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Renal > Lectures > Flashcards

Lectures Flashcards

1
Q

What does focal mean?

A

Less than 50% of the glomeruli affected

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2
Q

What does diffuse mean?

A

More than 50% of the glomeruli affected

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3
Q

What does segmental/global refer to?

A

Parts or all of the glomerulus affected

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4
Q

When would you see crescents?

A

In rapidly progressive glomerulonephritis

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5
Q

What type of drugs are cyclophosphamide/chlorambucil?

A

Alkylating drugs

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6
Q

Name 2 calcineurin inhibitors

A

Tacrolimus

Cyclosporin

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7
Q

What is complete remission?

A

Protein <300 mg/day

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8
Q

What is partial remission?

A

Protein <3g/day

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9
Q

What does calcium gluconate do?

A

It stabilised the myocardium - it does not lower potassium levels

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10
Q

Management of hyperkalaemia

A

IV calcium gluconate (stabilises myocardium)
Combined insulin/dextrose infusion
Nebulised salbutamol

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11
Q

How can you remove potassium from the body?

A

Calcium resonium (orally or enema)
Loop diuretics
Dialysis

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12
Q

What does a creatinine over 400 indicate?

A

End stage renal failure

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13
Q

A 51-year-old man presents to his GP with a new swelling of his left testicle. He has no past medical history and takes no regular medications. On examination there is a unilateral swelling of the left side of the scrotum which feels separate to the testicle itself, does not trans-illuminate and no superior border to the swelling can be felt in the top of the scrotum.

A

Inguinalscrotal hernia

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14
Q

A scrotal swelling you can’t get above

A

Inguinal hernia

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15
Q

When are muddy brown casts seen?

A

Acute tubular necrosis

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16
Q

What causes interstitial nephritis?

A

Usually arises from drug toxicity

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17
Q

Rough serum levels that diagnose hyperkalaemia

A

5.5 mmol/L and above is widely accepted as hyperkalaemia

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18
Q

Which type of stones are radiolucent?

A

Xanthine stones

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19
Q

Which types of stones are semi-opaque and have a “ground glass “ appearance?

A

Cysteine stones

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20
Q

Diagnosis of varicocele

A

Ultrasound with doppler study

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21
Q

Diagnosis of epididymal cysts

A

Ultrasound

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22
Q

Which conditions are associated with epididymal cysts?

A

Polycystic kidney disease
Cystic fibrosis
von Hippel-Lindau syndrome

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23
Q

A 14 year-old boy develops visible haematuria following an upper respiratory tract infection.

A

IgA nephropathy

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24
Q

Classical triad of renal cell carcinoma

A

Abdominal mass
Loin pain
Haematuria

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25
Q

Treatment for minimal change glomerulonephritis

A

Steroids

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26
Q

The acute management of renal colic

A

IM diclofenac 75mg

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27
Q

Investigating renal colic

A

1) ultrasound
2) then can do non-contrast CT to confirm diagnosis (95
9% of stones are visible on non-contrast CT)

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28
Q

What are staghorn calculi composed of?

A

Struvite (ammonium, magnesium phosphate, triple phosphate)

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29
Q

Goserelin mechanism of action?

A

GnRH agonist

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30
Q

What might cause an inaccurate eGFR?

A

Often inaccurate in people with extreme muscle mass e.g. bodybuilders
e.g. eleanor

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31
Q

Treatment of cranial diabetes inspidus

A

Desmopressin

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32
Q

Treatment of nephrogenic diabetes insipidus

A

Thiazide diuretics (e.g. chlorothiazide)

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33
Q

Fused podocytes

A

Minimal change disease

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34
Q

Causes of diffuse proliferative glomerulonephritis

A

Post-streptococcal

SLE

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35
Q

Rare type of renal carcinoma associated with exposure to chemicals in the textile, plastic and rubber industry

A

Renal transitional cell carcinoma

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36
Q

Another name for Wilm’s tumour?

A

Nephrpblastoma

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37
Q

Angiomyolipomas are associated with which condition?

A

Tuberose sclerosis

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38
Q

What antibiotic might cause acute interstitial nephritis?

A

Penicillin

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39
Q

ACEi and acute kidney injury

A

ACE inhibitors should be witheld in acute kidney injury

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40
Q

A 15-year-old boy develops sudden onset of pain in the left hemiscrotum. He has no other urinary symptoms. On examination the superior pole of the testis is tender and the cremasteric reflex is particularly marked.

A

Torsion of testicular appendage (torsion of hydatid appendage)

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41
Q

A 14-year-old boy develops sudden onset severe pain in the left testicle radiating to the left groin. He is distressed and vomits. On examination the testis is very tender and the cremasteric reflex is absent.

A

Torsion of spermatic cord

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42
Q

When can you check PSA after prostate biopsy?

A

6 weeks after

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43
Q

When can you check PSA after UTI?

A

4 weeks

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44
Q

When can you check PSA after digital rectal exam?

A

1 week

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45
Q

When can you check PSA after vigorous exercise/ejaculation?

A

48 hours

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46
Q

Most important differential for frank haematuria?

A

Renal cell carcinoma

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47
Q

Which types of cancers are you at an increased risk for if you have a transplant?

A

Squamous cell cancer
Lymphoma
Cervical cancer

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48
Q

Why might a renal adenocarcinoma present with mets?

A

Renal adenocarcinoma can produce cannon ball mets in the lungs, which cause haemoptysis

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49
Q

When do you need to perform semen analysis after vasectomy?

A

Need to perform twice at 16 and 20 weeks

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50
Q

Complications of vasectomy

A

Bruising, haematoma, infection, sperm granuloma, chronic testicular pain (affects between 5-30% of men)

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51
Q

You want to start someone on Goserelin, a GnRH agonist for prostate cancer, what should you co-prescribe at the beginning?

A

Give an anti-androgen at the beginning e.g. cyproterone acetate

52
Q

Nephrotic syndrome in young children/adults, what is it likely to be?

A

Minimal change glomerulonephritis

53
Q

Schistosomiasis increases your chances of which type of bladder cancer?

A

Squamous cell

54
Q

Which type of diuretic should you give for ascites?

A

Aldosterone antagonist - use spironolactone

55
Q

Antibiotic treatment for tunnelled catheter infection

A

Vancomycin and gentamicin

56
Q

B cell antibody that can be used to desensitise

A

Rituximab

57
Q

The transplanted kidney is attached to which vessels?

A

External iliac artery and vein

58
Q

How do basiliximab and dacluzimab work?

A

Monoclonal antibodies - block IL-2 receptor on CD4 T cells

59
Q

How does azathioprine and mycophenolate mofetil work?

A

Block purine synthesis

60
Q

Treatment for CMV infection in renal transplant patients

A

Prophylactic PO valganciclovir if at risk

IV ganciclovir if infected

61
Q

Commonest malignancies following renal transplant

A

Non-melanoma skin cancers
Lymphoma (e.g. EBV mediated PTLD)
Solid organs

PTLD - post lymphoproliferative disease

62
Q

Which type of bacteria are in the lower end of the urethra?

A

Coliforms and enterococci

63
Q

What is a complicated UTI?

A

A UTI complicated by systemic symptoms or urinary structural abnormality

64
Q

Foul smelling, burnt chocolate

A

Protues

65
Q

Causes struvite stones

A

Proteus

66
Q

What does proteus produce?

A

Produces urease, which breaks done urea to form ammonia (increase pH, which causes stones to form)

67
Q

Treatment of pseudomonas aeruginosa?

A

Ciprofloxacin

68
Q

What bacteria is associated with catheters and instrumentation?

A

Pseudomonas aeruginosa

69
Q

Where would you normally find enterococci?

A

In the GI tract

70
Q

Which type of bacteria is more common in hospital acquired UTI?

A

Enterococcus faecalis

71
Q

This type of bacteria usually causes UTI in women of child bearing age?

A

Staphylococcus saphrophyticus

72
Q

What urine sample do you want for UTI testing?

A

Mid-stream sample (first pass urine is usually contaminated)

73
Q

How long does a boricon container work for in UTI testing?

A

Up to 24 hours (contains boric acid)

74
Q

How long does a sterile universal container work for in UTI testing?

A

Must reach lab within 2 hours

75
Q

What urine sample would you get from children?

A

Clean catch

76
Q

What urine sample would you get from babies?

A

Bag urine

77
Q

Why are nitrites on dipstick not always effective?

A

Some bacteria can reduce nitrates to nitrites (mainly coliforms - enterococcus, staphylococcus, psuedomonas)

78
Q

How many days should you give abx for in an uncomplicated lower UTI in women?

A

3 days

79
Q

Treatment for coliforms

A

Gentamicin

80
Q

Treatment for enterococci

A

Amoxicillin

81
Q

How is gentamicin dose worked out?

A

7mg/kg and then bloods checked 6-14 hours later

82
Q

How long can you give gentamicin for?

A

Can only give for 3 days

83
Q

What makes bacteria resistant to all cephalosporins and almost all penicillins?

A

ESBL (extended spectrum beta-lactamase)

84
Q

What antibiotic are carbapenemase producing enterbacteriaceae resistant to ?

A

Meropenum

so basically resistant to all antibiotics

85
Q

How does trimethoprim work?

A

Inhibits folic acid synthesis

86
Q

How else can you give trimethoprim?

A

Can give as co-trimoxazole (trimethoprim combined with suphamethoxazole - but risk of stevens-johnson syndrome because of sulphonamide)

87
Q

Has activity against ESBLs

A

Pivmecillinam

88
Q

As effective as gentamicin. can be given to patients whose kidney function isn’t good enough for gentamicin

A

Temocillin

89
Q

The commonest cause of renal failure in the UK

A

Diabetes

90
Q

Management of myeloma

A

Chemotherapy

Stem cell transplant

91
Q

Which antibodies are associated with ANCA vasculitis?

A

ANCA
Anti-MPO
Anti-PR3

92
Q

Predominantly anti-PR3 antibodies

A

Granulomatosis with polyangitis (Wegener’s)

93
Q

Predominantly anti-MPO antibodies

A

Microscopic polyangitis

94
Q

Associated with asthma and eosinophilia

A

Churg-Strauss

2/3rds also have skin involvement

95
Q

How many samples do you need to define CKD?

A

Need a minimum of 2 samples at least 90 days apart

96
Q

What is alfacalcidol?

A

Active vitamin D

97
Q

What is cinacalcet

A

Calcimimetic

98
Q

Medication to reduce cyst volume and progression

A

Tolvaptan

99
Q

Congenital hepatic fibrosis in ADPKD or ARPKD

A

Congenital hepatic fibrosis more common in autosomal recessive kidney disease

100
Q

ADPKD which part of kidneys are affected?

A

Cysts arise from tubules

101
Q

ARPKD which part of the kidneys are affected?

A

Cysts arise from collecting ducts

102
Q

Alports syndrome inheritance

A

X-linked

103
Q

Characteristic biopsy feature of Alport’s?

A

Variable thickness GBM

104
Q

Diagnosis of Anderson Fabrys disease?

A

Plasma/leukocyte a-GAL activity
Renal biopsy
Skin biopsy

105
Q

Treatment of anderson fabrys disease

A

Enzyme replacement - fabryzyme

Management of complications

106
Q

Diagnosis of medullary cystic disease

A

Family history

CT scan

107
Q

Diagnosis of medullary sponge kidney

A

Diagnosis by excretion urography - to demarcate calculi

108
Q

Investigation for frank haematuria

A

CT urogram and cystoscopy

109
Q

Treatment for clot retention

A

Three way irrigating catheter

110
Q

Localised tenderness at upper pole and “blue dot” sign

A

Torsion of appendage

111
Q

Rx of torsion of appendage

A

If diagnosis confirmed then will resolve spontaneously without surgery

112
Q

Treatment of epidymitis

A

Analgesia and scrotal support, bed rest

Ofloxacin 400mg/day for 14 days

113
Q

Treatment of paraphimosis

A

Iced glove, granulated sugar for 1-2hrs, multiple punctures in oedematous skin
Manual compression of glans with distal traction on oedematous foreskin
Dorsal slit

114
Q

What is priapism?

A

Prolonged ejaculation (>4 hours)

115
Q

Treatment of priapism

A

Ischaemic – aspiration +/- irrigation with saline, injection of alpha-antagonist (e.g. phenylephrine), surgical shunt
Non-ischaemic – observe, may resolve spontaneously, selective arterial embolization with non-permanent materials

116
Q

Diagnosis of Fournier’s gangrene

A

Plain x-ray or USS may confirm gas in the tissues

117
Q

Treatment of Fournier’s gangrene

A

Antibiotics and surgical debridement

118
Q

Imaging for bladder injury

A

CT cystography

119
Q

Treatment of bladder injury

A

Large-bore catheter
Antibiotics
Repeat cystogram in 14 days

120
Q

What does a flame-shaped collection of contrast in the pelvis mean?

A

Extreperitoneal injury

121
Q

Butterfly perineal haematoma

A

Urethral injury

122
Q

Posterior urethral injury is often associated with what?

A

Fractured pubic rami

123
Q

Ix for urethral injury

A

Retrograde urethrogram

124
Q

Treatment of urethral injury

A

Suprapubic catheter

Delayed reconstruction after at least 3 months

125
Q

Treatment of penile fracture

A

Prompt exploration and repair

Circumcision incision with degloving of penis to expose all 3 compartments

126
Q

Ix and Rx for testicular injury

A

Ix: USS to assess integrity / vascularity

Rx: early exploration/repair improves testis salvage, reduces convalescence, better preserves fertility and hormonal function

Renal (3 decks)

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