Brainscape's Knowledge GenomeTM

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


See full index

Year 3 diagnosis and management > Renal & Urology > Flashcards

Renal & Urology Flashcards

1
Q

What is pre-renal, renal and post-renal AKI?

A

Pre-renal (40-70%)
• Inadequate perfusion e.g. hypotension (cirrhosis too)

Renal (10-15%)
• Cellular damage e.g. haemolytic uraemic syndrome

Post-renal (10-25%)
• Urinary tract obstruction e.g. prostatic hypertrophy

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

Symptoms and signs of AKI?

A
  • Oliguria
  • Dehydration
  • Hypertension
  • Palpable bladder or kidney
  • Renal bruit
  • Fluid overload (raised JVP, oedema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for AKI? What would you see on CXR, ECG, immunology tests, and USS?

A
  1. Urinalysis - RBCs, WBCs, proteinuria, nitrites, leukocytes
  2. Bloods - creatinine >26 confirms diagnosis (also check hyperkalaemia, leukocytosis etc.)
  • CXR - infection, pulmonary oedema
  • ECG - hyperkalaemia
  • Immunology - anti-dsDNA = SLE, anti-GBM = Goodpasture’s
  • Renal USS - stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of AKI?

A

ABCDE + treat hyperkalaemia (10% calcium gluconate)

  1. If hypovolaemia (most) - IV fluids
  2. If hypervoloaemia - IV furosemide
Treat cause
• Stop nephrotoxic drugs
• ABx
• Catheterise
• Dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is BPH?

A

Hyperplasia of periurethral (transitional) zone of prostate gland

(unlike peripheral layer in prostate carcinoma)

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

What are the acute and chronic retention symptoms of BPH?

A

Acute
• Sudden inability to pass urine
• Severe pain

Chronic
• Frequency - small volumes of urine
• Nocturia
• Painless

(signs: distended bladder)

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

Investigations for BPH?

A
  1. Urinalysis - pyruria
  2. PSA - elevated
  3. International prostate symptom score

• Transrectal Ultrasound Scan (TRUS)

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

Management of BPH?

A

Acute - urinary retention
• Catheterisation

Chronic

• Asymptomatic - conservative, monitor
• Symptomatic, medical:
1. Tamsulosin (alpha blocker)
2. + Finasteride (5a-reductase inhibitor)

• Symptomatic, surgical:
< 80mg = TURP or TUIP surgery. (transurethral resection/incision)
> 80mg = open prostectomy

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

Cell type of bladder cancer?

A

90% transitional cell carcinomas

80% confined to bladder mucosa, 20% penetrate muscle

Rarely squamous cell associated with chronic inflammation e.g. schistosomiasis

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

Grading of bladder cancer for prognosis?

A

Grade 1 - differentiated
Grade 2 - intermediate
Grade 3 - poorly differentiated

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

Symptoms of bladder cancer?

A
  • Painless macroscopic haematuria
  • Irritative/storage symptoms (frequency, urgency, nocturia, voiding irritability)
  • Recurrent UTIs

(obstruction is rare, often no signs)

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

Investigations for bladder cancer?

A
  • Urinalysis - haematuria, pyruria
  • Urine cytology
  • Cystoscopy (biopsy) - gold standard
  • USS/CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What defines chronic kidney disease?

A
  • eGFR < 60
  • eGFR > 60 with impaired renal function

> 3 MONTHS

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

Describe the stages of CKD

A

Stage 1: Normal
• eGFR > 90 with other evidence of CKD (proteinuria etc.)

Stage 2: Mild impairment
• eGFR 60-89 with other evidence of CKD

Stage 3a: Moderate impairment
• eGFR 45-59

Stage 3b: Moderate impairment
• eGFR 30-44

Stage 4: Severe impairment
• eGFR 15-29

Stage 5: Established renal failure
• eGFR < 15 or on dialysis

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

Signs of CKD?

A
  • Skin pigmentation
  • Uraemic tinge to skin - yellowish
  • Excoriation marks
  • Purpura
  • Peripheral oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigations for CKD? Including diagnosis of CKD and cause.

A
  1. Isotopic GFR - gold standard
  • Renal ultrasound
  • Glucose - diabetes
  • Serology - e.g. ANA for SLE
  • Renal biopsy - pathology diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Relationship between epididymitis and orchitis?

A

Most cases of epididymitis associated with orchitis and vice versa

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

Most common causes of epididymo-orchitis?

A

Bacterial (overall coliforms)
Children: underlying congenital abnormality
< 35 years : chlamydia and gonococcus
> 35 years : coliforms (enterobacter, klebsiella, e. coli)

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

Symptoms and signs of epididymo-orchitis?

A
  • Painful, swollen and tender epididymis/testis
  • Penile discharge
  • Dysuria
  • Painful walking
  • Pyrexia
  • Painful cremasteric reflex
  • Erythematous/oedematous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Investigations for epididymo-orchitis?

A

Exclude testicular torsion - emergency

  1. Urethral swab (G- diplococci)
    • Urine dipstick
    • Urine culture
  2. Colour duplex USS - diagnostic, important if possibility of TT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management for epididymo-orchitis?

A

2-4 weeks ABx
< 35 years - doxycycline for chlamydia, add ceftriaxone if gonorrhoea (treat partners)
> 35 years - ciprofloxacin
• analgesia + scrotal support

Surgical
• Exploration if TT can’t be excluded
• Abscess drainage

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

What 2 syndromes do glomerulonephritis patients present with?

A

Nephrotic - increase in permeability of glomerulus, loss of PROTEIN
Nephritic - thin glomerular BM with pores that allow protein and BLOOD through (haematuria, proteinuria, HTN)

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

Primary and secondary causes of nephrotic and nephritic syndrome?

A

Nephrotic
• Primary - minimal change disease
• Secondary - diabetes, hep B/C

Nephritic
• Primary - IgA nephropathy
• Secondary - SLE, vasculitis, anti-GBM, post-strep

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

Why may hyperlipidaemia be seen in nephrotic syndrome?

A

Hypoalbuminaemia cause liver to compensate and increase lipid production

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

Who usually presents with minimal change disease and give 2 causes

A
  • Child with nephrotic syndrome

* Causes: Hodgkin’s, NSAIDs

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

Investigations for glomerulonephritis?

A
  1. Urinalysis
  2. Bloods - elevated creatinine, LFTs, GFR, hyperlipidaemia
  3. Renal USS - exclusion
  4. Renal biopsy - diagnostic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a hydrocoele?

A

Excessive collection of serous fluid within the TUNICA VAGINALIS

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

Signs of hydrocoele?

A
  • Scrotal swelling
  • Possible to get above it
  • Transilluminates
  • Difficult to separate from testicle
29
Q

Investigations for hydrocoele?

A

Diagnosed clinically, but to exclude tumour:
1. Ultrasound - diagnostic

(2. Doppler USS - distinguish from varicocoele and TT)

30
Q

Definition of nephrotic syndrome?

A

Proteinuria, hypoalbuminuria, oedema and hypercholesterolaemia

31
Q

Cause of nephrotic syndrome?

A
  • 90% in children with minimal change glomerulonephritis

* Adults - DM

32
Q

Signs of nephrotic syndrome?

A
  • Periorbital, peripheral and genital oedema

* Ascites

33
Q

Cause of polycystic kidney disease?

A
  • Autosomal dominant

* PKD1 Chr16 - involved in cell-cell, cell-matrix interactions

34
Q

Renal and extra-renal manifestations of polycystic kidney disease?

A
  • Renal - cysts with glomerular filtrate arise from tubules then detach (fluid content then from secretion of lining) and damage adjacent nephrons
  • Extra-renal - liver cysts, intra-cranial aneurysm (SAH), mitral valve prolapse, ovarian cysts, diverticular disease
35
Q

Symptoms and signs of polycystic kidney disease?

A
  • Flank pain
  • Haematuria
  • Berry aneurysm and SAH presentation possible
  • Enlarged cystic kidneys
  • Palpable liver
  • Signs off AAA or aortic valve disease
36
Q

Investigations for polycystic kidney disease?

A
  1. Renal USS - diagnostic if there is FHx and patient meets result criteria
  2. CT if USS is unclear
  3. Genetic testing if imaging is inconclusive (PKD1/2)
37
Q

What cell type - prostate cancer?

A

Adenocarcinoma in peripheral prostate

38
Q

Investigations for prostate cancer?

A
  1. PSA - first line but not specific
  2. DRE
  3. TRUS-biopsy - gold-standard
  4. Isotope bone scan
39
Q

Main causes of renal artery stenosis?

A
  • Atherosclerosis 85%

* Fibromuscular dysplasia 10% (younger patients)

40
Q

Which hypertension meds are particularly bad in renal artery stenosis?

A

ACEi

41
Q

Presentation of renal artery stenosis?

A
  • History of HTN < 50 yrs
  • HTN resistant to treatment
  • Renal bruits
  • Abdominal / carotid / femoral bruits
  • Weak leg pulses
42
Q

Investigations for renal artery stenosis?

A
  1. Bloods (high creatinine, low potassium)
  2. Duplex USS
  3. CT/MR angiogram - risk of contrast nephrotoxicity
  4. Digital subtraction renal angiography - gold standard
43
Q

Which cells does renal cell carcinoma arise from?

A

Proximal renal tubular epithelium

44
Q

What are the histological subtypes of renal cell carcinoma?

A
  1. Clear cell 80%
  2. Papillary 10%
  3. Transitional cell 10% (renal pelvis)
45
Q

Which inherited conditions increase risk of renal cell carcinoma?

A
  • von Hippel-Lindau disease
  • Tuberous sclerosis
  • Polycystic kidney disease
46
Q

What is it called when renal cell cancer causes abnormal LFTs in the absence of liver mets?

A

Strauffer’s syndrome

47
Q

Triad of symptoms of renal cell carcinoma?

A
  • Haematuria
  • Flank pain
  • Abdominal mass
48
Q

How can a left-sided tumour cause a left-sided varicocoele?

A

Obstruction of left testicular vein as it joins the left renal vein

49
Q

Investigations for renal cell carcinoma?

A
  1. Bloods
  2. Abdo/pelvic USS
  3. CT abdo/pelvis - diagnostic (MRI if contrast contraindicated)
    • Robson staging
50
Q

Types of testicular cancers?

A
  • Seminoma 50% (age 30-45)
  • Non-seminomatous germ-cell tumours and teratomas 30% (age 20-35)
  • Rare: gonadal stromal (sertoli and leydig) and non-Hodgkin’s
51
Q

Symptoms and signs of testicular cancer?

A
  • Swelling or discomfort of testes
  • Backache (para-aortic lymph nodes)
  • Secondary hydrocoele
  • Lymphadenopathy
  • Gynaecomastia
52
Q

Investigations for testicular cancer?

A
  1. Doppler USS - diagnostic
  2. CT if not confirmed by 1
  3. Markers - beta-hCG, a-fetoprotein, LDH
53
Q

2 types of testicular torsion?

A

Intravaginal - most common
• spermatic cord twists within tunica vaginalis

Extravaginal - usually neonates
• entire testis and tunica vaginalis twists on spermatic cord

54
Q

Symptoms and signs of TT?

A
  • Sudden onset hemiscrotal pain - one testis
  • Nause and vomiting
  • Swollen, erythematous
  • Swollen testicle is slightly higher
  • Testicle may lie horizontal
  • Testicular appendix - may be this visible necrotic lesion on transillumination
55
Q

Investigation for TT?

A

EMERGENCY EXPLORATION SURGERY

(1. Doppler USS)

Arterial inflow
• Reduced in TT
• Increased in epididymo-orchitis

56
Q

Management of TT?

A
  1. Emergency scrotal exploration and repair
    • morphine and anti-emetic
  2. If unavailable, Manual Detorsion
  • Twisted back into place - bilateral orchidopexy - suture to prevent recurrence
  • Necrotic - orchidectomy
57
Q

Types of urinary tract calculi (composition)?

A
  • Calcium oxalate - most common
  • Struvite (magnesium ammonium phosphate) - staghorn, quite common
  • Urate 5%
  • Hydroxyapatite 5%
  • Cysteine 2%
58
Q

Symptoms and signs of urinary tract calculi?

A
  • Severe loin to groin pain
  • Urinary urgency, frequency or retention
  • Haematuria
  • Leaking AAA in older men
  • Systemic sepsis if infection above stone
59
Q

Investigations for urinary tract calculi?

A
  1. Urinalysis - microhaematuria
  2. CT-KUB (non-contrast) - gold standard
  3. Renal USS

(pregancy test in all women of child bearing age to exclude ectopic - if pregnant, USS first imaging)

60
Q

Management of urinary tract calculi?

A

95% are < 5mm and self-resolve, if no persistent pain, just drink fluids until it passes

Acute
• IV/IM or PR diclofenac OR morphine
• Ondansetron (anti-emetic)
• ABx - Trimethoprim if bacterial (IV cefuroxime/gentamicin if obstruction infection)

Removal of calculi - dependent on size or pain not resolving
• > 5mm - Tamsulosin (alpha-blocker) or nifedipine (CCB)
• > 10mm - extracorporeal shock wave lithotripsy followed by urethroscopy with JJ stent
• Consider percutaneous nephrolithotomy (keyhole) - large complex stones e.g. staghorn

61
Q

Which infection is common with urinary tract calculi?

A

Pyelonephritis

62
Q

What is the difference between an upper and lower UTI?

A
  • Upper - renal pelvis (pyelonephritis)

* Lower - urthera (urethritis), bladder (cystitis) or prostate (prostatis)

63
Q

What causes most UTIs?

A

E. coli

64
Q

Symptoms of UTI? (cystitis, prostatitis, pyelonephritis)

A

Cystitis
• Frequency, urgency, dysuria
• Haematuria
• Suprapubic pain

Prostatitis
• Flu-like
• Low backache
• Swollen and tender prostate on PR

Pyelonephritis
• High fever, rigors
• Vomiting
• Loin pain and tenderness

65
Q

Investigations for UTI?

A
  1. Dipstick urinalysis - leukocytes, nitrites
  2. MSU for MC+S (always for male, child, pregnant, immunosuppressed or ill)
  3. USS - not responding, recurring
66
Q

Management for UTI?

A
  1. ABx: empirical treatment before MC+S results - presume E.coli
    • Trimethoprim or nitrofurantoin, 3-5 days
    • Men may need long course

Severe or pyelonephritis (upper UTI) - admit with IV gentamicin, then 7 days co-amoxiclav

Recurrent - consider prophylactic ABx

67
Q

What is a varicocoele and which side are they most common on (explaining why)?

A

Dilated veins of pampiniform plexus

More common on the LEFT

Where left testicular vein meets left renal vein:
• angle
• lack of effective valves
• increased reflux from compression of LRV between superior mesenteric artery and aorta

68
Q

Symptoms and signs of varicocoele?

A
  • Subfertility
  • ‘Bag of worms’
  • Scrotum with varicocoele hangs lower, whens standing
  • Swelling may reduce when lying
  • Valsalva manouevre whilst standing increases dilatation

Incidence increases after puberty

69
Q

Investigations for varicocoele?

A

Clinical diagnosis

  1. Colour doppler USS
  2. Semen analysis (reduced sperm count)

Year 3 diagnosis and management (9 decks)

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