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Phase 1 Exam > Renal > Flashcards

Renal Flashcards

1
Q

What is the normal physiology of the bladder?

A
  • As the bladder fills with urine there are two mechanisms that control the continence before the next emptying:
    1. The intra vesicle pressure remains low and the detrusor muscles remain stable.
    2. The spinchter muscles remain stable at the bladder neck and the urethral muscles.
  • During the onset of voiding the spinchter muscles relax and the destrusor muscles contract in order to create voiding.
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2
Q

What is stress incontinence?

A
  • Due to spinchter weakness - can be iatrogenic in men and childbirth in women.
  • When intra abdominal pressure rises it causes small amounts of urine to leak.
  • Management in women is pelvic floor exercises, oestrogen creams and surgery and in men artifical spinchters and slings.
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3
Q

What is urge incontinence?

A
  • Urgency with frequency, with or without nocturia, when appearing in absence of local pathology.
  • Strong desire to void and may be unable to hold
  • Caused by detrusor instability.
  • Management = Behavioural therapy, decreased use alcohol and caffeine, as well as the use anti muscarnic agents and botox.
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4
Q

Definition of prostate cancer

A
  • Malignant tumour of glandular origin within the prostate
  • Adenocarcinoma
  • Most common malignant tumour in men.
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5
Q

Aetiology of prostate cancer

A
  • Increasing age, family history, genetic predisposition with BRAC2, afro caribbean descent and diet high in fat in association with red meat.
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6
Q

Risk factors of prostate cancer

A
  • Over 50, family history and black ancestry.
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7
Q

Histology of prostate cancer

A
  • Usually found in the peripheral zone with it feeling craggy and enlarged in a DRE.
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8
Q

Investigations of prostate cancer

A
  • Usually asymptomatic
  • PSA
  • Biopsies
  • CT scanning
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9
Q

Management of prostate cancer

A
  • Active surveillance, radical/partial prosecectomy, radio, chemo or hormone treatment.
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10
Q

Definition of renal cell carcinoma

A
  • Malignancy of the renal parenchyma/cortex and accounts for more than 85% of renal cancers.
  • Most commonly seen in patients over the age of 50 with peak incidence being 80 to 85.
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11
Q

Aetiology of renal cell carcinoma

A
  • Smoking, hypertension/obesity, renal transplant, family history
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12
Q

Presentation of renal cell carcinoma

A
  • Classic triad: mass, haematuria, loin pain in the flank.
  • Incidental finding in more than 50% of cases.
  • Malaise, weight loss and fatigue.
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13
Q

Investigations of renal cell carcinoma

A
  • Ultrasonography
  • CT
  • MRI for staging
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14
Q

Management of renal cell carcinoma

A
  • Surveillance
  • Radical/partial nephrocetomy
  • Ablatative techinques
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15
Q

Definition of bladder cancer

A
  • Most commonly uroethelial carcinoma.
  • Usually non muscle invasive tumours
  • Low grade - papillary and easy to visualise
  • High grade - flat and in situ and harder to visualise
  • Common, more common in men than women
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16
Q

Aetiology of bladder cancer

A
  • Smoking, exposure to chemicals such as aromatic amines including rubbers and dyes.
  • Patients that are type 2 diabetics are at risk.
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17
Q

Presentation of bladder cancer

A
  • Painless haematuria

- Dysuria and urinary frequency

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18
Q

Investigations of bladder cancer

A
  • CT urography and cytoscopy
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19
Q

Management of bladder cancer

A
  • If non muscle invasive then transurethral resection and post op chemo.
  • If locally invasive then radical/partial cytoscotmy and pre/post op chemo.
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20
Q

Definition of testicular cancer

A
  • Most common type of malignancy in young males between the ages of 20 and 34 but highly curable when caught early.
  • Pre cancerous condition known as carcinoma in situ that is highly specific of the condition.
  • Rare
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21
Q

Aetiology of testicular cancer

A
  • Unknown
  • Patients with undescended testes are at risk
  • Either teratomes or seminomas
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22
Q

Presentation of testicular cancer

A
  • Painless lump

- Mets include lungs leading to cough and dyspnoea and also paraaortic lymph nodes causing backpain.

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23
Q

Investigations of testicular cancer

A
  • Ultrasound
  • Teratomes = increased AFP and hCG
  • Seminomas = no increased AFP
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24
Q

Management of testicular cancer

A
  • Orchidectomy for histological grading

- Chemo/radio

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25
Q

Definition of pyelonephritis

A
  • Infection of the renal parenchyma and soft tissues of renal pelvis and upper ureter.
  • Usually seen in women over the age of 35.
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26
Q

Pathophysiology of pyelonephritis

A
  • Ascending (intercourse) or haematogenous (Staph aureus)
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27
Q

Presentation of pyelonephritis

A
  • Classical triad: fever, pyrexia and loin pain.
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28
Q

Investigations of pyelonephritis

A
  • Abdo exam, bloods and culture of MSU and ultrasound scan.
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29
Q

Management of pyelonephritis

A
  • Fluid, IV antibiotics, drain any obstructed kidney and analgesia.
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30
Q

Definition of Urolithiases

A
  • Nephrolithiasis presence of crystalline stones within either the kidneys or the ureter.
  • Mostly in the kidney and then pass down into the ureter.
  • Urolithiases is when it passes into the ureter.
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31
Q

Pathology of Urolithiases

A
  • Most stones are calcium - either calcium phosphate or calcium oxalate.
  • Calcium stones usually due to hypercaciuria (increased calcium excretion) and hyperoxoria (increased calcium oxalate excretion).
32
Q

Risk factors of Urolithiases

A
  • Increased protein intake, increased salt intake, male, white, dehydration, obesity, occupational expsure, family history and preciptant meds.
33
Q

Presentation of Urolithiases

A
  • Can be asymptomatic or present with symptoms such as haematuria, recurrent UTI’s or obstruction urinating.
  • Pain caused by obstruction usually.
  • Classic renal colic - unilateral sudden intense pain that radiates from the loin to the groin. Patient withering in pain, which is made worse with fluid and associated with nausea.
34
Q

Investigations of Urolithiases

A
  • Mid stream urine for culture
  • Plain abdo XR
  • CT is diagnostic
  • Potential NCCT - ICUB for females of child bearing age.
35
Q

Management of Urolithiases

A
  • Conservative
  • Analegesics
  • Lithoroscopy
  • Surgery
  • Prevention
36
Q

Definition of benign prostatic hyperplasia

A
  • Lower urinary tract infections that are caused by urether obstruction due to narrowing of the lumen because of increasing cells or decrease in apoptosis in the transitional zone.
  • It increases the prostatic smooth muscle tone mediated by alpha adrenergic receptors.
  • Usually seen in patients over the age of 70.
37
Q

Aetiology of benign prostatic hyperplasia

A
  • Due to an increase in age and also hormonal changes.
38
Q

Risk Factors of benign prostatic hyperplasia

A
  • Over 50, family history, non asian race, cigarette smoking, metabolic syndrome, male pattern baldness.
39
Q

Presentation of benign prostatic hyperplasia

A
  • Storage symptoms including frequency of micturition, nocturia and urgency.
  • Delay in initiation of micturition, weak stream, hesitancy, intermittency, straining, incomplete emptying and post void dribbling.
40
Q

Investigations of benign prostatic hyperplasia

A
  • Flow rates and residual volume
  • Frequency volume chart
  • Renal biochem
  • PSA/DRE to rule out prostate cancer
41
Q

Management of benign prostatic hyperplasia

A
  • Mild symptoms: ‘watchful waiting’
  • Selective a1 - adrenoreceptor antagonists used to relax the smooth muscle in the bladder neck and prostate to increase the lumen of the ureter.
  • 5a reductase inhibitors, block the conversion of testerterone.
  • Surgery
42
Q

Definition of erectile dysfunction

A
  • The inability to achieve or maintain an erection that is sufficient enough for sexual performance.
  • Usually seen in men over the age of 50
43
Q

Aetiology of erectile dysfunction

A
  • Metabolic syndrome: diabetes, hypertension, hyperlipidaemia, obesity.
  • Non organic causes such as sexual or relationship dysfunction or performance anxiety
44
Q

Taking a history of erectile dysfunction

A
  • Ask about onset, severity, duration, as well as early morning erections and masturbation.
  • Examination
45
Q

Investigations of erectile dysfunction

A
  • PSA and FBC
  • Fasting plasma glucose
  • Validated questionaires
  • Penile doppler USS
46
Q

Management of erectile dysfunction

A
  • Vaccum devices, penile prosthesis
  • Lifestyle changes
  • Medications such as PDE 5 inhibitors, intra urethral therapy and injectable therapies.
47
Q

Definition of CKD

A
  • Progressive and irreversible decline in renal function which is classified in 3 stages depending on the eGFR.
  • A normal function is more than 90
  • It differs from AKI as it is defined as persistent kidney damage and/or impaired GFR for more than 3 months.
48
Q

Aetiology of CKD

A
  • Diabetic nephropathy and hypertension most commonly.
49
Q

Risk factors of CKD

A
  • Smoking, hypertension, diabetes, more than 50, obesity
50
Q

Presentations of CKD

A
  • Can be asymptomatic at first with declining GFR and increasing urea and creatine.
  • As it progresses patient may present with lethargy, fatigue and bone disease, which can be due to anaemia, bone disease and neurological conditions.
  • Patients may have secondary hyperparathyroidism due to decrease in calcium and increase in phosphate.
51
Q

Investigations of CKD

A
  • Increased creatine and urea, as well as identifying serum microalbumin.
  • Renal ultrasound
  • Severe CKD would be classified as GFR of less than 60, as well as normochromic anaemia, small kidneys and renal osteodystrophy.
52
Q

Management of CKD

A
  • Renoprotective (Use of ACE inhibitors and CCB)
  • Decrease in CVD risk
  • Correction of complications
  • Refer
53
Q

What is nephrotic syndrome?

A
  • Caused by 5 main reasons minimal change disease, primary/secondary glomerular disease, diabetic nephropathy or amyloidosis.
  • Symptoms include proteinuria, oedema, hypoalbuminaemia, lipiduria and hyperlipidaemia.
  • Management is about diuretics, ACE/ARBs, steroids
54
Q

What is acute glomerulonephritis?

A
  • Often an immune response triggered by an infection.
  • Most common patient would be a child post strep infection around 1 to 3 weeks later, they might also be post infective endocarditis
  • Presentation with visible or non visible haematuria ,hypertension/oedema, proteinuria, oliguria and uraemia
  • Management, its often self limiting - supportive management, steroid use.
55
Q

What is IgA nephropathy?

A
  • Presence of dominant or co dominant mesangial IgA immune deposits,
  • Presents with microscopic haematuria that is episodic
  • Mangement is supportive with steriods
56
Q

Definition of UTI

A
  • Urinary tract infection
  • Can be lower tract or kidneys/bladder/urethera
  • Clinical features and bacteria in urine
  • Women > men
57
Q

Aetioloy of UTI

A
  • E.coli
58
Q

Risk factors of UTI

A
  • Women, postmenopausal, new sexual activity, family history, history of UTIs, catheters
59
Q

Presentation of UTI

A
  • Cardinal signs: dysuria, frequency, urgency

- Suprapubic pain/tenderness, haematuria and smelly urine

60
Q

Investigations of UTI

A
  • Uncomplicated no need - with 2/3 cardinal symptoms
  • MSU - culture
  • Urine dipstick - red colour due to gram negative reducing nitrates into nitrites.
61
Q

Management of UTI

A
  • Uncomplicated, treat imperically, with 3 days - trimethoprim or nitrofuratoin
  • Asymptomatic bacteriaumia over 65 or pregnant - don’t treat
62
Q

Definition of Chlamydia

A
  • Most common bacterial STI

- Caused by chlamydia trachomatis which is gram negative

63
Q

Risk factors of Chlamydia

A
  • Under the age of 25 and sexually active, new/multiple partners, lack of condoms, previous STI’s
64
Q

What is the incubation period of chlamydia?

A
  • 7 to 21 days
65
Q

Presentation of chlamydia

A
  • Most commonly asymptoamtic

- Can be cervical discharge, friable cervix, abnormal vaginal bleeding, vaginal/penile discharge

66
Q

Investigations of chlamydia

A
  • NAAT - vaginal swab/first morning void
67
Q

Mangement of chlamydia

A
  • Doxycycline for 7 days

- Partner notification

68
Q

Definition of gonorrhoea

A
  • Neisseria gonnorrhoea is a gram negative diplococcus

- STI usualyl seen in MSM and black patietns

69
Q

Aetiology of gonorrhoea

A
  • Sexual contact without a condom

- Includes penetrative sex that involves the mucosa lined orifice

70
Q

Presentation of gonoorhoea

A
  • In men, urethral discahrge as well as tenderness and/or swelling of the epididymis
  • Pelvic pain in women
71
Q

Investigations of gonorrhoea

A
  • NAAT
72
Q

Management of gonorrhoea

A
  • Contact tracing

- Ceftriaxone and azithroymic

73
Q

Definition of syphillis

A
  • STI caused by spirochaetal bacterium Treponema pallidum, sub species paludium
  • Usually seen in MSM
  • Can be primary or secondary
74
Q

Presentation of syphilis

A
  • Any genital ulcer is syphilis until proven otherwise

- Can also present with lymphadenopathy, diffuse rash, fever and malaise

75
Q

Investigations of syphilis

A
  • Serology
  • Screening EIA
  • TPPA
76
Q

Management of syphilis

A
  • Penicilin

- Partner tracing

Phase 1 Exam (25 decks)

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