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FINALS > Urology and Renal Medicine > Flashcards

Urology and Renal Medicine Flashcards

1
Q

List the functions of the renal system

A 
Excretion
Acid-base balance
Bone metabolism - activates Vit D
RBC production - erythropoeitin
Regulate BP
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2
Q

How many renal disease present on investigations?

A

Urinalysis - haematuria, proteinuria

U&Es - increase creatinine & urea, hyperkalaemia, reduced eGFR

LFTs - hypoalbuminaemia (also is -ve inflam marker!)

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3
Q

The “Act conditions” are UTI, acute cysitis, acute pyelo, prostatic acute urinary retention, severe hyperkalaemia.

Which one puts you at risk of arrythmias?

A

Hyperkalaemia

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4
Q

Hyperkalaemia is defined as K+ levels > ______?

  1. Management for K+ 5-5.9?
  2. What level requires ECG to look for changes?
  3. At what level do you just treat?
A

Hyperkalaemia = K+ >5

  1. Monitor, look at drug chart, check fluids
  2. 6-6.5
  3. > 6.5
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5
Q

State the treatment for hyperkalaemia.

A

10mls Calcium gluconate over 10 mins
10U Actrarapid + 50mls 50% Dextrose
+/- Salbutamol neb 5mg

If doesnt work –> Calcium resonium

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6
Q

The ECG changes of hyperkalaemia arebased on stringe thoery. As the T-waves move up it flatterns other waves.

What are the ECG changes?

A
  1. Tall-tented T waves
  2. Widened QRS
  3. Flattened P waves
  4. Often tachycardic +/- arrythmia

–> Sinusoidal

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7
Q

A 56 y/o man has BPH and recurrent UTIs.

The current UTI has give him a high urea and creatinine on U&Es.

How would you manage his condition?

What tests do you do to prevent complications?

A 
STOP AKI
Screen for sepsis
Stop nephrotoxic drugs
Fluids
Urinalysis

VBG - K+, metabolic acidosis
+/- CXR - pulmonary oedema

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8
Q

Symptoms of hyperkalaemia?

A

Arrthymias - palpitations, chest pain, light-headed, SOB

Cardiac arrest - Collapse, unresponsive

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9
Q

A patient with CKD gets an AKI from vomitting after an episode of infective GE.

They become acutely SOB, in resp distress and have diffuse bilateral crackles.

How would you manage this complication?

A

Acute pulmonary oedema - ABCDE + PODMAN

  1. Position upright
  2. Oxygen
  3. Diuretic - IV Furosemide 40-80mg
  4. Morphine - IV Diamorphine 2.5mg
  5. Anti-emetic
  6. Nitrate - GTN spray
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10
Q

Causes of pulmonary oedema include….

A
  1. PUMP FAILURE
  2. TOO MUCH FLUID

Acute renal failure - AKI
Heart failure
Fluid overload - IV fluids, blood transfusion

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11
Q

A 25 y/o female presents to GP with dysuria. haematuria, frequency and urgency.

The most common organism resonsible is ________

Risk factors are: ______

A

E.Coli (80%)
Other: Staph Saprophyticus, Proetus mirabilis

Female, sexually active, obstruction: preg, fibroids, constipation, BPH, PC, stones. Structural ab: VUR. Catheters. Fistula

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12
Q

What results on urinalysis suggest UTI?

Once confirmed you send a urine MCS to lab

A

+ve leu +ve nitrites

-ve leu +ve nitrites

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13
Q

In what cases do you refer a UTI to Urology?

A

Paeds - recurrent, atypical, <1yr..
Male
Unresponsive to rx
Persistent haematuria

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14
Q

What other infection can cause LUTS?

A

STI!

Always ask sexual hx

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15
Q

Which abx is contraindicated in pregnancy for UTI?

A

Trimethoprim

  • esp 1st trimester as folate anatgonist in bacterial cell
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16
Q

Complications of UTI are:

A

Ascend –> Pyelonephritis –> Sepsis
AKI
Hydronephritis

If preg –> still birth, developmental delay

17
Q

Acute pyelonephritis is an acute kidney infection by organisms from ___________ or _________-

A

Blood

Bladder

Esp 15-29yr Females >Infant boys > Elderly

18
Q

The risk factors for pyelo are the same as for UTI

True or False

A

True

19
Q

Symptoms of pyelonephritis?

A

Loin/back/suprapubic pain

LUTS - dysuria haematuria, urgency, freq, smelly urine

Sysetmic: Fever/rigors/night sweats. N/V

20
Q

You suspect pyelonephirits in 21 y/o female.

You order bloods: standard + blood cultures. You do urinalysis + urine MCS and organise a renal USS

What is the management?

A

Conservative: analgesia, anti-emetics, IV fluids

Medical: IV Abx for 10-14days

21
Q

Acute urinary retention is a common cause of abdo pain.

What is the surgical sieve for the causes?

A

I - AKI
T - spinal or bladder trauma
M - constipation, diabetic neuropathy, alcohol
I - Post-op*, meds: anti-cholinrergics
N - tumour. Other obstructions: BPH, stricture, preg, fibroids

22
Q

Examinations you do for anyone with urinary retention?

A

Abdo + PR

Neuro

23
Q

Symptoms of acute urinary retention?

A

Anuria/Oliguria - incl dribbling, urgency

Spurapubic tenderness/ fullness

Delirium

24
Q

A 69 y/o has BPH and has not urinated for the past 12hrs.

What tests do you order?

A

Bedside: bladder scan, Urinalysis

Labs: FBC, U&Es, PSA, +/- MCS

Imaging: Renal-USS +/- whole-spine MRI

25
Q

Renal USS can detect….

A

Stones
Hydronephrosis
Structural ab
Inflammatory fluid- pyelonephritis

26
Q

You insert a catheter into the man with acute urinary retention and conintue to monitor U&Es. Neurology was excluded. You investigate the underlying cause with the Urologist.

At what rate would you expect urine output to be?

A

100 mls/hr

27
Q

The 3 types of catheters are __________

A

Foley - standard

3-way - bladder irrigation for clots

Caude-tip - for large prostates

28
Q

What is the management of:

  1. BPH
  2. Prostate Cancer
A
  1. Avoid alcohol, caffeine. Finasteride or Tamulosin +/ TURP etc
  2. Fast-track:
    low risk - surveillance
    moderate- surveillance +/- hormone therapy
    high - hormone + Brachytherapy, radical RT, HIFU, radical prostatectomy

FINALS (4 decks)

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