Extras Sessions 9-12

Question 1

Primary cause for calcium-oxalate stones

Answer 1

Idiopathic hypercalciuria

Question 2

Which site is the normal site of prostatic cancer development

Answer 2

Adenocarcinomas, peripheral zone, enlargement only later causes urethral compression

D

Question 3

Extrinsic causes of ureteric obstruction

Answer 3

BPH, enlarged lymph nodes, primary bladder or rectal tumours

Question 4

Intrinsic causes of ureteric obstruction

Answer 4

Blood clots, Calculi, strictures

Question 5

Radiopaque lesion found in bladder region

Answer 5

Calcium containing stone- hypercalciuria

Question 6

Radiolucent region

Answer 6

Pure uric acid stone

Question 7

Urinary impact of AAA

Answer 7

Ureter entrapment

Ureter trapped by AAA causing unilateral hydronephrosis

Question 8

renal vein entrapment syndrome is associated with

Answer 8

Haematuria and proteinuria

Question 9

Which structure corresponds to A

Answer 9

Allantois

Future umbilical cord. Initially drains bladder, obliterated and becomes median umbilical ligament

Question 10

When is endoderm formed

Answer 10

Week 3 gastrulation

Question 11

What parts of the urogenital system are lined with endoderm

Answer 11

Allantois, cloaca, urinary bladder, hindgut, yolk sac

Question 12

The lower end of the mesonephric duct branches to form what

Answer 12

Ureteric bud

Single epithelial branch forms from each mesonephric duct

Part of early Metanephric formation

Question 13

Which components of the kidney are derived from the ureteric bud

Answer 13

Collecting system = ureter, renal pelvis, major and minor calyces, collecting tubules, collecting duct

Question 14

Bladder is a derivative of the

Answer 14

Hind gut

Question 15

What is the most common chief complaint related to UTIs in old men

Answer 15

Dysuria

Frequency and urgency

Question 16

Nitrofurantoin is not suitable if

Answer 16

UTI with prostate involvement

Question 17

E. Coli description

Answer 17

Gram negative aerobic bacilli

Question 18

Old man with catheter has gram positive cocci which is coagulase negative

Answer 18

Staphylococcus epidermis

Common with catheters

Question 19

Most likely pathogen in sexually active woman with coagulase negative coccus

Answer 19

Staphylococcus saprophyticus

Common after sex ‘honeymoon cystitis’, normal flora of female genital tract

Question 20

When a microbe is first introduced to the body a typical humoral primary response is characterised by release of which immunoglobulin

Answer 20

IgM

Question 21

urine with poly-morphonuclear leukocytes and WBC casts means

Answer 21

Infection probably in kidney, E. coli

Question 22

Which 2 places does PTH act to cause hypercalcaemia

Answer 22

Acts at the bone to increase bone mineralisation

Acts at kidneys to activate calcium channels in DCT, increase vit D formation, reduced phosphate, reabsorption in proximal tubule

Question 23

What happens to phosphate levels with PTH increases

Answer 23

Increased loss of phosphate in kidney

Question 24

Likely diagnosis in patient with parathyroid adenoma

Answer 24

Primary hyperparathyroidism

Low-normal phosphate, hyperparathyroidism

Question 25

What investigations confirm diagnosis of nephrotic syndrome

Answer 25

Hypoalbuminaemia and proteinuria

Question 26

What do GFR, electrolytes and urea show in nephrotic syndrome

Answer 26

Normal

Filtration can still occur and nephron still normal

Question 27

Why do you gain weight in nephrotic syndrome

Answer 27

Minimal change disease, albumin lost in urine, Hypoalbuminaemia, decreased oncotic pressure, less water in capillaries, more in insterstitium

Question 28

Explain hyperfiltration in diabetic nephropathy

Answer 28

Increased blood glucose, increased reabsorption of glucose in PCT coupled with Na reabsorption, reduction in delivery of Na to macula densa, RAAS = vasoconstrict efferent, increase hydrostatic pressure, increase GFR

Question 29

Which forces determine net filtration pressure in the glomerulus

Answer 29

Hydrostatic pressure of the tubule - (oncotic pressure of capillary + hydrostatic pressure of Bowman’s)

Question 30

Complications of stage 4 CKD

Answer 30

High blood pressure - ACEi, ARB, beta blocker, Ca2+ Channel blocker

Anaemia- IV if iron deficient, recombinant EPO

CKD bone and mineralisation disorder- vit D, lower phosphate in diet

Atherosclerosis- lifestyle, statins

Question 31

Signs and symptoms of uraemia

Answer 31

Cognitive dysfunction
Fatigue
Muscle cramps
Loss of appetite I

Question 32

Most likely cause of raised creatinine in old man

Answer 32

CKD

Increased creatinine, small kidneys, SOB, oedema

Question 33

Most appropriate diuretic for CKD

Answer 33

Loop diuretic - furosemide

Blocks NKCC co-transporter in thick ascending, decreased Na+ reabsorption, impairs corticopapillary gradient, less water reabsorbed from CD, more water lost in urine

Question 34

Most likely cause of raised creatinine in CKD

Answer 34

Pre renal AKI

Question 35

Management of pre renal AKI

Answer 35

Fluid resus, stop ACEi, treat volume depletion

Question 36

What is the typical prognosis with Polycystic kidney disease

Answer 36

Steadily progressive CKD

Question 37

Darker urine and atypical cells on cytology suggest

Answer 37

Urothelial carcinoma of renal pelvis

Question 38

3 peripherally located small cysts, a few oxalate crystals, likely diagnosis

Answer 38

Simple cortical cysts

(Not nephrolithiasis (kidney stone disease))