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Question 1

What are the three most likely causes of dark brown urine in a woman?

Answer 1

UTIAcute tubular necrosis``

Question 2

What investigations are done to assess renal status?

Answer 2

Dipstick of urine - blood, protein. MSU - exclude urine infection; find out if urine suggests nephritis - RBCs in urine, red cell cast Serum creatinine and urea - exclude acute renal failure Serum sodium and potassium - exclude hyperkalemia which may be urgently life threatening Ultrasound of kidneys - ensures no evidence of CKD, exclude severe parenchymal renal infection, abscess

Question 3

What investigations are done to assess infection?

Answer 3

Haemoglobin - normochromic anaemia White cell count and differential - neutrophilia - but not specific for infection Blood culture Chest radiograph - pneumonia can occur without physical sign CRP - along with other acute phase proteins not diagnostic; often raised in immune disease, higher in infection MSU and blood cultures [repeated] - no growth Hb 100.5 g/L, WCC 16x109/L - 90% neutrophils CxR – normal

Question 4

How can lupus be investigated?

Answer 4

Anti nuclear antiboidiesLow C3 and C4

Question 5

What physical signs are compatible with volume depletion?

Answer 5

sunken eyes dry nose or mouth mucous membrane longitudinal furrows on the tongue