Treatments

Question 1

Renal colic/nephrolithiasis - Acute

Answer 1

Acute
NSAIDs for pain
Antiemetics for vomiting and nausea
Allow stones <5mm to pass spontaneously

Question 2

Renal colic/nephrolithiasis - surgical interventions

Answer 2

Percutaneous nephrostomy

Extracorporeal shock wave lithotripsy

Question 3

AKI

Answer 3

Treat hyperkalaemia risk for arrhythmia
Fluid rehydration - if pre-renal
Stop nephrotoxic medications
Relieve obstruction

Question 4

CKD - Reduce risk of complications

Answer 4

Oral NaHO3 to treat metabolic acidosis 
Iron supplementation and erythropoietin to treat anaemia 
Vit D to treat renal bone disease 
Dialysis in the end stage renal failure 
Renal transplant in end stage failure

Question 5

Prostate cancer

Answer 5

• External beam radiotherapy directed at the prostate
• Brachytherapy
• Hormone therapy
• Bilateral orchiectomy - to remove testicles (rarely used)
  Surgery
• Removal of the prostate gland

Question 6

Prostate procedure side affects

Answer 6

ED and urinary incontinence

Question 7

Benign prostate hyperplasia - Mid/manageable

Answer 7

Behavioural management e.g. avoiding caffeine/alcohol

Question 8

Medical options

Answer 8

1st - Alpha blockers e.g. tamsulosin

5-alpha reductase inhibitors e.g. finasteride

Question 9

Mechanism of action Tamsulosin and Finasteride

Answer 9

Tamsulosin - relaxes smooth muscle

Finasteride - reduces size of the prostate

Question 10

BPH - Most common surgical management

Answer 10

Transurethral resection

Question 11

Urethritis - Gonorrhoea

Answer 11

Single IM dose of ceftriaxone if sensitivities unknown

Single does of oral ciprofloxacin if sensitivities are known

Question 12

Urethritis - Chlamydia

Answer 12

Single 1g dose of azithromycin

Plus 7 days doxycycline

Question 13

Varicocele

Answer 13

Uncomplicated can be managed conservatively - reassurance/observation
If testicular pain, atrophy or infertility risk then surgery may be indicated

Question 14

Testicular Torsion

Answer 14

Surgical emergency
Orchiopexy - correcting the position of the tesicles by fixing them in place
Orchidectomy - removal if surgery is delayed or there is necrosis

Question 15

SLE - mild disease

Answer 15

1st - Hydroxychloroquine - DMARD
Corticosteroids
NSAIDs
Sun cream and sun avoidance

Question 16

SLE - severe disease

Answer 16

Rituximab - MCAB that targets CH20 protein on B cells

Belimumab - MCAB that targets B-cell activating factor

Question 17

Minimal change disease

Answer 17

1st line - High dose corticosteroids 
Plus 
Fluid restriction/low salt diet 
Albumin infusion may be required in severe hypoalbuminemia 
Furosemide - diuretic to treat oedema

Question 18

MCD - Steroid Resistance

Answer 18

ACE inhibitors and immunosuppressants e.g. cyclosporine, tacrolimus and rituximab

Question 19

Bladder cancer - Surgical options

Answer 19

Transurethral resection of bladder tumour (TURBT)
Intravesical chemotherapy
Intravesical Bacillus Calmette-Guerin (BCG)
Radical cystectomy - removal of entire bladder

Question 20

Pyelonephritis

Answer 20

Cefalexin 7-10 days

Trimethoprim (E.coli) or amoxicillin if sensitive

Question 21

Prostatitis - Acute

Answer 21

Oral ABs - trimethoprim (E.coli)
Analgesia
Laxatives

Question 22

Prostatitis - Chronic

Answer 22

Alpha blockers e.g. tamsulosin 
Analgesia NSAIDs or paracetamol 
Psychological treatment e.g. CBT or ADs 
ABs 
Laxatives

Question 23

Epididymitis

Answer 23

ABx- Ofloxacin 
Alternatively Levofloxacin, doxycycline or Co-amoxiclav 
Analgesia
Supportive underwear 
Reduce physical activity 
Abstain from intercourse

Question 24

IgA nephropathy (Berger’s disease)

Answer 24

Moderate: Observation 
Severe: 
- Supportive treatment for renal failure 
- ACE-I - benazepril/ramipril 
- Immunosuppressant medications

Question 25

Post-strep glomerulonephritis

Answer 25

Usually resolves spontaneously

Question 26

Focal segmental glomerulosclerosis - | Asymptomatic or proteinuria <3g/24h

Answer 26

ACE-i e.g. ramipril Angiotensin-2 receptor antagonist e.g. irbesartan Plus dietary modification Adjunct: statin

Question 27

Focal segmental glomerulosclerosis - | Symptomatic or proteinuria 3g or more per 24h

Answer 27

Corticosteroid therapy | Plus ACE-I (ramipril) or A2RA (irbesartan)

Question 28

Membranous nephropathy

Answer 28

1st - Low-salt and low protein diet Plus: ACE-I (ramipril) /A2RA (irbesartan) - for hypertension Plus: Statin - For hyperlipidemia Plus: Furosemide +/- hydrochlorothiazide - if risk of progression to end stage to renal failure

Question 29

Polycystic kidney disease - Dominant

Answer 29

Vasopressin receptor antagonist e.g. can slow the development of the cysts and the progression to renal failure ACE-I/BB for hypertension e.g. ramipril/propranolol ABxs for infection Drainage of cysts Dialysis/transplant Genetic counselling Avoid contact sports to avoid cyst rupture

Question 30

Cystitis

Answer 30

ABx 3 days of trimethoprim or nitrofurantoin

Question 31

UTI - uncomplicated

Answer 31

Trimethoprim or nitrofurantoin

Question 32

UTI - Pregnancy

Answer 32

1st Nitrofurantoin | 2nd Cephalexin or amoxicillin

Question 33

Chlamydia

Answer 33

Single 1g dose of azithromycin | Plus 7 days doxycycline

Question 34

Gonorrhoea

Answer 34

Single dose Ceftriaxone IM dose

Question 35

Syphilis

Answer 35

IM benzathine benzylpenicillin (penicillin)