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EMQ questions Flashcards

1
Q

From the following list, choose the clinical limitations of measuring Serum Creatinine:

  1. Useful in investigating renal stone disease
  2. Useful in diagnosing renovascular disease
  3. Undergoes tubular secretion
  4. Invalid in patients on diuretics
  5. Disproportionately high in patients with dehydration
  6. Increased in those with high muscle mass
  7. Disproportionately low in patients with liver disease
  8. Used as a variable in MDRD eGFR equation
A
  1. Undergoes tubular secretion
  2. Increased in those with high muscle mass
  3. Used as a variable in MDRD eGFR equation
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2
Q

From the following list, choose the clinical limitations of measuring Intravenous Urogram:

  1. Useful in investigating renal stone disease
  2. Useful in diagnosing renovascular disease
  3. Undergoes tubular secretion
  4. Invalid in patients on diuretics
  5. Disproportionately high in patients with dehydration
  6. Increased in those with high muscle mass
  7. Disproportionately low in patients with liver disease
  8. Used as a variable in MDRD eGFR equation
A
  1. Useful in investigating renal stone disease
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3
Q

From the following list, choose the clinical limitations of measuring Urinary Sodium:

  1. Useful in investigating renal stone disease
  2. Useful in diagnosing renovascular disease
  3. Undergoes tubular secretion
  4. Invalid in patients on diuretics
  5. Disproportionately high in patients with dehydration
  6. Increased in those with high muscle mass
  7. Disproportionately low in patients with liver disease
  8. Used as a variable in MDRD eGFR equation
A
  1. Invalid in patients on diuretics
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4
Q

For Trimethoprim, choose the related adverse effects:

  1. Long term use may cause irreversible renal damage
  2. Reduces GFR by acting on efferent arteriole
  3. Increases plasma osmolality
  4. May cause acute tubular necrosis
  5. Hyponatremia
  6. May cause falsely high serum creatinine
  7. Hypernatraemia
  8. Hyperkalaemia
  9. hypokalaemia
A

May cause falsely high serum creatinine

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5
Q

What clinical diagnosis would give a frothy, foamy urine?

A

Nephrotic syndrome

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6
Q

What clinical diagnosis would give cloudy urine?

A

Acute pyelonephritis

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7
Q

What clinical diagnosis would give dark urine with red cell casts?

A

Acute post-streptococcal glomerulonephritis

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8
Q

What clinical diagnosis would give dark urine with no RBCs or red cell casts?

A

Rhabdomyolysis

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9
Q

What clinical diagnosis would give macroscopic haematuria with no red cell casts?

A

Bladder transitional cell carcinoma

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10
Q

Choose from the following list which drug can cause acute rhabdomyolysis:

  1. Bromocriptine
  2. Large doses of vitamin D
  3. Statins
  4. Gabapentine
  5. Paracetamol
  6. Frusemide
  7. ACE inhibitors
  8. Mannitol
A

Statins

(also cyclosporin & chloroquine)

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11
Q

Choose from the following list which drug requires reduction in patients with CKD:

  1. Bromocriptine
  2. Large doses of vitamin D
  3. Statins
  4. Gabapentine
  5. Paracetamol
  6. Frusemide
  7. ACE inhibitors
  8. Mannitol
A

Gabapentin

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12
Q

Choose from the following list which drug may cause post-renal failure by inducing retroperitoneal fibrosis:

  1. Bromocriptine
  2. Large doses of vitamin D
  3. Statins
  4. Gabapentine
  5. Paracetamol
  6. Frusemide
  7. ACE inhibitors
  8. Mannitol
A

Bromocryptin

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13
Q

Choose from the following list which drug may cause calcium stone formation:

  1. Bromocriptine
  2. Large doses of vitamin D
  3. Statins
  4. Gabapentine
  5. Paracetamol
  6. Frusemide
  7. ACE inhibitors
  8. Mannitol
A

Large doses of Vitamin D

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14
Q

What is the mechanism of renal injury when caused by laxative abuse?

  1. Afferent arteriolar vasoconstriction/ renal ischaemia
  2. Reduction in vasodilatory prostaglandins
  3. Dilatation of efferent arteriole
  4. Volume depletion
  5. Crystal formation
  6. Cast nephropathy
  7. Tubular obstruction
A

Volume depletion

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15
Q

What is the mechanism of renal injury when caused by ACE inhibitors?

  1. Afferent arteriolar vasoconstriction/ renal ischaemia
  2. Reduction in vasodilatory prostaglandins
  3. Dilatation of efferent arteriole
  4. Volume depletion
  5. Crystal formation
  6. Cast nephropathy
  7. Tubular obstruction
A

Dilatation of efferent arteriole

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16
Q

What is the mechanism of renal injury when caused by NSAIDs?

  1. Afferent arteriolar vasoconstriction/ renal ischaemia
  2. Reduction in vasodilatory prostaglandins
  3. Dilatation of efferent arteriole
  4. Volume depletion
  5. Crystal formation
  6. Cast nephropathy
  7. Tubular obstruction
A

Reduction in vasodilatory prostaglandins

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17
Q

What is the mechanism of renal injury when caused by radiocontrast agents?

  1. Afferent arteriolar vasoconstriction/ renal ischaemia
  2. Reduction in vasodilatory prostaglandins
  3. Dilatation of efferent arteriole
  4. Volume depletion
  5. Crystal formation
  6. Cast nephropathy
  7. Tubular obstruction
A

Afferent arteriolar vasoconstriction / renal ischaemia

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18
Q

Which of the following is useful in differentiating renal from pre-renal failure?

  1. Renal ultrasound scan
  2. eGFR
  3. Coronary angiography
  4. Urinary sodium
  5. Urinary Potassium
  6. Serum creatinine kinase
  7. Serum anion gap
  8. Urinary osmolarity
A

Urinary sodium

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19
Q

Which of the following may cause AKI in patients with renal disease?

  1. Renal ultrasound scan
  2. eGFR
  3. Coronary angiography
  4. Urinary sodium
  5. Urinary Potassium
  6. Serum creatinine kinase
  7. Serum anion gap
  8. Urinary osmolarity
A

Coronary angiography

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20
Q

Which of the following is safe to perform in patients with renal impairment to investigate obstruction?

  1. Renal ultrasound scan
  2. eGFR
  3. Coronary angiography
  4. Urinary sodium
  5. Urinary Potassium
  6. Serum creatinine kinase
  7. Serum anion gap
  8. Urinary osmolarity
A

Renal ultrasound scan

21
Q

Which of the following values may be falsely low in patients with high muscle mass?

  1. Renal ultrasound scan
  2. eGFR
  3. Coronary angiography
  4. Urinary sodium
  5. Urinary Potassium
  6. Serum creatinine kinase
  7. Serum anion gap
  8. Urinary osmolarity
A

eGFR

22
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

Unilateral hydronephrosis

23
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

? Bilateral polycystic kidneys ?

(answer not in lecture)

24
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

Unilateral renal cell carcinoma

25
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

Unilateral renal stone

26
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

Soft tissue shadow in the renal pelvis with hydronephrosis

27
Q

Choose the correct diagnosis for this image:

  1. Unilateral renal cell carcinoma
  2. Unilateral renal stone
  3. Unilateral hydronephrosis
  4. Normal kidney appearance
  5. Soft tissue shadow in the renal pelvis with hydronephrosis
  6. Bilateral renal artery stenosis
  7. Bilateral hydronephrosis
  8. Bilateral polycystic kidneys
  9. Right renal artery stenosis
  10. Bladder stone
A

Normal kidney

Rememver Ade; you have to know what normal looks like before you can recognise abnormal

28
Q

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?

  1. Bilateral renal artery stenosis
  2. Essential hypertension
  3. Diabetic nephropathy
  4. Unilateral renal artery stenosis
  5. Pheochromocytoma
  6. Polycystic kidney disease
  7. Renal tumours
  8. Polyarteritis Nodosa
A

Essential hypertension

29
Q

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) ?

  1. Bilateral renal artery stenosis
  2. Essential hypertension
  3. Diabetic nephropathy
  4. Unilateral renal artery stenosis
  5. Pheochromocytoma
  6. Polycystic kidney disease
  7. Renal tumours
  8. Polyarteritis Nodosa
A

Bilateral renal artery stenosis

30
Q

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?

  1. Bilateral renal artery stenosis
  2. Essential hypertension
  3. Diabetic nephropathy
  4. Unilateral renal artery stenosis
  5. Pheochromocytoma
  6. Polycystic kidney disease
  7. Renal tumours
  8. Polyarteritis Nodosa
A

Unilateral renal artery stenosis

31
Q

From the list, what is the most likely cause of hypertension in a patient with normal sized kidneys on USS, micro-aneurysms on fundoscopy?

  1. Bilateral renal artery stenosis
  2. Essential hypertension
  3. Diabetic nephropathy
  4. Unilateral renal artery stenosis
  5. Pheochromocytoma
  6. Polycystic kidney disease
  7. Renal tumours
  8. Polyarteritis Nodosa
A

Diabetic nephropathy

32
Q

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?

A

Pre-renal failure

33
Q

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?

A

Acute Tubular Necrosis

34
Q

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?

A

Obstructive uropathy

35
Q

A 28year old male develops AKI with haematuria two weeks after a sore throat.

What is the aetiology of AKi here?

A

Glomerulonephritis

36
Q

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?

A

Pre-renal failure

37
Q

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.

  1. Plasma osmolaity
  2. MRA of the renal arteries
  3. Anion gap
  4. Plasma creatine phosphokinase
  5. Urinary Na
  6. Renal ultrasound scan
  7. Mesangial leucocytes & eosiniophil infiltration on renal biopsy
  8. Urinary sodium
  9. EDTA GFR
  10. Reciprocal serum creatinine
A

Plasma creatinine phosphokinase

38
Q

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.

  1. Plasma osmolaity
  2. MRA of the renal arteries
  3. Anion gap
  4. Plasma creatine phosphokinase
  5. Urinary Na
  6. Renal ultrasound scan
  7. Mesangial leucocytes & eosiniophil infiltration on renal biopsy
  8. Urinary sodium
  9. EDTA GFR
  10. Reciprocal serum creatinine
A

Renal US

39
Q

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.

  1. Plasma osmolaity
  2. MRA of the renal arteries
  3. Anion gap
  4. Plasma creatine phosphokinase
  5. Urinary Na
  6. Renal ultrasound scan
  7. Mesangial leucocytes & eosiniophil infiltration on renal biopsy
  8. Urinary sodium
  9. EDTA GFR
  10. Reciprocal serum creatinine
A

MRA renal arteries

40
Q

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.

  1. Plasma osmolaity
  2. MRA of the renal arteries
  3. Anion gap
  4. Plasma creatine phosphokinase
  5. Urinary Na
  6. Renal ultrasound scan
  7. Mesangial leucocytes & eosiniophil infiltration on renal biopsy
  8. Urinary sodium
  9. EDTA GFR
  10. Reciprocal serum creatinine
A

Mesangial leukocytes & eosinophil infiltration on renal biopsy

41
Q

What histopathological findings would you expect with a rapidly progressive glomerulonephritis?

  1. Eosinophils in the interstitium
  2. Normal renal histopathology
  3. Crescentic change in the bowman’s space
  4. Mitotic figures in the tubular epithelial nuclei
  5. Interstitial fibrosis
  6. tubular dilatation
  7. tubular epithelial cell loss
  8. neutrophils in the interstitium
  9. glomerular hypertrophy
A

Crescentic change to bowman’s capsule

42
Q

What histopathological findings would you expect with acute interstitial nephritis?

  1. Eosinophils in the interstitium
  2. Normal renal histopathology
  3. Crescentic change in the bowman’s space
  4. Mitotic figures in the tubular epithelial nuclei
  5. Interstitial fibrosis
  6. tubular dilatation
  7. tubular epithelial cell loss
  8. neutrophils in the interstitium
  9. glomerular hypertrophy
A

Eosinophils in the interstitium

43
Q

What histopathological findings would you expect with acute tubular necrosis?

  1. Eosinophils in the interstitium
  2. Normal renal histopathology
  3. Crescentic change in the bowman’s space
  4. Mitotic figures in the tubular epithelial nuclei
  5. Interstitial fibrosis
  6. tubular dilatation
  7. tubular epithelial cell loss
  8. neutrophils in the interstitium
  9. glomerular hypertrophy
A

Mitotic figures in the tubular epithelial nuclei

44
Q

What histopathological findings would you expect with obstructive uropathy?

  1. Eosinophils in the interstitium
  2. Normal renal histopathology
  3. Crescentic change in the bowman’s space
  4. Mitotic figures in the tubular epithelial nuclei
  5. Interstitial fibrosis
  6. tubular dilatation
  7. tubular epithelial cell loss
  8. neutrophils in the interstitium
  9. glomerular hypertrophy
A

Tubular dilatation

45
Q

Which drug combinations from the list may cause AKI with hyperkalaemia?

  1. Vitamin D & oral calcium
  2. Loop diuretic & calcium channel blockers
  3. Loop diuretic & thiazide
  4. Digoxin & nitrates
  5. Spironolactone & ACEI
  6. Digoxin & calcium channel blockers
  7. Betablockers and Calcium channel blockers
  8. Statins and cyclosporin
A

Spironolactone & ACEi

46
Q

Which drug combinations from the list may cause AKI with hypercalcaemia?

  1. Vitamin D & oral calcium
  2. Loop diuretic & calcium channel blockers
  3. Loop diuretic & thiazide
  4. Digoxin & nitrates
  5. Spironolactone & ACEI
  6. Digoxin & calcium channel blockers
  7. Betablockers and Calcium channel blockers
  8. Statins and cyclosporin
A

VitD and oral calcium

47
Q

Which drug combinations from the list may cause AKI with high CK?

  1. Vitamin D & oral calcium
  2. Loop diuretic & calcium channel blockers
  3. Loop diuretic & thiazide
  4. Digoxin & nitrates
  5. Spironolactone & ACEI
  6. Digoxin & calcium channel blockers
  7. Betablockers and Calcium channel blockers
  8. Statins and cyclosporin
A

Statins and Cyclosporin

48
Q

Which drug combinations from the list may cause AKI with hyponatraemia?

  1. Vitamin D & oral calcium
  2. Loop diuretic & calcium channel blockers
  3. Loop diuretic & thiazide
  4. Digoxin & nitrates
  5. Spironolactone & ACEI
  6. Digoxin & calcium channel blockers
  7. Betablockers and Calcium channel blockers
  8. Statins and cyclosporin
A

Loop diuretic and thiazide

AKI (2 decks)

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