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CCs > Urology > Flashcards

Urology Flashcards

1
Q

What is increased in the serum in AKI?

A

Creatinine and urea

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2
Q

What is a pre-renal cause of AKI?

A

Hypotension

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3
Q

What is a post renal cause of AKI?

A

Obstruction
Stricture
Cancer
BPH

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4
Q

What would a urine dip show in AKI?

A

Blood
Protein
UTI

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5
Q

Name 4 nephrotoxic drugs.

A

NSAIDS
Gentamicin
ACEi
Metformin

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6
Q

How can uraemia present?

A 
Restless legs. 
Vomiting 
Bone pain 
Pruritus.
Fatigue.
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7
Q

When do symptoms start to occur in CKD?

A

Stage 4

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8
Q

What is the definition of CKD?

A

GFR<60 ml/min/1.73m2 for at least 3 months

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9
Q

What is the definition of end stage kidney disease?

A

GFR <15ml/min/1.73m2

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10
Q

What can cause CKD?

A 
Reflux nephropathy
Diabetes
Hypertension 
Vascular 
Pyelonephritis 
Glomerulonephritis
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11
Q

What anaemia may be present in CKD?

A

Normochromic anaemia

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12
Q

When might CKD warrant referral?

A 
Stage 4/5
Moderate proteinurea
Rapidly falling eGFR
BP poorly controlled
Genetic
Renal artery stenosis
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13
Q

What are the four stages of CKD management?

A

1) Identify and treat reversible causes: Obstructions, drugs, high calcium
2) Limit progression and complications:
- Reduce BP to 130/80
- Treat PTH to prevent renal bone disease
- Statin
- Healthy diet, avoiding potassium and phosphate
3) Symptom control
- replace iron, b12, folate for anaemia
- bicarbonate for any acidosis
- Quinine for restless legs and cramp
- gabapentin
4) prepare for replacement therapy

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14
Q

What will be positive on a UTI urine dip?

A

Nitrates

Leucocytes

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15
Q

What can cause sterile pyuria?

A 
Treated UTI 2 weeks previously 
Appendicitis
Polycystic kidneys
Bladder tumour 
Papillary necrosis 
Calculi/prostatitis
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16
Q

What is acute and chronic pyelonephritis?

A

Acute - infection within renal pelvis, may include parenchyma.
Chronic - scarring due to multiple infections

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17
Q

What may be viewed on a renal ultrasound scan of someone with CKD?

A

Small kidneys

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18
Q

What metabolite imbalance may exist in CKD?

A

Low calcium, high phosphate.

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19
Q

What can cause acute pyelonephritis?

A

Ascending bladder infection.

Spread from other source via the blood

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20
Q

Where may pain be felt in pyelonephritis?

A

Loin, suprapubic, back

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21
Q

Symptoms of acute pyelonephritis?

A

Systemically unwell: rigors, fever, malaise, nausea and vom.
Urinary symptoms.
Pain on kidney palpation

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22
Q

What does cloudy offensive smelling urine that tests positive for blood, nitrates, proteins & leucocytes suggest?

A

Acute pyelonephritis.

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23
Q

Complications of acute pyelonephritis?

A

AKI
Sepsis
Abscess
Papillary necrosis

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24
Q

Signs and symptoms of chronic pyelonephritis?

A

Systemic, dysuria, hypertension, loin pain, CKD.

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25
Q

What may imaging of the kidney show in chronic pyelonephritis?

A

Renal USS - small, thin cortex

IV pyelogram - cortical & ureteric scarring

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26
Q

How is chronic pyelonephritis managed?

A

Give longer ABx if UTI
Control BP to slow progression
Resolve any obstructions
Dialysis/transplant

27
Q

Why does hydronephrosis occur?

A

Generally due to an obstruction.

28
Q

What condition occurs when there is unilateral renal swelling due to a failure of normal urine drainage?

A

Hydronephrosis.

29
Q

What symptoms may occur in severe hydronephrosis?

A
  • abdo/flank pain
  • nausea/vom
  • dysuria
  • fever
  • incomplete voiding
30
Q

What is a common complication of hydronephrosis?

A

UTI

31
Q

How is hydronephrosis managed?

A
  • remove blockage
  • catheterise
  • ABx if needed
  • ureter stents
  • nephrostomy tube
  • surgery
32
Q

In what condition does the inner (transitional) zone of the prostate enlarge?

A

BPH

33
Q

What symptoms can occur in BPH?

A 
Nocturia
Haematuria 
Stones 
Frequency 
Hesitancy and post micturition dribbling 
Over flow incontinence
34
Q

Investigation of BPH

A 
Assess impact on life 
PR 
MSU 
U&amp;E
Cancer rule out - biopsy, USS
35
Q

What type of drug is finasteride?

A

5 alpha reductase inhibitor

36
Q

What drug is first line for BPH?

A

Alpha blocker such as Doxazotin

37
Q

How does alpha blockers work?

A

Block alpha adrenoreceptor: vasodilation & decreases resistance to bladder outflow

38
Q

Why does caution need to be taken with alpha blockers and antihypertensives?

A

Can lead to hypotension.

Omit B-blocker - inhibits compensatory tachycardia

39
Q

How does a 5 alpha reductase inhibitor work?

A

Shrinks prostate size

40
Q

What side effects can occur with 5 alpha reductase inhibitor?

A

Impotence, lowered libido, gynaecomastia - breast cancer

41
Q

Who needs to avoid exposure to finasteride?

A

pregnant women

42
Q

What is the commonest male malignancy?

A

Adenocarcinoma of the prostate

43
Q

How can prostate cancer spread?

A

Blood - blone

Locally through lymph - seminal vesicles, bladder and rectum

44
Q

When may a man be able to have a radial prostatectomy for their cancer?

A

If they are younger than 70 and the cancer is localised

45
Q

What are the 3 prognostic factors for prostatic cancer?

A

Pretreatment PSA
Tumour stage
Tumour grade

46
Q

What type of bladder cancer predominates in the UK?

A

Transitional cell

47
Q

What is a risk factor for squamous cell bladder carcinoma?

A

Schistosomiasis

48
Q

Red flag symptom of bladder carcinoma?

A

(Painless) haematuria

also may have recurrent UTIs and irritable voiding

49
Q

For what stage bladder carcinoma is transurethral cystoscopy/resection of the bladder considered?

A

Early stages up to T1

50
Q

When may intravesical chemo be considered as a treatment for bladder carcinoma?

A

If there are multiple small high grade tumours

51
Q

How can renal carcinomas spread?

A

Directly - renal vein
Lymph
Haemotogenous: bone, liver and lung

52
Q

What are the signs and symptoms of renal cell carcinoma?

A 
Haematuria
Loin pain
Abdo mass
Loss of appetite 
Malaise
53
Q

What investigations should be done for renal cell carcinoma?

A

BP - raised from renin secretion.
Bloods: FBC - polycythaemia, ESR, ALP, U&Es
Urine dip
Imaging

54
Q

What site of renal cell carcinoma is more common in men?

A

Proximal renal tubular epithelium

55
Q

What is the problem with radiotherapy and chemotherapy in renal cell carcinoma? What is the best treatment option?

A

It is resistant.
Radical nephrectomy
Consider biologics for mets

56
Q

What are the three common sites of urinary tract stones?

A

1) pelviureteric junction
2) Pelvic brim
3) Vesicoureteric junction

57
Q

What is the differential if there is loin to groin pain and the patient cannot lie still, feels sick?

A

Renal colic - renal stones

58
Q

What obstruction can mimic appendicitis and diverticulitis?

A

Mid ureter obstruction

59
Q

What obstruction may cause an irritable bladder, pain in scrotum, penile tip/labia majora?

A

Lower ureter obstruction

60
Q

Define strangury.

A

Urge to urinate but unable

61
Q

Symptoms and signs of obstruction:

A 
UTI
Pylonephritis
Haematuria
Sterile pyuria 
Proteinuria
Anuria
62
Q

What drugs can increase the risk of urinary stones?

A 
Diuretics
Antacids
Corticosteroids 
Theophylline 
Aspirin
63
Q

What is the management of urinary stones?

A 
Pain relief - diclofenac
ABx if required 
Fluids (lower ureter/small stones may spontaneously pass)
Medical expulsion therapy 
Percutaneous stent

CCs (12 decks)

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