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Finals > Urinary > Flashcards

Urinary Flashcards

1
Q

How do you define nephrotic syndrome?

A

Presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L)
and peripheral oedema

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2
Q

Key differentiating feature of nephrotic syndrome induced oedema? What simple test can give you an idea?

A

Facial as can lay flat, simply measure urine for protein as this is not high in CCF or Liver disease

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3
Q

Most common idiopathic type of nephrotic syndrome?

If primary how treated?

A

Focal segmental glomerulosclerosis 30-50%

Primary responds to immunosuppresion

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4
Q

Most common cause of CKD?

A

Diabetes and HTN is second

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5
Q

How is CKD stage 1 and 2 defined?

A

stage 1 Egfr >90 but evidence of kidney damage such as proteinuria/haematuria or other evidence

Stage 2 the same but from 60-89 Egfr

Note: without evidence these are normal Egfrs

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6
Q

45-60 Egfr stage ckd?

A

Stage 3a regardless of damage or not (moderate)

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7
Q

Stage 3b CKD?

A

30-44ml Egfr

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8
Q

Severe CKD?

A

Egfr 15-29

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9
Q

End stage renal failure Egfr?

A

<15ml

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10
Q

Presentation of CKD?

A

Fatigue due to reduced epo and anaemia
Nausea due to increased urea
Pruritis due to urea
Foamy urine - protein

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11
Q

Management of HTN in CKD?

A

If ACR >30 offer ACEi or ARB

If ACR <30 manage under normal guidelines

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12
Q

ACR of >70mg what to offer?

A

ACEi or ARB regardless of BP

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13
Q

For people with hypertension and CKD and an ACR of 70 mg/mmol or more and 70 or less, ideally aim for BP?

A

130/80 and 140/90

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14
Q

When to offer statin in CKD?

A

If egfr <60 or ACR>3 use 20mg atorvostatin

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15
Q

CKD diagnosed when what is persistent how long?

A

egfr <60 for 3 months or persistent proteinuria (ACR>3mg for 3 months

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16
Q

Older adults with nephrotic syndrome most common cause?

A

Membranous nephropathy

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17
Q

Focal segmental nephropathy 1 and 2 both benefit from?

A

ACEi

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18
Q

IgA nephropathy?

A

Recurrent visible haematuria after URTI or Gastoenteritis

painless haematuria, but may have loin pain, can get an AKI usually 20-30 years old

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19
Q

What must be done in IgA nephropathy?

A

Renal biopsy

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20
Q

Management of IgA nephropathy?

A

If BP high acei, if good BP control but proteinuria >1g day can have steroids

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21
Q

Haematuria, sub-nephrotic protein urea and HTN?

A

Nephritic syndrome

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22
Q

When does IgA nephropathy occur?

A

few days post infection

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23
Q

Post strep nephropathy occurs?

A

1-2 weeks after

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24
Q

30% of men undergoing a TURP do so for what?

A

Obstructive prostatic retention

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25
Q

Worsening LUTS and then retention?

A

Acute prostatic urinary retention

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26
Q

Confusion, Hyponatraemia, fatigue, nausea after Prostate surgery?

A

TURP syndrome

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27
Q

Pain relief of choice in renal colic? What is this is not suitable?

A

Diclofenac 75mg IM

Can use morphine if contraindicated

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28
Q

Other than pain relief offer what in renal colic?

A

Metoclopramide 10mg IM (reduce doses in renal impairment)

Or Cyclizine 50mg IM

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29
Q

Investigation of choice in Renal/Ureteric colic?

A

CT-Non contrast, initially a urine dipstick to support diagnosis

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30
Q

Symptoms of renal/ureteric colic?

A

Pain lasts minutes to hours and occurs in spasms, with intervals of no pain or dull ache.
Is often accompanied by nausea, vomiting, and haematuria.
Some of worst pain experienced
Cannot lie still

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31
Q

Management of pre-renal AKI?

A

Fluids Normal saline,. Vasopressors if hypotensive

Renal replacement- uraemia, K++ or Acidotic

32
Q

Intrinsic AKI management?

A

Fluids, underlying cause, stop drugs

33
Q

Post renal AKI treatments?

A

Catheter for prostatic obstruction
Nephrostomy
Lithotripsy/stenting if strictures

34
Q

Most important causative factor for bladder cancer?

A

Smoking

35
Q

Primary presenting complaint of bladder cancer?

A

Painless gross haematuria, dysuria/UTI accompanied

36
Q

Which sided varicocele can indicated a renal cancer?

A

Right sided

37
Q

RTA then urinary retention what could be the cause?

A

Urethral damage - can be blood at meatus

38
Q

Triad for renal cancer?

A

classical triad: haematuria, loin pain, abdominal mass

39
Q

Other features of renal cancer other then the triad?

A

Pyrexia of unknown origin, Right sided varicocele, polycythaemia

40
Q

Shcistosomiasis is a risk for what?

A

Squamous cell bladder

41
Q

unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection Age >45

A

Urgent referral (i.e. within 2 weeks)

42
Q

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

A

Urgent referral (i.e. within 2 weeks)

43
Q

Non urgent urology referal for who and what problem?

A

Aged 60 >= 60 years with recurrent or persistent unexplained urinary tract infection

44
Q

Glomerulonephritis induces what renal syndrome type?

A

Nephritic

45
Q

Define AKI? numbers etc not stages just beginning

A

a rise in serum creatinine of 26 micromol/litre or greater within 48 hours

a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days

a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults

46
Q

investigation of choice for reflux nephropathy?

A

micturating cystogram/graphy

47
Q

Non muscle invasive bladder cancer treatment?

A

Transurethral resection/intravesical chemo

48
Q

Muscle invasive bladder cancer treatment?

A

Partial/complete cystectomy and lymph nodes

49
Q

Stress incontinence treatment initially?

A

Training of bladder

50
Q

Stress vs urge incontinence?

A

Stress is when you laugh or cough, urge need it cant get there in time

51
Q

Urge incontinence treatments?

A

Antimuscarinics and bladder retraining

52
Q

Macroscopic haematuria investigation by urologist?

A

Cystoscopy

53
Q

Gold standard imaging for haematuria?

A

CT Urography (CTU)

54
Q

What to rule out in haematuria?

A

Is it Just transient?

55
Q

Microscopic haematuria investigation?

A

US +/- cystoscopy

56
Q

Type of cancer prostate?

A

Adenocarcinoma

57
Q

Which score used for prostate cancer?

A

Gleason

58
Q

Signs and symptoms of prostate cancer?

A

Erectile dysfunction, back pain, bone pain, haematuria, weight loss, LUTS(hesitancy dribbling overactive)

59
Q

When can PSA be raised?

A

Cancer, BPH, prostatitis, riding a bike, ejaculating, biopsy, DRE

60
Q

What to do in low risk prostate cancer?

A

Active surveillance, MRi and then PSA every few months

61
Q

Anything more than low risk prostate cancer what to do?

A

Radical prostatectomy radiotherapy and androgen deprivation

62
Q

Bilateral hydronephrosis causes?

A

Urethra stenosis, prostatic problems, bladder tumour, retroperitoneal fibrosis

63
Q

1st line investigation for hydronephrosis?

A

USS, can do CT KUB if stones suspected

64
Q

Most common kidney stone?

A

Calcium oxalate ++ calcium in urine

65
Q

Stones associated with proteus and pseudomonas/klebsiella?

A

Triple phosphate(struvite)

66
Q

Size of stone to think about percutaneous nephrolithotomy?

A

> 15mm

67
Q

Which stones not seen on xray?

A

Urate

68
Q

Subtype of renal cell most common?

A

Clear cell

69
Q

Definitive test for renal cell cancer?

A

Contrast enhanced CT Abdo and pelvis

70
Q

Which stage Renal cell is not with curative intent?

A

Stage 4

71
Q

Most common inheritance pattern for polycystic kidney disease?

A

Autosomal dominant

72
Q

Presentation of polycistic disease?

A

Anurysms, SAH, HTN young age, Murmurs, hepatomegaly and cysts there.

73
Q

ADPKD imaging?

A

USS

74
Q

USS diagnostic for polycystic?

A

Positive family history <30 and 2 cysts uni or bilat
>30-59 two cysts in both
>60 4 cysts in both

75
Q

Urethral stricture risk factors?

A

BPH, STIs and trans-urethral resections

Finals (16 decks)

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