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Y3 Charis > Urology - symptoms + signs > Flashcards

Urology - symptoms + signs Flashcards

1
Q

Reasons for raised PSA

A 
BPH
Prostatitis
Prostate cancer
Urinary retention
UTI
DRE
Catheterisation/Instrumentation
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2
Q

Symptoms of AKI

A
  • Nitrogenous waste build up
    Fatigue
    Drowsiness
    Confusion
  • Extracellular volume not properly regulated
    SOB
    Leg swelling
    Poor urine output
  • Electrolyte imbalance (e.g. hyperkalaemia)
    Chest pain
    Muscle pain
- Systemic features
   Rash (maculopapular)
   Myalgia
   Arthralgia
   Headaches
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3
Q

Signs of AKI

A
  • Peripheral stigmata
    Tachypnoeic
    Tachycardic
    Raised JVP
  • Bibasal creps
  • Ascites
  • Bilateral pitting oedema
  • Oliguria
    This is because of salt + water retention
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4
Q

Clinical features of CKD

A

Pt only gets symptoms when eGFR falls to very low levels (i.e. <30 ml/min/CKD 4/5)

  • Fatigue
  • Malaise
  • Thirst
  • Anorexia
  • Nausea
  • Itching
  • Uraemic skin (lemon yellow, bruises)
  • HTN
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5
Q

Symptoms of urolithiasis

A
  • Loin to groin pain
  • N+V
  • Urinary frequency/urgency
  • Haematuria
  • Testicular pain
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6
Q

Signs of obstruction

A
  • Passing less urine than usual
  • Large kidneys on scans
  • Increased creatinine
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7
Q

Intrarenal/perinephric abscess signs + symptoms

A
  • Persistently high fever
  • Bacteraemia (+ve blood cultures)
  • High WCC
  • Severe tenderness on examination
  • Failure to improve after appropriate therapy
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8
Q

Renal vein thrombosis likely cause + presentation + treatment

A

Nephrotic syndrome - pt will be in a hypercoaguable state due to loss of antithrombin III in urine

Presentation

  1. Loin pain
  2. Haematuria
  3. Palpable kidney
  4. Sudden deterioration in kidney function
Treatment Dalteparin (LMWH)
Following this, warfarin should be given for at least 3 months
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9
Q

Signs of CKD

A
  • Small scarred kidneys
  • Anaemia
  • Metabolic acidosis
  • Hypocalcaemia
  • Hyperphosphataemia
On examination
- Conjuctival pallor 
-EPO produced by the kidney
- Raised JVP 
- ESRF pt are overloaded
- Oedema 
- nephrotic syndrome 
- Crepitations on auscultation 
- Diabetic retinopathy 
- microaneurysms, cotton wool spots(suggestive of retinal ischaemia)
2o hyperparathyroidism 
- Low to normal [Ca], high PTHlow plasma [Ca] due to e.g. renal failure, vitamin D deficiency stimulates release of PTH to try to normalise serum calcium
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10
Q

Features of the nephrotic syndrome (8)

A
  • Heavy proteinuria (>3.5g/24h)
  • Hypoalbuminaemia (serum albumin <30g/L) - leukonychia
  • Oedema - ascites
  • Dyslipidaemia (due to hypoalbuminaemia liver tries to compensate by increasing production of lipids)
  • Prone to thromboebolic disease e.g. DVT, PE, MI
  • Deteriorating renal function
  • Immunological disorders
  • Increased risk of infections (loss of complement and IgA in urine)
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11
Q

Features of nephritic syndrome (7)

A

Triad

  • Haematuria
  • HTN
  • Oedema
  • Oliguria (<400ml/day)
  • Sub-nephrotic range proteinuria
  • Salt + water retention
  • Drop in eGFR
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12
Q

Cause + Symptoms + Signs of tubulointerstitial nephritis

A

Cause: Drug hypersensitivity reactions (e.g. penicillin, NSAIDs)

  • Fever
  • Skin rashes
  • Painful joints
  • Raised oesinophils

Ix: US/CT abdo

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13
Q

Renal tuberculosis onset + signs + symptoms

A
  • Insidious onset
  • STERILE PYURIA
  • Haematuria, increased frequency, nocturia
  • Pain affecting back, flanks, suprapubic region
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14
Q

Triad of symptoms in renal cancer (Von Grawitz tumour)Where does it usually grow

A
  • Haematuria
  • Flank pain
  • Abdominal mass

Usually grows on proximal tubular epithelium

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15
Q

BPH presenting symptoms

A

Storage/irritative* symptoms – FUND HIPS T
FUN storage symptoms, the rest are voiding symptoms
Storage symptoms –> due to detrusor overactivity
Voiding symptoms –> due to bladder outflow obstruction

  • Frequency*
  • Urgency*
  • Urge incontinence*
  • Nocturia*
  • Dysuria
  • Hesitancy
  • Incomplete voiding
  • Poor/intermittent stream
  • Straining
  • Terminal dribbling
  • Overflow incontinence
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16
Q

Signs and symptoms of metastatic prostate cancer

A
  • Bone pain/sciatica
  • Paraplegia/constipation/incontinence 2o to spinal cord compression
  • Lymph node enlargement (ureteric obsruction - loin pain + anuria)
  • Lethargy (anaemia, uraemia)
  • Weight loss, cachexia
  • Paraneoplastic (e.g. hypercalcaemia)

If someone comes in with back pain + not being able to walk one of the first things you do is to examine their prostate

17
Q

Signs of prostate cancer

A

• Enlarged, irregular, bumpy prostate on DRE
o Asymmetry of the gland
o Nodule within one lobe
o Induration of part or all of the prostate
o Lack of mobility – adhesion to surrounding tissue
o Palpable seminal vesicles

  • Raised PSA levels
  • Palpable bladder due to outflow obstruction
  • Advanced disease: general malaise, anorexia, weight loss, bone pain, paralysis due to cord compression, obstructive nephropathy
18
Q

Signs and symptoms of testicular cancer

A

Symptoms
• Hard, painless nodule on one testis
• Haematuria – cancer until proven otherwise
• Back pain from metastasis of seminomas to the para-aortic nodes
• Gynaecomastia from β-hcg production

Signs
• Normal testis – delicate, inflamed testis – tender, malignant testis – lacks normal level of sensation

19
Q

Symptoms of testicular torsion

A

• Acute swelling of the scrotum/testicular pain in a boy indicates torsion of the testis unless proven otherwise
• Acute testicular pain in the absence of fever, penile discharge
• Sudden onset severe hemiscrotal pain
o Often comes on during sport/physical activity
o A history of recurrent attacks of severe pain  intermittent testicular torsion + de-torsion
• Abdominal pain
o Always check testes when a boy presents with abdominal pain
• N+V

20
Q

Signs of testicular torsion

A

• Tender testicle
• Swollen, erythematous scrotum on affected side
o Abdominal pain referred from T10 sympathetic supply (reflects the embryological origin of the tests)
• High riding testis
• Testicle might lie horizontal
• Thickened cord

• Prehn’s sign (helps distinguish between epididymitis + testicular torsion)
o Positive Prehn’s - Elevating the scrotum relieves the pain - epididymitis
o Negative Prehn’s - Elevating the scrotum does not relieve the pain - testicular torsion
• Absent cremasteric reflex

NO fever
NO penile discharge

21
Q

Bladder cancer symptoms

A

• Gross or microscopic painless haematuria

•	Advanced disease may cause storage symptoms – FUND (not hips)
o	Frequency
o	Urgency
o	Nocturia
o	Dysuria

• FLAWS

22
Q

Epididymo-orchitis symptoms + signs

A
  • Scrotal pain + swelling + inflammation of the epididymis +/- inflammation of the testes – develops over the course of a few days (GRADUAL onset)
  • Erythematous, hot
  • Systemic symptoms
  • Fever – suggests infectious cause (in testicular torsion there is no fever)
  • Purulent urethral discharge – suggests STI (in testicular torsion there is no purulent discharge)
  • Frequent + painful micturition – suggests UTI
  • +ve Prehn’s signs
  • Present cremasteric reflex
  • Systemic symptoms

• Mumps – headache, fever, uni/bilateral parotid swelling

23
Q

Testicular cancer symptoms and signs

A
  • Hard, painless nodule on one testis - scrotum feels heavier than usual
  • Haematuria – cancer until proven otherwise
  • Back pain from metastasis of seminomas to the para-aortic nodes
  • Gynaecomastia from β-hcg production

Signs
• Normal testis – delicate, inflamed testis – tender, malignant testis – lacks normal level of sensation

24
Q

Acute pyelonehritis symptoms + signs

A 
Acute Pyelonephritis 
Systemic symptoms
High fever 
Rigors 
Vomiting

Local symptoms
Loin pain and tenderness
Oliguria (if AKI)
Symptoms of UTI, dysuria, haematuria, loin pain

25
Q

PKD polycystic kindey disease symptoms and signs

A

• Palpable kidneys/abdominal mass
• Abdominal/flank pain
o Need to exclude nephrolithiasis, infection, haemorrhage, UTIs, hepatic enlargement

  • Nocturia
  • Haematuria
  • UTIs (dysuria, urgency, suprapubic pain, fever)

• Impaired urine concentrating capacity – excessive water + salt loss

• Renal cysts
o Kidneys progressively enlarge + become distorted with little recognisable parenchyma on imaging studies
o Renal function drops
• Renal stones
o Twice as common as in the general population
o Uric acid stones are more common than calcium oxalate stones

• Hepatomegaly
o Due to polycystic liver disease
• Liver cysts – most common extra-renal manifestation of ADPKD

• Intracranial (berry) aneurysms
o May cause cranial nerve palsies or seizures

• HTN
o Will often present before renal function abnormalities
o Presents at a relatively young age – detection of HTN before any other clinical manifestations is often how disease is first detected in pt 20-34 years of age
o Associated with L ventricular hypertrophy
• Cardiac murmur
o Mitral valve prolapse, MR, AR
• Aortic root dilation
o Can cause aortic insufficiency
• Aortic root aneurysms

• Abdominal wall hernias

Often there is
• Bilateral renal enlargement and cysts
Or
• Presence of multiple bilateral renal cysts + hepatic cysts

26
Q

Renal cell carcinoma RCC symptoms + signs

A

Classic triad

  • Haematuria
  • Loin pain
  • Loin mass
Varicocele - Testicular swelling (blockage of the L gonadal vein which drains into the L renal vein)
Weight loss
Anorexia
Sweating
Fatigue
Fever

Symptoms of metastatic disease(commonly metastasises to the lungs + bones)

  • Haemoptysis
  • Bone pain
  • Pathological fractures

Paraneoplastic syndromes

  • Anaemia
  • Polycythaemia
  • Hypercalcaemia
  • Hepatic dysfunction
  • Amyloidosis
  • Renin - raised BP
27
Q

renal artery stenosis RAS symptoms + signs

A

• HTN
o Renal hypoperfusion - hyperactivation of the renin-angiotensin-aldosterone axis
o Abrupt onset
o Resistant to standard medical therapy
o HTN w hypokalaemia (due to hyperaldosteronism)

  • Hx of other peripheral vascular disease
  • Vascular risk factors – corneal arcus, xanthomata, xanthelasmata, raised BP
  • Abdominal ± carotid or femoral bruits, weak leg pulses
  • Hx of unexplained kidney dysfunction developing in a normotensive/hypertensive pt with vascular disease/risk factors
  • Biochemical evidence of renal impairment occurring during treatment with ACEi or ATII antagonist

• Sudden or unexplained pulmonary oedema
o CCF -May present with “flash pulmonary oedema” – recurrent episodes of acute pulmonary oedema with no obvious precipitant

28
Q

Renal osteodystrophy radiological signs?

A
  • Osteopenia
  • Salt + pepper skull
  • Subperiosteal erosions
  • Brown tumours
  • pseudofractures
  • Rugger jersey spine
29
Q

Minimal change disease

Commonest in
Associated with
histology
light microscopy

A 
Children + young adults
Associated with eczema + asthma
Loss of podocyte foot processes/podocyte fusion
Vacuolation
Appearance of microvilli on histology

Normal light microscopy

30
Q

Focal segmental glomerulosclerosis

Commonest age group
What is it assosciated with
Histology

A

young adults

HIV heroin use

  • Podocyte fusion
  • Segmental scars on histology
31
Q

Signs and symptoms of

Severe chronic uraemia
Uraemic encephalopathy

A

Severe chronic uraemia – yellow skin (lemon yellow, uraemic frost)
Uraemic encephalopathy – clouding of consciousness, acute confessional state, myoclonic jerks, seizure, coma, hiccoughing

32
Q

Goodpasture’s syndrome

A

Haemoptysis
Haematuria
anti-GBM ab
patients tend to be fluid overloaded (nephritic syndorme)
autoimmune - ab are formed against the GBM + alveolar membrane

33
Q

Analgesic nephrotpathy vs acute tubulointerstitial nephritis vs tubular necrosis

A 
Analgesic nephrotpathy 
chronic NSAID use
haematuria
Anaemia 
UTI 
Acute tubulointerstitial nephritis 
drug hypersensitivity reaction
fever
rash
arthralgia
oesinophilia

Acute tubular necrosis
commonly due to renal ischaemia
other causes - drugs, contrast agents, hypovolaemia (diuretics, heart failure)
Early oliguria followed by recovery of renal function and increase in renal output
GFR remains low due to tubular damage
full renal capacity regained within 6 weeks

Acute tubular necrosis – hypovolaemia, nephrotoxic drugs (hyponatraemia, hyperkalaemia)
Patients recover within a few days/week

Acute interstitial nephritis – adverse reaction to a drug
Fever, rash, nausea, vomiting

34
Q

HIV nephropathy symptoms + signs

A

Nephrotic range proteinuria
Large kidneys on US
Collapsing focal segmental glomerulosclerosis on renal biopsy

35
Q

Symptoms of CKD

A

Symptoms of CKD tend to occur once GFR <30

Anorexia
N+V
Pruritus
Fatigue
Muscle cramps
Peripheral oedema
Pulmonary oedema
36
Q

Acute tubular necrosis symptoms + signs

+ cause

A

Most common cause of intrinsic AKI
Results from renal hypoperfusion (e.g. CCF) or nephrotoxic drugs
Oliguria + features of renal failure

features of renal failure
Anorexia
N+V
Pruritus
Fatigue
Muscle cramps
Peripheral oedema
Pulmonary oedema
37
Q

Which 3 small vessel vasculitides cause nephritic syndrome?

A

Granulomatosis with polyangiitis (Wegener’s)
Eosinophilic Granulomatosis with polyangiitis (Churg Strauss)
Microscopic polyangiitis

Y3 Charis (35 decks)

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