Urology - general Flashcards

Question

First line ix for any scrotal mass

Answer 1

USS testis

Answer 2

• Radical orchidectomy done to remove testicular cancer Performed via an inguinal incision rather than a scrotal incision o Lymph node supply of scrotal skin is different to that of the inguinal cord + the testicle - you don’t want to spread cancer cells from one compartment (where the testicle drains) to the other (where the scrotal skin drains) testis - para-aortic scrotum - inguinal

Answer 3

20-30 - teratoma | 30-50 - seminoma

Answer 4

Left o R gonadal vein drains directly into IVC at an oblique angle o L gonadal vein drains into L renal vein at a 90o angle

Answer 5

Renal tumour compressing the L renal vein and compromising the drainage of the L gonadal vein

Answer 6

o Men <35 y/o - STIs (consider Chlamydia trachomatis (most common), Neisseria gonorrhoeae) o Men >35 y/o - UTIs (e.g. Escherichia Coli, Enterobacter, Klebsiella) o Anal intercourse - increases risk of epididymo-orchitis due to exposure to coliforms o Others - mumps, Candida

Answer 7

``` Acute onset Bilateral Extends into the groin Not painful Resolves over 48-72h Needs no further management ``` (testicular torsion, epididymo-orchitis - would all result in pain)

Answer 8

Medial to lateral - VAN

Answer 9

Impaired connective tissue metabolism causing abdominal wall weakness

Answer 10

Most of them are transitional cell carcinomas (90%) the rest are squamous cell carcinomas and adenocarcinomas

Answer 11

An excessive collection of serus fluid in the tunica vaginalis

Answer 12

Hydrocele - can't separate it from the testis | Epididymal cyst - can separate it from the testis

Answer 13

testis - para-aortic | scrotum - inguinal

Answer 14

Dilated veins of the pampiniform plexus forming a scrotal mass more common on the L associated with infertility

Answer 15

Clinical | o US – 1st line

Answer 16

Irreversible reduction in renal function, chronically abnormal renal function/structure present for MORE THAN 3 MONTHS (with assosciated health implications) or GFR <60ml/min for >3m

Answer 17

DM US reveals large kidneys Kimmestiel- Wilson nodules seen on histology - hallmark of diabetic glomerulosclerosis SGLT2 inhibitors have been shown to slow progression to ESRFe.g. empagliflozin HTN US revels small kidneys ACEi + ARBs

Answer 18

Degree of proteinuria - correlates with the rate of progression of the underlying disease

Answer 19

``` Nephrotic syndrome Affects children Related to underlying Hodgkin's disease in adults Does not progress to ESRF Podocyte fusion ``` * Podocyte fusion/loss of epithelial foot process on microscopy * Vacuolation * Appearance of microvilli * Normal light microscopy * Negative immunofluorescence

Answer 20

Nephrotic syndrome Affects adults Can be assosciated with HIV, heroin use or can be idiopathic Progresses to ESRF Podocyte fusion, segmental scars on histology

Answer 21

Nephrotic syndrome Most common nephrotic syndrome in adults Thickening of the glomerular basement membrane Deposition of immunoglobulin + graular deposits on GBM Can progress to ESRF

Answer 22

Nephritic syndrome - Anti-GBM disease/Goodpasture's syndrome - Pauci-immune crescentic glomerulonephritis (ANCA)/systemic vasculitis - granulomatosis with polyangiitis, microscopic polyangiiti - Immune complex-associated (SLE, IgA, post-infectious glomerulonephritis) Accumulation of macrophages + epithelial cells outside the capllary loops but within Bowman's capsule (fill up Bowman's space)

Answer 23

Nephritic syndrome Autoimmune Anti-GBM antibodies - affects lung + kidney (attack type IV collagen) Haemoptysis + haematuria

Answer 24

``` Nephritic syndrome children 1-2 weeks after URT infection Strep pyogenes most common bacterium IgG, IgM, C3 deposits ```

Answer 25

Nephritic syndrome Macrocopic haematuria immediately following URT or GI infections Children Mesangial cell proliferation with matrix expansion IgA, C3 deposits in matrix on biopsy

Answer 26

Fluid - oliguria, volume overload Electrolyte - hyperkalaemia, hyperphosphataemia, hypocalcaemia Acid-base - metabolic acidosis

Answer 27

``` Systemic variant IgA nephropathy Purpuric rash extensor surfaces Haematuria Polyarthritis Abdo pain Scrotal swelling ``` trad of abdo pain, arthritis, purpuric rash

Answer 28

ANCA associated Negative immunofluorescence in kidney but positive ANCA Antibodies bound to neutrophils Activation within glomerular capillary loops Many patients will also have vasculitis in other systems e.g. skin rash, lung haemorrhage

Answer 29

Ischaemia (low CO (HF, MI), hypovalaemia, systemic dilation (sepsis), renal vasoconstriction, hypotension) Toxins Drugs (NSAIDs, ACE-I, ARB, contrast, aminoglycosides (gentamycin), chemo, immunosuppresants (ciclosporin, MTX) myoglobinuria in rhabdomyolysis, myeloma etc.)

Answer 30

Hyperkalaemia Hyperphosphataemia Hypocalcaemia

Answer 31

Analgesic nephropathy is injury to the kidneys caused by analgesic medications such as aspirin, phenacetin, and paracetamol Renal papillary necrosis Chronic interstitial nephritis

Answer 32

1. Progressive failure of homeostatic function - Acidosis - Hyperkalaemia 2. Progressive failure of hormonal function - Anaemia - Renal Bone Disease - Osteomalacia 3. Cardiovascular disease - Vascular calcification - Uraemic cardiomyopathy 4. Uraemia and Death

Answer 33

The presence of a pure growth of > 10^5 organisms per mL of fresh MSU Presence of >100,000 of colony-forming units per mm of urine (1ml = 1000mm) infection of the kidneys (pyelonephritis), bladder (cystitis), urethra (urethritis) or prostate (prostatitis) Most common causative organism - E.coli

Answer 34

fluid filled cysts grow on the kidney, 10% of ESRF Autosomal dominant inheritance, onset at 30-60 years 1:1000 (85% of PKD1 Chr16, 15% PKD2 Chr4) rare AR inheritance on Chr6

Answer 35

• RCC originates from the proximal renal tubular epithelium (renal cortex) – lining of the proximal convoluted tubule also known as von Grawitz tumour, hypernephroma

Answer 36

``` Von Hippel Lindau • Common association • Short arm of Chr 3 • Benign cyst that forms in the CNS, kidneys – younger, bilateral, VHL gene • Vision loss, retina angiomatosis ```

Answer 37

* Narrowing of the renal artery lumen * Considered angiographically significant if >50% reduction in vessel diameter is present * Important cause of secondary HTN + CKD

Answer 38

* Older patients - Atherosclerosis | * Younger female patients - Fibromuscular dysplasia

Answer 39

Acute tubular necrosis In established acute tubular necrosis, the kidneys can't concentrate the sodium • Can’t concentrate their urine or conserve sodium • Urinary sodium >40mmol/L => urine is dilute (osmolarity <350mmol/L) • Urine:plasma osmolarity ratio <1:1

Answer 40

Acute interstitial nephritis Causes of acute interstital nephritis - Drugs - Infection - Immune disorders e.g. SLE - Lymphoma - Tumour lysis syndrome

Answer 41

Recurrent clots Haematuria extra lumen for irrigation https://www.urotoday.com/images/3_way_catheter.jpg

Answer 42

Proteus mirabilis 1st step - bladder wasout 2nd step - replace catheter

Answer 43

 NSAIDs --> reduce vasodilation of afferent arteriole (block production of PG)  ACEi --> reduce vasoconstriction of the Efferent arteriole (block conversion of ATI-->ATII)

Answer 44

Magnesium Ammonium Phosphate (MAP)/Struvite stones | Associated with chronic UTIs from gram -ve rods that break down urea into ammonia (pseudomonas, proteus)

Answer 45

Most common Hyperparathyroidism Diuretics Increased gut absorption of Ca

Answer 46

``` Infection NSAIDs Abx (penicillin, cephalexin) PPIs Allopurinol Phenytoin Cimetidine ```

Answer 47

renal ostedystrophy = alteration of one morphology in pt w CKD - no absorption of Ca, low Vitamin D - Osteopenia - Salt + pepper skull - Subperiosteal erosions - Brown tumours - pseudofractures - Rugger jersey spine

Answer 48

Overflow incontinence - involuntary release of urine from an overfull bladder - occurs in people with blockage of the bladder outlet (e.g. BPH, Prostate cancer) ix using urodynamic studies

Answer 49

2y to dialysis related amyloidosis due to depletion of β2 microglobulin

Answer 50

K cant be excreted Renal tubular damage - inadequate renin secretion and release - hypoaldosteronism - hyperkalaemia

Answer 51

``` AKI Flash pulmonary oedema Cough Dyspnoea Othropnoea Bilateral fine inspiratory crackles ``` ``` Other causes of flash pulmonary oedema ACEi in RAS Acute MI ARDS Heroin + cocaine use ```

Answer 52

older children + young adults HIV heroin use * Podocyte fusion * Segmental scars on histology

Answer 53

Renal cyst - Usually ASYMPTOMATIC - Incidental finding on US Renal abscess - Persistently high FEVER - Bacteraemia (+ve blood cultures) - High WCC - Severe tenderness on examination - Non specific symptoms (abominal pain, weight loss, malaise) - Failure to improve after appropriate therapy Pyelonephritis - Systemic symptoms - fever, nausea, vomiting, RIGORS, sweating - LOCAL symptoms of UTI - dysuria, haematuria, loin pain

Answer 54

medullary - phaechromocytoma cortex Conn's syndrome (produces aldosterone) Cushing's syndrome (produces cortisol)

Answer 55

B. UTI Severe UTIs - sepsis, hypovolaemia, collapse Orthostatic hypotenison - drop >20 mmHg in SBP or >10 mmHg in DBP, not just any drop in any BP Diabetic nephropathy - nephrotic syndorme therefore no haematuria, just proteinuria Hyoglycaemia - sweating, tachycardia, palpitations, irritability tremor

Answer 56

E. Minimal change glomerulonephritis most common cause of nephrotic syndrome in adults + young children thin basement membrane nephropathy + IgA nephrotpathy benign conditions thinning of the GBM DO NOT IMPACT RENAL FUNCTION - no sacral oedema!! ``` goodpastures triad of glomerulonephritis pulmonary damage causing haemorrahge anti-GBM antibodies T2 autoimmune rxn ``` Nephrotic syndrome The nephrotic syndrome (B) is likely in this patient with proteinuria resulting in oedema, however, the cause of these symptoms is minimal change glomerulonephritis, hence this is the best answer.

Answer 57

Hydronephrosis before bladder dilation Bladder is a strong muscular organ that requires significant built up of pressure before it becomes dilated

Answer 58

B. Microalbuminuria urine dipstick is not sensitive enough to detect microaluminuria Elevation of serum creatinine which is usually excreted by the kidney is a late marker of renal impairment + not appropriate for early risk identification

Answer 59

A. Sevelamer = phosphate binder (also lowers Ca and cholesterol) Hyperphosphataemia can cause vascular calcification Should be treated asap Oral vitamin D Oral vitamin D therapy (C) is useful in early renal disease as it lowers PTH levels, however it is not appropriate as first-line therapy since it increases calcium and phosphate reabsorption and so can inadvertently exacerbate the patient’s symptoms (normally, vitamin D increases Ca absorption + increases PO43- excretion but in CKD, PO43- can't be excreted by the kidney) High levels of phosphate (which can't be excreted) cause it to find and stick to any available calcium (which is increased if the patient is given vitamin D), which forms bone-like crystals in places that they shouldn’t be Once phosphate levels have been lowered, vitamin D therapy is then beneficial

Answer 60

Both cause nephritic syndrome (HTN, hameaturia, proteinuria) Post-infectious glomerulonephritis – tends to occur 4-6 weeks after a streptococcal infection (e.g. streptococcal pharyngitis, cellulitis) IgA nephropathy – tends to occur 5-7 days after the patient experiences symptoms of pharyngitis Hypertension – more common in post-strep glomerulonephritis Heavy proteinuria, systemic symptoms (abdo pain, skin rashes, arthritis) – more common in IgA nephropathy

Answer 61

Stress incontinence – incontinence when there is increased intra-abdominal pressure Urge incontinence – detrusor overactivity (neurological problem, intrinsic problem with the detrusor muscle) Functional incontinence – patients are unable to find a toilet before urinating (immobility, unfamiliar surroundings, not due to a physiological dysfunction) Overflow incontinence – involuntary release of urine from an overfull bladder (bladder outflow obstruction, detrusor weakness) Double incontinence – urinary + faecal incontinence (neurological disorders – MS, AD)

Urology - general Flashcards

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