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Finals > Renal/Urology guidelines > Flashcards

Renal/Urology guidelines Flashcards

1
Q

UTI management

  • non pregnant women
  • pregnancy woman
  • man
A
  • 3d nitrofurantoin/trimethoprim
  • 7d nitrofurantoin (even if asymptomatic)
  • 7d nitro/trimethoprim
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2
Q

Pyelonephritis Mx

A

cephalosporin 14d

Can also use quinolone (levofloaxin, ciprofloxacin)

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3
Q

Prostatitis Mx

A

Quinolone 14d (levofloxacin, ciprofloxacin)

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4
Q

UTI in children
<3m
>3m, lower UTI
>3m, upper UTI

A

<3m = admit if under 3m
>3m, lower UTI = treat as adult
>3m, upper UTI = admit for 10d cephalosporin

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5
Q

timeline for needing CTKUB for renal stones

A

within 14 hours

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6
Q

Mx of renal stone based on size

A

<0.5cm = expectant with alpha blocker (tamsulosin) or CCB (nifedipine)
<2cm = lithotripsy (uretoscopy if pregnant)
>2cm (or complex like staghorn) = percutaneous nephrolithotomy
Any size + infection/hydrocephalus

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7
Q

2 main drugs for BPH and SE

A

tamsulosin (a2 blocker) - post hypotension, dizziness

finasteride (5a reductase inhibitor) - libido, erections, retrograde ejaculation, gynaecomastia

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8
Q

do you need to do a biopsy for renal cancer

A

no, not if a nephrectomy is planned

CTCAP is good enough

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9
Q 
Mx of renal cancer
T1
T2+
chemotherapy
if is a transitional cancer of renal pelvis
A

T1 (<7cm in one kidney) = partial nephrectomy
T2+ = radical nephrectomy (without adrenals)
NO adjuvant chemo needed
If TCC, need to disconnect ureter at the bladder and remove it.

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10
Q

when do you refer for prostate cancer

A 
if craggy
if PSA above age specific range:
50-60 = 3
60-70 = 4
70+ = 5
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11
Q

1st line investigation once referred for prostate cancer and how this leads on to definitive investigation

A

Multiparametric MRI, reported using the 5 point Likert scale:
1-2 –> discuss pros and cons of biopsy
3+ –> perform trans rectal biopsy TRUS and then grade using gleason score

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12
Q

When can you do conservative treatment for prostate cancer and what does this entail

A

T1/T2 stage (local) AND

elderly + comorbid + 3/3 Gleason score (low).

This group needs active surveillance including re-biopsy

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13
Q

Mx of prostate cancer

- T3/4 (advanced to local structures)

A

surgery + radiotherapy +/- hormone therapy

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14
Q

Mx of prostate cancer

- Metastatic

A

Goserelin (GnRH agonist) + covering antiandrogen cytoperotone acetate

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15
Q

1st line for testicular cancer

A

USS

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16
Q

Mx of testicular cancer
always
seminoma
non-seminoma

A 
Always = orchidectomy via inguinal approach
Seminoma = radiotherapy
Non-seminoma = chemotherapy
17
Q

Approaches to hydrocele operation if adult or child

A

adult has scrotal approach (Lords or Jaboulay)

child (if persisting beyond 2yrs) has inguinal approach

18
Q

Ix of varicocele

when do you operate

A 
Ix = doppler studies
Mx = usually conservative. if pain or fertility issues, operate
19
Q

CKD management

  • high phosphate
  • low vit D
  • anaemia
  • hypertension
  • tertiary hyperPTH
A
  • use calcium based phosphate binders. Unless CKD bone disease is present in which case use Sevelamer (nonCabased)
  • give activated vit D calcitriol/alfacalcidol
  • IV iron or EPO
  • ACEi is good (allowed a 30% rise in creatinine or 25% reduction in eGFR)
  • parathyroidectomy of offending gland
20
Q

Stress incontinence Mx

A 
C = pelvic floor exercises, 8r, 3x/day 3 weeks
M = duloxetine (SNRI)
S = retropubic tabe
21
Q

Urge incontinence Mx

A 
C = bladder retraining
M = oxybutninin (antimuscarinic), mirabegron (B3) for old ladies worried about falls
S = botulinum toxin
22
Q

definition of AKI and stages

A

Stage 1 = <0.5ml/kg/hr, 50% (or 26umol) increase in creatinine in 48 hours
Stage 2 = 2x increase in creatinine or above for 12 hours
Stage 3 = 3x increase

23
Q

when do you do urine dip and renal USS for AKI

A

urine dip = always

renal USS = only if cause not known for AKI after 24 hours

24
Q

do you fluid resuscitate in AKI

A

If pre-renal, yes, but if ATN no.
Pre-renal: urinary sodium <30
ATN: urinary sodium >30

25
Q

What do you do FIRST if called to hyperkalaemia

A

do ECG and repeat VBG to check result

26
Q

When do you manage hyperK

A

If >6.5 or if ECG changes

27
Q

Mx and doses for hyper K

A 
1st = 10ml 10% calcium gluconate
Then = 10U actrapid in 50ml of 50% glucose over 10 mins
Consider = salbutamol. rectal Resonium.
28
Q

definition of nephrotic syndrome

A

> 3g/24hr protein

hypoalbuminaemia (<30)

29
Q

Investigation findings for the following:

  • MNCS
  • FSGS
  • membranous
  • IgA
  • Post-strep (proliferative)
  • Rapid progressive
A
  • MNCS = podocyte effacement on EM
  • FSGS = focal sclerosis and hyalinosis on light microscopy
  • membranous = subepithelial deposits ‘spike and dome’
  • IgA = mesangial hypercellularity, +ve for IgA and C3
  • Post-strep (proliferative) = low C3, high ASOT, endothelial proliferation and subepithelial humps
  • Rapid progressive = epithelial crescents
30
Q

AIN heptad

A

fever, eosinophilia, urinary white cell casts, rash

31
Q

General nephrotic syndrome Mx

General nephritic syndrome Mx

A

steroids + immunosuppression
with membranous type also use ACEi/ARB

Nephritic are usually self limiting or are caused by something systemic like GwPA so have special treatments

32
Q

Amyloidosis Ix (3)

A

Congo red stain shows apple green birefringence
Serum amyloid precursor scan (SAP scan)
Biopsy of rectal tissue

33
Q

Amyloidosis general Mx

A

Myoablative chemotherapy (as problem is often within the bone marrow)

34
Q

how do you screen for PCKD

A

USS

35
Q

How do you diagnose PCKS based on USS

A 
<30 = two cysts either kidney
30-60 = two cysts both kidneys
60+ = four cysts both kidneys
36
Q

Mx of PCKD

A

tolvaptan (ADH receptor 2 antagonist) if CKD2/3 or rapidly progressing

37
Q

Peyronie’s disease Ix and Mx

A 
Ix = USS
Mx = vitamin E and surgery

Finals (13 decks)

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