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Question 1
Incorrect
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A 26 year-old gentleman presented with complaints of multiple bruises over his body and reddish urine after a road traffic accident. Labs showed deranged renal function. The best management step would be?
Your Answer: Pain relief
Correct Answer: IV normal saline
Explanation:Rhabdomyolysis occurs after severe muscles injury and the patient presents with myoglobinuria and deranged RFTS. The best initial step in management is fluid resuscitation with normal saline. If initial management fails to treat the patient, we can go to haemodialysis.
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This question is part of the following fields:
- Renal System
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Question 2
Incorrect
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A 76-year-old man complains of painful microscopic haematuria and urgency. On examination of the abdomen, there is suprapubic tenderness but no palpable abnormality. He is apyrexial, inflammatory markers and PSA in the blood are normal. Which is the most likely diagnosis?
Your Answer: Benign prostatic hypertrophy
Correct Answer: Bladder calculi
Explanation:Painful haematuria suggests trauma, infection or calculi, whereas painless haematuria suggests a possible occult malignancy. This man is apyrexial with normal WCC and CRP which should effectively exclude infection as a cause for his symptoms. There is no history of trauma in this scenario (often catheter-associated) which makes this cause unlikely. It is worth noting that haematuria associated with injury tends to be macroscopic. Therefore, bladder calculi are the most likely source of his symptoms. Imaging will help to determine the presence of calculi.
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This question is part of the following fields:
- Renal System
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Question 3
Incorrect
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Which of the following is most helpful in differentiating chronic from acute renal failure?
Your Answer: Elevated parathyroid hormone
Correct Answer: Kidney size at ultrasound scan
Explanation:The size of the kidneys on ultrasound would differentiate chronic from acute renal failures. Chronic renal failure is more associated with small-sized kidneys.
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This question is part of the following fields:
- Renal System
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Question 4
Incorrect
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A 40-year-old man presents with periorbital and pedal oedema. 24h urine shows 9g of protein/d and serum cholesterol of 7 mmol/L. What would be the most likely diagnosis?
Your Answer: FSGS
Correct Answer: Membranous glomerulonephropathy
Explanation:Membranous glomerulonephritis . However some authors believe FSGS a more commoner cause of nephrotic syndrome.
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This question is part of the following fields:
- Renal System
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Question 5
Incorrect
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A 65-year-old gentleman gives a two week history of progressive lethargy and weakness. Eight weeks previously, he was treated for hypertensive heart failure with 120 mg furosemide and 5 mg enalapril daily. His haemoglobin at the time was 12.0, urea 14.2 mmol/l and creatinine 298 μmol/l. His blood pressure in clinic was 148/85 mmHg.
His blood results are shown below:
Hb 10.2g/dl
MCV 89.2 fl
WCC 4.9 x 109/l
Plats 175 x 109/l
Na+ 135
K+ 5.2 mmol/l
Urea 25.2 mmol/l
Creat 600 μmol/l
Assuming that he is not volume overloaded, what would be the most appropriate action?Your Answer: reduce the dose of enalapril
Correct Answer: stop the enalapril and furosemide
Explanation:The patient presents with worsened renal condition from the last consultation when he was started on enalapril (an ACE inhibitor) so this medication should be stopped. Because there is also no fluid overload; furosemide, a diuretic, should also be stopped.
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This question is part of the following fields:
- Renal System
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Question 6
Incorrect
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An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day.
ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
What diagnosis fits best with this clinical picture?Your Answer: Cirrhosis
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome usually presents with the symptoms in this patient: low albumin, abnormal cholesterol, increased urinary albumin excretion, oedema, and as a consequence, hypertension as well.
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This question is part of the following fields:
- Renal System
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Question 7
Incorrect
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A patient has an autosomal recessive disorder, which causes lysine, arginine, ornithine and cystine to appear in his urine. The treatment proposed is the combination of urinary alkalinisation with penicillamine. Choose the most likely type of renal calculus present.
Your Answer: Pure oxylate
Correct Answer: Cystine
Explanation:The presence in the urine of cystine, orthinine, arginine and lysine indicate a tubular reabsorption defect. This condition is a hereditary one, and stone formation is more common in homozygotes. The patient has no other abnormalities that could indicate stone formation.
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This question is part of the following fields:
- Renal System
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Question 8
Incorrect
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A 37-year-old male patient presented with bilateral kidney stones. He gave a history of sarcoidosis. What is the most probable cause for renal stones?
Your Answer: Hyperparathyroidism
Correct Answer: Hyper calcaemic
Explanation:Sarcoidosis is a multisystem granulomatous disorder which may involve the kidneys to a variable degree. Renal calculi have been reported to occur in about 10% of patients with chronic sarcoidosis. Hypercalcaemia due to marked hyperabsorption of dietary calcium, bone resorption and renal tubular calcium reabsorption causes hypercalciuria. Both hypercalcemia and hypercalciuria contribute to nephrolithiasis.
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This question is part of the following fields:
- Renal System
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Question 9
Incorrect
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A 63-year-old woman visits the diabetes clinic for review. She has had type-2 diabetes for 9 years and is now on insulin therapy. She has diabetic nephropathy, as exemplified by hypertension and proteinuria (urinary PCR 155); a recent creatinine level was 205 μmol/l and eGFR 24 ml/min.
Which of the following options best fits her prognosis or management?Your Answer: Non-dihydropyridine calcium antagonists have no effect on proteinuria
Correct Answer: Treatment with ARB or ACE-I may slow further deterioration in renal function
Explanation:Treatment with ARB or ACE-I may slow further deterioration in renal function in this patient, as studies have shown that blocking of the RAS in type 2 diabetic patients improve renal function.
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This question is part of the following fields:
- Renal System
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Question 10
Incorrect
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A 70-year-old man underwent emergency surgery for an acute abdomen. Following surgery, he was noted to be oliguric. Investigations revealed the following: Sodium 121 mmol/L (137-144) Potassium 6.6 mmol/L (3.5-4.9) Chloride 92 mmol/L (95-107) Urea 17.2 mmol/L (2.5-7.5) Creatinine 250 µmol/L (60-110) pH 7.16 (7.36-7.44) Standard bicarbonate 15.6 mmol/L (20-28). What is the calculated anion gap for this patient?
Your Answer: 25 mmol/L
Correct Answer: 20 mmol/L
Explanation:Anion gap is calculated as (Na + K) − (Cl + HCO3). Therefore in this patient, the calculated value is 20 mmol/L. The normal anion gap is between 8-16 mmol/l. The excessive value here reflects the presence of other acidic anions, and in this case with the metabolic acidosis, the constituents may be lactate, etc.
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This question is part of the following fields:
- Renal System
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Question 11
Incorrect
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A 19-year-old girl suffers from a hereditary disease and presents at her GP with a renal colic. She claims that her mother had this problem too. What type of renal calculus is most likely responsible for the renal colic?
Your Answer: Uric acid
Correct Answer: Cystine
Explanation:The patient seems to have inherited cystinuria which is an autosomal recessive disease. Typical for the disease is the abnormally high concentration of cysteine in the urine, finally causing cystinuria. In a person with cystinuria, the high concentrations of cysteine in the kidney results in the formation of stones with frequent colic pains and complications. If the genotype is partially expressed, then the phenotype might be even asymptomatic, thus the disease has a high variability.
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This question is part of the following fields:
- Renal System
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Question 12
Incorrect
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A 40-year-old female patient with a history of rheumatoid arthritis is diagnosed with type 1 renal tubular acidosis. What is the most probable sequela of this condition?
Your Answer: Hyperkalaemia
Correct Answer: Nephrocalcinosis
Explanation:Distal renal tubular acidosis is due to defective proton secretion from the alpha intercalated cells of the distal tubule caused by dysfunction of the H+/K+ antiporter on the apical membrane. This leads to failure of H+ excretion thereby causing systemic acidosis and potassium depletion. Inability to lower the urine pH below 5.3 in the presence of systemic acidosis is the diagnostic hallmark of type I or distal renal tubular acidosis. Hypercalciuria, hypocitraturia and elevated urinary pH observed in distal renal tubular acidosis can lead to nephrocalcinosis and may cause renal calculi, obstructive uropathy and renal failure necessitating surgical or endoscopic stone extraction.
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This question is part of the following fields:
- Renal System
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Question 13
Correct
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Which one of the following statements is true regarding autosomal recessive polycystic kidney disease?
Your Answer: May be diagnosed on prenatal ultrasound
Explanation:Autosomal recessive polycystic kidney disease (ARPKD) is less common than ADPKD (dominant form) but can already present with symptoms and be diagnosed on prenatal ultrasound.
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This question is part of the following fields:
- Renal System
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Question 14
Incorrect
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A 50-year-old gentleman with renal cell carcinoma has a haemoglobin of 19 g/dl. Which investigation will conclusively prove that this patient has secondary polycythaemia?
Your Answer: Reticulocyte count
Correct Answer: Erythropoietin level
Explanation:Erythropoietin (EPO) is used to distinguish between primary and secondary polycythaemia. Secondary polycythaemia can be caused by tumours in the kidney that may secrete EPO or EPO-like proteins.
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This question is part of the following fields:
- Renal System
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Question 15
Correct
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A 67-year-old male presents to the emergency complaining of frank haematuria. There are no associated symptoms. Which of the following would be the most helpful in pointing towards a diagnosis?
Your Answer: Cystoscopy
Explanation:Diagnostic indications for cystoscopy include the following: evaluation of patients with voiding symptoms (storage or obstructive), gross or microscopic haematuria, urologic fistulas, urethral or bladder diverticula and congenital anomalies in paediatric population.
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This question is part of the following fields:
- Renal System
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Question 16
Correct
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A 50-year-old male presented with pain in the left lumbar region. His abdominal X-ray revealed stones in his left kidney. Analysis of one of the stones that he passed in the urine showed that it was composed of uric acid. Which of the following is the most likely cause of this type of renal stone?
Your Answer: Thiazide diuretics
Explanation:Like all diuretics, thiazide diuretics decrease the amount of body fluid. This leads to an increase in the concentration of uric acid in the body; hence the chances of forming uric acid stones.
Allopurinol is actually a drug used to treat gout, reducing uric acid levels in the body. Therefore, allopurinol would rather decrease the chances of having uric acid stones.
Primary hyperparathyroidism is not concerned with uric acid stones. It is related to calcium metabolism and hence, calcium stones. -
This question is part of the following fields:
- Renal System
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Question 17
Incorrect
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A 38-year-old patient with hypertension presented with facial puffiness, ankle oedema, haematuria and frothy urine. Which of the following is a definitive diagnostic test?
Your Answer: Urine microscopy
Correct Answer: Renal biopsy
Explanation:The history is suggestive of nephritic syndrome. Renal biopsy is the definitive diagnostic test which shows the glomerular pathology.
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This question is part of the following fields:
- Renal System
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Question 18
Incorrect
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A 46-year-old gentleman diagnosed with type 2 diabetes, hypertension, and proteinuria is started on Ramipril to prevent development of renal disease. He reports to his GP that he has developed a troublesome cough since starting the medication. He has no symptoms of lip swelling, wheeze and has no history of underlying respiratory disease.
What increased chemical is thought to be the cause of his cough?Your Answer: Prostaglandins
Correct Answer: Bradykinin
Explanation:Ramipril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II as well as preventing the breakdown of bradykinin, leading to blood vessel dilatation and decreased blood pressure. However, bradykinin also causes smooth muscles in the lungs to contract, so the build-up of bradykinin is thought to cause the dry cough that is a common side-effect in patients that are on ACE inhibitors.
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This question is part of the following fields:
- Renal System
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Question 19
Incorrect
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A 30-year-old female presents with polyuria and is passing 4 litres of urine per day. She was recently started on a new medication.
Results show:
Serum sodium 144 mmol/L (137-144)
Plasma osmolality 299 mosmol/L (275-290)
Urine osmolality 210 mosmol/L (350-1000)
Which of the following drugs was prescribed?Your Answer: Glibenclamide
Correct Answer: Lithium
Explanation:The patient’s presentation is consistent with diabetes insipidus: eunatreaemia, high serum osmolality, and inappropriately dilute urine, which leads to the suspicion of lithium-induced diabetes insipidus.
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This question is part of the following fields:
- Renal System
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Question 20
Incorrect
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A woman with severe renal failure undergoes a kidney transplant. However, after a few hours, she develops fever and anuria. The doctors are suspecting hyperacute organ rejection. Which are the cells primarily responsible for hyperacute organ rejection?
Your Answer: Helper T Cells
Correct Answer: B Cells
Explanation:Hyperacute rejection appears in the first minutes following transplantation and occurs only in vascularized grafts. This very fast rejection is characterized by vessel thrombosis leading to graft necrosis. Hyperacute rejection is caused by the presence of antidonor antibodies existing in the recipient before transplantation. These antibodies induce both complement activation and stimulation of endothelial cells to secrete Von Willebrand procoagulant factor, resulting in platelet adhesion and aggregation. The result of these series of reactions is the generation of intravascular thrombosis leading to lesion formation and ultimately to graft loss. Today, this type of rejection is avoided in most cases by checking for ABO compatibility and by excluding the presence of antidonor human leukocyte antigen (HLA) antibodies by cross-match techniques between donor graft cells and recipient sera. This type of rejection is also observed in models of xenotransplantation of vascularized organs between phylogenetically distant species when no immunosuppressive treatment is given to the recipients.
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This question is part of the following fields:
- Renal System
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Question 21
Incorrect
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A 10-year-old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat 60 umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer: Henoch-Schönlein purpura
Correct Answer: IgA nephropathy
Explanation:A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).
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This question is part of the following fields:
- Renal System
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Question 22
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer: Idiopathic thrombocytopenic purpura (ITP)
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal System
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Question 23
Incorrect
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A 28-year-old female presents to her GP with joint pain , fever, a butterfly rash and fatigue. She has marked peripheral oedema. She is found to be hypertensive, in acute renal failure, low albumin levels and proteinuria.
A renal biopsy is performed and reveals focal glomerulonephritis with subendothelial and mesangial immune deposits.
What is the most likely diagnosis?Your Answer: Lupus nephritis class I
Correct Answer: Lupus nephritis Class III
Explanation:This case presents with characteristic symptoms of SLE and with her renal biopsy results of focal glomerulonephritis, this is clearly Class III SLE.
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This question is part of the following fields:
- Renal System
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Question 24
Incorrect
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A 69-year-old male with a history of Hepatitis C liver cirrhosis presented with spontaneous bacterial peritonitis. He had no symptoms of hypovolaemia. Choose the best treatment option to prevent the patient from developing hepatorenal syndrome.
Your Answer: Central venous pressure monitoring
Correct Answer: Intravenous albumin administration
Explanation:In randomised controlled trials, the administration of albumin has been shown to lower the risk of the hepatorenal syndrome – this is thought to be due to its positive effect on circulatory systems. Diuretics can aid in the prevention of renal failure, but this patient is not showing signs of hypovolaemia. Synthetic disaccharide lactulose is primarily used for the prevention of hepatic encephalopathy, which has no function in preventing hepatorenal syndrome. Limited evidence is available for the use of Neomycin as a treatment for hepatic encephalopathy, but is associated with nephrotoxicity and ototoxicity.
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This question is part of the following fields:
- Renal System
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Question 25
Correct
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A 71-year-old woman with a medical history of a blood transfusion in the early 1980s presents with a 10 month history of malaise and is noted to have impaired renal function. Her urine sediment reveals red cell casts.
The results of immunological investigations are as follows: serum IgG 6.5 g/L (normal range 6-13), IgA 1.5 g/L (normal range 0.8-4.0), IgM 5.7 g/L (normal range 0.4-2.0), serum electrophoresis shows a faint band in the gamma region, complement C3 1.02 g/L (normal range 0.75-1.65), complement C4 <0.02 g/L (normal range 0.20-0.65), and rheumatoid factor 894 IU/L (normal range <40).
Which of the following investigations is likely to be most important in making a definitive diagnosis?Your Answer: Cryoglobulins
Explanation:The patient’s history of a blood transfusion and lab results showing a markedly low C4 (with normal C3), elevated rheumatoid factor, and elevated serum IgM is highly suggestive of hepatitis C-associated cryoglobulinaemic vasculitis. Testing for Cryoglobulins will confirm this suspicion.
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This question is part of the following fields:
- Renal System
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Question 26
Incorrect
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A 75-year-old lady is referred to hospital from her GP. She has been treated for essential hypertension, with Bendroflumethiazide 2.5 mg once daily and triamterene 150 mg once daily.
Routine investigations show:
Serum sodium 134 mmol/L (137-144)
Serum potassium 5.9 mmol/L (3.5-4.9)
Serum urea 7.0 mmol/L (2.5-7.5)
Serum creatinine 100 μmol/L (60-110)
Her blood pressure is measured at 134/86 mmHg. Her electrocardiogram is normal. The GP has stopped the triamterene today.
Which of these is the most appropriate action?Your Answer: Start low potassium diet
Correct Answer: Repeat urea and electrolytes in one week
Explanation:Triamterene is a potassium-sparing diuretic that can cause hyperkalaemia, therefore, it was stopped in this patient. With all other lab results returning normal values and a normal ECG, management will simply require repeating the U & E after one week since the Triamterene has already be stopped.
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This question is part of the following fields:
- Renal System
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Question 27
Incorrect
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A 3-year old boy presents with an abdominal mass. Which of the following is associated with Wilms tumour (nephroblastoma)?
Your Answer: Autosomal dominant polycystic kidney disease
Correct Answer: Beckwith-Wiedemann syndrome
Explanation:Beckwith-Wiedemann syndrome is a inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm’s tumour and neonatal hypoglycaemia. Wilm’s tumour is a kidney cancer that usually occurs in children. The causes are unknown, however, risk factors include race and family history. Of note, Wilm’s tumour can occur as part of the following syndromes: WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedmann syndrome and not the other listed options in this question.
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This question is part of the following fields:
- Renal System
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Question 28
Incorrect
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A 40-year-old male presented with sudden onset chest pain and difficulty in breathing for the past 2 hours. On examination he had bilateral ankle swelling. Investigations revealed proteinuria of 6g/d. Which of the following is the most likely explanation for this presentation?
Your Answer: Reduced fibrinogen concentration
Correct Answer: Reduced antithrombin III activity
Explanation:This patient has presented with a thromboembolic event most probably secondary to nephrotic syndrome (nephrotic-range proteinuria). Hypercoagulability is due to urinary loss of anticoagulant proteins, such as antithrombin III and plasminogen and an increase in clotting factors, especially factors I, VII, VIII, and X.
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This question is part of the following fields:
- Renal System
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Question 29
Incorrect
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A 21-year-old woman presents with lethargy and confusion. On examination, you note a purpuric rash covering the abdominal wall and thighs, and a fever of 38C. Investigations reveal haemolytic anaemia, thrombocytopenia, and acute kidney injury.
Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?Your Answer: Acute kidney injury
Correct Answer: Confusion
Explanation:Confusion in the patient refers to neurological symptoms that are more associated with thrombotic thrombocytopenic purpura than with haemolytic uremic syndrome. All the other symptoms present in both conditions similarly.
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This question is part of the following fields:
- Renal System
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Question 30
Incorrect
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A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine. He is not known to have any previous prostatic problems and denies any dysuria. Following a digital rectal examination, he is started on Finasteride and Tamsulosin. Three months later he presents to the emergency department with urinary retention and is catheterized, and a craggy mass is felt on rectal examination. He is referred to a urologist, and a prostatic ultrasound and needle biopsy are arranged, and prostate serum antigen (PSA) is requested.
Which of the following factors is most likely to give a false negative PSA?Your Answer:
Correct Answer: Finasteride
Explanation:Finasteride is often prescribed for patients with Benign Prostatic Hyperplasia (BPH) or enlarged prostate. However, it has been known to cause a decrease in Prostatic Specific Antigen (PSA) levels in patients with BPH, which may lead to false negatives in a case like this, where a palpable mass has been detected and malignancy is suspected.
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This question is part of the following fields:
- Renal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
