mock questions Flashcards
what is the gold standard investigations for kidney stones?
non-contrast CT KUB (kidney
ureter bladder)
. A 28-year-old gentleman presents to A&E with severe 9/10 intermittent abdominal pain. The
pain woke him from sleep last night around midnight and is felt on his right side as well as in
his testicles. When he went to the toilet he also noticed his urine was red. He is a non-smoker
and on observations he does not have a fever.
kidney stones
what defines CKD?
- eGFR <60mls/min/1.73m2 >3 months
what defines end stage renal failure?
eGFR <15
what is a potential side effect of tamsulosin?
postural hypotension
why might tamsulosin be perscribed?
for benign prostate hyperplasia
what is the commonest type of renal cell carcinoma?
clear cell
Robert, a 76-year-old gentleman, presents to his GP with urinary frequency, haematuria and
night sweats. He also reports 2 stone recent weight loss. DRE reveals hard craggy mass.
prostate cancer
what class of drug is goserelin?
GnRH agonist
what class of drug is tamsulosin?
alpha blocker
what are the risk factors for erectile dysfunction?
Psychological causes include stress, depression and poor relationship with partner. Physical
causes include cardiovascular disease, diabetes, trauma. Lifestyle causes include smoking,
alcohol, obesity. Radical prostatectomy is a common cause.
where / why is erythropoietin secreted?
in the kidneys, due to low RBC count
what complicates a UTI?
male, pregnancy, children under 2 months old, immunocompromised, recurrent UTIs, structural abnormalities
how might autosomal dominant polycystic kidney disease cause a SAH?
causes a berry aneurysm, ruptures causing a SAH
what is the gold standard investigation for renal colic?
Non-contrast CT kidney, ureter, bladder
what is the most common composition of renal stones?
calcium oxalate
why might a renal stone be made of ammonium phophate?
occurs in renal colic caused by proteus, klebsiella and
pseudomonas bacterial infections causing ammonia build-up in the urine
what is the second most common composition of renal stones?
calcium phosphate
why might a renal stone be made up of cystine?
rare and tend to occur in people who have rare genetic disorders that cause
cystine to leak from the kidneys into the urine
. A 45-year-old painter presents to the GP with blood in his urine. He says he has the urge to
go to the bathroom more been going to the bathroom more often than normal and there
isn’t any pain when he goes. He states he has noticed he has lost some weight over the
last few weeks without trying to, but he has been quite happy about that. What is the
most likely diagnosis?
bladder cancer - Painless haematuria is a strong suggestion of bladder cancer especially with changes to their bladder
habits. The patient is a painter also suggests this as exposure to azo dyes is a risk factor
what might someone with BPH present with?
nocturia
poor stream
post-micturition dribbling
urgency incontinence
what are some common bacterial causes of UTIs?
e.coli proteus mirabilis klebsiella pneumoniae staphlococcus saprophticus enterococcus
how is nephrotic syndrome defined?
Proteinuria (>3.5g/day) – damaged glomerulus more permeable → more protein come across
from blood into nephron → proteinuria
• Hypoalbuminaemia – albumin leaves blood
• Oedema (periorbital and arms) – oncotic pressure falls due to less protein in blood → lower
osmotic pressure → water driven out of vessels into tissues
• Hyperlipidaemia and lipiduria – loss of protein = less lipid synthesis → more lipids in blood →
more in urine
what component of U&Es should we be most concerned about in a patient with AKI?
potassium - When a patient with an AKI’s kidney function start failing, they are unable to excrete potassium.
When this happens, it causes a build-up in the blood and leads to hyperkalaemia which is a medical
emergency as it can result in a cardiac arrest
what the GFR in stage 1 CKD?
> 90 ml/min with evidence of renal damage
what is the GFR in stage 2 CKD?
60-89 ml/min with evidence of renal damage
what is the GFR in stage 3a CKD?
45-59 ml/min with or without renal damage
what is the GFR in stage 3b CKD?
30-44 ml/min with or without renal damage
what is the GFR in stage 4 CKD?
15-29 ml/min with or without renal damage
what is the GFR in stage 5 CKD?
<15 ml/min, established renal failure
what is furosemide?
a loop diuretic which acts on the ascending limb of the loop of Henle and
inhibits the NKCC2 channels
what is spironolactone or amiloride?
potassium sparing diuretic and they typically act on the distal convoluted
tubule
what is bendrodflumathiazide?
a thiazide which acts on the
sodium/chloride transporters and prevents them from functioning properly
what is the most common cause of AKI?
acute tubular necrosis - tubular epithelial cells of the kidneys
die impairing the kidneys ability to filter waste products, intrarenal cause
is hyper or hypovolaemia more likely to cause AKI?
hypovolaemia
how can nephrotoxins cause AKI?
intrinsic or renal AKI; the kidneys are directly damaged impairing their ability
to function
what are risk factors for CKD?
diabetes, CKD family history, old age, recurrent UTIs
what is the most common cause of pylonephritis?
e.coli from bowel flora
what can cause pylonephritis?
ecoli (most common) staphlococcus saprophyticus enterococcus klebisella proteus
what is the best investigation for the management of pylonephritis?
Midstream urine microscopy, culture and sensitivity
Alex, a 45-year-old builder presents to your GP with a 7-month history of recurring perineal
pain as well as pain and difficulty when passing urine. He says he needs to go to the toilet
many times a day which is starting to affect his work. On further questioning he reluctantly
tells you that he has also had some pain when ejaculating. Alex mentions a workplace
incident that he thinks might be related, where he fell from height and injured his hip close
to a year ago. You decide to carry out a digital rectal exam- you don’t think his prostate is
hard or irregular. What is the most likely diagnosis based on the history so far?
prostatis - Chronic prostatitis is
characterised by pelvic or perineal pain lasting longer than 3 months as the key symptom. Also
trauma causing nerve damage in the lower urinary tract is a risk factor for chronic prostatitis
. Lucy is a 30-year-old woman who is 2 months pregnant, as her GP you find that she has a
lower urinary tract infection and are considering which antibiotic to prescribe her. Which of
the following medications would you definitely avoid prescribing?
trimethoprim - teratogenic risk in the first trimester as it inhibits folate synthesis.
James is a 25-year-old male who recently tested positive for Chlamydia, he went to get
tested after he noticed pain on urinating and discharge from his penis. He is now quite
concerned as his eyes have turned red and his ankles and feet have become swollen. What can be used to describe his symptoms?
reiter’s syndrome - also known as reactive arthritis, is the classic triad of conjunctivitis, urethritis,
and arthritis occurring after an infection
. Ray, a 32-year-old gentleman with heterozygous polycystic kidney disease (PKD) presents
to the genetic counselling clinic. He informs you that his wife, who does not suffer from
PKD, is pregnant and that they are expecting their first child in 3 months time. What is the
likelihood that their newborn child will also have PKD?
50% - autosomal dominant inheritance
what are the complications of PKD?
CVD, kidney stones, polycystic liver disease, SAH
what testicular cancer secretes ALP?
testicular seminoma
how do uric acid stones appear on x-rays?
radiolucent (transparent)
what is a prognostically beneficial drug for prostate cancer?
finasteride = inhibits testosterone to dihydrotestosterone (prognostic benefit to prostate cancer)
at what age are children no longer classed as complicated UTIs?
over 2 months old
what treatment would you give someone who has had one attack of gout and is asking for prophylaxis?
give lifestyle advice
what treatment would you give as prophylaxis to someone who has had 2 attacks of gout?
allopurinol and Colchicine (as gout is more common at start of treatment so need this too), after 2 weeks, stop colchicine
how would you treat hypercalcaemia?
fluids, bisphosphonates, calcitonin
what would be a secondary differential for UTI symptoms with suprapubic pain?
cystitis - bladder
what are risk factors for UTI?
female, post menopausal, DM, catheter
what is the gold standard investigation for transitional cell carcinoma?
cystoscopy
what is goodpasture’s syndrome?
type II hypersensitivity reaction, positive against anti-glomerular basement membrane antibodies. Affects type IV collagen which is found both in the lung alveoli and the glomerulus. Biopsy finds deposits of IgA and IgG. The haemoptysis and haematuria can cause anaemia. Nephritic syndromes are characterised by haematuria, hypertension, proteinuria, oliguria, and uraemia. Can be pANCA positive
A 45-year-old man was seen by his GP when he started coughing and found small amounts of blood in his
sputum. On taking a history it was found that the patient had not been urinating very much in a day. The GP
decides to get a chest x-ray, take some bloods and do a urine dip.
The results are:
• CXR – interstitial pneumonia with patchy alveolar infiltrates – suggestive of bleeding sites.
• Urine dipstick – positive for blood and protein, negative to nitrates.
• Bloods – cANCA negative, pANCA positive, haemoglobin low, anti-Glomerular basement membrane
Antibodies positive, urea high, eosinophils normal
What is the most likely diagnosis?
good pasture’s syndrome
how is chlamydia treated?
doxycycline or azithromycin
how is gonorrhoeae treated?
azithromycin and ceftriaxone
what does ANCA positive mean?
autoimmune vasculitis
what would IgA nephropathy that is ANCA positive indicate?
vasculitis / Pauci-immune necrotising glomerulonephritis
how are ANCA positive patients treated?
corticosteroids and rituximab
where are the 3 most common places for renal stone formation?
Pelviureteric junction/ureteropelvic junction – where the renal pelvis connects to the ureter
Pelvic brim – where the ureter crosses over the pelvic brim and the bifurcation of the common iliac arteries
Vesicoureteric junction/ureterovesicular junction – where the ureter connects to the urinary bladde
what are the risk factors for renal stone formation?
dehydration, infection, hypercalcaemia, hyperoxaluria, hypercalciuria, hyperuricaemia, primary renal disease, drugs: diuretics, antacids, corticosteroids, aspirin, allopurinol, vitamin c, vitamin d; diet: chocolate, tea, strawberries, rhubarb; gout, family history, anatomic abnormalities that predispose to stone formation
how would someone reduced the likelihood of them getting renal stones?
maintain hydration, low calcium intake in the diet e.g. reduce levels of dairy, green leafy veg, fish where you eat the bone e.g. sardines and food with fortified flour , low salt diet e.g. reduce the levels of processed meat, ready meals, reduce animal protein intake, reduce BMI, be active/exercise
what is the triad of symptoms for pyelonephritis?
loin pain, fever, polyuria
what is the diagnostic test for pyelonephritis?
midstream urine sample with microscopy, culture and sensitivity
what type of bacteria is neisseria gonnorrhoea?
gram negative diplococci
what is henoch-schonlein purpura?
triad of rash, abdominal pain, arthritis/arthralgia and glomerulonephritis. It is more common in males aged 3-15 and occurs after at URTI
what collagen does alport’s syndrome affect?
IV
what is the first line treatment of pylonephritis?
cephalexin
what is the second most common cause of renal stones?
magnesium ammonia phosphate
what is prehn’s sign?
pain relived when lifting the scrotum, indicates epididymytis
what is the first line treatment of diabetic nephropathy?
ACEi
where does the left testicular vein drain into?
left renal vein
what is silenafil?
viagra - 5-alpha-reductase inhibitor
what parasite can cause bladder cancer?
Schistosomiasis
what is the triad of symptoms for renal cell carcinoma?
haematuria, flank pain, palpable mass
what can cause intrarenal CKD?
Glomerulonephritis / PKD / Drugs e.g NSAIDS/Lithium
what is the definition of erectile dysfunction?
Inability to maintain an erect penis long enough to achieve sexual satisfaction
what are the storage symptoms of a UTI?
Frequency, Urgency, Nocturia, Incontinence
what are the voiding symptoms of a UTI?
Poor stream, Hesitancy, Straining, Incomplete emptying, Terminal dribble
how is stress incontinance managed?
Non-Pharmacological: Pelvic Floor Exercises
Pharacological: Duloxetine
Surgical : Sling / Colposuspension / Artificial urinary sphincter
what race is at a higher risk of developing prostate cancer?
afro-carribean
what is the name of the pathogen causing chlamydia?
Chlamydia Trachomatis
how is syphalis treated?
azithromycin
what can kidney stones be composed of?
calcium, uric acid, cholestrol, stiruvate
what is the radiological treatment for kidney stones?
Ultrasound shock wave therapy or ultrasound shock wave lithotripsy
