Lecture 23 - Revision

Question 1

Read the first SAQ1 text and investigations:

Answer 1a:

Answer 1

Parathyroid glands do be big since they are secreting excess PTH

At high serum calcium they should not be making PTH

Question 2

SAQ1 Question 1B:

Answer 2

PTH acts at bone to stimulate osteoclast activity increasing bone resorption to increase Ca2+ levels

PTH acts at the kidneys to increase the excretion of phosphate and resorption of calcium in the DCT via calcium channels

Question 3

SAQ 1:

1C

Answer 3

Increased PTH cause increased loss of phosphate in kidney

Question 4

SAQ 1
1D

Answer 4

Primary hyperparathyroidism

Parathyroid adenoma results in high calcium levels leading to stones forming

Question 5

What is the saying to remember the signs/symtpoms of Hypercalcaemia?

Answer 5

Bones, thrones, groans, stones and psychic moans

Question 6

What are the features of of Hypercalcaemia (bones, stones, thrones, groans and psychic moans)?

Answer 6

Bone pain
Fragility fractures
Renal calculi
Polyuria
Constipation
Confusion
Fatigue
Abdo pain
Pancreatitis

Question 7

In primary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?

Answer 7

Ca2+ high
PTH high
Phosphate low

Question 8

In secondary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?

Answer 8

PTH high
Ca2+ low
Phosphate low

Question 9

In tertiary Hyperparathyroidism , what are the levels of Ca2+, PTH and PO4(3-)?

Answer 9

When secondary parathyroid is unctreaeed

Low phosphate
PTH high
Ca2+ high

Question 10

SAQ 2

2A

Answer 10

STAGE 2

(Creatinine has doubled)

Question 11

SAQ 2

2b

Answer 11

240ml/8 = 30
30/64 = 0.47ml/h/kg

Stage 1 AKI

Question 12

SAQ 2

2C

Signs and symptoms of uraemia:

Answer 12

Confusion
Nausea
Itchy
Muscle weakness
Bone pain
Heart palpitation
Anxiety

Question 13

SAQ 2
2D

As well a uraemia, what other complications can an AKI develop to?

Answer 13

Fluid overload
Acidosis (can’t filter blood so H+ build up)
Hyperkalaemia

Question 14

SAQ 2
2e

Look at CT:

Answer 14

Right hydronephrosis + hydroureter

Question 15

SAQ 3:

3a

Answer 15

Renal cell carcinoma

Question 16

SAQ 3

3B
Which part of the tubule is the renal cell carcinoma most likely to have arisen from?

Answer 16

Proximal Covulted Tubule

PCT is mst common location for RCC

Question 17

SAQ 3

3c

Common risk factors for RCC

Answer 17

Obesity
Hypertension
Smoking

Dialysis

Question 18

How can small and larger RCC be treated?

Answer 18

Small = partial nephrectommy

Larger = radical nephrectomy (remove kidney, perinephric fat, adrenal gland and ureter)

Question 19

What increases the risk of developing squamous cell carcinoma of the bladder (rare)?

Answer 19

Anything that stimulates chronic inflammation of the bladder:

Neurogenic bladder
Renal stones
Schistosomiasis

Question 20

What part of the prostate does prostate cancer usually arise?

What about BPH?

Answer 20

Prostate cancer = peripheral zone

BPH = central transitional zone

Question 21

Why do patients with prostate cancer have lower back pain?

Answer 21

Most commonly metastasises to bone like the spine

Question 22

How would you treat a small renal cancer?

Large renal cancer treatment?

Answer 22

Small = partial nephrectomy
Large = radical nephrectomy

Question 23

Why can patients with metastatic renal cell carcinoma perestn with Hypercalcaemia?

Answer 23

Can produce PTH related peptides which inc osteoclast activity increasing bone resorption

Also increases kidneys resorption of Ca2+ and excretion of PO4(3-)

Question 24

What are some signs and symptoms of Hypercalcaemia?

Answer 24

Bones, thrones, groans, stones and psychic moans

Confusion
Abdominal pain
Vomiting
Depression
Polyuria
Bone pain and fragility fractures
Constipation