Renal and Urology Flashcards

Question 1

Q

Define benign prostatic hyperplasia.

Answer

A

BPH is multifactorial and involves smooth muscle hyperplasia, prostatic enlargement, and bladder dysfunction, as well as input from the central nervous system. Presents with both storage symptoms (frequency, urgency, nocturia, and incontinence) and voiding symptoms (weak stream, dribbling, dysuria, straining).

Question 2

Q

Explain the aetiology/risk factors of benign prostatic hyperplasia.

Answer

A

Age over 50 years Family history Non-Asian race Cigarette smoking

Question 3

Q

Summarise the epidemiology of benign prostatic hyperplasia.

Answer

A

The prevalence of histological BPH increases with age, affecting approximately 42% of men between the ages of 51 and 60 years and 82% of men between the ages of 71 and 80 years.

Question 4

Q

Recognise the presenting symptoms of benign prostatic hyperplasia. Recognise the signs of benign prostatic hyperplasia on physical examination.

Answer

A

Storage symptoms Voiding symptoms Fever with dysuria Urinary retention

Question 5

Q

Identify appropriate investigations for benign prostatic hyperplasia and interpret the results.

Answer

A

Urinalysis PSA International Prostate Symptom Score Global bother score Volume charting

Question 6

Q

Generate a management plan for benign prostatic hyperplasia.

Answer

A

Alpha blockers e.g. tamsulosin 5-alpha-reductase inhibitor e.g. finasteride Surgical intervention e.g. TURP, laser

Question 7

Q

Identify the possible complications of benign prostatic hyperplasia and its management.

Answer

A

BPH progression Urinary tract infection (UTI) Renal insufficiency Bladder stones Haematuria Sexual dysfunction Acute urinary retention Overactive bladder

Question 8

Q

Summarise the prognosis for patients with benign prostatic hyperplasia.

Answer

A

The majority of patients with BPH can expect at least moderate improvement of their symptoms with a decreased bother score and improved quality of life.

Question 9

Q

Define bladder cancer.

Answer

A

Cancer of the bladder. Over 90% of cancers of the urinary bladder are urothelial carcinoma (previously termed transitional cell carcinoma).

Question 10

Q

Explain the aetiology/risk factors of bladder cancer.

Answer

A

Tobacco exposure Exposure to chemical carcinogens e.g. naphthylamine Age >55 years Pelvic radiation Systemic chemotherapy Schistosoma infection Male sex Chronic bladder inflammation Positive FHx

Question 11

Q

Summarise the epidemiology of bladder cancer.

Answer

A

Bladder cancer ranks ninth in worldwide cancer incidence. It is the seventh most common cancer in men and the 17th most common cancer in women. Globally, the incidence of bladder cancer varies significantly, with Egypt, Western Europe, and North America having the highest incidence rates and Asian countries the lowest rates.

Question 12

Q

Recognise the presenting symptoms of bladder cancer. Recognise the signs of bladder cancer on physical examination.

Answer

A

Haematuria (gross or microscopic) Dysuria Urinary frequency

Question 13

Q

Identify appropriate investigations for bladder cancer and interpret the results.

Answer

A

Urinalysis

Question 14

Q

Define chronic kidney disease (CKD).

Answer

A

Chronic kidney disease (CKD), also known as chronic renal failure, is defined by either a pathological abnormality of the kidney, such as haematuria and/or proteinuria, or a reduction in GFR to <60 mL/minute/1.73 m² for ≥3 months' duration.

Question 15

Q

Explain the aetiology/risk factors of chronic kidney disease (CKD).

Answer

A

Explain the aetiology/risk factors of chronic kidney disease (CKD).

Question 16

Q

Summarise the epidemiology of chronic kidney disease (CKD).

Answer

A

This is a common condition that is often unrecognised until the most advanced stages. It is estimated that 11% of the adult population worldwide has CKD.

Question 17

Q

Recognise the presenting symptoms of chronic kidney disease (CKD). Recognise the signs of chronic kidney disease (CKD) on physical examination.

Answer

A

Presence of risk factors Fatigue Oedema Nausea with/without vomiting Pruritus Anorexia Arthralgia Enlarged prostate gland

Question 18

Q

Identify appropriate investigations for chronic kidney disease (CKD) and interpret the results.

Answer

A

Serum creatinine Urinalysis Urine microalbumin Renal ultrasound Estimation of GFR

Question 19

Q

Define epididymitis.

Answer

A

Epididymitis is an inflammation of the epididymis characterised by scrotal pain and swelling of less than 6 weeks' duration. It may be associated with irritative lower urinary tract symptoms, urethral discharge, and fever. It is usually unilateral.

Question 20

Q

Explain the aetiology/risk factors of epididymitis.

Answer

A

Unprotected sexual intercourse Bladder outflow obstruction Instrumentation of urinary tract

Question 21

Q

Summarise the epidemiology of epididymitis.

Answer

A

The most common cause of acute scrotal pain is epididymitis. In the UK, the reported incidence was 2.45 cases per 1000 men between 2003 and 2008.

Question 22

Q

Recognise the presenting symptoms of epididymitis. Recognise the signs of epididymitis on physical examination.

Answer

A

Presence of risk factors Age >19 years Unilateral scrotal pain and swelling of gradual onset Symptoms <6 weeks' duration Tenderness Hot, erythematous, swollen hemiscrotum

Question 23

Q

Identify appropriate investigations for epididymitis and interpret the results.

Answer

A

Gram stain of urethral secretions Urine dipstick test Urine microscopy Urine culture Nucleic acid amplification test (NAAT) of urethral secretions or first-void urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium Culture of urethral secretions

Question 24

Q

Generate a management plan for epididymitis.

Answer

A

Antibiotic therapy

Question 25

Q

Identify the possible complications of epididymitis and its management.

Answer

A

Abscess formation Testicular ischaemia/infarction Epididymal obstruction Chronic pain following epididymitis Male factor infertility

Question 26

Q

Summarise the prognosis for patients with epididymitis.

Answer

A

In men with infectious acute epididymitis, symptoms usually resolve rapidly following the initiation of appropriate antibiotic therapy. Inadequately treated infectious epididymitis, particularly sexually transmitted infection, can in rare cases lead to epididymal obstruction or testicular atrophy and subsequent infertility problems.

Question 27

Q

Define glomerulonephritis.

Answer

A

Glomerulonephritis (GN) denotes glomerular injury and applies to a group of diseases that are generally, but not always, characterised by inflammatory changes in the glomerular capillaries and the glomerular basement membrane (GBM).

Question 28

Q

Explain the aetiology/risk factors of glomerulonephritis.

Answer

A

Group A beta-haemolytic Streptococcus Respiratory infections Gastrointestinal infections Hepatitis B Hepatitis C Infective endocarditis HIV Systemic lupus erythematosus (SLE) Systemic vasculitis Hodgkin's lymphoma Lung cancer Colorectal cancer Non-Hodgkin's lymphoma Leukaemia Thymoma Haemolytic uraemic syndrome Drugs

Question 29

Q

Summarise the epidemiology of glomerulonephritis.

Answer

A

For every patient with clinically apparent GN, approximately 5 to 10 patients have undiagnosed subclinical disease. In the US and Europe, GN is the third commonest cause of end-stage renal disease (ESRD), after diabetes and hypertension.

Question 30

Q

Recognise the presenting symptoms of glomerulonephritis. Recognise the signs of glomerulonephritis on physical examination.

Answer

A

Haematuria Oedema Hypertension Oliguria Anorexia Nausea Malaise Weight loss Fever Skin rash Arthralgia Haemoptysis Abdominal pain Sore throat

Question 31

Q

Identify appropriate investigations for glomerulonephritis and interpret the results.

Answer

A

Urinalysis Comprehensive metabolic profile Glomerular filtration rate (GFR) Full blood count Lipid profile Spot urine albumin:creatinine ratio (ACR) Ultrasound of kidneys

Question 32

Q

Define hydrocoele.

Answer

A

A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord.

Question 33

Q

Explain the aetiology/risk factors of hydrocoele.

Answer

A

Male sex Prematurity and low birth weight Infants <6 months of age Infants whose testes descend relatively late Increased intraperitoneal fluid or pressure Inflammation or injury within the scrotum Testicular cancer Connective tissue disorders

Question 34

Q

Summarise the epidemiology of hydrocoele.

Answer

A

Hydroceles predominantly occur in males and are rare in females. They are common in male infants and children and in many cases are associated with an indirect inguinal hernia.

Question 35

Q

Recognise the presenting symptoms of hydrocoele. Recognise the signs of hydrocoele on physical examination.

Answer

A

Presence of risk factors Scrotal mass Transillumination Enlargement of scrotal mass following activity Variation in scrotal mass during the day

Question 36

Q

Identify appropriate investigations for hydrocoele and interpret the results.

Answer

A

Clinical diagnosis Ultrasound

Question 37

Q

Define nephrotic syndrome.

Answer

A

Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminemia (<30 g/L), and peripheral oedema.

Question 38

Q

Explain the aetiology/risk factors of nephrotic syndrome.

Answer

A

Diabetes Lupus Amyloidosis Other kidney diseases. NSAID use HIV Hepatitis B/C Malaria

Question 39

Q

Summarise the epidemiology of nephrotic syndrome.

Answer

A

Nephrotic syndrome is one of the most common chronic renal diseases in children. It has an incidence of 2 to 7 per 100,000 population and a prevalence of 16 per 100,000 population, well above the 1 per 1 million incidence of chronic renal failure in children.

Question 40

Q

Recognise the presenting symptoms of nephrotic syndrome. Recognise the signs of nephrotic syndrome on physical examination.

Answer

A

Oedema Foamy urine Proteinuria Weight gain due to excess fluid retention Fatigue Loss of appetite Xanthelasma Xanthomata Hypertension Hepatomegaly

Question 41

Q

Identify appropriate investigations for nephrotic syndrome and interpret the results.

Answer

A

Urine dipstick Blood microscopy FBC U+Es LFT ESR CRP 24 hour urine collection Renal USS

Question 42

Q

Define polycystic kidney disease.

Answer

A

Polycystic kidney disease (PKD) is part of a heterogeneous group of disorders characterised by renal cysts and numerous systemic and extrarenal manifestations. There are 2 types: autosomal-dominant PKD (ADPKD) and autosomal-recessive PKD (ARPKD). This monograph concentrates on ADPKD, the more common form.

Question 43

Q

Explain the aetiology/risk factors of polycystic kidney disease.

Answer

A

Family history of autosomal-dominant PKD (ADPKD) Family history of cerebrovascular event

Question 44

Q

Summarise the epidemiology of polycystic kidney disease.

Answer

A

Autosomal-dominant PKD (ADPKD) occurs worldwide and in all races. Prevalence in the US is estimated to be between 1 in 400 (including observed and estimated autopsy cases) and 1 in 1000 (clinically diagnosed cases only).

Question 45

Q

Recognise the presenting symptoms of polycystic kidney disease. Recognise the signs of polycystic kidney disease on physical examination.

Answer

A

Family history of autosomal-dominant PKD (ADPKD) or end-stage renal disease (ESRD) Family history of cerebrovascular event Renal cysts Hypertension Abdominal/flank pain Haematuria Palpable kidneys/abdominal mass Headaches Dysuria, urgency, suprapubic pain, fever Cardiac murmur Abdominal hernia or rectus abdominis diastasis Hepatomegaly

Question 46

Q

Identify appropriate investigations for polycystic kidney disease and interpret the results.

Answer

A

Renal ultrasound CT scan of abdomen/pelvis MRI of abdomen/pelvis Urinalysis/Gram stain and urine culture Serum electrolytes, urea, creatinine Fasting lipid profile ECG CT scan of brain

Question 47

Q

Define prostate cancer.

Answer

A

A malignant tumour of glandular origin, situated in the prostate. It is most commonly seen in older men; between 2011 and 2015 the median age at diagnosis in the US was 66 years.

Question 48

Q

Explain the aetiology/risk factors of prostate cancer.

Answer

A

Age >50 years Black ethnicity North American or northwest European descent Family history of prostate cancer High levels of dietary fat

Question 49

Q

Summarise the epidemiology of prostate cancer.

Answer

A

Between 2011 and 2015, the median age at diagnosis of prostate cancer was 66 years. The age-adjusted incidence rate during the same period was 112.6 per 100,000 men per year.

Question 50

Q

Recognise the presenting symptoms of prostate cancer. Recognise the signs of prostate cancer on physical examination.

Answer

A

Elevated prostate-specific antigen (PSA) Nocturia Urinary frequency Urinary hesitancy Dysuria Abnormal digital rectal examination

Question 51

Q

Identify appropriate investigations for prostate cancer and interpret the results.

Answer

A

Serum prostate-specific antigen (PSA) Testosterone LFTs FBC Renal function Prostate biopsy

Question 52

Q

Define renal artery stenosis.

Answer

A

Renal artery stenosis (RAS) is a narrowing of the renal artery lumen. It is considered angiographically significant if more than a 50% reduction in vessel diameter is present.

Question 53

Q

Explain the aetiology/risk factors of renal artery stenosis.

Answer

A

Dyslipidaemia Smoking Diabetes

Question 54

Q

Summarise the epidemiology of renal artery stenosis.

Answer

A

RAS has a prevalence of 0.2% to 5% in all hypertensive patients. Atherosclerotic RAS accounts for 90% of all RAS. Prevalence is as high as 25% in patients with CAD undergoing cardiac catheterisation. Two percent of end-stage renal disease (ESRD) is due to ischaemic nephropathy.

Question 55

Q

Recognise the presenting symptoms of renal artery stenosis. Recognise the signs of renal artery stenosis on physical examination.

Answer

A

Onset of hypertension age >55 years History of accelerated, malignant, or resistant hypertension History of unexplained kidney dysfunction History of multi-vessel coronary artery disease History of other peripheral vascular disease Abdominal bruit Sudden or unexplained recurrent pulmonary oedema

Question 56

Q

Identify appropriate investigations for renal artery stenosis and interpret the results.

Answer

A

Serum creatinine Serum potassium Urinalysis and sediment evaluation Aldosterone-to-renin ratio Duplex ultrasound CT angiography

Question 57

Q

Define renal calculi.

Answer

A

Renal calculi refers to the presence of crystalline stones within the urinary system (kidneys and ureter).

Question 58

Q

Explain the aetiology/risk factors of renal calculi.

Answer

A

High protein intake High salt intake White ancestry Male sex Dehydration Obesity Crystalluria

Question 59

Q

Summarise the epidemiology of renal calculi.

Answer

A

The lifetime prevalence of renal calculi is estimated to be between 5% and 12%, with the probability of having a stone varying according to age, gender, race, and geographical location. Renal calculi typically affects adult men more commonly than adult women, with a male to female ratio of 2 or 3:1.

Question 60

Q

Recognise the presenting symptoms of renal calculi. Recognise the signs of renal calculi on physical examination.

Answer

A

Acute, severe flank pain Previous episodes of nephrolithiasis Nausea and vomiting Urinary frequency/urgency Haematuria Testicular pain Obesity

Question 61

Q

Identify appropriate investigations for renal calculi and interpret the results.

Answer

A

Low radiation CT KUB Pelvic USS Urinalysis FBC Serum electrolytes, urea, and creatinine Urine pregnancy test Stone analysis

Question 62

Q

Generate a management plan for renal calculi.

Answer

A

Conservative management

Surgical decompression and management: ESWL PCNL Laser

Question 63

Q

Identify the possible complications of renal calculi and its management.

Answer

A

Post PCNL bleeding Post ESWL haematoma Post-ESWL, PCNL, or ureteroscopy treatment urosepsis Post-ESWL steinstrasse Post-ESWL, PCNL, or ureteroscopy ureteric injury Visceral organ injury Pneumothorax Ureteric stricture

Question 64

Q

Summarise the prognosis for patients with renal calculi.

Answer

A

The rate of recurrence of renal calculiin first-time stone formers is 50% at 5 years and 80% at 10 years. The patients at highest risk for recurrence are frequently those who are not compliant with medical therapy and dietary/lifestyle modifications, or where underlying metabolic abnormalities exist. Residual stone fragments from surgery will usually spontaneously pass as long as their size is <4 mm.

Answer 65

A

Renal cell carcinoma (RCC) is renal malignancy arising from the renal parenchyma/cortex, and accounts for about 85% of renal cancers.

Answer 66

A

Smoking Male sex Age 55 to 84 years Residence in developed countries Black/American-Indian ethnicity Obesity Hypertension Positive family history (FHx) of RCC History of hereditary syndromes History of acquired renal cystic disease

Answer 67

A

The majority (85%) of renal malignancies are RCC (arising from the renal cortical parenchyma). RCC accounts for 2% to 3% of all new cancers globally, and, depending on geographic region and gender, is the 6th to 8th most common adult malignancy.

Answer 68

A

Asymptomatic (incidental finding) Haematuria Flank pain Palpable abdominal mass

Answer 69

A

FBC LDH Corrected calcium Liver function tests (LFTs) Coagulation profile Creatinine Urinalysis Abdominal/pelvic ultrasound CT abdomen/pelvis MRI abdomen/pelvis

Answer 70

A

Cancer of the testicles. The most common malignancy in young adult men (20 to 34 years of age), and highly curable when diagnosed early.

Answer 71

A

Cryptorchidism Gonadal dysgenesis Family history of testicular cancer Personal history of testicular cancer Testicular atrophy White ethnicity HIV infection

Answer 72

A

Incidence of testicular cancer varies with geography. Across Northern Europe, incidence rates vary from 7.8 per 100,000 in Denmark to 0.9 per 100,000 in Lithuania.

Answer 73

A

Age 20 to 34 years Testicular mass Extratesticular manifestation

Answer 74

A

Ultrasound (colour Doppler) of testis CT scan (abdomen and pelvis) Serum beta-human chorionic gonadotrophin (beta-hCG) Serum alpha-fetoprotein (AFP) Serum lactate dehydrogenase (LDH)

Answer 75

A

Testicular torsion is a urological emergency caused by the twisting of the testicle on the spermatic cord leading to constriction of the vascular supply and time-sensitive ischaemia and/or necrosis of testicular tissue.

Answer 76

A

Age under 25 years Neonate Bell clapper deformity Trauma/exercise Intermittent testicular pain Undescended testicle Cold weather

Answer 77

A

In males <25 years of age, the annual incidence of torsion is 1 in 4000 in the US. Torsion can be seen at any age but it is not generally a disease affecting the elderly.

Answer 78

A

Testicular pain Intermittent or acute on-and-off pain No pain relief upon elevation of scrotum Scrotal swelling or oedema Scrotal erythema Reactive hydrocele High-riding testicle Horizontal lie Nausea and vomiting Abdominal pain

Answer 79

A

Grey-scale ultrasound Power Doppler ultrasound Colour Doppler ultrasound

Answer 80

A

Manual de-torsion followed by surgical testicular exploration

Answer 81

A

Infarction of testicle/permanent testicular damage/loss of testicles Infertility secondary to loss of testicle Psychological implication of losing a testis Cosmetic deformity Recurrent torsion Impaired pubertal development (significant or bilateral testicular loss)

Answer 82

A

The adage 'time is testicle' applies to patients with testicular torsion because the longer it takes for diagnosis and definitive repair, the greater the likelihood that the patient will develop tissue necrosis, decreased tissue viability, decreased spermatogenesis, and possible infertility.

Answer 83

A

Urinary tract infection (UTI) is an inflammatory reaction of the urinary tract epithelium in response to pathogenic microorganisms, most commonly bacteria.

Answer 84

A

Benign prostatic hypertrophy Urinary tract stones Urological surgery, instrumentation Urethral strictures Age >50 Previous UTI Catheterisation

Answer 85

A

Combined data for men and women from all patient-care settings identify urinary tract infection (UTI) as the most common infection, and it is the second most common infection among non-institutionalised patients.

Answer 86

A

Dysuria Urgency Frequency Suprapubic pain Hesitancy Nocturia Enlarged prostate

Answer 87

A

Dipstick urinalysis Urine microscopy Urine culture

Answer 88

A

Antibiotics e.g. nitrofurantoin, trimethoprim, ceftriaxone, cefalexin

Answer 89

A

Renal function impairment Prostatitis Pyelonephritis Sepsis

Answer 90

A

Younger men with UTI less often have complicated infection. In the absence of a complicated UTI, antibiotic therapy is more effective and results in fewer failures. Younger men have a good prognosis.

Answer 91

A

A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder. E.Coli is the most common organism responsible.

Answer 92

A

Sexual activity Spermicide use Post-menopause Positive family history of UTIs History of recurrent UTI Presence of a foreign body

Answer 93

A

Ten percent of women aged older than 18 years report at least one suspected UTI every 12 months. Approximately 20% to 40% of women with an initial UTI develop recurrent UTI. UTIs are among the most common conditions encountered in primary care, hospitals, and extended care facilities.

Answer 94

A

Dysuria Polyuria Fever Haematuria Back/flank pain Costovertebral angle tenderness

Answer 95

A

Urine dipstick Urine microscopy Urine culture and sensitivity

Answer 96

A

Course of antibiotics e.g. nitrofurantoin, trimethoprim, ceftriaxone, cephalexin

For recurrent UTIs, consider longer course of low dose antibiotics.

Hiprex, anti-bacterial

Lifestyle management

Answer 97

A

Sepsis Renal and perirenal abscess Acute kidney injury Emphysematous pyelonephritis Xanthogranulomatous pyelonephritis (XGP)

Answer 98

A

Prognosis for UTIs in women is excellent. With appropriate antimicrobial treatment and resolution of symptoms, there is unlikely to be long-term sequelae.

Answer 99

A

A varicocele is the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis.

Answer 100

A

Somatometric parameters (tall/low BMI) FHx of varicocele

All of these risk factors are quite weak though.

Answer 101

A

It has been estimated that between 10% and 15% of men and adolescent boys in the general population have varicocele. However, the true incidence of adolescent varicoceles may be under-reported, as most teens are not routinely examined in the upright position. The majority (>80%) of adult varicoceles are not associated with infertility. Ninety percent of varicoceles are on the left side, while approximately 10% are bilateral.

Answer 102

A

Painless scrotal mass Left-sided signs/symptoms Small testicle Infertility

Answer 103

A

Clinical diagnosis is usually sufficient.

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Renal and Urology Flashcards

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