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Renal and Urology > Pasmedicine/Pastest > Flashcards

Pasmedicine/Pastest Flashcards

1
Q

analgesia of choice in renal colic

A

diclofenac (IM 75mg)

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2
Q

describe the initial management of renal colic

A

pain relief - diclofenac
alpha blockers - can help stone passage

stones less than 5 mm will pass spontaneously within around 4 weeks
if severe may need surgery - Lithotripsy (if 2cm or less) and nephrolithotomy (if large or complex e.g. staghorn)

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3
Q

what investigations should be done in suspected renal colic

A

urinalysis - blood
initial - ultrasound - can see hydronephrosis
diagnostis gold standard - CT stone search/KUB (non contrast CT)

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4
Q

when would urgent/emergency treatment of a ureteric calculi be indicated

A

ureteric obstruction,
renal developmental abnormality such as horseshoe kidney
previous renal transplant
Ureteric obstruction due to stones together with infection
hydronephrosis
AKI - patient systemically unwells

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5
Q

describe the options of emergnecy treatment of urertic calculi

A

nephrostomy tube placement, insertion of ureteric catheters and ureteric stent placement (via uteroscopy).

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6
Q

in what situation is uteroscopy and stenting preferered to lithotripsy

A

pregnancy (lithotripsy contraindicated)

complex stone disease - also can do percutaneous nephrolithotimy in complex stone disease

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7
Q

1st line treatment of BPH

A

alpha blockers - tamsulosin

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8
Q

name a 5 alpha reductase inhibitor

A

finesteride

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9
Q

how long do BPH meds take to work

A

tamsulosin - immediatley effective

fnesteride takes 6months to work

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10
Q

side effects of tamsulonsin

A

dizziness
postural hypotension
dry mouth
low mood

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11
Q

side effects of finesteride

A

erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia

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12
Q

surgical treatment of BPH

A

transuretheral resection of prostate

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13
Q

side effect of urteretic stent insertion

A

normal to have loin to groin pain and haematurai afeter

just give analgesia

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14
Q

how to distinguish between an inguinal hernia and a hydrocoele in swollen testes

A

if ‘can get above it’ - hydrocoele

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15
Q

what is a staghorn calculi

A

stag-horn calculi involve the renal pelvis and extend into at least 2 calyces. They develop in alkaline urine and are composed of struvite (ammonium magnesium phosphate, triple phosphate). Ureaplasma urealyticum and Proteus infections predispose to their formation

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16
Q

stranding of periureteric fat

A

recent stone passage

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17
Q

medical indications for circumcision

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

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18
Q

things which cause an elevated PSA

A

benign prostatic hyperplasia (BPH)
prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
ejaculation (ideally not in the previous 48 hours)
vigorous exercise (ideally not in the previous 48 hours)
urinary retention
instrumentation of the urinary tract

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19
Q

commonest cause of testicula cancer

A

germ cell tumours - seminoma is most common

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20
Q

tumour marker that is elevated in germ cell testicular cancers

A

AFP - 70 percent
bHCG - 40 percent
usually presents in younger patients 20-30

21
Q

which ethnicity has an increased risk of prostate cancer

A

afrocarribean

22
Q

most common cause of epidydimo-orchitis

A

local spead of infection from genital or urinary tract- chlamydia or gonorrhea

23
Q

treatment of epididymo orchitis

A

if organism know - target treatment

if unknown IM ceftriaxone single dose + oral doxy BD for 10-14 days

24
Q

risk factors for testicular cancer

A 
mumps orchiditis
cryptorchidism
infertility
family history
Klinefelter's syndrome
25
Q

staghorn calculi are made up of

A

struvite

26
Q

type of stones that cant be seen on KUB

A

uric acid

27
Q

type of stones associated with inherited metabolic defect

A

cystine

28
Q

what score is used to determine prognosis of prostate cancer

A

gleason - lower score = better prognosis

made up of two scores out of five. 1st score is based on most prominent histoligal appearance and 2nd score is the 2 most promiment

lower score which is still suggestive of malignany is 6

29
Q

outline the treatment options in metastatic prostate cancer

A

Synthetic GnRH agonist
e.g. Goserelin (Zoladex)
cover initially with anti-androgen to prevent rise in testosterone

Anti-androgen
cyproterone acetate eg. flutamide prevents DHT binding from intracytoplasmic protein complexes

Orchidectomy

30
Q

pelvic trauma + highly displaced prostate

A

membranous urethral rupture

31
Q

A 4-year-old girl presents with symptoms of right sided loin pain, lethargy and haematuria. On examination she is pyrexial and has a large mass in the right upper quadrant.

A

nephroblastoma

32
Q

most common type of renal stone

A

calcium oxalate

33
Q

A 67-year-old man presents with painless frank haematuria. He recently began complaining of a mild testicular ache and describes his scrotum as a ‘bag of worms’. He is a heavy smoker smoking 60 cigarettes a day for 47 years. On examination he is cachectic. His left testicle appears to have a tortuous texture. His blood reveals anaemia and polycythemia. What is the most likely diagnosis?

A

renal cell carcinoma of the kidney

34
Q

complication of TURP resulting in hyponatraemia

A

TURP syndrome
lifethreatening
The pathophysiology is venous destruction and absorption of the irrigation fluid.

There are risk factors for developing TURP syndrome are : 
surgical time > 1 hr
height of bag > 70cm
resected > 60g
large blood loss
perforation
large amount of fluid used
poorly controlled CHF
35
Q

symptoms of testicular torsion but cremasteric reflex preserved

A

torsion of testicular appendige

36
Q

symptoms of testicular torsion with absent cremasteric reflex

A

torsion of spermatic cord

37
Q

staghorn calculi are associated with

A

proteus

38
Q

when should a PSA not be done as it will be elevated

A 
6 weeks of a prostate biopsy
4 weeks following a proven urinary infection
1 week of digital rectal examination
48 hours of vigorous exercise
48 hours of ejaculation
39
Q

complications of TURP

A

T RUP syndrome
U rethral stricture/UTI
R etrograde ejatulation
P erforation of prostate

40
Q

risk factors for transitional cell carcinoma of the bladder are

A

Smoking
Exposure to aniline dyes in the printing and textile industry: examples are 2-naphthylamine and benzidine
Rubber manufacture
Cyclophosphamide

41
Q

what type of bladder cancer does shistostomicis increase your risk of

A

squamous cell

42
Q

what antibiotic can be given for uti prophylaxis

t

A

controvesial area but trimethoprim and nitrofruitoin are liscensced

indicated if more than 1 infection per month + elderly, lots of comorbidities etc but look at local policy

43
Q

when is hormonal therapy for prostate cancer recommended after a ‘biochemical relapse’ ie rising psa following treatment

A

Symptomatic local disease progression, or
Any proven metastases, or
A PSA doubling time <3 months

44
Q

A 62-year-old man has a five month history of fatigue, perineal discomfort, lower back and loin pain. He experiences pain on micturition.

A

chronic bacterial prostatitis

45
Q

A 60-year-old man complains of dysuria and urgency.He gets some suprapubic pain which is relieved lying supine,and occasional terminal haematuria. There is no abnormality on examination of the abdomen.

A

bladder calculi

pain relieved by lying down suggest calculus

46
Q

how much glucose do you need per day

A

50-100g regardless of weight

47
Q

treatment of cranial diabetes insipdius

A

desmopressin

48
Q

treatment of nephrogenic diabetes insipidus

A

thiazide diuretic

49
Q

what drug does not need to be stopped in an AKI

A

low dose aspirin

Renal and Urology (20 decks)

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