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Internal Medicine > Urology > Flashcards

Urology Flashcards

1
Q

What ketones do dipsticks detect

And which one predominates during DKA

A

Acetoacetate

Betahydroxybutyrate predominates during DKA but as ketosis improves acetoacetate increases causing a positive on dipsticks and making the ketosis look like it is worsening

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2
Q

Causes of milky white urine

A

Pyuria
Lipid (cats with hepatic lipidosis)
Crystalluria

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3
Q

Differentiating haematuria, myoglobinuria and haemoglobinuria

A

Check sediment for RBCs

Spin down blood plasma will be pink if haemolysis and clear if myoglobin

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4
Q

What are hyaline casts and why do they form?

A

Pure protein precipitates
Parallel sides and rounded ends
Occur with fever, exercise and renal disease

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5
Q

What are granular casts and why do they form

A

These represent degenerated epithelial cellular casts

Observed with renal tubular disease

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6
Q

What are waxy casts

A

Arise from degeneration of granular casts

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7
Q

Side effects of progestagens in treatment of canine BPH

A

Adrenal atrophy
Cushings
Diabetes
Hypothyroidism

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8
Q

Pyometra is mediated by what hormone

A

Progesterone

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9
Q

Antibiotics for chronic prostatitis

A 
TMPS
Erythromycin
Clindamycin
Chloramphenicol
Flouroquinolones

Not usually anaerobic - gram positives and negatives

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10
Q

Drugs used in medical management of pyometra

A

Prostaglandin F

Dopamine agonists

Progesterone receptor antagonists (aglepristone (Alizin))

Antibiotics

(Prostaglandin and dopamine agonists combined therapy enhances luteolytic effects - progesterone levels fall within 24-48 hours and cervix opens in less than two days - cabergoline and cloprostenol. Resolution of signs in 10-13 days)

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11
Q

Prostaglandin F mode of action and dose

A

Luteolytic
Opens cervix
Promotes myometrial contraction
Natural - dinoprost 3-5x daily for 3-7days
Side effects: v/d/panting
Synthetic - cloprostenol - longer duration and less side effects
Neither licensed

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12
Q

Dopamine agonist

A

Cabergoline

Luteolytic

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13
Q

Progesterone antagonists and mode of action

A

Aglepristone
Opens cervix but doesn’t induce myometrial contractions

Can also combine with prostaglandin

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14
Q

Antiobiotics for pyometra

A

Potentiated amoxicillin
TMPS
Cephalosporins
Continue 10-14 days after resolution of clinical signs

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15
Q

Treatment of Cystic endometrial hyperplasia

A

Gnrh agonists eg deslorelin implant to prolong anoestrous but if implanted in anoestrous will bring bitch into oestrous

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16
Q

Causes of failure to cycle

A

Individual variations (4-12months)
Immaturity, intersex, ovarian aplasia, stress, systemic illness, endocrine dz
Silent heat
Luteal cysts
Senile or immune mediated ovarian failure
Ovarectomy

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17
Q

What to do if bitch fails to show oestrous

A 
Measure progesterone to exclude ovulation 
Vaginal cytology initially then twice weekly
House with other cycling bitches
Gnrh stimulation test
Ultrasonography
Aerial serum progesterone
Exploratory surgery 
Kayotyping if intersex
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18
Q

Treatment of Luteal cyst

A

Surgical removal or prostaglandin

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19
Q

Treatment of normal bitch who is failing to cycle

A

Cabergoline

Deslorelin

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20
Q

Infertility associated with abnormal oestrous cycles

A

Short interoestrous intervals - anovulatory cycles or CEH

Extended interoestrous intervals - ovarian failure, luteal cysts, progesterone secreting ovarian tumours (granulosa cell)
Persistent oestrous - follicular cyst
Vaginitis

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21
Q

Failure to conceive or early pregnancy failure

A 
Physical abnormalities
Miss timing
Endometritis/ CEH
Embryonic defects 
Herpes/brucellosis
Hypoluteodism (progesterone insufficiency)
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22
Q

Clinical signs of cystic ovarian remnants in the bitch

A 
Vaginal bleeding for several weeks
Vulval swelling 
alopecia
Dermal hyperpigmentation
PU/PD
Erythema on ventral abdomen
Mammary gland enlargement
Pollakiuria/strangurua
Poor coat
Weight loss
Recurrent UTIs
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23
Q

Side effects of progestagens in queens for ovarian remnant syndrome

A 
DM
CEH
Pyometra
Mammary adenoma/fibrosarcoma
Bone marrow toxicity
Thyroid dysfunction
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24
Q

Contraindications of medical treatment of pyometra

A

Pyretic or hypothermic patients likely to have peritonitis

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25
Q

When to consider low dose aspirin for PLN

A

If albumin < 20g/l due to loss of antithrombin

26
Q

Side effects of aluminium hydroxide

A

Microcytosis and muscle weakness

Neurological issues

27
Q

Treatment of metabolic acidosis in CKD

A

Stabilise on renal diet
Oral potassium citrate or sodium bicarbonate

B

28
Q

Causes of acute kidney injury

A 
Ischaemia
Toxins - lilies/grapes
Drugs 
Infections (pyelonephritis, leptospirosis)
Hypercalcaemia 
Sepsis
Acute pancreatitis
Renal lymphoma
Obstruction
29
Q

What will be found on urinalysis in AKI

A

Isosthenuria
Casts

Can see:
Haematuria
Glucosuria

May also see bacteruria/pyuria/crystals

30
Q

Routine evaluation of AKI

A

Bloods
Acid base
Urinalysis
Urine culture

31
Q

Normal kidney size

A

2-3x L2 in cats

2.5-3.5 x L2 in dogs

32
Q

What crystals form with ethylene glycol toxicity

A

Calcium oxalate monohydrate

33
Q

Antidote for antifreeze toxicity

A

4-methylpyrazole or Ethanol

Needs to be given within 8 hours of ingestion

Prognosis poor if already azotaemic or oliguric

34
Q

Treatment of NSAID toxicity

A

Misoprostol for at least 3 days

Synthetic prostaglandin analogue

35
Q

Prognostic factors for dogs in AKI

A 
Severe azotaemia (crea >900)
Hypocalcaemia
Anaemia
Anuria
If azotaemia doesn’t improve with treatment or wors an
Other disorders (sepsis/pancreatitis)
36
Q

Prognostic factors for cats with AKI

A

Hyperkalaemia
Low albumin
Decreased bicarbonate at presentation

(Azotaemia or changes in calcium/phosphate did not predict survival)

37
Q

Infectious causes of acute kidney injury

A

Primary:
Leptospirosis
Pyelonephritis
Borreliosis (lymes nephritis)

Secondary:
FIP
babesiosis
Leishmaniasis
Bacterial endocarditis
38
Q

When not to use mannitol in AKI

A

When anuric as this can cause volume overload

Works by solute diuresis

39
Q

Why is there increased risk of thromboembolic events with protein losing nephropathy

A

Loss of antithrombin III

Also changes in vessel walls and blood stasis etc

40
Q

Treatment of metabolic acidosis in ckd (iris stages 1-4)

A 
Renal diet (pH neutral)
Alkalinising salts (sodium bicarbonate or potassium citrate)

Use if bicarb or CO2 is <16mmol/l
Assess response by rechecking blood gases after 10-14 days

41
Q

Choice of potassium supplementation in ckd cats

A

Potassium gluconate or potassium citrate

Potassium chloride is acidifying so don’t use this

42
Q

What should be administered alongside darbepoeitin

A

Iron dextran
Can cause anaphylaxis so needs monitored
Sometimes one injection is all that is required

43
Q

When to use calcitriol therapy

A

In dogs with CKD stages three and four.

Proven benefit

Need to monitor PTH and calcium levels

44
Q

Radiolucent urinary stones

A

Cysteine
Urate
Xanthine

45
Q

Fluid of choice in blocked cats

A

Hartman’s as saline is acidify

Hartman’s potassium level is negligible

46
Q

Prazosin

A 
Smooth muscle relaxant (proximal third of urethra)
Alpha1 antagonist (so is phenoxybenzamine but prazosin is more effective - quicker and more selective for alpha one)
47
Q

Why do medications like steroids and furosemide increase risk of calcium oxalate urolithiasis

A

Decrease tubular reabsorption of calcium and increase calcitriol

48
Q

Treatment of ureteroliths and nephroliths

A

Extracorporeal shock wave lithotripsy

Surgery (ureteral bypass or nephrectomy)

Fluid diuresis and urinary smooth muscle relaxants : amitryptyline, prazosin, phenoxybenzamine, metoclopramide or cisapride

49
Q

What to avoid with calcium oxalate urolithiasis

A

Glucocorticoids
Furosemide
Vitamins D and C

50
Q

Urinary acidifiers used for struvite dissolution and side effects

A

Acetonydroxamic acid (AHA) - inhibits urease

Renal excreted so cant use in renal dz
Haemolytic anaemia
Anorexia
Vomiting
Hyperbilirbuinaemia
Bilirubinaemia
Predisposition to calcium oxalate formation
51
Q

Allopurinol mechanism of action
Side effects
Contraindications

A

Xanthine oxidase inhibitor

Formation of xanthine crystals if a low protein diet isn’t fed

Haemolytic anaemia
Trigeminal neuropathy and
Skin eruptions if given with ampicillin

CI in renal dz

52
Q

Metastatic potential of TCCs - how many and where to

A

60% metastasise

Lungs and lymph

53
Q

How to reduce sterile haemorrhaging cystitis with cyclophosphamide usage

A

Give with furosemide

54
Q

Treatment of BPH

A

Osaterone
Deslorelin implant
5-alpha reductase inhibitors (finasteride)

55
Q

Causes of detrusor atony

Treatment

A

Injury to sacral spinal cord s1-s3 or pelvic nerves
Direct damage due to overdistension

Bethanecol (for overdistension damage as the pelvic nerve is intact)

Metoclopramide, cisapride

56
Q

Lower motor neuron bladder

A

S1-s3 lesion
Easily expressive bladder that may empty with minor increases in abdominal pressure

Can use bethanecol

57
Q

What is bethanechol

A

A parasympathomimetic that affects only muscarinic receptors with no effect on nicotinic

58
Q

Side effects of oestrogen

A

Myelosuppression
Attractiveness to males
Mammary/vulvar swelling
Behaviour changes

59
Q

Causes of glucosuria without hyperglycaemia

A

Leptospirosis (acute kidney injury)
Primary renal glucosuria
Fanconis

60
Q

Causes of acquired fanconis syndrome

A 
Dried meat jerky treats
Drugs: tetracyclines, cisplatin, aminoglycosides, streptazotocin
Copper-associated hepatopathy 
Pyelonephritis
Hypoparathyroidism/vitamin D deficiency

Monoclonal gammopathies
Neoplasia

Internal Medicine (11 decks)

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