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3B week 5 - LUTS, The Scrotum and Genitalia > R&U placement > Flashcards

R&U placement Flashcards

1
Q

if a pt has eGFR >90, how can they have CKD?

A
  1. may have raised albumin
  2. underlying kidney disease that has not yet affected GFR e.g. polycystic kidney disease
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2
Q

3 main causes of haematuria

A
  1. infection
  2. stones
  3. cancers
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3
Q

why is hyperlipidemia seen in nephrotic sydrome

A

loss of cholesterol binding proteins leading to increased free cholesterol in the blood

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4
Q

why might a pt have proteinuria in the nephrotic range but not be otherwise symptomatic (i.e. no nephrotic syndrome)

A

liver can compensate well for loss of protein

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5
Q

what is pulmonary-renal syndrome

A

destruction of both the glomerular and alveolar basement membranes resulting in damage to both organs e.g. in goodpasture’s disease

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6
Q

resistant HTN in a young pt - what should be thought for the underlying diagnosis

A

phaechromocytoma

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7
Q

what are the 3 main electrolyte abnormalities seen in CKD

A
  1. hyperphosphatemia
  2. hypocalcaemia
  3. hyperkalaemia
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8
Q

what is uremic frost

A

a rare manifestation of severe azotemia where tiny, yellow-white urea crystals deposit on the skin, resulting in a frosted appearance as sweat evaporate

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9
Q

mgx for hypovolaemic hyponatremia

A

isotonic saline

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10
Q

mgx for euvolaemic hyponatremia (4)

A
  1. treat underlying cause
    consider:
  2. fluid restriction
  3. hypertonic saline
  4. tolvaptan (vasopressin V2 receptor antagonists -> increases water excretion)
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11
Q

mgx for oedematous hypovolaemia

A
  1. fluid restriction
  2. salt restriction
  3. diuretics
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12
Q

causes of SIADH (5)

A
  1. malignancy
  2. non-malignant chest disease
  3. CNS disease
  4. drugs
  5. other e.g. intermittent porphyria, surgery
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13
Q

what investigations should be done post finding an RCC

A
  1. triple phase CT -> non contrast KUB, contrast, delayed phase (will provide info on collecting system + bladder)
  2. CT chest (look for primary or mets)
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14
Q

what 2 things is a CT KUB used to look for

A
  1. stones
  2. hydronephrosis
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15
Q

active surveillance vs watchful waiting

A

active surveillance - curative, catch before becomes life threatening
watchful waiting - palliative, treat if symptoms

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16
Q

what is the bosniack classification

A

Bosniak classification system of renal cystic masses - divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT, and helps predict a risk of malignancy and suggests either follow-up or treatment

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17
Q

prostate cancer risk factors

A
  1. multiple young first degree relatives w prostate cancer
  2. age
  3. ethnicity
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18
Q

what area of the prostate does cancer usually arise

A

the periphery

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19
Q

visible haematuria investigations

A
  1. examine + DRE
  2. flexible cystoscopy
  3. USS
  4. CTU
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20
Q

bladder cancer presentation

A
  1. haematuria
  2. recurrent UTI (in men, ppl prone to bladder inflammation)
  3. storage symptoms
  4. systemic (weight loss etc. -> late stage)
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21
Q

bladder cancer mgx

A

surgical
1. TRUBT
2. radical cystectomy

non surgical
3. BCG
4. Intravesical mitomycin C (chemo)

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22
Q

bladder cancer risk factors

A
  1. smoking
  2. age
  3. exposure to toxic chemicals
  4. schistosomiasis
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23
Q

testicular cancer markers (3) !

A
  1. LDH (lymphone)
  2. Alpha-fetoprotein (AFP)
  3. Human chorionic gonadotrophin (HCG)
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24
Q

risk factors for testicular cancer

A
  1. Cryptorchidism
  2. Hypospadias
  3. Infertility
  4. Klinefelter’s syndrome
  5. Tall men
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25
Q

penile cancer presentation

A
  1. painless ulceration
  2. bleeding/abnormal discharge
    3 .chronic phymosis (present w ballonitis)
26
Q

penile cancer risk factors

A
  1. uncircumscised (unless they are obese)
  2. HPV
  3. lichen sclerosis
  4. phymosis
  5. smoking
27
Q

penile cancer mgx

A

surgical
1. glansectomy
2. penectomy
3. local inscision (partial glansectomy)

all get primary surgery + DSNB (look for drainage to lymph nodes and removal of any implicated)

28
Q

testicular cancer presentation

A
  1. Testicular lump
  2. Testicular pain/discomfort
  3. Back pain, flank pain (indicative of metastasis)
  4. Lymphadenopathy
  5. Gynaecomastia
29
Q

what is the test of choice in testicular cancer

A

USS - offers excellent visualisation and identifies likely malignant lesions

30
Q

what makes a substrate an acceptable surrogate for estimating GFR (3)

A
  1. under goes glomerular filtration
  2. tubular handling
  3. not excreted elsewhere
31
Q

what substances can be used to measure GFR as a surrogate marker (5)

A
  1. inulin (most accurate, but exogenous so only used in research)
  2. iohexol
  3. EDTA
  4. DTPA
  5. creatnine (the only one naturally present in the body)
32
Q

why is creatnine not that accurate a measure of GFR

A

more creatnine is secreted by the tubules into the filtrate => implies GFR is higher than it actually is

33
Q

how to calculate creatinine clearance from a 24hr urine collection

A

Cr clearance = ([creatinine in urine] x Vol of urine)/[Cr in serum]

34
Q

what must be checked as well as absolute creatinine levels

A

change from prior result e.g. increase for 60 to 90 can be fatal for a pt, despite 90 being in the ref range

35
Q

when should eGFR be not taken as actual GFR (6)

A
  1. AKI
  2. children
  3. pregant women
  4. extremes of body size
  5. amputees
  6. malnutrition
36
Q

how do the triad of nephrotic syndrome relate to each other

A

GN leads to filtration disruption -> proteinuria -> decrease in circulating protein -> hypoalbuminuria -> decreased oncotic pressure resulting in oedema as water exits the bvs

37
Q

what are some complications of nephrotic syndrome (3)

A
  1. DVT (loss of anti thrombotic factors e.g. antithrombin III)
  2. infection
  3. hypercholesterolaemia (increase cholesterol produciton by the liver as it tries to upreg protein synth to compensate for loss)
38
Q

why should children with a FH of polycystic kidney disease not have an US

A

high chance of false -ve as cysts only tend to develop later

39
Q

what is the scar for a kidney transplant

A

hockey stick scar in illiac fossa

40
Q

what lifethreatening arrythmia is most common to occur from hyperkalaemia

A

asystole

41
Q

what lifethreatening arrythmia is most common to occur from hypokalaemia

A

VF

42
Q

hyperkalaemia ECG changes (4)

A
  1. tall tented T waves
  2. broad QRS
  3. prolonged PR
  4. “sine wave pattern”
43
Q

what can be done other than calcium gluconate to increase K+ uptake into the cells (reducing hyperkalaemia)

A
  1. Beta 2 stimulation (salbutomol)
  2. insulin (+dextrose)
44
Q

what is calcium resonin and what can it be used for

A

an ion-exchange resin that can be used to increase excretion of K+ -> works slowly so not in emergency situ

45
Q

pulmonary oedema with AKI mgx

A
  1. consider NIV/intubation (after A-E)
  2. sit up
  3. loop diuretics (much higher dose than usual)
  4. nitrates/opiates
  5. venesection
46
Q

relation of uremia to pericarditis/pericardial effusion

A

accumulation of toxic metabolites within the pericardial sac leads to fluid within the pericardial sac

47
Q

standard bicarbonate vs total bicarbonate

A

standard - bicarb measured under standard conditions, adjusted for body conditions -> USE STANDARD if given both
total - total HCO3- in blood

48
Q

what is base excess on ABG

A

the titratable acidity (or base) of the blood sample -> It is defined as the amount of acid or base that must be added to a sample of oxygenated whole blood to restore the pH to 7.4 at standard conditions

e.g. -2 means 2 mol of alkali needed to make neutral

49
Q

anion gap on ABG

A

difference between anion and cations -> helps establish cause of metabolic acidosis/alkalosis

50
Q

3 functions of the kidneys

A
  1. excretory/regulatory (uraemic toxins, fluid, acid/base, electrolytes)
  2. metabolic function (vit D hydroxylation)
  3. synthetic function (EPO)
51
Q

what is renal osteodystrophy

A

a consequence of CKD when bones become weaker due to increased phosphate, decreased vit D etc.

52
Q

what might small vessel vasculidities present as initially

A

pulmonary-renal syndrome
-> if lung and kidney problems seen this indicates a rapidly deteriorating condition that need mgx

53
Q

what is micro angiopathic haemolytic anaemia

A

a subgroup of hemolytic anemia where there is fragmentation and hemolysis due to damage of erythrocytes in the small blood vessels -> It is characterized by the presence of red cell fragments or schistocytes on blood film review

54
Q

what is DIC

A

Disseminated intravascular coagulation - a widespread hypercoagulable state that can lead to micro- and macrovascular clotting and compromised blood flow

55
Q

how can DIC lead to the presence of schistocytes

A

fibrin stands form which can slice RBCs leading to schistocytes

56
Q

what is haemolytic uremic syndrome

A

combination of :
1. microangiopathic haemolytic anaemia
2. thrombocytopenia
3. renal failure

polymerisation of clotting components that are released in such large quantities they can’t be broken down in time

usually due to E.coli (be careful of giving abx as death of the bacteria in this case can cause massive release of pre formed toxins into the body)

57
Q

what is TTP

A

Thrombotic Thrombocytopenia Purpura -> clotting disorder where thrombi arise in small bvs

assoc w ADAMS13 deficency leading to lack of vWF or ADAMS13 auto-antibody

58
Q

HUS treatment

A

supportive - emergency dialysis, treat HTN

59
Q

why is alkilisation of the urine a treatment for rhabdomyolysis

A

Administration of Sodium Bicarbonate to increase urine pH is done as this alkalotic conditions reduces the precipitation of myoglobin

60
Q

what are bence-jones proteins

A

free light chains that may appear in the urine - seen in multiple myeloma

(now historical test)

61
Q

primary vs secondary hypertension

A
62
Q

how might renal artery stenosis present

A
  1. hypertension
  2. salt and water retention
  3. “flash pulmonary oedema”
  4. renal impairment (particularly following ACEi -> should be advised to stop for a few days if unwell)

3B week 5 - LUTS, The Scrotum and Genitalia (6 decks)

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