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Question 1
Correct
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A 63-year-old gentleman is admitted to the Emergency Department, with a past history of chronic renal failure, who complains of increasing shortness of breath. Bloods reveal a creatinine of 570 μmol/l, urea of 48 mmol/l. He is also anaemic with a haemoglobin (Hb) of 8.9 g/dl.
On examination he has a pericardial rub and there are bibasal crackles consistent with heart failure.
Which of the following represents the best treatment option for this patient?Your Answer: Urgent haemodialysis
Explanation:This case presents with symptoms and lab results suggestive of uremic pericarditis, which is an indication for immediate haemodialysis. Uremic pericarditis is caused by inflammation of the membranes of the pericardial sac, which usually resolves after a period of intensive dialysis.
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This question is part of the following fields:
- Renal System
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Question 2
Correct
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A 15-year-old boy presented to a urologist with a complaint of blood in the urine and pain in his abdomen. On examination, abdominal swelling is present and blood pressure is elevated. Which of the following is the most appropriate investigation in this case?
Your Answer: Ultrasound
Explanation:Haematuria and abdominal swelling may indicate either polycystic kidney disease or a tumour. Because of the patient’s age, the likelihood of a tumorous growth is small, thus an ultrasound is the best choice for this case.
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This question is part of the following fields:
- Renal System
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Question 3
Correct
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A 28-year-old male has presented to his doctor with hypertension. Upon examination, he is found to have palpable kidneys. An abdominal ultrasound shows enlarged cystic kidneys on both sides. From the list of options, choose the most likely condition present in this patient.
Your Answer: Polycythaemia
Explanation:The most likely diagnosis for this patient is adult polycystic kidneys. This disease is associated with the following: valvular heart abnormalities, incompetence, and aneurysms of the cerebral circulation. It can also be associated with excessive erythropoietin production and polycythaemia. There is an increased incidence of aortic incompetence, and mitral valve prolapse occurs in 25 per cent of patients. Hepatic cysts can also occur, and present in 70 per cent of patients – these can also involve the pancreas in 10 per cent of patients and the spleen. Cerebral berry aneurysms are present in around 5-8 per cent of patients, but familial clustering is also observed. That is if there is a family history, over 20 per cent of patients will also have an aneurysm. Diverticular disease is also thought to be increased in patients with polycystic kidney disease.
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This question is part of the following fields:
- Renal System
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Question 4
Correct
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A 45-year-old male suffers multiple injuries in a road traffic accident. He complains of inability to urinate for the past 4 hours. Radiological examination reveals a fractured pelvis. Which of the following will be the most appropriate step in the management of this patient?
Your Answer: Suprapubic catheter
Explanation:When faced with urethral trauma, initial management decisions must be made in the context of other injuries and patient stability. These patients often have multiple injuries, and management must be coordinated with other specialists, usually trauma, critical care, and orthopaedic specialists. Life-threatening injuries must be corrected first in any trauma algorithm. Initial emergent treatment remains controversial, but mainstays of therapy include drainage of the urinary bladder, often with placement of a suprapubic catheter (SPT) and primary endoscopic realignment of the urethra if possible.
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This question is part of the following fields:
- Renal System
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Question 5
Correct
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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: 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 6
Correct
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A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for review. His blood tests show:
Haemoglobin 11.2 g/dl (13.0 - 18.0 g/dL)
MCV 87 fl (80 - 96 fL)
Sodium 133 mmol/l (137 - 144 mmol/L)
Potassium 4.3 mmol/l (3.5 - 4.9 mmol/L)
Urea 19.1 mmol/l (2.5 - 7.5 mmol/L)
Creatinine 267 μmol/l (60 - 110 μmol/L)
Ferritin 150 μg/l (15 - 300 μg/L)
C reactive protein <5 mg/l (< 10 mg/L)
What is the most appropriate management of his anaemia?Your Answer: Monitor haemoglobin, no treatment required at present
Explanation:Because the patient has chronic kidney disease, we need to consider the associated adverse effects of trying to maintain normal haemoglobin levels (14-18g/dl in this patient) and instead only instigate therapy when the level falls below 11 g/dl. Thus, in this case we should just monitor the haemoglobin levels and not initiate therapy just yet.
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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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What is the site of action of antidiuretic hormone?
Your Answer: Distal convoluted tubule
Correct Answer: Collecting ducts
Explanation:Vasopressin, also called antidiuretic hormone (ADH), regulates the tonicity of body fluids. It is released from the posterior pituitary in response to hypertonicity and promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.. An incidental consequence of this renal reabsorption of water is concentrated urine and reduced urine volume. In high concentrations may also raise blood pressure by inducing moderate vasoconstriction.
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This question is part of the following fields:
- Renal System
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Question 8
Correct
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A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?
Your Answer: Reduced renal reabsorption
Explanation:Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.
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This question is part of the following fields:
- Renal System
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Question 9
Correct
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A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?
Your Answer: Urinary albumin
Explanation:This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.
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This question is part of the following fields:
- Renal System
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Question 10
Correct
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In idiopathic hypercalciuria, what management should be initiated if there is renal stone disease or bone demineralization?
Your Answer: Dietary modification and thiazide diuretics
Explanation:Idiopathic hypercalciuria presents with excess calcium in the urine without an apparent cause. Dietary modification is the first step in addressing this condition, however, because hypercalciuria increases the risk of developing renal stones and bone demineralisation, thiazide diuretics should be prescribed to increase calcium reabsorption when these symptoms are also present.
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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 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 factor VIII
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 12
Incorrect
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A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the most common problem that can arise in this case?
Your Answer: Viral hepatitis
Correct Answer: Protein-calorie malnutrition
Explanation:Protein-calorie malnutrition is observed in almost 50% of dialysis patients, contributing to increased morbidity and mortality. All the other complications listed can usually be prevented thanks to modern-day dialysis techniques.
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This question is part of the following fields:
- Renal System
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Question 13
Incorrect
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A 38-year-old woman has been reviewed in the hypertension clinic. Abdominal ultrasound scanning reveals that her left kidney is much smaller than her right kidney.
You suspect renal artery stenosis, as her GP noticed a deteriorating serum creatinine concentration within 1 month of starting ACE inhibitor therapy.
What is the most appropriate next investigation?Your Answer:
Correct Answer: Magnetic resonance angiography
Explanation:MRA is next appropriate management for this case. It is non-invasive and has been shown to correlate with angiographic appearance. Although Renal arteriography is considered gold standard, it is invasive, so a non-invasive option is preferred as first line of investigation in this case.
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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 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:
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 15
Incorrect
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Of the following disorders, which one causes acute tubular damage?
Your Answer:
Correct Answer: Myoglobinuria
Explanation:Myoglobinuria is the condition when there is degeneration of necrosed muscle that it is excreted in the urine. This condition would then cause acute tubular damage leading to renal failure.
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This question is part of the following fields:
- Renal System
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Question 16
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:
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 17
Incorrect
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A 23-year-old student commences chemotherapy for B-type acute lymphoblastic leukaemia. She suffers from vomiting, but 36 hours later her condition worsens and her bloods reveal a corrected calcium of 2.0 mmol/l and serum potassium of 6.7 mmol/l.
Which of the following options is the best way to avoid this problem from occurring?Your Answer:
Correct Answer: Hydration and allopurinol pre-chemotherapy
Explanation:This case is most likely tumour lysis syndrome, often occurring immediately after starting chemotherapy because the tumour cells are killed and their contents are released into the bloodstream. After treating lymphomas or leukaemia, there is a sudden hypocalcaemia, hyperphosphatemia, and hyperkalaemia
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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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In end stage renal disease, deficiency of erythropoietin can lead to which of the following conditions?
Your Answer:
Correct Answer: Anaemia
Explanation:Erythropoietin is necessary for normal Hb levels. Reduced levels of erythropoietin in renal failure leads to anaemia in these patients.
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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 38-year-old male presented with multiple bruises and fractured pelvis after a road traffic accident. He is also complaining of anuria for the past 4 hours. The next management step would be?
Your Answer:
Correct Answer: Suprapubic catheter
Explanation:Stress and urge urinary incontinence has been observed in patients who have sustained pelvic fractures due to trauma. The best treatment option would be to pass suprapubic catheter. If there is still no urine output, then ureteral damage might be the cause, which needs to be managed.
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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 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs due to:
Your Answer:
Correct Answer: Increased release of renin
Explanation:The oedema is an effect of the a decreased cardiac output that increases renin release which leads to vasoconstriction and sodium and water retention.
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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 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:
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 22
Incorrect
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A 3-year-old boy presents with recurrent urinary tract infections. What is the most common cause for this problem in a child of this age?
Your Answer:
Correct Answer: Vesicoureteric reflux
Explanation:Vesicoureteral reflux is the condition when the urine flows backwards from the bladder into the kidneys, which is the most common cause of UTI in patients this age.
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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 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor for a review. His symptoms are currently well controlled; he is taking Ramipril 10mg, Spironolactone 25mg, Bisoprolol 10mg, and Furosemide 40mg. His main complaint is of painful gynaecomastia that he says has developed over the past 6 months. Physical exam reveals a blood pressure of 125/80 mmHg and no residual signs of cardiac failure. Renal function is unchanged from 6 months earlier, with stable creatinine at 125 µmol/l.
Which of the following is the most appropriate next step?Your Answer:
Correct Answer: Change the spironolactone to eplerenone
Explanation:Spironolactone is an aldosterone antagonist diuretic that is well-known to cause gynaecomastia because it increases testosterone clearance and oestradiol production. The patient’s primary complaint of gynaecomastia should immediately prompt discontinuation of spironolactone and replacement with Eplerenone, which lacks the antiandrogenic effects, and thus there is less risk of gynaecomastia.
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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:
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
Incorrect
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A patient is told to consult a pathologist regarding the stone that was found in his urine. The pathologist describes the stone as laminated, with areas of black staining. Urinalysis indicates hypercalciuria. Which is the most likely type of renal calculus?
Your Answer:
Correct Answer: Calcium oxylate
Explanation:Hypercalciuria is the most common cause of kidney stone disease. It is an identifiable cause and can be primary (or idiopathic) or secondary. Secondary hypercalciuria might be due to hyperparathyroidism (2-3%), high levels of vitamin D, Cushing’s syndrome, sarcoidosis or milk-alkali syndrome. Hypercalciuria can also be idiopathic and is considered the commonest metabolic abnormality in people with stone disease. Factors favouring stone formation are: abnormal urine constituents, infection and stasis. In these cases, investigations fail to reveal any calcium metabolism disorders.
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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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Which one of the following statements regarding minimal change glomerulonephritis is incorrect?
Your Answer:
Correct Answer: Hypertension is found in approximately 25% of patients
Explanation:Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.
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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 34-year-old diabetic male is undergoing contrast radiography. What should you do to make sure that renal damage due to the contrast dye is prevented?
Your Answer:
Correct Answer: Plenty of fluids
Explanation:The risk of kidney damage during this procedure is greatly increased for a diabetic patient. It is therefore important that plenty of fluids are given to prevent dehydration and therefore damage to the kidneys.
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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 2-month-old infant was brought to the paediatrics ward by her mother with a complaint of excessive crying during urination. The urine culture of the infant revealed E.coli. Which of the following investigations should be done next?
Your Answer:
Correct Answer: US
Explanation:Urine culture confirms a diagnosis of a UTI. A kidney ultrasound will be the next best investigation because it will help us to visualise the bladder, kidneys, and ureters to rule out any congenital obstruction in the urinary tract that might be the actual cause of infection in this 2-month old girl.
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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:
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 53-year-old diabetic man presents to the emergency with pain in left loin and haematuria that was sudden in onset. Investigations revealed an 8mm stone in the left lower ureter. Supportive therapy was initiated with nifedipine and steroids. The patients returned to the emergency with vomiting and worsening pain and passage of two stones. Renal function tests are significant for an impending ARF. Which of the following steps would be employed in the management of this patient?
Your Answer:
Correct Answer: Percutaneous nephrostomy
Explanation:Nephrolithiasis encompasses the formation of all types of urinary calculi in the kidney, which may deposit along the entire urogenital tract from the renal pelvis to the urethra. Nephrolithiasis manifests as sudden onset colicky flank pain that may radiate to the groin, testes, or labia (renal/ureteric colic) and is usually associated with haematuria.
Risk factors include low fluid intake, high-sodium, high-purine, and low-potassium diets, which can raise the calcium, uric acid, and oxalate levels in the urine and thereby promote stone formation.
Diagnostics include noncontrast spiral CT of the abdomen and pelvis or ultrasound to detect the stone, as well as urinalysis to assess for concomitant urinary tract infection and serum BUN/creatinine to evaluate kidney function. Urinary stones are most commonly composed of calcium oxalate. Less common stones are made up of uric acid, struvite (due to infection with urease-producing bacteria), calcium phosphate, or cystine.
Small uncomplicated stones without concurrent infection or severe dilation of the urinary tract may be managed conservatively with hydration and analgesics to promote spontaneous stone passage. When the spontaneous passage appears unlikely or fails due to the stone’s size or location, first-line urological interventions include shock wave lithotripsy, ureterorenoscopy, and, in case of large kidney stones, percutaneous nephrolithotomy. The most important preventive measure is adequate hydration.
Collected stones should be sent for chemical analysis because in many cases specific lifestyle guidance, diet changes, and/or initiation of medical treatment (e.g., thiazide diuretics, urine alkalinisation) can prevent future stone formation. -
This question is part of the following fields:
- Renal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
