Nephrology/urology

Question 1

How does nephroblastoma (Wilma tumour) develop

Answer 1

Usually in 2-4 y/o

When glomeruli is forming in the embryo sometimes some cells are left over and they can turn into a tumour

Question 2

Most common sites of metastasis for nephroblastoma?

Answer 2

Bones
Lungs
Lymph nodes
Liver
Brain

Question 3

What values of creatinine and urea are characteristic of an AKI

Answer 3

Increase in serum creatinine by >26.5mol/l in 48 hr
OR
increase in serum creatinine by >1.5x the baseline within the last 7 days
OR
Urine volume <0.5ml/kg/h for 6 hours

Question 4

Which medications should be stopped during an AKI?

Answer 4

DAMN drugs

Diuretics
Ace inhibitors/ARB
Metformin/ methotrexate
NSAIDS

ACE inhibitors prevent angiotensin 2 from forming which vasoconstricts the efferent areteriole more than the afferent leading to increased GFR pressure

Question 5

What is the first line treatment for minimal change disease

Answer 5

Prednisolone as it has anti inflammatory properties and reduced the inflammation and permeability of the epaffected podocytes

Question 6

What commonly causes primary hyperparsthyroidism

Answer 6

A problem with the gland itself e.g.

Parathyroid gland adenoma
Hyperplasia (enlargement or increased cell reproduction rate) of all 4 glands
Parathyroid carcinoma

Question 7

What commonly causes secondary hyperparathyroidism

Answer 7

Vitamin D deficiency (as vit D exerts negative feedback on PTH)
Loss of extra cellular ca
Ca malabsorption
Abnormal parathyroid activity
Inadequate ca intake

Tertiary occurs after prolonged secondary or after conditions like CKD

Question 8

What is the relationship between phosphate and parathyroid

Answer 8

PTH decreases phosphate re absorption at the Pct
Phosphate ions in serum form insoluable salts with calcium causing decreased serum ca

Therefore the reduction of phosphate ions results in more ionised ca in blood

Question 9

What is type 1 renal tubular acidosis

Answer 9

RTA is a series of disorders characterised by impaired acid handling which manifests as a normal anion gap metabolic acidosis with maintained renal function

Type 1 ( distal) is characterised by the collecting ducts inability to excrete H+ ions leading to hypokalaemia hyperchloraemic metabolic acidosis

Management with urine alkalisation with potassium citrate or sodium bicarbonate

Question 10

What is the most common type of prostate cancer

Answer 10

Adenocarcinoma

Question 11

Smoking, exposure to aniline dyes, rubber manufacture and cyclophosphamide are risk factors for what type of cancer

Answer 11

Transitional cell carcinoma of the bladder

Question 12

What is the management of protein urea in CKD patients

Answer 12

ACE inhibitors or ARBs - first line in patients with coexist at hypertension and CKD I’d albumin:creatinine >30/3
If >70 they are indicated regardless of BP

SGLT-2 inhibitors - block reabsorption of glucose in PCT

Question 13

What test is performed in a diabetic review to test for diabetic nephropathy

Answer 13

Early morning specimen albumin:creating ration (ACR)

Question 14

In patients with ADPKD what medication is said to help slow the progression of CKD and renal insufficiency

Answer 14

Tolvaptan - a vasopressin receptor 2 antagonist is first line

Question 15

When is nephrostomy tube insertion indicated for renal stones over shockwave lithotripsy

Answer 15

Patients with obstructive urinary calculus (hydronephresis) and signs of infection require urgent renal decompression and I’ve antibiotics.

Hydroneohresis is dilation of the renal pelvis due to obstruction of urine

Question 16

What is the initial management for renal colick and further management

Answer 16

IM diclofenac (an NSAID), if contraindicated e.g. upper GI bleed then IV paracetamol is indicated

Then if stone is <5mm and asymptomatic then watch and wait
Then shockwave if <10
10-20 - shockwave or uteroscopy
If >20 mm percutaneous nephrolithotomy

Question 17

Why do are you more susceptible to clots when you have nephrotic syndrome

Answer 17

You are peeing out all your proteins including the ones that help to make blood clots e.g. antithrombin III

Also loosing IGs proteins so at risk of infections also

Question 18

How to manage nephrotic syndrome?

Answer 18

Manage symptoms first e.g. If fluid overloaded manage with it furisomide

But always biopsy to see what’s causing it and the give steroids after x

Question 19

What are the 2 week wait guidelines for haematuria?

Answer 19

Ages >45 AND unexplained visible haematuria without UTI/ persistent visible haematuria post UTI

Aged >60 AND unexplained visible haematuria with dysuria/ raised WCC

RAISED PSA in men with visible haematuria

Question 20

What does aldosterone do and what does is cause to be excreted

Answer 20

It works on your DCT to reabsorb Na Cl from solute to blood to help retain water and increase blood pressure

By doing this is excretes water therefore when giving antihypertensives you will retain potassium

Question 21

What is a common side effect if CCB

Answer 21

Leg swelling thought to be due to CCBs dilating the arteries which then causes intracapillary hypertension and fluid retention

Question 22

What is a common side effect of aldosterone antagonist

Answer 22

Hyperkalaemia
Gynacoemastia

Question 23

What is th equation for an anion gap? And what is considered high

Answer 23

Positive ions - negative ions

(Na+ + k+) - (cl- + HCO3)

> 18 is high below that is normal

Question 24

What are the causes of a high anion gap (acidosis)

Answer 24

M ethanol
U remia
D KA
P aracetamol
I Ron, isoniazid - (potent antibiotic used to treat TB)
L actate
E thanol
S alicylate e.g. aspirin

Question 25

Causes of normal anion gap acidosis ( bicarbonate loss)

Answer 25

H yperchloraemia
A ddisons ( adrenal insufficiency/ low cortisol)
R TA (renal tubular acidosis )
D iarrhoea
A cetazolamide (glaucoma treatment by excreting bicarbonate)
S piro (potassium sparing diuretic)
S Aline

Question 26

What is associated with IGA nephropathy

Answer 26

Happens few days after URTI
associated with Cole is disease and henloch- shonlein purpura ( condition that causes small blood vessels to become inflamed and bleed)

Question 27

What are some causes of membranous glomeruloneohritis

Answer 27

Presents with protinuria, nephrotic syndrome, ckd

Causes can be primary, infections such as hep b, drugs, autoimmune but commonly associated with malignancy

Question 28

What is rhabdomylisis and how can you tell if this is indicated

Answer 28

Serums condition where damage to your muscles occur and the tissues release it’s proteins and electrolytes into the blood which can damage the heart and kidneys

If patient is lying on floor for hours like 12 hours it’s usually rhapsodic in exam but CK has to be in the thousands >5000

Question 29

AKI, anaemia and low platelets are characteristic of what 2 kidney conditions

Answer 29

HUS - haemolytic ureamic syndrome- inflammation of blood vessels which can damage and form clots that damage heart and kidneys. Typically occurs after someone has had diarrhoea or infection with E. coli

TTP- thrombotic thrombocytopenia with purpura - rare blood coagulation disorder typically affecting women in 40s

All supportive management don’t give platelets !!!

Question 30

What’s an example of anticholinergics/ antimuscarinks and what are their side effects

Answer 30

Oxybutinin

Side effects include: dry mouth , dilated pupils/ blurred vision