Urology Flashcards
(385 cards)
1
Q
What are the 3 functions of the urinary tract
A
- To collect urine produced by the kidneys
- To store urine safely
- To expel urine when socially acceptable
2
Q
What type of organ is the kidney
A
Retroperitoneal
3
Q
Where does the kidney lie
A
T11-L3
4
Q
Where does the blood supply to the kidney come from
A
Renal artery direct from aorta at L1 level
5
Q
How much urine is produced per day
A
1-1.5L
6
Q
What type of structure are the ureters
A
Retroperitoneal
7
Q
Where do the ureters run
A
Over psoas muscle, cross the iliac vessel at the pelvic brin and insert into trigone of bladder
8
Q
How long are the ureters
A
25-30cm
9
Q
How is reflux of urine prevented
A
By valvular mechanism at the vesicoureteric junction
10
Q
Where are the 3 anatomical narrowings of the ureters
A
Pelvic ureteric junction
Crosses iliac vessels
Crosses into the back of the bladder - trigone
Kidney stones can get stuck
11
Q
Name the 4 nerve supply to the bladder and sphincter
A
Parasympathetic nerve
Sympathetic nerve
Somatic nerve
Afferent pelvic nerve
12
Q
Describe the nerve supply to the bladder by the parasympathetic nerve
A
Pelvic nerve
S2-4 - S2,3,4 keeps the pee of the floor
Acetylcholine neurotransmitter
Involuntary control
13
Q
Describe nerve supply to the bladder and sphincter by the sympathetic nerve
A
Hypogastric nerve
T11-L2
Noradrenaline neurotransmitter
Involuntary control
14
Q
Describe the nerve supply to the bladder and sphincter by the somatic nerve
A
Pudendal nerve
S2-4
‘Onuf’s nucleus’
Acetylcholine neurotransmitter
15
Q
Describe the nerve supply to the bladder and sphincter by the afferent pelvic nerve
A
Sensory nerve
Signal from detrusor muscle
16
Q
Describe the neural control of the bladder
A
Cortex = voluntary control
Pontine micturition centre/periaqueductal grey = co-ordination of voiding
Sacral micturition centre = micturition reflex
Onuf’s nucleus = guarding reflex
17
Q
Describe the micturition of the bladder
A
98% = storage phase
Either to:
Guarding phase = inappropriate to void
Micturition phase = appropriate to void
18
Q
Describe the storage phase of the bladder
A
Bladder fills continuously
- capacity 400-500mL
- first sensation 100-200mL
Volume bladder increases - pressure remains low due to ‘receptive relaxation’ and detrusor muscle compliance
19
Q
Describe the filling phase of the bladder
A
Lower volumes the afferent pelvic nerve sends slow firing signals to the pons via the spinal cord
Sympathetic nerve stimulation = maintains the detrusor muscle relaxation
Somatic nerve stimulation = maintains ureteral contraction
20
Q
Describe the voiding phase of the bladder (micturition reflex)
A
= Autonomic spinal reflex
Higher volumes stimulate afferent pelvic nerve to send fast signals to the sacral micturition centre in the sacral spinal cord.
Pelvic parasympathetic nerve stimulated = detrusor muscle contracts.
Pudendal nerve inhibited = external sphincter relaxes
21
Q
Describe bladder emptying
A
Detrusor contraction + external sphincter relaxation
Positive feedback until all urine expelled.
After complete detrusor relaxation and external sphincter contraction
22
Q
Describe the guarding reflex of the bladder
A
Adults have voluntary control of bladder.
Afferent signals from pelvic nerve received by PMC/PAG and transmitted to higher cortical areas.
If voiding inappropriate - guarding reflex occurs.
Sympathetic nerve stimulation = detrusor relaxation
Pudendal nerve stimulation = external urethral sphincter.
23
Q
Describe storage of the bladder
A
Receptive relaxation
Detrusor relaxation - sympathetic stimulation T11-L2
External uretheral sphincter contraction - pudendal stimulation S2-4
24
Q
Describe the nerve supply of micturition
A
Voluntary control from cortex and PMC
Detrusor contraction - parasympathetic stimulation S2-4
External urethral sphincter relaxation - pudendal inhibition S2-4
25
Define acute kidney injury
Acute decline in kidney function, leading to a rise in serum creatinine and/or fall in urine output.
26
Describe the 3 main types of causes of acute kidney injury
Pre-renal (most common)
Renal
Post-renal
27
Describe pre-renal acute kidney injury
Insufficient blood supply (hypoperfusion) to the kidneys reduces the filtration of blood
Dehydration
Shock
Heart failure
28
What is the most common cause of acute kidney injury
Pre-renal
29
Describe renal acute kidney injury
Intrinsic disease in the kidney
Example - acute tubular necrosis (most common form)
30
Describe post-renal acute kidney injury
Obstruction to the outflow of urine away from the kidney, causing back pressure into the kidney and reduces kidney function = obstructive uropathy
31
Name examples that could cause renal acute kidney injury
Acute tubular necrosis
Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis
32
Name examples of post-renal acute kidney injury
Kidney stones
Tumours - retroperitoneal, bladder or prostate.
Strictures of the ureters or urethra
Benign prostatic hyperplasia
Neurogenic bladder
33
Describe the risk factors of acute kidney injury
Older age (above 65)
Sepsis
Chronic kidney disease
Heart failure
Diabetes
Liver disease
Cognitive impairment
Medications
34
Name 3 clinical features of acute kidney injury
Hypotension
Reduced urine production
Lower UTI symptoms
35
Describe the investigations for acute kidney injury
Urinalysis - assess for protein, blood, leucocytes, nitrates and glucose.
Ultrasound
36
Describe the NICE guidelines for the diagnosis of an AKI
Rise in creatinine of more than 25 micromol/L in 48 hours
Rise in creatinine of more than 50% in 7 days
Urine output of less than 0.5 ml/kg/hour over at least 6 hours
37
Describe the management of acute kidney injury
Treatment - reverse underlying cause and supportive management
IV fluids
Without medications
Withhold/adjust medications
Relieve obstruction in a post-renal AKI
Dialysis may be required in severe cases
38
Describe the prevention of acute kidney injury
Avoid nephrotoxic medications where appropriate
Ensuring adequate fluid intake
Additional fluids before and after radiocontrast
39
What are the differential diagnosis of acute kidney injury
Chronic kidney disease
Increased muscle mass
Drug side effects
40
Define chronic kidney disease
Chronic reduction in kidney function sustained over three months - tends to be permanent and progressive
41
Describe the aetiology of chronic kidney disease
Naturally declines with age
Factors that speed up decline
- diabetes
- hypertension
- medications
- glomerulonephritis
- polycystic kidney disease
42
Define the risk factors of chronic kidney disease
Diabetes mellitus
Hypertension
Age > 50 years
Childhood kidney disease
43
Describe the clinical features of chronic kidney disease
Most asymptomatic
Signs and symptoms
Fatigue
Pallor
Foamy urine
Nausea
Loss of appetite
Pruritus
Oedema
Hypertension
Peripheral neuropathy
44
Describe the investigations for chronic kidney disease
eGFR
Proteinuria
Haematuria
Renal ultrasound
45
How is chronic kidney disease diagnosed
eGFR - below 60ml/min/1.73^2 - G score
ACR (quantified with urine albumin: creatinine ration) - above 3 mg/mmol - A score
46
What are the two scoring systems which can be used in chronic kidney disease
G score
A score
47
In chronic kidney disease what is used to estimate 5-year risk of kidney failure requiring dialysis
Kidney failure risk equation
48
Describe the management of chronic kidney disease
Treating underlying case
Reduce risk of complications
Management of end-stage renal disease
49
What medications can be used to help slow disease progression in chronic kidney disease
ACE inhibitors
SLGT-2 inhibitors
50
Define erectile dysfunction
Inability to achieve or maintain an erection sufficient for sexual performance
51
Describe the physiology of an erection
Autonomic
Somatic
Central
52
Describe the autonomic control of the physiology of an erection
Parasympathetic S2-4 produce erection
Sympathetic T11-L2 ejaculation and detumescence
53
Describe the somatic control of the physiology of an erection
Afferent dorsal penile to pudendal to S2-4
Efferent Onus's nucleus to ischiocavernosus and bulbocavernosus
54
Name the causes of erectile dysfunction
IMPOTENCE
Inflammatory
Mechanical
Psychological
Occlusive (Vascular)
Trauma
Extra
Neurogenic
Chemical
Endocrine
55
Name the risk factors of erectile dysfunction
Arterial disease
Psychosexual/relationship problems
Excess alcohol intake
Diabetes
Smoking
56
Describe the clinical features of erectile dysfunction
History
No clinical signs
57
Describe the essential tests of erectile dysfunction
Blood pressure
Essential bloods
- fating glucose and lipids
- early morning testosterone
58
Describe the 1st line management of erectile dysfunction
PDE5 inhibitors
59
Describe the 2nd line management of erectile dysfunction
Alprostadil
60
Describe the 3rd line management of erectile dysfunction
Devices - pumps blood into the penis
61
Describe prostate cancer
Almost always androgen dependent
Majority = adenocarcinomas.
Grown in peripheral zone of the prostate
62
Name the risk factors of prostate cancer
Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids
63
Describe the cause of prostate cancer
Unknown
Possible
High fat diet
Genetic factors
Ethnicity
Hormonal influence
64
Describe the clinical features of prostate cancer
May be asymptomatic
Symptomatic - lower urinary tract symptoms
65
Describe the investigations for prostate cancer
Prostate examination
Multiparametric MRI
Prostate biopsy
Isotope bone scan
66
Describe the feeling of a benign prostate on a prostate examination
Smooth, symmetrical and slightly soft
Maintained central sulcus
67
Describe the feeling of prostatitis (infected or inflamed prostate) on a prostate examination
Enlarged, tender and warm
68
Describe the feeling of a cancerous prostate on a prostate examination
Firm or hard, asymmetrical, craggy or irregular
Loss of central sulcus
May be hard nodule
69
What is the first line investigation in the diagnosis of prostate cancer
Multiparametric MRI
70
Describe a multiparametric MRI in prostate cancer
Results are scaled
1- very low suspicion to 5 - definite cancer
71
What grading system is used in prostate cancer
Gleason Grading
72
Describe the Gleason Grading system
Based on histology
Determines what treatment is appropriate
Grade 1 (closest to normal) to 5 (most abnormal)
Made up of 2 scores - the two most prevalent patterns in biopsy
6 = low risk
7 = intermediate
8 = high risk
73
Describe TNM Staging
T = tumour
N = nodes
M = metastasis
74
Describe the management of prostate cancer
Early = surveillance or watchful waiting
External beam radiotherapy
Brachytherapy
Hormone therapy
Surgery
75
Name 2 differential diagnosis of prostate cancer
Benign prostatic hyperplasia
Chronic prostatitis
76
Where does advanced prostate cancer spread to
Lymph nodes and bone
77
Describe the pathophysiology of testicular cancer
Arises from the germ cells of the testes
Germ cells produce gametes
78
What are the two types of testicular cancer
Seminomas
Non-seminomas
79
Describe the metastasis of testicular cancer
Lymphatic spread
Often occurs through spermatic cord lymphatics to the retroperitoneal lymph node chain
80
Describe the causes of testicular cancer
Genomic alterations
Congenital abnormalities
Perinatal factors
81
Name the risk factors of testicular cancer
Undescended testes
Male infertility
Family history
Increased height
82
Describe the typical presentation of testicular cancer
Painless lump
83
Describe the lump of testicular cancer
Non-tender
Arising from testicle
Hard
Irregular
Not fluctuant
No transillumination
84
Describe the investigations for testicular cancer
1st - scrotal ultrasound - confirm diagnoses
Tumour markers
Staging CT scan
85
What staging system is used in testicular cancer
Royal Marsden Staging System
86
Describe the Royal Marsden Staging System
Stage 1 - isolated
Stage 2 - spread to lymph
Stage 3 - spread above the diaphragm
Stage 4 - metastases to other organs
87
What are the common places that testicular cancer may metastasise
Lymphatics
Lungs
Liver
Brain
88
Are biopsies used in testicular cancer
Not advised
89
Describe the management of testicular cancer
Surgery - remove affected testicle
Chemotherapy
Radiotherapy
Sperm banking
90
Define bladder cancer
Arises from the endothelial lining (urothelium).
Majority are superficial (not invading the muscle) at presentation
91
Describe the pathophysiology of bladder cancer with carcinogens
Carcinogens are concentrated and excreted in urine - exposes to wall of urinary tract.
Exposure is prolonged to the bladder - malignant transformation can arise anywhere in the urinary tract
Malignant transformation of urothelial cells - high amount of mutations
92
Name 3 causes of bladder cancer
Smoking - main
Occupational risk to chemical carcinogens
Family history
93
Name the 2 main risk factors of bladder cancer
Smoking
Increased age
94
Name the clinical feature of bladder cancer
Painless haematuria
- Visible haematuria
- Microscopic haematuria
95
Describe the investigations of bladder cancer
Urinalysis
Cystoscopy
Bloods - FBC
Further imaging
96
Name the two types of bladder cancer
Non-muscle invasive bladder cancer
Muscle-invasive bladder cancer
97
Name 4 risk factors of bladder cancer
Smoking
Increased age
Aromatic amines - carcinogens
Schistosomiasis
98
Describe the NICE guidelines for a 2-week referral for bladder cancer
> 45 + unexplained visible haematuria
> 60 + microscopic haematuria + dysuria (or) raised with blood cell FBC
99
Describe the management options of bladder cancer
Transurethral resection of bladder tumour
Intravesical chemotherapy
Intravesical Bacillus Calmette-Guerin
Radical cystectomy
Chemotherapy/radiotherapy
Muscle-invasive tumours
100
Name the differential diagnosis for bladder cancer
Benign prostatic hyperplasia
Haemorrhagic cystitis
Prostatitis
UTI
101
Define benign prostate hyperplasia
Hyperplasia of the stromal and epithelial cells of the prostate
102
Describe the pathophysiology of benign prostate hyperplasia
LUTS caused by bladder outlet obstruction
2 components
Static - increase in tissue narrowing the urethral lumen
Dynamic - increase in muscle tone mediated by alpha-adrenergic receptors
103
Describe the causes of benign prostate hyperplasia
Shift in age related hormones
Prostatic stromal-epithelial interactions can occur with ageing
104
Name the risk factors of benign prostate hyperplasia
Age > 50
Family history
Non-Asian race
Cigarette smoking
Male pattern baldness
Metabolic syndrome
105
Name the clinical feature of benign prostate hyperplasia
LUTs
106
Describe the management of benign prostate hyperplasia
Mild symptoms - may not require interventions
Medications
Alpha-blockers
5-alpha reductase inhibitors
Surgical treatments
107
Name the differential diagnosis of benign prostate hyperplasia
Overactive bladder
Prostatitis
Prostate cancer
UTIs
Bladder cancer
Neurogenic bladder
108
Define hydrocele
Collection of fluid within the tunica vaginalis that surrounds the testes
109
Name the cause of hydrocele
Can be idiopathic
Or secondary
- testicular cancer
- testicular torsion
- Epididymo-orchitis
- Trauma
110
Name the risk factors of hydrocele
Male sex
Prematurity and low birth weight
Infants < 6 months of age
Infants whose testes descend relatively late
111
Name the clinical features of hydrocele
Painless
Soft scrotal swelling
112
Name the examination findings in hydrocele
Testicle palpable within the hydrocele
Soft, fluctuant - may be large
Irreducible and has no bowel sounds
Transilluminated
113
Name the investigations of hydrocele
Clinical diagnosis
Ultrasound - check for underlying pathology
114
Name the management of hydrocele
Exclude serious causes
Idiopathic hydroceles - managed conservatively
Large/symptomatic cases - surgery, aspiration or sclerotherapy
115
Define varicocele
Occurs where the veins in the pampiniform plexus become swollen
116
Describe the pathophysiology varicocele
Most occur left due to increased resistance of the left testicular vein (drains into the left renal artery)
117
Name the causes of varicocele
Anatomical features
Increased hydrostatic pressure in left renal vein
Incompetent or congenitally absent valves
118
Name the risk factors of varicocele
Somatometric parameters - tall/low BMI
Family history
119
Describe the symptoms of varicocele
Throbbing/dull pain or discomfort, worse when standing
Dragging sensation
Sub-fertility or infertility
120
Describe the signs of varicocele
Scrotal mass
More prominent on standing
Disappears when lying down
Asymmetry in testicular size if the varicocele has affected growth of the testicle
121
When would a suspected varicocele be a concern
If it does not disappear when lying down
Concerns about retroperitoneal tumours
122
How are varicocele diagnosed
Clinical
123
Describe the management of varicocele
Uncomplicated - conservative management
Pain, testicular atrophy or infertility - surgery or endovascular embolism may be indicated
124
Describe the pathology of penile cancer
95% are squamous cell carcinoma
3% Kaposi sarcoma
Precursor lesions
- HPV dependent undifferentiated PEIN
- HPV independent differentiated PEIN
125
Describe the epidemiology of penile cancer
Rare
1% male cancers
Incidence is increasing
126
What is the main cause of penile cancer
HPV
127
Name the risk factors of penile cancer
Increasing age
Premalignant lesions
Phimosis
Geography
HPV
Smoking
Immunocompromised
PUVA therapy
128
Describe the clinical features of penile cancer
Hard painless lump
Gland or prepuce
Up to 50% delay presenting
Blood discharge - haematuria
129
Describe the examination findings of a patient
General appearance and fitness
Abdomen
Lymph nodes in groins
Penis, lesion itself
DRE
130
Describe the investigations of penile cancer
Examination
Biopsy
Imaging - MRI for local staging, ultrasound
CT chest, abdomen and pelvis
131
Describe the management of superficial penile
Cream
Glands re-surfacing - take skin of the thigh
Get biopsy - can give local staging
132
Describe the management for invasive penile cancer
Removal
- Glandectomy
- Partial penectomy
- Radical penectomy
133
Describe the treatment for metastatic disease of penile cancer
Palliative surgery
Platinum chemotherapy
134
What are the differential diagnosis for penile cancer
Infections
- herpes simplex
- syphilis
Inflammatory conditions
- psoriasis
- lichen planus
- balanitis
Premalignant conditions
- genital warts
- Bowens disease
- Lichen sclerosus
135
Define hydrocele
Collection of fluid within the vaginalis that surrounds the testes
136
Define polycystic kidney disease
Genetic condition where the healthy kidney tissue is replaced by many fluid-filled cysts
137
What are the two types of polycystic kidney disease
Autosomal dominant
Autosomal recessive
138
Describe autosomal recessive polycystic kidney disease
More severe than autosomal dominant
Mutation in polycystic and hepatic disease (PKHD1) gene on chromosomal 6
Often picked up on antenatal scans with oligohydramnios
End-stage renal failure usually occurs before reaching adulthood.
139
What type of polycystic kidney disease is most common
Autosomal dominant
140
Describe autosomal dominant polycystic kidney disease
PKD1 gene on chromosome 16 - 85% cases
PKD2 gene on chromosome 4 - 15%
Has specific extra renal manifestations and complications
141
Name the risk factors for polycystic kidney disease
Family history of PKD
Family history of cerebrovascular event
142
Name the characterisations of polycystic kidney disease
Renal cysts
Extrarenal cysts
Intracranial aneurysms
Aortic root dilation and aneurysms
Mitral valve prolapse
Abdominal wall hernias
143
Describe the clinical features of polycystic kidney disease
Renal cysts
Hypertension
Abdominal/flank pain
Haematuria
Palpable kidneys/abdominal mass
Headaches
Dysuria, suprapubic pain, fever
144
Name the extra renal manifestations in autosomal dominant polycystic kidney disease
Cerebral aneurysms
Hepatic, splenic, pancreatic, ovarian, and prostatic cysts
Mitral regurgitation
Colonic diverticula
145
Name the investigations for polycystic kidney disease
Ultrasound
Genetic testing
Other tests
- other imaging
- urinalysis/gram stain
- serum electrolytes, urea, creatinine
- Fasting lipid profile
- ECG
146
Name the management of autosomal dominant polycystic kidney disease
Tolvaptan - vasopressin receptor antagonist
Can slow development of cysts and progression to renal failure
147
Describe the general management of polycystic kidney disease
Antihypertensives
Analgesia
Antibiotics
Drainage
Dialysis
Renal transplant
148
What is the most common cause of chronic kidney disease
Diabetes
149
What tests are used to monitor chronic kidney disease
eGFR
Albumin :creatinine ratio (ACR)
150
Describe the treatment plan for the control of hypertension is chronic kidney disease
uACR < 30 = follow NICE HTN guidelines
uACR > 30 = ACE/ARB 1st line
151
Describe dialysis
2 types
Haemodialysis
Peritoneal dialysis
Large impacts to life
152
Describe haemodialysis
Centre or home
Via AV fistula, graft or tunnelled line
3 days per week
153
Describe peritoneal dialysis
Via PD tube in abdominal wall
CAPD 1-4 exchanges per day
APD - 12 hours overnight
154
Approximately how many nephrons are present in the kidney? (total number over both kidneys)
2 million
155
What is the approximate number of litres of blood filtered by the kidneys per day?
180L
Approx. 179L reabsorbed
156
What is GFR influenced by
Net filtration pressure (NFP)
- hydrostatic pressure
- colloid osmotic pressures
Renal blood flow
- autoregulation
Filtration coefficient
- arteriolar endothelium (net -ve charge)
- glomerular podocytes
157
What is the biggest contributor to glomerular filtration pressure
Glomerular hydrostatic pressure (fluid out)
158
What are the 4 forces which affect the glomerular filtration pressure
Out
- Glomerular hydrostatic pressure
- Bowman's capsule colloid osmotic pressure
In
- Bowman's capsule fluid pressure
- Glomerular colloid osmotic pressure
159
What is the equation of net filtration pressure
GHP - (BCP + pieG)
Glomerular hydrostatic pressure - (bowman's capsule pressure + glomerular colloid osmotic pressure)
160
What would constriction of the afferent arteriole in the nephron cause?
Reduced GFR
Reduce peritubular flow
161
Describe renal autoregulation
Intrinsic feedback mechanism
Involves
- afferent and efferent arterioles
- tubuloglomerular feedback
162
What is the equation GFR as an indicator of renal function
= (creatinine urine / creatinine plasma) x urine flow rate (ml/min)
163
Name the drawbacks of eGFR
Does not consider creatinine tubular secretion (10-15% over estimate)
Creatinine metabolism reflection on lean body mass
Cimetidine, trimethoprim inhibit creatinine secretion.
Not valid in pregnancy
164
Name the drugs which can result in acute kidney injury
DAMN
Diuretics
ACEi/ARB
Metformin
NSAIDs
165
Name 6 factors that can reduce GFR
NSAIDs - increase afferent artery resistance
Angiotensin II (ACEi/ARB) - decrease efferent artery resistance
Increase plasma proteins (oncotic pressure) - decrease renal blood flow
Reduced arterial pressure - decreased GHP
Urinary tract obstruction (kidney stones) - Increased bowman's capsule pressure
Renal disease, diabetes mellitus, hypertension - decrease K
166
What ion has a key role in determining plasma volume and osmolality
Na+
167
Describe atrial natriuretic peptide effect in the kidneys
Afferent arteriole dilation - increase GFR
Inhibits renin secretion
- decrease angiotensin II, aldosterone secretion, systemic vascular resistance.
168
Name 3 inducers of renin secretion
Hypotension - decrease in afferent arteriole pressure
Decrease Na - macula densa
Increased sympathetic stimulation (B1) in JG Glandular cells
169
Name 6 roles of angiotensin-II functions
Increase SVR (vasoconstriction)
Increase ADH secretion
Induces cardiac hypertrophy
Increase aldosterone secretion
Increase Na+ uptake
Enhances sympathetic adrenergic activity
170
What is the cell of spermatogenesis
Sertoli cells
171
What is the cell in the testes with hormone production
Leydig cells
172
Describe the descent of the testes
8th week - transabdominal decent
26th week - testosterone produced - finish decent into the scrotum
Undescended can end up anywhere - most commonly the inguinal canal
173
Describe chlamydia
Intracellular organism - enters and replicates within the cells before rupturing the cell and spreading to others.
Incubation = 7-21 days.
Chlamydia trachomatis
Gram negative bacteria
174
What are the most sexually transmitted disease
Chlamydia
175
Name the risk factors for chlamydia and gonorrhoea
Age under 25 years
Sexually active
New/multiple partners
Condoms not used
History of prior STI
176
Describe the general clinical feature of chlamydia
Asymptomatic
50% men
75% in women
Can still pass on the infection
177
Name 5 symptoms of chlamydia in women
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding
Painful sex - dyspareunia
Painful urination - dysuria
178
Name 4 symptoms of chlamydia in men
Urethral discharge or discomfort
Painful urination - dysuria
Epididymo-orchitis
Reactive arthritis
179
Name the investigations for chlamydia and gonorrhoea
Charcoal test - allow for microscopy, culture and sensitivities
Nucleic amplification test - check for DNA or RNA
Examination
180
What do charcoal swabs which allow for microscopy, culture and sensitivities test for
Bacterial vaginosis
Candidiasis
Gonorrhoeae
Trichomonas vaginalis
Other bacteria e.g. group B strep
181
Describe the management of chlamydia
1st line - doxycycline
Contradicted in pregnancy and breastfeeding
Test of cure - not routinely done
Other management
- contact tracing
- Abstain for sex for 7 days
- treat and test other STIs
- advice
182
Name some examples of complications of chlamydia and gonorrhoea
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
Prostatitis (men)
Conjunctivitis
183
What is a medical emergency which is a complication of sexually transmitted disease in pregnancy
Gonococcal conjunctivitis in a neonate
Infection contracted from the mother during birth = ophthalmia neonatorum
Associated with sepsis, perforation of the eye and blindness.
184
Describe the National Chlamydia Screening Programme
Aims to screen every sexually active person under the age of 25 years
Annually or when change sexual partner
Test positive = re-test 3 months after treatment
185
Describe Gonorrhoea
Neisseria gonorrhoeae
Gram negative diplococcus bacteria
Infects mucous membranes with columnar epithelium
Spreads via contact with mucous secretions from infected areas.
186
Name the general clinical features of gonorrhoea
More likely to be symptomatic than chlamydia
90% of men
50% of women
Odourless purulent discharge - possibly green or yellow
Dysuria
Pelvic pain (females)/testicular pain or swelling - Epididymo-orchitis (males)
187
Name 4 other areas where someone could have a gonorrhoea infection
Rectal infection
Pharyngeal infection
Prostatitis
Conjunctivitis
188
Describe the management of gonorrhoea
High level antibiotic resistance to ciprofloxacin and azithromycin
Single dose IM ceftriaxone - sensitives NOT known
Single dose oral ciprofloxacin - sensitives known
All patients followed up
- NAAT test = asymptomatic
- Culture = symptomatic
189
Complication of gonorrhoea - disseminated gonococcal infection
Complication of untreated gonococcal infection where the bacteria has spread to the skin and joints
Causes
- Non-specific skin lesions
- Polyarthralgia
- Migratory polyarthritis
- Tenosynovitis
- Systemic symptoms
190
Describe the pathophysiology of renal cancer (renal cell carcinoma)
Driven by hypoxia in cells = down regulation of tumour suppressors
Arises mainly from the proximal convoluted tubules
Spread through direct invasion into the perinephric tissues, adrenal gland, renal vein or inferior vena cava
191
Name the 3 main types of renal cancer
Cell cell - 80%
Papillary - 15%
Chromophobe - 5%
192
Name the causes of renal cancer
Most common cause = smoking
Other causes (hypoxia causes)
- industrial exposure to carcinogens
- dialysis
- hypertension
- obesity
- anatomical abnormalities
193
Name the risk factors of renal cancer
Smoking
Obesity
Hypertension
End-stage renal failure
Von Hippel-Lindau Disease
Tuberous sclerosis
194
Name the clinical presentation of renal cancer
Palpable mass
Flank pain
Haematuria
Other symptoms
- non-specific symptoms of cancer
195
Name the investigations for renal cancer
Clinical examination
CT scan
Bloods
Urinalysis
196
Describe the 2 week wait for renal cancer
Age over 45 + unexplained visible haematuria + either without a UTI or persisting after treatment for a UTI
197
Describe the staging of renal cancer
By CT thorax, abdomen, pelvis.
Stage
1 - < 7cm + confined to kidney
2 - > 7cm + confined to kidney
3 - local spread to nearby tissue but not beyond Gerota's fascia
4 - spread beyond Gerota's fascia, including metastases
198
Describe the management of localised renal cancer
Surveillance or surgical management
If not surgery
- percutaneous radiofrequency ablation
- laparoscopic/percutaneous cryotherapy
- renal artery embolization
199
Describe the management for metastatic renal cancer
Chemotherapy - considered ineffective
Fit patients = nephrectomy + immunotherapy
Biological agents
Mastectomy - surgical removal of solitary metastases
200
Name 5 differential diagnosis of renal cancer
Benign renal cyst
Ureteric cancer
Bladder cancer
Angiomyolipoma
Upper urinary tract urothelial tumour
201
Name the complications of renal cancer
Spread
- cannonball metastases
Associated with paraneoplastic syndromes
- polycythaemia
- hypercalcemia
- hypertension
- Stauffer's syndrome
202
Describe syphilis
Bacteria - treponema pallidum
Spirochete - spiral shaped bacteria
Gets in through skin or mucous membranes, replicates and disseminates throughout the body
Incubation 21 days
203
Name the transmission routes of syphilis
Oral, vagina or anal sex
Vertical transmission
IDVU
Blood transfusions and other transplants (rare)
204
Describe the stages of syphilis
1. Primary - chancre at site of infection
2. Secondary - systemic symptoms (3-12 weeks)
3. Latent - no symptoms (can sit in here)
4. Tertiary - affects many organs
205
Describe the symptoms of tertiary syphilis
Several organs affected
Gummatous lesions
Aortic aneurysms
Neurosyphilis
206
Describe the investigations of syphilis
Antibody testing
- antibodies for T. pallidum bacteria
- screening
If positive - conformation by
- dark field microscopy
- polymerase chain reaction
207
Describe the management of syphilis
1st line - deep IM of benzathine benzylpenicillin
Other management
- full screening of STIs
- advice about avoiding sexual activity
- contact tracing
- prevention for future infections
208
Describe the complications of untreated syphilis
Facilitates HIV transmission
Considerable morbidity - cardiovascular, neurological disease
Major cause of miscarriage, stillbirth and perinatal morbidity and mortality (in some parts of the world).
209
Define pathophysiology of pyelonephritis
Inflammation of the kidney resulting from bacterial infection.
Inflammation affects the renal pelvis (joined between the kidney and ureter) and parenchyma (tissue).
210
Describe the pathophysiology of pyelonephritis in men
Prostatitis and benign prostatic hyperplasia - cause urethral obstruction leads to bacteriuria = pyelonephritis
Dilation and obstruction of the ureter cause inflammation of the kidney parenchyma
211
Name the causes of pyelonephritis
Most common - e. coli
Other
- K. pneumonia
- enterococcus
- pseudomonas aeruginosa
- s. saprophyticus
- c. albicans
212
Name the risk factors of pyelonephritis
Female sex
Structural urological abnormalities
Vesico-uteric reflux (children)
Diabetes
UTI
Stress incontinence
Pregnancy
Immunosuppression
213
Describe the clinical features of pyelonephritis
Lower UTI symptoms
+
Triad
- fever
- loin or back pain
- nausea/vomiting
214
Describe the investigations for pyelonephritis
Urine dipstick
- nitrites, leukocytes, blood
Midstream urine
- microscopy, culture and sensitivity
Blood tests
- raised white blood cells and inflammatory markers
Imaging to exclude other pathologies
215
Describe the clinical diagnosis of pyelonephritis
History + examination (urine output + urinalysis)
216
Describe the management of pyelonephritis
1st line - antibiotics 7-10 days
- cefalexin
- co-amoxiclav/trimethoprim (if culture available)
If sepsis - sepsis 6
217
What is sepsis 6
3 tests
- blood lactate level
- blood cultures
- urine output
3 treatments
- oxygen
- empirical broad spectrum IV antibiotics
- IV fluids
218
Describe the differential diagnosis pyelonephritis if it does not respond to treatment
Renal abscess
Kidney stone - obstructing the ureter
219
Describe chronic pyelonephritis
Recurrent episodes of infection in the kidneys
Leads to scaring of renal parenchyma = chronic kidney disease = can progress to end stage renal failure
Investigation - Dimercaptosuccinic acid
220
Name 5 complications of pyelonephritis
Need for catherterisation
Renal failure
Sepsis
Parenchymal renal scarring
Recurrent UTIS
221
Describe complicated UTI
Pregnant
Anatomical or functional abnormalities of urinary tract
Indwelling urinary catheter
Renal disease
Predisposing comorbidities
Men
222
Describe uncomplicated UTI
Caused by typical uropathogens
Non-pregnant woman
No known relevant anatomical or functional abnormalities of the urinary tract
No predisposing comorbidities
223
Define renal colic
Intense wave-like pattern related to the passage of ureteric stones
224
Define renal stones (renal calculi, urolithiasis, nephrolithiasis)
Hard stones that form in the renal pelvis, where the urine collects before travelling down the ureters
225
Where is the common place renal stones will become stuck
Vesico-uteric junction
226
Describe the types of renal stones
80% - calcium based
- calcium oxalate
- calcium phosphate
Others
- uric acid
- struvite
- cystine
227
Describe the 2 main risk factors for developing calcium renal stones
Hypercalcaemia
Low urine output
228
Describe the causes of renal stones
Response to elevated levels of urinary solutes
Decreased levels of stone inhibitors (citrate, magnesium)
Low urinary volumes and abnormally low or high urinary pH
229
Name the risk factors of renal stones
Dehydration
High salt intake
White ancestry
Male sex
Obesity
Crystalluria
230
Describe the clinical features of renal stones
Asymptomatic - until get stuck/irritate
Renal colic - presenting complaint
- unilateral loin to groin pain
- colicky
231
Describe the investigations of renal stones
Urine dipstick
Blood tests
Imaging
232
Describe the management of renal stones
NSAIDs
Antiemetics
Watchful waiting
Tamsulosin - help aid spontaneous passage
Surgical interventions
233
Describe the ongoing treatment of renal stones
Dietary modification with adequate hydration
234
Name the 2 key complications of renal stones
Obstruction - leading to acute kidney injury
Infection - with obstructive pyelonephritis
235
Define testicular torsion
Twisting of the spermatic cord with rotation of the testicle leading to constriction of the vascular supply and time-sensitive ischemia and/or necrosis of testicular tissue
236
Describe the causes of testicular torsion
Most common = anatomical defect - ball clapper deformity
Trauma
Exact = unknown
237
Describe the ball clapper deformity
Fixation between the testicle and the tunica vaginalis is absent.
Testicle hangs in a horizontal position instead of more vertical
Able to rotate within the tunica vaginalis, twisting the spermatic cord
238
Name 3 risk factors for testicular torsion
Age under 25 years
Neonate
Ball clapper deformity
239
Describe the clinical features of testicular torsion
Often triggered by an activity - e.g. playing sports
Acute rapid onset of testicular pain
- may be associated with abdominal pain and vomiting
240
Describe the examination findings of testicular torsion
Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abdominal testicular lie
Rotation
241
Describe the investigations of testicular torsion
History + physical examination = immediate surgical consultation
Other imaging
- ultrasound
242
Describe the management of testicular torsion
Nil by mouth
Analgesia
Urgent assessment
Surgical exploration of the scrotum
- Orchiopexy
- Orchiectomy
243
Describe a key differential diagnosis of testicular torsion
Testicular appendix torsion
Most common cause of acute scrotal pain in prepubertal children
Appendix testis - remnant of Mullerian duct
Located on superior pole of the testicle between the testis and epididymis
Mos common appendage to undergo torsion
244
Name differential diagnosis of testicular torsion
Testicular appendix torsion
Epididymitis/Epididymo-orchitis
Hydrocele
Varicocele
Testicular cancer
Inguinal hernia
245
Name the complications of testicular torsion
Infarction of testicles
Permanent damage/loss of testicle
Infertility secondary to loss of testicle
Recurrent torsion
Cosmetic deformity
Psychological implication
246
Describe a epididymal cyst
Fluid filled sac which occurs at the head of the epididymis
If contains sperm = spermatocele
247
Describe the clinical features and examination findings of epididymal cysts
Most cases = asymptomatic or present with a lump or ultrasound
Examination findings
- soft, round lump
- at top of testicle
- associated with epididymis
- May be able to transilluminate large cysts
248
Describe the management of epididymal cysts
Generally - no treatment
Cause pain and discomfort - removal may be considered
Surgery best avoiding in young men - can cause infertility
249
Define glomerulonephritis
Broad term that refers to a group of parenchymal kidney disease - inflammation and damage to glomeruli
250
What is the general pathophysiology of glomerulonephritis
Immunological mediated:
Immunoglobin deposits
Inflammatory deposits
Response to immunosuppressive therapy
Evidence from animal models
251
What are the 4 main presentations of glomerulonephritis
Nephritic syndrome
Nephrotic syndrome
Asymptomatic urinary abnormalities
Chronic kidney disease
252
Define nephritic syndrome
Generic term for inflammation in the kidneys
Descriptive term
NOT diagnosis
Refers to features that occur with nephritis
253
Describe the features of nephritic syndrome
Haematuria (blood in urine) - micro/macroscopic
Oliguria - significantly reduced urine output
Proteinuria - protein in urine. Less than 3g/24hrs. Higher protein than this suggests nephrotic syndrome
Fluid retention
254
Name the causes of nephritic syndrome
ANCA associated vasculitis
Goodpasture's disease
Systemic sclerosis
SLE
IgA nephropathy
Post strep
255
Describe ANCA associated vasculitis (nephritic)
Antineutrophil cytoplasmic antibodies
Multisystem small vessel vasculitis
256
Describe the clinical features of ANCA associated vasculitis (nephritic)
Systemic inflammatory features
Features of other organ involvement
Splinter haemorrhage
Pulmonary oedema
Crescentic glomerulonephritis
257
Describe the diagnosis of ANCA associated vasculitis (nephritic)
Serum ANCA - changes correlate with disease activity
Biopsy
- segmental glomerular necrosis with crescent formation
258
Describe the treatment of ANCA associated vasculitis (nephritic)
Immunosuppressants
Other - plasma exchange
259
Define Goodpasture's disease
Glomerular injury due to autoimmunity directed against the alpha-3 chain of type IV collagen mediated by both humoral and cellular processes.
Smoking damage more.
260
What is the serology of Goodpasture's disease (nephritic)
Anti-glomerular basement membrane antibodies
261
Name the 2 risk factors for Goodpasture's disease
HLA-DRB1 or DR4
Smoking
262
Describe the clinical features of Goodpasture's disease (nephritic)
Rapidly progressive kidney failure + pulmonary haemorrhage
Active dipstick
Haemoptysis
263
Describe the investigations of Goodpasture's disease (nephritic)
Biopsy - linear deposits of antibody along basement membrane
Serological testing
Important to avoid renal damage
264
Describe the treatment for Goodpasture's disease (nephritic)
Remove antibody = plasma exchange + agents to prevent production
Immunosuppression
265
Describe the pathophysiology of SLE (nephritic)
Chronic multisystem disorder
Antinuclear antibodies
266
What is the serology of SLE (nephritic)
Anti-nuclear antibody positive
Double stranded DNA antibody positive
Low complement levels - C3,4
267
Name the 4 risk factors for SLE (nephritic)
Female sex (commonly effects women in reproductive years)
> 30 years
African descent in Europe or US
Drugs
268
Describe the clinical features of SLE (nephritic)
Rash
Arthralgia
Kidney failure
Neurological symptoms
Pericarditis
Pneumonitis
269
Describe the investigations of SLE (nephritic)
Bloods
urinalysis
Chest X-ray
ECG
ISPN classification
270
Describe the treatment of SLE (nephritic)
Immunosuppression
271
Define IgA nephropathy (nephritic)
Presence of dominant or co-dominant mesangial IgA immune deposits, often accompanied by C3 and IgG in association with a mesangial proliferative glomerulonephritis of varying severity.
272
What is Henoch Schoenlein purpura
Systemic form of IgA nephropathy
Triad
- Purpuric rash
- Abnormal pain
- Acute kidney injury
Often self limiting
273
What are the risk factors of IgA nephropathy (nephritic)
Family history
Male sex
Age 20-30
Asian/white/native American ancestry
IgA vasculitis
Chronic liver disease
HIV infection
274
Describe the clinical features of IgA nephropathy (nephritic)
Episodic microscopic haematuria
AKI
275
Describe the treatment of IgA nephropathy (nephritic)
1st line - supportive treatment (main - not much medication)
Budesonide
ACE inhibitors (proteinuria)
Statin (cardiovascular)
276
Describe the investigations for IgA nephropathy (nephritic)
Urinalysis
Urine microscopy & culture
Basic biochemistry
Immunofluorescence
- diffuse mesangial IgA deposits
277
Define nephrotic syndrome
Occurs when the basement membrane in the glomerulus becomes highly permeable resulting in significant proteinuria
Refers to a group of features without specifying the cause
278
What are the clinical features of nephrotic syndrome
Heavy proteinuria
- > 3.5g/24 hrs
- OR UPCR of 300-350 mg/mmol
Hypoalbuminemia < 30 g/L
Oedema - peripheral
279
Describe minimal change disease (nephrotic)
Most common nephrotic syndrome
Characterised by - heavy proteinuria, oedema, hypalbuminaemia, hyperlipidaemia
280
Name the causes of minimal change disease (nephrotic)
90% cases are idiopathic
May be secondary to certain conditions
- Hodgkin's lymphoma
- leukaemia
281
Name 4 risk factors for minimal change disease (nephrotic)
Age > 1 years but < 8 years
Hodgkin's lymphoma
Leukaemia
Recent viral illness
282
Describe the clinical features of minimal change disease (nephrotic)
Onset gradual, often following recent viral illness
Facial swelling with/without puffy hands/or feet
Oedema of the legs
Nausea and vomiting
283
Describe the investigations of minimal change disease (nephrotic)
Urinalysis
Biopsy - electron microscopy - fused podocytes
284
Describe the management for minimal change disease (nephrotic)
Steroids
2nd line - tacrolimus, cyclosporin, cyclophosphamide or rituximab
285
Describe membranous nephropathy (nephrotic)
Thickening of the glomerular capillary wall
IgG complement deposit in subepithelial surface causing leaky glomerulus
286
Describe primary and secondary membranous nephropathy (nephrotic)
Primary - glomerular podocyte membrane PLA2R antigen is the targeted antigen
Secondary - Associated with autoimmune conditions, viruses, drugs and tumours
287
Name the risk factors for membranous nephropathy (nephrotic)
Male sex
Age > 40 years
HLA-DR3
Autoimmune disease
Hepatitis B and C
Syphilis
Solid organ carcinoma
Medications
288
Describe the diagnosis of membranous nephropathy (nephrotic)
Serum PLA2R Ab
Look for secondary causes
Renal biopsy
Other investigations
289
Describe the treatment in low risk membranous nephropathy (nephrotic)
Low risk - wait and see
290
Describe the treatment in moderate risk membranous nephropathy (nephrotic)
Wait and see OR rituximab OR calcineurin inhibitor +/- glucocorticoids
291
Describe the treatment in high risk membranous nephropathy (nephrotic)
Rituximab OR cyclophosphamide + glucocorticoids OR calcineurin inhibitor + rituximab
292
Describe the treatment for very high risk membranous nephropathy (nephrotic)
Cyclophosphamide + glucocorticoids
293
Describe the investigations for nephrotic syndromes
Bloods
Urine protein: creatinine ratio
Serum and urine electrophoresis
Lupus tests
Anti-phospholipase A2 receptor antibody (membranous)
HpBsAg, HepCAb - Hep B/C associated
294
Define bacteriuria
Presence of bacteria in the urine (symptomatic or asymptomatic)
295
Define pyuria
Presence of leukocytes in the urine.
Associated with infection
296
Define an uncomplicated UTI
Caused by typical pathogens in people with normal urinary tract and kidney function and no predisposing co-morbidities
297
Define a complicated UTI
UTI with increased likelihood of complications e.g. persistent infection, treatment failure and recurrent infection
298
Describe the reasons for cystitis
Stasis during pregnancy
Low urinary volume - dehydrated
Ureteric stones
Bladder stones or tumour
Obstruction from prostatic hypertrophy
Catheterisation allowing colonisation
299
What's the common cause of cystitis
E.coli > 50%
Proteus 10-15% - associated with renal stones
Klebsiella 10% - hospital/catheter associated
300
Name the risk factors of cystitis
Sexual activity
Spermicide use
Post-menopause
Positive family history of UTIs
History of recurrent UTI
Presence of foreign body
301
Describe what would result in an increase risk of cystitis in men
Usually due to benign prostatic hypertrophy, urinary tract stones, urological surgery, urethral strictures.
302
Describe catheterisation of an increased risk factor of cystitis in men
All become colonised 7-32 days
Cultures should always be sent (not dipstick)
Change of remove catheter when starting treatment
Send a fresh sample
Formation of biofilms
Incomplete voiding
303
How do you prevent catheter associated cystitis
Prevent catheterisation
Prevent bacteria - keep closed, remove asap
Prevention of complications - do not treat asymptomatic, catheter replacement
304
Name the clinical features of cystitis
Dysuria
New nocturia
Cloudy urine
Frequency, urgency
Suprapubic pain or tenderness
Haematuria
305
Describe the investigations of cystitis
Urinalysis
- nitrites
- leucocytes
- blood - haematuria
urine sample
Microscopy
Culture
Sensitivity testing
306
In microscopy for cystitis what presentation of white blood cells would be pyuria
10^4 wbc/ml
307
What amount of bacteria in a urine sample would be positive for cystitis (or an infection)
10^5 cfu/ml
308
Describe the management of cystitis (uncomplicated UTI)
1st line - antibiotics (non pregnant - nitrofurantoin)
Avoid broad spectrum antibiotics
3 days
Advice
309
Cystitis - In asymptomatic bacteriuria what is the treatment in over 65's
Do not treat
310
What is the treatment course of complicated UTI
Always send sample for culture
Longer antibiotic course required.
311
Describe the treatment for a UTI in pregnancy
Asymptomatic bacteriuria common in pregnancy (should be treated)
Culture rather than dipstick - confirmed with 2nd sample
> 7 days
Test of cure 1 week after treatment
-
312
Define urethritis
Inflammatory condition of the urethra that results from either infection or trauma
313
What are the infectious cause of urethritis
Gonococcal - Neisseria gonorrhoeae
Non-Gonococcal - chlamydia trachomatis and mycoplasma genitalium
314
What are the causes of urethritis
STI
Post traumatic
- catheterisation
- instrumentation
- Foreign body insertion
- Vigorous urethral stripping (compression)
315
Name the risk factors for urethritis
Age 15-24 years
Female sex
Men who have sex with men
New or multiple sex partners
Prior or current STD
Incosistent condom use
316
Describe the clinical features of urethritis
Presents - acute urethral discharge following unprotected sex
Others
Dysuria
Pruritus
317
Describe the investigations of urethritis
Urinalysis - positive for leukocyte esterase
Gram stain and culture of urethral discharge and/or urine sediment
NAAT
HIV/syphilis test
318
Describe the management of urethritis
Men - all referred to GUM
Empirical treatment for STI
Test for other STI
UTI - treat
319
Name the possible complications of urethritis
Untreated gonococcal - disseminate
- arthiritis
- meningitis
- endocarditis
Untreated non-gonococcal
- reactive arthiritis
- infertility
320
Name the differential diagnosis of urethritis
UTI
Candida balanitis or vaginitis
Non-infectious urethritis
Nephrolithiasis
Interstitial cystitis
Reactive arthiritis
Chronic prostatitis
321
Define Epididymo-orchitis
Result of infection in the epididymis and testicle on one side
Epididymitis - inflammation of the epididymis
Orchitis - inflammation of the testicle
322
Name 4 causes of Epididymo-orchitis
E. coli
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps
323
Name the risk factors of Epididymo-orchitis
Male 15-30 years
Mumps
Male > 60
Sexual intercourse
Catheterisation
Prostate enlargement
Men who have sex with men
324
Describe the clinical features of Epididymo- orchitis
Testicular pain
Dragging or heavy sensation
Swelling of testicle and epididymis
Urethral discharge (think STI)
Systemic symptoms
325
Describe the investigations of Epididymo-orchitis
Urine microscopy, culture and sensitivity
NAAT test, Charcoal swab
Saliva swab
Serum antibodies (mumps)
Ultrasound (torsion or tumours)
326
Describe the management of Epididymo-orchitis
STI - refer to GUM, treat
Acutely unwell or septic patients = IV antibiotics
Antibiotics e.g. E.coli
Other
- analgesia
- supportive underwear
- reduce physical activity
- abstain from intercourse
327
Define prostatitis
Inflammation of the prostate with evidence of recent or ongoing bacterial infection
328
How can prostatitis be classed
Acute bacterial - acute infection
Chronic - > 3 months
- chronic prostatitis
- chronic bacterial prostatitis
329
Describe the causes of prostatitis
Cause of chronic unclear
- initially triggered by an infection
- inflammation persists after the infection has be resolved
Acute - E.coli
330
Name the risk factors of prostatitis
UTI
Benign prostatic enlargement
Urinary tract instrumentation/manipulation
Others
- poor general health/immunosuppression
- smoking and alcohol consumption
- genetics
331
Describe the clinical features of chronic prostatitis
Pelvic pain
Lower UTI symptoms
Sexual dysfunction
Pain with bowel movements
Tender and enlarged prostate on examination
332
Describe the clinical features of acute prostatitis
Similar symptoms to chronic - come on quicker
Systemic
- fever
- myalgia
- nausea
- fatigue
- sepsis
333
Describe the investigations of prostatitis
urine dipstick
Urine microscopy, culture, and sensitivities
NAAT testing
334
Describe the treatment of acute prostatitis
Oral antibiotics
- 2-4 wees
Analgesia
Laxatives
335
Describe the treatment of chronic prostatitis
Alpha-blockers (tamsulosin)
Analgesia
Psychological treatment (where indicated)
Antibiotics
Laxatives
336
Name the differential diagnosis of prostatitis
Benign prostatic hyperplasia
Prostate cancer
UTI
Bladder cancer
Colorectal cancer
Epididymitis/orchitis
337
Describe the pathophysiology of post-strep infection (nephritic)
Bacterial infection causing rapid deterioration of kidney function due to an inflammatory response following a strep infection
Type II hypersensitivity reaction
Effects patients under 30
Presents 1-3 weeks after strep infection
338
Describe the cause of post-strep infection (nephritic)
Follows strep infection
Skin infections - impetigo
Throat infections - pharyngitis
339
Describe the investigations of post strep infection (nephritic)
Anti-streptolysin titre and anti nicotinamide-adenine denuclerotiase - previous strep
C3
Urine analysis
Renal function tests
Imaging
340
Describe the management of post strep infection (nephritic)
Pharmacological
- antimicrobials
- diuretics
- antihypertensive medications
Dialysis - if needed
General measures
- salt/water restriction - oedema
- Bed rest and immobilisation
- Throat culture from patient and family
341
Describe the prognosis of post strep infection (nephritic)
Patients usually make a full recovery
342
How is IgA nephropathy a differential diagnosis of post strep infection (nephritic)
IgA - usually occurs after upper resp tract or GI infection
Post-strep - usually occurs after skin or throat infection
343
Define focal segmental glomerulosclerosis (nephrotic)
Chronic pathological process caused by injury to podocytes in the renal glomeruli
344
Describe the pathophysiology of focal segmental glomerulosclerosis
Damage to podocyte triggers apoptosis
Causes podocytes to deattach from the glomerular basement membrane and to be destroyed
Numbers decline, glomerular basement membrane is exposed, deposition of collagen.
Glomerular tuft undergoes sclerosis.
345
Describe the causes of focal segmental glomerulosclerosis
Primary - idiopathic (unknown cause)
Secondary - underlying cause
- HIV
- obesity
- medications
- maladaptive response to decreased renal mass
346
Describe the clinical features of focal segmental glomerulosclerosis (nephrotic)
Manifests initially proteinuria
Progresses to nephrotic syndrome
Then end-stage renal failure
347
Name the risk factors of focal segmental glomerulosclerosis (Nephrotic)
Male sex
Black race
Family history
Heroin abuse
Use of known causative agents
Chronic viral infections
348
Describe the investigations of focal segmental glomerulosclerosis (nephrotic)
Bloods
- serum urea
- creatinine
- GFR
- serum albumin
- serum lipid profile
Urinalysis
- with microscopy
- urine protein-to-creatinine ratio
- 24 hour urine collection for protein
349
Describe the management of focal segmental glomerulosclerosis (nephrotic)
1st line - corticosteroid therapy
2nd line - treatment of underlying cause
350
Name the differential diagnosis of focal segmental glomerulosclerosis (nephrotic)
Membranous nephropathy
Minimal change disease
Amyloidosis
Diabetic nephropathy
Membranoproliferative glomerulonephritis
Light chain deposition disease
351
Describe the pathophysiology of diffuse proliferative glomerulonephritis
Depends on underlying aetiology
Activated inflammatory process.
Increased cellular proliferation.
Antibodies.
352
What is the most common cause of diffuse proliferative glomerulonephritis
Systemic lupus erythematosus
353
What are the associated infections of diffuse proliferative glomerulitis
Endocarditis
Hepatitis B
Hepatitis C
354
Describe the clinical features of diffuse proliferative glomerulonephritis
Generalised systemic symptoms
Hypertension
Decreased urinary output
Frothy urine (proteinuria)
Generalised body swelling
Pedal oEdema
Microscopic or gross haematuria
355
Describe the investigations of diffuse proliferative glomerulonephritis
FBC
U&Es
Urine analysis
24-hour urine protein to creatinine ratio
24 hour urine sample for protein sample
Renal ultrasound
356
What is the gold standard for diagnostic test for diffuse proliferative glomerulonephritis
Renal biopsy
With light microscopy, electron microscopy, immunofluorescence study
357
Name the management for (3) diffuse proliferative glomerulonephritis
Conservative treatment - ACE inhibitors
Statin
Corticosteroids - then tapered off
358
How can different types of glomerulonephritis be differentiated
Can only be differentiated by renal biopsy
359
What is a poor serological indicator of disease in diffuse proliferative glomerulonephritis
Low levels of complement
360
Name the complications of diffuse proliferative glomerulonephritis
Hypoalbuminemia
Hyperlipidaemia
Clotting disorders due to loss of anti-thrombin III
Renal biopsy complications
End-stage renal disease
361
Define membranoproliferative glomerulonephritis
Group of immune-mediated disorders characterised by glomerular basement membrane thickening and proliferative changes on light microscopy
362
Name 3 causes of membranoproliferative glomerulonephritis
Idiopathic
Hepatitis C
Autoimmune conditions e.g. SLE
363
What are the investigations of membranoproliferative glomerulonephritis
Renal biopsy
Immunofluorescence
364
What would be seen on a renal biopsy of membranoproliferative glomerulonephritis (3)
Thickened basement membrane
Thickened mesangium
Tram tracking appearance
365
What would immunofluorescence of membranoproliferative glomerulonephritis
Shows subendothelial deposition of IgG
366
Describe the management of membranoproliferative glomerulonephritis
Dipyridamole and aspirin
Kidney transplant for patients with end-stage renal disease
367
What is the difference between membranous glomerulonephritis and membranoproliferative glomerulonephritis
Membranous glomerulonephritis = basement membrane thickened, mesangium is not
Membranoproliferative = mesangial proliferation
368
Name the types of LUTS
Stress incontinence
Urgency incontinence
Mixed incontinence
369
Define stress incontinence
Involuntary loss of urine with coughing or sneezing or physical exertion
370
Define urgency incontinence
Involuntary loss of urine associated with or immediately proceeded by urgency
371
Name the causes of LUTS
No single cause
Increasing age
Pregnancy/vaginal delivery
Obesity
Constipation
Deficiency in supporting tissues
Family history
Smoking
372
Name the causes of overflow incontinence
Urinary retention which can be due to bladder outlet obstruction or detrusor underactivity
Medications that can decrease bladder contractility
373
Name causes of urinary retention
Most common in men = benign prostatic hyperplasia
Other
- urethral blockage
- drug treatment
- neurogenic causes
- occur postpartum or postoperatively
- conditions that reduce detrusor contractions or interfere with relaxation of the urethra
374
Define the reversible causes of LUTS
DIAPPERS
Delirium
Infection
Atrophic vaginitis/urethritis
Psychological
Pharmacological
Endocrine
Restricted mobility
Stool impaction
375
What is the main risk factor of LUTS
Older age
376
Name risk factors of LUTS
Older age
Obesity
Diabetes
Inflammation
Benign prostatic hyperplasia
Pregnancy and vaginal delivery
Constipation
Family history
377
Name the clinical features of LUTS
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining
Terminal dibbling
Incomplete emptying
Nocturia
378
What are the symptoms of storage LUTS
Frequency
Nocturia
Urgency
379
Name the features of voiding LUTS
Hesitancy
Intermittency
Slow flow
Terminal dribbling
Straining
380
What are the 3 main investigations in LUTS
Urinalysis +/- urine culture
Post void bladder scan
Frequency chart
381
What can be used to assess the severity of LUTS in benign prostate hyperplasia
International prostate symptom score
382
What is the conservative management of LUTS
Weight loss
Fluid modification
Avoid triggers - smoking, bladder irritants
Bladder re-training
Pelvic floor muscle exercises
Containment
383
What is the pharmacological treatment of urgency incontinence
Antimuscarinic agents
Mirabegron
Desmopressin
384
What are the differential diagnosis of LUTS
Phimosis
Meatal stenosis
Penile cancer
UTI
Upper UTI
Urological cancer
Urological infection
Sciatica
Benign prostate enlargement
385
What are the red flag symptoms of LUTS
Abrupt onset
Pelvic pain - constant, worsened or improved with voiding
Haematuria
