Miscellaneous- GU Flashcards
What nephrotoxic drugs should be stopped in AKI
NSAIDS
aminoglycosides- gentamicin
ACEIs/ARBs
Diuretics
What drugs should be suspended in AKI
Metformin
Lithium
Digoxin
Name 2 complications of CKD
Osteomalacia
Renal osteodystrophy
What histology change is seen in membranous glomerulopathy
Prominent spike and dome patterns on silver stain
What are the histological changes in IgA nephropathy
IgA deposition in the mesangium
What are the signs of nephrotic syndrome
Hypoalbuminaemia
Hyperlipidemia
Oedema
Proteinuria (>3g/24hr)
Sings of nephritic syndrome
Haematuria
Oliguria
Proteinuria (<3G/24hr)
HTN
Name 5 Nephritic syndromes
IgA Nephropathy Post streptococcal glomerulonephritis SLE Hencoh purpura Goodpastures
Schistosomiasis is associated with what type of bladder cancer
Squamous cell carcinoma
List 5 Sx of TCC
Painless haematuria Weight loss Frequency Urgency Night sweats
List 5 rf of tcc
Smoking Increase age FHx Aromatic amines/Rubber industry Male
Gs investigation for TCC
Flexible cystoscopy and biopsy
Tx for T0, T1 AND Tcis TCC
TURBT and chemo
Tx for T2 and T3 TCC
Radical cystectomy and chemo
Tx for T4/TCC
Palliative chemo + chronic catherisatioj
Where does bladder cancer metastasise to
Bone
Lungs
Liver
What is the treatment for stress incontinence in females
Pelvic floor exercises
Duloxetine (concerns for se)
Surgery
Tx for stress incontinence in males
Artificial sphincter
Sling
List 5 symptoms for BPH
Increased frequency Hesitancy nocturia Post void dribbling Urgency
Treatment for mild BPH
Watchful waiting
Pharmacological tx for BPH
Tamsulosin (alpha blocker)
Finestaride (5 alpha reductase inhibitor)
Surgical tx for BPH
TURP
Where is prostate cancer most likely found
In the peripheral zone
1st line investigation for prostate cancer
Multiparametric MRI
Gs Ix for prostate cancer
Trans rectal ultrasound guided biopsy
What hormonal tx is available for the tx of prostate cancer
GnRH agonists- gosrelin
Androgen receptor blockers- biculamatide
GnRH antagonist- degralix
Se of hormonal therapy in prostate cancer
Hot flushes Osteoporosis Gynecomastia Diabetes Decreased libido
3 rf for RCC
Smoking
Obesity
Hypertension
What grading system is used in prostate cancer
Gleason grading
What is the most likely cause of epididymo-orchitis in
A) under 35
B) over 35
A) sti e.g. chlamydia
B) UTI
What nerves innervated the relaxation of the detrusor muscle
Hypogastric nerve (t10-l2)
What nerve is responsible for detrusor muscle contraction
Pelvic nerve
What are the main causative organisms in UTIs
Klebsiella E-coli Enterococci Proteus S.sapprophyticus
Tx for gonorrhoea
IM ceftriaxone + azithromycin
Tx for chlamydia
Doxycycline 7 days
Tx for syphyllis
IM benzylpenicilin
Which stone is radiolucent on X-ray
Uric acid stones
Most common places to find renal stones
Pelvic brim
Pelvicoureteric junction
Vesicoureteric junction
Gs Ix for CKD
eGFR- 2x tests 3 months apart
Name 4 tx options for prostate cancer
Radical prostectomy TURP Hormone therapy Brachytherapy External beam therapy
What are the tumour markers for testicular cancer
LDH
Alpha fetoprotein
Beta HCG
Tx for nephrotic syndrome
Fluid and salt restriction Loop diuretics Treat cause ACEIs/ARBs Give statins
Tx for nephritic syndrome
ACEIs/ARBs
Corticosteroids
Pharmacological tx for urge incontinence
Anti ACh- oxybutinin
What changes can be observed in minimal change disease
Effacement of podocyte foot processes
What is the causative Agent in PSG
Group a beta haemolytic strep
What is a +ve phren sign and in which disease may it be implicated in
Pain relieved when scrotum elevated
Seen in epididymo-orchitis
What is klinfelters syndrome
47XXY
Tall stature
Hypogonadism
Gynecomastia
Delayed puberty
Where are changes seen in BPH
Transitional zone
What is the triad associated with pyelonephritis
Unilateral loin pain
Fever
N+V
Most common nephrotic syndrome in adults
Focal segmental glomerulonephritis
What is the gs Ix of nephrolithiasis
Non contrast CT KUB
What pharmacological drug can be given to aid the removal of stones
Tamsulosin
What advice would you give to someone to prevent renal stone formation
Keep hydrated- increase fluid intake
Low salt diet
Decrease intake of carbonated drinks
All lemon juice to water
What classification is used to risk stratify AKI
KDIGO Classification
Stage 1- x1.5 creatinine levels + >0.5ml/kg an hour for > 6hours
Stage 2- x2 creatinine level + <0.5ml/kg and hour for >12 hours
Stage 3- x3 creatinine level <0.3ml/kg/hour for >24 hours
List 5 causes of AKI
Pre renal- hypovolameia, shock, renal artery stenosis
Renal- acute tubular necrosis, acute interstitial necrosis, glomerulonephritis, haemolytic uraemia syndrome. Tumour lysis syndrome, rhbdomyolysis
Post renal- BPH, obstruction (renal stone), tumour
What ECG changes may you see in AKI
Hyperkalaemia
Causes of CKD
Diabetes HTN Nephritic and nephrotic syndromes Obstructive uropathy Infections SLE/RA medications
What investigations may you do in CKD
eGFR
Urine dipstick
Renal ultrasound
What is the management in CKD
Slow progression of disease- diabetic and hypertensive control
Reduce CVS risk
Exercise, stop smoking
Special diet (low sodium, protein, potassium)
What is the most common malignancy in men 20-30
Testicular cancer
Where does testicular cancer metastasise to
Lungs
Lymph nodes of chest
Pelvis
Base of neck
List 4 types of testicular cancer
Seminomas- central nuclei, clear cytoplasm, surrounded by lymphocytes
Teratomas-
Yolk sac- Schiller duval bodies
Choriocarcinoma- cause frequent bleeding, secrete high level of b HCG
What is 1st line Ix for testicular cancer
Scrotal uss
What is the commonest kidney cancer of childhood
Wilms tumour
Sx of kidney cancer
Hameaturia
Flank pain
Palpable abdo mass
What occasion can result in a high PSA level
Prostate cancer BPH Prostatitis UTI Exercise Recent ejaculation
Storage Sx of LUTs
Frequency
Urgency
Nocturia
Dysuria
Voiding Sx of LUTs
Straining
Hesitancy
Incomplete emptying
Poor stream
Management of ED
Cx- lose weight, stop smoking, education and counselling of patient and partner
Rx-
1st line- phosphodiesterase inhibitors- sildenafil
2nd line- intra cavernous injections/ vacuum devices
3rd line- penile prosthesis implantation
Rf for Ed
Smoking
Obesity
Dm
Lack of exercise
Triad of Sx in urethritis
Dysuria
Urethral discharges
Urethral puritis
1st line tx for pyelonephritis
Cefalexin
What is the triad associated with pyelonephritis
N+v
Loin pain
Fever
Which cancers spread to bone
Lung Kidney Prostate Thyroid Breast
What is gs ix for varicocele
Ultrasound with Doppler imaging
Where does the right renal vein drain into
IVC
1st line tx for Goodpastures
Oral prednisalone
1st line tx for minimal change
Corticosteroids
Causes of FSGN
Idiopathic Secondary to renal pathology HIV- viral infections Obesity Sickle cell Alports Heroin lithium
Commonest cause of glomerulonephritis worldwide
IgA nephropathy
Is membranous nephropathy a nephritic or nephrotic syndrome
Nephrotic-
Idiopathic- anti M type phospholipase A2 antibody associated Autoimmune Hep b and c Gold lithium Sarcoidosis
Most common type of PKD
Autosomal dominant PKD type 1
Where is the mutation found for
A- ADPKD type 1
B- ADPKD type 2
Chromosome 16
Chromosome 4
What gene is found to be defected in ARPKD
Fibrocystin
Sx of PKD
Renal cysts HTN Hamaturia Abdominal/flank pain Headaches Cyst in liver and pancreas Berry aneurysms Murmurs
1st line Ix for PKD
Renal ultrasound
What drug can slow down disease progression in PKD
Tolvaptan (vasopressin receptor 2 antagonist)
What advice should be give to this with diagnosed chlamydia and gonorrhoea
Abstain from sex for 7 days
Refer to GUM for contact tracing and informing sexual partners
Advice on safe sex
Test and treat for any other STIs
What condition is associated with hydroceles and may require surgery
Inguinal hernias
