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Flashcards in Week 3 Deck (59):
0

What do diuretics enhance the excretion of?

Salt and water

1

What causes oedema

Imbalance between the rate of formation and apportion of interstitial fluid

3

What is nephrotic syndrome?

Involves the disorder of glomerular filtration allowing protein the the filtrate

4

How do diuretics reduce oedema?

Cause excretion of water so blood is more concentrated, so oncotic pressure increase meaning more fluid travels into the capillaries in the peripheries so reducing the oedema

5

Where do loop diuretics act and what do they block?

The Na/K/2Cl co transporter in the thick ascending loop of henle

6

Where do thiazide diuretics act and what do they block?

Act in distal convoluted tubule and block the Na/Cl co transporter

7

Where do potassium sparing diuretics act and what do they block?

Act in collecting tubule and block Na/K exchange

8

Where do carbonic anhydrase inhibitors work?

Proximal and distal convoluted tubule

9

Which produces a milder diuresis, loop or thiazide?

Thiazide

10

Why do thiazide diuretics predispose you to gout?

Because they compete for transport with uric acid at OAT

11

Name two loop diuretics?

Furosemide and bumetanide

12

How do loop diuretics work?

Inhibit Na/K/Cl carrier by binding to the Cl site

13

5 clinical indications of loop diuretics?

Pulmonary oedema, chronic kidney failure, hepatic cirrhosis, chronic heart failure, nephrotic syndrome

14

5 Adverse effect of loop diuretics?

Hypokalaemia, shift in acid base balance towards alkaline, hypovolaemia, hypotension, depletion of calcium and magnesium, hyperuricaemia

15

Name 2 thiazide diuretics?

Bendroflumethiazide, hydrochlorothiazide

16

How do thiazide diuretics work?

Inhibit Na/Cl carrier by binding to Cl site

17

5 indications of thiazide diuretics?

Mild heart failure, hypertension, severe oedema, renal stones, nephrogenic diabetes insipidus

18

5 adverse effect of thiazides?

Hypokalaemia, metabolic alkalosis, hypovolaemia, hypotension, depletion of Mg, hyperuricaemia, male sexual dysfunction, impaired glucose tolerance

19

How does spironolactone work?

Competes with aldosterone for binding to intracellular receptors

20

Name 2 potassium sparing diuretics?

Amiloride, triamterene

21

4 clinical indications of potassium sparing diuretics?

Heart failure, conns, resistant essential hypertension, secondary hyperaldosteronism

22

What % of benign renal cysts are asymptomatic?

70%

23

What is an oncocytoma, what is the risk of metastases and what is the treatment?

Benign renal mass
Will not metastasise
Usually a nephrectomy because some RCC look like oncoytoma on imaging - and also to reduce mass effect

24

Why is there an area of central necrosis in an oncocytoma?

Because it does not recruit a new blood supply unlike RCC

25

What is renal cell carcinoma?

Adenocarcinoma of proximal tubule

26

What is the triad of symptoms in RCC and what % of patients have this?

Loin pain, renal mass, haematuria
Only in 15% of patients

27

Where is the most common spread of RCC?

Renal veins

28

Where is the most common site of metastases of RCC?

Lung

29

Surgery of choice in RCC?>

Laproscopic nephrectomy

30

What is 5 year survival rate of T1N0M0 RCC?

90%

31

How might balantis xerotica obliterans present?

White patches, fissuring, bleeding, scarring

32

How might SSC of the penis present?

Red velvety patches

33

What increases the risk of testicular tumours?

Undescended testes, by 3x

34

Is more RCC radiosenstive or not?

Not

35

What is alpha calcidol?

Hydroxylated form of vitamin D given in renal failure because kidneys can't hydroxylate it

36

What ages do dominant and recessive polycystic kidney disease present in?

Dominant - adult
Recessive - childhood

37

What GFR would require dialysis?

about 8

38

Give on example of an osmotic diuretic?

Mannitol

39

What are 2 indications for osmotic diuretics?

Prevention of acute hypovolaemic renal failure, raised intracranial or intraocular pressure

40

Carbonic anhydrase inhibitors are no longer used for diuresis, what are they used for?

Galucoma and following eye surgery
Prophylaxis of altitude sickness
Infantile epilepsy

41

What are the symptoms of diabetes insipidus?

Thirst, polyuria, polydipsia, copious dilute urine

42

What are the two types of diabetes insipidus and describe them?

Nephrogenic - inability of the nephron to respond to vasopressin
Neurogenic - lack of vasopressin secretion from the posterior pituitary

43

How is neurogenic diabetes insipidus treated?

With desmopressin

44

How do vaptans work?

Competitive antagonists of vasopressin receptors
Cause excretion of water without the accompanying Na

45

Where is glucose reabsorbed?

In the proximal tubule

46

How do prostaglandins effect GFR?

Vasodilator effect on afferent arteriole
Release renin - increases filtration pressure

47

Treatment for acute urinary retention?

Catheter, uroselective alpha blocker

48

What are the indications to treat a renal calculi?

Pain unrelieved, pyrexia, persistent nausea vomiting

49

6 causes of frank haematuria?

Infection, stones, tumours, BPH, polycystic kidneys, trauma

50

What is the most likely cause of a swollen, painful testes in a young boy?

Torsion of the testes - until proven otherwise

51

What does the blue dot sign on the testes suggest?

Torsion of appendix testes

52

Treatment of epididymitis?

Ofloxacin

53

What is common cause of paraphimosis?

Foreskin retracted and not replaced after catheter insertion

54

What may happen to bowel sounds in a bladder injury?

Be diminished

55

Symptoms of prostatism?

Difficulty starting micturition, poor stream, and overflow incontinence

56

Which part of prostate is more commonly associated with prostate carcinoma?

Peripheral zone

57

How many patients have advanced disease at presentation of prostate carcinoma?

2/3rds

58

What is the difference between teratoma in a man and woman?

Always malignant in a man, not always in women - tissue is mature

59

How is renal colic typically described?

Loin pain radiating to groin