Genitourinary

Question 1

Rectal biopsy: apple-green positive birefringence when stained with Congo red and viewed under polarised light

Associated with chronic conditions, e.g.

• Sepsis (eg. TB)
• Inflammatory conditions (eg arthritides, RA)
• Malignancy

Answer 1

Renal amyloidosis

of the AA variant

Question 2

Cushing’s reflex

Answer 2

Hypertension
Bradycardia
Apnoea

Associated with raised intracranial pressure

Question 3

Sterile pyuria

• Definition
• Causes

Answer 3

Sterile pyuria is the presence of elevated numbers of white cells (>10 white cells/mm3) in urine which appears sterile using standard culture techniques.

A recently (within preceding two weeks) treated urinary tract infection (UTI) or inadequately treated UTI.
UTI with ‘fastidious’ organism (an organism that grows only in specially fortified artificial culture media under specific culture conditions) - eg, Neisseria gonorrhoeae.
Renal tract tuberculosis.
Chlamydial urethritis.
False negative culture due to contamination with antiseptic.
Contamination of the sample with vaginal leukocytes.
Interstitial nephritis: sarcoidosis (lymphocytes not neutrophils).
Urinary tract stones.
Renal papillary necrosis: diabetes, sickle cell disease, analgesic nephropathy.
Urinary tract neoplasm, including renal cancer and bladder cancer.
Polycystic kidneys.
Interstitial cystitis.
Prostatitis.
Kawasaki disease.
Other reported associations include appendicitis and systemic lupus erythematosus.

Question 4

Squamous cell carcinoma is associated with ? infection

Answer 4

Schistosomiasis

Endemic in Africa and the middle East

Question 5

What biochemical abnormality (U&E) will be seen in a haemorrhage, e.g. bleeding oesophageal and gastric varices

Answer 5

Raised urea

- Due to absorption of the protein from blood within the gut lumen; effectively a v. large protein meal

Question 6

Signs of uraemia

Answer 6

Nausea and vomiting
Hiccups 
Pericarditis 
Seizures
Decreasing levels of consciousness

Question 7

Common nephrotoxic drugs

Answer 7

NSAIDs

Antibiotics - gentamicin, vancomycin

Question 8

Symmetrical erosive polyarthropathy
Anti-Ro and anto-La antibodies
Vasculitic rash: hands and feet
Mixed cryoglobulinaemia

Answer 8

Sjogren’s syndrome

Classic triad: arthralgia, skin and renal involvement
Rx: steroids, cytotoxins +/- plasmapheresis

Question 9

Cryoglobulinaemia

Answer 9

Blood contains large amounts of cryoglobulins – proteins (mostly immunoglobulins themselves) that become insoluble at reduced temperatures.

Cryoglobulinemia is classically grouped into three types according to the Brouet classification.

Type I - Isolated monoclonal Ig
Most commonly encountered in patients with a plasma cell dyscrasia such as multiple myeloma or Waldenström macroglobulinemia.

Types II - immune complexes formed by monoclonal IgM
Associated with infective processes, e.g. CMW, HBV, HBC, EBV

Type III is strongly associated with autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis.

Question 10

Raised ESR
Lymphoplasmacytoid cells in bone marrow
Paraproteinaemia
Absence of hypercalcaemia or lytic lesions in bones

Answer 10

Waldenstrom’s macroglobulinaemia

Question 11

Nocturnal enuresis in childhood

Answer 11

Sickle-cell disease

Question 12

Crohn’s disease > small-bowel resection > predispose to what renal abnormality

Answer 12

Oxalate renal stones

Oxalate stones are due to excessive GI absorption of oxalate. Hyperoxaluria occurs in patients with small bowel resection, inflammatory bowel disease and other malabsorptive states. The increased intestinal fat binds dietary calcium, which is then unavailable to bind oxalate as usual. Therefore, increased oxalate absorption in large bowel (unabsorbed bile salts may aid this) occurs and
precipitates in the kidney. Increased oxalate can also occur in people who drink large amounts of tea, coffee, beer, chocolate and ethylene glycol overdose.

Question 13

Sensory and motor loss in limbs
Constipation
Incontinence
Known cancer diagnosis

Answer 13

Spinal cord compression

Incontinence is overflow incontinence secondary to a ‘neurogenic’/atonic bladder

Rx: surgical decompression of the cord

Question 14

Normal-pressure hydrocephalus

• Triad?
• Presents with ____

Answer 14

Confusion + incontinence + gait dyspraxia

Leads to falls

Patients have varying cerebrospinal fluid pressure through the day, with periods of high and normal pressure

CT head: dilated ventricles with relative sparing of the sulci

Rx: neurosurgical insertion of a ventriculo-periotneal shunt may improve symptoms

Question 15

Staghorn calculi is associated with which renal infection

Answer 15

Recurrent Proteus renal tract infection

- Causes alkalinisation of the urine > Ca precipitates > struvite stones

Question 16

Palpable purpura - LL and buttocks extensor surfaces
Flitting arthritis
Gut disturbance: colicky abdo pain + malaena
Glomerulonephritis

Answer 16

Henoch-Schonlein purpura

- Systemic variant of IgA nephropathy

Question 17

Severe uric acid nephropathy

Answer 17

Tumour lysis syndrome: massive tumour cell destruction

Question 18

Hereditary tubulointerstitial nephritis (ESRF) + Dead + ocular abnormalities

Answer 18

Alport’s sydnrome
- X-linked disorder
Accounts for 5% of childhood ESRF

Question 19

1. Pharyngitis, frank haematuria 24-48hrs after

2. URTI symptoms > haematuria 10-14 days after

Answer 19

1. IgA nephropathy

2. post-streptococcal GN

Question 20

Rectal biospy: apple-green positive birefringence when stained with Congo red and viewed under polarised light

Answer 20

Renal amyloidosis