Genitourinary

Question 1

What is the definition of acute kidney injury?

Answer 1

Significant deterioration in renal function occurring over hours or days

Question 2

What is the aetiology of acute kidney injury?

Answer 2

Pre-renal (decreased perfusion), renal (acute tubular necrosis, glomerulonephritis, post-renal (benign prostatic hyperplasia, kidney stones, tumour)

Question 3

What is the clinical presentation of acute kidney injury?

Answer 3

Oliguria, fatigue, or tiredness, shortness of breath (severe cases: pulmonary oedema, encephalopathy, pericarditis)

Question 4

What are the investigations of acute kidney injury?

Answer 4

o Creatinine: elevated
o Urine output: <0.5 ml/kg for > 6 consecutive hours
o Urea: elevated

Question 5

What is the treatment of acute kidney injury?

Answer 5

Treat underlying cause, dialysis, manage complications (hyperkalaemia, pulmonary oedema, uraemia, acidaemia), fluid management

Question 6

What is the definition of chronic renal failure?

Answer 6

Abnormalities of kidney structure or function present for > 3 months

Question 7

What is the aetiology of chronic renal failure?

Answer 7

Acute renal failure, hypertension, diabetes, kidney disease

Question 8

What is the clinical presentation of chronic renal failure?

Answer 8

Asymptomatic, tired, bone pain, fluid overload, anorexia

Question 9

What are the investigations of chronic renal failure?

Answer 9

o Blood: low calcium, high phosphate, high PTH

o Kidney biopsy

Question 10

What is the treatment of chronic renal failure?

Answer 10

BP control, ACE inhibitors, treat complications, dialysis, transplant

Question 11

What is the classification of chronic renal failure?

Answer 11

o G1: GFR ≥ 90 (normal or high)
o G2: GFR 60-80 (mildly decreased)
o G3a: GFR 45-59 (mildly to moderately decreased)
o G3b: GFR 30-44 (moderately to severely decreased)
o G4: GFR 15-29 (severely decreased)
o G5: GFR <15 (kidney failure)

Question 12

What is the definition of acute nephritic syndrome?

Answer 12

Inflammation and damage to the glomeruli due to an immune response triggered by an infection

Question 13

What is the aetiology of acute nephritic syndrome?

Answer 13

IgA nephropathy, streptococcal infection, SLE, Goodpasture’s, ANCA

Question 14

What is the pathophysiology of acute nephritic syndrome?

Answer 14

IgA immune complex deposition

Question 15

What is the clinical presentation of acute nephritic syndrome?

Answer 15

Asymptomatic, visible haematuria, hypertension, oedema

Question 16

What are the investigations of acute nephritic syndrome?

Answer 16

o Renal biopsy: IgA deposition
o Urinalysis: haematuria and red cell casts, proteinuria
o Urine output: low

Question 17

What is the treatment of acute nephritic syndrome?

Answer 17

ACE inhibitors (reduce BP and proteinuria)

Question 18

What is the definition of nephrotic syndrome?

Answer 18

Proteinuria due to podocyte pathology

Question 19

What is the aetiology of nephrotic syndrome?

Answer 19

Minimal change disease (podocyte fusion), diabetes, amyloid, SLE, focal segmental glomerulosclerosis

Question 20

What is the clinical presentation of nephrotic syndrome?

Answer 20

Pitting oedema, frothy urine

Question 21

What are the investigations of nephrotic syndrome?

Answer 21

o Urinalysis: proteinuria

o Serum albumin: hypalbuminaemia

Question 22

What is the treatment of nephrotic syndrome?

Answer 22

Fluid and salt restriction, and diuretics (oedema), treat underlying cause (steroids in minimal change disease), ACE inhibitor (reduce proteinuria)

Question 23

What is the definition of polycystic kidney disease?

Answer 23

Inherited disorder in which clusters of cysts develop within the kidney causing them to enlarge and lose function

Question 24

What is the aetiology of polycystic kidney disease?

Answer 24

ADPKD (PKD1/2), ARPKD (PKHD1)

Question 25

What is the clinical presentation of polycystic kidney disease?

Answer 25

Hypertension, flank pain and mass, haematuria, polycystic liver disease, intracranial aneurysms (subarachnoid haemorrhage)

Question 26

What are the investigations of polycystic kidney disease?

Answer 26

Ultrasound scan

Question 27

What is the treatment of polycystic kidney disease?

Answer 27

High water intake (suppress cyst growth), BP control, cyst decompression

Question 28

What is the definition of nephrolithiasis?

Answer 28

Stones in the urinary tract, usually consisting of calcium oxalate

Question 29

What is the clinical presentation of nephrolithiasis?

Answer 29

Renal colic, loin pain which radiates to the groin, dysuria, urgency, frequency, recurrent UTI's, haematuria, vomiting

Question 30

What are the investigations of nephrolithiasis?

Answer 30

o Bloods (calcium, phosphate, and urate) o Urinalysis o Ultrasound: hydronephrosis (swelling of the kidney) o NCCT-KUB

Question 31

What is the treatment of nephrolithiasis?

Answer 31

Conservative (<5mm, IV fluids, analgesia, anti-emetics), medical (nifedipine), Lithotripsy (fragment stones), surgical (PCNL for larger stag horn stones)

Question 32

What is an epididymal cyst?

Answer 32

Benign cyst of the epididymis which presents with small paratesticular swelling which may be tender and can be removed if symptomatic

Question 33

What is hydrocele?

Answer 33

Accumulation of fluid in between the tunica vaginalis layers due to trauma. It presents with scrotal swelling and can spontaneously resolve, or require aspiration or surgery

Question 34

What is varicocele?

Answer 34

Persistent abnormal dilation of the pampiniform venous plexus which presents with nodularity, dull ache, distended scrotal blood vessels. Surgery can be performed if symptomatic

Question 35

What is the clinical presentation of a testicular torsion?

Answer 35

Sudden onset of pain in testes, abdominal pain, nausea and vomiting

Question 36

What are the investigations of a testicular torsion?

Answer 36

o Doppler ultrasound: lack of blood flow | o Surgical exploration

Question 37

What is the treatment of a testicular torsion?

Answer 37

Surgical untwisting

Question 38

What is the definition of benign prostatic hyperplasia?

Answer 38

Enlargement of the prostate gland due to an increase in cell number

Question 39

What is the clinical presentation of benign prostatic hyperplasia?

Answer 39

Frequency, nocturia, hesitancy, post void dribbling

Question 40

What is the treatment of benign prostatic hyperplasia?

Answer 40

Alpha-blockers (tamsulosin), 5-alpha-reducatse inhibitors, transurethral resection of prostate

Question 41

What is the aetiology of urinary treat infections?

Answer 41

E. coli, coagulase negative staphylococcus, proteus mirabililis, enterococci, klebsiella pneumonia

Question 42

What is the clinical presentation of urinary treat infections?

Answer 42

Frequency, urgency, dysuria, haematuria, suprapubic pain, (fever, rigors, vomiting, pyuria, loin pain if pyelonephritis)

Question 43

What are the investigations of urinary treat infections?

Answer 43

o Urinalysis: leucocytes or nitrates o Microscopy: WBCs, RBCs, casts, bacteria o MCS MSU: >105 organisms/ml

Question 44

What is the treatment of urinary treat infections?

Answer 44

Antibiotics (trimethoprim (avoid in pregnancy), nitrofurantoin)

Question 45

What is the clinical presentation of Chlamydia Trachomatis?

Answer 45

o Male: asymptomatic, urethritis, testicular pain | o Female: asymptomatic, vaginal discharge, bleeding, lower abdominal/pelvic pain

Question 46

How is Chlamydia Trachomatis diagnosed?

Answer 46

Nucleic acid amplification test

Question 47

What is the treatment of Chlamydia Trachomatis?

Answer 47

Avoid sexual intercourse, doxycycline (CI pregnancy) or azithromycin, contact tracing

Question 48

What is the clinical presentation of Neisseria Gonorrhoea?

Answer 48

o Male: asymptomatic, urethritis, purulent discharge, dysuria o Female: endocervicitis (pelvic pain), vaginal discharge, itch, dysuria

Question 49

How is Neisseria Gonorrhoea diagnosed?

Answer 49

o Nucleic acid amplification test | o Microscopy: gram-negative diplococci with polymorphonuclear cells

Question 50

What is the treatment of Neisseria Gonorrhoea?

Answer 50

Ceftriaxone