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Urology > Disease Table Notes: > Flashcards

Disease Table Notes: Flashcards

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1
Q

Aetiology prostate cancer

A 
commonest male cancer
older
African Caribbean 
Western countries 
FH
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2
Q

Pathology prostate cancer

A

Mostly adenocarcinomas

Affecting peripheral zone

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3
Q

Signs prostate cancer

A

PSA

Mass on PR

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4
Q

Symptoms prostate cancer

A

Often asymptomatic
Prostatic symptoms
Weight loss
Lethargy

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5
Q

Prostatic symptoms

A

Hesitancy
Poor stream
Termina dribbling

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6
Q

Symptoms locally invasive prostate cancer

A 
Haematuria 
Suprapubic pain 
Anuria 
Weight loss 
Lethargy 
Incontinence 
Impotence
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7
Q

Symptoms distant mets prostate cancer

A

Bone pain
Sciatica
Paraplegia
LN enlargement

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8
Q

Investigations prostate cancer

A 
PSA 
PR 
Transrectal US + biopsy 
CT 
MRI
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9
Q

Rx for prostate cancer

A

Watchful waiting
Radical prostatectomy
Hormone therapy
Active surveillance

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10
Q

What is PSA

A

Protease produced by semen

Many leaked into serum

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11
Q

when do you not measure PSA?

A

after PR

ejaculation

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12
Q

What can causes elevations in PSA?

A

UTI
Chronic prostatitis
BPH
Prostate cancer

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13
Q

Risk factors testicular cancer

A 
Young males 
Infertility 
Atrophic testis 
Previous cancer in contralateral testis 
FH
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14
Q

2 types of testicular cancer

A

Seminoma

Non-seminomatous:

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15
Q

Commonest type of testicular cancer

A

Germ cell tumour

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16
Q

Testicular cancer tumour markers

A

Alpha fetoprotein
Beta HCG
LDH/lactase dehydrogenase

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17
Q

Symptoms testicular cancer

A

Painless lump
Trauma often brings people to notice lumps
Pain

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18
Q

Symptoms lung mets in testicular cancer

A

Dyspnoea

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19
Q

Investigations testicular cancer

A

MSSU
Testicular USS

Mets:
CXR
CT chest/abdo/pelvis

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20
Q

Rx testicular cancer

A

Orchidectomy

Radiotherapy

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21
Q

Rx testicular cancer metastases

A

Chemotherapy

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22
Q

Common mets site testicular cancer

A

Para-aortic LN
Chest
Bone

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23
Q

Risk factors renal cancer

A 
M
FH 
Smoking 
Anti-hypertensives
OBesity 
End-stage renal disease
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24
Q

Subtypes renal cancer

A

Clear cell
Papillary
Chromophobe

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25
Classic triad renal cancer
Flank pain Haematuria Mass
26
Symptoms renal cancer
Haematuria Loin pain Weight loss Anorexia
27
Investigations for renal cancer
``` U&E's FBC US CT MRI ```
28
RX renal cancer
radical nephrectomy
29
How does RCC respond to chemo and radio?
Resistant to both
30
2 benign lesions of kidneys
Oncocytoma | Angiomyolipoma
31
Risk factors TCC bladder cancer
Smoking | Aromatic amines
32
Risk factors squamous cell carcinoma
Schistosomiasis Chronic cystitis Recurrent UTI Pelvis radiotherapy
33
What do most RCC arise from
TCC
34
Symptoms of bladder cancer
Frank haematuria Recurrent UTI Dysuria
35
Investigations for bladder cancer
Cystoscopy + biopsy CT urogram USS
36
Investigations for bladder cancer staging
CT MRI Bone scan if suspected mets
37
RX for grade non-muscle invasive bladder cancer
TURBT | Followed by chemo
38
Rx for High grade non-invasive bladder cancer
BCG therapy | Radical surgery
39
RX muscle invasive bladder cancer
Radical cystectomy | Radiotherapy
40
Follow up bladder cancer
Regular cystoscopy
41
Common mets bladder cancer
Iliac LN Para-aortic LN Liver Lungs
42
Risk factors UTI
``` F (short urethra) Sexual activity DM Pregnancy Renal cysts Renal stones Catheterisation Instrumentation (cystoscopy) BPH Loss of bladder sensation (stasis of urine) Congenital ```
43
Common UTI organisms
E.coli Proteus sp. Staph saprophyticus
44
Symptoms UTI
``` Dysuria Frequency Urgency Polyuria Haematuria Suprapubic pain ```
45
Investigations for UTI
MSSU: >105 Catheter: Collected from catheter sampling port
46
Uncomplicated UTI treatment
3d course: Trimethoprim Nitrofurantoin eGFR >30
47
RX Men UTI
7d course Trimethoprim Nitrofurantoin eGFR>30
48
RX UTI in pregnancy
Nitrofurantoin | NOT trimethoprim
49
Who should be screened for UTI
Pregnant W
50
What might recurrent UTI in young males be a sign of?
Chlamydia
51
What is acute polynephritis
Acute kidney infection
52
Symptoms of acute polynephritis
Fever Rigors Loin pain Urinary symptoms
53
Rx for acute polynephritis
Ciproflaxin
54
Commonest kidney stone type
Calcium oxalate
55
Are more M or F affected with urothliasis
M
56
Symptoms of kidney stone?
Loin tenderness Dysuria Haematuria UTI
57
Commonest presentation of kidney stones
Loin pain
58
Imaging for kidney stones
CT KUB KUB x-ray USS
59
Investigations for kidney stones
``` FBC U&E's Creatinine Albumin Calcium Phosphate ```
60
Rx for kidney stones
Analgesics: NSAIDS ESWL PCNL Ureteroscopy
61
When is ESWL not effective for renal stones?
>2cm Cystine stones In pregnancy
62
Indications for PCNL
Large stones | PUJ stenosis
63
What is AKI
Sudden episode of kidney failure or kidney damage that occurs within hrs/days Increase in Serum Creatinine by ≥26.5 umol/l Or ≥1.5x baseline Urine output <0.5ml/kg/hr for 6 hrs
64
Who is AKI common in
Hospitalised patients
65
Risk factors for AKI
``` Age>75 Previous AKI HF Liver disease CKD DM Vascular disease Common hospitalised patients ```
66
Pre-renal causes AKI
``` Hypovolaemia Arterial occlusion ACE inhibitors Haemmorhage Hypotension (shock) ```
67
Renal causes AKI
``` Toxin related (NSAIDS, aminoglycosides) Acute interstitial nephritis Acute tubular necrosis Acute GN Vasculitis ```
68
Which drugs are notoriously renal toxic?
Gentamicin NSAIDs Aminoglycosides
69
Post renal causes AKi
``` Obstruction Stones Malignancy Stricture Fibrosis ```
70
Investigations AKI
``` Serum creatinine Urine output Potassium ECG USS Renal biopsy Proteinuria? Haematuria? ```
71
ECG signs hyperkalaemia
Tall tented T waves | Increased PR interval
72
Rx fluid balance AKI
Volume resuscitation Optimised BP Stop ACE inhibitors
73
Rx toxicity AKI
Stop nephrotoxic drug
74
RX for hyperkalaemis
Calcium gluconate IV insulin + glc Salbutamol
75
Consequences AKI
``` Acidosis Electrolyte imbalance Intoxication Fluid overload Uraemia symptoms: gout ```
76
Definition of CKD
Defined by either the presence of kidney damage Or eGFR <60ml/min that is present 3 months
77
Causes of CKD
``` Hypertension DM GN Renovascular disease Polycystic kidney disease Chronic exposure to toxins ```
78
Define stage 1 CKD
GFR>90
79
Define stage 2 CKD
GFR 60-89
80
Define stage 3 CKD
GFR 30-59
81
Define stage 4 CKD
15-29
82
Define stage 5 CKD
<15
83
Blood investigations CKD
``` U&E’s K+ Urea Creatinine Bicarb Albumin Calcium LFT’s ```
84
Urine investigations CKD
Blood Protein PCR 24hr collection
85
Histology investigations CKD
Biopsy | Clotting factors
86
Radiology investigations CKD
USS Plain radiograph CT MRI
87
Rx hypertension CKD
Look diuretics
88
RX CKD
``` Manage the underlying cause Establish good DM control Treat hypertension Erythropoietin Sodium bicarbonate Restrict fluid and salt intake Loop diuretics Activated vitamin D analogues RRT Kidney Tx ```
89
When is RRT required for CKD
Stage 5 | <15 GFR
90
Long term complications of CKD
``` Acidosis Renal bone disease Death and dialysis Uraemic complications Hypertension ```
91
Examples of uraemic complications in AKI and CKD
Pericarditis Encephalopathy Gout
92
How does CKD lead to anaemia
Kidneys are responsible for erythropoietin production Which stimulate production of RBC from bone marrow So in CKD: Reduced erythropoietin production Lower production of RBC Anaemia
93
Treatment for anaemia in CKD
Rx give erythropoietin
94
Describe bone disease in CKD
Loss or renal tissue leads to lack of activated Vit D3 Indirect reduction in calcium absorption from gut Leads to hypocalcaemia PTH is released causing the bones to lose calcium Over time this resorption of calcium from the bones leads to brittle bones
95
Describe serum calcium and phosphate levels in CKD
High serum phosphate | Low serum calcium
96
Describe acidosis in CKD
Worsen hyperkalaemia
97
Describe hyperkalaemia in CKD
K+ normally secreted with exchange for Na+ absorption in distal tubule Reduced deliver of Na+ to distal tubule as GFR falls Therefore, retain potassium Leading to hyperkalaemia
98
What can K+ >7mmol/L cause
Fatal cardiac arrhythmia
99
Which zone does BPH typically affect?
Transitional zone
100
What is BPH common with?
Increasing age
101
Which score is used for prostate symptoms?
International prostate symptoms score
102
What are the voiding symptoms of BPH
Hesitancy Poor stream Terminal dribbling Incomplete emptying
103
What are storage symptoms of BPH
Frequency Nocturia Urgency Urge incontinence
104
Investigations for BPH
``` PSA MSSU Flow rate study Urea Creatinine Flexible cystoscopy Renal USS Prostate biopsy ```
105
Medical therapy for BPH
Alpha blocker | 5 alpha reductase inhibitors
106
Surgical treatment for BPH
Transurethral resection of prostate | TURP
107
Potential side effect of TURP
Impotence
108
Complications of BPO
``` Progression of LUTS Acute or chronic urinary retention Urinary incontinence UTI Bladder stone Renal failure due to hydronephrosis ```
109
Characteristics of nephritis syndrome
Haematuria Hypertension Little proteinuria Low urine vol.
110
Pathology of IgA nephropathy
IgA deposits in the mesangium Causing increased proliferation in mesangial cells Irritates mesangial cells and causes them to proliferate and produce more matrix IgA becomes stuck in mesangium and becomes clogged with antibody
111
Symptoms of IgA nephropathy
Haematuria Proteinuria <1g Hypertension
112
Investigations for IgA nephropathy
Renal biopsy
113
Rx IgA nephropathy
ACEi/ARB | Corticosteroids
114
What does post infective nephritis commonly follow?
Pharyngitis Impetigo Streptococcal infection
115
How long after infection does post infective nephritis occur?
10-21 days
116
Rx for post-infective nephritis
Antibiotics for infection
117
Pathology of post infective nephritis
Streptococcal antigen deposits in the glomerulus leading to immune complex formation and inflammation
118
Triad of nephrotic syndrome
Heavy proteinuria Oedema Hypoalbuminaemia
119
Treatment for oedema
Furosemide
120
3 main nephrotic syndromes
Minimal change disease Membranous Nephropathy Focal Segmental Glomerulonephritis
121
3 main Nephritic Syndormes
IgA Nephropathy Post infective Nephritis Cresentic Glomerulonephritis
122
Who is minimal change disease most commonly seen in?
Children
123
Symptoms minimal change disease
Sudden onset oedema Proteinuria Hyperlipidaemia
124
Treatment for minimal change disease
Corticosteroids: | Prednisolone
125
Does minimal change disease cause renal failure?
No
126
Investigations for minimal change disease
Urinanalysis 24hr protein urine Serum albumin levels Urine protein/creatinine reation
127
Pathology membranous glomerulonephritis
Thickened glomerular basement membrane Diffusely thickened due to sub epithelial deposits of IgG Activates compliment C3 which punches holes in the membrane Glomerular membrane thickened by leaky Allowing albumin to be filtered (oedema)
128
Signs of membranous glomerulonephritis
Oedema Hypoalbuminaemia Heavy proteinuria
129
Which antibody is seen in membranous glomerulonephritis
PLA2R
130
Which three areas does glomerulonephritis with polyangitis commonly affect
Kidney Lungs Nose
131
What can membranous glomerulonephritis be secondary to?
Malignancy Infection Rheumatoid Arthritis Drugs
132
Pathology of focal and segmental glomerulosclerosis
Scar tissue formation in segments of some glomeruli | Segmental sclerosis and hyalinosis
133
Symptoms/signs of focal and segmental glomerulosclerosis
Proteinuria Hypoalbuminaemia Hyperlipidaemia Oedema
134
Does focal and segmental glomerulosclerosis pose a risk of CKD?
yes
135
Rx for focal and segmental glomerulosclerosis
ACEi/ARB Furosemide Rutiximab

Urology (13 decks)

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