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urology and nephrology > urology and nephrology > Flashcards

urology and nephrology Flashcards

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1
Q

what is the typical presentation for glomerulonephritis?

A

Child/young adult, immunocompromised, abdominal pain, haematuria, proteinuria and oedema.

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2
Q

What are the investigations for glomerulonephritis?

A

Urinalyis - haematuria, proteinuria, leukocytosis

USS of kidneys - reduced/normal

EGFR-normal/reduced

FBC-anaemia

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3
Q

What is the Mx for glomerulonephritis?

A

Manage BP, hyperlipidemia and proteinuria.

Reduced salt intake
ACE inhibitor Ramipril
Angiotensin Losartan
Abx Amoxicillin

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4
Q

What are the RF for prostate carcinoma?

A

Older
African American
Family Hx

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5
Q

Investigations and examination for prostate carcinoma?

A

PSA >4

DRE - painless prostate, asymmetric in shape

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6
Q

Causes of increased PSA?

A

Prostate carcinoma
BPH
UTI
Prostatitis

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7
Q

What is cryptorchidism?

A

Cryptorchidism is the failure of the testicle to descend into the scrotum.

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8
Q

What is the Mx for prostate carcinoma?

A

2ww referral

options:
watchful waiting (no treatment, regular tests)

active surveillance (regular tests)

Radical prostatectomy (for T1-T3 tumours)

Radiotherapy (For T1-T3 tumours

Hormone therapy (for metastatic disease)

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9
Q

What has raised creatinine kinase?

A

It is an enzyme found in muscles, increased amounts are raised into blood if there is muscle damage.

Rhabdomyolysis
Renal injury

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10
Q

What is paraphimosis and causes of it?

A

Paraphimosis is unable to return retraction of foreskin. Can be caused by catherisation, during surgery.

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11
Q

What is phimosis and cause of it?

A

Unable to retract foreskin, can be congenital cause.

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12
Q

What is Mx of phimosis?

A

If <2 yrs just reassurance

If >2yrs give topical corticosteroid to loosen foreskin

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13
Q

What is Mx of paraphimosis?

A

Manual fixing

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14
Q

What is acute kidney injury?

A

Decline in renal function, leading to rise in serum creatinine and fall in urine output. Occurs within 24 hours

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15
Q

How is AKI classified?

A

Pre-renal - reduced renal perfusion e.g. hypovolaemia, sepsis
Intrinsic - e.g. glomerulonephritis,
Post renal - mechanical obstruction to urinary outflow e.g. strictures, stones, urinary retention

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16
Q

What is investigations for AKI?

A

Serum creatinine raised
Hyperkalaemia
Urinalysis - leucocytes, nitres for infection, glucose for diabetes

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17
Q

What is Mx of AKI?

A

Fluid rehydration in pre-renal AKI

Stop nephrotoxic medications e.g NSAIDS, ACE inhibitors

Sodium bicarbonate for metabolic acidosis (kidney injury causes imbalance of acids in body and kidneys unable to remove acid, bicarbonate replaces low carbonate)

Relieve obstruction in post renal AKI e.g catheter

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18
Q

Examples of nephrotoxic drugs?

A

NSAIDS e.g naproxen, ibuprofen
ACE inhibitors e.g. ramipril, lisinopril
Aminoglycosides (Abx) e.g vancomycin

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19
Q

What are the Risk factors for bladder carcinoma?

A 
Tobacco exposure
Old Age
Males
Chronic cystitis
Chemical carcinogens
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20
Q

What does bladder carcinoma present?

A

Presents with frank haematuria (macroscopic), painless

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21
Q

What is the Mx for bladder carcinoma?

A

2ww referral - if >45, unexplained visible haematuria

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22
Q

What is CKD?

A

Decline in renal function and structural damage present for >3months

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23
Q

What is the investigations for CKD?

A

Urinalysis - proteinuria, haematuria

Hx of symptoms > 3months

eGFR - reduced (less than 60 mL/minute/1.73 m²)

Renal USS

Serum creatinine - raised

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24
Q

What are the most common causes of CKD?

A

DM (most common), hypertension, pyelonephritis, glomerulonephritis

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25
What are the RF for CKD?
Smoking DM Old age Hypertension
26
Mx for CKD?
Slow progression of disease - optimise blood pressure - optimise diabetic control Reduce risk of complications - exercise, healthy weight, smoking cessation - atorvastatin for prevention of cardiovascular disease Treat complication - Oral sodium bicarbonate to treat metabolic acidosis - Iron supplementation and erythropoietin to treat anaemia - Dialysis in end stage renal failure - Renal transplant in end stage renal failure
27
Complications of CKD?
CVD disease Anaemia Peripheral neuropathy - damage to peripheral nerves e.g. hands, feet and arms
28
What is serum urea and causes of increased urea?
Urea is produced from breakdown of amino acids in liver, excreted by kidneys Increased - increased protein breakdown (trauma, infection, trauma), high protein intake, dehydration, GI bleed Serum creatinine and serum urea both increased - renal failure
29
What is the cause of testicular carcinoma and main type?
Genetic cause, teratoma (tumour made up of several different type of tissues)
30
Tumour marker raised in testicular carcinoma?
AFP elevated
31
Characteristic symptoms for testicular carcinoma?
Painless testicular lump
32
Mx for testicular carcinoma?
2ww referral- unexplained symptoms, tender less lump on testicle Radical orchiectomy
33
What is the most common type of renal calculi?
Calcium oxalate
34
What are the RF for uro/nephrolithiasis?
Men Dehydration High salt diet
35
What is characteristic symptom of for nephrothialisis?
Flank pain radiating to groin, dysuria, fever
36
Mx for nephro/urolithiasis
Need hospital admission - NSAIDS e.g. diclofenac - Antiemetics e.g. ondansetron - Alpha blocker e.g. tamsulosin
37
What is the action of alpha blockers and treatments for what?
Vasodilation - used as add on treatment to hypertension Relax prostate and bladder to allow urine to flow - used for BPH (1st line)
38
Which site is more common for prostate carcinoma to occur transitional or peripheral zone? Which region is hyperplasia more likely to occur in BPH?
Transitional zone makes up most of prostate, more prostate carcinomas are located
39
Role of prostate?
Secretes prostatic fluid, component of seminal fluid
40
Symptoms and signs presented in BPH?
Storage symptoms - blader should be storing urine (frequency, urgency, nocturia and incontinence) Voiding - bladder outlet obstruction do difficult to urinate (weak stream, dribbling, incontinence, straining)
41
Mx for BPH?
Alpha blockers - tamsulosin 5-alpha-reductase inhibitors (shrinks prostate gland) - Finasteride Transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate
42
Differentiate between Prostate cancer, prostatitis and BPH (DRE)?
Enlarged prostate on DRE - prostatitis Asymmetry on DRE - prostate cancer Smooth symmetrical enlarged prostate - BPH
43
What is nephrotic syndrome?
Condition characterised by proteinuria, oedema and hypoalbuminaemia
44
What is Px of nephrotic syndrome?
Nephrotic syndrome occurs when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.
45
Most common type of nephrotic syndrome?
Minimal change disease is seen mostly in children
46
What are these symptoms associated with: proteinuria, hypoalbuminaemia, deranged lipid profile, hypertension and hyper-coagulability and oedema?
Nephrotic syndrome
47
Classification of nephrotic syndrome?
Primary - problem in kidneys e.g. glomerulonephritis | Secondary - problem other than kidney e.g. HIV, malignancy
48
Mx of nephrotic syndrome?
Fluid and salt restriction Diuretic e.g. furosemide Treat complications e.g. statin for lipid control
49
What is hydrocele?
Hydrocele is painless accumulation of fluid in sac around testes
50
What is varicocele?
Enlargement of testes from abnormal dilation of spermatic veins
51
What is negative cremasteric reflex?
Stroking of inner thigh does not cause upward movement of testicles (testicular torsion)
52
What is found on examination of varicocele?
Feeling of bag of warms, negative transillumination
53
What is found on examination of hydrocele?
Transillumination with light
54
What is Phregn's test?
Alleviation of testes relieves pain in epididymitis Alleviation of testes does not relieve pain testicular torsion
55
What is testicular torsion and who is commonly affected?
Twisting of testicles around spermatic cord and affects teenagers.
56
Mx of testicular torsion
Surgical exploration to correct twisting
57
What condition is associated with flank pain, that radiates from loin to groin?
Renal calculi
58
Which class of medications should be suspended from someone with AKI?
ACE inhibitors
59
What causes decreased creatinine kinase?
Alcoholic liver disease are considered to reflect the reduced muscle mass
60
What are the 3 types of incontinence?
Overflow incontinence (unable to fully empty bladder, causing you to leak) - associated with men with BPH Urge incontinence (urine leaks as you feel sudden urge to pee)- associated with DM, infection, obesity, detrusor overactivity, caffeine Stress incontinence (loss of urine associated with rise in intrabdominal pressure) - coughing, sneezing, pregnancy, childbirth
61
What can painless haematuria indicate?
Bladder cancer
62
What is the most common type of bladder cancer in the UK?
Transitional cell carcinoma can be caused by smoking
63
Triad of oedema, hypoalbuminaemia and proteinuria, what condition is this associated with?
Minimal change disease in children (form of nephrotic syndrome). - Oedema can cause puffy face - proteinuria on urinalysis - Fluid protein decreased
64
Differences between nephrotic syndrome vs glomerulonephritis?
Nephrotic syndrome - proteinuria, hypalbuminaemia, hypovolaemia - causes are glomerular damage, idiopathic - s/s weight gain, puffy face, fatigue, oedema, glomerulonephritis - proteinuria, haematuria - causes strep infection/primary cause - s/s dark urine, edema
65
What is priapism and the management for it?
Prolonged and painful erection lasting greater than 2 hours after sex. Manage by aspiration of the blood within corpus cavernosa and irrigation with normal saline.
66
What is a cause of priapism?
Sildenafil (viagra)
67
What is the Mx for stress incontinence?
- 1st line General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks - 1st line Pelvic floor exercises - 2nd line Medication Duloxetine
68
What is the Mx for urge incontinence?
- 1st line General lifestyle advice such as avoiding caffeine, fizzy and sugary drinks - 1st line Pelvic floor exercises - 2nd line anticholinergic medication Oxybutynin

urology and nephrology (1 decks)

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