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Phase 2a > Urogenital > Flashcards

Urogenital Flashcards

1
Q

Give the name and class of 2 drugs used to treat Benign Prostatic Hyperplasia

A
  • Alpha Blocker/ Alpha-adrenergic antagonist (1) – Tamsulosin (1)
  • 5-alpha-reductase inhibitor (1) – Sildenafil / Viagra (1)
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2
Q

Berry aneurysms are a complication of which kidney disease?

A

Autosomal Dominant (1) Polycystic Kidney Disease (1)

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3
Q

What parasite can cause bladder cancer?

A

Schistosomiasis

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4
Q

What antibiotic is used to treat cystitis?

A

Trimethoprim or nitrofurantoin

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5
Q

What is the classical triad of symptoms for a renal cell cancer?

A
  • Flank pain (1)
  • Haematuria (1)
  • Palpable Mass (1)
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6
Q

Give 3 function of the kidney

A

Excretion of: water/soluble wastes/urea/creatinine/drugs

  • Ultrafiltration
  • Maintains: volume of circulating fluids/ electrolyte balance / acid-base balance
  • Endocrine functions: Produces Epo
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7
Q

Give a Pre-renal, Renal and Post-renal cause of Chronic Kidney Disease

A
  • Pre-renal: BP/ DM/ High Cholesterol (1)
  • Renal: Glomerulonephritis / PKD / Drugs e.g NSAIDS/Lithium (1)
  • Post-renal: Kidney stones / Enlarged Prostate (1)
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8
Q

What is the definition of erectile dysfunction?

A

The inability to gain and maintain an erection (1) long enough to achieve sexual satisfaction (1)

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9
Q

Give 3 clinical features of Nephrotic Syndrome?

A
  • Proteinuria / Frothy Urine (1)
  • Hypoalbuminaemia (1)
  • Hyperlipidaemia (1)
  • Peripheral Oedema/ Fluid overloaded (1)
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10
Q

Give a cause of Nephritic Syndrome?

A
  • IgA nephropathy
  • Post streptococcal infection
  • ANCA
  • Goodpasture’s
  • SLE
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11
Q

Give 2 storage and 2 voiding symptoms in relation to the lower urinary tract

A

Storage: Frequency, Urgency, Nocturia, Incontinence

- Voiding: Poor stream, Hesitancy, Straining, Incomplete emptying, Terminal dribble

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12
Q

Stress incontinence is a prevalent urinary problem in women that increases with age. Give an example of a non pharmacological, pharmacological and surgical management option for stress incontinence.

A

Non-Pharmacological: Pelvic Floor Exercises (1)

  • Pharacological: Duloxetine (1)
  • Surgical : Sling / Colposuspension / Artificial urinary sphincter (1)
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13
Q

Prostate cancer is the most common cancer in men with an average lifetime risk of 1/8.
Which ethnic group are at an increased risk of prostate cancer?

A

Afro-Caribbean

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14
Q

Name the gram negative bacteria that causes chlamydia

A

Chlamydia Trachomatis

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15
Q

Name the gram negative bacteria that causes gonorrhoea

A

Neisseria Gonhorroea

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16
Q

What drug is used in the treatment of Syphilis?

A

Benzathine Penicillin/ Azithromycin

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17
Q

What are the roles of the kidneys?

A

A WET BED

  • Acid base balance
  • Water balance
  • EPO
  • Toxin removal
  • Blood pressure
  • Electrolyte balance (Phosphate excretion, urea K+, creatinine etc)
  • (Vit) D activation
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18
Q

What would happen in CKD to blood pressure?

A
  • Fluid overload

= Hypertension

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19
Q

What would happen to blood in CKD?

A
  • EPO production failure

= Anaemia

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20
Q

What would happen to blood pH in CKD?

A
  • Failure of pH homeostasis

= Acidosis

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21
Q

What would happen to PTH in CKD?

A
  • low vit D activation so hypocalcaemia
  • Low phosphate excretion so hyperphosphataemia
    = Excess PTH production (secondary)
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22
Q

What is CKD?

A

Abnormalities of kidney structure or function, present for >3 months with implications for health

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23
Q

What statistically counts as abnormal kidney function?

A

eGFR < 60 ml/min

or Albuminuria

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24
Q

What are the G stages of CKD?

A

They show the GFR with 1 being >90, and 5 being <15

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25
Q

What are the A stages of CKD?

A

They show the extent of albuminuria

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26
Q

How is CKD diagnoised?

A

eGFR <60 ml/min

Urine ACR >3mg/mmol

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27
Q

How does CKD present?

A

Usually asymptomatic (can get occasional haematuria, oedema)

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28
Q

What are the most common causes of CKD?

A

Diabetes
Hypertension/ atherosclerosis
Glomerulonephritis

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29
Q

How would CKD be treated?

A
  • Give up smoking
  • Lipid control (healthy diet, low alcohol, statin)
  • Blood pressure control
  • Glycaemic control if diabetic
  • Reduce proteinuria
  • Dietary supplements
  • Fluid control- low salt intake, diuretics
  • Dialysis and transplant
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30
Q

What is “CKD MBD”?

A

Chronic kidney disease mineral bone disease

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31
Q

Name a potassium-sparing diuretic

A

Amiloride.
Eplerenone
Spironolactone

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32
Q

Name a non-potassium sparing diuretic

A

Furosemide

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33
Q

What are the types of kidney replacement therapy?

A
  • Haemodialysis
  • Peritoneal dialysis
  • Kidney transplant
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34
Q

Give 2 pros of haemodialysis

A
  • Can be commenced quickly (can be used in an emergency)
  • Patient doesn’t need training
  • Gives good clearances (can be used in obese patients or anuric patients)
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35
Q

Give 2 cons of haemodialysis

A
  • Usually performed in hospitals
  • Issues with vascular access
  • Patients can feel “washed out” after
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36
Q

Give 2 pros of peritoneal dialysis

A
  • Fits round the patient’s life easily
  • Gentler, less hypotension
  • Better individualised to patient’s residual kidney function
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37
Q

Give 2 cons of peritoneal dialysis

A
  • Requires training
  • Infection
  • May be inadequate in those with poor residual function or a high BMI
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38
Q

Give 2 pros of kidney transplant in CKD

A
  • Near complete physiological correction
  • Improved mortality
  • Better quality of life
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39
Q

Give 2 cons of kidney transplant in CKD

A
  • Supply of organs
  • Operative risk
  • Immunosuppresion
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40
Q

What type of diuretic is given to CKD patients and why?

A

Non-potassium sparing diuretic e.g. furosemide
(Loop diuretic)

CKD leads to hyperphosphataemia, so a potassium sparing diuretic would exacerbate this

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41
Q

Where do the kidneys lie?

A

T11-L3

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42
Q

Where do the renal arteries come off?

A

L1

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43
Q

How much urine does each kidney produce per day?

A

1-1.5L

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44
Q

Approx how long are the ureters?

A

25-30cm

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45
Q

Is the detrusor relaxed or contracted during voiding?

A

Contracted

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46
Q

What is the action and origin of the hypogastric nerve?

A

It relaxes the detrusor and originated from T10-L2 (sympathetic)

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47
Q

What is the action and origin of the pelvic nerve?

A

IT contracts the detrusor and originates from S2-S4 (parasympathetic)

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48
Q

What is the action and origin of the pudendal nerve?

A

It causes external sphincter contraction and originates from s2-s4 (Somatic)

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49
Q

How does the bladder increase in volume?

A

The detrusor muscle relaxes to accommodate increase in fluid volume

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50
Q

What is the nervous response if the bladder is full but it is inappropriate to void?

A
  • Afferents reaching PAG and higher cortical centres are processed and PMC is not activated
  • Inhibits parasympathetic
  • Stimulates sympathetic and somatic
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51
Q

What is the nervous response if the bladder is full and it is appropriate to void?

A
  • Afferents reaching PAG and higher cortical centres are processed and PMC is activated
  • Stimulates parasympathetic
  • Inhibits sympathetic and somatic
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52
Q 
Which of the following is not a function of the kidneys? 
A) Water removal 
B) Vitamin D activation
C) Erythropoietin production 
D) Creatinine production 
E) Acid-base balance
A

D

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53
Q 
What is the average GFR? 
A) 1 ml/min
B) 125 ml/min
C) 150 ml/min
D) 1000 ml/min 
E) 2000 ml/min
A

B

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54
Q 
Which of the following makes a substance less likely to be filtered? 
A) Increased blood pressure
B) Smaller substance
C) Attachment to a protein
D) High surface a rea 
E) Positively charged substance
A

C

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55
Q 
Which tubule section of the nephron has cuboidal epithelium with microvilli for bulk reabsorption?
 A) Proximal convoluted tubule
B) Descending limb of loop of henle
C) Ascending limb of loop of henle
D) Distal convoluted tubule
E) Collecting duct
A

A

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56
Q

Which of the following is false?
A) The loop of henle is only found on juxtamedullary (15%) of nephrons- 85% do not extend into medulla
B) The ascending limb is impermeable to water, and functions for Na, K and Cl reabsorption
C) The macula densa is detected on the distal convoluted tubule, and signals for renin release if there are low Na level
D) The principle cells of the collecting to control acid-base levels by adjusting levels of H+ and HCO3-
E) Aldosterone and ADH act upon the cells of the distal convoluted tubule and collecting duct for fine tuning of the urine

A

D

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57
Q 
Which of the following can cause metabolic acidosis? 
A) Hypoventilation
B) Diarrhoea 
C) Respiratory failure
D) Vomitting
E) High aldosterone
A

B

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58
Q 
What receptor does ADH bind to?
A) V2R 
B) P2C
C) GLUT 2
D) GLUT 4
E) S4K
A

A

V2R receptors on principle cells

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59
Q

Which of the following is not an effect of angiotensin II?
A) Tubular reabsorption of Na+ and Cl-, and excretion of K+
B) Increased thirst response
C) Vasoconstriction of blood vessels
D) Aldosterone release from zona glomerulosa
E) Increased parasympathetic activity

A

E

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60
Q

Which of the following is true?
A) Aldosterone causes excretion of Na+
B) ANP is released when there is a lack of cardiac distention signalling BP is too low
C) ANP acts by blocking sodium channels in the collecting duct
D) ANP increases aldosterone release via renin secretion
E) ANP causes vasoconstriction of the afferent arteriole, decreasing GFR

A

C

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61
Q 
What is the active form of vitamin D? 
A) 7-decholesterol
B) Calcitriol 
C) 25 OH Vitamin D
D) 25, 25 (OH)2 Vitamin D
E) Calcitrioic acid
A

B

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62
Q 
What is the name of the muscle of the bladder used for micturition? 
A) Puborectalis
B) Pubococcygeus 
C) Detrusor
D) Sartorius
E) Soleus
A

C

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63
Q 
What part of the urogenital sinus forms the urethra? 
A) The upper part
B) The pelvic part
C) The phallic part
D) The caudal part
A

B

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64
Q 
What is the developing system of the definite kidney? 
A) Prosenephros
B) Mesonephros
C) Metanephros 
D) Rhombencephalon
E) Prosencephalon
A

C

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65
Q 
Which of the following could cause post-renal acute kidney injury?  
A) Heart failure
B) Sepsis
C) ACE inhibitors
D) Glomerulonephritis
E) Enlarged prostate
A

E

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66
Q 
Which of the following is NOT region of the male urethra? 
A) Pre-prostatic
B) Prostatic
C) Membranous
D) Pelvic
E) Spongy
A

D

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67
Q

What is the role of hCG during pregnancy?
A) Regulates levels of progesterone, prepares the uterus for the baby, prepares the breasts for lactation, induces synthesis for oxytocin receptors
B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility
C) Stimulates oestrogen/progesterone production by ovary
D) Role in initiation of labour
E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour

A

C

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68
Q

What is the role of prostaglandins during pregnancy?
A) Limits uterine activity, softens cervix, and involved in cervical ripening for delivery
B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility
C) Increases milk production
D) Role in initiation of labour
E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour

A

D

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69
Q

Which of the following does not happen during pregnancy?
A) Increased cardiac output
B) Increased systemic blood pressure
C) Darkened areola of breasts
D) Increased acid reflux and gastroparesis
E) Increased blood volume

A

B

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70
Q

What happens during the latent phase of labour?
A) Small amount of cervical dilation
B) Organised uterine contractions and dilation
C) Foetal expulsion
D) Placental expulsion
E) Rupture of amniotic sac

A

A

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71
Q

Which of the following is false?
A) During pregnancy, the uterus is sealed at the outlet by firm, inflexible collagen fibres- this is maintained by progesterone
B) In the last few weeks of pregnancy, the cervix becomes soft and flexible
C) Cervical ripening occurs due to enzymatically mediated breakdown of collagen fibres
D) Synthesis of enzymes is mediated by progesterone, hGC, and oxytocin
E) Labour is initated by PGFa

A

D

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72
Q 
What is the outermost serous layer of the uterus? 
A) Endometrium
B) Perimetrium
C) Myometrium
D) Endomysium
E) Epimysium
A

B

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73
Q 
Which of the following hormones is NOT produced by the placenta during pregnancy?
A) hCS
B) Progesterone
C) Prolactin 
D) Oestrogen
E) Relaxin
A

C

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74
Q 
What is the first follicle in the cycle known as?
A) Secondary follicle
B) Small primary follicle
C) Primordial follicle 
D) Pre-ovulatory follicle 
E) Corpus luteum
A

C

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75
Q

What triggers shedding of the stratum functionalis during the menstrual cycle?
A) An increase in hGRH
B) A drop in LH levels after the LH surge
C) An increase in FSH levels
D) An increase in oestrogen levels
E) A drop in progesterone levels

A

E

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76
Q 
Of an average 28 cycle, on which day is the highest LH levels seen? 
A) Day 10-11
B) Day 12-13 
C) Day 14
D) Day 15-16
E) Day 18-20
A

B

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77
Q 
What stage comes after the cleavage stage of embryo development?
A) Syngamy
B) Compaction
C) Cavitation
D) Expansion
E) Hatching
A

B

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78
Q 
What is the first stage of embryo implantation?
A) Apposition
B) Attachment
C) Trophoblast differentiation
D) Invasion
E) Maternal recognition
A

A

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79
Q 
Which of the following does not derived from the Mullerian duct? 
A) Fallopian tubes
B) Uterus
C) Cervix
D) Upper 1/3 of vagina
E) Clitoris
A

E

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80
Q

Which of the following statements is false?
A) Sertoli cells in the testis secrete Mullerian inhibitory factor, which causes degeneration of the paramesonephric duct
B) 5- alpha reductase converts testosterone to dihydryotestosterone androgen which triggers development of the external male genitalia
C) If an individual is SRY positive their wolffian duct regresses and Mullerian duct develops
D) The genitalia is differentiated by 10 weeks
E) Leydig cells of the testes secrete testosterone, which causes the wolffian duct to become the seminal vesicle, vas deferens and epididymis

A

C

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81
Q 
During which phase of meiosis does crossing over occur? 
A) Prophase I
B) Metaphase I 
C) Anaphase I
D) Prophase II 
E) Metaphase II
A

A

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82
Q 
During which phase of meiosis do oogonia arrest at until puberty? 
A) Prophase I
B) Metaphase I 
C) Anaphase I
D) Prophase II 
E) Metaphase II
83
Q

Which of the following statements is true?
A) Pale (Ap) cells are stem cells that stay outside of the blood-testes barrier and produce more daughter cells until death
B) Type A cells differentiate into primary spermatocytes
C) Spermatids differentiate into spermatozoa via spermatogenesis
D) Primary spermatocytes can pass through the blood testes barrier through tight junctions of Sertoli cells
E) Androgen binding protein (released by Leydig cells) bind to testosterone within the seminiferous tubule, which in turn stimulates sperm production

84
Q 
What does sperm travel into after the rete testis? 
A) Epididymis
B) Vas deferens 
C) Efferent ducts
D) Ejaculatory duct
E) Seminiferous tubules
85
Q

What is the route that sperm take outside of the body?

A 
Seminiferous tubules
Rete testis
Efferent ducts
Epididymis
Vas deferens
Ejaculatory duct
Urethra
Penile urethra
86
Q

What is the first stage of embryo development?

A

Syngamy (day 1)= fusion of the male and female pronuclei

87
Q

What is the mucosal lining of the uterine cavity?

A

Endometrium

88
Q

What is the role of oestrogen during pregnancy?

A

Regulates levels of progesterone, prepares the uterus for the baby, prepares the breasts for lactation

89
Q

What is the role of progesterone during pregnancy?

A

Prevents miscarriage builds up endometrium for support of placenta, inhibits uterine contractility

90
Q

What is the role of prolactin during pregnancy?

A

increases cells that produce milk, prevent ovulation (unreliably)

91
Q

What is the role of relaxin during pregnancy?

A

Helps limit uterine activity, softens cervix & involved in cervical ripening for delivery

92
Q

What is the role of oxytocin during pregnancy?

A

Triggers ‘caring’ reproductive behaviour, responsible for uterine contractions during pregnancy and labour

93
Q

What are the storage symptoms?

A
  • Frequqency
  • Urgency
  • Nocturia
94
Q

What are the voiding symptoms?

A
  • Weak/ intermitant stream
  • Incomplete emptying
  • Hesitancy
  • Dribbling
  • Straining
  • Haematuria
  • Dysuria
95
Q

What is BPH?

A

Increased number of epithelial and stromal cells in the periurethral area of the prostate

96
Q

Why is BPH more common in Afro-Caribbean men?

A

Increased testosterone

97
Q

What are the two types of nephron?

A
  • Cortical nephrons (70-80%)= Glomeruli in outer cortex, short looped
  • Juxtamedullary nephrons (20-30%)= Glomeruli border on medulla, long looped
98
Q

What are vasa recta?

A

Counter-current blood flow around loop of henle

99
Q

What alters the plasma colloid oncotic pressure?

100
Q

What pressures affect GFR?

A
  • Systemic arterial pressure
  • Afferent pressure
  • Efferent pressure
101
Q

What would happen to the GFR if you restricted blood flow through the afferent arteriole?

A

It would drop

102
Q

What would happen to GFR if you restricted blood flow through the efferent arteriole?

A

It would increase, but if it is a very severe constriction, the GFR will eventually fall

103
Q

What causes constriction of the afferent arteriole?

A

Prostaglandins (Inhibited by NSAIDs so NSAIDs can cause AKI)

104
Q

What metabolite is used for eGFR?

A

Creatinine

105
Q

What is the main action of the glomerulus?

A

Filtration of water and solutes

106
Q

What is the main action of principal cells?

A

Aldosterone sensitive= potassium secretion

Reabsorb Na

107
Q

What is the main action of intercalated cells?

108
Q

What is the overall action of ANP?

A

It falls if there is a fall in blood pressure, causing renal sodium retention, water retention and K+ excretion
= BP raised

109
Q

What is neuropathic bladder?

A

One that has dysfunctional voiding due to damage to the innervation

110
Q

What are the principles of management of neuropathic bladders?

A
  1. Protect the upper urinary tract
  2. Improve quality of life
  3. Achieve continence
111
Q

What is the gold standard investigation for a patient with neuropathic bladders?

A

Video urodynamics

112
Q

What is bladder compliance?

A

The ability of the bladder to change in volume without an alteration in detrusor pressure

113
Q

What is an areflexive bladder?

A

One with no innervation- patient may have retention

114
Q

What is autonomic dysreflexia?

A

A response to a stimuli in a patient with a spinal cord injury at T6 or higher

115
Q

What are the main symptoms of autonomic dysreflexia?

A
  • Headache
  • Increase BP above site of injury
  • Pale, cool below site of injjry
116
Q

How is autonomic dysreflexia treated?

A
  • Sit patient upright
  • 2 sprays of sublingual GTN
  • Remove tight clothing, identify the noxious stimuli
  • Administer nifedipine 5-10 mg
  • Contact anaesthetics
117
Q

What are the types of incontinence?

A
  • Transient= Delirium, infection, drugs, psychiatric, endocrine causes, reduced mobility
  • Urgency
  • Stress
  • Overflow
  • Continuous
118
Q

What is urge incontinence?

A

The involuntary loss of urine preceded by sudden urgency

119
Q

What is the first line pharmacological treatment for urge incontinence?

A

Anticholinergic (oxybutynin)

120
Q

What is stress incontinence?

A

The involuntary loss of urine during activities that increase intra-abdominal pressure (e.g. cough, sneeze, laugh etc)

121
Q

What is the first line treatment for stress incontinence?

A

Lifestyle modification- stop smoking, weight loss

Pelvic floor muscle therapy

122
Q

What are the clinical features of acute nephritic syndrome?

A
  • Haematuria
  • Proteinuria
  • Deteriorating kidney function
  • Hypertension
  • Oliguria
  • Fluid overload
  • Uraemia
123
Q

What causes acute nephritic syndrome?

A
  • ANCA associated vasculitis
  • Goodpasture disease
  • SLE, Systemic sclerosis
  • Post-strep infection
  • Crescentic IgA nephropathy
124
Q

What is acute nephritic syndrome?

A

An immune response triggered by infection or other disease

125
Q

64 year old man saw his GP with malaise, lethargy and weight loss. He has had a “head cold” for a few weeks and noticed some bleeding when he blows his nose. On tests, he has anaemia, hyperuricemia, very high creatinine, and a high CRP. He was ANCA-antibody +ve. What is it likely to be?

A

Nephritic syndrome due to ANCA associated vasculitis

126
Q

A 17 year old patient presents to his GP with “passing cola coloured urine” for the last 24 hrs. He has a mild cough and sore throat for the last few days. His creatinine and blood pressure are high. What is this likely to be?

A

IgA nephropathy causing acute nephritic syndrome

127
Q

What is the typical triad of nephrotic syndrome?

A

Heavy proteinuria
Hypoalbuminaemia
Oedema

128
Q

How is minimal change disease treated?

A

Steroids = prednisolone

129
Q

What type of cancer is a renal cell carcinoma?

A

Adenocarcinoma

130
Q

How does renal cell carcinoma usually present?

A
  • Often asymptomatic
  • Haematuria, loin pain and mass
  • Symptoms of metastatic disease
  • Anaemia, hypertension
131
Q

What type of cancer is bladder carcinoma normally?

A

Transitional cell carcinoma

132
Q

What are some common urological causes of persistent non-visable haematuria?

A

BPH, Cancer, stone disease, infection

133
Q

What are some common nephrological causes of persistent non-visable haematuria?

A

IgA nephropathy, thin basement membrane disease, vasculitis

134
Q

What is the chemotherapy treatment for bladder TCC?

A

CMV: Cisplatin, methotrexate, vinblastine

135
Q

Where would testicular cancer spread to first?

A

Para-aortic lymph nodes

136
Q

What are the 3 categories of erectile dysfunction?

A
  • Neurogenic= Failure to initiate
  • Arteriogenic= Failure to fill
  • Venogenic= Failure to store
137
Q

What is the first line treatment for erectile dysfunction?

A

PDE-5 Inhibitors (Viagra/ sildenafil)

138
Q

Where is the prostate gland?

A

At the base of the bladder surrounding the base and the urethra

139
Q

What is gleason grading used for?

A

Prostate cancer

140
Q

What can make a UTI complicated?

A
  • Pregnant
  • Men
  • Catheterised
  • Children
  • Recurrent infection
  • Immunocompromised
  • Structural abnormalities
141
Q

What are the most common pathogens causing a UTI?

A

KEEPS

  • Klebsiella
  • E. Coli
  • Enterococci
  • Proteus
  • Staph spp.
142
Q

How would you treat E. Coli pyelonephritis in an elderly man?

A

Co-amoxiclav for 14 days

143
Q

What would protein in the urine during pregnancy be indicative of?

A

Possibility of pre-eclampsia

144
Q

What are epithelial cells in urine sample indicative of?

A

Contaminated sample

145
Q

Ms A. Vrige (23 years-old) has been complaining of dysuria and frequency passing urine. Similar urinary symptoms over last few months were treated with 3-days of cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill
Her urinalysis shows protein, nitrites and leukocytes.
What would be an appropriate antibiotic?

A

Trimethoprim 200mg twice daily for 3 days

or

Nitrofurantoin 50mg four times a day for 3 days

146
Q

What are the tumour markers for testicular cancer?

A

Alpha-fetoprotein and the beta subunit of hCG

147
Q

A patient presents with haematuria. What are the possibilities?

A
  • UTI
  • urothelial carcinoma
  • stone disease
  • adenocarcinoma of the prostate
  • benign prostatic hypertrophy (BPH)
  • Transitional cell carcinoma of the bladder
148
Q

What is the lifetime risk of stones in the urogenital tract?

149
Q

Do men or women get more renal stones?

150
Q

What are renal stones usually made of?

A

Calcium oxalate are most common

Others include calcium phosphate, uric acid, cystine stones

151
Q

How can kidney stones be prevented?

A
  • Overhydration
  • Low salt diet
  • Reduce BMI
  • Active lifestyle
152
Q

What are the symptoms of kidney stones?

A
  • Asymptomatic
  • Loin pain
  • Renal colic
  • UTI symptoms
  • Recurrent UTI
  • Haematuria
153
Q

What is renal colic?

A

Sudden, severe pain in the loin which then spreads to groin. Associated nausea/ vomitting. Colicky pain, worse with fluid loading.

154
Q

What is the first line and gold standard diagnosis for renal stones?

A
  • First line= KUBXR
  • Gold standard= NCCT-KUB

Also dipstick and bloods (U and Es, creatinine, Calcium)

155
Q

What is pyonephrosis?

A

Combination of infection and obstruction

156
Q

What is ESWL?

A

Extracorporeal shockwave lithotripsy= Used to break up renal stones

157
Q

A 46 year old man presents to A&E with severe sudden onset left loin to groin pain. He also has frequency. He is otherwise fit and well, and is slightly overweight. What would be your response?

A
  • Analgesia
  • Dipstick
  • Non-contrast CT of kidney, ureter and bladder to see stones
158
Q

A 34 year old woman present to A&E with severe sudden onset left loin to groin pain. She has signs of sepsis (increased heart rate, increased temperature, increased resp rate, lowBP). What would be your response?

A
  • Resus
  • Follow sepsis 6
  • Confirm renal stones, then renal drainage
159
Q

What are the sepsis 6?

A
  1. High flow oxygen
  2. Blood cultures
  3. IV antibiotics
  4. Fluids
  5. Measure lactate
  6. Measure urine output
160
Q

Define glomerulonephritis

A

Glomerulonephritis is any of a group of diseases that injure the part of the kidney that filters blood (the glomeruli).

161
Q

What is the difference in presentation between nephritic and nephrotic syndrome?

A 
Nephritic= Blood in urine and decreased urine output with hypertension
Nephrotic= Oedema, with increased protein in urine but decreased protein in serum
162
Q

What is the medical emergency most associated with AKI?

A

Hyperkalaemia

163
Q

What are the 4 commonest types of urinary tract stones?

A
  • Calcium stones (oxalate, phosphate) 80%
  • Uric acid 10%
  • Struvite 5-10%
  • Cystine 1%
164
Q

Give 5 common symptoms of renal tract stones

A
  • Asymptomatic
  • Loin pain
  • Renal colic
  • UTI symptoms
  • Recurrent UTIs
  • Haematuria
165
Q

What are the criteria for a 2 week wait referral for suspected bladder cancer?

A

Over 45= Unexplained visible haematuria without UTI

Over 60= Unexplained non-visible haematuria, with either dysuria or raised wcc

166
Q

List 5 symptoms common with urinary tract obstruction in men

A
  • Frequency
  • Nocturia
  • Urgency
  • Hesitancy
  • Straining
  • Poor/intermittent stream
  • Incomplete emptying
  • Post micturition dribbling
167
Q

What are the two groups of drugs commonly used in symptomatic benign prostatic hypertrophy?

A
  • Alpha-adrenergic antagonists e.g. tamsulosin, alfuzosin

- 5-alpha reductase inhibitors e.g. finasteride

168
Q

What issues are there which prevent the Prostate Specific Antigen (PSA) test being used routinely for screening?

A
  • It is not cancer specific= raised in BPH, UTI

- It can be raised in a normal healthy man

169
Q

What is the commonest presentation of testicular cancer?

A
  • A painless lump in the testicle which may be hard and craggy
  • It can be palpated above it
170
Q

Name five medical conditions associated with erectile dysfunction?

A
  • Diabetes mellitus
  • Cardiovascular disease e.g. MI, Hypertension
  • Liver disease
  • Renal failure
  • Pelvic fracture
171
Q

How is erectile dysfunction treated?

A

Phosphodiesterase inhibitors e.g. sidenafil

172
Q

Which STI is most commonly diagnosed?

173
Q

How is chlamydia treated?

A
  • Partner notification
  • Test for other STIs
  • Doxycycline for 7 days or azithromycin stat
174
Q

How is Urinary tract infection defined?

A

Bacteria in the urine combined with clinical features

175
Q

What is the classical triad of symptoms in pyelonephritis?

A

Loin pain, fever and pyuria

176
Q

A 68 year-old patient has got an estimated glomerular filtration rate of of 50ml min/1.73m2. What stage of chronic kidney disease does he have?

177
Q 
What is the most common cause of chronic kidney disease in the UK? 
A.  Renal artery stenosis
B.  Long use of NSAIDs
C. Benign prostatic hyperplasia
D. Diabetes
E. Renal vein thrombosis
178
Q

What biochemical changes can be observed in acute kidney injury?
A. Hyperkalaemia, hyponatremia, hypercalcaemia
B. Hyperkalaemia, hyponatremia, hypocalcaemia
C. Hyperkalaemia, hypernatremia, hypercalcaemia
D. Hypokalaemia, hypernatremia, hypercalcaemia
E. Hypokalaemia, hyponatremia, hypocalcaemia

179
Q 
A 9 year-old child presents to your GP clinic with his mother. His mother tells you that she has noticed the child has a lot more swelling in his face and his urine seems frothy. The child also seems to be a little bit lethargic compared to normal. You do a urine dipstick on the child’s urine discovering significant (+++) proteinuria but no haematuria. What is the most likely cause of these symptoms?
A) SLE
B) Rickets
C) Minimal Change Disease
D) Post-streptococcal glomerulonephritis
E) Goodpasture’s syndrome
180
Q 
A 6 year-old child presents to A&E with their father. His father is quite anxious as he noticed blood in his child’s urine earlier in the morning. When asking about a more detailed history, you discover that the child had a really sore throat and cold 2 weeks earlier. What is the most likely cause of these symptoms?
A) Granulomatosis with polyangitis
B) IgA nephropathy
C) Henoch-Schonlein purpura
D) Post-streptococcal glomerulonephritis
E) NSAIDs
181
Q 
A 42 year-old man presents to A&E. He complains of coughing up blood as well as noticing a darkness to his urine. You perform a urine dipstick on his urine which shows some blood. What is the most likely cause of these symptoms?
A) Granulomatosis with polyangitis
B) IgA nephropathy
C) Henoch-Schonlein purpura
D) Goodpasture’s syndrome
E) SLE
182
Q 
A 52 year old woman presents to you in A&E complaining of severe flank pain that is radiating towards her groin. The pain is constant but has peaks where it is much more severe. She tells you she has not passed urine for 2 days. What is the most appropriate investigation and management for this patient?
A) Ultrasound KUB + codeine
B) Ultrasound KUB + ibuprofen
C) X-ray KUB + paracetamol
D) X-ray KUB + morphine
E) CT-KUB + Diclofenac
183
Q 
A 28 year old pregnant woman presents to you in GP complaining of very frequent urination and it is quite painful. She has brought you a urine sample which appears quite cloudy. You suspect a UTI. What is the most appropriate choice of antibiotic for this patient?
A) Nitrofurantoin
B) Trimethoprim
C) Ceftriaxone
D) Amoxicillin
E) Cefalexin
184
Q 
A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass.
What is the most likely diagnosis?
a)	Left orchitis
b)	Left primary hydrocele
c)	Left secondary hydrocele
d)	Left varicocele
e)	Left spermatocele
185
Q

A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass.
What would be the first line investigation to confirm this diagnosis?
a) USG
b) CT scan
c) Venography
d) MRI
e) Mid-stream urine sample

186
Q

A 72 year old man comes to see his GP, he has recently experienced urethral discharge and has been needing to urinate often with urgency and pain, and has blood in his urine. The GP notices his left testis very hot and tender, and is swollen. Light cannot be shone through it.
What is the most likely causative organism?
a) Streptococcus pyogenes
b) Neisseria gonorrhoea
c) Chlamydia trachomatis
d) Klebsiella spp.
e) Escherichia Coli

187
Q

Which of these is correct?

a) A left hydrocele can be a sign of left kidney cancer
b) A right hydrocele can be a sign of right kidney cancer
c) A left varicocele can be a sign of left kidney cancer
d) A right varicocele can be a sign of right kidney cancer

188
Q

Why can a left varicocele be a sign of left kidney cancer?

A

Left testicular vein enters the left renal vein, so can be compressed by left kidney cancer, causing a varicocele.

189
Q

A 17 year old male is brought to A&E with left testicular pain that started in the last hour. He is embarrassed and says he wants to leave and go home, however he admits the pain is so bad that walking is very uncomfortable. Upon examination you discover his left testis is very tender and warm. It is also larger than normal, and is not lying in its normal position in the scrotum.
Within what time window does surgery need to happen?
a) 2 hours
b) 6 hours
c) 9 hours
d) 12 hours
e) 24 hours

190
Q

Which of these is more common?

a) Testicular cancer vs prostate cancer
b) Benign prostate hyperplasia vs prostate cancer

A

a) Prostate cancer

b) BPH

191
Q

Which of these is more common in young men?

a) Testicular cancer vs prostate cancer
b) Testicular cancer vs benign prostate hyperplasia

A

A) Testicular cancer

B) Testicular cancer

192
Q

Describe the difference between how the prostate would feel on a digital rectal exam

A

BPH= Smooth enlarged prostate

Prostate cancer= Hard irregular prostate

193
Q

A 66 year old man has had problems with urinary frequency and needing to urinate at night for 2 months. He finds that when he urinates it takes him a while to be able to start, and he often experiences dribbling after finishing. After a transrectal prostate biopsy he is diagnosed with benign prostatic hyperplasia.
Which of these would be the first line treatment for BPH?
a) Oxybutynin
b) Finasteride
c) Tamsulosin
d) Transurethral resection of prostate (TURP)
e) Goserelin

194
Q

What type of urinary incontinence can diabetic neuropathy lead to?

a) Urge incontinence
b) Overflow incontinence
c) Stress incontinence

195
Q

What type of urinary incontinence can a spastic spinal cord injury lead to?

a) Urge incontinence
b) Overflow incontinence
c) Stress incontinence

196
Q

What is the most common STI in young people?

197
Q

What is Fitz Hugh Curtis syndrome?

A

When pelvic inflammatory disease (PID) causes swelling of the tissue around the liver

198
Q

What are the best sample types to diagnose chlamydia?

A

Women; self collected vaginal swab

Men; First void urine

199
Q

A man presents with urethral discharge. You take a sample and it shows gram negative diplococci. What is it likely to be?

A

Gonorrhoea

200
Q

What is the bacteria that causes syphilis?

A

Treponema pallidum

201
Q

A patient presents with a dusky macule on the labia which has developed into a non-tender ulcer. What is it likely to be?

202
Q

How would you diagnose syphilis?

A

Screening- EIA

TTPA, VDRL, RPR

203
Q

How is syphilis treated?

A

Penicillin injection

204
Q

What is the RBCD transmission model for STIs?

A

Reproductive rate
B= Infectivity rate
C= Partners over time
Duration of infection

Phase 2a (31 decks)

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