Urology/ Nephrology

Question 1

most common type renal stone

Answer 1

calcium oxalate

Question 2

32 F
HTN
headache
K+ 7.2
acute deterioration after ACEi started

Answer 2

renal artery stenosis

Question 3

acute loss of renal excretory function

Answer 3

acute tubular necrosis

Question 4

renal problem with increased antistreptolysin O titres

Answer 4

post streptococcal glomerulonephritis

Question 5

IgA nephropathy is also called

Answer 5

Bergers disease
24hr-28hr after URTI or GI infection

Question 6

nephritic Vs nephrotic disease

Answer 6

NEPHRITIC: (blood, low protein, oliguria, haematuira)
- poststreptococcal glomerulonephritis
- IgA nephropathy
- Alports
- glomerulonephritis

NEPHROTIC syndrome:
- deibatic nephropathy
- focal segmental glomerulosclerosis

Question 7

inability to clean under foreskin is associated with..

Answer 7

cancer of penis in adulthood

Question 8

haematuria
flank pain
HTN

Answer 8

polycystic kidney disease

Question 9

specific gravity in urine: high vs low

Answer 9

LOW= dilute urine
e/g. excessive fluid intake

HIG= dehydrated
renal artery stenosis
proteinuria
SIADH
heart failure (less blood flow to kidneys

Question 10

smooth flucutal swelling within scrotum
separate to testes
when aspirated –> milky fluid

Answer 10

spermatocele

(similar to epididymal cysts but milky rather than clear fluid)

Question 11

initial imaging investigation for enlarged kidneys ?polycystic

Answer 11

US

Question 12

interstitial cystitis (bladder pain syndorme)

Answer 12

diagnosis of exclusion
extended duration of symptoms
pelvic pain
urinary symptoms
lack of gynaecological symptoms

Question 13

How is CKD classified

Answer 13

eGFR
AND
albumin to creating ration (ACR)

has to be > 3 months

Question 14

BCG vainne cane be used of a treatment for which cancer

Answer 14

bladder

Question 15

CKD blood gas

Answer 15

metabolic acidosis

Question 16

what foods contain oxalate (and so should avoid in renal stones)

Answer 16

tea, chocolate, nuts, strawberries, rhubarb, spinach, beans, beetroot, fluids

Question 17

Alkalosis, insulin, B agonists, hypo-osmolarity

Answer 17

all push K+ INTO cells (–> HYPOkalaemia)

HENCE Cushings is low K+ –> alkalosis
Addisons —> acidosis

Question 18

does hydrocele transluminate

Answer 18

YES

Question 19

BPH management drugs

Answer 19

a- adrenergic receptor ANTAGONISTS
5a-reductase inhibitors

other:
transurethral microwave therapy
transurethral needle ablation
TURP

Question 20

diabetes insipidus

Answer 20

most common cause= LESS ADH
2nd= non responsive to ADH

opposite impact of ADH

excessive thirst, excretion of large amounts of diluted (low osmolality) urine

management:
- STOP DRUGS
- ensure adequate water intake
- consider: thiazide diuretics (excrete NaCl),, NSAIDs, sodium restiriton, desmopressin (ADH)

Question 21

how to tell difference between diabetes insidious and polydipsia

Answer 21

Water deprivation test

Question 22

vague pains
bilateral hydronephrosis
drawing together of the ureters in midline on CT/MRI
prei-aoritc mass

Answer 22

retroperitoneal fibrosis

associated with:
autoimmune disease
metastatsis
drugs: BB, methydopa

raised ESR and CRP, aneamia, uraemia

Question 23

NICE recognise any of the following criteria to diagnose AKI in adults:

Answer 23

↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours

Question 24

what is normal anion gap (1)
how calculated (1)

Answer 24

8-14

(Na + K) - (Cl + Bicarb)

Question 25

management minimal change disease

Answer 25

steroids

Question 26

what causes minimal change disease
(NEPHROTIC syndrome)

Answer 26

The majority of cases are idiopathic, but in around 10-20% a cause is found:
drugs: NSAIDs, rifampicin
Hodgkin’s lymphoma, thymoma
infectious mononucleosis

Features
nephrotic syndrome
normotension - hypertension is rare
highly selective proteinuria
only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus
renal biopsy
normal glomeruli on light microscopy
electron microscopy shows fusion of podocytes and effacement of foot processes

Question 27

prognosis minimal change disease

Answer 27

1/3 have just one episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood

Question 28

acid base balance in diarrheoa

Answer 28

Diarrhoea - normal anion gap metabolic acidosis

Question 29

kidneys on US - size in chronic

Answer 29

SMALL shrunken kidnetsy

Question 30

electrolye change seen in chronic renal failure

Answer 30

hypocalcaemia

Question 31

when is biopsy indicated in minimal change disease

Answer 31

if steroid response poor

Question 32

vomiting acid base balance

Answer 32

Diarrhoea can cause a normal anion gap acidosis whereas vomiting causes alkalosis

Question 33

what infection causes haemolytic uraemia syndrome

Answer 33

E coli

triad of acute kidney injury, microangiopathic haemolytic anaemia and thrombocytopenia

Management
treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
there is no role for antibiotics, despite the preceding diarrhoeal illness in many patients
the indications for plasma exchange in HUS are complicated
as a general rule plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
eculizumab (a C5 inhibitor monoclonal antibody) has evidence of greater efficiency than plasma exchange alone in the treatment of adult atypical HUS

Question 34

Post-streptococcal glomerulonephritis; what test confirms it

Answer 34

anti-streptolysin O titre

Question 35

Too many bags of NaCl - what complication

Answer 35

hyperchloaremic metabolic acidosis

Question 36

in water deprivation test what to conclude if mOsm/kg does not change with exogenous ADH

Answer 36

nephrogenic diabetes insipidus
(unresponsive to ADH–> nephrogenic diabetes insipidus)

Question 37

what caner do you have varicocele in

Answer 37

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)
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
25% have metastases at presentation

Question 38

Kidney transplant failure:
A 24-year-old woman is recovering from a renal transplant. Less than 24 hours after the procedure she reports worsening pain at the transplant site. On examination she is febrile, tender over the transplant and has been anuric since the procedure. Her creatinine has risen markedly over the last 24h.

Answer 38

Pre-existing antiboides against ABO or HLA antigens

(HYPERACUTE rejection)

FYI cell mediated (cytotoxic T cell) rejection is cause of acute rejection in first 6 months to first 24hr

Question 39

kidneys in diabetic nephropathy vs chronic kidney disease

Answer 39

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

Question 40

peritoneal dialysis - most common cause

Answer 40

Complications
peritonitis
coagulase-negative staphylococci such as Staphylococcus epidermidis is the most common cause. Staphylococcus aureus is another common cause
antibiotics should cover both Gram positive and Gram negative organisms
the BNF recommends vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid OR vancomycin added to dialysis fluid + ciprofloxacin by mouth
aminoglycosides are sometimes used to cover the Gram negative organisms instead of ceftazidime
sclerosing peritonitis

Question 41

CKD on haemodialysis - most likely cause of death

Answer 41

IHD