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Medicine Phase 2a GU > General > Flashcards

General Flashcards

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1
Q

Functions of the kindey

A
  • Filter or secrete waste/excess substances
  • Retain albumin and circulating cells
  • Reabsorb glucose, amino acids and bicarbonates
  • Control BP, fluid status and electrolytes
  • Activates 25-hydroxy vitamin D (by hydroxylating it to form 1,25 dihydroxy
    vitamin D)
  • Synthesis erythropoietin
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2
Q

Define GFR

A

Glomerular filtration rate

Volume of fluid filtered from the glomeruli into Bowman’s space per unit time (mins)

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3
Q

Normal GFR

A

120ml/min (7.2L/h)

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4
Q

What % of the cardiac output does each kidney receive

A

20%

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5
Q

True or False:

eGFR can help predict creatinine generation

A

True
Creatinine is produced by muscles and eliminated (only) by the kidneys
Predicts Creatinine generation from age gender and race also

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6
Q

What is reabsorbed at proximal convoluted tubule?

A

Sugars
Amino acid
Bicarbonate
Main portion of Na+ (70%) and water follows

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7
Q

True or False:

PCTs are not vulnerable to ischaemic injury

A

False

ARE vulnerable to ischaemic injury, resulting in acute tubular necrosis

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8
Q

What part of nephron is most vulnerable to damage

A

Proximal Convoluted Tubule

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9
Q

Example of disease of PCT

A

Fanconi syndrome:

  • proximal tubular insult
  • caused by cytinosis, Wilsons and TENOFOVIR drug (used in HIV)
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10
Q

What can result from disease of the PCT

A

Glycosuria (glucose in urine)
Acidosis with failure of urine acidification
Phosphate wasting resulting in rickets/osteomalacia
Aminoaciduria (amino acid in urine)

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11
Q

What % of Na+ is reabsorbed by Loop of Henle

A

25%

and water follows

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12
Q

Example of a drug that can act on Loop of Henle

A

Loop diuretic

as alot of Na+ filtered here and water follows, if can block here can have a large effect

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13
Q

Example of loop diuretic

A

Furosemide

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14
Q

Which part of the LoH are sodium potassium chloride transporters more active?

A

Ascending loop

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15
Q

What % of sodium is reabsorbed in Distal Convulted Tubule

A

5%

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16
Q

What diuretics act on DCT

A

Thiazide diuretics e.g. Chlorothiazide

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17
Q

When would Juxtaglomerular apparatus release renin

A

Juxtaglomerular apparatus is a solute sensing organ.
If detects high solutes (e.g. Na+), it will think GFR is low so releases renin.
JXA effectively senses Blood Pressure

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18
Q

What part of nephron does salt handling

A

Collecting duct as by this point, most of salt has been reabsorbed

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19
Q

What ions are secreted by the collecting duct into urine

A

K+

H+

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20
Q

Name 2 hormones that act on collecting ducts

A

Aldosterone - increases the transcription of eNac channels which absorb Na+ in exchange for K+
Vasopressin - water is absorbed via aquaporin 2
channels

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21
Q

How does hyperaldosteronism lead to hypokalemic alkalosis

A

In hyperaldosteronism (high aldosterone) there is lots of Na+ reabsorption resulting in a negative lumen, consequently K+ and H+ rush in and this results in hypokalaemic alkalosis.

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22
Q

What can you give to correct hyperkalemic acidosis (like in Addisons)

A

Sodium Bicarbonate

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23
Q

Would you get alkalosis or acidosis with loop diuretics

A

Alkalosis

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24
Q

Which hormone acts on renal potassium control

A

Aldosterone

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25
K+ is freely filtered and mostly reabsorbed in which parts of nephron
PCT | LoH
26
Effect of insulin or catecholamines on cellular K+ uptake
Increase uptake
27
Which K+ modifying renal medication cause hypokalemia
Loop diuretics | Thiazide diuretics
28
Which K+ modifying renal medication cause hyperkalemia
- Spironolactone (aldosterone antagonist) - Amiloride (acts on eNac channels) - ACE inhibitors (Ramipril) - Angiotensin receptor blockers (ARB) - Trimethoprim (acts on eNac channels but milder)
29
Are diuretics nephrotoxic
Diuretics are NOT NEPHROTOXIC but hypovolaemia (which they can cause e.g. loop & thiazide diuretics) IS Loop and thiazide diuretics together are extremely powerful and effective together resulting in profound diuresis
30
If plasma is too concentrated, what is released by hypothalamus/posterior pituitary to dilute it
ADH (vasopressin)
31
What is erythropoietin
Hormone that produces haemoglobin | Produced in response to tissue hypoxia
32
When can erythropoietin be given
In advanced kidney disease and anaemia to help increase O2 transport
33
In anaemia, what is expected GFR
GFR <30
34
True or false: | Renal cortex acts as an oxygen sensor
True | Blood flow and oxygen are matched
35
What reaction occurs in kidneys in production of vitamin D
25-hydroxy vitamin D is hydroxylated to form 1,25-dihydroxy vitamin D (calcitriol)
36
What is effect on Calcium levels in kidney failure
Kidney cannot hydroxylate 25-hydroxy vitamin D to calcitriol. Therefore Calcium cant be absorbed from gut and so would theoretically decrease
37
Effects of calcitriol
* Increases Ca2+ and phosphate absorption from the gut * Increases phosphate absorption to a lesser extent * Suppresses parathyroid hormone (PTH)
38
What condition can result from calcitriol deficiency and why
Secondary Hyperparathyroidism Low vitamin D results in low Ca2+ and phosphate resulting in increased PTH (which causes Ca2+ and phosphate leeching from bones as well as increased osteoclast activity and reduced bone)
39
What comprises upper urinary tract
Kidneys | Ureters
40
What comprises lower urinary tract
Bladder (reservoir) Prostate gland (in men) (Uterus in women) Urethra and urethral sphincter
41
What is the function of (lower) urinary tract
Micturition To convert the continuous process of excretion (urine production) to an intermittent, controlled volitional process
42
Essential features of lower urinary tract
* Low pressure and insensible storage of urine of adequate capacity * Prevent leakage of the urine stored * Allow rapid, low-pressure voiding at an appropriate time and place
43
What is the mean arterial pressure that drives filtration in the Bowman's capsules
60-70mmHg
44
Why is there a progressive reduction in pressure along the nephron
Due to reabsorption as you go along | Pressure in collecting duct system is 3-10mmHg
45
Describe neuronal control of voiding
Pontine micturition centre stimulates excitatory control to detrusor nucleus and inhibits Onuf’s nucleus. Signal is transmitted from spinal root S2-4 via the parasympathetic nervous system and this results in contraction of detrusor muscles and relaxation of the urethra.
46
Which spinal roots stimulate urination (voiding)
S2-S4 (parasympathetic - cholinergic)
47
Describe neuronal control of stopping urination (storage)
Pontine storage centre stimulates and sends inhibitory signals to detrusor muscles and excitatory signals to Onuf’s nucleus Signal is transmitted from spinal root T10 to L2 via the sympathetic nervous system and this results in the relaxation of the bladder and contraction of the urethral sphincter
48
What is the storage of the bladder
around 500ml
49
Epithelium of bladder
Urothelium (transtitional) Highly specialised stratified 3-7 cells thick Umbrella structure that is completely impermeable so cannot reabsorb urine Able to fold and unfold to increase volume
50
Why are men more likely to develop problems with retention
Have a greater voiding pressure due to them having a longer urethra. Thus more likely to develop retention.
51
Why are women more likely to have problems with incontinence
Have a shorter urethra with lower resistance and thus higher flow rates
52
What urology complications can occur if the spinal cord is cut above S2-4?
Will only be able to urinate when the bladder is full | Descending pathway will not be able to inhibit this
53
Normal flow rates in men aged: <40 40-60 >60
21ml/s (<40) 18ml/s (40-60) 13ml/s (>60)
54
What can reduce flow rates
Obstruction within the lower urinary tract | Detrusor underactivity
55
How much urine needs to be void for representative flow rate measurement
At least 125ml
56
What is normal PVR (Post Void Residual)
<12ml
57
Examples of disease that can occur from elevated PVR (Post Void Residual)
Hydronephrosis | Elevated creatinine
58
Example cause of high PVR (Post Void Residual)
Detrusor underactivity
59
Complications of BPE
``` Symptom progression (17-40%) Infections (0.1-12%) Stones (0.3-3.4%) Haematuria Acute retention (1-2% per year) Chronic retention Interactive obstructive uropathy (<2.5%) ```
60
What is main substance made by prostate
PSA - liquifies semen - glycoprotein produced by prostate cells
61
What zone of the prostate is the urethra in
Transitional zone (adjacent to central zone and surrounded by peripheral zone)
62
Which zone of prostate is most often enlarged by prostate tumour
Peripheral zone
63
Prostate cancer epidemiology
``` Fam Hx in 5-10% Mean diagnosis age is 72 Common in industrialised West Most commonly diagnosed cancer in men Lifetime risk ~15% ```
64
What type of cancer is prostate cancer
Adenocarcinoma
65
Where does prostate cancer spread
Spreads locally thorugh prostate capsule | Metastasises to lymph nodes and bone (sclerotic) and occasionally to lung, liver and brain
66
Biomarkers for prostate cancer
Tissue biopsy Serum (blood) Prostate-Specific Antigen or Prostate-Specific Membrane Antigen (more leakage of PSA, not more produced) Urine - PCA3 or Gene fusion products (TMPRSS2-ERG)
67
when would you see high PSA
Benign prostate enlargement UTI Prostatitis (70% of men with high PSA do NOT have prostate cancer, 6% of men with prostate cancer will have a normal PSA) higher PSA means higher risk of prostate cancer >20ng/ml likely metastatic cancer (most common place is bone) <2.5 not likely cancer
68
Diagnosis of prostate cancer
``` LUTS PSA Transrectal ultrasound scan Prostate biopsy Prostate cancer grading ```
69
Grading of prostate cancer
``` Gleason grading (from biopsy) Partin's nomograms - combine clinical T stage, PSA and biopsy Gleason score ```
70
Staging of prostate cancer
T stage: T1-no palpable tumour on DRE T2-palpable tumour, confined to prostate T3-palpable tumour extending beyond prostate N stage = MRI scan, CT scan, (laparoscopy) M stage = Bone scan
71
Treatment of Localised Prostate cancer
Curative - surgery; radiotherapy (external beam, brachytherapy); adjuvant hormones If not then just observation (active monitoring/survellience
72
Treatment of Locally advanced prostate cancer
Local control: | Surgery; radiotherapy + neoadjuvant hormone therapy
73
Treatment of Metastatic prostate cancer
Palliative - Hormone therapy
74
How could you confirm localised prostate cancer if high PSA is detected
Transrectal ultrasound | Biopsy of prostate gland
75
Surgery for localised prostate cancer (also do radiotherapy)
Radical prostatectomy | Open, robotic (most robotic)
76
What is focal therapy (prostate cancer)
High intensity ultrasound (HIFU), photodynamic therapy (TOOKAD)
77
Pros of radical treatment of localised prostate cancer
Curative treatment High mortality in prostate cancer Reduced patient anxiety Benefits of surgery shown by longitudinal studies
78
Cons of radical treatment of localised prostate cancer
Disease of the elderly Competing causes of death 30% of men with prostate cancer die OF prostate cancer Adverse effects of treatment
79
Treatment of metastatic prostate cancer
``` Surgical castration -reduced pain due to bony metastases -prolonged survival -median survival 2.5 years Androgen deprivation therapy (GNrH analogues; LH antagonists) ```
80
Prognosis of advanced prostate cancer
80% androgen-sensitive Castration leads to remission of advanced disease (apoptosis of cancer cells) Median response is 2 years
81
What can be given if prostate cancer is castration-resistant
2nd line HRT: Abiraterone and Enzalutamide Cytotoxic chemo Bisphosphonates (Zoledronic acid) Palliation
82
Most common site of metastasis of prostate cancer
Bone
83
Are majority or minority of prostate cancer cases T1c
Majority (detected on PSA testing)
84
Reasons for screening for prostate cancer
Commonest cancer in men – lifetime risk c. 9% Responsible for 10,000 deaths per annum in UK. 4th most common cause of cancer death. 3% of men will die of prostate cancer.
85
Reasons against screening for prostate cancer
Uncertain natural history Overtreatment Morbidity of treatment
86
Benefits of PSA testing
Early diagnosis of localised disease (cure) | Early treatment of advanced disease (effective palliation)
87
Risks of PSA testing
Over-diagnosis of insignificant disease | Harm caused by investigation/ treatment
88
Prevention of prostate cancer
Dietary | 5 alpha-reductase inhibitors

Medicine Phase 2a GU (18 decks)

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