Free Printable Week 12

1.

A 42 year old man is found to have multiple cysts on both kidneys and his liver on an ultrasound performed for abdominal pain. What is the most likely diagnosis?

a)

Medullary sponge kidney

b)

Alport’s syndrome

c)

Autosomal recessive polycystic kidney disease

d)

Congenital nephronophthisis

e)

Autosomal dominant polycystic kidney disease

2.

A 77 year old woman is found by her carer on the floor 14 hours after a fall. Her heart rate is 110 bpm, BP is 90/45 mmHg and her right leg is shortened and externally rotated.

Investigations:

creatine kinase 17000 U/L (24 – 170 U/L)

serum potassium 5.4 mmol/L (3.5 – 4.9)

urea 8.8 mmol/L (2.5 – 7.0 mmol/L)

creatinine 216 μmol/L (60 – 110 μmol/L)

What is the most appropriate initial management?

a)

Intravenous fluids

b)

furosemide

c)

dialysis

d)

urinary alkalisation

e)

hemiarthroplasty

3.

A 72 year old woman presents with urinary frequency and dysuria secondary to a urinary tract infection. Which is the most likely causative organism?

a)

Stenotrophomonas

b)

Coliform

c)

Haemophilus

d)

Streptococcus

e)

Staphylococcus

4.

A 63 year old man with heart failure is found to have a serum creatinine of 141umol/l, which is unchanged 3 months later. His eGFR is 38ml/min/1.73m^2.What stage of CKD does he have?

a)

stage 5

b)

stage 2

c)

stage 4

d)

stage 1

e)

stage 3

5.

A 69 year old man presents with ankle swelling and is found to have pr++++ on urine dipstick. Urine protein:creatinine ratio measures 693mg/mmol. You suspect nephrotic syndrome.

Which other measure do you need to check to confirm your diagnosis?

a)

Serum cholesterol

b)

Serum potassium

c)

Serum albumin

d)

ANCA

e)

Serum creatinine

6.

A 79 year old patient is admitted to hospital with a lower respiratory tract infection and develops acute kidney injury. Which of the following classes of drugs is it most important to stop?

a)

Calcium channel blocker

b)

NSAID

c)

Beta blocker

d)

antibiotic

e)

alpha blocker

7.

A 36 year old man presents with a 3 month history of general malaise, fatigue and over the last 2 weeks he has been nauseated and vomiting. Over the last 2 days he has not passed any urine. He is catheterised and does not pass any urine. ECG shows tall tented T waves with a bizarre QRS complex.

Initial biochemistry shows:

serum potassium 8.2 mmol/L (3.5 – 4.9)

urea 42.7 mmol/L (2.5 – 7.0 mmol/L)

creatinine 1618 μmol/L (60 – 110 μmol/L)

What is the most important next step?

a)

Intravenous insulin and dextrose

b)

Intravenous adenosine

c)

Oral calcium resonium

d)

Intravenous calcium gluconate

e)

Oral sodium bicarbonate

8.

A 36 year old man presents with a 3 month history of general malaise, fatigue and over the last 2 weeks he has been nauseated and vomiting. Over the last 2 days he has not passed any urine. He is catheterised and does not pass any urine. ECG shows tall tented T waves with a bizarre QRS complex.

Initial biochemistry shows:

serum potassium 8.2 mmol/L (3.5 – 4.9)

urea 42.7 mmol/L (2.5 – 7.0 mmol/L)

creatinine 1618 μmol/L (60 – 110 μmol/L)

What is the most important next step?

a)

kidney ultrasound

b)

intravenous fluids

c)

haemodialysis

d)

immunology testing

e)

transplantation

9.

Which method of renal replacement therapy is associated with the best survival?

a)

haemodialysis

b)

peritoneal dialysis

c)

transplant

10.

A 72 year old man is diagnosed with prostate cancer. What is the commonest site of metastases from prostate cancer?

a)

bladder

b)

lung

c)

liver

d)

bone

e)

brain

11.

Serum creatinine rises once kidney function is lost. On average, how much kidney function is lost before the serum creatinine rises?

a)

10%

b)

50%

c)

80%

12.

A 72 year old woman presents with urinary frequency and dysuria secondary to a urinary tract infection. Which is the most likely causative organism?

a)

coliform

b)

Haemophilus

c)

Staphylococcus

d)

Stenotrophomonas

e)

Streptococcus

13.

A 72 year old man is diagnosed with prostate cancer. What is the commonest site of metastases from prostate cancer?

a)

bladder

b)

bone

c)

brain

d)

liver

e)

lung

14.

A 69 year old man presents with ankle swelling and is found to have pr++++ on urine dipstick. Urine protein:creatinine ratio measures 693mg/mmol. You suspect nephrotic syndrome.

Which other measure do you need to check to confirm your diagnosis?

a)

serum albumin

b)

serum cholesterol

c)

serum creatinine

d)

serum potassium

e)

ANCA

15.

A 34 year old man is found to have blood and protein on urinalysis during a routine work medical. Which underlying glomerulonephritis is he most likely to have?

a)

focal segmental glomerulosclerosis

b)

IgA nephropathy

c)

membranous nephropathy

d)

minimal change disease

e)

mesangiocapillary GN

16.

A 72 year old man has an eGFR of 36ml/min confirmed on repeat testing 3 months apart. What stage of CKD does he have?

a)

stage 1

b)

stage 2

c)

stage 3

d)

stage 4

e)

stage 5

17.

60y woman – admitted with ischaemic leg

PMH: PVD, T2DM (2018), TIA, ↑BP, angina, COPD

Smokes 20/day

SCr 120umol/L

O/Ex thin, BP 195/90mmHg, wheeze, carotid and femoral bruits, poor peripheral pulses.

Anaesthetist says BP is too high for GA - Started on ramipril - BP falls to 125/75mmHg - Anaesthetist unhappy as SCr now 270umol/L

Urinalysis: no protein, no blood

Non-proteinuric AKI

Differential diagnosis?

4 lines

18.

Acute medical receiving unit

42y male with 20y history of ulcerative colitis

Admitted with leg swelling

Normal ECG

SCr 95umol/L

Albumin 15

BP 105/65mmHg

Urinalysis P4+ B-

What are some differential diagnoses?

uPCR 742 (7.5g/24h)

4 lines

19.

what is the pathophysiology behind diabetic nephropathy?

4 lines

20.

which medications would you stop in the context of renal artery stenosis?

4 lines

21.

36y old medical secretary

SCr 200umol/L (70umol/L Jan 2019)

Urinalysis P4+, B3+

uPCR 400, albumin 29

list some differential diagnoses?

4 lines

22.

Where are ureteric stones most likely to obstruct?

4 lines

23.

list some types of ureteric stones that can be found?

4 lines

24.

What factors affect stone formation?

4 lines

25.

what is the gold standard imaging for ureteric stones?

4 lines

26.

what are the surgical options for management of ureteric stones?

4 lines

27.

when do we decide that the kidneys have failed?

a)

eGFR <7ml/min

b)

eGFR 7-10ml/min

c)

eGFR <30ml/min

d)

eGFR <4ml/min

e)

eGFR 10-15ml/min

28.

who is unsuitable for kidney transplant?

4 lines

29.

what types of tissue rejection can occur in kidney transplantation?

4 lines

30.

which immunosuppressive drugs are used in renal transplants?

4 lines

31.

What are the indications for renal replacement therapy?

4 lines

32.

what are the aims of haemodialysis?

4 lines

33.

what are the pre-renal causes of acute kidney injury?

4 lines

34.

What are the post renal causes of acute kidney failure?

4 lines

35.

what are the intra-renal causes of acute kidney injury?

4 lines

36.

what level of potassium would constitute a medical emergency?

a)

<6

b)

6-6.4

c)

>6.5

d)

>7

e)

>8

37.

What are the most likely organisms that cause renal abscesses?

4 lines

38.

What is the definition of CKD?

4 lines

39.

What stage of CKD does someone have if their eGFR of 17ml/min/1.73m2?

a)

1

b)

2

c)

3

d)

4

e)

5

40.

what is albumin?

4 lines

41.

what is a normal ACR?

a)

<3

b)

<2.5

c)

>6

d)

>10

e)

<20

42.

what is a normal PCR result?

a)

<2.5

b)

<3

c)

>7

d)

<20

e)

<10

43.

what are some symptoms of advanced CKD?

4 lines

44.

what are the signs of advanced CKD?

4 lines

45.

what is the most common prostate cancer?

a)

squamous cell carcinoma

b)

adenocarcinoma

c)

adenoma

46.

what is PSA?

4 lines

47.

what are the treatment options for advanced prostate cancer?

4 lines

48.

what do hydrocarbons have to do with bladder cancer?

4 lines

49.

what is the most common type of bladder cancer?

a)

squamous carcinoma

b)

adenoma

c)

adenocarcinoma

d)

transitional cell carcinoma

e)

carcinoid tumour

50.

what is the treatment for bladder cancer?

4 lines

51.

what is the treatment for metastatic bladder cancer?

4 lines

52.

what investigations would you do for testicular cancer?

4 lines

53.

what pattern of inheritance does adult PKD show?

a)

autosomal recessive

b)

autosomal dominant

c)

x-linked dominant

d)

x-linked recessive

e)

mitochondrial

54.

what genes are involved in APKD?

4 lines

55.

what is von hippel lindau?

4 lines

56.

what is tuberous sclerosis?

4 lines

57.

what is autosomal recessive polycystic kidney disease?

4 lines

58.

what is medullary cystic kidney disease?

4 lines

59.

what is alport's syndrome?

4 lines

60.

what are the basics of glomerulonephritis?

4 lines

61.

what is involved in a glomerulonephritis screen?

4 lines

62.

what is renal agenesis?

4 lines

63.

what is renal hypoplasia?

4 lines

64.

what is renal dysplasia?

4 lines

65.

what is renal hypodysplasia?

4 lines

66.

what can cause hydronephrosis?

4 lines

67.

what are the features of nephrotic syndrome?

4 lines

68.

what are the features of nephritic syndrome?

4 lines

69.

what can cause nephrotic syndrome?

4 lines

70.

what can cause nephritic syndrome?

4 lines

71.

what is IgA nephropathy?

4 lines

72.

what is membranous glomerulonephritis?

4 lines

73.

what is rapidly progressive glomerulonephritis?

4 lines

Week 12 - Nephrology

Total questions: 73

Worksheet time: 3hrs 39mins

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