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Phase 2a > Renal and GU > Flashcards

Renal and GU Flashcards

1
Q

What is renal colic?

A

Renal colic is a SYMPTOM:

  • Acute, unilateral pain
  • ‘Loin to groin’ distribution
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2
Q

What is the main cause of renal colic?

A

Kidney stones (renal calculi)

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3
Q

What are the three most common sites for kidney stones to get stuck?

A
  • Pelviureteric junction
  • Pelvic brim
  • Vesicoureteric junction
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4
Q

What is a kidney stone likely to be composed of?

A

Calcium oxalate (75% of stones)

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5
Q

What causes kidney stones?

A

Supersaturation of urine with salt/minerals

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6
Q

Describe the symptoms of kidney stones

A
  • Acute unilateral pain with a ‘loin to groin’ distribution (renal colic)
  • Problems associated with passing urine: dysuria, urinary retention, haematuria
  • Nausea and vomiting
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7
Q

What investigations are required in a case of suspected renal colic?

A
  • Bloods/urinalysis

- Diagnostic: CT abdomen (picks up 99% of stones)

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8
Q

Describe the management of renal colic.

A
  • Pain relief
  • Stones <5mm in diameter = pass spontaneously
  • Stones >5mm in diameter = require medical intervention - either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL)
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9
Q

How are future kidney stones prevented?

A

Drink plenty of water!

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10
Q

Nephrotic syndrome: causes, pathology and clinical presentation

A

Causes:

  • Minimal change glomerular disease
  • Membranous nephropathy
  • Focal segmental glomerulosclerosis

Pathology:
-Glomerular damage without inflammation

Clinical presentation:

  • Proteinuria
  • Hypoalbuminaemia
  • Oedema
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11
Q

Nephritic syndrome: causes, pathology and clinical presentation

A

Causes:

  • Post-streptococcal glomerulonephritis/IgA nephropathy (presents days/weeks after URTI)
  • Autoimmune glomerulonephritis (EITHER anti-glomerular basement membrane disease (which with lung involvement is called Goodpasture’s syndrome) OR anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis

Pathology:
-Glomerular damage WITH INFLAMMATION

Clinical presentation:

  • Haematuria
  • Proteinuria
  • Hypertension
  • Low urine volume
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12
Q

Describe the pathophysiology of ADPKD.

A
  • Caused by mutations in PKD1/PKD2 gene
  • This results in alterations in polycystin 1/2 respectively (protein)
  • Polycystins regulate tubular and vascular development in the kidney as well as other organs (e.g liver, heart)… This leads to cyst development
  • As cysts grow, there is renal enlargement and progressive decline in renal function due to destruction of healthy tissue
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13
Q

Describe the symptoms and signs of ADPKD

A

Symptoms:
- Acute loin pain (caused by cyst haemorrhage/infection and renal calculi)

Signs:

  • Decline in renal function
  • Hypertension
  • Hepatomegaly
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14
Q

What is the diagnostic investigation for ADPKD?

A

Abdominal US

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15
Q

Describe the management of ADPKD.

A
  • No cure
  • Patient/family counselling
  • Frequent monitoring to check disease progression
  • Treat complications, e.g. hypertension
  • Dialysis for end stage renal failure
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16
Q

What is benign prostatic hyperplasia?

A

Benign proliferation of the musculofibrous/glandular tissue of the transitional (inner) zone of the prostate due to the effect of dihydrotestosterone

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17
Q

Describe the clinical presentation of BPH.

A

LUTS!! - separated into ‘storage’ and ‘voiding’ symptoms

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18
Q

What are the ‘storage’ LUTS?

A
  • Urgency
  • Frequency
  • Nocturia
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19
Q

What are the ‘voiding’ LUTS?

A
  • Urinary retention
  • Hesitancy
  • Poor stream
  • Post-micturition dribbling
  • Overflow incontinence
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20
Q

Which investigations are carried out in a case of suspected BPH?

A
  • DRE = smooth and enlarged

- PSA test +/- TRUSS (trans-rectal ultrasound scan) to exclude malignancy

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21
Q

Describe the conservative management of BPH.

A

Reduce alcohol/caffeine intake

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22
Q

Describe the pharmacological management of BPH.

A
  • 1st line = alpha blocker, e.g. Tamsulosin

- 2nd line = 5-alpha reductase inhibitor, e.g. finasteride

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23
Q

Describe the interventional management of BPH.

A
  • Catheterisation (if urinary retention/overflow incontinence)
  • TURP (trans-urethral resection of prostate)
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24
Q

What are the red flag symptoms which may indicate prostate cancer rather than BPH?

A
  • Haematuria

- Bone pain

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25
Q

What kind of cancer is prostate cancer?

A

Adenocarcinoma (usually of peripheral zone of prostate)

26
Q

What are the common sites of prostate cancer metastasis?

A
  • Adjacent structures
  • Bone
  • Brain
  • Liver
  • Lung
27
Q

Which investigations would be carried out in a case of suspected prostate cancer?

A
  • DRE = hard and irregular
  • PSA test
  • Biopsy
  • TRUSS
  • Bone scan
28
Q

How is prostate cancer staged?

A
  • Gleason score

- TNM staging

29
Q

What kind of cancer is renal cell carcinoma?

A

Adenocarcinoma

30
Q

What are the common sites of metastasis for renal cell carcinoma?

A
  • Bone
  • Brain
  • Liver
  • Lung
31
Q

Describe the symptoms of RCC.

A
  • Loin pain
  • Haematuria
  • Abdominal mass
  • Urinary outflow obstruction
  • Weight loss, fatigue
32
Q

What investigations would be carried out for suspected RCC?

A
  • Bloods (FBC, U+E. LFTs)… FBC mayshow ploycythaemia as tumour may cause increased EPO production
  • Urine dip (haematuria)
  • Abdo Ultrasound - visualise tumour
33
Q

Describe the management of RCC.

A
  • Localised = radical nephrectomy

- Metastatic = biological therapy, e.g. mTOR inhibitors (temsirolimus)

34
Q

What types of bladder cancer are there? Which is the most common?

A
  • Transitional cell carcinoma (90%)
  • Squamous cell carcinoma
  • Adenocarcinoma
35
Q

What is the key red flag symptom for a suspected bladder cancer?

A

PAINLESS HAEMATURIA

36
Q

What are the risk factors for bladder cancer?

A
  • Occupation (azo dyes, rubber)
  • Lifestyle - smoking
  • Bladder conditions - schistosomiasis, chronic cystitis
37
Q

What are the investigations for suspected bladder cancer?

A
  • Bloods (FBC, U+E, LFTs)
  • Urine dip -haematuria
  • Cystoscopy and biopsy
38
Q

Describe the management of bladder cancer.

A
  • Localised = TURBT (transurethral resection of bladder tumour) or radical cystectomy
  • Metastatic - chemo/radiotherapy
39
Q

What is the most common type of testicular tumour?

A

Seminoma (germ-cell tumour)

40
Q

What is the key red flag symptom for suspected testicular cancer?

A

Painless testicular lump

41
Q

What are the risk factors for testicular cancer?

A
  • Undescended testes
  • Infant hernia
  • Infertility
42
Q

What are the investigations for a suspected testicular cancer?

A
  • Bloods = serum tumour markers: alpha-fetoprotein (a-FP), beta-human chorionic gonadotrophin (b-hCG) and lactate dehydrogenase (LDH)
  • Testicular US
  • Testicular lump biopsy
43
Q

Describe the management of testicular cancer.

A
  • Seminomas = radical orchidectomy + radiotherapy

- Non-seminomas = chemotherapy

44
Q

What is the definition of UTI?

A

Pure growth of >10^5 organisms per mL of fresh mid-stream urine (MSU)

45
Q

How are UTIs categorised?

A

Anatomically:

  • Upper: pyelonephritis, ureteritis
  • Lower: cystitis, urethritis, prostatitis

Complicated (pregnant/men/catheterised) and uncomplicated (everyone else!)

46
Q

Which organisms are commonly associated with UTIs?

A
  • E. coli
  • Klebsiella
  • Enterococci
47
Q

Compare/contrast symptoms of upper and lower UTIs.

A

Lower:

  • PAIN - suprapubic
  • Haematuria
  • Dysuria
  • Urgency
  • Frequency

Upper:

  • PAIN - loin
  • Fever
  • N + V
48
Q

What are the investigations for suspected UTI?

A
  • MC+S of fresh MSU (gold standard)

- OR Urine dip (leukocytes, nitrites, haematuria)

49
Q

Describe the pharmacological management of UTI

A
  • Abx: lower UTI = trimethoprim/nitrofurantoin, upper UTI = ciprofloxacin/co-amoxiclav (if complicated case refer to specialist)
  • Pain relief
  • Fluid intake
50
Q

What is testicular torsion?

A

Twisted spermatic cord, which cuts off blood supply to the testes (ischaemia)
MEDICAL EMERGENCY

51
Q

Describe the symptoms of testicular torsion

A
  • Sudden onset testicular pain/swelling (unilateral)

- N+V

52
Q

Describe the management of testicular torsion

A

Surgery without delay

53
Q

What is the definition of acute kidney injury? What are the criteria used to define AKI?

A

Sudden decline in renal function over hours to days

Criteria:

  • Rise in creatinine > 26 micromol/L in 48 hours
  • Rise in creatinine > 1.5 x baseline
  • Urine output < 0.5 ml/kg/hr for > 6 consecutive hours
54
Q

Give some causes of acute kidney injury (how are these causes classified?)

A

Pre-renal causes:
- Hypoperfusion, e.g. hypotension, renal artery stenosis, drugs (e.g. NSAIDs, ACEi/ARBs)

Renal causes:

  • Acute tubular necrosis (most common)
  • Glomerulonephritis

Post-renal causes:
- Urinary tract obstruction, e.g. stones, malignancy

55
Q

Describe the symptoms of acute kidney injury

A
  • Oliguria/anuria (urinary retention)
  • N+V
  • Dehydration
  • Confusion
56
Q

Describe the management of acute kidney injury

A
  • Aim for euvolaemia
  • Stop nephrotoxic drugs
  • Treat complications, e.g. hyperkalaemia (give insulin/dextrose or salbutamol neb with calcium gluconate)
57
Q

What is chronic kidney disease?

A

Progressive decline in renal function over time

58
Q

Give some risk factors for developing CKD

A
  • Hypertension
  • DM
  • Glomerular disease
59
Q

Describe the investigation of CKD

A

Abdo US = bilaterally small kidneys

60
Q

Describe the conservative management of UTI

A

Increase fluid intake
Regularly void
Void post coitus

Phase 2a (16 decks)

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