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yr3 > renal and uro SBAs > Flashcards

renal and uro SBAs Flashcards

1
Q

A 17 year old male presents with a 1 week history of fever, malaise, pain on swallowing + has found lumps in the neck. On examination a tender scrotal swelling is also noted.

A

Mumps - parotitis and swelling of parotid gland(s) which is present in 95% of symptomatic mumps. Mumps epididymo-orchitis is also a common feature shown as a tender scrotal swelling. Treatment of this viral infection involves isolation and supportive care with paracetamol or ibuprofen.

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2
Q

Acute features of kidney failure

A

Oliguria & acute rise in Cr/urea

Electrolyte imbalance (hyperK+)
Nausea and vomiting
Drowsiness (malaise)

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3
Q

Chronic features of kidney failure

A 
Oedema
Poor appetite
Drowsiness (malaise)
Anaemia
Bone weakness (high phosphate, renal osteodystrophy, low calcitriol, high oestrogen)
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4
Q

Renal colic medical Rx (suitable for <10mm calculi)

A 
Analgesia e.g. diclofenac
IV fluids to rehydrate
Drugs to reduce ureteric spasm:
-Tamsulosin (a-blocker)
-Nifedipine (CCB)
Active stone removal if stone >7mm

Long-term diet changes, hydration, allopurinol

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5
Q

Which pathogens are most likely to cause epididymo-orchitis in patients <35 years and >35 years?

A 
<35years = STIs (Chlamydia trachomatis and Neisseria gonorrhoeae)
>35years = UTIs (E coli)
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6
Q

Commonest cause of nephrotic syndrome in children is

A

Minimal change glomerulonephritis

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7
Q

Commonest causes of nephrotic syndrome in adults

A

Diabetes mellitus
Membranous glomerulonephritis

n.b. any type of glomerulonephritis can cause nephrotic syndrome but these are just the most common.

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8
Q

Nephrotic syndrome

A

Hypoalbuminaemia
Oedema
Proteinuria
(hypercholesterolaemia)

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9
Q

SLE can cause glomerulonephritis. What would you test for to confirm this?

A

ANA

Anti-dsDNA

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10
Q

Goodpasture’s syndrome can cause glomerulonephritis. What would you test for to confirm this?

A

Anti-GBM antibodies

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11
Q

Wegener’s polyangiitis antibody

A

cANCA

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12
Q

Main causes of renal artery stenosis

A 
Atherosclerosis (older)
Fibromuscular dysplasia (younger)
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13
Q

Fibromuscular dysplasia resembles a string of beads on angiography. What conditions is it associated with?

A

Causes RAS in the young.

Associated with collagen disorders, neurofibromatosis, Takayasu’s disease, and microaneurysms in renal arteries.

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14
Q

Renal artery stenosis gold standard investigation

A

Digital subtraction angiography

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15
Q

Types of renal calculi

A 
Calcium oxalate (65%)
Calcium phosphate (15%)
Magnesium ammonium phosphate (10%)
Uric acid (5%)
Cysteine (1%)
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16
Q

Renal calculi risk factors

A

Dehydration
UTIs

Changes in urinary pH
HyperCa2+, hyperoxaluria, hyperuricaemia, cystinuria

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17
Q

Kidney functions

A

Maintains fluid compartments (ECF Na+ and ICF H2O)
Electrolyte/acid-base balance (K+ and pH)
Excretion of waste products (urea)
Hormone production (erythropoietin and vit D)

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18
Q

Causes of pre-renal AKI

40-70% of AKI

A

Renal hypoperfusion
e.g. hypotension:
hypovolaemia, sepsis
Renal artery stenosis ±ACEi

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19
Q

Causes of intrinsic renal AKI

(10-50%) These may require renal biopsy for diagnosis.

A

Tubular - ATN (pre-renal damage, nephrotoxic drugs, rhabdomyolysis, myeloma)
Glomerular - autoimmune
Interstitial - acute interstitial nephritis (drugs, infiltration)
Vascular - vasculitis, thrombus

20
Q

Causes of post-renal AKI

10-25%

A

Urinary tract obstruction

e.g. stones, blood clots, malignancy, retroperitoneal fibrosis

21
Q

Pulmonary oedema Rx

A

Sit up, give O2 ±CPAP
IV GTN
IV furosemide
IV diamorphine

22
Q

Complications of AKI that need to be treated

A

HyperK+
Metabolic acidosis
Pulmonary oedema

23
Q

Acute kidney injury Rx

after complications have been treated

A 
IV fluids
Treat infection - Abx
Stop nephrotoxic drugs (ACEi and NSAIDs)
Treat intrinsic renal disease
Relieve obstruction
Optimise nutrition
Consider future dialysis
24
Q

Epidydimo-orchitis

A 
<35years 
Chlamydia: doxycycline/ azithromycin
Gonorrhoea: + ceftriazone
>35years
UTIs: ciprofloxacin/oflaxacin

Antibiotics should be used for 2-4weeks
Analgesia, scrotal support, drainage of abscess

25
Q

Nephrotoxic agents

A

NSAIDs
Aminoglycosides (gentamicin, streptomycin)
Contrast agents
ACEi
Immunosuppressants (ciclosporin, methotrexate)

26
Q

Obstructive LUTS

A 
Stream (poor)
Hesitancy
Incomplete voiding
Terminal dribbling
Overflow incontinence
Near retention
27
Q

Irritative LUTS

A

Frequency (polyuria)
Urgency
Nocturia
Dysuria

28
Q

Prostate cancer most commonly metastases to…

A

Bones
Lymph nodes
Liver
Brain

29
Q

Bladder cancer histology

A

transitional cell carcinoma

30
Q

Renal cell carcinoma (von Grawitz tumour) classical triad

A

Haematuria
Loin pain
Abdominal mass

31
Q

Testicular cancers germ cell cancer examples are…

A

seminomas (40%) - epithelium of seminiferous tubules

teratomas (10%) - all 3 germ cell layers

32
Q

Seminoma + teratoma tumour markers

A

Seminomas - b-hCG

Teratomas - b-hCG and AFP

33
Q

Seminoma + teratoma prognosis

A

Seminomas - better prognosis

Teratomas - more aggressive, poorer prognosis

34
Q

Non-resolving urge incontinence best investigation

A

Urodynamic study

35
Q

A 62year old Afro-Caribbean man complains of waking up 2-3 times at night to pass urine for the past 8 months. He takes a while to start going and occasionally wets himself by the time he gets back in bed. Urine dipstick is normal. What would be the best investigation to diagnose his condition?

A

Transrectal USS

Measures prostate size and assists prostate biopsy

36
Q

Henoch-Scholein Purpura (HSP) presents with …

A

Arthritis of large joints
Abdo pain
Purpuric rash of lower limb skin

37
Q

A 40 year old man presents with a painless swelling in his scrotum which is fluctuant & transilluminable. Both testes are easily palpable. What is the likely diagnosis?

A

Epididymal cyst

38
Q

A 45 year old man presents with a painless swelling in his scrotum. His left testis cannot be felt. The swelling transilluminates. What is the likely diagnosis?

A

Hydrocoele

39
Q

Extracorporeal shockwave lithoscopy (ESWL)

A

Provides non-invasive outpatient treatment and usually combined with medical treatment. Usually suitable for smaller stones in the kidneys or ureter.

40
Q

Cystoscopy for renal stones

A

allows visualization of the stone and urinary tract as well as laser to break up the stone

41
Q

What is the treatment for calculi >2cm or not suitable for other modalities (e.g. ESWL or cystoscopy)?

A

Percutaneous nephrolithotomy

42
Q

Commonly used antibiotics for cystitis UTI

A 
Females:
Oral co-trimoxazole
Trimethoprim
Nitrofurantoin
or Amoxicillin

(ciprofloxacin in males)

43
Q

Antibiotics for pyelonephritis

A

IV gentamicin, cefuroxime or ciprofloxacin

44
Q

Causes of acute tubular necrosis (this is an intrinsic cause of AKI)

A

Ischaemia (hypoperfusion, rhabdomyolysis)
Nephrotoxic drugs
Multiple myeloma

45
Q 
Weakness
Arrythmias
Palpitations
Nausea+vomiting
are signs of ...
A

hyperK+

46
Q

Hyperuriaemia may result in what heart condition

A

Pericarditis

47
Q

Stages of CKD by GFR (mL/min)

A 
1 - >90 (kidney damage)
2 - 60-89 (mild)
3 - 30-59 (moderate)
4 - 15-29 (severe)
5 - <15 (ESRF)

yr3 (19 decks)

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