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Phase 3b > Renal/Urology > Flashcards

Renal/Urology Flashcards

1
Q

What level is they kidney found at?

A

T12 and L3

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2
Q

Which kidney is slightly lower than the other one?

A

The right kidney

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3
Q

What are the 3 layers of the kidney and name a key structure in each of the layers:

A

Renal Cortex: This is Maude up of the glomerulus and the bowman’s capsule

Renal Medulla: Collecting ducts and the loop of Henle

Renal Pelvis: where the urine collects. Contains the collecting ducts. lined with transitional cell epithelium

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4
Q

What does the renal artery branch into? (5 branches)

A

Renal Artery

Segmental Artery

Arcuate Arteries

Interlobar Arteries

Interlobular Arteries

Afferent Arterioles

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5
Q

What is the basic function of the PCT?

A

Needed to absorb solutes

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6
Q

Basic Function of the Loop of Henle?

A

To concentrate the urine

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7
Q

What is the purpose of the DCT?

A

To absorb any further water and/or solutes

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8
Q

What is the purpose of the collecting ducts?

A

Water reabsorption and acid/base balance.

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9
Q

What is the JGA and what does it do?

A

The JGA is an afferent arteriole that responds to low levels of Na+ in the macula densa

If Na+ goes down you get vasodilation of your afferent arterioles and increased glomerular filtration.

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10
Q

What are mesangial cells?

A

These are SM cells that surround the arterioles allowing GFR to change in the kidney.

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11
Q

What is the charge of the glomerular filtration membrane?

What type of molecules can pass through?

A

The GFM is negatively charged

As such it means that you repel your negatively charged ions like albumin.

It can let small molecules through like potassium creatinine and glucose.

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12
Q

When is ADH secreted?

A

When the blood volume is low

Leading to increasing tubular permeability to H2O and causing an increase in blood volume.

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13
Q

What two hormones causes there to be an increased reabsorption of of Na+?

A

You have ANP

You also have Aldosterone.

Both work by acting on the ENAC channels. increasing Na+ reabsorption and increasing K+ excretion.

These channels are found in the collecting ducts

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14
Q

Where do thiazide like diuretics work>?

A

They work on the DCT

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15
Q

What is reabsorbed at the PCT?

A

Sugar
Amino Acids
Bicarbonates

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16
Q

Briefly explain the main points of the Renin Angiotensin System:

A

Drop in Blood Pressure/Blood Volume causes the kidney to release Renin

Renin acts on angiotensinogen released by the liver. This causes it to break into angiotensin I

Angiotensin I is the converted by ACE enzyme in the Lungs to create angiotensin II this acts directly on the blood vessels causing vasoconstriction. And causes the adrenal gland to release aldosterone. This increases Na+ reabsorption.

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17
Q

Is urinating a parasympathetic or sympathetic process?

A

It is parasympathetic

Storing of urine is sympathetic and relies on Onuf’s nucleus.

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18
Q

Renal Stones

What are 3 RF of them?

A

Renal Stones RF include

Dehydration
Cancer/Gout
Medications (diuretics, allopurinol and aspirin)
Trauma (infection) and congenital issues (such as a duplex kidney)

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19
Q

Renal Stones

What is the presentation like in a renal stone?

A

Can be asymptomatic

But once symptomatic you generally get loin to groin pain. Pain on urination, Blood in urine, increased frequency of urinating.

Nausea and Vomiting. generally feel unwell

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20
Q

Renal Stones

What are the 4 main types of renal stones

A

Calcium oxalate

Calcium phosphate

Uric Acid

Infection induced stones

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21
Q

Renal Stones

What are some investigations you would like to do?

What is your GOLD STANDARD investigation?

A

FBC
U+E
Urine Dip and MC+S
Non Contrast CT KUB or an Ultrasound (if pregnant)

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22
Q

Renal Stones

State the management of renal stones for varying sizes

A

Small size: possibly can pass on their own. For these patients give analgesia (IV diclofenac) and possibly Nifedipine

Larger stones may need to have ESWL!

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23
Q

Acute Kidney Injury

What is defined as AKI?

A

An acute sustained drop in kidney function

Normally seen as a rise in serum urea and creatinine due to a rapid decline in GFR

Generally seen as a rise in creatinine by a 20 point jump

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24
Q

AKI

How can you stage/classify the AKI?

A

You use the RIFLE classification.

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25
Q

AKI

Who are AKI common in? give a general scenario:

A

Common in the elderly

Associated with diarrhoea, vomiting and dehydration

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26
Q

AKI

Name a couple of pre renal, renal and post renal causes

A

Common causes: ischaemia, sepsis and nephrotoxins

Pre renal: hypoperfusion, hypovolaemia and renal hypotension. Or rhabdomyosis or NSAID or ACE inhibitor induced.

Renal: glomerulonephritis, haemolytic uraemic syndrome or acute tubular necrosis

Post renal: Urinary tract obstruction via stones, clots or masses

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27
Q

AKI

Give two examples of nephrotoxic drugs that can lead to an AKI

A

NSAIDs

ACE inhibitors

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28
Q

AKI

How does a patient typically present when they have an AKI?

A

Poor urine output

High urea causes: Confused, Nausea, Vomiting, Seizures and Fatigue

Thirsty

Irregular Heartbeat (hyperkalemia)

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29
Q

AKI

How do you diagnose an AKI?

A

You need to do

Ultrasound
U&Es, serum calcium, phosphate and uric acid

Urine dipstick, microscopy and culture
ECG to exclude Arrhythmias
Renal Biopsy to exclude renal causes
CT-KUB may be indicated

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30
Q

AKI

How do you treat a pre renal, renal and post renal AKI?

A

Pre Renal: get the patient hydrated with IV fluids. Treat any underlying infection

Renal: you need to treat the cause. I.e nephritis give the patient immunosuppressive therapy or prednisolone

Post renal: catheterise, stop nephrotoxic drugs. Is there an option for surgery

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31
Q

AKI

How do you treat acidosis in your patient?

How do you treat hyperkalaemia?

A

You give them sodium bicarbonate

You give them calcium gluconate and insulin

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32
Q

Nephritic Syndrome:

What is nephritic syndrome characterised by?

A

Triad of

  • Haematuria
  • Proteinuria
  • Hypertension/oedema
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33
Q

What is the commonest cause of nephritic syndrome?

A

IgA nephropathy

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34
Q

Nephritis

What are 3 causes of nephritis?

A

Ig A nephropathy
Post strep infection
SLE or ANCA associated vasculitis

Hep B or C

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35
Q

Nephritis

How does it present?

A

It presents via a triad of:

Proteinuria 
Oedema/ Hypertension 
Haematuria 
Oliguria 
Uraemia (anorexia, lethargy, nausea and decreased kidney function)
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36
Q

Nephritis:

How is it diagnosed?

A

You need to do GFR/U&Es and renal US and biopsy

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37
Q

Nephritis:

How do you manage the condition?

A

You need to treat the HTN by giving loop diuretics CCB and salt restriction

You need to treat the cause

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38
Q

Nephrotic Syndrome

What is it a triad of?

A

Hypoalbuminemia

Oedema

Proteinuria

Severe hyperlipidaemia is also common

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39
Q

Nephrotic syndrome:

What are 3 common causes of it?

A

Minimal change syndrome

Membranous nephropathy

Focal Segmental Glomerulosclerosis

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40
Q

Nephrotic syndrome

What is the presentation?

A

Normal / slightly increased BP

Proteinuria

Hypoalbuminaemia

Pitting oedema of the ankles, genitals and the face

Frothy urine

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41
Q

How do you diagnose nephrotic syndrome?

A

You diagnose it through doing routine blood s for albumin, autoantibodies , urine dipstick and then do a

Renal Biopsy! Gold Standard

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42
Q

What is the management of nephrotic syndrome?

A

manage the oedema with furosemide people

Reduce proteinuria with ramipril

Reduce clot reduction with warfarin and simvastatin

For minimal change syndrome give the patient high dose steroids.

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43
Q

How do you treat Ig A nephropathy?

A

You give the patient Ramipril to prevent proteinuria and HTN

You give cyclophosphamide to prevent the autoimmune response.

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44
Q

CKD

What is CKD? .

A

CKD is when there is progressive impairment in renal function (Haematuria and proteinuria) for more than 3 months.

Normally seen as GFR <60 for 3 months or more

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45
Q

CKD

What are 3 causes of CKD?

A

Diabetes
Amyloid

HTN
PKD
Atherosclerosis

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46
Q

CKD

How does it present?

A

Generally assymptomatic to begin with. However, once the urea starts to rise you start getting an increase in symptoms such as:

Malaise 
Anorexia 
Insomnia 
Polyuria 
Nausea
Vomiting and oedema

Long term complications include: anaemia and bone pain, high urea levels can also lead to seizures and paresthesia

HTN and CVS disease can occur as RAAS is not working correctly and HTN ensures.

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47
Q

CKD

How can it be diagnosed?

A

You need to do U&Es, eGRF, urine dipstick, MSU C+S

Important to look at electrolyte levels, PTH, all phosphatase as well

You need to do an US of the kidney will show small kidneys

ECG to see if high K+ levels are contributing to any arrhythmia

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48
Q

CKD

How is it managed?

A

You give

Ramipril (ACE inhibitor) to control BP

Vitamin D and calcium supplements

CVD control via aspirin and statin use

Oedema (give furosemide) and if anaemia (give EPO)

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49
Q

CKD

Give the stages of CKD from stage 1 to stage 5.

A

Stage 1: damage kidney but normal kidney function. GFR >90

Stage 2: mild loss 60-89

Stage 3a: mild to moderate loss 45-59

Stage 3b: moderate to severe loss 30-44

Stage 4: severe loss 15-29

Stage 5: kidney failure: < 15

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50
Q

What are the two receptors that control fluid balance in the body?

Where are they found and how do they work?

A

Osmoreceptors are found in the posterior pituitary and release ADH. This causes vasoconstriction and increased BP

Baroreceptors are found in the aortic arch and carotid sinus. They stimulate ADH release from the posterior pituitary

51
Q

What are 4 indications for dialysis in a patient?

A

Fluid Overload resulting in pulmonary oedema

High K+ that is resulting in symptoms such as tall tented t waves etc

Symptomatic uraemia

52
Q

What are the 2 types of dialysis?

A

Haemodialysis

Peritoneal dialysis

53
Q

What are 3 complications of dialysis?

A

Increased risk of malignancy

Amyloid deposit

Infection

CVS disease

54
Q

ADPKD

When does AD polycystic kidney disease normally manifest its self?

What are some symptoms of PKD?

A

Normally in the 20s to 30s

Sx: include loin pain, haematuria, renal colic, renal stones, renal mass and HTN.

55
Q

Is EPO preserved in PKD

true or false?

A

True!

56
Q

ADPKD

What is the management?

A

BP control Ramipril

Pain relief

Ultimately will need a kidney transplant

57
Q

ARPKD

When does AR PKD normally present?

What other conditions is it associated with?

A

It presents normally in utero or in infant hood. Worse and more progressive form.

It is also associated with liver involvement through causing congenital hepatic fibrosis

58
Q

Testicular Lumps: diagnose the following

Separate and cystic

Separate and solid

Can’t get over the lump

Testicular and cystic

Testicular and solid

A

Separate and cystic: epididymal cyst

Separate and solid: varicocele

Can’t get over the lump: inguinoscrotal hernia

Testicular and cystic: hydrocele

Testicular and solid: testicular tumour

59
Q

What is the main function of the testes? How does it do this?

A

To produce sperm

Seminiferous tubules -> spermatozoa -> rete testes -> efferent tubule -> epididymis

60
Q

What structure is the penis made up of?

A

Crura is made up of corpus cavernousa

The bulb is made up of corpus spongiosum and is where the urethra runs through

61
Q

Epididymal Cysts:

What is one?

Who is it common in?

How does it present?

How to diagnose/manage?

A

These are cystic changes that happen in the testicle

It is common in men around there 40s . Tend to be. Well defined. Multiple of them and bilateral

They are tender and swollen lumps

They are diagnosed via US and if needed an aspirate can be taken

management: conservative.

62
Q

Hydrocele

What is one?

Who is it common in?

How does it present?

How to diagnose/manage?

A

Abnormal fluid collection in the tunica vaginalis.

They can be primary: congenital due to a patent processus vaginalis
Secondary: trauma, malignancy or TB.

Px: normally smooth and non tender. They are not painful.

Diagnosis: US and alpha feto protein/ HCG to exclude tumours
Management: in infancy they resolve on their own. In adults you may want to aspirate.

63
Q

Varicocele

What is one?

Who is it common in?

How does it present?

How to diagnose/manage?

A

Is when you have abnormal dilation of the testicular veins in teh pampinform plexus. Commonly affecting the left renal vein and left testicle more

Scrotum may feel a bit like a bag of worms and have a heavy/ache feeling.

Diagnosis: colour Doppler ultrasound

Mx: unless pain/infertility you can just leave it.

64
Q

Testicular Torsion:

What testicle is more likely affected?

A

The left hand side

65
Q

What’s the presentation of testicular torsion?

A

The person is normally young in age. And you get sudden onset abdominal/testicular pain that is worse on one side. Walking is hard

Likely to have nausea and vomiting.

66
Q

What should you do if you think the patient has testicular torsion>?

A

Urgent surgical exploration!!

Do orchidectomy and fix the opposite testicle

67
Q

Testicular Tumours;

What age are they common in?
What are two RF:
What is the clinical presentation?

A

They are common in men aged 15-44

Two RF include: undescended testes and infant hernia

The patient will have a painless testicular lump that may present with a hydrocele. The patient may have testicular or abdominal pain. Likewise if the patient has a cough or back pain the patient is likely to have lung/bone mets

68
Q

Testicular Tumours:

What are some useful diagnostic methods that can be used

A

Ultrasound biopsy and histology

Alpha Fetoprotein
B-HCG

69
Q

What tumour type in testicular cancer is common in

Children

Adults

A

Children: non seminomas aka teratomas

Adults: germ cell aka seminomas tumours

70
Q

What are some reasons why PSA would be raised?

A

An increased BMI

Afro Caribbean heritage

Prostate Cancer

BPH

Perianal trauma or recent ejaculation

71
Q

BPH

What are two tools you can use to measure the impact BPH is having on a patient?

A

Frequency Volume Chart

IPSS (international prostate symptom score)

72
Q

Acute urinary retention:

What are some causes of this?

How would you diagnose it?

A 
BPH 
Infection 
Alcohol 
Constipation 
Anticholinergics
73
Q

How do you manage acute urinary retention?

A

Prescribe a catheter

Alpha 1 blockers (Tamsulosin)

If BPH give the patient a 5 alpha reductase inhibitors i.e. finasteride

74
Q

Chronic Urinary Retention:

What are the two types?

What are the 3 main causes?

A

Low Pressure: detrusor failure

High Pressure: interactive obstructive uropathy

Causes: BPH, pelvic malignancy and Diabetes

75
Q

How does Chronic Urinary Retention presents?

How do you treat it?

A

It generally presents with overflow incontinence/ day or night wetting

Loss of appetite, constipation and distended abdomen

Treat the cause and Cathertise the patient

76
Q

What are the 3 types of urinary tract obstruction? Give an example for each:

A

Luminal: stones, blood clot or tumour

Mural: congenital, NM dysfunction or schistosomiasis

Extra mural abdominal or pelvic mass or BPH or prostate cancer

77
Q

On a urinary tract obstruction what investigation would you like to do?

A

Bloods (U&E, MSU culture and sensitivity)

Ultrasound

78
Q

How would you manage a urinary tract obstruction?

A

You would give the patient if

Upper tract obstruction: alpha antagonist (Tamsulosin) and a 5 alpha reductase inhibitor (finasteride)

Lower tract obstruction: put a catheter in (good long term = suprapubic catheter). If necessary you may need to do TURP.

79
Q

What are the indications for surgery in a patient with LUTS symptoms?
RUSHES

A 
Retention 
UTI 
Stones
Haematuria 
Elevated creatinine 
Symptom deterioration
80
Q

What layer of the prostate becomes enlarged in BPE/Benign prostatic hyperplasia?

A

You get an enlargement of the inner transitional layer

81
Q

What layer of the prostate enlarges with prostate cancer?

A

The layer that enlarges in prostate cancer is your peripheral layer

In BPH you get enlargement of the transitional zone

82
Q

What medication would you give to a patient with BPH?

A

tamulosin (alpha 1 antagonist)

Finasteride (5 alpha reductase inhibitor)

83
Q

Renal Cell Carcinoma:

What is the typical presentation?
How is it diagnosed?
How is it managed?

A

You can get loin pain/abdominal mass
Or you can get malaise, weight loss etc

Haematuria is common (microscopic)

Diagnosis is via an US and also byCT

Management: nephew followed by biological chemotherapy like sunitinib

84
Q

Bladder Cancer:

What are the symptoms?

How is it diagnosed?

How is it treated?

A

Painless haematuria
Recurrent cystitis
LUTS

Diagnosis: cystoscopy and biopsy

Management: surgery and chemotherapy.

85
Q

What region of the prostate is prostate carcinoma seen in?

What is the name given to the staging system used?

A

It is seen in the peripheral zone.

Gleason’s Scale

86
Q

What is the gold standard investigation for prostate cancer?

A

The gold standard is trans rectal ultrasound and biopsy.

87
Q

What is the main treatment for prostate cancer?

A

You can do Androgen deprivation therapy with the LHRH agonist like Goserelin

Alternatively. If you want a rapid decline in sx such as bone pain. Do a radical prostatectomy

88
Q

What is the first line antibiotic treatment to use in a non pregnant lady with UTI

What should you use in a pregnant lady with a UTI first and second trimester?
What should you use in a pregnant lady with a UTI in her 3rd trimester?

A

Nitrofurantoin

1st and 2nd trimester use Nitrofurantoin

3rd trimester use Trimethoprim

89
Q

What Abx should you use a patient (non pregnant) with pyelonephritis?

A

Co amoxiclav

90
Q

What should you use in a patient with pyelonephritis and pregnant

A

Ceflaxin

91
Q

Prostatitis

What is the most common cause in men <35 ?

What is the most common cause in men >35?

A

Common in under 35 yrs to be STI related generally chlamydia

Over 35s test to be E.coli related

92
Q

Prostatitis

How does acute prostatitis present?

How does chronic prostatitis present

A

Acute prostatitis presents with fevers, rigours and malaise. LUTS symptoms and pain on ejaculation/pelvic pain

Chronic prostatitis: recurrent UTIs, pelvic pain an acute symptoms for more than 3 months.

93
Q

Prostatitis:

How do you manage the Acute form?

How do you manage Chronic prostatitis?

A

Acute: give abx such as gentamicin and co amoxicillin

Chronic: tends not to respond well to abx. Instead give alpha blockers (Tamsulosin) and NSAIDs

94
Q

Urethritis:

What is the most common cause?

A

Chlamydia

Other causes include trichomonas vaginalis and gonorrhoea

95
Q

How does urethritis present?

A

It presents with pain on seeing

Discharge
Urethral pain
Penile discomfort
Systemic symptoms

96
Q

What antibiotics do you use for chlamydia?

A

Doxycycline

97
Q

What abx do you use for gonorrhoea?

A

IM ceftriaxone and doxycycline

98
Q

What are causes of epididymal orchitis in under 35s vs over 35s

What is a pathogen that can also cause it?

A

Under 35 think: STI related

Over 35 think: KEEPs related

Pathogen associated is MUMPS

99
Q

What is bradytherapy?

A

This is when you get radioactive seeds placed within the prostate. These produce radiation over time.

100
Q

What do you have to give alongside a LHRH agonist?

A

LHRH agonist and also an anti-androgen

This prevents tumour flare

Eg. Goserelin

101
Q

Give a comparison of a LHRH agonist vs a LHRH antagonist:

A

LHRH antagonist work within 24 hrs to castrate the individual. No anti androgen is necessary as no chance of tumour flare.

Eg. Degarelix this is useful for symptomatic metastatic disease as it works with 24 hours.

102
Q

What is the gold standard investigation for renal stones?

A

Non contrast CT :)

103
Q

What is phimosis?

A

A non retractible foreskin. Common in boys under the age of 2

Only an issue if it becomes symptomatic through local pain, haematuria or urinary obstruction.

104
Q

Two causes of phimosis?

A

Congenital

Balanoposthitis (recurrent infection leads to scar tissue formation)

105
Q

How does Phimosis present?

A

Non retractable foreskin or parents may notice a ballooning structure on urination.

If pathological secondary to balanopsitis. The patient may have painful erections, haematuria, recurrent UTIs, swelling or redness

106
Q

What is the treatment for congenital and pathological phimosis?

A

Congenital: only treat if it is still there after the age of 2. Likely treatment is circumcision

Pathological phimosis may need abx or steroids

107
Q

What is paraphimosis?

A

This is a condition where you have a tight prepuce that is retracted an is unable to be replaced when the glans swells.

108
Q

What are some risk factors of paraphimosis?

A 
Vigorous sexual activity 
Chronic balanopositis (common in DM)
109
Q

How does paraphimosis presents?

A

It presents with pain and oedema around the prepuce band.

Pain on erection

the glans can then become blue/black after necrosis.

Infants can present with irritability

110
Q

How do you treat paraphimosis?

A

You can do gentle compression with a saline swab

Gentle manual reduction

Surgery

111
Q

how do you treat Balanitis?

A

Topical steroids and an anti fungal

112
Q

What is fournier’s gangrene?

A

This is a form of necrotising fasciitis that occurs around the scrotum or the vulva

It involves and deep soft tissue compartment i.e. dermis, S.C. fat or fascia

113
Q

Why is it hard to diagnose fournier’s gangrene?

A

It is hard to diagnose as its a great mimicker of cellulitis.

Note. The patient will be experiencing pain, tenderness and be systemically unwell out of proportion to if they had cellulitis

114
Q

How long does it roughly take for fournier’s gangrene to develop?

Does it respond to abx?

A

It roughly takes 1-2 days

It does not respond to antibiotics typically used for cellulitis

115
Q

How do you investigate fournier’s gangrene?

A

You investigate fournier’s gangrene with X-Rays and also explorative surgery.

116
Q

How do you treat fournier’s gangrene?

A

You treat it with surgical explorative and debridement

You then use broad spectrum abx

117
Q

What is priapism?

A

This is when you have an unwanted painful erection of the penis that is not associated with sexual desire lasting more than 4 hours

118
Q

What is a big RF for priapism?

A

Sickle Cell anaemia

Leukaemia

Viagra

Spinal, perineal or penile trauma

119
Q

What investigations do you organise for priapism?>

A

You need to do a corporeal blood gas. to determine if it is ischaemic or non ischaemic

Routine bloods, clotting, drug profile and also HB electrophoresis

120
Q

How do you manage priapism?

A

You manage it through doing corporeal aspiration

Intracavernosal injection of adrenaline

may need surgical management (put a shunt in)

121
Q

What is the pathophysiology of a penile fracture?

A

A penile fracture happens when you get traumatic rupture of the tunica albuginea and the corpus cavernosa

122
Q

What are the clinical features of a penile fracture:

A

Forceful thrust to the perineum of the partner followed by a popping sensation with pain, swelling and detumescence (drop from the erection)

The penis will swell and will become discoloured. It will deviate to the opposite side of the lesion.

There will be a immobile firm haematoma s the start (rolling sign) whilst a butterfly sign signifies urethral damage.

123
Q

How do you investigate a penile fracture?

A

Mostly diagnosed clinically however, you can also do a cavernosography!

124
Q

What is the management of a penile fracture ?

A

Anti emetic

Analgesia

Surgery

Abstinence from SI for 6-8 weeks

Phase 3b (3 decks)

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