Urogenital Flashcards
(204 cards)
1
Q
Give the name and class of 2 drugs used to treat Benign Prostatic Hyperplasia
A
- Alpha Blocker/ Alpha-adrenergic antagonist (1) – Tamsulosin (1)
- 5-alpha-reductase inhibitor (1) – Sildenafil / Viagra (1)
2
Q
Berry aneurysms are a complication of which kidney disease?
A
Autosomal Dominant (1) Polycystic Kidney Disease (1)
3
Q
What parasite can cause bladder cancer?
A
Schistosomiasis
4
Q
What antibiotic is used to treat cystitis?
A
Trimethoprim or nitrofurantoin
5
Q
What is the classical triad of symptoms for a renal cell cancer?
A
- Flank pain (1)
- Haematuria (1)
- Palpable Mass (1)
6
Q
Give 3 function of the kidney
A
Excretion of: water/soluble wastes/urea/creatinine/drugs
- Ultrafiltration
- Maintains: volume of circulating fluids/ electrolyte balance / acid-base balance
- Endocrine functions: Produces Epo
7
Q
Give a Pre-renal, Renal and Post-renal cause of Chronic Kidney Disease
A
- Pre-renal: BP/ DM/ High Cholesterol (1)
- Renal: Glomerulonephritis / PKD / Drugs e.g NSAIDS/Lithium (1)
- Post-renal: Kidney stones / Enlarged Prostate (1)
8
Q
What is the definition of erectile dysfunction?
A
The inability to gain and maintain an erection (1) long enough to achieve sexual satisfaction (1)
9
Q
Give 3 clinical features of Nephrotic Syndrome?
A
- Proteinuria / Frothy Urine (1)
- Hypoalbuminaemia (1)
- Hyperlipidaemia (1)
- Peripheral Oedema/ Fluid overloaded (1)
10
Q
Give a cause of Nephritic Syndrome?
A
- IgA nephropathy
- Post streptococcal infection
- ANCA
- Goodpasture’s
- SLE
11
Q
Give 2 storage and 2 voiding symptoms in relation to the lower urinary tract
A
Storage: Frequency, Urgency, Nocturia, Incontinence
- Voiding: Poor stream, Hesitancy, Straining, Incomplete emptying, Terminal dribble
12
Q
Stress incontinence is a prevalent urinary problem in women that increases with age. Give an example of a non pharmacological, pharmacological and surgical management option for stress incontinence.
A
Non-Pharmacological: Pelvic Floor Exercises (1)
- Pharacological: Duloxetine (1)
- Surgical : Sling / Colposuspension / Artificial urinary sphincter (1)
13
Q
Prostate cancer is the most common cancer in men with an average lifetime risk of 1/8.
Which ethnic group are at an increased risk of prostate cancer?
A
Afro-Caribbean
14
Q
Name the gram negative bacteria that causes chlamydia
A
Chlamydia Trachomatis
15
Q
Name the gram negative bacteria that causes gonorrhoea
A
Neisseria Gonhorroea
16
Q
What drug is used in the treatment of Syphilis?
A
Benzathine Penicillin/ Azithromycin
17
Q
What are the roles of the kidneys?
A
A WET BED
- Acid base balance
- Water balance
- EPO
- Toxin removal
- Blood pressure
- Electrolyte balance (Phosphate excretion, urea K+, creatinine etc)
- (Vit) D activation
18
Q
What would happen in CKD to blood pressure?
A
- Fluid overload
= Hypertension
19
Q
What would happen to blood in CKD?
A
- EPO production failure
= Anaemia
20
Q
What would happen to blood pH in CKD?
A
- Failure of pH homeostasis
= Acidosis
21
Q
What would happen to PTH in CKD?
A
- low vit D activation so hypocalcaemia
- Low phosphate excretion so hyperphosphataemia
= Excess PTH production (secondary)
22
Q
What is CKD?
A
Abnormalities of kidney structure or function, present for >3 months with implications for health
23
Q
What statistically counts as abnormal kidney function?
A
eGFR < 60 ml/min
or Albuminuria
24
Q
What are the G stages of CKD?
A
They show the GFR with 1 being >90, and 5 being <15
25
What are the A stages of CKD?
They show the extent of albuminuria
26
How is CKD diagnoised?
eGFR <60 ml/min
| Urine ACR >3mg/mmol
27
How does CKD present?
Usually asymptomatic (can get occasional haematuria, oedema)
28
What are the most common causes of CKD?
Diabetes
Hypertension/ atherosclerosis
Glomerulonephritis
29
How would CKD be treated?
- Give up smoking
- Lipid control (healthy diet, low alcohol, statin)
- Blood pressure control
- Glycaemic control if diabetic
- Reduce proteinuria
- Dietary supplements
- Fluid control- low salt intake, diuretics
- Dialysis and transplant
30
What is "CKD MBD"?
Chronic kidney disease mineral bone disease
31
Name a potassium-sparing diuretic
Amiloride.
Eplerenone
Spironolactone
32
Name a non-potassium sparing diuretic
Furosemide
33
What are the types of kidney replacement therapy?
- Haemodialysis
- Peritoneal dialysis
- Kidney transplant
34
Give 2 pros of haemodialysis
- Can be commenced quickly (can be used in an emergency)
- Patient doesn't need training
- Gives good clearances (can be used in obese patients or anuric patients)
35
Give 2 cons of haemodialysis
- Usually performed in hospitals
- Issues with vascular access
- Patients can feel "washed out" after
36
Give 2 pros of peritoneal dialysis
- Fits round the patient's life easily
- Gentler, less hypotension
- Better individualised to patient's residual kidney function
37
Give 2 cons of peritoneal dialysis
- Requires training
- Infection
- May be inadequate in those with poor residual function or a high BMI
38
Give 2 pros of kidney transplant in CKD
- Near complete physiological correction
- Improved mortality
- Better quality of life
39
Give 2 cons of kidney transplant in CKD
- Supply of organs
- Operative risk
- Immunosuppresion
40
What type of diuretic is given to CKD patients and why?
Non-potassium sparing diuretic e.g. furosemide
(Loop diuretic)
CKD leads to hyperphosphataemia, so a potassium sparing diuretic would exacerbate this
41
Where do the kidneys lie?
T11-L3
42
Where do the renal arteries come off?
L1
43
How much urine does each kidney produce per day?
1-1.5L
44
Approx how long are the ureters?
25-30cm
45
Is the detrusor relaxed or contracted during voiding?
Contracted
46
What is the action and origin of the hypogastric nerve?
It relaxes the detrusor and originated from T10-L2 (sympathetic)
47
What is the action and origin of the pelvic nerve?
IT contracts the detrusor and originates from S2-S4 (parasympathetic)
48
What is the action and origin of the pudendal nerve?
It causes external sphincter contraction and originates from s2-s4 (Somatic)
49
How does the bladder increase in volume?
The detrusor muscle relaxes to accommodate increase in fluid volume
50
What is the nervous response if the bladder is full but it is inappropriate to void?
- Afferents reaching PAG and higher cortical centres are processed and PMC is not activated
- Inhibits parasympathetic
- Stimulates sympathetic and somatic
51
What is the nervous response if the bladder is full and it is appropriate to void?
- Afferents reaching PAG and higher cortical centres are processed and PMC is activated
- Stimulates parasympathetic
- Inhibits sympathetic and somatic
52
```
Which of the following is not a function of the kidneys?
A) Water removal
B) Vitamin D activation
C) Erythropoietin production
D) Creatinine production
E) Acid-base balance
```
D
53
```
What is the average GFR?
A) 1 ml/min
B) 125 ml/min
C) 150 ml/min
D) 1000 ml/min
E) 2000 ml/min
```
B
54
```
Which of the following makes a substance less likely to be filtered?
A) Increased blood pressure
B) Smaller substance
C) Attachment to a protein
D) High surface a rea
E) Positively charged substance
```
C
55
```
Which tubule section of the nephron has cuboidal epithelium with microvilli for bulk reabsorption?
A) Proximal convoluted tubule
B) Descending limb of loop of henle
C) Ascending limb of loop of henle
D) Distal convoluted tubule
E) Collecting duct
```
A
56
Which of the following is false?
A) The loop of henle is only found on juxtamedullary (15%) of nephrons- 85% do not extend into medulla
B) The ascending limb is impermeable to water, and functions for Na, K and Cl reabsorption
C) The macula densa is detected on the distal convoluted tubule, and signals for renin release if there are low Na level
D) The principle cells of the collecting to control acid-base levels by adjusting levels of H+ and HCO3-
E) Aldosterone and ADH act upon the cells of the distal convoluted tubule and collecting duct for fine tuning of the urine
D
57
```
Which of the following can cause metabolic acidosis?
A) Hypoventilation
B) Diarrhoea
C) Respiratory failure
D) Vomitting
E) High aldosterone
```
B
58
```
What receptor does ADH bind to?
A) V2R
B) P2C
C) GLUT 2
D) GLUT 4
E) S4K
```
A
| V2R receptors on principle cells
59
Which of the following is not an effect of angiotensin II?
A) Tubular reabsorption of Na+ and Cl-, and excretion of K+
B) Increased thirst response
C) Vasoconstriction of blood vessels
D) Aldosterone release from zona glomerulosa
E) Increased parasympathetic activity
E
60
Which of the following is true?
A) Aldosterone causes excretion of Na+
B) ANP is released when there is a lack of cardiac distention signalling BP is too low
C) ANP acts by blocking sodium channels in the collecting duct
D) ANP increases aldosterone release via renin secretion
E) ANP causes vasoconstriction of the afferent arteriole, decreasing GFR
C
61
```
What is the active form of vitamin D?
A) 7-decholesterol
B) Calcitriol
C) 25 OH Vitamin D
D) 25, 25 (OH)2 Vitamin D
E) Calcitrioic acid
```
B
62
```
What is the name of the muscle of the bladder used for micturition?
A) Puborectalis
B) Pubococcygeus
C) Detrusor
D) Sartorius
E) Soleus
```
C
63
```
What part of the urogenital sinus forms the urethra?
A) The upper part
B) The pelvic part
C) The phallic part
D) The caudal part
```
B
64
```
What is the developing system of the definite kidney?
A) Prosenephros
B) Mesonephros
C) Metanephros
D) Rhombencephalon
E) Prosencephalon
```
C
65
```
Which of the following could cause post-renal acute kidney injury?
A) Heart failure
B) Sepsis
C) ACE inhibitors
D) Glomerulonephritis
E) Enlarged prostate
```
E
66
```
Which of the following is NOT region of the male urethra?
A) Pre-prostatic
B) Prostatic
C) Membranous
D) Pelvic
E) Spongy
```
D
67
What is the role of hCG during pregnancy?
A) Regulates levels of progesterone, prepares the uterus for the baby, prepares the breasts for lactation, induces synthesis for oxytocin receptors
B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility
C) Stimulates oestrogen/progesterone production by ovary
D) Role in initiation of labour
E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour
C
68
What is the role of prostaglandins during pregnancy?
A) Limits uterine activity, softens cervix, and involved in cervical ripening for delivery
B) Prevents miscarriage- builds up endometrium for support of placenta, inhibits uterine contractility
C) Increases milk production
D) Role in initiation of labour
E) Triggers “caring” response, responsible for uterine contractions during pregnancy and labour
D
69
Which of the following does not happen during pregnancy?
A) Increased cardiac output
B) Increased systemic blood pressure
C) Darkened areola of breasts
D) Increased acid reflux and gastroparesis
E) Increased blood volume
B
70
What happens during the latent phase of labour?
A) Small amount of cervical dilation
B) Organised uterine contractions and dilation
C) Foetal expulsion
D) Placental expulsion
E) Rupture of amniotic sac
A
71
Which of the following is false?
A) During pregnancy, the uterus is sealed at the outlet by firm, inflexible collagen fibres- this is maintained by progesterone
B) In the last few weeks of pregnancy, the cervix becomes soft and flexible
C) Cervical ripening occurs due to enzymatically mediated breakdown of collagen fibres
D) Synthesis of enzymes is mediated by progesterone, hGC, and oxytocin
E) Labour is initated by PGFa
D
72
```
What is the outermost serous layer of the uterus?
A) Endometrium
B) Perimetrium
C) Myometrium
D) Endomysium
E) Epimysium
```
B
73
```
Which of the following hormones is NOT produced by the placenta during pregnancy?
A) hCS
B) Progesterone
C) Prolactin
D) Oestrogen
E) Relaxin
```
C
74
```
What is the first follicle in the cycle known as?
A) Secondary follicle
B) Small primary follicle
C) Primordial follicle
D) Pre-ovulatory follicle
E) Corpus luteum
```
C
75
What triggers shedding of the stratum functionalis during the menstrual cycle?
A) An increase in hGRH
B) A drop in LH levels after the LH surge
C) An increase in FSH levels
D) An increase in oestrogen levels
E) A drop in progesterone levels
E
76
```
Of an average 28 cycle, on which day is the highest LH levels seen?
A) Day 10-11
B) Day 12-13
C) Day 14
D) Day 15-16
E) Day 18-20
```
B
77
```
What stage comes after the cleavage stage of embryo development?
A) Syngamy
B) Compaction
C) Cavitation
D) Expansion
E) Hatching
```
B
78
```
What is the first stage of embryo implantation?
A) Apposition
B) Attachment
C) Trophoblast differentiation
D) Invasion
E) Maternal recognition
```
A
79
```
Which of the following does not derived from the Mullerian duct?
A) Fallopian tubes
B) Uterus
C) Cervix
D) Upper 1/3 of vagina
E) Clitoris
```
E
80
Which of the following statements is false?
A) Sertoli cells in the testis secrete Mullerian inhibitory factor, which causes degeneration of the paramesonephric duct
B) 5- alpha reductase converts testosterone to dihydryotestosterone androgen which triggers development of the external male genitalia
C) If an individual is SRY positive their wolffian duct regresses and Mullerian duct develops
D) The genitalia is differentiated by 10 weeks
E) Leydig cells of the testes secrete testosterone, which causes the wolffian duct to become the seminal vesicle, vas deferens and epididymis
C
81
```
During which phase of meiosis does crossing over occur?
A) Prophase I
B) Metaphase I
C) Anaphase I
D) Prophase II
E) Metaphase II
```
A
82
```
During which phase of meiosis do oogonia arrest at until puberty?
A) Prophase I
B) Metaphase I
C) Anaphase I
D) Prophase II
E) Metaphase II
```
B
83
Which of the following statements is true?
A) Pale (Ap) cells are stem cells that stay outside of the blood-testes barrier and produce more daughter cells until death
B) Type A cells differentiate into primary spermatocytes
C) Spermatids differentiate into spermatozoa via spermatogenesis
D) Primary spermatocytes can pass through the blood testes barrier through tight junctions of Sertoli cells
E) Androgen binding protein (released by Leydig cells) bind to testosterone within the seminiferous tubule, which in turn stimulates sperm production
D
84
```
What does sperm travel into after the rete testis?
A) Epididymis
B) Vas deferens
C) Efferent ducts
D) Ejaculatory duct
E) Seminiferous tubules
```
C
85
What is the route that sperm take outside of the body?
```
Seminiferous tubules
Rete testis
Efferent ducts
Epididymis
Vas deferens
Ejaculatory duct
Urethra
Penile urethra
```
86
What is the first stage of embryo development?
Syngamy (day 1)= fusion of the male and female pronuclei
87
What is the mucosal lining of the uterine cavity?
Endometrium
88
What is the role of oestrogen during pregnancy?
Regulates levels of progesterone, prepares the uterus for the baby, prepares the breasts for lactation
89
What is the role of progesterone during pregnancy?
Prevents miscarriage builds up endometrium for support of placenta, inhibits uterine contractility
90
What is the role of prolactin during pregnancy?
increases cells that produce milk, prevent ovulation (unreliably)
91
What is the role of relaxin during pregnancy?
Helps limit uterine activity, softens cervix & involved in cervical ripening for delivery
92
What is the role of oxytocin during pregnancy?
Triggers ‘caring’ reproductive behaviour, responsible for uterine contractions during pregnancy and labour
93
What are the storage symptoms?
- Frequqency
- Urgency
- Nocturia
94
What are the voiding symptoms?
- Weak/ intermitant stream
- Incomplete emptying
- Hesitancy
- Dribbling
- Straining
- Haematuria
- Dysuria
95
What is BPH?
Increased number of epithelial and stromal cells in the periurethral area of the prostate
96
Why is BPH more common in Afro-Caribbean men?
Increased testosterone
97
What are the two types of nephron?
- Cortical nephrons (70-80%)= Glomeruli in outer cortex, short looped
- Juxtamedullary nephrons (20-30%)= Glomeruli border on medulla, long looped
98
What are vasa recta?
Counter-current blood flow around loop of henle
99
What alters the plasma colloid oncotic pressure?
Albumin
100
What pressures affect GFR?
- Systemic arterial pressure
- Afferent pressure
- Efferent pressure
101
What would happen to the GFR if you restricted blood flow through the afferent arteriole?
It would drop
102
What would happen to GFR if you restricted blood flow through the efferent arteriole?
It would increase, but if it is a very severe constriction, the GFR will eventually fall
103
What causes constriction of the afferent arteriole?
Prostaglandins (Inhibited by NSAIDs so NSAIDs can cause AKI)
104
What metabolite is used for eGFR?
Creatinine
105
What is the main action of the glomerulus?
Filtration of water and solutes
106
What is the main action of principal cells?
Aldosterone sensitive= potassium secretion
| Reabsorb Na
107
What is the main action of intercalated cells?
ADH
108
What is the overall action of ANP?
It falls if there is a fall in blood pressure, causing renal sodium retention, water retention and K+ excretion
= BP raised
109
What is neuropathic bladder?
One that has dysfunctional voiding due to damage to the innervation
110
What are the principles of management of neuropathic bladders?
1. Protect the upper urinary tract
2. Improve quality of life
3. Achieve continence
111
What is the gold standard investigation for a patient with neuropathic bladders?
Video urodynamics
112
What is bladder compliance?
The ability of the bladder to change in volume without an alteration in detrusor pressure
113
What is an areflexive bladder?
One with no innervation- patient may have retention
114
What is autonomic dysreflexia?
A response to a stimuli in a patient with a spinal cord injury at T6 or higher
115
What are the main symptoms of autonomic dysreflexia?
- Headache
- Increase BP above site of injury
- Pale, cool below site of injjry
116
How is autonomic dysreflexia treated?
- Sit patient upright
- 2 sprays of sublingual GTN
- Remove tight clothing, identify the noxious stimuli
- Administer nifedipine 5-10 mg
- Contact anaesthetics
117
What are the types of incontinence?
- Transient= Delirium, infection, drugs, psychiatric, endocrine causes, reduced mobility
- Urgency
- Stress
- Overflow
- Continuous
118
What is urge incontinence?
The involuntary loss of urine preceded by sudden urgency
119
What is the first line pharmacological treatment for urge incontinence?
Anticholinergic (oxybutynin)
120
What is stress incontinence?
The involuntary loss of urine during activities that increase intra-abdominal pressure (e.g. cough, sneeze, laugh etc)
121
What is the first line treatment for stress incontinence?
Lifestyle modification- stop smoking, weight loss
| Pelvic floor muscle therapy
122
What are the clinical features of acute nephritic syndrome?
- Haematuria
- Proteinuria
- Deteriorating kidney function
- Hypertension
- Oliguria
- Fluid overload
- Uraemia
123
What causes acute nephritic syndrome?
- ANCA associated vasculitis
- Goodpasture disease
- SLE, Systemic sclerosis
- Post-strep infection
- Crescentic IgA nephropathy
124
What is acute nephritic syndrome?
An immune response triggered by infection or other disease
125
64 year old man saw his GP with malaise, lethargy and weight loss. He has had a "head cold" for a few weeks and noticed some bleeding when he blows his nose. On tests, he has anaemia, hyperuricemia, very high creatinine, and a high CRP. He was ANCA-antibody +ve. What is it likely to be?
Nephritic syndrome due to ANCA associated vasculitis
126
A 17 year old patient presents to his GP with "passing cola coloured urine" for the last 24 hrs. He has a mild cough and sore throat for the last few days. His creatinine and blood pressure are high. What is this likely to be?
IgA nephropathy causing acute nephritic syndrome
127
What is the typical triad of nephrotic syndrome?
Heavy proteinuria
Hypoalbuminaemia
Oedema
128
How is minimal change disease treated?
Steroids = prednisolone
129
What type of cancer is a renal cell carcinoma?
Adenocarcinoma
130
How does renal cell carcinoma usually present?
- Often asymptomatic
- Haematuria, loin pain and mass
- Symptoms of metastatic disease
- Anaemia, hypertension
131
What type of cancer is bladder carcinoma normally?
Transitional cell carcinoma
132
What are some common urological causes of persistent non-visable haematuria?
BPH, Cancer, stone disease, infection
133
What are some common nephrological causes of persistent non-visable haematuria?
IgA nephropathy, thin basement membrane disease, vasculitis
134
What is the chemotherapy treatment for bladder TCC?
CMV: Cisplatin, methotrexate, vinblastine
135
Where would testicular cancer spread to first?
Para-aortic lymph nodes
136
What are the 3 categories of erectile dysfunction?
- Neurogenic= Failure to initiate
- Arteriogenic= Failure to fill
- Venogenic= Failure to store
137
What is the first line treatment for erectile dysfunction?
PDE-5 Inhibitors (Viagra/ sildenafil)
138
Where is the prostate gland?
At the base of the bladder surrounding the base and the urethra
139
What is gleason grading used for?
Prostate cancer
140
What can make a UTI complicated?
- Pregnant
- Men
- Catheterised
- Children
- Recurrent infection
- Immunocompromised
- Structural abnormalities
141
What are the most common pathogens causing a UTI?
KEEPS
- Klebsiella
- E. Coli
- Enterococci
- Proteus
- Staph spp.
142
How would you treat E. Coli pyelonephritis in an elderly man?
Co-amoxiclav for 14 days
143
What would protein in the urine during pregnancy be indicative of?
Possibility of pre-eclampsia
144
What are epithelial cells in urine sample indicative of?
Contaminated sample
145
Ms A. Vrige (23 years-old) has been complaining of dysuria and frequency passing urine. Similar urinary symptoms over last few months were treated with 3-days of cephalexin by another GP. She is in a stable relationship with her husband and takes the oral contraceptive pill
Her urinalysis shows protein, nitrites and leukocytes.
What would be an appropriate antibiotic?
Trimethoprim 200mg twice daily for 3 days
or
Nitrofurantoin 50mg four times a day for 3 days
146
What are the tumour markers for testicular cancer?
Alpha-fetoprotein and the beta subunit of hCG
147
A patient presents with haematuria. What are the possibilities?
- UTI
- urothelial carcinoma
- stone disease
- adenocarcinoma of the prostate
- benign prostatic hypertrophy (BPH)
- Transitional cell carcinoma of the bladder
148
What is the lifetime risk of stones in the urogenital tract?
10-15%
149
Do men or women get more renal stones?
Men (2:1)
150
What are renal stones usually made of?
Calcium oxalate are most common
| Others include calcium phosphate, uric acid, cystine stones
151
How can kidney stones be prevented?
- Overhydration
- Low salt diet
- Reduce BMI
- Active lifestyle
152
What are the symptoms of kidney stones?
- Asymptomatic
- Loin pain
- Renal colic
- UTI symptoms
- Recurrent UTI
- Haematuria
153
What is renal colic?
Sudden, severe pain in the loin which then spreads to groin. Associated nausea/ vomitting. Colicky pain, worse with fluid loading.
154
What is the first line and gold standard diagnosis for renal stones?
- First line= KUBXR
- Gold standard= NCCT-KUB
Also dipstick and bloods (U and Es, creatinine, Calcium)
155
What is pyonephrosis?
Combination of infection and obstruction
156
What is ESWL?
Extracorporeal shockwave lithotripsy= Used to break up renal stones
157
A 46 year old man presents to A&E with severe sudden onset left loin to groin pain. He also has frequency. He is otherwise fit and well, and is slightly overweight. What would be your response?
- Analgesia
- Dipstick
- Non-contrast CT of kidney, ureter and bladder to see stones
158
A 34 year old woman present to A&E with severe sudden onset left loin to groin pain. She has signs of sepsis (increased heart rate, increased temperature, increased resp rate, lowBP). What would be your response?
- Resus
- Follow sepsis 6
- Confirm renal stones, then renal drainage
159
What are the sepsis 6?
1. High flow oxygen
2. Blood cultures
3. IV antibiotics
4. Fluids
5. Measure lactate
6. Measure urine output
160
Define glomerulonephritis
Glomerulonephritis is any of a group of diseases that injure the part of the kidney that filters blood (the glomeruli).
161
What is the difference in presentation between nephritic and nephrotic syndrome?
```
Nephritic= Blood in urine and decreased urine output with hypertension
Nephrotic= Oedema, with increased protein in urine but decreased protein in serum
```
162
What is the medical emergency most associated with AKI?
Hyperkalaemia
163
What are the 4 commonest types of urinary tract stones?
* Calcium stones (oxalate, phosphate) 80%
* Uric acid 10%
* Struvite 5-10%
* Cystine 1%
164
Give 5 common symptoms of renal tract stones
- Asymptomatic
- Loin pain
- Renal colic
- UTI symptoms
- Recurrent UTIs
- Haematuria
165
What are the criteria for a 2 week wait referral for suspected bladder cancer?
Over 45= Unexplained visible haematuria without UTI
| Over 60= Unexplained non-visible haematuria, with either dysuria or raised wcc
166
List 5 symptoms common with urinary tract obstruction in men
- Frequency
- Nocturia
- Urgency
- Hesitancy
- Straining
- Poor/intermittent stream
- Incomplete emptying
- Post micturition dribbling
167
What are the two groups of drugs commonly used in symptomatic benign prostatic hypertrophy?
- Alpha-adrenergic antagonists e.g. tamsulosin, alfuzosin
| - 5-alpha reductase inhibitors e.g. finasteride
168
What issues are there which prevent the Prostate Specific Antigen (PSA) test being used routinely for screening?
- It is not cancer specific= raised in BPH, UTI
| - It can be raised in a normal healthy man
169
What is the commonest presentation of testicular cancer?
- A painless lump in the testicle which may be hard and craggy
- It can be palpated above it
170
Name five medical conditions associated with erectile dysfunction?
- Diabetes mellitus
- Cardiovascular disease e.g. MI, Hypertension
- Liver disease
- Renal failure
- Pelvic fracture
171
How is erectile dysfunction treated?
Phosphodiesterase inhibitors e.g. sidenafil
172
Which STI is most commonly diagnosed?
Chlamydia
173
How is chlamydia treated?
- Partner notification
- Test for other STIs
- Doxycycline for 7 days or azithromycin stat
174
How is Urinary tract infection defined?
Bacteria in the urine combined with clinical features
175
What is the classical triad of symptoms in pyelonephritis?
Loin pain, fever and pyuria
176
A 68 year-old patient has got an estimated glomerular filtration rate of of 50ml min/1.73m2. What stage of chronic kidney disease does he have?
Stage 3a
177
```
What is the most common cause of chronic kidney disease in the UK?
A. Renal artery stenosis
B. Long use of NSAIDs
C. Benign prostatic hyperplasia
D. Diabetes
E. Renal vein thrombosis
```
D
178
What biochemical changes can be observed in acute kidney injury?
A. Hyperkalaemia, hyponatremia, hypercalcaemia
B. Hyperkalaemia, hyponatremia, hypocalcaemia
C. Hyperkalaemia, hypernatremia, hypercalcaemia
D. Hypokalaemia, hypernatremia, hypercalcaemia
E. Hypokalaemia, hyponatremia, hypocalcaemia
B
179
```
A 9 year-old child presents to your GP clinic with his mother. His mother tells you that she has noticed the child has a lot more swelling in his face and his urine seems frothy. The child also seems to be a little bit lethargic compared to normal. You do a urine dipstick on the child’s urine discovering significant (+++) proteinuria but no haematuria. What is the most likely cause of these symptoms?
A) SLE
B) Rickets
C) Minimal Change Disease
D) Post-streptococcal glomerulonephritis
E) Goodpasture’s syndrome
```
C
180
```
A 6 year-old child presents to A&E with their father. His father is quite anxious as he noticed blood in his child’s urine earlier in the morning. When asking about a more detailed history, you discover that the child had a really sore throat and cold 2 weeks earlier. What is the most likely cause of these symptoms?
A) Granulomatosis with polyangitis
B) IgA nephropathy
C) Henoch-Schonlein purpura
D) Post-streptococcal glomerulonephritis
E) NSAIDs
```
D
181
```
A 42 year-old man presents to A&E. He complains of coughing up blood as well as noticing a darkness to his urine. You perform a urine dipstick on his urine which shows some blood. What is the most likely cause of these symptoms?
A) Granulomatosis with polyangitis
B) IgA nephropathy
C) Henoch-Schonlein purpura
D) Goodpasture’s syndrome
E) SLE
```
D
182
```
A 52 year old woman presents to you in A&E complaining of severe flank pain that is radiating towards her groin. The pain is constant but has peaks where it is much more severe. She tells you she has not passed urine for 2 days. What is the most appropriate investigation and management for this patient?
A) Ultrasound KUB + codeine
B) Ultrasound KUB + ibuprofen
C) X-ray KUB + paracetamol
D) X-ray KUB + morphine
E) CT-KUB + Diclofenac
```
E
183
```
A 28 year old pregnant woman presents to you in GP complaining of very frequent urination and it is quite painful. She has brought you a urine sample which appears quite cloudy. You suspect a UTI. What is the most appropriate choice of antibiotic for this patient?
A) Nitrofurantoin
B) Trimethoprim
C) Ceftriaxone
D) Amoxicillin
E) Cefalexin
```
A
184
```
A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass.
What is the most likely diagnosis?
a) Left orchitis
b) Left primary hydrocele
c) Left secondary hydrocele
d) Left varicocele
e) Left spermatocele
```
C
185
A 45 year old man presents with a left scrotal mass. He had a vasectomy 2 years ago. The mass is painless and unilateral. On examination it is soft and smooth, and his left testis cannot be palpated. Light can be shone through the mass.
What would be the first line investigation to confirm this diagnosis?
a) USG
b) CT scan
c) Venography
d) MRI
e) Mid-stream urine sample
A
186
A 72 year old man comes to see his GP, he has recently experienced urethral discharge and has been needing to urinate often with urgency and pain, and has blood in his urine. The GP notices his left testis very hot and tender, and is swollen. Light cannot be shone through it.
What is the most likely causative organism?
a) Streptococcus pyogenes
b) Neisseria gonorrhoea
c) Chlamydia trachomatis
d) Klebsiella spp.
e) Escherichia Coli
E
187
Which of these is correct?
a) A left hydrocele can be a sign of left kidney cancer
b) A right hydrocele can be a sign of right kidney cancer
c) A left varicocele can be a sign of left kidney cancer
d) A right varicocele can be a sign of right kidney cancer
C
188
Why can a left varicocele be a sign of left kidney cancer?
Left testicular vein enters the left renal vein, so can be compressed by left kidney cancer, causing a varicocele.
189
A 17 year old male is brought to A&E with left testicular pain that started in the last hour. He is embarrassed and says he wants to leave and go home, however he admits the pain is so bad that walking is very uncomfortable. Upon examination you discover his left testis is very tender and warm. It is also larger than normal, and is not lying in its normal position in the scrotum.
Within what time window does surgery need to happen?
a) 2 hours
b) 6 hours
c) 9 hours
d) 12 hours
e) 24 hours
B
190
Which of these is more common?
a) Testicular cancer vs prostate cancer
b) Benign prostate hyperplasia vs prostate cancer
a) Prostate cancer
| b) BPH
191
Which of these is more common in young men?
a) Testicular cancer vs prostate cancer
b) Testicular cancer vs benign prostate hyperplasia
A) Testicular cancer
| B) Testicular cancer
192
Describe the difference between how the prostate would feel on a digital rectal exam
BPH= Smooth enlarged prostate
| Prostate cancer= Hard irregular prostate
193
A 66 year old man has had problems with urinary frequency and needing to urinate at night for 2 months. He finds that when he urinates it takes him a while to be able to start, and he often experiences dribbling after finishing. After a transrectal prostate biopsy he is diagnosed with benign prostatic hyperplasia.
Which of these would be the first line treatment for BPH?
a) Oxybutynin
b) Finasteride
c) Tamsulosin
d) Transurethral resection of prostate (TURP)
e) Goserelin
C
194
What type of urinary incontinence can diabetic neuropathy lead to?
a) Urge incontinence
b) Overflow incontinence
c) Stress incontinence
B
195
What type of urinary incontinence can a spastic spinal cord injury lead to?
a) Urge incontinence
b) Overflow incontinence
c) Stress incontinence
A
196
What is the most common STI in young people?
Chlamydia
197
What is Fitz Hugh Curtis syndrome?
When pelvic inflammatory disease (PID) causes swelling of the tissue around the liver
198
What are the best sample types to diagnose chlamydia?
Women; self collected vaginal swab
| Men; First void urine
199
A man presents with urethral discharge. You take a sample and it shows gram negative diplococci. What is it likely to be?
Gonorrhoea
200
What is the bacteria that causes syphilis?
Treponema pallidum
201
A patient presents with a dusky macule on the labia which has developed into a non-tender ulcer. What is it likely to be?
Syphilis
202
How would you diagnose syphilis?
Screening- EIA
| TTPA, VDRL, RPR
203
How is syphilis treated?
Penicillin injection
204
What is the RBCD transmission model for STIs?
Reproductive rate
B= Infectivity rate
C= Partners over time
Duration of infection
