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3 FoCP > Urology and Endocrine > Flashcards

Urology and Endocrine Flashcards

1
Q

core urinary symptoms

A 
frequency
nocturia
urgency
incontinence
incomplete voiding
visceral pain
haematuria
dysuria
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2
Q

what is phimosis

A

foreskin cannot be pulled back

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3
Q

what is paraphimosis

A

when foreskin cannot be reduced

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4
Q

what are some obstructive symptoms that can occur in LUT

A 
poor flow
hesitancy
intermittency
post micturition dribbling
incomplete voiding
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5
Q

what hormone fuels BPH?

A

testosterone

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6
Q

what does early, terminal and continuous haematuria indicate about the source

A

early - urethral/piping
terminal - prostate
continuous - bladder

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7
Q

what are some possible causes of haemturia

A 
BPH
cancer
infection
stones
trauma
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8
Q

what is enuresis?

A

unconscious voiding

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9
Q

what is the typical age for testicular torsion presentation

A

10-11

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10
Q

what could a scrotal mass be

A 
hernia
torsion
tumour
trauma
varicocele
cyst
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11
Q

what endocrine dysfunction manifests in CKD?

A

RAAS - heart/BP
EPO - anaemia
Vit D - bone

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12
Q

what is usually included in a U n E panel

A 
sodium
potassium
eGFR
creatinine
urea
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13
Q

low urea is a cause of concern - true or false

A

false

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14
Q

what can high urea suggest?

A

acute or chronic kidney failure
or shock
or dehydration

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15
Q

how should creatinine be interpreted?

A

against the patients demographic’s baseline.

big muscular patients have high creatinine baseline.

oppo is true

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16
Q

what two markers are best for indicating kidney function

A

creatinine and eGFR

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17
Q

symptoms of hypernatraemia

A

lethargy, weakness
confusion
coma/seizures

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18
Q

what can cause hypernatraemia

A

dehydration
diabetes insipidus
iatrogenic (too much IVT)

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19
Q

symptoms of hyponatraemia

A 
nausea
malaise
headache
irritability
confusion
muscle weakness
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20
Q

what ECG changes can be seen with hyperkalaemia

A

tented T wave
flattening of P waves
progressive lengthening of PR intervals/QRS

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21
Q

common causes of hyperkalaemia

A

acute/chronic kidney failure
drugs (ACEI/ARBs)
Diabetic ketoacidosis (T1DM)
addision’s disease

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22
Q

common causes of hypokalaemia

A

diuretics
V and D
cushings/steroid use

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23
Q

symptoms of hypokalaemia

A 
muscle weakness
hypotonia
hyporeflexia
cramps
palpitations
constipations
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24
Q

what kind of antibiotics can cause acute kidney injury

A

aminoglycosides e.g. gentamicin

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25
what are some pre-renal, renal and post renal causes of acute kidney injury
absolute or relative loss of fluid renal disease drugs urinary tract obstruction
26
symptoms of acute kidney injury
``` fatigue nausea confusion dehydration reduced urine output ```
27
causes of chronic kidney disease
``` hypertension diabetes polycystic kidney disease chronic urinary tract obstruction primary or secondary glomerular disease ```
28
what factors should be considered in management of CKD
BP control anaemia vitamin D modify risk factors
29
describe fibroadenosis,
Fibroadenosis is fibrocystic disease Rubbery and bilateral. Pain and lumpiness Fluctuates with period cycle
30
describe a fibroadenoma
Hyperplasia of terminal duct lobules Firm, non-tender and highly mobile lump (untethered) usually <30 YO
31
fibroadenomas have no increase in breast cancer link - true or false?
true
32
describe a breast cyst
fluid filled sacs in breast tissue smooth firm lumps soft and fluctuant or hard and painful common 30-60 YO
33
2 types of breast abscess
lactational abscess | non-lactational abscess
34
describe a non-lactational breast abscess
usually under areola, nipple inversion associated. common in young female smokers
35
symptoms of breast abscess
erythema, pain, swelling
36
symptoms of breast cancer
``` breast/axilla lump discharge skin changes thickened tissue change in size ```
37
modifiable risk factors of breast cancer
``` OCP obesity breast feeding alcohol HRT ```
38
how to conduct a breast exam?
intro - chaperone look - 4 hand positions palpation - hand behind head, check axillary and supraclavicular lymph nodes
39
what does a patients HbA1C tell u?
three month average plasma glucose concentration
40
what should a normal HbA1C reading be?
<42 mmol/mol
41
what is a diabetic HbA1C reading?
48+ mmol/mol
42
what are 3 possible diagnostic criteria for DM?
random glucose >11.1 w/ symptoms 2x random glucose >11.2 w/o symptoms HbA1C >48 or 6.5%
43
what are some possible secondary causes of diabetes
acromegaly cushing's haemochromatosis pancreatitis
44
macrovascular effects of diabetes
CVS - angina, MI, CHF CBVS - stroke, TIA
45
microvascular effects of stroke
eyes - retinopathy, glaucoma, cataracts kidneys- nephropathy PNS - peripheral neuropathy PVD - absent foot pulse, ischaemic skin changes, gangrene
46
what is the normal range for blood glucose
<7.8
47
stages of diabetic retinopathy
background retinopathy - micro aneurysm pre-proliferative retinopathy - hard exudates, soft exudates proliferative retinopathy - neovascularisation and possible hemorrhage
48
what is the surgical sieve
VITAMIN C D E F ``` vascular inflammatory/infection trauma autoimmune Metabolic Iatrogenic Neoplastic ``` Congenital Degenerative Endocrine/environment Functional
49
1 unique feature of quinsy
Difficulty opening mouth
50
Describe the partitions of the neck 1 - 6
``` 1 - under the mandible 2 - top of SCM (angle of jaw) 3 - middle of SCM 4 - bottom of SCM to clavicle 5 - posterior triangle 6 - tracheal region ```
51
What are some dysfunctions one can have in ENT?
Breathing Swallowing Voice Endocrine
52
How to tell if a lump is a thyroglossal cyst
Will move when tongue is protruded
53
Why does a thyroglossal cyst move with protrusion of the tongue
Cyst attached to hyoid bone, tongue attached to hyoid bone.
54
Describe the features of a branchial cyst
Well defined anterior border, but undefined posterior and superior borders because its under SCM and jaw
55
Features of a thyroglossal cyst? Signs and site?
Midline neck lump Painless Smooth Cystic Moves on swallowing and protrusion of tongue Around the region of the hyoid bone
56
Features of a branchial cyst
Smooth Slowly enlarging mass +/- fistula
57
What can cause swelling of the parotid gland?
Mumps
58
Where would a parapharyngeal abscess be located?
Behind the jaw
59
Symptoms of a parapharyngeal abscess?
Fever Sore throat Odynophagia Neck swelling
60
Features of a malignant lymphadenopathy
Hard | Tethered to skin
61
What should not be forgotten when presenting with ear pain?
The throat!
62
How does candidiasis of the throat look like
Yellowy white reddish patches of the pharynx
63
indications for a PR exam
``` constipation cauda equina syndrome hemorrhoids prostatic conditions rectal cancer ```
64
symptoms of BPH
``` >storage increased frequency urgency nocturia incontinence ``` ``` >voiding hesitency intermittency incomplete voiding weak flow dribbling ``` >post-micturition dysuria urinary retention bladder pain
65
a urinary catheter is the first line for incontinence - true or false
false - used a "condom" type tube
66
indications for urinary catheter
relieve urinary retention monitor urine output collect urine sample bladder irrigation
67
what factors are used to diagnose acute kidney injury?
serum creatinine and urine output
68
what are the risk factors for acute kidney injury
``` age >75 CKD cardiac failure PVD chronic liver disease diabetes sepsis drugs fluid imbalance hx of urinary symptoms ```
69
what is the criteria for stage 3 AKI
>3x serum creatinine baseline increase <0.3 mL/kg/hr for 24hr OR anuria for 12 hr
70
signs and symptoms of CKD
``` anaemia GI disturbance (anorexia, NVD) polyneuropathy CNS dysfx CVS dysfx oedema bone dysfx ```
71
how to differentiate acute and chronic kidney failure
previous sCr to determine pattern duration of symptoms small kidney on U/S
72
what factors are used in the staging of CKD
eGFR and albumine-creatinine ratio
73
what is the duration criteria for CKD
3 months
74
which benign breast lumps are not associated with pain
fibroadenoma
75
common age for fibroadenoma
<30
76
benign breast lumps associated with period cycle
fibrocystic disease fibroadenoma breast cyst
77
common ages for fibrocystic disease
20-50 (premenopausal)
78
fibrocystic disease is associated with a discharge true or fals
true
79
common locationfor fibrocystic disease
bilateral, multiple lumps
80
texture of fibroadenoma lump
firm/ rubbery
81
which breast lump is the most mobile
fibroadenoma
82
how does fat necrosis in the breast arise
trauma
83
what associated symptoms come with breast abscess
inflammatory, infection - redness, swelling, pain
84
what causes diabetic ketoacidosis
lack of insulin leads to rise in blood glucose and metabolism of fatty acids yielding high ketone bodies.
85
signs and symptoms of DKA
``` Nausea and vomiting thirst polyuria abdominal pain tachycardia and hypotension kussmaul respiration pear drops scent reduced GCS dehydration hyperglycaemia cerebral edema ```
86
Main aims on how should a patient with DKA be treated
rehydrate give insulin potassium
87
What is hyper osmolar hyperglycaemic state
Happens in uncontrolled type 2 DM High blood glucose, dehydration, high blood osmolality. Little to no ketones
88
Signs of hyper osmolar hyperglycaemic state
Dehydration | Reduced GCS
89
Insulin levels in HHS
Low, but sufficient to prevent ketogenesis. But no enough to prevent hyperglycaemia
90
What often precipitates HHS
Infection - pneumonia
91
Blood biochemical differences between DKA and HHS
HHS has higher bicarb, urea and blood glucose. High pH also cos lower ketones.
92
Main aims of treatment for HHS
Rehydrate. Some insulin Replace lost electrolytes
93
Complications of insulin therapy
Hypoglycaemia Lipohypertrophy at injection sites Insulin resistance Weight gain
94
2 classifications of symptoms in hypoglycaemia
Adrenergic | Neruglycopaenic
95
Adrenergic symptoms in hypoglycaemia
``` Sweating Shaking Pallor Anxiety Hunger Abdominal discomfort Dilated pupils N&V Palpitations ```
96
Neuroglycopenic symptoms in hypoglycaemia
``` Reduced GCS Confusion Impaired judgement Seizures Memory loss Lethargy Blurred vision Slurred speech Ataxia Paraesthesia and paralysis Coma ```
97
What can be found in a typical hypobox
Sugary drinks Dextrose tablets IV glucose Dextrose gel
98
What can cause secondary diabetes
Acromegaly Cushing’s syndrome Haemochromatosis Pancreatitis
99
What is the most common cause of blindness in people under 65?
Diabetes
100
What causes diabetic retinopathy
High blood glucose causing damage to retinal vessels
101
Stages of diabetic retinopathy
Non-proliferative Pre-proliferative Proliferative Advanced retinopathy
102
Features of non-proliferative diabetic retinopathy
Microaneurysms (dot haemorrhages) Blot haemorrhages Hard exudates (protein + lipid)
103
What causes hard exudates in non-proliferative retinopathy
Breakdown of blood-retina barrier causing lipid and proteins to leak into the retina
104
Description of hard exudates in diabetic retinopathy
Bright yellowish color Irregular outline Sharply defined margin
105
Features in pre-proliferative diabetic retinopathy
Cotton wool spots Venous loops and beading Intraretinal microvascular remodelling
106
What causes cotton wool spots in diabetic retinopathy
Edema from retinal infarcts
107
Description of cotton wool spots in diabetic retinopathy
Greyish white Indistinct margins Dull matte surface
108
Difference in appearance between cotton cool spots and hard exudates in diabetic retinopathy
Hard exudates are bright yellow and shiny Cotton wool spots are greyish white and dull
109
What causes venous loops and beading in diabetic retinopathy
Retinal ischaemia
110
Where do you find intraretinal microvacular remodelling in diabetic retinopathy
Borders of non-perfused retina
111
Features of proliferative diabetic retinopathy
Pre-retinal neovascularisation Haemorrhages of neovessels Vitreous haemorrhage
112
Features of advanced diabetic retinopathy
Retinal fibrosis | Retinal detachment
113
Features of maculopathy in diabetic retinopathy
Maculo edema | Perimacular hard exudates
114
What causes diabetic nephropathy?
Persistent glycosaemia causes reactive oxygen species and glycation products. Damaging glomeruli and proteinuria. Eventually kidney failure occurs as damage spreads.
115
How to diagnose diabetic nephropathy?
Urine albumin Starts off as microalbuminuria Then more albumin leaks through eventually leading to proteinuria detectable by dipsticks.
116
What causes diabetic neuropathy
Occlusion of blood supply to peripheral nerves and/or accumulation of glucose products disrupting nervous function
117
What is the first stage of diabetic neuropathy
Symmetrical sensory neuropathy
118
Describe the progression of diabetic sensory neuropathy
Starting in feet, loss of vibration sense, pain, temperature. Followed by proprioception and balance.
119
Complications of diabetic sensory neuropathy
Loss of pain sensation leads to unrecognised trauma, ulceration and neuropathic arthropathy like Charcot’s joint
120
What causes charcots joint
Loss of pain sensation leads to abnormal mechanical stress on the joints, accumulation of which leads to joint deformities like large bony swellings
121
What does motor nerve neuropathy in diabetics lead to
Muscle wasting | Distortion of feet with high arches and clawed toes
122
Describe acute painful neuropathy in diabetes
Burning crawling pain in lower limbs, worst at night and exacerbated by pressure
123
What is mononeuritis and mononeuritis multiplex in diabetics?
Radiculopathy involving one or more nerve roots causing pain along a dermatome/myotome.
124
What is a common diabetic mononeuritis?
Carpal tunnel
125
What is the most common cranial mononeuritis in diabetes
3rd and 6th nerve palsy
126
Describe 3rd and 6th nerve mononeuritis multiplex in diabetics
Unilateral pain, ptosis and diplopia - no change in pupillary function.
127
What is it called when a diabetic has marked quadriceps muscles wasting with pain and diminished or absent knee reflexes?
Diabetic amyotrophy
128
What systems are commonly affected in diabetic autonomic neuropathy
Cardiovascular GI Bladder Penile
129
What is the effect of diabetic autonomic neuropathy on the CVS
``` Resting tachycardia Loss of sinus arrhythmia Postural hypotension Peripheral vasodilation - warmth in feet Bounding pulse ```
130
What is sinus arrhythmia
Physiological response to the respiratory cycle causing increase or decrease vagal tone leading to change in heart rate
131
What can prolonged diarrhea in a diabetic indicate?
Autonomic neuropathy in the GI system
132
What will autonomic neuropathy in diabetes do to a patient’s sex life
Males will get erectile dysfunction
133
What signs are indicative of someone at risk to diabetic feet
Neuropathic signs | Vascular disease signs
134
What vascular disease signs can be found on someone at risk to diabetic feet
``` Thin skin Hair loss Bluish discoloration of skin Reduced skin temperature Absent foot pulses ```
135
What should be considered in someone at risk to diabetic feet
Regular chiropody checks Special shoes Daily feet inspection Avoid heat sources
136
Why should regular subcutaenous insulin injection sites be rotated
Prone to lipohypertrophy at injection site
137
What is the biggest risk to the patient when having insulin infusions
Hypoglycaemia
138
Having a goitre is indicative of thyroid pathology - T or F?
False.
139
What types of goitres are there
Diffuse Multinodular Singular nodule
140
What does a goitre associated with lymphadenopathy indicate?
Malignancy
141
What can cause a diffuse goitre
``` Overactive or underactive thyroid Iodine deficiency Graves disease Hashimoto’s disease Acute viral thyroiditis ```
142
What investigations should be done on a patient with a goitre
Bloods - thyroid function tests Imaging - U/S FNA
143
Which is the biologically active hormone, T3 or T4
T3
144
In a hyperthyroid patient, what symptoms only occur in Graves disease
Exophthalmos and opthalmoplegia (restricted eye movement) Thyroid acropachy
145
What is seen in thyroid acropachy
Hand swelling Clubbing Perioesteal new bone formation
146
3 most common causes of hyperthyroidism
Graves Toxic multinodular goitre Toxic adenoma
147
Biochemical picture of hyperthyroidism
Low TSH | High T4 and T3
148
Symptoms of hyperthyroidism
``` Weight loss Increased appetite Irritability Tremor Heat intolerance Diarrhea Eye symptoms Period disturbance Sweating Palpitations ```
149
Signs of hyperthyroidism
``` Tachycardia Lid lag Warm vasodilated peripheries Tremor Hyperkinesis Exopthalmos Goitre bruit Weight loss Pretibial myxoedema Palmar erythema ```
150
Common causes of hypothyroidism
Autoimmune (hasimotos or thyroid atrophy) Iatrogenic Drug induced Iodine deficiency (endemic)
151
Some medication that can cause hypothyroidism
Carbimazole Lithium Amiodarone Interferon
152
What to look for in suspected autoimmune hypothyroidism
Antibodies
153
Biochemical markers of hypothyroidism
High TSH | Low T3, T4
154
Symptoms of hypothyroidism
``` Weight gain Lethargy Cold intolerance Poor appetite Goitre Dry brittle hair Dry skin Constipation Period disturbance Low moods ```
155
Signs of hypothyroidism
Dry thin hair Bradycardia Dri skin Slow relaxing reflexes
156
How do reflexes change in hypothyroidism
Slow relaxing reflexes. Initial reflex is normal, but muscle will be slow to relax.
157
What kind of goiter would someone with hasimotos classically present with
Hard non-tender
158
What is addison’s disease
Primary hypoadrenalism -> loss of adrenal gland function
159
What is the difference between primary, secondary and tertiary hypoadrenalism
Primary = adrenal gland problem Secondary = pituitary gland problem Tertiary = hypothalamus problem
160
What is the HPA axis?
Hypothalamus makes CRH which stimulates anterior pituitary to make ACTH which stimulates adrenal glands to make cortisol.
161
Clinical features of addison’s disease
``` Lethargy Depression Anorexia Weight loss Postural hypotension Hyperpigmentation In women, vitiligo and body hair loss ```
162
Why is hyperpigmentation seen in addison’s diseaser
Stimulation of melanocytes by excess ACTH
163
Where is hyperpigmentation often seen in addison’s disease
Buccal mucosa Skin creases Pressure points Recent scars
164
What causes postural hypotension in addison’s disease
Dehydration and low electrolytes (low aldosterone)
165
What can precipitate an addison’s crisis
Infection, illness
166
Symptoms of an addison’s crisis
``` Vomiting Abdominal pain Weakness Hypoglycaemia Hypovolaemic shock ```
167
What are some investigations that can be done for suspected addison’s disease
Cortisol measurement ACTH level ACTH stimulation test
168
What is the hptm, pituitary, thyroid axis
Hypothalamus makes TRH which stimulates anterior pituitary to make TSH which stimulates thyroid gland to make T4/T3
169
Difference between cushing’s disease and cushing’s syndrome
Cushing’s disease is specifically caused by ACTH over production by the pituitary gland causing excess glucocorticoid production. Cushing’s syndrome can be caused by anything that causes excess glucocorticoids
170
Symptoms of cushings syndrome
Weight gain - central, trunk, abdomen “Buffalo hump” Moon face Thin easily bruised skin Purple striate on abdomen, breasts and thigh Pigmentation in ACTH overproduction causes
171
Causes of cushings syndrome
ACTH dependent Pituitary-dependent Ectopic ACTH producing tumours ACTH administration ACTH independent Adrenal gland malignancy Glucocorticoid administration
172
What are some common ectopic ACTH producing tumours
Small cell lung cancer | Carcinoid tumours
173
what is the most common cause of lumps in the neck
reactive lymph node from infection (bacterial, viral or others)
174
how would a thyroglossal cyst be identified
midline lump | moves with swallowing and tongue protrusion
175
which age group is more likely to get inflammatory and congenital neck lumps
children and teens.
176
what is the onset pattern of 1. inflammatory lump 2. malignant lump 3. salivary gland blockage
inflammatory lumps come and ago within 2-6 weeks. malignant lumps enlarge progressively in a short time transient swelling with associations with eating suggest salivary gland blockage
177
how to malignant lump necks tend to feel?
hard
178
what lumps move with swallowing?
thyroid gland swallowing and thyroglossal cysts
179
what does a tender lump indicate?
infection over the lump
180
what do midline lumps tend to be?
thyroid swelling thyroglossal dermoid cysts
181
what does a a bilateral tender swelling across the mandibular angle suggest
parotid infection (mumps)
182
where is virchows node and what does it suggest
left supraclavicular fossa | metastatic malignancy
183
signs and symptoms of bells palsy
``` unilateral facial muscle weakness facial tingling phonophobia some pain around ear loss of taste in anterior 2/3 of tongue on affected side ```
184
how to diagnose bells palsy?
by excluding other possible causes of unilateral facial weakness
185
4 side effects of med-long term steroid use
weight gain skin thinning hyperglycaemia -> Diabetes brittle bones
186
what TSH, T4 and T3 pattern can suggest someone who is 'sick euthyroid'
normal TSH normal T4 low T3 (with ongoing illness)
187
what is a toxic adenoma (in hyperthyroidism)
solitary overactive nodule producing excess thyroid hormones
188
what is de Quervain's thyroiditis
associated with viral infection or post-partum patients experience period of hyperthyroid, then hypothyroidism before resolving back to euthyroidism.
189
what is carbimazole sometimes given for?
hyperthyroidism - Graves disease
190
what are the symptoms and signs of a 'thyroid storm' or thyroid crisis
hyperpyrexia tachycardia extreme restlessness with more progression, it can lead to delirium, coma and death
191
what can precipitate a thyroid storm or thyroid crisis
infection stress surgery radioactive iodine therapy
192
what causes addison's disease?
autoimmune antibodies
193
why does vitiligo and loss of body hair happen in women with addison's disease?
hair growth is dependent on adrenal androgens
194
what is the most common history of someone presenting in addison's crisis?
someone who is on long term corticosteroid therapy, sudden withdrawal causing addison's crisis
195
what does the short-ACTH test involve and show?
exogenous introduction of a small amount of ACTH, if cortisol does not go up, then it demonstrates primary adrenal insufficiency (problem is due to adrenal glands)
196
what further test can be done to determine secondary or tertiary hypoadrenalism?
CRH test.
197
symptoms of HHS
lethargy, confusion, focal neurological deficits, seizures, | leg weakness, cramps, visual impairment.
198
risk factors of HHS
type 2 diabetics, old, dementia, immunosuppressed
199
signs of HHS
signs of dehydration tachycardia, hypotension, tachypnea signs of cause of HHS - infection? thyroid? acute abdomen?
200
how to differentiate DKA from HHS?
level of ketones in bloods, "pear drops breath", history (DKA is faster)
201
how to differentiate BPH from prostate cancer?
BPH is smooth on PR exam, prostate cancer is hard/irregular
202
how to diagnose prostate cancer?
transrectal ultrasound of prostate, elevated PSA, and biopsy
203
symptoms of prostate cancer
urgency, increased frequency, nocturia, dribbling, retention, or retention with overflow incontinence.
204
3 most common organisms causing UTI
E coli proteus staph saprotiphycius/epidermis
205
in an uncomplicated pyelonephritis, what is the likely cause of persistent illness despite 2-3 days of antibiotics? what should be done ti investigate?
do a imaging of utrinary tract to check for abscesses
206
what is the first investigation done for someone presenting with UTI symptoms?
urine dipstick - look for nitrites and luekocytes
207
definition of nephrotic syndrome?
proteinuria and hypoalbuminaemia
208
most common cause of nephrotic syndrome in children?
minimal change glomerular disease
209
symptoms of nephrotic syndrome?
facial swelling, wide spread edema | systemic fatigue, anorexia
210
which age group is more common in pharyngeal pouch?
>70s
211
symptoms of pharyngeal pouch
``` chronic cough aspiration halitosis dysphagia regurgitation ```
212
what can an enlarged left supraclavicular lymph node suggest?
cancer of the internal organs
213
a new born baby is found to have several large lumpbs on the side of the neck, they are soft and appear fluid filled. what is an important thing to check in the newborn for fear of further complications?
ACBDE assessment and then chromsomal abnormalities
214
common age group for bells palsy
15-60
215
causes of bells palsy
can be after viral infection or idiopathic
216
how long does bells palsy usually last
about 3 weeks
217
investigations of a goitre?
blood tests - TFTs imaging - US/Xray Fine needle aspirate
218
a 10 year old with background of JIA, presents to the A&E with vomiting, abdominal pain, fatigue, muscle pains, cramps, and dehydration. what differentials have to be considered?
infection - gastroenteritis, sepsis DKA addison's crisis

3 FoCP (11 decks)

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