Flashcards in Urology Deck (218):
What are the indications for dialysis?
Electrolyte abnormalities with ECG changes
Intoxication with SLIME - salicylates, lithium, isopropanol, methanol, ethylene glycol
Overloaded with fluid
Uremic symptoms - pericarditis or encephalopathy
A 62 year old man has a 5 month hx of fatigue, perineal discomfort, lower back pain and loin pain. He experiences pain on micturition. What is the likely diagnosis?
Chronic bacterial prostatitis
60 year old man presents with dysuria and urgency. He gets some suprapubic pain which is relieved when lying supine and occasional terminal haematuria. there is no abnormality on examining the abdomen. What is the likely diagnosis?
Painful haematuria suggests this rather than malignancy
72 year old man presents to ED with acute back pain and leg weakness. He has been experiencing hesitancy and dribbling of urine for 12 months. On examination he has spastic paraparesis and palpable bladder. What is the likely diagnosis?
Signs of collapsed vertebrae - mets
Spinal cord compression - dorsal, stamping gait due to proprioceptive loss
What is the triad of symptoms associated with renal cell carcinoma?
What is nephrotic syndrome?
Too much protein excreted by kidney
Patient usually presents with oedema around the eyes and legs
What is the first line treatment for benign prostatic hyperplasia?
Tamulosin - alpha blocker
What is the second line treatment for benign prostatic hyperplasia?
Alpha reductase inhibitor which reduces dihydrotestosterone and therefore prostate volume
What should patients taking finasteride be warned about contraception?
Use barrier contraception as it is excreted in semen and can cause birth defects in the foetus
What factors in the history would make you worry about bladder malignancy?
Occupational exposure to aniline dyes and rubber
What is the first line painkiller for renal colic pain?
A 55 year old man presents to his GP with a painless lump in his right testicle which he has noticed over the last few weeks. A blood test shows normal alpha feto protein. He is found to have testicular cancer. What type is he most likely to have?
Seminoma - age and normal AFP
What is paraphimosis?
Complication of urinary catheterisation if the health professional forgets to replace the foreskin
What is the management for paraphimosis?
Attempted reduction by applying cold compresses to area and applying sustained firm pressure
If this fails, surgical management may be required
What is balanitis?
Infection of glans usually caused by streptococcus or staph
Common in diabetics
On which side are varicocoeles most likely to occur?
Left side due to:
Angle at which left testicular vein joins left renal vein
Lack of valves
Which veins are affected in a varicocoele?
What is the first line treatment for stress incontinence?
Pelvic floor exercises
What treatments are used in urge incontinence?
Oxybutynin - anticholinergic
A 21 year old man presents with malaise fever and bilateral large tender testes. What is the likely diagnosis?
A 27 year old man complains that there is a lump on his right testicle which transilluminates relatively poorly. He had a vasectomy two years earlier. Examination reveals a small non tender smooth 1cm mass arising from superior pole of testis. What is the likely diagnosis?
What are symptoms of hypercalcaemia?
Bones: arthralgia, pseudogout
Stones: renal colic
Groans: peptic ulceration
Constipation, polyuria and nocturia
What can be a devastating consequence of correcting hyponatraemia too quickly?
Osmotic demyelination syndrome
(Central pontine demyelination)
What are the 5 Rs of IV fluid therapy?
Describe how total body water is divided up
Extracellular: 20% Na Cl HCO3
Intracellular: 40% K
What components of the extracellular compartment are there?
Intravascular: haematocrit and plasma
What contributes to plasma oncotic pressure?
Where can fluids be lost from?
What is the average daily intake of water sodium and potassium?
What is insensible loss of fluid?
Evaporation of water from lungs and skin
0.5L - 1L/day
How much fluid is lost from the GI tract per day?
What factors can negatively affect fluid balance?
Changes in albumin
Changes in potassium
Why can liver disease lead to oedema?
Reduced albumin levels
Reduces plasma oncotic pressure and intravascular volume
What is crystalloid fluid?
Glucose or salt containing fluids
What are colloid fluids?
Microscopic particles: starch or protein suspended in crystalloid
Used for Intravascular volume expansion
6% hydroxyethyl starch
4% succinylated gelatin
What is a balanced salt solution?
Crystalloid containing electrolytes in a concentration as close to plasma as possible
Which fluids are better for interstitial volume correction?
What imaging would you do to confirm a suspected prostatic malignancy?
Trans rectal ultrasonography
What is a Gleason score?
Evaluate prognosis of men with prostate cancer using samples from prostate biopsy
Cancers with higher Gleason score are more aggressive and have a worse prognosis, score 1-10
What is goserelin?
LH hormone releasing agonist
Suppress production of sex hormones
What characterises autosomal dominant Polycystic kidney disease?
Multiple bilateral renal cysts
Cyst formation in other organs such as pancreas and liver
A 67 year old man is admitted with a ruptured infrarenal abdominal aortic aneurysm and undergoes a successful repair. Post operatively, urine output is poor despite adequate central venous pressure after control of the aneurysm. What is the likely problem?
Acute tubular necrosis
Common after major/emergency surgery when there are periods of prolonged hypotension
Which drugs could precipitate urinary retention?
Anticholinergic - TCAs
Antipsychotics - chlopromazine
What are the 3 most common causes of end stage kidney disease?
What are the different classifications of glomerulopathies? What are characteristics of each?
Nephrotic syndrome: massive proteinuria, hypoalbuminaemia, oedema, lipiduria, hyperlipidaemia
Acute glomerulonephritits (nephritic): haematuria, proteinuria, oedema, HTN, transient renal impairment
Rapidly progressive glomerulonephritits: acute nephritis, focal necrosis, rapidly progressing renal failure
What is the difference between bland and active urine sediments?
Active: cellular elements, red or white cells, or casts. Implies a process actively damaging your kidneys, causing them to bleed or get inflamed
Bland: other elements, crystals, protein, and urinary casts. May imply a more serious, long-standing kidney problem such as uncontrolled diabetes
What are negative prognostic factors for glomerulopathies?
Greater degree renal impairment
What are pathological changes seen in diabetic nephropathy?
Glomerular basement membrane thickening
What is the commonest form of glomerulonephritits worldwide?
What is the definition of chronic kidney disease?
GFR 65 mg/mmol
Protein/creatinine ratio 100mg/mmol
List some causes of chronic kidney disease
Congenital: polycystic kidney disease
Glomerular disease: focal glomerulosclerosis, SLE, wegeners granulomatosis, HUS, TTP
Vascular disease: hypertensive nephrosclerosis, vasculitis
Tubulointerstitial disease: tubulointerstitial nephritis, reflux nephropathy, multiple myeloma
Urinary tract obstruction: calculus disease, prostatic disease, pelvic tumour
What are uraemic symptoms of CKD?
Loss of appetite
Nocturia and polyuria
Nausea, vomiting, diarrhoea
Paraesthesia due to polyneuropathy
Restless legs syndrome
Bone pain - metabolic bone disease
Tetany - hypocalcaemia
Peripheral and pulmonary oedema
What are red cell and granular casts?
Granular: abnormal cells in tubular lumen, indicate active renal disease
Red cell: glomerulonephritits
What are some complications of chronic kidney disease?
Bone disease - renal osteodystrophy
Skin disease - itching
Nephrogenic systemic fibrosis
GI: decreased gastric emptying and increased redux
Lipid metabolism abnormalities
Decreased testosterone - erectile dysfunction
Oligomenorrhoea or amenorrhoea
Impaired growth in children
Abnormal thyroid hormone levels
Median nerve compression
Restless leg syndrome
What is renoprotective management for chronic kidney disease?
Angiotensin receptor blocker
Calcium channel blocker
What are treatment aims for chronic kidney disease renoprotection?
What can be complications of haemodialysis?
Anaphylaxis to ethylene oxide
Hard water syndrome
What can be complications of continuous ambulatory peritoneal dialysis?
Infection around catheter site
Failure of peritoneal membrane function
What are contraindications to continuous ambulatory peritoneal dialysis?
Previous peritonitis causing adhesions
Presence of a stoma
Active intra abdominal sepsis
Visual impairment - difficulty performing exchanges
What are complications of renal transplant?
Acute tubular necrosis
Technical failures - occlusion or stenosis of anastamosis, urinary leaks
Infection - CMV
Post transplant lymphoproliferative disorder
Chronic allograft nephropathy
Post transplant osteoporosis
What are risk factors for the development of an inguinal hernia?
Collagen vascular disease
Previous open appendectomy
What are the boundaries of hesselbachs triangle?
Inferior: inguinal ligament
Lateral: inferior epigastric artery and vein
Medial: lateral border of rectus abdominus
In which type of inguinal hernia is strangulation most common?
Indirect - narrow neck
Describe what happens when a piece of bowel gets strangulated in an inguinal hernia
Segment of intestine prolapses through defect in anterior abdominal wall
Sequestration of fluid within lumen of herniated bowel
Impaired lymph and venous drainage which compounds swelling
Arterial supply becomes impaired
Gangrene ensues and if left untreated, perforation occurs
What are the different sub classifications of inguinal hernias?
Irreducible or incarcerated
What are possible complications of an inguinal hernia repair?
Urinary retention post operative
Inguinal wound haematoma
Division of vas deferens
Dysejaculation post surgery
Bowel obstruction post surgery
In which babies are hydrocoeles more common?
Testes descend late
What are some possible complications of a hydrocoele?
Testicular injury from surgery
Lower extremity oedema
What factors make up nephrotic syndrome?
What can repeated use of sodium chloride cause? And what are some consequences of this?
Reduce renal blood flow so lead to Hyperchloraemic acidosis
GIT mucosal acidosis
What are balanced Crystalloids? What benefits do they have over NaCl?
Lower amounts of sodium and chloride compared to other Crystalloids
Contain K, Ca, Mg, lactate, reduce acidosis
What are risks of using 5% dextrose and 0.18% sodium chloride/4% dextrose?
Hyponatraemia in elderly and children with SIADH
Name an isotonic crystalloid fluid which can be used when prescribing fluids
0.9% sodium chloride
Name a hypotonic crystalloid fluid which can be used when prescribing fluids
0.18% sodium chloride/4% dextrose
5% dextrose (initially isotonic)
Describe a hypertonic crystalloid solution which can be used when prescribing fluids
3% sodium chloride
Which fluid is most useful to give in hypoglycaemia?
25% or 50% glucose
Which fluid is most useful to give in a hypotensive patient?
0.9% sodium chloride
Which fluid is most useful in a hyponatraemic patient?
0.9% sodium chloride
What are some indications for IV fluids?
Pre operative resuscitation: before emergency surgery, elective surgery in patient with sepsis
Replacement of abnormal losses: vomiting, diarrhoea, ileostomy bags
Provision of normal daily requirements if patient is nil by mouth
Post operative resuscitation
What is the constitution of Hartmanns solution?
110 mmol Cl
131 mmol Na
What are risks of giving IV fluids?
Sodium/chloride and water overload
How can you monitor patients receiving IV fluid?
Clinical examination: cap refil, pulse, BP, jvp, skin turgor, auscultate lungs and heart sounds, oedema, urine output
Fluid balance charts
Regular weighing (daily)
Daily U and Es
Give examples of when fluid resuscitation is useful
Blood loss from injury or surgery
Plasma loss from burns, pancreatitis
GI or renal losses of salt/water
What is the recommendation for IV fluid for resuscitation purposes?
500ml of balanced crystalloid stat (less than 15 mins)
250ml if cardiac failure
What are the principles of fluid replacement?
Daily maintenance requirements
Plus like for like water and electrolyte replacement for any losses
What are the aims of fluid maintenance?
Restore insensible loss 500-1000ml
Provide sufficient water and electrolytes to maintain normal status of body fluid compartments
Sufficient water to enable kidney to excrete waste products 500-1500ml
What signs on clinical examination would make you think that a patient needs some IV fluid?
Systolic blood pressure less than 100
Heart rate more than 90
Cap refil more than 2 secs or peripheries cold to touch
Resp rate more than 20
News score 5 or more
How much glucose should be given in IV fluids for maintenance?
50-100g per day
In which patients might you consider prescribing less IV fluid for maintenance?
Malnourished with risk of refeeding syndrome
In which patients should you seek expert help for their fluid prescription?
Hyponatraemia or hypernatraemia
Renal, liver and/or cardiac impairment
Post operative fluid retention and redistribution
Malnourished and refeeding issues
Why can resuscitation with crystalloid solution lead to pulmonary oedema?
Dilutes plasma proteins so reduces plasma oncotic pressure
How do you calculate a patients ideal body weight from their height?
Male: (Height in cm - 154) X 0.9) + 50
Female: same equation but + 45.5 instead of 50
What fluid should be given to someone with acute hyponatraemia and neurological symptoms?
Bolus doses of hypertonic saline (1.8%)
Assess clinical response
A 55 year old male presents with a left testicular swelling. On examination he has a large left testis of approximately 30 ml in volume. The mass is smooth, tender, fluctuant and transilluminates. What is the likely cause?
A 32 year old male presents after recently noting a lump in the testis. On examination there is a non tender 2cm solid nodule within the testis. What is the likely diagnosis?
Seminoma (troops and sergeants: troops are 18-25, sergeants are usually 30 plus)
A 40 year old male presents with a lump in the shaft of his penis. On examination there is a non tender, fibrotic nodule in the left lateral half of the penis of 1.5cm diameter. What is the likely diagnosis? What is it associated with?
Peyronie's disease - fibrotic process in the tunica albuginea
Associated with penile curvature and pain
Can be associated with dupuytrens contracture
Why can a ruptured AAA mimic Ureteric colic?
Pooling of blood from the aorta into the retroperitoneum
What are risk factors for testicular torsion?
Age under 25
Bell clapper deformity
Intermittent testicular pain
How do you calculate corrected calcium?
Serum calcium + 0.8 X (4- serum albumin)
What is prehns sign?
Negative Prehn's sign: no pain relief with lifting affected testicle, testicular torsion which is a surgical emergency
Positive Prehn's sign: pain relief with lifting affected testicle, which points towards epididymitis
Why is a scrotal biopsy not a good idea for a patient with a suspected testicular tumour?
Tunica albugenia is a natural barrier to local mets so should not be compromised
Lymph drainage of scrotal skin is different to testicle so don't want to risk spreading it
What are risk factors for testicular cancer?
FH of testicular cancer
Personal hx of testicular cancer
Low sperm count
Genetic abnormality of chromosome 12
What investigations might you order in a suspected testicular tumour?
USS with Doppler
CT abdo pelvis
Serum beta hCG >0.7
Serum alpha fetoprotein >25
Serum LDH >25
CXR - mets
During what week of development does the processus vaginalis form?
How long is the inguinal canal in adults?
What are the boundaries of the inguinal canal?
Posterior wall: transversalis fascia lateral, conjoint tendon medial
Anterior wall: internal oblique lateral, aponeurosis of external oblique
Roof: internal oblique and transversus abdominis muscles
Floor: inguinal ligament and lacunar ligament medially
What are the boundaries of hesselbachs triangle?
Lateral: inferior epigastric artery
Medial: rectus abdominis muscle
Inferior: inguinal ligament
What are contents of the inguinal canal in males and females?
Male: spermatic cord, ilioinguinal nerve
Female: round ligament of uterus, ilioinguinal nerve, genital branch of genitofemoral nerve
What is the contents of the spermatic cord?
3 fascia: external spermatic fascia, cremasteric muscle and fascia, internal spermatic fascia
3 arteries: testicular, vas deferens, cremasteric
3 nerves: sympathetics, ilioinguinal, genital branch of genitofemoral nerve
3 structures: vas deferens, pampiniform plexus, processus vaginus
What is the femoral sheath?
Extension of transversalis and iliopsoas fascia
Encloses proximal parts of femoral vessels
3-4cm inferior to inguinal ligament
What are the borders of the femoral canal?
Anterior: inguinal ligament
Posterior: pectineal ligament
Medial: lacunar ligament
Lateral: femoral vein
What is cloquets node?
Lymph node in inguinal region
Part of deep inguinal node group
Describe pathway of sperm from seminiferous tubule to ductus deferens
Seminiferous tubule to straight tubule to rete testis to efferent ductules to caput epididymis to corpus epididymis to cauda epididymis to ductus deferens
What is the epididymis?
Posterior border of testis
Composed of 3 parts: head, body and tail
Allows space for storage and maturation of sperm
What is the blood supply to the testes? Describe their path
Testicular arteries which arise from abdominal aorta just inferior to renal arteries
Travel retroperitoneally, cross over ureters and external iliacs to pass through deep inguinal ring
Describe venous drainage of the testes
Network of 8-12 veins called pampiniform plexus
Veins converge superiorly forming a testicular vein at deep inguinal ring
Right enters IVC, left drains into left renal vein
Where does lymph drain to from the testes?
Pre aortic nodes
Give some ddx for inguinal swelling
Femoral artery aneurysm
Give some ddx for scrotal swelling
What questions are important in the assessment of a scrotal lump?
When first noticed
Is it changing
Is it lump reducible
What symptoms are present: Pain, Systemic symptoms, GI/GU disturbances
How was it noticed: Precipitating activity, Recent illness
What are important parts of an examination of a scrotal lump?
Position shape and size
Relations to the surrounding structures
Regional lymph nodes
Hernia test: Standing and lying, Getting above it, Cough impulse, Reducibility and control
Associated structures: Testes, Lymph nodes
Special test: Trans illumination
What investigations can be performed for a scrotal lump?
Ultrasound: for early hernias not so reliable
Doppler/duplex: useful for testes/vascular assessment
What can be causes of inguinal lymphadenopathy?
Secondary: Malignant, Benign
Physiolgical response to infection
What would do to manage a patient with inguinal lymphadenopathy?
Exclude inflamatory cause: Abx/observe
Exclude malignancy: Biopsy, FNAC/Open
What are some causes of a saphenous varix?
What examination feature would make it clear that the patient has a saphenous varix?
Disappears on lying flat
What should be done to diagnose a saphenous varix?
What is the treatment for a saphenous varix?
What are differences between true and false femoral artery aneurysms?
True: Pulsatile, Associated with other aneurysmal diseases –AAA, popliteal
False: Secondary to punctures
What is used to diagnose a femoral artery aneurysm?
What can be done to treat a true and false femoral artery aneurysm?
True: repair if indicated, >2/3 cm
False: surgical excision/repair
What is cryptorchidism?
Absence of one or both testes from the scrotum
What are problems with cryptorchidism?
By what age should both testes be descended?
What would you do to investigate a patient who you suspect has a testicular tumour?
CT chest abdo pelvis
What are the different classifications of hydrocoele?
Vaginal: confined to scrotum (distends tunica vaginalis)
Congenital: communicating with peritoneal cavity
Infantile: extending upwards to internal ring
Hydrocele of the cord: confined to the cord
What can causes of a hydrocoele?
Reactive: tumour, infection, trauma
What investigations and management should be done for a hydrocoele?
Aspiration not helpful
What is a varicocoele?
Dilation of pampiniform plexuses of veins
On which side is a varicocoele most likely to occur?
What is a potential long term consequence of a varicocoele?
How does a varicocoele usually present?
Bag of worms
May reduce on lying down
What investigations and management should be done for a varicocoele?
USS: Exclude sinister cause
Ligation at deep ring
What can cause epididymo orchitis?
E coli (most common)
What time frame do you have to save a testicle which has undergone torsion?
After 12 hours, the testis cannot be salvaged
What is the treatment for testicular torsion?
What is a hernia?
Protrusion of an organ or part of anorgan through a defect in wall of the cavity normally containing it
What are the different clinical classifications of hernias?
Reducible: hernia can be easily manipulated back into place
Irreducible or incarcerated: this cannot usually be reduced manually, adhesions form in hernia sac
Obstructed: With features of bowel obstruction
Strangulated: compromise to blood supply of involved bowel
What does inguinal hernia repair aim to achieve?
Strengthen posterior inguinal wall with mesh
Where anatomically are you likely to find a femoral hernia?
Neck of the sac is below and lateral the pubic tubercle
What is a femoral hernia most likely to contain?
Name 3 complications of mesh hernia repair
A 45-year-old man had developed a direct inguinal hernia several months after having an emergency appendectomy. The examining doctor linked the cause of hernia to accidental nerve injury that happened during appendectomy and weakened the falx inguinalis. Which nerve had been injured?
A 40 years old gentle man presents with painless lump in his scrotum and weight loss. Clinical examination reveals enlarged hard non tender right hemiscrotum. Inguinal lymph nodes were
not enlarged. No cough impulse could be demonstrated. Most likley diagnosis
A patient with a suspected seminoma has non palpable inguinal lymph nodes. This patient is unlikely to have metastatic disease, true or false? And why?
Intraabdominal origin, testis have lymph drainage to the lumbar lymph nodes. Thus, infection of the epididymis or testicular carcinoma does not typically cause enlarged inguinal lymph nodes
What structures are at risk during a femoral hernia repair ?
Accessory obturator artery
What are management steps for testicular torsion?
Analgesia and reassure
Organize theatre to explore his scrotum
What measurements are required for diagnosis of CKD?
EGFR x2 and albumin creatinine ratio
What is the management for CKD?
ACE if proteinuria
What is Peyronie's disease?
Fibrosis in plantar fascia and penis
Why does the pain of a ruptured AAA mimic that of ureteric colic?
Pooling of blood from aorta into retroperitoneum
Give 3 drugs which may have to be stopped in AKI due to increased toxicity, but don't usually worsen the AKI themselves
Give 3 drugs which should be stopped in AKI as they may worsen renal function
What are treatments for hyperkalaemia?
IV sodium gluconate
Insulin dextrose infusion
What are normal maintenance requirements for fluids and electrolytes?
Water: 25-30 ml/kg/day
Sodium, potassium and chloride: up to 1 mmol/kg/day
Glucose: 50-100 g/day
What are signs and symptoms of salt and water retention?
Pink frothy sputum
What are signs and symptoms of salt and water depletion?
Skin tugor down
Postural BP drop
What are causes of hyperkalaemia?
Excess intake: IV or oral, dietary
Excess production: haemolysis, rhabdomyloysis, tumour lysis, crush injury, burns
Redistribution: acidosis, insulin deficiency, b blockers, digoxin
Diminished excretion: AKI, CKD, Addison's, Renal tubular acidosis, NSAIDs, cyclosporine, ACEi, ARB, spironolactone
What are the clinical manifestations of hyperkalaemia?
Cardiac arrhythmia and arrest
Ascending muscle weakness
How do you manage hyperkalaemia?
Calcium gluconate, insulin and dextrose, salbutamol nebs, sodium bicarbonate, calcium resonium, haemodialysis
What are causes for hypokalaemia?
Gastro losses: vomiting, diarrhoea, draining tubes, laxatives
Urinary losses: diuretics, conns, hypomagnesaemia
Increased translocation into cells: beta agonists, insulin excess, alkalosis
Increased sweat loss
What are clinical manifestations of hypokalaemia?
Severe muscle weakness
Cardiac arrhythmia and ECG abnormalities
What ECG changes are present in hypokalaemia?
Small or absent t waves
Prominent u waves
First or second degree AV block
Slight st depression
QT prolongation, can induce torsades and VF
What is the treatment for hypokalaemia?
Supplemental potassium at a rate of no more than 20 mmol per hour and monitor cardiac rhythm
What are causes of hyponatraemia?
Isotonic: hyperproteinaemia, hyperlipidaemia
Hypotonic hypovolaemic: dehydration, diarrhoea, vomiting, diuretics, ACEi, nephropathy, mineralocorticoid deficiency
Hypotonic euvolaemic: SIADH, post op, hypothyroidism, psychogenic polydipsia
Hypervolaemic: congestive heart failure, liver disease
What is acute hyponatraemia?
Drop in sodium more than 10 mmol/L in 24 hrs
What are symptoms of hyponatraemia?
Nausea and vomiting
Cardio respiratory distress
How do you manage severe symptoms of hyponatraemia?
3% normal saline, restrict fluids if hypervolaemic
Monitor sodium levels every 4 hours
Aim for maximum increase 8 mmol/24 hrs and 8 mmol next 24 hrs
Stop infusion if sodium 130 or more than 8mmol increase
What is central pontine myelinolysis?
Rapid correction of hyponatraemia
Leads to coma and paralysis
What are causes of hypernatraemia?
Loss of thirst mechanism
Hyperglycaemic hyperosmolar non ketotic coma
What investigations should be done for hypernatraemia?
If DI suspected: desmopressin test
What is the treatment for diabetes insipidus?
Replace fluid - 0.45% saline 5% dextrose
What is a normal anion gap?
How do you calculate anion gap?
Sodium - (chloride and bicarbonate)
What are some causes of a raised anion gap?
What causes of metabolic acidosis would result in a normal anion gap?
Renal tubular acidosis
What is management for severe metabolic acidosis?
Check glucose for DKA
Measure creatinine and urine output
Oral sodium bicarbonate/IV
Low gcs/encephalopathy - dialysis
What are some respiratory causes for respiratory acidosis?
Obstructive sleep apnea
Respiratory muscle weakness - Guillain barre, chest wall abnormality
What are some causes of metabolic alkalosis?
Excess alkali ingestion
What is the AKIN criteria for AKI?
Stage 1: creatinine raised 1.5-2x, urine
What are potential complications of AKI?
What are the principles of managing AKI?
Look for and treat cause
Fluid balance assessment
Daily U and Es
Nephrology specialist input
What are some systemic causes of haematuria?
Sub-acute bacterial endocarditis
What are some renal causes of haematuria?
What are some Ureteric causes of haematuria?
What are some bladder causes of haematuria?
What are some outflow tract causes for haematuria?
What investigations might you do for haematuria?
Urine dip and microscopy culture and sensitivity
FBC, U and Es, coag studies
What cell type does a renal cell carcinoma originate from?
Proximal renal tubular epithelium
What factors increase the risk of renal cell carcinoma?
Middle aged man
Von Hippel Lindau syndrome
What are symptoms of a renal cell carcinoma?
What are risk factors for bladder cancer?
Chronic bladder inflammation
Transitional cell: Exposure to aniline dyes in printing and textile industry, Rubber manufacture, Cyclophosphamide
Squamous cell: Schistosomiasis,BCG treatment
What are symptoms of bladder cancer?
Presence of risk factors
What stage is a bladder tumour if it has invaded into the muscle?
At least 2
What can cause acute urinary retention in a man?
Penile constricting bands
Bladder calculi, Bladder cancer, Faecal impaction, GI/ retroperitoneal Ca, Urethral strictures, Foreign bodies, Stones
What can cause acute urinary retention in a woman?
Prolapse (cystocele, rectocele, uterine)
Pelvic mass (gynaecological malignancy, uterine fibroid, ovarian cyst)
Retroverted gravid uterus
Bladder calculi, Bladder cancer, Faecal impaction, GI/ retroperitoneal Ca, Urethral strictures, Foreign bodies, Stones
What drugs can cause acute urinary retention?
Opioids and anaesethetics
Alpha adrenoceptor agonists
Calcium channel antagonist
What drugs can lead to chronic urinary retention?
What factors increase the risk of prostate cancer?
Family history: around 5-10% of cases have a strong family history
What can be symptoms of prostate cancer?
Bladder outlet obstruction
Pain: back, perineal, testiular
DRE: asymmetrical hard nodular enlargement and loss of median sulcus
What investigations can be done for prostate cancer?
PSA (normal in 30% of cancers)
What are treatment options for prostate cancer?
What is IgA nephropathy?
Commonest cause of glomerulonephritits worldwide
Mesangial deposition of IgA complexes
How might IgA nephropathy present?
Recurrent macroscopic haematuria
Associated mucosal infection: URTI
What is trousseau's sign?
Hypocalcaemia, carpal spasm occurs after inflating a blood pressure cuff above systolic pressure
What is chvosteks sign?
Spasm of facial muscles following tapping over facial never seen in hypocalcaemia
What is L'Hermitte's sign?
Multiple sclerosis, lesion of dorsal columns of spinal cord at cervical level
On flexing neck, shooting sensation down spine