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Y3 > Renal > Flashcards

Renal Flashcards

1
Q

AKI diagnosis

A

Serum creatinine >1.5x baseline
Urine volume <0.5ml/kg/h for 6h

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2
Q

AKI management

A

Pulmonary oedema:
IV furosemide

Uraemia:
Haemodialysis

Metabolic acidosis:
Sodium bicarbonate

Hyperkalaemia:
IV calcium gluconate
IV insulin & dextrose

STOP DAMN:
diuretics
ACEi/ARB
Metformin
NSAIDs

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3
Q

Nephrotic syndrome signs and symptoms

A

Frothy/foamy urine
Leg/facial swelling

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4
Q

Nephrotic syndrome causes

A

Adults:
Women->SLE
Men->membranous glomerulonephritis

Children:
Minimal change glomerulonephritis

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5
Q

Nephrotic syndrome diagnosis

A

Oedema
Hypoalbuminaemia <30g/L
Proteinuria >3g/24h

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6
Q

Nephrotic syndrome management

A

LMWH if serum albumin <20g/L
Prevent PE and DVT
ACEi to reduce proteinuria
Diet to manage hypoalbuminaemia and hyperlipidaemia
Prednisolone

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7
Q

CKD signs and symptoms

A

Normocytic anaemia
Hypocalcaemia
Hyperphosphataemia
Hypertension
Pleural effusion
Weight loss
Pruritus
Impotence

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8
Q

CKD investigations

A

Bloods: FBC, U&E, glucose, calcium, PTH
ECG
Urine dipstick
USS KUB

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9
Q

CKD management

A

Low phosphate diet
Low potassium diet
BP control
Erythropoietin injection
Vit D
Peritoneal/haemodialysis

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10
Q

Epididymo-orchitis signs and symptoms

A

Tender scrotal lump, usually unilateral
Sexual history/recent UTI
Urinary symptoms

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11
Q

Epididymo-orchitis investigations

A

Young: urethral swab + NAAT
Old: mid stream urine sample

Scrotal Doppler ultrasound
Bloods: CRP, FBC
Normal cremasteric reflex

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12
Q

Epididymo-orchitis management

A

Ceftriaxone 1mg IM single dose
Doxycycline 100mg oral BD 10-14 days

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13
Q

Testicular torsion signs and symptoms

A

High lying sudden onset unilateral testicular pain
Absent cremasteric reflex
Normal urine dipstick

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14
Q

Testicular torsion management

A

Analgesia
Exploratory surgery and bilateral orchidopexy/orchidectomy

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15
Q

Bladder cancer risk factors and type of cell

A

TCC(commonest):
Smoking
Rubber/dye industry

SCC:
Schistosomiasis
Smoking

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16
Q

Bladder cancer signs and symptoms

A

Painless haematuria
Persistent microscopic haematuria
Suprapubic pain
Lower urinary tract symptoms and UTI
Metastatic disease symptoms

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17
Q

Bladder cancer investigations

A

Painless visible haematuria:
CT uro gram
Renal function test
Flexible cystoscopy

Persistent non-visible haematuria:
Flexible cystoscopy
Ultrasound KUB

Suspected cancer:
CT renal triple phase
CT CAP staging
Bone scan if symptomatic

18
Q

Bladder cancer management

A

Cystoscopy + TURB (can be curative)
Non-muscle invasive -> TURB + chemo/BCG
Muscle invasive -> cystectomy, radiotherapy, palliative treatment

19
Q

Prostate cancer risk factors

A

Usually adenocarcinoma
Usually asymptomatic unless metastatic

Age
Western nations
Afrocarribean ethnicity

20
Q

Prostate cancer investigations

A

PSA (sensitive but not specific): cancer, UTI, prostatitis

Gold standard: MRI

Transperineal prostate biopsy

21
Q

Prostate cancer management

A

Conservative:
Anti-androgen e.g. GnRH antagonist

Young and fit:
High grade->radical prostatectomy/radiotherapy
Low grade->active surveillance(PSA, MRI, biopsy)

Old and unfit:
High grade->hormone therapy
Low grade->PSA monitoring

22
Q

Prostatectomy side effects and monitoring

A

Commonest: retrograde ejaculation

Proximal urethral sphincter damage->urinary incontinence
Cavernous nerve damage->ED

Monitor PSA:
Should be undetectable or <0.01ng/ml
>=0.02ng/ml -> relapse

23
Q

Testicular cancer signs and symptoms

A

Non tender lump, solid on ultrasound
25-40y
History of cryptorchidism
Could have gynaecomastia

24
Q

Testicular cancer investigations

A

Seminoma:
PLAP, LDH raised
30-40y
Solid, homogenous

Teratoma:
AFP, LDH raised
25-35y
Solid and cystic

hCG raised if gynaecomastia
CT CAP

25
Q

Testicular cancer management

A

Inguinal orchidectomy
Teratoma -> chemo(bleomycin, etopiside, cisplatin)
Seminoma -> radiotherapy
Monitor tumour markers

26
Q

BPH signs and symptoms

A

Hesitancy in starting urination
Poor stream
Post micturition dribble
High frequency, nocturia
Acute retention
Testosterone therapy

27
Q

BPH investigations

A

Exclude: prostate cancer, cauda equina syndrome, high pressure chronic retention
Urine dipstick
Voiding diary
PSA
USS KUB
Uro dynamics
Cystoscopy if bladder cancer suspected

28
Q

BPH management

A

1: Weight loss, reduce caffeine/fluid intake in evening
2: Alpha blocker (tamsulosin/alfuzosin)
3: 5 alpha reductase inhibitor (finasteride)
4: TURP

29
Q

Stress urinary incontinence signs and symptoms

A

Involuntary leakage on exertion/coughing/sneezing
Smoking
Obesity
Age
Route of foetal delivery

30
Q

Stress incontinence investigations

A

Stress test with noticeable urine loss
Urodynamics

31
Q

Stress incontinence management

A

Pelvic floor exercises
Surgical mid urethral sling
Duloxetine

32
Q

Overactive bladder signs and symptoms

A

Urinary urgency
Nocturia
No evidence of UTI

33
Q

Overactive bladder investigations

A

Urine dipstick
Voiding diary

34
Q

Overactive bladder management

A

Anticholinergics: oxybutynin(can cause dry mouth)
Beta 3 agonist: mirabegron

35
Q

Urinary tract calculi signs and symptoms

A

Loin to groin colicky pain
N+V
Haematuria

36
Q

Urinary tract calculi investigations

A

Urinalysis: possible UTI signs
CT KUB non contrast

37
Q

Urinary tract calculi management

A

IV fluid and anti-emetic
IV paracetamol/PR diclofenac
IV antibiotics if pyonephrosis

> 5mm:
Percutaneous nephrostomy insertion if pyonephrosis
Shockwave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy (only if other 2 fail/staghorn calculi)

38
Q

Dehydration investigations

A

FBC
Glucose
TFT
Calcium
U&E

39
Q

UTI signs and symptoms

A

Increased urinary frequency and urgency
Dysuria
Suprapubic pain
Fever
Confusion

40
Q

UTI investigations

A

Urine dipstick: leukocyte, nitrite

41
Q

UTI management

A

Lower: Trimethoprim 200mg BD 3(F) or 7(M) days
Pyelonephritis: trimethoprim 200mg BD 14/7

nitrofurantoin
co-amoxiclav 500mg TDS 7-10/7

42
Q

AKI causes

A

Pre renal: sepsis, hypovolaemia

Renal: drugs, glomerulonephritis

Post renal: obstruction

Y3 (9 decks)

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