Renal and urology

Question 1

Dialysis indications (6)

Answer 1

Uraemia
Resistant hyperkalaemia
Pulmonary oedema with oliguria (resistant)
Drug toxicity e.g. lithium
Resistant metabolic acidosis
End-stage renal failure eGFR<15

Question 2

Order of renal replacement therapy

Answer 2

1) Peritoneal dialysis
2) Haemodialysis (1st if IBD)
3) Transplant

Question 3

When is automated peritoneal dialysis used?

Answer 3

At night

Question 4

How long does an AV fistula take to form and what can be used in the meantime?

Answer 4

4-6 weeks

Tesio line (central line to internal jugular)

Question 5

Treatment for hyperacute rejection (<24 hours) ABO/HLA?

Answer 5

Remove transplant

Question 6

Treatment for chronic rejection (>6 months) unknown aetiology?

Answer 6

Dialysis

Question 7

Urine sodium in pre-renal and renal AKI?

Answer 7

Pre-renal <20
Renal >40

Question 8

Which drugs should be stopped in AKI?

Answer 8

DAMN
Diuretics, digoxin
ACEi, ARBs
Metformin
NSAIDs

Lithium

Question 9

AKI investigations

Answer 9

Urinalysis
Renal USS within 24 hours if no identifiable cause

Question 10

CKD stages

Answer 10

1) >90 (+other signs)
2) 60+ (+other signs)
3) 30+
4) 15+
5) <15

Question 11

CKD management

Answer 11

Fluid restriction (and reduce phosphate, sodium, potassium)
Phosphate binders
Vitamin D
Parathyroidectomy

Question 12

When to offer ACEi in CKD according to ACR?

Answer 12

> 3 + diabetes
30 + HTN
70

Question 13

Most common gene affected in ADPKD?

Answer 13

PKD1, Chromosome 16

Question 14

ADPKD management

Answer 14

Tolvaptan (vasopressin V2-receptor antagonist)

Question 15

IgA nephropathy management

Answer 15

Most resolve in 4 weeks
Arthralgia - NSAIDs
Scrotal involvement/oedema/abdo pain - PO prednisolone
Renal involvement - IV corticosteroids

Question 16

Which nephro cancer causes loin pain?

Answer 16

Renal cell

Question 17

Management for renal and clear cell cancer

Answer 17

Nephrectomy

Question 18

Management for bladder/transitional cell cancer in and ex-situ

Answer 18

In-situ: TURBT
Ex-situ: radical cystectomy

Question 19

Why does nephrotic syndrome predispose to thrombosis?

Answer 19

Loss of anti-thrombin III, protein C, and protein S
Rise in fibrinogen

Question 20

What ABG change are all types of renal tubular acidosis associated with?

Answer 20

Hyperchloraemic metabolic acidosis

Question 21

Which renal tubular acidosis types cause hypokalaemia?

Answer 21

1 and 2

Question 22

Which renal tubular acidosis types cause hyperkalaemia?

Answer 22

4

Question 23

Which renal tubular acidosis is distal and caused by an inability to secrete H+?

Answer 23

1

Question 24

Why do germ-cell tumours cause gynaecomastia?

Answer 24

hCG release
Increase in oestrodiol more than testosterone

Question 25

Investigations for testicular cancer

Answer 25

Bedside - examination, urinalysis
Bloods - tumour markers
Imaging - USS, CT CAP if positive

Question 26

What main problem are varicocoeles associated with?

Answer 26

Subfertility

Question 27

Main risk for testicular cancer?

Answer 27

Undescended testis
Can affect contralateral testicle
Early orchidopexy does not eliminate risk

Question 28

What’s useful for monitoring testicular cancer?

Answer 28

Tumour markers (bHCG, AFP, LDH)

Question 29

Which testicular cancer is AFP raised in?

Answer 29

Non-seminomatous germ cell tumour (NSGCT)

Question 30

Which testicular cancer is bHCG raised in?

Answer 30

Choriocarcinoma (NSGCT) > teratoma > seminoma

Question 31

Which testicular cancer is LDH raised in?

Answer 31

Seminoma

Question 32

Testicular cancer management

Answer 32

Inguinal orchidectomy
Sometimes chemotherapy

Question 33

Patient referred for 2ww for bladde cancer - what investigations are done?

Answer 33

Flexible cystoscopy
CT urogram (US KUB if non-visible haematuria/lower risk)