Urology and Nephrology

Question 1

Bladder cancer

Answer 1

RF: smoking (TCC), occupation (TCC), inflammation (SCC)
Symptoms: haematuria, LUTS, recurrent UTIs
Ix: dip, USS, cytology and cystoscopy - gold standard
Treatment: surgery TURBT or cystectomy if invaded wall, if systemic chemo
Complications: metastases lung, very common relapse

Question 2

Renal cancer

Answer 2

Risk factors: smoking, genetic renal conditions, obesity
Symptoms: haematuria, pain, abdo mass
Ix: dip, USS, CT, biopsy
Treatment; nephrectomy, chemo with tyrosine kinase inhibitors
Complications: mets lung, liver, paraneoplastic syndrome –> polycythaemia

Question 3

Renal stones

Answer 3

Causes: biochemical - calcium, gout, anatomical defects
Px: loin to groin colicky pain, moving around, sore tenderness, no guarding
Differentials: ectopic pregnancy, AAA (low BP), appendicitis, peritonitis, PCKD (trauma), pancreatitis (epigastric), bowel obstruction (constipation and distension)
Ix: dip, bloods, CT abdo (gold standard) KUB x-ray
Tx: pain relief (NSAIDS) unless in renal failure or gastritis, anti-emetics, less than 5mm –> fluids, more than - surgery or expulsion therapy with CCB nifedipine, tamsulosin
Complications: UTIs, obstruction (stent)

Question 4

Thrush

Answer 4

Candida albicans, inflammation, itchy, sore, cottage cheese discharge
See hyphae on microscopy
Topical clotrimAzole

Question 5

Trichomaniasis

Answer 5

Trchimonas vaginalis, inflammation, itchy and sore, frothy green discharge, unprotected sex with someone from a tropical country, alkaline pH
See flagellated protozoan
Metronidazole

Question 6

Bacterial vaginosis

Answer 6

smelly fishy thin grey discharge, alkaline pH
Self limiting, treat with metronidazole
Essential to treat with pregnancy otherwise can cause preterm delivery

Question 7

Polycystic kidney disease

Answer 7

Most common autosomal dominant
Loin pain, haematuria, hypertension, possibly palpable kidneys
Ix UT ultrasound
supportive treatment

Question 8

Nephrotic syndrome

Answer 8

Hypoalbuminaemia, oedema, hyperlipidaemia, proteinuria
Associated with SLE, diabetes, minimal change disease etc
Mx: sodium intake restriction and diuretic eg furosemide

Question 9

Acute tubulointerstitial nephritis

Answer 9

Drug hypersensitivity reaction usually due to penicillin or NSAID use
Px fever, skin rash, joint pain
Eosinophilia and elevated IgE

Question 10

Post streptococcal glomerulonephritis

Answer 10

Group a strep infection causes deposition of immune complex in the glomeruli
Haematuria, proteinuria, red cell casts in urine, oedema