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Question 1

Causes of SIADH

Answer 1

CNS - trauma, stroke, haemorrage, infection
Pulmonary- pneumonia, ARDS, pneumothorax
HIV
drugs - SSRIs, chemotherapy, MAOIs, TCAs, haloperidol, carbamazepine, amiodarone
Malignancy - small cell lung ca, rarely head and neck

Question 2

Where do aminoglycosides damage the kidneys and what time course?

Answer 2

Affect proximal and distal tubular cells and you lose concentrating ability
Typically non oliguric
Occurs 5-7 days after drug given
Improves after ~21 days as tubular cells regenerate

Question 3

Risk factors for amino glycoside related ATN

Answer 3

Prolonged duration of treatment
Older age
Co morbid disease eg diabetes, leukemia
Sepsis
Other nephrotoxic drugs

Question 4

Criteria for SIADH

Answer 4

Euvolaemic
Low serum Na
Low serum osmolality less than 275
Raised urine osmolality greater than 100
Urinary sodium greater than 40

Question 5

What organisms are responsible for CAPD peritonitis

Answer 5

Gram positive (staph aureus and coagulate neg staph) in 50%
Other: gram negative (15%), fungal, mycobacterium

Question 6

Empiric treatment for CAPD peritonitis

Answer 6

Cover gram positives - vancomycin or first gen cephalosporin eg cephazolin or cephalexin
Cover gram negatives - gentamicin or third gen cephalosporin eg cefepime or ceftazidime

Question 7

Indications for removal of CAPD catheter in peritonitis

Answer 7

Fungal or mycobacterial peritonitis
Relapsing peritonitis - occur within 4 weeks of previous infection
Refractory peritonitis - no improvement after 5 days of antibiotics
Catheter site infections
Intrabdominal pathology

Question 8

What does growth of multiple enteric organisms (or both gram negative and gram positive bugs) in PD fluid indicate

Answer 8

Possible intra-abdominal pathology

Question 9

Extra-renal manifestations of polycystic kidney disease?

Answer 9

Cerebral aneurysm - 5-20%, more likely to rupture if greater than 7mm
Hepatic cysts - 10-20% in 30y, 50-70% in over 60y
Pancreatic cysts -7-10%
Cardiac - mild MR and AR
Diverticula disease
Hernias

Question 10

What are the causes of nodular glomerulosclerosis?

Answer 10

diabetic nephropathy (Kimmelsteil Wilson nodules)
light chain nephropathy
amyloidosis
Lupus nephropathy
Primary GN - membranous, FSGS, MPGN

Question 11

How does amyloid stain on biopsy?

Answer 11

Postive congo red stain