Renal Flashcards
22 year old male reviewed in outpatient clinic following admission with change in mood and inappropriate behaviour. Initial bloods revealed elevated liver function tests, low serum copper levels and high urinary copper levels. Slit lamp shows evidence of kayser flies her rings. His doctor suspects Wilson’s disease and a genetic screening has confirmed the presence of the mutant ATP7B gene. What treatment should be commenced?
Penicillamine
This is first line for the treatment of Wilson’s disease. It binds to copper and facilitates increased urinary excretion.
A 4 month old male infant presents with a right scrotal mass. The swelling is intermittent as it appears after he is being carried and disappears when he goes to sleep. Physical examination shows a non-tender swelling on the right side and transilluminates when a torch light is shone through it.
What is the next best course of action?
Scrotal swelling which transilluminates suggest congenital communicating hydrocele, due to failure of closure of processus vaginalis. Infants of 4 months old with hydrocele usually need no intervention as the hydrocele will resolve spontaneously by 1 year of age.
ADH binds to vasopressin 2 receptors on collecting duct cells. By what mechanism does ADH allow for water reabsorption?
Insertion of Aquaporin 2 channels onto the luminal membrane
The binding of ADH to vasopressin 2 receptors activates a cAMP second messenger system, which leads to increased synthesis of Aquaporin 2 channels and fusion of these with the luminal membrane (between the tubular lumen and collecting duct cells)
Describe ECG changes in hyperkalaemia
tall, tented T waves, wide QRS complex and P wave flattening on the ECG
atients aged 45 years and over with unexplained visible hematuria without urinary tract infection, a suspected cancer pathway referral should be initiated to rule out what type of cancer?
Bladder cancer
history of painless hematuria with constitutional symptoms and smoking suggest bladder cancer unless proven otherwise. Cystoscopy and biopsy enables direct visualisation of the urethra and bladder muscosa, while taking tissue sample for microscopic and macroscopic analysis, is the gold standard in diagnosing bladder tumour.
Young adults presenting with signs of hepatic impairment and symptoms suggestive of movement and psychiatric disorders is a typical presentation of what condition? And how do you treat it?
Clue: Common symptoms and signs include psychological symptoms such as depression, loss of memory and delusions, neurological symptoms include tremor, dysarthria and dystonia, and patients often suffer with hepatitis.
Wilson’s disease
Give Penicillamine to chelate copper
A 26-year-old man presents to the Emergency Department with progressively worsening lower back pain that began earlier in the day and is not relieved by paracetamol or ibuprofen. He reports increased urinary frequency and dysuria. On examination, there is tenderness in the left flank, and his temperature is 38.2ºC. Urinalysis shows positive results for haemoglobin, leucocytes and nitrite. He is concerned as he has a new sexual partner that he didn’t wear protection with two days ago.
What is the most likely causative organism?
-Proteus mirabilis
-Chlamydia trachomatis
-Escherichia coli
-Klebsiella pneumoniae
-Pseudomonas aeruginosa
A 28-year-old man requires a urethral catheter to be inserted prior to undergoing a splenectomy. Where is the first site of resistance to be encountered on inserting the catheter?
-Bulbar urethra
-Membranous urethra
-Internal sphincter
-Prostatic urethra
-Bladder neck
Small or absent P waves, tall tented T waves and broad bizarre QRS complexes are all ECG signs of what?
Hyperkalaemia
Prolongation of the PR interval may be found in hypo/hyperkalaemia?
Potentially in both
ST-segment depression is an ECG sign of what?
Hypokalaemia
