4th Year Additions Flashcards
1
Q
what happens if hydronephrosis causes a reduction in kidney function?
A
post-renal AKI
2
Q
options for relieving blockage in urinary tract?
A
nephrostomy (drain inserted into the back)
urethral catheter
suprapubic catheter
3
Q
what is idiopathic hydronephrosis?
A
narrowing of the pelvicureteric junction (PUJ)
4
Q
management of idiopathic hydronephrosis
A
pyeloplasty
5
Q
what is vesicoureteral reflux?
A
urine refluxing from the bladder back into the ureters
6
Q
where is the renal angle?
A
12th rib and vertebral column posteriorly
7
Q
catheter indications
A
pre-surgery post-surgery monitoring UO in unwell patient relieve obstruction neurogenic complications medication delivery
8
Q
what cells produce PSA?
A
epithelial cells in the prostate
9
Q
what is orchitis?
A
inflammation of the testicle
10
Q
parotid gland swelling + orchitis?
A
mumps (can also cause pancreatitis)
11
Q
presentation of epididymo-orchitis
A
pain dragging/ heavy sensation swelling urethral discharge systemic symptoms
12
Q
management of epididymo-orchitis
A
ofloxacin
13
Q
management of prostatitis
A
ciprofloxacin
14
Q
causes of testicular lumps
A
hydrocele varicocele (should disappear when lying flat) epididymal cyst testicular cancer epididymo-orchitis inguinal hernia testicular torsion
15
Q
what can a left-sided varicocele indicate?
A
renal cell carcinoma (obstruction to left testicular vein as it drains into the left renal vein)
also called Stauffer’s syndrome
16
Q
what to consider if varicocele does not disappear when lying flat?
A
retroperitoneal tumour
17
Q
leydig tumour presentation
A
testicular cancer
gynaecomastia
18
Q
risk factors for bladder cancer
A
dyes and rubber (aromatic amines)
smoking
schistosomiasis (SCC)
19
Q
management of bladder cancer
A
resection cystectomy chemotherapy BCG vaccine urostomy (ileal conduit)
20
Q
most common type of kidney stone?
A
calcium oxalate
21
Q
types of kidney stones
A
calcium stones
uric acid
struvite
cystine
22
Q
conservative/ lifestyle management of renal stones
A
increase oral fluid intake add lemon juice avoid carbonated drinks reduced salt maintain calcium intake
recurrence= potassium citrate or thiazides
23
Q
most common types of renal cell carcinomas
A
clear cell
papillary
chromophobe
24
Q
who get’s Wilm’s tumour?
A
<5
25
renal transplant typical immunosuppression regime?
tacrolismus
mycophenolate
prednisolone
26
side effect of renal transplant immunosuppression
seborrheic warts and skin cancer
tacrolimus= tremor
cyclophosphamide= gum hypertrophy
cushing's
27
renal biopsy criteria
BP <160/95
Hb >9
platelets >100
clotting/ stopping anticoagulants
28
do renal patients have ideal weight?
yes
29
where does Fanconi's syndrome affect in the kidney?
PCT
30
what are thiazides good for?
OP and renal stones
| caution in gout and DM
31
what can acute tubulointerstitial nephritis present with?
eosinophilia
32
what is erectile dysfunction?
inability to maintain or develop an erection during sex
33
causes of ED
```
finasteride
psychological
back/pelvic trauma
stroke
MS
endocrine
hypertension/ diabetes
```
34
point and shoot
erection is parasympathetic and ejaculation is sympathetic
35
what is an indicator that ED is psychogenic?
spontaneous morning erection
36
management of ED
PDE-5 inhibitors e.g. sildenafil
testosterone treatment
vacuum erection devices
prosthetic implants
37
side effect of azathioprine
bone marrow suppression
38
ciclosporin side effect
lymphoma
39
what antibiotic should be avoided in renal transplant?
trimethoprim
40
causes of green urine
amitriptyline
| propofol
41
causes of white urine
pyuria
| phosphate crystals
42
what can cause hyaline casts
diuretics
43
what does uric acid crystals + ARF indicate?
tumour lysis syndrome
44
what is TURP-syndrome?
hyponatraemia post-TURP due to glycerine and venous plexus absorption
45
how to calculate anion gap?
(Na+ + K+) – (Cl- + HCO3-).
indicator this needs to be done is being given chloride in the question
46
normal anion gap?
10-14 or 8-14?
47
normal anion gap metabolic acidosis causes
GI losses
RTA
acetazolamide
addison's
48
raised anion gap metabolic acidosis causes
lactate
ketones
urate
acid poisoning (salicylates)
49
definition of AKI
rise in creatine to >26umol/L
| <0.5 urine UO for >6 hours
50
causes of peritonitis on PD
staph epidermidis
| staph aureus
51
management of peritonitis while on PD
vanc + ceftazidime or ciprofloxacin
52
usual immunosuppression regime in renal tranpslant
tacrolismus
mycophenolate
prednisolone
53
management of septic renal stones
percutaneous nephrostomy
| JJ stent
54
management of of stones <7mm
repeat CT in 3-4 weeks
55
management of stones >7mm
shock wave lithotripsy
laser lithotripsy
ureteric stents (last 1 year)
56
screening for diabetic neprhopathy?
annual ACR
57
ACR that indicates microalbuminuria
>2.5
58
when are diabetics given ACEI?
ACR >3
59
TNM staging for renal cell carcinoma
T1 <7cm
T2 >7cm
T3 beyond
T4 beyond Gerota's fascia
60
what is acute tubular necrosis?
death of epithelial cells
61
can you recover from acute tubular necrosis?
yes, epithelial cells regenerate in 7-21 days
62
diagnosis of ATN
muddy brown casts
63
management of ATN
IV fluids
| stop nephrotoxics
64
what acidosis does RTA cause?
hyperchloremic metabolic acidosis
65
four types of RTA?
- Type 1= distal tubule is unable to secrete H+
- Type 2= proximal tubule unable to resorb bicarbonate, usually Fanconi’s anaemia
- Type 3= combination of above
- Type 4= lack of aldosterone
66
what is rhabdomyolysis?
muscle cell death releasing myoglobin, K+, phosphate and CK
67
how does rhabdomyolysis cause AKI?
myoglobin release
68
diagnosis of rhabdomyolysis
CK
U&Es
urinalysis
ECG
69
management of rhabdomyolysis
IV fluids
IV sodium bicarbonate (for myoglobin)
hyperkalaemia management if needed
70
when to review alpha blockers?
6 weeks
71
how long do 5-alpha reductase inhibitors take to work?
6 months
72
superficial bladder cancer management
resection, chemo
73
invasive bladder cancer management
radical cystectomy
| radical radiotherapy
74
when to avoid trimethoprim for treatment of UTI?
first trimester (folate antagonist)
75
when to avoid nitrofurantoin in UTI?
3rd trimester (haemolysis)
76
hormonal therapies used in prostate cancer
anti-androgens (testosterone antagonists) e.g. bicalutamide
GnRH agonists (goserelin
GNRH e.g. degarelix (bone spread)
bilateral orchidectomy
77
what must be used with GnRH antagonists?
anti-androgen cover as initially increases test and can cause spinal cord compression
78
examples of anti-androgens
bicalutamide
cyproterone acetate
flutamide
79
side effects of finasteride?
ED
| secreted into semen so needs condoms
80
what causes green urine?
amitriptyline
| propofol
81
what is TURP syndrome?
hyponatraemia post-TURP due to venous damage
82
how to calculate the anion gap?
(Na+ + Cl-) - (H+ + HCO3-)
83
what is the normal range of the anion gap?
8-14mmol/L
84
causes of normal anion gap?
hyperchloraemic metabolic acidosis
- GI bicarbonate loss (diarrhoea)
- RTA
- drugs e.g. acetazolamide
- ammonium chloride injection
- Addison's
85
causes of a raised anion gap?
lactate ( shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failrue)
acid poisoning (salicylate, methanol)
86
swelling that you cannot get above in teh testicle?
hernia
87
which swelling is separate from the body of the testicle?
epididmyal cyst
88
diagnosis of urethral injury
ascending urethrogram
89
which diuretics cause renal stones?
loop
90
ACR sample
first pass urine
91
paediatric fluid prescribing
100ml/24 hours for every 0-10 kg
50ml/24 hours for every 11-20kg
20ml for each kg after that
92
maximum K+ infusion rate?
10mmol/hr
93
DI results
high plasma osmolality
| low urine osmolality
94
what GFR should you stop metformin?
<45
| statins <10
95
can you continue aspirin in AKI?
yes if cardioprotective dose (75mg)
96
what does fat stranding indicate?
recent passage of stone
97
method for removing stones if pregnant?
ureteroscopy
98
USS criteria for ADPKD
- two cysts, unilateral or bilateral if aged <30
- two cysts in both kidneys if aged 30-59
- four cysts in both kidneys if aged >60
99
staging of hyperkalaemia
```
mild= 5.5-5.9
mod= 6.0-6.4
severe= 6.5 or more
```
100
which drug should be held before coronary angiography?
metformin if at risk of contrast induced nephropathy
