Renal/ Urology

Question 1

What organism is the most common cause of peritonitis secondary to peritoneal dialysis?

Answer 1

Staphylococcus epidermidis

Question 2

What is the most common cause of death in dialysis patients?

Answer 2

Ischaemic heart disease

Question 3

What size will the kidneys be (enlarged or small) in diabetic nephropathy versus CKD?

Answer 3

Diabetic nephropathy - normal or enlarged kidneys

CKD - small kidneys

Question 4

What test is used to confirm the causative organism is post streptococcal glomerulonephritis?

Answer 4

Anti-Streptolysin O titre

Question 5

How is anion gap calculated?

Answer 5

(sodium + potassium) - (bicarbonate + chloride)

Normal is 8-14mmol

Question 6

What causes a normal anion gap metabolic acidosis?

Answer 6

gastrointestinal bicarbonate loss: diarrhoea, fistula, renal tubular acidosis

drugs: e.g. acetazolamide

ammonium chloride injection

Addison’s disease

Question 7

What causes a raised anion gap metabolic acidosis?

Answer 7

lactate

ketones

urate: renal failure

acid poisoning: salicylates, methanol

5-oxoproline: chronic paracetamol use

Question 8

What is the daily glucose requirement?

Answer 8

50-100g/day

Question 9

What is the most common cause of nephrotic syndrome in children/ young adults? How is it treated?

Answer 9

Minimal change disease - treated with steroids
Doesn’t develop into esrf

Question 10

What is the inheritance pattern in polycystic kidney disease?

Answer 10

Autosomal dominant

Question 11

When dosed IgA nephropathy vs post steptococcal glomerulonephritis present?

Answer 11

IgA nephropathy - days
Post streptococcal glomerulonephritis - 1-2 weeks

Question 12

Other than raised CK what other biochemical abnormality do you see in rhabdomyolysis?

Answer 12

Hypocalcaemia

Patients with rhabdomyolysis should have a bone profile taken to measure calcium and phosphate. Calcium typically binds to myoglobin released from damaged muscle tissue causing serum hypocalcaemia.

Question 13

MUDPILES = the causes of raised anion gap metabolic acidosis. What is included in it?

Answer 13

M- Methanol
U - Uraemia (renal failure)
D - DKA
P - Propylene glycol
I - Infection
L - Lactic acidosis
E - Ethylene glycol
S - Salicytlates

Question 14

How does acute interstitial nephritis present?

Answer 14

Fever, rash, arthralgia
Raised eosinophils
Raised urinary white cells

Question 15

Which conditions can cause rapidly progressive glomerulonephritis?

Answer 15

Goodpasture’s, vasculitis, SLE

Question 16

What type of glomerulonephritis is HIV associated with?

Answer 16

Focal segmental glomerulonephritis

Question 17

How does polycystic kidney disease present?

Answer 17

Progressive renal impairment

Cyst haemorrhage/ infection

Hypertension, LVH

Increased malignancy risk

Berry aneurysms > subarachnoid haemorrhage

Question 18

How is polycystic kidney disease treated?

Answer 18

Hypertension control

Tolvaptan to reduce cyst volume and progression

Question 19

What are some of the potential causes of pre renal AKI?

Answer 19

Hypotension

Hypoperfusion > NSAIDs, ACE.I

Acute tubular necrosis

Question 20

What are some of the causes of renal AKI?

Answer 20

Vasculitis

Glomerulonephritis

Drugs eg gent

Question 21

What are some of the causes of post renal AKI?

Answer 21

Obstruction - stones, cancer, strictures

Question 22

What ECGs changes are seen in hyperkalaemia?

Answer 22

Tall T waves

Small P waves

Wide QRS > VF

Question 23

What ECG changes are seen in hypokalaemia?

Answer 23

Small / inverted T waves

Long PR

ST depression

Question 24

How would you investigate proteinuria?

Answer 24

Exclude UTI and repeat
Check for haematuria and albumin: creatinine ratio
Check BP
Check U&Es

Question 26

How does haenolytic uraemic syndrome present?

Answer 26

Childen AKI Follows gastroenteritis E.Coli Bloody diarrhoea Proteinuria/ haematuria Anaemia, thrombocytopenia, purpura Admit for specialist reveiw

Question 27

What causes renal artery stenosis and how does it present?

Answer 27

Causes - atheroma or firbomucular hyperplasia in the younger patient High BP Bruit Reduced kindney function, proteinuria

Question 28

Which type of renal stones are associated with proteus UTI?

Answer 28

Staghorn calculi

Question 29

How would you investigate haematuria?

Answer 29

Renal function, ACR PSA/ DRE - men Pelvic US - if older female, other gynae sx Renal US if visible haematuria or persistent

Question 30

What are the most common causes of bladder ca?

Answer 30

Transitional cell carcinoma in the UK Squamous cell carcinoma worldwide

Question 31

What general advice can you give to try and prevent recurrent cystitis? What other preventative measures are there?

Answer 31

Frequent urination (note in urge invontinence advice is the opposite - try to resistance urge for longer periods) Increase fluids Double void (go again after 5-10 mins) Void after intercourse Prophylactic abx Men with BPH > finasteride, doxazosin Women - topical oestrogen

Question 32

How does interstitial cystitis present?

Answer 32

Frequency, urgency, pelvic/ suprapubic pain MSU: no organism Antispasmodics, amitriptyline and bladder surgery can help

Question 33

What drugs can exacerbate/ cause incontinence?

Answer 33

Diuretics A- blockers Anticholinergics

Question 34

What are the medication options for urge incontinence?

Answer 34

Oxybutynin Solifenacin Tolterodine Duloxetine

Question 35

What is retroperitoneal fibrosis/ how does it present?

Answer 35

Ureters become embedded in fibrous plaques in the retroperitoneal space Associated with some longterm conditions Fever, leg oedema, hypertension ,palpable mass, renal failure Mx options: steroids, nephrostomy

Question 36

Which medciations are used for BPH/ what drug classes are they?

Answer 36

Tamsulosin - alpha blockers Finasteride - 5a reductase inhibitors

Question 37

Tx for prostatitis?

Answer 37

Ciprofloxacin 4 weeks

Question 38

What medications are used to treat prostate cancer?

Answer 38

Goserelin sc every 4-12 weeks (LHRH analogue) Cyproterone acetate, flutamide, bicaluatmide (anti-androgens) - used to prevent side effects with LHRH analogues

Question 39

What is hypospadias?

Answer 39

The urethral meatus opens on the ventral side of the penis

Question 40

What is peyronie's disease/ how does it present/ how is it managed?

Answer 40

Hard lumps in the shaft of the penis Can cause pain when erect No tx routinely but can refer to urology for consideration of surgical management

Question 41

How is balanitis (inflammation of the glans/ foreskin) managed?

Answer 41

Oral abx (eg fluclox), topical antifungals eg clotrimazole

Question 42

What is erythroplasia of queyrat?

Answer 42

premalignant condition of the glans > needs referral to urology for surgical management

Question 43

How does testicular torsion present?

Answer 43

Severe scrotal pain, RIF pain, Hard high riding testicle

Question 44

How does epididymo-orchitis present an how is it managed?

Answer 44

Acute testicular pain, swelling and tenderness, fevers, can be urinary symptoms abx/ but if in doubt admit to urology

Question 45

What is a hydrocele and how is it managed?

Answer 45

Collection of fluid in the tunica vaginalis Presents with swelling in the scrotum - testis is within the swelling and not palpable separately. Should be able to get above the swelling. Refer adults for US if can't palpate the testicle Some need referral to urology Haematoceoeles are blood filled - need urgent referral (due to direct trauma)

Question 46

What is a varicocele and how is it managed?

Answer 46

Collection of varicose veins in the pampniform plexus Dull ache in the testis Some managed with reassurance, some need referral for surgery

Question 47

How do epididymal cysts present and how are they managed?

Answer 47

Middle aged men Painless lump, often bilateral US if unsure Reassure/ referral to urology if painful Note spermatocoeles are cysts that contain sperm and present in the same way with the same mx

Question 48

How are testicular lumps investigated/ managed?

Answer 48

Testicular lumps should be treated as cancer until proven otherwise US > but don't delay referral

Question 49

What is Fournier's gangrene?

Answer 49

Necrotising fasciitis of the scrotal skin / penis Mx - surgical debridement and IV abx