Renal

Question 1

What may green urine suggest?

Answer 1

Propofol
Amitryptiline

Question 2

What may red urine suggest?

Answer 2

Haematuria

Question 3

What may orange urine suggest?

Answer 3

Rifampicin

Question 4

What may black urine suggest?

Answer 4

Malignancy
Haemolysis (pre-renal AKI)

Question 5

What is the most dominant type of PKD?

Answer 5

ADPKD

85%

Question 6

How do you diagnose PKD?

Answer 6

US-Kidney

Question 7

How do you manage PKD?

Answer 7

Control hypertension e.g. Tolvaptan (vasopressin receptor 2 antagonist)

Question 8

What are the main risk factors for renal cell cancer?

Answer 8

Smoking
VHL Syndrome
Tuberous sclerosis

Question 9

How may RCC present?

Answer 9

Haematuria
Loin pain
Abdominal mass

PUO
weight loss

Varicocele (LHS)

Paraneoplastic syndrome - EPO, ACTH, PTHrp

Question 10

How is RCC managed?

Answer 10

Surgical management - Radical, Partial or Total nephrectomy

Question 11

What forms of congenital renal obstruction are you aware of?

Answer 11

Potters Syndrome

UPJ obstruction
Posterior urethral valves

Renal dysplasia

Renal hypoplasia

Horseshoe kidney

Question 12

What drugs should be stopped in AKI?

Answer 12

DAMN

Diuretics
ARBs/ACEi
Metformin
NSAIDs

Question 13

When should you refer to a nephrologist in an AKI?

Answer 13

Poor response to treatment Renal transplant
Complicated (ITU/GN/TN/Vasculitis/Cancer)
Stage 3
CKD 4<
RRT (AEIOU)

Question 14

What type of casts are seen in AKI?

Answer 14

Muddy brown casts

Question 15

What are the key differences between ATN and AIN?

Answer 15

ATN:
- Toxins
- Muddy brown casts
- Histology shows epithelial cells in collecting tubules and desquamation

AIN:
- Drugs
- Systemic disease

• Haematuria, Fever, rash and arthralgia
• AKI
• White cell casts
• Sterile pyuria

Question 16

What signs are present in a testicular torsion?

Answer 16

Abdominal pain
Elevated testes
Negative Cremasteric test
Negative Prehn’s Sign

Question 17

What are the causes of epididymo-orchitis?

Answer 17

Young: STI

Older: E.coli

Question 18

What are the clinical signs present in Epididymo-orchitis?

Answer 18

Unilateral testicular pain and swelling
Urethral meatus discharge
Elevation of testes relieves pain (

Question 18

What are the clinical signs present in Epididymo-orchitis?

Answer 18

Unilateral testicular pain and swelling
Urethral meatus discharge
Positive Prehn’s sign (Elevation of testes relieves pain)

Question 19

What may visualisation of a blue dot suggest on a background of acute onset testicular pain?

Answer 19

Hydatid of Morgagni Torsion

Question 20

How should you treat epididymoorchitis?

Answer 20

Empirical ABX: Ceftriaxone IM 500mg STAT + Doxycycline 100mg BDSPO 14/7

Question 21

What investigations may you wish to conduct in a patient presenting with erectile dysfunction?

Answer 21

Bloods: FBC, U+E, Lipids, CRP, Testosterone

Question 22

What are the risk factors for BPH?

Answer 22

Male

African

Question 23

Name the main storage symptoms.

Answer 23

FUN

Frequency
Urgency
Nocturia

Question 24

Name the main voiding (obstructive) symptoms.

Answer 24

Weak stream
Intermittency
Straining
Emptying

Question 25

What PSA level is considered raised?

Answer 25

Age-dependent however above 3 generally

Question 26

What else may raise PSA?

Answer 26

BPH
Prostatitis
Ejaculation
Vigorous exercise
Urinary retention
Instrumentation

Question 27

What is the most common cause of prostatitis?

Answer 27

E. coli

Question 28

What are the differences between a direct and indirect inguinal hernia?

Answer 28

Direct inguinal hernia protrudes through Hesselback triangle, passing medial to inferior epigastric artery

Indirect inguinal hernia passes lateral to the inferior epigastric artery

Question 29

What is the term for a hernia which cannot be reduced?

Answer 29

Incarcerated hernia

Question 30

Which proportion of hernias become strangulated?

Answer 30

1 in 500

Question 31

What are the symptoms of a strangulated hernia?

Answer 31

Pain
Fever
Erythema
SBO (N/V/distension)
Bowel ischaemia (bloody stools)

Question 32

What should you do with a strangulated hernia?

Answer 32

DO NOT manually reduce

This can cause generalised peritonitis

Question 33

What differentials exist for a potential femoral hernia?

Answer 33

Lymphadenopathy
Abscess
Femoral artery aneurysm
Hydrocele
Varicocele
Lipoma
Inguinal hernia

Question 34

How do you manage a hernia?

Answer 34

Refer to general surgery for a laparoscopic repair or open repair

Question 35

Should you use belts/ trusses for femoral hernias?

Answer 35

No, do not use in case of risk of strangulation

Question 36

How may a hydrocele present?

Answer 36

Soft, non-tender swelling of the semi-scrotum
Transilluminates with pen torch

Question 37

How do you manage a hydrocele?

Answer 37

Should resolve by 2 years old, otherwise conservative management and rule out underlying cause e.g. tumour

Question 38

What investigations would you do in a suspected UTI?

Answer 38

Urinalysis (if <65 years old)

±
MS+C
Bloods
CT-KUB
Ultrasound

Question 39

What are the indications to send for a MCS in suspected UTI?

Answer 39

Recurrent UTI (>3 in 12 mo.)
Men
Pregnant women
Haematuria
Child
Pyrexia

Question 40

What is the recommended management of UTI in women?

Answer 40

Trimethoprim;
Nitrofurantoin

Pregnant: Amoxicillin for 7 days

Question 41

What is the recommended management of UTI in men?

Answer 41

Trimethoprim; Nitrofurantoin

7 days