone with an AKI?

A

-urine dipstick +ve blood and protein ?intrinsic kidney disease.
-new onset AKI stage 2 or 3.
-AKI with development of complications:
K+ 6-6.5 mmol/L
K+ 5.5- 5.9 + patient unwell
Uraemic symptoms
Metabolic acidosis
Fluid overload
Pre-existing CKD stage 3+
Creatinine 1.5-2 x baseline, and rising

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8
Q

Symptoms of advanced kidney disease

A

Tiredness, pain, loss of appetite, constipation, anxiety, depression, sleep disturbance, itch, cramps, and restless legs.

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9
Q

Definition CKD

A

presence of kidney damage (urine ACR>30) or decreased kidney function (eGFR less than 60) for more than 3 months.

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10
Q

Risk factors for CKD

A

Diabetes
HTN
CVD
FHx
Hx AKI
Haematuria
Renal calculi
Prostatic hypertrophy
SLE
NSAIDs

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11
Q

Causes raised urine ACR

A

CKD
UTI
High protein intake
CCF
Multiple myeloma
Fever
Heavy exercise within last 24 hours
Menstruation or vaginal discharge
Drugs, especially NSAIDs

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12
Q

What is CKD stage 3? Management

A

eGFR 30-59
Measure urine ACR
If ACR>3 then consider ACEi
Check BP, HbA1c
Consider statin

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13
Q

When should you refer CKD to nephrology? (routine)

A

eGFR<60 a+ eGFR decreased 15+ in 12 months or ACR> 70.
eGFR<30
intrinsic kidney disease – glomerulonephritis, polycystic kidney disease, interstitial kidney disease

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14
Q

Features of nephrotic syndrome

A

Peripheral oedema, and
low serum albumin.
heavy proteinuria, ACR> 220
Facial puffiness, weight gain, and frothy urine.

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15
Q

Features of nephritic syndrome

A

Oliguria
Haematuria – can be macroscopic
Proteinuria
Hypertension

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16
Q

Findings on dipstick interpretation

A

persistent dipstick proteinuria – assess ACR
microscopic haematuria– urological cause (bladder ca, renal ca, stones) or an intrinsic cause of kidney disease.
blood and protein present – consider an intrinsic cause eg glomerulonephritis.
isolated proteinuria – multisystem issue (diabetes or myeloma)
leucocytes or nitrites – UTI.

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17
Q

Management of pyelonephritis

A

Admit if septic,
Cefalexin 500 mg BD for 7-10 days.
Co-amoxiclav 625mg TDS 7-10 days.
Trimethoprim 200 mg twice a day for 14 days.
Change catheter
Review after 48hrs

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18
Q

6 LUTS symptoms

A

Obstructive:
Poor flow
Hesitancy
Terminal dribbling
Irritative (secondary):
Frequency
Nocturia
Urgency

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19
Q

Ix of LUTS in men

A

Exclude UTI, diabetes, constipation, overactive bladder
Abdo exam rule out palpable bladder
DRE
U+E + PSA

20
Q

Management LUTS

A

Reduce caffeine, alcohol, and fluids in the evening.
Lose weight if overweight
Ensure regular bowels
If due to prostatic hypertrophy:
Tamsulosin 400mcg OD or Doxazosin if HTN as well
Finasteride 5mg OD, response after 3-6 months, may cause sexual dysfunction

21
Q

Causes of erectile dysfunction

A

Psychogenic
CVD
Diabetes (vasculopathy or neuropathy)
Testosterone deficiency, thyroid disorder, or hyperprolactinaemia
Medications (SSRIs, finasteride) Alcohol, smoking
Neurologic (PD, MS, spinal cord injury)
Post radical prostatectomy or radiotherapy
Local penile factors, e.g. Peyronie’s disease, or cavernous fibrosis

22
Q

Erectile dysfunction hx

A

Ability to achieve erection spontaneously, masturbating, morning erections
Duration of erection, quality of erection, and circumstances
Pain or bend or deviation in the erection (Peyronie’s disease)
Ability to reach orgasm and achieve partner’s orgasm
Impact on relationship with partner
Premature ejaculation
Meds- finasteride/spiro/thiazides
Smoking, alcohol, fitness
STI hx, trauma, surgery
Gynaecomastia/body hair/testicular shrinkage

23
Q

Ix for erectile dysfunction

A

FBC, U+E, testosterone, HbA1c, lipids, LFTs, B12, TFTs, prolactin

24
Q

Management erectile dysfunction

A

Lose weight, get fitter, stop smoking/alcohol
Psychological support
Sildenafil (NOT with nitrates)
Vacuum pump device
Refer if low testosterone

25
Q

Management premature ejaculation

A

The “squeeze method” - the head of the penis is withdrawn and squeezed just before ejaculation.
The “start-stop” technique
Thick condom reduces sensation
SSRI daily
Emla cream

26
Q

Risk factors for renal tract malignancy

A

Age>45
Smoking
Pelvic irradiation
Macroscopic haematuria
Occupational history of chemical or dye exposure benzenes +amines
Cyclophosphamide
Long‑term catheterisation

27
Q

Causes of haematuria

A

Renal/urinary tract/prostate cancer
Renal/bladder stones
UTI
Polycystic kidney disease
Glomerulonephritis
BPH

28
Q

Management of haematuria

A

Admit if urinary retention
If macroscopic or 2/3 of dipsticks
-FBC, U+E, PSA, HbA1c
If protein + blood= glomerulonephritis, do urine ACR
if just blood, no UTI then ?cancer
Renal USS (if doesn’t fulfill USC criteria)
USC:
Macroscopic haematuria age> 45 without a UTI, or if haematuria persists after treatment for a UTI.
Microscopic haematuria without UTI and the patient is older than 60 years and with:
dysuria, or
a raised WCC on FBC.
IDA+ haematuria, if GI Ix is negative

29
Q

Causes of raised and lowered PSA

A

Finasteride and dutasteride will approximately halve the PSA level.
Raised:
UTI/prostatitis, catheter, cystoscopy, prostate biopsy, BPH

30
Q

USC referral criteria for prostate

A

PSA is elevated above the threshold on 2 separate occasions at least 4 to 6 weeks apart in an asymptomatic patient.
single PSA higher than 10.
DRE is suspicious of malignancy.

31
Q

What is recurrent UTI?

A

3 in 1 year or 2 in 6 months

32
Q

Ix and management recurrent UTI

A

?stone or difficult to treat- USS KUB
Hydration
Avoid douching
Cotton underwear
If after sex: pee after sex, trial of a lubricant, avoid spermicide-coated condoms
If menopause consider vaginal oestrogen cream
D-mannose 200 ml of 1% solution OD in evening
? probiotics
Methenamine hippurate
Prophylactic abx (eg nitro/trimethoprim)
if triggered by sex – take prophylactic antibiotic, one dose immediately after intercourse.

33
Q

When would you admit someone with a renal stone?

A

suspected obstruction or infection, fever and documented stone, or infection on MSU.
urinary retention.
pregnancy.
uncontrollable symptoms (pain or vomiting).
stone diameter 5 mm or larger in ureter.
acute renal failure.
solitary kidney or transplant patient.

34
Q

Advice to reduce renal stone reoccurrence

A

Keep urine clear aim for 2.5 to 3 litres water/day
Avoid carbonated drinks
Add fresh lemon juice to water.
Reduce salt.
Reduce meat, incr fruit + veg
Avoid calcium supplements

35
Q

Management incidental ureteric stone

A

If distal ureteric stone<10mm, consider tamsulosin 400mcg OD14 days
Arrange rpt imaging at 4 weeks to rule out persistent obstruction.
request urgent urology assessment if the stone has not passed.- risk renal injury

36
Q

Referral criteria renal tract stones

A

Urgent ref:
decreased renal function due to the stone.
persistent or recurrent symptoms.
residual stone on follow‑up imaging.
large volume or staghorn stone on imaging.
recurrent urolithiasis.
asymptomatic stones larger than 5 mm.

37
Q

Symptoms testicular cancer

A

Solid or firm mass that is not separable from the testis, usually painless and non-tender.
Does not transilluminate.
May be associated with epididymo-orchitis or hydrocele.
-> USC USS

If metastatic:
back pain
weight loss
dyspnoea
cough

38
Q

Features epididymal cyst/spermatocele

A

Small lump.
Smooth swellings in the epididymis, at any point along
Age>40 years, more common after vasectomy.
Testis is palpable separately from the cyst to help distinguish from testicular tumour.
Typically fluctuate and often transilluminate.

39
Q

Features of hydrocele

A

Small, if allows palpation of scrotal contents.
A large hydrocele may make examination of the scrotum difficult.
Swelling is usually confined to the scrotum.
A hydrocele will transilluminate.
A reactive hydrocele may occur with testicular cancer or acute epididymo-orchitis.

40
Q

Features of inguinal hernia

A

Hernias are usually reducible and have a cough impulse and on examination you cannot get above them – large hernias may be inguinoscrotal.

41
Q

Features of varicocele

A

Upper scrotal swelling which is separate from the testis and epididymis.
More prominent when standing, often disappearing when supine.
Feels like a bag of worms
If new varicocele, arrange renal ultrasound to exclude renal carcinoma. (right sided varicocele USC USS)

42
Q

Indications for catheterisation

A

Peri-operatively
Urinary retention (BPH, clots)
Chronic retention with impaired renal function
Urinary incontinence + groin moisture damage
Palliative care

43
Q

Causes of overflow incontinence

A

Confirmed if post void vol>500ml
bladder outlet obstruction- BPH, urethral stricture.
neurological- MS, stroke, Parkinson’s disease.
medications causing a hypo‑contractile bladder.

44
Q

Management UTI adults

A

Don’t dipstick if age >65 or if age<65 2+ classical features UTI- just treat
Age>65, send MSU as resistance common
3 days uncomp women, 7 days men + comp women, 7-14 days upper UTI
Nitrofurantoin MR 100mg BD
Trimethoprim 200mg BD

Upper: cipro 7d, trimethoprim 14d

45
Q
A

MRCGP (20 decks)

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