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urology and nephrology > urology and nephrology > Flashcards

urology and nephrology Flashcards

1
Q

what is the typical presentation for glomerulonephritis?

A

Child/young adult, immunocompromised, abdominal pain, haematuria, proteinuria and oedema.

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2
Q

What are the investigations for glomerulonephritis?

A

Urinalyis - haematuria, proteinuria, leukocytosis

USS of kidneys - reduced/normal

EGFR-normal/reduced

FBC-anaemia

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3
Q

What is the Mx for glomerulonephritis?

A

Manage BP, hyperlipidemia and proteinuria.

Reduced salt intake
ACE inhibitor Ramipril
Angiotensin Losartan
Abx Amoxicillin

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4
Q

What are the RF for prostate carcinoma?

A

Older
African American
Family Hx

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5
Q

Investigations and examination for prostate carcinoma?

A

PSA >4

DRE - painless prostate, asymmetric in shape

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6
Q

Causes of increased PSA?

A

Prostate carcinoma
BPH
UTI
Prostatitis

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7
Q

What is cryptorchidism?

A

Cryptorchidism is the failure of the testicle to descend into the scrotum.

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8
Q

What is the Mx for prostate carcinoma?

A

2ww referral

options:
watchful waiting (no treatment, regular tests)

active surveillance (regular tests)

Radical prostatectomy (for T1-T3 tumours)

Radiotherapy (For T1-T3 tumours

Hormone therapy (for metastatic disease)

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9
Q

What has raised creatinine kinase?

A

It is an enzyme found in muscles, increased amounts are raised into blood if there is muscle damage.

Rhabdomyolysis
Renal injury

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10
Q

What is paraphimosis and causes of it?

A

Paraphimosis is unable to return retraction of foreskin. Can be caused by catherisation, during surgery.

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11
Q

What is phimosis and cause of it?

A

Unable to retract foreskin, can be congenital cause.

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12
Q

What is Mx of phimosis?

A

If <2 yrs just reassurance

If >2yrs give topical corticosteroid to loosen foreskin

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13
Q

What is Mx of paraphimosis?

A

Manual fixing

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14
Q

What is acute kidney injury?

A

Decline in renal function, leading to rise in serum creatinine and fall in urine output. Occurs within 24 hours

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15
Q

How is AKI classified?

A

Pre-renal - reduced renal perfusion e.g. hypovolaemia, sepsis
Intrinsic - e.g. glomerulonephritis,
Post renal - mechanical obstruction to urinary outflow e.g. strictures, stones, urinary retention

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16
Q

What is investigations for AKI?

A

Serum creatinine raised
Hyperkalaemia
Urinalysis - leucocytes, nitres for infection, glucose for diabetes

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17
Q

What is Mx of AKI?

A

Fluid rehydration in pre-renal AKI

Stop nephrotoxic medications e.g NSAIDS, ACE inhibitors

Sodium bicarbonate for metabolic acidosis (kidney injury causes imbalance of acids in body and kidneys unable to remove acid, bicarbonate replaces low carbonate)

Relieve obstruction in post renal AKI e.g catheter

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18
Q

Examples of nephrotoxic drugs?

A

NSAIDS e.g naproxen, ibuprofen
ACE inhibitors e.g. ramipril, lisinopril
Aminoglycosides (Abx) e.g vancomycin

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19
Q

What are the Risk factors for bladder carcinoma?

A 
Tobacco exposure
Old Age
Males
Chronic cystitis
Chemical carcinogens
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20
Q

What does bladder carcinoma present?

A

Presents with frank haematuria (macroscopic), painless

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21
Q

What is the Mx for bladder carcinoma?

A

2ww referral - if >45, unexplained visible haematuria

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22
Q

What is CKD?

A

Decline in renal function and structural damage present for >3months

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23
Q

What is the investigations for CKD?

A

Urinalysis - proteinuria, haematuria

Hx of symptoms > 3months

eGFR - reduced (less than 60 mL/minute/1.73 m²)

Renal USS

Serum creatinine - raised

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24
Q

What are the most common causes of CKD?

A

DM (most common), hypertension, pyelonephritis, glomerulonephritis

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25
Q

What are the RF for CKD?

A

Smoking
DM
Old age
Hypertension

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26
Q

Mx for CKD?

A

Slow progression of disease

  • optimise blood pressure
  • optimise diabetic control

Reduce risk of complications

  • exercise, healthy weight, smoking cessation
  • atorvastatin for prevention of cardiovascular disease

Treat complication

  • Oral sodium bicarbonate to treat metabolic acidosis
  • Iron supplementation and erythropoietin to treat anaemia
  • Dialysis in end stage renal failure
  • Renal transplant in end stage renal failure
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27
Q

Complications of CKD?

A

CVD disease
Anaemia
Peripheral neuropathy - damage to peripheral nerves e.g. hands, feet and arms

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28
Q

What is serum urea and causes of increased urea?

A

Urea is produced from breakdown of amino acids in liver, excreted by kidneys

Increased - increased protein breakdown (trauma, infection, trauma), high protein intake, dehydration, GI bleed

Serum creatinine and serum urea both increased - renal failure

29
Q

What is the cause of testicular carcinoma and main type?

A

Genetic cause, teratoma (tumour made up of several different type of tissues)

30
Q

Tumour marker raised in testicular carcinoma?

A

AFP elevated

31
Q

Characteristic symptoms for testicular carcinoma?

A

Painless testicular lump

32
Q

Mx for testicular carcinoma?

A

2ww referral- unexplained symptoms, tender less lump on testicle

Radical orchiectomy

33
Q

What is the most common type of renal calculi?

A

Calcium oxalate

34
Q

What are the RF for uro/nephrolithiasis?

A

Men
Dehydration
High salt diet

35
Q

What is characteristic symptom of for nephrothialisis?

A

Flank pain radiating to groin, dysuria, fever

36
Q

Mx for nephro/urolithiasis

A

Need hospital admission

  • NSAIDS e.g. diclofenac
  • Antiemetics e.g. ondansetron
  • Alpha blocker e.g. tamsulosin
37
Q

What is the action of alpha blockers and treatments for what?

A

Vasodilation - used as add on treatment to hypertension

Relax prostate and bladder to allow urine to flow - used for BPH (1st line)

38
Q

Which site is more common for prostate carcinoma to occur transitional or peripheral zone? Which region is hyperplasia more likely to occur in BPH?

A

Transitional zone makes up most of prostate, more prostate carcinomas are located

39
Q

Role of prostate?

A

Secretes prostatic fluid, component of seminal fluid

40
Q

Symptoms and signs presented in BPH?

A

Storage symptoms - blader should be storing urine (frequency, urgency, nocturia and incontinence)

Voiding - bladder outlet obstruction do difficult to urinate (weak stream, dribbling, incontinence, straining)

41
Q

Mx for BPH?

A

Alpha blockers - tamsulosin

5-alpha-reductase inhibitors (shrinks prostate gland) - Finasteride

Transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate

42
Q

Differentiate between Prostate cancer, prostatitis and BPH (DRE)?

A

Enlarged prostate on DRE - prostatitis

Asymmetry on DRE - prostate cancer

Smooth symmetrical enlarged prostate - BPH

43
Q

What is nephrotic syndrome?

A

Condition characterised by proteinuria, oedema and hypoalbuminaemia

44
Q

What is Px of nephrotic syndrome?

A

Nephrotic syndrome occurs when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.

45
Q

Most common type of nephrotic syndrome?

A

Minimal change disease is seen mostly in children

46
Q

What are these symptoms associated with: proteinuria, hypoalbuminaemia, deranged lipid profile, hypertension and hyper-coagulability and oedema?

A

Nephrotic syndrome

47
Q

Classification of nephrotic syndrome?

A

Primary - problem in kidneys e.g. glomerulonephritis

Secondary - problem other than kidney e.g. HIV, malignancy

48
Q

Mx of nephrotic syndrome?

A

Fluid and salt restriction
Diuretic e.g. furosemide
Treat complications e.g. statin for lipid control

49
Q

What is hydrocele?

A

Hydrocele is painless accumulation of fluid in sac around testes

50
Q

What is varicocele?

A

Enlargement of testes from abnormal dilation of spermatic veins

51
Q

What is negative cremasteric reflex?

A

Stroking of inner thigh does not cause upward movement of testicles (testicular torsion)

52
Q

What is found on examination of varicocele?

A

Feeling of bag of warms, negative transillumination

53
Q

What is found on examination of hydrocele?

A

Transillumination with light

54
Q

What is Phregn’s test?

A

Alleviation of testes relieves pain in epididymitis

Alleviation of testes does not relieve pain testicular torsion

55
Q

What is testicular torsion and who is commonly affected?

A

Twisting of testicles around spermatic cord and affects teenagers.

56
Q

Mx of testicular torsion

A

Surgical exploration to correct twisting

57
Q

What condition is associated with flank pain, that radiates from loin to groin?

A

Renal calculi

58
Q

Which class of medications should be suspended from someone with AKI?

A

ACE inhibitors

59
Q

What causes decreased creatinine kinase?

A

Alcoholic liver disease are considered to reflect the reduced muscle mass

60
Q

What are the 3 types of incontinence?

A

Overflow incontinence (unable to fully empty bladder, causing you to leak) - associated with men with BPH

Urge incontinence (urine leaks as you feel sudden urge to pee)- associated with DM, infection, obesity, detrusor overactivity, caffeine

Stress incontinence (loss of urine associated with rise in intrabdominal pressure) - coughing, sneezing, pregnancy, childbirth

61
Q

What can painless haematuria indicate?

A

Bladder cancer

62
Q

What is the most common type of bladder cancer in the UK?

A

Transitional cell carcinoma can be caused by smoking

63
Q

Triad of oedema, hypoalbuminaemia and proteinuria, what condition is this associated with?

A

Minimal change disease in children (form of nephrotic syndrome).

  • Oedema can cause puffy face
  • proteinuria on urinalysis
  • Fluid protein decreased
64
Q

Differences between nephrotic syndrome vs glomerulonephritis?

A

Nephrotic syndrome

  • proteinuria, hypalbuminaemia, hypovolaemia
  • causes are glomerular damage, idiopathic
  • s/s weight gain, puffy face, fatigue, oedema,

glomerulonephritis

  • proteinuria, haematuria
  • causes strep infection/primary cause
  • s/s dark urine, edema
65
Q

What is priapism and the management for it?

A

Prolonged and painful erection lasting greater than 2 hours after sex. Manage by aspiration of the blood within corpus cavernosa and irrigation with normal saline.

66
Q

What is a cause of priapism?

A

Sildenafil (viagra)

67
Q

What is the Mx for stress incontinence?

A
  • 1st line General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks
  • 1st line Pelvic floor exercises
  • 2nd line Medication Duloxetine
68
Q

What is the Mx for urge incontinence?

A
  • 1st line General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks
  • 1st line Pelvic floor exercises
  • 2nd line anticholinergic medication Oxybutynin

urology and nephrology (1 decks)

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