Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > Renal/Uro > Flashcards

Renal/Uro Flashcards

1
Q

what is interstitial cystitis?

A

chronic inflammation of the urinary bladder- aka bladder pain syndrome or hypersensitive bladder syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the top 3 causative organisms for cystitis?

A

E.Coli - most common
Staph saprophyticus
Klebsiella pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the presentation of interstitial cystitis?

A

> 6 weeks of

Suprapubic pain
frequency of urination
urgency of urination
symptoms may be worse during menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 2 things that may be seen on cystoscopy in interstitial cystitis?

A

Hunner lesions - red inflamed patches of bladder mucosa

Granulations - tiny haemorrhages in bladder wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the management of interstitial cystitis?

A

supportive management - diet, smoking, bladder retraining, CBT

Analgesia, antihistamines, anticholinergics

Intravesical medications (direct to bladder) - lidocaine, etc

Hydrodistension and surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 6 voiding LUTS?

A

weak stream
splitting or spraying, intermittency
hesitancy
straining
Terminal dribbling
incomplete emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 6 storage LUTS?

A

Frequency
Urgency
Nocturia
Urge incontinence
stress incontinence
leaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the pathophysiology of BPH?

A

there is hyperplasia in the glandular epithelial and stromal cells of the prostate due to increased action of 5-alpha reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are 5 risk factors for BPH?

A

Increasing age - 50+
FHx
Obesity
Afro-Caribbean
Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are 3 manifestations of BPH?

A

Voiding LUTS
Storage LUTs
Urinary retention - lower abdo pain, inability to urinate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are 4 initial investigation for BPH?

A

Urinalysis
PSA
U+E - may cause renal failure in obstruction
DRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the conservative management of BPH?

A

treat constipation
reduce caffeine and fluid intake
medication review
retrain bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the pharmacological managements of BPH?

A

1 - alpha blocker
Tamsulosin 400 micrograms MR OD

2 - 5-alpha reductase inhibitor - can take up to 6 months to work
Finasteride 5mg OD PO

Phosphodiesterase-5 inhibitors can be used for severe LUTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are 6 indications for surgical management of BPH?

A

RUSHES

Recurrent refractory retention
UTIs, Recurrent
Stones in bladder
Haematuria, refractory
Elevated creatinine due to bladder outflow obstruction
Symptoms despite max medical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 3 surgical managements of BPH?

A

Transurethral incision of prostate <30g
Transurethral resection of prostate 30-80g
Open prostatectomy >80g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are 5 complications of BPH?

A

urinary retention
UTIs
bladder stones
renal dysfunction
haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are 3 complications of BPH surgery?`

A

retrograde ejaculation
erectile dysfunction
TURP syndrome - life threatening triad of fluid overload, dilutional hyponatraemia and neurotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What hormone does the prostate secrete?

A

Dihydrotestosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Chronic Kidney Disease?

A

Progressive deterioration in renal function, present for ≥3 months, with implications for health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the GFR value for CKD?

A

<60 ml/min/1.73 m2

At least 2 readings separated by at least 90 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is stage 1 CKD?

A

eGFR >90 PLUS evidence of renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is stage 2 CKD?

A

eGFR 60-89 PLUS evidence of renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is stage 3A CKD?

A

eGFR 45-59 ml/min/1.73m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is stage 3B CKD?

A

eGFR 30-44 ml/min/1.73m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is stage 4 CKD?

A

eGFR 15-29 ml/min/1.73m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is stage 5 CKD?

A

eGFR <15 ml/min/1.73m2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are 6 finding that can evidence renal damage?

A

Albuminuria ACR >3mg/mmol
Urine sediment abnormalities
Electrolyte and other abnormalities due to renal disfunction
Histological abnormalities
Structural abnormalities on imaging
Hx of kidney transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are 6 causes of CKD?

A

Diabetes - 1/3rd of people with DM
HTN
Polycystic kidney disease
Medications - NSAIDs, Lithium
Chronic Glomerulonephritis or pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are 5 early manifestations of CKD?

A

asymptomatic in early stages

Fatigue - due to toxin build up and anaemia due to reduced EPO

Polyuria or nocturia

HTN

Puffiness or swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are 8 later manifestations of CKD?

A

Decreased urine output
Fluid overload
Uraemic symptoms
Neuro symptoms - fatigue to seizures
Cardio symptoms
Anaemia symptoms
Bone and mineral disease
Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are 6 symptoms of uraemia?

A

nausea and vom
anorexia
metalic taste in mouth
hiccups
pruritus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are 3 investigations for CKD?

A

eGFR
Albumin creatinine ratio - urine spot sample - >3mg/mmol = proteinuria

FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the difference between CKD and AKI on renal US?

A

CKD = usually small b/l kidneys

other than if due to
- autosomal dominant polycystic kidney disease
- diabetic nephropathy
- amyloidosis
- HIV associate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

who in AKI should have a renal US?

A

if no identifiable cause or at risk of obstruction => US within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

when should you refer to renal in CKD? 3

A

eGFR <30

urinary ACR >70

Decrease in eGFR 25% or 15 within 1 year

5 Year risk of dialysis over 5%

Uncontrolled HTN with 4+ hypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the name of the formula that can be used to calculate eGFR?

A

Modification of diet in renal disease equation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the management for CKD?

A

Lifestyle advice - smoking, exercise, nephrotoxins, low salt and potassium diet

Optimise diabetic control
optimise HTn control
Reduce/avoid nephrotoxic drugs
Treat glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How is anaemia managed in CKD?

A

Target Hb 100-120 g/L
Optimise iron status

Erythropoiesis stimulating agents - Darbepoetin alfa,

Blood transfusions aren’t used as can sensitise immune system (allosensitization) and increase risk of future transplant rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the management of bone disease in CKD?

A

1 - reduced dietary phosphate intake

Vitamin D - alfacalcidol, calcitriol
Calcium intake and supplements

Phosphate binders - calcium based binders (calcium acetate) or Sevelamer

Bisphosphonates if osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

why does CKD cause bone disease?

A

Kidney cannot excrete enough phosphate or convert vitamin D to active form

Reduced phosphate excretion = increased calcium sequestration

Reduced active vitamin D = reduced calcium absoprtion

Reduced serum calcium = increased PTH

Increased PTH = increased osteoclastic activity to raise serum calcium = OSTEOMALACIA and OSTEOSCLEROSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is one sign of CKD bone disease on x-ray?

A

Rugger jersey spine on spinal X-ray

Sclerosis of both ends of vertebral body (more white) and osteomalacia (less white) in the central vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is the 1st line management of HTN in CKD with proteinuria?

A

ACEi

Need close potassium monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How should CVD risk be managed in CKD?

A

ACEi - for HTN + Proteinuria or Diabetes

Furosemide if eGFR <45 as lowers serum potassium

Atorvostatin 20mg for prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what SGLT-2 inhibitors are used in CKD?

A

DAPAGLIFLOZIN

In diabetes WITH urine ACR >30 mg/mmol

Consider in Diabetes with ACR 3-30 mg/mmol or non diabetic with ACR >22.6mg/mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what equation can be used to estimate 5 year risk of kidney failure requiring dialysis?

A

Kidney failure risk equation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are 5 complications of CKD?

A

anaemia - normochromic, normocytic
CKD metabolic bone disease
Cardiovascular disease
End stage kidney disease
Secondary hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what type of anaemia is seen in CKD?

A

Normocytic normochromic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what percentage of CO do the kidneys receive?

A

25%

- 1000 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is an epididymal cyst?

A

smooth, extratesticular spherical cyst in head of epididymus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what do epididymal cysts look like?

A

Contain clear or milky (spermatocele) fluid
Transluminate
Lie above and behind the testis
testis palpable and separate from cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what are 3 differentials for epididymal cyst?

A

spermatocele
hydrocele
varicocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is nephrotic syndrome?

A

the presence of proteinuria, hypoalbuminaemia, and peripheral oedema often caused by sclerosis of the podocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what are the 4 different nephrotic syndromes?

A

minimal change disease
focal segmental glomerulosclerosis
membranous nephropathy
Membranoproliferative glomerulonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the 5 features of nephrotic syndromes?

A
  1. Proteinuria (> 3.5 g/day)
  2. Hypoalbuminemia(< 30 g/L) which leads tooedema
  3. Hyperlipidaemia as the liver increases synthesis of lipids in response to low albumin
  4. Hypogammaglobulinemia: due to loss of immunoglobulin in the urine
  5. Hypercoagulability: due to loss of antithrombin III, and protein C and S in the urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what is there not in nephrotic syndromes?

A

HAEMATURIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are 5 general manifestations of nephrotic syndromes?

A 
hypertension 
frothy urine (lipids)
facial and peripheral oedema
recurrent infections 
predisposition to thrombotic events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what are 4 investigations for nephrotic syndromes?

A

Urinalysis:**proteinuria > haematuria, lipid casts
24-hour urine protein collection - > 3.5 g protein
Urine albumin-creatinine ratio (ACR) -raised due to proteinuria
U&Es - monitor eGFR and creatinine to assess for renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the most common nephrotic syndrome affecting children?

A

Minimal change disease

M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what might minimal change disease be preceded by?

A

a upper respiratory tract infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what cancer is associated with minimal change disease?

A

Hodgkin’s lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what 3 things can trigger minimal change disease?

A

recent infection
recent vaccination
immune stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

what are 3 risk factors for minimal change disease?

A

Hodgkin’s lymphoma
leukaemia
Hep B/C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what is the pathophysiology of minimal change?

A

T cells release cytokines-glomerular-permeability factor => flattens out podocytes (effacement) so they fuse together => allow albumin (but not immunoglobulins) into nephron => selective proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what are 3 investigations of minimal change disease?

A

urinalysis - red cast and oval bodies
24-hour urine protein - high
serum albumin - low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what are 3 differentials for minimal change?

A

acute glomerulonephritis
focal segmental glomerulosclerosis
congestive HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what is the management for minimal change disease?

A

corticosteroids - prednisolone!!!

fluid restriction and low salt diet
immunosuppressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what are 3 complications of minimal change disease?

A

spontaneous peritonitis
thrombosis
relapse in adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the most common cause of nephrotic syndrome is adults of African or hispanic descent?

A

Focal segmental glomerulosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what are 4 potential causes of focal segmental glomerulosclerosis?

A

heroine use
HIV infection
sickle cell disease
SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is seen on light microscopy in focal segmental glomerulosclerosis?

A

sclerosis and hyalinosis

only parts of some glomeruli are affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what are 4 causes of membranous nephropathy?

A

SLE
Drugs - NSAIDS, gold
infection - Hep B/C, syphilis
tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

is focal segmental glomerulosclerosis a nephrotic or Nephritic?

A

nephrOtic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

is minimal change disease nephrotic or nephritic?

A

nephrOtic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what is seen histologically in membranous nephropathy?

A

diffuse capillary and basement membrane thickening due to immune complex deposition
spike and dome pattern of basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what are two conditions that can cause nephropathy?

A

amyloidosis

diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what is nephrolithiasis?

A

kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what are 6 risk factors for renal stones?

A

Male
Prev stones
Dehydration
Hypercalcaemia, hypercalciuria, hyperparathyroid
Renal tubular acidosis
Gout - for urate stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what are 4 drugs that increase risk of renal stones?

A

Loop diuretics - furosemide
Steroids
Acetazolamide
Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what is the most common composition of renal stones?

A

calcium oxalate

black/dark brown stones, more likely to form in acidic urine
radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what are struvite renal stones associated with?

A

UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what can struvite renal stones cause?

A

Staghorn caliculi - branching calcifications due to recurrent UTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what type of renal stones are radiolucent?

A

Uric acid

Associated with gout and malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what causes cysteine renal stones?

A

Cystinuria in autosomal recessive cystinuria disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what are 5 manifestations of renal stones?

A

Loin to groin severe renal colic

Haematuria
Nausea and vomiting
reduced urine output
Symptoms of sepsis/infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what are 3 investigations for renal stones?

A

non-contrast CT kidney, ureter and bladder - GOLD
urinalysis - haematuria
U+Es - raised creatinine - AKI due to obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the 1st line investigation for renal stones?

A

Urinalysis - haematuria

bloods -inflammatory markers, u+e, bone profile and urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is the gold standard for renal stones and how quickly should it be done?

A

Non-contrast CT KUB

within 14 hours of admission or immediately in sepsis or one kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what is the initial management of renal stones?

A

IV fluids
anti-emetics - metoclopramide, prochlorperazine, cyclizine
NSAIDs - IM diclofenac or IV paracetamol if contraindicated
antibiotics - if infection
Alpha blockers - tamsulosin - cause smooth muscle relaxation may aid passage/ease pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what is the management for renal stones <5mm?

A

watchful waiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is the management of renal stones 5-10mm?

A

Shockwave lithotripsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what is the management of renal stones 10-20mm?

A

Shock wave lithotripsy or ureteroscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what is the management of renal stones >20mm?

A

percutaneous nephrolithotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what are 6 strategies for preventing renal stones?

A

Increase fluid intake
add lemon juice to drinking water
avoid carbonated drinks
limit salt intake
potassium citrate
thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what are 5 complications of renal stones?

A

obstruction and hydronephrosis
Urethral strictures
Infection and urosepsis
CKD and AKI
Recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what is testicular torsion?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what deformity makes testicular torsion more likely?

A

Bell clapper - testicle lies in more horizontal position and has improper attachment of tunica vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what are 5 risk factors for testicular torsion?

A

Young age - peak incidence 13-15 years
Trauma/exercise
undescended testicles
Bell-clapper deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what are 5 manifestations of testicular torsion?

A

severe testicular pain
elevated testicle
no relief upon scrotal elevation
scrotal swelling or oedema
abnormal testicular lie
absent cremasteric reflex
Rotation - non-posterior epididymis

Associated with nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what are 4 investigations for testicular torsion?

A

US testicle - fluid and whirlpool sign

power doppler ultrasound - decreased blood flow
colour doppler ultrasound - decreased blood flow
surgical exploration - gold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what sign might be seen on USS of the testicles in testicular torsion?

A

whirlpool sign - spiral appearance of spermatic cord and blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what is the management for testicular torsion?

A

nil by mouth
analgesia
urgent senior urology assessment
surgical exploration of scrotum
Bilateral orchiopexy
orchidectomy if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what is urethritis?

A

inflamation of the urethra - usually a sexually transmitted disease that typically presents with dysuria, urethral discharge, and/or pruritus at the end of the urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what are the 2 most common causative organisms of urethritis?

A

N. gonorrhoea - gram -ve diplococci

Chlamydia trachomatis - gram -ve - most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what are 3 risk factors for urethritis?

A

15-24 years
multiple sexual partners/new sexual partner
unprotected sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what are 5 manifestations of urethritis?

A

many asymptomatic

acute urethral discharge following unprotected sex
irritation/itching 
dysuria 
orchalgia/pelvic pain
no rash or arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what are 3 investigations for urethritis?

A

gram stain, microscopy and culture of urethral discharge/urine sediment
nucleic acid amplification test
blood cultures

107
Q

what are 3 differentials for urethritis?

A

UTI
candid balnitis/vaginitis
epididymitis

108
Q

what is the 1st and 2nd line treatment for chlamydia ?

A

1 - Doxycycline

2 - Azithromycine

109
Q

what are 3 complications of urethritis?

A

reactive arthritis
gonococcal conjunctivitis
prostatitis

110
Q

what is the most common causative organism of uncomplicated UTIs?

A

E. Coli

111
Q

what is classed as an uncomplicated UTI?

A

Caused by typical uropathogens in non-pregnant women with no known anatomical or functional abnormalities of the urinary tract

112
Q

what is classed as a recurrent UTI?

A

2+ UTIs in 6 months or 3 + in one year

113
Q

what are the 5 organisms that most often cause UTIs?

A

KEEPS

klebsiella pneumoniae
E. coli
Enterococci
Proteus aprophyticus
Staphylococcus saprophytic - coagulase -ve

114
Q

what are 9 risk factors for UTIs?

A

Sexual activity
Female
post-menopausal
Pregnancy - physiological urinary statsis and vesicoureteral reflux
Catheters
BPH/Prostitis
Dysfunctional voiding
Anatomical abnormalities - vesicoureteral reflux, renal stones
Immunosupression

115
Q

what are 7 manifestations of UTIs?

A

Dysuria
Frequency
Urgency
Cloudy/offensive smelling urine
Haematuria
Lower abdo pain
Fever - low grade
malaise

acute confusion in elderly

116
Q

what are 3 investigations for UTI?

A

urine dipstick - + nitrates and leukocytes
Urine MSU for MCS - always in complicated patients

117
Q

what is the management of uncomplicated UTI?

A

1 - Nitrofurantoin 100mg MR BD for 3 days
OR
Trimethoprim 200mg BD for 3 days

2 - Nitrofurantoin 100mg MR BD for 3 days
OR
Pivmecillinam 400mg initially then 200mg TDS for 3 days
OR
Pivmecillinam 3g single dose sachet

118
Q

when should women with haematuria be referred 2ww to urology?

A

> 45 with visible haematuria after successful UTI treatment
60 with unexplained non-visible haematuria and either and either dysuria or raised WCC

119
Q

when should women with recurrent UTIs be referred to Uro?

A

> 60 years recurrent or persistent unexplained UTI
40 and no know cause

120
Q

what are 5 self care measures women can take to prevent UTI?

A

avoid risk factors
maintain adequate hydration - 1.5L a day
Avoid douching and wearing occlusive underwear
Wipe from to back
Avoid delay or habitual or post coital urination

Do not recommend use of over the counter products of d-mannose

121
Q

what antibiotics can be used as prophylaxis in recurrent uncomplicated UTI?

A

1 - trimethoprim 100mg at night
OR Nitrofurantoin 50-100mg

2 - amoxicillin 250mg at night
OR cefalexin 125mg at night

122
Q

what is the management of UTI in pregnancy?

A

SEND FOR MCS

1 - Cefalexin 500mg TDS 7 days
OR
Amoxicillin 500mg TDS 7 days
OR
Nitrofurantoin 100mg MR BD 7 days
OR
Trimethoprim 200mg BD 7 days

123
Q

when should nitrofurantoin be avoided in pregnancy?

A

3rd trimester due to risk of neonatal haemolysis

124
Q

when should trimethoprim be avoided in pregnancy?

A

1st trimester works as a folate antagonist - congenital malformations, neural tube defects

125
Q

How should asymptomatic bacteriuria in pregnancy be managed?

A

immediately with same ABx as UTI - due to risk of progression to pyelo

126
Q

How long should complicated UTIs be treated for?

A

7 days

127
Q

what is a contraindication to nitrofuranoin?

A

eGFR <45

also avoid in 3rd trimester pregnancy

128
Q

what are 5 complications of UTI?

A

Acute/chronic pyelonephritis
Urosepsis
Renal/peri-renal abscess
AKI
Increased risk pre-term delivery in pregnancy

129
Q

what is varicocele?

A

the abnormal dilation of the internal spermatic veins and pampiniform plexus that drain blood from the testis caused by venous reflux

130
Q

which teste is varicocele most common in?

A

left - due to increased resistance in L testicular vein which drains into L renal vein whereas R testicular vein drains into IVC

131
Q

what are 2 risk factors for varicocele?

A

somatic factors - tall/ low BMI

132
Q

what are 6 manifestations of varicocele?

A

Throbbing, dull pain or discomfort worse on standing
Dragging sensation
Subfertility or infertility

O/E
- scrotal ‘bag of worms’ mass
- more prominent on standing
- disappears when lying

133
Q

when should varicoceles be referred for urgent investigation?

A

if do not disappear on lying - may be due to retroperitoneal tumours obstructing renal vein drainable

134
Q

what can be used to confirm diagnosis of varicocele?

A

US doppler
Semen analysis
Hormonal testing

135
Q

what is one possible surgical intervention for varicocele?

A

Surgery or endovascular embolization

136
Q

what are 3 complications of varicocele?

A

Infertility
Testicular atrophy
Pain

137
Q

what is nephritic syndrome?

A

inflammation of the glomerular basement membrane leading to haematuria and limited proteinuria

138
Q

what are the 6 different types of nephritic syndromes?

A 
post-streptococcal glomerulonephritis
IgA nephropathy
diffuse proliferative glomerulonephritis
membranoproliferative glomerulonephritis 
rapidly progressing glomerulonephritis
alport syndrome
139
Q

which 3 nephritic syndromes are caused by type III hypersensitivity?

A

post-streptococcal glomerulonephritis
IgA nephropathy
Diffuse proliferative glomerulonephritis

140
Q

what are 5 manifestations of nephritic syndromes?

A 
haematuria
proteinuria < 3.5g/day
arterial hypertension 
peripheral and peri-orbital oedema 
decreased urine output
141
Q

what are 3 investigations for nephritic syndromes?

A

bloods - increased creatinine and blood urea nitrogen
urinalysis - haematuria, RBC cast, proteinuria <3.5g/day
renal biopsy

142
Q

what is the management for nephritic syndromes?

A

immunosuppression - steroids
blood pressure control - ACEi/ARB (furosemide)
statins
omega-3 fatty acids

143
Q

what are 2 complications of nephritic syndromes?

A

AKI

CKD

144
Q

what is post-streptococcal glomerulonephritis?

A

nephritic syndrome occurring after pharyngitis or skin infection caused by streptococcus pyogenes infection

145
Q

what are 3 investigations of post-streptococcal glomerulonephritis?

A

bloods - low levels of C3 and CH50
positive streptozyme test
kidney biopsy

146
Q

what is IgA nephropathy?

A

an autoimmune nephritic syndrome caused by mesangial IgA immune deposits
age 16-35 most commonly

147
Q

what is the most common nephritis?

A

IgA nephropathy

148
Q

what are 4 risk factors for IgA nephropathy?

A

male
HIV
FHx
ethnicity - asian

149
Q

what usually precedes IgA nephropathy?

A

upper respiratory tract infection (or less usually gastroenteritis)

150
Q

what is the most common form of lupus nephritis?

A

diffuse proliferative glomerulonephritis - also worst prognosis

151
Q

what are 4 risk factors for membranoproliferative glomerulonephritis?

A

age 8-16
infections
CLL
acquired partial lipodystrophy

152
Q

what can cause rapidly progressive glomerulonephritis?

A

goodpasture’s syndrome

153
Q

what is Aport syndrome?

A

An X-linked genetic disease in which there’s a mutation in the gene that codes for type IV collagen - can cause nephritic syndrome due to glomerular basement membrane destruction

154
Q

what are 5 manifestations of Aport syndrome?

A 
hearing loss in late childhood/adolesence
retinopathy and lens dislocation
learning disability
haematuria
proteiuria
hypertension
oedema
fatigue and dyspnoea
155
Q

what is a fungi that can cause cystitis in the immunosuppressed and those with indwelling catheters?

A

Candida

156
Q

what is the surgical management for nephrolithiasis?

A

uteroscopy
extracorporeal shock wave lithotripsy
Percutaneous nephtolithotomy

157
Q

What drug is given to protect the myocardium in hyperkalaemia?

A

calcium glutinate - 10ml at 10%

158
Q

what drugs are given to drive potassium into the cells in hyperkalaemia?

A

Insulin + glucose

beta agonist - salbutamol

159
Q

what kind of anaemia can CKD causes?

A

normocytic normochronic

due to low EPO

160
Q

what are 4 manifestations of pyelonephritis?

A

tender loin
high fever and rigors
dysuria and urinary frequency
haematuria

161
Q

what is xanthogranulomatous pyelonephritis?

A

a chronic pyelonephritis caused by an infected kidney stone causing obstruction

162
Q

what is the most common causative pathogen of prostatitis?

A

E. coli

163
Q

what is the treatment for bacterial prostatitis?

A

14 days oral ciprofloxacin

164
Q

what are 3 complications of prostatitis?

A

acute urinary retention
chronic prostatitis
prostatic abscess

165
Q

what is prehn’s sign and what conditions is it positive in?

A

pain relief with lifting affected testicle

positive in orchitis and epididymitis
NEGATIVE IN TORSION

166
Q

what 2 genes are affected in autosomal dominant polycystic kidney disease?

A

PKD1 and PKD2

on chromosome 16 and 4 respectively

167
Q

what is the presentation of autosomal dominant polycystic kidney disease?

A

haematuria
loin pain
hypertension
recurrent UTIs
Kidney stones
SAH
palpable kidneys/mass

168
Q

what are 4 extrarenal manifestations of autosomal dominant polycystic kidney disease?

A

Cerebral aneurysm - berry
Hepatic, splenic, pancreatic, ovarian, prostatic cysts
Mitral regurgitation
Colonic diverticula

169
Q

what cardiac condition is associated with autosomal dominant polycystic kidney disease?

A

mitral regurg

170
Q

what are 6 complications of autosomal dominant polycystic kidney disease?

A

chronic loin/flank pain
hypertension
fross haematuria
recurrent UTIs
Renal stones
end stage renal failure around 50 years

171
Q

is autosomal dominant or recessive polycystic kidney disease more common?

A

dominant

recessive is more severe but less common

172
Q

what is the presentation of autosomal recessive polycystic kidney disease?

A

Usually on antenatal scans due to oligohydramnios which leads to underdeveloped foetal lungs and respiratory failure

often develop end stage renal failure before adulthood

May have dysmorphic features - underdeveloped ear cartilage, low set ears, flat nasal bridd=ge

173
Q

what medication can be used to slow development of cysts in autosomal dominant polycystic kidney disease?

A

Tolvaptan - vasopressin receptor antagonist

174
Q

where in the brain is the micturition centre?

A

the pons

175
Q

what is urge incontinence?

A

overactive bladder due to uninhibited detrusor muscle

176
Q

what is stress incontinence?

A

urine leaks out due to high abdominal pressure

177
Q

what are 3 causes of incontinence?

A

diabetes
bladder cancer
MS

178
Q

berry aneurysms are a complication of what renal disease?

A

autosomal dominant polycystic kidney disease

179
Q

what is the pharmacological management of stress incontinance?

A

Duloxetine

180
Q

What is the treatment for syphilis?

A

Benzanthine Penicillin and Azithromycin

181
Q

when is trimethoprim most teratogenic?

A

1st trimester

182
Q

when is nitrofurantoin not recommended in pregnancy?

A

3rd trimester

183
Q

what s oxybutynin used for?

A

overactive bladder

184
Q

is there hyperlipidaemia in nephritic syndromes?

A

NO!!! only nephrotic

185
Q

what condition can cause muddy brown casts on urinalysis?

A

acute tubular necrosis

186
Q

what is the 1st line treatment for Gonorrhoea?

A

cefriaxone IM 250mg

187
Q

what is the 1st line treatment for pyelonephritis is pregnancy?

A

cefelaxin

188
Q

what are the 6 functions of the kidney?

A

Fluid volume management
Waste excretion and selective reabsorption
RBC production
Vitamin D metabolism
Acid-base regulation
Blood pressure management

189
Q

what is glomerulonephritis?

A

any of a group of diseases that injure the part of the kidney that filters blood (the glomeruli).

190
Q

what are the characteristic finding is nephritic syndromes?

A

oedema
proteinuria
decreased protein and increased lipids in blood

191
Q

what are the characteristic features of nephritic syndromes?

A

blood in the urine (especially Red blood cell casts with dysmorphic red blood cells) and a decrease in the amount of urine in the presence of hypertension

192
Q

what are the criteria for the 2 week wait for bladder cancer?

A

45+ with unexplained visible haematuria without UTI

60+ with unexplained non-visible haematuria and either dysuria or a raised WCC

193
Q

what percentage of men with raised PSA will not have prostate cancer?

A

specificity = 30%

194
Q

what percentage of men with normal PSA will have prostate cancer?

A

sensitivity = 94%

195
Q

what are 5 medical conditions associated with erectile dysfunction?

A 
DM
CVD
liver failure
renal failure 
trauma
196
Q

what is the 1st line treatment for erectile dysfunction?

A

phsophodistesterase 5 inhibiters

SILDENAFIL

197
Q

what is a UTI?

A

bacteria in the urine combined with clinical features

198
Q

when would you refer someone with UTIs for a bladder cancer review?

A

60+ with recurrent/persistent UTIs

199
Q

what is the triad of pyelonephritis?

A

loin pain
fecer
pyuria (WBC in urine)

200
Q

what is the 1st line management of pyelonephritis?

A

co-amoxiclav

201
Q

what is the 1st line pyelonephritis management in someone with a penicillin allergy?

A

cefalexin

202
Q

what is the management of epididymal cysts?

A

Observation and scrotal support if needed

Aspiration and sclerotherapy
Surgical excision

203
Q

what is a hydrocele?

A

collection of fluid in the tunica vaginalis that surrounds the testes

204
Q

what is the presentation of hydrocele?

A

Swollen scrotum with testicles palpable inside hydrocele
Soft and fluctuant
Irreducible and no bowel sounds
Transilluminates

205
Q

what are 5 causes of hydrocele?

A

idiopathic

Testicular cancer
testicular torsion
Epididymo-orchitis
trauma

206
Q

what are the 2 different types of hydrocele?

A

Simple - just due to trapped fluid

Communicating - fluid coming from peritoneal cavity via the processus vaginalis leading to fluctuant size

207
Q

what is the management of a simple hydrocele?

A

usually self resolves

208
Q

what is the management of a communicating hydrocele?

A

ligation/removal of processus vaginalis

209
Q

what are 4 causes of epididymo-orchitis?

A

Escherichia coli
Chalmydia trachomatis
Neisseria gonorrhoea
Mumps - often only orchitis

210
Q

what is the presentation of epididymo-orchitis?

A

Gradual onset

Testicular pain
dragging or heavy sensation
swelling of testicle or epididymis
Tenderness on palpation
urethral discharge - chlamydia or gonorrhoea
Systemic symptoms

211
Q

what are 6 investigations for epididymo-orchitis?

A

urine MSC
first pass urine NAAT for chlamydia and gonorrhoea
Charcoal swab
saliva swab for mumps
serum antibodies for mumps
US testicles

212
Q

what is the management of e. coli epididymo-orchitis?

A

Ofloxacin 14 days

Levofloxacin 10 days

Co-amox 10 days - when quinolones contraindicated

213
Q

what are 2 side effects of quinolones?

A

Tendon damage and rupture - classically achilles
Lowers seizure threshold

214
Q

what are 5 complications of epididymo-orchitis?

A

Chronic pain
chronic epidiymitis
testicular atrophy
subfertility/infertility
Scrotal abscess

215
Q

what sign can distinguish testicular torsion from epididymo-orchitis?

A

Prehn sign

Pain relived on elevation of scrotum

216
Q

what is the management of unknow STI in epididymo-orchitis?

A

Ceftriaxone 500mg IM
PLUS
Doxycycline 100mg PO BD 10-14 days

217
Q

what is acute interstitial nephritis?

A

inflammation oedema and infiltration of connective tissues between renal tubules

218
Q

what re 3 causes of acute interstitial nephritis?

A

Drugs - most common
Systemic disease - SLE, sarcoidosis, Sjogren’s syndrome
Infection - hanta virus, staphylococci

219
Q

what are 6 medications that can cause acute interstitial nephritis?

A

Penicillin
Rifampicin
NSAIDs
Allopurinol
Furosemide
PPIs

220
Q

what are 4 features of acute interstitial nephritis?

A

Fever, rash, arthralgia
Eosinophilia
Mild renal impairment
Hypertension

221
Q

what are 3 urine dip/MCS results in acute interstitial nephritis?

A

High WCC WITHOUT infection
White cell casts
Protein

222
Q

what is the gold standard investigation for acute interstitial nephritis?

A

Renal biopsy

223
Q

what is renal tubular acidosis?

A

Metabolic acidosis due to pathology in renal tubules which balance H+ and HCO3- ions to maintain blood pH

224
Q

what is type 1 renal tubular acidosis?

A

Distal tubule cannot excrete H+ ions

Leads to high urinary pH

Lead to LOW serum potassium

225
Q

what is type 2 renal
tubular acidosis?

A

Proximal tubule cannot reabsorb bicarb

urinary pH = HIGH

Serum potassium = LOW

226
Q

what is type 4 renal
tubular acidosis?

A

Low aldosterone or impaired aldosterone function

Urinary pH = LOW

Serum potassium = HIGH

227
Q

what is the most common type of renal
tubular acidosis?

A

Type 4

228
Q

what is classed as high urinary pH?

A

pH >6

229
Q

what are 3 features of type 1 renal
tubular acidosis?

A

High urinary pH - due to absence of H+ ions

Metabolic acidosis - due to retained H+ ions

Hypokalaemia - due to failure of H+/K+ATPase

230
Q

what are 7 causes of type 1 renal
tubular acidosis?

A

genetic
SLE
Sjogren’s
Primary biliary cholangitis
Hyperthyroidism
Sickle cell anaemia
Marfan’s

231
Q

what is the management of types 1 and 2 renal
tubular acidosis?

A

oral bicarb

232
Q

what is the presentation of type 2 renal
tubular acidosis?

A

High urinary pH - excess bicarb in urine

Metabolic acidosis - inadequate bicarb retention

Hypokalaemia - urinary loss of potassium with bicarb

233
Q

what are 3 causes of type 2 renal
tubular acidosis?

A

Inherited
Multiple myeloma
Fanconi’s syndrome

234
Q

what is the pathophysiology o f type 4 renal
tubular acidosis?

A

Aldosterone usually stimulates sodium reabsorption and potassium and H+ excretion in distal tubules

when aldosterone dysfunctional there is increased potassium and H+ retention

Hyperkalaemia also suppresses ammonia production in distal tubule which usually buffers H+ ions in urine leading to acidic urine

235
Q

what is the presentation of type 4 renal
tubular acidosis?

A

Metabolic acidosis - due to retained H+ ions
Hyperkalaemia - due to retained potassium
Low urinary pH - due to reduced ammonia

236
Q

what are 3 causes of type 4 renal
tubular acidosis?

A

Adrenal insufficiency
Diabetic nephropathy
Meds - ACEi, spiro, eplerenone

237
Q

what is the management of type 4 renal
tubular acidosis?

A

Manage underlying

Fludrocortisone
Oral bicarb
Hyperkalaemia management

238
Q

what type of metabolic acidosis is seen in renal
tubular acidosis?

A

hyperchloremic metabolic acidosis with normal anion gap

239
Q

what is the most common intrarenal cause of AKI?

A

Acute tubular necrosis

240
Q

what is Acute tubular necrosis?

A

necrosis of the renal tubular epithelial cells severely affecting the functioning of the kidneys

241
Q

what are the 2 main causes of Acute tubular necrosis?

A

Ischaemia
Nephrotoxicity - med and rhabdo

242
Q

what are 10 drugs that can cause acute tubular necrosis?

A

Aminoglycosides - gent
Acyclovir
Sulfa drugs
Cisplatin
Radiocontrast medium
tacrolimus and ciclosporin
IVIG
Ethylene glycol
Lead
Myoglobin

243
Q

what is seen on urine MCS in Acute tubular necrosis?

A

muddy brown casts

244
Q

what is urine sodium like in acute tubular necrosis vs pre-renal AKI?

A

ATN >40 mmol/L

PR-AKI >20 mmol/L

245
Q

why is serum sodium high and urine sodium low in pre-renal AKI?

A

Kidneys hold on to sodium to preserve water and circulating volume

246
Q

what is urine osmolality like in acute tubular necrosis vs pre-renal AKI?

A

ATN <350 mOsm/Kg

PR-AKI >500 mOsm/Kg

247
Q

what is fractional sodium excretion like in acute tubular necrosis vs pre-renal AKI?

A

ATN >1%

PR-AKI <1%

248
Q

what is serum urea: creatinine ration like in acute tubular necrosis vs pre-renal AKI?

A

ATN = normal

PR-AKI = raised

249
Q

what are 9 causes of glomerulonephritis?

A

IgA nephropathy
Membranous nephropathy
Membranoproliferative glomerulonephritis
Post-streptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
Goodpasture syndrome
Henoch-schonlein purpura
Vasculitis - microscopic polyangiitis or granulomatosis with polyangiitis
Lupus nephritis

250
Q

what antibodies are present in goodpastures syndrome?

A

Anti-glomerular basement membrane antibodies

251
Q

what are 2 antibodies present in microscopic polyangiitis?

A

p-ANCA or MPO antibodies

252
Q

what are 2 antibodies present in granulomatosis with polyangiitis?

A

c-ANCA or PR3 antibodies

253
Q

what is Alport syndrome?

A

genetic condition leading to defects in type IV collagen needed in the glomerular basement membrane, cochlear, retina and cornea

254
Q

what is the inheritance of Alport syndrome?

A

X-linked dominant

255
Q

what ae 5 features of Alport syndrome?

A

microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus - protrusion of lens into anterior chamber

256
Q

what is seen on renal biopsy in Alport syndrome?

A

splitting of lamina densa on electron microscopy resulting in basket weave appearance

257
Q

what is Rhabdomyolysis?

A

breakdown of skeletal muscle due to myocyte apoptosis leading to AKI

258
Q

what are 4 things released in Rhabdomyolysis?

A

Myoglobin
Potassium
Phosphate
Creatinine Kinase

259
Q

what breakdown product in Rhabdomyolysis is particularly toxic in high concentrations?

A

myoglobin

260
Q

what are 5 causes of Rhabdomyolysis ?

A

Prolonged immobility/long lie
Extremely rigorous exercise
Crush injuries
Seizures
Statins

261
Q

what are 8 presentations of Rhabdomyolysis ?

A

Muscle pain
muscle weakness
muscle swelling
Oliguria
Red-brown urine
Fatigue
Nausea and vomiting
Confusion

262
Q

what are 4 investigations for Rhabdomyolysis?

A

Creatinine kinase - raised
Urine dip +ve for blood - myoglobinuria
U+Es deranged
ECG - for hyperkalaemia

263
Q

what is the management of Rhabdomyolysis ?

A

IV fluids

Correct hyperkalaemia

Dialysis if needed

Phase 4 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions