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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
Q

What discriminatory symptoms are associated with epididymitis compared with testicular torsion?

A
  • Dysuria
  • Present cremasteric reflex
  • Infection/pyrexia
  • Penile discharge
  • Occurs over a few days
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26
Q

What is varicocele?

A

Dilated veins of the pampiniform plexus forming a scrotal mass

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27
Q

Why does varicocele occur?

A

Increased hydrostatic pressure in the left renal vein

Incompetent venous valves

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28
Q

Varicocele is common on which side?

A

Left

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29
Q

How should you examine varicocele?

A

Patient must be standing for examination - reduce when lying down

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30
Q

What radiological examinations are performed in vaircocele?

A

Retroperitoneal USS/CTAP

-Identify any masses obstructing the venous return (When varicocele does not reduce)

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31
Q

What is the management for varicocele?

A

Reassurance + observation

-Semen analysis abnormal - surgical repair should be offered

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32
Q

What is the presentation of Varicocele?

A

‘Bag of worms’

Asymptomatic

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33
Q

What is the definition of hydrocoele?

A

Excessive collection of serous fluid within the tunica vaginalis

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34
Q

What is a communicating hydrocoele?

A

Processus vaginallis is left open - peritoneal fluid free to flow (Connects the abdomen with the tunia vaginalis, allows peritoneal fluid to flow freely)

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35
Q

What is a non-communicating hydrocoele?

A

Processus vaginalis is closed - more fluid is being produced than is absorbed

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36
Q

What are the risk factors for hydrocoele?

A

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

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37
Q

Management of hydrocoele?

A

Asymptomatic

  • Scrotal swelling
  • Possible to get above the swelling
  • Enlarges following activity- coughing, straining
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38
Q

What characteristic examination is done in hydrocoele?

A

Transillumination

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39
Q

What investigations are performed in hydrocoele?

A

Urine dip
USS - Exclude tumour
blood test - Testicular tumour markers

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40
Q

What is the management for hydrocoele?

A

Observation

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41
Q

What are the two main types of testicular cancer?

A

Seminomas. - 50%

Non-seminomas - germ cell tumours and teratomas

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42
Q

What are the main risk factors for testicular cancer?

A

Cryptorchidism
Ectopic testes
Testicular atrophy
FHx

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43
Q

What is the presentation of testicular cancer?

A

Painless hard nodular - testicular mass - unilateral

Lymphadenopathy

Gynaecomastia backache

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44
Q

What tumour markers are associated with testicular cancer?

A

AFP
b-HCG
LDH

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45
Q

What is the diagnostic investigation for testicular cancer?

A

Testicular ultrasound

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46
Q

What imaging allows visualisation of the tumour, monitor Tx response?

A

CTAP

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47
Q

Which lymph nodes does testicular cancer travel through?

A

Para-aortic lymph nodes- affect mediastinal structures

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48
Q

What is the management for testicular cancer?

A

Surgical removal -orchiectomy

Chemotherapy

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49
Q

What is the definition of a UTI?

A

Presence of a pure growth >10^5 organisms per mL of fresh MSU

50
Q

What is the common causative organism for UTI?

A

E.coli

51
Q

What are the risk factors for developing UTI?

A 
Sexual intercourse
Pregnancy
Immunosuppression
Catheterisation
Urinary tract obstruction- BPH calculi
52
Q

What is the presentation of UTI?

A

Increased frequency
Urgency
Dysuria
Foul-smelling

Acute pyelonephriti

  • Flank pain
  • Fever
  • Malaise
53
Q

What is the first-line investigation for a UTI?

A

Urine dipstick - increased leucocytes and nitrites

54
Q

What is the gold standard investigation for a UTI?

A

MSU for MC&S to identify the bacteria (Pyelonephritis will have white cell casts)

55
Q

What is the management for UTI?

A

Empirical ABx

-Nitrofurantoin

56
Q

What are UT calculi?

A

The presence of stones in the urinary system

57
Q

What are the three common sites of urinary tract calculi?

A

Ureteropelvic junction
Pelvic brim
Ureterovesicle junction

58
Q

What is the most common type of urinary tract calculi?

A

Calcium oxalate

59
Q

What are the other types of kidney stones?

A

Struvite
Urate/uric acid - not visible on X-ray
Hydroxyapatite

60
Q

What is the aetiology for UT calculi?

A

Supersaturation of urinary solutes and precipitate out of solution
-Ca, Uric acid, oxalate, Na

61
Q

What are the risk factors for urinary tract calculi?

A

Dehydration
High protein intake
High salt
Structural abnormalities

3x more common in males
Higher prevalence in hot dry countries
30-50 years

62
Q

What is the presentation of urinary tract calculi?

A

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
Q

What is the 1st-line investigation for urinary tract calculi?

A

Urine dipstick

-In women also perform pregnancy test

64
Q

What is the gold-standard radiological investigation to diagnose urinary tract calculi?

A

Non-contrast KUB (USS in pregnancy)

65
Q

What is the acute management for urinary tract calculi?

A

Fluids
Diclofenac (analgesia)
Anti-emetics (Odanestron)
Urine collection -collect passed stone

66
Q

What analgesia is given for urinary tract calculi?

A

Diclofenac

67
Q

What is the management for urinary calculi <5mm?

A

Leave to pass spontaneously with increased fluid intake

68
Q

What is the pharmacological management for urinary tract calculi <10mm?

A

Alpha-blockers (tamsulosin) to pass after 4-6 weeks

69
Q

What is the definitive management for urinary tract calculi >10mm?

A

1st line - extracorporeal shock wave lithotripsy

Percutaneous nephrostolithotomy - difficult shape stones staghorns

70
Q

What is the management for staghorn calculi?

A

Percutaneous nepphrostolithotomy

71
Q

What are the complications for urinary tract calculi?

A 
Pyelonephritis
Septicaemia
Obstruction
Urinary retention
Hydronephrosis, AKI
72
Q

What is BPH?

A

Diffuse hyperplasia of the peri urethral zone

73
Q

Which zone is enlarged in BPH?

A

Transitional zone (surrounds the urethra)

74
Q

What is the presentation of symptomatic BPH?

A 
FUND HIPS
Frequency
Urgency
Nocturia
Dysuria
Hesistancy
Incomplete voiding
Poor stream
75
Q

What are the discriminatory symptoms for prostate cancer compared with BPH?

A

Haematuria

Metastatic spread - bone pain, cord compression

76
Q

What is the first-line investigations for Bph?

A

Urinalysis to exclude for UTI

77
Q

What are the DRE examinations for prostate cancer?

A

Asymmetrical hard nodular prostate

Loss of midline sulcus

78
Q

What is found in a DRE in suspected BPH?

A

Smoothly enlarged palpable midline groove

79
Q

What tumour marker is elevated in BPH and prostate cancer?

A

PSA

80
Q

What is the gold-standard investigation for prostate cancer and BPH?

A

Transrectal ultrasound-guided needle biopsy

81
Q

What additional investigation is performed in prostate cancer after a biopsy?

A

Isotope scan to check for mets

82
Q

What is the emergency management for urinary retention?

A

Catheterisation

83
Q

What are the conservative measures for BPH?

A

Monitor symptom progression
Lifestyle -AVOID CAFFEINE
Medication review

84
Q

What is the medical management for BPH?

A

Selective alpha-1 blocker - tamsulosin

5-alpha reductase inhibitor - finasteride

85
Q

What is the surgical management for BPH?

A

Transurethral resection of the prostate (TURP)

86
Q

What are the two types of bladder cancer?

A

Urothelial carcinoma

Rare- squamous cell carcinoma associated with chronic inflammation

87
Q

What are the risk factors for urothelial cancer?

A 
Smoking
Carcinogen exposure
aromatic amines
PAHs
Arsenic
Painters and hairdressers
88
Q

What is the presentation of bladder cancer?

A

Painless macroscopic haematuria

FLAWs

Irritative/storage symptom

89
Q

What is the 1st line for bladder cancer?

A

Urinalysis

90
Q

What is the gold-standard investigation for bladder cancer?

A

Cystoscopy and biopsy

91
Q

What s KDIGO criteria for AKI? [Serum creatinine and Urine output]

A

Baseline x1.5
>26 umol/l increase

UO: <0.5mL/kg/h for 6-12 hours

92
Q

What are the complications of AKI?

A

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
Q

What is the management of fluid overload in AKI?

A

IV furosemide/GTN infusion haemodialysis if refractory

94
Q

What is the management of uraemia?

A

Haemodialysis

95
Q

What is the management of metabolic acidosis in AKI?

A

IV/PO sodium bicarbonate, dialysis if refractory

96
Q

ECG changes with severe hyeparkalaemia?

A 
Wide QRS Complex
Tented t-wave
Flattened  p wave
Prolonged PRS
Sinusodial wave

Bradycardia

97
Q

What is the management of hyperkalaemia?

A

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
Q

What are the investigations for AKI?

A

Fluid assessment

ABG/VBG - Potassium and bicarbonate ,

Bloods: FBC, U&Es, CRP, LFTs, CK and clotting

99
Q

What are the pre-renal causes of AKI?

A

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
Q

What are the post-renal causes of AKI?

A

Luminal - kidney stones, urethra pain and renal colic

Mural - Cancers of renal tract/strictures

Extramural - abdominal/pelvic pain, BPH

101
Q

What are the tubular causes of AKI?

A

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
Q

What is acute tubular necrosis?

A

Reversible necrosis of the renal tubular epithelial cells

  • Ischaemia
  • Nephrotoxins
103
Q

What are the features associated with acute tubular necrosis?

A

Raised urea, creatinine, potassium

Granular muddy brown casts in the urine

104
Q

Muddy brown casts in the urine is associated with what renal pathology?

A

Acute tubular necrosis

105
Q

What are the histopathological features of acute tubular necrosis?

A

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
Q

What is acute interstitial necrosis?

A

Presents with a rash, fever, arthralgia, and eosinophilia

White cell casts on urinalysis

107
Q

What are the vascular causes of AKI?

A

HUS- Haemolytic uraemic syndrome

TTP - thrombotic thrombocytopenia purpua

108
Q

What is the main cause of HUS?

A

EHEC infection - presents with bloody diarrhoea

109
Q

What is the main cause of TTP?

A

ADAMTS 13 deficiency

Enzyme responsible for vWF breakdown

110
Q

What is the management of TTP?

A

Plasmapheresis and Rituximab

111
Q

What is glomerulonephritis?

A

Damage to the glomerulus

-Inflammation of glomerular capillaries and glomerular basement membrane

112
Q

What are the signs and symptoms of nephrotic syndrome?

A

Massive proteinuria - foamy urine

Hypoalbuminaemia

Oedema (Periorbital and eyes)

Hyperlipidaemia + lipiduria

Fatty casts on microscopy

113
Q

What are the signs and symptoms of nephritic syndrome?

A 
Haematuria
Proteinuria
Oedema
Progressive renal impairment
HTN
114
Q

Haematuria is a feature of which type of glomerulonephritis?

A

Nephritic syndrome

115
Q

What is PROTEIN COAL?

A 
Proteinuria
Cholesterol up
Oedema
Albumin down 
Lipids up
116
Q

What is Protein HOB in nephritic syndrome?

A

Proteunuria
Haematuria
Oedema
Blood pressure up

117
Q

What is the most common cause of the nephrotic syndrome in children?

A

Minimal change disease

118
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous glomerulonephritis

119
Q

What are the symptoms associated with membranous glomerulonephritis?

A

Oedema
Xanthelasma
Foamy urine
BM thickening

120
Q

What are the risk factors of nephrotic syndrome?

A

Autoimmune disease, hep B/C syphilis, malignancy, certain medication (NSAIDs, gold, lithium)

121
Q

What does an electron microscope reveal in nephrotic syndrome?

A

Spike and dome appearance (glomerular matrix on top of IC deposits) podocyte effacement

122
Q

Kimmelstiel Wilson nodules are associated with what?

A

Diabetic nephropathy

Phase1c Medicine (11 decks)

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