Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

FINALS > Renal & uro-genital > Flashcards

Renal & uro-genital Flashcards

1
Q

CKD

How is chronic kidney disease (CKD) scored using the G system?

A
  • G1 = GFR>90 but needs kidney damage (protein or haematuria) for Dx
  • G2 = GFR 60–90 but needs kidney damage (above incl. raised urine ACR) for Dx
  • G3a = GFR 45–59
  • G3b = GFR 30–44
  • G4 = 15–29
  • G5 = <15 end stage renal failure (ESRF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CKD

What variables does the Modification of Diet in Renal Disease equation use to calculate GFR?

A

CAGE –

  • Creatinine
  • Age
  • Gender
  • Ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CKD

How is CKD scored using the A system?

A
  • A1 = <3mg/mmol
  • A2 = 3–30mg/mmol
  • A3 = >30mg/mmol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CKD

What are the causes of CKD?

A
  • Systemic (v common) = DM, HTN
  • Glomerular = primary (IgA nephropathy) or secondary (SLE)
  • Vascular = vasculitis + renal artery stenosis
  • Tubulointerstitial = amyloidosis + myeloma
  • Congenital = PKD + Alport syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CKD

What is the clinical presentation of CKD?

A
  • Non-specific = nausea, HTN, anaemia, loss of appetite, pruritus, pallor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CKD

What initial investigations would you do in someone for CKD?

A
  • FBC = normocytic anaemia of chronic disease, check iron studies
  • U&E, Ca2+ (low), phos (high), PTH (high) = secondary hyperparathyroid
  • Albumin creatinine ratio (ACR) from first void urine ≥3mg/mmol = significant
  • Renal USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CKD

When would you refer someone with CKD to a nephrologist?

A
  • eGFR <30
  • ACR ≥70mg/mmol
  • Uncontrolled HTN despite ≥4 antihypertensives
  • Accelerated progression = decrease in eGFR of 15 or 25% in 12m
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CKD

What are the various complications of CKD and why they occur?

A
  • CVD = #1 cause of death
  • Inadequate waste excretion = uraemia (encephalopathy, pericarditis), high phosphate + potassium
  • Poor fluid balance regulation = HTN, oedema
  • Acid-base imbalance = metabolic acidosis
  • Reduced EPO = anaemia
  • Lack of vitamin D activation for calcium + waste excretion of phosphate = renal bone disease (osteomalacia, osteoporosis + osteosclerosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CKD
In CKD how do you manage…

i) CVD risk?
ii) oedema?
iii) anaemia?
iv) ESRF?

A

i) Atorvastatin
ii) Fluid + salt restriction or if not furosemide
iii) Correct iron deficiency first, then monthly s/c EPO
iv) Renal replacement therapy (haemodialysis, peritoneal dialysis or renal transplant)

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

CKD

What is the management of mineral bone disease in CKD?

A
  • Renal diet (avoid high K+ & phosphate foods) = first-line
  • Phosphate binders like calcium carbonate/acetate = second-line
  • Alfacalcidol for vitamin D deficiency or parathyroidectomy last-line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CKD

What is a side effect of using calcium based phosphate binders?

A
  • Hypercalcaemia

- Vascular calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
CKD
What is the management of proteinuria and HTN in CKD?
What's the criteria for starting?
How might this affect renal function?
What are your targets?
A
  • ACEi/ARB are first-line
  • DM + ACR >3, HTN + ACR >30, all with ACR >70
  • Decrease in eGFR of ≤25% or creatinine rise of ≤30% is acceptable
  • <140/90 or <130/80 if ACR >70
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CKD

What is the process of haemodialysis?

A
  • AV fistula (brachiocephalic, radiocephalic) created by vascular surgeons 8w before treatment or can use tunnelled cuffed catheter so they can be dialysed 3x/week in hospital via machine with counter-current flow of blood/dialysate, haemofiltration via decreased dialysate hydrostatic pressure.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CKD

When examining a fistula, what should you notice?

A
  • Palpable thrill

- Machinery murmur on auscultation

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

CKD

What is the process of peritoneal dialysis?

A
  • Dialysate is injected into abdominal cavity via a permanent catheter + filtration occurs using the peritoneal membrane as the dextrose concentration of the solution draws waste products from the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CKD

What are the 2 types of peritoneal dialysis?

A
  • Continuous ambulatory peritoneal dialysis (CAPD) = dialysate in peritoneum all day + changed about QDS, pts continue normal activities
  • Automated peritoneal dialysis (APD) = machine continuously replaces dialysate in abdomen overnight to optimise ultrafiltration over 8–10h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CKD
What are the 2 types of renal transplants?
What is the ongoing management?
What might you find on examination?

A
  • Living donor (lasts 12–15y) or deceased donor (lasts 10–12y)
  • Lifelong immunosuppression = tacrolimus, mycophenolate
  • Hockey-stick scar and palpable kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CKD

What are the main complications with haemodialysis?

A
  • Infection
  • Aneurysm
  • Thrombosis
  • Stenosis
  • STEAL syndrome = inadequate blood flow to limb distal of AV fistula leading to ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CKD
What is the key complication of peritoneal dialysis?
How does it present?
How do you manage it?

A
  • Peritonitis from coagulase-negative staphylococcus epidermidis
  • Abdo pain, pyrexia, cloudy PD fluid
  • Vancomycin in dialysate + PO ciprofloxacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CKD

What are some other complications of peritoneal dialysis?

A
  • Peritoneal sclerosis > failure
  • Constipation can make ineffective
  • Weight gain
  • Ultrafiltration failure overtime as dextrose absorbed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CKD

What are some complications of renal transplant?

A
  • Malignancy
  • Infection (incl unusual PCP, CMV, TB)
  • Graft rejection (hyperacute in mins, acute <6m or chronic >6m)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CKD

What is the difference between hyperacute and acute graft rejection?

A
  • Hyperacute = pre-existing Ab against ABO/HLA antigens leading to T2HR needing GRAFT REMOVAL
  • Acute = mismatched HLA, ?reversible with steroids + immunosuppressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

AKI

What is acute kidney injury (AKI) defined by?

A

Abrupt deterioration in renal function leading to…

  • Increase of serum creatinine of 26.5umol/L <48h
  • Increase in serum creatinine ≥1.5x baseline within 1w OR
  • Urine output <0.5ml/kg/h for 6h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

AKI

What are the three stages of AKI?

A
  • Stage 1 = creatinine 1.5–1.9x baseline, UO <0.5ml/kg/h for 6h, creatinine rise ≥26 in 48h
  • Stage 2 = creatinine 2–2.9x baseline, UO <0.5ml/kg/h for 12h
  • Stage 3 = creatinine ≥3x baseline, UO <0.3ml/kg/h for ≥4h or creatinine >354
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
AKI | How is the aetiology of AKI divided?
- Pre-renal = impaired perfusion of the kidneys - Renal = instrinsic kidney damage - Post-renal = obstructive uropathy causing urine backflow affecting renal function
26
AKI | What are some pre-renal causes of AKI?
- Shock = hypovolaemia, cardiogenic, sepsis | - Atherosclerosis = renal artery stenosis
27
AKI | What are some renal causes of AKI?
- Glomerular = glomerulonephritis - Tubules = acute tubular necrosis - Interstitium = acute interstitial nephritis (can be caused by penicillins) - Vessels = HUS, vasculitis - Tumour lysis syndrome + rhabdomyolysis
28
AKI | What are some post-renal causes of AKI?
- Stones - Renal/urinary tract malignancy - BPH
29
AKI | What are some risk factors for developing an AKI?
- Age ≥75 - CKD + renal transplant - Heart failure + hypovolaemia - DM - Nephrotoxic drugs = NSAIDs, aminoglycosides, ACEi/ARBs, diuretics, contrast
30
AKI | What are the complications and so clinical presentation of AKI?
- Hyperkalaemia = arrhythmias = cardiac arrest - Fluid overload = pulmonary + peripheral oedema - Metabolic acidosis - Oliguria - Uraemia > encephalopathy, pericarditis
31
AKI What investigations would you do in AKI? What result would make you think of dehydration as a cause?
- FBC, U&E, LFT, glucose, clotting, calcium, ABG - Urinalysis, bladder scan, ECG, CXR - Renal USS <24h if ?cause + risk of urinary tract obstruction - Urea proportionally higher than rise in creatinine
32
AKI | What is the management of a pre-renal AKI?
- IV fluids if hypovolaemia - IV Abx if septic - Stop DAMN drugs (Diuretics, ACEi, Metformin, NSAIDs) also gent - Suspend renally excreted drugs = lithium, digoxin - Adjust renally excreted drugs = opioids (oxycodone preferred) - Monitor fluid balance input/output
33
AKI | What is the mechanism of NSAIDs and ACEi causing AKI?
- Prostaglandins cause DILATION of AFFERENT arterioles so NSAIDs cause CONSTRICTION + so reduced perfusion/GFR - Angiotensin-II causes CONSTRICTION of EFFERENT arterioles so ACEi cause DILATION + so reduced pressure/GFR
34
AKI What is the management of... i) renal AKI? ii) post-renal AKI?
i) Nephrology review to identify the less common causes | ii) Catheterisation + urology r/v
35
AKI | What are the indications for acute dialysis?
AEIOU – - Acidosis (severe metabolic pH <7.2) - Electrolyte imbalance (persistent refractory hyperkalaemia >7) - Intoxication (poisoning) - Oedema (refractory pulmonary oedema) - Uraemia (encephalopathy or pericarditis)
36
HYPERKALAEMIA | What are the causes of hyperkalaemia?
- Impaired excretion = AKI/CKD, ACEi, K+ sparing diuretics, LMWH, Addison's - Increased release = rhabdo, tumour lysis, lactic acidosis
37
HYPERKALAEMIA | What investigations would you do in hyperkalaemia?
- U&Es > mild 5.5–5.9, moderate 6.0–6.4, severe ≥6.5 - ECG (tall-tented T waves, small P waves + widened QRS) - Can eventually lead to sinusoidal pattern + asystole or VF
38
HYPERKALAEMIA When would hyperkalaemia require emergency treatment? What first-line treatment would you give? How does it work?
- Severe ≥6.5 or ≥6 WITH ECG changes - IV calcium gluconate 10ml of 10% - Stabilises the myocardium, does NOT impact potassium levels
39
HYPERKALAEMIA What other acute treatment is given in emergent hyperkalaemia? What does this do to potassium levels?
- Combined insulin/dextrose infusion (actrapid 10 units/dex 50ml of 50%) - Nebulised salbutamol - Short-term shift of K+ from ECF > ICF
40
HYPERKALAEMIA | What treatments for hyperkalaemia actually removes the potassium from the body?
- Calcium resonium (PO or enema which is more effective as K+ secreted from rectum) - Loop diuretics (furosemide) - Dialysis if refractory hyperkalaemia >7mmol/L
41
RENAL STONES | What are the different types of renal stones that you can get?
- Calcium oxalate = #1, radiopaque - Calcium phosphate = RTA types 1 + 3 - Struvite = staghorn calculi, associated with Proteus mirabilis + recurrent UTI - Cysteine = semi-opaque, ground glass appearance, seen in AR cystinuria - Xanthine + uric acid stones = radiolucent
42
RENAL STONES | What are some risk factors for the development of renal stones?
- Dehydration - Hypercalciuria + hypercalcaemia - Hyperparathyroidism - Drugs (calcium stones) = loop diuretics, steroids, acetazolamide
43
RENAL STONES | What is the clinical presentation of renal stones?
- Renal colic = unilateral loin>groin, fluctuates in onset and severity - Haematuria - N+V
44
RENAL STONES | What initial investigations would you do in renal stones?
- Urine dipstick = haematuria and send urine MC&S - FBC, CRP (infection), U&E to monitor electrolytes - Calcium + urate levels
45
RENAL STONES What is the first-line and gold standard imaging? What might it show? What other imaging would you consider and why?
- Non-contrast CT KUB = peri-ureteric stranding ?recent stone passage - XR for Mx as need visible stone for extracorporeal shockwave lithotripsy
46
RENAL STONES | What is a key complication of renal stones?
- Obstruction, commonly at ureteropelvic junction, pelvic brim or vesicoureteric junction leading to AKI or infection with obstructive pyelonephritis
47
RENAL STONES | How can you prevent calcium stone formation?
Decrease hypercalciuria – - High fluid intake, low animal protein + low salt diet - Thiazide diuretics to increase distal tubular calcium resorption
48
RENAL STONES | How can you prevent oxalate stones?
- Cholestyramine + pyridoxine to reduce urinary oxalate secretion
49
RENAL STONES | How can you prevent uric acid stones
- Allopurinol ± urinary alkalinisation (e.g., PO bicarb)
50
RENAL STONES When would renal stones need emergency management? How would you manage it?
- Ureteric obstruction with infection | - Decompression via nephrostomy tube, ureteric catheter or stent
51
RENAL STONES | What is the management for renal stones?
- NSAID analgesia = IM diclofenac 75mg - Ureteric calculi <5mm = expectant - Stone burden <2cm = extracorporeal shockwave lithotripsy - Stone burden <2cm in pregnancy = ureteroscopy - Complex renal calculi + staghorn = percutaneous nephrolithotomy
52
URINARY TRACT INFECTION What is the pathophysiology of urinary tract infections (UTI)? What is the most common cause? What are some other causes?
- Trans-urethral ascent of colonic commensals - E.coli (gram -ve anaerobic rod) - Klebsiella, Proteus, pseudomonas
53
URINARY TRACT INFECTION | What are some risk factors for UTIs?
- Women (shorter urethra than men) - Pregnancy - Catheters - Renal stones
54
URINARY TRACT INFECTION | What is the clinical presentation of lower UTIs?
- LUTS = dysuria, increased frequency, urgency, offensive urine, haematuria - Suprapubic tenderness - Low-grade fever
55
URINARY TRACT INFECTION What is the clinical presentation of upper UTIs? What are some complications of this?
- Loin/back pain with renal angle tenderness on examination - Fever, N+V - Renal abscess, chronic pyelonephritis + sepsis
56
URINARY TRACT INFECTION What first-line investigations would you do in suspected UTI? What results would confirm the diagnosis?
- Urine dipstick + send off MSU for MC&S - Nitrites + leukocytes (nitrites suggest bacteria, isolated leukocytes not UTI) - Haematuria may be present
57
URINARY TRACT INFECTION | What additional investigations would you consider in pyelonephritis?
- Routine bloods show raised inflammatory markers (WCC, CRP) | - Renal USS to look for hydronephrosis if severe infection + ?post-renal AKI
58
URINARY TRACT INFECTION What is the management of UTI in... i) not pregnant women? ii) symptomatic pregnant women? iii) men? iv) catheterised not-pregnant? v) catheterised pregnant?
i) Nitrofurantoin or trimethoprim for 3d ii) Nitrofurantoin (avoid 3rd trimester), 2nd line = amoxicillin or cefalexin iii) Nitrofurantoin or trimethoprim for 7d iv) ONLY if symptomatic give nitrofurantoin or trimethoprim for 7d v) Cefalexin for 7d
59
URINARY TRACT INFECTION How would you detect asymptomatic bacteriuria in pregnant women? How and why is it managed?
- Sample sent at first antenatal visit | - Immediate nitro if not amox/cefalexin with follow-up test of cure due to risk of progression to pyelonephritis
60
URINARY TRACT INFECTION | What antibiotic should absolutely not be given to pregnant women and why?
- Trimethoprim, folate antagonist + teratogenic in first trimester
61
URINARY TRACT INFECTION How do you manage pyelonephritis in the community? How do you manage someone severely unwell with pyelonephritis?
- PO cefalexin (7–10d) or PO ciprofloxacin (7d) | - Admission, broad-spectrum IV Abx (e.g., cipro, gent)
62
RENAL CELL CARCINOMA What is a renal cell carcinoma (RCC)? What is the most common histological subtype?
- Adenocarcinoma of renal cortex arising from PCT epithelium | - Clear cell
63
RENAL CELL CARCINOMA | What are some associations of RCC?
- Male aged >55 - Smoking, obesity, HTN - Von-Hippel-Lindau syndrome + tuberous sclerosis
64
RENAL CELL CARCINOMA What is the classic clinical presentation of RCC? What other complications may arise form it?
- Triad of haematuria, loin pain and palpable abdominal mass - Endo = may secrete EPO (polycythaemia), PTH (hypercalcaemia), renin + ACTH (HTN) - LEFT varicocele > occlusion of L testicular vein which drains into L renal vein
65
RENAL CELL CARCINOMA What is the 2ww criteria for suspected RCC? What investigations would you consider?
- ≥45 with unexplained visible haematuria without UTI/after treatment - Urinalysis = haematuria - USS renal ?mass, CT/MRI abdomen for Dx - CXR may show classic cannonball metastases in the lung
66
RENAL CELL CARCINOMA | What is the management of RCC?
- Confined disease = partial (T1 lesions) or radical nephrectomy (T2 + above) - Often resistant to chemo and radiotherapy
67
BLADDER CANCER | What are the types of bladder cancer?
- Most common = transitional cell carcinoma | - Regions affected by schistosomiasis = squamous cell carcinoma
68
BLADDER CANCER | What are the risk factors for the two main types of bladder cancer?
- Smoking (TCC + SCC) - Exposure to aromatic amines (rubber, dyes, chemical industry) for TCC - Schistosomiasis (SCC)
69
BLADDER CANCER | What is the clinical presentation of bladder cancer?
- Classically painless, macroscopic haematuria - May present with UTIs and hydronephrosis - Systemic = weight loss, night sweats
70
BLADDER CANCER | What is the 2ww criteria for bladder cancer?
- ≥45 + unexplained visible haematuria without UTI/after treatment - ≥60 + unexplained non-visible haematuria WITH dysuria or raised WCC
71
BLADDER CANCER | What is the diagnostic investigation for bladder cancer?
- Flexible/rigid cystoscopy with biopsy | - CT/MRI CAP for staging
72
BLADDER CANCER What counts as muscle non-invasive bladder cancer? What is the management?
- Carcinoma in situ, Ta + T1 | - Transurethral resection of the bladder tumour (TURBT) ± intravesical chemotherapy ± BCG immunotherapy
73
BLADDER CANCER What is the management of muscle invasive bladder cancer? What happens afterwards?
- Radical cystectomy with urinary diversion - Urostomy formation e.g., ileal conduit, neo-bladder - Radio/chemotherapy may be offered in either curative or palliative capacity
74
PROSTATE CANCER What is the histology of prostate cancers? What are some risk factors?
- Majority adenocarcinoma affecting peripheral zone - Non-modifiable = African ethnicity, FHx, increasing age - Modifiable = obesity, smoking
75
PROSTATE CANCER | What is the clinical presentation of prostate cancer?
- LUTS = urgency, hesitancy + retention - Erectile dysfunction - Metastatic = bone pain - Asymmetrical, hard, nodular prostate with loss of central sulcus on DRE
76
PROSTATE CANCER What blood test would you consider in prostate cancer? How would you act on it?
- Prostate specific antigen (PSA) | - Men 50–69 2ww if PSA ≥3.0ng/ml OR abnormal DRE
77
PROSTATE CANCER What are the drawbacks of the PSA test? What contributes to this?
- Poor sensitivity + specificity with high rate of false +ve/-ve so need counselling prior but >50 can request - False +ve = prostatitis, UTI, BPH, vigorous DRE/exercise, ejaculation
78
PROSTATE CANCER What is the first line investigation for prostate cancer? What other investigations would you do?
- Multiparametric MRI reported using Likert scale (≥3 go on for transrectal ultrasound guided biopsy) - CT CAP + isotope bone scan for staging, graded using Gleason grading system
79
PROSTATE CANCER | What is the management of localised prostate cancer (T1/2)?
- Conservative = active monitoring + watchful waiting - Radical prostatectomy - Radiotherapy = external beam + brachytherapy
80
PROSTATE CANCER | What is the management of localised advanced prostate cancer (T3/4)?
- Hormonal therapy with synthetic GnRH agonists (Goserelin) and anti-androgens (Bicalutamide) - Radical prostatectomy - Radiotherapy as previous
81
PROSTATE CANCER | What is the mechanism of action of synthetic GnRH agonists in prostate cancer management?
- Paradoxically blockades LH/FSH at pituitary causing overstimulation which disrupts feedback systems - Leads to transient testosterone increase for 2–3w before falling to castration levels so need anti-androgen cover to prevent tumour flair
82
PROSTATE CANCER What are the complications of... i) hormonal therapy? ii) radical prostatectomy? iii) radiotherapy?
i) Libido loss, gynaecomastia, osteoporosis, weight gain, infertility ii) Erectile dysfunction iii) Increased risk of bladder + colorectal cancer, proctitis
83
PROSTATE CANCER | What is the management of metastatic prostate cancer?
- Hormonal therapy (Goserelin and bicalutamide)
84
TESTICULAR CANCER | What are the two main types of testicular cancers?
- 95% germ-cell tumours (seminoma #1, non-seminomatous e.g., embryonal, teratoma, yolk sac, choriocarcinoma) - Non-germ cell tumours (Leydig cell tumours + sarcomas)
85
TESTICULAR CANCER | What are some risk factors for developing testicular cancer?
- Cryptorchidism - Infertility - FHx - Klinefelter's syndrome - Mumps orchitis
86
TESTICULAR CANCER | What is the clinical presentation of testicular cancer?
- Painless lump (hard, irregular, non-fluctuant) - Hydrocele - Men aged 20–30 - Gynaecomastia
87
TESTICULAR CANCER | Why does gynaecomastia occur in testicular cancer?
- Increased oestrogen:androgen ratio as germ-cell tumours release hCG leading to Leydig cell dysfunction so rise in oestradiol >testosterone
88
TESTICULAR CANCER | What investigations would you do for testicular cancer?
- Tumour markers non-seminomas = AFP ± beta-hCG, seminomas = LDH (few have beta-hCG) - First-line = USS scrotum - CT CAP for staging (Royal Marsden)
89
TESTICULAR CANCER | What is the management of testicular cancer?
- Radical orchidectomy with prosthesis + sperm banking | - Chemo/radiotherapy may be given depending on staging
90
BPH What is the pathology of benign prostatic hyperplasia (BPH)? What are some risk factors?
- Hyperplasia of the stromal + epithelial cells of the prostate in the transition zone - Age + ethnicity (black > white > Asian)
91
BPH | What is the clinical presentation of BPH?
- Voiding = straining, hesitancy, weak/intermittent flow, incomplete emptying - Storage = urgency, frequency, incontinence, nocturia - Post-micturition = terminal dribbling - DRE = smooth, symmetrical with maintained central sulcus
92
BPH | What are some investigations for BPH?
- Urinalysis, U&E, PSA (if obstructive Sx) - Urinary frequency-volume chart for at least 3d - International prostate symptom score assesses impact of LUTS on QOL
93
BPH | What are some complications of BPH?
- UTI - Urinary retention (acute or chronic) - Obstructive uropathy > AKI
94
BPH What is the first line management of BPH? How does it work? Side effects?
- Alpha-1 antagonists (tamsulosin) - Decreases smooth muscle tone of prostate + bladder, helps voiding Sx - Postural hypotension, dizziness, dry mouth
95
BPH What is the second line management of BPH? How does it work?
- 5 alpha-reductase inhibitors (finasteride) - Blocks testosterone > dihydrotestosterone conversion causing reduction in prostate volume + can slow disease progression (can take 6m)
96
BPH When are 5 alpha-reductase inhibitors indicated? What are some side effects?
- Significantly enlarged prostate + high risk of progression | - Erectile dysfunction, reduced libido, ejaculation problems
97
BPH | When would you consider combining both tamsulosin and finasteride?
- Mod-severe voiding Sx and prostatic enlargement
98
BPH Other than medical management, what other management may be considered for BPH? What are the potential complications?
- Transurethral resection of prostate | - Bleeding, infection, erectile dysfunction, urethral strictures
99
NEPHROTIC SYNDROME What is the pathology of nephrotic syndrome? What are the classic findings?
- Increased permeability of serum protein through a damaged basement membrane - Triad of: – Proteinuria >3g/24h (>1g/m^2/24h or +++ in paeds) = frothy urine – Hypoalbuminaemia <30g/L (<25g/L in paeds) – Oedema
100
NEPHROTIC SYNDROME | What are the three main conditions which make up nephrotic syndromes and what's the epidemiology?
- Minimal change disease = #1 in paeds 2–5y/o - Membranous glomerulonephritis = commonest overall, bimodal peak in 20s + 60s - Focal segmental glomerulosclerosis = #1 in adults, more common in Afro-Carribbean
101
NEPHROTIC SYNDROME What are the causes of... i) minimal change disease? ii) membranous glomerulonephritis? iii) focal segmental glomerulosclerosis?
i) #1 idiopathic, drugs (NSAIDs, rifampicin), Hodgkin's lymphoma ii) #1 idiopathic, cancers, infections (hep B), SLE iii) Idiopathic, HIV, Alport's
102
NEPHROTIC SYNDROME What does renal biopsy/histology show in... i) minimal change disease? ii) membranous glomerulonephritis? iii) focal segmental glomerulosclerosis?
i) Normal light microscopy, podocyte fusion + foot process effacement on electron ii) IgG + complement deposits on basement membrane iii) Focal + segmental sclerosis
103
NEPHROTIC SYNDROME What is the management of... i) minimal change disease? ii) membranous glomerulonephritis? iii) focal segmental glomerulosclerosis?
i) Majority steroid responsive, if not cyclophosphamide, relapse likely ii) BP control with ACEi/ARB, steroids iii) Steroids/cyclophosphamide, may progress to ESRF
104
NEPHROTIC SYNDROME | What investigations would you do in suspected nephrotic syndrome?
- Urinalysis (proteinuria) + urinary ACR (raised) - FBC, CRP/ESR, complement C3/4 levels, autoimmune screen - Renal biopsy in ALL adults but ONLY in children if atypical presentation
105
NEPHROTIC SYNDROME | What are some complications from nephrotic syndrome?
- VTE risk due to loss of antithrombin III - Hyperlipidaemia - Infection due to urinary immunoglobulin loss - Loss of thyroxine-binding globulin lowers total but not free thyroxine levels
106
NEPHRITIC SYNDROME What is nephritic syndrome? How does it present?
- Immune complexes trigger an inflammatory response - Haematuria (micro or macroscopic) - Fluid retention > HTN - Proteinuria but not nephrotic range (<3g/L)
107
NEPHRITIC SYNDROME | What are the 4 main types of nephritic syndrome?
- IgA nephropathy (Berger's disease) = commonest primary glomerulonephritis - Post-streptococcal glomerulonephritis - Membranoproliferative glomerulonephritis - Rapidly progressive glomerulonephritis
108
NEPHRITIC SYNDROME How does IgA nephropathy present? What is the histology of IgA nephropathy?
- Macroscopic haematuria in young people ONE TO TWO DAYS post URTI - IgA deposits + glomerular mesangial proliferation
109
NEPHRITIC SYNDROME | How is IgA nephropathy managed?
- Follow-up - ACEi if proteinuria - Active disease = steroids
110
NEPHRITIC SYNDROME What causes post-streptococcal glomerulonephritis? What pertinent investigations would you see?
- Proteinuria ONE TO TWO WEEKS post Strep pyogenes tonsillitis/impetigo - Low complement levels + raised ASO titre
111
NEPHRITIC SYNDROME What is membranoproliferative glomerulonephritis? How does it present?
- Capillary basement membrane thickening associated with hepatitis - Nephritic or nephrotic
112
NEPHRITIC SYNDROME What are the causes of rapidly progressive glomerulonephritis? What is it classically associated with?
- Goodpasture's syndrome, granulomatosis with polyangiitis | - Associated with formation of epithelial crescents in majority of glomeruli
113
TESTICULAR TORSION What is testicular torsion? What is the epidemiology?
- Twisting of testis + spermatic cord > testicular ischaemia | - Teenagers
114
TESTICULAR TORSION | What are some causes of testicular torsion?
- Trauma | - Bell-clapper deformity = tunica vaginalis has abnormally high attachment to the spermatic cord
115
TESTICULAR TORSION | What is the clinical presentation of testicular torsion?
- Tender, red testicle which may be swollen + retracted upwards - Acute abdo pain (lower abdo/scrotal) - N+V - Loss of cremasteric reflex - Elevation of testis does NOT ease pain (Prehn's sign differentiates from epididymitis)
116
TESTICULAR TORSION What is a key differential of testicular torsion? How does it present?
- Torsion of testicular appendage (hydatid) = remnant of Mullerian duct - Can rapidly enlarge prior to puberty due to gonadotropins = blue dot sign
117
TESTICULAR TORSION | What investigations would you do in testicular torsion?
- Doppler USS = decreased blood flow (testicular ischaemia) but do NOT delay surgical exploration until torsion excluded
118
TESTICULAR TORSION | What is the management of testicular torsion?
- Urgent surgical exploration = untort <6h, fixate both testes (orchidopexy) - Orchidectomy if testicle dead
119
EPIDIDYMO-ORCHITIS What is epididymo-orchitis? What is a key DDx?
- Infection of the epididymis + testes due to local spread of genital tract infections - Testicular torsion
120
EPIDIDYMO-ORCHITIS | What are the causes of epididymo-orchitis?
- <35, new sexual partners in past 12m + urethral discharge = STI (#1 = chlamydia trachomatis, neisseria gonorrhoea) - >35 more likely E. coli - Can be mumps
121
EPIDIDYMO-ORCHITIS | What is the clinical presentation of epididymo-orchitis?
- Unilateral testicular pain + swelling - ?Urethral discharge - Prehn's sign positive
122
EPIDIDYMO-ORCHITIS | What are the investigations and management of epididymo-orchitis?
- Urine MC&S, chlamydia + gonorrhoea NAAT on first pass urine, USS scrotum - Organism unknown = IM ceftriaxone 500mg STAT + doxycycline 100mg PO BD 10–14d
123
HYDROCELE What is a hydrocele? What are the two types? What are the causes?
- Accumulation of fluid within the tunica vaginalis - Communicating + non-communicating - Idiopathic or secondary to testicular cancer, torsion, epididymo-orchitis + trauma
124
HYDROCELE | What is the difference between communicating + non-communicating hydroceles?
- Communicating = patency of processus vaginalis > peritoneal fluid drains into scrotum (newborn males, usually resolve within first few months) - Non-communicating = excess fluid production within tunica vaginalis
125
HYDROCELE | What is the clinical presentation of hydrocele?
- Soft, non-tender swelling of hemi-scrotum - Swelling confined to scrotum + can get ABOVE mass on examination - Transilluminates with pen torch
126
HYDROCELE | What are the investigations and management for hydrocele?
- USS to confirm Dx esp. in adults to exclude tumour - Paeds = repair if not resolved by 1-2y - Adults = conservative if not severe
127
VARICOCELE What is a varicocele? Where does it normally affect?
- Abnormal dilatation of the testicular veins (pampiniform plexus) - L due to angle of L testicular vein entering the L renal vein
128
VARICOCELE | What is the clinical presentation of varicocele?
- 'Bag of worms' - Heavy dragging sensation - More prominent on standing - Subfertility
129
VARICOCELE | What are the investigations + management of varicocele?
- USS with doppler studies | - Conservative unless pain then embolisation or surgery
130
EPIDIDYMAL CYST | What are some associations with epididymal cysts?
- Polycystic kidney disease - Cystic fibrosis - Von Hippel-Lindau syndrome
131
EPIDIDYMAL CYST | What is the clinical presentation of an epididymal cyst?
- Separate from the body of the testicle | - Found posterior to testicle
132
EPIDIDYMAL CYST | What is the investigations + management of epididymal cysts?
- Diagnosis = USS | - Conservative but surgical removal or sclerotherapy if larger or symptomatic
133
PROSTATITIS What is the most common cause for prostatitis? What are some risk factors?
- E. coli | - Recent UTI, catheter, recent prostate biopsy, epididymitis
134
PROSTATITIS | What is the clinical presentation of prostatitis?
- Pain can be referred to perineum or prostate - LUTS = dysuria, frequency, urgency - Systemic = fever + rigors
135
PROSTATITIS | What investigations would you do in prostatitis?
- DRE = tender, warm, swollen prostate gland - MSU for MC&S - Screen for STIs with NAAT testing on first pass urine
136
PROSTATITIS | What is the management of prostatitis?
- Analgesia | - 14d course of quinolone e.g., ciprofloxacin
137
POLYCYSTIC KIDNEY DISEASE | What are the two types of polycystic kidney diseases (PKD) and what are the genetics behind it?
Autosomal dominant – - PKD1 polycystin 1 = chromosome 16 in 85%, renal failure earlier - PKD2 polycystin 2 = chromosome 4 in 15%, renal failure later Autosomal recessive – - Fibrocystin gene on chromosome 6
138
POLYCYSTIC KIDNEY DISEASE | What is the pathophysiology of autosomal dominant PKD?
- Cystic dilation of renal tubular epithelium leading to destruction of renal parenchyma - Can be clear, turbid or bloody fluid
139
POLYCYSTIC KIDNEY DISEASE | What is the pathophysiology of autosomal recessive PKD?
- Fibrocystin responsible for renal tubulogenesis so often presents in pregnancy with oligohydramnios leading to pulmonary hypoplasia + potentially Potter syndrome requiring early dialysis
140
POLYCYSTIC KIDNEY DISEASE | What is the clinical presentation of PKD?
- Renal = flank pain, HTN, haematuria, palpable costovertebral masses - Extra-renal = cysts (liver, pancreas, spleen), SAH (berry aneurysms), mitral valve prolapse (regurg), diverticular disease
141
POLYCYSTIC KIDNEY DISEASE | What are the investigations for PKD?
- Diagnosis by renal USS + genetic testing - Screening for relatives = abdominal USS - Monitoring = U&E, regular USS
142
POLYCYSTIC KIDNEY DISEASE | What medical management would you consider in PKD and why?
- Tolvaptan = vasopressin receptor 2 antagonist | - Can slow development of cysts + progression of renal failure
143
POLYCYSTIC KIDNEY DISEASE | What conservative management is there in PKD?
- Treat complications (HTN) - Genetic counselling - Avoid contact sports due to risk of cyst rupture - Avoid anti-inflammatory meds + anticoagulants
144
ERECTILE DYSFUNCTION What is erectile dysfunction? What are some risk factors?
- Persistent inability to attain + maintain an erection sufficient to permit satisfactory sexual performance - CVD risk factors, alcohol, drugs (SSRIs, beta-blockers)
145
ERECTILE DYSFUNCTION | What are some causes of erectile dysfunction?
- Vascular = atherosclerosis - Autonomic neuropathy (DM) - Psychogenic (sudden onset, decrease libido) - Pelvic surgery = bladder, prostate - Peyronie's disease = fibrous scar tissue on penis (bent, painful erections)
146
ERECTILE DYSFUNCTION | How would you investigate erectile dysfunction?
- Young man always had difficulties = urology - Free testosterone measured 9–11am - If low/borderline then repeat with FSH/LH + prolactin and if abnormal = endo referral
147
ERECTILE DYSFUNCTION What is the first-line management of erectile dysfunction? What is offered if that isn't acceptable?
- Phosphodiesterase-5 inhibitors e.g., sildenafil | - Vacuum erection devices
148
ERECTILE DYSFUNCTION | What are some contraindications and side effects of phosphodiesterase-5 inhibitors?
- Recent stroke/MI, nitrates, hypotension, arrhythmias | - Nasal congestion, flushing, blue visual disturbances, priapsim
149
ERECTILE DYSFUNCTION | What conservative advice is given in erectile dysfunction?
- Cycle >3h/w then stop
150
ACUTE INTERSTITIAL NEPHRITIS | What is the histology of acute interstitial nephritis?
- Marked interstitial oedema + interstitial infiltrate in the connective tissue between renal tubules
151
ACUTE INTERSTITIAL NEPHRITIS | What causes acute interstitial nephritis?
- Hypersensitivity reaction to drugs #1 = Abx (penicillin, rifampicin), NSAIDs, allopurinol, furosemide - Or systemic disease = SLE, sarcoidosis, Sjogren's
152
ACUTE INTERSTITIAL NEPHRITIS | How does acute interstitial nephritis present?
- Fever, rash + arthralgia - Eosinophilia, sterile pyuria + white cell casts - Renal impairment + HTN
153
RENAL TUBULAR ACIDOSIS | What is the pathophysiology of renal tubular acidosis (RTA)?
- Normal anion gap hyperchloraemic metabolic acidosis due to impaired acid excretion leading to activation of RAAS > potassium wasting
154
``` RENAL TUBULAR ACIDOSIS What is type 1 RTA? What are the causes? What are the features? How is it managed? ```
- Inability to secrete H+ in DISTAL tubule > hypoK+ - SLE, Sjogren's, RA - Rickets/osteomalacia, renal stones, nephrocalcinosis > ESRF, high urinary pH >6 - PO bicarb
155
``` RENAL TUBULAR ACIDOSIS What is type 2 RTA? What are the causes? What are the features? How is it managed? ```
- Decreased HCO3- reabsorption in PROXIMAL tubule > hypoK+ - Fanconi syndrome, idiopathic - High urinary pH >6 - PO bicarb
156
RENAL TUBULAR ACIDOSIS | What is type 3 RTA?
- Very rare | - Carbonic anhydrase II deficiency > hypoK+
157
``` RENAL TUBULAR ACIDOSIS What is type 4 RTA? What are the causes? What are the features? How is it managed? ```
- Reduced aldosterone > reduced PROXIMAL tubular ammonium excretion = HIGH K+ - Adrenal insufficiency, SLE, HIV, diabetes - Low urinary pH - Fludrocortisone, PO bicarb
158
ACUTE TUBULAR NECROSIS | What is acute tubular necrosis?
- Necrosis of renal tubular epithelial cells leading to intrinsic AKI (#1 cause)
159
ACUTE TUBULAR NECROSIS | How is the aetiology of acute tubular necrosis split?
- Ischaemic = shock, sepsis | - Nephrotoxins = NSAIDs, aminoglycosides, myoglobin (rhabdo), contrast agents
160
ACUTE TUBULAR NECROSIS What are the clinical features of acute tubular necrosis? How is it managed?
- AKI = raised urea, creatinine + potassium, oliguria - Muddy brown casts on urinalysis = pathognomonic - Manage as per AKI (IV fluids, stop DAMN drugs)
161
ACID-BASE DISORDERS How do you calculate the anion gap? What picture does a normal anion gap show?
- (Na + K) – (HCO3 + Cl) | - Hyperchloraemic metabolic acidosis
162
ACID-BASE DISORDERS | What are some causes of a normal anion gap metabolic acidosis?
- GI bicarb loss = diarrhoea - Renal tubular acidosis - Addison's disease
163
ACID-BASE DISORDERS | What are some causes of a high anion gap metabolic acidosis?
MUDPILES – - Methanol - Uraemia (renal failure) - DKA - Paracetamol - Isoniazid/iron - Lactic acidosis - Ethanol - Salicylates
164
ACID-BASE DISORDERS What causes a metabolic alkalosis? What are some causes?
- Loss of H+ or gain of HCO3- - Vomiting + hypokalaemia - Diuretics - Primary hyperaldosteronism + Cushing's syndrome - Congenital adrenal hyperplasia
165
ACID-BASE DISORDERS What causes a respiratory acidosis? What are some causes?
- Inadequate ventilation - Obstruction = COPD - Resp depression = opiates - Neuromuscular disease = GBS, MND, MG - Pulmonary disease = fibrosis, pneumonia
166
ACID-BASE DISORDERS What causes a respiratory alkalosis? What are some causes?
- Hyperventilation - Pulmonary embolism + hypoxia - Anxiety - Increased respiratory drive (salicylate poisoning)

FINALS (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions