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3rd year medicine > renal > Flashcards

renal Flashcards

1
Q

classification of CKD

A
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2
Q

proteinuria?

A
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3
Q

earliest expression of diabetic nephropathy?

A

microalbuminuria

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4
Q

how to differentiate between pre-renal failure and intrinsic renal damage

A
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5
Q

functions of kindey

A

maintain water + electoclyte balance

acid-base balance

excrete waste products (urea + creatinine)

produces erythropoetin adn renin

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6
Q

function of proximal covoluted tubule?

loop of henle?

distal convoluted tubule?

A

PCT = reabsorbs 100% glucose, proteins, carbohydrates

* 70% Na+ and H2O

Loop of Henle = creates hypeosmotic environment in medulla

DCT = reabsorbs water, Na+ and bicarbnate, excretes K+ and H+

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7
Q

epithelial cells lining glomerular capallaries?

glomerular filter?

A

podocytes

glomerular filter = enodthelium of capillary + basement membrane + pedicels of podocytes

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8
Q

blood supply to renal medulla?

A

vasa recta

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9
Q

hormone that acts on DCT?

A

ALDOSTERONE

increases reabsorption of Na+ thus water, increasing BP

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10
Q

what hormone acts on collecting ducts?

A

ADH - increases water reabsoprtion

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11
Q

structures lined by transitional epihtelium (urothelium)?

features

A

mior calyx, major calyx, ureter, bladder

cells of luminal surface called umbrella cells because domed

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12
Q

urethra of female vs male

A

female 3-5cm

* lined by trnasitional epithelium which transitions to stratified squamous

male 20cm

* prostatic urethra (from bladder through prostate) - transitional epithelium

* membranous (from prostate to bulb of penis) - transitional changes to straified columnar

* penile urethra - changes to stratified squamous

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13
Q

osmolarity of body fluids

A

300 mosmol/l

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14
Q

body water components

A

ICF = 70%

ECF = 30%

* ECF = plasma (20%), interstitial fluid (80%), lymph

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15
Q

how to calculate body fluid compartments

A

TBW = ICF + ECF

tracer for ECF = inulin

TBW = H2O

ICF = TBW - ECF

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16
Q

ionic concentrations of ICF vs ECF

A
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17
Q

osmotic concentratiosn of ECF vs ICF

A

IDENTICAL 300 mosmol/l

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18
Q

extracellular K+?

A

>95% of K+ is intracellular

leakages can cause

* muscle weakness + paralysis

* arrhythmias and cardaic arrest

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19
Q

regulation of renal blood flow thus GFR

A

extrinsic = sympathetic via baroreceptor reflex

intrinsic = myogenic + tubuloglomerular feedback

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20
Q

if capillary blood pressure falls…

A

GFR will decrease

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21
Q

kidney response to haemorrhage

A
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22
Q

mucula densa cell function?

A

sense NaCl content of tubular fluid

high levels = constriction of afferent arterioles

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23
Q

other determinants of glomerular filtration rate

A
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24
Q

plasma clearance of inulin? - what is used instead

glucose?

what is used to calculate renal plasma flow?

A

inulin = GFR (creatinine used clinically)

glucose = 0

para-amino hippuric acid (PAH) used to calculate renal plasma flow

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25
Q

accelerated hypertension?

A

medical emergency

diastolic BP >120 mmHg

papilloedema

encephalopathy, fits, cardiac failure, acute renal failure

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26
Q

leukonychia?

splinter haemorrhages?

A

leukonychia seen in nephrotic syndrome - low albumin

splinter haemorrhages - CKD, vasculitis

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27
Q

UTI urinalysis

A

leukocytes + nitrites

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28
Q

normal 24 hour urine?

normal P:CR

grading proteinuria

A

normal 24 hour = <150mg/24 hours

urine protein:creatinine = 0.5g/24 hours

asymptomatic low grade = PCR <1g/day

heavy proteinuria = PCR 1-3 g/day

nephrotic = PCR >3g/day

ACR >30 = proteinuria

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29
Q

what does this show?

A

LVH!!

(probably severe hypertension)

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30
Q

what does this show?

A

hyperkalaemia - tall teneted T waves

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31
Q

Acute kidney injury?

classifcation?

A

An abrupt (<48 hrs) reduction in kidney function defined as:

  • Increase in serum creatinine by >26.4umol/l (50%)
  • Reduction in UO
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32
Q

nephrotic syndrome triad?

A

proteinuria >3g/day

hypoaluminaemia

oedema

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33
Q

nephritic syndrome symptoms?

A

AKI

oliguria

oedema/fluid retention

hypertension

active urinary sediment - RBCs (haematuria), leukocytes

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34
Q

risk factors AKI?

A

older age

CKD

Diabetes

Cardiac failure

Liver disease

PVD

Previous AKI

Also – hypotension, hypovolaemia, sepsis, deteriorating NEWS, recent contrast, exposure to certain medications

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35
Q

Ax pre-renal AKI?

Tx?

A

pre-renal AKI (commonest cause of AKI in hopsital - sepsis + severe dehydration)

  • hypovolaemia = haemorrhage, burns
  • hypotension = cardiogenic shock, sepsis, anapylaxis
  • renal hypoperfusion = NSAIDs, ACEI, hepatorenal syndrome, rhadbomyolysis

Tx = fluid challenge for hypovolaemia (NaCL, NOT dextrose)

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36
Q

Ax AKI?

A

pre-renal

renal

post-renal

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37
Q

untreated pre-renal AKI?

A

leads to tubular necrosis

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38
Q

Ax renal AKI?

A

Vascular

  • Vasculitis, renovascular disease

Glomerular

  • Glomerulonephritis

Interstitial nephritis

  • Drugs - antibiotics e.g. penicillin
  • Infection (TB)
  • Systemic (sarcoid)

Tubular injury

  • Ischaemia
  • Drugs (gentamicin)
  • Contrast
  • Rhabdomyolysis
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39
Q

s/s renal AKI?

A

Anorexia, weight loss, fatigue

N + V

Itch

Fluid overload – oedema, SOB

Signs

  • Fluid overload – hypertension, oedema, pul oedema, effusions
  • Uraemia – itch, pericarditis
  • Oliguria
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40
Q

clues to cause of renal AKI?

A

History e.g. sore throat (antibiotics), rash (vasculitis), joint pains, D + V, haemoptysis

Recent contrast

Drugs

Bloods – eosinophilia, CK

Vascular bruits

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41
Q

Dx renal AKI?

A

obviously increase in serum creatinine >26.4 (50%)

+ reduction in UO

in addition:

  • U + Es (hyperkalaemia)
  • FBC + coagulation (abnormal clotting, anaemia, CK)
  • urinalysis (haematoproteinuria)
  • USS (?obstruction)
  • immunology - ANA, ANCA, GBM
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42
Q

Tx renal AKI?

A

Stop nephrotoxics

Establish good perfusion pressure – fluid resuscitiate (if no improvement = inotropes, vasopressors)

Treat underlying cause

Dialysis if no urine passage

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43
Q

life threatening complications AKI?

A

Hyperkalaemia

Fluid overload (pulmonary oedema)

Severe acidosis (pH <7.15)

uraemic pericardial effusion

severe uraemia (>40)

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44
Q

post-renal AKI Ax?

Tx?

A

Obstruction of urine flow leading to back pressure (hydronephrosis)

Ax = Stones, cancer, strictures, BPH

Tx = relieve obstruction, catheter/nephrostomy

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45
Q

life threatening hyperkalaemia?

signs?

Tx?

A

Life threatening hyperkalemia = >6.5

signs = muscle weakness, T waves on ECG

Tx = calicum gluconate (to protect myocardium), then insulin with 50% dextrose (move K+ back into cells), then calcium resonium (to stop GI absoprtion)

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46
Q

urgent indications for dialysis?

A

Hyperkalaemia >7 ( or >6.5 unresponsive to therapy)

Sever acidosis pH <7.15

Fluid overload

Urea >40, pericardial rub/effusion

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47
Q

ECG changes hyperkalaemia?

A
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48
Q

medicines to stop on sick days?

A

ACE-I and ARBS

NSAIDs

diuretics

metformin + empagliflozin

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49
Q
A

1 = goodpasture’s syndrome

2 = rhabdomyolysis?

3 = acute tubular necrosis?

4 = obstructive uropathy

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50
Q
A

furosemide

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51
Q
A

calcium gluconate

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52
Q
A

elevated creatinine

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53
Q

kidneys reabsorb….

A

99% of fluid

99% of salt

100% of glucose

100% of amino acids

50% of urea

0% creatinine

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54
Q

proximal tubule absoprtion + secretion?

fluid is?

A

Reabsorbed in PT

  • 70% Na (via K+ATPase) + water
  • 100% glucose + amino acid
  • phosphate, sulphate, lactate

Secreted in PT

  • H+, neurotransmitters, bile pigments, uric acid, drugs, toxins

fluid is iso-osmitic (~300) in PT

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55
Q

Loop of Henle function?

physiology

A

formation of hypertonic urine

entire loop functions as countercurrent multiplier

together the loop and vasa recta establish a hyper-osmotic medullary interstitial fluid

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56
Q

ascending vs descending limb loop of henle?

A
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57
Q

CKD Dx?

complications?

A

CKD requires 2 samples at least 90 days apart

comps = AKI, falls, fragility

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58
Q

stages CKD?

A
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59
Q

ACR CKD?

A
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60
Q

golden rules of CKD?

A

Monitor people for development/progression of CKD for at least 2-3 years after AKI, EVEN IF serum creatinine has returned to baseline

Advise people who have had AKI that they are at increased risk of CKD

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61
Q

accelerated progression CKD?

risk factors associated wtih CKD progression?

A

Sustained decrease in GFR of >25% within 12 months

OR

Sustained decrease in GFR of 15/ml/min per year

risk factors = CVD, AKI, hypertension, diabetes, smoking, chronic use of NSAIDs, untreated urinary outflow obstruction, African/Asian origin

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62
Q

people with CKD who should be referred for specialist assessment?

A

GFR <30 (G4 + 5)

ACR >70

ACR >30 with haematuria

sustained decrease of GFR by 25% in 12 months

poorly controlled hypertension

suspected renal artery stenosis

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63
Q

blood pressure targets CKD?

A

In people with CKD, aim to keep <140/90

In people with CKD and diabetes, keep <130/80

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64
Q

CKD Tx?

A

ACE-I/ARB

atorvastatin 20mg

alfacalcidol, phosphate binders, calcimimetic for CKD-MBD

iron therapy for anaemia

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65
Q

Ax CKD?

A
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66
Q

clinical signs CKD?

A

Anaemia – conjunctival + palmar pallor

Weight loss

Advanced uraemia

  • Lemon yellow
  • Uraemic frost
  • Twitching
  • Encephalopathic flap
  • Confusion
  • Pericardial rub/effusion
  • Kussmaul breathing (metabolic acidosis)
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67
Q

symptoms CKD?

A

Uraemic

  • N + V
  • Anorexia
  • Weight loss
  • Fatigue
  • Itch
  • Altered taste
  • Restless legs
  • Muscle twitching
  • Difficulties concentrating
  • Confusion

Thirst

Anaemia = fatigue, muscle weakness

Pain = bony, neuropathic, ischaemic, visceral

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68
Q

consequences CKD?

A

Renal

  • Pain, haemorrhage, infection
  • Haematuria, proteinuria
  • Impaired salt and water handling
  • Hypertension
  • Electrolyte abnormalities
  • Acid-base disturbance (metabolic acidosis)
  • ESRD

Extra-renal

  • CVD
  • Mineral and bone disease (extra PTH, calcium moved from inside bones)
  • Anaemia
  • Malnutrition
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69
Q

ESRD Tx?

A

dialysis

transplant

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70
Q

CVD in CKD?

A

Starts early – eGFR <50

Risk increases with microalbuminuria even if eGFR normal

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71
Q

Tx CKD-mineral bone disease

A

Phosphate restriction

Salt reduction

Potassium restriction

Fluid restriction

meds = alfacalcidol, phosphate binders (aluminium), calcimimetic (Cinacalcet)

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72
Q

renal anaemia?

Target?

A

renal anemia = HB <100 despite no iron deficiencies

target Hb = 100-120g/l

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73
Q

autosomal dominant polycystic renal disease Ax?

significance?

S/s?

extra-renal features?

A

Mutation in PKD1 gene

Important cause of ESRD!!

s/s = chronic pain (back), hypertension, haematuria (cyst rupture etc), cyst infection, renal failure

extra-renal:

  • hepatic cysts
  • intra-cranial aneurysms!!
  • cardiac valvular disease
  • abdominal/inguinal hernias
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74
Q

Dx ADPKD?

A

USS = cysts + renal enlargement

CT/MRI

genetics - PKD1

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75
Q

ADPKD genetic counselling?

A

Offspring of affected individual 50% risk of having disease

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76
Q

Tx ADPKD?

A

Tolvaptan!

control BP

if progressed to renal failure = dialysis + transplant

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77
Q

autosomal recessive PKD affects?

gene?

cysts where?

S/s?

A

children - associated with hepatic lesions

gene = PKDH1 on chromosome 6

cysts bilateral + symmetrical, collecting ducts!

S/s

  • kidneys always palpable
  • hypertension
  • recurrent UTI
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78
Q

Alport’s syndrome?

S/s?

Dx?

Tx?

A

X-linked herediatary nephritis

S/s = haematuria, sensorineural deafness, anterior lenticonus, leiomyoma of oesophagus/genitalia

Dx = suspect in haematuria + hearing loss

renal biopsy characteristic feature = variable GMB thickness

Tx = no specific treatment, treat BP, maybe dialysis/transplant

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79
Q

Anderson Farby’s disease clinical features?

Dx?

Tx?

A

features = renal failure, angiokeratomas, cardiomyopathy + valve disease, stroke, acroparaesthesia

Dx = plasma a-GAL, renal biopsy

Tx = enzyme replacement - fabryzyme

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80
Q

medullary cystic kidney?

difference from ADPKD?

Dx?

Tx?

A

autosomal dominant

difference from ADPKD = normal sized/small kindeys (in ARPKD and ADPKD kidneys are enlarged + palpable)

Dx = family history + CT scan

Tx = renal transplant

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81
Q

medullary sponge kidney?

A

sporadic inheritance - medulla looks like a sponge

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82
Q

fluid in loop of henle?

A

Tubular fluid leaving loop of Henle entering distal convoluted tubule is hypo-osmotic to plasma

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83
Q

hormones controlling fluid + electolyte balance?

A

ADH = increased water reabsorption (collecting duct)

Aldosterone = increased Na reabsorption, increased H+/K+ secretion (DCT)

Atrial natriuretic hormone = decreased Na reabsorption

Parathyroid hormone (PTH) = increased calcium reabsorption, decreased phosphate reabsorption

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84
Q

distal tubule fluid?

permeability?

segments?

A

Tubular fluid is hypo-osmotic to plasma

Distal tubule has LOW permeability to water and urea

Distal tubule can be described as 2 segments (early + late)

  • Early = NaCl reabsorption
  • Late = Ca, Na, K reabsorption (except K+ is secreted in presence of aldosterone) + H+ secretion
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85
Q

high ADH?

low ADH?

A

High ADH = high water permability + hypertonic urine

Low ADH = low water permeability + hypotonic urine

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86
Q

diabetes insipidus s/s?

Tx?

A

s/s = large volumes of dilute urine + constant thirst

Tx = ADH replacement

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87
Q

ADH release?

A

hypothalamic osmoreceptors!!! = most important

also stimulated by decreased left atrial pressure = increased ADH

GI stretch receptors = inhibits ADH

nicotine stimulates ADH, alcohol inhibits

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88
Q

aldosterone released by?

when?

function?

A

aldosterone secreted by adrenal cortex

secreted in response to rising K+ or falling Na+ in the blood

OR activation of RAAS

stimulates Na+ reabsorption and K+ secretion in DCT

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89
Q

effect of aldosterone?

A

Normally 90% of K+ is reabsorbed in proximal tubule

When aldosterone absent, the rest is reabsorbed in the distal tubule (therefore, no K+ excreted in urine)

An increase in [k+] directly stimulates adrenal cortex

Aldosterone stimulates secretion of K+ in distal tubule

A decrease in plasma [Na+] promotes indirect secretion of aldosterone

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90
Q

triggers for renin release from JGA?

A

reduced pressure in afferent arteriole

macula densa cells (decreased NaCl)

reduced arterial blood pressure

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91
Q

what is responsible for fluid retention in congestive heart failure?

Tx?

A

RAAS

Tx = low salt diet, loop diuretics + ACE-I

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92
Q

Atrial natriuretic peptide?

A

Heart produces ANP which is stored in atrial muscle cells

ANP released when cells mechanically stretched due to increase in circulating plasma volume

ANP promotes excretion of Na+ and diuresis

Lowers BP :))

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93
Q

micturation controlled by?

A

Micturition reflex

  • Stretch receptors in bladder wall initiate micturition reflex
  • Bladder contraction and opening of internal and external urethral sphincters

Voluntary control

  • Tightening of external sphincter and surrounding pelvic diaphragm
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94
Q

aldosterone summary

A
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95
Q

pH of artrial vs venous blood?

increase in [H+]?

A

pH of arterial blood = 7.45

pH of venous blood = 7.35

An increase in H+ REDUCES pH

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96
Q

complication of acidosis?

alkalosis?

A

acidosis = depression of CNS

alkalosis = overexcitability of PNS and then CNS

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97
Q

most important physiological buffer

A
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98
Q

what is the most common cause of ESRD?

2nd most common?

A

most common = diabetes

2nd most common = chronic glomerulonephritis

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99
Q

what is glomerulonephritis?

A

Immune-mediated disease affecting glomeruli

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100
Q

clinical presentation glomerulonephritis?

A

Damage to endothelial or mesangial cells leads to proliferative lesion + red cells in urine

Damage to podocytes leads to non-proliferative lesion and protein in urine

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101
Q

Ix glomerulonephritis?

A

Clinical presentation

Blood tests

Urinalysis – haematuria, proteinuria

Urine protein:creatinine ratio

Kidney biopsy

102
Q

S/s glomerulonephritis?

A

nephritic syndrome/nephrotic syndrome/mixed

impaired renal function (can lead to ESRD)

hypertension

103
Q

s/s nephritic syndrome?

indicative of?

A

Acute renal failure

Oliguria

Oedema/fluid retention

Hypertension

RBCs, RBC and granular casts in urine

Indicative of a proliferative process affecting endothelial cells

104
Q

nephrotic syndrome s/s?

indicative of?

A

Proteinuria >3g/day

Hypoalbuminemia (<30)

Oedema

Hypercholesterolaemia

Usually normal renal function

Indicative of a non-proliferative process affecting podocytes

105
Q

nephrotic syndrome complications?

A

Infections – loss of antibodies

Renal vein thrombosis - loss of anticoagulants

Pulmonary emboli

Volume depletion – overuse of diuretics may lead to ARF (pre-renal)

Vit D deficiency - also lost in urine

Subclinical hypothyroidism - urinary loss protein-bound thyroid hormones

106
Q

Ax glomerulonephritis?

A

idiopathic GN (types discussed later)

secondary = infections, drugs, malignancy, systemic disease (ANCA, lupus, goodpastures, HSP)

107
Q

crescenteric glomerulonephritis?

A

Crescentic = presence of crescents in e.g. RPGN in vasculitis

108
Q

Tx glomerulonephritis?

A

immunosuppression - corticosteroids, azathioprine, cyclophosphamide/chlorambucil

anti-hypertensives (target <130/80 or <120/75 if proteinuria)

ACE-I/ARBs

statins

?anticoagulants

109
Q

Tx nephrotic patients?

remission?

A

Fluid + salt restriction

Diuretics

ACEI/ARBS

Anticoagulation

IV albumin (only if volume depletion)

Immunosuppression

  • Complete remission = proteinuria <300mg/day
  • Partial remission = proteinuria <3g/day
110
Q

idiopathic GN main types?

A

Minimal change

Focal segmental glomerulosclerosis (FSGS)

Membranous

Membranoproliferative

IgA nephropathy

111
Q

minimal change nephropathy?

Dx?

Tx?

ESRD?

A

COMMONEST cause of nephrotic syndrome in children!!

Dx = normal renal biopsy!!

Tx = 94% complete remission with oral steroids

  • second-line drugs = cyclophosphamide

does NOT cause progressive renal failure

112
Q

focal segmental glomerulosclerosis?

Ax?

Dx?

Tx?

Complication?

A

COMMONEST cause of nephrotic syndrome in adults!!

1* or 2* (HIV, heroin use, obesity, reflux nephropathy)

Dx renal biopsy = minimal immune deposition

Tx = steroids (60% remission)

50% progress to ESRF after 10 years

113
Q

membranous nephropathy?

Ax?

Dx?

Tx?

Complication?

A

2nd commonest cause of nephrotic syndrome in adults

1* or 2* - important secondary causes:

  • infections (hep B/parasites)
  • connective tissue disease (lupus)
  • malignancies!!! (lung, colon + melanoma)
  • drugs (gold/penicillamine, NSAIDs)

Dx renal biopsy = subepithelial immune complexes in basement membrane

Tx = steroids, alkylating agents (cyclophosphamide + chlorambucil), monoclonal Ab

30% progress to ESRF in 10 years

114
Q

PLA2r antibody?

A

present in >70% of primary membranous nephropathy

115
Q

IgA nephropathy clinical features?

Ax?

Associated with?

Dx?

Tx?

complication?

A

Asymptomatic microhaematuria + non-nephrotic proteinuria

Classic presentation = macroscopic haematuria after resp/GI infection

Associated with HSP

Dx renal biopsy = mesangial cell proliferation and IgA deposits

Tx = ACEI/ARB + fish oil

25% lead to ESRF in 10-30 years

116
Q

rapidly progressive glomerulonephritis?

Clinical features?

Ax?

characteristic feature?

A

rapid deterioration in renal function over days/weeks

clinical features = RBCs, red blood cell clasts + granular clasts in urine

Ax = pic

characteristic feature = glomerulr crescents on biopsy

117
Q

goodpasture’s syndrome can cause?

Dx?

Tx?

A

goodpasture’s syndrome can cause rapidly progressive glomerulonephritis (pulmonary-renal syndrome)

Dx = anti-GBM antibody (IgG)

Tx = steroids, cyclophosphamide, plasmapheresis

118
Q

Ax nephritis?

A

infective = pyelonephritis

non-infective = glomerulonephritis

119
Q

acute urinary retention?

Ax?

S/s?

triggering events?

Tx?

A

renal emergency!!

Ax = BPH, prostatitis, anticholinergic medication

S/s = inability to urinate resulting in increasing pain

triggering events = surgery, catheter, anaesthesia

Tx = catheter, alpha blocker, 5-alpha reductase inhibitor

120
Q

Acute loin pain DDx?

Tx?

if stone hasn’t passed within a month?

A

ureteric colic secondary to calculus (renal stone)

DDx = AAA

Tx renal stone = NSAIDs + opiate, tamsulosin (alpha-blocker) for small stones that are expected to pass

if stone hasn’t passed in a month = ureteric stent, stone fragmentation

for infected hydroneprhosis = nephrostomy

121
Q

indications to treat renal stone urgently?

Tx?

A

pain unrelieved

pyrexia

persistent nausea/vom

high-grade obstruction

Tx

  • Ureteric stent
  • Stone fragmentation
  • Nephrostomy for infected hydronephrosis
122
Q

Causes of frank haematuria?

Ix?

A

Ax

  • cystitis/pyelonephritis
  • Stones
  • bladder cancer
  • BPH
  • Polycystic kidneys
  • Trauma
  • Coagulation/platelet deficiencies

Ix = CT urogram + cystoscopy

123
Q

acute scrotum Ax

A

Torsion of spermatic cord

Epididymitis

Inguinal hernia

Hydrocele

Trauma/insect bite

Inflammatory vasculitis

Tumour

124
Q

Torsion of spermatic cord epidemiology?

S/s?

O/E?

Ix?

Tx?

A

teenage boys - puberty

S/s = severe pain (often woken from sleep), nausea + vomiting, sometimes referal of pain to lower abdomen

O/E = testis high in scrotum, absence of cremasteric reflex

Ix = doppler USS

Tx = emergency surgery (within 4 hours)!!!!

NB - fix contralteral side otherwise bell-clapper deformity

125
Q

torsion of appendage symptoms?

clinical features?

dinstinguish from testicular torsion?

Tx?

A

s/s = variable, may be same as spermatic cord torsion

clinical features = localised tenderness at upper pole + blue dot sign

difference from cord torsion = testis mobile + cremasteric reflex present

Tx = resolves on its own

126
Q

epididymitis s/s?

Ax?

when to suspect?

Dx?

Tx?

(how to diff. from testicular torsion)

A

s/s = dysuria + pyrexia

Ax = UTI, urethritis, catheterisation

suspect if pyuria (pus in urine)

Dx = doppler (swollen epididymis) + urine culture

Tx = ofloxacin 400mg for 14 days

(NB - can differentiate from TT = cremasteric reflex is present)

127
Q

idiopathic scrotal oedema?

A

self-limiting, unknown cause, usually associated with scrotal erythema

no fever, minimal tenderness, may be pruritus

128
Q

paraphimosis?

Ax?

Tx?

A

Painful swelling of foreskin distal to a phimotic ring

Often happens after foreskin retracted for catheterisation and staff member forgets to replace it in natural position

Tx

  • Iced glove, granulated sugar 1-2hrs, multiple punctures in oedematous skin
  • Manual compression of glans with distal traction on oedematous foreskin
  • Dorsal slit
129
Q

Fournier’s gangrene?

Ax?

S/s?

Dx?

Tx?

A

Form of necrotising fasciitis occurring around male genitalia

Ax = diabetes, local trauma, urinary extravasation, perianal infection

S/s

  • Starts as cellulitis – swollen, erythematous, tender, marked pain, fever, systemic toxicity
  • swelling + crepitus of scrotum, dark purple areas
  • marked toxicity out of proportion to local findings

Dx = x-ray or USS may confirm gas in tissues

Tx = antibiotics + surgical debridement

130
Q

nephritic vs nephrotic syndrome

how to distinguish cause of glomerulonephritis?

A

Nephritic = haematuria, hypertension

Nephrotic = heavy proteinuria, non-dependent oedema, hyperlipidaemia

distinguish cause = renal biopsy

  • Light microscopy
  • Electron microscopy
  • Immunofluorescence (goodpasture’s = linear IgG)
131
Q

s/s minimal change disease?

FSGS?

Membranous?

IgA?

A

minimal change = nephritic (haematuria + HTN)

FSGS = nephritic

membranous = nephrotic (proteinuria, oedema, hyperlipidaemia)

IgA = nephritic

132
Q

membranoproliferative GN Ax?

Dx?

A

idiopathic primary or 2* (infection, lupus, malignancy)

Dx = tram tracks on microscopy

133
Q

diabetes kidney?

A

Nodules = kimmelstiel Wilson lesion

134
Q

bosniak score?

A

predicts cancer risk in renal cysts

135
Q

Xanthogranulomatous pyelonephritis?

A

infection creates kidney mass

136
Q

renal tumours staging?

benign tumours?

malignant?

paediatric tumour?

A

1 = benign

4 = malignant

benign - oncocytoma

malignant = chromophobe, clear cell, papillary and collecting duct

paediatric = Wilm’s tumour

137
Q

oncoytoma features?

A

BENIGN

small, oval, well-circumscribed

brown with stellate star

138
Q

chromophobe features?

A

Difficulty is histological similarity to oncocytomas (benign vs malignant)

Oncocytotic but with raison-like nuclei and perinuclear haloes

139
Q

papillary tumour kindey features?

A

2nd most common malignant tumour

papillary = finger-like projections

140
Q

collecting duct tumour kidney?

A

least common malignant tumour

very poor survival

141
Q

clear cell tumour kidney?

risk factors?

s/s?

features?

A

most common malignant tumour

when people say renal cancer they normally mean clear cell

risk factors = obesity + genetics

S/s

  • heamaturia
  • mass
  • hypertension

BRIGHT YELLOW TUMOUR SURFACE (histologically clear)

142
Q

significance of clear cell renal cancer?

A

has potential for renal vein involvement and can even extend into vena cava and grow towards the heart!!!

143
Q

genetics renal cancer?

A

Von Hippel Lindau

144
Q

Von Hippel Lindau increases risk of?

A

Renal cell carcinoma

Cerebellar hemangioblastoma

Pancreatic tumours

Epididymal tumours

145
Q

systemic causes of CKD?

A

Diabetes (most common)

Myeloma

Amyloidosis

Vasculitis

SLE

146
Q

multiple myeloma?

S/s?

classic presentation?

A

Cancer of plasma cells

symptoms

  • Bone pain
  • Weakness + fatigue
  • Weight loss
  • Recurrent infections

Signs

  • Anaemia
  • Hypercalcaemia
  • Renal failure
  • Lytic bone lesions

classic presentation = back pain and renal failure!!

147
Q

Dx multiple myeloma?

Tx?

A

Bloods = serum protein electrophoresis, serum free light chains

Urine = bence jones protein

Bone marrow biopsy

Skeletal survey (lytic lesions)

Renal biopsy

Tx = manage hypercalcaemia (saline + bisphosphonates), chemo, stem cell transplant, plasma exchange to remove light chains, dialysis (supportive)

148
Q

amyloidosis?

types?

A

Deposition of amyloid in tissues or organs

Types:

primary/light chain amyloidosis (AL)

secondary/systemic/inflammatory (AA)

dialysis-related amyloidosis (DRA)

hereditary and old age amyloidosis

149
Q

primary AL amyloidosis pathophys?

affects?

prognosis?

A

Production of abnormal immunoglobulin light chains from plasma cells

Light chains enter bloodstream and cause amyloid deposits

affects heart, bowel, skin, nerves + kidneys

prognosis = 6 months - 4 years untreated

150
Q

AA amyloidosis associated with?

e.g.?

Dx?

A

Associated with systemic inflammation from either chronic inflammatory conditions (RA, IBD, psoriasis) or chronic infections (TB, osteomyelitis, bronchiectasis)

Dx = production of acute phase protein – serum amyloid A protein (SAA)

151
Q

presentation amyloidosis?

A

Depends on organs or tissues involved:

  • Renal (nephrotic) = proteinuria + impaired renal function
  • Cardiac – cardiomyopathy
  • Nerves – peripheral or autonomic neuropathy
  • Hepatomegaly/splenomegaly
  • GI – malabsorption
152
Q

S/s renal amyloidosis?

Ix renal amyloidosis?

A

s/s = nephrotic syndrome (proteinuria + impaired renal function)

Ix

  • urinalysis (protein)
  • bloods - U+E, CRP, protein electrophoresis, serum free light chain assay
  • renal biopsy (congo red, apple green under polarised light)
  • SAP scan i.e. scintigraphy with radiolabelled serum amyloid, shows extent of disease
153
Q

Tx amyloidosis?

A

no cure

AA – treat underlying condition

AL – immunosuppression (steroids, chemo, stem cell transplant)

154
Q

summary amyloidosis

155
Q

ANCA associated vasculitis general s/s?

Dx?

A

Fever, arthralgia, weight loss, anorexia, malaise

Dx

  • Urinalysis – blood, protein
  • Bloods – raised CRP, AKI i.e creatinine, anaemia
  • Immunology – ANCA, MPO, PR3
  • Renal biopsy
156
Q

p-ANCA vs c-ANCA

A

p-ANCA = MPO

c-ANCA = PR3

157
Q

tx vasculitis?

A

Steroids!

  • Also cyclophosphamide + ritixumab
  • plasma exchange
  • dialysis (supportive)
158
Q
A

malar rash of SLE

159
Q

lupus diagnostic criteria

(MD SOAP BRAIN)

160
Q

SLE kidney disease s/s?

Dx?

A
  • Nephrotic!!! – proteinuria
  • Red-cell clasts!!
  • Microhaematuria
  • Reduced renal function
  • Hypertension
  • Hyperkalaemia

Dx

  • bloods - raised CRP, ANA + anti-dsDNA, complement proteins
  • urinalysis - proteins + microhaematuria
161
Q

most frequently observed abnormality in lupus nephritis?

A

proteinuria

162
Q

most common cancer in men in UK?

Dx?

Tx?

A

prostate cancer

Dx

  • bloods (PSA) + biopsy

Tx

  • Surgery
  • Radiotherapy
  • Brachytherapy
  • Anti-androgens
  • LHRH-agonists
163
Q

staging prostate cancer

A

gleasons plus…

164
Q

most common bladder cancer?

presentation?

Dx?

A

transitional cell carcinoma

presentation = 80% with visible haematuria

Dx = CT urogram + cystoscopy!!

165
Q

Tx bladder cancer?

A

Surgery

If muscle invasion = radiotherapy

If metastatic = cisplatin based chemotherapy

166
Q

urothelium lines?

A

Bladder, ureters and collecting ducts

also significant proportion of urethra

167
Q

cystitis important subtypes?

A
  • bacterial
  • parasites and mycotic (fungal) infection
  • aseptic
  • reactive to catheters
168
Q

parasitic Ax cystitis?

where?

complication?

A

Schistosomiasis – swims up urethra

found in lake Malawi

if untreated = persistent inflammation = squamous metaplasia = squamous cell carcinoma

169
Q

aseptic cystitis?

presents with?

Tx?

A

Used to be called interstitial cystitis (painful bladder syndrome)

presents with dysuria but with persistently negative cultures + urinalysis

Tx = NSAIDs + tricyclics

170
Q

urothelial neoplasia risk factors?

A

SMOKING+++ (almost as strong an association as lung cancer)

beta-napthylamine (dye industry) - regulated now

171
Q

transitional cell carcinoma appearance?

A

papillary - finger-like projections

172
Q

other types of bladder cancer?

A

Adenocarcinoma (can occur due to metaplasia - difficult to distinguish from colon cancer that has metastasised)

Squamous cell carcinoma – catheters + schistosomiasis

173
Q

prostate cancer usually occurs where?

risk factors?

A

Usually occurs in periphery of gland

Risk factors = cadmium battery workers

174
Q

when is PSA unreliable for diagnosing prostate cancer?

A

unreliable in:

  • big prostates
  • prostatitis
  • immediately following PR exam
  • bike-riding
  • spironolactone
175
Q

Ax bladder outflow obstruction (BOO)?

A

Benign prostatic hyperplasia (BPH)

Urethral stricture

Prostate cancer

Bladder stones

Extrinsic – cystocele, cancers

drugs like anticholinergics and nasal decongestants - ASK ABOUT MEDICATIONS

176
Q

symptoms of BOO

A

storage – when bladder is filling with urine

  • frequency
  • urgency
  • nocturia

voiding – when patient is trying to pass urine

  • hesitancy
  • poor flow
  • intermittent flow
  • sensation of incomplete emptying
  • post-micturition dribbling
177
Q

red flag signs bladder cancer?

A

Haematuria

Suprapubic pain

Recurrent urinary tract infections

178
Q

Ix BOO?

A

Ix

  • Frequency-volume chart
  • Urinalysis
  • Serum creatinine
  • PSA
  • renal USS if - loin pain, haematuria
  • cystoscopy if - haematuria, pain, recurrent UTIs
179
Q

Tx for LUTS (storage vs voiding)

A

alpha blocker = tamsulosin

5-alpha reducstase inhibitor = finasteride

180
Q

benign renal tumours?

malignant?

A

Benign

  • Simple cysts
  • Angiomyolipoma
  • Oncocytoma

Malignant

  • Renal cell carcinoma
  • Transitional cell carcinoma
  • Lymphoma
181
Q

s/s oncocytoma?

difficulty?

Dx?

Tx?

A

S/s = asymptomatic (85%), loin pain, haematuria

radiologically very difficult to distinguish from renal cell carcinoma

Dx

  • CT scan - spoke wheel pattern
  • biopsy

Tx - depends on size

  • <3cm = surveillance (unfit) or ablation (fit)
  • >3cm = partial nephrectomy
  • large tumours = laparoscopic (gold standard) radical nephrectomy
182
Q

angiomyolipoma?

Ax?

s/s?

Dx?

Tx?

A

most common benign renal tumor

Ax = 80% sporadic in middle ages females, 20% associated with tuberous sclerosis

s/s = asymptomatic, loin pain, haematuria, mass

10% Wunderlich’s syndrome - massive retroperitoneal bleed

Dx

  • USS + CT (fatty tumour of low density)

Tx

  • elective = embolisation + partial nephroctomy
  • emergency = embolisation + emergency nephrectomy
183
Q

Wunderlich’s syndrome?

associated with?

A

emergency - massive retroperitoneal bleed

associated with angiomyolipoma of the kidney

184
Q

renal cell carcinoma?

types?

A

Adenocarcinoma of renal cortex

types

  • clear cell (80%)
  • papillary
  • chromophobe
  • collecting duct (rare - young patients, v poor prognosis)
  • medullary cell = sickle cell patients
185
Q

medullary cell renal carcinoma associated with?

A

SICKLE CELL

186
Q

staging renal cancer?

A

T1 - <7cm

T2 - >7cm confined to kidney

T3 – extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC

T4 – beyond Gerota’s fascia into surrounding structures

187
Q

s/s renal cancer?

Dx?

A

Haematuria, loin pain, mass

Pyrexia of unknown origin

Varicocele (appears suddenly)

Paraneoplastic syndrome (30%)

Dx

  • USS
  • CT chest, abdomen, pelvis for staging
  • FBC
  • renal and liver functions
188
Q

Tx renal cell carcinoma?

follow-up?

A

Small tumours <3cm = surveillance (unfit) + ablation (fit)

>3cm = partial nephrectomy

large tumours

  • radical nephrectomy
  • laparoscopic approach gold standard

Followup

  • FBC/renal and liver functions
  • CT/USS + CXR
  • 5-10 years
189
Q

testicular cancer epidemiology?

risk factors?

A

Epidemiology

  • Men 20-45
    • Seminomatous 35-45 y/o
    • Non-seminomatous <35 y/o

risk factors = previous TC (increased risk in contralateral testi), cryptochordism, HIV, family history

190
Q

types testicular cancer?

A

seminoma is same as dysgerminoma in females

191
Q

clinical presentation testicular cancer?

O/E?

A

s/s

  • Scrotal lump!!!
  • 5% acute pain due to bleeding
  • 10% symptoms of advanced disease: weight loss, neck lumps, chest symptoms or bone pain

O/E

  • Asymmetry or slight scrotal discolouration
  • Hard, non-tender, irregular mass
  • Secondary hydrocele
  • Abdominal mass = advanced disease
192
Q

Ix testicular cancer?

A

Imaging – USS testicle, CT abdomen + chest for staging

Bloods – serum tumour markers

  • Alpha fetoprotein - yolk sac
  • B-HCG - choriocarcinoma
  • LDH - seminoma

FBC

LFTs + renal function tests

193
Q

Tx testicular cancer?

A

Radical inguinal orchidectomy – offer sperm preservation

  • re-check tumour markers 1 week post-op

Chemo as adjuvant even in non-metastatic cases

194
Q

penile cancer types?

A

Squamous cell carcinoma (95%) – i.e. skin cancer

Kaposi’s sarcoma

BCC, malignant melanoma, sarcoma

195
Q

risk factors penile cancer?

A

Age (50-60)

Phimosis – chronic inflammation

Geography – Asia, Africa, South America

HPV types 16 + 18

Smoking

Immunocompromised patients

196
Q

most common site of penile cancer?

197
Q

presentation penile cancer?

Ix?

A

Hard painless lump

Ix

  • MRI to assess tumour depth
  • CT scan abdomen, pelvis, chest in advanced disease
198
Q

Tx penile cancer?

A

Prepucal lesions = circumcision

Glans lesions

  • Superficial = glans resurfacing
  • Deep = glansectomy

More advanced disease

  • total penile amputation with formation of perineal urethrostomy

Inguinal lymphadenectomy if involved

199
Q

micturation reflex?

A

S2-S3 – pelvic parasympathetic nerves (pudendal)

200
Q

overflow incontinence s/s?

A

Huge palpable bladder

Chronic retention

Often wet at night

Renal impairment

201
Q

detrusor overactivity?

Ax?

A

can be a cause of urge incontinence

Ax

  • irritation of bladder - afferent overstimulation
  • paraplegia (loss of central inhibition)
  • idiopathic
202
Q

extraurethral causes of incontinence?

A

ectopic ureter (rare, congenital)

vesico-vaginal fistula

203
Q

BXO?

A

Balantitis xerotic obliterans i.e. lichen sclerosis of the penis

204
Q

testicular lumps differential?

A

Hernia

Cystocele

Hydrocele

Spermatocele

testicular cancer

205
Q

hydrocele?

features?

A

Accumulation of fluid around testes

  • between 2 layers of tunica vaginalis

Unicystic, smooth and fluid filled - transilluminates!!

206
Q

spermatocele?

Ax?

presentation?

A

Cystic change within vas deferens (epididymis)

Unknown cause and usually asymptomatic

(normally present after self-examination)

207
Q

Varicocele?

A

Varicose venous plexus that drains testis

May present having felt a lump “bag of worms”

remember sudden variocele can be symptom of RCC

208
Q

potato tumour?

prognosis?

A

seminoma

excellent cure rate

209
Q

respiratory alkalosis Ax?

A

excessive removal of CO2 from body

  • Altitude hypoxia
  • Hyperventilation (fever, brainstem damage)
  • Hysterical overbreathing
210
Q

urine alkaline when?

A

metabolic compensation for respiratory alkalosis

211
Q

metabolic acidosis Ax?

A

ingestion of acids

excessive metabolic production of H+ (lactic acid during exercise or ketoacidosis)

excessive loss of base from the body (e.g. diarrhoea – loss of HCO3-)

212
Q

metabolic alkalosis Ax?

A

Loss of HCL from stomach (vomiting)

Ingestion of alkali or alkali-producing foods (used to be a problem with old antacids!!)

Aldosterone hypersecretion (causes stimulation of Na+/H+ exchange at apical membrane of tubule = acid secretion)

213
Q
214
Q

loop diuretics e.g.?

mechanism?

used for?

containdications?

A

furosemide + bumetanide

mechanism = inhibit Na/K/2Cl- co-transporter in loop of henle

used in = acute pulmonary oedema, heart failure, CKD, ascites, nephrotic syndrome, to reduce acute hypercalcaemia

containdications

  • severe hypovolaemia or dehydration
  • severe hypokalaemia/hyponatraemia
  • hepatic encephalopathy
  • GOUT
215
Q

adverse effects loop diuretics?

A

hypokalaemia

metabolic alkalosis – increased H+ secretion

hypocalcaemia/hypomagnesaemia

hypovolemia and hypotension (especially in the elderly)

hyperuricemia – may precipitate acute gout attack!!

Dose-related loss of hearing

216
Q

thiazide + thiazide-like diuretics e.g.?

mechanism?

benefits?

A

thiazide = bendroflumethiazide

thiazide-like = chlorthalidone, indapamide and metolazone (thiazide-like)

mechanism = inhibits Na/Cl co-transporter in DCT

benefit = has vasodilator action which is effective for hypertension

  • also no hypocalcaemia like loop diuretics (advantage in elderly patients with osteoporosis)
217
Q

clinical uses thiazide diuretics?

contraindications?

A

uses:

  • heart failure
  • Hypertension
  • Severe resistant oedema
  • Renal stone disease (nephrolithiasis) – reduced urinary excretion of Ca++ discourages Ca++ stone formation
  • Nephrogenic diabetes insipidus (mechanism not clearly understood)

Contraindications

  • Hypokalaemia
  • Hyponatraemia
  • Gout
218
Q

adverse effects thiazide diuretics?

A

Hypokalaemia

Metabolic alkalosis

Hypovolemia and hypotension (esp in elderly)

Hypomagnaesmia (not hypocalcaemia – advantage in elderly patients with osteoporosis)

Hyperuricemia – may precipitate gout

Erectile dysfunction

Impaired glucose tolerance in diabetics

219
Q

potassium sparing diuretics?

mechanism?

A

Spironolactone and eplerenone

mechanism = aldosterone antagonists

220
Q

drugs to avoid with potassium-sparing diuretics?

clinical uses?

containdications

A

do not use with ace-inhibitors = SEVERE HYPERKALAAEMIA

clinical uses of aldosterone antagonists:

  • Heart failure
  • Primary hyperaldosteronism (conn’s syndrome)
  • Resistant essential hypertension
  • Secondary hyperaldosteronism (due to hepatic cirrhosis with ascites)

contraindications

  • severe renal impairment
  • hyperkalaemia
  • Addison’s disease
221
Q

carbonic anhydrase inhibitor e.g.?

clinical use

A

acetazolamide

use:

  • glaucoma
  • altitude sickness prophylaxis
222
Q

diabetes insipidus Ax?

Tx?

A

neurogenic (lack of ADH from post. pituitary)

  • Tx = desmopressin

nephrogenic (inability of kidney to respond to ADH)

  • genetic
  • drugs - lithium, demecloclycine, vaptans
  • Tx = thiazides + NSAIDs
223
Q

what drugs are of use in hypervolaemic hyponatraemia (i.e. SIADH)?

A

vaptans e.g. Tolvaptan

224
Q

complicated UTI?

A

complicated UTI = a UTI complicated by systemic symptoms OR urinary structural abnormality/stones

225
Q

does bacteriuria mean UTI?

A

no - esp in elderly patients or patients with catheter

226
Q

bacteria Ax UTI?

A

E.Coli

Klebsiella

enterobacter

proteus

pseudomonas aeruginosa

227
Q

what makes E.coli dangerous?

A

endotoxin in LPS layer

228
Q

proetus UTI?

A

produces urease which breaks down urea to form amonia

increases urinary pH which causes formation of phosphate stones

229
Q

pseudomonas aeruginosa?

Ax UTI?

Tx?

A

Gram negative bacillus but not a coliform

Associated with catheters

Tx = ciprofloxacin

230
Q

staph aureus UTI?

A

uncommon - usually from bacteraemia rather than urinary tract

231
Q

s/s UTI?

Dx?

A

S/s

  • Dysuria (pain passing urine)
  • Frequency
  • Nocturia
  • Haematuria
  • Fever
  • Loin pain (suggests involvement of kidneys, complicated)
  • Rigors (complicated)

Dx = MSU sample

  • can also do dipstick but NOT in elderly or catheter patients
    • nitrites + leukocytes indicate UTI
232
Q

Kass’s criteria?

A

>10^5 organisms/ml = probable UTI (significant bacteriuria)

<10^3 organisms/ml = not significant bacteriuria

10^4 organisms/ml – contaminated? Infection? Repeat specimen

233
Q

asymptomatic bacteriuria?

A

Significant bacteriuria (>10^5 orgs/ml)

No pus cells in urine

Antibiotic treatment often not required EXCEPT in pregnancy

234
Q

asymptomatic bacteriuria in pregnancy?

Tx?

A

MUST TREAT

if untreated can cause sepsis, IUGR

Tx = nitrofurantoin 7 days

235
Q

UTI catheterised patients?

A

Catheterised patients with >10^5 orgs/ml should ONLY be given antibiotics if there is supporting evidence of UTI (fever, symptoms)

236
Q

UTI Tx?

A

female uncomplicated = nitrofurantoin or trimethoprim 3 days

male UTI = nitrofurantoin or trimethoprim 7 days

complicated UTI/pyelonephritis = co-amoxiclav or co-trimoxazole 7 days

  • hospital = IV gentamicin + amoxicillin 7 days
    • if penicillin allergic = co-trimox + gentamicin
237
Q

complicated UTI pregnancy?

A

AVOID gentamicin !!!!

238
Q

ESBL bacteria?

Tx?

A

resistant to ALL cephalosporins and to almost all penicillins

Tx

  • Nitrofurantoin (oral), pivmecillinam (oral)
  • Fosfomycin (oral), temocillin (IV)
  • Meropenem (IV), ertapenem (IV)
239
Q

trimethoprim pregnancy?

forms?

A

avoid in 1st trimester (3 months) of pregnancy

can be given on its own or as co-trimoxazole

240
Q

nitrofurantoin pregnancy?

A

Avoid in late pregnancy (can cause neonatal haemolysis), breastfeeding and children <3 months old

so 1st and 2nd trimester = nitrfurantoin

3rd trimester = trimethoprim

241
Q

drugs implicated in AKI?

A

1 – pre-renal failure – hypotension, hypovolemia

  • e.g. diuretics, ACEI/ARBs

2 – renal – AIN/tubular necrosis (ATN)

  • e.g. gentamicin, sulphonamides (trimethoprim), aspirin (NSAIDs)

3 – post renal – retroperitoneal fibrosis, crystalluria, urinary calculi

  • e.g. methysergide or chemotherapy
242
Q

drug reactions to know about

A

Theophylline and macrolide antibiotics

Statins and macrolides/fibrates

Warfarin and multiple drugs (aspirin, antibiotics)

ACE and sulphonylureas (hypoglycaemia)

Clopidogrel and PPIs

243
Q

drug-disease interactions

A

Urinary retention in BPH patients on decongestants or anticholinergics

Constipation worsened by calcium, anticholinergics, CCB

Neuroleptics, tramadol and quinolones = worsen epilepsy

Beta blockers and asthma

244
Q

drug-food interactions

A

Bananas, oranges, green leafy vegetables (K+ rich) interact with ACEI, ARBS, K-sparing diuretics

Apples, chickpeas, spinach, nuts, broccoli, cranberry juice interact with warfarin

Chicken, turkey, milk, soy, cheese, yoghurt = antibiotics, thyroid meds, digoxin, diuretics

Grapefruit, apple, orange and cranberry = statins + antihistamines

245
Q

type B drug reaction examples?

A

drug rashes

bone marrow aplasia (chloramphenicol)

hepatic necrosis (halothane)

HIGH MORTALITY

246
Q

long term effect of steriods?

B-blockers?

NSAIDs?

A

steroids = cushings

b-blockers = diabetes

NSAIDs = hypertension

247
Q

type E (end of treatment) drug reaction examples?

A

Beta-blocker withdrawal and angina

steroid withdrawal and Addison crisis

anticonvulsant withdrawal and changes in epilepsy frequency

248
Q

haematuria?

A

regarded as urologic malignancy until proven otherwise

249
Q

inflammatory causes of haematuria?

A

Urethritis

Prostatitis

Cystitis

Ureteritis

Pyelonephritis

Glomerulonephritis

250
Q

jogger’s haematuria?

Tx?

A

due to renal/bladder trauma

Tx = self-limiting (lasts 7 days)

251
Q

red diaper syndrome?

A

serratia marcescens infection

252
Q

referal to urology vs nephrology

A

urology

  • all patients with visible haematuria
  • all patients with symptomatic miscroscopic haematuria
  • >40 years with asymptomatic microscopic haematuria

nephrology

  • evidence of declining renal function
  • CKD eGFR <30
  • significant proteinuria
  • isolated haematuria with hypertension in <40 y/o
  • visible haematuria coinciding with infection

3rd year medicine (13 decks)

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