Term
| causes of urinary incontinence |
|
Definition
|
|
Term
| ix for urinary incontinence? |
|
Definition
bladder diary 3 days
PV exam to exclude cystocoele
urine dipstick and culture |
|
|
Term
| mx for urge incontinence? |
|
Definition
bladder retraining 6 weeks to increase intervals between voiding
antimuscarinics eg oxybutynin, tolterodine, darifenacin (od preparation) |
|
|
Term
| mx for stress incontinence? |
|
Definition
pelvic floor training 8 contractions 3 times a day for minimum 3 months
surgical procedures: retropubic mid urethral tape procedures |
|
|
Term
| define acute urinary retention? |
|
Definition
| pt unable to urinate despite a full bladder, painful medical emergency |
|
|
Term
| causes of acute urinary retention in men |
|
Definition
BPH
malignancy
foreign bodies, stones
bilharzia
urethral strictures
paraphimosis in uncircumcised men who cant pull foreskin over tip
prostate cancer
balanitis |
|
|
Term
| causes of acute urinary retention in women? |
|
Definition
prolapse
pelvic mass
retroverted gravid uterus
Fowler's syndrome
malignancy
foreign bodies, stones
bilharzia
strictures |
|
|
Term
what is fowler's syndrome
who does it affect?
what is the associated condition? |
|
Definition
there is a failure of the bladder sphincter muscle to relax
affects young women
up to 50% of pt have polycystic ovaries |
|
|
Term
| which drugs can cause urinary retention? |
|
Definition
anticholinergics
TCA
opioids
alpha agonists
BDZ
NSAIDs
Antihistamines
Alcohol |
|
|
Term
| surgical sieve causes of urinary retention |
|
Definition
BPH
infective causes: cystitis
malignancy: prostate, GI malignancy
structural: strictures
neurological: NPH, SCC, DM
post op: pain, instrumentation
drugs: opioids |
|
|
Term
| tests in urinary obstruction? |
|
Definition
urinalysis for infection, blood, protein glucose
UandE, FBC, PSA
CT for pelvic masses
MRI for disc prolapse
Cystoscopy, urodynamic studies depending on cause of obstruction |
|
|
Term
|
Definition
immediate catheterisation.
then trial without cathter in men with BPH and acute retention. By giving an alpha blocker before starting TWOC significantly increases chances of success |
|
|
Term
| what rug is offered before removal of cathter? |
|
Definition
| alpha blocker. it increases success in TWOC |
|
|
Term
| what is prolonged catheterisation associated with? |
|
Definition
| increased morbidity from infection |
|
|
Term
| complications of acute retention? |
|
Definition
AKI
UTIs
Post obstructive diuresis
Post retention haematuria - self limiting |
|
|
Term
what complication of urological surgery can cause bladder obstruction?
how is this managed? |
|
Definition
clot retention is a complication.
mx: 3 way catheter and bladder washout |
|
|
Term
| after acute retention which 2 medications are used and why? |
|
Definition
Finesteride 5mg/PO decreases prostate size and retention risk
Tamsulosin: decreases risk of recathterisation after acute retention |
|
|
Term
| difference between acute and chronic retention |
|
Definition
acute is painful
chronic is more insidious and may be painless |
|
|
Term
| complications of chronic urinary retention? |
|
Definition
hydronephrosis
renal impairment
puts pt at risk of acute on chronic retention |
|
|
Term
| common cause of chronic retention |
|
Definition
BPH
prostate carcinoma
drugs
botulinum toxin to rx over active bladder
trauma
urethral strictures from infection eg TB |
|
|
Term
| commonest cause of chronic urinary retention in women? |
|
Definition
Fowler's syndrome
failure of urethral sphincter to relax properly |
|
|
Term
| symptoms of chronic retention? |
|
Definition
frequency, urgerny
terminal dribble
nocturia
incontinence
lower abdo discomfort
lethargy
itching
recurrent UTI
HTN |
|
|
Term
| signs of chronic retention |
|
Definition
non tender palpable bladder
check BP
kidney enlargement by balloting
PR prostamegaly
neuro exam for cord compression and perianal sensation |
|
|
Term
| how are the severity of prostate symptoms classified? |
|
Definition
international Prostate Symptom Score
this classifies severity of symptoms. there is one Q in particular on Qof L it says 'if you were to spend the rest of your life with your urinary condition, how would you feel?'
the response to this is a strong predictor for intervention. |
|
|
Term
| mx for chronic retention? |
|
Definition
intermittent self cathter
meds review
lifestyle advice
surgery |
|
|
Term
| when should you catheterise pt with chronic retention? |
|
Definition
if in
PAIN
UTI
renal impairment |
|
|
Term
| complications of chronic retention? |
|
Definition
acute on chronic
hypertrophy of detrusor and formation of bladder diverticula
hydronephrosis due to back pressure
urinary incontinence due to overflow |
|
|
Term
define AKI
AKI is an independent risk factor for mortality |
|
Definition
| rapid reduction in kidney function over hours to days. It is measured by serum U&E |
|
|
Term
|
Definition
rise in Cr >26umol/L in 48hours
rise in Cr > 1.5 X baseline
urine output < 0.5ml/kg/h for >6 consecutive hours |
|
|
Term
| how much must the creatinine rise in 48hours to diagnose AKI? |
|
Definition
> 26umol/L in 48 or
> 1.5 x BL |
|
|
Term
there are 3 stages of AKI what are these?
the name of the staging is KDIGO |
|
Definition
stage 1 = >26umol/L in 48 hours or increase > 1.5 x BL. urine <0.5ml/kg/h for >6h
stage 2 = increase from BL by 2-2.9. urine <0.5ml/kg/h for >12h
stage 3 = increase BL >3x, >354umol/l or commenced on RRT. urine <0.3ml for >24h or anuria for 12 hours |
|
|
Term
| a pt Cr has risen by >1.5 x their baseline and their urine output for the past 7 hours has been < 0.5ml/kg/h. what stage of AKI are they in? |
|
Definition
stage one.
this is characterised by rise in cr >26umol/L or > 1.5x BL and urine output is <0.5ml/kg/h for >6h |
|
|
Term
| a man has been started on RRT and has had no urine output for 13 hours. what stage of AKI is he? |
|
Definition
STAGE 3.
This is characterised by
> 3 x rise in BL creatinine or > 354umol/L or RRT has been commenced. Urine < 0.3ml/kg/h for >24h or anuria for 12 hours |
|
|
Term
| what is stage 2 AKI characterised by? |
|
Definition
BL creatine raised 2-2.9 x
urine <0.5ml/kg/h >12hours |
|
|
Term
|
Definition
hypoperfusion: shock, sepsis, hypotension, hypovolemia from haemorrhage
renal artery stenosis +/- ACE-i |
|
|
Term
renal causes for AKI?
tubular
glomerular
interstitial
vascular |
|
Definition
tubular: ATN from aminoglycosides, contrast, myoglobin from rhabdomyolysis
crystal damage: ethylene glycol poisoning and uric acid
myeloma
glomerular causes: glomerulonephritis, AI conditions
interstitial: drugs, infiltration e.g tumor lysis syndrome following chemo
vascular: vasculitis, cholesterol emboli, Haemolytic ureamic syndrome, malignant HTN |
|
|
Term
| post renal causes for AKI |
|
Definition
obstruction: stones, clots
Mural: malignancy, BPH, strictures
Extrinsic compression: pelvic malignancy and retroperitoneal fibrosis. |
|
|
Term
| how can you tell if the kidney disease is acute or chronic? e.g on USS or blood results? |
|
Definition
in chronic kidney disease: on USS <9cm, anemia, low Ca2+ and high PO43.
definitive sign for chronic kidney disease: previous blodds showing high Cr and low eGFR |
|
|
Term
| when to refer to nephrologist in AKI |
|
Definition
high K in oliguric pt
high K and fluid overload not responding to medical rx
urea >40mmol/l +/- signs of uraemia
if there is no reversible cause and Cr >300 or rising >50umol/L day |
|
|
Term
|
Definition
pericarditis
glomerulonephritis
blood/protein on dipstick |
|
|
Term
which drugs can be treated with RRT?
remember BLAST |
|
Definition
Barbiturates
Lithium
Alcohol
Salicylates
Theophyline |
|
|
Term
|
Definition
refractory pulmonary oedema
K >7mmol
PH <7.2 or BE <10
ureamic complications
drug overdose:BLAST |
|
|
Term
|
Definition
asses volume
stop nephrotoxic drugs
monitor fluids, weight, nutrition, UE
treat underlying condition |
|
|
Term
|
Definition
correct volume depletion
rx sepsis with Abx
if in shock consider ITU for inotropic support |
|
|
Term
|
Definition
cathter
CTKUB
urology referral
discuss stents |
|
|
Term
| if the pt is stable for ward based care and is haemodynamically ok which RRT is rx of choice? |
|
Definition
haemodialysis
this can be done intermittently
good clearance of solutes in short periods |
|
|
Term
| how does heamofiltration differ from haemodialysis. where is it most often used? |
|
Definition
slower at clearing solutes
done continuously
usually in pts in ICU
advantage: fluid shifts are less significant so unlikely for BP to drop |
|
|
Term
| if a pt is not heamodynamically stable and we are concerned about dramatic change sin BP but we need to provide RRT which option would we choose and why? |
|
Definition
| we would go for heamofiltration as opposed to haemodialysis because in filtration fluid shifts are less significant so it will be unlikely for BP to drop. |
|
|
Term
| signs of Hyperkalemia on ECG? |
|
Definition
tall tented T waves
small P waves
prolonged PR interval
widened QRS
sine wave pattern leading to asystole |
|
|
Term
|
Definition
10ml of 10% calcium gluconate under ECG monitoring slowly over 2mins to stabilise cardiac membrane
IV insulin and glucose
Salbutamol nebs |
|
|
Term
| when to use sodium bicarbonate therapy in hyperkalemia mx? |
|
Definition
if pt is acidotic.
MOA: it can drive K into cells but the effect is unpredictable. |
|
|
Term
| mx of pulmonary oedema in AKI? |
|
Definition
sit pt up high flow 02
2.5mg diamorphine and antiemetic
furosemide 80-250mg IV bolus or infusion
if no response then urgent RRT
consider CPAP
IV nitrates may help |
|
|
Term
| how to reduce contrast induce nephropathy? |
|
Definition
keep pt well hydrated e.g 1litre saline 0.9% over 12 hours pre and post
n acetylcysteine may help too |
|
|
Term
| drugs that should be stopped in AKI? |
|
Definition
NSAIDs
ACE-I/ARBs
diuretics
aminoglycoside |
|
|
Term
| Drugs that may have to be stopped in AKI but don't worsen AKI themselves. |
|
Definition
metformin: if Cr is increasing or is >150
Lithium
Digoxin |
|
|
Term
| drugs which are usually safe to continue in AKI |
|
Definition
paracetamol/aspirin (75mg)/clopidogrel
warfarin
statins
beta blockers |
|
|
Term
| what happens to opioid excretion in renal failure? |
|
Definition
| diminished so it can accumulate. reduce dose and keep naloxone handy. |
|
|
Term
| define chronic kidney disease? |
|
Definition
impaired renal fx >3months based on abnormal structure/fx
OR
GFR <60ml for >3months +/- evidence of kidney damage |
|
|
Term
what are the 5 stages of CKD?
symptoms occur in stage 4 GFR <30
ESRF is <15ml or need for RRT |
|
Definition
stage 1 - >90 with other evidence of renal damage
stage 2 - 60-89
stage 3A - 45-59
stage 3B - 30-44
stage 4 - 15-29 - symptomatic
stage 5 - <15 - ESRF |
|
|
Term
|
Definition
idiopathic
diabetes
HTN
glomerulomephritis
pyelonephritis and reflux nephropathy
myeloma, adult polycystic kidney disease |
|
|
Term
| if the kidneys are asymmetrical on imaging which investigation would you do to see the contribution of each kidney to the overall function? |
|
Definition
|
|
Term
mx of CKD - mild or moderate stages are managed in community.
when would you refer? |
|
Definition
stage 4 or 5
proteinuria with haematuria
rapidly falling eGFR >5ml in 1 year or >10ml in 5 years
HTN despite 4 antiHTN meds
renal artery stenosis
rare kidney disease |
|
|
Term
| what happens to calcium and phosphate in chronic kidney disease? |
|
Definition
calcium goes down
phosphate raises
raised phosphate raises PTH
mx: reduce dietary phosphate and use phosphate binders e.g calcichew |
|
|
Term
| what is the role of vit D and calcium in CKD? |
|
Definition
| they decrease bone disease and hyperparathyroidism |
|
|
Term
|
Definition
| thiazide like diuretic used in edema of CKD |
|
|
Term
| in CKD what may worsen restless legs? |
|
Definition
| low ferritin..anaemia can worse it. |
|
|
Term
| complications from long term RRT |
|
Definition
infection
blockage
stenosis
failed AV fistula
steal syndrome: ischeamia from AV fistula |
|
|
Term
| peritoneal dialysis uses a tenchkoff catheter and the peritoneum to infuse fluid. it gives the pt freedom but what are potential complications? |
|
Definition
peritonitis
exit site infection
loss of membrane fx overtime leading to switch to alternate form of RRT |
|
|
Term
|
Definition
20% annualy mortality mostly due to CVD
protein calorie malnutrition more common in haemodialysis
infection
renal bone disease
amyloid: build up can cause carpal tunnel, arthritis, fractures
malignancy: more common in dialysis pts |
|
|
Term
| absolute CI for renal transplant |
|
Definition
active infection
cancer: if >5 years ago then consider cured
severe comorbidity |
|
|
Term
|
Definition
donor after death: organ retrieved only after cardiac output has stopped.
donor after brainstem death: donor remains on cardioresp support during organ retrieval
living donor grafts: can be un/related. all donors are independently assessed by hman tissue authority. |
|
|
Term
| in which type of renal graft is there a high risk of delayed graft fx due to long warm ischemic time? |
|
Definition
| donor after cardiac death |
|
|
Term
| how does ciclosporin work as an immunosuppresor? |
|
Definition
| it is a calcineurin inhibitor |
|
|
Term
| causes for false postives PSA results? |
|
Definition
prostatitis
UTI
BPH
vigourous DRE
ejaculation |
|
|
Term
| features of prostate cancer? |
|
Definition
95% adenocarcinoma
70% lie in peripheral zone
graded using gleason score
stages using MRI/CT |
|
|
Term
|
Definition
histology
2 grades awarded; 1 for most dominant and 2 for second most dominant
the 2 scores added together to give Gleason score where
2 = best prognosis
10 = the worst |
|
|
Term
| which lymph nodes does prostate cancer spread to first? |
|
Definition
|
|
Term
|
Definition
watch and wait
radiotherapy; external and localised brachytherapy
hormonal therapy: LHRH.
surgery: prostatectomy and obturator node removal: erectile dysfx is a common side effect. |
|
|
Term
| side effects of external radiotherapy in prostate cancer? |
|
Definition
| radiation proctitis and rectal malignancy are later problems |
|
|
Term
| risk factors for prostate cancer |
|
Definition
increasing age
obesity
afro Caribbean
FHx |
|
|
Term
| DRE finidngs in prostate cancer |
|
Definition
| assymetrical hard nodular enlargement |
|
|
Term
| risk factors for prostate cancer |
|
Definition
increasing age
obesity
afro Caribbean
FHx |
|
|
Term
| DRE finidngs in prostate cancer |
|
Definition
| assymetrical hard nodular enlargement |
|
|
Term
| risk factors for prostate cancer |
|
Definition
increasing age
obesity
afro Caribbean
FHx |
|
|
Term
| DRE finidngs in prostate cancer |
|
Definition
| assymetrical hard nodular enlargement with loss of median sulcus |
|
|
Term
| if someone wanted PSA testing but had a recent UTI or treatment for prostatitis how long should you delay the test for? |
|
Definition
| delay for 1 month because both these things can give a falsely raised PSA |
|
|
Term
| what are the normal PSA ranges for 50,60 and 70 year olds? |
|
Definition
50-59 = 3
60-69 = 4
>70 = 5 |
|
|
Term
| what can we say about the sensitivity and specificity of the PSA test? |
|
Definition
it is not sensitive nor specific.
around 33% of men with raised PSA 4-10 have prostate cancer
20% of men with normal PSA have prostate cancer |
|
|
Term
| what is the mainstay mx in metastatic prostate cancer? |
|
Definition
hormone therapy
this is a synthetic GnRH agonist called
Goserelin
initially you need to cover with anti androgen to prevent the rise in testosterone.
anti androgen: cyroterone acetate |
|
|
Term
what is the MOA of cyproterone acetate?
it is an anti androgen |
|
Definition
given at the start of rx with GnRH for metatstatic prostate cancer
this works by prevent dihydrotestosterone binding with intracytoplasmic protein complexes. |
|
|
Term
| what are lower urinary tract symptoms? |
|
Definition
poor flow
nocturia
hesitancy
incomplete and double voiding
terminal dribble
urgency
incontinence |
|
|
Term
|
Definition
lifestyle: stop smoking, alter fluid intake
medications: alpha blockers and 5 alpha reductase inhibitors
surgery: TURP |
|
|
Term
| alpha receptors are found where in the bladder? |
|
Definition
on the bladder neck
tamsulosin is an alpha blocker |
|
|
Term
|
Definition
retrograde ejaculation
urosepsis
haemorrhage
TURP syndrome now reduce due to change in type of irrigation solution |
|
|
Term
|
Definition
insertion of scope via penile urethra
bladder and prostate irrigated
strips of prostatic tissue removed using diathermy |
|
|
Term
|
Definition
blcoks conversion of testosterone to dihydrotestosterone which is known to induce BPH
se: erect |
|
|
Term
moa of finesteride
it can reduce serum PSA
and also size of prostate but takes time ~6months |
|
Definition
blcoks conversion of testosterone to dihydrotestosterone which is known to induce BPH
se: erectile dysfx, reduced libido, gynacomastia |
|
|
Term
| causes of transient non visible heamturia |
|
Definition
uti
menstruation
vigourous exercise
sexual intercourse |
|
|
Term
| causes of persistent non visible heamaturia |
|
Definition
cancer
stones
BPH
prostatitis
urethritis
renal causes: IgA
spurious causes: beetroot, drugs like rifampicin, doxorubicin, levodopa |
|
|
Term
| how to define persistent non visible haematuria? |
|
Definition
| blood present in 2 out of 3 dipsticks done 2-3 weeks apart |
|
|
Term
NICE 2 week wait guidelines
when to refer? |
|
Definition
age >45 and:-
unexplained visible haematuria without UTI or
visible blood in urine that persists or reoccurs after successful rx of UTI
aged 60 or > AND have:
unexplained non visible blood in urine and either dysuria or a raised WCC on blood test. |
|
|
Term
| cause sfor non urgent referral in haematuria? |
|
Definition
60 or more with
recurrent or persistent unexplained UTI |
|
|
Term
| in AKI how would you tell the difference between ATN and pre renal uraemia? |
|
Definition
check the urinary sodium. it should be low
this is because in pre renal uraemia the kidneys hold onto sodium to preserve volume. |
|
|
Term
| brown granular casts are seen in which renal cause of AKI? |
|
Definition
|
|
Term
| in mx hyperkalemia what are the steps? |
|
Definition
stabilise membrane 10ml 10% calcium gluconate
IV insulin/dextrose and nebs salbutamol
calcium resonium,hameodialysis, loop diuretics |
|
|
Term
| a 14 year old girl presents with haemolytic ureamic syndrome secondary to blood diarrhoea. what is the most likely causative agent? |
|
Definition
|
|
Term
| what is the triad for haemolytic ureamic syndrome? |
|
Definition
AKI
microangiopathic haemolytic uraemia
thrombocytopenia |
|
|
Term
| causes of hypokalemia with HTN |
|
Definition
Conns
Cushings
Liddles
Renal artery stenosis
check renin and aldosterone levels
Cushings and Conns: high aldosterone and low renin
Renal artery stenosis: both high
Liddles: both low |
|
|
Term
| what is the commonest cause of nephrotic syndrome in children and young adults? |
|
Definition
minimal change disease.
majority of cases idiopathic and respond well to steroids |
|
|
Term
| electron microscope features in minimal change glomerulonephritis? |
|
Definition
fusion of podocytes
mx: majority are steroid responsive.
the next step is cyclophosphamide for those who are not. |
|
|
Term
| causes of nephrotic syndrome? |
|
Definition
majority idiopathic
drugs: NSaids, Rifampicin
Cancer: hodgkins, thymoma
infectious mononucleiosis |
|
|
Term
| explain secondary hyperparathyroidism leading to renal osteodystrophy |
|
Definition
the commonest cause is CKD.
decreasing kidney fx means the kidneys cannot convert enough vitamin D to its active form and are not able to excrete phosphate properly.
this causes the formation of insoluble calcium phosphate and removes calcium from the circulation resulting in hypocalcaemia.
parathyroid glands detect this and release PTH to try and raise serum calcium. this is done in many ways including increasing the osteoclasting activity of bone which causes renal osteodystrophy. |
|
|
Term
| mx of secondary hyperparathyroidism due to CKD |
|
Definition
dietary phosphorus restriction
active vitamin D supplement
phosphate binders |
|
|
Term
| what tumour can be caused by secondary hyperparathyroidism due to CKD? |
|
Definition
browns tumour.
a bone lesion due to excess osteoclastic activity |
|
|
Term
| what is the main benefit of EPO rx in CKD? |
|
Definition
it is used to rx anaemia and can help improve exercise tolerance.
it does not improve renal function. |
|
|
Term
there are two types of adult polycystic kidney disease
which chromosomes are involved
how are family members screened? |
|
Definition
type 1 - chromosome 16
type 2 - chromosome 4
family members are screened by USS |
|
|
Term
define severe hypokalemia
symptoms of severe hypokalemia? |
|
Definition
serum K <2.5
symptoms: weakness, leg cramps, palpitations secondary to cardiac arrhythmias and ascending paralysis. |
|
|
Term
| mx of mild to moderate hypokalemia? |
|
Definition
oral K providing there are no ECG changes
mild to moderate = 2.5 - 3.4 |
|
|
Term
| mx of severe hypokalemia? |
|
Definition
IV replacement
infusion rate of K should not be >20mmol/H |
|
|
Term
| in rhabdomyolysis why may you see low calcium |
|
Definition
| because myoglobin binds calcium |
|
|
Term
| CKD on heamodyalisis. most likely cause of death is? |
|
Definition
IHD
cardiovascular events account for 50% of the mortality in dialysis pts. |
|
|
Term
| body builders often have an inapproapiate high or low eGFR? |
|
Definition
|
|
Term
| what is the most common presentation of transitional cell carcinoma of the bladder? |
|
Definition
| painless visible haematuria |
|
|
Term
| wilms tumour typically presents in children under the age of? |
|
Definition
5. features:
abdominal mass
flank pain
painless blood in urine
unilateral in 95% of cases |
|
|
Term
features of ALports syndrome
this is ax linked dominant condition in 85% of cases |
|
Definition
microscopic haematuria
progressive renal failure
bilateral sensorineural deafness
lenticonus
retinitis pigmentosa
renal biopsy electron microscope: splitting of lamina densa |
|
|
Term
|
Definition
| protrusion of lens into anterior chamber |
|
|
Term
| which x linked dominant condition is characterised on electron microscopy by splitting of the lamina densa? |
|
Definition
|
|
Term
which virus causes an owls eye appearance in the cells that it infects?
rx:IV gancyclovir |
|
Definition
CMV.
in the eye it can cause retinitis. the fundus has PIZZA-PIE appearance of cotton wool spots, hemorrhages and infiltrates.
those who have a renal transplant and are on immunosuppression are at increased risk from infection from CMV. |
|
|
Term
when a pt with CKD is started on ACE-i it is expected that there will be a fall in eGFR and a rise in creatinine.
what limit is acceptable in this rise and fall? |
|
Definition
a fall in eGFR of 25% is ok
a rise in creatinine of up to 30% is ok
these are relative to the BL. |
|
|
Term
| which loop diuretic can be used as an anti hypertensive in people with CKD whose eGRF is <45? |
|
Definition
Furosemide.
it has the added benefit of lowering serum potassium |
|
|
Term
| which of the nephritic/nephrotic syndromes is caharacterised by haematuria and HTN? |
|
Definition
nephritic
nephrotic: oedema and proteinuria |
|
|
Term
| causes of nephrotic syndrome |
|
Definition
primary glomerulonephritis
drug:gold
systemic disease: DM,SLE, amyloidosis |
|
|
Term
causes of nephritic syndrome
RIA |
|
Definition
rapid progressive GN
IgA nephropathy
Alports |
|
|
Term
| commonest organism involved in infection in continuous ambulatory peritoneal dialysis? |
|
Definition
Staph epidermis: coagulase negative
staph aureus is another |
|
|
Term
MDRD is used to calculate eGFR
name some factors that can affect this result |
|
Definition
pregnancy
muscle mass:body builders or amputees
eating red meat 12 hours before |
|
|
Term
metformin:
following contrast CT how long should it be stopped for? |
|
Definition
48 hours.
in CKD if Cr is >150 it should also be stopped OR
if eGFR <30 it should be stopped |
|
|
Term
| following renal transplant which cancer are patient at most increased risk for? |
|
Definition
| squamous cell carcinoma of the skin |
|
|
Term
| symptoms of anaemia in CKD? |
|
Definition
fatigue
pallor
tachycardia
aortic flow murmur |
|
|
Term
| what must all pts with a K of >6 undergo? |
|
Definition
|
|
Term
| analgesia of choice for renal colic? |
|
Definition
|
|
Term
| which medication do the urine doctors associate endorse that we give to people to help passage of ureteric stones? |
|
Definition
|
|
Term
| imaging for renal stones? |
|
Definition
1st - USS
then non contract CT aka CTKUB |
|
|
Term
stones < which diameter will usually pass spontaneously?
this is typically within 4 weeks of symptom onset |
|
Definition
< 5 mm
in severe cases you can use lithotripsy or nephrolithotomy |
|
|
Term
| in kidney stones what factors would indicate more urgent rx? |
|
Definition
ureteric obstruction
previous renal transplants
abnormality eg horse shoe kidney |
|
|
Term
| ureteric obstruction due to stone plus infection = |
|
Definition
surgical emergency
the system must be decompressed
options:
nephrostomy tube
stents
catheters |
|
|
Term
| mx options for stones in non emergency settings include? |
|
Definition
shock wave lithotripsy
percutaneous nephrolithotomy
uteroscopy |
|
|
Term
| features of shock wave lithotripsy |
|
Definition
uncomfortable for pt so analgesia needed dduring and after rx
external shock causes stones to fragment and pass through
may cause solid organ damage
complications: fragmentation of larger stones can cause obstruction |
|
|
Term
| a pregnant women presents with renal stone more than 5mm so it cannot pass spontaneously. can you do shockwave lithotripsy in pregnancy? |
|
Definition
NO you cannot.
the choice here is uteroscopy. you pass it retrograde through ureter and then access renal pelvis. usually a stent is lent in situ for 4 weeks |
|
|
Term
| what happens in percutaneous nephrolithotomy? |
|
Definition
access gain to renal collecting system
once in intracorporeal lithotripsy or stone fragmentation is performed and stone fragments are removed.
this is the preferred mx for staghorn calculi |
|
|
Term
| stones less than 5mm are managed expectantly and shold pass within 4 weeks. how would you manage staghorn calculi and complex renal stones? |
|
Definition
percutaneous nephrolithotomy.
gain access to collecting system percutaneously. once in perform intra corporeal lithotripsy or stone fragmentation and remove them. |
|
|
Term
staghorn calculi?
what would you do? |
|
Definition
| percutaneous nephrolithotomy |
|
|
Term
| stone burden of < 2 cm in pregnant females. what would you do? |
|
Definition
uteroscopy
pass a scope up urethra to renal pelvis. stent left in situ for 4 weeks. |
|
|
Term
| stone <2cm in a non pregnant and non complicated setting? |
|
Definition
|
|
Term
| which medications can be used to prevent oxalate stones? |
|
Definition
|
|
Term
| how can you reduce the formation of uric acid stones with medication? |
|
Definition
allopurinol
urinary alkalization: oral bicarbonate |
|
|
Term
| renal cell carcinoma classic triad presentation? |
|
Definition
|
|
Term
| histology in renal cell carcinoma shows what characteristic pattern? |
|
Definition
A 'clear cell' pattern
clear cytoplasm
small nuclei |
|
|
Term
| features of transition cell carcinoma |
|
Definition
makes up 90% of lower urinary tract tumours
males affected 3x than females
industrial exposure to chemical dyes and rubbers increase risk
diagnosis and staging is with CT IVU |
|
|
Term
| common xray finidng in type 1 RTAcidosis |
|
Definition
nephrocalcinosis
type 1 RTA is distal |
|
|
Term
causes of type 2 RTA?
this is the proximal type |
|
Definition
|
|
Term
| which stones are radio lucent on xray? |
|
Definition
|
|
Term
| which stones are semi opaque on xray and show a ground glass appearance? |
|
Definition
|
|
Term
| what ph of urine do staghorn calculus develop in? |
|
Definition
alkaline urine
also proteus infection increase risk of them forming. |
|
|
Term
| how would you image radio opaque stones? |
|
Definition
|
|
Term
| how can thiazides prevent calcium stones? |
|
Definition
| they increase the reabsorbtion of calcium in the DCT thus less in the ureters |
|
|
Term
| complication of pyelonephritis? |
|
Definition
|
|
Term
| what is a DMSA scan good for and what is it not good for |
|
Definition
to ID cortical defects or aberrant kidneys
not good for ureter or collecting system because it mostly localises to the renal cortex |
|
|
Term
| what scan could you use to test for bladder reflux? |
|
Definition
Micturation cystourethrogram
MCUG |
|
|
Term
|
Definition
renal colic
pyelonephritis
blood clots
papillary necrosis
tumours
renal infarction
dissecting AAA
herpes zoster
muscular pain
retroperitoneal fibrosis |
|
|
Term
you do a urine test in a person with loin pain.
if the pH is <6 what would you think?
what if the ph was >8? |
|
Definition
PH <6 = uric acid stone
PH >8 = infection with urea splitting organism such as proteus |
|
|
Term
| which pyelogram can be done in pt allergic to contrast and with renal failure. |
|
Definition
a retrograde pyelogram.
this is because no contrast medium ever enters the blood stream. |
|
|
Term
| risk factors for pyelonephritis? |
|
Definition
structural renal abnormalities including vesicoureteric reflux
calculi and catheterisation
stents
pregnancy
diabetes
neurogenic bladder
immunocompromised |
|
|
Term
| preseantion of pyelonephritis |
|
Definition
pt looks ill
rigors fever,
loin pain
nausea vomiting
ix: urine will be cloudy |
|
|
Term
| imaging in pyelonephritis |
|
Definition
uss
contrast enhance helical/spiral CT |
|
|
Term
|
Definition
Abx
ciprofloxacin or co-amoxiclav for 7 days.
in children:-
co-amoxiclav or cefixime |
|
|
Term
| complications of pyelonephritis |
|
Definition
perinephric abscesses
renal abscess
papillary necrosis
AKI/CKD |
|
|
Term
| which scan is the best to show renal scars? |
|
Definition
|
|
Term
| features of minimal change disease |
|
Definition
does not progress to ESRF
nephrotic syndrome
electron microscope: fusion of podocytes
normal renal fx, normal BP
may be underlying Hodgkins disease in adults. |
|
|
Term
| focal segmental glomerulosclerosis features |
|
Definition
the are fusion of podocytes with some segmental scarring of glomeruli
haematuria, HTN, renal impairment
50% respond to steroid but needed for 4months
progresses to ESRF in 50% but can be slowed down with steroids. |
|
|
Term
|
Definition
widespread thickening of GBM
immunofluorescence reveals granular deposits of immunoglobulin and complement.
commonest cause of nephrotic syndrome in adults
30-50% progress to ESRF |
|
|
Term
| in proteinuria, which ix are better than 24 hour urine collection? |
|
Definition
albumin:creatinine
protein:creatinin |
|
|
Term
describe steal syndrome
AV fistula using the brachial artery is more likely to cause this syndrome. |
|
Definition
dialysis associated distal hypoperfusion ischemic syndrome
there is shunting of blood flow through AV fistula and disital ischemia
can present as ischemic ulcers and necrosis |
|
|
Term
| goodpastures syndrome features |
|
Definition
nephritic syndrome: HTN, haematuria, proteinuria
anti GBM antibodies,
linear immunofluorescence
light microscopy shows crescents |
|
|
Term
| Wiring loop of capillaries is seen in.. |
|
Definition
| diffuse membranous glomerulonephritis |
|
|
Term
| Alports syndrome - you may see what on imaging? |
|
Definition
Splitting of the basement membrane
due to abnormality in type IV collagen |
|
|
Term
| lumpy bumpy appearance on imaging seen in which type of glomerulonephritis? |
|
Definition
|
|
Term
people with crohns who have under gone small bowel surgery have increased risk to calcium oxalate stones.
what can be given to reduce this? |
|
Definition
| dietary supplementation with calcium citrate |
|
|
Term
| radiolucent means they are or are NOT seen in xray? |
|
Definition
they cannot be seen on XRAY
uric acid, xanthine and cysteine stones are all lucent and cant be seen on xray |
|
|
Term
| what is the effect of ACE-i on afferent and efferent arteriole? |
|
Definition
vasoconstricts afferent
vasodilates efferent |
|
|
Term
| classical feature of p. jiroveci is desaturation on exercise. how can this be measured on ward? |
|
Definition
| pulse oximetry before and after walking up and down ward |
|
|
Term
| list 3 types of renal tubular acidosis with a cause for each |
|
Definition
type 1 - sickle cell
type 2 - heavy metal toxicity
type 4 - Addison's disease |
|
|
Term
| two diabetic causes for a high anion gap acidosis? |
|
Definition
|
|
Term
| findings in renal tubular acidosis? |
|
Definition
hyperchloreamia
normal anion
metabolic acidosis |
|
|
Term
| how is the blood flow in the vasa recta? high or low. and what significance does this have? |
|
Definition
| the blood flow is low in the vasa recta and this assists with formation of concentrated urine |
|
|
Term
| congo red is used to diagnose amyloidosis. what colour does it stain? |
|
Definition
red.
it also shows a green fluorescence under polarised light. |
|
|
Term
| list 3 features that would suggest a person has chronic renal failure? |
|
Definition
normochromic normocytic anaemia
Hypoalbuminaemia
hypocalcemia, hyperphosphotaemia |
|
|
Term
| how to manage anaemia in CKD |
|
Definition
exclude iron, vit b12 and folate deficieny
give blood transfusion if symptomatic
consider giving EPO |
|
|
Term
| how to manage renal impairment in CKD? |
|
Definition
maintain good BP control
rx underlying/reversible factors
dialysis/renal transplant |
|
|
Term
| mx of hypocalcemia and hyperphosphateamia in CKD |
|
Definition
low ca: calcium supplements, Alfacalcidol
high phosphate: phosphate binders e.g aluminium hydroxide. |
|
|
Term
true or false:
in renal vein thrombosis venography is the most appropriate technique preferred? |
|
Definition
FALSE
MRI, CT, Doppler USS preferred to renography for diagnosis of renal vein thrombosis |
|
|
Term
| what can happen after a urinary tract obstruction is relieved? |
|
Definition
there may be a period of salt losing nephropathy.
urinary sodium >30mmol |
|
|
Term
| ovoid parasites on a wet saline mount? |
|
Definition
trichomonas.
metronidazole 400-500mg BD 7 days or stat 2g dose. |
|
|
Term
| associations of adult polycystic kidney disease |
|
Definition
berry aneurysm
liver cysts
hepatic fibrosis
diverticular disease
pancreatic cysts
mitral valve prolapse
aortic incompetence |
|
|
Term
| what is the most sensitive modality for detecting renal stones? |
|
Definition
|
|
Term
| list 4 ix you would perform on admission with someone if you suspect pyelonepritis |
|
Definition
FBC, UE, glucose
Blood cultures
MSU urinalysis
plain XR |
|
|
Term
| if someone has repeated pyelonephritis which ix would you want to do to check for vesicoureteric reflux? |
|
Definition
|
|
Term
| classical finding of kidneys in chronic pyelonephritis? |
|
Definition
|
|
Term
| rapidly progressive glomerulonephritis |
|
Definition
may occur in SLE
usually accompanied by cresentic change in renal biopsy
can be associated with anti GBM antibodies which are pathagnomonic
should be treated with high dose immunosupression |
|
|
Term
| what does rapidly progressive glomerulonephritis occur in? |
|
Definition
Goodpastures
SLE
ANCA positive vasculitis |
|
|
Term
history of bilateral flank pain, renal failure and marked proteinuria.. there is a history of antiphospholipid syndrome
what is the diagnosis? |
|
Definition
| bilateral renal vein thrombosis |
|
|
Term
|
Definition
| binds to glucocorticoid receptor to alter gene transcription in inflammatory pathways |
|
|
Term
|
Definition
|
|
Term
| MOA of mycophenolate mofetil? |
|
Definition
| blocks lymphocyte purine synthesis |
|
|
Term
| MOA of Basiliximab and SE |
|
Definition
anti CD 25 antibody
SE: hypersensitivity |
|
|
Term
| calcineurin blocking drugs |
|
Definition
|
|
Term
| purine synthesis inhibitors |
|
Definition
azathioprine
mycophenolate |
|
|
Term
| features of lymphogranuloma venereum |
|
Definition
form of chlamydia infection in several areas of the world including carribean.
characteristically begins with a painless ulcer, followed a few weeks later by severe painful inguinal lymphadenopathy
diagnosis often made by PCR
mx:3 week course of doxycycline or erythromycin
untreated disease can manifest itself as large perianal or vulval abscesses |
|
|
Term
|
Definition
thin white homogenous vaginal discharge
offensive vaginal odour after sex
odour can be replicated by applying potassium hydroxide to speculum
microscopic exam of vaginal fluid: gram neg rods |
|
|
Term
| what criteria is used to diagnose BV? |
|
Definition
amsel's criteria: you need at least 3 of the following:
homogenous discharge
microscopy showing vaginal epithelial cells coated with a large number of bacilli
vaginal PH > 4.5
fishy odour on adding 10% KOH to vaginal fluid |
|
|
Term
| what can increase risk of BV |
|
Definition
recent ABx
excessive washing (soap)
presence of IUD may all increase risk of infection |
|
|
Term
|
Definition
metronidazole and clindamycin
7 day course usually |
|
|
Term
| reasons for renal impairment in a chronic RA pt? |
|
Definition
amyloidosis
drugs e.g NSAIDs and gold salts |
|
|
Term
| how is a diagnosis of amyloid made? |
|
Definition
|
|
Term
| causes of nephrotic syndrome |
|
Definition
glomerulonephritis
diabetes
myeloma
SLE
infections: malaria
drugs: penicilamine, GOLD |
|
|
Term
| which nephropathy is the most common nephrotic syndrome in adults and is seen in malignancies such as GI cancers? |
|
Definition
|
|
Term
| Alports syndrome features |
|
Definition
sensorineural deafness
abnormalitiy in GBM
ACE-i shown to slow progression in renal disease
post renal transplant anti GBM disease may occur
90% develop ESRF by aged 40 |
|
|
Term
| conditions where renal papillary necrosis is seen |
|
Definition
pyelonephritis
sickle cell
chronic paracetamol use
diabetes mellitus |
|
|
Term
| features of cholesterol emboli |
|
Definition
petechial rash affecting feet
small rise in peripheral eosinophil count |
|
|
Term
| which two HPV serotypes are most associated with cervical cancer? |
|
Definition
|
|
Term
| which serotypes of HPV associated with genital warts? |
|
Definition
|
|
Term
| erythromycin and rifampicin. how should the dose be adjusted in renal failure? |
|
Definition
| it does not need to be adjusted because it is eliminated hepatically. |
|
|
Term
| what may result from high dose amoxicillin in those with renal impairment? |
|
Definition
|
|
Term
| in severe renal failure which medication is preferred for GORD? |
|
Definition
ranitidine.
cimetidine is cleared by the liver but metabolites can lead to confusion |
|
|
Term
| ulcer on penis filled with malodourous yellow exudate and unilateral tender lymphadenopathy. whats the diagnosis? |
|
Definition
chancroid
caused by H ducreyi |
|
|
Term
| indication for urgent dialysis? |
|
Definition
severe hyperkalemia
significant uraemia
furosemide resistant fluid overload
ureamic pericarditis
acidosis |
|
|
Term
in haemachromotosis what is the cause for:
polyuria and polydipsia
suntanned appearance
arthritis? |
|
Definition
polydipsia/uria: pancreatic infiltration leading to DM
suntan: melanin deposition in the skin
arthritis:pyrophosphate arthropathy |
|
|
Term
| mx of asymptomatic hyperkalemia in RRT pts |
|
Definition
mild >5.5 -6 =calcium resonium PO/PR
moderate >6.5 =infusion dextrose insulin and calcium resonium
severe >7 and/or ECG changes = iv ca gluconate plus 50ml 50% dextrose and 10-15 soluble insulin |
|
|
Term
| indications for emergency RRT |
|
Definition
persistant hyperkalemia
fluid overload
acidosis
pericarditis |
|
|
Term
| factors that suggest CHRONIC kidney disease |
|
Definition
normocytic normochromic anaemia
hypoalbuminaemia
low calcium and high phosphate |
|
|
Term
| 3 tests you can do at GP to elucidate cause of renal failur |
|
Definition
BP lying and standing
Urinalysis
capillary Blood glucose |
|
|
Term
| name calcium supplements given in chronic renal failure? |
|
Definition
|
|
Term
| name a phosphate binder given in chronic renal failure? |
|
Definition
|
|
Term
meralgia paraesthetica affects which nerve?
where is the presentation?
risk factors? |
|
Definition
affects lateral femoral cutaneous nerve
causes numbness of lateral thigh in a relatively narrow strip.
associated with conditions where there is rapid large volume weight gain e.g pregnancy but can also be postpartum from trauma of delivery.
there are no motor deficits in this condition |
|
|
Term
|
Definition
infection
can be displaced or pulled out
sore around insertion site |
|
|
Term
| when changing a long term catheter what must be considered as prophylaxis against introducing infection while changing catheter? |
|
Definition
| a single dose of gentamicin unless there are CI like severe renal failure |
|
|
Term
| which antibody is associated with granulomatosis with polyangitis? |
|
Definition
c-ANCA
c-ANCA and Anti-serine protease 3 is most predictive of the diagnosis |
|
|
Term
| antibodies in primary biliary cirrhosis? |
|
Definition
| anti mitochondrial antibodies |
|
|
Term
| in renal tubular acidosis you will see what blood result |
|
Definition
| hypercholreamic metabolic acidosis |
|
|
Term
| list 4 causes of Bells palsy |
|
Definition
idiopathic
parotid infiltration
herpes zoster
mononeuritis multiplex
pontine tumours and stroke |
|
|
Term
| 70% of cerebellopontine angle tumours are? |
|
Definition
schanomas. these are benign so radiotherapy has little role and surgery is mainstay of therapy
MRI is ix of choice |
|
|
Term
| what happens to systolic BP on standing in normal people? |
|
Definition
it falls slightly
the diastolic normally rises |
|
|
Term
| define postural hypotension |
|
Definition
fall in SBP >20
OR
fall in diastolic >10 |
|
|
Term
| causes of anemia in someone with ESRF and on dialysis |
|
Definition
EPO deficiency secondary to renal failure
haemantinic deficiencies secondary to repeated phlebotomy and small volume blood loss at the end of dialysis sessions |
|
|
Term
| chronic metabolic complications of haemodialysis treated ESRF? |
|
Definition
amyloidosis
secondary/tertiary hyperparathyroidism
dyslipidaemia
hyperhomocysteinaemia |
|
|
Term
| which bacteria causes uti typically after instrumentation? |
|
Definition
|
|
Term
| UTI affects approximately what percentage of women in their lifetime? |
|
Definition
| 25-35% of all women sometimes in their life |
|
|
Term
| which bone deformity is commonly present in osteomalacia? |
|
Definition
kyphosis
there is also proximal myopathy, bone pain and bone tenderness. |
|
|
Term
| which neuro signs would you expect with a corticospinal tract lesion? |
|
Definition
|
|
Term
| in SLE limited to skin and joints what medication would you use? |
|
Definition
hydroxychloroquine.
DMARDS reserved for rx of more aggressive disease |
|
|
Term
what is oliguria in adults?
what is oliguria in children? |
|
Definition
|
|
Term
| normal urine output for adults and children? |
|
Definition
adults >0.5ml/kg/h
children 1ml/kg/h |
|
|
Term
features of hydroceale.
you can get above this. remember by saying hi-gher..drocele |
|
Definition
non tender
fluctuant
can get above
clear fluid
will trans illuminate
can be presenting feature of testicular cancer in young men. |
|
|
Term
| features of testicular tumors |
|
Definition
discrete testicular nodule and it may have a hydrocele associated with it (you can get above a hydrocele)
ix: USS scrotum, serum AFP and bHCG |
|
|
Term
on which side do varicoceles usually occur. why is this?
bilateral varicoceles can affect fertility |
|
Definition
| they usually occur on the left because testicular vein drains into renal vein |
|
|
Term
| which scrotal mass may be the presenting complaint of renal cell carcinoma? |
|
Definition
varicocele
hydrocele may be associated with testicular cancer |
|
|
Term
| which two scrotal lumps can you typically 'get above' on examination? |
|
Definition
| hydrocele and epidydimal cysts |
|
|
Term
| features of epidydimal cysts |
|
Definition
may be single or multiple cysts
they lie above and behind testes
painless
usually occur in those over 40
may contain clear or opalescent fluid |
|
|
Term
| clinical exam differention between epididimoorchitis and testicular torsion? |
|
Definition
| with testicular torsion, the pain is not relieved by elevation of the testes but it is relieved in the other one |
|
|
Term
| features of testicular torsion |
|
Definition
sudden severe onset of testicular pain
risk factors include abnormal testicular lie
typically affects adolescents and young males
O/E tender testes and pain not relieved by elevation
mx: urgent surgery indicated. the contralateral testes should also be fixed.
surgery: sutures or placement of testes in a dartos pounch. |
|
|
