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URGENT > Lectures - URGENT > Flashcards

Lectures - URGENT Flashcards

1
Q

Give 4 kidney functions

A

Production of EPO, activation of 25(OH)2 vitamin D (into 1,25 dihydroxyvitamin D), renin production (BP control), secrete toxic substances, blood pH homeostasis

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2
Q

How much cardiac output do the kidneys receive?

A

20%

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3
Q

What are the stages of CKD in terms of eGFR?

A

1 (>90), 2 ( to help, all are multiples of 15

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4
Q

Why do you get anaemia and bone disease in renal failure?

A

Because there is reduced functioning of the kidney - i.e. reduced vitamin D activation

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5
Q

What does eGFR use in its calculation?

A

serum creatinine (+ height, age, gender, race)

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6
Q

why is serum creatinine used in eGFR calculations?

A

It is excreted by the liver fully

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7
Q

What drug affects creatinine excretion?

A

Trimethoprim

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8
Q

What are the causes of coloured urine?

A

Jaundice (haemoglobinuria), beeturia, myoglobinuria, drugs (rifampicin - orange wee)

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9
Q

What are normal physiological causes of haematuria?

A

Strenuous exercise and menstruation

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10
Q

What should you ask a patient in their history concerning haematuria?

A

Whether the blood is early on or late in their stream? pain? unilateral loin pain? bilateral loin pain? FHx of bladder cancer? occupation?

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11
Q

What does MSSU and MC&S stand for?

A

Mid-stream sample of urine and microscopy, culture and sensitivity

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12
Q

give causes of haematuria

A

Bladder cancer, BPH, prostate cancer, post TURP, UTI,

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13
Q

What is the total body water? What does this split into in the compartments?

A

42L: i.c. fluid (28L), interstitial fluid (11L) and plasma (3L)

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14
Q

What occurs to potassium in renal failure?

A

It isn’t excreted - it is retained –> hyperkalaemia

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15
Q

What 3 things should you look out for in a patient with renal failure?

A

Hyperkalaemia, acidosis and volume overload (salt and water retention)

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16
Q

Give 3 pre-renal causes of oliguria

A

dehydration, HF + shock, blood loss

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17
Q

Give a renal causes of oliguria

A

Acute tubular necrosis

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18
Q

Give a post-renal cause of oliguria

A

Obstruction (prostate cancer, BPH, stones)

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19
Q

How do shock and HF lead to oliguria?

A

Reduced kidney perfusion

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20
Q

Why does someone with volume overload become hypoxic?

A

Pulmonary oedema

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21
Q

What two signs might suggest a patient is fluid overloaded?

A

raised JVP and pitting oedema (+ ascites)

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22
Q

Give 5 causes of fluid loss

A

Burns, surgery + blood loss, nephropathy, diarrhoea, bowel obstruction, vomiting

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23
Q

What is the criteria for SIRS?

A

2 of:

  • > 38 or 20
  • pCO2 12000 or
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24
Q

What is the definition of sepsis?

A

SIRS + confirmed or suspected infection

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25
Q

What defines septic shock?

A

infection/sepsis with persistent hypotension

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26
Q

What is the most likely source of sepsis?

A

UTI

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27
Q

What is the treatment for sepsis?

A

SEPSIS 6: High flow 100% O2, IV fluid resuss, blood culture, IV Abx, serum lactate (+FBC + U+E), monitor urine output by putting in a catheter

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28
Q

When should you treat asymptomatic bacteruria?

A

If the patient is PREGNANT

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29
Q

Give 6 causes of urinary tract obstruction

A

Within the lumen: calculus, tumour (renal pelvis or ureter), blood clot, sloughed renal papillae
Within the wall: congenital abnormalities, stricture, neuropathic bladder
Outside: BPH, prostatic tumour, pelvic tumours, AAA

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30
Q

What is hydronephrosis?

A

Dilatation of renal pelvis + calyces

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31
Q

What does urinary tract obstruction lead to?

A

Inflammation, haemodynamic and functional changes to the kidney

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32
Q

What happens to the size of the kidney after prolonged obstruction of the urinary tract?

A

Enlarges? or shrinks?

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33
Q

What are the symptoms of an upper urinary tract obstruction?

A

Pain in the flank region, anuria (if bilateral obstruction)

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34
Q

What are the symptoms of lower urinary tract obstruction? (LUTS)

A

Terminal dribbling, hesitancy, poor stream , frequency, sense of incomplete emptying, retention with overflow, UTI

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35
Q

What signs might you find on examination for urinary tract obstruction?

A

Pelvic tumour, rectal exam (BPH or tumour), enlarged bladder, enlarged liver

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36
Q

What investigations might you order to investigate urinary tract obstruction?

A

Urine: dipstick, MC&S
Blood tests: FBC, U+E
Imaging: US, CT, XR

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37
Q

What might USS show in urinary tract obstruction?

A

Hydronephrosis

38
Q

What is the 1st line treatment usually for urinary tract obstruction?

A

surgery

39
Q

What is the 2nd line treatment usually for urinary tract obstruction?

A

Catheter

40
Q

Who should you avoid NSAIDs in?

A

Renal insufficiency or GI bleeds

41
Q

Why should NSAIDs be avoided in patient’s with renal insufficiency?

A

Because NSAIDs vasoconstrict the afferent arteriole of the nephron (they prevent the production of PG needed to dilate the afferent arteriole)

42
Q

What is a risk after re-establishing urinary flow in patient with

A

Post-obstructive diuresis

43
Q

What else might you do in the management of urinary obstruction?

A

Fluid resuscitation

44
Q

What is the definition of haematuria?

A

> 3 RBCs/hpf (high powered field)

45
Q

What bacteria can induce kidney stones?

A

proteus mirabilis

46
Q

What predisposes to testicular torsion?

A

Bell clapper deformity (congenital)

47
Q

What is the pathophysiology of testicular torsion?

A

Spermatic cord twists reducing the blood supply to the ipsilateral testis - ischaemia –> infarction (testicular loss)

48
Q

What are the symptoms and signs of tesicular torsion>

A

Symptoms: sudden and severe pain, associated abdominal pain, nausea, vomiting, fever

Signs: 1 testis is swollen, tender, hot and has an absent cremesteric reflex

49
Q

How would you treat testicular torsion?

A

Analgesia (morphine), anti-emetic (ondasetron)

Salvagable: surgerical detorsion

unsalvagable: orchidectomy

50
Q

What is surgical removal of testis called?

A

Orchidectomy

51
Q

What is an epididymal cyst?

A

A fluid filled sac of the epididymus

52
Q

What are the symptoms and signs of an epididymal cyst?

A

Asymptomatic

signs: well defined + separate lump from the testis; transilluminates

53
Q

How and why would you investigate a epididymal cyst?

A

USS - to rule out other lesions (e.g. cancer)

54
Q

How would you treat an epididymal cyst?

A

No treatment

55
Q

What differentiates epididymal cysts, hydrocoeale and varicocoeale from a testicular tumour?

A

Testicular tumour doesn’t transilluminate

56
Q

What is a hydrocoeale?

A

Fluid within the TUNICA VAGINALIS

57
Q

What are the causes of a hydrocoeale?

A

Primary: patent processus vaginalis

Secondary to: trauma, testicular cancer, infection (epididymo-orchitis), testicular torsion

58
Q

What are the clinical features of a hydrocoeale?

A

scrotal swelling, pain only if infected, testis palpable within the hydrocoeale, transilluminates

59
Q

What investigations would you carry out to diagnose a hydrocoeale and why?

A

To look for a cause:

  • USS
  • serum AFP and hCG
60
Q

What is the treatment for a hydrocoaele?

A

aspiration or surgery

61
Q

what is a varicocoaele?

A

Dilatation of pampiniform plexus veins

62
Q

What side are varicocoaele more common on and why?

A

L side as the L testi drains into the L renal vein (backpressure from L renal vein)

63
Q

What are the symptoms of a varicocoaele?

A

Dull ache, infertility

64
Q

What would you feel on examination in someone with a varicocoaele?

A

“Bag of worms”

65
Q

What complication is varicocoaele associated with?

A

Subfertility

66
Q

What investigations might you carry out for a varicoale?

A

Sperm count

67
Q

What is the treatment for varicocoeale?

A

If pain –> ablation/embolisation or surgery
Sperm bank
tight fitting + supportive underwear

68
Q

If you’re unsure of a diagnosis of testicular torsion what investigation would you do?

A

Doppler USS - shows lack of blood flow to the testicle

69
Q

What are the two types of lower urinary tract symptoms?

A

Storage and voiding symptoms

70
Q

What are the storage lower urinary tract symptoms?

A

Frequency, urgency, nocturia, overflow incontinence

71
Q

What are the voiding lower urinary tract symptoms?

A

Terminal dribbling, hesitancy, poor stream/flow, inadequate emptying, straining

72
Q

What are lower urinary tract symptoms caused by?

A

Obstruction (BPH)

73
Q

What is the differential diagnosis of BPH?

A

Prostatic cancer, stone, prostatitis, overactive bladder, bladder cancer…

74
Q

Which part of the prostate does BPH first affect?

A

transitional zone

75
Q

What are the red flag symptoms of prostatic tumour that distinguish it from BPH?

A

Back pain, haematuria, weight loss

76
Q

What assessment is used to determine the impact symptoms of BPH have on someone’s quality of life?

A

IPSS - international prostate scoring system

77
Q

What are the 3 zones in the prostate? Which does BPH and prostatic cancer affect more?

A

Transitional (inner) zone (BPH), central zone, peripheral zone (Cancer)

78
Q

Describe the pathophysiology of BPH

A

5-alpha reductase converts testosterone into its active form: DHA. DHA stimulates hyperplasia of prostatic cells

79
Q

What is the definition of hyperplasia?

A

Enlargement of a tissue due to increase in the number of cells

80
Q

What are the symptoms of BPH?

A

LUTS (nocturia, hesitency, terminal dribbling, frequency, urgency, incomplete emptying of the bladder)

81
Q

What examination would you perform on a patient (older male) who comes in with LUTS? What would you find if the cause was BPH and prostatic cancer?

A

DRE:

  • BPH –> smooth enlarged prostate
  • Prostatic cancer: craggy, hard and nodular enlarged prostate
82
Q

What are the signs of BPH?

A

DRE –> smooth enlarged prostate

83
Q

What investigations would you carry out to diagnose BPH?

A

PSA, MSU/dipstick, U+E (kidney function), cystoscopy (LUT endoscopy), TRUSS

84
Q

What diseases are PSA levels raised in?

A

BPH, prostatic cancer, prostatitis

85
Q

What is the conservative management for BPH?

A

Reduce coffee + alcohol intake

Change diuretic to another anti-hypertensive

86
Q

What is the medical management of BPH

A

Alpha blockers

87
Q

Give an example of an alpha blocker. What are the side effects of alpha blockers?

A

Doxazosin

SEs: dry mouth, hypotension, drowsy, ejaculatory failure

88
Q

Give an example of a 5-alpha reductase inhibitor. What are the side effects?

A

Finasteride

SEs: decreased labido, ED

89
Q

What are the surgical treatments for BPH?

A

TURP (TULIP + TUIP)

90
Q

What are the complications of TURP?

A

TUR syndrome, haemorrhage, infection, sepsis, ED, incontinence

91
Q

What are the indications for surgery to correct

A

RUSHES:

  • Retention
  • UTIs
  • Stones
  • Haematuria
  • elevated creatinine

URGENT (2 decks)

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