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USMLE Step 2 - Top 5% > Nephrology & Urology 🫘 > Flashcards

Nephrology & Urology 🫘 Flashcards

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USMLE® Step 1 flashcards
1
Q

Patient needs fluids
No symptoms, except mild ortho static hypotension
How much?

A

2-4 L within 24 hours

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2
Q

Patient needs fluids
Patient is in pre shock
How much?

A

4-6 L within 24 hours

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3
Q

Patient needs fluids
Patient in shock
How much?

A

6-10L in 24 hours (1-2 L given at first and continue until stable)

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4
Q

When is HCO3 given

A

Severe acidosis (pH < 7.2) or (<7 in DKA)

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5
Q

Dextrose use?

A

To hydrate not resus

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6
Q

Hypernatremia algorithm, first question.

A

Urine Osmolality (<300 or >600)

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7
Q

Main DDX for patients with low urine osm and hypernatremia

A

DI (central and Nephrogenic)

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8
Q

How to Diff against central and nephrogenic DI

A

Give desmopressin

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9
Q

Next thing to check if hypernatremic patient has high urine osmolality

A

Check urine Na (high when taking in hypertonic saline, low when patient just losing fluids)

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10
Q

Rather than hyperNa algorithm, if patient presents with polyuria, how to do we invx

A

Water deprivation then desmopressin (DDX polydipsia, DI)

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11
Q

Central DI Mx

A

Desmopressin

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12
Q

Nephrogenic DI mx

A

Thiazide

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13
Q

When treating hyperna, what is the main thing we need to know

A

Volume status

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14
Q

Hypvolemic patient with hyperna, regardless of stability. How to Mx

A

Isotonic NaCl

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15
Q

Euvolemic patient with hyperna. How to Mx

A

D5W, or 0.45% NaCl

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16
Q

Hypervolemic hypernatremia Mx

A

D5W and diuretic combo

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17
Q

How to determine how much fluids needed in 24 hours in hyperna

A

(0.5 * weight) * (Na/140 - 1)

Second part of equation is sort of “excess Na”

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18
Q

Hyponatremia causing coma, siezure, usually occurs at what number

A

<120

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19
Q

Hyponatremia patient. Best initial test?

A

Serum osmolality

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20
Q

Hyponatremia and hypertonic serum osm. What’s going on here? What should we measure?

A

Likely another osmole. Measure glucose to rule out hyperglycaemia

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21
Q

Hyponatremia and isotonic serum osm. What’s going on here? What should we measure?

A

Like a pseudohyponatremia. Where lipids and proteins shift water in EC space. Measure lipids, Proteins. Don’t give Na

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22
Q

Hyponatremia and hypotonic serum osm. Assess what next

A

Volume status

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23
Q

Hyponatremia and hypotonic serum osm. And hypovolemic. Assess what?

A

FeNa

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24
Q

Hyponatremia and hypotonic serum osm. And hypovolemic. FeNa <1%. Causes

A

Losses of Na and water, not from kidney. Diahrrea, burns, third spacing (rarely as more hypervolemia)

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25
Q

Hyponatremia and hypotonic serum osm. And hypovolemic. FeNa >2%. Causes

A

Na and water loss renally. Diuretics, RTA, adrenal insuff

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26
Q

Hyponatremia and hypotonic serum osm. And euvolemic. Assess what?

A

Urine osmolality

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27
Q

Hyponatremia and hypotonic serum osm. And euvolemic. Urine osmolality above 100

A

SIADH (or hypothyroidism or GC deficiency = both cause high ADH)

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28
Q

Hyponatremia and hypotonic serum osm. And euvolemic. Urine osmolality below 100

A

Primary polydipsia, beer drinker

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29
Q

Hyponatremia and hypotonic serum osm. And hypervolemic. Measure what?

A

FeNa

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30
Q

Hyponatremia and hypotonic serum osm. And hypervolemic. FeNa < 1%. Causes and explanation

A

Proper low IV volume patients, will have higher ADH which causes low Na. Cirrhosis, CHF, nephrotic

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31
Q

Hyponatremia and hypotonic serum osm. And hypervolemic. FeNa > 2%. Causes

A

AKI and CKD

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32
Q

Main Tx of hyponatremia

A

0.9% NaCl

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33
Q

When consider hypertonic fluids for hyponatremia

A

If Na < 120/has seizures

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34
Q

Tx for hypovolemic hyponatremia.

A

0.9% NaCl

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35
Q

Risk of hypernatremia when treating hypovolemic hyponatremia. Tx of it?

A

As the patient becomes euvolemic, ADH rises and excretes free water only, causing hypernatremia. Give a little desmo if this occurs

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36
Q

Euvolemic hyponatremia Tx

A

Fluid restriction (usually an increased ADH case). Can do NaCl tablets/hypertonic fluids, loops if doesn’t work

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37
Q

Hypervolemic hyponatremia Tx

A

Fluid restriction (+- loops, ACEi). Cause of hyponat is likely due to fluids

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38
Q

SIADH specific Mx

A

Democlocylcine (NS worsens it)

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39
Q

Causes of hyperK

A

Hemolysis, ACEi, any kidney injury, TIV RTA, spirinolactone, insulin def, Beta blocker, DKA, digoxin, foods

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40
Q

Careful when correcting chronic hyponatremia?

A

Do > 72 hour duration. To avoid osmotic demyelination

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41
Q

Invx for suspected hyperkalemia

A

Repeat blood draw. Then ECG

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42
Q

If K above 6.5 or ECG changes. Initial Tx, and other follow up?

A

Ca Gluconate. Give insulin and glucose, B agonist, +- bicarb.

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43
Q

Tx if hyperkalemia, mild and no ECG changes

A

Patiromer, polysterene (kayexalate), loops, IV saline (if hypovolemic)

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44
Q

Tx for patients with CKD and hyperkalemia

A

Dialysis

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45
Q

Causers of hypokalemia

A

Insulin, B agonist, alkalosis, GI losses, loop, thiazide, 2° hyperaldosteronism, Barter/Gitelman, TII & I RTA, hypoMg, DKA Tx

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46
Q

Some stuff to Invx in hypokalemia

A

24 hour urine potassium and Cl. ABG. ECG. If HTN check aldosterone. Mg too

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47
Q

Mx for Barter and Gitelman

A

NaCl, KCl, Mg, spirinolactone for life,

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48
Q

Tx for hypokalemia

A

Oral potassium. IV potassium can cause phlebitis, only give for symptomatic hypokalaemia for ECG changes

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49
Q

Consider which other electrolyte when treating hypokalaemia

A

Magnesium

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50
Q

Main causes of hypercalcaemia

A

Primary and tertiary hyper parathyroidism, malignancy, milk alkali, high vitamin D, granulomatous diseases, supplementation, thiazides

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51
Q

I’m Best initial tests for high calcium.

A

Total and ionised calcium, albumin, phosphate, PTH

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52
Q

Other tests to order when determining hypercalcaemia

A

Vitamin D, PTHRP, ACE, ECG, protein electrophoresis

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53
Q

Treatment of calcium should be done in what circumstances

A

If more than 14 and or symptomatic

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54
Q

Calcium of more than 14, how to treat

A

Isotonic IV fluids plus or furosemide. And calcitonin. Bisphosphonate can also be given

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55
Q

Causes of hypocalcaemia

A

Hypo parathyroidism, secondary hyperparathyroidism, vitamin D deficiency, malnutrition, pancreatitis, blood products (Citrate 💪), hypomagnesaemia

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56
Q

Best tests for hypocalcaemia

A

Calcium and PTH

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57
Q

Aside from calcium and PTH, which of the tests should be ordered for hypocalcaemia

A

Magnesium albumin vitamin D buen and creatinine and ALP (depending on the circumstance)

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58
Q

Common scenario in patients with thyroid surgery, relating to calcium

A

Post thyroidectomy patient getting hypocalcaemia signs, from iatrogenic removal of the parathyroid gland

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59
Q

Treatment of hypocalcaemia

A

Treat underline disorder, oral calcium supplement, or IV if severe symptoms. Ensure magnesium repletion

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60
Q

Common populations to have low magnesium

A

Alcoholics, PPI patience, diuretics, malnutrition, TPN, diarrhoea and vomiting

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61
Q

How does low low magnesium affect calcium and potassium

A

Causes low calcium and potassium

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62
Q

Treatment for low magnesium

A

Oral or IV supplements depending on severity.

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63
Q

Timeframe for AKI Dx

A

Renal function decreasing in less than three months

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64
Q

Type A versus type B lactic acidosis

A

Type A: Tissue hypoxia

Type B: Decrease lactate clearance,

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65
Q

Bicarb is given to patients with metabolic acidosis, except which cause

A

Lactic acidosis

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66
Q

Guess the RTA.

A high urine pH, patient has history of SLE, patient has nephrolithiasis and a metabolic acidosis. Potassium is low

A

Type one (distal)

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67
Q

Guess the RTA.

Patient has metabolic acidosis, low potassium previously high urinary pH now becoming low.

A

Type two (Proximal

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68
Q

Guess the RTA.

Patient with Ricketts, severe low phosphate, High urinary pH, low serum potassium.

A

Patient has type two RTA, seen in Fanconi syndrome

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69
Q

Guess the RTA.

A metabolic acidosis, high potassium, patient is on spironolactone, urinary pH high or low

A

Type four

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70
Q

How to treat type one RTA

A

Potassium bicarb

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71
Q

How to treat type 2RTA

A

Sodium and potassium bicarb

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72
Q

Best treatment for chronic kidney disease patients to decrease the progression of the disease

A

ACE inhibitors or ARB

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73
Q

General treatment and management for chronic kidney disease patients

A

ACEI, EPO, phosphate binders, calcitriol, potassium restriction, supportive dietary management for fluids sodium potassium and phosphate

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74
Q

AKI. Stage one?


A

Creatinine up 50%, GFR down 25%, urine output less than 0.5 and six hours

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75
Q

AKI. Stage two?

A

Creatinine up 100%, GFR down 50%, urine output less than 0.5 in 12 hours

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76
Q

AKI . Stage three?

A

Creatinine up 200 percent, GFR down 75%, anuria for less than 12 hours

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77
Q

AKI. Stage four?

A

Complete loss of kidney function for more than a month

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78
Q

AKI. Stage five?

A

Complete loss of kidney function for less than three months

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79
Q

Treatment for prerenal AKI, and exceptions to this?

A

Fluid replacement, except for a hepato Renal, nephrotic syndrome, congestive heart failure

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80
Q

Treatment and management for post renal AKI

A

Urgent BladderScan and catheter to relieve any obstruction

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81
Q

Acute tubular necrosis, patient is asymptomatic with mild orthostatic hypotension. What is the management

A

Patient has mild fluid depletion, and is in oliguric phase of ATN. Replace 2 to 4 L within 24 hours

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82
Q

Patient with acute tubular necrosis. Patient has high heart rate normal blood pressure, and moderate high lactic acid. How to manage

A

Patient is in pre-shock, in oliguric phase of acute tubular necrosis. Replace 4-5 L within 24 hours

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83
Q

Patient with acute tubular necrosis has cool clammy hands, tachycardia, hypotension, lactic acidosis, mental status impairment. How to manage

A

Patient is in shock, secondary to the oliguric phase of acute tubular necrosis. Give 8 L within 24 hours. 1 to 2 of the litres should be given ASAP

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84
Q

Acute kidney injury, indications for dialysis

A

AEIOU

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85
Q

Long-term follow-up for AKI.

A

Evaluate patient at least yearly

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86
Q

Difference between ACR and PCR For protein collection

A

Albumin creatinine ratio has high sensitivity and can be done as a spot test. PCR is less sensitive and requires 24 hour collection

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87
Q

Patient has urine protein on urinalysis. Do what next

A

Repeat qualitative proteinuria testing

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88
Q

What is orthostatic proteinuria

A

An adolescent condition with benign proteinuria. Monitor periodically

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89
Q

After quantifying proteinuria, you find it’s more than 3 g. What does this point towards and what should we do

A

Points towards the glomerular disease, consider a biopsy

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90
Q

After quantifying proteins in proteinuria patience, you find it’s less than 3 g, it’s not pure albuminuria, and the monoclonal light chains on normal. What is a likely diagnosis

A

 Tubulointerstitial nephritis, explore autoimmune, allergy, medication et cetera

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91
Q

After quantifying proteinuria in proteinuria patient, you find it’s less than 3 g, and a protein immuno electrophoresis shows you it’s mainly albumin, what is a likely diagnosis

A

Glomerulosclerosis, for example diabetic nephropathy. Or could be a minimal change

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92
Q

What is overflow proteinuria

A

From too many proteins in the blood, seen in myeloma, HEMOLYSIS, rhabdomyolysis

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93
Q

What type of proteinuria is caused by UTIs, bladder cancer, nephrolithiasis

A

A post renal proteinuria, usually less than 1 g a day

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94
Q

Out of overflow, glomerular, tubulointerstitial, post renal, proteinuria Which usually have more than 3 g a day

A

Usually glomerular and overflow

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95
Q

Treatments for renal osteodystrophy in chronic kidney disease

A

 phosphate binders and calciminetics

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96
Q

How to treat metabolic acidosis in chronic kidney disease

A

Sodium bicarb

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97
Q

Treatment for anaemia in chronic kidney Disease

A

EPO

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98
Q

Diabetes patient, yearly exam shows GFR less than 60, dipstick haematuria negative. Patient reevaluated over three months later, GFR still less than 60, and ACR more than three. What’s your diagnosis

A

Chronic kidney disease

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99
Q

KDIGO, two categories to determine CKD

A

GFR and albuminuria

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100
Q

Ranges for A1 A2 A3, in the KDIGO staging of CKD

A

A1 = less than 30 mg

A2 = between 30 and 300 mg

A3 = above 300 mg

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101
Q

G1 to G5 Ranges, in the KDIGO staging of CKD (recall rule of 30, 15, 15, 15)

A

G1 = above 90

G2 = 60–89

G3A = 45–59

G3B = 30–44

G4 = 15–29

G5 = less than 15

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102
Q

Risk stratification for a patient with chronic kidney disease with G5 A2

A

Very high risk

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103
Q

Risk stratification in a patient with chronic kidney disease with G2 A2

A

Moderate-risk

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104
Q

Risk stratification for a chronic kidney disease patient with G4 A1

A

Very high

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105
Q

I risk stratification for a chronic kidney disease patient with G2 A1

A

Low risk

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106
Q

Risk stratification for a chronic kidney disease patient with G3A A2

A

High risk

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107
Q

Risk stratification for a chronic kidney disease patient with G2 A2

A

Moderate risk

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108
Q

Risk stratification for a chronic kidney disease patient with G1 A2

A

Moderate risk

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109
Q

Risk stratification for a chronic kidney disease patient with G1 A3

A

High risk

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110
Q

Risk stratification for a chronic kidney disease patient with G3B A1

A

High risk

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111
Q

Risk stratification for a chronic kidney disease patient with G3B A2

A

Very high risk

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112
Q

Risk stratification for a chronic kidney disease patient with G3A A3

A

Very high risk

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113
Q

Hypertensive patient with chronic kidney disease, first line treatment

A

ACE inhibitor

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114
Q

Patient with pruritus from uraemia, treatment

A

Antihistamine first generation

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115
Q

First line treatment for renal artery stenosis (medically and lifestyle)

A

Ace inhibitor and healthy eating/diet

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116
Q

 What is diabetic nephropathy screening

A

ACR, detecting micro albuminuria, Between 30 and 300 mg. Usually asymptomatic

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117
Q

Treatment for diabetic nephropathy

A

ACE inhibitors at first, then eventually may need dialysis/kidney transplant

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118
Q

Diagnosis Invx of nephritic syndrome

A

Do urinanalysis and renal biopsy

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119
Q

Treatment of post strep GN

A

Supportive, diuretics

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120
Q

Treatment of IGA GN

A

ACEI, glucocorticoids

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121
Q

Treatment of Wegners renal disease

A

High-dose corticosteroids, cytotoxic’s, or rituximab.

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122
Q

Treatment of microscopic polyangiitis

A

High-dose corticosteroids, cytotoxic’s, or rituximab.

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123
Q

Treatment of churg Strauss

A

High-dose corticosteroids, cytotoxic’s, or rituximab.

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124
Q

Treatment of good pastures

A

Plasma exchange, steroids, cyclo phosphide

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125
Q

Minimal change treatment

A

Steroids

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126
Q

Focal segmental glomerulosclerosis Tx

A

Prednisone, ACEI,

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127
Q

Treatment of membranous nephropathy

A

RAAS inhibition

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128
Q

Treatment for lupus Nephritis

A

Prednisone, or immuno surpression 

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129
Q

Treatment of membranoproliferative GN

A

Prednisone plus or minus immuno suppressant

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130
Q

Investigations for nephrotic syndrome

A

Urinanalysis, spot PCR, albumin and lipid blood test, renal biopsy

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131
Q

Which vaccine is needed in nephrotic syndrome and why

A

23 polyvalent pneumococcal vaccine, due to loss of Ig

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132
Q

After urinanalysis, what is the gold standard investigation to diagnose kidney stones

A

Non-contrast abdomen CT (KUB)

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133
Q

Aside from abdomen CT, which imaging is helpful to see progression/treatment of larger stones

A

X-ray

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134
Q

Medical therapy for calcium stones

A

Hydration, sodium restriction, thiazide diuretics. Consider citrate supplementation

135
Q

Ethylene glycol and RTA type one cause what stone type

A

Calcium stones

136
Q

Treatment (medically) for struvite stones

A

Hydration, antibiotics, but will most likely need surgical removal

137
Q

Medical therapy for uric acid stone

A

Hydration, Alkalinise urine, Allopurinol

138
Q

Medical therapy for cysteine stones

A

Hydration, sodium restriction, alkalinise urine, penicillinamine

139
Q

Child or pregnant woman with kidney stones. First line imaging

A

Ultrasound

140
Q

General medical therapy for all stones

A

Hydration, sodium restriction, analgesia, very often citrate

141
Q

Kidney stone below 5 mm, treatment

A

Pain control and medical therapy, no other intervention

142
Q

Kidney stone between 5–10 mm, therapy

A

The usuals. Alpha blocker or calcium channel blocker

143
Q

When do we do shockwave lithotripsy for kidney stones

A

Between 10–20 mm, and stone is in the kidney, not in ureter. Not for very hard stones or patients on anticoagulation

144
Q

When do we do semirigid ureteroscopy with laser fragmentation and basket extraction 

A

Usually stones between 10 to 20 mm, that are in the ureter, and patient can go home the same day

145
Q

When do we do Flexible ureteroscopy with laser fragmentation

A

When kidney stone is between 10 to 20 mm, and stone is in the kidney/renal pelvis. Likely when lithotripsy cannot be done

146
Q

When do we do percutaneous nephrolithotomy

A

Four stones above 20 mm, hard stones that cannot be accessed via flexible ureteroscopy, for staghorn calculi, or emergency cases

147
Q

First investigation for PKD

A

Ultrasound or CT

148
Q

Confirmatory investigation for PKD

A

Genetic testing, Although not necessary

149
Q

Blood pressure control in PKD

A

Ace inhibitor

150
Q

Why is tolvaptan used in PKD

A

ADH stimulates Cyst growth

151
Q

Investigations for hydronephrosis

A

Ultrasound first, CT to find potential cause

152
Q

Easiest and first test for UTI

A

Urine dipstick. Look for white blood cells and nitrates and leukocyte esterase

153
Q

You have just done a urine dipstick and you see leucocytes and nitrates, what is the next step

A

Is midstream urine sample, to identify pathogen

154
Q

If a patient has recurrent complicated UTIs, what is two investigations can we do

A

Ultrasound, x-ray KUB,

155
Q

In UTI investigation, if you suspect con commitment malignancy what investigation do you do

A

CT urogram

156
Q

When do we do a flexible cystoscopy in UTIs

A

Patients over 50 years old with haematuria

157
Q

Diagnosis/investigations/initial Mx for acute pyelonephritis (kinda the same for acute and chronic)

A

Midstream urine sample and culture, empirical antibiotics (3rd gen ceph), ultrasound, blood tests and cultures

158
Q

When do we worry about upper UTIs

A

Men, pregnant women, any child, any elderly, Frequent In women

159
Q

Management of acute pyelonephritis, say as much as you can

A

I admit the patient (if signs of sepsis or systemic symptoms). ABC approach. Gain IV access, collect blood samples, IV fluids and resus, Do urinanalysis, MSU. Give empiric Comoxiclav and IV aminoglycoside if severe. Antibiotics should be given for at least 24 hours and then converted to oral for two weeks.

160
Q

Investigation for vesicoureteral reflux

A

Micturating cystourethrogram, biopsy if evidence of scarring

161
Q

Grade 1–5, of vesicoureteral reflux

A

Grade one – reflux into ureter

Grade 2 – reflux into renal pelvis

Grade 3 – mild to moderate dilation of ureter, pelvis, calyx

Grade 4– Dilation of pelvis, and calyx with ureteral tortuosity

Grade 5 – gross dilation of whole calycal system and severe tortuosity

162
Q

Any prophylaxis we give to VUR patients?

A

Give prophylactic antibiotics.

163
Q

What indications are there for VUR surgery

A

If a patient on prophylactic antibiotics has a breakthrough febrile UTI. All patients can be considered for surgery anyway

164
Q

Follow-up management an investigation for VUR (given case when not doing surgical correction)

A

Monitor proteinuria, MSU, full blood count, blood pressure, ultrasound of kidney and bladder, cystogram every 1 to 2 years.

165
Q

List some investigations in a haematuria case

A

Urine dipstick (to detect the haematuria), renal function to get GFR, ACR or PCR, urine microscopy

166
Q

How to manage this patient? Less than 40 years old, hematuria, normal renal function no proteinuria and normotensive

A

No referral, just manage in primary care

167
Q

How to manage this patient? A patient who is above 60 with haematuria, and the background of UTI

A

Non-urgent referral

168
Q

Patient above 45, with unexplained haematuria (without UTI or persistent after treatment of UTI). How do you manage that patient

A

Urgent referral, within two weeks

169
Q

Patient above 60 with hematuria, and no UTI

A

Urgent referral, within two weeks

170
Q

Diagnosis of varicocoel

A

Doppler

171
Q

Management overview of varicocoel

A

Conservative, but do surgery if painful or big enough for fertility affected. Surgery includes surgical debride meant and embolisation

172
Q

Treatment of cryptorchidism

A

Orchidopexy at 6 to 18 months. If intra-abdominal, maybe do laparoscopy

173
Q

Diagnosis of hydrocele

A

Clinical diagnosis. Ultrasound done if there is doubt

174
Q

Management of infantile hydrocele

A

Watch and wait for the first two years, surgical correction after

175
Q

Management of adult hydrocele

A

Conservative approach if small and asymptomatic

176
Q

hematocele mx

A

Drainage or excision

177
Q

Investigations for epididymitis/orchitis

A

STI screening, MSU, urinanalysis, blood tests for mumps and HIV, urgent Doppler to rule out torsion

178
Q

Treatment of epididymitis/orchitis if secondary to STI

A

Doxy foxy

179
Q

Treatment of epididymitis/orchitis if secondary to UTI

A

Fluoroquinolone

180
Q

First investigation for testicular torsion

A

Ultrasound with Doppler

181
Q

Management for testicular torsion

A

Emergency orchidectomy and orchidopexy. Do orchidopexy on other testy to

182
Q

Paraphimosis management

A

Attempt manual retraction within three weeks, giving antibiotics and analgesics. If this fails do circumcision

183
Q

If a child has penile lichen sclerosis, how to manage:
If assymp
If symp
Step up
If therapy doesn’t work

A

No treatment
Topical steroids
Tacrolimus
Circumcision

184
Q

If urethra is involved in lichen sclerosis, what investigation must be done, and what treatments can be offered given that strictures have occurred

A

Cystourethroscopy to identify severity and location. If stricture has occurred must do dilation and direct visual internal urethrotomies

185
Q

Any follow-up needed for a patient with lichen sclerosus

A

Yes, yearly follow-up to check for squamous cell carcinoma

186
Q

Only treatment for phimosis

A

Circumcision

187
Q

Some investigations ideas for BPH

A

Urinanalysis, and culture to rule out infections and he materia. PSA. Bloods to rule out obstructive uropathy. And bladder ultrasound scan to assess hydronephrosis.

188
Q

Best initial therapy for BPH

A

Alpha blockers

189
Q

After alpha blockers, what is the next best treatment for BPH

A

Five alpha reductase inhibitors

190
Q

When do we do transurethral resection of the prostate

A

In patients with severe symptoms of BPH (renal problems, stones, UTI).
Not responsive to medical therapy

191
Q

When do we do a transrectal ultrasound in BPH

A

Before starting finasteride or TURP, we need to know the prostate volume

192
Q

PSA less than 4 versus PSA more than 10. What do we do?

A

Less than four do not biopsy. More than 10 biopsy

193
Q

Patient has PSA between 4–10, you calculate the free : total PSA, which is less than 25%. What do you do

A

Biopsy

194
Q

Most accurate test to diagnose prostate cancer

A

Ultrasound – guided transrectal biopsy

195
Q

Once diagnosed prostate cancer, which of the investigations do we need to do

A

CT abdomen pelvis, and bone scan. MRI also good (shereen)

196
Q

When do we watch and wait in prostate cancer

A

And if patients are low risk, Gleeson is 3+3, PSA less than 0.15, cancer is less than 50% of the biopsy,
Patients are elderly

197
Q

Patients with prostate cancer who have watch and wait/active surveillance, what is this

A

Core biopsies taken, and re-biopsy, with yearly DRE and imaging and 6 monthly PSA

198
Q

Treatment for bone pain in metastasis from prostate cancer

A

Radiation therapy

199
Q

List five conditions which you should wait at least seven days after the resolution of, before testing PSA

A

BPH, prostatitis, UTI, DRC, sexual intercourse, catheterisation

200
Q

Name a couple of therapies for prostate cancer

A

Brachyherapy (radioactive pellets injected into prostate), radiotherapy, da Vinci robotic prostatectomy

201
Q

Do we screen for Bladder cancer

A

No

202
Q

How to diagnose bladder cancer

A

Cystoscopy with biopsy

203
Q

What imaging is needed for staging of bladder cancer

A

CT, or MRI

204
Q

Treatment for bladder carcinoma in situ

A

Intravesicular chemo therapy

205
Q

Treatment for non-muscle invading bladder cancer, that is low risk

A

Transurethral resection, then mitomycin and surveillance for six months

206
Q

Treatment for non-muscle invading bladder cancer, that is intermediate risk

A

Transurethral resection, mitomycin and BCG and surveillance for three months

207
Q

Treatment for non-muscle invading bladder cancer, that is high risk

A

Resect and BCG, and considered radical cystectomy

208
Q

Treatment for muscle invading bladder cancer

A

Radical cystectomy, or radiotherapy alone for patients who are poor candidates for surgery, note this is the worst survival

209
Q

Treatment for invasive bladder cancer with distant metastasis

A

Chemotherapy alone, consider this palliative

210
Q

Use of Bosniak classification

A

To assess if a renal cyst needs a CT to rule out cancer.
It takes into account wall septation, calcification and enhancement

211
Q

Best imaging investigation for renal cell carcinoma. How to confirm diagnosis

A

CT, then Histology on nephrectomy specimen

212
Q

Stage one renal cancer

A

Less than 7 cm

213
Q

Stage two renal cancer

A

More than 7 cm

214
Q

Stage three renal carcinoma

A

Tumour spread into renal vein/IVC

215
Q

Stage 4 renal cell carcinoma

A

Haematogenous spread

216
Q

Small RCC Mx (and when to do active surveillance)

A

Active surveillance if: elderly/frail (CI for Sx), <4cm (stage 1 only), slow growth
Cryotherapy if above not applicable

217
Q

Indications for when to do Partial nephrectomy for RCC

A

Mass less than 4-6 cm, patient has one kidney, or diseased kidneys, if tumour bilateral, (all makes sense )

218
Q

Indication for radical nephrectomy for RCC

A

Large tumours, or inaccessible tumours

219
Q

Aside from surgery, good Tx for RCC

A

Tyr kinase inhibitors, (not radio or chemo)

220
Q

First invx for testicular mass

A

US (don’t biopsy!)

221
Q

Seminoma localised to teste. Mx!

A

sperm bank visit. radical orchiectomy and Radiotherapy!

222
Q

Non seminoma CA localised to teste, mx

A

Sperm bank visit. Radical orchiectomy, LN dissec and BEP

223
Q

What is testicular microlithiasis

A

Calcified stones on teste, can mimic cancer

224
Q

Who should have a contralateral teste biopsy, if germ cell CA diagnosed

A

If <40, and small contralateral teste

225
Q

LDH is not sensitive or specific for any teste cancer, but does indicate what

A

Px

226
Q

Teste cancer with abdominal mets. Mx?

A

Radical inguinal orchidectomy and chemo. BEP too

227
Q

Pulmonary mets in Teste CA. Mx?

A

Chemo prior to radical inguinal orchidectomy

228
Q

Invx for acute urinary retention syndrome

A

UA, urea/Cr, FBC, bladder US to confirm. Not PSA (falsely elevated)

229
Q

Mx and for acute retention syndrome. What confirms the Dx (ml wise)

A

Catheter to decompress.
Vol > 400ml confirms Dx. <200 means not ARS. Between = clinical judgment

230
Q

Mx for ureteral stenosis. And specifically at the UPJ

A

Stenting, and pyeloplasty if at UPJ

231
Q

Time to appreciate KDIGO

A
232
Q

Polycystic kidney disease diagnostic requirement in a less than 30-year-old

A

Two cysts total can be on the same kidney or on each kidney

233
Q

Polycystic kidney disease, diagnostic requirement for patients aged 30 to 59

A

Need to do more cysts on each kidney. So four or more cysts in total

234
Q

Diagnostic requirement for polycystic kidney disease, in patients 60 years or above

A

At least four cysts on each kidney. So a total of eight cysts or more

235
Q

Management for most cases of HUS

A

Support of management; fluids, antihypertensives.

Plasma exchange only in severe cases with no diarrhoea

Haemodialysis impatience with AKI

236
Q

The nice guidelines for fluid. How many mils per kilogram per day of water does a patient need

A

25 to 30 mls

237
Q

According to nice, how much potassium, sodium, chloride is needed a day

A

1 MMOL/kg/day… Not what the doctor said

238
Q

When does a patient have to stop taking Metformin in chronic kidney disease

A

When the GFR is below 30. But below 45 you should be cautious

239
Q

Which screening test is used for polycystic kidney disease suspicion

A

Ultrasound

240
Q

Patient 45 or above with unexplained hematuria without a UTI, or persistent after UTI treatment. What referral do we do

A

Urgent referral

241
Q

Patient with chronic kidney disease, I want to do a contrast enhanced CT (of the lungs for example) what measures can we take to protect this patient

A

IV hydration before an after contrast infusion

242
Q

Management off mild/moderate hypokalaemia (2.5–3.4) And no ECG findings

A

Oral potassium

243
Q

Severe hypokalaemia management (less than 2.5) or symptomatic and ECG changes

A

Cardiac monitoring, potassium chloride in saline IV

244
Q

2 variations of fluid therapy

A

Replacement and maintenance

245
Q

Maintenance therapy requirements

A

2 L of fluid, 2 mmol per kilogram of sodium, 0.5 mmol per kilogram of potassium, 50 to 100 g of glucose

246
Q

Example of good maintenance fluid regime

A

1 L saline, 1 L 5% dextrose, 20 minimal potassium chloride

247
Q

When considering fluid replacement therapy what is the most important question to ask

A

Volume status

248
Q

case of testicular torsion. how to Mx

A

book for surgical exploration… dont do US with doppler if it would delay time. (time is gonad)

249
Q

Renal replacement indications

A
  1. Uraemic pericarditis
  2. Pulmonary oedema unresponsive to diuretic treatment
  3. Severe Hyperkalaemia
  4. Severe Acidosis
  5. Uraemic encephalopathy
250
Q

Definition of AKI

A

Rise in serum creatinine >0.3mg/dl from
baseline within 48hrs. Or ↑ serum creatinine 1.5x from baseline, or urine output <0.5ml/kg for >6 hours

251
Q

How much Na and K does a patient need per day?

A

150 of Na, 40 of K

252
Q

Max decrease in Na per day in a hypernatremic patient?

A

around 10mmol

253
Q

how to calculate fluid admin per day in chronic hypernat

A

first calc water deficit (like acute). Then calculate how much Na needs to be decreased by. (patient Na - 140). Since Na can only be decreased by 10 max, per day, you can calc how many days it takes to get to 140. Then calc volume/no. of days

254
Q

Two Mx options for patient with renal stone who get hydronephrosis?

A

JJ stent or percutaneous nephrostomy

255
Q

VUR patient, less than 1 years old. When to give prophlx ABx?

A

Give when the patient has grade 3-5 hydroneph. Be careful to give Abx in this age

256
Q

When to do Sx for VUR?

A

Best way to prevent UTI. Give in all patients who have breakthrough UTI despite ABx prophlx

257
Q

Prior to prostate CA biopsy, what is the best invx?

A

MRI

258
Q

After acute urinary retention…. Post obstructuve diuresis Mx?

A

IV fluids. Recall pathogenesis of the diuresis

259
Q

If patient with paraphimosis comes in with evidence of strangulation…how to Mx?

A

Ice, needle decompression, and inject hyaluronidase, analgesia. Refer for circumcision

260
Q

Initial tests for epidydmo-orchitis? Consider if above or below 35

A

US to rule out torsion. MSU and culture for above 35 (likely uti), and first void urine if below 35 (likely STD).

261
Q

Tx of epidydmoorchitis (if uti or std)

A

Analgesia and scrotal support…
STD: doxy foxy (azythromycin if neisseria)
UTI: -floxacin
Followup in 2 weeks

262
Q

Lord and Jaboulay repair are used for what

A

Hydrocele Tx (if large/symptomatic)

263
Q

What is the rule for correcting sodium levels in a patient with hyperglycaemia above 200

A

For every 100 mg/dL Above 200 of glucose, add a 1.6 to the sodium. For example a patient with 133 sodium and 400 glucose, is actually around 136 sodium

264
Q

When do you actually give hypertonic saline for a patient who has hyponatraemia

A

If the sodium is less than 120, and all the patient has seizures

265
Q

What are the contraindications for giving potassium for hypokalaemia

A

Illyus, bowel obstruction, ischaemic gut or pancreatic transplant 

266
Q

Can acromegaly, adrenal insufficiency, Zollinger Ellison cause hypercalcaemia

A

The answer is yes

267
Q

How much does calcium full body for every one decrease in albumin below 4

A

0.8

268
Q

Treatment of a patient with calcium above 14

A

IV fluids (isotonic). Can also give Luke diuretics to. Calcitonin and bisphosphonate should be considered

269
Q

Patient has serum calcium between 12 and 14, and is asymptomatic. What kind of treatment regime are you doing

A

They don’t require emergency treatment, but can give fluids or loops if you want

270
Q

Most accurate test for hypercalcaemia And other lab tests we can do

A

Ionised calcium and PTH. Other labs include magnesium, albumin, vitamin D, and consider LP, BUN, creatinine

271
Q

How to prevent contrast nephropathy

A

IV fluids or a non-ionic contrast agent

272
Q

Definition of chronic kidney disease

A

GFR less than 60 (less than 90 in children) for more than three months regardless of course

273
Q

What is the unique GFR definition for chronic kidney disease in children. And what is the most common cause of chronic kidney disease in children

A

GFR must be less than 90. And congenital abnormalities is the most common cause

274
Q

Went to give statins to patients with chronic kidney disease

A

If they are above 50. Or if they’re both 18 and they have a coronary artery disease, diabetes, prior stroke

275
Q

Patience with GFR is less than 30 and chronic kidney disease, what should the nephrologist start doing

A

Education should be started regarding renal replacement therapy and an AV fistula should be considered

276
Q

Can cholesterol emboli cause nephritic syndrome

A

Yes. And C3 and C4 is low

277
Q

General treatment for nephritic syndrome

A

AAS blockade, salt restriction, treat any hypertension, often glucocorticoids with another immuno suppressant

278
Q

What is the cut off from the nephrotic syndrome Regarding protein to creatinine ratio

A

Two

279
Q

General overview of treatment for nephrotic syndrome

A

RAAS blockade, statins, steroids with another immuno suppressant, ace inhibitors, and vaccinate with 23 PPV

280
Q

Gold standard for diagnosing kidney stones

A

Non-contrast abdominal CT

281
Q

Best test for imaging for kidney stones in pregnant women and children

A

Ultrasound

282
Q

First aid algorithm for kidney stone treatment (surgical/urological approach)

A
283
Q

Why is it important to manage UTIs quickly in PCKD patience

A

To prevent renal cyst infection

284
Q

What is an unusual vascular cause of hydronephrosis

A

Aortic

285
Q

Neurogenic bladder treatment

A

Clean intermittent catheterisation regime

286
Q

Urinary tract obstruction treatment

A

Stent. Percutaneous nephrostomy

287
Q

In what hydrocele type with increasing Valsalva increase the size of it

A

Communicating hydrocele

288
Q

How does chronic prostatitis or chronic pelvic pain syndrome present

A

Irritation avoiding. Culture is negative

289
Q

Treatment for chronic prostatitis or chronic pelvic pain syndrome

A

Alpha blockers or five alpha reductase inhibitors

290
Q

 Risk factors for erectile dysfunction

A

TCA SSRI hypertension heart disease prostate cancer treatment spinal cord injury diabetes atherosclerosis

291
Q

What is the diagnosis for erectile dysfunction

A

Clinical diagnosis. But check for neurological cause or hypergonadism. And then do screening for risk factors

292
Q

First line therapy for erectile dysfunction

A

Sildenafil. Testosterone if hypergonadism. Psychotherapy if psychogenic

293
Q

Second line for erectile dysfunction if sildenafil does not work or is contra indicated

A

Vacuum pumps, intracavernosal injections, another inflatable prosthesis

294
Q

What is the first important investigation impatience with BPH symptoms

A

After digital rectal exam you should do your analysis and urine culture just to rule out infection and haematuria

295
Q

Most accurate test to diagnose prostate cancer

A

Transrectal ultrasound guided biopsy

296
Q

How to manage bone pain in prostate cancer met

A

Radiation therapy

297
Q

When should screening for prostate cancer be earlier and more strongly indicated

A

In black men and first-degree relatives with prostate cancer. Normal screening can start at 50 years old

298
Q

Diagnostic investigation for patients with bladder cancer suspect

A

Cystoscopy and biopsy

299
Q

Best initial test and then confirmatory test for renal cell carcinoma

A

CT. Then Histology on nephrectomy specimen

300
Q

Main treatment for localised renal cell carcinoma

A

Surgical resection of thermal ablation

301
Q

Since response rates to radiation and chemo are low what is the best medication for renal cell carcinoma

A

Tyrosine kinase inhibitor is

302
Q

Most common cancer in men Between 15 and 34

A

Testicular cancer

303
Q

General treatment for seminoma testicular cancer 

A

Radical orchiectomy and chemo or radiotherapy

304
Q

General treatment for nonseminomatous germ cell tumour

A

Retro peritoneal lymph node dissection with the radical orchiectomy

305
Q

What can be added to the treatment regime of testicular cancer in advance cases

A

Platinum based chemo

306
Q

A few possible regimes for uncomplicated UTI treatment

A

TNT SMX for three days or nitrofurantoin for 5 to 7 days

307
Q

Do you need cultures for uncomplicated UTI

A

No it’s a clinical diagnosis. You culture only if treatment fails

308
Q

What’s examples of complicated UTIs

A

Pregnant, co mobs like diabetes, infants, man, Immuno compromised, stance, catheter, systemic symptoms

309
Q

Take me through some choices for treatment for complicated UTI

A

Fluoroquinolones, 3rd/4th gen Catholics foreign, TMP SMX.

310
Q

Two antibiotic choices for a symptomatic bacteruria pregnant women

A

Amoxicillin or nitrofurantoin

311
Q

When are prophylactic antibiotics given for UTIs

A

If a patient has two or more UTIs in six months. Or three or more infections in one year

312
Q

Clinical suspicion for pyelonephritis, how to investigate

A

Blood cultures and urine cultures and urine analysis

313
Q

If a patient with pyelonephritis has a high complication risk, how do you Further investigate

A

Do imaging (CTO ultrasound) to assess for anatomical causes

314
Q

Haemodynamically stable patience. Treatment for pyelonephritis 

A

Outpatient care. Quinolones or 3rd/4th generation Catholics foreign OTMPS max

315
Q

Haemodynamically unstable patients with pyelonephritis. How to treat

A

Inpatient care. Parental antibiotics including Kev trioxane, ampicillin, piperacillin, fluoroquinolone

316
Q

Why 10 nitrofurantoin only be used for cystitis and not pyelonephritis

A

It cannot penetrate renal parenchyma only the bladder,

317
Q

Severe Acute prostatitis treatment

A

Hospitalisation, IV antibiotics like a fluoroquinolone plus or minus Catholics foreign.

318
Q

Mild acute prostatitis treatment

A

Patient, give TMP SMX or fluoroquinolone.

319
Q

Treatment for prostatitis usually takes how long and why

A

4 to 6 weeks for acute, 6 to 8 for chronic. Take this long to achieve therapeutic levels in the prostate

320
Q

Management of pyelonephritis associated abscess

A

Drain and continue antibiotics

321
Q

How to confirm the diagnosis of acute prostatitis

A

 Your analysis and urine culture, blood cultures if haemodynamically unstable

322
Q

10 days of increasing unilateral flank pain/tenderness. UTI symptoms (eg, dysuria, urinary urgency) are absent. urinalysis results often include pyuria. Hx of UTI month ago. Fever and chills present. Little weight loss.

A

Renal,abscess

323
Q

AKI in patient who is older. And the Ca is high… sus?

A

Should be low most of the time. Consider myeloma

324
Q

Cyclical hematuria and dysuria…. (Days before mense). UTI tests negative

A

consider endometriosis

325
Q

If a hydro seal increases during Valsalva what does this tell us

A

That is his a communicating type

326
Q

Describe some of the symptoms of interstitial cystitis

A

Pain when filling bladder, exercise, sexual intercourse, alcohol consumption, prolonged sitting. Pain is relieved and voiding. Diagnosis of exclusion. At least six weeks of LUTS

327
Q

BPH patients who get recurrent UTIs or bladder stones or signs of renal insufficiency , this would be an indication to do what

A

This would be an indication to do some form of surgery (TURP or prostatectomy

328
Q

AP essay above which level is heavily indicative of prostate cancer

A

10

329
Q

What is bicalutamide

A

Androgen receptor blocker (decent for prostate cancer metastasis disease

330
Q

Usual prostate cancer screening can start around 50 (this is quite flexible). But which to patient types would you consider doing earlier screening in

A

Positive family history, and first-degree relative

331
Q

What age and above patient with haematuria, unexplained buy anything else, would you do a cystoscopy

A

35.

332
Q

What is the most common malignancy and 15 to 34-year-olds

A

Testicular cancer

333
Q

Although testicular cancer is more common in the 15 to 30-year-old range, what is the incidence mainly for seminomas

A

40 to 50. They have a bimodal age distribution

USMLE Step 2 - Top 5% (34 decks)

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