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Question 1

What is the imaging of choice in renal stones?

Answer 1

non-contrast CT-KUB

Question 2

If stones <5mm and not causing infection they can pass spontaneously. If >6mm, persistent pain and failing conservative management what is then done?

What pain relief is used?

Answer 2

Same as biliary colic - IM diclofenac

1. alpha blockers - nifedipine (promote dilation of ureter)
2. ESWL (extracoroporeal shock wave lithotripsy)
3. If large/complex/multiple - percutaneous nephrolithotomy (keyhole)

Question 3

Struvite forms what kind of kidney stone?

Answer 3

Staghorn

Question 4

Name a thiazide like diuretic?

Answer 4

Bendroflumethiazide
Indapamide

Question 5

Why is phosphate closely monitored in CKD?

What is done to manage it?

Answer 5

CKD leads to low vit D -> 1-alpha hydroxylation normally occurs in kidneys so can’t activate vit D

CKD leads to high phosphate -> can’t excrete it the way it normally does

High serum phosphate “drags” calcium from bones = osteomalacia

Manage
1. reduce dietary phosphate
2. phosphate binders (calcium acetate)

Question 6

What kind of kidney stones are associated with chemotherapy?

Answer 6

Uric acid

Chemo and cell death causes an increase in uric acid levels

Question 7

Pt with iron deficient anaemia in CKD - how is this managed?

How would this change if they had a normocytic anaemia?

Answer 7

Manage Fe+ deficiency first before any EPO stimulating agents

Normocytic suggests due to EPO insufficiency - manage that

Question 8

What complication can occur post TURP (transurethral resection of prostate)

Answer 8

TURP

TURP syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of prostate

TURP syndrome occurs due to irrigation fluid entering the circulation - hyponatremia + fluid overload

Question 9

What is finasteride?

Answer 9

5-alpha reductase inhibitor
- reduces proste volume by blocking androgen activity on prostate

2nd line in BPH after tamsulosin etc. (alpha-1 antagonists - reduce smooth muscle tone of prostate and bladder)

Question 10

What are the two meds that are recommended for managing HTN in CKD?

What other med should be added on diagnosis?

Answer 10

1. ACEi
2. Furosemide

Statin

Question 11

What imaging is used for stroke vs TIA?

Answer 11

Stroke - non-contrast CT

TIA - MRI with diffusion-weighted imaging - can be done next day too

Question 12

What imaging is used in optic neuritis?

Answer 12

MRI brain and orbits with contrast