Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dannys Medicine Finals > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

AKI

Criteria?

A

1) Rise in creatinine of > 25 umol/L in 48hrs
2) Rise in creatinine of >50% in 7 days
3) Urine output of <0.5ml/kg/hr for >6hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

AKI

Stages?

A

STAGE 1
- >1.5-1.9x baseline OR <0.5ml/kg/hr for 6-12hrs

STAGE 2
- >2.0-2.9x baseline OR <05ml/kg/hr for 12+hrs

STAGE 3
- 3x baseline or >353umol/L OR <0.3ml/kg/hr for 24hrs OR anuria for >12hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

AKI

Risk factors?

A

HANDS C

Heart failure / Hypovolaemia/ Hx of AKI
Age >65
Nephrotoxic drugs (NSAIDs/ ACEi) 
Diabetes 
Sepsis

CKD/ CLD / contrast agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AKI

What is Acute Tubular Necrosis?

How does Necrosis occur?

A

damage and death (necrosis) of the epithelial cells of the renal tubules and most common cause of AKI

Necrosis occurs due to ischaemia or toxins (drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

AKI

Pathognomonic finding of ATN?

A

“Muddy brown casts” found on urinalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AKI

How does ATN cause a reduction in eGFR?

A

Reduced blood supply
AND
dead cells slough off into lumen causing further obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AKI

Pre-renal causes?

A

Secondary to renal hypoperfusion

  • reduced circulating volume (e.g. hypovolaemia)
  • reduced cardiac output (e.g. cardiac failure),
  • systemic vasodilatation (e.g. sepsis)
  • arteriolar changes (e.g. secondary to ACE-inhibitor or NSAID use)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

AKI

Intrinsic causes?

A

(structural damage)

Glomerulonephritis
ATN and Interstitial Nephritis
Rhabdomyolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AKI

Post-renal causes?

A

Obstructive causes (10%)

  • Renal stones
  • Prostatitis/ cancer / BPH
  • Urinary stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AKI

Investigations?

A

Urinalysis - Infection (leucocytes), glucose, protein, blood

Ultrasound - if looking for obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

AKI

Clinical features?

A

Pre-renal - dehydration and hypovolaemia or hypervolaemia for cardiac failure (oedema etc)

Intrinsic - Nephrotic / nephritic syndromes

Post renal- loin to groin pain, haematuria, N+V, LUTS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

AKI

Clinical features of Acute Interstitial Nephritis and most common cause?

A

drugs are the most common cause, particularly antibiotics - penicillin / rifampicin
NSAIDs
allopurinol
furosemide

Features - fever, rash, arthralgia
eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AKI

Management?

A

RENAL DRS 26

Record baseline creatinine
Exclude Obstruction (US) 
Nephrotoxic drugs stopped
Assess and correct fluids and electrolytes 
Losses recorded +/- cathether

Dipstick (blood/protein/infection/glucose)
Review meds
Screen

26 creatinine rise for AKI diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HYPERKALAEMIA

Causes?

A

CKD
Rhabdomyolysis
AKI / Addison’s
Metabolic Acidosis

drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HYPERKALAEMIA

Signs on ECG and cardiac complications?

A
  • Tall T
  • Absent P
  • Broad QRS
  • Sinusoidal wave pattern

COMPLICATIONS - VF / arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HYPERKALAEMIA

Management?

A

Cardiac protection = IV calcium gluconate

Shift extracellular K+ intracellular =
• Combined insulin/dextrose infusion
• Nebulised salbutamol

Removal of potassium from body =
• Calcium resonium (orally or enema)
• Loop diuretics
• Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of Hydronephrosis?

A

Various obstructions e.g

Unilateral - calculi, ureteric obstruction and tumours

Bilateral - stenosis of urethra/ prostatic enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

RHABDOMYOLYSIS

Classic presentation?

A

Patient fell and prolonged seizure found to have AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RHABDOMYOLYSIS

What does muscle cell apoptosis release?

A

Myoglobin
Potassium
Phosphate
Creatine Kinase

ALL filtered by kidney and myoglobin TOXIC to kidney = AKI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

RHABDOMYOLYSIS

Investigations?

A

Raised CK
Myoglobinuria (red-brown urine)
U+E (AKI and hyperkalaemia)
ECG (hyperkalaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

RHABDOMYOLYSIS

Causes?

A

CCSSEE

Crush injury
Collapse
Seizure
Statin + Clarithromycin 
Ecstasy 
excessive exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

RHABDOMYOLYSIS

Management?

A

IV fluids
IV Sodium bicarbonate (make kidneys more alkaline)
IV Mannitol to increase GFR and reduce oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Triad of Haemolytic Uraemic Syndrome?

A

AKI
haemolytic Anaemia
thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Common cause of HUS?

A

classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7 (90%)

(secondary cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Classic presentation of HUS?

A

Bloody diarrhoea and then:

bruising (low platelets) 
abdo pain
Confusion (uraemia) 
pallor (anaemia) 
Hypertension (renal failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tx of HUS?

A

Supportive + antihypertensives

No role for antibiotics despite preceding diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute Urinary Retention

Presentation and Investigation?

A

Male 13:1

Acute confused and inability to pass urine / lower discomfort

Bladder US!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of Acute Urinary Retention?

A

most commonly secondary to BPH

Others include strictures, calculi, masses +

DRUGS - benzos, Anticholinergics, Opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

DIABETIC NEPHROPATHY

What is it?

A

high levels of glucose passing through glomerulus causing glomerulosclerosis

Most common cause of CKD and glomerular pathology in the UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

DIABETIC NEPHROPATHY

key feature?

A

Proteinuria - diabetics needed screening by ACR and U+E

Tx - ACE-i BP control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

CKD Risk factors / causes?

A

Smoking
Hypertension
Old age
Polycystic kidney disease

Diabetes
Medications (lithium, PPI, NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dx of CKD?

Significant proteinuria?

A

Two U+Es 3 months apart (eGFR)

ACR of >3mg/mol

For CKD eGFR <60 or proteinuria needed for dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Staging of CKD?

A

G score and A score

G score is based on eGFR - 
G1 - >90
G2 - 60-89
G3a 45-59
G3b 30-44
G4 - 15-29
G5 - <15 end stage RF

A score is based on ACR

A1 - <3mg/mmol
A2 - 3-30mg/mmol
A3 - >30mg/mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Complications of CKD?

A 
Secondary hyperparathyroidism + high 
phosphate 
CVD
Renal Bone disease (low Vit D and treat with Vit D)
Anaemia (treat with iron)
Peripheral Neuropathy

SCRAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Presentation of Nephrotic Syndrome?

A
  • Proteinuria (>3.5g day)
  • Hypoalbuminaemia (<25g/L)
  • Oedema

+ hyperlipidaemia
+ hypercoagulable state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Presentation of Nephritic Syndrome?

A
  • haematuria
  • Proteinuria
  • Oliguria
  • Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Causes of Nephrotic?

A

Minimal change disease
focal segemental glomerulonephritis
membranous GN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Causes of Nephritic?

A

Rapidly progressive GN (goodpastures / wegeners)
IgA nephropathy
Post strep GN
Alport syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is IgA nephropathy?

Classical presentation?

A

Most common glomerulonephritis worldwide

macroscopic haematuria in young people following an URTI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Difference between post strep GN and IgA nephropathy presentation?

A

Post strep = 1-2 weeks after URTI + proteinuria

IgA nephropathy = 1-2 days after URTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What conditions are we thinking if someone presents with Acute Renal Failure and Haemoptysis?

A

Either Anti GBM disease or Granulomatosis with Polyangiitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Polycystic Kidney Disease

What is the Ultrasound diagnostic criteria?

A

<30 years - 2 cysts uni/bi

3-59 years - 2 cysts bilaterally

> 60 years - 4 cysts bilaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Features of PCKD?

Extra renal features?

A

Recurrent UTIs, stones, HTN, abdo pain, haematuria

EXTRA RENAL - liver cysts (70%)
berry aneurysms (8%) rupture - SAH
CV disease (mitral regurgitation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Management of PCKD?

A

Tolvaptan

if end stage RF - dialysis and transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Types of PCKD?

A

Autosomal dominant 1 (85% - chromosome 16)
Autosomal dominant 2 (15% - chromosome 4)
Autosomal recessive - end stage RF before adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management and cause for Urge Incontinence?

A

Cause - Detrusor overactivity

1st - Bladder retraining (6 weeks)

2nd - oxybutynin/ tolterodine / darifenacin

3rd - Mirabegron if old and frail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management and cause for Stress Incontinence?

A

Cause - leaking when cough/ laugh etc

1st - pelvic floor muscle training (8 - 3x day for 3 months)

2nd - Duloxetine

surgical procedures: e.g. retropubic mid-urethral tape procedures

48
Q

Signs of Varicocele?

A

bag of worms. On the left is concern for Renal cell carcinoma

49
Q

Signs of testicular torsion

A

Painful tender testes retracted upwards

Whirlpool sign on US

50
Q

signs of Hydrocele

A

Transilluminate clear fluid and painless

51
Q

Signs and cause of epididymo-orchitis

A

Local spreading of chlamydia / gonorrhoea

- dysuria and discharge

52
Q

Management of epididymo-orchitis

A

if the organism is unknown BASHH recommend: ceftriaxone 500mg intramuscularly single dose,

plus doxycycline 100mg by mouth twice daily for 10-14 days

53
Q

Lower urinary tract symptoms?

A

cant UNSHIFT the urine

Urgency
Nocturia
Straining
Hesitancy
Intermittent flow
Frequency
Terminal dribbling

weak flow and incomplete emptying

54
Q

BPH / LUTS initial assessment?

A 
DRE
Abdo exam
Dipstick
Urinary frequency chart
PSA
55
Q

How does a cancerous prostate feel?

A

Hard, assymetrical craggy/ irregular and loss of central sulcus

56
Q

Causes of increased PSA?

A

1) Prostate cancer
2) BPH
3) Prostatitis
4) UTIs
5) Vigorous exercise (cycling)
6) Recent stimulation e.g. ejaculation

57
Q

Management of BPH and what the medication does?

A

Alpha blockers - Tamsulosin (relax smooth muscle)

5 - alpha reductase inhibitors - Finasteride (reduce size by blocking conversion of testosterone to DHT)

58
Q

Acute Bacterial Prostatitis cause and treatment?

A

E.coli

Tx - Quinolones for 14 days

59
Q

Surgical treatment of BPH?

A

Transurethral resection of the prostate (TURP)

removed by diathermy loop through resectoscope in urethra

60
Q

Alport Syndrome signs?

A

Can’t see - Lenticonus
Can’t pee - CKD, hematuria
Can’t hear a high C - sensorineural deafness

61
Q

An important marker to distinguish between pre-renal and renal causes of an acute kidney injury?

A

Assess urinary sodium

pre-renal (hypovolaemia) = kidney tries to preserve sodium to encourage water retention

renal = elevated levels of urinary sodium due to inability to preserve sodium levels through renal damage

62
Q

PROSTATE CANCER

Likely tumour type?

A

Androgen dependant adenocarcinoma

(95%) - peripheral zone

63
Q

PROSTATE CANCER

Most likely spread?

A

Bones and lymph nodes

64
Q

PROSTATE CANCER

Risk factors?

A

Afro caribbean
Increasing age
Obesity
Family history

65
Q

PROSTATE CANCER

What PSA result guides referral?

A

men aged 50-69 years should be referred if the PSA is >= 3.0 ng/ml

OR there is an abnormal DRE

66
Q

PROSTATE CANCER

First line investigation?

A

Multiparametric MRI

2nd- prostate biopsy

67
Q

PROSTATE CANCER

Features?

A 
LUTS
Haematuria 
ED
Bone pain (bone mets) 
weight loss
Abnormal DRE
68
Q

PROSTATE CANCER

Medical management?

A

Reduce androgen levels

Goserelin

Bicalutamide

69
Q

PROSTATE CANCER

Complication of of radical prostatectomy

A

Erectile dysfunction

70
Q

PROSTATE CANCER

Risks with radiotherapy? (tx for types T3/4)

A

increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer

71
Q

How is Prostate cancer graded?

A

Gleason Grading Score

72
Q

Typical cause of Pyelonephritis?

A

E.coli

73
Q

Features of Pyelonephritis?

A 
LUTS
Fever
Loin pain
vomiting
white cell casts in urine
74
Q

Treatment for Pyelonephritis?

A

broad-spectrum cephalosporin or a quinolone for 10 - 14 days

(cefalexin)

75
Q

What type of tumour are 95% of testicular cancers

A

Germ cell tumours - seminomas and non seminomas

76
Q

Tumour markers of testicular cancer?

A

seminomas: hCG may be elevated in around 20%
non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
LDH is elevated in around 40% of germ cell tumours

77
Q

Risk factors of testicular cancer?

Common age of incidence?

A

Infertlity
Klinefelters

20-30 years

78
Q

Diagnosis and treatment of testicular cancer?

A

Ultrasound and Orchidectomy

79
Q

features of testicular cancer?

A

Painless lump

Gynaecomastia due to an increased oestrogen:androgen ratio

80
Q

Most likely mets from testicular cancer?

A

Brain, lung, lymph, liver

81
Q

When should trimethoprim be avoided in pregnancy and why?

A

Avoid in first trimester due to folate antagonist properties which cause neural tube defects such as spina bifida

82
Q

When should Nitrofurantoin be avoided in pregnancy and why?

A

Avoid close to term (3rd trimester) due to `neonatal haemolysis’

83
Q

Risk factors for transitional cell carcinoma of the bladder include:

A

Smoking

Aromatic Amines
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine

Rubber manufacture

Cyclophosphamide

84
Q

Risk factors for squamous cell carcinoma of the bladder include:

A

Schistosomiasis

Smoking

85
Q

Most common type of bladder cancer?

A

Urothelium - transitional cell carcinoma (95%)

86
Q

Presentation of bladder cancer?

A

painless, macroscopic haematuria

87
Q

How is bladder cancer diagnosed and staged?

A

Cystoscopy and Biopsies and staged by TNM

88
Q

Treatment of bladder cancer?

A

TURBT if superficial (not invading muscle)

T2 disease = surgery (cystectomy + urostomy)

89
Q

Referral guidance for bladder cancer?

A

Over 45 with unexplained visible haematuria, persisting after UTI treatment

Over 60 with microscopic haematuria plus dysuria or Raised WCC

90
Q

RENAL STONES

symptoms?

A

Unilateral loin to groin pain
Colicky
Haematuria
N+V

91
Q

RENAL STONES

Types of stones?

Drugs that can cause stones?

A 
Calcium oxalate (oaque on radiograph) 
Urate (Radio-lucent)

Loop diuretics
steroids
acetazolamide
theophylline

92
Q

RENAL STONES

How to prevent renal stones?

A 
High fluid intake
Avoid carbonated drinks
citric acid 
reduce salt
thiazide diuretics
93
Q

RENAL STONES

Risk factors?

A 
Hypercalcaemia
Hyperparathyroid
Dehydration 
High dietary oxalate 
PCKD
Renal tubular acidosis

urate stones : GOUT

94
Q

RENAL STONES

Medical treatment?

Best imaging?

A

Pain - Diclofenac (NSAID)

Tamsulosin (Alpha blocker)

Non contrast CT-KUB

95
Q

RENAL STONES

Surgical treatment?

A

Extracorpeal shock wave lithotripsy (ESWL)

Ureteroscopy

96
Q

RENAL CELL CARCINOMA

Common type?

A

Adenocarcinoma

  • Clear cell (80%)
  • Papillary
  • chromophobe
97
Q

RENAL CELL CARCINOMA

Risks?

A 
Smoking
obesity
hypertension
end stage renal failure 
von hippel-lindau
tuberous sclerosis
98
Q

RENAL CELL CARCINOMA

Features?

A

classical triad: haematuria, loin pain, abdominal mass

99
Q

RENAL CELL CARCINOMA

Associations with other organs?

A

Left varicocele (due to occlusion of left testicular vein)

cannonball mets (mets to liver due to RCC)

100
Q

RENAL CELL CARCINOMA

Paraneoplastic features?

A

EPO - Polycythaemia

mimic PTH - hypercalcaemia

HTN - renin

Abnormal LFTs - Stauffer syndrome

101
Q

RENAL CELL CARCINOMA

Stages?

A

1 - <7cm confined to kidney
2 - >7cm confined to kidney
3 - local spread (within gerotas fascia)
4 - spread beyond (lung, bone, brain)

102
Q

RENAL CELL CARCINOMA

Management?

A

Total nephrectomy unless T1 could be partial

103
Q

examples of quinolones?

A

Ciprofloxacin
Ofloxacin
Levofloxacin

104
Q

what are quinolones mainly used for

A

UTIs
Prostatitis
Epididymo orchitis
Pyelonephritis

105
Q

Key side effects of Quinolones?

A

1) Tendon damage/ rupture (Achilles)
2) Lower seizure threshold (in epilepsy)
3) lengthens QT interval

Avoid in breastfeeding and pregnant

106
Q

Causes of NAGMA?

A

HARDUPS

Hyperalimentation (XS saline) 
Acetazolamide
Renal tubular acidosis
Diarrhoea
Ureterostomy (new outlet)
Post hypocapnic state
Spironolactone (hypoadrenalism)
107
Q

Causes of HAGMA?

A

MUDPILES

Methanol
Uraemia (AKI/CKD) 
DKA
Propylene glycol
Isoniazid / Iron
Lactic Acidosis
Ethanol / Ethylene Glycol 
Salicylates (aspirin)
108
Q

Why does raised anion gap acidosis occur?

A

Accumulation of an unmeasured anion that consumes bicarbonate with no reciprocal increase in Cl-

109
Q

how to calculate anion gap?

What is a normal anion gap

A

(sodium + potassium) - (bicarbonate + chloride)

A normal anion gap is 8-14 mmol/L

110
Q

Complications of Peritoneal Dialysis and likely cause?

A

peritonitis:

coagulase-negative staphylococci such as Staphylococcus epidermidis is the most common cause

111
Q

RENAL TUBULAR ACIDOSIS

Where the different types found on the glomerulus

A

2 - proximal CT
1 - distal CT
4 - Collecting duct

112
Q

RENAL TUBULAR ACIDOSIS

Potassium changes?

A

2 LOW - hypokal
1 LOW - hypokal
4 MORE - hyperkal

113
Q

RENAL TUBULAR ACIDOSIS

Calcium changes?

A

2 - normal
1 - high
4 - normal

1 is odd therefore odd one out

114
Q

RENAL TUBULAR ACIDOSIS

pH changes?

A

2 - <5.5
1 - OVER 5.5
4 - <5.5

1 is odd therefore odd one out

115
Q

RENAL TUBULAR ACIDOSIS

kidney stones?

A

2 - No
1 - YES (high calcium)
4 - No

1 is odd therefore odd one out

Dannys Medicine Finals (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions