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renal and urogenital Flashcards

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1
Q

risk factors of kidney stones

A

dehydration
hypercalciuria, hyperparathyroidism, hypercalcaemia
- for the calcium related stones eg calcium oxalate which is also most common

gout for uric acid stones

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2
Q

presentation of kidney stones

A

loin (to groin) pain -
SUDDEN onset
very severe cholicky (waves of worsening due to the ureter spasms)

haematuria, patients moving around unable to find comfort
vomiting and nausea

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3
Q

investigation for kidney stones

A

urinalysis for haematuria and renal function and other bloods ect
CTKUB diagnostic

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4
Q

PAIN management of kidney stones

A

NSAIDS although be weary of cardiovascular adverdse effects
diclofenac suggested from NICE

IF NSAIDS contraindicated give IV paracetamol

if requiring admission give parenteral analgesic eg IM diclofenac

can also give alpha blocker for distal ureteric stone

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5
Q

treatment of kidney stones

A

if <5mm watchful wait
if 5-10 mm? shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
>20 percutaneous nephrolithotomy

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6
Q

differentials of severe loin (to groin) pain

A

renal colic
ruptured AAA!- look for hypotension and tachy - systemic upset
pyelonephritis
MSK pain
radiculopathy ( compression or inflammation of spinal nerve roots)

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7
Q

most common type of kidney stone and some others

A

calcium oxalate

some others:
calcium phosphate
uric acid – where gout is risk factor

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8
Q

CKD clinical presentation

A

usually asymptomatic unless late stage and undiagnosed: polyuria, lethargy, peripheral oedema, pruritus due to uraemia, anorexia, nausea and vomiting, HT

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9
Q

CAUSES of CKD

A

chronic pyelonephritis,
chronic glomerulonephritis,
DIABETIC nephropathy,
HT,
adult polycystic kidney disease

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10
Q

what does eGFR calculation take into account?

A

age
sex
ethnicity
creatinine – all put in MDRD equation

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11
Q

factors that can affect creatinine levles that are not accounted for in eGFR calc

A

red meat consumption
pregnancy
muscle mass

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12
Q

KEY pathologies and findings in CKD

A

Anaemia (erythropoetin related prob)
calcium/ phosphate related problems
proteinuria

general picture:
deranged U+E
low eGFR

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13
Q

CLASSIfication of stages of CKD

A

STAGE 1 eGFR> 90 (WITH DERANGED u+e)
stage 2 gfr<90
st 3<60
st4<30
renal failure <15

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14
Q

with what levels of GFR can you get anaemia of CKD

A

GFR is less than 35 ml/min (other causes of anaemia should be considered if the GFR is > 60 ml/min)

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15
Q

management of anaemia of CKD?

A

DETERMINATION And optimisation of IRON STATUS BEFOREEEE giving erythropoiesis-stimulating agents (ESA).

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16
Q

when to give oral or iV iron in anaemia of CKD?

A

oral iron should be offered for patients who are NOTTT on ESAs or haemodialysis.

(If target Hb levels are not reached within 3 months then IV)

patients on ESAs or haemodialysis generally require IV iron!!!!!

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17
Q

WHAT IS THe best ratio to measure proteinuria

A

its ACR

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18
Q

WHAT IS considerd a clinically significant proteiniuria in acr

A

3 mg/ mmol and above

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19
Q

what acr indigates nephrologist referral

A

ACR >70 mg/mmol

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20
Q

management options of proteinuriaaa

A

ACE inhibitors if ACR is >30 and coexistent HT

AND >70 indicated regardless of HT

sglt2 other option

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21
Q

what are the clacium phospahte related abnormalities arisIng in CKD

A

the high phosphate level ‘drags’ calcium from the bones, resulting in osteomalacia
low calcium: due to lack of vitamin D, high phosphate
secondary hyperparathyroidism: due to low calcium, high phosphate and low vitamin D

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22
Q

management of calcium/ phosphate related abnormalities in ckd?

A

reduced dietary intake of phosphate is the first-line management
phosphate binders
vitamin D: alfacalcidol, calcitriol
parathyroidectomy may be needed in some cases

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23
Q

MASTItis what is it

A

breast pathology
typically in breastfeeding stage

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24
Q

mastitis features

Study These Flashcards
A

red hot swollen painful one breast in breastfeeding stage

25
management of mastitis
keep breastfeeding and analgesia nd warm compresses is conservative management
26
how to manage mastitis if not resolved conservatively
flucloxacillin 10-14 days
27
other indications for mastitis flucloxaxillin
systemically unwell fever ect nipple fissure
28
what is nephrotic syndrome
a syndrome, so a collection of symptoms a triad: proteinuria (massive usually) oedema hypoalbuminaemia
29
nephrotic vs nephritic syndrome
different causes and the NEPHRITIC features include: hypertension, haematuria in addition to proteinuria
30
pathophysiology of nephrotic syndrome conditions
damage to glomerular basement membrane leading to increased permeability to proteins in the urine this means that theres less of all sorts of proteins in blood 1) less in general- low oncotic pressure so fluid moves to exracellular space: oedema 2) less antithrombin-III leads to predisposition to thrombosis 3) loss of thyroxine binfing globulin leads to low TOTAL but not FREE THYROXINE levels
31
nephrotic syndrome most common primary cause and other primary causes
minima change disease (most common in children 2-5) focal segmental glomerulosclerosis membranous nephropathy
32
nephrotic syndrome secondary causes
diabetes mellitus, SLE, amyloidosis, infections (HIV, HEP B AND C) nsaids and gold therapy?
33
initial investigations for nephrotic syndrome
Urine dipstick: proteinuria and check for microscopic haematuria MSU to exclude urinary tract infection. Quantify proteinuria using an early morning urinary protein:creatinine ratio or albumin:creatinine ratio. FBC and coagulation screen Urea and electrolytes
34
complications of nephrotic syndrome
immunosupressed due to loss of immunoglobulins, thrombosis
35
management of nephrotic syndromes
from specialist paediatrician with nephrologist high dose steorids- 4 weeks and gradually wheene over 8 weeks. low salt siuretics for oedema albumin infusion in svere hypoaplbuminemia
36
what are some conditions under interstitial lung disease
idiopathic pulmonary fibrosis secondary pulmonary fibrosis asbestosis hypersensitivity pneumonitis
37
presentation of interstitial lung diseases
SOB particularly on exertion dry cough fatigue
38
typical findings on examnation of idiopathic pulmonary fibrosis
bibasal FINE end-inspiratory crackles clubbing
39
DIAGNOSIS of ILD
CLINICAL features, high resolution CT thorax (ground glass features) spirometry if in doubt: lung biopsy, bronchoalveolar lavage
40
FINDINGS oF ILD in spirometry
restrictive pattern so FVC and FEV1 significantly reduced and FEV1:FVC ratio> 70%
41
general management of ILD AND prognosis
POOR prognosis management is limited and supportive: remove or treat underlying cause if secondary or allergic home oxygen if hypoxic physiotherapy and pulmonary rehab pneumococcal flu vaccine advanced care planning and palliative when appropriate lung transplant is an option but careful weighing
42
two medications licensed specifically for idiopathic pulmonary fibrosis
pirfenidone nintedanib (inhibits tyrosine kinase)
43
causes of secondary pulmonary fibrosis
Several drugs can cause pulmonary fibrosis: Amiodarone (also causes grey/blue skin) Cyclophosphamide Methotrexate Nitrofurantoin Pulmonary fibrosis can occur secondary to other conditions: Alpha-1 antitrypsin deficiency Rheumatoid arthritis Systemic lupus erythematosus (SLE) Systemic sclerosis Sarcoidosis
44
what pathogenic processes does asbestos trigger and how long does it take for pathologies to develop
sbestos is fibrogenic, meaning it causes lung fibrosis. It is also oncogenic, meaning it causes cancer. The effects of asbestos usually take several decades to develop.
45
specific diseases caused by asbestos inhalation
Lung fibrosis Pleural thickening and pleural plaques Adenocarcinoma Mesothelioma
46
risk factors for BPH
---age around 50% of 50-year-old men will have evidence of BPH and 30% will have symptoms around 80% of 80-year-old men have evidence of BPH ----ethnicity: black > white > Asian
47
PRESENTATION OF BPH
lower urinary tract symptoms (LUTS), which may be categorised into: 1) voiding symptoms (obstructive): weak or intermittent urinary flow straining hesitancy terminal dribbling incomplete emptying 2) storage symptoms (irritative) urgency frequency urgency incontinence nocturia 3) post-micturition dribbling 4) complications urinary tract infection retention obstructive uropathy
48
investigations for BPH
dipstick urine U&Es: particularly if chronic retention is suspected PSA: should be done if there are any obstructive symptoms, of if the patient is worried about prostate cancer urinary frequency-volume chart should be done for at least 3 days International Prostate Symptom Score (IPSS)
49
what is the international prostate symptom score IPSS
tool for classifying the severity of lower urinary tract symptoms (LUTS) and assessing the impact of LUTS on quality of life Score 20-35: severely symptomatic Score 8-19: moderately symptomatic Score 0-7: mildly symptomatic
50
WHAT IS THE FIRst line management option for BPH IF if moderate-to-severe voiding symptoms (IPSS ≥ 8)
alpha-1 antagonists e.g. tamsulosin, alfuzosin decrease smooth muscle tone of the prostate and bladder improve symptoms in around 70% of men adverse effects: dizziness, postural hypotension, dry mouth, depression
51
which medication is indicated if the patient with bPH has a significantly enlarged prostate and is considered to be at high risk of progression
5 alpha-reductase inhibitors e.g. finasteride block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months may also decrease PSA concentrations by up to 50% adverse effects: erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia
52
other management options in case of milder or more severe disease that doesnt tolerate monotherapy
watchful wait if milder combination therapy (alpha-1 antagonist + 5 alpha-reductase inhibitor) if there is a mixture of storage symptoms and voiding symptoms that persist after treatment with an alpha-blocker alone, then an antimuscarinic (anticholinergic) drug such as tolterodine or darifenacin may be tried ansurethral resection of prostate (TURP)
53
most common type of bladder cancer in developed counries and second most common
transitional cell carcinoma squamous cell carcinoma
54
risk factors for transitional cell carcinoma of the bladder
Smoking Exposure to aromatic amines (employed in rubber, dyes, and chemical industry) Use of Cyclophosphamide
55
risk factors for squamous cell carcinoma
Schistosomiasis infection Long-term catheterisation (10+ years)
56
signs and symptoms of bladder cancer
Local features: Painless visible haematuria Recurrent UTIs Hydronephrosis can also invade the obturator nerve: neuropathic pain on the medial thigh. Systemic features: Unintended weight loss Night sweats
57
initial diagnostic investigation for bladde cancer
flexible cystoscopy of urethra and bladder and after that CT urogram also
58
when to refer fpr bladder cancer under 2ww pathway
If they are aged 45 years and over and have: Unexplained visible haematuria without urinary tract infection, or Visible haematuria that persists or recurs after successful treatment of urinary tract infection. If they are aged 60 years and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
59

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