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MSRA > Renal/ Urology > Flashcards

Renal/ Urology Flashcards

1
Q

What organism is the most common cause of peritonitis secondary to peritoneal dialysis?

A

Staphylococcus epidermidis

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2
Q

What is the most common cause of death in dialysis patients?

A

Ischaemic heart disease

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3
Q

What size will the kidneys be (enlarged or small) in diabetic nephropathy versus CKD?

A

Diabetic nephropathy - normal or enlarged kidneys

CKD - small kidneys

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4
Q

What test is used to confirm the causative organism is post streptococcal glomerulonephritis?

A

Anti-Streptolysin O titre

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5
Q

How is anion gap calculated?

A

(sodium + potassium) - (bicarbonate + chloride)

Normal is 8-14mmol

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6
Q

What causes a normal anion gap metabolic acidosis?

A

gastrointestinal bicarbonate loss: diarrhoea, fistula, renal tubular acidosis

drugs: e.g. acetazolamide

ammonium chloride injection

Addison’s disease

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7
Q

What causes a raised anion gap metabolic acidosis?

A

lactate

ketones

urate: renal failure

acid poisoning: salicylates, methanol

5-oxoproline: chronic paracetamol use

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8
Q

What is the daily glucose requirement?

A

50-100g/day

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9
Q

What is the most common cause of nephrotic syndrome in children/ young adults? How is it treated?

A

Minimal change disease - treated with steroids
Doesn’t develop into esrf

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10
Q

What is the inheritance pattern in polycystic kidney disease?

A

Autosomal dominant

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11
Q

When dosed IgA nephropathy vs post steptococcal glomerulonephritis present?

A

IgA nephropathy - days
Post streptococcal glomerulonephritis - 1-2 weeks

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12
Q

Other than raised CK what other biochemical abnormality do you see in rhabdomyolysis?

A

Hypocalcaemia

Patients with rhabdomyolysis should have a bone profile taken to measure calcium and phosphate. Calcium typically binds to myoglobin released from damaged muscle tissue causing serum hypocalcaemia.

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13
Q

MUDPILES = the causes of raised anion gap metabolic acidosis. What is included in it?

A

M- Methanol
U - Uraemia (renal failure)
D - DKA
P - Propylene glycol
I - Infection
L - Lactic acidosis
E - Ethylene glycol
S - Salicytlates

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14
Q

How does acute interstitial nephritis present?

A

Fever, rash, arthralgia
Raised eosinophils
Raised urinary white cells

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15
Q

Which conditions can cause rapidly progressive glomerulonephritis?

A

Goodpasture’s, vasculitis, SLE

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16
Q

What type of glomerulonephritis is HIV associated with?

A

Focal segmental glomerulonephritis

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17
Q

How does polycystic kidney disease present?

A

Progressive renal impairment

Cyst haemorrhage/ infection

Hypertension, LVH

Increased malignancy risk

Berry aneurysms > subarachnoid haemorrhage

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18
Q

How is polycystic kidney disease treated?

A

Hypertension control

Tolvaptan to reduce cyst volume and progression

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19
Q

What are some of the potential causes of pre renal AKI?

A

Hypotension

Hypoperfusion > NSAIDs, ACE.I

Acute tubular necrosis

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20
Q

What are some of the causes of renal AKI?

A

Vasculitis

Glomerulonephritis

Drugs eg gent

21
Q

What are some of the causes of post renal AKI?

A

Obstruction - stones, cancer, strictures

22
Q

What ECGs changes are seen in hyperkalaemia?

A

Tall T waves

Small P waves

Wide QRS > VF

23
Q

What ECG changes are seen in hypokalaemia?

A

Small / inverted T waves

Long PR

ST depression

24
Q

How would you investigate proteinuria?

A

Exclude UTI and repeat
Check for haematuria and albumin: creatinine ratio
Check BP
Check U&Es

25
Q
A
26
Q

How does haenolytic uraemic syndrome present?

A

Childen
AKI
Follows gastroenteritis
E.Coli
Bloody diarrhoea
Proteinuria/ haematuria
Anaemia, thrombocytopenia, purpura

Admit for specialist reveiw

27
Q

What causes renal artery stenosis and how does it present?

A

Causes - atheroma or firbomucular hyperplasia in the younger patient

High BP
Bruit
Reduced kindney function, proteinuria

28
Q

Which type of renal stones are associated with proteus UTI?

A

Staghorn calculi

29
Q

How would you investigate haematuria?

A

Renal function, ACR

PSA/ DRE - men
Pelvic US - if older female, other gynae sx

Renal US if visible haematuria or persistent

30
Q

What are the most common causes of bladder ca?

A

Transitional cell carcinoma in the UK
Squamous cell carcinoma worldwide

31
Q

What general advice can you give to try and prevent recurrent cystitis?

What other preventative measures are there?

A

Frequent urination (note in urge invontinence advice is the opposite - try to resistance urge for longer periods)
Increase fluids
Double void (go again after 5-10 mins)
Void after intercourse

Prophylactic abx
Men with BPH > finasteride, doxazosin
Women - topical oestrogen

32
Q

How does interstitial cystitis present?

A

Frequency, urgency, pelvic/ suprapubic pain
MSU: no organism
Antispasmodics, amitriptyline and bladder surgery can help

33
Q

What drugs can exacerbate/ cause incontinence?

A

Diuretics
A- blockers
Anticholinergics

34
Q

What are the medication options for urge incontinence?

A

Oxybutynin
Solifenacin
Tolterodine
Duloxetine

35
Q

What is retroperitoneal fibrosis/ how does it present?

A

Ureters become embedded in fibrous plaques in the retroperitoneal space
Associated with some longterm conditions

Fever, leg oedema, hypertension ,palpable mass, renal failure

Mx options: steroids, nephrostomy

36
Q

Which medciations are used for BPH/ what drug classes are they?

A

Tamsulosin - alpha blockers

Finasteride - 5a reductase inhibitors

37
Q

Tx for prostatitis?

A

Ciprofloxacin 4 weeks

38
Q

What medications are used to treat prostate cancer?

A

Goserelin sc every 4-12 weeks (LHRH analogue)

Cyproterone acetate, flutamide, bicaluatmide (anti-androgens) - used to prevent side effects with LHRH analogues

39
Q

What is hypospadias?

A

The urethral meatus opens on the ventral side of the penis

40
Q

What is peyronie’s disease/ how does it present/ how is it managed?

A

Hard lumps in the shaft of the penis
Can cause pain when erect
No tx routinely but can refer to urology for consideration of surgical management

41
Q

How is balanitis (inflammation of the glans/ foreskin) managed?

A

Oral abx (eg fluclox), topical antifungals eg clotrimazole

42
Q

What is erythroplasia of queyrat?

A

premalignant condition of the glans > needs referral to urology for surgical management

43
Q

How does testicular torsion present?

A

Severe scrotal pain, RIF pain, Hard high riding testicle

44
Q

How does epididymo-orchitis present an how is it managed?

A

Acute testicular pain, swelling and tenderness, fevers, can be urinary symptoms

abx/ but if in doubt admit to urology

45
Q

What is a hydrocele and how is it managed?

A

Collection of fluid in the tunica vaginalis

Presents with swelling in the scrotum - testis is within the swelling and not palpable separately. Should be able to get above the swelling.

Refer adults for US if can’t palpate the testicle
Some need referral to urology

Haematoceoeles are blood filled - need urgent referral (due to direct trauma)

46
Q

What is a varicocele and how is it managed?

A

Collection of varicose veins in the pampniform plexus
Dull ache in the testis

Some managed with reassurance, some need referral for surgery

47
Q

How do epididymal cysts present and how are they managed?

A

Middle aged men
Painless lump, often bilateral

US if unsure
Reassure/ referral to urology if painful

Note spermatocoeles are cysts that contain sperm and present in the same way with the same mx

48
Q

How are testicular lumps investigated/ managed?

A

Testicular lumps should be treated as cancer until proven otherwise

US > but don’t delay referral

49
Q

What is Fournier’s gangrene?

A

Necrotising fasciitis of the scrotal skin / penis
Mx - surgical debridement and IV abx

MSRA (13 decks)

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