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3rd year medicine > Renal/Urology guidelines > Flashcards

Renal/Urology guidelines Flashcards

1
Q

UTI management - non pregnant women - pregnancy woman - man

A
  • 3d nitrofurantoin/trimethoprim - 7d nitrofurantoin (even if asymptomatic) - 7d nitro/trimethoprim
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2
Q

Pyelonephritis Mx

A

cephalosporin 14d Can also use quinolone (levofloaxin, ciprofloxacin)

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3
Q

Prostatitis Mx

A

Quinolone 14d (levofloxacin, ciprofloxacin)

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4
Q

UTI in children <3m >3m, lower UTI >3m, upper UTI

A

<3m = admit if under 3m >3m, lower UTI = treat as adult >3m, upper UTI = admit for 10d cephalosporin

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5
Q

timeline for needing CTKUB for renal stones

A

non-contrast CT within 14 hours

if fever or solitary kidney or when diagnosis uncertain - CT KUB immediately

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6
Q

Mx of renal stone based on size

A

<0.5cm = expectant with alpha blocker (tamsulosin) or CCB (nifedipine)

<2cm = lithotripsy (uretoscopy if pregnant)

>2cm (or complex like staghorn) = percutaneous nephrolithotomy Any size + infection/hydrocephalus

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7
Q

2 main drugs for BPH and SE

A

tamsulosin (a2 blocker) - post hypotension, dizziness finasteride (5a reductase inhibitor) - libido, erections, retrograde ejaculation, gynaecomastia

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8
Q

do you need to do a biopsy for renal cancer

A

no, not if a nephrectomy is planned CTCAP is good enough

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9
Q

Mx of renal cancer T1 T2+ chemotherapy if is a transitional cancer of renal pelvis

A

T1 (<7cm in one kidney) = partial nephrectomy T2+ = radical nephrectomy (without adrenals) NO adjuvant chemo needed If TCC, need to disconnect ureter at the bladder and remove it.

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10
Q

when do you refer for prostate cancer

A

if craggy if PSA above age specific range: 50-60 = 3 60-70 = 4 70+ = 5

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11
Q

1st line investigation once referred for prostate cancer and how this leads on to definitive investigation

A

Multiparametric MRI, reported using the 5 point Likert scale: 1-2 –> discuss pros and cons of biopsy 3+ –> perform trans rectal biopsy TRUS and then grade using gleason score

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12
Q

When can you do conservative treatment for prostate cancer and what does this entail

A

T1/T2 stage (local) AND elderly + comorbid + 3/3 Gleason score (low). This group needs active surveillance including re-biopsy

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13
Q

Mx of prostate cancer - T3/4 (advanced to local structures)

A

surgery + radiotherapy +/- hormone therapy

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14
Q

Mx of prostate cancer - Metastatic

A

Goserelin (GnRH agonist) + covering antiandrogen cytoperotone acetate

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15
Q

1st line for testicular cancer

A

USS

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16
Q

Mx of testicular cancer always seminoma non-seminoma

A

Always = orchidectomy via inguinal approach Seminoma = radiotherapy Non-seminoma = chemotherapy

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17
Q

Approaches to hydrocele operation if adult or child

A

adult has scrotal approach (Lords or Jaboulay)

child (if persisting beyond 2yrs) has inguinal approach

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18
Q

Ix of varicocele when do you operate

A

Ix = doppler studies Mx = usually conservative. if pain or fertility issues, operate

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19
Q

CKD management - high phosphate - low vit D - anaemia - hypertension - tertiary hyperPTH

A
  • use calcium based phosphate binders. Unless CKD bone disease is present in which case use Sevelamer (nonCabased) - give activated vit D calcitriol/alfacalcidol - IV iron or EPO - ACEi is good (allowed a 30% rise in creatinine or 25% reduction in eGFR) - parathyroidectomy of offending gland
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20
Q

Stress incontinence Mx

A

C = pelvic floor exercises, 8r, 3x/day 3 weeks M = duloxetine (SNRI) S = retropubic tabe

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21
Q

Urge incontinence Mx

A

C = bladder retraining M = oxybutninin (antimuscarinic), mirabegron (B3) for old ladies worried about falls S = botulinum toxin

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22
Q

definition of AKI and stages

A

Stage 1 =

urine production: <0.5ml/kg/hr for >6hrs

creatinine: increase 1.5-1.9x baseline

Stage 2 =

urine production: <0.5ml/kg/hr for >12hrs

creatinine: increase 2-2.9x baseline

Stage 3 =

urine production: <0.3ml/kg/hr for >24hrs or anuric for 12hr

creatinine: 3x increase or >354 or placed on renal replacement therapy

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23
Q

when do you do urine dip and renal USS for AKI

A

urine dip (urinalysis) = always

renal USS = only if cause not known for AKI after 24 hours

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24
Q

do you fluid resuscitate in AKI

A

If pre-renal, yes, but if ATN no. Pre-renal: urinary sodium <30 ATN: urinary sodium >30

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25
Q

What do you do FIRST if called to hyperkalaemia

A

do ECG and repeat VBG to check result

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26
Q

When do you manage hyperK

A

If >6.5 or if ECG changes

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27
Q

Mx and doses for hyper K

A

1st = 10ml 10% calcium gluconate

Then = 10U actrapid in 50ml of 50% glucose over 10 mins

Consider = salbutamol. rectal Resonium.

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28
Q

definition of nephrotic syndrome

A

>3g/24hr protein hypoalbuminaemia (<30)

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29
Q

Investigation findings for the following:

  • MNCS
  • FSGS
  • membranous
  • IgA
  • Post-strep (proliferative)
  • Rapid progressive
A
  • MNCS = podocyte effacement on EM
  • FSGS = focal sclerosis and hyalinosis on light microscopy
  • membranous = subepithelial deposits ‘spike and dome’
  • IgA = mesangial hypercellularity, +ve for IgA and C3
  • Post-strep (proliferative) = low C3, high ASOT, endothelial proliferation and subepithelial humps
  • Rapid progressive = epithelial crescents
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30
Q

AIN heptad

A

fever, eosinophilia, urinary white cell casts, rash

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31
Q

General nephrotic syndrome Mx General nephritic syndrome Mx

A

steroids + immunosuppression with membranous type also use ACEi/ARB Nephritic are usually self limiting or are caused by something systemic like GwPA so have special treatments

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32
Q

Amyloidosis Ix (3)

A

Congo red stain shows apple green birefringence Serum amyloid precursor scan (SAP scan) Biopsy of rectal tissue

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33
Q

Amyloidosis general Mx

A

Myoablative chemotherapy (as problem is often within the bone marrow)

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34
Q

how do you screen for PCKD

A

USS

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35
Q

How do you diagnose PCKS based on USS

A

<30 = two cysts either kidney 30-60 = two cysts both kidneys 60+ = four cysts both kidneys

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36
Q

Mx of PCKD

A

tolvaptan (ADH receptor 2 antagonist) if CKD2/3 or rapidly progressing

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37
Q

Peyronie’s disease Ix and Mx

A

Ix = USS Mx = vitamin E and surgery

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38
Q

inguinoscrotal swelling

cannot get above it on examination

cough impulse may be present

may be reducible

diagnosis?

A

inguinal hernia

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39
Q

tests for testicular tumours

A

USS scrotum

serum AFP and BHCG

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40
Q

dysuria and urethral discharge

swelling may be tender and eased by elevating testis

diagnosis

A

acute epididymo-orchitis

most cases due to chlamydia

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41
Q

painless

single or multiple cysts

above and behind testis

usually possible to get above lump

diagnosis

A

epidiymal cyst

Mx: excised using scrotal approach

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42
Q

non painful

soft fluctuant swelling of testes

usually contain clear fluid

will often transiluminate

may be presenting feature of testicular cancer in young men

diagnosis

A

hydrocele

accumulation of fluid in tunica vaginalis

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43
Q

severe sudden onset testicular pain

adolescents and young males

not eased by elevation

diagnosis

A
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44
Q

bag of worms appearance testes

A
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45
Q

risk factors for bladder cancer

A

smoking

exposure to hydrocarbons

schistosommiasis (flat worm) infection - in countries with endemic (squamous cell carcinoma)

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46
Q

most common type of bladder cancer

A

transitional cell carcinoma

others:

squamous cell carcinoma

adenocarcinoma

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47
Q

most common feature of bladder cancer

A

painless macroscopic haematuria

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48
Q

staging of bladder cancer

A

cystoscopy and biopsies or TURBT (transurethral resection of bladder tumour)

pelvic MRI to determine spread

CT for distant disease

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49
Q

Mx bladder cancer

A

superficial lesions = TURBT

recurrences or higher grade = intravesical chemotherapy

T2 = surgical (radical cystectomy and ileal conduit) or radical radiotherapy

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50
Q

causes of pre-renal AKI

A

hypovalaemia due to vomiting/ diarrhoea

renal artery stenosis

cause ischaemia/reduced blood flow to kidneys

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51
Q

causes of intrinsic AKI

A

glomerulonephritis

acute tubular necrosis (ATN)

acute interstitial nephritis (AIN), respectively

rhabdomyolysis

tumour lysis syndrome

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52
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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53
Q

nephrotoxic drugs causing increased risk of AKI

A

NSAIDs

aminoglycosides (gentamicin)

ACEi (ramapril)

ARBs (candastartan, losartan)

diuretics

iodinated contrast agents within past week

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54
Q

symptoms and signs of AKI

A
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55
Q

diagnosis of AKI

A
  • rise in serum creatinine of 26 or greater within 48hrs
  • 50% or greater rise in serum creatinine in past 7 days

fall in urine output to less than 0.5ml/kg/hr for more than 6hrs in adults

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56
Q

drugs to stop in AKI due to risk of toxicity

A

metformin

lithium

digoxin

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57
Q

when should haemodialysis be used in AKI

A

for patients not responding to medical treatment of complications:

  • hyperkalaemia
  • pulmonary oedema
  • acidosis
  • uraemia
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58
Q

mx renal stone + infection

A

surgical emergency

decompression - nephrostomy tube placement (drain kideny through skin), insertion of ureteric catheters and ureteric stent placement

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59
Q

causes of normal anion gap metabolic acidosis

A

gastrointestinal bicarb loss (diarrhoea, ureterosigmoidostomy, fistula)

renal tubular acidosis

addisons disease

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60
Q

causes of raised anion gap metabolic acidosis

A

lactate: shock, sepsis, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure

acid poisoning: salicylates (aspirin), methanol

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61
Q

polyuria

polydipsia

normal blood glucose

diagnosis

A

diabetes insipidus

normal blood glucose levels but kidneys cannot balance fluid

  • high serum osmolality
  • low urine osmolality
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62
Q

pre-renal uraemia vs acute tubular necrosis urine sodium levels

A

pre-renal uraemia: urine sodium <20

kidneys hold onto sodium to preserve volume

urine: plasma urea high

acute tubular necrosis: urine sodium >40

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63
Q

most common histological subtype of renal cell cancer

A

clear cell

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64
Q

associations of renal cancer

A

more common in middle-aged men

smoking

Von Hippel-Lindau syndrome

tuberous sclerosis

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65
Q

features of renal cell cancer

A

classic triad: haematuria, loin pain, abdo mass

pyrexia of unknown origin

left varicocele (due to occlusion of left testicular vein)

endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH

paraneoplastic hepatic dysfunction - cholestasis/ hepatosplenomegaly

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66
Q

what can be used to shrink size of renal cell tumour

A

alpha-interferon and interleukin-2

receptor tyrosine kinase inhibitors

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67
Q

risk factors for bladder cancer: transitional vs squamous

A

transitional cell carcinoma:

  • smoking
  • exposure to aniline dyes in printing and textile industry
  • rubber manufacture
  • cyclophosphamide

squamous cell carcinoma:

  • schistosomiasis
  • smoking
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68
Q

IgA nephropathy

A

also known as Berger’s disease

commonest cause of glomerulonephritis worldwide

presentation:

  • macroscopic haematuria
  • young people
  • recent URTI
  • no proteinuria (which there is in post-strep)
  • quick onset (1-2 days instead of few weeks like post-strep)
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69
Q

IgA nephropathy vs post-strep glomerulonephritis

A
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70
Q

what type of electrolyte acid/alkali does diarrhoea give

A

diarrhoea - normal anion gap metabolic acidosis

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71
Q

urine in pre-renal uraemia vs acute tubular necrosis

A

pre-renal uraemia: normal/ ‘bland’ sediment

acute tubular necrosis: brown granular casts

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72
Q

acute interstitial nephritis causes

A

accounts for 25% of drug induced AKI

drugs: (particularly abx)
- penicillin
- rifampicin
- NSAIDs
- allopurinol
- furosemide
- systemic disease: SLE, sarcoidosis, sjogren’s
infection: Hanta virus, staphylococci

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73
Q

acute interstitial nephritis features

A

fever, rash, arthralgia

eosinophilia

mild renal impairment

hypertension

sterile pyuria

white cell casts

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74
Q

extra-renal manifestations of polycystic kidney disease

A

liver cysts (70%) - may cause hepatomegaly

berry aneurysms - rupture can cause subarachnoid haemorrhage

mitral valve prolapse, mitral incompetence, aortic root dilation, aortic dissection

cysts in other organs: pancreas, spleen

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75
Q

diagnosis

A

polycystic kidney disease

can also have cysts in liver as seen on CT attached here

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76
Q

prevention of renal stones

  • calcium stones
  • oxalate stones
  • uric acid stones
A

calcium stones:
- high fluid intake

  • low animal protein, low salt diet
  • thiazides diuretics (increase calcium resorption therefore less in kidneys)

oxalate stones:

  • cholestyramine
  • pyridoxine

uric acid stones:

  • allopurinol
  • urinary alkalinization e.g oral bicarb
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77
Q

what type of strep with post-streptococcal glomerulonephritis

A

group A beta-haemolytic Streptococcus infection (usually Streptococcus pyogenes)

most commonly in young children

develops 1-2 weeks after URTI

proteinuria

low complement

78
Q

goodpasture’s syndrome

A

haemoptysis + renal failure

renal biopsy: linear IgG deposits along basement membrane

79
Q

nephrotic syndrome

normal blood pressure

blood tests normal

diagnosis

A

minimal change disease

80
Q

renal papillary necrosis causes

A

severe acute pyelonephritis

diabetic nephropathy

obstructive nephropathy

analgesic nephropathy

= NSAIDs

sickle cell anaemia

features:

visible haematuria

loin pain

proteinuria

pale areas (ischaemia) on pic

81
Q

newborn

renal failure

liver fibrosis

palpable masses in loins

Potter’s syndrome

diagnosis

A

autosomal recessive polycystic kidney disease

found prenataly or infancy

mutation chromosome 6

Potter’s syndrome 2ndry to oligohydramnios

end-stage renal failure develops in childhood

also usually have liver involvement (portal and interlobular fibrosis)

renal biopsy: multiple cyclindrical lesions at right angles to cortical surface

82
Q

Alport’s syndrome

A

X-linked

more severe in males

usually presents in childhood

Alport’s patient with failing renal transplant - due to anti-GBM

features:

  • microscopic haematuria
  • progressive renal failure
  • bilateral sensorineural deafness

renal biopsy: basket weave appearance

83
Q

membranoproliferative glomerulonephritis type 1

A

90% of cases

renal biopsy: tram-track appearance

causes: cryoglobulinaemia, hep C

84
Q

Membranoproliferative glomerulonephritis type 2

A

‘dense deposit disease’ - seen on biopsy

causes:

  • partial lipodystrophy (loss of subcut tissue from face)
85
Q

triad:

AKI

microangiopathic haemolytic anaemia

thrombocytopenia

A

Haemolytic uraemic syndrome

triad:

AKI

microangiopathic haemolytic anaemia

thrombocytopenia

mostly caused by shiga toxin-producing E.coli 0157:H7 (mostly in children)

presentation: child presents with acute renal failure shortly after bloody diarrhoea and fever

86
Q

chromosome for autosomal dominant polycystic kidney disease

A

type 1: chromosome 16 - 85%

type 2: chromosome 4

87
Q

Fanconi syndrome

A

Fanconi syndrome results in:

  • type 2 renal tubular acidosis
  • polyuria
  • aminoaciduria
  • glycosuria
  • phosphaturia
  • osteomalacia
88
Q
A
89
Q

Mx for polycystic kidney disease

A

tolvaptan

90
Q

bipolar with increased urinary frequency

A

lithium causes polyuria

lithium is a common treatment for bipolar

91
Q

treatment for aspirin overdose

A

IV sodium bicarbonate - if metabolic acidosis (to cause alkalinisation)

activated charcoal - recent overdose

92
Q

most appropriate first step for treating someone with suspected anaemia of chronic disease secondary to CKD

A

iron status should be checked prior to commencing erythropoietin (EPO)

anaemia in CKD usually due to reduced production of EPO by kidney - normochromic normocytic anaemia

need adequate iron stores to form red blood cells (by EPO)

93
Q

13yrs

recently gaining weight

puffy face

frothy urine

protein +ve urine

dx

A

minimal change disease - usually presents as nephrotic syndrome in children

features:

  • nephrotic syndrome
  • proteinuria
  • normal glomeruli on light microscopy
94
Q

mx for minimal change disease

A

oral prednisolone and urgent outpatient referral

cyclophosphamide for steroid-resistant cases

24hr urinary protein measurement would help confirm diagnoiss but should not delay starting treatment

95
Q

what do all diabetic patients require annual screening for

A

annual screening for:

albumin: creatinine ration (ACR) in early morning specimens

ACR > 2.5 = microalbuminuria

96
Q

pelvic fracture + urinary retention + distended bladder

whats most likely to be damaged

A

urethral injury

pelvic fracutures

features:
- urinary retention

  • blood at urethral meatus
  • high riding prostate on digital recatal exam
97
Q

ix and mx or urethral damage

A

ascending urethrogram

mx: suprapubic catheter (surgical placement)

98
Q

mx for recurrent balanitis

A

balanitis = inflammation of glans penis

causes:

  • STI
  • dermatitis
  • bacterial infection
  • opportunistic fungal infection (candida) likely 2ndry to diabetes

Mx for recurrent balanitis: indication for circumcision

99
Q

balanitis mx

A

acute infections managed with saline baths + treatment for underlying cause:

STI: appropriate treatment of infection

dermatitis: topical hydrocortisone
candida: topical clotrimazole

bacterial infection: flucloxacillin or erythromycin

recurrent: circumcision

100
Q

diagnosis of CKD

A

diagnosis of stages 1 & 2 can only be made by eGFR + supporting evidence

supporting evidence:

  • alb:creat ratio >3
  • histological abnormalities
  • structural abnormalities
101
Q
A
102
Q

nephritic vs nephrotic syndrome

A
103
Q

what conditions are you at risk of with nephrotic syndrome

A

thrombosis:

  • loss of antithrombin-III, proteins C & S and rise in fibringoen

low total thyroxin levels

104
Q

> 45yrs unexplained visible haematuria without UTI next step

A

urgent 2ww referral

aged >45yrs +:

unexplained visible haematuria without UTI

or visible haematuria that persists after successful treatment of UTI

aged >60yrs +

unexplained nonvisible haematuria and either dysuria or raised WCC

105
Q

indications for non-urgent referral

A

>60yrs with recurrent or persistent unexplained UTI

106
Q

first line diagnostic test for testicular cancer

A

USS

107
Q

which has a better prognosis of testicular cancer - seminoma or teratoma

A

seminoma has better prognosis

108
Q

monitoring after relief of urinary retention

A

daily monitoring of U&Es after relief of outlet flow obstruction

they have diuresis (excess urination) after relieving the obstruction

  • can lead to hypovolaemia, dehydration and electrolyte imbalances
109
Q

diagnostic investigation of acute urinary retention

A

bladder ultrasound

volume >300 confirms diagnosis

110
Q

mx acute urinary retention

A

urinary catheterisation

111
Q

mx HUS

A

treatment is supportive: fluids, blood transfusions and dialysis

112
Q

ix to confirm diagnosis of rhabdomyolysis causing AKI

A

creatinine kinase - elevated

causes:

due to long lie

seizure

ecstacy

drugs: statins

113
Q

mx for rhabdomyolysis

A

IV fluids - to maintain good urine output

114
Q

guidelines on PSA testing

A

6 wks: prostate biopsy

4wks: proven UTI

1 wk: digital rectal examination

48hrs: vigorous exercise
48hrs: ejaculation

115
Q

PSA cut offs for referral

A

Referral

50-69 yrs: PSA >=3

>70: PSA >5

116
Q

what can gentamicin cause in kidneys

A

intrinsic AKI

would have proteinuria (showing intrinsic)

117
Q

scrotal swelling you cant get above

A

inguinal hernia

118
Q

first line definitive investigation for prostate cancer

A

multiparametric MRI

report results using 5-point Likery scale

if >=3 - prostate biopsy offered

if 1-2: discuss pros and cons of biopsy

119
Q

Ix for suspicious digital rectal examination

A

urgent 2ww referral for USS guided biopsy

regardless of PSA

120
Q

acute vs chronic upper urinary tract obstruction

A

acute: nephrostomy tube (percutaneous drainage)
chronic: ureteric stent or pyeloplasty

121
Q

vasectomy

A

more effective than female sterilisation

doesnt work immediately

semen analysis performed twice following before having unprotected sex (at 16 and 20wks)

chronic testicular pain (5-30% men)

success reversal rate - 55% within 10yrs

122
Q

what organism causes staghorn calculus

A

proteus - proteus mirabilis

struvite stones - result of urease producing bacteria

123
Q

what can you find in the urine of menstruating women

A

microscopic haematuria

124
Q

red cell casts in urine

A

nephritic syndrome

125
Q

bland urinary sediment in urine

A

prerenal uraemia

126
Q

brown granular casts in urine

A

acute tubular necrosis

127
Q

hyaline casts in urine

A

seen in normal urine, after exercise, during fever, or with loop diuretics

consist of Tamm-Horsfall protein

128
Q

IV fluid resus

A

crystalloid

initial bolus of 500ml over 15mins

0.9 saline - better if AKI as hartmanns contains K+ which is a worry in AKI

129
Q

maintenance fluids

A

25-30 ml/kg/day of water

+ 1mmol/kg/day of K+, Na+, Cl-

+ 50-100g/day of glucose to limit starvation ketosis

e.g. 80kg patient:

2L of water

80mmol potassium

for first 24hrs: 25-30ml/kg/day NaCl 0.18% in 4% glucose with 27mmol/l K+ on day 1

130
Q

risks of using large volumes of 0.9% saline in large volumes

A

large volumes of 0.9% saline (NaCl):

increased risk of hyperchloraemic metabolic acidosis

131
Q

urge incontinence first line mx

A

bladder retraining

medical: antimuscarinics are first-line = oxybutynin

132
Q

stress incontinence first line mx

A

pelvic floor muscle training

133
Q

type 1 vs type 2 hepatorenal syndrome

A

hepatic failure causing renal failure

type 1:

rapidly progressive (< 2wks)

usually following acute event

doubling of serum creat or halving of creat clearance

type 2:

slowly progressive

associated with refractory ascites

134
Q

what type of VBG pic for renal tubular acidosis

A

metabolic acidosis with normal anion gap - low potassium and high chloride

135
Q
A
136
Q

USS suggesting probable stone in ureter

next Ix

A

non-contrast CT KUB

137
Q

infection stones

A

struvite

carbonate apatite

ammonium urate

138
Q

most common type of renal stone

A

calcium oxalate

139
Q

differentials of kidney stone

A

AAA

pancreatitis

perforated ulcer

ectopic pregnancy - preg test in all women of child bearing age

diverticular disease

PE

140
Q

stone associated with UTI

A

struvite

caused by proteus

141
Q

stone associated with metabolic syndrome

A
142
Q

signs of sepsis and/or anuria + obstructive uropathy (stone)

A

urological emergency

urgent decompression with cystocopy + ureteric stenting

or percutanous nephrostomy - less common if stent doesnt work

urine and blood cultures

IV abx

143
Q

asymptomatic renal stone <5mm

A

watchful wait

144
Q

renal stone <10mm

A

shockwave lithotripsy

145
Q
A
146
Q
A

ureteric stent

147
Q

ureteric colic + renal failure

A

suggests single kidney or bilateral obstruction or pre-existing renal disease

do non-contrast CT KUB

148
Q

typical translucent renal stone

A

urate stone

149
Q
A
150
Q

complex renal calculi and staghorn calculi mx

A

percutaneous nephrolithotomy

151
Q
A

partial duplex ureter

duplex collecting system on right side

radio lucent stone on right side in ureter

152
Q

> 300ml post void residual volume

A

evidence of chronic retention

153
Q

>30ml volume of prostate on USS

A

prostate cancer

154
Q

mx for BPH

A

alpha blcoker or 5-alpha reductase inhibitor

155
Q

chronic urinary retention

high vs low pressure

A

high pressure: hydronephrosis

leading to renal failure

156
Q

risk factors for testicular torsion

A

bell clapper deformity

testicular tumour

undescended testis

trauma

exercise

157
Q
A
158
Q

sudden onset scrotal pain

lifting testis does not relieve pain

mx

A

testicular torsion

mx:

surgical exploration

159
Q
A
160
Q

testicular pain onset over hrs to days

positive Prehns sign

urethral discharge

signs of UTI

diagnosis

mx

A

epididymo-orchitis

Prehn’s sign +ve: relieving pain on lifting up testis

mx: abx

161
Q

testes transiluminating

swelling

non-painful

A

hydrocele

if symptomatic:

exploratory surgery

jaboulay (inversion of sac)

Lords (plication of sac)

DO NOT ASPIRATE - risk of infection

162
Q
A

peyronie’s disease

mx: surgical

163
Q
A

phimosis

in child <2yrs: watchful waiting, avoid forcebale retraction

mild scarring: topical steroids

if fails: circumcision

164
Q
A

paraphimosis

mx: manual pressure and reduction

surgical

can happen post catheterisation if you forget to replace the foreskin

165
Q

bag of worms

A
166
Q

young female patient with AKI after starting ACEi

A

fibromuscular dysplasia

90% female

proliferation of cells in walls of arterues - string of beads appearance on angiography

in older women with AKI after ACEi think atherosclerosis of renal arteries

167
Q

what renal condition is associated

A

rapidly progressive glomerulonephritis

seen in Wegners (granulomatosis with polyangiitis)

168
Q

priapism

A

prolonged penile erection lasting more than four hrs in the absence of sexual stimulation and remains despite orgasm

usually very painful, corpora rigid, glans penis soft

VCG on penis would show low O2

ischaemic/ non-ischaemic/stuttering:

  • sickle cell (do FBC), thalasseamia, psychotropic meds (schitzophrenia)
    tx: aspiration + irrigation with saline in unsuccessful aspiration
169
Q

varicoceles more common on which side

A

80% more common on left side

bag of worms appearance

if new onset right varicocele - CT scan to look for renal tumour

170
Q

nutcracker syndrome

A

compression of left renal vein by aorta and SMA

think if varicocele with abdo pain and haematuria

171
Q

epididymal cyst

A

risk factors: cystic fibrosis, von-hippel-landau syndrome, polycysti kidney disease

chinese lantern appearance on transillumination

Ix: USS

Mx: excise cyst if needed. do not aspirate

172
Q

3month hx of scrotal swelling and discomfot

unilateral swelling of left scrotum which transilluminates

swelling soft non-tender

testis not fully palpable

next course of action

A

urgent testicular USS

hydrocele can be due to testicular cancer and as the testis cannot be examined a USS is essential

if testis can be felt then re-examine in a few months

173
Q

mx for stress incontinence if pelvic floor retraining doesnt work

A

colposuspension

if no surgery then duloxetine

174
Q

overative bladder mx

A

for urinary urgency

first line: bladder retraining

antimuscularinics: oxybutynin

if unresponsive to medical: Botulinum A toxin

175
Q

acute urinary retention mx

A

urethral catheterisation and measure volume drained

treat underlying cause: if BPH- tamsulosin

if >1000ml monitor for post-obstructive diuresis (loss of urea therefore lose fluid)

176
Q

previous gonorrhoea infection + post void dribbling

A

urethral stricture due to the gonorrhoea

177
Q

renal cancer mx

A

radical nephrectomy if early on

chemo and radio dont help

178
Q

mx for renal cancer

A

T1 <7cm: partial nephrectomy

T2 >7cm: radical nephrectomy

T3 and 4: open radical nephrectomy

179
Q

most common type of bladder cancer

A

transitional cell carcinoma

180
Q

what type of bladder cancer does schistosomiasis cause

A

squamous cell carcinoma

181
Q

2ww referral for bladder cancer

A

>45yrs: unexplained visible haematuria without UTI or persistent visble haematuria refractory to treatment of UTI

>60yrs + unexplained non-visible haematuria and dysuria or raised WCC

182
Q

bladder cancer mx

A

non invasive: TURBT + mitomycin

183
Q

grading score for prostate cancer

A

Gleason score

max score of 10 from biopsies of two different areas

184
Q

diagnostic test for prostate cancer

A

US guided prostate biopsy

if cant be done then MRI

185
Q

most likely mets place for prostate cancer

A
186
Q

germ cell vs non germ cell tumour of testicle

A

germ cell: hard lump on testis

non-germ cell: most common lymphoma: diffuse larger testis

187
Q

tumour markers for testicular cancer

A

elevated AFP: non-seminomatous = teratoma or yolk sac tumour

B-HCG: mainly non-seminomatous and sometimes seminomas

LDH: all germ cell tumours (seminoma and non-seminomas)

188
Q

testicular cancer mx

A

seminoma: responds well to radiotherapy

non-seminoma: chemotherapy

189
Q

peritonitis due to peritoneal dialysis

most common causative bacteria

A

staph.epidermidis

190
Q

side effects of nephrotic syndrome

mx

A

risk of thrombosis - lose antithrombin -III + associated rise in fibrinogen

need to give LMWH

loss of thyroxine-binding globulin - lowers total but not free thyroxine levels

191
Q

most common bacteria causing epididymitis

for younger men

for older men

A

younger men:

  • N.gonorrhoea
  • chlamydia tachomatis

older men:

  • e.coli especially with a hx of BPH
192
Q

most common cause of nephrotic syndrome in adults

A

membranous nephropathy

can occur secondary to malignancy

3rd year medicine (31 decks)

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