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
2
Q
Pyelonephritis Mx
A
cephalosporin 14d Can also use quinolone (levofloaxin, ciprofloxacin)
3
Q
Prostatitis Mx
A
Quinolone 14d (levofloxacin, ciprofloxacin)
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
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
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
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
8
Q
do you need to do a biopsy for renal cancer
A
no, not if a nephrectomy is planned CTCAP is good enough
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.
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
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
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
13
Q
Mx of prostate cancer - T3/4 (advanced to local structures)
A
surgery + radiotherapy +/- hormone therapy
14
Q
Mx of prostate cancer - Metastatic
A
Goserelin (GnRH agonist) + covering antiandrogen cytoperotone acetate
15
Q
1st line for testicular cancer
A
USS
16
Q
Mx of testicular cancer always seminoma non-seminoma
A
Always = orchidectomy via inguinal approach Seminoma = radiotherapy Non-seminoma = chemotherapy
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
18
Q
Ix of varicocele when do you operate
A
Ix = doppler studies Mx = usually conservative. if pain or fertility issues, operate
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
20
Q
Stress incontinence Mx
A
C = pelvic floor exercises, 8r, 3x/day 3 weeks M = duloxetine (SNRI) S = retropubic tabe
21
Q
Urge incontinence Mx
A
C = bladder retraining M = oxybutninin (antimuscarinic), mirabegron (B3) for old ladies worried about falls S = botulinum toxin
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
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
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
25
What do you do FIRST if called to hyperkalaemia
do ECG and repeat VBG to check result
26
When do you manage hyperK
If \>6.5 or if ECG changes
27
Mx and doses for hyper K
1st = 10ml 10% calcium gluconate
Then = 10U actrapid in 50ml of 50% glucose over 10 mins
Consider = salbutamol. rectal Resonium.
28
definition of nephrotic syndrome
\>3g/24hr protein hypoalbuminaemia (\<30)
29
Investigation findings for the following:
- MNCS
- FSGS
- membranous
- IgA
- Post-strep (proliferative)
- Rapid progressive
- 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
30
AIN heptad
fever, eosinophilia, urinary white cell casts, rash
31
General nephrotic syndrome Mx General nephritic syndrome Mx
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
32
Amyloidosis Ix (3)
Congo red stain shows apple green birefringence Serum amyloid precursor scan (SAP scan) Biopsy of rectal tissue
33
Amyloidosis general Mx
Myoablative chemotherapy (as problem is often within the bone marrow)
34
how do you screen for PCKD
USS
35
How do you diagnose PCKS based on USS
\<30 = two cysts either kidney 30-60 = two cysts both kidneys 60+ = four cysts both kidneys
36
Mx of PCKD
tolvaptan (ADH receptor 2 antagonist) if CKD2/3 or rapidly progressing
37
Peyronie's disease Ix and Mx
Ix = USS Mx = vitamin E and surgery
38
inguinoscrotal swelling
cannot get above it on examination
cough impulse may be present
may be reducible
diagnosis?
inguinal hernia
39
tests for testicular tumours
USS scrotum
serum AFP and BHCG
40
dysuria and urethral discharge
swelling may be tender and eased by elevating testis
diagnosis
acute epididymo-orchitis
most cases due to chlamydia
41
painless
single or multiple cysts
above and behind testis
usually possible to get above lump
diagnosis
epidiymal cyst
Mx: excised using scrotal approach
42
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
hydrocele
accumulation of fluid in tunica vaginalis
43
severe sudden onset testicular pain
adolescents and young males
not eased by elevation
diagnosis
44
bag of worms appearance testes
45
risk factors for bladder cancer
smoking
exposure to hydrocarbons
schistosommiasis (flat worm) infection - in countries with endemic (squamous cell carcinoma)
46
most common type of bladder cancer
transitional cell carcinoma
others:
squamous cell carcinoma
adenocarcinoma
47
most common feature of bladder cancer
painless macroscopic haematuria
48
staging of bladder cancer
cystoscopy and biopsies or TURBT (transurethral resection of bladder tumour)
pelvic MRI to determine spread
CT for distant disease
49
Mx bladder cancer
superficial lesions = TURBT
recurrences or higher grade = intravesical chemotherapy
T2 = surgical (radical cystectomy and ileal conduit) or radical radiotherapy
50
causes of pre-renal AKI
hypovalaemia due to vomiting/ diarrhoea
renal artery stenosis
cause ischaemia/reduced blood flow to kidneys
51
causes of intrinsic AKI
glomerulonephritis
acute tubular necrosis (ATN)
acute interstitial nephritis (AIN), respectively
rhabdomyolysis
tumour lysis syndrome
52
post renal causes of AKI
kidney stone in ureter or bladder
benign prostatic hyperplasia
external compression of the ureter
53
nephrotoxic drugs causing increased risk of AKI
NSAIDs
aminoglycosides (gentamicin)
ACEi (ramapril)
ARBs (candastartan, losartan)
diuretics
iodinated contrast agents within past week
54
symptoms and signs of AKI
55
diagnosis of AKI
- 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
56
drugs to stop in AKI due to risk of toxicity
metformin
lithium
digoxin
57
when should haemodialysis be used in AKI
for patients not responding to medical treatment of complications:
- hyperkalaemia
- pulmonary oedema
- acidosis
- uraemia
58
mx renal stone + infection
surgical emergency
decompression - nephrostomy tube placement (drain kideny through skin), insertion of ureteric catheters and ureteric stent placement
59
causes of normal anion gap metabolic acidosis
gastrointestinal bicarb loss (diarrhoea, ureterosigmoidostomy, fistula)
renal tubular acidosis
addisons disease
60
causes of raised anion gap metabolic acidosis
lactate: shock, sepsis, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates (aspirin), methanol
61
polyuria
polydipsia
normal blood glucose
diagnosis
diabetes insipidus
normal blood glucose levels but kidneys cannot balance fluid
- high serum osmolality
- low urine osmolality
62
pre-renal uraemia vs acute tubular necrosis urine sodium levels
pre-renal uraemia: urine sodium \<20
kidneys hold onto sodium to preserve volume
urine: plasma urea high
acute tubular necrosis: urine sodium \>40
63
most common histological subtype of renal cell cancer
clear cell
64
associations of renal cancer
more common in middle-aged men
smoking
Von Hippel-Lindau syndrome
tuberous sclerosis
65
features of renal cell cancer
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
66
what can be used to shrink size of renal cell tumour
alpha-interferon and interleukin-2
receptor tyrosine kinase inhibitors
67
risk factors for bladder cancer: transitional vs squamous
transitional cell carcinoma:
- smoking
- exposure to aniline dyes in printing and textile industry
- rubber manufacture
- cyclophosphamide
squamous cell carcinoma:
- schistosomiasis
- smoking
68
IgA nephropathy
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)
69
IgA nephropathy vs post-strep glomerulonephritis
70
what type of electrolyte acid/alkali does diarrhoea give
diarrhoea - normal anion gap metabolic acidosis
71
urine in pre-renal uraemia vs acute tubular necrosis
pre-renal uraemia: normal/ 'bland' sediment
acute tubular necrosis: brown granular casts
72
acute interstitial nephritis causes
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
73
acute interstitial nephritis features
fever, rash, arthralgia
eosinophilia
mild renal impairment
hypertension
sterile pyuria
white cell casts
74
extra-renal manifestations of polycystic kidney disease
**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
75
diagnosis
polycystic kidney disease
can also have cysts in liver as seen on CT attached here
76
prevention of renal stones
- calcium stones
- oxalate stones
- uric acid stones
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
77
what type of strep with post-streptococcal glomerulonephritis
group A beta-haemolytic Streptococcus infection (usually Streptococcus pyogenes)
most commonly in young children
develops 1-2 weeks after URTI
proteinuria
low complement
78
goodpasture's syndrome
haemoptysis + renal failure
renal biopsy: linear IgG deposits along basement membrane
79
nephrotic syndrome
normal blood pressure
blood tests normal
diagnosis
minimal change disease
80
renal papillary necrosis causes
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
newborn
renal failure
liver fibrosis
palpable masses in loins
Potter's syndrome
diagnosis
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
Alport's syndrome
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
membranoproliferative glomerulonephritis type 1
90% of cases
renal biopsy: tram-track appearance
causes: cryoglobulinaemia, hep C
84
Membranoproliferative glomerulonephritis type 2
'dense deposit disease' - seen on biopsy
causes:
- partial lipodystrophy (loss of subcut tissue from face)
85
triad:
AKI
microangiopathic haemolytic anaemia
thrombocytopenia
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
chromosome for autosomal dominant polycystic kidney disease
**type 1: chromosome 16** - 85%
type 2: chromosome 4
87
Fanconi syndrome
Fanconi syndrome results in:
- type 2 renal tubular acidosis
- polyuria
- aminoaciduria
- glycosuria
- phosphaturia
- osteomalacia
88
89
Mx for polycystic kidney disease
tolvaptan
90
bipolar with increased urinary frequency
lithium causes polyuria
lithium is a common treatment for bipolar
91
treatment for aspirin overdose
IV sodium bicarbonate - if metabolic acidosis (to cause alkalinisation)
activated charcoal - recent overdose
92
most appropriate first step for treating someone with suspected anaemia of chronic disease secondary to CKD
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
13yrs
recently gaining weight
puffy face
frothy urine
protein +ve urine
dx
minimal change disease - usually presents as nephrotic syndrome in children
features:
- nephrotic syndrome
- proteinuria
- normal glomeruli on light microscopy
94
mx for minimal change disease
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
what do all diabetic patients require annual screening for
annual screening for:
albumin: creatinine ration (ACR) in early morning specimens
ACR \> 2.5 = microalbuminuria
96
pelvic fracture + urinary retention + distended bladder
whats most likely to be damaged
urethral injury
pelvic fracutures
features:
- urinary retention
- blood at urethral meatus
- high riding prostate on digital recatal exam
97
ix and mx or urethral damage
ascending urethrogram
mx: suprapubic catheter (surgical placement)
98
mx for recurrent balanitis
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
balanitis mx
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
diagnosis of CKD
diagnosis of stages 1 & 2 can only be made by eGFR + supporting evidence
supporting evidence:
- alb:creat ratio \>3
- histological abnormalities
- structural abnormalities
101
102
nephritic vs nephrotic syndrome
103
what conditions are you at risk of with nephrotic syndrome
thrombosis:
- loss of antithrombin-III, proteins C & S and rise in fibringoen
low total thyroxin levels
104
\> 45yrs unexplained visible haematuria without UTI next step
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
indications for non-urgent referral
\>60yrs with recurrent or persistent unexplained UTI
106
first line diagnostic test for testicular cancer
USS
107
which has a better prognosis of testicular cancer - seminoma or teratoma
seminoma has better prognosis
108
monitoring after relief of urinary retention
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
diagnostic investigation of acute urinary retention
bladder ultrasound
volume \>300 confirms diagnosis
110
mx acute urinary retention
urinary catheterisation
111
mx HUS
treatment is supportive: fluids, blood transfusions and dialysis
112
ix to confirm diagnosis of rhabdomyolysis causing AKI
creatinine kinase - elevated
causes:
due to long lie
seizure
ecstacy
drugs: statins
113
mx for rhabdomyolysis
IV fluids - to maintain good urine output
114
guidelines on PSA testing
6 wks: prostate biopsy
4wks: proven UTI
1 wk: digital rectal examination
48hrs: vigorous exercise
48hrs: ejaculation
115
PSA cut offs for referral
Referral
50-69 yrs: PSA \>=3
\>70: PSA \>5
116
what can gentamicin cause in kidneys
intrinsic AKI
would have proteinuria (showing intrinsic)
117
scrotal swelling you cant get above
inguinal hernia
118
first line definitive investigation for prostate cancer
multiparametric MRI
report results using 5-point Likery scale
if \>=3 - prostate biopsy offered
if 1-2: discuss pros and cons of biopsy
119
Ix for suspicious digital rectal examination
urgent 2ww referral for **USS guided biopsy**
regardless of PSA
120
acute vs chronic upper urinary tract obstruction
acute: nephrostomy tube (percutaneous drainage)
chronic: ureteric stent or pyeloplasty
121
vasectomy
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
what organism causes staghorn calculus
**proteus** - proteus mirabilis
struvite stones - result of urease producing bacteria
123
what can you find in the urine of menstruating women
microscopic haematuria
124
red cell casts in urine
nephritic syndrome
125
bland urinary sediment in urine
prerenal uraemia
126
brown granular casts in urine
acute tubular necrosis
127
hyaline casts in urine
seen in normal urine, after exercise, during fever, or with loop diuretics
consist of Tamm-Horsfall protein
128
IV fluid resus
crystalloid
initial bolus of 500ml over 15mins
0.9 saline - better if AKI as hartmanns contains K+ which is a worry in AKI
129
maintenance fluids
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
risks of using large volumes of 0.9% saline in large volumes
large volumes of 0.9% saline (NaCl):
increased risk of hyperchloraemic metabolic acidosis
131
urge incontinence first line mx
bladder retraining
medical: antimuscarinics are first-line = oxybutynin
132
stress incontinence first line mx
pelvic floor muscle training
133
type 1 vs type 2 hepatorenal syndrome
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
what type of VBG pic for renal tubular acidosis
metabolic acidosis with normal anion gap - low potassium and high chloride
135
136
USS suggesting probable stone in ureter
next Ix
non-contrast CT KUB
137
infection stones
struvite
carbonate apatite
ammonium urate
138
most common type of renal stone
calcium oxalate
139
differentials of kidney stone
AAA
pancreatitis
perforated ulcer
ectopic pregnancy - preg test in all women of child bearing age
diverticular disease
PE
140
stone associated with UTI
struvite
caused by proteus
141
stone associated with metabolic syndrome
142
signs of sepsis and/or anuria + obstructive uropathy (stone)
urological emergency
**urgent decompression with cystocopy + ureteric stenting**
or percutanous nephrostomy - less common if stent doesnt work
urine and blood cultures
IV abx
143
asymptomatic renal stone \<5mm
watchful wait
144
renal stone \<10mm
shockwave lithotripsy
145
146
ureteric stent
147
ureteric colic + renal failure
suggests single kidney or bilateral obstruction or pre-existing renal disease
do non-contrast CT KUB
148
typical translucent renal stone
urate stone
149
150
complex renal calculi and staghorn calculi mx
percutaneous nephrolithotomy
151
partial duplex ureter
duplex collecting system on right side
radio lucent stone on right side in ureter
152
\> 300ml post void residual volume
evidence of chronic retention
153
\>30ml volume of prostate on USS
prostate cancer
154
mx for BPH
alpha blcoker or 5-alpha reductase inhibitor
155
chronic urinary retention
high vs low pressure
high pressure: hydronephrosis
leading to renal failure
156
risk factors for testicular torsion
bell clapper deformity
testicular tumour
undescended testis
trauma
exercise
157
158
sudden onset scrotal pain
lifting testis does not relieve pain
mx
testicular torsion
mx:
surgical exploration
159
160
testicular pain onset over hrs to days
positive Prehns sign
urethral discharge
signs of UTI
diagnosis
mx
epididymo-orchitis
Prehn's sign +ve: relieving pain on lifting up testis
mx: abx
161
testes transiluminating
swelling
non-painful
hydrocele
if symptomatic:
exploratory surgery
jaboulay (inversion of sac)
Lords (plication of sac)
DO NOT ASPIRATE - risk of infection
162
peyronie's disease
mx: surgical
163
phimosis
in child \<2yrs: watchful waiting, avoid forcebale retraction
mild scarring: topical steroids
if fails: circumcision
164
paraphimosis
mx: manual pressure and reduction
surgical
can happen post catheterisation if you forget to replace the foreskin
165
bag of worms
166
young female patient with AKI after starting ACEi
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
what renal condition is associated
rapidly progressive glomerulonephritis
seen in Wegners (granulomatosis with polyangiitis)
168
priapism
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
varicoceles more common on which side
80% more common on left side
bag of worms appearance
if new onset right varicocele - CT scan to look for renal tumour
170
nutcracker syndrome
compression of left renal vein by aorta and SMA
think if varicocele with abdo pain and haematuria
171
epididymal cyst
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
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
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
mx for stress incontinence if pelvic floor retraining doesnt work
**colposuspension**
if no surgery then duloxetine
174
overative bladder mx
for urinary urgency
first line: bladder retraining
antimuscularinics: oxybutynin
if unresponsive to medical: Botulinum A toxin
175
acute urinary retention mx
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
previous gonorrhoea infection + post void dribbling
urethral stricture due to the gonorrhoea
177
renal cancer mx
radical nephrectomy if early on
chemo and radio dont help
178
mx for renal cancer
T1 \<7cm: partial nephrectomy
T2 \>7cm: radical nephrectomy
T3 and 4: open radical nephrectomy
179
most common type of bladder cancer
transitional cell carcinoma
180
what type of bladder cancer does schistosomiasis cause
squamous cell carcinoma
181
2ww referral for bladder cancer
\>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
bladder cancer mx
non invasive: TURBT + mitomycin
183
grading score for prostate cancer
Gleason score
max score of 10 from biopsies of two different areas
184
diagnostic test for prostate cancer
US guided prostate biopsy
if cant be done then MRI
185
most likely mets place for prostate cancer
186
germ cell vs non germ cell tumour of testicle
germ cell: hard lump on testis
non-germ cell: most common lymphoma: diffuse larger testis
187
tumour markers for testicular cancer
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
testicular cancer mx
seminoma: responds well to radiotherapy
non-seminoma: chemotherapy
189
peritonitis due to peritoneal dialysis
most common causative bacteria
staph.epidermidis
190
side effects of nephrotic syndrome
mx
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
most common bacteria causing epididymitis
for younger men
for older men
younger men:
- N.gonorrhoea
- chlamydia tachomatis
older men:
- e.coli especially with a hx of BPH
192
most common cause of nephrotic syndrome in adults
membranous nephropathy
can occur secondary to malignancy
