Nephrology

Question 1

Reasons for Dialysis

Answer 1

A - acidosis
E - electrolyte imbalance
I - intoxication
O - overload
U - uraemia

Question 2

Top causes of CKD

Answer 2

Diabetes, unknown, glomerulonephritis, HTn, pyelonephritis

Question 3

Causes of glomerulonephritis

Answer 3

IgA, HSP, SLE, anti GBM, Post strep, rapidly progressive GN,

Question 4

Trio glomerulonephritis

Answer 4

HTN, haematuria, low eGFR

Question 5

Causes Pre renal AKI

Answer 5

Hypoperfusion, RAS

Question 6

Causes Renal AKI

Answer 6

Tubular - ATN, drugs, contrast, myoglobinuria
Glomerular - autoimmunie (SLE),HSP, drugs, infections
Interstitial - drugs, infiltration (myeloma)
Vascular - vasculitis, malignant BP, thrombus

Question 7

IgA nephropathy

Answer 7

Nephritic - micro/ macro haematuria
Most common
young man, episodic
Increased IgA > complexes > deposit mesangial cells
renal biopsy as above
Control BP, immunosuppression
20% ESRF 20yrs

Question 8

HSP

Answer 8

small vessel vasculitis
purpura extensor surfaces
flitting polyarthritis, abdo pain
clinical diagnosis normally
or as iga biopsy showed, tx as iga 
if nephritis + nephrotic syndrome 50% > ESRF

Question 9

Anti GBM

Answer 9

autoantibodies type 4 collagen
lung > haemorrhage
nephritic syndrome
plasma exchange, steroids +- cytotoxics

Question 10

Post strep

Answer 10

nephritic syndrome
antigens deposit in glomerulus > host reaction > immune complexes
serology high ASOT
most recover

Question 11

rapidly progressive GN

Answer 11

ESRF days
biopsy - crescents glomeruli- immune complexes
aggressive immunosuppression

Question 12

Nephrotic syndrome

Answer 12

Proteinuria >3.5, oedema, hypoalbuminaemia, hypercholesterolaemia.
Minimal change, membranous nephropathy
Secondary - hep, SLE
children - MCGN - steroids
adults - biopsy
Tx - furosemide, ace I - reduce proteinuria, anticoagulate, statin, vaccines,

Question 13

Minimal change

Answer 13

Most common kids

Question 14

Membranous nephropathy

Answer 14

Most adults

diffuse thickening gbm

Question 15

Causes gout

Answer 15

Primary, relatives, thiazide, small dose aspirin, renal failure, myeloproliferative disorders, psorasis

Question 16

A blockers

Answer 16

Urinary retention
Doxa
Smooth muscle relaxation urethra
Hypotension

Question 17

Anti androgen

Answer 17

5 a reductase inhibitors

Finasteride

Question 18

Antimuscurinic

Answer 18

Oxybutynin
Detrusor muscle
Incontinence

Question 19

ED

Answer 19

Phosphodiesterase I type 5 > increase cGMP > relax smooth penile muscles
Sildenafil

Question 20

CKD classes

Answer 20

1 - >90
2 - 60-90
3a 45-60
3b 30-45
4 - 15-30
5 <15

Question 21

CKD - when to refer to nephrology

Answer 21

ACR >70

ACR > 30 + haematuria (or lower if other factors)

Question 22

ACR cateogories

Answer 22

A1 - <3
A2 - 3-30
A3 - >30

Question 23

UTI < 3 months

Answer 23

Refer paeds urgent

Question 24

UTI in children investigations

Answer 24

< 6 months - US

> 6 months - recurrent or atypical

Question 25

Haematuria 2WW

Answer 25

>45 visible | >60 non visiblie + raised WCC/ dysuria

Question 26

Abx for UTI in pregnancy

Answer 26

Tx any bacturia for 7/7 Nitro (not close to end) Amox Not trimeth

Question 27

LUTs in men - voiding issues

Answer 27

IPSS moderate - a blocker BPH - finasteride Mixed storage/ voiding - persist after a blocker - try antimuscurinic

Question 28

OAB treatment

Answer 28

``` Urine containment products Supervised bladder training Antimuscurinic Oxybutynin (IR) - not if frail Tolterodine (IR) Darifenacin (OD) Mirabegron ```

Question 29

Nocturnal Polyuria

Answer 29

Lifestyle Furosemide 40mg afternoon Urology

Question 30

Tumour markers in testicular cancer

Answer 30

LDH, AFP, sometimes HCG

Question 31

Epidydimal cyst

Answer 31

Separate from testicle, posterior Common US if unsure

Question 32

Hydrocoele

Answer 32

``` accumulation of fluid in the tunica vaginalis anterior below attached to testes Infantile - repair if > 1year Adult - US exclude tumour ```

Question 33

Epididymo orchitis

Answer 33

Norm STIs, > 35 coliforms Painful - r/o torsion Cef + doxy

Question 34

Varicocele

Answer 34

``` Bag of worms Infertility Dull ache USS doppler Think RCC ```

Question 35

Oxalate stones

Answer 35

cholestyramine and pyridoxine reduce urinary oxalate secretion

Question 36

Uric acid stones

Answer 36

Allopurinol/ bicarb

Question 37

Medical indications for circumcision

Answer 37

phimosis recurrent balanitis balanitis xerotica obliterans paraphimosis