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Renal & Urology > MedEd > Flashcards

MedEd Flashcards

1
Q

what is AKI

A

rapid decline in renal function

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2
Q

what is CKD

A

impaired renal function for >3months

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3
Q

what are features of AKI

A

failure to maintain homeostasis of:
fluid - oliguria, volume overload
electrolytes - hyperkalaemia
acid-base - metabolic acidosis

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4
Q

what can causes of AKI be sorted into

A

pre-renal
renal
post-renal

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5
Q

what are causes of pre-renal AKI

A

failure of perfusion

  • hypovolaemia (bleeding)
  • reduced cardiac output (HF, LF, sepsis)
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6
Q

what are causes of renal AKI

A 
drugs (ACEi, NSAIDs, aminoglyclosides)
vascular
glomerular
tubular (ischaemia, rhabdomylosis)
interstitial
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7
Q

what are post-renal causes of AKI

A

obstruction

  • BPH
  • kidney stones
  • blocked catheter
  • malignancy
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8
Q

what are vascular causes of AKI

A 
large vessel (renal artery/vein obstruction, HTN, vasculitis)
small vessel
-HUS
-TTP
-DIC
-vasculitis
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9
Q

what is HUS

A

triad of
1 microangiopathic haemolytic anaemia
2 AKI
3 thrombocytopenia

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10
Q

what is the main cause of HUS

A

gastroenteritis with e coli

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11
Q

what is the aetiopathophysiology of HUS

A

gastroenteritis (ecoli) releases toxins which cause endothelial damage, this leads to thrombosis, platelet consumption and fibrin strand deposition
RBCs get cut up by fibrin strands and under go haemolysis

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12
Q

what are features of HUS on presentation

A

abdo pain and dysentry
AKI (N+V, oliguria, haematuria, proteinuria)
bleeding due to thrombocytopenia
fatigue due to MAHA

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13
Q

what is the aetiopathophysiology of TTP

A

deficiency of protein which cleaves vWF
large vWF multimers form
platelet aggregation and fibrin deposition occurs which can cause microthrombi in the kidneys

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14
Q

what is TTP

A

1 microangiopathic haemolytic anaemia
2 AKI
3 thrombocytopenia
4 fluctuating CNS signs

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15
Q 
1. A young woman presents after a seizure. She is noted to have a fever and icterus. Her urine output is low. 
The most likely diagnosis is: 
A) Haemolytic Uraemic Syndrome
B) Renal stone 
C) Thrombotic Thrombocytopenic Purpura  
D) Hepatic failure 
E) Polycystic kidney disease
A

TTP

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16
Q

what are consequences of glomerulonephritis

A

loss of barrier function

loss of filtering capacity

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17
Q

what are features of loss of barrier function

A
  • proteinuria

- haematuria

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18
Q

what are features of loss of filtering capacity

A

-reduced excretion which causes accumulation of waste products

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19
Q

what are causes of glomerulonephritis

A 
1 IgA nephropathy
2 Henoch Schonlein Purpura
3 Anti-GBM (goodpastures)
4 post-strep glomerulonephritis
5 pauci-immune
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20
Q

what features are present with IgA nephropathy

A

days following URTI
increased IgA immune complex formation

episodic haematuria

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21
Q

what features are present with HSP

A

systemic variant IgA nephropathy

haematuria
purpuric rash on extensor surfaces commonly in legs
polyarthritis

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22
Q

what features are present with anti-GBM (goodpastures)

A

autoantibodies to Type IV collagen (GBM & lung)

haematuria
haemoptysis

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23
Q

what features are present with post-strep glomerulonephritis

A

post strep or skin infection
strep antigens are deposited at the glomerulus which leads to immune complex formation

nephritic syndrome

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24
Q

what features are present with pauci immune

A

ANCA

associated vasculitis or limited to kidney

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25
Q

what is the most common cause of glomerulonephritis

A

pauci immune

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26
Q

what do anti-GBM antibodies bind to in the lungs

A

alveolar basement membranes

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27
Q

what is used to treat proteinuria in glomerulonephritis

A

ACEi or ARBs

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28
Q

why do ACEi or ARBs work for treating proteinuria

A

angiotensin II constricts afferent and efferent arterioles (but efferent preferentially), this build up of pressure increases pressure and so more protein is filtered through causing proteinuria
ACEi or ARBs reduce intraglomerular pressure be inhibitiing angiotensin IIs vasoconstriction on the efferent arteriole which reduces pressure and filtration of protein

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29
Q

what is the most common renal cause of AKI

A

acute tubular necrosis

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30
Q

what causes acute tubular necrosis

A

ischaemia

nephrotoxins

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31
Q

what are different types of nephrotoxins

A

drugs
myoglobulinaemia (rhabodomyolysis)
haemaglobinuria

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32
Q

how does ischaemia cause AKI

A

ischaemia leads to tubular cell injury called acute tubular necrosis
this leads to obstruction of tubular by debris which causes a decrease in GFR

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33
Q

what are the phases of AKI caused by ischaemia

A

1 initiation
-acute decrease in GFR, high Cr and urea
2 maintenance
-sustained decrease in GFR, normal Cr and high urea
3 recovery
-tubular function regenerates, increased urine volume and low urea and creatine

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34
Q

what causes rhabdomylosis

A

ischaemia, trauma, drugs which causes skeletal muscle breakdown

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35
Q

what is released in rhabdomylosis

A

lots of myoglobin which causes dark urine
lots of potassium
lots of CK

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36
Q

what is seen in the urine in rhabdomylosis

A

blood on dipstick but no RBCs on microscopy

urinary myoglobin

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37
Q

what metabolic disturbances can cause rhabdomyolysis

A

hypokalaemia

hypophosphataemia

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38
Q

what is myeloma

A

malignant disease of bone marrow plasma cells with clonal expansion of plasma cells which leads to monclonal paraprotein production

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39
Q

what is the mneumonic for features of myeloma

A

CRAB

Calcium - high
Renal failure (acute/chronic) with high urea and creatinine
Anaemia
Bone - osteolytic bone lesions which present as pain or fracture

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40
Q

why does renal failure occur in myeloma

A

high calcium

free light chains of paraprotein are deposited in the kidneys causing inflammation

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41
Q

what are common nephrotoxins

A 
NSAIDs
aminoglycosides (gentamicin, streptomycin)
contrast agents
ACEi and ARBs
immunosuppressants (methotrexate)
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42
Q

what causes interstitial nephritis causing AKI

A

lymphoma

tumour lysis syndrome following chemo

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43
Q
  1. A 53 year old man suffers a ruptured aortic aneurysm and is rushed into theatre. He undergoes a successful operation and is recovering on the wards. 1 day after the operation he becomes oliguric with elevated urea and creatinine. After 1 week his urine output increases but his GFR remains low at 30ml/min.
1 rhabdomyolysis
2 HUS
C Nephrotoxic agent
4 TTP
5 Acute tubular necrosis
A

Acute tubular necrosis

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44
Q
  1. A 17 year old student presents to A&E with a 6 day history of sore throat and flu-like symptoms. He know has frank haematuria, swelling of his ankles and poor urine output..
1 IgA nephropathy
2 HUS
3 Post-strep glomerulonephritis
4 TTP
5 HSP
A

IgA nephropathy

post URTI

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45
Q
  1. A 84 year old woman is found on the floor of her flat by her neighbour. She had a fall 3 days prior to her ‘rescue’ and had been unable to get up or raise the alarm. At hospital, she is assessed and found to have acute kidney injury.
A. Rhabdomyolysis 
B. Myeloma 
C. Nephrotoxic agent 
D. Polycystic kidney disease 
E. Acute tubular necrosis
A

A. Rhabdomyolysis

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46
Q
  1. A 79 year old man presents to A&E after his GP has found deranged U&Es and raised creatinine on routine blood work. He has a history of back pain over the last few months and says that he has been very tired recently.
A. Nephrotoxic agent 
B. Diabetes mellitus 
C. Post streptococcal glomerulonephritis 
D. Rhabdomyolysis 
E. Myeloma
A

E. Myeloma

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47
Q
  1. A 10 year old girl presents to A&E with irritability, abdominal pain and reduced urine output. Her parents says she has had diarrhoea for the last few days.
A. IgA nephropathy
B. HUS
C. Post streptococcal glomerulonephritis 
D. TTP
E. Henoch Schonlein Purpura (HSP)
A

B. HUS

often follows e coli toxin

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48
Q

aetiology of nephrotic syndrome

A

impaired glomerular filtration leads to proteinuria

due to low protein levels in the blood (hypoalbuminaemia) water is drawn into soft tissues (oedema)

liver attempts to compensate for producing more LDL and VLDL which causes hyperlipidaemia

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49
Q

what is the triad of nephrotic syndrome

A

proteinuria >3.5/24hrs
low albumin <30g/l
oedema

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50
Q

what is nephritic syndrome

A

more severe glomeruli damage which leads to leakage of larger proteins and more damage (red cell casts)
haematuria is present

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51
Q

what is nephritic syndrome common in

A

glomerulonephritis

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52
Q

what is the triad of nephritic syndrome

A

proteinuria
haematuria
oedema

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53
Q

what is a characteristic features of nephritic syndrome

A

red cell cast - glomerular damage

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54
Q

what are common primary causes of nephrotic syndrome

A

membranous
minimal change
focal segmental glomerulosclerosis
mesangiocapillary glomerulonephritis

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55
Q

what are common secondary causes of nephrotic syndrome

A

diabetes
SLE
amyloid
HBV/HCV

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56
Q 
1. A 17 year old patient is referred by his GP after presenting with periorbital oedema. The patient noticed the oedematous eyes 3 days ago, but reports feeling unwell since a throat infection 3 weeks ago. Urine dip is positive for protein and blood. 
The mostly likely diagnosis is 
A) nephrotic syndrome
B) nephritic syndrome
C) renal failure
D) glomerulonephritis
E) Acute tubular necrosis
A

glomerulonephritis

patient presents with nephritic syndrome however the diagnosis or cause is post strep glomerulonephritis

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57
Q 
A 22 year old woman is found to have ankle oedema and +++ protein. BP is 120/80. The most useful  diagnostic investigation is: 
A) FBC
B) Urine albumin: Creatinine ratio 
C) Echocardiography 
D) Renal US 
E) Renal biopsy
A

E) Renal biopsy

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58
Q

what is the treatment for diabetic nephropathy

A

ACEi or ARBs

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59
Q

what are the two biggest causes of CKD

A

HTN

DM

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60
Q

A 75M with known severely impaired renal function presents with palpitations and vomiting. What is the likely cause of his symptoms?

A) Hypercalcemia 
B) Hyponatraemia 
C) Hyperkalemia 
D) Atrial Fibrillation 
E) Hyperparathyroidism
A

Hyperkalemia

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61
Q

A 70M with known severely impaired renal function presents in a confused state. On listening to his chest the medical student hears a strange rubbing sound. What is the underlying cause of this finding?

A) Hypercalcemia 
B) Hyponatraemia 
C) Hyperkalemia 
D) Atrial Fibrillation 
E) Hyperuraemia
A

Hyperuraemia

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62
Q

A 70M with known severely impaired renal function presents in a confused state. The same gentleman becomes short of breath and the X-ray reveals bats wing shadowing. What treatment does he need?

A) Sit up and high flow oxygen 
B) Venous vasodilator ( eg diamorphine) 
C) Furosemide IV 
D) Dialysis 
E) All of the above
A

All of the above

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63
Q

what are complications of AKI

A 
uraemia
volume overload
hyperkalaemia
hyperphosphataemia
metabolic acidosis
CKD
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64
Q

what does uraemia cause

A

pericarditis and a pericardial rub

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65
Q

how does hyperuraemia occur in AKI

A

amino acids are broken down to ammonia (toxic) which goes to the liver and is converted to urea
urea should be excreted by kidney but if there is reduced function levels rise

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66
Q

what is the majority of potassium found

A

in the cells

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67
Q

how is most potassium excreted

A

in the urine

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68
Q

what does potassium excretion depend on

A

adequate sodium delivery to distal convoluted tubule

for exchange of sodium resorption and potassium excretion

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69
Q

what are symptoms of hyperkalaemia

A 
fatigue or weakness
numbness or tingling
N+V
chest pain
palpitations
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70
Q

how does volume overload occur in AKI

A

kidney cant excrete fluid

fluid builds in circulation

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71
Q

what are signs of volume overload

A

oedema (pulmonary + peripheral)

  • swollen feet
  • SOB + crepitations
  • HTN
  • raised JVP
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72
Q

how does metabolic acidosis present in AKI

A 
rapid breathing (respiratory compensation)
confusion
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73
Q

how is AKI managed

A 
1 Assess volume + potassium
-OE (BP, JVP, cap refill)
-ABG
-ECG for hyperkalaemia
2 aim for euvolaemia
-fluids
-fluid restriction
3 stop nephrotoxins
-NSAIDs
-ACEi
-aminoglycosides
4 treat underlying cause
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74
Q

what does insulin do to potassium

A

stimulates intracellular uptake of K+

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75
Q

what features of hyperkalaemia on ECG

A

tall tented t waves
absent p waves
widening QRS

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76
Q

what is cardioprotective against hyperkalaemia

A

10ml 10% calcium gluconate

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77
Q

what should be given to reduce hyperkalaemia if patient is acidic

A

IV sodium bicarbonate

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78
Q

what should be given to treat pulmonary oedema

A

sit up and high flow oxygen
venous vasodilator
furosemide IV

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79
Q

name a venous vasodilator

A

diamorphine

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80
Q

what is the mneumonic for indications of dialysis on AKI

A

AEIOU

Acid-base disturbance
-severe metabolic acidosis (pH <7.2 or BE <10)
Electrolytes
-persistant hyperkalaemia >7
Intoxication
-drugs (BLAST: barbiturates, lithium, alcohol, salicylates, theophyline)
Overload of volume
-refractory pulmonary oedema
Uraemia
-encephalopathy or pericarditis
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81
Q

what is the def of CKD

A

impaired renal function for >3months based on abnormal structure or function

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82
Q

what is a normal GFR

A

> 90ml/min/1.73^2

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83
Q

what are the stages of CKD

A 
1 kidney damage - normal GFR
2 kidney damage - mildly decreased GFR
3 decreased GFR
4 severely decreased GFR
5 end stage renal disease
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84
Q

what GFR is associated with stage 2 CKD

A

60-89

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85
Q

what GFR is associated with stage 3 CKD

A

30-59

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86
Q

what GFR is associated with stage 4 CKD

A

15-29

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87
Q

what GFR is associated with stage 5 CKD

A

<15 or dialysis

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88
Q

what is the most common cause of CKD

A

diabetes

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89
Q

what are the two most common causes of CKD

A

diabetes

HTN

90
Q

what are causes of CKD

A 
diabetes
HTN
atherosclerosis
chronic glomerulonephritis
polycystic kidney disease
91
Q

what are consequences of CKD

A 
1 progressive failure of homeostatic function
-acidosis
-hyperkalaemia
2 progressive failure of hormonal function
-anaemia
-renal bone disease
3 CVD
-vascular calfication
-uraemic cardiomyopathy
4 uraemia + death
92
Q

how does anaemia of chronic renal disease occur

A

progressive decline in erythropoietin producing cells with loss of renal parenchyma

93
Q

what sort of anaemia is anaemia of chronic disease

A

normochromic, normocytic anaemia

94
Q

why is there reduced calcium in CKD

A

decreased alpha hydroxylase

95
Q

what does low calcium from CKD lead to

A

secondary hyperparathyroidism

96
Q

what is a complication of low calcium in CKD and why

A

osteomalacia

-bone underdoes resorption by increased PTH to increase calcium

97
Q

how is renal osteodystrophy treated in CKD

A

calcichew (a Ca supplement)

calcium acetate - phosphate binders

98
Q

what is used to treat anaemia caused by CKD

99
Q

what is used to treat acidosis in CKD

A

sodium bicarb

100
Q

what is used to treat oedema in CKD

A

loop diuretics

restriction of fluids

101
Q

what sort of dialysis is used for CKD

A

haemodailysis

  • increase HCO3- in blood
  • decrease urea and creatinine in blood
102
Q

how is access gained in haemodialysis

A

1 arteriovenous fistula

2 artiovenous graft

103
Q

what is arteriovenous fistula

A

connection between artery and vein
requires 3 months for vein to get bigger and stronger
then 2 needles can be inserted (one to take and one to return blood)

104
Q

what is an anteriovenous graft

A

synthetic tube under skin to form a bridge between artery and vein

105
Q

what is the treatment of choice for ESRF

A

transplantation

106
Q

what is haematuria

A

blood in urine

107
Q

what is microscopic haematuria

A

blood in urine only seen on urinalysis

108
Q

what is macroscopic haematuria

A

blood in urine which can be seen with the eye

109
Q

An 86 year old smoker presents with a 3 day history of noticing blood in his urine. He was recently booked an outpatients appointment for symptoms of frequency and hesitancy but failed to attend. On questioning, he mentions some weight loss and lower back pain he has had for a few months.

Bladder cancer 
Renal-cell carcinoma 
Prostate Cancer 
Ureteric Calculus 
Polycystic Kidney Disease
A

Prostate Cancer

110
Q

what are obstructive LUTS

A 
Poor stream 
Hesitancy 
Terminal dribbling 
Incomplete voiding 
Overflow incontinence 
Near retention
111
Q

what are irritative LUTS

A

Frequency (polyuria)
Urgency
Nocturia
Dysuria

112
Q

what is a mneumonic for LUTS

A

FUND HIPS T

Frequency (polyuria)
Urgency
Nocturia
Dysuria

Hesitancy
Intermittent stream
Polyuria
Stream (poor)

(Terminal dribbling)

113
Q

what is the most common presentation of bladder cancer

A

gross haematuria

114
Q

where is cancer in the bladder found

A

in the epithelium lining

115
Q

epi of bladder cancer

116
Q

risk factors of bladder cancer

A

smoking
aromatic amines used in rubber and dye
schistosomiasis (egypt)
age

117
Q

what is polystic kidney disease

A

fluid filled cysts on the kidney

118
Q

how does polycystic kidney disease progress

A

cyst increase in size

leads to renal enlargement

119
Q

why does PKD lead to HTN

A

increased activity of RAS

120
Q

why does PKD cause increased Hb

A

excess erythropoietin

121
Q

what is renal cell carcinoma

A

also known as von Grawitz tumour

122
Q

what are features of renal cell carcinoma

A

1 haematuria
2 loin pain
3 abdominal mass

123
Q

A 30 year old male presents with a 4 hour history of sudden onset severe loin pain. Urinalysis demonstrates microscopic haematuria.

A

renal stones

124
Q

what are the most common renal stones

A

1 calcium stones (75%)
2 magnesium ammonium phosphate (15%)
3 uric acid stones (5%)

125
Q

what are the different types of calcium stones

A

calcium oxalate

calcium phosphate

126
Q

what stones are visible on XRAY

A

calcium stones (oxalate or phosphate)

127
Q

when do magnesium ammonium phosphate stones occur

A

often after infections with urease producing organisms (proteus)

128
Q

what are common causes of uric acid stones

A

high protein, diet, obesity, gout

129
Q

what stones are not visible on XRAY

A

uric acid stones

130
Q

epi of renal stones

A

common

men>women

131
Q

risk factors for renal stones

A

dehydration
hypercalcaemia
hyperurea

132
Q

what is the imaging for renal stones

133
Q

what are features of renal stones

A 
Haematuria 
Loin to groin pain 
Rigors and fever.
Dysuria.
Urinary retention.
Nausea and vomiting
134
Q

what is the immediate management for renal stones

A

analgesia
rehydration if necessary
antiemetics if necessary

135
Q

what is the medical management for renal stones

A

CCBs

alpha blockers

136
Q

what is the surgical management for renal stones

A

extracorporeal shock wave lithotripsy

137
Q

when is stone removal indicated

A

persistant obstruction

increasing or unremitting colic

138
Q

what is extracorporeal shock wave lithotripsy

A

non-invasive treatment to focus shock waves on the stone to break it up
stone particles pass spontaneously

139
Q

what is uretetoscopy

A

laser to break up stone

140
Q

what is percutaneous nepholithotomy

A

when ESWL or ureteroscopy contraindicated
nephroscope is passed into collecting system
stone is fragmented

141
Q

when is open surgery required for removal of renal stones

A

ESWL, ureteroscopy and percutaneous nephrolithotomy has failed

142
Q

what are complications of renal stones

A

reduced renal function
ureteric stricture
pylonephritis
sepsis

143
Q

what can causes of GN be split into

A

non-proliferative

proliferative

144
Q

what are non-proliferative causes of GN

A

minimal change GN
focal segmental glomerulosclerosis
membranous GN

145
Q

what are proliferative causes of GN

A

IgA nephropathy
rapidly progressive GN
post-strep GN

146
Q

1) A 66-year-old man presents with increased urinary frequency, poor stream and terminal dribbling. He wet himself when he woke up this morning. What is the most likely diagnosis?

A. Normal Pressure Hydrocephalus
B. Benign Prostatic Hyperplasia
C. Spinal Cord Compression 
D. Urge Incontinence
E. Functional Incontinence
A

B. Benign Prostatic Hyperplasia

147
Q

2) A 73 year old woman with breast cancer presents to the A&E with urinary incontinence and weakness in her lower limbs. On examination, she has a palpable bladder and a sensory level defined at T10. What is the most likely diagnosis?

A. Normal Pressure Hydrocephalus
B. Benign Prostatic Hyperplasia
C. Spinal Cord Compression 
D. Urge Incontinence
E. Functional Incontinence
A

Spinal Cord Compression

148
Q

3) A 87-year-old man has presented to the outpatient clinic with incontinence and urges to urinate 10 times a day. He has been having more falls recently and has been having difficulty with his memory. On examination muscle strength and peripheral sensation are normal and he has a wide-based gait. His AMTS score is 5/10.

A. Normal Pressure Hydrocephalus
B. Benign Prostatic Hyperplasia
C. Spinal Cord Compression 
D. Urge Incontinence
E. Functional Incontinence
A

Normal Pressure Hydrocephalus

149
Q

4) A 52-year-old lady says she is unable to control the urge to pass urine and increased frequency of going to the toilet. She has been avoiding drinking coffee and tea as they make her symptoms worse. What is the most likely diagnosis?

A. Normal Pressure Hydrocephalus
B. Benign Prostatic Hyperplasia
C. Spinal Cord Compression 
D. Urge Incontinence
E. Functional Incontinence
A

Urge Incontinence

150
Q

5) An 87-year-old man with Parkinson’s complains that he sometimes wets himself during the day as he is unable to reach the toilet in time. He has bad cataracts from his diabetes. What is the most likely diagnosis?

A. Normal Pressure Hydrocephalus
B. Benign Prostatic Hyperplasia
C. Spinal Cord Compression 
D. Urge Incontinence
E. Functional Incontinence
A

Functional Incontinence

151
Q

what are symptoms of BPH

A 
hesistancy
poor stream
intermittent flow
terminal dribbling
incomplete emptying
152
Q

epi

A

age

afro-caribbeans

153
Q

what is the management of acute BPH

154
Q

what is the management of chronic BPH

A

watchful waiting

155
Q

what is the medical management for BPH

A

alpha-1 adrenoreceptor blocker (tamsulosin, prazosin)

156
Q

what is the surgical treatment of BPH

157
Q

what are symptoinms of spinal cord compression

A 
spinal pain
leg weakness
incontinence
sensory loss below level of lesion
UMN signs below lesion
158
Q

what are causes of spinal cord compression

A

secondary malignancy
infection
disc prolapse
haematoma

159
Q

what is normal pressure hydrocephalus

A

CSF absorption is impaired in subarachnoid space

160
Q

what would be seen on CT head with NPH

A

enlarged ventricles as CSF accumualtes and distortion of the peri-ventricular white matter

161
Q

what are causes of NPH

A

meningitis
head injury
idiopathic

162
Q

what are cardinal features of NPH

A

3Ws

Wet - incontinence
Wobbly - unsteady gait
Wacky - dementia

163
Q

what is the normal micturition reflex

A

bladder is stretched which causes increased frequency of action potentials from bladder wall to S2-4
parasympathetic afferent neurones are activated which causes contraction of the detrusor muscle and internal uretheral sphincter

if urination not convenient brain signals to spinal cord to inhibit micturition reflex
impulses are carried via somatic motor neurons keep external urinary sphincter contracted

164
Q

what is urge incontinence

A

urgency to pass urine followed by incontinence

165
Q

what is urge incontinence precipitated by

A

the cold
sound of running water
coffee, tea

166
Q

what causes urge incontinence

A

UMN pathology causing loss of higher inhibition of micurition reflex

167
Q

what may cause UMN pathology in urge incontinence

A

parkinsons
MS
stroke

168
Q

what is functional incontinence

A

too slow finding toilet

169
Q

1) A 12-year-old boy presented to the emergency department with sudden onset of severe right scrotal pain and vomiting. On examination his right testes was swollen and hanging higher than the left. The right testes was so tender to palpation that he refused careful examination. How would you manage this patient?

A. Azithromycin + Ceftriaxone
B. Orchidectomy
C. Surgical Exploration 
D. Drain right testes
E. Wait and watch
A

Surgical Exploration

170
Q

2) A 32-year-old man presented to the A&E with 3 days of increasingly severe right scrotal pain and swelling since he returned from his business trip to Thailand. On examination, he had a temperature of 39oC, and his right hemi-scrotum was swollen and tender. The overlying skin was red and hot. What is the best treatment?

A. Surgical Exploration and fixing of testicle
B. Clarithromycin and co-amoxiclav
C. Chemotherapy and surgery
D. Cefriaxone and azithromycin
E. Watch and wait
A

Cefriaxone and azithromycin

171
Q

3) A 22-year-old man presents to his GP with a dull ache in the left scrotum. On examination, there is soft, lumpy swelling on the left side of his scrotum.

A. Hydrocele
B. Testicular teratoma
C. Varicocoele
D. Epididymo-orchitis
E. Testicular seminoma
F. Testicular torsion
A

varicocele

172
Q

4) A 24-year-old male has noticed a hard, smooth swelling in his right testes for the last month. He underwent orchidopexy as a child for undescended testes. On examination, it is not tender, does not transilluminate and there is no cough impulse. Blood tests show raised βhCG and αFP.

A. Hydrocele
B. Testicular teratoma
C. Varicocoele
D. Epididymo-orchitis
E. Testicular seminoma
F. Testicular torsion
A

B. Testicular teratoma

173
Q

5) A 43-year-old man complains of painless swelling of his left scrotum which is causing him social embarrassment. On examination, his left scrotum is swollen, non-tender, fluctuant and transilluminable. The testes was impalpable.

A. Hydrocele
B. Testicular teratoma
C. Varicocoele
D. Epididymo-orchitis
E. Testicular seminoma
F. Testicular torsion
174
Q

what testicular torsion

A

testis twists within the tunica vaginalis causes ischaemia

175
Q

who gets testicular torsion

A

young boys

176
Q

what are symptoms of testicular torsion

A

sudden onset pain in one testes
abdominal pain
vomiting

177
Q

what are signs of testicular torsion

A

inflammation of one testes - tender, hot, swollen

one may lie higher than other

178
Q

what is the management of testicualr torsion

A

surgical exploration with possible orchidectomy

179
Q

when is doppler USS performed in testicular torsion

A

uncertain diagnosis

180
Q

what is epididymo orchitis

A

inflammationof testicles and epididymis due to infection

181
Q

what causes epididymo orchitis

A

e coli following UTI
chlamydia
gonorrhoea

182
Q

what are symptoms of epididymo orchitis

A

aute onset severe pain with fever and discharge

183
Q

what could distinguishe epididymo orchitis and testicular torsion

A

raised the scrotum will relieve pain in EO

184
Q

what is seen OE with epididymo orchitis

A

tender, red, warm, swollen epididymis

185
Q

investigaitons for EO

186
Q

what is the management for EO

A

chlamydia - azithromycin/doxycycline

gonorrhoea - ceftriaxone

187
Q

what is varicocele

A

dilated veins in pampniform plexus

188
Q

aetiology

A

valvular dysfunction

compression to venous drainage

189
Q

what are symptoms of varicocele

A

asymptomatic

or a dull ache

190
Q

what is seen OE of varicocele

A

bag of worms

191
Q

what are the different types of testicular tumours

A

germ cell

non-germ cell

192
Q

what are the most important types of germ cell tumours

A

seminomas

teratoma

193
Q

what is more common, a seminoma or a teratoma

194
Q

who gets testicular cancer

195
Q

what are symptoms of testicular cancer

A

painless testicular lump (few have pain)

196
Q

what are features OE of testicualr cancer

A

lump within testes which is firm and does not transilluminate

197
Q

what is the management for testicular cancer

A

orchidectomy via groin incision

198
Q

where does teratoma originate from

A

all germ cell layers

199
Q

where does seminoma originate from

A

epithelium of semiferous tubules

200
Q

what tumour markers are assocated with teratoma

A

high aFP

high BhCG

201
Q

what tumour markers are associated with seminoma

A

high BcHG

aFP normal

202
Q

which has better prognosis, teratoma or seminoma

203
Q

what is the management for teratoma

A

chemo and orchidectomy

204
Q

what is the management for seminoma

A

radiotherapy + orchidectomy

205
Q

what is hydrocele

A

fluid around testis

206
Q

epi of hydrocele

207
Q

what causes hydrocele

A

idiopathic causing increased fluid production by tunica vaginalis

208
Q

what are symptoms of hydrocele

A

slowly enlarging mass which becomes more tense over time

209
Q

what are signs of hydrocele

A

impalpable testis
smooth swelling
transilluminates

210
Q

what is the investigation for hydrocele

211
Q

1) A 45-year-old man comes in complaining of a sharp, stabbing main in his left loin which radiates down to his groin. The pain comes on a few times an hour and is debilitating. He noticed some blood in his urine today. Which is the most appropriate investigation to make a diagnosis?

A. Abdominal USS
B. Urodynamic study 
C. IV Pyelography
D. CT kidney, ureter, bladder
E. Urinary MC&amp;S
A

CT kidney, ureter, bladder

212
Q

when is a CTKUB indicated

A 
ureteric stones (no contrast required, more sensitive and specific)
tumour staging of bladder or renal
213
Q

when is USS indicated

A

good imaging of kidney and bladder but cannot view ureters due to overlying gas

renal mass, retention, pyelonephritis

214
Q

when is urodynamic study indicated

A

urge incontinence which is not resolving

215
Q

when is IV pyelography indicated

A

contrast + XRAY imaging

looks for filling defects and identification of congenital urinary tract abnormalities

216
Q

2) An 81year old woman who used to work in a dye industry comes to the GP worried that her urine has been pink recently. She does not experience any pain or dysuria. Her basic observations are all normal. What is the most appropriate investigation to reach a diagnosis?

A. CT kidney, ureter, bladder
B. Renal USS
C. Cystoscopy
D. IV Pyelography
E. Renal biopsy
A

Cystoscopy

217
Q

when is cytoscopy indicated

A

scope inserted into bladder and biopsy

for bladder cancer

218
Q

when is CTKUB indicated for bladder cancer

A

generally done for staging, higher radiation

219
Q

when is renal USS completed with painless haematuria

A

presence of renal masses

220
Q

3) A 62year old Afro-Caribbean man complains of waking up 2-3 times at night to pass urine for the past 8 months. He takes a while to start going and occasionally wets himself by the time he gets back in bed. Urine dipstick is normal. What would be the best investigation to diagnose his condition?

A. Transrectal USS
B. Bladder USS
C. Cystoscopy
D. IV Pyelography
E. Urinary MC&amp;S
A

transrectal USS

221
Q

what is a transrectal USS indicated

A

obstructive symptoms such as hesitancy, poor stream, terminal dribbilng) - BPH

222
Q

what is bladderUSS for mostly

A

urinary retention

Renal & Urology (18 decks)

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