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Medicine > Renal & urology > Flashcards

Renal & urology Flashcards

1
Q

Epididymal cyst characteristics: get above? separate/testicular, solid/cystic, transilluminable

A

Can get above
Separate
Cystic
Transilluminable

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2
Q

Hydrocele characteristics: get above? separate/testicular, solid/cystic, transilluminable

A

Can get above (usually)
Testicular
Cystic
Transilluminable

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3
Q

Varicocele characteristics: get above? separate/testicular, solid/cystic, transilluminable

A

“Bag of worms”

Can get above
Separate
Solid
Not transilluminable

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4
Q

Inguinal hernia: get above? separate/testicular, solid/cystic, transilluminable

A

Cannot get above
Separate
Solid
Not transilluminable

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5
Q

Epididymitis: get above? separate/testicular, solid/cystic, transilluminable

A

Can get above
Separate
Solid
Not transilluminable

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6
Q

Orchitis: get above? separate/testicular, solid/cystic, transilluminable

A

Can get above
Testicular
Solid
Not transilluminable

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7
Q

Testicular tumour: get above? separate/testicular, solid/cystic, transilluminable

A

Can get above
Testicular
Solid
Not transilluminable

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8
Q

Most common renal stone

A

Calcium oxalate

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9
Q

Best investigation for renal stones

A

NC CTKUB

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10
Q

Medication to prevent calcium stones

A

Thiazide diuretics

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11
Q

Medication to prevent oxalate stones

A

Cholestyramine and pyridoxine – reduce oxalate secretion

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12
Q

Medication to prevent uric acid stones

A

Allopurinol

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13
Q

Management of complex renal calculi

A

Percutaneous nephrolithotomy

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14
Q

Which type of renal stone is radiolucent?

A

Uric acid stones

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15
Q

NICE AKI diagnostic criteria

A

1 of:
Rise in creatinine of ≥ 26µmol/L in 48 hours
≥ 50% rise in creatinine over 7 days
Fall in urine output to less than 0.5ml/kg/hour for more than 6 hours in adults (8 hours in children)

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16
Q

CKD stages according to GFR

A

1: > 90
2: 60-90
3a: 45-60
3b: 30-45
4: 15- 30
5: < 15

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17
Q

Pre-renal causes of AKI

A

Hypovolaemia secondary to diarrhoea/vomiting
Renal artery stenosis

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18
Q

Intrinsic causes of AKI

A

Glomerulonephritis
Acute tubular necrosis (ATN)
Acute interstitial nephritis (AIN)
Rhabdomyolysis
Tumour lysis syndrome

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19
Q

Post-renal causes of AKI

A

Kidney stone in ureter or bladder
Benign prostatic hyperplasia
External compression of the ureter

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20
Q

Examples of nephrotoxic drugs

A

NSAIDs
ACE-I
ARB
Loop diuretics

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21
Q

Examples of drugs which worsen AKI

A

Metformin
Digoxin
Lithium

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22
Q

RIFLE system

A

Categorising AKI

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23
Q

AKI management

A

Calcium gluconate for hyperkalaemia

Prerenal: fluids
Intrinsic: specialist treatment
Postrenal: catheter

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24
Q

Presence of eosinophilia in AKI

A

Acute interstitial nephritis

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25
Q

Acute tubular necrosis urine microscopy findings

A

Muddy, brown casts

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26
Q

Management of hyperkalaemia in AKI

A

Calcium gluconate - protect myocardium
Insulin & dextrose - shift K+ intracellularly
/ Loop diuretics - remove K+ from body

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27
Q

Why are ACE inhibitors can be given in CKD but not AKI?

A

In CKD, filtration pressure is reduced by ACEi – minimise loss of blood components
AKI, filtration further impaired as GFR is falling. CKD – filtration is already fucked

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28
Q

3 complications of CKD

A

Renal osteodystrophy
Anaemia
Oedema

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29
Q

Medications used to maintain BP in CKD

A

ACEi / ARBs

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30
Q

Management of mineral bone disease in CKD

A

1: Low phosphate diet
2: Phosphate binders: sevelamer
3: Vitamin D: calcitriol
4: Parathyroidectomy

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31
Q

Kidney size in CKD

A

Small

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32
Q

Electrolyte abnormalities seen in CKD

A

Hypocalcaemia due to raised PTH

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33
Q

Complications seen in CKD

A

Anaemia
Oedema
Hypertension
Proteinuria
Mineral bone disease

34
Q

Benign prostatic hyperplasia symptoms

A

LUTS: voiding, dribbling, incomplete empting, hesistancy

35
Q

Benign prostatic hyperplasia investigations

A

DRE - smooth, enlarged prostate
PSA

36
Q

Benign prostatic hyperplasia management

A

1) Tamsulosin (alpha 1 blocker)
2) Finasteride (5 alpha reductase inhibitor)

37
Q

Prostate cancer management options

A

Localised: radical prostatectomy
Advanced: zoladex (GnRH agonist)

38
Q

Most common type of prostate cancer

A

Adenocarcinoma

39
Q

Varicocele pathophysiology

A

Abnormal enlargement of testicular veins

40
Q

Hydrocele pathophysiology

A

Fluid in tunica vaginalis

41
Q

Testicular torsion clinical features

A

Unilateral, swollen, tender testicle
Prehn’s sign -ve
Absent cremaster reflex

42
Q

Testicular torsion management

A

Surgical detorsion - do not await imaging

43
Q

Epididymitis clinical features

A

Acute, unilateral pain
Prehn’s sign +ve

44
Q

Epididymitis management

A

Urine NAAT for causative organism

< 35 IM Ceftriaxone + doxycycline (assuming STI)
>35 – ciprofloxacin

45
Q

Testicular cancer clinical features

A

Painless lump, non-transilluminable
Possible lung metastasis
Gynaecomastia

46
Q

Why is biopsy contraindicated in testicular cancer?

A

Risk of seeding into scrotum

47
Q

Testicular cancer tumour markers

A

Seminoma - b-HCG
Teratoma - AFP

48
Q

Testicular cancer risk factors

A

Undescended testes
Family history

49
Q

Most common testicular cancer

A

Seminoma

50
Q

Testicular cancer management

A

Orchidectomy
Offer sperm banking

51
Q

Nephritic syndrome causes

A

SLE
Post strep GN
Small vessel vasculitis
Goodpasture’s/anti-GMB disease
IgA nephropathy

52
Q

Nephritic syndrome investigations

A

Diagnostic: Kidney biopsy
Urinalysis: Hematuria
Bloods: increased ESR and CRP, sometimes anaemia

53
Q

Nephritic syndrome management

A

BP control: ACE-I/ARB - to reduce proteinuria and preserves renal function

Corticosteroids

54
Q

Management of Goodpasture’s disease

A

Plasma exchange, steroids + cyclophosphamide

55
Q

Presentation of Goodpasture’s disease

A

SOB
Oliguria

56
Q

Most common cause of nephritic syndrome

A

IgA nephropathy

57
Q

Management of nephrotic syndrome

A

Fluid and salt restriction
Loop diuretics- to manage oedema
Treat cause
ACE-I/ARB to reduce protein loss
Manage complications

58
Q

Causes of nephrotic syndrome

A

Minimal change disease (most common in children)
Focal segmental glomerulosclerosis
Membranous nephropathy (most common in adults)

59
Q

Which cause of nephrotic syndrome is associated with malignancy?

A

Membranous nephropathy

60
Q

Causes of focal segmental glomerulosclerosis

A

Idiopathic
HIV
Heroin
Lithium

61
Q

Diagnosis of minimal change disease

A

Normal appearance on microscopy

62
Q

Bladder cancer investigations

A

Urine cytology to rule out infection – bloods, urine sample

Best: Flexible cystoscopy + biopsy

CTT urogram for staging

63
Q

Bladder cancer management

A

T1: TURBT – transurethral resection of bladder tumour
Followed by chemotherapy via catheter - intravesical chemotherapy – CISPLASTIN

T2-3: radical cystectomy

T4: palliative chemo + radiotherapy

64
Q

Bladder cancer risk factors

A

Phenacetin – banned analgesic
Smoking – #1 risk factor
Analine – rubbers & dyes (PAINTERS, HAIRDRESSERS) – aromatic amines!
Alcohol abuse
Cyclophosphamide – medication to treat cancers & autoimmune disorders

65
Q

What is the greatest risk factor for bladder cancer?

A

Smoking

66
Q

Bladder cancer symptoms

A

Painless haematuria
Suprapubic, pelvic mass
Frequency, urgency

67
Q

Most common type of bladder cancer

A

Transitional cell carcinoma

68
Q

Schistosomiasis bladder cancer association

A

Squamous cell carcinoma

69
Q

Renal cancer symptom triad

A

Haematuria
Flank pain
Palpable abdominal mass

70
Q

Renal cancer investigations

A

Bloods: polycythaemia from erythropoietin secretion
Raised BP: due to renin secretion
Ultrasound
CT/MRI
CXR- shows cannon ball mets

71
Q

Renal cancer risk factors

A

Haemodialysis
Smoking
Hypertension

72
Q

Renal cancer staging + management

A

Stage I: partial or radical nephrectomy
Stage II: radical nephrectomy
Stage III: radical nephrectomy and adrenalectomy
Stage IV: systemic treatment

73
Q

Renal cancer metastatic sites

A

Bone
Liver
Lungs

74
Q

Renal cancer most common site of origin

A

90% proximal tubular epithelium

75
Q

UTI most common causative organisms

A

KEEPS:

Klebsiella
E coli- most common causing >50% of cases
Enterococci
Proteus
Staphylococcus coagulase negative

76
Q

Pyelonephritis presentation

A

Loin pain
Fever
Pyuria

77
Q

Antibiotics for UTI

A

3 days
1st: Nitrofurantoin/Trimethoprim
2nd: Pivmecillinam

78
Q

Indications for 7 days antibiotics for UTI in adults

A

Male
Pregnancy

79
Q

Antibiotic management for prostatitis

A

Ciprofloxacin or levofloxacin for 14 days

80
Q

Antibiotic management for pyelonephritis

A

Empirical
1st: Cefalexin/Ciprofloxacin

Medicine (13 decks)

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