MedEd Flashcards
1
Q
what is AKI
A
rapid decline in renal function
2
Q
what is CKD
A
impaired renal function for >3months
3
Q
what are features of AKI
A
failure to maintain homeostasis of:
fluid - oliguria, volume overload
electrolytes - hyperkalaemia
acid-base - metabolic acidosis
4
Q
what can causes of AKI be sorted into
A
pre-renal
renal
post-renal
5
Q
what are causes of pre-renal AKI
A
failure of perfusion
- hypovolaemia (bleeding)
- reduced cardiac output (HF, LF, sepsis)
6
Q
what are causes of renal AKI
A
drugs (ACEi, NSAIDs, aminoglyclosides) vascular glomerular tubular (ischaemia, rhabdomylosis) interstitial
7
Q
what are post-renal causes of AKI
A
obstruction
- BPH
- kidney stones
- blocked catheter
- malignancy
8
Q
what are vascular causes of AKI
A
large vessel (renal artery/vein obstruction, HTN, vasculitis) small vessel -HUS -TTP -DIC -vasculitis
9
Q
what is HUS
A
triad of
1 microangiopathic haemolytic anaemia
2 AKI
3 thrombocytopenia
10
Q
what is the main cause of HUS
A
gastroenteritis with e coli
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
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
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
14
Q
what is TTP
A
1 microangiopathic haemolytic anaemia
2 AKI
3 thrombocytopenia
4 fluctuating CNS signs
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
16
Q
what are consequences of glomerulonephritis
A
loss of barrier function
loss of filtering capacity
17
Q
what are features of loss of barrier function
A
- proteinuria
- haematuria
18
Q
what are features of loss of filtering capacity
A
-reduced excretion which causes accumulation of waste products
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
20
Q
what features are present with IgA nephropathy
A
days following URTI
increased IgA immune complex formation
episodic haematuria
21
Q
what features are present with HSP
A
systemic variant IgA nephropathy
haematuria
purpuric rash on extensor surfaces commonly in legs
polyarthritis
22
Q
what features are present with anti-GBM (goodpastures)
A
autoantibodies to Type IV collagen (GBM & lung)
haematuria
haemoptysis
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
24
Q
what features are present with pauci immune
A
ANCA
associated vasculitis or limited to kidney
25
what is the most common cause of glomerulonephritis
pauci immune
26
what do anti-GBM antibodies bind to in the lungs
alveolar basement membranes
27
what is used to treat proteinuria in glomerulonephritis
ACEi or ARBs
28
why do ACEi or ARBs work for treating proteinuria
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
29
what is the most common renal cause of AKI
acute tubular necrosis
30
what causes acute tubular necrosis
ischaemia
| nephrotoxins
31
what are different types of nephrotoxins
drugs
myoglobulinaemia (rhabodomyolysis)
haemaglobinuria
32
how does ischaemia cause AKI
ischaemia leads to tubular cell injury called acute tubular necrosis
this leads to obstruction of tubular by debris which causes a decrease in GFR
33
what are the phases of AKI caused by ischaemia
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
34
what causes rhabdomylosis
ischaemia, trauma, drugs which causes skeletal muscle breakdown
35
what is released in rhabdomylosis
lots of myoglobin which causes dark urine
lots of potassium
lots of CK
36
what is seen in the urine in rhabdomylosis
blood on dipstick but no RBCs on microscopy
| urinary myoglobin
37
what metabolic disturbances can cause rhabdomyolysis
hypokalaemia
| hypophosphataemia
38
what is myeloma
malignant disease of bone marrow plasma cells with clonal expansion of plasma cells which leads to monclonal paraprotein production
39
what is the mneumonic for features of myeloma
CRAB
Calcium - high
Renal failure (acute/chronic) with high urea and creatinine
Anaemia
Bone - osteolytic bone lesions which present as pain or fracture
40
why does renal failure occur in myeloma
high calcium
| free light chains of paraprotein are deposited in the kidneys causing inflammation
41
what are common nephrotoxins
```
NSAIDs
aminoglycosides (gentamicin, streptomycin)
contrast agents
ACEi and ARBs
immunosuppressants (methotrexate)
```
42
what causes interstitial nephritis causing AKI
lymphoma
| tumour lysis syndrome following chemo
43
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
```
Acute tubular necrosis
44
2. 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
```
IgA nephropathy
post URTI
45
3. 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. Rhabdomyolysis
46
4. 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
```
E. Myeloma
47
5. 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)
```
B. HUS
often follows e coli toxin
48
aetiology of nephrotic syndrome
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
49
what is the triad of nephrotic syndrome
proteinuria >3.5/24hrs
low albumin <30g/l
oedema
50
what is nephritic syndrome
more severe glomeruli damage which leads to leakage of larger proteins and more damage (red cell casts)
haematuria is present
51
what is nephritic syndrome common in
glomerulonephritis
52
what is the triad of nephritic syndrome
proteinuria
haematuria
oedema
53
what is a characteristic features of nephritic syndrome
red cell cast - glomerular damage
54
what are common primary causes of nephrotic syndrome
membranous
minimal change
focal segmental glomerulosclerosis
mesangiocapillary glomerulonephritis
55
what are common secondary causes of nephrotic syndrome
diabetes
SLE
amyloid
HBV/HCV
56
```
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
```
glomerulonephritis
patient presents with nephritic syndrome however the diagnosis or cause is post strep glomerulonephritis
57
```
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
```
E) Renal biopsy
58
what is the treatment for diabetic nephropathy
ACEi or ARBs
59
what are the two biggest causes of CKD
HTN
| DM
60
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
```
Hyperkalemia
61
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
```
Hyperuraemia
62
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
```
All of the above
63
what are complications of AKI
```
uraemia
volume overload
hyperkalaemia
hyperphosphataemia
metabolic acidosis
CKD
```
64
what does uraemia cause
pericarditis and a pericardial rub
65
how does hyperuraemia occur in AKI
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
66
what is the majority of potassium found
in the cells
67
how is most potassium excreted
in the urine
68
what does potassium excretion depend on
adequate sodium delivery to distal convoluted tubule
| for exchange of sodium resorption and potassium excretion
69
what are symptoms of hyperkalaemia
```
fatigue or weakness
numbness or tingling
N+V
chest pain
palpitations
```
70
how does volume overload occur in AKI
kidney cant excrete fluid
| fluid builds in circulation
71
what are signs of volume overload
oedema (pulmonary + peripheral)
- swollen feet
- SOB + crepitations
- HTN
- raised JVP
72
how does metabolic acidosis present in AKI
```
rapid breathing (respiratory compensation)
confusion
```
73
how is AKI managed
```
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
```
74
what does insulin do to potassium
stimulates intracellular uptake of K+
75
what features of hyperkalaemia on ECG
tall tented t waves
absent p waves
widening QRS
76
what is cardioprotective against hyperkalaemia
10ml 10% calcium gluconate
77
what should be given to reduce hyperkalaemia if patient is acidic
IV sodium bicarbonate
78
what should be given to treat pulmonary oedema
sit up and high flow oxygen
venous vasodilator
furosemide IV
79
name a venous vasodilator
diamorphine
80
what is the mneumonic for indications of dialysis on AKI
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
```
81
what is the def of CKD
impaired renal function for >3months based on abnormal structure or function
82
what is a normal GFR
>90ml/min/1.73^2
83
what are the stages of CKD
```
1 kidney damage - normal GFR
2 kidney damage - mildly decreased GFR
3 decreased GFR
4 severely decreased GFR
5 end stage renal disease
```
84
what GFR is associated with stage 2 CKD
60-89
85
what GFR is associated with stage 3 CKD
30-59
86
what GFR is associated with stage 4 CKD
15-29
87
what GFR is associated with stage 5 CKD
<15 or dialysis
88
what is the most common cause of CKD
diabetes
89
what are the two most common causes of CKD
diabetes
| HTN
90
what are causes of CKD
```
diabetes
HTN
atherosclerosis
chronic glomerulonephritis
polycystic kidney disease
```
91
what are consequences of CKD
```
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
how does anaemia of chronic renal disease occur
progressive decline in erythropoietin producing cells with loss of renal parenchyma
93
what sort of anaemia is anaemia of chronic disease
normochromic, normocytic anaemia
94
why is there reduced calcium in CKD
decreased alpha hydroxylase
95
what does low calcium from CKD lead to
secondary hyperparathyroidism
96
what is a complication of low calcium in CKD and why
osteomalacia
| -bone underdoes resorption by increased PTH to increase calcium
97
how is renal osteodystrophy treated in CKD
calcichew (a Ca supplement)
| calcium acetate - phosphate binders
98
what is used to treat anaemia caused by CKD
human EPO
99
what is used to treat acidosis in CKD
sodium bicarb
100
what is used to treat oedema in CKD
loop diuretics
| restriction of fluids
101
what sort of dialysis is used for CKD
haemodailysis
- increase HCO3- in blood
- decrease urea and creatinine in blood
102
how is access gained in haemodialysis
1 arteriovenous fistula
| 2 artiovenous graft
103
what is arteriovenous fistula
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
what is an anteriovenous graft
synthetic tube under skin to form a bridge between artery and vein
105
what is the treatment of choice for ESRF
transplantation
106
what is haematuria
blood in urine
107
what is microscopic haematuria
blood in urine only seen on urinalysis
108
what is macroscopic haematuria
blood in urine which can be seen with the eye
109
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
```
Prostate Cancer
110
what are obstructive LUTS
```
Poor stream
Hesitancy
Terminal dribbling
Incomplete voiding
Overflow incontinence
Near retention
```
111
what are irritative LUTS
Frequency (polyuria)
Urgency
Nocturia
Dysuria
112
what is a mneumonic for LUTS
FUND HIPS T
Frequency (polyuria)
Urgency
Nocturia
Dysuria
Hesitancy
Intermittent stream
Polyuria
Stream (poor)
(Terminal dribbling)
113
what is the most common presentation of bladder cancer
gross haematuria
114
where is cancer in the bladder found
in the epithelium lining
115
epi of bladder cancer
men>women
116
risk factors of bladder cancer
smoking
aromatic amines used in rubber and dye
schistosomiasis (egypt)
age
117
what is polystic kidney disease
fluid filled cysts on the kidney
118
how does polycystic kidney disease progress
cyst increase in size
| leads to renal enlargement
119
why does PKD lead to HTN
increased activity of RAS
120
why does PKD cause increased Hb
excess erythropoietin
121
what is renal cell carcinoma
also known as von Grawitz tumour
122
what are features of renal cell carcinoma
1 haematuria
2 loin pain
3 abdominal mass
123
A 30 year old male presents with a 4 hour history of sudden onset severe loin pain. Urinalysis demonstrates microscopic haematuria.
renal stones
124
what are the most common renal stones
1 calcium stones (75%)
2 magnesium ammonium phosphate (15%)
3 uric acid stones (5%)
125
what are the different types of calcium stones
calcium oxalate
| calcium phosphate
126
what stones are visible on XRAY
calcium stones (oxalate or phosphate)
127
when do magnesium ammonium phosphate stones occur
often after infections with urease producing organisms (proteus)
128
what are common causes of uric acid stones
high protein, diet, obesity, gout
129
what stones are not visible on XRAY
uric acid stones
130
epi of renal stones
common
| men>women
131
risk factors for renal stones
dehydration
hypercalcaemia
hyperurea
132
what is the imaging for renal stones
CT KUB
133
what are features of renal stones
```
Haematuria
Loin to groin pain
Rigors and fever.
Dysuria.
Urinary retention.
Nausea and vomiting
```
134
what is the immediate management for renal stones
analgesia
rehydration if necessary
antiemetics if necessary
135
what is the medical management for renal stones
CCBs
| alpha blockers
136
what is the surgical management for renal stones
extracorporeal shock wave lithotripsy
137
when is stone removal indicated
persistant obstruction
| increasing or unremitting colic
138
what is extracorporeal shock wave lithotripsy
non-invasive treatment to focus shock waves on the stone to break it up
stone particles pass spontaneously
139
what is uretetoscopy
laser to break up stone
140
what is percutaneous nepholithotomy
when ESWL or ureteroscopy contraindicated
nephroscope is passed into collecting system
stone is fragmented
141
when is open surgery required for removal of renal stones
ESWL, ureteroscopy and percutaneous nephrolithotomy has failed
142
what are complications of renal stones
reduced renal function
ureteric stricture
pylonephritis
sepsis
143
what can causes of GN be split into
non-proliferative
| proliferative
144
what are non-proliferative causes of GN
minimal change GN
focal segmental glomerulosclerosis
membranous GN
145
what are proliferative causes of GN
IgA nephropathy
rapidly progressive GN
post-strep GN
146
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
```
B. Benign Prostatic Hyperplasia
147
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
```
Spinal Cord Compression
148
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
```
Normal Pressure Hydrocephalus
149
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
```
Urge Incontinence
150
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
```
Functional Incontinence
151
what are symptoms of BPH
```
hesistancy
poor stream
intermittent flow
terminal dribbling
incomplete emptying
```
152
epi
age
| afro-caribbeans
153
what is the management of acute BPH
catheter
154
what is the management of chronic BPH
watchful waiting
155
what is the medical management for BPH
alpha-1 adrenoreceptor blocker (tamsulosin, prazosin)
156
what is the surgical treatment of BPH
TURP
157
what are symptoinms of spinal cord compression
```
spinal pain
leg weakness
incontinence
sensory loss below level of lesion
UMN signs below lesion
```
158
what are causes of spinal cord compression
secondary malignancy
infection
disc prolapse
haematoma
159
what is normal pressure hydrocephalus
CSF absorption is impaired in subarachnoid space
160
what would be seen on CT head with NPH
enlarged ventricles as CSF accumualtes and distortion of the peri-ventricular white matter
161
what are causes of NPH
meningitis
head injury
idiopathic
162
what are cardinal features of NPH
3Ws
Wet - incontinence
Wobbly - unsteady gait
Wacky - dementia
163
what is the normal micturition reflex
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
what is urge incontinence
urgency to pass urine followed by incontinence
165
what is urge incontinence precipitated by
the cold
sound of running water
coffee, tea
166
what causes urge incontinence
UMN pathology causing loss of higher inhibition of micurition reflex
167
what may cause UMN pathology in urge incontinence
parkinsons
MS
stroke
168
what is functional incontinence
too slow finding toilet
169
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
```
Surgical Exploration
170
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
```
Cefriaxone and azithromycin
171
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
```
varicocele
172
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
```
B. Testicular teratoma
173
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
```
Hydrocele
174
what testicular torsion
testis twists within the tunica vaginalis causes ischaemia
175
who gets testicular torsion
young boys
176
what are symptoms of testicular torsion
sudden onset pain in one testes
abdominal pain
vomiting
177
what are signs of testicular torsion
inflammation of one testes - tender, hot, swollen
| one may lie higher than other
178
what is the management of testicualr torsion
surgical exploration with possible orchidectomy
179
when is doppler USS performed in testicular torsion
uncertain diagnosis
180
what is epididymo orchitis
inflammationof testicles and epididymis due to infection
181
what causes epididymo orchitis
e coli following UTI
chlamydia
gonorrhoea
182
what are symptoms of epididymo orchitis
aute onset severe pain with fever and discharge
183
what could distinguishe epididymo orchitis and testicular torsion
raised the scrotum will relieve pain in EO
184
what is seen OE with epididymo orchitis
tender, red, warm, swollen epididymis
185
investigaitons for EO
MSU
| swabs
186
what is the management for EO
chlamydia - azithromycin/doxycycline
| gonorrhoea - ceftriaxone
187
what is varicocele
dilated veins in pampniform plexus
188
aetiology
valvular dysfunction
| compression to venous drainage
189
what are symptoms of varicocele
asymptomatic
| or a dull ache
190
what is seen OE of varicocele
bag of worms
191
what are the different types of testicular tumours
germ cell
| non-germ cell
192
what are the most important types of germ cell tumours
seminomas
| teratoma
193
what is more common, a seminoma or a teratoma
seminoma
194
who gets testicular cancer
young men
195
what are symptoms of testicular cancer
painless testicular lump (few have pain)
196
what are features OE of testicualr cancer
lump within testes which is firm and does not transilluminate
197
what is the management for testicular cancer
orchidectomy via groin incision
198
where does teratoma originate from
all germ cell layers
199
where does seminoma originate from
epithelium of semiferous tubules
200
what tumour markers are assocated with teratoma
high aFP
| high BhCG
201
what tumour markers are associated with seminoma
high BcHG
| aFP normal
202
which has better prognosis, teratoma or seminoma
seminoma
203
what is the management for teratoma
chemo and orchidectomy
204
what is the management for seminoma
radiotherapy + orchidectomy
205
what is hydrocele
fluid around testis
206
epi of hydrocele
children
207
what causes hydrocele
idiopathic causing increased fluid production by tunica vaginalis
208
what are symptoms of hydrocele
slowly enlarging mass which becomes more tense over time
209
what are signs of hydrocele
impalpable testis
smooth swelling
transilluminates
210
what is the investigation for hydrocele
USS
211
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&S
```
CT kidney, ureter, bladder
212
when is a CTKUB indicated
```
ureteric stones (no contrast required, more sensitive and specific)
tumour staging of bladder or renal
```
213
when is USS indicated
good imaging of kidney and bladder but cannot view ureters due to overlying gas
renal mass, retention, pyelonephritis
214
when is urodynamic study indicated
urge incontinence which is not resolving
215
when is IV pyelography indicated
contrast + XRAY imaging
| looks for filling defects and identification of congenital urinary tract abnormalities
216
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
```
Cystoscopy
217
when is cytoscopy indicated
scope inserted into bladder and biopsy
| for bladder cancer
218
when is CTKUB indicated for bladder cancer
generally done for staging, higher radiation
219
when is renal USS completed with painless haematuria
presence of renal masses
220
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&S
```
transrectal USS
221
what is a transrectal USS indicated
obstructive symptoms such as hesitancy, poor stream, terminal dribbilng) - BPH
222
what is bladderUSS for mostly
urinary retention
