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GU Flashcards

1
Q

common presentations of a renal colic?

A

acute loin pain that comes and goes, can’t get comfortable and radiates to groin

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2
Q

what is the gold standard investigation for a renal colic?

A

non-contrast CT of kidney, ureter and bladder

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3
Q

what is the complication that may occur when obtaining a contrast CT?

A

risk of anaphylaxis

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4
Q

what is the first line investigation for a renal colic?

A

XR of kidney, ureter and bladder - isn’t as specific as CT

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5
Q

What is the most common composition of renal stones?

A

calcium oxalate

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6
Q

what is most common presentation in bladder cancer?

A

painless haematuria

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7
Q

what storage symptoms occur in BPH?

A

Frequency, Urgency, Nocturia

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8
Q

what voiding symptoms occur in BPH?

A

Straining, Hesitancy, Incomplete emptying, Poor stream, Post-micturition dribbling

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9
Q

how does tamsulosin work in respect to BPH?

A
  • it is a selective alpha 1-adrenenergic receptor antagonist
  • relaxes the smooth muscle in the bladder neck and prostate -> increasing urinary flow rate -> improves obstructive symptoms
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10
Q

what are potential side effects of alpha 1 adrenoceptors, e.g. tamsulosin?

A

postural hypotension, dizziness and syncope (due to alpha 1 adrenoceptors also being found in smooth muscle of blood vessels, therefore can also lower vascular resistance)

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11
Q

list the most common organisms to cause a UTI

A

KEEPS - Klebsiella, E. Coli, Enterococcus, Proteus/Pseudomonas, Staphylococcus saprophyticus

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12
Q

how do you define minimal change disease?

A

Proteinuria (>3.5g/day), Hypoalbuminaemia, Oedema (periorbital and arms), Hyperlipidaemia and lipiduria

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13
Q

why does proteinuria occur in minimal change disease?

A

damaged glomerulus is more permeable → more protein come across from blood into nephron → proteinuria

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14
Q

why does oedema occur in minimal change disease?

A

oncotic pressure falls due to less protein in blood → lower osmotic pressure → water driven out of vessels into tissues

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15
Q

why does Hyperlipidaemia and lipiduria occur in minimal change disease?

A

loss of protein = less lipid synthesis → more lipids in blood → more in urine

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16
Q

why do potassium levels need to be regulated in AKI?

A

failed kidney function -> inability to excrete potassium -> builds up in blood -> hyperkalaemia -> medical emergency / cardiac arrest

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17
Q

describe the stages of CKD in relation to GFR

A
  • Stage 1 > 90 ml/min with evidence of renal damage
  • Stage 2 60-89 ml/min with evidence of renal damage
  • Stage 3a 45-59 ml/min with or without renal damage
  • Stage 3b 30-44 ml/min with or without renal damage
  • Stage 4 15-29 ml/min with or without renal damage
  • Stage 5 <15 ml/min, established renal failure
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18
Q

describe furosemide’s pharmacology

A

a loop diuretic which acts on the ascending limb of the loop of Henle and inhibits the NKCC2 channels

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19
Q

which tumour marker is most likely to be raised in suspected testicular cancer?

A

alpha feto-protein (AFP)

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20
Q

what is the gold standard investigation for transitional cell carcinoma?

A

cystoscopy

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21
Q

what is the name of the staging system used for prostate cancer?

A

Gleason scoring

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22
Q

those with ADPKD have a 10-15% chance of suffering with a what?

A

intercranial aneurysm e.g. subarachnoid haemorrhage

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23
Q

what is released from where in response to decreased renal perfusion (e.g. hypovolaemia)?

A

renin from juxtaglomerular cells in kidney

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24
Q

how can you determine between nephrotic and nephritic syndrome in a q?

A

nephritic = haematuria
nephrOtic = nO haematuria

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25
Q

what is acute tubulointerstitial disease? what can cause it?

A
  • presence of inflammatory cell infiltrate in the interstitium of the kidney
  • common cause is allergic reaction to drug (e.g. NSAIDs)
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26
Q

what causes a UTI to be deemed complicated?

A

pregnancy, males, children, recurrent UTIs, elderly, abnormal urinary tract (e.g. catheter)

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27
Q

list the common symptoms of pyelonephritis

A

fever, rigor, vomiting, loin pain/tenderness, costovertebral pain, associated cystitis pain, septic shock, loss of appetite, headache, oliguria

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28
Q

what antibiotic is used to treat chlamydia trachomatis?

A

1g azithromycin or 100mg doxycycline

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29
Q

what class of drugs is the first line treatment for BPH?

A

A-blockers

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30
Q

symptoms of renal cell carcinoma?

A
  • weight loss/anorexia
  • loin pain
  • varicocele
  • enlarged lymph nodes
  • bilateral ankle oedema
  • pyrexia
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31
Q

what causes hypertension in renal cell carcinoma?

A

increased renin secretion causes increased bp due to increased RAAS activation

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32
Q

What scoring system is used to stage renal cell carcinoma?

A

TNM for malignancy

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33
Q

Name an investigation that would be used to stage RCC

A

CT/MRI

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34
Q

define hydrocele

A

abnormal collection of fluid within the remnants of the proceus vaginalis

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35
Q

what is treatment for a hydrocele?

A

watch and wait, surgery if inguinal hernia appears

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36
Q

investigations for testicular torsion?

A

clinical/physical exam - no time for imaging

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37
Q

first line treatment for testicular torsion?

A

surgery called manual distorsion

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38
Q

complication for testicular torsion?

A

testicular ischaemia / infarction

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39
Q

What is the name of the form of incontinence y when coughing or laughing?

A

stress

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40
Q

In urge incontinence the detrusor muscle is overstimulated. What class of medication can be used to counteract this?

A

antimuscarinics

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41
Q

name 3 types of nephrotic syndrome

A

minimal change disease, membranous adenopathy, amyloidosis, advanced renal disease, focal segmental glomerulosclerosis

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42
Q

What is the most common form of nephrotic syndrome in children?

A

Wilm’s tumour

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43
Q

What is the mainstay treatment for nephrotic syndrome?

A

glucocorticoids

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44
Q

how do thiazide diuretics work?

A

inhibition of Na+ and Cl- cotransporter in the distal tubule

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45
Q

how to loop diuretics work?

A

inhibition of the Na+/K+/Cl- contransporter in the loop of henle

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46
Q

how do K+ sparring diuretics work?

A

inhibition of Na+ reabsorption and K+ secretion in the distal tubule ad collecting duct

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47
Q

how do osmotic diuretics work?

A

inhibition of water and Na+ reabsorption in the proximal tubule, loop of Henle and collecting duct

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48
Q

how do carbonic anhydrase inhibitors work?

A

inhibition of bicarbonate reabsorption in the proximal tubules

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49
Q

Name 5 risk factors for chronic kidney disease

A

increasing age, hypertension, DM, AKI, microalbuminaemia, proteinuria, obesity, smoking, alcohol, drugs

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50
Q

As CKD progresses kidney function begins to reduce, what hormone secretion might begin to reduce?

A

vit D / EPO

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51
Q

What is the first line treatment in CKD? Give an example

A

ACEi e.g. ramipril

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52
Q

first line treatment for HTN?

A

> 55yo or Afro-Carribean, it is calcium channel blocker, Otherwise give ACE-i

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53
Q

What does a positive PKD 2 gene mutation indicate?

A

high risk of developing PKD, more severe form, rarer than PKD1

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54
Q

List 3 some signs & symptoms picked up from a patient with chronic kidney disease

A

oedema, pruritis, fatigue, polyuria

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55
Q

presentations of hypercalcaemia?

A

stones, bones, groans, moans

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56
Q

What ratio would be used to monitor renal function?

A

urea:creatinine ratio

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57
Q

what is diagnostic of IgA nephropathy?

A

presence of IgA deposits within the glomerulus and mesangial cells under immunofluorescence

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58
Q

ANCA positive blood tests in glomerulonephritis points to which condition?

A

vasculitis / pauci-immune necrotising glomerulonephritis

59
Q

What medications are given to patients with ANCA positive disease?

A

corticosteroids + rituximab

60
Q

What are the three most common areas for a renal stone to become lodged?

A
  • Pelviureteric junction/ureteropelvic junction – where the renal pelvis connects to the ureter
  • Pelvic brim – where the ureter crosses over the pelvic brim and the bifurcation of the common iliac arteries
  • Vesicoureteric junction/ureterovesicular junction – where the ureter connects to the urinary bladder
61
Q

Give 4 risk factors that would make someone more susceptible to renal stone formation

A
  • dehydration
  • infection
  • hypercalcaemia, hyperoxaluria, hypercalciuria, hyperuricaemia
  • primary renal disease
  • drugs (diuretics, antacids, corticosteroids, aspirin, allopurinol, vitamin c, vitamin d)
  • diet (chocolate, tea, strawberries, rhubarb)
  • gout
  • family history
  • anatomic abnormalities that predispose to stone formation
62
Q

Give 3 examples of what you could do to prevent the recurrence of renal stone formation.

A
  • maintain hydration
  • low calcium intake in the diet
  • eat green leafy veg
  • low salt diet e.g. reduce the levels of processed meat, ready meals, reduce animal protein intake, - reduce BMI, be active/exercise
63
Q

Name 2 investigations you could conduct to diagnose BPH

A
  • DRE – smooth enlarged prostate
  • Serum Prostate Specific Antigen (PSA) – blood test
64
Q

What triad of symptoms most commonly present in someone with pyelonephritis?

A

loin pain, polyuria, fever

65
Q

What is the gold standard investigation for Pyelonephritis?

A

midstream urine sample

66
Q

Name 2 bacteria that you would expect to find in pyelonephritis

A

KEEPS!!
- Klebsiella spp.
- E.coli
- enterococcus spp.
- Proteus spp.
- coag negative staphylococcus spp

67
Q

what type of bacteria is neisseria gonorrhoeae?

A

gram negative diplococci

68
Q

What antibiotic would you give to treat the Neisseria gonorrhoeae?

A

ceftriaxone and azithromycin

69
Q

what is the first line treatment for an uncomplicated UTI? when is it contraindicated in pregnancy?

A

nitrofurantoin
- avoided at term pregnancy due to neonatal haemolysis

70
Q

painless haematuria is the typical finding of which cancer?

A

bladder

71
Q

what is the first choice antibiotic for pregnant women with acute pyelonephritis?

A

cefalexin

72
Q

What is the second most common mineral composition of renal calculi?

A

magnesium ammonium phosphate

73
Q

what is Prehn’s sign?

A

clinical sign in which there is relief of pain upon elevation of the left scrotum.

74
Q

first line treatment for diabetic neuropathy?

A

ACE-i e.g. ramipril

75
Q

Where does the left testicular (gonadal) vein drain into?

A

left renal vein

76
Q

what drug class is diclofenac?

A

NSAID

77
Q

where is aldosterone produced?

A

zona glomerulosa

78
Q

What is the first line test for diagnosing renal stones and what is the gold standard diagnostic test for them?

A

1st line = Kidney, ureter, bladder ultrasound. Gold standard = Non-contrast computerised tomography (NCCT) of kidney, ureter, and bladder

79
Q

If a patients renal stone is less than 5mm what treatment should be given to them?

A

Watch and wait for spontaneous passage/ give a strong analgesic (IV diclofenac)

80
Q

what type of virus is HIV?

A

Reterovirus subgroup lentivirus

81
Q

what CD4 count is the defining level for an AIDs diagnosis?

A

<200/ul

82
Q

What is the overall name for treatment given to HIV patients and what sub-groups of medication are given – write in full

A
  • HAART (highly active antiretroviral therapy)
  • NRTI (nucleoside reverse transcriptase inhibitors)
83
Q

What test would be performed to confirm an STD and how would a sample be collected?

A

First void urine and NAAT/culture OR swab urethral secretions and microscopy

84
Q

A patient is found to have Gonorrhoea. Describe the appearance of this bacteria on microscopy?

A

Gram negative diplococci

85
Q

what is usual function of PSA?

A

liquifies semen

86
Q

which cells produce PSA?

A

luminal cells

87
Q

A biopsy shows two histological findings consistent with prostate cancer, what could these be?

A

infiltrative medium sized glands, nuclear enlargement, prominent nuclei

88
Q

What would electron microscopy show in IgA nephropathy?

A

immune deposits in mesangium

89
Q

Name a condition that shows the same signs as IgA nephropathy on microscopy but can affect more than just the kidneys.

A

Henoch-Scholein purpura

90
Q

What type of hypersensitivity reaction is IgA nephropathy?

A

type III

91
Q

What causes IgA nephropathy?

A

Galactose deficient IgA antibodies are not recognised as foreign so accumulate. Anti-glycan IgG antibodies bind forming immune complexes. These immune complexes deposit in the kidney

92
Q

What can IgA nephropathy progress to?

A

kidney failure

93
Q

How do corticosteroids prevent immune complex formation in IgA nephropathy?

A

They prevent production of IgA and anti-glycan IgG

94
Q

What is the gold standard of investigations for a UTI?

A

mid-stream urine microscopy, culture and sensitivity

95
Q

Give an example of an antibiotic used to treat a UTI

A

Nitrofurantoin, Trimethoprim, Amoxicillin (co- amoxiclav), Cefalexin

96
Q

Where is the excess fluid located within the testis?

A

tunica vaginalis

97
Q

Name 3 causes of Hydrocele

A

trauma, infection, testicular torsion, patent processus vaginalis

98
Q

Give 2 differential diagnoses of Hydrocele

A

testicular torsion, strangulated hernia

99
Q

Name 1 test that would be done to exclude a malignant teratoma and confirm Hydrocele

A
  • Serum alpha-fetoprotein
  • Serum hCG (human chorionic gonadotropin)
100
Q

Give 2 treatment options for Hydrocele

A
  • watch and wait - will resolve spontaneously
  • surgical removal of hydrocele
101
Q

Name 2 ways the doctor confirm the diagnosis of kidney stones, and the positive result of them.

A
  • Urine dipstick, haematuria/protein/glucose
  • NCCT-KUB, visualisation of stone
102
Q

What type of drug would the doctor prescribe for renal colic, and give an example of this drug?

A

analgesic - IV diclofenac

103
Q

What type of stone will only form in acidic urine?

A

uric acid stones

104
Q

Which ethnicity is more severely affected by BPH, and suggest a reason why.

A

afro-caribbean men, higher levels of testosterone

105
Q

What hormone is essential for the BPH? And thus, what procedure protects individuals against developing BPH?

A

testosterone, removal of testes

106
Q

Why would a mid-stream urine sample help you exclude from your differential diagnoses?

A

infection

107
Q

What protein can sometimes be raised in the blood of someone with BPH?

A

prostate specific antigen

108
Q

what parasite can cause bladder cancer?

A

schistosomiasis

109
Q

what antibiotic is used to treat cystitis?

A

trimethoprim

110
Q

classic triad of symptoms of renal cell cancer?

A

loin/flank pain, haematuria, palpable mass

111
Q

give 3 functions of the kidney

A
  • excretion of water/waste material
  • ultrafiltration
  • maintains circulating fluid balance
  • produces EPO
112
Q

what is the definition of erectile dysfunction?

A

the inability to gain and maintain an erection long enough to achieve sexual satisfaction

113
Q

give 3 causes of nephritic syndrome

A

IgA nephropathy, ANCA, post strep infection, SLE, Goodpastures disease

114
Q

what pharmacological treatment is given for stress incontinence?

A

duloxetine

115
Q

what surgical treatment is given for stress incontinence?

A

sling, artificial urinary sphincter

116
Q

give 4 risk factors for CKD

A

diabetes, family history, old age, recurrent UTIs

117
Q

Which organism is the most common cause of pyelonephritis?

A

E. Coli

118
Q

characteristics of chronic prostatitis?

A

pelvic/perineal pain lasting longer than 3 months, RF: trauma causing nerve damage in LUT

119
Q

what is significant about trimethoprim?

A
  • used to treat UTIs
  • TERATOGENIC
120
Q

what does Budd-Chiari syndrome present with?

A

abdo pain, ascites and hepatosplenomegaly

121
Q

what is Reiter’s syndrome aka?

A

reactive arthritis

122
Q

which artery plays an important role in erectile dysfunction?

A

internal pudendal artery

123
Q

What anatomical differences between men and woman make stress incontinence more likely in women?

A

women only have one sphincter and it is shorter

124
Q

what are the 5 types of incontinence?

A

stress, urgency, mixed, continuous, overflow

125
Q

what test rules out prostate cancer?

A

serum PSA

126
Q

list 4 fisk factors of prostatitis

A

increasing age, STIs, UTIs, DRE, catheters

127
Q

2 features felt on prostate exam in prostatitis?

A

warm, tender, nodular / normal

128
Q

Describe 2 treatments for acute bacterial prostatitis

A

ciprofloxacin, analgesia, catheter

129
Q

describe the pathogenesis of CKD

A
  • scarred nephrons fail ->
  • burden of filtration falls to remaining healthy nephrons ->
  • glomerular hypertrophy
  • increased glomerular capillary pressure and strain and damage remaining nephrons
130
Q

what is the most common cause of an AKI?

A

sepsis

131
Q

what eGFR is used to diagnose CKD?

A

<60ml/min/1.73m^2>3months

132
Q

What is the commonest type of renal cell carcinoma?

A

clear cell

133
Q

name 1 drug and action for prostate cancer

A

Goserelin - GnRH agonist

134
Q

What is the first-line management for maintaining remission in Crohn’s disease?

A

1st line is Azathioprine or mercaptopurine. (2nd line = Methotrexate)

135
Q

what is treatment/investigations for testicular torsion?

A

if low pain score - US, if high surgical exploration and untwisting if required

136
Q

give the triad of symptoms that make up nephrotic syndrome

A

hypoalbuminaemia, oedema, proteinuria

137
Q

what haematological cancer is associated with amyloidosis

A

non-hodgkins lymphoma

138
Q

What does the L in AL amyloidosis stand for

A

light chain

139
Q

Name 2 cardiac complications of amyloidosis

A

Restrictive cardiomyopathy, arrhythmia, angina

140
Q

What colour would you expect amyloid to stain on Congo Red staining?

A

red

141
Q

oral melphalan for amyloidosis. How does this drug work?

A

damages DNA in plasma cells that create light chains

142
Q

what is amyloidosis

A

caused by a build-up of an abnormal protein amyloid in organs and tissues throughout the body

143
Q

define CKD

A

GFR < 60mL/min/1.73 m2 for more than 3 months

144
Q

Why would CKD cause anaemia?

A

reduced erythropoietin production

past questions (11 decks)

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