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Urology/Renal Flashcards

1
Q

Prostate cancer associated with which genes?

A

BRCA1 and BRCA2

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2
Q

Investigations for prostate cancer?

A

PSA
Multi-parametric MRI - 1st line
Prostate biopsy

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3
Q

Uncomplicated UTI in non-pregnant woman management?

A

Nitrofurantoin (3days)
or
Trimethoprim (3days)

send MSU IF >65Y or haematuria

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4
Q

UTI in pregnant woman management?

A

Nitrofurantoin (7days)

if close to term then amoxicillin or cefalexin

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5
Q

UTI in male management?

A

Nitrofurantoin (7days)

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6
Q

Triad of symptoms of pyelonephritis?

A

Fever
loin pain
Nausea and vomiting

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7
Q

Pyelonephritis manegement?

A

Cefalexin (10-14days)

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8
Q

Renal stones investigations?

A

GOLD STANDARD - non-contrast CTKUB

urinalysis - blood +ve
bloods - FBC, U&U, urate, bone profile
x-ray KUB

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9
Q

Renal stones <5mm manegement?

A

conservative

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10
Q

Renal stones 5-10mm, uncomplicated, manegement?

A

medical expulsion therapy e.g. tamsulosin

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11
Q

Renal stones 5-10mm (persistant obstruction) manegement?

A

shock wave lithotripsy
or
ureteroscopy

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12
Q

Renal stones 10-20mm manegement?

A

percutaneous nephrolithotomy

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13
Q

Difference between high and low pressure chronic retention?

A

high - hydronephrosis and abnormal renal function
low - normal kidneys and function

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14
Q

BPH affects which cells?

A

glandular epithelial cells and stromal cells

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15
Q

BPH management?

A
  1. alpha-1 antagonists (e.g. tamsulosin)
  2. 5-alpha-reductaste inhibitors (e.g. finasteride)
  3. combination therapy
  4. surgery - transurethral resection of the prostate
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16
Q

How long does medical management of BPH take to work?

A

6 months

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17
Q

Painless scrotal swelling, soft, fluctuant, transilluminates - what is it?

A

hydrocele

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18
Q

Hydrocele investigation?

A

USS to exclude underlying tumour

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19
Q

Cause of varicocele?

A

veins in pampiniform plexus become swollen - increased resistance in testicular vein

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20
Q

scrotal swelling, painful (throbbing/dull, worse on standing), feels like “a bag of worms”, disappears when lying down - what is it?

A

varicocele

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21
Q

Unilateral, red, swollen testicle + cremasteric reflex preserved + pain relief when testicle lifted (Phren’s sign) - what is it?

A

Epididymo - orchitis

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22
Q

Epididymo - orchitis - risk factors?

A
  • STI related
  • elderly (E.coli from bladder)
  • chronic bladder retention
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23
Q

Inguinal hernia passes through what?

A

into scrotum via external inguinal ring - can be indirect (internal ring) or direct (hasselbach’s triangle)

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24
Q

acute onset unilateral testicular pain, vomiting + abdo pain + firm + swollen testicle + absent cremasteric reflex - what is it?

A

testicular torsion

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25
Q

renal artery stenosis investigation?

A

MRI with gadolinium contrast
or
CT angiography

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26
Q

investigation for epidiymo-orchitis ?

A

depends on age:
- elderly +low sexual health risk = mid-stream urine for culture
- STD risk - NAAT

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27
Q

enteric organism epidiymo-orchitis management?

A
  • MSU culture
  • oral quinolone for 2 weeks e.g. ofloxacin
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28
Q

Nephrotic syndrome triad?

A

proteinuria + hypoalbuminaemia + oedema

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29
Q

polycystic kidney disease investigation?

A

USS

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30
Q

hydronephrosis investigations?

A

USS
Intravenous urogram (IVU)
CT - if suspect renal colic

31
Q

What features makes a UTI ‘complicated’?

32
Q

Types of bladder cancer?

A

Transitional cell carcinoma (90%)
squamous cell carcinoma (10%)

33
Q

Visible haematuria is ____ until proven otherwise?

A

bladder cancer

34
Q

Common metastatic sites of bladder cancer?

A

Lungs
Liver
Bone

35
Q

Investigations for bladder cancer?

A

CT urogram
flexible cystoscopy

36
Q

Treatment for non-muscle invasive bladder cancer?

A

Transurethral resection of the bladder tumour (TURBT) +/- chemotherapy +/- immunotherapy

37
Q

Treatment for muscle invasive bladder cancer?

A

cystectomy
or
chemotherapy +/- radiotherapy

38
Q

NICE 2 week referral for bladder cancer suspicion criteria?

A

> /= 45y + painless visible haematuria

39
Q

AKI staging?

A

Stage 1 - 1-1.9x baseline creatinine
stage 2 - 2-2.9x baseline creatinine
stage 3 - >3x baseline creatinine

40
Q

Pre-renal causes of AKI?

A

REDUCED BLOOD FLOW TO KIDNEYS

  • Fluid loss (blood, sweat, vomit, diarrhoea, reduced intake)
  • Sepsis - peripheral vasodilation
41
Q

Management of pre-renal AKI?

A
  • Fluid resus
  • stop hypertensives or any nephrotoxic drugs
  • Control loss of fluids (e.g. anti-emetics)
  • monitor urine output
  • if BP not improving after all that then HDU +/- vasopressors
42
Q

Indications for acute haemodyalasis?

A
  • Hyperkalaemia (>6)
  • Uraemic pericarditis
  • Acidaemia
  • Pulmonary oedema
43
Q

Causes of post-renal AKI?

A

Obstruction anywhere past the kidneys i.e. ureter, bladder or urethra

Prostate enlargement
Stones
External pressures e.g. tumours
(less likely but gynae malignancy)

44
Q

Investigation for AKI?

A

USS for all AKI’s
U&E’s
creatinine

45
Q

Renal causes of AKI?

A

Glomerulnephritis
vasculitis
acute intestinal nephritis

46
Q

What is nephritic syndrome?

A
  • acute decline in kidney function (AKI)
  • oliguria
  • oedema caused by fluid retention
  • hypertension
  • ‘active’ urinary sediment = +ve urinalysis - most commonly blood ++
47
Q

What is nephrotic syndrome?

A
  • proteinuria - 3g/day
  • hypoalbuminaemia (<30)
  • oedema
  • hypercholesteraemia
  • usually normal renal function
48
Q

Asymptomatic bacteria in catheterised patient management?

A

No treatment

49
Q

Management of testicular torsion?

A

Urgent bilateral orchidopexy - both to prevent other testes from torsion

50
Q

Which criteria have to be met to diagnose AKI?

A
  • rise in serum creatinine of >/=26 micromol/litre within 48 hours
  • > /=50% rise in serum creatinine known or presumed to have occurred within the past 7 days
  • a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
51
Q

Which medications should be stopped in AKI?

A

NSAIDs and ACE inhibitors (as they reduce the filtration pressure)

52
Q

Symptoms / signs of chronic kidney disease?

A
  • itching
  • loss of appetite
  • nausea
  • oedema
  • muscle cramps
  • peripheral neuropathy
  • pallor
  • hypertension
53
Q

Investigations for chronic kidney disease?

A
  • eGFR (2 tests 3 months apart to confirm)
  • urine albumin:creatinine ratio (>/= 3mg/mmol)
  • haematuria
  • renal ultrasound
54
Q

When would you refer to a specialist for chronic kidney disease?

A
  • eGFR < 30
  • ACR ≥ 70 mg/mmol
  • Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year
  • Uncontrolled hypertension despite ≥ 4 antihypertensives
55
Q

First line antihypertensive for CKD?

A

ACE inhibitors

56
Q

Why do some patients get anaemic with CKD?

A

damaged kidney cells in CKS cause a drop in erythopoietin (hormone responsible for stimulating the production of red blood cells) which results in drop in red blood cells and subsequent anaemia.

57
Q

What are the stages of CKD?

A

stage 1 - eGFR >90ml/min (signs of kidney damage on other tests)
stage 2 - 60-90 eGFR
stage 3 - 45-59 ml/min eGFR
stage 3b - 30-44ml/min eGFR
stage 4 - 15-29ml/min eGFR
stage 5 - <15ml/min eGFR

58
Q

Features of nephritis syndrome?

A
  • haematuria
  • oliguria
  • proteinuria
  • fluid retention
59
Q

Features of nephrotic syndrome?

A
  • peripheral oedema
  • proteinuria (frothy urine)
  • serum albumin <25g/L
  • hypercholesterolaemia
60
Q

Most common cause of nephrotic syndrome in kids?

A

Minimal change disease

61
Q

Most common cause of nephrotic syndrome in adults?

A

focal segmental glomerulosclerosis.

62
Q

Nephrotic syndrome + histology showing “IgA deposits and glomerular mesangial proliferation”?

A

IgA nephropathy

63
Q

Clinical features of IgA nephropathy?

A
  • recurrant episodes of macroscopic haematuria
  • follows URTI
64
Q

Triad of findings for HUS?

A

AKI
thrombocytopenia
normocytic anaemia

65
Q

UTI in woman >65y management?

A

3 days nitrofurantuin + MSU

66
Q

Diagnostic investigation in nephrotic syndrome?

A

Renal biopsy

67
Q

Most common type of renal stone?

A

calcium oxalate

68
Q

‘ground glass’ renal stone?

A

cystine stone

69
Q

Why can AKI cause hyperkalaemia?

A

when kidney function starts falling - they are unable to excrete K+ - this can lead to build up in the blood and leads to hyperkalaemia.

70
Q

RCC - tumour <7cm + confined to kidney management?

A

partial nephrectomy

71
Q

RCC- tumour >7cm + not confined to kidney (e.g. invading renal capsule) - management?

A

total nephrectomy

72
Q

upper renal obstruction causing hydronephrosis - management?

A

nephrostomy

73
Q

complications of nephrotic syndrome?

A
  • increased risk of thromboembolism e.g. DVT, PE, renal vein thrombosis
  • hyperlipidaemia
  • increasing risk of acute coronary syndrome, stroke etc
  • chronic kidney disease
  • increased risk of infection
74
Q

Management of anaemia due to CKD?

A
  1. check iron stores + correct deficiency (aim for 110-120 levels) - if oral doesn’t work in 3 months then IV iron.
  2. Then if patient will benefit - Erythropoietin (EPO) administration

Finals (18 decks)

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