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Nephro 2 Flashcards

1
Q

How would you investigate a testicular lump?

A

Testicular lump = cancer until proven otherwise

  • can you get above it?
  • is it separate from the testis?
  • cystic or solid?

Cannot get above - inguinoscrotal hernia

Separate and cystic - epididymal cyst

Separate and solid - epididymitis or varicocele

Testicular and cystic - hydrocele

testicular and solid - tumour , haematocele

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2
Q

What is an Epididymal cyst?

A

smooth, extratesticular, spherical cyst on head of the epididymis

develops around 40

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3
Q

How would an epididymal cyst present?

A

often multiple and bilateral
asymp until large
well defined and will transluminate since fluid-filled

testis palpable separately from cyst

scrotal USS investigation

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4
Q

How would you treat an epididymal cyst?

A

none needed

if painful then surgical excision

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5
Q

What is a primary hydrocele? Whom do you normally see it in?

A

Abnormal collection of fluid within the tunica vaginalis

more common in younger men

assoc. with patent processus vaginalis

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6
Q

What are causes of secondary hydroceles?

A

older boys and older men

testis tumour
trauma
infection
TB
testicular torsion
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7
Q

How does a hydrocele present? How would you investigate?

A

scrotal enlargement with a non-tender smooth cystic swelling

no pain unless infected

usually clinical or USS

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8
Q

What is a varicocele? Whom do you normally see it in?

A

abnormal dilation of the testicular veins in pampiniform venomous plexus - caused by venous reflux

usually around 40 y/o

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9
Q

How does a varicocele present?

A

Often visible as distended scrotal blood vessels - bag of worms

Dull ache or scrotal heaviness

scrotum hangs lower on the side of the varicocele

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10
Q

How would you investigate varicocele?

A

scrotal USS
semen analysis
serum FSH

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11
Q

What is testicular torsion? How urgent is treatment needed?

A

torsion of spermatic cord resulting in occlusion of testicular blood vessels = ischaemia and infarct

Typically neonates or post-pubertal boys 11-30

surgery <6 hrs salvage rate is 90-100%

> 24 hrs 0-10%

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12
Q

How does testicular torsion present? What treatment is needed?

A

Any boy presenting with abdo pain - check testis

Sudden onset pain in one testis

testis - very tender, hot and swollen

emergency scrotal exploration - manual detorsion

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13
Q

What are some causes of acute urinary retention?

A 
Prostatic obstruction
Urethral strictures
Anti-cholinergics
Alcohol
Constipation
Post-op
Infection
Neurological
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14
Q

What examinations would you carry out in a presentation of acute urinary retention?

A

Abdomen exam

Prostate exam (DRE)

Perineal sensation (check for cauda equina)

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15
Q

What investigations would you do for acute urinary retention? management?

A

normal renal biochem

renal USS

PSA - for BPH/prostate cancer

Manage - catheter, Tamsulosin (alpha-1 blocker, relaxes smooth muscle neck to aid voiding)

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16
Q

What are some causes/RFs of chronic urine retention?

A

Prostatic enlargement

Pelvic malignancy or rectal surgery

Diabetes

low pressure - detrusor failure

high pressure - interactive obstructive uropathy

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17
Q

How would chronic urinary retention present?

A

Overflow incontinence

Loss of appetite

Constipation

Distended abdomen

UTI

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18
Q

What is the function of the prostate?

A

secretes 70% of the volume of seminal fluid and is hormone dependent

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19
Q

How does BPH present?

A 
Nocturia
Frequency
Urgency
Post-micturition dribbling
Poor stream/flow
Hesitancy
haematuria
Bladder stones
Abdo exam = enlarged bladder
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20
Q

How would you investigate BPH?

A

PSA
Urinalysis
International Prostate Symptom score

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21
Q

Treatment of BPH?

A

Watchful waiting
Alpha-blocker - Tamsulosin

5-alpha-reductase inhibitor - finasteride

Phosphodiesterase-5 inhibitor - sildenafil

Anticholinergic - tolterodine

TURP - transurethral resection of prostate

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22
Q

What some characteristics of Renal Cell Carcinoma?

A

Also known as hypernephroma/Grawitz tumour

Arises from proximal convoluted tubular epithelium

Most common renal tumour in adults

Usually after 50 y/o

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23
Q

What are risk factors for RCC?

A 
Smoking 
Obesity
Hypertension
Renal failure
PKD
Von Hippel Lindau syndrome
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24
Q

Presentation of RCC?

A 
Asymp
haematuria, loin/flank pain
anorexia, malaise and weight loss
can cause varicocele
hypertension
anaemia (erythropoietin suppression)
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25
How would you investigate RCC?
lactate dehydrogenase - poor prognostic marker corrected calcium - poor prognostic marker LFTs - if deranged may indicate metastases Abdo USS Abdo/Pelvis CT
26
Treatment for RCC?
surgery interleukin-2 and interferon alpha
27
What are some characteristics of bladder cancer?
type of transitional cell carcinoma calyces, renal pelvis, ureter, bladder and urethra are ALL lined by transitional epithelium more common in males, peaks in 8th decade
28
What are some risk factors for bladder cancer?
Smoking Occupational exposure - beta-napthylamine, benzidine, workers in petroleum, chemical, cable and rubber industries Drugs - phenacetin and cyclophosphamide Schistomiasis
29
What are presentations of bladder cancer?
Painless haematuria - over 40 always assume it is tumour Recurrent UTIs Voiding irritability
30
How would you investigate bladder cancer?
urine cytology - positive in 90% of patients with carcinoma, sterile pyuria Renal and bladder USS Cystoscopy Intravenous urogram FBC Alk Phos
31
Treatment for bladder cancer?
Transurethral resection - non-invasive Radical or partial cystectomy - locally invasive tumour Intravesical chemo - mitomycin, cisplastin
32
What type of cancer is prostate carcinoma? Most common metastases?
Adenocarcinomas - in peripheral zone of prostate Common metastases - bone and lymph nodes
33
Risk factors for prostate cancer?
Increases testosterone Family Hx Black
34
How does prostate carcinoma present?
All BPH symps Weight loss Bone pain Anaemia
35
How would you investigate prostate carcinoma?
DRE - hard, irregular prostate PSA Transrectal USS & Prostate biopsy
36
How would you treat prostate carcinoma?
Bracytherapy - transperineal impnat - radioactive source into prostate gland External-beam radiotherapy Radical prostatectomy and lymph node dissection
37
What are the characteristics of testicular tumours?
15-44 y/old 96% from germ cells - seminomas 25-40 and 60 y/o, teratomas -infancy 4% non-germ cells - Leydig, Sertoli, sarcomas
38
What are risk factors for testicular tumours?
Undescended testis Infant hernia Infertility Family Hx
39
How does a testicular tumour present?
Painless lump in the testicle Testicular pain Hydrocele Cough and dyspnoea Back pain Abdo mass
40
How would you investigate a testicular tumour?
USS CT scan Serum beta-human chorionic gonadotrophin - elevated in choriocarcinoma Serum AFP - elevated in embryonal, teratoma, yolk sac tumours or combined tumours Serum lactate dehydrogenase Serum LDH - elevated in 50% of cases
41
How would you treat testicular tumours?
Radical orchiectomy External beam radiation post orchiectomy
42
What organisms normally cause UTIs?
KEEPS ``` Klebsiella E.coli (most common) Enterococci Proteus Staphylococcus ```
43
Risk factors for UTI?
``` Female Sex Pregnancy Menopause Decrease in host defence Urinary tract obstruction Catheter ```
44
What is pyelonephritis?
Infection of the renal parenchyma and soft tissues or renal pelvis and upper ureter
45
How does pyelonephritis present?
TRIAD : loin pain, fever and pyuria Rigors Significant bacteriria Malaise, nausea, vomiting Oliguria
46
Investigations of pyelonephritis?
``` Urinalysis Gram stain Urine culture FBC ESR & CRP Blood culture ```
47
Treatment for pyelonephritis?
Ciprofloxacin Ceftriaxone Cranberry juice Analgesia
48
RFs for Cystitis?
Women/children Urinary obstruction Previous damage to bladder Bladder stones Poor bladder emptying
49
Presentation of cystitis?
``` dysuria frequency urgency suprapubic pain haematuria offensive smelling/cloudy urine ```
50
Investigations for cystitis?
MC&S of sterile mid-stream urine Dipstick
51
Treatment for cystitis?
Trimethoprim Ciprofloxacin
52
Risk factors for prostatitis?
Streptococcus faecalis ``` E.coli Chlamydia STI Indwelling catheter Post-biopsy Increasing age ```
53
How would prostatitis present?
Systemically unwell Fevers, rigor, malaise Pain on ejaculation Significant voiding issues - poor intermittent stream, hesitancy, incomplete emptying
54
How would you investigate prostatitis?
DRE - prostate is tender or hot to touch Hard from calcification Urine dipstick Mid-stream MC&S Blood cultures
55
How would you treat prostatitis?
Gentamicin + Co-amoxiclav + IV tazocin TRUSS guided abscess drainage if necessary
56
What are causes/RFs for urethritis?
Normally sexually acquired disease ``` Neisseria gonorrhoea Chlamydia Trichomonas vaginalis Trauma Urethral stricture Urinary calculi Unprotected sex Male to male sex ```
57
Presentation of urethritis?
``` Asymp Dysuria Urethral pain Penile discomfort Skin lesions ```
58
Investigation of urethritis?
Nucleic acid amplification test (NAAT) - female (self-collected vaginal swab) male (first void volume) Microscopy of gram-stained smears Blood cultures Urine dipstick Urethral smear
59
Indications for dialysis? Long term and short
``` Short - AEIOU Acidosis Electrolyte (unresponsive hyperkalaemia) Intoxication (overdose) Oedema (severe unresponsive pulm oedema) Uraemia symps (seizures, reduced consciousness) ``` Long - end stage renal failure
60
Types of peritoneal dialysis? complications?
Continuous Ambulatory Peritoneal Dialysis - dialysis solution in peritoneum at all times Automated - dialysis overnight (8-10 hrs) peritonitis, peritoneal sclerosis, ultrafiltration failure, weight gain, psychosocial
61
What is haemodialysis? What is needed? Complications?
Blood filtered by machine - from 4hrs a day to 3 days a week Need tunnelled cuffed catheter (infection) or arterior-venous fistula (aneurysm, infection, thrombosis, stenosis, STEAL syndrome)

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