renal 2 peer tute

A 75-year-old woman presents to her General Practitioner with a one-week history of episodic epigastric discomfort. She reports that over this period, each episode has lasted around 10 minutes, with the discomfort being relieved by lying down on her sofa. The most recent event occurred this morning when she was weeding in the garden. It lasted around 15 minutes and was accompanied by nausea and tiredness. She has a medical history of hypertension and type 2 diabetes mellitus. Her medications include perindopril and metformin. On examination, her pulse rate is 94/min, blood pressure 152/92 mmHg, and temperature 37.2°C. Examination of her chest and abdomen is unremarkable.

What is your first investigation?

• Serum Lipase

• ECG

• Serum Lactate

• Upper Abdominal Ultrasound

Mr Smith placed on thiazide diuretic, where does this act?

• ENac

• Na/k/2Cl

• Na/Cl

• Na/H

A 68-year-old woman presents to the Emergency Department with a two-day history of fever, chills, and productive cough. She has a medical history of hypertension and type 2 diabetes mellitus. Her medications include lisinopril. On examination, she appears unwell with a pulse rate of 115/min, blood pressure 85/50 mmHg, respiratory rate 28/min, SpO2 92% on room air, and temperature 38.9°C. Her chest examination reveals crackles in the right lower zone. She has only passed 10 mL of urine in the last six hours

• Start IV fluids

• Insert urinary catheter

• Commence haemodialysis

• Start Frusemide

A 28-year-old woman presents to the General Practice clinic with a two-month history of fatigue and intermittent diarrhoea, frequently containing blood and mucus. She describes faecal urgency and an occasional feeling of incomplete defaecation. When the diarrhoea occurs, she experiences diffuse colicky abdominal pain. In addition, she has noticed erythematous painful nodules on the anterior aspect of her shins in the last week. She has not been able to associate her symptoms with dietary triggers. She had a short course of antibiotics for treatment of a chest infection two months ago. She went on a walking holiday in Nepal three months ago. On examination, she appears well with vital signs within normal limits. The abdominal examination is unremarkable apart from some mild diffuse tenderness. There are several tender, erythematous lesions on the anterior aspect of both shins

• Inflammatory bowel disease

• Giardia Infection

• Clostridium Difficile colitis

• Irritable bowel syndrome

80 yo F presents to the Emergency Department with a 48-hour history of fevers and difficulty breathing. On examination, she appears unwell and confused. Her pulse rate is 120/min, blood pressure 90/60 mmHg, respiratory rate 26/min, SpO2 91% on room air, and temperature 38.8°C. She is treated for bacterial pneumonia with IV fluids, antibiotics and supplemental oxygen

While her haemodynamic status improves over 48 hours, her eGFR falls to 25 mL/min/1.73m². Urinalysis shows muddy brown casts, renal tubular epithelial cells, and proteinuria.

Likely finding on renal biopsy?

• Post strep-gloerulonephritis

• Acute tubular necrosis

• IgA nepropathy

• Acute exacerbation of CKD

Amy is 35yo F presents to GP with increasingly swollen ankles, fatigue, SOB and frothy urine, what other symptoms may be seen?

• Bradycardia

• Haematuria

• Increased Urine Osmolality

• Increased plasma Renin

A 68-year-old man presents to the Emergency Department with a five-day history of decreased urine output and lower abdominal discomfort. He has a medical history of hypertension and a 40 pack-year smoking history. His regular medications include amlodipine and aspirin. He reports intermittent painless haematuria over the past three months but has not sought medical attention for this.

On examination, he appears unwell. His pulse rate is 92/min, blood pressure 160/95 mmHg, respiratory rate 20/min, SpO2 96% on room air, and temperature 37.5°C. His abdomen is distended and tender in the suprapubic region.

Investigations reveal:

• Serum creatinine: 450 µmol/L (60-110)

• Serum urea: 25 mmol/L (3.0-8.0)

• Serum potassium: 5.6 mmol/L (3.5-5.0)

• Haemoglobin: 98 g/L (130-170)

• Benign Prostatic Hyperplasia

• Bladder Cancer

• Pyelonephritis

• Medication related nephrotoxicity

A 72-year-old woman is admitted to hospital with increasing drowsiness following a total knee replacement three days ago. She has a history of moderate chronic obstructive pulmonary disease and takes regular tiotropium and budesonide/formoterol. She is receiving regular oxycodone for post-operative pain.

On examination, she appears drowsy but rousable. Her pulse rate is 88/min, blood pressure 135/85 mmHg, respiratory rate 8/min, SpO2 92% on room air, and temperature 36.5°C. Her chest is clear on auscultation.

Arterial blood gas results reveal:

pH 7.28 (7.35-7.45)
PaCO2 60 mmHg (35-45)
PaO2 60 mmHg (80-100)
HCO3 30 mmol/L (22-26)
Base excess +2 mmol/L (-2 to +2)

Which one of the following is the most likely diagnosis?

• Acute COPD exacerbation

• Opioid induced respiratory distress

• Pneumonia

• Pulmonary Embolism

Mrs Q 75yo F is delirious on day 2 post-op hip replacement, she takes enalapril for HF and given Ibuprofen for pain and swelling at her surgical site, she is haemodynamically stable. You are called in to review her what should you do next?

• Cease Ibuprofen

• Cease Enalapril

• Start IV lfuids

• Back to theatre to look at wound site

A 45-year-old woman presents with a three month history of episodic pruritis, upper abdominal pain and jaundice. On these occasions she has noticed dark urine and pale stools. The patient has a history of ulcerative colitis, which has been effectively managed with medication for the past five years. Blood tests reveal an elevated alkaline phosphatase level, and an ultrasound examination shows dilatation of the intrahepatic bile ducts.

• Autoimmune hepatitis

• Cholangiocarcinoma

• Choledocholithiasis

• Primary Sclerosing Cholangitis