Nephrology/Urology

Question 1

Describe HSP

Answer 1

systemic immune mediated vasculitis of small blood vessels (IgA vasculitis) occurs commonly post throat infection or gastroenteritis. Effects children under the age of 5 most commonly can affect adults of all ages

Question 2

What are the symptoms of HSP

Answer 2

Common
Skin rashes (palpable purpura) + joint pain and swelling + abdominal pain + N+V

Less common
Haematuria + proteinuria + HTN appendicitis + GI haemorrhage + pancreatitis _ swelling of testicles + intususception

Question 3

How do you diagnose HSP

Answer 3

Palpable purpura + one of the following
- renal involvement
- Arthritis
- Abdominal pain
- IgA antibodies

Question 4

How do you treat HSP

Answer 4

No specific treatment necessary most have spontaneous remission after 2-4 weeks generally simple analgesia such as paracetamol is all that is required for symptomatic relief. NSAIDs can be prescribed for joint or abdominal pains

Question 5

What are the risk factors for renal calculi?

Answer 5

age 40-60
high urine pH
Low urine volume
Low concentrations of stone inhibiting magesium and citrate
dehydration
high protein diet
calcium containing medication

Question 6

Tell me about testicular torsion

Answer 6

usually affects young males under 25 and can happen spontaneously on exertion or occassionally as a result of trauma

Get a swollen erythematous and tender scrotum
Additionally reactive hydrocele may develop
affected testicle can be high riding/have horizontal lie

Often absent cremaasteric reflex
Elevation of scrotum does not relieve any pain

Question 7

Treatment of testicular torsion

Answer 7

Surgical exploration and detorsion is first line

midline raphe or transverse scrotal incision followed by incision in the tunical vagnalis to reach testicle

salvageable testicles are usually fixed to the scrotal wall using sutures to prevent further episodes

necrotic lesions need to be removed

Question 8

What are the risks of transurethral resection of prostate?

Answer 8

urinary incontinence
erectile dysfunciton
haematuria
retrograde ejaculation
infection
bladder injury

Question 9

Explain the important notes on testicular swellings

Answer 9

Epididymal cyst - painless - soft smooth and fluctuant

Epididymitis - no discrete lump but if it does it is usually isolated to the epididymis. painful better by lifting (usually caused by STDs or UTIs)

Inguinal hernia - may cause a groin mass that disappears when pressure is applied or the patient lies down impossible to get above the swelling

Testicular torsion - severe sudden pain - loss of cremasteric reflex

seminoma - painnless nodule - solid and firm involving all or part of the testicle

Question 10

Behcet’s disease and epididymitis

Answer 10

Refer these patients to rheumatology rather than starting immunosuppression yourself. You get oral ulceration, genital ulceration and eye disease

Question 11

Tell me about IgA nephropathy

Answer 11

chronic autoimmune kidney disorder where IgA settles

Usually affects men in 30s

Haematuria _ proteinuria _ HTN + peripheral oedema

URTI/GI infection can both cause sympotms to occur

ACEI/ARBs + prednisolone (in rare casese)

Question 12

Renal artery stenosis how do you manage BP

Answer 12

1st line captopril/enalapril/valsartan/losartan

2nd line hydrochlorothiazide/furosemide/atenolol/amlodipine/nifedipine/prazosin

Question 13

Renal Artery stenosis explain it

Answer 13

narrowing of renal artery lumen (>50% reduction)

HTN + unexplained kidney dysfunction + sudden or unexplained recurrent pulmonary oedema

Strong risk factors

Dyslipidaemia
Smoking
Diabetes

Investigations
Duplex ultrasound
Ct angiography/MR/captropril renal scan (follows the above in non-CKD patients)
If CKD patient then consider on-contrast MR angiography

Management

CONTROL HTN - captopril
Statin for arthresclerosis
Antiplately aspirin 70-300mg OD

If you insert a stent then use clopidogrel 75mg OD

Question 14

What tumour causes varicocele?

Answer 14

Renal cell carcinoma –> left testicle

Question 14

Nephritic vs nephrotic bloods

Answer 14

Nephritic - Blood
Nephrotic - protein

Question 15

What is Nephrotic syndrome

Answer 15

Condition where patients have heavy proteinuria (>3.5g per 24 hours) , hypoalbuminaemia (<30g/L) and peripheral oedema

Mostly idiopathic. Sometimes T2Dm, smyloidosis and SLE may also lead to the disorder

In children most common cause is minimal change disease

In younger adults FSGS is majority of cases

In older adults Membranous is most cmomon cause

Question 16

Symptoms of nephrotic syndrome

Answer 16

Peripheral oedema
Ascites/periporbital oedema
Proteinuria (foamy urine)
Significant weight gain
Exertional dyspnoea

Question 17

Management of nephrotic syndrome

Answer 17

corticosteroid therapy
cyclophosphamide
Mycophenolate mofetil

Question 18

What is torted hydatid of Mogagni

Answer 18

hyadtid of Morgagni remnant of Mullerian duct - presents with intense scrotal pain - localised to superior aspect of the testis

scrotum is often swollen and tender and usually hard tender nodule which may become iscahemic and blue in colour (blue dot sign).

Ix - colour dopple US
Mx - Rest Ice Scrotal elevation, NSAIDs, analgesia

Question 19

Schistosoma haematboium increases the risk of which cancer

Answer 19

Squamous cell carcinoma of the bladder

Question 20

What is the most common type of bladder cancer?

Answer 20

Transitional cell carcinoma
(squamous is more common in urethra)

Risk factors
Men
>65
Smoker
HPV16 infection
Chronic inflammation of urinary tract
Iarrogenic
Schisotosoma haematboium infeciton increases squamous cell carcinoma risk

Question 21

What is pyelonephritis

Answer 21

Inflammation of the kidneys most commonly secondary to baceterial infection

Bacteria travel to the kidney’s by blood stream. most commmon bacteria is e.coli

Ascend form the lower urinary tract or very occasionally the lymphatic system.

Question 22

What is emphysematous pyelonephritis

Answer 22

Dangerous form of pyelonephritis. most commonly found in diabetic patients caused by gas-forming bacteria. Does not respond well to IV ABx and may require nephrostomy insertion or percutaneous drainage of fluid/pus collections

Question 23

End stage renal disease symptoms

Answer 23

Peripheral oedema
Exertional dyspnoea
Haematuria
Kussmaul respiration (due to metabolic acidosis)

Question 24

Which germ cell tumour respond well to radiotherapy

Answer 24

Seminoma

Question 25

ACE I side effects

Answer 25

A - angiodema
C - cough
E - extra red (flushing)
g-I - disturbance

cam also cause asthma exacerbation and hypotension and muscle spasms

Question 26

Orchiectomies what are the types and reasons you do them?

Answer 26

Radical orchectomy - to prevent potential spread of malignancy through spermatic cord as it also removes most of the spermatic cord

Simple orchectomy - remove the testicle only really for palliative therapy in prostate cancer and for gender reassignment surgery

bilateral induinal orchiectomy - bilateral malignancy

Partial orchidectomy - if sometimes bilateraly or if a patient already only has one testicle and wants to have a family

Question 27

Stages of CKD and correspondent EGFR

Answer 27

1 - >90
2 - 60-90
3 a - 45-60
3b 30-45
4 13-29
5 <15

Question 28

Cranial diabetes insipidus

Answer 28

ADH produced by hypothalamus in cranial diabetes insipidus (metabolic disorder) not enough ADH is produced by hypothalamus, this means kidney is unable to retain water and therefore you pee more

IX - desmopressin challenge if responds to desmopressin then the problem is the brain not the kidney. Then to MRI to show posterior pituitary (mass/injury)

Tx - desmopressin (intranassally, PO, or IM)

Question 29

How do you confirm hypertensive nephropathy?

Answer 29

Histology - histology is how you confirm anything

Question 30

What tumour gene is carried by up to 20% of men on X chromosome which increases the risk fo testicular malignancy by up to 50 times

Answer 30

TGCT1 (testicular germ cell tumour 1

HPGDS + TIPARP are also associated with testicular cancer