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Urology/Renal Flashcards

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1
Q

Prostate cancer associated with which genes?

A

BRCA1 and BRCA2

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2
Q

Investigations for prostate cancer?

A

PSA
Multi-parametric MRI - 1st line
Prostate biopsy

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3
Q

Uncomplicated UTI in non-pregnant woman management?

A

Nitrofurantoin (3days)
or
Trimethoprim (3days)

send MSU IF >65Y or haematuria

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4
Q

UTI in pregnant woman management?

A

Nitrofurantoin (7days)

if close to term then amoxicillin or cefalexin

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5
Q

UTI in male management?

A

Nitrofurantoin (7days)

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6
Q

Triad of symptoms of pyelonephritis?

A

Fever
loin pain
Nausea and vomiting

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7
Q

Pyelonephritis manegement?

A

Cefalexin (10-14days)

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8
Q

Renal stones investigations?

A

GOLD STANDARD - non-contrast CTKUB

urinalysis - blood +ve
bloods - FBC, U&U, urate, bone profile
x-ray KUB

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9
Q

Renal stones <5mm manegement?

A

conservative

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10
Q

Renal stones 5-10mm, uncomplicated, manegement?

A

medical expulsion therapy e.g. tamsulosin

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11
Q

Renal stones 5-10mm (persistant obstruction) manegement?

A

shock wave lithotripsy
or
ureteroscopy

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12
Q

Renal stones 10-20mm manegement?

A

percutaneous nephrolithotomy

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13
Q

Difference between high and low pressure chronic retention?

A

high - hydronephrosis and abnormal renal function
low - normal kidneys and function

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14
Q

BPH affects which cells?

A

glandular epithelial cells and stromal cells

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15
Q

BPH management?

A
  1. alpha-1 antagonists (e.g. tamsulosin)
  2. 5-alpha-reductaste inhibitors (e.g. finasteride)
  3. combination therapy
  4. surgery - transurethral resection of the prostate
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16
Q

How long does medical management of BPH take to work?

A

6 months

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17
Q

Painless scrotal swelling, soft, fluctuant, transilluminates - what is it?

A

hydrocele

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18
Q

Hydrocele investigation?

A

USS to exclude underlying tumour

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19
Q

Cause of varicocele?

A

veins in pampiniform plexus become swollen - increased resistance in testicular vein

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20
Q

scrotal swelling, painful (throbbing/dull, worse on standing), feels like “a bag of worms”, disappears when lying down - what is it?

A

varicocele

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21
Q

Unilateral, red, swollen testicle + cremasteric reflex preserved + pain relief when testicle lifted (Phren’s sign) - what is it?

A

Epididymo - orchitis

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22
Q

Epididymo - orchitis - risk factors?

A
  • STI related
  • elderly (E.coli from bladder)
  • chronic bladder retention
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23
Q

Inguinal hernia passes through what?

A

into scrotum via external inguinal ring - can be indirect (internal ring) or direct (hasselbach’s triangle)

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24
Q

acute onset unilateral testicular pain, vomiting + abdo pain + firm + swollen testicle + absent cremasteric reflex - what is it?

A

testicular torsion

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25
renal artery stenosis investigation?
MRI with gadolinium contrast or CT angiography
26
investigation for epidiymo-orchitis ?
depends on age: - elderly +low sexual health risk = mid-stream urine for culture - STD risk - NAAT
27
enteric organism epidiymo-orchitis management?
- MSU culture - oral quinolone for 2 weeks e.g. ofloxacin
28
Nephrotic syndrome triad?
proteinuria + hypoalbuminaemia + oedema
29
polycystic kidney disease investigation?
USS
30
hydronephrosis investigations?
USS Intravenous urogram (IVU) CT - if suspect renal colic
31
What features makes a UTI 'complicated'?
Fever
32
Types of bladder cancer?
Transitional cell carcinoma (90%) squamous cell carcinoma (10%)
33
Visible haematuria is ____ until proven otherwise?
bladder cancer
34
Common metastatic sites of bladder cancer?
Lungs Liver Bone
35
Investigations for bladder cancer?
CT urogram flexible cystoscopy
36
Treatment for non-muscle invasive bladder cancer?
Transurethral resection of the bladder tumour (TURBT) +/- chemotherapy +/- immunotherapy
37
Treatment for muscle invasive bladder cancer?
cystectomy or chemotherapy +/- radiotherapy
38
NICE 2 week referral for bladder cancer suspicion criteria?
>/= 45y + painless visible haematuria
39
AKI staging?
Stage 1 - 1-1.9x baseline creatinine stage 2 - 2-2.9x baseline creatinine stage 3 - >3x baseline creatinine
40
Pre-renal causes of AKI?
REDUCED BLOOD FLOW TO KIDNEYS - Fluid loss (blood, sweat, vomit, diarrhoea, reduced intake) - Sepsis - peripheral vasodilation
41
Management of pre-renal AKI?
- Fluid resus - stop hypertensives or any nephrotoxic drugs - Control loss of fluids (e.g. anti-emetics) - monitor urine output - if BP not improving after all that then HDU +/- vasopressors
42
Indications for acute haemodyalasis?
- Hyperkalaemia (>6) - Uraemic pericarditis - Acidaemia - Pulmonary oedema
43
Causes of post-renal AKI?
Obstruction anywhere past the kidneys i.e. ureter, bladder or urethra Prostate enlargement Stones External pressures e.g. tumours (less likely but gynae malignancy)
44
Investigation for AKI?
USS for all AKI's U&E's creatinine
45
Renal causes of AKI?
Glomerulnephritis vasculitis acute intestinal nephritis
46
What is nephritic syndrome?
- acute decline in kidney function (AKI) - oliguria - oedema caused by fluid retention - hypertension - 'active' urinary sediment = +ve urinalysis - most commonly blood ++
47
What is nephrotic syndrome?
- proteinuria - 3g/day - hypoalbuminaemia (<30) - oedema - hypercholesteraemia - usually normal renal function
48
Asymptomatic bacteria in catheterised patient management?
No treatment
49
Management of testicular torsion?
Urgent bilateral orchidopexy - both to prevent other testes from torsion
50
Which criteria have to be met to diagnose AKI?
- rise in serum creatinine of >/=26 micromol/litre within 48 hours - >/=50% rise in serum creatinine known or presumed to have occurred within the past 7 days - a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
51
Which medications should be stopped in AKI?
NSAIDs and ACE inhibitors (as they reduce the filtration pressure)
52
Symptoms / signs of chronic kidney disease?
- itching - loss of appetite - nausea - oedema - muscle cramps - peripheral neuropathy - pallor - hypertension
53
Investigations for chronic kidney disease?
- eGFR (2 tests 3 months apart to confirm) - urine albumin:creatinine ratio (>/= 3mg/mmol) - haematuria - renal ultrasound
54
When would you refer to a specialist for chronic kidney disease?
- eGFR < 30 - ACR ≥ 70 mg/mmol - Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year - Uncontrolled hypertension despite ≥ 4 antihypertensives
55
First line antihypertensive for CKD?
ACE inhibitors
56
Why do some patients get anaemic with CKD?
damaged kidney cells in CKS cause a drop in erythopoietin (hormone responsible for stimulating the production of red blood cells) which results in drop in red blood cells and subsequent anaemia.
57
What are the stages of CKD?
stage 1 - eGFR >90ml/min (signs of kidney damage on other tests) stage 2 - 60-90 eGFR stage 3 - 45-59 ml/min eGFR stage 3b - 30-44ml/min eGFR stage 4 - 15-29ml/min eGFR stage 5 - <15ml/min eGFR
58
Features of nephritis syndrome?
- haematuria - oliguria - proteinuria - fluid retention
59
Features of nephrotic syndrome?
- peripheral oedema - proteinuria (frothy urine) - serum albumin <25g/L - hypercholesterolaemia
60
Most common cause of nephrotic syndrome in kids?
Minimal change disease
61
Most common cause of nephrotic syndrome in adults?
focal segmental glomerulosclerosis.
62
Nephrotic syndrome + histology showing "IgA deposits and glomerular mesangial proliferation"?
IgA nephropathy
63
Clinical features of IgA nephropathy?
- recurrant episodes of macroscopic haematuria - follows URTI
64
Triad of findings for HUS?
AKI thrombocytopenia normocytic anaemia
65
UTI in woman >65y management?
3 days nitrofurantuin + MSU
66
Diagnostic investigation in nephrotic syndrome?
Renal biopsy
67
Most common type of renal stone?
calcium oxalate
68
'ground glass' renal stone?
cystine stone
69
Why can AKI cause hyperkalaemia?
when kidney function starts falling - they are unable to excrete K+ - this can lead to build up in the blood and leads to hyperkalaemia.
70
RCC - tumour <7cm + confined to kidney management?
partial nephrectomy
71
RCC- tumour >7cm + not confined to kidney (e.g. invading renal capsule) - management?
total nephrectomy
72
upper renal obstruction causing hydronephrosis - management?
nephrostomy
73
complications of nephrotic syndrome?
- increased risk of thromboembolism e.g. DVT, PE, renal vein thrombosis - hyperlipidaemia - increasing risk of acute coronary syndrome, stroke etc - chronic kidney disease - increased risk of infection
74
Management of anaemia due to CKD?
1. check iron stores + correct deficiency (aim for 110-120 levels) - if oral doesn't work in 3 months then IV iron. 2. Then if patient will benefit - Erythropoietin (EPO) administration

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