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Urology Flashcards

1
Q

What ketones do dipsticks detect

And which one predominates during DKA

A

Acetoacetate

Betahydroxybutyrate predominates during DKA but as ketosis improves acetoacetate increases causing a positive on dipsticks and making the ketosis look like it is worsening

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2
Q

Causes of milky white urine

A

Pyuria
Lipid (cats with hepatic lipidosis)
Crystalluria

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3
Q

Differentiating haematuria, myoglobinuria and haemoglobinuria

A

Check sediment for RBCs

Spin down blood plasma will be pink if haemolysis and clear if myoglobin

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4
Q

What are hyaline casts and why do they form?

A

Pure protein precipitates
Parallel sides and rounded ends
Occur with fever, exercise and renal disease

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5
Q

What are granular casts and why do they form

A

These represent degenerated epithelial cellular casts

Observed with renal tubular disease

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6
Q

What are waxy casts

A

Arise from degeneration of granular casts

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7
Q

Side effects of progestagens in treatment of canine BPH

A

Adrenal atrophy
Cushings
Diabetes
Hypothyroidism

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8
Q

Pyometra is mediated by what hormone

A

Progesterone

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9
Q

Antibiotics for chronic prostatitis

A 
TMPS
Erythromycin
Clindamycin
Chloramphenicol
Flouroquinolones

Not usually anaerobic - gram positives and negatives

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10
Q

Drugs used in medical management of pyometra

A

Prostaglandin F

Dopamine agonists

Progesterone receptor antagonists (aglepristone (Alizin))

Antibiotics

(Prostaglandin and dopamine agonists combined therapy enhances luteolytic effects - progesterone levels fall within 24-48 hours and cervix opens in less than two days - cabergoline and cloprostenol. Resolution of signs in 10-13 days)

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11
Q

Prostaglandin F mode of action and dose

A

Luteolytic
Opens cervix
Promotes myometrial contraction
Natural - dinoprost 3-5x daily for 3-7days
Side effects: v/d/panting
Synthetic - cloprostenol - longer duration and less side effects
Neither licensed

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12
Q

Dopamine agonist

A

Cabergoline

Luteolytic

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13
Q

Progesterone antagonists and mode of action

A

Aglepristone
Opens cervix but doesn’t induce myometrial contractions

Can also combine with prostaglandin

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14
Q

Antiobiotics for pyometra

A

Potentiated amoxicillin
TMPS
Cephalosporins
Continue 10-14 days after resolution of clinical signs

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15
Q

Treatment of Cystic endometrial hyperplasia

A

Gnrh agonists eg deslorelin implant to prolong anoestrous but if implanted in anoestrous will bring bitch into oestrous

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16
Q

Causes of failure to cycle

A

Individual variations (4-12months)
Immaturity, intersex, ovarian aplasia, stress, systemic illness, endocrine dz
Silent heat
Luteal cysts
Senile or immune mediated ovarian failure
Ovarectomy

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17
Q

What to do if bitch fails to show oestrous

A 
Measure progesterone to exclude ovulation 
Vaginal cytology initially then twice weekly
House with other cycling bitches
Gnrh stimulation test
Ultrasonography
Aerial serum progesterone
Exploratory surgery 
Kayotyping if intersex
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18
Q

Treatment of Luteal cyst

A

Surgical removal or prostaglandin

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19
Q

Treatment of normal bitch who is failing to cycle

A

Cabergoline

Deslorelin

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20
Q

Infertility associated with abnormal oestrous cycles

A

Short interoestrous intervals - anovulatory cycles or CEH

Extended interoestrous intervals - ovarian failure, luteal cysts, progesterone secreting ovarian tumours (granulosa cell)
Persistent oestrous - follicular cyst
Vaginitis

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21
Q

Failure to conceive or early pregnancy failure

A 
Physical abnormalities
Miss timing
Endometritis/ CEH
Embryonic defects 
Herpes/brucellosis
Hypoluteodism (progesterone insufficiency)
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22
Q

Clinical signs of cystic ovarian remnants in the bitch

A 
Vaginal bleeding for several weeks
Vulval swelling 
alopecia
Dermal hyperpigmentation
PU/PD
Erythema on ventral abdomen
Mammary gland enlargement
Pollakiuria/strangurua
Poor coat
Weight loss
Recurrent UTIs
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23
Q

Side effects of progestagens in queens for ovarian remnant syndrome

A 
DM
CEH
Pyometra
Mammary adenoma/fibrosarcoma
Bone marrow toxicity
Thyroid dysfunction
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24
Q

Contraindications of medical treatment of pyometra

A

Pyretic or hypothermic patients likely to have peritonitis

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25
When to consider low dose aspirin for PLN
If albumin < 20g/l due to loss of antithrombin
26
Side effects of aluminium hydroxide
Microcytosis and muscle weakness | Neurological issues
27
Treatment of metabolic acidosis in CKD
Stabilise on renal diet Oral potassium citrate or sodium bicarbonate B
28
Causes of acute kidney injury
``` Ischaemia Toxins - lilies/grapes Drugs Infections (pyelonephritis, leptospirosis) Hypercalcaemia Sepsis Acute pancreatitis Renal lymphoma Obstruction ```
29
What will be found on urinalysis in AKI
Isosthenuria Casts Can see: Haematuria Glucosuria May also see bacteruria/pyuria/crystals
30
Routine evaluation of AKI
Bloods Acid base Urinalysis Urine culture
31
Normal kidney size
2-3x L2 in cats | 2.5-3.5 x L2 in dogs
32
What crystals form with ethylene glycol toxicity
Calcium oxalate monohydrate
33
Antidote for antifreeze toxicity
4-methylpyrazole or Ethanol Needs to be given within 8 hours of ingestion Prognosis poor if already azotaemic or oliguric
34
Treatment of NSAID toxicity
Misoprostol for at least 3 days | Synthetic prostaglandin analogue
35
Prognostic factors for dogs in AKI
``` Severe azotaemia (crea >900) Hypocalcaemia Anaemia Anuria If azotaemia doesn’t improve with treatment or wors an Other disorders (sepsis/pancreatitis) ```
36
Prognostic factors for cats with AKI
Hyperkalaemia Low albumin Decreased bicarbonate at presentation (Azotaemia or changes in calcium/phosphate did not predict survival)
37
Infectious causes of acute kidney injury
Primary: Leptospirosis Pyelonephritis Borreliosis (lymes nephritis) ``` Secondary: FIP babesiosis Leishmaniasis Bacterial endocarditis ```
38
When not to use mannitol in AKI
When anuric as this can cause volume overload Works by solute diuresis
39
Why is there increased risk of thromboembolic events with protein losing nephropathy
Loss of antithrombin III | Also changes in vessel walls and blood stasis etc
40
Treatment of metabolic acidosis in ckd (iris stages 1-4)
``` Renal diet (pH neutral) Alkalinising salts (sodium bicarbonate or potassium citrate) ``` Use if bicarb or CO2 is <16mmol/l Assess response by rechecking blood gases after 10-14 days
41
Choice of potassium supplementation in ckd cats
Potassium gluconate or potassium citrate Potassium chloride is acidifying so don’t use this
42
What should be administered alongside darbepoeitin
Iron dextran Can cause anaphylaxis so needs monitored Sometimes one injection is all that is required
43
When to use calcitriol therapy
In dogs with CKD stages three and four. Proven benefit Need to monitor PTH and calcium levels
44
Radiolucent urinary stones
Cysteine Urate Xanthine
45
Fluid of choice in blocked cats
Hartman’s as saline is acidify | Hartman’s potassium level is negligible
46
Prazosin
``` Smooth muscle relaxant (proximal third of urethra) Alpha1 antagonist (so is phenoxybenzamine but prazosin is more effective - quicker and more selective for alpha one) ```
47
Why do medications like steroids and furosemide increase risk of calcium oxalate urolithiasis
Decrease tubular reabsorption of calcium and increase calcitriol
48
Treatment of ureteroliths and nephroliths
Extracorporeal shock wave lithotripsy Surgery (ureteral bypass or nephrectomy) Fluid diuresis and urinary smooth muscle relaxants : amitryptyline, prazosin, phenoxybenzamine, metoclopramide or cisapride
49
What to avoid with calcium oxalate urolithiasis
Glucocorticoids Furosemide Vitamins D and C
50
Urinary acidifiers used for struvite dissolution and side effects
Acetonydroxamic acid (AHA) - inhibits urease ``` Renal excreted so cant use in renal dz Haemolytic anaemia Anorexia Vomiting Hyperbilirbuinaemia Bilirubinaemia Predisposition to calcium oxalate formation ```
51
Allopurinol mechanism of action Side effects Contraindications
Xanthine oxidase inhibitor Formation of xanthine crystals if a low protein diet isn’t fed Haemolytic anaemia Trigeminal neuropathy and Skin eruptions if given with ampicillin CI in renal dz
52
Metastatic potential of TCCs - how many and where to
60% metastasise Lungs and lymph
53
How to reduce sterile haemorrhaging cystitis with cyclophosphamide usage
Give with furosemide
54
Treatment of BPH
Osaterone Deslorelin implant 5-alpha reductase inhibitors (finasteride)
55
Causes of detrusor atony | Treatment
Injury to sacral spinal cord s1-s3 or pelvic nerves Direct damage due to overdistension Bethanecol (for overdistension damage as the pelvic nerve is intact) Metoclopramide, cisapride
56
Lower motor neuron bladder
S1-s3 lesion Easily expressive bladder that may empty with minor increases in abdominal pressure Can use bethanecol
57
What is bethanechol
A parasympathomimetic that affects only muscarinic receptors with no effect on nicotinic
58
Side effects of oestrogen
Myelosuppression Attractiveness to males Mammary/vulvar swelling Behaviour changes
59
Causes of glucosuria without hyperglycaemia
Leptospirosis (acute kidney injury) Primary renal glucosuria Fanconis
60
Causes of acquired fanconis syndrome
``` Dried meat jerky treats Drugs: tetracyclines, cisplatin, aminoglycosides, streptazotocin Copper-associated hepatopathy Pyelonephritis Hypoparathyroidism/vitamin D deficiency ``` Monoclonal gammopathies Neoplasia

Internal Medicine (11 decks)

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