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Year 2 Incorrect Questions > Renal > Flashcards

Renal Flashcards

1
Q

How is potassium affected in vomiting/dehydration?

A

Incr potassium secretion by beta cells of late distal tubule and collecting duct
- because low H+ causes alkalosis
- create K+ conc gradient

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2
Q

Which cells line prox and distal convoluted tubule?

A

Prox - simple cuboidal with microvilli
Distal - simple cuboidal cells

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3
Q

Management of CKD patient vomiting with low pH

A

Hypovolaemia -> metabolic acidosis
IV sodium chloride

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4
Q

Urine appearance indicating ATN

A

Muddy brown casts
- high fractional sodium excretion

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5
Q

What creatinine level indicates stopping ACE inhibitor?

A

More than 30% increase in creatinine in 2 weeks

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6
Q

Features of benign prostatic hypertrophy causing post-renal AKI

A

Urinary retention - tamsulosin
Worsening lower abdo pain
Tender suprapubic mass which is dull to percussion

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7
Q

First line investigation after urine dipstick in suspected nephrotic syndrome

A

Serum albumin

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8
Q

Describe features of HIV seroconversion illness

A

Pyrexia
Myalgia
Maculo-papular rash
(most common viral cause of FSGS)

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9
Q

Diagnostic investigation for nephrotic syndrome

A

Renal biopsy

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10
Q

Complication of membranous nephropathy causing flank pain and haematuria

A

Renal vein thrombosis

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11
Q

How to differentiate between post-strep GN and IgA nephropathy in patient with haem/proteinaturia after cold symptoms?

A

48h - IgA
Weeks - post-strep

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12
Q

Child with reclapsing minimal change disease and recurrent infections, why?

A

Loss of immunoglobulins in urine
- decr ability to fight infections

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13
Q

What drug should pt with high albumin:creat ratio be started on?

A

ACE inhibitor e.g. ramipril

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14
Q

Stage 2 of CKD

A

eGFR 60-89
Evidence of kidney damage e.g. haem/proteinuria

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15
Q

Inidication of chronic renal failure on US

A

Bilateral shrunken kidneys

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16
Q

Why does CKD cause CVD?

A

Accelerates atherosclerosis

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17
Q

Contraindication for erythropoietin therapy?

A

Iron-deficient anaemia

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18
Q

Flank pain, fever, urine positive for leucocytes, blood and nitrates?

A

Pyelonephritis

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19
Q

What type of stroke is associated with ADPKD?

A

Subarachnoid haemorrhage

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20
Q

Common complication of renal artery stenosis

A

Flash pulmonary oedema
- sudden fluid overload in lung interstitium
- due to solitary working kidney
- resolves in minutes

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21
Q

Why would you not prescribe ACEi in bilateral RAS?

A

Can completely switch of kidney filtration and perfusion

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22
Q

Which sided varicocoele is abnormal?

A

Right sided

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23
Q

Which parts of scrotum drain to which lymph nodes?

A

Testes - abdo and pelvic
Scrotal skin - inguinal

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24
Q

What part of prostate is affected by BPH?

A

Transitional

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25
Q

Which tumour marker is most commonly seen in seminomatous testicular cancer?

A

LDH

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26
Q

Which tumour marker is most commonly seen in seminomatous testicular cancer?

A

LDH

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27
Q

Which tumour marker is most commonly seen in seminomatous testicular cancer?

A

LDH

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28
Q

Limb weakness, difficulty in walking, sensory loss or bladder or bowel dysfunction are metastatic complications of which type of cancer?

A

Prostate cancer
- advanced disease usually metastasises to the spine

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29
Q

What is the cause of peripheral oedema assoc with renal cancer?

A

IVC obstruction
- not heart failure!!!!

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30
Q

Difficulty passing urine and 3 day history of transient visual loss could suggest which condition?

A

MS
- investigate with MRI head and spine

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31
Q

First line investigation of testicular lump?

A

Ultrasound of testes

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32
Q

Management of bacterial prostatitis

A

Oral Ciprofloxacin

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33
Q

How is creatinine clearance measured?

A

Cockcroft-Gault formula
- requires the following variables: age, gender, creatinine and weight.

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34
Q

What is the most likely mechanism of low vitamin D in CKD?

A

Reduced alpha hydroxylase 1 expression

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35
Q

Which antibiotic can increase creatinine?

A

Trimethoprim

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36
Q

Management of UTI in pregnancy with G6PD deficiency

A

Cefalexin

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37
Q

Recreational drug causing bladder inflammtion and haematuria

A

Ketamine

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38
Q

Antibiotic to treat UTI in pregnant person at term

A

Amoxicillin
- avoid nitrofurantoin due to neonatal haemolysis

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39
Q

Drug acting on kidney assoc with electrolyte loss

A

Loop diuretics e.g. furosemide
- avoid w digoxin, corticosteroids, aminoglycosides, any condition causing hypokalaemia

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40
Q

How do NSAIDs affect kidneys?

A

Afferent arteriole constriction

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41
Q

Low BP does what to aldosterone

A

Increases aldosterone secretion from mesangial cells

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42
Q

Signs of hyperkalaemia on ECG other than T wave changes

A

Wide QRS complexes, small/absent P waves, sinusoidal waveforms

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43
Q

What is hungry bone syndrome?

A

The result of a sudden drop in previously high parathyroid hormone levels, assoc with hypocalcaemia
- e.g. post-parathyroidectomy for chronic hyperparathyroidism

44
Q

How does penicillin cause AKI?

A

Acute interstitial nephritis

45
Q

Most important blood test to do in suspected rhabodomyolysis

A

Creatinine kinase

46
Q

Mesangial hypercellularity on histology suggests?

A

IgA nephropathy

47
Q

Imaging for locoregional spread of bladder cancer post-excision

A

Pelvic MRI

48
Q

Sore and swollen scrotum,urinary frequency and dysuria, history of unprotected sex?

A

Epididmo-orchitis

49
Q

Management of testicular torsion

A

Urgent surgical exploration with orchidoplexy fixation

50
Q

Management of HT in patient with IgA nephropathy

A

ACE inhibitor
- reduces proteinuria and rate of kidney disease progression

51
Q

Why does nephrotic syndrome increase risk of DVT?

A

The loss of proteins such as endogenous anti-coagulants like antithrombin III result in hypercoagulability, which can predispose patients to venous thromboembolic events

52
Q

FSGS on renal biopsy

A

Focal areas of mesangial collapse and sclerosis
- cresentic formations = rapidly progressive

53
Q

Anti-MPO antibodies with necrotising crescentic GN?

A

Microscopic polyangitis

54
Q

Goodpasture’s presents with antibodies against which type of collagen

A

Type IV collagen

55
Q

Investigation after urine in minimal change

A

Serum albumin

56
Q

Complication of nitrofurantoin assoc with SoB

A

Restrictive lung disease
- normal ratio, low FEV1 and FVC

57
Q

Most common cause of renal artery stenosis in young women

A

Fibromuscular dysplasia

58
Q

Stages of AKI

A

Stage 1: creatinine rise of 1.5x compared to baseline or urine output <0.5 ml/kg/hour for 6 hours.
Stage 2: creatinine rise of 2x compared to baseline or urine output <0.5 ml/kg/hour for 12 hours.
Stage 3: creatinine rise of 3x compared to baseline or urine output <0.3 ml/kg/hour for 24 hours (or anuria for 12 hours) or serum creatinine >354umol/dl

59
Q

Can’t pee, can’t see, can’t hear a bee?

A

Alport’s

60
Q

Presentation of acute interstitial nephritis

A

Delayed (2-40 days) picture of:
- rash, fever, acute kidney injury and eosinophilia after a triggering medication

61
Q

Most common PKD

A

Autosomal dominant mutation of PKD1

62
Q

Management of BPH of differing severity

A

Moderate - alpha-blocker e.g. tamsulosin
Mod-sevre - alpha blocker, 5-alpha reductase inhibitor (finasteride)

63
Q

Absolute indication for dialysis in ATN

A

A potassium level of 6.9mmol/L, with minimal response to insulin + dextrose treatment

64
Q

Management of kidney stones in patient with AKI and hydronephrosis

A

Percutaneous nephrostomy

65
Q

3+ protein on dipstick = ?

A

Approx 300mg

66
Q

Drugs to stop in AKI

A

DAMN
- Diuretics, ACEi/ARBs, Metformin, NSAIDs

67
Q

Dull to percuss mass in suprpubic area with stage 1 AKI may be caused by?

A

BPH

68
Q

What are kidney stones most commonly made of?

A

Calcium oxalate

69
Q

Subepithelial ‘humps’ on electron microscopy suggest?

A

Post-strep glomerulonephritis
- caused by lumpy immune complex deposits

70
Q

Oxalate nephropathy is seen in excess of which vitamin?

A

Vitamin C

71
Q

Which immune complexes are deposited in basement membrane in post-strep GN?

A

IgG, IgM, and C3.

72
Q

Patient on chemo for leukaemia most likely has kidney stones made out of…

A

Uric acid
- strongly associated with hyperuricaemia seen in diseases with high cell turnover (e.g. leukaemia)

73
Q

Urease-positive bacteria e.g. proteus can cause what type of kidney stones?

A

Ammonium magnesium phosphate (struvite)

74
Q

What class of drugs can decrease risk of kidney stones?

A

Thiazide diuretics

75
Q

What are the main causes of increased serum potassium/hyperkalaemia?

A

M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, haemolysis
I - Intake - Excessive
N - Nephrons, renal failure
E - Excretion - Impaired

76
Q

What type of GN is assoc with anti-phospholipase A2 antibodies?

A

Idiopathic membraneous GN

77
Q

Characteristic finding of amyloidosis

A

Deposition of light chain fragments
- in tissues including the kidneys, heart and peripheral nerves.

78
Q

Long QT secondary to hypocalcaemia can precede which heart disorder?

A

Torsades de Pointes

79
Q

Dialysis indications

A

Hypekalaemia over 7
Fluid overload
Acidosis less than 7.15
Urea over 40

80
Q

What happens when a patient is dialysed too much and too quickly?

A

Dialysis disequilibrium syndrome

81
Q

First line investigation of suspected local prostate cancer

A

Multiparametric MRI

82
Q

Management of undescended testes

A

Bilateral -immediate senior peds review to exclude CAH -> review at 3 months -> surgeons at 6m if still present
Unilateral- if at birth -> review at 6-8 weeks -> if still present then, review at 3 months -> if still present, refer to surgeons to be seen by 6 months

OPERATE AROUND 12 MONTHS

83
Q

WHich complication of prostatectomy can cause LUTS?

A

Urethral stricture
- prostatic urethra is divided and strictures can form at this anastomosis over time

84
Q

10 years post-HLA matched renal transplant presenting with direct nephrotoxicity (tubular atrophy and fibrosis), gum hypertrophy and hypertension?

A

Ciclosporin use

85
Q

Which electrolyte imbalance presenting with confusion and bradycardia can occur after TURP?

A

Hyponatraemia

86
Q

Cyclophosphamide assoc with new onset haematuria?

A

Haemorrhagic cystitis

87
Q

Management of epidydmitis secondary to STI?

A

M Ceftriaxone and PO Doxycycline
- covers gonorrhoea and chlamydia

88
Q

Side effect of tacrolimus

A

Tremor

89
Q

Differentiating between acute and chronic graft rejection

A

<6 months = acute
>6 months = chronic

90
Q

Appearance of transitional cell carcinoma

A

Macroscopically: multifocal with flat to papillary lesions. Microscopically: foci of squamous differentiation or extensive keratinization and intercellular bridges

91
Q

Appearance of transitional cell carcinoma

A

Macroscopically: multifocal with flat to papillary lesions. Microscopically: foci of squamous differentiation or extensive keratinization and intercellular bridges

92
Q

Most common bone complication following renal transplant

A

Avascular necrosis

93
Q

Contraindication to tamsulosin

A

Hypotension and postural hypotension

94
Q

Type of urinary incontinence caused by patient on loads and loads of pain meds e.g. amitriptyline and gabapentin

A

Functional incontinence
- can be due to opiates

95
Q

Stones assoc with gout

A

Uric acid

96
Q

Which part of the nephron is involved in SIADH presenting with confusion and hyponatraemia?

A

Incr water absorption in collecting duct

97
Q

Is renal stone search contrast or non-contrast CT?

A

Non-contrast

98
Q

Acute abdomen, peritonitis or renal stones - how is patient sitting with pain?

A

Peritonitis - still patient
Stones - writhing around

99
Q

Urological complication of tricyclic antidepressants e.g. amitriptyline

A

Urinary retention

100
Q

What testicular swelling can be a presenting factor of renal cell carcinoma?

A

Varicocele

101
Q

Pain management of renal colic

A

Diclofenac, either PR or IM

102
Q

Sterile pyuria is caused by…..

A

TB
UT stones
Partially treated UTI

103
Q

Bacteria causing perito dialysis peritonitis

A

Staph epidermidis

104
Q

FHx of brain bleeds with PCKD screening

A

MRA head every 5 years

105
Q

Causes of AIN

A

5P’s - pee (diuretics), pain (NSAIDs), penicillins (and cephalosporins), PPIs and rifamPin

106
Q

Investigation for TB urine

A

Early morning samples for mycobacterium

Year 2 Incorrect Questions (9 decks)

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