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JMS - Renal/Urology > Renal Questions > Flashcards

Renal Questions Flashcards

1
Q

Lucy is a pregnant 36y/o female with T2DM and a history of recurrent UTI’s. She presents to the GP with dysuria, a high fever, rigors, N/V and loin pain.

What is the most likely diagnosis?

a) Cystitis
b) Urethritis
c) Prostatitis
d) Pyelonephritis

A

pyelonephritis

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2
Q

Lucy is a pregnant 36y/o female with T2DM and a history of recurrent UTI’s. She presents to the GP with dysuria, a high fever, rigors, N/V and loin pain.

What will you prescribe?

a) Cefalexin
b) Ciprofloxacin
c) Trimethoprim
d) Erythromycin

A

cefalexin

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3
Q

A 24y/o, sexually active female has a confirmed UTI. On MC&S a gram +ve organism is found.

What is the most likely causative organism?

a) P. mirabilis
b) S. saprophyticus
c) E. coli
d) P. aeruginosa

A

S. saprophyticus

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4
Q

A 45-year-old type 1 diabetic arrives at the GP for his annual diabetic review. Which of the following should be performed in this patient to assess if he has any signs of diabetic nephropathy?

ACR in early morning specimen 
ACR in late night speciment 
24 hour urinary protein 
Serum U+E 
Renal USS
A

ACR in early mornig specimen

All diabetic patients reuire annual screening for albumin:creatinine ratio (ACR) in early morning specimens

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5
Q

what is the investigation of choice for bladder cancer/

A

flexible cystoscopy

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6
Q

A 65-year-old diabetic woman has noticed her urine has become frothy and presents to her GP. He performed a urinalysis and finds protein in the urine. As part of the workup of a suspected diabetic nephropathy, she is sent for an ultrasound. What would you expect to see in the ultrasound report on her kidney size ?

A

Chronic diabetic nephropathy will have large/normal sized kidneys on ultrasound whereas most patients with chronic kidney disease have bilateral small kidneys

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7
Q

A 62-year-old man presents with nocturia, hesitancy and terminal dribbling. Prostate examination reveals a moderately enlarged prostate with no irregular features and a well defined median sulcus. Blood tests show:

PSA 1.3 ng/ml

What is the most appropriate management?

alpha 1 antagonist
5 alpha reductase inhibitor
non-urgent referral for TURP
urgent referral to urology

A

alpha 1 antagonist

Alpha-1 antagonists are first-line in patients with benign prostatic hyperplasia

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8
Q

A 72-year-old woman who has been on the ward for the past five days is noted by the nurses not to be passing much urine. She was admitted originally with pneumonia but has since developed diarrhoea. Blood tests show her creatinine has increased from 98 to 172 µmol/l. Which one of the following tests is most useful when determining whether there is prerenal uraemia or acute tubular necrosis?

serum urea level
urinary urea
plasma osmolality
urinary sodium

A

urinary sodium

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9
Q

You are discussing an elevated PSA result with one of your patients, a 62-year-old man with a PSA level of 7.2 ng/ml. Which procedure is he most likely to have following referral to a urologist?

prostatectomy
staging CT scan
MRI pelvis
TRUS-guided biopsy

A

TRUS-guided biopsy

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10
Q

You are reviewing a 65-year-old in the renal clinic. He has been on haemodialysis for chronic kidney disease for the past 6 years. What is he most likely to die from?

hyperkalaemia
malignancy
dialysis related sepsis
IHD

A

CKD on haemodialysis - most likely cause of death is IHD

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11
Q

A 56-year-old man presents with lethargy, haematuria and haemoptysis. On examination he is hypertensive and has a right loin mass. A CT scan shows a lesion affecting the upper pole of the right kidney, it has a small cystic centre. Which of the options below is the most likely diagnosis?

squamous cell carcinoma of kidney
nephroblastoma
renal adenocarcinoma
transitional cell carcinoma of kidney

A

Renal adenocarcinoma are the most common renal tumours. Th

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12
Q

A 62-year-old man with chronic kidney disease secondary to diabetes mellitus is reviewed. When assessing his estimated glomerular filtration rate (eGFR), which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?

Age
Serum creatinine 
Ethnicity
Gender 
Serum urea
A

Serum urea

eGFR variables - CAGE - Creatinine, Age, Gender, Ethnicity

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13
Q

Which of the following types of renal stones are radio-lucent?

cystine
calcium phosphate
xanthine stones
calcium oxalate

A

xanthine

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14
Q

A 33-year-old is admitted to the Emergency Department with suspected renal colic. He has a ultrasound that shows a probable stone in the left ureter. What is the most appropriate next step with respect to imaging?

non-contrast CT
IV urography
Plain radiograph KUB
MRI

A

non contrast CT

Following initial US assessment, NCCT should be used to confirm stone diagnosis in patients with acute flank pain

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15
Q

A 45-year-old female presents with fluctuating loin to groin pain and visible haematuria. She is unable to get comfortable. Examination is normal, with no signs of peritonitis. Which of the following investigations is most likely to be diagnostic?

pregnancy test 
AXR 
USS abdomen 
Cystography 
CT KUB
A

CT KUB

Non-contrast computerised tomography of the kidneys, ureters and bladder (CT KUB) is the gold standard investigation for suspected urolithiasis.(renal stones)

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16
Q

A 46-year-old African gentleman presents with painless haematuria. Whilst taking a urological history he mentions that he has had Schisotosoma haematobium infection in the past. What malignancy is he at increased risk of developing as a result?

squamous cell carcinoma of bladder
transitional cell carcinoma of bladder
adenocarcinoma of bladder
renal cell carcinoma

A

Painless haematuria should ring alarm bells for bladder cancer. Schistosoma infection is closely linked to risk of developing squamous cell carcinoma of the bladder

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17
Q

. A 60-year-old man presents with visible haematuria for the past three weeks. He has an ache in the left loin but examination is unremarkable other than a left varicocele. He also notes to feeling intermittently hot and sweaty

A.	Transitional cell carcinoma of the bladder
B.	Renal stones
C.	Chlamydia
D.	IgA nephropathy
E.	Urinary tract infection
F.	Renal cell carcinoma
A

Features of renal cell carcinoma:
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)

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18
Q

A patient is started on finasteride for the treatment of benign prostatic hyperplasia. How long should the patient be told that treatment may take to be effective?

within 8 hours 
within 3 days 
up to 7 days 
upto 4 weeks 
upto 6 months
A

Finasteride treatment of BPH may take 6 months before results are seen

19
Q

You are bleeped by a nurse in the evening who you asks you to urgently review a 68-year-old lady who is two days post-op because her afternoon blood results have just been reported as being abnormal. You have never met the patient before and are not aware of their clinical course. She tells you the results are as follows:

K+ high 6.1

You are unable to come to the ward for 10 minutes. What should you ask the nurse to do before you get there?

12 lead ECG
give calcium gluconate
blood culture

A

12 lead ECG

20
Q

A 45-year-old man presents with symptoms of urinary colic. In the history he has suffered from recurrent episodes of frank haematuria over the past week or so. On examination he has a left loin mass and a varicocele. The most likely diagnosis is:

renal adenocarcinoma
renal cortical adenoma
squamous cell carcinoma of renal pelvis

A

Renal adenocarcinoma are the most common renal malignancy and account for 75% cases.

21
Q

What is the mechanism of action of goserelin in prostate cancer?

A

Goserelin (Zoladex) is a synthetic GnRH agonist which provides negative feedback to the anterior pituitary

22
Q

Which one of the following factors is most likely to invalidate the use of the Modification of Diet in Renal Disease (MDRD) equation to calculate a patients eGFR?

diuretic use
pregnancy
T2DM
female gender

A

pregnancy

GFR tends to increase during pregnancy.although the eGFR may not reflect this

23
Q

A 55-year-old man with end stage renal failure is due to have a renal transplant. He has read that having a renal transplant do will increase his risk of cancer and would like to know more about this.

The risk of which one of the following cancers is he most at risk of following renal transplantation?

pancreatic cancer
myeloma
squamous cell carcinoma of skin
gastric cancer

A

squamous cell carcinoma of skin

The risk of all skin cancers increases following kidney transplantation, evidence has shown that in particular the risk of squamous cell carcinoma is increased

24
Q

A 45-year-old man with a history of alcoholic liver disease presents with abdominal distension. Examination reveals tense ascites which is drained. What is the appropriate type of diuretic to help prevent reaccumulation of ascites?

aldosterone antagonist
loop diuretic
thiazide diuretic
osmotic diuretic

A

aldosterone antagonist

Ascites - use spironolactone

25
Q

You are prescribing maintenance fluids for a 60-year-old woman who has had a stroke. Her most recent blood results are shown below:

Na+ 140 mmol/l
K+ 4.0 mmol/l
Urea 5.0 mmol/l
Creatinine 88 µmol/l

She weighs 62 kg. What is the most appropriate amount of potassium that she should receive over a 24-hour period?

20
40
60
80
120
A

60

When prescribing fluids, the potassium requirement per day is 1 mmol/kg/day

26
Q

A 63-year-old man attends for a GP appointment and states that he has had two episodes of visible blood in his urine. One episode occurred last week and the other this morning. There was not any pain. He denies any lower urinary tract symptoms. A urinalysis shows +++ blood and is negative for all other markers. What investigation should be requested?

CT scan pelvis 
Urine culture 
IV urogram 
Cystoscopy 
Urinary biomarkers
A

Cystoscopy

Gold standard for bladder cancer diagnosis is cystoscopy

This patient has had two episodes of painless frank haematuria.

27
Q

A 51-year-old man presents to his GP with a new swelling of his left testicle. He has no past medical history and takes no regular medications. On examination there is a unilateral swelling of the left side of the scrotum which feels separate to the testicle itself, does not trans-illuminate and no superior border to the swelling can be felt in the top of the scrotum.

What is the most likely diagnosis?

Inguinioscrotal hernia 
Hydrocele 
Testicular cancer 
Epididmo-orchiditis 
Epididmal cyst
A

Inguinoscrotal Hernia

Scrotal swelling you can’t get above: inguinal hernia

28
Q

Which one of the following is most associated with male infertility?

Sodium valproate therapy 
BPH 
Varicoceles 
Epididymal cysts 
Hydroceles
A

Varicoceles

Varicoceles may be associated with infertility

29
Q

A 3-year-old girl is brought to surgery as her parents have noticed blood in her urine. Examinations reveals a loin mass. MSU shows no evidence of a urinary tract infection. The only relevant family history is her grandmother who has chronic kidney disease.

A.	Transitional cell carcinoma of the bladder
B.	Renal stones
C.	Benign prostatic hyperplasia
D.	Wilms' nephroblastoma
E.	Urinary tract infection
F.	Renal cell carcinoma
G.	Polycystic kidney disease
H.	Goodpasture's syndrome
I.	Rhabdomyosarcoma
J.	Renal vein thrombosis
A

. Wilms’ nephroblastoma

Wilms’ nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old.

Features
abdominal mass (most common presenting feature)
flank pain
painless haematuria

30
Q

A 57-year-old man presents with left sided abdominal pain radiating to his scrotum. The pain is severe and not controlled by a combination of paracetamol and ibuprofen. Urine dipstick shows: blood++, protein+, leucocytes++, nitrites negative. Clinical examination is unremarkable.

A.	Transitional cell carcinoma of the bladder
B.	Renal stones
C.	Benign prostatic hyperplasia
D.	Wilms' nephroblastoma
E.	Urinary tract infection
F.	Renal cell carcinoma
G.	Polycystic kidney disease
H.	Goodpasture's syndrome
I.	Rhabdomyosarcoma
J.	Renal vein thrombosis
A

Renal stones

31
Q

A 68-year-old man presents with visible haematuria for the past two weeks. There is no history of pain. MSSU confirms haematuria but fails to show any organism.

A.	Transitional cell carcinoma of the bladder
B.	Renal stones
C.	Benign prostatic hyperplasia
D.	Wilms' nephroblastoma
E.	Urinary tract infection
F.	Renal cell carcinoma
G.	Polycystic kidney disease
H.	Goodpasture's syndrome
I.	Rhabdomyosarcoma
J.	Renal vein thrombosis
A

Transitional cell carcinoma of the bladder

32
Q

A concerned mother attends your GP surgery with her 7-year-old son. She is very concerned as she reports that ‘there is blood in his urine.’ Urine dipstick is ++++ for blood with no leukocytes, nitrates or protein. The boy reports that he first noticed the haematuria this morning. Physical examination is unremarkable, with normal heart and lung sounds and a soft non-tender abdomen. He is afebrile and does not have any symptoms of a urinary tract infection. His past medical history is unremarkable but his mother reports that he recently had a cold 2 days prior and has had several colds over the past year.

Given the history and examination findings, what is the most likely diagnosis?

  • Minimal change disease
  • IgA nephropathy
  • Post-streptococcal glomerulonephritis
  • focal segmental glomerulosclerosis
A

Haematuria following URTI in a boy - think IgA nephropathy

33
Q

A 23-year-old woman presents unconscious to the Emergency Department (ED). A passerby told the ambulance crew that the woman had been jogging and then suddenly grabbed the back of her head and screamed like she was in intense pain before becoming unconscious. At this time, no past medical history, drug history, social history, or family history is known.

She is stabilised in the ED. On examination, her GCS is 11 (E2V3M5) and pupils are equal and reactive to light. Her respiratory and cardiovascular examination is unremarkable. On examination of her abdomen, there are large ballotable masses in both flanks.

What is the most likely underlying condition?

renal carcinoma
marfan syndrome
Polycystic kidney disease
systemic vasculitis

A

Polycystic kidney disease

ADPKD is associated with intracranial aneurysms

a story of sudden onset intense head pain is suggestive of subarachnoid haemorrhage. Given the lack of a history of trauma and the young age, this is most likely be due to rupture of an intracerebral aneurysm

34
Q

A 65-year-old man presents with lower urinary tract symptoms. For the past few months, he has had problems with urinary urgency and has had several episodes of incontinence when he could not reach the toilet in time. He describes good urinary flow with no hesitancy or straining. Urinalysis and prostate examination are unremarkable.

Which one of the following medications is most likely to help alleviate his symptoms?

alpha blocker
antimuscarinic
5-alpha reductase inhibitor
loop diuretic

A

Antimuscarinic drugs are useful in patients with an overactive bladder

35
Q

An 85-year-old man is diagnosed with prostate adenocarcinoma following prostatic biopsy. He is advised that conservative management is preferable because of his advanced age and relatively low Gleason score. What is the lowest Gleason score that is indicative of malignancy?

5
6
7
8
9
A

6

The lowest Gleason score of prostate cancer found on biopsy is 6
Prostate biopsies are given a Gleason grade from 1 to 5.
the Gleason score can range from 2 to 10

36
Q

A 20-year-old complains of severe pain in the right scrotal area after jumping onto his moped. He has also noticed discomfort in this area over the past few months. On examination there is a swollen, painful testis that is drawn up into the groin.

A.	Haematocele
B.	Epididymal cyst
C.	Hydrocele
D.	Testicular torsion
E.	Orchitis
F.	Epididymo-orchitis
A

Testicular torsion 65%

Testicular torsion: Severe pain which can be spontaneous or precipitated by minor trauma. There is usually severe pain and the patient will often not tolerate the testis being touched.

37
Q

A 20-year-old complains of severe pain and swelling of the scrotum after a cystoscopy. He had mumps as a child. The testis is tender. The urine dipstick is positive for leucocytes

A.	Haematocele
B.	Epididymal cyst
C.	Hydrocele
D.	Testicular torsion
E.	Orchitis
F.	Epididymo-orchitis
A

Epididymo-orchitis 61%

Epididymo-orchitis: acute pain and swelling after urological intervention. To differentiate from testicular torsion there is usually pyrexia and positive urine dipstick.

38
Q

NSAIDs should be stopped in AKI except?

A

aspirin at cardio-protective dose (low dose aspirin)

39
Q

A 50 year old man presents to his GP with a swollen scrotum. This had not troubled him but his wife insisted he had it seen to. On examination there is a left sided swelling of the scrotal sac which is non-tender and fully transluminates. The testicle is not palpable. What is the most likely cause?

varicocele
hydrocele
epididymo-orchitis

A

hydrocele

this man has a swelling confined to the scrotal sac. It is non-tender and fully transluminates. The only option from the above that fits this criteria is a hydrocele

40
Q

A 69-year-old man is started on tamsulosin for benign prostatic hyperplasia. What side-effects he may experience?

side effects of finasteride?

A

dizziness + postural hypertension

erectile dysfunction and reduced libido

41
Q

A 67-year-old man presents with painless frank haematuria. He recently began complaining of a mild testicular ache and describes his scrotum as a ‘bag of worms’. He is a heavy smoker smoking 60 cigarettes a day for 47 years. On examination he is cachectic. His left testicle appears to have a tortuous texture. His blood reveals anaemia and polycythemia. What is the most likely diagnosis?

HCC
Torsion 
Epidymo-orchiditis
Hydrocele 
Renal cell carcinoma of kidney
A

Varicocele can be a sign of malignancy due to compression of the renal vein between the abdominal aorta and the superior mesenteric vein - known as the nutcracker angle

42
Q

A 63-year-old man is admitted with severe right sided loin pain to the Emergency Department. A urine dipstick shows blood +++, leucocytes +, protein +. An abdominal radiograph is therefore ordered which shows a stag-horn calculus in the right renal pelvis. What are stag-horn calculi normally composed of?

Xanthine 
Magnesium ammonium PO4 
Calcium oxalate 
Uric acid 
Mg Calcium PO4
A

Mg Ammonium phosphate

43
Q

A 72-year-old man is diagnosed with prostate cancer and goserelin (Zoladex) is prescribed. Which one of the following is it most important to co-prescribe for the first three weeks of treatment?

tamoxifen 
lansoprazole 
allopurinol 
cyproterone acetate 
tamsulosin
A

Anti-androgen treatment such as cyproterone acetate should be co-prescribed when starting gonadorelin analogues due to the risk of tumour flare.

44
Q

A 42-year-old man presents with a painless lump in the left testicle that he noticed on self examination. Clinically there is a firm nodule in the left testicle, ultrasound appearances show an irregular mass lesion. His serum AFP and HCG levels are both within normal limits. What is the most likely diagnosis?

yolk sac tumour
seminoma
testicular teratoma
epididymo-orchitis

A

seminoma

Seminomas typically have normal AFP and HCG. These are usually raised in teratomas and yolk sac tumours

JMS - Renal/Urology (13 decks)

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