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Flashcards in Clinical Deck (547):
1

what is kidney agenesis?

a congenital absence of one or both kidneys

2

what is kidney hypoplasia?

a congenital condition causing small kidneys with normal development and function
(reduced capacity)

3

what is a horseshoe kidney?

kidneys congenitally fused at either pole- usually lower

4

do simple cysts usually cause a functional disturbance?

no

5

what are the 2 main types of polycystic kidney disease?

-autosomal recessive PKD (prev known as infantile)
-autosomal dominant PKD (prev known as adult)

6

what is the most common subtype of ARPKD?

perinatal group

7

what does the perinatal group of ARPKD cause?

terminal renal failure

8

what happens to the medullary collecting ducts in ARPKD?

cystic dilation

9

what liver condition is ARPKD associated with?

congenital hepatic fibrosis

10

what is the most common inherited kidney disease?

autosomal dominant polycystic kidney disease

11

compare ADPKD 1 and ADPKD2 in terms of chromosomes affected? (give percentages)

ADPKD 1: defect on chromosome 16 (90%)
ADPKD 2: defect on chromosome 4 (10%)

12

what is the aetiology of ARPKD?

genetic

13

what is the aetiology of ADPKD?

genetic

14

when does ADPKD present?

usually in middle adult life

15

what does ADPKD present with?

abdominal mass
haematuria
chronic renal failure
hypertension

16

where do cysts arise in ARPKD?

medullary collecting tubules

17

where do cysts arise in ADPKD?

any part of the nephron

18

which other organs can be affected with cysts in ADPKD?

liver
pancreas
lung

19

what functionally happens to the liver, pancreas, lung when affected in ADPKD?

no funcional effect

20

what aneurysm is ADPKD associated and what can this lead to?

berry aneurysm in circle of Willis

can lead to subarachnoid haemorrhage

21

compare ARPKD and ADPKD in terms of the gross shape of the kidney?

ARPKD- enlargment but shape is still there
ADPKD- massive enlargement, shape is distorted

22

why can haematuria occur in ADPKD?

cysts can be filled with blood

23

compare the causes of intracerebral haemorrhage and subarachnoid haemorrhage in ADPKD?

intracerebral- due to hypertension caused by chronic renal faiulre
subarachnoid- due to berry aneurysm in circle of Willis

24

what is the most common benign renal tumour?

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