Renal and GU presentations Flashcards
(29 cards)
A 65-year-old male smoker with diabetes mellitus, hypertension, dyslipidaemia, and chronic kidney disease presents with chest pain. ECG changes suggest an acute myocardial infarction. He is taken for an urgent coronary angiogram. Three days later, he is noticed to have developed an elevated serum creatinine, oliguria, and hyperkalaemia.
Acute Kidney Injury
A 45-year-old man presents to the emergency department with a 1-hour history of sudden onset of left-sided flank pain radiating down towards his groin. The patient is writhing in pain, which is unrelieved by position. He is nauseous and has been vomiting.
Nephrolithiasis
A 54-year-old man with a 10-year history of diabetes and hypertension, with complications of diabetic retinopathy and peripheral neuropathy, presents to his primary care physician with complaints of fatigue and weight gain of 4.5 kg over the past 3 months. He denies any changes in his diet or glycaemic control but does state that he has some intermittent nausea and anorexia. He states that he has noticed that his legs are more swollen at the end of the day but improve with elevation and rest. Physical examination reveals an obese man with a sitting blood pressure of 158/92 mmHg.
Chronic Kidney Disease
A 60-year-old man presents to his primary care physician with a 3-month history of increasing urinary frequency without burning and nocturia 3 times each evening. He has limited his fluid consumption and caffeine intake in the evening without much benefit. Examination demonstrates no suprapubic mass or tenderness. A rectal examination demonstrates normal rectal tone and a moderately enlarged prostate without nodules or tenderness.
Benign Prostatic Hyperplasia
A 72-year-old man presents with a 6-month history of weak stream, straining, and hesitancy. There is no history of prostate cancer. The physical examination demonstrates a severely enlarged prostate without nodules. There is moderate suprapubic fullness prior to voiding
Benign prostatic hyperplasia
A 34-year-old woman who is otherwise healthy has had a fever, nausea, and right-sided back pain for 2 days. The physical examination shows a temperature of 39.0ºC, blood pressure of 120/60 mm Hg, pulse of 110, respiratory rate of 18, and right-sided costovertebral angle tenderness to percussion. Dipstick urinalysis is positive for leukocytes, nitrites, and blood.
Acute pyelonephritis
A 60-year-old woman presents with a long history of poorly controlled type 2 diabetes mellitus, musculoskeletal pains attributed to fibromyalgia, and depression. She has been seen several times with a variety of vague complaints; today, she states that she has lost her appetite and has been feeling feverish. Her lower back is bothering her more than ever, especially on the right, and her usual pain medication is not helping. Temperature is 38°C (100.5°F), weight is 3.6 kg (8 lb) lower than on her last visit, and physical examination is remarkable for right costovertebral angle tenderness.
Chronic pyelonephritis
History of poorly controlled T2DM - RF for UTI
Lower back pain localised to the right could be a sign of kidney involvement
Costovertebral angle tenderness –> Pyelonephritis
A 76-year-old male with diabetes with known incomplete bladder emptying due to benign prostatic obstruction presents with haematuria, suprapubic pain, frequency, and urgency with associated fever.
Acute Cystitis (with urinary retention)
A 24-year-old man presents with copious urethral discharge 4 days after having unprotected sex with a new partner. He is HIV-negative but has a history of prior STD treatments.
Urethritis
A 20-year-old woman presents with vaginal discharge, dysuria, and dyspareunia. Her last sex partner got “a shot and some antibiotics”, but she is not sure for what. She “sometimes” uses condoms.
Urethritis
A 21-year-old man presents with a 3-day history of worsening left-sided scrotal pain and swelling. He reports noticing a white urethral discharge over the last 24 hours. He is otherwise fit and well, and takes no regular medicine. He is heterosexual and has a single female partner, with whom he has unprotected intercourse.
Examination reveals a tender, erythematous, swollen left hemiscrotum with a palpably thickened epididymis
Epididymo-orchitis -
As there is urethal discharge - most likely due to N.gonnorhoea/C.trachomatis
A 30-year-old man presents with a 3-day history of a progressively diminishing urinary stream, dysuria, and urinary frequency. He considers there is no possibility of a sexually transmitted infection. He is sufficiently ill with malaise and chills to require hospital admission. On examination, he is febrile with a temperature of 38.5°C (101.3°F).
Digital rectal examination reveals a tender, boggy, and slightly enlarged prostate.
Prostatitis
A 40-year-old man presents with a recent history of dysuria and genital and perineal pain. He has felt feverish and unwell intermittently but has not previously sought medical attention.
Digital rectal examination reveals an enlarged, soft-feeling, and tender prostate.
Prostatitis
(Should kind of know from genital and perineal pain with dysuria?) - but otherwise add above)
An otherwise healthy 22-year-old Japanese-American man presents with visible haematuria accompanied by flank pain. He has a 2-day history of sore throat, fever, chills, malaise, and headache. Physical examination reveals erythema and inflammation of the uvula and pharynx, enlarged tonsils with patchy greyish-white exudates, and tender anterior cervical lymphadenopathy. The rest of the examination is normal. Urinalysis shows cola-coloured urine with haematuria and 3+ protein.
IgA Nephropathy - 2 day history of sore throat
(Post strep glomerulonephritis - 2-4 weeks)
A 35-year-old man with no past medical history presents to the emergency department after he noted cola-coloured urine. He denies pain or fever associated with the blood in the urine, but has had a sore throat for the past 3 days, which is getting better. He has not had a similar episode previously. Examination reveals a non-blanching purpuric rash over both his legs. There are no other abnormalities.
Glomerulonephritis
Non blanching purpuric rash suggests - henoch schnolein purpura which can cause inflammation of the blood vessels of the kidneys
As a result it could be leaning to IgA nephropathy more than other nephritic diseases
A 52-year-old man presents to his physician complaining of one week of progressively worsening weakness, anorexia, malaise, cough, and dark urine. He reports feeling bad for the past few weeks and thought that he was simply recovering slowly from an upper respiratory tract infection. Over the past two days he has been alarmed to notice small amounts of blood in his sputum. He has been having some shortness of breath. He has no prior personal or family history of renal disease. He has been a smoker for 30 years and he smokes a packet of cigarettes a day. He works as a car mechanic.
Good pasture’s disease
Haemoptysis + Dark urine (haematuria)
Renal + lung pathology = good pasture’s
A 5-year-old boy presents with a short history of facial oedema that has now progressed to total body swelling involving the face, abdomen, scrotum, and feet. Other symptoms include nausea, vomiting, and abdominal pain. The parents report that the child had a viral illness with fever a few days before the development of the swelling
Minimal change disease (nephrotic syndrome)
Age
- Progressive oedema
- Nausea, vomiting - due to fluid overload
A 42-year-old white man with no previous medical history presents to his primary care physician with progressively increasing oedema of both lower extremities. The patient has pitting pedal oedema rated as 3+ (5 mm oedema, pit formed on palpation is deep and lasts >1 minute). Urinalysis reveals marked proteinuria (3+).
Nephrotic syndrome
Difficult to tell apart between focal segmental glomerulosclerosis and membranous nephropathy
(BMJ - Focal segmental glomerulosclerosis)
A 48-year-old man presents to his family doctor with a recent lower-extremity swelling that is gradually worsening. Over the last few weeks, he has also noticed puffiness under his eyes. A urinalysis demonstrates significant proteinuria, and a 24-hour urine collection confirms proteinuria of 12 g. He has no history of diabetes mellitus, macroscopic haematuria, or hypertension.
Nephrotic syndrome
Difficult to tell apart between focal segmental glomerulosclerosis and membranous nephropathy
(BMJ - membranous nephropathy)
A thin 65-year-old man with no significant past medical history presents with a 5-month history of right-sided flank discomfort and abdominal fullness. He finally seeks medical attention because of 2 weeks of lower extremity oedema, and 4 days of gross haematuria with clots. On examination, his blood pressure is 160/90 mmHg, heart rate is 120 bpm and regular, and he is afebrile. He is found to have a palpable right-sided lower abdominal mass, and pitting oedema to the mid-shins bilaterally, which is worse on the right.
Renal cell carcinoma
5 month history (Chronic) - flank discomfort and abdominal fullness - can indicate renal mass
Lower extremity oedema - could be due to IVC compression or obstruction due to a tumour or thrombus formation (complication of RCC)
Gross haematuria with clots - visible blood in urine –> RCC
Hypertension - due to increased renin
Palpable right sided mass.
A 64-year-old retired painter presents with painless haematuria. He had a similar episode 1 year ago and was given antibiotics for a presumed urinary infection and his bleeding resolved. He has a decreased urinary stream and nocturia twice a night. He has smoked a pack of cigarettes daily for 45 years.
Bladder cancer
0-year-old black man presents to his general practitioner with complaints of difficulty with urination. He describes a weak stream and a sense of incomplete voiding. He describes nocturia (5 episodes per night) and has been taking an alpha-blocker for this with minimal improvement. He says he can last about 60-90 minutes without urinating. He denies any suprapubic tenderness, dysuria, or haematuria. He further denies any back pain or gastrointestinal complaints. Rectal examination reveals his prostate to be approximately 60 mL, asymmetrical, with a large 2-cm nodule at the right base.
Prostate cancer
A 35-year-old man presents with non-specific testicular discomfort and the feeling of a mass in the testis. On examination, a 2 cm by 1 cm smooth, painless mass is palpated in the right testis. The mass does not transilluminate with light. There is no lymphadenopathy.
Testicular cancer- mass
Varicocele usually described as a bag of worms (also usually on the left side)
A 30-year-old healthy man presents with primary infertility. He has been unable to establish a pregnancy for the last 12 months with his partner. On physical examination, a scrotal mass that feels like a bag of worms is easily palpable when the patient is standing and is non-palpable when supine. The testicles are symmetrical and normal in size.
Varicocele
