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FCM Y1 SGUL > GU/Renal > Flashcards

GU/Renal Flashcards

1
Q 
weak intermittent flow 
hesitancy 
terminal dribbling 
urgency/frequency
nocturia
UTI 
obstruction/retention

typically in older men 50-80yrs, more common in Black and Asian People

A

Benign Prostate Hyperplasia

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2
Q

Management of BPH

A

sometimes watchful waiting
first line = alpha blockers = tamsulosin
5a-reductase inhibitors = finasteride

surgery = TURP

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3
Q

involuntary leakage of urine or sudden urge to pass urine

A

urge incontinence

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4
Q

involuntary leakage on exertion, coughing or sneezing

A

stress incontinence

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5
Q

involuntary leakage on exertion and sudden urge to pass urine

A

mixed incontinence

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6
Q

management of urge incontinence

A

first line = oxybutynin, (alt = tolterodine & darifenacin)
mirabegron in elderly patients

bladder retraining for 6 weeks

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7
Q

management of stress incontinence

A

duloxetine
pelvic floor muscle training
surgery

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8
Q

management of undescended testes

A

orchidopexy at 6-18months

= inguinal exploration and mobilise testes

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9
Q

retractile testes

A

usually appear in warm conditions

surgery usually indicated

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10
Q

soft, non tender swelling
swelling confined to the scrotum
transillumination
difficult to palpate if large

A

hydrocele

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11
Q

management of hydrocele

A

infantile hydrocele are generally repaired if they do not spontaneously resolve by 1-2yrs

adults - take conservative approach - reassurance and scrotal support
usually do an ultrasound to exclude an underlying tumour

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12
Q

painless scrotal swelling - usually left
‘bag of worms’
subfertility

A

varicolcele

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13
Q

Ix for varicocele

A

US and doppler studies

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14
Q

management of varicocele

A

usually conservative
supportive underwear and analgesia for any discomfort
semen analysis if concerned with subfertility

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15
Q

abrupt onset of abdominal pain - mainly in flank/loin
nausea and vomiting
haematuria
some haematuria, dysuria, and straining

A

nephro/urothialisis = renal stones

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16
Q

black/dark brown stones
radiopaque
acidic urine

A

calcium oxalate stones

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17
Q

dirty white

radiopaque on X-ray

A

calcium phosphate

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18
Q

Ix for renal stones

A

urine dip = exclude infection
non-contrast CT KUB
US if pregnant

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19
Q

management of renal stones

A

NSAID for pain relief - IM diclofenac

conservative = in young/less symptomatic pts with stone <5mm = watchful waiting
if severe = lithotripsy or nephrolithotomy

medical = alpha blocker to facilitate spontaneous passage

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20
Q

ureteric obstruction management

A

urgent decompression surgery

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21
Q

complex renal calculi and staghorn calculi

A

percutaneous nephrolithotomy

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22
Q

persistent erection lasting over 4 hrs
pain localised to penis
history of trauma to genital/perianal region

A

priapism

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23
Q

Ix in priapism

A

cavernosal blood gas analysis

Doppler or duplex ultrasonography

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24
Q

management of priapism

A

if longer than 4hrs = aspiration/shunt blood from the cavernosa and saline flush
if aspiration fails = phenylephrine
surgical options considered

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25
Q

non-retractable forekine behind glans penis

forms ring

A

paraphimosis

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26
Q

management of paraphimosis

A

manual manipulation

emergency surgical reduction

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27
Q 
pain is usually severe and sudden onset 
nausea and vomiting may be present 
swollen testes, retracted upwards
cremasteric reflex is lost 
Prehn's sign is absent
A

testicular torsion

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28
Q

management of testicular torison

A

urgent surgical exploration

both testes should be fixed prophylactically

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29
Q

usually gradual onset
unilateral testicular pain and swelling
prehn’s sign positive
potential discharge

A

epididymo-orchitis

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30
Q

management of epididymo-orchitis

A

If STI related
ceftriaxone 500mg IM
doxycycline 100mg BD 10-14/7

If enteric organism
ofloxacin 200mg BC 14 days
OR levofloxacin 500mg OD 10days

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31
Q

painless lump in scrotum
possibly with a hydrocele
gynaecomastia
AFP and LDH elevated

commonly in men aged 20-30

A

testicular cancer/tumour

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32
Q

Ix of testicular cancer

A

US

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33
Q

management of testicular cancer

A

orchidectomy +/- chemo-radiotherapy

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34
Q

penile soreness and itch
bleeding from the foreskin with possible odour
dysuria/dyspareunia

A

Balanitis

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35
Q

management of candidal balanitis

A

topical clotrimazole for 2 weeks

36
Q

management of bacterial balanitis

A

oral flucloxacillin

OR alternative is clarithromycin
if anaerobic organism = metronidazole

37
Q

management of dermatitis balanitis

A

topical corticosteroids

38
Q

management of lichen sclerosis balanitis

A

topical steroids = clobetasol

and potential circumcision

39
Q

pain in perineum, penis, rectum or back
obstructive voiding symptoms
fevers and rigors
PR exam reveals a tender, boggy prostate

A

prostatitis

40
Q

management of prostatitis

A

quinolone = ciprofloxacin for 14 days

41
Q

can be asymptomatic

typically present with dysuria +/- urethral discharge

A

urethritis

42
Q

Ix for urethritis

A

urethral swab - NAAT studies

43
Q

management of urethritis

A

oral doxycycline 7 days
OR
oral azithromycin single dose

44
Q 
dysuria 
frequency +/- urgency 
cloudy/offensive smelling urine 
lower abdo pain
low grade fever 
malaise
A

UTI/cystitis

45
Q

management of UTI

A

nitrofurantoin 3 days (trimethoprim alternative)

nitrofurantoin first line in pregnancy but alternatives
include amoxicillin and cefalexin (AVOID TRIMETHOPRIM)

46
Q

loin/flank pain
nausea and vomiting
fevers
white casts in urine

can also present with myalgia, flu-like symptoms
recent LUTI

A

pyelonephritis

47
Q

management of acute pyelonephritis

A

cefalexin 500mg for 7-10days BD/TDS

other options include co-amoxiclav, trimethoprim and ciprofloxacin

48
Q 
flank/loin pain 
haematuria 
hypertension 
palpable/ballotable kidneys bilaterally 
UTI/pyelonephritis
A

Polycystic kidney disease = PKD

49
Q

Ix for PKD

A

abdo ultrasound

50
Q

management of PKD

A

vasopressin 2 antagonist = tolvaptan

51
Q

PKD associated risks

A

liver cysts

berry aneurysms in brain = SAH risk if ruptured

52
Q

asymptomatic
painless haematuria/proteinuria (frothy urine)
can present with oedema

A

glomerulonephritis

53
Q

Ix for glomerulonephritis

A

renal biopsy = spike and dome appearance

54
Q

management of glomerulonephritis

A

all patients = ACEi/ARB

severe progressive disease = immunosuppression with cyclophosphamide

55
Q

proteinuria (<3g/24hr)
hypoalbuminemia (<30g/L)
oedema

Peripheral oedema (more common in adults)
Facial oedema (more common in children)
Frothiness of urine
Fatigue
Poor appetite
Recurrent infections
A

nephrotic syndrome

56
Q 
haematuria 
hypertension 
red cell clasts 
moderate proteinuria
?oliguria
A

nephritic syndrome

57
Q 
mainly asymptomatic in early stages 
lowered urine output (0.5kg/hr/mol)
peripheral or pulmonary oedema 
arrhythmias
uraemia - pericarditis/encephalopathy

rise in creatinine - 26micromol/L

A

AKI

58
Q

Management of AKI

A

largely supportive - careful fluid balance

stop meds = diuretics, ACEi/ARB, metformin or NSAIDs

renal replacement therapy if no response to treatment

hyperkalemia (and subsequent arrhythmias) = IV calcium gluconate

59
Q

pre-renal causes of AKI

A

renal artery stenosis

hypovolemia (due to D&V)

60
Q

intrinsic/renal causes of AKI

A 
glomerulonephritis 
acute tubular necrosis 
acute interstitial necrosis 
rhabdomyolysis 
tumour lysis syndrome
61
Q

post-renal causes of AKI

A 
kidney stones (ureter/bladder)
BPH
external compression of ureter
62
Q

Immunoglobulin A nephropathy GN diagnosis and management

A

haematuria, proteinuria, oedema

Biopsy

BP control with ACEi/ARB

63
Q

minimal change disease diagnosis and management

A

nephrotic syndrome
Dx = Light microscopy
mx = prednisolone

64
Q

focal and segmental GN diagnosis and management

A

development of scar tissue

Dx= biopsy 
mx = BP control = ACEi/ARB (corticosteroid if idiopathic)
65
Q

membranous nephropathy diagnosis and management

A

manifests as nephrotic

Dx = anti-phospholipase A2 receptor antibody 
mx = ACEi/ARB
66
Q

painless macroscopic haematuria

+B symptoms

A

bladder cancer

67
Q

management of bladder cancer

A

superficial lesions managed using TURBT

higher grade/risk = intravesicular chemotherapy

68
Q

dx of bladder cancer

A

cytology and biopsies or TUBRT

69
Q

most common type of bladder cancer

A

transitional

Squamous cell carcinoma is linked to schistosomiasis

70
Q

inability to pass urine
lower abdo discomfort
considerable pain/discomfort
acute confusion/altered mental state - esp in elderly

A

acute urinary retention

71
Q

management of urinary retention

A

confirm diagnosis with US - <300cc

decompressing bladder using catheterisation

72
Q

painless and insidious inability to pass urine

A

chronic urinary retention

73
Q

management of chronic urinary retention

A

patient with chronic urinary retention can be taught to self-catheterise

finasteride can take upto 6 months to come into effect

74
Q 
haematuria, loin pain and abdo mass 
pyrexia 
left varicocele 
polycythaemia 
hypercalcaemia

middle aged men, smoker, PKD

A

renal cell carcinoma

75
Q

management of Renal cell carcinoma

A

confined disease = partial or total nephrectomy
a-interferon/interleukin 2 = reduce tumour size
tyrosine kinase inhibitors = sorafenib and sunitinib

76
Q

often asymptomatic
hesitancy, urinary retention
haematuria
back pain

DRE = hard asymmetric, nodular enlargement and median sulcus loss

A

prostatic cancer/carcinoma

77
Q

management of prostatic cancer

A

localised (T1/2) = active monitoring, radical prostatectomy and radiotherapy

localised-advanced (T3/4) = radical prostatectomy, radiotherapy + hormonal therapy GnRH agonist - gosrelin

metastatic disease = hormonal therapy + GnRH agonist

78
Q

what scores is used to asses prostate cancer

A

GLEASON SCORE - grading the cancer (high score = higher grade cancer

Likert scale = 3+ - have MRI and if 1-2 discuss pros/cons of biospy

79
Q

typically in children

abdominal mass
painless haematuria
flank pain
anorexia and fevers

A

Wilm’s tumour

80
Q

management for wilms tumour

A

usually arrange a paediatric review in 48hrs

mx = nephrectomy and chemo
if advances = radiotherapy

81
Q

young male
recurrent macroscopic haematuria
develops 1-2days after URTI

A

IgA nephropathy / Berger’s disease

82
Q

non urgent referral for haematuria

A

above 60yrs with recurrent or persistent UTI

83
Q

Urgent referral for hematuria

A

aged 45+ unexplained visible hematuria and no UTI

aged 60+ unexplained microscopic haematuria + dysuria and increased WCC

84
Q

raised serum creatinine or serum eGFR of less than 60mL/min
proteinuria (ACR above 3mg)
persistent hematuria after exclusion of UTI
urine sediment abnormalities = RBCs/WBCs, granular casts and renal tubular epithelial cells

A

chronic kidney disease

85
Q

indications for renal-replacement therapy/

A 
acidosis 
electrolyte disturbance 
intoxication 
overload (fluid)
urinary complication
86
Q

usually iatrogenic - common in gynae surgery

delayed diagnosis may lead to loin pain, fever and urinary leak

A

ureteric trauma

contrast CT?

87
Q

management of ureteric trauma

A

prophylactic stenting

FCM Y1 SGUL (15 decks)

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