Renal and Urology

Question 1

Recall 3 pre-renal causes of AKI

Answer 1

Hypovolaemia
Renal hypoperfusion
Heart failure

Question 2

How does hypovolaemia cause AKI?

Answer 2

Decreased renal BP causes reduced GFR

Question 3

Give 2 intrinsic renal causes of AKI

Answer 3

Glomerulonephritis

Interstitial nephritis

Question 4

Other than thrombi and emboli, what might cause vessel obstruction leading to AKI?

Answer 4

Haemolytic microangiopathy (HUS or TTP)

Question 5

Which type of cancer is most strongly associated with AKI and with what investigation might it be detected/ excluded?

Answer 5

Myeloma

Microscopy: looking for Bence-Jones protein

Question 6

What ECG sign shows hyperkalaemia?

Answer 6

Tented T waves

Question 7

What is the first line of management for hyperkalaemia?

Answer 7

10mls of calcium gluconate 10%

Question 8

Recall 3 common complications of AKI

Answer 8

Hyperkalaemia
Metabolic acidosis
Pulmonary oedema

Question 9

Recall the 4 principles of management for AKI

Answer 9

1. Protect against hyperkalaemia
2. Optomise fluid balance
3. Stop any nephrotoxic drugs
4. Consider for dialysis

Question 10

Which part of the prostate is hypertrophic in BPH?

Answer 10

Periurethral (transitional) zone

Question 11

What would be the main DRE finding in BPH?

Answer 11

Palpable midline groove

Question 12

What is the option for medical management of BPH and why?

Answer 12

Alpha blockers - relax SMCs

Question 13

What is the eGFR diagnostic of CKD?

Answer 13

<60

Question 14

What is the eGFR diagnostic of established renal failure?

Answer 14

<15

Question 15

Give 2 skin signs of CKD

Answer 15

Pigmentation

Excoriation

Question 16

Recall 3 non-skin signs of CKD

Answer 16

Anaemia
Leuconychia
Kussmaul breathing due to acidosis

Question 17

Are CKD patients acidotic or alkalotic?

Answer 17

Acidotic

Question 18

What sort of diet should be fed to CKD patients?

Answer 18

High energy, low potassium

Question 19

Recall 2 autoimmune conditions that can cause CKD

Answer 19

SLE

Goodpasture’s

Question 20

With what comorbidity does orchitis always present?

Answer 20

Epidydimitis

Question 21

What are the most likely infective causes of epidydimitis/orchitis in <35s?

Answer 21

Gonorrhoea/ chlamydia

Question 22

What are the most likely infective causes of epidydimitis/orchitis in >35s?

Answer 22

Klebsiella/ enterobacter

Question 23

How do you distinguish epidydmitis/orchitis from testicular torsion?

Answer 23

Testicular torsion has very sudden onset of symptoms

Question 24

What is the most likely complication of epidydimitis?

Answer 24

Testicular abscess

Question 25

What are the complications of mumps orchitis?

Answer 25

Testicular atrophy | Infertility

Question 26

Define glomerulonephritis

Answer 26

Immunologically-mediated inflammation of the renal glomeruli

Question 27

What is the nephrotic syndrome?

Answer 27

Triad of proteinuria, low albumin and oedema

Question 28

What is the nephritic syndrome?

Answer 28

Triad of hypertension, proteinuria and haematuria

Question 29

What is the main difference in the symptoms of nephrotic syndrome and nephritic syndrome?

Answer 29

Nephrotic: proteinuria Nephritic: haematuria

Question 30

Define hydrocele

Answer 30

Excessive collection of serous fluid within the tunica vaginalis

Question 31

When is hydrocele most common?

Answer 31

First year of life

Question 32

What is the main sign of hydrocele?

Answer 32

Scrotal swelling

Question 33

Recall 2 tumour markers for testicular cancer

Answer 33

Beta-HCG | Alpha-fetoprotein

Question 34

What is the usual composition of urinary tract calculi?

Answer 34

Calcium oxalate

Question 35

Describe the pain produced by urinary tract calculi

Answer 35

Severe loin to groin

Question 36

Recall the symptoms of urinary tract calculi

Answer 36

Severe loin to groin pain Nausea and vomiting Urinary symptoms may be frequency or retention

Question 37

What is the main differential to consider in suspected urinary tract calculi when the patient is an elderly man?

Answer 37

Leaking AAA

Question 38

What blood tests outside of the usual would you order in urinary tract calculi?

Answer 38

Calcium Phosphate Urate

Question 39

What % of urinary tract calculi are radio-opaque?

Answer 39

80%

Question 40

Stones of what size in the urinary tract will pass spontaneously?

Answer 40

<5mm

Question 41

What would make a urinary tract stone an acute presentation?

Answer 41

Obstructed or infected kidney

Question 42

What is the most commonly-implicated pathogen in UTI?

Answer 42

E coli

Question 43

Recall the symptoms of cystitis

Answer 43

Frequency and urgency Dysuria Suprapubic pain WBCs in urine

Question 44

Recall the symptoms of pyelonephritis

Answer 44

Flank pain High fever Malaise WBCs in urine

Question 45

Under what group of conditions does prostatitis fall?

Answer 45

UTIs

Question 46

Describe the symptoms of prostatitis

Answer 46

Lower backache Obstructive urinary symptoms Flu-like symptoms

Question 47

What is the first choice of antibiotic for uncomplicated UTI in women and men?

Answer 47

Women: nitrofurantoin Men: flucloxacillin

Question 48

What are the typical abnormalities seen on urine dip in UTI?

Answer 48

Raised WBC | Nitrites

Question 49

On which side does varicocele usually present?

Answer 49

Left

Question 50

What is the cause of varicocele?

Answer 50

Venous incompetence in the pamphiniform plexus

Question 51

What are the usual symptoms of varicocele?

Answer 51

Scrotal heaviness but no pain

Question 52

What is the best investigation to do for varicocele?

Answer 52

Colour doppler ultrasound