Nephrology & Urology Flashcards

Question

Infant UTi treatment

Answer 1

- IV trimethoprim/gentamicin, benzyl penicillin

Answer 2

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

Answer 3

- 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

Answer 4

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

Answer 5

IgA nephropathy

Answer 6

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

Answer 7

Poststreptococcal glomerulonephritis (PSGN)

Answer 8

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

Answer 9

Focal segmental glomerulosclerosis (FSGS)

Answer 10

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

Answer 11

Severe hypercalcaemia

Answer 12

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

Answer 13

- hyperphosphatemia - Vitamin D deficiency - hypocalcaemia - secondary hyperparathyroidism - hyperphosphataemia

Answer 14

renal osteodystrophy: - Osteomalacia - osteosclerosis - osteitis fibrosa cystica

Answer 15

Hypotension

Answer 16

Increase dialysis duration

Answer 17

- Advanced liver cirrhosis - Ascites medication

Answer 18

- Ischemic heart disease - Type 2 DM

Answer 19

Peripheral neuropathy

Answer 20

- 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

Answer 21

Paraneoplastic syndromes: - squamous cell carcinoma of the head and neck - Renal cell carcinoma - Carcinoma of lung - Multiple myeloma

Answer 22

- 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

Answer 23

without spasm: uraemia with spasms: hypercalcaemia

Answer 24

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

Answer 25

Polycystic kidney disease (PCKD)

Answer 26

Presence of 2 or more cysts in each kidney

Answer 27

cerebral aneurysms

Answer 28

increased activity of renin angiotensin system

Answer 29

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

Answer 30

Fluoroquinolones (lipid soluble)

Answer 31

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 3. CT abdomen non contrast

Answer 32

**malignant unless proven otherwise** initial: US lab test for tumour markers: 1. The beta subunit of beta-hCG 2. AFP 3. actate dehydrogenase (LDH)

Answer 33

Benign prostate hyperplasia (BPH)

Answer 34

- 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)

Answer 35

hydronephrosis and kidney damage

Answer 36

Retrograde ejaculation 80-90%

Answer 37

Filling: -urinary frequency, - urgency, - dysuria, - nocturia. Voiding: - poor stream - hesitancy - terminal dribbling, - incomplete voiding - overflow incontinence (occurs in chronic retention)

Answer 38

Prostatitis

Answer 39

Borad spectrum antibiotics for 3 weeks

Answer 40

Prostatic cancer

Answer 41

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

Answer 42

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

Answer 43

- PSA measurements every 3 months - PE + DRE every 6 months - Repeat prostate biopsy within 6–12 months of starting protocol

Answer 44

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

Answer 45

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

Answer 46

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

Answer 47

retrograde urethrogram followed by Foley (bladder or urinary) catheter

Answer 48

Pelvic injury with urethral meatus blood

Answer 49

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

Answer 50

Immediate surgery to prevent infarction

Answer 51

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

Answer 52

Anti–glomerular basement membrane disease (Goodpasture’s)

Answer 53

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)

Answer 54

- plasma exchange - corticosteroids - cytotoxic therapy

Answer 55

Testicular torsion

Answer 56

epididymitis

Answer 57

varicocele (renal tumour) - mostly on the left side

Answer 58

bladder carcinoma

Answer 59

- male - smoking - printing/leather dye industry work

Answer 60

Cystoscopy

Answer 61

Pioglitazone

Answer 62

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

Answer 63

Cytomegalovirus (CMV)

Answer 64

- steroid boost - monoclonal antibodies to CD3 (OKT3) - pooled antibodies against lymphocytes (ALGs)

Answer 65

Unilateral: ACEi Bilateral: CCB, BB

Answer 66

- thiazide diuretics (indapamide)

Answer 67

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

Answer 68

- Pelvic floor exercises (Kuegels) - Bladder neck suspension/sling

Answer 69

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

Answer 70

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

Answer 71

Rule out malignancy

Answer 72

gross = investigations ? microscopic

Answer 73

ciclofosfamida = CISTITIS (dolor ) + HEMORRAGICA

Answer 74

**NO X RAY** -A) **Struvita** stones = staghorn caluculus (proteus, psudomonas, klebsiella) B) **uric** acid stones ( DM, gout, rapid weight loss, hemolitic anemia, chronic diarrea) (dissolvde with urina alkalinizaition >6,5) C) **Indinavir** D) **Cystine** ## Footnote nephrolitiasis

Answer 75

Non-enhanced CT is the ‘gold-standard’ for diagnosis of ureteric colic. ●Low-dose CT protocols can be effectively used in acute renal colic ●Immediate imaging is required when patients do not improve after treatment and / or when there is fever and / or leukocytosis and / or the patient has renal failure or a single kidney ●However, because of concerns about ionisingradiation and because the vast majority ofureteric stones pass without the need for intervention, **ultrasound (US) has been increasingly recommended and used as the initial imaging modality**, with no sacrifice in patient outcome, thus avoiding the need for CT in about 70% of cases ●Ultrasound is also capable of identifying most of the alternative diagnoses listed as mimickers of renal colic ●US in combination with plain x-ray KUB misses very few clinically important stones ●**In pregnant patients US**, but it should be borne in mind that unless a calculus is visualized it may be difficult to differentiate obstructive hydronephrosis due to a calculus from ‘physiological’ hydronephrosis of pregnancy. In selected cases, MRI urography may be then required **●Conventional IVP can now be considered almost obsolete for the diagnosis of renal colic** ●Ultrasonography may be useful in patients in whom avoiding radiation is necessary (egyoung people, women who are pregnant), but CT is still the preferred imaging modality of urologists as it allows better decision-making for further management. Ultrasonography can be useful for following calyceal stones, butis much less accurate than CT at detecting ureteric stones and at measuring stone size (a key determinant of further management). ●Imaging is important for confirming diagnosis and guiding treatment. Computed tomography (CT) and X-rays of the kidneys, ureters and bladder (KUB) should be ordered and performed on the same day

Answer 76

1. **Pain control: **During an acute episode of renal colic, management is **focused on pain control.** Both nonsteroidal anti-inflammatorydrugs (NSAIDs). Mind renal function. (**Australia uses ketorolaco**) 2. **Medical expulsion therapy: **stones >5mm and <=10 Ureter location -with alpha-blockers (tamsulosin) x 4 weeks facilitate expulsion -Alpha-1a antagonists are contraindicated in patients with end-stage hepatic or renal failure, and patients with severe orthostatic hypotension –Not PBS 3.**Confirmation of stone passage:** US, KUB Xray, CT (X-ray KUB if the stone is definitely seenon initial X-ray, or CT KUB if it is not seen) should be organisedfor **four weeks after the initial visit,** unless a stone has been collected and verified by the GP or urologist ●**Straining urine: **Patients should be instructed to strain their urine for several days and bring in any stone that passes for analysis. ●**Treatment of urinary tract infection** —Patients with evidence of a concurrent urinary tract infection should be promptly treatedwith antibiotics. ●**Urologic consultation** —Urgent urologic consultation is warranted in patients with urinary tract **infection**, acute **kidney** **injury** beyond that expected from unilateral obstruction, anuria, and/or unyielding pain, nausea, or vomiting, Stones >7 mm are less likely to pass, conservative management for three weeks and have not passed their stone ●Lastly, patients who have passed stones but have ongoing blood in the urine should be referred to a urologist for investigation of haematuria, preferably with three urine cytology tests and a CT IVP.

Answer 77

2. 1. UTI 2. DOS rinones + aki 3. UN solo rinon + aki

Answer 78

**1. laser lithiotripsy / called SWL **2. extracorporeal shock wace lothotripsy 3. percutaneous nephrolithotomy (>2cm)

Answer 79

indications surgery

Answer 80

sterile pyruia tb cancer chlamidia cistitis + fever = PIELONEFRITIS

Answer 81

Screening for and treatment of asymptomatic bacteriuria is Not recommended unless: ●Pregnancy ●Urolithiasis ●Vesicouretericr eflux ●Renal transplant recipients ●The immunocompromised, and ●Before instrumentation of the urinary tract. **elderly and delirius yes treat , if neurological normal dont**

Answer 82

UTI Pyelonephritis Adults dx

Answer 83

This patient's dysuria, increased urinary frequency, and mild suprapubic tenderness in the absence of fever, malaise, and costovertebral angle tenderness is concerning for an uncomplicated acute cystitis. Uncomplicated acute cystitis is empirically treated with antibiotics without needing further diagnostic evaluation.Acute cystitis describes inflammation of the lower urinary tract and bladder and is caused by ascension of uropathogensvia the urethra and into the bladder. Acute cystitis is said to be uncomplicated if the patient is immunocompetent, premenopausal, not pregnant, and there is no evidence that the infection has extended beyond the bladder (e.g., flank pain or costovertebral angle tenderness) or having symptoms suggestive of systemic illness (e.g., fever, rigors, significant fatigue, and sepsis). Women with acute uncomplicated cystitis present with dysuria, increased urinary frequency, urinary urgency, and suprapubic discomfort. The diagnosis is clinically made and often further evaluation (e.g., urinalysis with urine culture, cystography) is not necessary. Most women with symptoms highly suggestive of acute uncomplicated are empirically treated with first-line antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. If symptoms resolve with antibiotic treatment, follow-up urine studies are not necessary.

Answer 84

**first pass of urine test**

Answer 85

**CT with contrast (look for malignancy**

Answer 86

## Footnote testicular cancer

Answer 87

## Footnote testicular cancer

Answer 88

tx ? ## Footnote testicular cancer treatment

Answer 89

## Footnote This patient presents with signs and symptoms consistent with benign prostatic hypertrophy (BPH); this condition places one at increased risk for hydronephrosis.BPH is a common condition seen in older men. It typically presents with any number of lower urinary tract symptoms ("LUTS"), including: increased frequency, nocturia, hesitancy, urgency, and weak stream. Enlarged prostate on examination can confirm the diagnosis. Over time, the retrograde pressure caused by BPH can cause hydronephrosis and even renal failure; this is also associated with bladder diverticula. Patients with BPH are at increased risk for developing urinary tract infections, but not prostate cancer.Incorrect Answers:Answers A, C, D: All of these are not associated with BPH, whereas hydronephrosis is.Answer E: Although bladder stones can be associated with BPH, nephrolithiasis is not.

Answer 90

## Footnote This patient is presenting with sudden-onset urinary retention in the setting of benign prostatic hyperplasia (BPH) and startingan alpha-1 agonist (phenylephrine), suggesting his symptoms are secondary to this medication.Urinary retention typically presents in men with BPH and can present with straining to urinate, a painful and distended bladder,and incomplete voiding. Chronic treatment for BPH is finasteride, which is a 5-alpha-reductase inhibitor that can slow the progression of BPH. Acute treatments include tamsulosin, which is an alpha-1 antagonist which can aid in voiding. Patients who start medications with anticholinergic properties or alpha-1 agonist medications can worsen their urinary retention. Anticholinergics decrease cholinergic tone on the bladder which is required for urination.On the other hand, alpha-1 agonists increase the tone of the urinary tract sphincters making it more difficult to urinate. The treatment of medication-induced urinary retention is to stop the offending agent and to potentially start tamsulosin if symptomspersist. Incorrect Answers: Answer A: Constipation is a potential etiology of urinary retention and could possibly be worsening this patient’s symptoms of urinary retention. However, the patient’s symptoms started 3 days ago, and his symptoms did not improve with a bowel movement 2 days ago. Though this patient’s constipation should be better managed, it is not the most likely etiology of his urinary retention. Answer C: Prostatic adenocarcinoma is unlikely to cause urinary retention when compared to benign prostatic hypertrophy. Prostatic adenocarcinoma typically presents with a rock hard and nodular prostate in contrast to a soft, symmetric, and enlarged prostate in BPH and is less likely to obstruct the urinary tract. Answer D: Urinary tract infection would present with symptoms of dysuria including urinary urgency, burning, and increased frequency rather than urinary retention.Answer E: Worsening benign prostatic hyperplasia is a possible contributing etiology to this patient’s urinary retention; however, it would not cause a sudden onset of urinary retention as was seen in this patient. Rather, it would be a gradual worsening of urinary retention

Answer 91

**ED is common in men with systemic disorders such as hypertension, ischemic heart disease, and diabetes mellitus, and its prevalence increases with age. Although sexual dysfunction is more common in older men, it also affects younger men (ages 18 to 25 years)** **phosphodiesterase-5 (PDE5) inhibitors, **

Answer 92

drugs potential male infertility ## Footnote chemotherapy, lithium, SSRs