Medicine Tips 2

Question 1

Haemolytic uraemic syndrome

Answer 1

Triad of acute renal failure, microangiopathic haemolytic anaemia and thrombocytopenia
Causes - E. coli 0157:H7, tumours, pregnancy, SLE, HIV, ciclosporin, COCP
Ix - FBC (anaemia, thrombocytopaenia, fragmented blood film), U&Es (AKI), stool culture
Mx - supportive (fluids, blood transfusion, dialysis)

Question 2

Nephritic syndrome

Answer 2

Haematuria, oliguria and hypertension

Rapidly progressive glomerulonephritis, IgA nephropathy

Question 3

Nephrotic syndrome

Answer 3

Proteinuria, oedema and hypoalbuminaemia

Minimal change disease, membranous glomerulonephritis, focal segmental glomerulonephritis

Question 4

Fibromuscular dysplasia

Answer 4

Renovascular disease in young people

Hypertension that is resistant to treatment and a declining renal function

Question 5

Mixed nephritic and nephrotic syndrome

Answer 5

Haematuria, hypertension, protienuria and oedema

Diffuse proliferative glomerulonephritis, membranoproliferative glomerulonephritis

Question 6

Rapidly progressive glomerulonephritis

Answer 6

AKA Crescentic glomerulonephritis
Rapid onset, often presents as AKI
Causes - Goodpasture’s, ANCA positive vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis)

Question 7

IgA nephropathy

Answer 7

Young adult with haematuria following an URTI

Question 8

Diffuse proliferative glomerulonephritis

Answer 8

Post-streptococcal glomerulonephritis
Most common form of renal disease in SLE
Presents as nephritic syndrome/AKI

Question 9

Membranoproliferative glomerulonephritis

Answer 9

Type 1: cryoglobulinaemia, hepatitis C

Type 2: partial lipodystrophy

Question 10

Minimal change disease

Answer 10

Child with nephrotic syndrome
Causes - Hodgkin’s, NSAIDs
Good response to steroids

Question 11

Membranous glomerulonephritis

Answer 11

Presents with proteinuria/nephrotic syndrome/CKD
Causes - infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop CKD

Question 12

Focal segmental glomerulosclerosis

Answer 12

Idiopathic or secondary to HIV, heroin

Presents with proteinuria/nephrotic syndrome/CKD

Question 13

Hyperkalaemia management

Answer 13

ECG - prolonged PR segment, broad QRS complex, flattened P wave, tented T wave
10mL of 10% calcium chloride + 10 units of IV actarapid & 25g IV glucose + calcium resonium with lactulose 15g tds

Question 14

Fractional sodium excretion

Answer 14

(urine sodium/plasma sodium) / (urine creatinine/plasma creatinine) x 100

Question 15

Fractional urea excretion

Answer 15

(urine urea /blood urea ) / (urine creatinine/plasma creatinine) x 100

Question 16

Pre-renal uraemia

Answer 16

Urine sodium	- <20mmol/L
Fractional sodium excretion	- <1%
Fractional urea excretion - <35%
Urine:plasma osmolality - >1.5
Urine:plasma urea - >10:1
Specific gravity - >1020
Urine - 'bland' sediment
Response to fluid challenge	- Yes

Question 17

Acute tubular necrosis

Answer 17

Urine sodium	- >30mmol/L
Fractional sodium excretion	- >1%
Fractional urea excretion - >35%
Urine:plasma osmolality - <1.1
Urine:plasma urea - <8:1
Specific gravity - <1010
Urine - brown granular casts
Response to fluid challenge	- No

Question 18

Primary open-angle glaucoma

Answer 18

Slow rise in intraocular pressure, visual field defect, optic disc cupping, hazy cornea, sees haloes, semi-dilated pupil
Mx - prostaglandin analogues (latanoprost), beta-blockers (timolol), alpha2-adrenoceptor agonist (brimonidine), carbonic anhydrase inhibitors (dorzolamide), muscarinic receptor agonist (pilocarpine)