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AMC MCQ - You Can Do It!!!!!❤️❤️ > Nephrology & Urology > Flashcards

Nephrology & Urology Flashcards

1
Q

Normal PaCO2

A

35-45 mmHg

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2
Q

Normal PaO2

A

85%

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3
Q

Normal HCO3

A

22-32 mmol/L

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4
Q

Normal PH

A

7.40-7.45

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5
Q

urinary urgency + urinary frequency + nocturia

A

Overactive bladder

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6
Q

Peaked T-waves are seen in lead V2,V3,V4 and V5 + widening of QRS, decreased amplitude of P waves

A

hyperkalaemia

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7
Q

ACE inhibitors + spironolactone

A

Increased risk of hyperkalaemia

The combination of ACE inhibitors and spironolactone increases the risk of hyperkalemia due to their complementary mechanisms of action on the renin-angiotensin-aldosterone system (RAAS), both leading to reduced potassium excretion.

1.	ACE Inhibitors:
•	ACE inhibitors (e.g., lisinopril, enalapril) block the conversion of angiotensin I to angiotensin II.
•	Angiotensin II normally stimulates the release of aldosterone from the adrenal glands.
•	Aldosterone promotes sodium and water reabsorption in the kidneys and potassium excretion.
•	By inhibiting this pathway, ACE inhibitors lead to reduced aldosterone levels, resulting in decreased potassium excretion and potential hyperkalemia.
2.	Spironolactone:
•	Spironolactone is an aldosterone antagonist, meaning it directly blocks the action of aldosterone on its receptors in the kidneys.
•	This further reduces sodium reabsorption and potassium excretion.
•	Since aldosterone’s effect is to promote potassium excretion, blocking it with spironolactone leads to retention of potassium.
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8
Q

Causes of hyperkalaemia

RAAMUN

A

– Renal failure.
– Metabolic acidosis.
– Addison’s disease.
– Use of aldosterone antagonists like spironolactone.
– ACEi.
– NSAIDs.

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9
Q

Renal stone recurrence management

A
  • Increase water intake about 2.5 to 3 litres/day
  • calcium-rich foods
  • thiazide diuretics
  • lewer oxalate-rich foods (Oxalate stones)
  • Allopurinol
  • urinary alkaliniser (potassium citrate)
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10
Q

Renal stones initial investigation

A

1st case: CT KUB
2nd recurrent: ultrasound + X-ray KUB

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11
Q

Renal stones diagnostic investigation

A

spiral CT KUB non-contrast

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12
Q

alkaline urine + “Staghorn calculi”

A

Struvite stones

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13
Q

Proteus pathogen renal stone

A

Struvite
-magnesium ammonium phosphate

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14
Q

Uric acid stone treatment

A
  • Allopurinol
  • urine alkalinization
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15
Q

Oxalate stone treatment

A
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16
Q

Renal stones in renal pelvis management

A

< 2.5cm: Extracorporeal lithotripsy
< 2.5cm: Percutaneous lithotripsy

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17
Q

Renal stones in ureter

A

Upper half < 1cm: Lithotripsy
Upper half: >1 cm: Lithotripsy or nephrolithotomy
Lower half < 1cm: Lithotripsy
Lower half > 1cm: Lithotripsy or endoscopy

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18
Q

Renal stones in bladder

A

< 3cm: Transurethral lithotomy
> 3cm: Cystotomy

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19
Q

Low potassium + hypertension
Investigations

A

Investigate serum aldosterone

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20
Q

Most common complication of radical prostatectomy

A

Erectile Dysfunction (ED)

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21
Q

Premature ejaculation treatment

A

1st line: SSRI (raises orgasm threshold)

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22
Q

main complication of retroperitoneal lymph node dissection (RPLND)

A

Retrograde ejaculation

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23
Q

most common complication of TURP

A

Urinary tract infection (UTI)

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24
Q

UTI requiring hospitalisation

A

any infant < than 3 months
- increased risk of urosepsis

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25
Q

Infant UTi treatment

A
  • IV trimethoprim/gentamicin, benzyl penicillin
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26
Q

Erectile Dysfunction (ED) management

A

Initial :
- Optimise modifiable risk factors / related comorbidities (HTN, DM, diet/exercise etc)
- Treat reversible causes
(Low testosterone, Medication-induced erectile dysfunction, Psychogenic erectile dysfunction – consider referral to a therapist)
- Pharmacological/Surgical treatment
- 1st line: phosphodiesterase type 5 inhibitor (sildenafil)
- 2nd line: penile injections, vacuum erection devices, external shock wave lithotripsy
3rd line: penile prosthesis

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27
Q

polycystic kidney disease features

A
  • Polyuria and nocturia
    – Renal failure
    – Hypertension
    – Abdominal wall and inguinal hernias
    – Colonic diverticulosis
    – Hepatic cysts
    – Subarachnoid or cerebral haemorrhage
    – Cardiac anomalies including mitral valve prolapse
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28
Q

albuminuria in diabetes

A

first void spot specimen Urinary albumin to creatinine (ACR) ratio

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29
Q

URTI + proteinuria + haematuria + immediate onset

A

IgA nephropathy

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30
Q

IgA nephropathy treatment

A

Asymptomatic microscopic haematuria: 2 positive
UAs out of 3 in 2-3 weeks
Symptomatic: corticosteroids

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31
Q

URTI + proteinuria + haematuria + onset within weeks + facial oedema

A

Poststreptococcal glomerulonephritis (PSGN)

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32
Q

HIV px + taking indinavir + haematuria + loin pain

A

Indinavir induced nephrolithiasis
- Only detectable on US
- Remove/Change indinavir

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33
Q

onset within weeks + HIV hx + haematuria + proteinuria

A

Focal segmental glomerulosclerosis (FSGS)

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34
Q

HIV-associated nephropathy (HIVAN)

A

-Nephrotic range proteinuria
-Azotaemia
-Normal to large kidneys on ultrasound images
-Focal segmental glomerulosclerosis (FSGS)

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35
Q

shortened QTc interval on ECG

A

Severe hypercalcaemia

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36
Q

Dialysis indications

A
  1. Pericarditis or pleuritis (urgent indication).
  2. Progressive uraemic encephalopathy or neuropathy (confusion,
    asterixis, myoclonus, wrist or foot drop, or, in severe cases, seizures (urgent indication).
  3. A clinically significant bleeding diathesis attributable to uraemia (immediate indication).
  4. Persistent metabolic disturbances that are refractory to medical therapy (hyperkalemia, metabolic acidosis, hypercalcemia,hypocalcemia,
    hyperphosphatemia)
  5. Fluid overload refractory to diuretics
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37
Q

Dialysis metabolic abnormalities

A
  • hyperphosphatemia
  • Vitamin D deficiency
  • hypocalcaemia
  • secondary hyperparathyroidism
  • hyperphosphataemia
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38
Q

Dialysis skeletal abnormalities

A

renal osteodystrophy:
- Osteomalacia
- osteosclerosis
- osteitis fibrosa cystica

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39
Q

Most common acute complication of haemodialysis

A

Hypotension

40
Q

Paradoxical hypertension

A

Increase dialysis duration
Over dialysis cause paradoxical high bp and hypotension

41
Q

Acute renal failure risk

A
  • Advanced liver cirrhosis
  • Ascites medication
42
Q

Chronic renal failure risk

A
  • Ischemic heart disease
  • Type 2 DM
43
Q

Most common neurologic complication of chronic renal failure

A

Peripheral neuropathy

44
Q

Hypercalcaemia manifestations

A

Hypercalcemia, which is too much calcium in the blood, can cause a variety of symptoms. Here’s an easy way to remember the key manifestations:

  1. Stones:
    • Kidney Stones: High calcium levels can lead to the formation of kidney stones, which can cause pain in the back or sides and sometimes blood in the urine.
  2. Bones:
    • Bone Pain: Excess calcium can be pulled from the bones, leading to bone pain, aches, or even fractures.
  3. Groans:
    • Abdominal Pain: Hypercalcemia can cause digestive issues, including abdominal pain, nausea, constipation, and sometimes peptic ulcers (stomach ulcers).
  4. Thrones:
    • Frequent Urination and Dehydration: High calcium levels can make you pee a lot, leading to dehydration. This can also cause increased thirst.
  5. Psychiatric Overtones:
    • Mental Symptoms: High calcium can affect the brain, causing confusion, lethargy, fatigue, memory problems, depression, and in severe cases, hallucinations or even coma.
  • Stones (kidney stones), Bones (bone pain), Groans (abdominal issues), Thrones (frequent urination), and Psychiatric Overtones (mental changes) are the main symptoms of hypercalcemia. These clues can help you remember the broad range of effects high calcium levels can have on the body.
  • constipation
  • anorexia
  • nausea and vomiting
  • abdominal pain
  • ileus
    – Bone pain.
    – Muscular weakness
  • Peptic ulceration.
    – Pancreatitis.
    – Neurological
  • Short QT interval on ECG

renal impairment:
- polyuria, nocturia, and
polydipsia

> Ca 3mmol/L:
- emotional labiality
- confusion,
- delirium
- depression/psychosis
- stupor
- coma

45
Q

Hypercalcaemia risk factors

A

Paraneoplastic syndromes:

  • squamous cell carcinoma of the head and neck
  • Renal cell carcinoma
  • Carcinoma of lung
  • Multiple myeloma
46
Q

Hypocalcaemia manifestations

A
  • Paraesthesia and numbness of the fingertips and perioral area.
    -Chvostek’s sign: Twitching of the ipsilateral facial musculature (perioral, nasal, and eye muscles) by tapping over cranial nerve VII at the ear.
    -Trousseau’s sign: carpal spasm induced by inflation of the blood pressure cuff around the arm.
    -Spontaneous muscle cramps.
    -Tetany is seen in severe hypocalcaemia
47
Q

Causes of confusion in kidney disease

A

without spasm: uraemia
with spasms: hypercalcaemia

48
Q

Treatment of urge incontinence

A

**1st line: Bladder retraining
2nd line: TCA/intravesical botulism
3rd line: Surgery

49
Q

Haematuria+ hypertension + bilateral palpable
kidneys + abdomen and flank fullness

A

Polycystic kidney disease (PCKD)

50
Q

autosomal dominant polycystic kidney disease (ADPKD) dx

A

Presence of 2 or more cysts in each kidney

51
Q

autosomal dominant polycystic kidney disease (ADPKD) complications

A

cerebral aneurysms

52
Q

Polycystic kidney disease (PCKD) high BP mechanism

A

increased activity of renin angiotensin system

53
Q

Polycystic kidney disease (PCKD) risk factors

A

– Younger age dx
– Black Race.
– Male sex.
– Presence of polycystin-1 mutation.
– Hypertension.

54
Q

Good cyst penetration medication

A

Fluoroquinolones
(lipid soluble)

55
Q

Painless haematuria investigation protocol

A
  1. urine
    microscopy and culture to rule out urinary tract infection
  2. serum electrolytes, urinary proteins, red cell casts in the urine and check BP to rule out glomerulonephritis
  3. urinary tract US and
    cystoscopy
  4. CT abdomen non contrast

Painless
Haematuria+ Gross/macroscopic+55 year=

= Initial Urine analysis next? Cystoscopy
Haematuria+Gross/macroscopic+35 year=== initial Urine analysis next ?CT abdomen
shahriar cop
Haematuria +microscopict 55 years:
initial urine analysis next? USG/ cystoscpoy
Haematuria+microscopic+30 years=== initial urine analysis next? USG/Cystoscopic

Painful,

Haematuria +40 years
Initial urine analysis next? X ray next to confirm? Spiral CT
Haematuria,

Female,
Initial urine analysis(abnormal)=
> repeat the test
If you find clean catch urine reagarding UTI== choose this is as answer

56
Q

Scrotal lumps investigation

A

malignant unless proven otherwise

initial: US

lab test for tumour markers:
1. The beta subunit of beta-hCG
2. AFP
3. actate dehydrogenase (LDH)

57
Q

most common
cause of lower urinary tract symptoms (LUS)

A

Benign prostate hyperplasia (BPH)

58
Q

Benign prostate hyperplasia (BPH) management

A
  • 1st line: Finasteride that needs to be bridged with selective α-blocker such as doxazosin, terazosin, or pprazosin
  • gold standard: Transurethral resection of the prostate (TURP)
59
Q

Benign prostate hyperplasia (BPH) complications
To kidneys

A

hydronephrosis and kidney damage

60
Q

Most common expected Longterm complication of TURP

A

Retrograde ejaculation 80-90%

61
Q

lower urinary tract symptoms (LUS) symptoms

A

Filling:
-urinary frequency,
- urgency,
- dysuria,
- nocturia.

Voiding:
- poor stream
- hesitancy
- terminal dribbling,

  • incomplete voiding
  • overflow incontinence (occurs in chronic retention)

Lower Urinary Tract Symptoms (LUTS) refer to a group of symptoms related to problems with urination. Here’s a simple explanation:

LUTS are usually divided into two categories: storage symptoms and voiding symptoms.

  • Urgency: A sudden, strong need to urinate, often with little warning.
  • Frequency: Needing to urinate more often than usual, typically more than 8 times a day.
  • Nocturia: Waking up at night to urinate one or more times.
  • Urge Incontinence: Leaking urine before you can get to the toilet due to a sudden urge to urinate.
  • Weak Stream: The flow of urine is slower or weaker than usual.
  • Hesitancy: Difficulty starting urination, even when you feel the urge to go.
  • Intermittency: Starting and stopping several times while urinating.
  • Straining: Needing to push or strain to start urination or to continue urinating.
  • Incomplete Emptying: Feeling like the bladder isn’t completely empty even after urinating.
  • Post-void Dribbling: Leaking a small amount of urine after finishing urination.
  • Storage symptoms involve issues with holding urine, like needing to go frequently or urgently.
  • Voiding symptoms involve issues with emptying the bladder, like a weak stream or difficulty starting urination.

LUTS can be caused by various conditions, such as an enlarged prostate in men, urinary tract infections, or bladder disorders, and may require different treatments depending on the underlying cause.

62
Q

fever + perineal region pain + frequency, urgency, dysuria + oliguria + leukocytosis + prostate tenderness + with/o hypotension and tachycardia

A

Prostatitis

63
Q

Prostatitis treatment

A

Borad spectrum antibiotics for 3 weeks

64
Q

elderly patient + sclerotic changes in vertebrae and pelvis

A

Prostrate cancer

65
Q

Prostate cancer T staging

A

T1 - impalpable
T2 - confined to one nodule
T3a - outside capsule
T3b - into seminal vesicle

66
Q

Prostate cancer active surveillance criteria

A
  • PSA ≤ 10.0 ng/mL
  • clinical stage T1–2a
  • Gleason score ≤ (3 + 4 = 7) and pattern 4 component < 10% after pathological review
67
Q

Prostate cancer active surveillance protocol

A
  • PSA measurements every 3 months
  • PE + DRE every 6 months
  • Repeat prostate biopsy within 6–12 months of starting protocol
68
Q

Prostate PSA

A

40–49 years: <2.5 ng/mL
50–59 years: <3.5
60–69 years: <4.5
70+ years: <6.5

69
Q

Gleason grade

A

1: mild - no intervention
2:-3 moderate - conservative measures
3-5: high - requiring surgical intervention

70
Q

Gleason score

A

< 6: low risk
7 (3+4)
7 (4+3)
8
9-10

71
Q

urethral injury initial investigation

A

retrograde urethrogram followed by Foley (bladder or urinary) catheter

72
Q

indwelling catheter (Foley) contraindications

A

Pelvic injury with urethral meatus blood

73
Q

suprapubic catheter contraindications

A

– Coagulopathy
– Urinary Bladder carcinoma
– Pregnancy
– Ascites
– Severe obesity
– Lower abdominal scar tissue, mesh or adhesions from previous surgeries, pelvic cancer or radiation treatment

74
Q

testicular torsion management

A

Immediate surgery to prevent infarction

75
Q

testicular tumour malignancy investigation

A
  1. scrotal ultrasound
    with colour Doppler
  2. CT abdomen and chest x-ray
  3. inguinal orchiectomy
76
Q

testicular tumour lymphatic spread would indicate the worst prognosis

A

Cervical

77
Q

young male+ low haemoglobin & haematocrit + hypertension + haematuria + proteinuria + with/o haemoptysis/SOB/cough/dyspnoea

A

Anti–glomerular basement membrane disease (Goodpasture’s)

78
Q

Anti–glomerular basement membrane disease

A

Goodpasture’s disease:
- Young males most common
- development of autoantibodies against the non-collagenous domain of type IV collagen
- haemoptysis may also be a feature (smokers)

79
Q

Anti–glomerular basement membrane disease treatment

A
  • plasma exchange
  • corticosteroids
  • cytotoxic therapy
80
Q

Sudden onset of severe testicular pain + nausea and vomiting + Asymmetric high riding testes + Absent cremasteric reflex + Negative Prehn’s sign

A

Testicular torsion

81
Q

fever & rigors + tender upper pole of testes + positive Prehn’s sign + lower urinary tract symptoms

A

epididymitis

82
Q

sudden onset + painless testicular swelling that decreases when supine + “ bag of worms” sensation

A

varicocele (renal tumour)
- mostly on the left side

83
Q

Painless haematuria w/o other symptoms

A

bladder carcinoma

84
Q

bladder carcinoma risk factors

A
  • male
  • smoking
  • printing/leather dye industry work
85
Q

Bladder carcinoma diagnostic investigation

A

Cystoscopy

86
Q

Drug is associated with increased risk of bladder carcinoma

A

Pioglitazone

87
Q

Hypertension post dialysis treatment

A
  • Conservative: remove excess sodium and dry weight reduction
  • 1st line: BB Atenolol
    -2nd line: CCB amlodipine
  • ACEi or ARBs
    -Diuretics (monitor for ototoxicity)
88
Q

most common opportunistic pathogen in
transplant

A

Cytomegalovirus (CMV)

89
Q

Graft rejection treatment

A
  • steroid boost
  • monoclonal antibodies to CD3 (OKT3)
  • pooled antibodies against lymphocytes (ALGs)
90
Q

Renal artery stenosis (RAS) treatment

A

Unilateral: ACEi
Bilateral: CCB, BB

91
Q

Hyponatremia causing medication

A
  • thiazide diuretics (indapamide)
92
Q

Smoking cessation medication

A

– 1st line: Varenicline
– Nicotine replacement therapy
– Bupropion (1st line pregnancy)

93
Q

stress incontinence management

A
  • Pelvic floor exercises (Kuegels)
  • Bladder neck suspension/sling
94
Q

Partial nephrectomy

A

< 7 cm
- not centrally located
- expected to live > 5 years with/o other comorbidities

95
Q

Total nephrectomy

A
  • size > 7cm
  • central location
  • lymph node involvement
  • associated with renal vein/IVC thrombus
  • Direct extension into ipsilateral adrenal gland
96
Q

Painless haematuria

A

Rule out malignancy

97
Q
A

AMC MCQ - You Can Do It!!!!!❤️❤️ (50 decks)

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