Renal Flashcards
1
Q
- Haematuria (1)
A 21-year-old man presents with painless haematuria which he has noticed in the
last 3 days. He suffers from type 1 diabetes which is well controlled, but is otherwise
fit and healthy. The patient has recently recovered from a mild throat infection.
Urine dipstick analysis reveals blood and protein in the urine. The most likely
diagnosis is:
A. Henoch–Schonlein purpura
B. Benign prostate hypertrophy
C. IgA nephropathy
D. Diabetic nephropathy
E. Urinary tract infection (UTI)
A
C
2
Q
- Hyponatraemia
A 74-year-old type 2 diabetic woman undergoes a bowel resection for cancer of the
colon. She is well prior to the operation with well–controlled diabetes and no other
underlying disease. The operation is successful and the patient is given postoperative
insulin and IV dextrose. Two days after the operation she becomes very agitated.
Sodium 124 (135–145)
Potassium 3.3 (3.5–5.0)
Urea 3.1 (3.0–7.0)
Glucose 7.2 (2.5–6.0)
Serum osmolality 265 (275–295)
Urine osmolality 150
The most likely cause of the hyponatraemia is:
A. Addison’s disease
B. Syndrome of inappropriate anti-diuretic hormone (SIADH)
C. Diabetic nephropathy
D. Excess insulin
E. Water overload
A
E
3
Q
- Fever
A 16-year-old boy presents with a low-grade fever which started 1 week ago. The
patient also reports feeling fatigued and indicates pain in his joints. His parents
mention that he has been visiting the toilet more often than usual. A urine dipstick
shows trace proteins, while a blood test shows raised eosinophils. The most likely
diagnosis is:
A. Acute tubulointerstitial nephritis
B. Renal failure
C. Diabetes mellitus
D. UTI
E. Reactive arthritis
A
A
4
Q
- Pitting oedema
A 58-year-old African man presents with pitting oedema of his ankles. He suffers
from recently diagnosed hypertension, but is otherwise healthy. Blood results show
low albumin and a urine dipstick is positive for protein. The most appropriate
initial treatment is:
A. High protein diet
B. Diuretics
C. Prophylactic anticoagulation
D. ACE inhibitor
E. Bed rest
A
B
5
Q
- Flank pain
A 33-year-old woman presents to accident and emergency with severe right flank
pain. The pain started 3 hours ago and is not constant, occasionally moving towards
her right iliac fossa. The patient also feels nauseous and has a low-grade fever. The
most appropriate investigation is:
A. Abdominal x-ray
B. Magnetic resonance imaging (MRI) scan
C. Intravenous urography
D. Computed tomography (CT) scan
E. Abdominal ultrasound (US) scan
A
E
6
Q
- Dysuria
A 42-year-old diabetic Asian male complains of dysuria, increased urinary frequency
and general malaise for the past six months. In the last few days, he has noticed blood
in the urine. Examination of the urine shows the presence of neutrophils with no
organisms detected on urine culture. The most likely diagnosis is:
A. Tuberculosis
B. Renal cell cancer
C. Diabetic nephropathy
D. Bladder cancer
E. Nephritic syndrome
A
A
7
Q
- Periorbital oedema
A 17-year-old patient is referred by his GP after presenting with periorbital oedema.
The patient noticed the oedematous eyes 3 days ago, but reports feeling unwell
since a throat infection 3 weeks ago with nausea and vomiting in the last week.
A urine dipstick is positive for protein and blood while serum creatinine and urea
are mildly deranged. The most likely diagnosis is:
A. Nephrotic syndrome
B. Nephritic syndrome
C. Renal failure
D. Glomerulonephritis
E. Von Grawitz tumour
A
D
8
Q
- Urinary tract infection in pregnancy
A 28-year-old woman patient who is 13 weeks pregnant presents for an antenatal
clinic appointment. The patient feels embarrassed when asked to provide a urine
sample and produces enough for a urine dipstick test only which is positive for
leukocytes and nitrites. The patient denies any symptoms. The most appropriate
treatment is:
A. Trimethoprim
B. Quinolone
C. Tetracycline
D. Cephalexin
E. Ampicillin
A
D
9
Q
- Distress
A 32-year-old builder presents in accident and emergency in a distressed state. He
reports suffering from chest pain for the last 2 weeks, the pain is sharp and only
occurs when he moves heavy objects. He has a family history of cardiovascular
disease and is worried about a heart attack. His blood gas findings are as follows:
pH = 7.47; PCO2 = 3.3; PO2 = 15.3; bicarbonate = 17.53. The most likely diagnosis is:
A. Respiratory acidosis with metabolic compensation
B. Acute metabolic acidosis
C. Respiratory alkalosis with metabolic compensation
D. Metabolic acidosis with respiratory compensation
E. Acute respiratory alkalosis
A
E
10
Q
- Nocturia
A 21-year-old woman complains of urinary frequency, nocturia, constipation and
polydipsia. Her symptoms started 2 weeks ago and prior to this she would urinate
twice a day and never at night. She has also noticed general malaise and some pain
in her left flank. A urine dipstick is normal. The most appropriate investigation is:
A. Serum phosphate
B. Serum calcium
C. Parathyroid hormone (PTH)
D. Plasma glucose
E. Serum potassium
A
B
11
Q
- Breathlessness
A 58-year-old man presents with breathlessness, he reports feeling unwell over the
last three months with nausea, vomiting and difficulty breathing. You notice his
ankles are swollen and he has bruises on his arms. The patient mentions he has not
been urinating as often as normal. The most appropriate investigation is:
A. Urine microscopy
B. Renal ultrasound
C. Serum electrolytes, urea and creatinine
D. Renal biopsy
E. Chest x-ray
A
C
12
Q
- Abdominal pain
A 24-year-old man presents with a four-month history of abdominal pain which
has been getting worse. The patient describes the pain as generalized, dull in
character and does not radiate but often occurs alongside loin pain. An irregular
mass is palpable in both flanks and a mid-systolic click can be auscultated. The
most appropriate investigation is:
A. MRI scan
B. Abdominal US scan
C. Excretion urography
D. CT scan
E. Abdominal x-ray
A
B
13
Q
- Proteinuria
A 55-year-old woman is seen in clinic, she has a ten-year history of type 2
diabetes treated with glibenclamide. Her blood pressure is 148/93 with new onset
proteinuria, her serum results show elevated lipid levels, glycated haemoglobin of
5.5 per cent and fasting glucose of 6.0 mmol/L. A renal biopsy shows the presence
of Kimmelstiel–Wilson lesions. The most appropriate management is:
A. Increase oral hypoglycaemic dosage
B. ACE II antagonists
C. Start cholesterol lowering therapy
D. Start ACE inhibitors
E. Start renal dialysis
A
D
14
Q
- Weight loss
A 52-year-old man complains of a 3-week history of malaise and shortness of
breath. He has lost weight in the last few months but attributes this to a loss of
appetite possibly due to stress at work. On examination, he has a palpable mass in
the right lumbar region. He has no urinary symptoms. However, the urine dipstick
detected blood. The most likely diagnosis is:
A. Renal abscess
B. Renal cyst
C. Renal carcinoma
D. Adrenal tumour
E. Pyelonephritis
A
C
15
Q
- Hypercalciuria
A 37-year-old man presents with a 5-day history of haematuria. Abdominal
examination is unremarkable. Urine analysis reveals hypercalciuria and excretion
urography reveals small calculi within the papilla of the patient’s right kidney. The
patient has presented several times in the past with UTIs and renal stones, but is
otherwise healthy. The most likely diagnosis is:
A. Medullary sponge kidney
B. Renal cell carcinoma
C. Medullary cystic disease
D. Horse-shoe kidney
E. Tertiary hyperparathyroidism
A
A