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Phase 2a Summaries > Renal / G-U > Flashcards

Renal / G-U Flashcards

1
Q

What is the KG+DIGO classification for AKI?

A

1) Rise in Creatinine >26micromol/L in 48 hours
2) Rise in Creatinine >50% (best figure in last 6 months)
3) Urine output <0.5ml/kg/hr for > 6 consecutive hours
- Only need 1/3 for the diagnosis of AKI

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2
Q

Name 3 pre-renal causes of AKI?

A

Shock, haemorrhage, Drugs (NSAIDS), sepsis, renal hypo perfusion, DVT

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3
Q

Name 3 renal causes of AKI?

A

Glomerulonephritis
Vasculitis
Drug Reaction

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4
Q

Name 3 post-renal causes of AKI?

A

Renal malignancy

Strictures, Stones, pelvic malignancy

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5
Q

What is seen on ECG in a patient with Hyperkalaemia?

A

Tall T waves, Increase PR interval, widened QRS

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6
Q

Name 3 indications for dialysis in a patient with AKI?

A

Persistant hyperkalemia
Refractory pulmonary oedema
Severe metabolic acidicosis
Uraemic encephalopathy

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7
Q

Name 6 risk factors to forming urothiliases?

A

Anatomical factors eg horshoe kidney, obstruction, trauma, hypercalaemia, dehydration, recurrent UTI, diuretics, stents/catheters

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8
Q

Name 4 ways to prevent stone formation?

A
  1. Over-hydration
  2. Low Na diet
  3. Health protein intake
  4. Reduced BMI
  5. Active lifestyle
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9
Q

What is first line treatment/management in urothiliases?

A

Hydration

Analegesia - pain relief

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10
Q

What treatment is used in larger stones?

A

Shockwave- Lithotripsy

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11
Q

Which 3 tumour markers are seen in testicular tumour?

A

AFP. LDH, b-HCG

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12
Q

What are the 3 stages of testicular tumour?

A
  1. Confined to testicle
  2. Spread below the diaphragm
  3. Above diaphragm or in solid organs
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13
Q

Name 3 difference between chlaymydia and gonorrhoea?

A

Gonorrhoea implied recent partner change

Chlaymdia longer incubation period

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14
Q

How do you diagnose chlamydia in women?

A

Vaginal Swab

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15
Q

How do you diagnose chlamydia in men?

A

First void urine

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16
Q

How do you diagnose gonorrhoea?

A

Near patient test - culture look for gram negative diplococci

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17
Q

Name 3 causes of nephritic syndrome?

A

IgA Nephropathy
Goodpastures
Rapidly progressive Gn

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18
Q

Name 3 primary causes of Nephrotic syndrome?

A
  1. Minimal change disease
  2. Membranous nephropathy
  3. Focal segmental glomerulosclerosis
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19
Q

Name 3 secondary causes of nephrotic syndrome?

A
  1. Lupus nephritis
  2. Diabetes myeloma
  3. Amyloid
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20
Q

What is detected in serum in membranous GN?

A

PLA2R

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21
Q

Name 3 complications of nephrotic syndrome?

A

Thromboembolism
Infection - urine loss of Ig’s
Hyperlipideamia due to hepatic synthesis in respinse to decrease oncotic pressure and defective lipid breakdown

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22
Q

What is first line treatment for ED?

A

Phosphodiesterase inhibitor eg Sildenfanil

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23
Q

Which medication is contraindicated with phosphodiesterase inhibitors?

A

Nitrates - unpredictable falls in BP

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24
Q

Name 3 side effects of Sildenfanil (viagra)?

A

Headache, flushing, dizziness, back pain and myalgia

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25
Q

Name the 3 second line treatments for ED?

A
  1. Vacuum constriction device
  2. Intra-cavernosal injections
  3. Intra-urethral aloporstdail
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26
Q

Name complication of intra-cavernosal injections?

A

Priapism (if erection lasts longer than 4 hours)

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27
Q

Name the 3rd line treatment for ED?

A

Penile prosthesis - malleable or inflatable

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28
Q

What is the definition of UTI?

A

Defined at >10^5 organisms/ml of fresh-mid stream urine

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29
Q

In what circumstances is a UTI complicated?

A

Pregnant, male, catheterised, child, structural abnormality of urinary tract, recurrent infection, urosepsis

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30
Q

Name 4 risk factors of UTI?

A
  1. Increased bacterial inoculation (sex)
  2. Increasing binding of url-pathogenic bacteria (post-menopausal)
  3. Decreased urinary flow (dehydration/obstruction)
  4. Increased bacterial growth (diabetes, urinary catheter)
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31
Q

Why are you more susceptible to UTI’s post menopause?

A

Loss of oestrogenisation, normal vagina colonised with lactobacilli, post menopause pH rises and increased colonisation of colonic flora

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32
Q

What are the symptoms of an upper UTI?

A

Loin pain, fevers, rigors and occasional haematuria

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33
Q

When would you use a urine dipstick to diagnose UTI?

A

In a woman <65 with less than 3 symptoms

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34
Q

What do red cell casts detect?

A

Indicate kidney damage

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35
Q

When would you not treat a UTI?

A

> 65 asymptomatic bacteruria

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36
Q

If it is a complicated UTI what is the GOLD standard diagnosis?

A

Culture

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37
Q

When should nitrofurantoin be avoided?

A

In final trimester of pregnancy and poor renal function eGFR<45

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38
Q

How do you diagnose a UTI for a catheter sample?

A

Send fresh sample not from bag

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39
Q

Name 3 prevention methods to prevent UTI from catheter samples?

A
  1. Intermittent catheterisation or suprapubic catheritse, keep catheter clean and remove as soon as possible, don’t treat if asymptomatic
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40
Q

What is the pathophysiology of pyelonephritis?

A

Ascending bacterial infection from bladder to renal parenchyma

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41
Q

What would be present on abdominal investigation in a patient with pyelonephritis?

A

Renal angle tenderness

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42
Q

How do you treat pyelonephritis?

A

Oral ciprofloxain or oral co-amoxiclav

43
Q

How do you diagnose urinary tract tuberculosis?

A

Early morning urine sample

44
Q

Name 2 complications of pyelonephritis?

A

Renal abscess, emphysematous pyelonephritis (rare, gas accumulation in tissues)

45
Q

Name 5 causes of CKD?

A
  1. Diabetes Melltius
  2. Glomerulonephritis
  3. Hypertension
  4. Vasculitis
  5. SLE
  6. PKD
  7. Nephrotoxic Drugs
  8. Urinayr tract obstruction
46
Q

Why is there increased PTH in stage 3 CKD?

A

Renal phosphate retention and impaired 1,25-dihydroxy vitamin D production leads to a fall in serum Calcium and thus a compensatory increase in PTH which can result in skeletal decalcification leading to bone disease

47
Q

Name 4 complications of CKD?

A
  1. Anaemia - decreased EPO production
  2. Bone disease due to increased PTH
  3. Postural hypotension, depressed cerebral function
  4. Hypertension, hyperlipidaemia and vascular calcification –> CVD
48
Q

Name 3 complications fo peritoneal dialysis.?

A

Peritonitis, abdominal wall herniation, intestinal perforation

49
Q

Name 3 complications fo haemodialysis.?

A

Hypotension, fevers, infection, chest pain, nausea

50
Q

Name 4 differences between AKI and CKD?

A
  1. CKD- small kidney AKI = normal
  2. No anaemia in AKI, Anaemia in CKD
  3. Low BP in AKI, high BP in CKD
  4. Oliguria present in AKI, oliguria only present in advanced disease in CKD
  5. rapid onset AKI, gradual onset CKD
51
Q

In which disease would you see bilateral kidney enlargement?

A

PKD polycystic kidney disease

52
Q

What are the storage symptoms?

A

Frequency, urgency, urgency incontinence, nocturia

53
Q

What are the voiding symptoms?

A

Dysuria, dribbling, hesitancy, straining, haematuria, incomplete emptying, poor stream

54
Q

What lifestyle advice would you suggest in a man with BPH?

A

Avoid caffeine, alcohol Relax when voiding. Void twice in a row to aid emptying. Control urgency by practising distraction methods (eg breathing exercises). Train the bladder by ‘holding on’ between voiding.

55
Q

Name 3 methods to diagnose BPE?

A
  1. DRE
  2. Renal Biochem - PSA
  3. Frequency volume chart
56
Q

If patient presents with nocturnal enuresis (bed wetting) and pain loin to groin. What would you suspect?

A

Interactive obstructive uropathy, diagnose by checking standing and lying blood pressures to see if patient can cope with diuresis

57
Q

What is acute retention of urine caused by?

A

Prostatic obstruction, urethral strictures, alcohol

58
Q

How do you treat acute retention of urine?

A

Catheterisation and alpha 1 blocker

59
Q

When should you think about surgery in a patient with LUTS?

A

Retention, UTI, Stones, Haematuria, Elevated creatinine, Symptoms progression

60
Q

What is the GOLD standard surgery in LUTS?

A

Trans-urethral resection of prostate (TURP)

61
Q

Give two side effects of finesteradide?

A

Incompetence and decreased libido

62
Q

When should you not prescribe Tamulosin and name 3 other side effects ?

A

Postural hypotension

dizzy, depression, dry mouth, dec. BP

63
Q

What is the equation for renal blood flow?

A

aortic pressure- renal venous pressure renal vascular resistance

64
Q

Name 3 renal causes of urinary obstruction?

A

PKD, TB infection, renal cell carcinoma

65
Q

Name 3 causes of urinary obstruction in ureters?

A

Stricture, schistosomiasis, pregnancy

66
Q

Name 3 causes of urinary obstruction in the bladder?

A

Urethral stricture, TCC, prostatitis

67
Q

What is hydoureterhonehrosis?

A

Dilatation of the renal pelvis, calyces and ureter caused by the obstruction to free flow of urine from the kidney, leading to progressive atrophy of the renal cortex

68
Q

Which investigation for renal stones is safe in pregnancy?

A

Ultrasound

69
Q

How do you treat metastatic prostate cancer?

A
  1. Surgical castration

2. Medical androgen deprivation therapy with GNrH analogues and LH antagonists

70
Q

Name 3 possible methods to treat localised prostate cancer?

A
  1. Watch and wait
  2. brachytherapy - radioactive beads placed in prostate
  3. Radical prostatectomy
71
Q

What is the definition of overactive bladder?

A

Urgency with frequency, with or without nocturia, then appearing in the absence of local pathology

72
Q

Name 5 methods to treat OAB?

A
  1. behavioural therapy
  2. Anti-muscanics
  3. B3 agonist
  4. Botox
  5. Sacral neuromodulation
  6. Surgery
73
Q

Name two treatment methods in stress incontinence in women post pregnancy?

A

Pelvic floor physiotherapy

Surgery – (Sling, bulking agents, artificial sphincter)

74
Q

Name two methods of bladder management in paraplegic patients?

A
  1. Suprapubic catheter

2. Convene drainage

75
Q

When should you refer a patient with haematuria to have an appointment within two weeks?

A
  1. > 45, unexplained visible haematuria or visible haematuria that perisists after UTI treatment
  2. > 60 non-visible haematuria, dysuria and raised WCC
  3. > 60 with recurrent or persistent unexplained urinary tract infection
76
Q

Name 4 investigations in a patient with visible haematuria?

A
  1. FBC
  2. MSU- microscopy and culture
  3. Cytology
  4. Flexible cystoscopy
  5. Imaging: Ultrasound/CT
77
Q

What is stage 3 or renal cancer?

A

Above diagram and towards right atrium

78
Q

Name 5 risk factors for bladder cancer?

A
  1. Paraplegic
  2. Smoking
  3. Occupation eg dye
  4. Drugs eg cyclophosphamide
  5. Bladder stones
  6. Schistosomiasis
79
Q

How do you confirm the diagnosis of bladder cancer?

A

Trans-urethral resection of bladder tumour (TURB)

80
Q

What complication arises during TURB?

A

Perforate bladder, due to obturator kick

81
Q

What are the 4 stages of bladder cancer?

A

Ta- Surface of bladder
T1- Through lamina propria but not muscle
T2-T4- Through muscular layer

82
Q

How do you grade non-muscular invasive bladder cancer?

A

G1 - low grade bladder tumour
G2. moderate differentiation
G3- poorly differentiated

83
Q

Name 6 differential diagnosis of testicular tumour?

A
  1. Epididymal orchitis
  2. Hydrocele
  3. Variocele
  4. Haematocele
  5. Epididymal - cysts
  6. Testicular torsion
84
Q

What class of drug is oxybutynin?

A

Anti-muscarinic

85
Q

How does oxybutin work?

A

Inhibits acetylchloine by blocking muscarinic receptors on M3 and promoting bladder relaxation

86
Q

What are the side effects of oxybutinin?

A

Dry cough, tachycardia, constipation and blurred vision

87
Q

How does primary syphillis present?

A

Maculole - papuole - painless ulcer

88
Q

How does secondary syphillis present?

A

Rash (70%), common on hands and soles of feet, fever, myalgia, lymphadenopathy

89
Q

Give 2 signs and 2 symptoms of AKI?

A 
Symptoms = dehydration, confusion, fever 
Signs = Postural hypotension, peripheral oedema, raised JVP, pallor
90
Q

Give 5 investigations you would do into AKI?

A
  1. Urinalaysis - bloods, leukocytes
  2. Bloods - eg vasculitis, IgG
  3. Urine electrophoresis
  4. Skeletal survey for myeloma
  5. Doppler US of renal artery and veins
91
Q

What are the complications of AKI?

A
  1. Hyperkalaemia
  2. Bleeding
  3. Pulmonary oedema
  4. Metabolic Acidosis
92
Q

What components make up the eGFR?

A

Creatinine, age, gender, race

93
Q

What lifestyle advice would you give a patient with CKD?

A

Encourage exercise health weight, stop smoking and patient education on CKD

94
Q

Give 4 medications to manage the complications of CKD?

A

Bone disease (calcitriol), anaemia (epo/iron supplements), Decreases BP (ace), oedema (furosemide) and CVD (statins

95
Q

Name 4 problems with using eGFR?

A

Creatinine is secreted and filtered, drugs eg trimethorprom inhibit creatinine secretion so make function look worse, extremes of muscle mass can be misleading and requires a steady state

96
Q

Where is IgA commonly found?

A

Breast milk, respiratory tract, GI tract, saliva, tears and GU

97
Q

Give 2 management steps for a patient with IgA nephropathy?

A
  1. Reduce BP = ACE and lifestyle changes

2. Steroids to stop deposition

98
Q

What is the pathophysiology of IgA nephropathy?

A

Type 3 hypersensitivity, immune complexes deposit in the mesangium –> glomerular injury

99
Q

Give 2 methods of diagnosis of IgA nephropathy?

A
  1. Biopsy to show mesangial deposits

2. Immunoflouresence IgA

100
Q

Give 4 features of nephritic syndrome?

A 
Haematuria (cola-coloured)
Red cell casts 
Proteinuria
Hypertension
Low urine volume <300ml/day
101
Q

What are the 3 features of nephrotic syndrome?

A
  1. Proteinuria
  2. Hypoalbuminaemia
  3. Oedema
102
Q

Which 3 geoups of patients commonly have bacteruria?

A

> 65, catheterised and pregnant women

103
Q

Give 3 times with PSA will be raised?

A

UTI, exercise, prostatitis, ejaculation

Phase 2a Summaries (12 decks)

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