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Kyla's Phase 2a Flashcards > Renal & Genitourinary > Flashcards

Renal & Genitourinary Flashcards

1
Q

Difference in presentation between lower UTI and upper UTI

A
  • Lower UTI: Dysuria (painful urination) + frequency
  • Upper UTI: Haematuria + fever
  • Difference: Upper UTI patients are more unwell - lower is more localised symptoms
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2
Q

Signs of cystitis

A
  • Dysuria (pain, stinging or burning when passing urine)
  • Suprapubic pain or discomfort
  • Frequency
  • Urgency
  • Incontinence
  • Confusion is commonly the only symptom in older + frail patients
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3
Q

What will urinalysis show in a lower UTI

A
  • Leukocytes
  • Nitrates
  • Haemogloblin
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4
Q

What type of urine sample is best to give for testing for a lower UTI?

A

Midstream urine
(MSU)

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5
Q

What plate do you use for a urine culture + sensitivity?

A

CLED plate (lactose fermenting bacteria)

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6
Q

What are the causative bacteria for cystitis?

Nmeumonic

A

KEEPS
* Klebsiella spp
* E. coli
* Enterococcus spp
* Proteus mirabilis/pseudomonas aeruginosa
* Stapylcoccus aureus

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7
Q

What antibobiotic should you avoid in pregnancy?

Cystitis and pregnancy

A

Nitrofurantoin
(in the third trimester)

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8
Q

Which and what duration of antibiotic should be prescribed for cystitis in pregnancy?

A

Amoxicillin (after sensitivies are known)
7 days (complicated)

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9
Q

What type of UTIs is nitrofurantoin useful in?

A

Lower UTIs (cystistis)

Nitrofurantoin = useless in upper UTIs

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10
Q

Contraindications in nitrofurantoin

A
  • Pregnancy (third trimester)
  • Renal function eGFR <45
  • Side effects (nausea, vomiting, liver problems, neuropathy etc)
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11
Q

What is a problem with trimethoprim?

A

High rates of bacterial resistance

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12
Q

What group of people should you not treat for cystitis?

A

Above 65yrs that are asymptomatic

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13
Q

How long do you give someone (uncomplicated) with cystitis antibiotics for?

Un-complicated = non-pregnant women

A

3 day course of antibiotics

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14
Q

Define ‘complicated’ with UTIs

A
  • Any UTI in the presence of a structurally or functionally abnormal urinary tract - with or without host compromise
  • Pregnant
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15
Q

Ix and Mx for a complicated lower UTI

A
  • Always send a sample for culture
  • 7 days (longer) antibiotics
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16
Q

Notes: Duration of antibiotics for Lower UTIs

A
  • 3 daysof antibiotics for simple lower urinary tract infections in women
  • 5-10 daysof antibiotics for immunosuppressed women, abnormal anatomy or impaired kidney function
  • 7 daysof antibiotics for men, pregnant women or catheter-related UTIs
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17
Q

Complications of cystitis

A
  • Pyelonephritis
  • Urosepsis
  • Septic shock
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18
Q

Complicating factors for UTIs

Complicated

A
  • Anatomical or functional abnormalities within the urinary tract
  • Male sex
  • Pregnancy
  • Immunosuppression (e.g., renal transplant),
  • Diabetes
  • incomplete voiding,
  • indwelling urinary catheter,
  • recent instrumentation,
  • healthcare-associated infection,
  • History of infection with extended-spectrum beta-lactamase-producing organisms or other multi-drug resistant organisms.
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19
Q

Who are classed as ‘uncomplicated’ for lower UTIs?

A

Non-pregnant women

That’s it

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20
Q

Causes of pyleonephritis

A

****KEEPS C******

  • Klebsiella pneumoniae(gram-negative anaerobic rod)
  • ****Escherichia coli**** (gram-neg, anaerobic rod)
    • Most common cause
    • Part of the normal lower intestinal microbiome → found in faeces + can easily spread to the bladder
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staphylococcus saprophyticus
  • Candida albicans(fungal)
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21
Q

Name the routes of infection for pyelonephritis

A
  • **Ascending**
    • Urethra colonised with bacteria
      • Massage of urethra during intercourse can force bacteria into the female bladder
  • Haematogenous
    • S. aureus/Candida
  • ****Lymphatic spread****
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22
Q

Presentating Sx for pyeolnephritis

A

Lower UTI + triad of symptoms:
* Loin or back pain (bilateral or unilateral)
* N+V
* Pyuria (fever)

  • Haematuria
  • Renal angle tenderness O/E
  • Systemic illness
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23
Q

Ix for pyelonephritis

A
  • Urine dipstick - signs of infection
    • Nitrates
    • Leukocytes
    • Non-visible haematuria
    • WBC casts (indicate pyuria of renal origin)
  • Midstream urine (MSU) - for microscopy, culture, sensitivity
    • Essential to establish the causative organism
    • Collect before starting antibiotics
  • Blood tests
    • Raised WBC count (leukocytosis)
    • Raised inflammatory markers (CRP, ESR)
  • Creatinine (elevated with impaired kidney function)
  • Abdominal examination
    • Tender loin
    • Renal angle tenderness
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24
Q

Mx for pyelonephritis

A
  • Fluid replacement
  • IV antibiotics (7-10days) - broad spectrum e.g. co-amoxiclav +/- gentamicin, trimethoprim
  • Drain obstructed kidney
  • Catheter
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25
Q

Complications of pyelonephritis

A
  • Scarring of the parenchyma
  • CKD
  • End-stage renal failure
  • Renal abscess
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26
Q

Most common cause of non-gonococcal urethritis?

A

Chlamydia

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27
Q

Young male patient presents with dysruria, discharge and pus from urethra with pain. Possible diagnosis?

A

Urethritis

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28
Q

Ix for urethritis

A

Nucleic acid amplification test (NAAT)

High specifity and sensitivity

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29
Q

Treatment for chlamydia and gonnorrhoea

A

Azithromycin

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30
Q

Two main causative organisms of urethritis

A
  • Neisseria gonorrhoae
  • Chlamydia trachomatis
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31
Q

Sx for epidydimo-orchitis

A
  • Palpable swelling of testicles + epididymis (tenderness)
  • Subacute onset of unilateral scrotal pain + swelling
  • STI epidydimo-orchitis (urethritis + urethral discharge)
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32
Q

Causes of prostatitis

A

E. coli
Chlamydia

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33
Q

Rx for prostatitis

A
  • STI
  • UTI
  • Indwelling catheter
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34
Q

Presentation of prostatitis

A
  • Extreme lower abdominal, ejaculatory, rectal and perineal pain
  • LUTS (dysuria, hesitancy frequency, retention)
  • Sexual dysfunction
  • Pain and bowel movements
  • Tender + enlarged prostate (on DRE)
  • Systemic symptoms: Fever, chill, malaise
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35
Q

Differentials for prostatitis

A
  • BPH
  • Cystsitis
  • Prostate cancer
  • Epidydimo/orchitis
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36
Q

Antibiotic for acute and chronic prostasitis

A

Acute: Trimethoprim
Chronic: Tamulosin (alpha-blockers)

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37
Q

Define testicular torsion

A

Twisting of the testicular on the spermatic cord → constriction pf the vascular supply → time-sensitive ischaemia → necrosis of testicular tissue → sub-infertility or infertility

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38
Q

8 y/o patient presents with unilateral testicular pain, firm swollen (erythematous) and elevated (retracted) testicle. Possible diagnosis?

A

Testicular torsion

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39
Q

Gold standard Ix for testicular torsion

A

Colour doppler ultrasound/ scrotal ultrasound
(Whirlpool sign - absent or decreased blood flow in the affected testicle)

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40
Q

Surgical options for testicular torsion

A
  • Orchiopexy (correct position)
  • Orchidectomy (removal of testicle)
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41
Q

What is testicular appendage torsion presentation?

A

Blue dot sign
Hard tender nodule - may be palpable on the upper pole of the testicle

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42
Q

What is a varicocele

A

Abnormal dilation of the internal spermatic veins + pampiform venous plexus - that drain from the testis
(caused by venous reflux)

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43
Q

What side does 90% of varicoceles occur?

A

Left testis

Left testicular vein - left renal vein, right testicular - IVC

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44
Q

What is the condition in which the testis can be described as a ‘bag of worms’

A

Varicocele

Dull ache, scrotal heaviness

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45
Q

What is an epidydimal cyst that contains sperm called?

A

Spermatocele

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46
Q

Where do epiydimal cysts lie?

A

Above and behind testis

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47
Q

What does a epidydimal cysts feel like O/E?

A

Soft round lump
(typically at the top of the testicle)

May be able to transilluminate

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48
Q

Difference O/E between an epidydimal cyst and a hydrocele

A
  • Epidydmial cyst - testis palpable quite separately from cyst
  • Hydrocele - testis palpable within the fluid swelling
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49
Q

Symptoms a patient may feel with an epidydimal cysts

A

Often asymptomatic
(Painful once they get large)

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50
Q

Ix for epidydimal cyst

A

Scrotal ultrasound

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51
Q

Management for an epidydimal cyst

A
  • Management = usually not necessary
  • Surgical excision if painful or symptomatic
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52
Q

What is a hydrocele?

A

Abnormal collection of fluid within the tunica vaginalis (fluid surrounds the testes)
(Soft scrotal swelling + usually painless)

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53
Q

Hydroceles can be idiopathic and secondary to what?

A
  • Testicular cancer
  • Testicular torsion
  • Epididymo-orchitis
  • Trauma
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54
Q

What does a hydrocele of the testis look like O/E?

A
  • Soft, non-tender, smooth, cystic swelling
  • Irreducible
  • Transilluminated (testicle floats within the fluid)
  • Painless
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55
Q

Ix for a hydrocele

A
  • Clinical diagnosis
  • Scrotal ultrasound (exclude serious causes e.g. cancer)
  • Serum AFP + hCG (exclude malignant teratoma or other germ cell tumours)
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56
Q

How do you treat a hydrocele?

A
  • Idiopathic hydrocele = managed conservatively
    • Resolve spontaneously
  • Large + symptomatic cases
    • Surgery (surgical removal)
    • Aspiration
    • Sclerotherapy
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57
Q

Underlying pathology of BPH

A

Hyperplasia of the stromal + epithelial cells of the prostate

Testosterine + dihydrotestosterone (DHT) = most significant contributers

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58
Q

How does BPH cause LUT symptoms

A

Prostate gets bigger → squeezes or partially blocks:
* The bladder → urine retnetion → bladder dilation + hypertrophy → urine statsis → UTIs
* The urethra → urination problems

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59
Q

What is the scoring system for LUTS?

A

International Prostate Symptoms Score (IPSS)

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60
Q

Signs of BPH

A
  • Bladder stones
  • Acute urinary retention
  • UTIS (stagnation of urine)
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61
Q

Mneumonic for LUTS

A

FUNI SHIT PM
* Storage (FUNI): Think pregnant women
* Voiding (SHIT): Think BPH
* PM = post-micturition

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62
Q

3 categories for LUTS

A
  • Storage
  • Voiding
  • Post-micturition
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63
Q

Name storage LUTS

A

FUNI:
* F - Frequency
* U - Urgency
* N - Nocturia
* I - Incontinence (urgency)

Think pregnant women

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64
Q

Name the voiding LUTS

A

S - Straining
H - Hestitancy
I - Incomplete emptying/Intermittent stream
T - Terminal dribbling

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65
Q

Ix for BPH

A
  • DRE
  • Abdo examination
  • Bladder diary
  • Internation Prostate Symptoms Score (IPSS)
  • Prostate-specific antigen (PSA) - UNRELIABLE (75% FP, 15% FN) - Patient counselling
  • Urinalysis
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66
Q

What does a benign prostate feel like O/E?

A
  • Smooth
  • Symmetrical
  • Slightly soft
  • Maintained central sulcus
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67
Q

What does a cancerous prostate fell like O/E?

A
  • Firm/hard
  • Asymmetrical
  • Craggy or irregular
  • Loss of central suclus
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68
Q

Other Ix for BPH

A
  • Ultrasound of prostate
  • CT abdomen/pelvis
  • Cystoscopy (prostate size + shape)
  • Assessment of renal function
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69
Q

Differentials for BPH

A
  • Prostate cancer
  • UTI
  • Bladder cancer
  • Urethral stricture
  • Overactive bladder
  • Prostatitis
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70
Q

Lifestyle advice for mild + manageable symptoms of BPH

A
  • Avoid caffeine + alcohol
  • Void twice in a row to aid emptying
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71
Q

Name medications to treat BPH and their class

A
  • Alpha-blockers → tamulosin
  • 5-alpha reductase inhibitors → finasteride

Tamulosin can cause postural hypotension

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72
Q

Gold standard treatment of BPH (surgical)

A

Transurethral resection of the prostate (TURP)

Old men use turps!

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73
Q

Complications of BPH

A
  • UTIs
  • Bladder stones
  • Haematuria
  • Sexual dysfunction
  • Acute urinary retention
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74
Q

Aetiology of BPH

A

Smooth muscle hyperplasia + bladder dysfunction

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75
Q

What symptoms does someone with BPH present with?

A

LUTS
* Storage (freq, urgency, nocturia, incontinence)
* Voiding (weak stream, dribbling, dysuria, straining)

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76
Q

BPH

A

Evaluation includes history and examination including an abdominal examination for a palpable bladder, a digital rectal exam, and a neurological assessment.

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77
Q

Define nephrits

A

Inflammation of the kidneys

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78
Q

Features of Nephritic syndrome?

A

HOOP:
* Haematuria
* Oliguria (reduced urine output)
* Oedema (fluid retention)
* Proteinuria

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79
Q

What are the levels of proteinuria in nephritic and nephrotic syndrome?

A
  • Nephritic: less than 3g/24 hours
  • Nephrotic: more than 3g/24 hours
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80
Q

What is the brief pathology of nephritic syndrome?

A
  • Nephritic → inflammation → haematuria
  • Diseases caused by inflammation → damage to the kidney → become more permeable → allows RBCs into urine → haematuria
  • Signs, symptoms, pathology:
    • Damage → permeable glomeruli → haematuria + proteinuria
    • Decreased glomerular filtration rate → oedema + hypertension
    • Less waste product excreted → uraemia
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81
Q

What are the causes of nephritic syndrome in children + adults?

A

Children/adolescents:
* IgA nephropathy
* Post-streptococcal glomerulonephritis

Adults:
* Systemic Lupus Erythematosus (SLE)
* Goodpasture’s syndrome (anti-glomerular basement membrane disease)
* Rapidly progressive glomerulonephritis

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82
Q

Name the major complication of nephritic syndrome

A

Acute kidney failure

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83
Q

Brief underlying pathology for nephrotic syndrome

A

Collection of diseases caused by inflammation → damage to glomeruli → more permeable → allow proteins from blood into urine → proteinuria

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84
Q

Features of nephrotic syndrome

Mneumonic

A

Protein LACE:
* Proteinuria (more than 3g/24 hours)
* Lipid up
* Albumin down (serum less than 25g/L)
* Chlosterol up (hypercholesterolaemia)
* Edema (peripheral oedema)

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85
Q

What are most types of glomerulonephritis treated with?

A
  • Immunosuppresion (e.g. steroids)
  • Blood pressure control - by blocking RAAS (ACEi or ARBs)
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86
Q

What does frothy urine indicate?

A

Protenuria

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87
Q

How do most nephrotic patients present?

A
  • Oedema
  • Frothy urine (proteinuria)
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88
Q

What does nephrotic sundrome predispose a patient to?

A
  • Thrombosis
  • Hypertension
  • High cholesterol
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89
Q

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

A
  • Children: Minimal change disease
  • Adults: Focal segmental glomerulosclerosis
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90
Q

If a patient presents with acute renal failure and haemoptysis - what two conditions should you think of?

A
  • Goodpasture syndrome
  • Granulomatosis with polyangiitis (Wegener’s granulomatosis)
  • Goodpasture syndromes = associated with anti-GBM antibodies
  • Wegener’s granulomatosis = a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA).
    • Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.
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91
Q

What histological feature is characteristic of rapidly progressive glomerulonephritis?

A

Cresent glomerulonephritis

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92
Q

What is the main differentiator between nephritic and nephrotic syndrome?

A

Nephritic: Hameaturia
Nephrotic: Proteinuria (more than 3g/24 hours)

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93
Q

What type of hypersensitivity reaction underpins nephritic syndrome?

A

Type III hypersensitivity

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94
Q

Low does nephritic syndrome lead to hypertension?

A

Low filtration → low perfusion to the kidney → activation of RAAS → hypertension

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95
Q

Pathology underlying IgA nephropathy (Berger’s disease)

A
  • Abnormal IgA forms → deposits in kidney → kidney inflammation (nephritis) → kidney damage
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96
Q

What is associated with IgA nephropathy (Berger’s disease) - that can make it a differentiating factor in diagnosis?

A
  • Associated with GI + respiratory tract infections
  • Very short duration between (1-3 days)
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97
Q

First line and gold standard investigations for IgA nephropathy

A
  • First line: Urinalysis (haematuira, proteinuria); eGFR (reduced); CT KUB (normal)
  • Gold standard: Kidney biopsy (diffuse mesangial IgA deposition)
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98
Q

What is the positive histological feature of IgA nephropathy (Berger’s disease)

A

Diffuse mesangial IgA deposition

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99
Q

Treatment for IgA nephropathy (Berger’s disease)

A
  • Immunosuppressants (prednisolone + cyclophoshamide)
  • ACEi for hypertension
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100
Q

What is post-streptococcal glomulerilonephritis?

A
  • Inflammation of the glomeruli as a complication of a bacterial infection
  • Occurs 1-3 weeks after a Group A β-haemolytic streptococcusinfection, such astonsillitiscaused byStreptococcus pyogenes.
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101
Q

A patient presents with haematuria after having tonsilits 2 weeks before. Possible diagnosis?

A

Post-streptococcal glomerulonephritis

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102
Q

What causes post-streptococcal glomerulonephritis?

A

Group A beta-haemolytic streptococcal pyogenes infection
(1-2 weeks after throat infection)
(6 weeks after skin infection (impetigo))

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103
Q

Underlying pathology of post-streptococcal glomerulonephritis

A
  • Group A β-haemolytic streptococcus pyogenes infection (e.g. tonsillitis)
  • 1-3 weeks after immune complexes (strep antigens + antibodies + complement proteins) = get stuck in the glomeruli of the kidneys
  • Inflammation → acute deterioration in renal function → acute kidney injury (AKI)
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104
Q

Symptoms that a patient may experience with post-streptococcal glomerulonephritis

A
  • Fever
  • Headache
  • Malaise
  • Anorexia
  • Nausea
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105
Q

Ix for post-streptococcal glomerulonephritis

A
  • Urinalysis: Proteinuira, haematuria
  • Tonsilitis-related: Throat swab (charcoal. positive for strep).
  • Kidney biopsy: Subepithelial humps
106
Q

What type of microscopy is used to look at the histology for kidney biopsies?

A

Mainly electron microscopy (not light microscopy)

107
Q

Treatment for post-streptococcal glomerulonephritis

A

Supportive (80% recovery)

Complications:
* Antihypertensive (hypertension)
* Diuretics (oedema)

108
Q

What two major presentations does Goodpasture’s syndrome consist of?

A
  • Glomerulonephrtis
  • Pulmonary haemorrhage
109
Q

Genetic risk factors for Goodpasture’s syndrome

A

HLA-DR4 or B1

110
Q

Which antibodies are involved in Goodpasture’s syndrome?

A

Anti-GMB (glomerular basement membrane)
(They attack the glomerulus + pulmonary basement membranes → CAUSING GLOMERULONEPHRITIS + PULMONARY HAEMORRHAGE)

111
Q

If a patient presents with an AKI and haemoptysis, what glomerulonephritis are we going to test for?

A

Goodpasture’s syndrome
(presence of anti-GBM antibodies)

Kidney + lung → Goodpasture’s

112
Q

Sx for Goodpasture’s syndrome

A
  • HOOP
  • Crackles on lung eximation
  • Cough
  • Dyspnoea
  • Nausea
113
Q

What are the diagnostic tests for Goodpasture’s syndrome?

A
  • Anti-GBM serologies
  • Renal biopsy (cresent glomerulonephritis + IgG immunofluorescence)
114
Q

Management for Goodpasture’s syndrome

A
  • Oral corticosteroid (prednisolone)
  • Plasmapheresis (remove the pathogenic antibody (anti-GBM)
  • Cyclophosphamide
115
Q

What antibodies cause nephritic syndrome in SLE?

A

Anti-dsDNA
They form antibody complexes → initiate inflammatory response → Type III hypersensitivity reaction

116
Q

Is SLE nephropathy nephritic or nephrotic?

A

Both

117
Q

Mx for SLE nephropathy

A

Immunosuppression
(prednisolone + cyclophosamide)

118
Q

Complications of SLE nephropathy

A
  • Rein vein thrombosis
  • Pulmonary embolism
  • Rapidly progressive glomerulonephritis
119
Q

What is minimal change disease?

A
  • Most common nephrotic syndrome in children
  • T cells release cytokines = cause effacement (flattened) of podocytes
  • Lose albumin in urine
120
Q

Signs of minimal change disease

A

More rapid onset (days to weeks) - compared to others.
Nephrotic (Protein LACE)
* Proteinuria (frothy urine)
* Lipid up (hyperlipidaemia)
* Albumin down (less than 25g/L)
* Cholesterol up (hypercholesterolaemia)
* Edema (facial or generalised)
* Hypercoagulablity (risk of DVT, thrombosis)

121
Q

Why do you get high triglycerides + cholesterol in nephrotic syndrome?

A

Compensation, as there is a loss of protein in the urine + low albumin in serum
(Serum albumin level and total cholesterol level are inversely related: the lower the serum albumin level, the higher the cholesterol level)

122
Q

First and gold standard Ix for minimal change disease

A

First: Urinalysis (proteinuria); 24-hour urine protein; serum albumin level (low)
Gold standard: Renal biopsy (podocyte effacement - electron microscopy)

123
Q

Mx of minimal change disease

A
  • Corticosteroid (prednisolone)
  • Fluid restriction + low sodium diet
  • Albumin + furosemide (IV)
124
Q

Complications of nephrotic syndrome (2)

A
  • Hypertension (?fluid retention)
  • Thrombosis (hypercoagulability)
125
Q

What is the most common nephrotic syndrome in adullts?

A

Focal segmental glomulerosclerosis

Mainly men

126
Q

What conditions can focal segmental glomerulosclerosis be secondary to?

A
  • HIV
  • Obesity
  • Medications
  • Maladaptive response to decreased renal mass
127
Q

Rx for focal segmental glomerulosclerosis

A
  • Male sex
  • Black race
  • Family history of focal segmental glomerulosclerosis
  • Heroin abuse
    • Presumed mechanism = direct toxic effect on the podocyte
  • Use of known causative medications
    • Interferon alfa, lithium, sirolimus, and pamidronate
  • Chronic viral infections
    • HIV-1, parvovirus B19, and cytomegalovirus
  • Solitary kidney
128
Q

Ix for focal segmental glomerulosclerosis

A
  • **Serum urea ** (elevated - suggests renal dysfunction)
  • Creatinine (elevated - suggests renal dysfunction)
  • eGFR (decreased)
  • Urine protein-to-creatine ratio (asymptomatic <1; symptomatic >3)
  • Serum albumin (hypoalbuminaemia)
  • Serum lipid profile (increased total cholesterol + LDL)
  • Renal biopsy + histology
129
Q

What histological features show on a renal biopsy for focal segmental glomerulosclerosis

A
  • Light microscopy: Focal segmental sclerosis
  • Electron microscopy: Effacement of podocyte foot processes
  • Immunofluroscence: Non-specific focal deposits of IgM and C3
130
Q

First and second line management for focal segmental glomerulosclerosis

A

First line: Treat underlying cause; ACEi (lisinopril) or ARB + sodium; restriction, corticosteroid (pred)
Second line:
- Furosemide ± thiazide diuretic
- Treat oedema
- Statin (atorvastatin)
- High serum cholesterol and low-density lipoprotein produced by nephrotic syndrome
- Ciclosporin ± corticosteroid (prednisolone)
- Ciclosporin = induce remission + preserve renal function

131
Q

Name some causes of membranous nephropathy

A

Primary:
* Idiopathic (most common)
* Associated with HLA alleles

Secondary:
- Auto-antibodies generated in response to underlying conditions
- Infections
- Hep B
- Hep C
- Syphilis
- Medications
- NSAIDs, penicillamine
- Autoimmune
- Systemic lupus erythematosus (SLE)
- Malignancy

132
Q

Rx for membranous nephropathy

A
  • Male sex
  • Age>40 years
  • HLA-DR3
  • Autoimmune disease
  • Hepatitis B and C
  • Syphilis
  • Solid organ carcinoma
  • Medication
133
Q

Underlying pathology of membranous nephropathy

A

Inflammation of glomerular basement membrane triggered by immune complex deposits → increased permeability → proteinuria → nephrotic syndrome

134
Q

Px of membranous nephropathy

A
  • Oedema
  • Hypertension
  • Xanthelasma (yellow growths on or near eyelids - hypercholesteraemia)
  • Foamy urine (proteinuria)
  • Fatigue/malaise
  • Anorexia
135
Q

What histological feature is characteristic of membranous nephropathy?

A

Diffuse thickening of glomerular basement membrane

136
Q

Mx for membraneous nephropathy

A
  • Low salt + low protein diet
  • Hypertension → ACEi or ARB
  • Hyperlipidaemia → simvastatin or atorvastatin
  • Oedema → furosemide ± hydrochlorothiazide
  • Moderate to high risk pf progressive kidney injury → corticosteroid (prednisolone) + cytotoxic or immunosuppressive therapy (cyclophosphamide)
137
Q

Define an AKI

A
  • Acute drop in kidney function → leading to a rise in serum creatinine and/or fall in urine output
  • Decrease in function LESS THAN 3 MONTHS
138
Q

What is the diagnostic criteria for an AKI

A

Ix: Urea and electrolytes - CREATININE
- Rise in creatinine of ≥ 25 micromol/L in 48 hours
- Rise in creatinine of ≥ 50% in 7 days
- Urine output of < 0.5ml/kg/hour for > 6 hours

139
Q

What population are AKIs most common in?

A

Elderly

140
Q

What are the 3 categories for the causes of an AKI?

A
  • Pre-renal
  • Renal
  • Post-renal
141
Q

Name some pre-renal causes of an AKI

Inadequate blood supply to the kidney → ↓filtration of blood

A
  • Hypotension (shock)
  • Heart failure
  • Dehydration
  • Hypovolaemia (fluid loss)
    • GI losses → diarrhoea + vomiting
    • Acute haemorrhage → trauma + bleeding
    • Renal losses → diuretics or osmotic diuresis
    • Dermal losses → burns
142
Q

Name some renal causes of an AKI

Intrinsic disease in the kideny → ↓filtration of blood

A
  • Glomerulonephritis
  • Interstitial nephritis
  • Nephrotoxic drugs
    • NSAIDs → inhibits COX → causes excess vasoconstriction of afferent arteriole
    • ACEi/ARBs → results in dilated efferent arterioles → decreasing GFR
    • Methotrexate
  • Malignant hypertension
  • Autoimmune disease
143
Q

How do NSAIDs effect the kidney?

A

inhibits COX → causes excess vasoconstriction of afferent arteriole

144
Q

How do ACEi/ARBs effect the kidney?

A

Dilation of efferent arterioles → decreasing GFR

ACEi.ARBs → after efferent

145
Q

Name some post-renal causes for an AKI

A

Caused by obstruction to outflow of urine from the kidney → causing back-pressure into the kidney → ↓kidney function = OBSTRUCTIVE UROPATHY
* Kidney stones (nephrolithiasis)
* Masses (cancer in abdomen or pelvis)
* Ureter or uretheral strictures
* Enlarged prostate or prostate cancer
* Blood clot

Anything blocking the outflow of the kidney reducing outflow

146
Q

Rx question: When should you consider the possibility of an AKI in patients?

A

Patients with an acute illness (e.g. infection) or having a surgery
* Chronic kidney disease
* Heart failure
* Diabetes
* Older age (above 65 years)
* Nephrotoxic medications (NSAIDs and ACEi)
* Malignant hypertension
* Trauma
* Sepsis

147
Q

Signs of an AKI

A
  • Tachycardia
  • Peripheral oedema
  • Poor tissue turgor
  • Postural hypotension (dehydration)
  • Hypotension (pre-renal cause of AKI)
  • Fluid overload + increased JVP, pulmonary oedema (CXR)
  • Abdomen: large, painless bladder (chronic retention)
148
Q

Symptoms of an AKI

A
  • Early stages = asymptomatic
  • Oliguria (decreased urine output)
  • Anuria
  • Dehydration
  • Nausea + vomiting
  • Confusion
  • Fever (sepsis)
  • Uraemia - weakness, tremor, fatigue, nausea, vomiting, mental confusion, seizures, coma
  • LUTS
    • Prostatic hyperplasia = an obstructive post-renal cause of AKI
149
Q

What are the NICE criteria for an AKI?

A
  • Urine output less than 0.5ml/kg/hr for >6 hours
  • Rise in creatinine of ≥ 25 micromol/L in 48 hours
  • Rise in creatinine of ≥ 50% in 7 days
150
Q

Ix for an AKI

A

First line:
- Urinalysis:
- Leucocytes + nitrates → suggest infection
- Protein + blood → suggest acute nephritis (but can be positive in infection)
- Glucose → suggests diabetes
- Urine + blood cultures → look for infection
- KUB Ultrasound → look for obstruction

Other:
* Monitor urine output - catheter
* KUB XR (non-contrast)
* Autoantibodies (Anti-GBM, ANCA)

151
Q

Differential diagnosis for an AKI

A
  • Chronic kideny disease (>3 months of creatinine rise)
  • Drug side effect (cimetidine or trimethoprim)
  • Increased muscle mass
152
Q

How can you prevent an AKI?

A
  • Avoid nephrotoxic medications (NSAIDs and ACEis)
  • Adequate fluid input (IV fluids if not oral)
153
Q

What are the treatments of an AKI? For the 3 categories

A
  • Pre-renal: Fluid rehydration (IV fluids)
  • Renal: Stop nephrotoxic medications e.g. NSAIDS and antihypertensives that reduce the filtration pressure (i.e. ACE inhibitors)
    • NSAIDs e.g. aspirin, ibuprofen
    • ACEi e.g. ramipril
    • Gentamicin
    • Amphotericin
  • Post-renal obstruction: Catheterise and consider CT KUB
    • E.g. insert catheter for a patient in retention from an enlarged prostate
154
Q

What are the major complications of an AKI?

A
  • Hyperkalaemia
  • Fluid overload, heart failure, pulmonary oedema
  • Metabolic acidosis
  • Uraemia (high urea) → encephalopathy or pericarditis
155
Q

Why is hyperkalaemia a complication of kideny failure?

A

When the kidneys are failing → they cannot excrete potassium → cardiac arrest

156
Q

How does hyperkalaemia present on an ECG?

A
  • Tall peaked T waves
  • Wide QRS complex
  • Small P waves
157
Q

What is the management for hyperkalaemia?

A
  • Calcium gluconate (membrane stabiliser → protects heart)
    ** * Insulin + dextrose** (insulin drives K+ into cells)
  • **IV fluid **
  • Salbutamol
158
Q

Name some causes of chronic kidney disease (CKD)

A
  • Diabetes
  • Hypertension
  • Age-related decline
  • Glomerulonephritis
  • Polycystic kidney disease
  • Nephrotoxic medications (NSAIDs, PPIs, Lithium)
159
Q

Pathology of chronic kidney disease (CKD)

A

Damaged nephrons → blood diverted to healthy nephrons → increased flow + stress to these nephrons → these nephrons start to fail → detection as new/increasing proteinuria

160
Q

What does CKD often progress to?

A

End-stage kidney disease

161
Q

Symptoms of CKD

A
  • Asymptomatic (unless advanced stages)
  • Pruritus (itching)
  • Loss of appetite
  • Nausea
  • Muscle cramps
162
Q

Signs of chronic kidney disease (CKD)

A
  • Oedema
  • Hypertension
  • Peripheral neuropathy
  • Pallor
163
Q

What is the diagnostic criteria for CKD?

A
  • Proteinuria or haematuria
    AND/OR
  • Reduction in eGFR for more than 3 months
164
Q

Ix for chronic kidney disease

A
  • U&E (eGFR - 3 months apart to confirm diagnosis)
  • Proteinuria (urine albumin:creatinine ratio, ≥ 3mg/mmol is significant)
  • Haematuria (urine dipstick (1+))
  • Renal ultrasound
165
Q

What are the aims of management for CKD?

A

Slow progression + reduce complication risk
* Slow disease progression
* Reduce CVD risk
* Reduce complications risk
* Treat complications

166
Q

How do you reduce the complications of CKD?

A
  • Exercise, maintain a healthy weight and stop smoking
  • Special dietary advice about phosphate, sodium, potassium and water intake
  • Offer atorvastatin 20mg for primary prevention of cardiovascular disease
167
Q

What is the treatment for metabolic acidosis in CKD?

A

Oral sodium bicarbonate

168
Q

Name two treatments for end-stage renal failure

A
  • Dialysis
  • Renal transplant
169
Q

What is the first line treatment for hypertension in CKD patients?

A

ACEi
(aim BP < 140/90 mmHg)

170
Q

What electrolyte level needs to be monitored in CKD?

A

Serum potassium
* CKD + ACEis both cause hyperkalaemia

171
Q

What are complications of CKD?

A
  • Cardiovascular disease
  • Peripheral neuropathy
  • Anaemia
    • Healthy kidneys produce erythropoietin (= the hormone that stimulates the production of RBCs)
  • Renal bone disease
  • Dialysis related problems
172
Q

Where can renl calculi get deposited and irritate?

A

Anywhere from the renal pelvis to the urethra
(Most common place = the vesco-ureteric junction)

173
Q

Which sex is more likely to develop kidney stones?

A

Male

174
Q

Name some causes of kidney stones

A
  • Anatomic deformity (horshoe, duplex)
  • Hypercalciuria (from hyperparathyroidism)
  • Hypercalcaemia
    • Calcium supplementation
    • Hyperparathyroidism
    • Cancer (myeloma, breast or lung)
  • Infection-induced struvite – proteus, klebsiella and pseudomonas
  • Hyperoxaluria (high oxalate in the urine)
175
Q

What is the most common form of renal calculi?

A

Calcium oxalate

176
Q

What are the types of renal calculi?

A
  • Calcium-based (80%)
  • Uric acid (not visable on x-ray)
  • Struvite (bacterial infection)
  • Cystine
177
Q

What are the risk factors of calcium-based kidney stones?

A
  • Reduced urine output
  • Hypercalcaemia
178
Q

What does a staghorn calculus look like and when do they develop?

A
  • Kidney stone in the shape of the renal pelvis → seen on x-ray
  • Most commonly made out of struvite → recurrent upper UTIs
  • Recurrent UTIs (bacteria hydrolyses the urea in the urine → ammonia → solid struvite)
179
Q

What is the described as with kidney stones?

A

Renal colic
* Unilateral loin to groin pain (excruciating)
* Colicky (fluctuating in severity) as the stone moves and settles
* Unable to get comfortable

180
Q

Patient presents with haematuria and reduced urine output. Patient is also feeling nauseous and has loin to groin pain that fluctuates in severity. Possible diagnosis?

Kidney stones can also be asymptomatic!

A

Kidney stones
(renal calculi, urolithiasis, nephrolithiasis)

181
Q

Name the UTI symptoms

A
  • Dysuria (painful or difficulty urinating)
  • Stangury (burning when urinating)
  • Urgency
  • Frequency
182
Q

First line and gold standad Ix for kidney stones

A

First line:
* Urine dipstick (haematuria, exclude infection)
* Blood test (eGFR, infection, serium calcium (potential hypercalcaemia)
* Abdominal x-ray (calcium-based = show; uric acid stones = don’t show (radiolucent))

Gold standard: **Non-contrast CT KUB (diagnostic) **
* KUB = kidneys, ureters, bladder
* Within 24 hours of presentation

183
Q

First and second line management for kidney stones

A

First line:
** * Hydration + analgesia** (NSAIDs (ibuprofen) or IV paracetamol)
* Antibiotics (if bacteriuria)
* Watchful waiting (stones less than 5 mm)

Second line: Extracorporeal shock wave lithotripsy

184
Q

Preventative treatment for recurrent infections?

A
  • Increase fluid intake (2.5-3 litres per day)
    ** * Reduce dietary salt intake **
  • Maintain normal calcium intake (low calcium may increase risk)
  • Thiazide diuretics (indapamide) - in patients with calcium oxalate stones and raised urinary calcium
185
Q

2 complications fo kidney stones

A
  • AKI (caused by obstruction)
  • Infection with obstructive pyelonephritis
186
Q

Risk factors for developing kidney stones

A
  • Chronic dehydration
  • Diet
  • Obesity
  • Positive family history
  • Metabolic abnormalities (hyperparathyroidism)
187
Q

What is the presentation of hypercalcaemia mneumonic?

A

Renal stones, painful bones, abdominal groans and psychiatric moans

188
Q

What are the 3 causes of hypercalcaemia?

A
  • Calcium supplementation
  • Hyperparathyroidism
  • Cancer (myeloma, breast, lung cancer)
189
Q

What is polycystic kidney disease?

A

Genetic disease
Kidneys fill with hundreds of cysts → become larger → kidenys unable to function

190
Q

What are the two types of polycystic kidney diseasae (PKD)?

A
  • Autosomal dominant (ADPKD) = adult PKD (more common)
  • Autosomal recessive (ARPKD) = childood PKD
191
Q

What are the gene mutations involved in autosomal dominant PKD (ADPKD)?

A
  • Polycystin 1 (PKD1) = more severe - earlier onset
  • Polycystin 2 (PKD2) = less severe - later onset
192
Q

What is the genetic mutation associated with autosomal recessive PKD?

A

Polycystic kidney hepatic disease 1 (PKHD1)

Both parents hasve to pass on the mutation

193
Q

Pathology of polcytsic kidney disease

A
  • Cysts in cortex + cysts in medulla
  • Cysts become larger over time → compress blood vessels of neighbouring healthy nephrons → starve neighbouring nephrons of oxygen
  • Poor perfusion of kidneys → activates renin-angiotensin-aldosterone system → retain fluid → hypertension
  • Large cysts → compress collecting system → urinary stasis → kidney stones
194
Q

Name some extra-renal manifestations of ADPKD

A
  • Hepatic, splenic, pancreatic, ovarian and prostatic cysts
  • Cardiac valve disease (mitral regurgitation)
  • Aortic root dilation
  • Cerebral aneurysms
195
Q

Name come complications of ADPKD

A
  • Chronic loin pain
  • Hypertension
  • Cardiovascular disease
  • Kidney stones
  • End-stage renal failure (mean age 50 yrs)
  • Gross haematuria (occurs with cyst rupture - resolves within few days)
196
Q

What are the symptoms of polycystic kidney diseasse?

A

Flank pain
UTIs: Dysuria, subrapubic pain, fever

197
Q

What are the key presentations of polycystic kidney disease?

A
  • Flank pain
  • Hypertension
  • Palpable kidney mass
  • Haematuria (upon cyst rupture)
  • Renal insufficiency
198
Q

Ix for polycystic kidney disease first line and gold-standard

A

First line:
* Renal ultrasound
* Genetic teasting (PKD1, PKD2, PKHD1)

Gold standard: Contrast-enhanced CT scan abdomen/pelvis, MRI of abdomen/pelvis

199
Q

What investigation should be performed and what is seen when suspecting ARPKD?

A

Prenatal ultrasound
* Bilaterally large kidneys with cysts
* Oligohydramnios

200
Q

What medication is used in ADPKD to slow the development of cysts and renal failure?

A

Tolvaptan

201
Q

First line and second line management for ADPKD

A

First line:
* Tolvaptan orally
* Lifestyle measures (optimal weight, regular exercise, no smoking
* Hypertension: ACEi (ramipril) or ARB (valsartan)
* Infected renal cyst (ciprofloxacin)

Second line:
* Dialysis (haemodialysis - preferred over peritoneal dialysis)
* Renal transplant

202
Q

Name some complications of PKD

A
  • Hypertnesion (due to renal failure) - cardiac complications
  • Liver failure (due to liver fibrosis)
  • Portal hypertension (leading to oesophageal varices)
  • Progerssive renal failure
  • Chronic lung disease
203
Q

What type of neoplasm is prostate cancer and where do they grow?

A

Adenocarcinoma
Grow in the peripheral zone of the prostate

204
Q

What are some Rx for prostate cancer?

A
  • Increasing age
  • Family history
  • Black African or Caribbean origin
  • Tall stature
  • Anabolic steroids
  • Peripheral obesity (Waist circumference by 10cm - mortality increases by 18%)
205
Q

What hormone is prostate cancer dependent on to grow?

A

Prostate cancer = androgen-dependent (rely on testosterone to grow)

206
Q

What are the signs of prostate cancer?

A
  • Haematuria
  • Erectile dysfunction
  • DRE: A cancerous prostate may feel firm or hard, asymmetrical, craggy or irregular, with loss of the central sulcus
207
Q

What are the symptoms of prostate cancer?

A
  • Asymptomatic
  • Lower urinary tract symptoms (LUTS) - similar to BPH
    • Hesitancy
    • Frequency
    • Weak flow
    • Terminal dribbling
    • Nocturia
  • Symptoms of advanced disease or metastasis
    • Weight loss
    • Bone pain
    • Cauda equina syndrome
208
Q

What are the first line investigations for prostate cancer?

A
  • DRE - prostate examination
    • Cancerous prostate = firm/hard, asymmetrical, craggy/irregular with loss of central sulcus, may have a hard nodule
  • Multiparametric MRI - Likert scale:
    • 1 – very low suspicion
    • 2 – low suspicion
    • 3 – equivocal
    • 4 – probable cancer
    • 5 – definite cancer
  • Prostate-Specific Antigen (PSA):
    • High rate of false positive
    • Unreliable
209
Q

What is the gold standard investigation for prostate cancer?

A
  • Prostate biopsy (transrectal ultrasound-guided biopsy (TRUS))
210
Q

What grading system is based on the histology from the prostate biopsies

Helps to determine appropriate treatment

A

Gleason Grading System
* 6 = low risk
* 7 = intermediate risk
* 8 or above = high risk
(The greater the Gleason score, the more poorly differentiated the tumour is (the cells have mutated further from normal prostate tissue) and the worse the prognosis)

211
Q

What staging system is used in prostate cancer?

A

TNM Staging

212
Q

Name the grading and staging systems for prostate cancer

A
  • Grading: Gleason Grading System
  • Staging: TNM Staging System
213
Q

2 differentials for prostate cancer?

A
  • Benign prostatic hyperplasia
  • Chronic prostatitis
214
Q

How do you monitor a patient with prostate cancer?

A

‘Watchful waiting’ - with PSA

215
Q

What’s the difference between grade and stage of a cancer?

A
  • Grade = how it might biologically behave
  • Stage = The amount of tissue there is around (the extent)
216
Q

Management of prostate cancer

A
  • Surveillanceorwatchful waitingin early prostate cancer
  • External beam radiotherapydirected at the prostate
  • Brachytherapy
    • Implanting radioactive metal ‘seeds’ into the prostate
    • Delivers targeted radiotherapy to the prostate
  • Hormone therapy
    • Reduce level of androgens (e.g. testosterone that stimulate the cancer to grow
      • Androgen-receptor blockerssuch as bicalutamide
      • GnRH agonists such as goserelin(Zoladex) orleuprorelin(Prostap)
  • Surgery
    • Radical prostatectomy = removal of the entire prostate
    • Aim = to cure prostate cancer confined to the prostate
217
Q

What is the androgen-receptor blocker used in prostate cancer?

A

Bicalutamide

218
Q

Complications of prostate cancer

A

Radiation-induced:
- Dysuria
- Urinary frequency
- Rectal bleeding
- Erectile dysfunction
- Hot flushes

Hormone-induced:
- Gynaecomastia
- Hot flushes

219
Q

What is the staging process of prostate cancer?

A

TNM Staging

  • T stage:
    • T1 - no palpable tumour on DRE
    • T2 - palpable tumour, confined to prostate
    • T3 - palpable tumour extending beyond prostate capsule
    • T4 – invading local structures (sphincter/rectum)
  • N stage:** MRI scan, CT scan, (laparoscopy)**
  • M stage: **Bone scan/ PET scan/MRI
220
Q

What are the two types of testicular cancer?

A
  • Seminomas
  • Non-seminomas (mostly teratomas)
221
Q

What age group is testicular cancer most common in?

A

Young men (15-34)

222
Q

Rx for testicular cancer

A
  • Undescended testes
  • Male infertility
  • Family history
  • Increased height
223
Q

What are is the key presentation of testicle cancer?

A
  • Haematospermia
  • Testicular lump (hard, irregular, non-tender, NOT FLUCTUANT, NO TRANSILLUMINATION)

(Gynaecomastia (breast enlargement - Leydig cell tumour)

224
Q

Why might you develop symptoms with testicular cancer?

A

Metastases!
- Cough/dyspnoea → indicative of lung metastases
- Back pain → indicative of para-aortic lymph node metastasis

225
Q

What are the first line investigations for testicular cancer?

A
  • Scrotal ultrasound (colour Doppler of testis) (diagnostic)
  • Bloods for tummour markers
    • Lactate dehydrogenase (LDH) = non-specific tumour marker
    • Beta-hCG (may be raised in teratomas + seminomas)
226
Q

What is the staging system for testicular cancer?

A

Royal Marsden Staging

227
Q

Where are the most likely metastases sites for testicular cancer?

A
  • Lymphatics
  • Brain
  • Liver
  • Lungs
228
Q

Differentials for testicular cancer?

A
  • Epidydimal cyst
  • Hydrocele
  • Epididymo-orchitis
229
Q

Treatment of prostate cancer?

A
  • Radical orchidectomy - via inguinal approach
  • Chemotherapy
  • Radiotherapy
230
Q

What type of neoplasm is bladder cancer and where does it arise from?

A
  • Arises from the endothelium lining (urothelium)
  • Transitional cell carcinoma (90%)
  • Squamous cell carcinoma (5%)
231
Q

A patient is a retired dye factory worker with painless haematuria. Possible diagnosis?

A

Transitional cell carcinoma (bladder cancer)

232
Q

Rx for bladder cancer

A
  • Snoking
  • Increasing age
  • Aromatic dyes (dye + rubber industries)
  • Schistosomiasis (= causes squamous cell carcinoma of the bladder)
233
Q

What are the key presentations of bladder cancer?

A
  • Painless haematuria
  • UTI symptoms (absence of infection): Dysuria, frequency, urgency
234
Q

What are the cancer B symptoms

A
  • Unexplained weight loss
  • Night sweats
  • Loss of appetite
235
Q

When do you use a two week wait referral for bladder cancer?

A
  • Aged over 45 withunexplained visible haematuria, either without a UTI or persisting after treatment for a UTI
  • Aged over 60 withmicroscopic haematuria(not visible but positive on a urine dipstick)PLUS:
    • Dysuriaor;
    • Raised white blood cellson a full blood count
236
Q

What is the first line and gold standard Ix for bladder cancer?

A
  • First line: Urinalysis (haematuria)
  • Gold standard: Flexible cystoscopy + biopsy
237
Q

What is the staging system for bladder cancer?

A

TNM

238
Q

Differentials for bladder cancer?

A
  • BPH
  • Prostatitis
  • UTI
  • Nephrolithiasis
  • Renal cell carcinoma
239
Q

What is the managment for non-muscle invading bladder cancer?

A

Transurethral resection of bladder tumour (TURBT)

240
Q

What is the managment for muscle invading bladder cancer?

A

Radical cystoscopy
(Removal of the entire bladder)

241
Q

What is the classic triad of Px for renal cell carcinoma?

A
  • Flank pain
  • Haematuria
  • Palpable mass

DDx - PKD only has haematuria when cyst ruptures

242
Q

What is the most common type of renal cell adenocarcinoma?

A

Clear cell

243
Q

Rx for renal cell adenocarcinoma

A
  • Renal abnormalities (PKD, horseshoe kidneys)
  • Hypertension
  • Smoking
  • Emd-stage renal failure
244
Q

Where does renal cell carcinoma arise from?

A

Proximal tubular epithelium

245
Q

Patient present with vague loin pain, weight loss, and complains that he is sweating a lot in the night. O/E you palpate a renal mass and haematuria. Possible diagnosis?

A

Renal cell carcinoma

246
Q

What are the first line and gold-standard Ix for renal cell carcinoma?

A

First line:
* Abdome/pelvis ultrasound (differentiate benign cyst from solid tumour)
* Blood (paraneoplastic syndrome - reduced Hb; eGFR may be reduced)
* Urinalysis (haematuria and/or proteinuria)

Gold standard:
* CT scan (abdomen/pelvis) = more sensitive

247
Q

Management of renal cell carcinoma

A
  • Stage 1 or 2: Surveillance, local ablation therapy (radiofrequency ablation (RFA))
  • Stage 3: Radical nephrectomy
  • Stage 4: Partial nephrectomy, chemotherapy, palliative radiation
248
Q

Complications of renal cell carcinoma

A
  • Anaemia
  • Adverse effects from targeted therapies
  • Paraneoplastic syndromes - production of hormones
    • EPO - more RBCs → polycythaemia
    • PTHrP → hypercalcaemia
    • ACTH - more cortisol → Cushing’s
249
Q

What is the staging system for renal cell carcinoma?

A

TNM staging system

250
Q

Is Chlamydia trachomatis gram-positive or gram-negative bacteria?

A

Gram-negative

251
Q

What are the serovars of Chlamydia?

A

D-K
Urogenital infection, conjuctivitis

252
Q

What STI results in yellow, cloudy vaginal discharge?

A

Chlamydia

253
Q

What anorectal symptoms does chlamydia cause?

A
  • Discomfort
  • Discharge
  • Bleeding
  • Change in bowel habbit
254
Q

What are the key presentations of chlamydia in men and women?

A

Female:
* Asymptomatic (majority)
* Abnormal vaginal discharge
* Dysuria (painful urination)
* Painful sex
* Abnormal vaginal bleeding

Male:
* Urethral discharge or discomfort
* Painful urination (dysuria)
* Epididymo-orchitis

O/E
* Pelvic or abdominal tenderness
* Inflamed cervix

255
Q

Key Ix for chlamydia

A
  • Nucleic acid amplification test (NAAT)
  • Swab (men = urethral; women = vulvovaginal)
  • First-catch urine sample (men + women)
256
Q

First line treatment for chlamydia (and alteranative)

A

Uncomplicated: Doxycycline BD (7 days)
Pregnant + breastfeeding: Azithromycin (2/3 days)

257
Q

Complications of chlamydia

A
  • Pelvic inflammatory disease
  • Infertility
  • Ectopic pregnancy
  • Conjunctivitis
  • Reactive arthriris

Pregnancy-related complications:
* Preterm delivery
* Low birth weight
* Neonatal infection (conjunctivitis and pneumonia)

258
Q

What is the bacteria that causes gonorrhoea?

A

Neisseria gonorrhoea
(Gram-negative diplococcus)

259
Q

Which STI is more likely to be symptomatic, chlamydia or gonorrhoea?

A

Gonorrhoea

260
Q

What are they presentations of gonorrhoea?

A
  • Odourless purulent discharge - green or yellow
  • Dysuria
  • Pelvic pain
  • Testicular pain or swelling (epididymo-orchitis)
261
Q

Ix for gonorrhoea

A
  • Endocervival, vulvovaginal or urethral swabs OR **first-catch urine sample **
  • NAAT (detects the RNA or DNA of gonorrhoea)
  • CHARCOAL SWAB - for culture + sensitivities (gonorrhoea has a high level of antibiotic resistance)
262
Q

Treatment for gonorrhoea

A

Intramusclular ceftriaxone

Kyla's Phase 2a Flashcards (11 decks)

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