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phase 2a > GU conditions > Flashcards

GU conditions Flashcards

1
Q

where do kidney stones (nephroliathiasis) form and what are 90% of them made of

A

stones form in renal pelvis + travel down to ureters
90%= calcium oxalate stones (radio-opaque)

other types=
calcium phosphate
uric acid (radiolucent therefore not seen on x-ray)
struvite (made by bacteria)
cystine

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2
Q

list 8 risk factors for kidney stones

A

male
chronic dehydration
obesity
high protein/salt diet
recurrent UTIs
low urine output
hyperparathyroidism/hypercalcaemia
Hx of previous stone

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3
Q

pathology of kidney stones

A

excess solute in dehydration= supersaturated urine> favours crystallisation
-stones cause regular outflow obstruction= hydronephrosis
-dilation + obstruction of renal pelvis= damage

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4
Q

presentations of kidney stones

A

pain originating @ loin, radiating 2 groin that is colicky, peristaltic waves
patient can’t lie still
haematuria
n+v
decreased urine output

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5
Q

1st line investigations for kidney stones (4)

A

urine dipstick- haematuria, leukocytes, nitrates
FBC- CRP (infection)
U&Es- hypercalcaemia
abdo x-ray- Ca stones (no uric acid stones as radiolucent)

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6
Q

gold standard investigation for kidney stones

A

non-contrast CT KUB (kidney, ureter, bladder)- presence of stones

non-contrast bc contrast needs to be excreted by kidneys and therefore is harmfulf is there is a renal obstruction

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7
Q

symptomatic management of kidney stones

A

symptomatic relief= hydration, NSAIDS (diclofenac), antiemtics, Abxs if UTI eg gentomycin
watchful waiting- stones <5mm norm pass spontaneously

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8
Q

elective treatment of kidney stones

A

elective treatment if stones= too big
-extracorpeal shock wave therapy (ESWL- break stones into smaller fragments using shock waves)- smaller stones <20mm

-percutaneous nephrolithotomy (PCNL- use nethoscope to remove stone) larger than 20mm+

-ureteroscopy & laser lithotripsy

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9
Q

lifestyle modifications for managing kidney stones

A

decrease sodium & protein intake
increase citrus fruit
adequate fluid intake

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10
Q

define an acute kidney injury (AKI)

A

AKI= sudden decline in kidney function determined by increased serum creatinine and decreased urine output

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11
Q

what is the KDIGO classification for AKI

A

rise in creatinine of >26 micromol/L within 48 hrs
OR
rise in creatinine of >50% from baseline within 7 days
OR
urine output of <0.5 ml/Kg/hr for >6hrs

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12
Q

what is pre renal AKI and what causes it

A

prerenal= inadequate blood supply to the kidneys
causes:
dehydration
hypotension (shock)
heart failure
renal artery blockage
drugs (NSAIDS + ACEi)

decreased blood vol> decreased perfusion> decreased GFR + creatinine clearance

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13
Q

what is intra renal AKI and what are its causes

A

intrinsic disease/damage to the kidney causing reduced filtration
causes:
acute tubular necrosis
glomerulonephritis
interstitial nephritis
toxins (sepsis)

kidney damage> decreased oncotic + hydrostatic pressure = decreased GFR

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14
Q

what is post renal kidney disease and what are its causes

A

obstruction to outflow of urine= back pressure + decreased function (obstructive uropathy)
causes:
kidney stones
cancerous masses
ureter/urethra strictures
enlarged prostate/prostate cancer
drugs (anticholinergic, CCBs)

obstruction>back pressure 2 kidney> decrease in hydrostatic pressure> decrease in GFR

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15
Q

a decrease in GFR leads to a build of which normally excreted products (5)

A

creatinine
K+ (arrhythmias)
urea (confusion, uraemia)
fluid (oedema)
H+ (acidosis)

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16
Q

list 5 risk factors for an AKI

A

increasing age
co-morbidities (HTN, T2DM, chronic heart failure)
hypovolemia
nephrotoxic drugs (ACEi. NSAIDS)
cirrhosis/already have kidney problems

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17
Q

presentation of an AKI

A

due 2 substance accumulation:

increase in creatinine, decreased urine output
hyperkalaemia (arrhythmias, musc weakness)
uraemia (pericarditis, n+v. encelopathy)
fluid overload (pulmonary + peripheral oedema, hypovolemic shock, orthopnoea)
HTN
sepsis/acute illness

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18
Q

list signs of an AKI for pre, intra and post renal

A

pre= hypotension, syncope, d+v
intra= infection, signs of underlying disease
post= LUTS + low urine output

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19
Q

list symptoms of an AKI

A

n + v
fever + dizziness
altered mental state

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20
Q

investigations for an AKI

A

establish cause (pre/intra/post) + diagnose using KDIGO classification

use urea:creatinine ratio
pre= >100:1
intra= >40:1
post= 40-100:1

metabolic panel and urine output monitoring
-check K+, H+, urea, creatinine w U&Es

urinalysis: leukocytes + nitrites= infection

renal biopsy> to confirm intrarenal cause
USS for post renal

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21
Q

1st line management of an AKI

A

1st=
treat underlying causes
stop nephrotoxic drugs (ACEi + NSAIDS)
treat comps:
-hyperkalemia= Ca gluconate
-metabolic acidosis= Na bicarb
-fluid overload= diuretics

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22
Q

management of severe AKI

A

severe=
renal replacement therapy
-haemodialysis
indicated in AFUK
Acidosis
Fluid overload
Uremia
K+ >6.5/ECG changes

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23
Q

define chronic kidney disease (CKD)

A

chronic reduction in kidney function which is permanent + progressive >3months

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24
Q

what are the diagnostic criteria for CKD

A

eGFR <60 ml/min/1.73m2 for 3+ months (norm= 120)
OR
eGFR <90ml/min/1.73m2 + signs of renal damage
OR
albuminuria (albumin in urine)>30mg/24hrs

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25
Q

list 4 risk factors for CKD

A

DM + HTN (mc)
male
increasing age
smoking

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26
Q

describe the pathology of CKD

A

many nephrons damaged= a decrease in GFR- this increases the burden on the remaining nephrons
- compensatory RAAS to increase GFR
BUT:
increase in transglomerular pressure= shearing + loss of basement membrane permeability- causes proteinuria/haematuria

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27
Q

list 5 signs of CKD

A

asymptomatic until end stage
Sxs due to substance accumulation + renal damage

haematuria
proteinuria
peripheral neuropathy
HTN
oedema

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28
Q

list 6 symptoms of CKD

A

pruritis
loss of appetite
nausea
musc cramps
pallor
fatigue

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29
Q

investigations for CKD (4)

A

FBC- anaemia of chronic disease
U&E- GOLD for estimated eGFR function. (diagnostic)
urine dip (proteinuria)
GFR func. staging 1-5

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30
Q

describe eGFR function staging 1-5

A

uses 4 parameters:
creatine, age, gender, ethnicity

  1. 90+ w. renal signs
  2. 60-90 w. renal signs
  3. a. 45-59 b. 30-44
  4. 15-29
  5. <15

highest score= well functioning kidneys
lowest= most severe kidney damage

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31
Q

management of CKD

A

no cure so treat comps:
-anaemia= ferrous sulphate + erythropoietin
-oedema= diuretics
-metabolic acidosis= Na bicarb
-osteodystrophy= vit D supps
-CVD= ACEi + statins

end stage= renal replacement therapy (eGFR<15) dialysis
eventually- kidney transplant= cure

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32
Q

AKD vs CKD

A

AKD=
-increase in serum creatinine + decrease in urine output
-shorter Sx onset
-no anaemia
-USS= normal

CKD=
-decrease in eGFR
-3+ months Sx onset
-anaemia of CKD
-USS= bilateral, small, abnormal kidneys

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33
Q

describe benign prostate hyperplasia (BPH)

A

non-malignant hyperplasia of stromal + epithelial cells of prostate- causes enlarged prostate which partially blocks urethra

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34
Q

list 5 risk factors for BPH

A

increasing age
increase in testosterone (castration= protective)
FHx
smoking
non-asian

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35
Q

presentation of BPH

what is used to assess these symptoms

A

LUTS- lower urinary tract symptoms
STORAGE:
frequency, urgency, incontinence, nocturia
VOIDING:
dysuria, poor/intermittent stream, dribbling, straining, incomplete emptying, hesitancy

IPSS (international prostate symptom score) used to assess severity of LUTS

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36
Q

investigations for BPH (including GOLD)

A

GOLD= DRE- smooth but enlarged prostate (prostate cancer= hard + irregular)
-prostate specific antigen raised (v. unreliable as can be raised in cancer as well)
-urine frequency volume chart
-urine dipstick (rule out infection)

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37
Q

management of BPH

A

lifestyle- reduce caffeine/alcohol intake
1st= alpha blockers eg tamsulosin (relaxes smooth musc in bladder neck + prostate)
2nd= 5-alpha reductase inhibitors eg finasteride (blocks conversion of testosterone to dihydrotestosterone which decreases prostate size)
surgery= last resort- TURP, transurethral resection of prostate

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38
Q

describe renal cell carcinoma + list 4 risk factors for it

A

adenocarcinoma rising from PCT
mc. of renal cancer

RFs:
smoking
obesity
hereditary
von hippel-lindau (autodom loss of tumour suppressor gene)

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39
Q

presentations of renal cell carcinoma (including a triad)

A

triad=
1. haematuria
2. flank pain
3. palpable mass

may have L varicocele
cancer symptoms= wt. loss, fatigue, anorexia, night sweats

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40
Q

1st line and gold standard investigations for renal cell carcinomas

A

1st=
bloods= increased: RBCs, Ca, LDH (lactate dehydrogenase)
abdo/pelvis USS

GOLD= CT chest/abdo/pelvis

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41
Q

management of renal cell carcinomas

A

nephrectomy/partial nephrectomy

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42
Q

define bladder cancer and give the mc. subtype of bladder cancer

A

cancer in bladder arising from urothelium
mc. subtype= transitional cell carcinoma

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43
Q

Risk factors for bladder cancer

A

occupational exposure to dyes/paints/rubber (aromatic amines)
-painter
-hairdresser
-mechanic working w. tyres
-dye factory worker

age 65+
male
caucasian
smoking
pelvic radiation

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44
Q

presentations of bladder cancer

A

painless haematuria (macro or microscopic)
urgency
dysuria
suprapubic/pelvic mass
pelvic pain
recurrent UTI
signs of metastases: bone pain, wt. loss

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45
Q

1st line and GOLD investigations for bladder cancer

A

1st=
urinalysis 4 microscopy + culture
bladder USS

GOLD= flexible cystoscopy + biopsy

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46
Q

management of bladder cancer

A

conservative= support eg specialist nurse
medical= chemo/radio
surgical= TURBT (transurethral resection of bladder tumour)

last resort= cystectomy (bladder removal)1

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47
Q

where does prostate cancer develop

A

peripheral zone of the prostate
-mc. cancer in men + v. slow growing

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48
Q

list 5 risk factors for prostate cancer

A

genetic- BRCA2, HOXB13
FHx
increasing age
afro-caribbean
anabolic steroids

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49
Q

what are lower urinary tract symptoms (LUTS)

A

STORAGE: need to pee
-frequency
-urgency
-nocturia
-incontinence

VOIDING: hard 2 pee
-poor stream
-incomplete emptying
-hesitancy
-need 2 pee

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50
Q

presentation of prostate cancer

where does it typically metastasise to

A

LUTS (like BPH) but w. systemic cancer symptoms (wt. loss, fatigue, night pain) + bone pain
haematuria
erectile dysfunction

typically metastasises to bone (thick sclerotic lesions), liver, lungs & brain

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51
Q

1st line investigations for prostate cancer

A

DRE + prostate exam- firm + hard + asymmetrical + rough
test for prostate specific antigen in community setting - increased

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52
Q

gold standard investigation for prostate cancer + grading system

A

transrectal USS + biopsy
Gleason grading system- based on biopsy
- higher score= worse prognosis

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53
Q

management of prostate cancer in a local setting

A

prostatectomy if <70
active surveillance if 70+
external beam radiotherapy
brachytherapy

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54
Q

management of prostate cancer that has metastasised

A

chemo/radio
bilateral orchidectomy (GOLD hormonal treatment)
androgen deprivation therapy
palliative care 2 relieve symptoms eg TURP

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55
Q

where does testicular cancer arise from and list the germ and non-germ cell cancers

A

cancer arising from germ cells in the testes
-90% germ cell cancers (semimomas, teratomas)
-10% non-germ cell cancers (leydig, sertoli, lymphoma)

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56
Q

list 5 risk factors for testicular cancer

A

undescended testes (cryptorchidism)
male infertility
FHx
tall
HIV

57
Q

presentation of testicular cancer

A

palpable painless lump in testicle- which does NOT TRANSILLUMINATE
haematospermia (blood in semen)
gynecomastia

58
Q

investigations for testicular cancer

A

urgent USS (doppler) of testes

tumour markers:
-alpha fetoprotein (AFP)= increased in teratomas
-beta HCG= increased in seminomas + teratomas
lactate dehydrogenase= non-specific raised

59
Q

management of testicular cancer

A

urgent radical orchidectomy- offer sperm storage (semen cryopreservation
metastatic lymph node removal, chemo, radio

60
Q

what is obstructive neuropathy

A

blockage of urinary flow
- can affect 1 (urine output + serum creatinine may remain the same) or both kidneys

61
Q

what are 2 causes of obstructive neuropathy and describe the pathology of an obstruction

A

renal stones
BPH

obstruction= urinary retention> increase in kidney or ureter or bladder pressure > refluxing of urine into renal pelvis= hydronephrosis (dilated renal pelvis which is more infection prone)

62
Q

list 3 presentations of a renal obstruction

A

flank pain
LUTS
fever
-may be asymptomatic of only one kidney affected

63
Q

investigations for obstructive neuropathy (4)

A

urinary dipstick
renal USS
urea & creatinine
FBC

64
Q

management of an obstructive neuropathy

A

1st= relieve pressure on the kidneys: urethral catheter, ureteric stent, nephrostomy tube

treat underlying cause: renal stones, BPH, infection

65
Q

list 1 upper kidney UTI and 4 lower (bladder onward) UTIs

A

upper= pyelonephritis

lower=
cystitis
prostatitis
urethritis
epididymo-orchiditis

66
Q

list the organisms that cause UTIs (KEEPS)

A

Kiebsella
Enterobacter
E. coli
Proteus
S. saprophyticus

80% of cases= uropathogenic E.coli

67
Q

what is the first line investigation for all types of UTIs and what are the results

A

urine dipstick
-positive 4 leukocytes
-positive 4 nitrites (bacteria break down nitrates into nitrites)
-+/- haematuria

68
Q

what is the gold standard investigation for all types of UTIs

A

midstream microscopy + serology
-confirm UTI + identify pathogen

69
Q

describe pyelonephritis

A

upper UTI
inflammation of kidney renal pelvis caused by bacterial infection (mc. enteropathogenic E.coli)
-mostly acquired via ascending transurethral spread

70
Q

list 4 risk factors for pyelonephritis

A

female
urinary stasis (BPH, stones, cancer)
vesicoureteral reflux
catheter

71
Q

presentations of pyelonephritis (including a triad)

A

triad of: loin pain, fever, pyuria (increased levels of WBCs or pus in urine)
+
urgency
frequency
dysuria
suprapubic pain
n+v
back pain
headache

72
Q

management of pyelonephritis

A

analgesia- paracetamol
Abxs- ciprofloxacin or co-amoxiclav
- if pregnant, cefalexin

73
Q

describe cystitis

A

lower UTI causing an inflamed bladder
m.c caused by enteropathogenic E.coli

74
Q

list 5 risk factors for cystitis

A

female
urine stasis (BPH, stones, cancer)
frequent sex
catheter
bladder lining damage

75
Q

presentations of cystitis (4)

A

suprapubic tenderness + discomfort
increased frequency + urgency
haematuria + polyuria
confusion in elderly

76
Q

management of cystitis

A

Abxs: trimethoprim/nitrofurantoin

preggo=
no trimethoprim in 1st trimester (inhibits folate synthesis)
no nitrofutantoin in 3rd trimester

use amoxicillin, cefalexin instead

77
Q

describe urethritis

A

lower UTI
urethral inflammation +/- infection
mc. sexually acquired condition

78
Q

what are the 2 types of bacteria that cause infective urethritis

A

gonococcal- neisseria gonorrhoea

non-gonococcal- chlamydia trachomatis

79
Q

list 3 risk factors for urethritis

A

female
MSM
unprotected sex

80
Q

1st line investigations for urethritis

A

urine dipstick + microscopy & culture

NAAT- nucleic acid amplification test- detect UTI (chlamydia/gonorrhoea)

81
Q

gold standard investigation for urethritis

A

urethral discharge gram stain
- decrease in polymorphonuclear leucocytes confirms urethritis

presence of gram negative cocci= gonorrhoea

82
Q

management of urethritis

A

Neisseria gonorrhoea- 1g IM ceftriaxone + 1g azithromycin

chlamydia trachomatis- 100mg doxycycline or azithromycin

83
Q

describe epidiymo-orchitis

A

lower UTI
inflammation of epididymis + testes
- usually due 2 UTI (gonorrhoea, chlamydia) or by enteric pathogens (E.coli)

84
Q

list 3 risk factors for epidiymo-orchitis

A

unprotected sex
bladder outflow obstruction (BPH, stones, cancer)
catheter

85
Q

presentation of epidiymo-orchitis

A

gradual onset of unilateral scrotal pain + swelling
pain relieved w. elevated testis (positive prehn’s sign)
cremaster reflex intact
urethral discharge
LUTS

DDx= rule out testicular torsion (much more acute, n+v , no cremaster reflex)

86
Q

1st line + gold investigations for epidiymo-orchitis

A

1st= urine dipstick= leukocytes + nitrites + blood
GOLD=
NAAT (nucleic acid amplification test)
urine microscopy + cultures
other= USS 2 rule out testicular torsion

87
Q

management of epidiymo-orchitis

A

neisseria gonorrhoea= 1g IM ceftriaxone + 1g azithromycin

chlamydia trichomatis= 100mg doxycycline or azithromycin

E.coli= 500mg levofloxacin

88
Q

what do nephr0tic syndromes cause

A

group of conditions which cause glomerular basement membrane 2 become permeable to protein

89
Q

list 4 common characteristics of nephr0tic syndrome

A

proteinuria
peripheral oedema
hypoalbuminemia
hypercholesterolemia

90
Q

what are 3 primary causes of nephr0tic syndrome

A

minimal change disease (mc. in kids, unknown cause, immune mediated)

membranous glomerularnephritis (adults)

focal segmental glomerulosclerosis (causes= HIV, sickle cell, mc. in adults)

91
Q

what is a secondary cause of nephr0tic syndrome

A

diabetic nephropathy

92
Q

presentations of nephr0tic syndrome

A

proteinuria (>3.5g/24hrs)
-frothy, apple juice urine + infection
hypoalbuminemia (<30g/L)
peripheral oedema
hypercholestrolaemia
haematuria
hyperlipidaemia + wt. gain
HTN

93
Q

1st line investigations for nephr0tic syndrome

A

bloods eg decreased albumin
mid-stream urinalysis + dip stick
kidney USS

94
Q

gold standard investigation for nephr0tic syndrome and what would you see with each primary cause

A

needle biopsy + microscopy

minimal change disease:
light microscopy= no change
electron microscopy= podocyte loss

membranous glomerulonephritis:
light microscopy= thickened capillary wall
electron= subpodocyte immune complex deposition (spike + dome appearance)

focal segmental glomerulosclerosis:
light= segmental sclerosis

95
Q

management of nephr0tic syndrome

A

high does steroids - 12 weeks prednisolone

treat comps:
oedema= diuretics
hyperlipidaemi= statins
hypercoagulable state= anticoagulant eg warfarin
infection= Abxs

96
Q

describe nephritic syndrome

A

group of glomerulonephritis pathologies that cause inflammation of the kidneys
-increased permeability of glomeruli allows movement of RBCs into filtrate= haematuria + proteinuria

97
Q

list 5 causes of nephritic syndrome

A

IgA neuropathy (Berger’s disease, mc.)
SLE
post-streptococcal glomerulonephritis
good pasture’s syndrome
haemolytic uraemic syndrome

98
Q

what are the causes of nephritic syndrome (apart from good pastures) all examples of

A

type 3 hypersensitivity reactions
(goodpastures= type 2)

99
Q

IgA nephropathy (Sx, Dx, Tx) and what is a DDx

A

Sx= visible haematuria 1-2 days after viral infection- coke/ribena urine

Dx= immunofluroscence microscopy- IgA complex deposition

Tx= non-curative, BP control (ACEi)

DDx= Henloch schonlein purpura
-Sxs are exactly same
diff=
IgAn- only kidney deposition
HSP- systemic deposition

100
Q

post streptococcal glomerulonephritis (Sx, Dx, Tx)

A

Sx= visible haematuria- coke/ribena urine
-2 weeks after pharyngitis from group A,B haemolytic strep

Dx=
light microscopy= hypercellular glomeruli
electron microscopy= subendothelial immune complex deposition
immunofluorescence- ‘starry sky’ appearance

Tx= usually self limiting - penicillin

101
Q

SLE (Dx, Tx)

A

lupus nephritis secondary 2 SLE (ANA deposition in endothelium)

Dx= ANA positive, anti dsDNA positive

Tx= hydroxychloroquine + cyclophosphamide

102
Q

good pasture’s (Dx, Tx)

A

pulmonary + alveolar haemorrhage

Dx= anti-GBM autoantibodies
Tx= steroids + plasma exchange

103
Q

describe polycystic kidney disease

A

fluid filled cysts form within renal parenchyma (cortex + medulla)

104
Q

what are the 2 types of polycystic kidney disease

A

auto-dom= mutated PKD-1 chromosome (85%) or PKD-2 (15%)

auto-rec= gene on chromosome 6 (L.C, prebrith/infancy w. high mortality)de

105
Q

describe the pathology of polycystic kidney disease

A

cysts grow + develop overtime into tubular portion of nephron= compression of Rena architecture + vasculature

progressive impairment- gets bigger + worse w age

106
Q

presentation of polycystic kidney disease

A

bilateral flank/back or abdo pain (+/- haematuria & HTN)
LUTS
palpable kidneys

extra-renal manifestations:
cerebral aneurysms (esp Berry- if ruptured= subarachnoid haemorrhage)
hepatic, splenic, pancreatic, ovarian and prostatic cysts
abdo hernia

107
Q

investigations for polycystic kidney disease

A

kidney USS- enlarged bilateral kidneys w. multiple cysts

15-39 @ least 3 cysts uni or bilateral
40-59 @ least 2 in each kidney
60+ @ least 4 in each kidney

other= genetic testing + FHx of PKD

108
Q

management of polycystic kidney disease

A

non-curative
Tolvaptan (ADH receptor antagonist)- slows development of cysts + progression of renal failure

supportive= antihypertensives, Abxs if infected, drainage + surgical removal of cysts
dialysis + transplant (ESRF)

109
Q

name 4 non-cancerous scrotal conditions/diseases

A

epididymal cyst
hydrocele
varicocele
testicular torsion

110
Q

what is a epididymal cyst, where is it normally located and what does it contain (will it transilluminate)

A

smooth intra testicular spherical cyst @ top of testicle
-contains clear + milky fluid - WILL TTRANSILLUMINATE

111
Q

investigations and management of epididymal cysts

A

Dx= USS of scrotum
Tx= none, surgery if causing pain

112
Q

describe hydrocele including simple and communicating

A

hydrocele= abnormal collection of fluid in tunic vaginalis

simple= overproduction of fluid
communicating= peritoneal fluid + scrotum are connected

113
Q

presentation of hydrocele (will it transilluminate)

A

non-tender, smooth scrotal swelling
WILL transilluminate

114
Q

investigations + management of hydrocele

A

Dx= clinical diagnosis + USS of scrotum
Tx= observation or surgery/aspiration 4 larger, symptomatic hydroceles

115
Q

describe varicocele and what are 2 things that can cause it

A

abnormal dilation of testicular veins in pampiform venous plexus

caused by either increased resistance in testicular vein or incompetent valves causing reflux

116
Q

which testicle is mc affected in varicocele and how can it lead to infertility

A

L side mc affected due 2 angle L testicular vein enters L renal vein

infertility can occur bc pampiform plexus regulates temp of blood entering testes- varicocele can disrupt this

117
Q

presentation of varicocele (4)

A

scrotal mass that feels like a bag of worms
dragging + heaviness of scrotum
throbbing/dull pain
worse on standing

118
Q

investigations + management for varicocele

A

Dx=
clinical diagnosis
other= USS w. doppler
semen analysis for fertility

Ix= surgical repair if pain, infertility, atrophy

119
Q

what happens in testicular torsion and what can happen if it is not dealt with ASAP

A

spermatic cord twists on itself - causes occlusion of testicular artery + ischaemia
- gangrene of testes if not dealt with

surgical emergency

120
Q

what is a risk factor for testicular torsion

A

bell clapper deformity- horizontal lie of testes

121
Q

presentation of testicular torsion

A

severe, unilateral testicular pain
hurts 2 walk
cremasteric reflex lost (stroke inner thigh- ipsilateral testicle elevates)
no pain relief w elevating testes (negative phren sign)
firm + swollen testicle
abdo pain
n + v

122
Q

1st line and gold investigations for testicular torsion

A

1st= immediate surgical exploration if there is high risk

gold= scrotal USS- whirlpool sign (spiral appearance of spermatic cord + blood vessels

123
Q

management of testicular torsion

A

urgent surgery within 6hrs
orchiopexy (corrections position of testicles)
orchidectomy (remove testicle)

124
Q

what are 3 types of incontinence and management

A

stress -sphincter weakness due to trauma/post preggo

urge- detrusor musc overactivity

spastic paralysis

Tx= surgery + anticholinergic drugs

125
Q

what is retention, give 4 causes of retention and management

A

inability 2 pass urine even when bladder full (500ml)

causes= obstruction
-BPH
-stones
-neurological flaccid paralysis

Tx= catheterise

126
Q

what are storage symptoms of LUTS

A

LUTS= lower urinary tracts symptoms

storage= need 2 pee
-frequency
-nocturia
-urgency
-incontinence

127
Q

what are voiding symptoms of LUTS

A

voiding= hard 2 pee
-poor stream
-incomplete emptying
-hesitancy
-need 2 pee

128
Q

what are red flag LUTS

A

dysuria + haematuria

129
Q

presentations of chlamydia trachomatis (including Sxs in women VS men)

A

chlamydia trachomatis= gram negative bacteria (mc. UTI in UK)

Sxs:
women=
abnormal vaginal discharge
vaginal bleeding
cervical inflammation
painful sex + urination

men=
painful urination
penis discharge

130
Q

investigations for chlamydia trachomatis

A

nucleic acid amplification test (NAAT)
-swabs check directly for DNA or RNA organism

swabs= endocervical, vulvovaginal, 1st catch urine sample, men= urethral

131
Q

management of chlamydia trachomatis

A

doxycycline 100mg x2 daily for 7 days

CI= preggo + breast feeding
instead use clarithromycin, amoxicillin, azithromycin

132
Q

what does neisseria gonorrhoea affect

A

neisseria gonorrhoea= gram negative diplococcus
- infects mucous membranes w. columnar epithelium

133
Q

presentations of neisseria gonorrhoea (men vs women- 3 each)

A

women=
odourless purulent discharge (green/yellow)
painful urination
pelvic pain

men=
odourless purulent discharge (green/yellow)
painful urination
testicular pain/swelling (epididymis-orchitis)

134
Q

1st line and gold investigations for neisseria gonorrhoea

A

1st= charcoal swab for microscopy, culture and antibiotic sensitivity

gold= NAAT- checks for DNA/RNA of organism
swabs= endocervical, vulvovaginal, 1st catch urine, men= urethral

135
Q

management of neisseria gonorrhoea

A

IM ceftriaxone (cephalosporin)- 1g if sensitivity not known

oral ciprofloxacin- 500mg if sensitivities are known

136
Q

what is syphilis caused by

A

Syphilis= STI caused by treponema palladium- spirochaete bacterium which gets thru skin + mucous membranes

137
Q

presentations of primary, secondary and tertiary syphilis

A

primary=
painless genital ulcer
lymphadenopathy

2ndary=
maculopapular rash
condylomata lata (grey wart-like lesions around genitals)
fever
lymphadenopathy

tertiary=
gummatous lesions (granulomatous lesions on skin, organs, bones)
AAA

138
Q

presentations of neurosyphilis

A

headache
altered behaviour
dementia
tremor
paralysis

139
Q

investigations for neurosyphilis

A

IM benzathine benzylpenicillin
CI penicillin allergy= ceftriaxone, amoxicillin, doxycycline (doxycycline CI in breast feeding + pregnancy)

phase 2a (12 decks)

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