other

Question 1

d. The paediatrician suspects Beckwith–Wiedemann syndrome.

This syndrome is associated with increased risk of which of the following childhood cancers?

Answer 1

Wilms’ tumor, a cancer of the kidney, is the most common cancer found in these children. Ninety five percent of Wilms’ tumors occur in Beckwith-Wiedemann syndrome or hemihypertrophy patients by age 7.

Question 2

what is beck with-wiedemann syndrome

Answer 2

Beckwith-Wiedemann syndrome is a genetic disorder commonly characterized by overgrowth.

macroglossia, hepatomegaly and renomegaly as well as a characteristic ear crease

Question 3

Where in the gastrointestinal tract is the majority of water absorbed?

Answer 3

jejunum

Question 4

bladder during uriantion what nerves and then again in holding urine

Answer 4

During urination, the detrusor muscle is contracted via parasympathetic branches from the pelvic splanchnic nerves

The bladder receives sympathetic innervation from the superior and inferior hypogastric plexuses

Question 5

normal cell lining of the bladder

Answer 5

The bladder is lined with transitional epithelia. This is a form of stratified epithelia which has a varying appearance based on bladder state. In an empty bladder, these cells are large and round. When these cells are stretched, due to bladder distension, they become much flatter. This property allows these cells to adequately cope with varying fluid levels. The cells also have a role in maintaining a barrier between the urine and the bloodstream

Question 6

signs of bladder cancer

Answer 6

Haematuria in an elderly male with a smoking history is an extremely worrying sign and may be due to bladder cancer

Question 7

penis drains to

Answer 7

deep inguinal

Question 8

drainage of spleen liver and pancreas

Answer 8

Superior mesenteric lymph nodes

Question 9

drainage to vulva or scrotum

Answer 9

Superficial inguinal lymph nodes

Question 10

amiodarone treat

Answer 10

gout or aarhyias

Question 11

hyper acute transplant rejection what hypesnesitivty

Answer 11

Hyperacute transplant rejection is a type II hypersensitivity reaction - a cytotoxic reaction that is caused by pre-existing antibodies to the ABO or HLA antigens. This causes widespread thrombosis and ischaemia/necrosis within the graft and requires surgical removal of the transplanted orga

Type I (allergic) hypersensitivity is an immediate IgE mediated hypersensitivity. This is a fast response that typically occurs in minutes. Examples include anaphylaxis.

Type III (immune complex) hypersensitivity is an IgM mediated hypersensitivity. Antibodies bind to soluble antigens, forming a circulating immune complex. This type of hypersensitivity is seen in systemic lupus erythematosus and hypersensitivity pneumonitis.

Type IV (delayed-type) hypersensitivity is a cell-mediated response that typically takes weeks to occur. This is seen in chronic graft rejections.

Type V (autoimmune) hypersensitivity is an IgG/IgM mediated reaction. The auto-antibodies bind to cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand. Type V hypersensitivity is seen in Graves’ disease and myasthenia gravis.

Question 12

at what range do the kidneys maintain systolic blood pressure re

Answer 12

between 80-100mg with little change to maintain perfusion as kidneys are sensitive to reduced perfusion

Question 13

The pelvic splanchnic nerves are the parasympathetic innervation for the bladder.

Answer 13

Sympathetic innervation of the bladder is from the hypogastric nerve plexuses.

The sympathetic nervous system regulates the process of urine storage in the bladder. In contrast, the parasympathetic nervous system controls bladder contractions and the passage of urine

Question 14

extreme anxiety, palpitations, and fear with associated sweating about twice a week for the past 6 months.

Answer 14

adrenaline

Question 15

what in the anion gap

Answer 15

The anion gap may be calculated by using (sodium + potassium) - (bicarbonate + chloride)
= (142 + 4.0) - (104 + 19) = 23 mmol/L

It is useful to consider in patients with a metabolic acidosis:

Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease

Causes of a raised anion gap metabolic acidosis
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use

Question 16

how does alhcol increase polyuria

Answer 16

Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria

Question 17

bleeding activates

Answer 17

renin-angiotensin system

Question 18

low blood pressure activates

Answer 18

renin angiotneion system

Question 19

when is EPO secreted

Answer 19

Erythropoietin is secreted by the kidney in response to cellular hypoxia.

Question 20

Progesterone to 11-deoxycorticosterone

Answer 20

21-hydroxylase

Question 21

Hypernatraemia
Rising haematocrit
Metabolic acidosis
Rising lactate
Increased serum urea to creatinine ratio
Urinary sodium <20 mmol/litre
Urine osmolality approaching 1200mosmol/kg

Answer 21

dehydration

Question 22

polycythaemia

Answer 22

increased Hb in blood

Question 23

A 54-year-old man who has end stage diabetic nephropathy is being assessed for a renal transplant. When assessing the HLA matching between donor and recipient what is the most important HLA antigen to match?

Answer 23

DR

The human leucocyte antigen (HLA) system is the name given to the major histocompatibility complex (MHC) in humans. It is coded for on chromosome 6.

Some basic points on the HLA system
class 1 antigens include A, B and C. Class 2 antigens include DP,DQ and DR
when HLA matching for a renal transplant the relative importance of the HLA antigens are as follows DR > B > A

Question 24

90% of bladder cancer are

Answer 24

transilitonal cell carcinoma present with persisitant heamtuia

Question 25

what viruses are associated with post transplant

unwell with jaundice, fatigue and arthralgia. On examination she has jaundice, widespread lymphadenopathy and hepatomegaly

Answer 25

Post transplant lymphoproliferative disorder is most commonly associated with Epstein-Barr virus. It typically occurs 6 months post transplant and is associated with high dose immunosupressant therapy. Remember cytomegalovirus presents within the first 4 weeks to 6 months post transplant.

Question 26

aldosterone does what

Answer 26

Stimulates the reabsorption of sodium from the distal tubules, with a consequant excretion of potassium

Question 27

sepsis increases acute phase proteins what are they

Answer 27

Acute phase proteins
CRP*
procalcitonin
ferritin
fibrinogen
alpha-1 antitrypsin
caeruloplasmin
serum amyloid A
serum amyloid P component**
haptoglobin
complement

albumin
transferrin
transthyretin cortisol binding protein
are not

Question 28

Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate?

Answer 28

insulin

Question 29

A 92-year-old female is brought into the emergency department following a fall at home. She was found by her neighbour and told the paramedics she had fallen 6 hours before but had been unable to get up due to osteoarthritis in her knees. Which blood test is it important to do in a patient who has had a long duration of time lying on the floor unable to move?

Answer 29

creatinine kinase

lead to hyperkalalmia

Question 30

Locoregional spread of bladder cancer is best determined using

Answer 30

pelvic MRI