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Medicine - Finals > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

Medications to avoid in AKI

A

ACEI (ARBs), NSAIDs, Gentamicin, Diuretics, Metformin,, Lithium, Digoxin

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2
Q

Medications that are safe in AKI

A

Paracetamol, Warfarin, Statins, Aspirin (at a cardioprotective dose of 75mg od), Clopidogrel, Beta-blockers

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3
Q

Which antibiotic used for pyelonephritis can lower seizure threshold?

A

Ciprofloxacin

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4
Q

Daily maintenance fluid consists of …

A

20-30ml/kg of Water
1mmol/kg of Na/K/Cl
50-100g of glucose

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5
Q

Fluid of choice for resuscitation

A

Crystalloid - Hartmann’s unless risk of hyperkalaemia

Excess saline risks hyperchloraemic metabolic acidosis - Saline should be used in Rhabdomyolysis (due to risk of hyperkalaemia

Colloid fluids are useful in sepsis to keep fluid in vessels e.g. human albumin 5%

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6
Q

Blood samples needed for a massive haemorrhage

A

FBC, Coag screen, Fibrinogen, Crossmatch, U&E, Calcium

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7
Q

What will blood banks issue in a massive haemorrhage? What is given if further products are needed?

A

Initially:
4 units of RBCs
4 units of FFP
1 unit of platelets

Ongoing bleeding:
RBC and FFP at a ratio of 2:1 (or 1:1 in a trauma)

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8
Q

If emergency resuscitation - which blood group is used?

A

O -

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9
Q

What is the risk of correcting sodium balance too quickly?

A

Osmotic pontine demyelination

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10
Q

Which type of nephron produces concentrated urine?

A

Juxtamedullary

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11
Q

Which type of cell produces renin?

A

Juxtaglomerular/Granular

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12
Q

Which compound most accurately assesses GFR?

A

Inulin

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13
Q

Which compound can be used to calculate renal flow?

A

Para-amino Hippuric Acid (PHA)

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14
Q

Where is most glucose reabsorbed in the nephron?

A

Proximal tubule

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15
Q

What does Atrial Natruretic Peptide do?

A

Released in response to atrial stretch. Increases Na excretion at kidney to reduce water reabsorption. Therefore, BP and fluid levels drop.

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16
Q

Nephrotoxic drugs (CANTDOG-M)

A 
Contrast 
ACEI
NSAIDs
Trimethoprim (decreases creatinine clearance)
Diuretics
Omeprazole (PPIs)
Gentamicin
-
Metformin
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17
Q

Define AKI

A

Abrupt decline in kidney function characterised by decreased urine (<0.5ml/kg/hr) and increased creatinine

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18
Q

Define stages of AKI

A

1 - 1-1.9x baseline creatinine (urine <0.5ml/kg/hr for >6 hours)
2 - 2-2.9x baseline creatinine (urine <0.5ml/kg/hr for >12 hours)
3 - >3x baseline creatinine or requiring dialysis (urine <0.3ml/kg/hr for >24 hours or anuria)

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19
Q

Diagnosis of CKD

A

2 samples of GFR <20ml/min 90 days apart

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20
Q

Staging of CKD

A 
Stages: 
1 - GFR >90 + kidney damage
2 - GFR 60-90 + kidney damage 
3A - GFR 45-60
3B - GFR 30-45
4 - GFR 15-30
5- GFR <15 or Renal replacement therapy

Albumin Creatinine Ratio (ACR
A1- <3 (Normal)
A2 - 3-30
A3 - >30

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21
Q

Management of CKD

A

ACEI, Sprinolactone, Atorvastatin

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22
Q

Most common cause of pyelonephritis

A

E.coli

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23
Q

Risk factors of Urothelial Squamous Cell Carcinoma

A

Schistosomiasis
Long-term catheterisation
Smoking
Calculi

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24
Q

Most common glomerulonephritis in children

A

Minimal change

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25
Q

Management of minimal change glomerulonephritis

A

steroids

cyclophosphamide

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26
Q

EM changes seen in minimal change glomerulonephritis

A

fusion of podocyte feet processes

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27
Q

Important findings in membranous glomeulonephritis

A

anti-PLA2r
Associated with malignancy
Thickened basement membrane on silver stain
Spike and dome appearance

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28
Q

Management of membranous glomerulonephritis

A

steroids

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29
Q

Which type of glomerulonephritis is associated with PWIDS and HIV

A

Focal Segmental

30
Q

Glomerulonephritis and haematuria in the young

A

Post-streptococcal and IgA

31
Q

Screening for diabetic nephropathy

A

Albumin:Creatinine ratio

32
Q

Management of epididymitis

A

Ofloxacin 400mg daily for two weeks

33
Q

How long does a AV fistual take to mature before beginning dialysis?

A

6 weeks

Tunnelled venous catheter can be used immediately (but for short periods due to risk of infection)

34
Q

Which malignant renal cancer is most common in children?

A

Nephroblastoma (Wilm’s)

35
Q

Which malignant renal cancer is most common in adults?

A

Renal Cell Carcinoma

36
Q

Classical triad of renal cell carcinoma

A

Haematuria
Loin Pain
Renal Mass

37
Q

Cannonball metastases

A

Renal Cell Carcinoma –> Lung

38
Q

Management of BPH

A

a1 blockers e.g. Tamsulosin
5alpha reductase inhibitors e.g. Finastride
TURP

39
Q

Commonest germ cell tumour of the testes

A

Seminoma

40
Q

What UTI is associated with catheters?

A

Pseudomanas auriginosa

41
Q

Which UTI type predisposes triple phosphate stones?

A

Proteus

42
Q

UTI with burnt chocolate smell

A

Proteus

43
Q

Kass’ criteria for UTI diagnosis

A

> 10^5 organisms/ml - high possibility
~10^4 organisms/ml - repeat or contamination
<10^3 organisms/ml - low possibility

44
Q

Treatment of Pseudomonas UTI

A

Ciprofloxacin

45
Q

UTI management in pregnancy

A

Urine culture done routinely at first antenatal visit

First line: Nitrofurantoin

Second-line: Amocicillin or Cefalexin

Test for cure

Trimethoprim - teratogenic in first trimester

Nitrofurantoin - avoid in late pregnancy

46
Q

Buzzword. CTKUB - Periureteric fat stranding

A

indicates recent stone passage, if a ureteric calculus is not present.

47
Q

CKD 1 Diagnosis

A

Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)

48
Q

CKD 2 Diagnosis

A

60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)

49
Q

CKD 3a Diagnosis

A

45-59 ml/min, a moderate reduction in kidney function

50
Q

CKD 3b Diagnosis

A

30-44 ml/min, a moderate reduction in kidney function

51
Q

CKD 4 Diagnosis

A

15-29 ml/min, a severe reduction in kidney function

52
Q

CKD 5 Diagnosis

A

Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed

53
Q

Hyperkalaemia + Very high Urea + Slightly raised creatinine

A

Dehydration

54
Q

Which haematological condition is associated with cranial diabetes insipidus?

A

Hereditary Haemchromatosis

55
Q

Causes of cranial diabetes insipidus

A 
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome)
haemochromatosis
56
Q

Causes of nephrogenic diabetes insipidus

A

genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel
electrolytes: hypercalcaemia, hypokalaemia
lithium
lithium desensitizes the kidney’s ability to respond to ADH in the collecting ducts
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

57
Q

Pain relief in palliative care patients that have renal impairment

A

Buprenorphine or Fentanyl

58
Q

Causes of hyponatraemia with urinary sodium >20nmol/L

A

Hypovolaemic:

  • diuretics e.g. thiazides or loops
  • renal failure
  • addison’s

Euvolaemic:

  • SIADH (urine osmolality >500mmol/kg)
  • hypothyroidism
59
Q

Causes of hyponatraemia with urinary sodium <20nmol/L

A

Extra-Renal Sodium Depletion:

  • diarrhoea, vomiting, sweating
  • burns
  • adenoma of the rectum

Water Excess

  • secondary hyperaldosteronism (heart failure and liver cirrhosis)
  • nephrotic syndrome
  • IV dextrose
  • psychogenic polydipsia
60
Q

Management of hyponatraemia

A

Mild - fluid restrict (<800ml) + loop diuretics
Mod - hypertonic saline over few hours + mild
Severe - bolus of hypertonic saline until symptomatic relief ± convivaptan if no hypovolaemic)

61
Q

Drug causes of SIADH

A

Remember: SS CC TV

Sulfonylureas esp. Glipizide
SSRIs

Carbamazepine
Cyclophosphamide

TCAs
Vincristine

62
Q

Which drug used in SIADH reduces response to ADH in collecting tubule?

A

Demeclocycline

63
Q

UTI symptoms

A 
dysuria 
frequency
urgency
smelly/cloudy urine
abdominal/back pain
low-grade fever
malaise
confusion in the elderly
64
Q

When should a urine culture be sent off in UTI?

A 
Resistant 
Complicated 
>65 yo 
Haematuria 
Pregnant
65
Q

Men with UTI

A

7 days immediate-start antibiotics
First-line: Nitrofurantoin or Trimethoprim

Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI)

66
Q

Most common cause of UTI in children

A

E coli followed by proteus and pseudomonas

67
Q

Risk factors to developing UTI in childhood

A 
Vesicoureteric reflux - 35% 
Infrequent voiding 
Hurried micturition 
Obstruction due to constipation 
Neuropathic bladder 
Poor hygiene (especially females)
68
Q

Which gender experience more UTI in <3 years old?

A

Males, from then it is females

69
Q

Management of UTI in <3 months

A

Refer immediately to paediatrician

70
Q

Features of Goodpastures/GBM disease

A
  • Anti-GBM
  • Small vessel vasculitis
  • Pulmonary haemorrhage
  • Rapidly Progressive GN (haematuria and proteinuria)
  • Men (2:1) 20-30 or 60-70
  • HLA-DR2
71
Q

Management of Goodpastures/GBM disease

A

Plasma Exchange
Steroids
Cyclophosphamide

Medicine - Finals (21 decks)

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