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Renal and friends Flashcards

1
Q
  1. What is the term for blockage of urine flow ?
A
  • Obstructive uropathy
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2
Q
  1. What is the term that describes kidney swelling ?
A
  • Hydronephrosis
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3
Q
  1. What is the term for urine passing from the bladder to the ureter ?
A
  • Vesicoureteric reflux
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4
Q
  1. What is the term for abnormal nerve function in the bladder ?
A
  • Neurogenic bladder
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5
Q
  1. What are the classifications of acute kidney injury ?
A
  • Pre-renal
  • Renal
  • Post-renal
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6
Q
  1. What are the top causes of upper renal obstruction ?
A
  • Kidney stones
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7
Q
  1. What are the top causes of lower renal obstruction ?
A
  • Benign prostatic hyperplasia
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8
Q
  1. What is used to bypass an upper renal obstruction ?
A
  • Nephrostomy
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9
Q
  1. What is the most common cause of acute urinary retention ?
A
  • Benign prostatic hyperplasia
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10
Q
  1. What medication can be used to treat urinary retention ?
A
  • Confirm with US then catheterisation
  • Tamsulosin (alpha-blocker)
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11
Q
  1. What can be used if urethral entry is not possible with a catheter ?
A
  • Suprapubic catheter
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12
Q
  1. How does benign prostatic hyperplasia present ?
A
  • Urinary hesitancy
  • Frequency
  • Terminal dribbling
  • Nocturia
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13
Q
  1. How is BPH scored ?
A
  • International prostate symptom score
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14
Q
  1. What are medical options for BPH ?
A
  • Alpha blockers e.g. tamsulosin
  • 5-alpha reductase inhibitors e.g. finasteride
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15
Q
  1. What are surgical options for BPH ?
A
  • Transurethral resection (TURP)
  • Transurethral electrovaporisation (TEVAP)
  • Holmium laser enucleation (HoLEP)
  • Open prostatectomy
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16
Q
  1. How does acute bacterial prostatitis present ?
A
  • 2 weeks of pain in the perineum and rectum
  • Pain on opening bowels
  • Pain on ejaculation
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17
Q
  1. What would the findings on DRE be for a pt with acute bacterial prostatitis ?
A
  • Tender and enlarged prostate
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18
Q
  1. What is the cut off for acute verse chronic acute bacterial prostatitis ?
A
  • 3 months
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19
Q
  1. What micro tests would be ordered for a pt with acute bacterial prostatitis ?
A
  • Mid-stream urine for culture
  • Chlamydia and gonorrhea and NAAT
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20
Q
  1. What is 1st line abx for patients with acute bacterial prostatitis ?
A
  • Ciprofloxacin
  • Ofloxacin
  • Trimethoprim
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21
Q
  1. What is the duration of abxs in a patient with acute bacterial prostatitis ?
A
  • 2-4 weeks
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22
Q
  1. What are the false +ve and false -ve rates for PSA ?
A
  • 75% false positive
  • 15% false negative
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23
Q
  1. What is 1st line imaging for localised disease with prostate cancer ?
A
  • Multiparametric MRI
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24
Q
  1. What test can confirm the diagnosis of prostate cancer ?
A
  • Prostate biopsy
  • Can be transrectal or transperineal
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25
Q
  1. What is the test for spread of prostate cancer to the bones ?
A
  • Isotope bone scan
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26
Q
  1. What is the grading system for prostate cancer ?
A
  • Gleason grading system
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27
Q
  1. What is the hormone is involved in the growth of prostate cancer ?
A
  • Androgens (testosterone)
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28
Q
  1. What hormone treatment options are available for prostate cancer ?
A
  • GNRH agonists
  • Androgen-receptor blockers (block testosterone)
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29
Q
  1. What non-hormonal treatment options are available for prostate cancer ?
A
  • Radiotherapy
  • Brachytherapy
  • Surgery
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30
Q
  1. What are surgical complications of prostate removal ?
A
  • Erectile dysfunction
  • Urinary incontinence
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31
Q
  1. A 35 yo presents with 3 days of unilateral testicular pain ?
A
  • Epididymo-orchitis
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32
Q
  1. What are key differentials for Epididymo-orchitis ?
A
  • Testicular torsion
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33
Q
  1. What are the top causes of Epididymo-orchitis ?
A
  • Escherichia coli
  • Chlamydia trachomatis
  • Neisseria gonorrhea
  • Mumps
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34
Q
  1. What antibiotic options are available for Epididymo-orchitis ?
A
  • If the organism is unknown: Ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days
  • Oral Ciprofloxacin if sensitivity is known
  • If enteric organisms ofloxacin, levofloxacin or co-amoxiclav
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35
Q
  1. What are key adverse effects of quinolone abxs (e.g. ciprofloxacin, levofloxacin, ofloxacin) ?
A
  • Tendon damage/rupture
  • Lower seizure threshold
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36
Q
  1. What reflex will be absent in testicular torsion ?
A
  • Cremasteric reflex
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37
Q
  1. What is the associated deformity for testicular torsion ?
A
  • Bell-Clapper deformity
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38
Q
  1. What are the surgical options for testicular torsion ?
A
  • Orchiopexy (fixing the position)
  • Orchidectomy (removing the testicle)
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39
Q
  1. What would the outcome be of delayed treatment for TT ?
A
  • Ischemic  necrosis  reduced fertility
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40
Q
  1. What ultrasound sign will be seen in testicular torsion ?
A
  • Whirlpool sign
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41
Q
  1. What is a hydrocele ?
A
  • An accumulation of fluid in the tunica vaginalis
  • Can be communicating or non-communicating
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42
Q
  1. How will a hydrocele present ?
A
  • Soft, non-tender swelling of the hemi-scrotum usually anterior and below the testical
  • Swelling is confined to the scrotum and you can ‘get above’ the mass on examination
  • Transilluminates with a pen torch
  • Testis may be difficult to palpate if hydrocele is large
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43
Q
  1. What is a varicocele ?
A
  • An abnormal enlargement of the testicular veins
  • Usually asymptomatic but may be important as associated with infertility
  • Much more common on the left side
  • ‘Bag of worms’
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44
Q
  1. What is an epididymal cyst ?
A
  • The most common cause of scrotal swellings seen in primary care
  • ~30% of men will get one
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45
Q
  1. What is a complication of varicocele ?
A
  • Infertility
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46
Q
  1. What can cause a hydrocele ?
A
  • Testicular cancer
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47
Q
  1. What about a varicocele would prompt an urgent referral and why ?
A
  • The varicocele does not disappear on lying down
  • Possibility of a retroperitoneal tumour
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48
Q
  1. A 22 yo presents with a hard painless testicular lump. What is the diagnosis ?
A
  • Testicular cancer
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49
Q
  1. What cells can testicular cancers arise from ?
A
  • Germ cells
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50
Q
  1. What are RFs for testicular cancer ?
A
  • Family history
  • Infertility
  • Increased height
  • Undescended testes
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51
Q
  1. What type of tumour can cause gynecomastia ?
A
  • Leydig cell tumour
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52
Q
  1. What are the initial investigations for testicular cancer ?
A
  • Ultrasound
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53
Q
  1. What are tumour markers for testicular cancer and what types of cancer do they corelate to ?
A
  • Alpha-fetoprotein  teratomas
  • Beta-HCG  teratomas and seminomas
  • Lactate dehydrogenase (LDH)  Non-specific
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54
Q
  1. What is the staging system for testicular cancer ?
A
  • Royal Marsden
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55
Q
  1. What are common sites of metastasis of testicular cancer ?
A
  • Liver
  • Lymphatics
  • Lungs
  • Brain
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56
Q
  1. How would a UTI present in a young female ?
A
  • Dysuria
  • Suprapubic pain
  • Frequency
  • Urgency
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57
Q

What feature of a UTI suggests that the infection could be spreading to the kidneys ?

A
  • Fever
  • Loin/back pain
  • Vomiting
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58
Q
  1. What is the most common cause of a UTI ?
A
  • E.coli
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59
Q
  1. What are the most common dipstick findings in a UTI ?
A
  • Nitrites
  • Leukocytes
  • Blood
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60
Q
  1. What is 1st line management ?
A
  • Nitrofurantoin
  • Trimethoprim
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61
Q
  1. What duration of Abx is given for UTI in a non-pregnant women ?
A
  • 3 days
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62
Q
  1. What duration of Abx is given for UTI in a pregnant patient ?
A
  • 7 days
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63
Q
  1. What duration of Abx is given for UTI in men ?
A
  • 7 days
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64
Q
  1. What duration of Abx is given for UTI in catheters ?
A
  • 7 days
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65
Q
  1. 40 yo women with increased frequency and urgency of urination and suprapubic pain is relieved by emptying her bladder. What is the diagnosis ?
A
  • Interstitial cystitis
  • Bladder pain syndrome
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66
Q
  1. What would be found in the bladders of patient suffering from interstitial cystitis or bladder pain syndrome ?
A
  • Hunter lesions
  • Granulations
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67
Q
  1. What test is used to visualize the bladder mucosa ?
A
  • Cystoscopy
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68
Q
  1. How is interstitial cystitis managed – supportive management ?
A
  • Diet changes such as avoiding alcohol, caffeine and tomatoes
  • Stopping smoking
  • Pelvic floor exercises
  • Bladder retraining
  • Cognitive behavioral therapy
  • Transcutaneous electrical nerve stimulation (TENS)
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69
Q
  1. How is interstitial cystitis managed – oral medications ?
A
  • Analgesia
  • Antihistamines
  • Anticholinergic medications (e.g., solifenacin or oxybutynin)
  • Mirebegron (beta-3-adrenergic-receptor agonist)
  • Cimetidine (histamine-2-receptor antagonist)
  • Pentosan polysulfate sodium
  • Ciclosporin (an immunosuppressant)
70
Q
  1. How is interstitial cystitis managed – intravesical medication ?
A
  • Lidocaine
  • Pentosan polysulfate sodium
  • Hyaluronic acid
  • Chondroitin sulphate
71
Q
  1. What is the mechanism of action of Solifenacin ?
A
  • Anticholinergic
72
Q
  1. What is the MOA of mirabegron ?
A
  • Beta-3-receptor agonist
73
Q
  1. What is the MOA of cimetidine ?
A
  • Histamine-2-receptor antagonist
74
Q
  1. How are medications administered to the bladder ?
A
  • Intravesical
75
Q
  1. A 68 yo female presents with painless macroscopic haematuria – what is the most likely diagnosis ?
A
  • Bladder cancer
76
Q
  1. What carcinogen is linked to bladder cancer ?
A
  • Aromatic amines
77
Q
  1. What infection is linked to bladder cancer ?
A
  • Schistosomiasis
78
Q
  1. What extra requirements for a 2ww in a >60 with microscopic haematuria are needed ?
A
  • Dysuria or
  • Raised WBC on FBC
79
Q
  1. What is the main staging criteria for bladder cancer ?
A
  • Non-muscle invasive or
  • Muscle invasive
80
Q
  1. What is the early-stage surgery for bladder cancer ?
A
  • Transurethral resection of bladder tumour (TURBT)
81
Q
  1. What immunotherapy can be used for bladder cancer ?
A
  • Intravesical BCG vaccine
82
Q
  1. What late stage surgery can be used for bladder cancer ?
A
  • Radical cystectomy
83
Q
  1. What can be used to urine after a radical cystectomy ?
84
Q
  1. What is the triad of symptoms for pyelonephritis
A
  • Fever
  • Back pain
  • Nausea vomiting
85
Q
  1. What is the most common cause of pyelonephritis ?
86
Q
  1. What bacteria can cause pyelonephritis ?
A
  • MCC – e.coli
  • Klebsiella pneumonia
  • Enterococcus
  • Pseudomonas
  • Staphylococcus saprophyticus
87
Q
  1. What are the findings seen on urine dip for pyelonephritis ?
A
  • Nitrates
  • Leukocytes
  • Blood
88
Q
  1. What are findings on bloods for pyelonephritis ?
A
  • WBC raised
  • CRP raised
89
Q
  1. What oral abx can be used for pyelonephritis ?
A
  • Cefalexin
  • Co-amoxiclav (if culture results are available)
  • Trimethoprim (if culture results are available)
  • Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
90
Q
  1. What is the treatment for sepsis ?
A
  • Sepsis 6
  • Urine
  • Cultures
  • lactate
  • Fluids
  • Oxygen
  • Tazasin
91
Q
  1. What potential cause would you suspect of pyelonephritis which does not respond to treatment ?
A
  • Renal abscess
  • Kidney stones
92
Q
  1. What scan we be done for suspected kidney damage ?
93
Q
  1. How would kidney stones present ?
A
  • Renal colic = Unilateral loin to groin pain + colicky pain (fluctuating in severity) as the stones move and settles
  • Also haematuria, nausea and vomiting, reduced urine output and symptoms of sepsis if infection develops
94
Q
  1. What are key complications of kidney stones ?
A
  • Obstruction
  • Infection
95
Q
  1. What can kidney stones form from ?
A
  • Calcium oxalate (MCC) or calcium phosphate
  • Uric acid
  • Struvite
  • Cystine
96
Q
  1. What is the most common type of kidney stone ?
A
  • Calcium Oxalate
97
Q
  1. What is the initial imaging for renal stones ?
98
Q
  1. What type of kidney stones are not seen on X-ray ?
99
Q
  1. What is the most effective analgesia for renal stones ?
A
  • NSIADs e.g. diclofenac
100
Q
  1. What medication aids passage of kidney stones ?
A
  • Tamsulosin
101
Q
  1. What surgical interventions are available for kidney stones ?
A
  • Extracorporeal shock wave lithotripsy
  • Ureteroscopy and laser lithotripsy
  • Percutaneous nephrolithotomy
102
Q
  1. In renal cell carcinoma what hormone/enzyme causes polycythemia ?
A
  • Erythropoietin
103
Q
  1. In renal cell carcinoma what hormone/enzyme causes hypercalcemia ?
A
  • Parathyroid hormone-related protein
104
Q
  1. In renal cell carcinoma what hormone/enzyme causes hypertension ?
105
Q
  1. What type of renal cancer presents in under 5’s ?
A
  • Wilm’s tumour
106
Q
  1. What staging system is used for renal cell carcinoma ?
A
  • TNM staging system
107
Q
  1. How is renal cell carcinoma managed ?
A

Nephrectomy

108
Q
  1. What cancers can be caused by immunosuppression ?
A
  • Skin squamous cell carcinoma
  • Non-Hodgkin lymphoma
109
Q
  1. What would bilateral abdominal bulky masses indicate ?
A
  • Polycystic kidney disease
110
Q
  1. What is cyclosporine used to treat and what is a common side effect ?
A
  • Prevents transplant rejection
  • Gum hypertrophy
111
Q
  1. What is the diagnostic criteria for AKI ?
A
  • Rise in creatinine of more than 25 micromol/L in 48 hours
  • Rise in creatinine of more than 50% in 7 days
  • Urine output of less than 0.5 ml/kg/hour over at least 6 hours
112
Q
  1. What categories of causes are there for AKI ?
A
  • Pre-renal e.g. dehydration, shock and HF
  • Renal e.g. Acute tubular necrosis, glomerulonephritis, rhabdomyolysis
  • Post-renal e.g. stones, tumours, BPH, strictures and neurogenic bladder
113
Q
  1. What is the most likely cause of AKI in an 89 yo lady with HTN, HF and memory impairment ?
A
  • Pre-renal e.g. dehydration/antihypertensives
114
Q
  1. What is the management of a non-infective AKI ?
A
  • Stop nephrotoxic drugs e.g. ACE-I
  • Cautious fluid rehydration
115
Q
  1. What are the most common causes of CKD ?
A
  • Diabetes
  • Hypertension
116
Q
  1. What staging criteria is used for CKD using eGFR ?
A
  • G1 = eGFR > 90
  • G2 = eGFR 60-89
  • G3a = eGFR 45-59
  • G3b = eGFR 30-44
  • G4 = eGFR 15-29
  • G5 = eGFR < 15
117
Q
  1. What staging criteria is used for CKD using ACR ?
A
  • A1 = ACR < 3mg/mmol
  • A2 = ACR 3-30mg/mmol
  • A3 = ACR > 30mg/mmol
118
Q
  1. What referral criteria is used for CKD ?
A
  • eGFR < 30
  • ACR > 70
  • Uncontrolled HTN
  • Accelerated progression
119
Q
  1. What is 1st line for blood pressure if urine albumin to creatinine ration (ACR) is > 30 ?
A
  • ACE-I or ARB
  • (ARB preferred in Black African/Caribbean)
120
Q
  1. What can cause anaemia in CKD ?
A
  • Low erythropoietin
121
Q
  1. What are the indications for acute dialysis ?
A
  • AEIOU
  • Acidosis
  • Electrolytes
  • Intoxication (overdose)
  • Oedema
  • Uraemia symptoms
122
Q
  1. What stage of CKD requires long-term dialysis ?
A
  • CKD stage 5
123
Q
  1. What catheter are used in peritoneal dialysis ?
124
Q
  1. What options are available for hemodialysis ?
A
  • Tunnelled cuffed catheter
  • Arterio-venous fistula
125
Q
  1. What blood vessels can be formed into an AV fistulae ?
A
  • Radio-cephalic
  • Brachio cephalic
  • Brachio-basilic
126
Q
  1. What are complications of AV fistulae ?
A
  • Aneurysm
  • Infection
  • Thrombosis
  • Stenosis
  • Steal syndrome
  • High-output heart failure
127
Q
  1. What immunosuppressants are used after renal transplant ?
A
  • Tacrolimus
  • Mycophenolate
  • Prednisolone
128
Q
  1. A 24 yo man presents with haematuria. Urine dipstick shows 4+ blood and 2+ protein. What is the most likely diagnosis ?
A
  • Glomerulonephritis
129
Q
  1. What type of glomerulonephritis is associated with IgA deposits and glomerular mesangial proliferation ?
A
  • IgA nephropathy (Berger’s disease)
130
Q
  1. What type of glomerulonephritis is associated with IgA and complement deposits on the basement membrane ?
A
  • Membranous glomerulonephritis
131
Q
  1. What type of glomerulonephritis is associated with tonsillitis ?
A
  • Post-streptococcal glomerulonephritis
132
Q
  1. What type of glomerulonephritis is associated with pulmonary haemorrhage ?
A
  • Goodpasture syndrome
133
Q
  1. What are the main treatments for glomerulonephritis ?
A
  • Immunosuppression e.g. Steroids
  • ACE-I or ARBs for blood pressure
134
Q
  1. A 45 yo presents with fever, rash and mild oedema. He recently started naproxen after a shoulder injury. BP is 163/96. Blood results should raised creatinine and eosinophils. What is the diagnosis ?
A
  • Acute interstitial nephritis
135
Q
  1. What can cause nephritis ?
A
  • Hypersensitivity reaction e.g. to NSAIDs
136
Q
  1. What is the diagnostic test for nephritis ?
A
  • Kidney biopsy for histology
137
Q
  1. What is the management for nephritis ?
A
  • Remove/treat the underlying cause
  • Steroids
138
Q
  1. How does acute tubular necrosis present ?
A
  • Features of AKI: raised urea, creatinine, potassium
  • Muddy brown casts in the urine
139
Q
  1. What is the most common cause of acute tubular necrosis ?
140
Q
  1. What can cause renal ischemia ?
A
  • Shock
  • Sepsis
  • Dehydration
141
Q
  1. What common toxins can cause acute tubular necrosis ?
A
  • Radiology contrast dye
  • Gentamycin
  • NSAIDs
  • Lead
  • Myoglobin secondary to rhabdomyolysis
142
Q
  1. What findings would present on urinalysis of acute tubular necrosis ?
A
  • Muddy brown casts
143
Q
  1. What is the treatment for acute tubular necrosis ?
A
  • Stop nephrotoxic medications
  • IV fluids
144
Q
  1. What is renal tubular acidosis ?
A
  • Metabolic acidosis due to pathology in the tubules of the kidneys
  • The tubules balance H+ and bicarbonate ions (HCO3-) between the blood and urine to maintain pH
  • There are 4 types with type 4 being the most common
145
Q
  1. What are the different types of renal tubular acidosis ?
A
  • Type 1 - when the distal tubule cannot excrete hydrogen ions.
  • Type 2 - when the proximal tubule cannot reabsorb bicarbonate from the urine to the blood
  • Type 3 – mix of 1&2
  • Type 4 - caused by reduced aldosterone causing hyperkalemia
146
Q
  1. What is the pathophysiology of renal tubular acidosis type 1
A
  • Inability to generate acidic urine (H+) in the distal tubule
  • Causing hypokalemia
  • Complications: nephrocalcinosis and renal stones
147
Q
  1. What are the cause of renal tubular acidosis type 1
A
  • Idiopathic
  • RA
  • SLE
  • Sjogren’s
  • Amphotericin B toxicity
  • Analgesic nephropathy
148
Q
  1. What is the pathophysiology of renal tubular acidosis type 2
A
  • Decreased HCO3- reabsorption in the proximal tubule
  • Causing hypokalemia and alkalosis (I know right)
  • Complications include Osteomalacia
149
Q
  1. What are the cause of renal tubular acidosis type 2
A
  • Idiopathic
  • Part of Fanconi syndrome
  • Wilson’s disease
  • Carbonic inhibitors e.g. acetazolamide or topiramate
150
Q
  1. What is the pathophysiology of renal tubular acidosis type 4
A
  • A reduction in aldosterone leads in turn to a reduction in proximal tubular ammonium excretion
  • Causing hyperkalemia
151
Q
  1. What are the cause of renal tubular acidosis type 4
A
  • Hypoaldosteronism
  • DM
152
Q
  1. An 18 yo presents 5 days after recovering from a period of blood diarrhoea. She has reduced urine output, dark urine and bruising. What is the diagnosis ?
A
  • Haemolytic uraemic syndrome
153
Q
  1. What can cause haemolytic uraemic syndrome ?
A
  • E.coli producing 0157
  • Shigella producing Shiga toxin
154
Q
  1. What is the triad of features associated with haemolytic uraemic syndrome ?
A
  • Haemolytic anaemia
  • Low platelet count
  • AKI
155
Q
  1. How is haemolytic uraemic syndrome managed ?
A
  • Supportive
  • Anti-hypertensive medication
  • Blood transfusion and dialysis if required
156
Q
  1. In rhabdomyolysis when muscle breaks down. What are the products and which is most toxic to the kidneys ?
A
  • Myoglobin (most toxic to kidneys)
  • Potassium
  • Phosphate
  • Creatinine kinase
157
Q
  1. What colour is the urine in rhabdomyolysis ?
A
  • Red-brown
  • Myoglobinuria
158
Q
  1. What is the key diagnostic test for rhabdomyolysis ?
A
  • Creatine kinase (CK)
159
Q
  1. What is the treatment for rhabdomyolysis ?
160
Q
  1. What are ECG changes associated with hyperkalemia ?
A
  • Absent P waves
  • Broad QRS complexes
  • Tall T waves (occurs first)
161
Q
  1. What medications can most commonly cause hyperkalemia ?
A
  • Aldosterone antagonists
  • ACE-I
  • Angiotensin 2 receptor blockers
  • NSAIDs
162
Q
  1. What can commonly cause false hyperkalemia results ?
A
  • Haemolysis while taking the sample
163
Q
  1. What needs to be monitored with hyperkalemia ?
A
  • ECG changes
164
Q
  1. What is the main treatment to correct hyperkalemia ?
A
  • Insulin and dextrose infusions
165
Q
  1. What treatment can be used to stablise the heart muscle cells ?
A
  • IV calcium gluconate
166
Q
  1. A 50 yo with end stage renal failure and palpable masses in the abdomen presents. What is the most likely diagnosis ?
A
  • Polycystic kidney disease
167
Q
  1. What is the inheritance in adult PKD ?
A
  • Autosomal dominant
168
Q
  1. How would PKD impact the brain, colon and heart ?
A
  • Brain  cerebral aneurysms
  • Colon  Diverticular disease
  • Heart  Valve disease (mitral regurgitation)
169
Q
  1. What is the initial investigation for PKD ?
A
  • Ultrasound
170
Q
  1. How does PKD cause gross haematuria ?
A
  • Cyst rupture

Phase 4 (17 decks)

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