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Phase1c Medicine > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

What is the definition of testicular torsion?

A

Twisting of the spermatic cord resulting in constriction of the vascular supply and ischaemia of testicular tissue

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2
Q

What are the two types of testicular torsion?

A

1) Intravaginal (Most common)
- Twisting within the tunica vaginalis

2) Extravaginal - Entire testes and tunica vaginalis twists

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3
Q

What are the risk factors of testicular torsion?

A

Age under 25 years
Bell clapper deformity - Responsible for 90% of cases
Intravaginal (Most common)

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4
Q

What is the bell clapper deformity in terms of testicular torsion?

A

Deformity allows testicles to rotate freely within the tunica vaginalis - above and above the epididymis - high attachment.

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5
Q

What is the presentation of testicular torsion?

A

Symptomatic

  • Painful
  • Swollen, hot, tender erythematous scrotum
  • Unilateral
  • High riding testicle
  • Absent cremasteric reflex
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6
Q

What reflex is absent in testicular torsion?

A

Cremasteric reflex

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7
Q

Within what time period should testicular torsion be treated?

A

Within 6 hours on symptom onset

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8
Q

What is the cremasteric reflex?

A

Pinching the inner thigh - the testicle will lift up.

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9
Q

What is the definitive management of testicular torsion?

A

Emergency surgical exploration of the scrotum within the 6 hours.

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10
Q

What type of surgery is performed in testicular torsion?

A

Bilateral orchidopexy

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11
Q

What is the send line management for testicular torsion is surgery is not available within 6 hours?

A

Manual de-torsion

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12
Q

What sign would be revealed in a doppler USS in testicular torsion?

A

Whirlpool sign

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13
Q

What is epididymitis and orchitis?

A

Inflammation of the epididymis or testes

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14
Q

What is the most common cause of epididymitis?

A

Infective - Bacterial
<35 years - chlamydia trachomatis

> 35 years - Klebsiella, E.coli, enterococcus faecalis

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15
Q

What is the most common infective cause for epididymitis in patients <35 years?

A

Chlamydia trachomatis >Neisseria gonorrhoea

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16
Q

What is the most common infective cause for epididymitis in patients >35 years?

A

Klebsiella, E.coli

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17
Q

What are the risk factors for E.coli epididymitis?

A

Bladder outflow obstruction

UTI

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18
Q

What are the atypical organisms associated with epididymitis?

A

Candida

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19
Q

What is the largest risk factor for epidiymitis?

A 
Unprotected sex - Main cause in younger patients
Immunosuppressed
Trauma
Vasculitis
Medication - amiodarone
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20
Q

What is the presentation of epididmyitis?

A

Painful, swollen, hot tender and erythematous scrotum.

  • Unilateral
  • Happens across all age groups

Less acute that testicular torsion (Presents over a few days)

Dysuria and urgency

Penile discharge associated with STI

Pyrexia

Present cremasteric reflex

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21
Q

What investigations are performed in epididymitis?

A

Urine dipstick -MSU for MC&S - identify pathogen.

Bloods
-FBC - high WCC
U&Es

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22
Q

What imaging is performed in suspected epididymitis?

A

Colour duplex ultrasound

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23
Q

What is the conservative management for epididymitis?

A

Bed rest and scrotal elevation

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24
Q

What is the medical management for epididymitis?

A

Analgesia (Paracetomol/ibuprofen).

ABx to target infection

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25
What discriminatory symptoms are associated with epididymitis compared with testicular torsion?
- Dysuria - Present cremasteric reflex - Infection/pyrexia - Penile discharge - Occurs over a few days
26
What is varicocele?
Dilated veins of the pampiniform plexus forming a scrotal mass
27
Why does varicocele occur?
Increased hydrostatic pressure in the left renal vein Incompetent venous valves
28
Varicocele is common on which side?
Left
29
How should you examine varicocele?
Patient must be standing for examination - reduce when lying down
30
What radiological examinations are performed in vaircocele?
Retroperitoneal USS/CTAP | -Identify any masses obstructing the venous return (When varicocele does not reduce)
31
What is the management for varicocele?
Reassurance + observation | -Semen analysis abnormal - surgical repair should be offered
32
What is the presentation of Varicocele?
'Bag of worms' | Asymptomatic
33
What is the definition of hydrocoele?
Excessive collection of serous fluid within the tunica vaginalis
34
What is a communicating hydrocoele?
Processus vaginallis is left open - peritoneal fluid free to flow (Connects the abdomen with the tunia vaginalis, allows peritoneal fluid to flow freely)
35
What is a non-communicating hydrocoele?
Processus vaginalis is closed - more fluid is being produced than is absorbed
36
What are the risk factors for hydrocoele?
Male, very common in children in first year of life Non-communicating - Inflammation/injury to the scrotum - trauma, infection, testicular torsion - Epididymo-orchitis - Testicular cancer Communcating -Increased intraperitoneal fluid - acites
37
Management of hydrocoele?
Asymptomatic - Scrotal swelling - Possible to get above the swelling - Enlarges following activity- coughing, straining
38
What characteristic examination is done in hydrocoele?
Transillumination
39
What investigations are performed in hydrocoele?
Urine dip USS - Exclude tumour blood test - Testicular tumour markers
40
What is the management for hydrocoele?
Observation
41
What are the two main types of testicular cancer?
Seminomas. - 50% | Non-seminomas - germ cell tumours and teratomas
42
What are the main risk factors for testicular cancer?
Cryptorchidism Ectopic testes Testicular atrophy FHx
43
What is the presentation of testicular cancer?
Painless hard nodular - testicular mass - unilateral Lymphadenopathy Gynaecomastia backache
44
What tumour markers are associated with testicular cancer?
AFP b-HCG LDH
45
What is the diagnostic investigation for testicular cancer?
Testicular ultrasound
46
What imaging allows visualisation of the tumour, monitor Tx response?
CTAP
47
Which lymph nodes does testicular cancer travel through?
Para-aortic lymph nodes- affect mediastinal structures
48
What is the management for testicular cancer?
Surgical removal -orchiectomy | Chemotherapy
49
What is the definition of a UTI?
Presence of a pure growth >10^5 organisms per mL of fresh MSU
50
What is the common causative organism for UTI?
E.coli
51
What are the risk factors for developing UTI?
``` Sexual intercourse Pregnancy Immunosuppression Catheterisation Urinary tract obstruction- BPH calculi ```
52
What is the presentation of UTI?
Increased frequency Urgency Dysuria Foul-smelling Acute pyelonephriti - Flank pain - Fever - Malaise
53
What is the first-line investigation for a UTI?
Urine dipstick - increased leucocytes and nitrites
54
What is the gold standard investigation for a UTI?
MSU for MC&S to identify the bacteria (Pyelonephritis will have white cell casts)
55
What is the management for UTI?
Empirical ABx | -Nitrofurantoin
56
What are UT calculi?
The presence of stones in the urinary system
57
What are the three common sites of urinary tract calculi?
Ureteropelvic junction Pelvic brim Ureterovesicle junction
58
What is the most common type of urinary tract calculi?
Calcium oxalate
59
What are the other types of kidney stones?
Struvite Urate/uric acid - not visible on X-ray Hydroxyapatite
60
What is the aetiology for UT calculi?
Supersaturation of urinary solutes and precipitate out of solution -Ca, Uric acid, oxalate, Na
61
What are the risk factors for urinary tract calculi?
Dehydration High protein intake High salt Structural abnormalities 3x more common in males Higher prevalence in hot dry countries 30-50 years
62
What is the presentation of urinary tract calculi?
Acute severe loin to groin pain = renal colic Nausea and vomiting Unable to lie still/writhing in pain Urinary symptoms - Urgency - Frequency - Haematuria - microscopic 85%
63
What is the 1st-line investigation for urinary tract calculi?
Urine dipstick | -In women also perform pregnancy test
64
What is the gold-standard radiological investigation to diagnose urinary tract calculi?
Non-contrast KUB (USS in pregnancy)
65
What is the acute management for urinary tract calculi?
Fluids Diclofenac (analgesia) Anti-emetics (Odanestron) Urine collection -collect passed stone
66
What analgesia is given for urinary tract calculi?
Diclofenac
67
What is the management for urinary calculi <5mm?
Leave to pass spontaneously with increased fluid intake
68
What is the pharmacological management for urinary tract calculi <10mm?
Alpha-blockers (tamsulosin) to pass after 4-6 weeks
69
What is the definitive management for urinary tract calculi >10mm?
1st line - extracorporeal shock wave lithotripsy Percutaneous nephrostolithotomy - difficult shape stones staghorns
70
What is the management for staghorn calculi?
Percutaneous nepphrostolithotomy
71
What are the complications for urinary tract calculi?
``` Pyelonephritis Septicaemia Obstruction Urinary retention Hydronephrosis, AKI ```
72
What is BPH?
Diffuse hyperplasia of the peri urethral zone
73
Which zone is enlarged in BPH?
Transitional zone (surrounds the urethra)
74
What is the presentation of symptomatic BPH?
``` FUND HIPS Frequency Urgency Nocturia Dysuria Hesistancy Incomplete voiding Poor stream ```
75
What are the discriminatory symptoms for prostate cancer compared with BPH?
Haematuria | Metastatic spread - bone pain, cord compression
76
What is the first-line investigations for Bph?
Urinalysis to exclude for UTI
77
What are the DRE examinations for prostate cancer?
Asymmetrical hard nodular prostate | Loss of midline sulcus
78
What is found in a DRE in suspected BPH?
Smoothly enlarged palpable midline groove
79
What tumour marker is elevated in BPH and prostate cancer?
PSA
80
What is the gold-standard investigation for prostate cancer and BPH?
Transrectal ultrasound-guided needle biopsy
81
What additional investigation is performed in prostate cancer after a biopsy?
Isotope scan to check for mets
82
What is the emergency management for urinary retention?
Catheterisation
83
What are the conservative measures for BPH?
Monitor symptom progression Lifestyle -AVOID CAFFEINE Medication review
84
What is the medical management for BPH?
Selective alpha-1 blocker - tamsulosin 5-alpha reductase inhibitor - finasteride
85
What is the surgical management for BPH?
Transurethral resection of the prostate (TURP)
86
What are the two types of bladder cancer?
Urothelial carcinoma | Rare- squamous cell carcinoma associated with chronic inflammation
87
What are the risk factors for urothelial cancer?
``` Smoking Carcinogen exposure aromatic amines PAHs Arsenic Painters and hairdressers ```
88
What is the presentation of bladder cancer?
Painless macroscopic haematuria FLAWs Irritative/storage symptom
89
What is the 1st line for bladder cancer?
Urinalysis
90
What is the gold-standard investigation for bladder cancer?
Cystoscopy and biopsy
91
What s KDIGO criteria for AKI? [Serum creatinine and Urine output]
Baseline x1.5 >26 umol/l increase UO: <0.5mL/kg/h for 6-12 hours
92
What are the complications of AKI?
Pulmonary overload - fluid overload Uraemia - Uraemic encephalitis (lethargy, confusion), uraemic pericrditis Hyperkalaemia -Arrythmias, muscle weakness, cramps, paraesthesia Metabolic acidosis - Confusion, tachycardia, Kussmaul's breathing, N&V
93
What is the management of fluid overload in AKI?
IV furosemide/GTN infusion haemodialysis if refractory
94
What is the management of uraemia?
Haemodialysis
95
What is the management of metabolic acidosis in AKI?
IV/PO sodium bicarbonate, dialysis if refractory
96
ECG changes with severe hyeparkalaemia?
``` Wide QRS Complex Tented t-wave Flattened p wave Prolonged PRS Sinusodial wave ``` Bradycardia
97
What is the management of hyperkalaemia?
Cardiac monitor - visualise ECG changes Mx: Calcium gluconate 10% 30mls IV - Protects myocardium 10U Soluble insulin -Drives potassium into cells 50mls of 50% glucose
98
What are the investigations for AKI?
Fluid assessment ABG/VBG - Potassium and bicarbonate , Bloods: FBC, U&Es, CRP, LFTs, CK and clotting
99
What are the pre-renal causes of AKI?
Hypovolaemia - Excess fluid loses -acute bleed, GI losses, diuresis, burns, third-spacing Low volume - Heart failure , heptorenal Vascular insult - Damage to arteries supplying the kidneys -ACEi/ARBs, NSAIDs. contrast
100
What are the post-renal causes of AKI?
Luminal - kidney stones, urethra pain and renal colic Mural - Cancers of renal tract/strictures Extramural - abdominal/pelvic pain, BPH
101
What are the tubular causes of AKI?
Acute tubular necrosis (ATN) -Ischaemic -damage to tubular cell secondary to prolonged and severe ischaemia Toxic - Endogenous toxins - myoglobulin, uric acid (tumour lysis syndrome)< monoclonal light chains (multiple myeloma) Exogenous toxins - aminoglycosides .cisplatin, NSAIDs, heavy metals, radiocontrast agents
102
What is acute tubular necrosis?
Reversible necrosis of the renal tubular epithelial cells - Ischaemia - Nephrotoxins
103
What are the features associated with acute tubular necrosis?
Raised urea, creatinine, potassium Granular muddy brown casts in the urine
104
Muddy brown casts in the urine is associated with what renal pathology?
Acute tubular necrosis
105
What are the histopathological features of acute tubular necrosis?
Tubular epithelium necrosis - loss of nuclei, and detachment of tubular cells from the basement membrane - Dilatation of the tubules may occur - Necrotic cells obstruct the tubule lumen
106
What is acute interstitial necrosis?
Presents with a rash, fever, arthralgia, and eosinophilia White cell casts on urinalysis
107
What are the vascular causes of AKI?
HUS- Haemolytic uraemic syndrome TTP - thrombotic thrombocytopenia purpua
108
What is the main cause of HUS?
EHEC infection - presents with bloody diarrhoea
109
What is the main cause of TTP?
ADAMTS 13 deficiency | Enzyme responsible for vWF breakdown
110
What is the management of TTP?
Plasmapheresis and Rituximab
111
What is glomerulonephritis?
Damage to the glomerulus -Inflammation of glomerular capillaries and glomerular basement membrane
112
What are the signs and symptoms of nephrotic syndrome?
Massive proteinuria - foamy urine Hypoalbuminaemia Oedema (Periorbital and eyes) Hyperlipidaemia + lipiduria Fatty casts on microscopy
113
What are the signs and symptoms of nephritic syndrome?
``` Haematuria Proteinuria Oedema Progressive renal impairment HTN ```
114
Haematuria is a feature of which type of glomerulonephritis?
Nephritic syndrome
115
What is PROTEIN COAL?
``` Proteinuria Cholesterol up Oedema Albumin down Lipids up ```
116
What is Protein HOB in nephritic syndrome?
Proteunuria Haematuria Oedema Blood pressure up
117
What is the most common cause of the nephrotic syndrome in children?
Minimal change disease
118
What is the most common cause of nephrotic syndrome in adults?
Membranous glomerulonephritis
119
What are the symptoms associated with membranous glomerulonephritis?
Oedema Xanthelasma Foamy urine BM thickening
120
What are the risk factors of nephrotic syndrome?
Autoimmune disease, hep B/C syphilis, malignancy, certain medication (NSAIDs, gold, lithium)
121
What does an electron microscope reveal in nephrotic syndrome?
Spike and dome appearance (glomerular matrix on top of IC deposits) podocyte effacement
122
Kimmelstiel Wilson nodules are associated with what?
Diabetic nephropathy

Phase1c Medicine (11 decks)

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