Clinical Flashcards
(547 cards)
1
Q
what is kidney agenesis?
A
a congenital absence of one or both kidneys
2
Q
what is kidney hypoplasia?
A
a congenital condition causing small kidneys with normal development and function
(reduced capacity)
3
Q
what is a horseshoe kidney?
A
kidneys congenitally fused at either pole- usually lower
4
Q
do simple cysts usually cause a functional disturbance?
A
no
5
Q
what are the 2 main types of polycystic kidney disease?
A
- autosomal recessive PKD (prev known as infantile)
- autosomal dominant PKD (prev known as adult)
6
Q
what is the most common subtype of ARPKD?
A
perinatal group
7
Q
what does the perinatal group of ARPKD cause?
A
terminal renal failure
8
Q
what happens to the medullary collecting ducts in ARPKD?
A
cystic dilation
9
Q
what liver condition is ARPKD associated with?
A
congenital hepatic fibrosis
10
Q
what is the most common inherited kidney disease?
A
autosomal dominant polycystic kidney disease
11
Q
compare ADPKD 1 and ADPKD2 in terms of chromosomes affected? (give percentages)
A
ADPKD 1: defect on chromosome 16 (90%)
ADPKD 2: defect on chromosome 4 (10%)
12
Q
what is the aetiology of ARPKD?
A
genetic
13
Q
what is the aetiology of ADPKD?
A
genetic
14
Q
when does ADPKD present?
A
usually in middle adult life
15
Q
what does ADPKD present with?
A
abdominal mass
haematuria
chronic renal failure
hypertension
16
Q
where do cysts arise in ARPKD?
A
medullary collecting tubules
17
Q
where do cysts arise in ADPKD?
A
any part of the nephron
18
Q
which other organs can be affected with cysts in ADPKD?
A
liver
pancreas
lung
19
Q
what functionally happens to the liver, pancreas, lung when affected in ADPKD?
A
no funcional effect
20
Q
what aneurysm is ADPKD associated and what can this lead to?
A
berry aneurysm in circle of Willis
can lead to subarachnoid haemorrhage
21
Q
compare ARPKD and ADPKD in terms of the gross shape of the kidney?
A
ARPKD- enlargment but shape is still there
ADPKD- massive enlargement, shape is distorted
22
Q
why can haematuria occur in ADPKD?
A
cysts can be filled with blood
23
Q
compare the causes of intracerebral haemorrhage and subarachnoid haemorrhage in ADPKD?
A
intracerebral- due to hypertension caused by chronic renal faiulre
subarachnoid- due to berry aneurysm in circle of Willis
24
Q
what is the most common benign renal tumour?
A
fibroma
25
what part of the kidney does a fibroma originate from?
medulla
26
what is an adenoma? (of anywhere)
a benign tumour of the epithelium
27
where do renal adenomas originate from?
usually capillary walls in the cortex
28
what type of cells do renal angiomyolipomas contain?
fat, muscle, blood vessels
29
what type of cells does a juxtaglomerular cell tumour arise from?
juxtaglomerular cells
30
what renal tumour is tuberous sclerosis associated?
renal angiomyolipomas
31
why can juxtaglomerular cell tumours cause secondary hypertension?
they overproduce renin
32
even though renal angiomyolipomas are benign, why may they cause kidney dysfunction?
because they can be large and multiple
33
what is the most common intra-abdominal tumour in children?
nephroblastoma (Wilm's tumour)
34
what cells does a nephroblastoma (Wilms tumour) arise from?
primitive renal tissue
35
where do urothelial carcinomas tend to arise?
renal pelvis and calyces
36
where do renal cell carcinomas arise from?
renal tubular epithelium
37
what are renal cell carcinomas also known as?
clear cell carcinoma
hypernephroma
grawitz tumour
38
what is the commonest primary renal tumour in adults?
renal cell carcinoma
39
what age group do renal cell carcinomas tend to present in?
55-60 years old
40
who is more likely to get a renal cell carcinoma- M or F?
males
41
what does a renal cell carcinoma present with?
abdominal mass
haematuria
flank pain
systemic features of malignancy
42
what are the paraneoplastic manifestations of renal cell carcinoma?
erythropoietic stimulating substance: polycythaemia and increased haemaglobin
hormone similar to parathyroid: hypercalcaemia
43
what specific finding is a poor prognosis of a renal cell carcinoma?
renal vein extension
44
compare blood and lymph spread in renal cell carcinoma?
blood spread is first
| lymph spread is later
45
which is the most common subtype of renal cell carcinoma?
clear cell type
46
what system is used to histologically grade renal cell carcinomas?
Fuhrman grading system
47
what is the most common type of bladder cancer?
transitional cell carcinoma
48
where can transitional cell carcinomas arise?
renal calyces right down to urethra
49
what industries have occupational risk of transitional cell carcinoma?
dye industry
rubber industry
hydrocarbon industry
50
what is the biggest risk factor of transitional cell carcinoma?
smoking
51
what chronic parasitic infestation is a risk factor for transitional cell carcinoma?
schistosomiasis
52
what is the commonest symptom of transitional cell carcinoma?
haematuria
53
where do 75% of transitional cell carcinomas occur?
trigone region
54
what does a pTa grade transitional cell carcinoma mean?
superficial and non invasive carcinomal
55
what does a pT1 grade transitional cell carcinoma mean?
stromal invasion
56
what does a pT2 grade transitional cell carcinoma mean?
detrusor muscle invasion
57
which lymph nodes do transitional cell carcinomas tend to spread to?
obturator nodes in pelvis
58
why can transitional cell carcinomas in the badder lead to hydroureter and hydronephrosis?
obstruction causing back pressure of urine
59
what are the 3 risk factors of an adenocarcinoma in the urinary tract?
- congenital bladder extroversion
- urachal remnants
- long standing cystitis cystica
60
what are urachal remnants?
when the urachus- which connects bladder to umbilical cord- doesnt become fully obliterated
61
what is cystitis cystica?
a benign proliferation of the bladder as a response to chronic irritation
62
what are the 2 risk factors of a squamous cell carcinoma in the urinary tract?
- calculi
| - long term schistosomiasis
63
why can calculi lead to a squamous cell carcinoma?
cause irritation which leads to metaplasia then dysplasia
64
what is the most common malignant bladder tumour in children?
embryonal rhabdomyosarcoma
65
what is urinary incontinence?
complaint of any involuntary leakage of urine
66
what is stress urinary incontinence?
involuntary leakage of urine on effort or exertion (ie sneezing/coughing)
67
what is urgency urinary incontinence?
involuntary leakage of urine accompanied by urgency
68
what is urgency?
complaint of a sudden compelling desire to pass urine which is difficult to defer
69
what is overactive bladder syndrome/urge syndrome/urgency-frequency syndrome?
urgency +/- urge incontinence, usually with frequency, and nocturia
70
what is detrusor overactivity incontinence?
involuntary leakage of urine due to an involuntary detrusor contaction
71
what is mixed urinary incontinence?
involuntary leakage of urine associated with urgency and also exertion/effort
72
what is the name of this collection of symptoms- slow stream, splitting of urinary stream, spraying of urinary stream, hesitancy, straining?
voiding symptoms
73
what is a frequency volume chart?
a chart which records volumes voided and times of each micturation for at least 24 hours
74
what are the 4 types of urinary incontinence? (urethral route)
overflow incontinence
stress incontinence
urge incontinence
mixed incontinence
75
what are the 2 main causes of extraurethral route of urine?
ectopic ureter
| fistula
76
in storage phase, compare intravesical and urethral pressure?
intravesicle pressure is less than urethral pressure
77
in voiding phase, compare intravesical and urethral pressure?
intravesicle pressure is more than urethral pressure
78
what is urodynamic testing?
determines pressures within the micturation system
79
in a normal situation, what happens to the intravesicle pressure on coughing?
increases
80
in a normal situation what happens to the abdominal pressure on coughing?
increases
81
in a normal situation what happens to the detrusor pressure on coughing?
no change
82
what is the underlying cause of overflow incontinence?
bladder outflow obstruction causing chronic retention
83
in overflow incontinence, is there an urgency to urinate?
no, you don't realise you have done it
84
compare the frequency of urination in a normal patient to someone with urge syndrome?
frequency is increased
85
compare the volume of urine voided in a normal patient to someone with urge syndrome?
small voided volumes
86
in a patient with urge syndrome due to detrusor overactivity, what happens to the detrusor pressure on coughing?
increases
87
what is the main cause of urge syndrome?
detrusor overactivity
88
what are the causes of detrusor overactivity?
- something in the wall of the bladder causing irritation (stone, tumour)
- loss of central inhibition of micturation reflex (paraplegia)
- idiopathic
89
compare loss of central inhibition of micturation reflex (paraplegia) to destruction of S2,3 centre in terms of cause of urge incontinence?
loss of central inhibition (paraplegia)- overacitivty of detrusor
destruction of S2-3 centre- loss of detrusor muscle function
90
what is idiopathic detrusor overacitivity?
urge syndrome caused by detrusor overacitivty with no undelying cause
91
how do you diagnose urge incontinence/syndrome?
urodynamic testing
92
what causes stress incontinence?
damage to pelvic floor or urethral function
93
what is the most common underlying cause of damage to pelvic floor/urethral function in stress incontinence?
childbirth
94
how do you diagnose stress incontinence?
urodynamic testing
95
is there urgency in stress incontinence?
no
| unless mixed incontinence
96
in a patient with stress incontinence, what happens to the detrusor pressure on coughing?
nothing (detrusor is working normally)
97
what happens to the volume of the urine leak in stress incontinence as the bladder becomes fuller?
volume increases
98
why might people with stress incontinence go to the toilet frequently even though there is no sense of urgency?
a learned habit, a technique to prevent the bladder volume getting large therefore preventing leaking volumes being large
99
what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and unable to get below it in a female who has amenorrhoea?
pregnancy
100
what is the most likely cause of a painless palpable mass arising from the pelvis which is dull to percus and cannot get below it in a middle aged male?
bladder
101
how do you treat overflow urinary incontinence?
catheterise and teach patient to intermittently self catheterise (rehabilitates the bladder)
102
what is the dietary treatment of urge urinary incontinence?
avoid caffeine
103
what is the pharmacological treatment of urge urinary incontinence?
antimuscarinics (oxybutynin, tolterodine)
| beta 3 adrenergic (mirabegron)
104
what invasive surgery can be done for the treatment of urge urinary incontinence?
bladder pacemaker
| enterocystoplasty (makes bladder larger)
105
what is the lifestyle treatment of stress incontinence?
weight loss
| stop smoking
106
what is the physio treatment of stress incontinence?
pelvic floor exercises
107
what is the surgical treatment of stress incontinence?
colposuspension
| tape procedures
108
what is the cause of an ectopic ureter?
congenital
109
what is the main cause of a vesico-vaginal fistula in developing countries?
prolonged obstructed labour
110
describe the appearance of bowen's disease of the penis?
dry crusty appearance
111
describe the appearance of erythroplasia of queyrat?
red velvety appearance
112
what type of 'carcinoma-in-situ' are bowen's disease and erythroplasia of queyrat when sited on the penis?
squamous carcinoma-in-situ
113
which has a bigger risk of squmaous carcinoma of the penis- circumscised or uncircumcised?
uncircumcised
114
where in the penis does squamous carcinoma tend to occur?
glans or prepuce
115
what are the risk factors of squamous carcinoma of the penis?
poor hygiene
HPV
phimosis
116
what occupational risk can predispose to SCC of scrotum?
chimney sweeps
117
what is benign nodular hyperplasia of the prostate?
irregular proliferation of both glandular and stromal prostatic tissue within the prostate
118
what is the aetiology of benign nodular hyperplasia?
hormonal imbalance
| alteration of androgen:oestrogen ratio
119
what is prostatism?
a group of symptoms caused by prostate disease
120
what are the main consequences of benign nodular hyperplasia of the prostate?
bladder hypertrophy
diverticulum
hydroureter/hydronephrosis
infection
121
what is the management of benign nodular hyperplasia?
usually drugs: alpha blockers, 5 alpha reductase inhibitors
| surgery: transurethral resection
122
what is the peak incidence of prostate carcinoma?
60 - 80 years old
123
where in the prostate are carcinomas most likely to occur?
peripheral ducts and glands
| usually posterior lobe
124
why are symptoms of prostatism a sign of advanced prostate cancer?
peri-urethral zone involved at a later stage
125
why are prostatic cancer bone mets distinct?
osteosclerotic instead of osteolytic
126
what protein is usually increased in prostatic carcinomas?
prostate specific antigen (PSA)
127
how do you take a biopsy of the prostate?
transurethal resection
| multiple needle core biopsies under US (trans rectal)
128
what might you feel on a PR exam of a prostate carcinoma?
craggy, hard, irregular mass
129
what is the drug management of a prostate carcinoma?
hormone therapy:
anti-androgens
LHRH agonists
oestrogens
130
what is the management of prostatic carcinoma bone mets?
radiotherapy
131
what is the surgical management of a prostate carcinoma?
radical prostatectomy
132
what type of prostate carcinoma is a radical prostatectomy reserved for?
organ-confined disease
133
what is a major risk factor for a testicular tumour?
maldescent
134
what is the usual presenting complaint of a testicular tumour?
testicular enlargement
135
describe the pain felt with testicular enlargement in a testicular tumour?
painless
136
why can gynaecomastia be a feature of testicular tumour?
hormonal secretion
137
what is the main type of testicular tumour?
germ cell tumours
138
what are the types of germ cell testicular tumours?
seminoma
teratoma
mixed
139
what are the types of stromal testicular tumour?
sertoli cell
| leydig cell
140
which specific stromal testicular cell tumour is known to cause gynaecomastia?
leydig cell tumour
141
what is the most common type of germ cell testicular tumour?
seminoma
142
what is the peak age of incidence of a seminoma?
30-50 years old
143
which lymph nodes does a seminoma usually spread to?
para-aortic lymph nodes
144
why is there such a high cure rate for seminomas, even with mets?
very radiosensitive
145
what is the peak age of incidence of a teratoma?
20-30 years
146
what cells does a teratoma arise from?
all 3 cell lines: endoderm, mesoderm, ectoderm
147
what are the 4 types of teratoma?
differentiated teratoma (DT)
malignant teratoma intermediate (MTI)
malignant teratoma undifferentiated (MTU)
malignant tertoma trophoblastic (MTT)
148
which of the teratomas is benign?
differentiated teratoma (DT)
149
which of the teratomas is entirely malignant?
malignant teratoma undifferentiated (MTU)
150
which of the teratomas contains trophoblastic (placental) tissue?
malignant teratoma trophoblastic (MTT)
151
which of the teratoma contains a mixture of differentiated and undifferentiated tissue?
malignant teratoma intermediate (MTI)
152
what hormone can malignant teratoma trophoblastic tumours secrete?
human chorionic gonadatrophin (bHCG)
153
what is a mixed seminoma teratoma tumour?
a type of germ cell tumour of the testes with seminoma and any variant of teratoma
154
what hormone can seminomas secrete?
placental alkaline phospatase (PLAP)
155
what part of the embryo secretes alpha fetoprotein? (AFP)
yolk sac
156
what tumours can secrete alpha fetoprotein? (AFP)
germ line tumours (testicular or ovarian)
hepatocellular carcinomas
liver mets
157
compare glomerulonephritis and pyelonephritis in terms of what causes it?
glomerulonephtiris- immunologcal basis
| pylonephritis- infectious agent
158
why can glomerulonephritis occur several weeks after an infection despite it being non-infective?
```
immunological mechanism
(ie antibody production)
```
159
what are the 2 main types of glomerulonephritis?
diffuse
| focal
160
which is more common- diffuse or focal glomerulonephritis?
diffuse
161
what is the main type of infectious agent which causes pyelonephritis
bacterial infection
162
what parts of the kidneys are involed in pyelonephritis?
renal pelvis, calyces
| spread into the tubules and interstitium
163
what is the most common organism of pyelonephritis?
E. Coli
164
what are the 2 subtypes of pyelonephritis?
acute
| chronic
165
is pyelonephritis more common in F or M?
females
166
what are the 2 ways of infection spread causing pyelonephritis? -which is more common?
```
haematogenous (rare)
ascending infection (common)
```
167
what is cystitis?
infection/inflammation of the bladder
168
why is pyelonephritis more common in females?
they have a shorter, wider urethra
169
why can pregnancy be a risk factor for pyelopnephritis?
ureteric dilatation with urine stasis because of:
- hormonal effects
- anatomial effects
170
what hormonal effects in pregnancy causes ureteric dilation with urine stasis? (a risk factor for pyelonephritis)
relaxation of smooth muscle in ureters
171
what anatomical effects in pregnancy cause ureteric dilation with urine stasis? (a risk factor for pyelonephritis)
obstruction from pregnant uterus
172
what is a major risk factor for pyelonephritis due to urine stasis?
urinary tract obstruction
173
what type of reflux can be a risk factor for pyelonephritis?
vesico-ureteric reflux
174
how can vesico-ureteric reflux be congenital?
ureters enter bladder perpendicular instead of oblique
175
what condition is a risk factor for pyelonephritis due to sugar content of urine?
diabetes
176
why do patients with chronic pyelonephritis urinate large volumes?
kidney damage so isn't able to concentrate urine as effectively
177
what infection of the kidney does 'sterile pyuria' indicate?
TB
178
how does TB spread to the kidneys?
haemotengous spread (usually from lung primary)
179
what is dysuria?
painful passing of urine
180
what is the principle techniquie for diagnosing TB?
PCR
181
what is the type of inflammation/necrosis that occurs with TB?
caseating granulomatous inflammation
182
when can cystitis become necrotising?
if associated with outlet obstruction
183
what can form within the benign hyperplasia of ureteritis or cystitis cystica?
fluid filled cysts
184
is urethral obstruction more common in F or M?
M
185
why is urethral obstruction more common in males?
they have a longer, tortuous urethra
186
what is the main cause of bladder outlet obstruction in a newborn male?
posterior urethral valves (in utero development abnormality)
187
what are the 2 main causes of hydronephrosis?
urinary tract obstruction
| prolonged vesico-ureteric reflux
188
would a neurogenic disturbance (ie in a paraplegic patient) cause unilateral or bilateral hydronephrosis?
bilateral
189
would a urethral obsturcion cause unilateral or bilateral hydronephrosis?
bilateral
190
would a calculi or neoplasm in a ureter cause unilateral or bilateral hydronephrosis?
unilateal
191
what happens to urine production if there is a sudden and complete obstuction?
urine production quickly ceases
192
what happens to urine production if there is gradual and partial obstruction?
urine production remains the same
193
compare sudden and complete obstruction to gradual and partial obstruction in terms of hydronephrosis?
sudden: little dilation
gradual: dilation
194
what is the term for secondary infection of a hydronephrotic kidney?
pyonephrosis
195
how do you determine whether there is haematuria?
urine dipstick test
196
what does macroscopic haematuria mean?
visible haematuria
197
wht does microscopic haematuria mean?
non-visible haematuria
198
what is a common contaminate of urine in a women of child-bearing age, causing it to become red?
menstruation
199
why might there be myglobin within the urine? (causing it to become red)
```
rhabdomyolisis
mcArdle disease (metabolic disorder)
bywaters/crush syndrome
```
200
what drugs cause red urine?
```
doxyrubicine
chloroquine
rifampicin
nitrofurantoin
senna containing laxatives
```
201
what toxins can cause red urine?
lead
| mercury
202
what colour urine might increased urobilinogen in the urine cause?
brown coloured urine
203
what causes pneumaturia?
any connection between bowel and bladder
204
what causes faecaluria?
any connection between bowel and bladder
205
on CT urogram, what is indicated if there is a defect of bladder filling?
there is an obstruction within the bladder
206
what is a urethrocystoscopy?
an endoscopic picture of the bladder by placing an endoscope through the urethra
207
what is post-obstructive diuresis?
dramatic increase in urine output (200ml/hr) after release of urinary tract obstruction (must be bilateral- ie both kidneys affected)
208
what are the 2 factors necessary for post-obstructive diuresis?
accumulation of total body water, sodium and urea (eg oedema, CCF, hypertension, uraemia)
OR
impairement of tubular re-absorption
209
compare physiological post-obstructive diuresis to pathological post-obstructed diuresis?
physiological- self limiting, stops after return to euvolaemic state
pathological- inappropriate diuresis beyond euvolaemic state
210
usually post-obstructive diuresis is self limiting, how long does this take?
24-48 hours
211
in severe cases of post-obstructive diuresis beyond euvolaemic state, what management is needed?
IV fluid
| sodium replacement
212
what is the treatment for ureteric colic?
NSAIDs +/- opiate,
+ alpha blocker (tamsulosin) for small stones expected to pass
wait for 1 month to see if surgical intervention is necessary
213
what is the likelihood of spontaneous passage of renal stones if they are less than 4mm?
80%
214
what is the likelihood of spontaneous passage of renal stones if they are between 4-6mm?
50-60%
215
what is the likelihood of spontaneous passage of renal stones if they are above 6mm?
20%
216
what are the indications for urgent intervention of a renal stone?
pain unrelieved
pyrexia
persistent nausea and vomiting
high-grade obstruction
217
what is the intervention for renal stones in the absence of infection?
ureteric stent
| stone fragmentation
218
what is the intervention for renal stones with infected hydronephrosis?
percutaneous nephrostomy
219
what age is torsion of the spermatic cord most common?
puberty
220
torsion of spermatic cord is usually spontaneous but may occur with what?
trauma
| athletic activities
221
describe the pain with torsion of spermatic cord?
sudden onset severe pain
may have prev episodes of self limiting pain
referral of pain to lower abdomen
222
on examination of torsion of spermatic cord what signs do you see?
testis high in scrotum
transverse lie
absence of cremasteric reflex
223
what is the management of torsion of spermatic cord?
prompt surgical exploration
224
why must you fix the contralateral side in testicular torsion?
to prevent it occuring to the other testis
| -due to bell clapper deformity
225
what is the most common cause of testicular torsion?
bell clapper deformity
226
how is torsion of appendage differentiated from torsion of spermatic cord?
testis should be mobile
cremasteric reflex present
blue dot sign
227
what is generally seen in the history of epididymitis?
UTI
urethritis
catheterisation/instrumentation
228
is the cremasteric reflex present in epididymitis?
yes
229
what is a general indicator of epididymitis over testicular torsion?
pyrexia
230
what will you see on doppler US of epididymitis?
swollen epididymis, increased bloodflow
231
what is the management of confirmed torsion of appendage?
will resolve spontaneously
232
what is the management of epididymitis?
analgesia + scrotal support
bed rest
ofloxacin 400mg 14 days
233
instead of pain, what may be felt in idiopathic scrotal oedema?
pruiritis
234
what is paraphimosis?
painful swelling of foreskin distal to a phimotic ring
235
what often causes paraphimosis within hospital?
forgetting to replace foreskin in natural position after catheterisation or cystoscopy
236
what is priapism?
prolonged (often painful) erection >4hours
237
is priapism associated with sexual arousal?
no
238
what are the 5 causes of priapism?
- intracorporeal injection for erectile dysfunction
- trauma
- haematological conditions (eg sickle cell)
- neurological conditions
- idiopathic
239
what are the classifications of priapism?
ischaemic (low flow)
| non-ischamic (high flow)
240
what is seen in the aspirate of blood from corpus cavernosum in low flow (ischaemic) priapism?
dark blood, low O2, high CO2
241
what is seen in the aspirate of blood from corpus cavernosum in high flow (non-ischaemic) priapism?
normal arterial blood flow
242
what is seen in duplex US in low flow (ischaemic) priapism?
minimal or absent flow
243
what is seen in duplex US in high flow (non-ischaemic) priapism?
normal to high flow
244
what is the management of ischaemic priapism?
aspiration +/- irrigation with saline
injections of alpha-agonist
surgical shunt
(only if early presentation)
245
what is the management of a non-ischaemic priapism?
observe, may resolve spontaneously
| if not: selective arterioal embolisation with non-permanent materials
246
what is fornier's gangrene?
necrotising fasciitis occuring around the male genitalia
247
what are the 4 main risk factors of fornier's gangrene?
diabetes
local trauma
periurethral extravasation
perianal infection
248
how does fornier's gangrene start?
as a cellulitis: swollen, red, tender, pain, fever
249
what investigations can confirm gas in the tissues in fornier's gangrene?
US or X-ray
250
what is the management of fornier's gangrene?
antibiotics
| surgical debridement
251
what types of pathogens cause emphysematous pyelonephritis?
gas forming uropathogens
| usually E coli
252
what risk factors predisposed to emphysematous pyelonephritis?
diabetics
| ureteric obstruction
253
what investigations can confirm gas in the tissues in emphysematous pyelonephritis?
CT KUB
254
what does a perirenal abscess usually result from?
a rupture of an acute cortical abscess
| or from haematogenous seeding from other sites of infection
255
how do you investigate a perirenal abscess?
CT
256
what is the management of a perinephric abscess?
antibiotics
| percutaneous or surgical drainage
257
describe renal trauma type 1?
non-expanding haematoma, subcapsular, no parenchymal laceration
258
describe renal trauma type 2?
laceration less than 1cm parencymal depth
| no urinary extravasation
259
describe renal trauma type 3?
laceration greater than 1cm
| no collecting system rupture or extravasation
260
describe renal trauma type 4?
laceration through cortex, medulla and collecting system
| arterial/venous injury with contained haemorrhage
261
describe renal trauma type 5?
shattered kidney
avulsion of hilum
devascularised kidney
262
what are the indications for imaging the kidneys after trauma in an adult?
frank haematuria
| non visible haematuria + shock/penetrating injury
263
what are the indications for imaging the kidneys after trauma in a child?
frank or non-visible haematuria
264
what is the investigation for imaging the kidneys after trauma?
CT contrast
265
what fracture is bladder injury most commonly associated with?
pelvic fracture
266
what are the 6 main signs of bladder injury?
```
suprapubic/abdo pain
inability to void
suprapubic tenderness
lower abdo bruising
guarding
diminished bowel sounds
```
267
what is the imaging investigation of choice for possible bladder trauma?
CT cystography
268
on examination of a urethral injury what 5 main signs are seen?
```
blood at external urethra meatus
inability to urinate
palpably full bladder
'high riding' prostate
butterfly perineal haematoma
```
269
what is the imaging investigation of choice for possible urethra trauma?
retrograde urethrogram
270
what fractures are urethral injuries often associated with?
fracture of pubic rami
271
when do penile fractures typically occur?
during sex
| -buckling injury when penis slips out of vagina and strikes pubis
272
what sound is heard on penile fracture?
cracking or popping
273
what are the symptoms of penile fracture?
pain
rapid detumescence
discolouration
swelling
274
what is the management of a penile fracture?
prompt exploration and repair
| 'degloving of penis' to expose all 3 compartments
275
what is the investiation of choice for testicular trauma?
ultrasound
276
what is the management of a urethral injury?
supraupubic catheter
| delayed reconstruction after at least 3 months
277
what is the management of bladder injury with no indications for immediate repair?
antibiotics
| repeat cystogram in 14 days
278
what is the verumontanum of the prostate?
where the ejaculatory ducts drain to each side of the prostatic urethra
279
what is the transitional zone of the prostate?
the area which surrounds the urethra, proximal to the verumontanum
280
what is the central zone of the prostate?
cone shaped region which surrounds the ejaculatory ducts
281
what is the peripheral zone of the prostate?
posteriolateral prostate
282
which zone of the prostate gives rise to benign prostate hyperplasia?
transitional zone
283
which zone of the prostate gives rise to the majority of carcinomas?
peripheral zone
284
what is the anterior part of the prostate made up?
fibromuscular stroma
285
what is the most common malignancy affecting men in the UK?
prostate cancer
286
what type of cancers are the majority of prostate cancers?
multifocal adenocarcinomas
287
what scoring system grades prostate cancers?
gleason's scoring
288
what hormones is the growth of prostate cancer cells under the influence of?
testosterone
| dihydrotestosterone
289
what happens if prostate cells are deprived of androgenic stimulation?
undergo apoptosis
290
what can initially happen on treatment of prostate carcinoma with LHRH agonists?
initial androgen surge
291
what can be given to prevent initial androgen surge with LHRH?
anti-androgens
292
what is the function of LHRH in prostate carcinoma?
cause suppression of pituitary LH and FSH secretion and therfore testosterone production
293
compare steroidal and non-steroidal anti-androgens in terms of libido and sexual interest?
steroidal (eg cyprosterone): loss of libido and sexual interest
non-steroiral: no loss of libido or sexual interest
294
what are the 2 types of transitional cell carcinoma? and give percentages
papillary 80%
| non papillary 20%
295
compare papillary and nonpapillary transitional cell carcinomas in terms of percentage that are considered to be malignant?
papillary: 50%
| non-papillary: all considered to be malignant
296
what are the 2 subtypes of papillary transitional carcinoma?
papilloma
| invasive papillary carcinoma
297
what are the 2 subtypes of nonpapillary transitional carcinoma?
flat non invasive carcinoma
| flat invasive carcinoma
298
what are the most common benign asymptomatic renal lesions?
benign renal cysts
299
what imaging is best for looking at a renal cyst?
ultrasound
300
what is the main consequence of angiomyolipomas?
haemorrhage
| may have wunderlich's syndrome- massive retroperitoneal bleeding
301
what imaging is best for looking at a suspected angiomyolipoma?
CT
302
what benign renal tumour can appear to be a carcinoma?
oncoytoma
303
what feature of oncocytoma is very characteristic?
stellate scar
304
what type of carcinoma is a renal cell carcinoma?
adenocarcinoma
305
what part of the kidney is affected by renal cell carcinoma?
proximal convoluted tubule
306
if renal cell carcinoma is multifocal or bilateral then what syndrome should you suspect?
von hippel-lindau syndrome
307
what is the best imaging for diagnosing a renal cell carcinoma?
triple phase contrast CT
308
what is the main form of renal cell carcinoma treatment?
radical or partial nephrectomy
309
what are the 4 main premalignant conditions of penile cancer?
Bowen's disease
Erythroplasia of Queyrat
Balanitis Xerotica Obliterans
Leukoplakia
310
what do you see in balanitis xerotica obliterans of the penis?
white patches, fissuring, bleeding, scarring of prepuce and glans
311
what is the treatment of balantis xerotica obliterans?
circumcision
| may need glans resurfacing
312
what is the main difference in location of bowen's disease and erythroplasia of queyrat of the penis? (both are squamous cell carcinoma in situ)
erythroplasia of queyrat is on glans, prepuce or shaft
| bowen's is on the other parts of genitalia
313
what is the treatment of bowen's disease or srythroplasia of queyrat of the penis?
circumcision
| topical 5-fluorouracil
314
what is the surgical treatment of a penis carcinoma?
total/partial penectomy
| reconstruction
315
what is the best imaging technique for suspected testicular tumour?
ultrasound
316
what hormone is 100% elevated in a malignant teratoma trophobastic?
bHCG
317
what is the main underling cause for glomerulonephritis?
immune-complex deposition
318
why can renal artery stenosis worsen pre-existing hypertension?
RAS kicks in
319
what type of necrosis is found in the kidneys due to malignant hypertension?
fibrinoid necrosis
320
compare seminomas and teratomas in terms of radio/chemotherapy?
seminomas- radiosensitive
| teratomas- chemosensitive
321
why can a patient become anaemia due to kidney failure?
loss of production of erythropoietin
322
what must you do to a patient who has a pericardial rub in the presence of uraemia?
immediate dialysis
323
why might vomiting cause acute kidney injury?
due to dehydration
324
what does ACEI/ARBs have a protective function against?
proteinuria
| -help preserve kidney function
325
what does ACEI/ARB have a negative effect on?
dehydration
| ie in vomiting
326
who is at risk of contrast nephropathy?
patients who are dehydrated
| patients who already have renal impairment
327
in what condition are you most likely to feel palpable kidneys?
ADPKD
328
why must you always correct hypotension in kidney disease?
kidneys need a certain perfusion to work
329
below what blood pressure should you aim to get a patient who has kidney disease?
less 130/80
330
what is the diastolic pressure above in accelerated hypertension?
above 120mmHg
331
what can be seen on fundoscopy of accelerated hypertension?
papilloedema
332
what is leukonychia found in?
profound hypoalbuminaemia
333
what immunoglobulin is involved in Henoch-Schonlein Purpura?
IgA
334
what is the classic distribution of Henoch-Schonlein Purpura?
extensor surfaces of legs and buttocks
335
what is rhabdomyolysis and why can it cause kidney injury?
muscle breakdown
| myoglobin is a product and cannot be processed properly by the kidney
336
what is the CK like in rhabdomyolysis?
very high
337
how many grams of protein in the urine classes as asymptomatic low grade proteinuria?
up to 1g
338
how many grams of protein in the urine classes as heavy proteinuria?
1-3g per day
339
how many grams of protein in the urine classes as within nephrotic range?
>3g per day
340
what are the 2 main ways to quantify urine protein?
24 hour urinary collection
| urine protein/creatinine ratio
341
under microscopy of urine, compare what isomorphic and dysmorphic red blood cells indicate?
isomorphic- coming from lower down renal tract
| dysmorphic- coming frohigher up the renal tract
342
what biochemistry abnormality does tented T waves on ECG suggest?
hyperkalaemia
343
what does hyperkalaemia eventually lead to in terms of patients heart rate/pulse?
cardiac arrest
344
what stage of kidney disease does GFR >90 with symptoms indicate?
stage 1
| kidney damage with normal GFR
345
what stage of kidney disease does GFR from 60-89 with symptoms indicate?
stage 2
| kidney damage with mildly reduced GFR
346
what stage of kidney disease does GFR from 30-59 indicate?
stage 3
| moderately reduced GFR
347
what stage of kidney disease does GFR from 15- 29 indicate?
stage 4
| severely reduced GFR
348
what stage of kidney disease does GFR of less than 15 indicate?
stage 5
| kidney failure
349
what are the main features of nephrotic syndrome?
proteinuria >3g per day
hypoalbuminuria
oedema
(hypercholesterolaemia)
350
why might it be hard to determine if someone has nephrotic syndrome?
often have normal renal function
351
oedema of what site is a classical sign of nephrotic syndrome?
periorbital oedema
352
compare nephrotic syndrome and nephritic syndrome in terms of pulmonary oedema?
no pulmonary oedema in nephrotic syndrome
| pulmonary oedema in nephritic syndrome
353
why do you not tend to get pulmonary oedema in nephrotic syndrome even though oncotic pressure is low?
becasue the capillary pressure within the lungs is still very low
354
which are you more likely to get with acute kidney injury- nephrotic or nephritic syndrome?
nephritis syndrome
355
what are the 5 main symptoms/signs of nephritic syndrome?
```
oliguria
hypertension
oedema
proteinuria
haematuria
```
356
what is chronic kidney disease?
reduced GFR over a length of time
357
what is eGFR calculated using?
serum creatinine
358
when muscle mass is low, is eGFR under or over estimated?
over estimated
359
when muscle mass is high is eGFR under or over estimated?
under estimated
360
stage 1 and stage 2 of CKD are dependent on evidence of kidney damage, what does this mean?
proteinuria, haematuria (in absence of lower urinary tract cause), or abnormal imaging
361
what does CKD do to cardiovascular disease?
increases risk
362
what does proteinuria do to the likelyhood of CKD to progress stages?
increases risk of progression
363
why can reflux nephropathy cause CKD?
due to recurrent UTI causing scarring
364
what is the most common cause of CKD?
diabetes
365
what might happen initially to gfr when putting a patient with CKD on an ACEI/ARB?
initial fall
366
what do ACEI/ARB do to proteinuria?
reduces proteinuria
367
what does smoking do to the rate of progression of CKD?
increases rate progression
368
at what stage of CKD are statins recommended?
stage 4
369
how do you correct iron deficiency anaemia in CKD?
IV iron
370
if patient on CKD is anaemic but iron has been replaced, what hmight be indicated?
erythropoietin injections
371
why can bone disease occur in CKD?
vitamin D cant be hydroxylated properly
leading to reduced calcium absorption
leading to secondary hyperparathyroidism which takes calcium out of bones to maintain serum calcium
372
what happens to the levels of serum phosphate in CKD and what does this do to the levels of PTH?
serum phosphate increases
| PTH increases
373
what eventually happens to CKD patients in secondary hyperparathyroidism?
tertiary hyperparathyroidism
374
what happens to the blood vessels and heart valves in a patient with CKD who has tertiary hyperparathyroidism?
vascular and valvular calficiation
375
how do you treat bone disease in CKD?
alfacalcidol (hydroxylated vit D)
| phosphate binders
376
at what gfr should dialysis education be started?
20ml/min (earlier if progressing fast)
377
what is the best form of access for haemodialysis?
arteriovenous fistula
378
how long does it take for an arteriovenous fistula to mature for haemodialysis?
6 weeks
379
at what gfr should you refer a patient to vascular surgeons for the creating of an arteriovenous fistula?
15ml/min
380
how long after creation of a catheter for peritoneal dialysis can it be used?
1-2 weeks
381
when do patients get put on the cadaveric transplantation list for a kidney?
within roughly 6 months of dialysis
382
what is acute kidney injury?
an abrupt reduction in kidney function defined as an absolute increase in serum creatinine by 26.4micromoles per litre (or 50% increase over baseline)
383
how should you split the causes of AKI?
pre renal
renal
post renal
384
what does pre-renal causes of AKI mean?
anything that reduces kidney perfusion
385
what does post-renal causes of AKI mean?
obstruction of renal outflow
386
what does renal causes of AKI mean?
intrinsic causes
387
what are the 3 subgroups of pre-renal AKI?
hypovolaemia
hypotension
renal hypoperfusion
388
why might haemorrhages, diarrhoea, vomitting or burns cause AKI?
causes hypovolaemia which is a pre-renal cause of AKI
389
why might cardiogenic, septic or anaphylactic shock cause AKI?
causes hypotension which is pre-renal cause of AKI
390
why might NSAIDs or ACEI/ARBs cause AKI?
reduces renal perfusion which is a pre-renal cause of AKI
391
what is hepatorenal syndrome?
kidney failure as a result of liver failure
392
why does hepatorenal syndrome cause AKI?
reduces renal perfusion which is a pre-renal cause of AKI
393
how do you calculate urine output depending on weight?
0.5ml/kg/hr
394
what defines oliguria?
less than 0.5mls/kg/hr of urine output
395
what does untreated pre-renal AKI lead to?
acute tubular necrosis
396
what is the commonest form of AKI?
acute tubular necrosis due to decreased renal perfusion (from a combination of factors)
397
what is the main aim of pre-renal AKI treatment?
reverse factors that have caused it (ie eupportive treatment)
398
to reverse hypotension causing AKI, what do you do?
fluid challenge with saline, if over 1000mls has been given with no improvement seek help
399
what are the 4 subgroups of renal AKI?
vascular disease
glomerular disease (glomerulonephritis)
interstitial injury
tubular injury
400
what is the main cause of vascular disease causing renal AKI?
vasculitis (eg ANCA associated)
401
what are the 3 main causes of interstitial nephritis causing renal AKI?
drugs
infection eg TB
systemic causes eg sarcoidosis
402
what types of drugs cause interstitial nephritis?
PPI
NSAIDs
antibiotics
403
what type of renal AKI does rhabdomyolysis cause?
tubular injury
404
what kind of renal AKI does contrast cause?
tubular injury
405
what does renal vascular bruits indicate?
renal artery stenosis
406
why can compartment syndrome lead to AKI?
causes rhabdomyolysis (a renal cause of AKI)
407
what initial tests alow you to look for myeloma?
protein electrophoresis and bence-jones protein
408
what 3 things must you ensure before performing a renal biopsy?
normal clotting
normotensive
no hydronephrosis
409
what imaging technique do you usually use to assist with renal biopsy?
ultrasound
410
what are the 4 indications for immediate dialysis?
- hyperkalaemia over 7 (or 6.5 unresponsive to medical therapy)
- fluid overload
- severe acidosis (pH below 7.15)
- uraemia (urea over 40) with pericardial effusion
411
what are the 2 ways of treating post renal AKI to relieve obstruction?
catheter
| nephrostomy
412
what is the normal range for serum potassium?
3.5-5
413
what range of potassium indicates hyperkalaemia?
over 5.5
414
what range of potassium indicates life threatening hyperkalaemia?
over 6.5
415
what happens to the T wave, P wave and QRS complex in hyperkalaemia? (on ECG)
T wave becomes peaked
loss p of wave
widening of QRS complexes
416
what 4 drugs are indicated in acute life threatening hyperkalaemia?
calcium gluconate
insulin
dextrose
nebulised salbutamol
417
what is the function of calcium gluconate in hyperkalaemia?
protects myocardium
418
what is the function of insulin, dextrose and salbutamol in hyperkalaemia?
moves K back into cells
419
what is the function of calcium resonium?
prevents K absorption from the GI tract
420
what drug do you give a patient who is acidotic?
sodium bicarbonate
421
what are the 3 main nephrotoxic drugs?
NSAIDs
ACEI/ARB
antibiotics (eg gentamicin)
422
what are the 4 main risk factors for AKI development?
age, diabetes, CKD, co-morbidities
423
what is the most common cause of end stage renal disease?
diabetes
424
what is the second most common cause of end stage renal disease?
chronic glomerulonephritis
425
what is glomerulonephritis?
immune-mediated disease of the kidneys afecting the glomeruli
426
does damage to endothelial or mesangial cells lead to a proliferative or non-proliferative glomerulonephritis?
proliferative
427
does damage to podocytes lead to a proliferative or non-proliferative glomerulonephritis?
non-proliferative
428
what abnormality is found in urine in proliferative glomerulonephritis?
red blood cells
| some protein
429
what abnormality is found in urine in non-proliferative glomerulonephritis?
protein
430
what does microalbuminuria mean?
30-300mg of albuminuria per day
431
is nephritic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?
proliferative glomerulonephritis
432
is nephrotic syndrome indicative of a proliferative or non-proliferative glomerulonephritis?
non-proliferative
433
compare nephritic and nephrotic syndrome in terms of renal function?
nephritic- renal failure
| nephrotic- normal renal function usually
434
why might nephrotic syndrome cause you to become mildly immunosuppressed?
lots of antibodies leave in the urine
435
why is there a prothrombotic state in nephrotic syndrome?
liver increases production of prothrombotic factors (exacerbated by volume depletion)
436
which vein should you be particularly concerned about thrombosis in within nephrotic syndrome?
renal vein thrombosis
437
compare focal and diffuse glomerulonephritis?
focal- less than 50% of glomeruli affected
| diffuse- more than 50% of glomeruli affected
438
compare global and segmental glomerulonephritis?
global- all of glomerulus affected
| segmental- parts of glomerulus affected
439
what drugs should be used for hypertension in the treatment of GN and why?
ACEI/ARB
| also control proteinuria
440
what indicates complete nephrotic syndrome remission?
proteinuria less than 300mg per day
441
what indicates partial nephrotic syndrome remission?
proteinuria less than 3g per day
442
what is the most common cause of nephrotic syndrome in children?
minimal change glomerulonephritis
443
what do you see on light microscopy, electron microscopy and immunofluorescence (renal biopsy) of minimal change glomerulonephritis?
LM- normal
IF- normal
EM- foot process fusion
444
can minimal change nephropathy progress to renal failure?
no
445
what is the main treatment for minimal change glomerulonephritis?
oral steroids
446
is minimal change glomerulonephritis proliferative ir non-proliferative?
non proliferative
447
what is the most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis
448
can focal segmental glomerulosclerosis progress to renal failure?
yes
449
is focal segmental glomerulosclerosis proliferative or non-proliferative?
non proliferative
450
what is the 2nd most common cause of nephrotic syndrome in adults?
membranous nephropathy
451
what is seen on renal biopsy of membranous nephropathy?
immune complex deposition in the basement membrane
452
can membranous glomerulonephritis progress to renal failure?
yes
453
is membranous glomerulonephritis proliferative or non-proliferative?
non proliferative
454
what is the most common type of glomerulonephritis?
IgA nephropathy
455
can IgA nephropathy progress to renal failure?
yes
456
is IgA nephropathy proliferative or non-proliferative?
proliferative
457
what vasculitis is IgA nephropathy associated with?
Henoch-Schonlein Purpura
458
what glomerulonephritis is associated with glomerular crescents?
rapidly progressive glomerulonephritis
459
what are the 2 subgroups of rapid progressive glomerulonephritis?
anca positive
| anca negative
460
what type of glomerulonephritis is SLE associated with?
rapidly progressive glomerulonephritis
461
is rapidly progressive glomerulonephritis proliferative or non proliferative?
proliferative
462
what type of glomerulonephritis is goodpastures disease associated with?
rapidly progressive glomerulonephritis
463
compare post-strep glomerulonephritis and IgA nephropathy in terms of how long after URTI it occurs?
post strep- 2-3 weeks
| IgA nephropathy- 2-3 days
464
is post strep glomerulonephritis proliferative or non-proliferative?
proliferative
465
what does CKD do to the risk of cardiovascular disease?
increases it
466
what kind of diet must a patient who is on dialysis have?
fluid restricted (1l per day)
low salt
low potassium
low phosphate (take phosphate binders with meals)
467
what is the gold standard dialysis access?
fistula
468
compare a fistula to other dialysis access in terms of infection risk?
fistula access has a reduced infection risk
469
what can happen if haemodialysis isn't done by a gradual build up?
disequilibrium syndrome
| -cerebral oedema and seizures
470
what type of diabetic patients can get a kidney pancreas dual transplant?
type 1 diabetic patients
471
which MHC class are HLA A, HLA B and HLA DR?
```
class 1: HLA A, HLA B
class II, HLA DR
```
472
what antibiotics are given for pneumocystits jirovecii?
co-trimoxazole
473
what type of skin cancer is much increases post transplant?
SCC
474
what cancercan does post-transplant EBV infection cause?
lymphoma
475
what are the 3 phases of rejection?
hyperacute (minutes)
acute
chronic
476
what is hyperacute rejection caused by?
preformed antibodies
477
how is hyperacute rejection treated?
unsalvageable
478
what is acute rejection caused by?
T or B cell mediated response
479
what are the 3 phases of transplant immunosuppression?
induction
consolidation
maintenance
480
what drug must azathioprine never be given with?
allopurinol
481
what are the types of donor kidney?
- deceased brain dead
- deceased cardiac death
- live donor
482
what is diabetic nephropathy defined by?
albuminuria (greater than 300mg in 24 hours) on 2 occasions 3-6 months apart
483
what are the haemodynamic changes that diabetes does to the afferent arteriolar? and how?
vasodilation of afferent arteriole by vasoactive mediaprs
484
why does diabetes initially cause a raised GFR?
vasodilated afferent arteriole increases the blood flow and so increases the filtration pressure
485
how does diabetes cause renal hypertrophy?
plasma glucose stimulates several growth factos within the kidneys
486
what are kimmelstein wilson lesions?
nodular lesions of diabetic glomerulosclerosis
487
why does proteinuria occur in diabetes?
glomerular basement membrane thickens and the podocytes become impaired (bigger spaces between them)
488
why may haematuria require renal biopsy in the context of diabetic nephropathy?
haematuria is not a feature of diabetic nephropathy so need to look for another cause
489
how do you prevent/treat diabetic nephropathy?
- good glycaemic control
- good blood pressure control
- lipid sontrol
490
what drugs are used as anti-hypertensive therapy to prevent/treat diabetic nephropathy?
ACE I/ARB
491
what drugs are used to maintain good lipid control to prevent/treat diabetic nephropathy?
statin
492
how do ACE I/ARBs help to reduce progression of proteinuria in diabetics?
dilates the efferent arteriole so reduces the filtration pressure
(this pressure was initially increased because of filation of the afferent arteriole due to diabetes)
493
what drug should you offer a diabetic patient with persistent microalbuminuria who is normotensive?
ACE I/ARB
494
what drugs should you offer a diabetic patient with persistent microalbuminruria and hypertension?
ACE I/ARB
| plus diuretic or another antihypertensive
495
what is renovascular hypertension?
hypertension secondary to renal artery stenosis (renovascular disease)
496
why does renal artery stenosis cause hypertension?
reduces renal perfusion activates RAS system
497
what are the 2 main types of renovascular disease?
fibromuscular dysplasia
| atherosclerotis renovascular disease
498
what is ischaemic nephropathy?
reduced renal blood flow (ie renal artery stenosis) beyond the level of autoregulatory compensation so gfr is reduced
499
what does ischaemic nephropathy lead to?
renal atrophy and progressive CKD
500
what is the treatment for renal artery stenosis?
blood pressure control
reduce cardiovascular risk factors
angioplasy
stenting
501
what is multiple myeloma?
a cancer of plasma cells which accumulates in the bone marrow
502
why can you get normocytic anaemia in multiple myeloma?
plasma cell accumulation in bone marrow and so intereferes with production of red blood cells
503
what paraprotein does myeloma tend to produce?
Bence Jones protein
504
why are the proteins secreted in myeloma not detected on urine dipstick?
urine dipstick only tests for albumi so doesnt detect abnormal paraproteins
505
what type of lesions are found on skeletal survey of multiple myeloma?
lytic lesions
506
what are the 4 renal manifestations of myeloma?
hypercalcaemia (leading to AKI)
monoclonal immunoglobulin deposition disease
cast nephropathy
amyloidosis
507
what are the 2 types of amyloidosis?
primary
| secondary
508
what type of conditions does secondary amyloidosis occur in?
chronic inflammatory conditions
509
what is seen histologically in amyloidosis?
positive congo red staining showing apple-green birifringence under polarised light
510
why can GPA, eGPA, MPA have pulmonary haemorrhage?
as a consequence of alveolar capillary involvement
511
what is seen on renal biopsy of GPA, MPA and eGPA?
segmental necrotising glomerulonephritis
512
what are the 6 classes of lupus nephritis?
1: minimal mesangial
2: mesangial proliferative
3: focal proliferative
4: diffuse proliferative
5. membranous
6: advanced sclerosing
513
how do you calculate the therapeutic index?
Lethal Dose 50/Effective Dose 50
514
what are the 2 phases of drug metabolism?
phase 1: oxidation, reduction and hydrolysis
| phase 2: conjugation (makes drug water soluble)
515
do adverse drug reactions tend to happen in phase 1 or phase 2 of metabolism?
phase 1
516
what are type A drug reactions?
dose dependent and predictable
517
what are type B drug reactions?
idiosyncratic
| -dose independent and unpredictable
518
what are type C drug reactions?
chronic effects
519
What are type D drug reactions?
delayed effects
520
What are type E drug reactions?
end of treatment efects
521
what are type F drug reactions?
failure of therapy
522
what are the most common type of drug reactions?
type A
523
compare ADPKD type 1 to ADPKD type 2 in terms of progression to end stage kidney failure?
ADPKD 1 develops ESKF at an earlier stage
524
what is the most common extral renal feature of ADPKD?
hepatic cysts
525
what is the management of ADPKD before renal failure?
hypertension control
hydration
proteinuria control
control cyst haemorrhage/infection
526
what drug treatment can be used to reduce cyst volume and progression in ADPKD?
tolvaptan
527
what is the management of ADPKD after renal failure?
dialysis
| transplant
528
what type of inheritance is Alport's syndrome?
X linked
529
what type of collagen is affected in Alports syndrome?
type IV collagen
530
what does alports syndrome cause?
hereditary nephritis
531
what is the characteristic feature of alport's syndrome?
haematuria
532
what confers bad prognosis in alport's syndrome?
proteinuria
533
what are the 3 main extra renal manifestations of alports syndrome?
sensorineural deafness
ocular lens defect (anterior displacement)
dysphagia
534
what is the treatment of alports syndrome?
BP control
proteinuria control
dialysis
transplantation
535
what is seen on renal biopsy of alports disease?
variable thickness glomerular BM
536
what is the inheritance of anderson fabrys disease?
X linked
537
what causes anderson fabrys disease?
inborn error of metabolism
| deficiency of a-galactosidase A
538
what is seen on the skin of patients with anderson fabrys disease?
angiokeratomas
539
what is the treatment of anderson fabrys disease?
fabryzyme (enzyme replacement)
| management of complications
540
what is the inheritance of medullary cystic kidney?
autosomal dominant
541
where are cysts fund in medullary cystic kidney?
corticomedullary junction or medulla
542
what is the gross appearance of medullary cystic kidney?
normal or small kidneys
543
what is the treatment of medullary cystic kidney disease?
renal transplant
544
what hapens to the collecting ducts in medullary sponge kidney?
become dilated
545
how do you diagnose medullary sponge kidney?
excretion urography
546
what is seen in the cysts within medullary sponge disease?
calculi
547
what is the inheritance of medullary sponge kidney?
sporadic
