EMQ questions Flashcards
From the following list, choose the clinical limitations of measuring Serum Creatinine:
- Useful in investigating renal stone disease
- Useful in diagnosing renovascular disease
- Undergoes tubular secretion
- Invalid in patients on diuretics
- Disproportionately high in patients with dehydration
- Increased in those with high muscle mass
- Disproportionately low in patients with liver disease
- Used as a variable in MDRD eGFR equation
- Undergoes tubular secretion
- Increased in those with high muscle mass
- Used as a variable in MDRD eGFR equation
From the following list, choose the clinical limitations of measuring Intravenous Urogram:
- Useful in investigating renal stone disease
- Useful in diagnosing renovascular disease
- Undergoes tubular secretion
- Invalid in patients on diuretics
- Disproportionately high in patients with dehydration
- Increased in those with high muscle mass
- Disproportionately low in patients with liver disease
- Used as a variable in MDRD eGFR equation
- Useful in investigating renal stone disease
From the following list, choose the clinical limitations of measuring Urinary Sodium:
- Useful in investigating renal stone disease
- Useful in diagnosing renovascular disease
- Undergoes tubular secretion
- Invalid in patients on diuretics
- Disproportionately high in patients with dehydration
- Increased in those with high muscle mass
- Disproportionately low in patients with liver disease
- Used as a variable in MDRD eGFR equation
- Invalid in patients on diuretics
For Trimethoprim, choose the related adverse effects:
- Long term use may cause irreversible renal damage
- Reduces GFR by acting on efferent arteriole
- Increases plasma osmolality
- May cause acute tubular necrosis
- Hyponatremia
- May cause falsely high serum creatinine
- Hypernatraemia
- Hyperkalaemia
- hypokalaemia
May cause falsely high serum creatinine
What clinical diagnosis would give a frothy, foamy urine?
Nephrotic syndrome
What clinical diagnosis would give cloudy urine?
Acute pyelonephritis
What clinical diagnosis would give dark urine with red cell casts?
Acute post-streptococcal glomerulonephritis
What clinical diagnosis would give dark urine with no RBCs or red cell casts?
Rhabdomyolysis
What clinical diagnosis would give macroscopic haematuria with no red cell casts?
Bladder transitional cell carcinoma
Choose from the following list which drug can cause acute rhabdomyolysis:
- Bromocriptine
- Large doses of vitamin D
- Statins
- Gabapentine
- Paracetamol
- Frusemide
- ACE inhibitors
- Mannitol
Statins
(also cyclosporin & chloroquine)
Choose from the following list which drug requires reduction in patients with CKD:
- Bromocriptine
- Large doses of vitamin D
- Statins
- Gabapentine
- Paracetamol
- Frusemide
- ACE inhibitors
- Mannitol
Gabapentin
Choose from the following list which drug may cause post-renal failure by inducing retroperitoneal fibrosis:
- Bromocriptine
- Large doses of vitamin D
- Statins
- Gabapentine
- Paracetamol
- Frusemide
- ACE inhibitors
- Mannitol
Bromocryptin
Choose from the following list which drug may cause calcium stone formation:
- Bromocriptine
- Large doses of vitamin D
- Statins
- Gabapentine
- Paracetamol
- Frusemide
- ACE inhibitors
- Mannitol
Large doses of Vitamin D
What is the mechanism of renal injury when caused by laxative abuse?
- Afferent arteriolar vasoconstriction/ renal ischaemia
- Reduction in vasodilatory prostaglandins
- Dilatation of efferent arteriole
- Volume depletion
- Crystal formation
- Cast nephropathy
- Tubular obstruction
Volume depletion
What is the mechanism of renal injury when caused by ACE inhibitors?
- Afferent arteriolar vasoconstriction/ renal ischaemia
- Reduction in vasodilatory prostaglandins
- Dilatation of efferent arteriole
- Volume depletion
- Crystal formation
- Cast nephropathy
- Tubular obstruction
Dilatation of efferent arteriole
What is the mechanism of renal injury when caused by NSAIDs?
- Afferent arteriolar vasoconstriction/ renal ischaemia
- Reduction in vasodilatory prostaglandins
- Dilatation of efferent arteriole
- Volume depletion
- Crystal formation
- Cast nephropathy
- Tubular obstruction
Reduction in vasodilatory prostaglandins
What is the mechanism of renal injury when caused by radiocontrast agents?
- Afferent arteriolar vasoconstriction/ renal ischaemia
- Reduction in vasodilatory prostaglandins
- Dilatation of efferent arteriole
- Volume depletion
- Crystal formation
- Cast nephropathy
- Tubular obstruction
Afferent arteriolar vasoconstriction / renal ischaemia
Which of the following is useful in differentiating renal from pre-renal failure?
- Renal ultrasound scan
- eGFR
- Coronary angiography
- Urinary sodium
- Urinary Potassium
- Serum creatinine kinase
- Serum anion gap
- Urinary osmolarity
Urinary sodium
Which of the following may cause AKI in patients with renal disease?
- Renal ultrasound scan
- eGFR
- Coronary angiography
- Urinary sodium
- Urinary Potassium
- Serum creatinine kinase
- Serum anion gap
- Urinary osmolarity
Coronary angiography
Which of the following is safe to perform in patients with renal impairment to investigate obstruction?
- Renal ultrasound scan
- eGFR
- Coronary angiography
- Urinary sodium
- Urinary Potassium
- Serum creatinine kinase
- Serum anion gap
- Urinary osmolarity
Renal ultrasound scan
Which of the following values may be falsely low in patients with high muscle mass?
- Renal ultrasound scan
- eGFR
- Coronary angiography
- Urinary sodium
- Urinary Potassium
- Serum creatinine kinase
- Serum anion gap
- Urinary osmolarity
eGFR
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

Unilateral hydronephrosis
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

? Bilateral polycystic kidneys ?
(answer not in lecture)
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

Unilateral renal cell carcinoma
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

Unilateral renal stone
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

Soft tissue shadow in the renal pelvis with hydronephrosis
Choose the correct diagnosis for this image:
- Unilateral renal cell carcinoma
- Unilateral renal stone
- Unilateral hydronephrosis
- Normal kidney appearance
- Soft tissue shadow in the renal pelvis with hydronephrosis
- Bilateral renal artery stenosis
- Bilateral hydronephrosis
- Bilateral polycystic kidneys
- Right renal artery stenosis
- Bladder stone

Normal kidney
Rememver Ade; you have to know what normal looks like before you can recognise abnormal
From the list, what is the most likely cause of hypertension in a patient with normal sized kidneys on renal US, and a normal urine dipstick?
- Bilateral renal artery stenosis
- Essential hypertension
- Diabetic nephropathy
- Unilateral renal artery stenosis
- Pheochromocytoma
- Polycystic kidney disease
- Renal tumours
- Polyarteritis Nodosa
Essential hypertension
From the list, what is the most likely cause of hypertension in a patient with asymetrical kidneys and acute rise in serum creatinine after introduction of Candesartan (Angiotensin receptor blocker) ?
- Bilateral renal artery stenosis
- Essential hypertension
- Diabetic nephropathy
- Unilateral renal artery stenosis
- Pheochromocytoma
- Polycystic kidney disease
- Renal tumours
- Polyarteritis Nodosa
Bilateral renal artery stenosis
From the list, what is the most likely cause of hypertension in a patient with asymetrical kidneys with minimal/no change in serum creatinine after introduction of ACEI?
- Bilateral renal artery stenosis
- Essential hypertension
- Diabetic nephropathy
- Unilateral renal artery stenosis
- Pheochromocytoma
- Polycystic kidney disease
- Renal tumours
- Polyarteritis Nodosa
Unilateral renal artery stenosis
From the list, what is the most likely cause of hypertension in a patient with normal sized kidneys on USS, micro-aneurysms on fundoscopy?
- Bilateral renal artery stenosis
- Essential hypertension
- Diabetic nephropathy
- Unilateral renal artery stenosis
- Pheochromocytoma
- Polycystic kidney disease
- Renal tumours
- Polyarteritis Nodosa
Diabetic nephropathy
A 71 yrs male with a permanent ileostomy following pan colectomy (1999) for UC is being investigated for a recent onset weight loss. Following an oral barium study, he reported increased stoma output (>3 litres/ day), a previously normal s. creatinine was found to be 220 umol/l.
What is the aetiology of AKI here?
Pre-renal failure
A 76 yrs old female developed AKI post elective hip replacement. Preoperatively she was treated with normal saline (1 litre/12hrs), and a single dose of genatmicin 240mg.
What is the aetiology of AKI here?
Acute Tubular Necrosis
A 55 yrs female has completed a course of pevic readiotherapy for the treatment of advance cervical cancer. Two weeks later, she developed oliguria, urine test showed hematuria, S creatinine 350umol/l.
What us the aetiology of AKI here?
Obstructive uropathy
A 28year old male develops AKI with haematuria two weeks after a sore throat.
What is the aetiology of AKi here?
Glomerulonephritis
A 76 yrs old female developed AKI post elective hip replacement. Preoperatively she was kept nil by mouth for 36 hours. Fluid chart indicates she was given 1 litre normal saline during that period .
What is the aetiology of AKI here?
Pre-renal failure
Coose from the list the test that would establish the cause of renal injury in a 24-yr-old construction worker has sustained a construction accident. His thighs have been trapped under a pile of rubble for several hours. He arrived to the A& E with AKI & swollen right thigh.
- Plasma osmolaity
- MRA of the renal arteries
- Anion gap
- Plasma creatine phosphokinase
- Urinary Na
- Renal ultrasound scan
- Mesangial leucocytes & eosiniophil infiltration on renal biopsy
- Urinary sodium
- EDTA GFR
- Reciprocal serum creatinine
Plasma creatinine phosphokinase
Coose from the list the test that would establish the cause of renal injury in a 79-yr-old man with advanced prostatic carcinoma with extensive pelvic and retroperitoneal spread is admitted with high serum creatinine. Urinary catheter produced 75 mls in 6 hours. Urinalysis showed macroscopic haematuria.
- Plasma osmolaity
- MRA of the renal arteries
- Anion gap
- Plasma creatine phosphokinase
- Urinary Na
- Renal ultrasound scan
- Mesangial leucocytes & eosiniophil infiltration on renal biopsy
- Urinary sodium
- EDTA GFR
- Reciprocal serum creatinine
Renal US
Coose from the list the test that would establish the cause of renal injury in a 63 yrs male, with normal serum creatinine, started on Irbesartan (angiotensin receptor blocker) 150 mg/day for treatment of hypertension. 4 weeks later, routine tests showed serum creatinine 330, K 5.8.
- Plasma osmolaity
- MRA of the renal arteries
- Anion gap
- Plasma creatine phosphokinase
- Urinary Na
- Renal ultrasound scan
- Mesangial leucocytes & eosiniophil infiltration on renal biopsy
- Urinary sodium
- EDTA GFR
- Reciprocal serum creatinine
MRA renal arteries
Coose from the list the test that would establish the cause of renal injury in a 41 yrs male treated with amoxicillin for chest infection, two weeks later developed fever & a skin rash. Blood tests showed a serum creatinine of 250umol/l.
- Plasma osmolaity
- MRA of the renal arteries
- Anion gap
- Plasma creatine phosphokinase
- Urinary Na
- Renal ultrasound scan
- Mesangial leucocytes & eosiniophil infiltration on renal biopsy
- Urinary sodium
- EDTA GFR
- Reciprocal serum creatinine
Mesangial leukocytes & eosinophil infiltration on renal biopsy
What histopathological findings would you expect with a rapidly progressive glomerulonephritis?
- Eosinophils in the interstitium
- Normal renal histopathology
- Crescentic change in the bowman’s space
- Mitotic figures in the tubular epithelial nuclei
- Interstitial fibrosis
- tubular dilatation
- tubular epithelial cell loss
- neutrophils in the interstitium
- glomerular hypertrophy
Crescentic change to bowman’s capsule
What histopathological findings would you expect with acute interstitial nephritis?
- Eosinophils in the interstitium
- Normal renal histopathology
- Crescentic change in the bowman’s space
- Mitotic figures in the tubular epithelial nuclei
- Interstitial fibrosis
- tubular dilatation
- tubular epithelial cell loss
- neutrophils in the interstitium
- glomerular hypertrophy
Eosinophils in the interstitium
What histopathological findings would you expect with acute tubular necrosis?
- Eosinophils in the interstitium
- Normal renal histopathology
- Crescentic change in the bowman’s space
- Mitotic figures in the tubular epithelial nuclei
- Interstitial fibrosis
- tubular dilatation
- tubular epithelial cell loss
- neutrophils in the interstitium
- glomerular hypertrophy
Mitotic figures in the tubular epithelial nuclei
What histopathological findings would you expect with obstructive uropathy?
- Eosinophils in the interstitium
- Normal renal histopathology
- Crescentic change in the bowman’s space
- Mitotic figures in the tubular epithelial nuclei
- Interstitial fibrosis
- tubular dilatation
- tubular epithelial cell loss
- neutrophils in the interstitium
- glomerular hypertrophy
Tubular dilatation
Which drug combinations from the list may cause AKI with hyperkalaemia?
- Vitamin D & oral calcium
- Loop diuretic & calcium channel blockers
- Loop diuretic & thiazide
- Digoxin & nitrates
- Spironolactone & ACEI
- Digoxin & calcium channel blockers
- Betablockers and Calcium channel blockers
- Statins and cyclosporin
Spironolactone & ACEi
Which drug combinations from the list may cause AKI with hypercalcaemia?
- Vitamin D & oral calcium
- Loop diuretic & calcium channel blockers
- Loop diuretic & thiazide
- Digoxin & nitrates
- Spironolactone & ACEI
- Digoxin & calcium channel blockers
- Betablockers and Calcium channel blockers
- Statins and cyclosporin
VitD and oral calcium
Which drug combinations from the list may cause AKI with high CK?
- Vitamin D & oral calcium
- Loop diuretic & calcium channel blockers
- Loop diuretic & thiazide
- Digoxin & nitrates
- Spironolactone & ACEI
- Digoxin & calcium channel blockers
- Betablockers and Calcium channel blockers
- Statins and cyclosporin
Statins and Cyclosporin
Which drug combinations from the list may cause AKI with hyponatraemia?
- Vitamin D & oral calcium
- Loop diuretic & calcium channel blockers
- Loop diuretic & thiazide
- Digoxin & nitrates
- Spironolactone & ACEI
- Digoxin & calcium channel blockers
- Betablockers and Calcium channel blockers
- Statins and cyclosporin
Loop diuretic and thiazide