GU Flashcards
1
Q
What is the most common cause of hypercalcaemia leading to renal stone formation?
A
Hyperparathyroidism
2
Q
What 3 main places do renal stones get stuck?
A
Pelviureteric junction, Pelvic brim and Vesicoureteric junction
3
Q
Pre-renal causes of AKI?
A
FRIST F- failure --> heart/liver/skin I- infection/sepsis, intrarenal haemodynamics R- red cell haemorrhage S- sick --> gi losses, stenosis T- thrombosis
4
Q
Define AKI
A
= abrupt DETERIORATION in parenchymal renal function which is usually but not invariably REVERSIBLE over a period of days or weeks
5
Q
Define CKD
A
= LONG STANDING and usually PROGRESSIVE DECLINE in renal fucntion
6
Q
3 main causes of rapidly progressive GN?
A
- background of acute nephritic syndrome
- antiglomerular BM disease (Goodpastures if w. lung involvement)
- ANCA-assoc. vasculitis
7
Q
Triad of features seen in nephrotic syndrome?
A
proteinuria, hypoalbuminaemia and oedema
may also get hyperlipidaemia
8
Q
why do pts get recurrent infections in nephrotic syndrome?
A
Due to decreased IgG levels as they are lost in urine/deposited in glomerular BM
9
Q
why do pts get hyper-coagulability symptoms in nephrotic syndrome and give an example
A
–> venous/arterial thrombosis due to loss of proteins and clotting factors in the urine
10
Q
most common causes of chronic kidney disease
A
DM
HTN
Atherosclerotic renal vascular disease
(=most common causes in european countries)
11
Q
RF for CKD
A
CVD, proteinuria, HTN, DM, AKI, recurrent UTIs
12
Q
How do you distinguish between AKI and CKD?
A
normochromic anaemia, small kidneys on US and presence of renal osteodystrophy favour chronic process
13
Q
What GFR level is considered as established renal failure?
A
14
Q
3 possible causes of severe fluid losses
A
burns
diarrhoea/vomiting
virus/fever
15
Q
Advantages of renal transplant rather than dialysis (4)
A
- survival advantage
- QoL advantage
- economic advantage
- enable successful pregnancy
16
Q
Why are women with CKD less likely to conceive
A
women normally stage 4/5 CKD when they reach CBA and often develop anaemia –> decrease likelihood of conception
17
Q
Complications of kidney transplant
A
- malig and inf much more common due to immunosuppressant therapy
Others: CVD, cerebrovascular disease and tx withdrawal
18
Q
indications for dialysis in AKI
A
hyperK metabolic acidosis (DKA) pulm. oedema uraemic pericarditis severe uraemia (can --> neurological complications
19
Q
Wha are the criteria for absolute exclusion of transplant (renal)
A
malig HIV active infection not fit for general anaesthesia life expectancy
20
Q
inhibitors of creatinine secretion?
A
trimethoprin, cimetidine, ritonavir
21
Q
Albumin levels in urine & their interpretation:
A
300mg = macro-(proper)-albuminuria >1g = heavy, golemrular pathology likely >3g = nephrotic range (--> hypoalbuminaemia --> periph. oedema)
22
Q
where do thiazide diuretics work?
A
distal tubule
23
Q
medication causing hypokalaemia
A
loop diuretics (furosemide, bumetanide) thiazide diuretics (bendoflumethiazide)
24
Q
medication causing hyperkalaemia
A
spironolactone (= aldosterone antag)
amiloride (= potassium sparing diuretic)
ACEIs (ramipril, lisinopril, perindopril)
ARBs (trimethroprin and calcineurin inhibitors) - eg losartan, irbesartan
25
calcitriol actions
- increases calcium and phosphate absorption from the gut
| - suppressed PTH
26
EPO=?
= eryhtropoietin, a hormone secreted by the kidney that stimulates RBC production by bone marrow
27
What do polycystins do and what is their relation to PKD?
PKD1 & 2 cause mutations in polycystins 1 and 2
polycystins regulate tubular and vascular development in kindneys
also in other organs, incl. liver, brain, arterial blood vessels and pancreas --> casuing extra-renal manifestations of PKD
28
what is a varicocoele?
= abnormal dilation of the testicular veins in the pampiniform plexus, caused by venous reflux
29
2 complications of varicocoeles
- reduced testicular function
| - male infertility
30
when is surgery indicated in varicocoele
pain
infertility possibility
possible testicular atrophy
31
typical presentation of testicular torsion
sudden, severe pain in one testes, makes walking uncomfortable
may spread to lower abdo
comes on during sport or exercise
32
How do you differentiate between testicular torsion and epididymo-orchitis?
torsion = sudden onset pain, younger pt
EO = slower onest of symps in an older pt (often assoc with STD)
both have inflamed and painful testis
33
histological appearance of benign prostatic hyperplasia
cell hyperplasia and reduced apoptosis
34
What would DRE find in benign prostatic hyperplasia
smooth enlargement of prostate, often asymmetrical across lateral lobes
35
4 factors involved in UT obstruction in prostatic hyperplasia
1. hyperplastic nodules compress and stretch prostatic urethra
2. involvement of periurethral zone interferes with sphincter mechanism
3. contraction of hyperplastic SM in stroma
4. inflam cell infiltration
36
role of dihydrotestosterone
enlargement of the prostate gland and seminal vesicles (in puberty)
37
Where in prostate does benign hyperplasia occur
Transitional zone (lateral lobes)
38
Where in prostate does prostate cancer occur?
Peripheral zone
39
5 cancers that metastasise to bone
```
breast
lung
kidney
thyroid
prostate
```
40
What is PSA
= prostate specific antigen, an protease responsible for the liquefaction of semen
will be raised in any prostatic disease
41
Pros of screening for prostate cancer
- saves lives (decreases mortality 30%)
- earlier detection = better prognosis
- commonest cancer of men
- 4th most common cause of cancer death
42
Cons of screening for prostate cancer
- goes against 'do more good than harm' --> detect cancer where tx won't help --> pt anxiety
- overdx of insignificant disease
- negative implications fo dx/tx
- uncertain natural history
43
presentation of renal cell carcinoma
classic triad:
| haematuria, loin pain, loin mass (in flank)
44
What is Wilms tumour
= undifferentiated mesodermal tumour of the intermediate cell mass
Most common intra-abdo tumour of CHILDHOOD (20% of all childhood malig)
45
What cell line do most testicular tumours arise from?
>96% from germ cells
46
3 physiological examples of dipstick +ve haematuria
```
menstruation
sport (muscle breakdown)
sexual intercourse
```
47
why is Von Hippel Lindau premalignant
pts are predisposed to forming cysts, an then lose their normal gene to inhibit this, leading to multiple cysts forming which can develop into cancerous lesions
48
indicators of psychological aetiology of ED?
sudden onset
good nocturnal/early morning erections
situational ED
young patient
49
examples of drugs with negative effect on ED
ACEI
B-blockers
diuretics
(ang. II receptor blockers may have positive effect)
50
why are UTIs more common in women
short urethra & its proximity to anus facilitates transfer of bowel organisms to bladder
51
what is the most common cause of UTI and where does it arise from?
E. coli, usually arises from pt's own bowel flora (bacteria colonise urethral orifice and ascend urinary tract
52
5 main bacterial causes of UTI
```
E.COLI (70%),
Proteus Mirabilis,
Staph saprophyticus/epidermis,
Klebsiella,
Enterococcus faecalis
```
53
Definition of UTI
>10^5 organisms per ml (or for dx 10^2 with pyruia)
54
RF for UTI
Female, sex/new sexual partner, immunosuppression/DM, pregnancy and catheter, any abnormality in urinary tract or internal/external obstruction, age
55
Normal host defences preventing bacterial colonisation of UT (preventing UTI)
```
pH of urine
flow of urine washes out bacteria
commensals
tamm-harsfall protein (from kidney)
GAG layer
```
56
definition of recurrent UTI
>2 episodes in 6m OR
| >3 episodes in 12m
57
definition of complicated UTI
= UTI in the presence of:
- structurally/functionally abnormal UT (w. or w/o host compromise
- poor renal function
- outflow obstruction
- virulent organisms
58
indications for ix of UTIs
recurrent episodes
signif LUTS
haematuria
men/children
59
abnormalities that encourage cystitis
UT obstruction/stasis
previous damage to bladder epi
bladder stones
poor emptying
60
symptoms of UTI (lower)
frequency, dysuria, strangury, haematuria, suprapubic pain
61
signs of UTI
fever
abdo/loin tenderness
foul smelling urine
62
Tx of UTI
trimethoprim (empirical)
nitrofurantoin
ADVICE: increase fluids, urinate often (& void pre and post intercourse)
63
S&S of acute pyelonephritis (=inflam of kidneys)
rigors, pyrexia, N&V, loin pain & tenderness
64
uncomplicated UTI = ?
UTI in otherwise healthy, non-pregnant woman with functionally normal UT
65
pyelonephritis = ?
neutrophil infiltration of parenchyma, (small cortical abscesses and streaks of pus in renal medulla often present)
66
vesicoureteric reflux = ?
incompetent valve between bladder and ureter, allowing reflux of urine up ureters during bladder contraction and voiding
(usually ceases by ~ puberty but normally damage is already done by then)
67
epididymo-orchitis = ?
syndrome consisting of pain swelling and inflam of epididymus ± inflam of testes
68
Most common aetiology in epididymo-orchitis
35yrs = mostly G -ve enteric organisms, eg E. coli, pseudomonas
69
RF for epididymo-orchitis
previous infection
indwelling catheters
anal intercourse
structural/functional abnormalities of UT
70
typical presentation fo epididymo-orchitis
UNILATERAL scrotal pain and swelling of ACUTE ONSET, with UTI symps
71
presentation of prostatitis
fever, malaise, myalgia, rigors
(plus UTI symptoms)
pain in low back/abdomen
pain on ejaculation
72
tx of prostatitis
```
analgesia,
suprapubic catheter (if retention),
parenteral ABX,
flouroquinolones - eg ciprofloxacin - 4 wks
2nd line - trimethoprim/macrolides
```
73
presentation of urethritis
urethral pain, dysuria ± discharge
| NB primarily sexually acquired
74
presentation of pyelonephritis
Classic triad: loin pain, fever and pyuria
75
why does dairy consumption reduce chance of UT stone formation?
it doesnt impact calcium in urine, BUT it binds to oxalate removing it from gut and urine, hence decreasing stone formation
76
give 4 preventative measures for reducing stone formation
```
decrease salt in diet
overhydration
normal dietary intake/healthy protein intake
physical activity/regular exercise
reduce BMI
```
77
what condition is classically described by pain thats 12/10 or 'worse than labour'
Renal colic
78
what is gold standard for dx of renal stone?
NCCT KUB - v. rapid, 99% sens for stones
79
mx of ureteric colic
analgesia - NSAID suppository, opiates
antiemetics
± admit and IV fluids
observe for sepsis
80
whats the most common cause of stress incontinence (in women)
childbirth --> denervation of pelvic floor and urethral sphincter
81
what medication do you give in renal colic and when
if stone is >5mm give tamsulosin (=a blocker) - relaxes smooth muscle allowing the stone to pass OR nifedipine (CCB)
82
RF for AKI
PMH - DM, CKD, prostate cancer
| elderly
