ACC core conditions

Question 1

What does frank haematuria refer to?

Answer 1

Blood in urine which is visible (not just picked up on urine dipstick)

Question 2

What is painless frank (visual) haematuria often a sign of?

Answer 2

Bladder cancer

Question 3

What are the renal causes of haematuria? (6)

Answer 3

1. Renal cancer
2. Glomerulonephritis (IgA nephropathy)
3. Polycystic kidney disease
4. Papillary necrosis
5. Pyelonephritis
6. Trauma

Question 4

What are the extra-renal causes of haematuria? (4)

Answer 4

1. Calculi
2. Neoplasia
3. Catheterisation
4. Drugs e.g. cephalosporins, ciprofloxacin, furosemide, NSAIDs

Question 5

What might cause glucose in urine? (4)

Answer 5

1. Diabetes
2. Pregnancy
3. Sepsis
4. Renal tubular damage

Question 6

Causes of ketones in urine? (2)

Answer 6

1. Starvation

2. Ketoacidosis

Question 7

Causes of leucocytes in urine? (2)

Answer 7

1. UTI

2. Vaginal discharge

Question 8

Causes of nitrites in urine? (2)

Answer 8

1. UTI

2. High protein meal

Question 9

Causes of bilirubin in urine? (1)

Answer 9

Obstructive jaundice

Question 10

Which organism most commonly causes a UTI?

Answer 10

E.coli (75-95%)

Question 11

What are the symptoms of acute pyelonephritis? (5)

Answer 11

1. High fevers
2. Rigors
3. Vomiting
4. Loin pain & tenderness
5. Oliguria (if acute kidney injury)

Question 12

Symptoms of cystitis?

Answer 12

1. Frequency
2. Dysuria
3. Urgency
4. Haematuria
5. Suprapubic pain

Question 13

How is an AKI defined?

Answer 13

An abrupt deterioration in kidney function with an increase in serum creatinine of >26umol/l or >50% increase from baseline, or a reduction of urine output <0.5ml/kg per hour for more than 6 hours.

Question 14

How may an AKI present? (10)

Answer 14

1. May be asymptomatic
2. Elevated creatinine during biochemical screening
3. Oliguria
4. Malaise, confusion, seizures or coma
5. Nausea, vomiting, or anorexia
6. Oliguria or abnormal urine colour
7. Haematuria (pink rather than frank blood)
8. Drug overdose (paracetamol)
9. Vascullitic rash
10. Multi-organ failure

Question 15

In 80% of cases, how can AKI be resolved?

Answer 15

1. Adequate volume replacement
2. Treatment of sepsis
3. Stopping nephrotoxic drugs

Question 16

What is important to determine/what are the priorities in someone with an AKI?

Answer 16

1. Volume assessment and fluid challenge 1L saline over 2 hours, assess urine output
2. Stop all nephrotoxic drugs
3. Is the patient septic? (pyrexia, high CPR, leucocytosis)
4. History: hypertension, diabetes, prostatism, haematuria
5. Urgent ultrasound scan - look for obstruction, blood flow, size, cysts, symmetry
6. Urinalysis and microscopy to look for red or white cell casts, myoglobinuria and haematuria

Question 17

What are the pre-renal causes of AKI? (5)

Answer 17

1. Hypovolaemia
2. Hypotension, shock
3. Renal artery emboli
4. Renal artery stenosis + ACEi
5. Hepatorenal syndrome

Question 18

What are the renal (parenchymal) causes of AKI? (7)

Answer 18

1. Vasculitis (SLE)
2. Glomerulonephritis
3. Acute tubular necrosis (ishcaemia, septicaemia, toxins, drugs, malaria)
4. Thrombotic microangiopathy
5. Scleroderma crisis
6. Sepsis
7. Calcium, urate, oxalate overload

Question 19

What are the post-renal causes of AKI? (5)

Answer 19

1. Renal vein thrombosis
2. Increased intra-abdominal pressure
3. HIV drugs (indinavir)
4. Ureteric stones/tumour
5. Urethral - prostatic hypertrophy

Question 20

What assessments of the patient should be done in someone with pre-renal AKI? (3)

Answer 20

1. Check postural BP and HR
2. Assess volume status, measure CVP
3. Sepsis screen

Question 21

In the management of AKI, what is the treatment for hyperkalamia? (3)

Answer 21

1. 10mL of 10% calcium gluconate IV
2. 50mL 50% glucose with 5U soluble insulin over 15min
3. Nebulised salbutamol

Question 22

How do you treat metabolic acidosis?

Answer 22

50-100mL of 8.4% bicarbonate via central line over 15-30 minutes

Question 23

How do you treat pulmonary oedema?

Answer 23

1. O2 - consider CPAP
2. IV GTN 2-10mg/h
3. IV furosemide 250mg over 1 hour
4. IV diamorphine single dose of 2.5mg - relieves anxiety and breathlessness
5. Haemofiltration or dialysis

Question 24

What are the different types of pericarditis? (5)

Answer 24

1. Pericardial effusion
2. Cardiac tamponade
3. Constrictive pericarditis
4. Pericardial masses
5. Acute/subacute/chronic/recurrent pericarditis

Question 25

What is the most common infectious cause of pericarditis?

Answer 25

Viral infection - enteroviruses (coxsackie) herpesviruses, adenoviruses, parvovirus B19

Question 26

What is the most common bacterial cause of pericarditis?

Answer 26

Mycobacterium tuberculosis

Question 27

What are the common autoimmune causes of pericarditis? (4)

Answer 27

1. Systemic lupus erythematous 2. Sjogren syndrome 3. Rheumatoid arthritis 4. Scleroderma

Question 28

Which two cancers are most common to cause metastatic spread pericardial masses?

Answer 28

1. Lung cancer | 2. Breast cancer

Question 29

Other than ones previously listed, what are the other causes of pericarditis? (4)

Answer 29

1. Amyloidosis 2. Aortic dissection 3. Chronic heart failure 4. Pulmonary arterial hypertension

Question 30

What are the signs/symptoms of acute pericarditis? (3)

Answer 30

1. Chest pain - typically sharp and pleuritic, improved by sitting up and leaning forward 2. Pericardial friction rub - superficial scratchy or squeaking sound best head with the diaphragm of the stethoscope over the left sternal border 3. Pericardial effusion

Question 31

What may be seen on an ECG of someone with pericarditis?

Answer 31

Widespread ST elevation or PR depression

Question 32

What blood markers may be raised in someone with acute pericarditis? (3)

Answer 32

CRP ESR WCC

Question 33

Chest X-ray of someone with pericarditis is usually normal, unless the pericardial effusion exceeds what amount?

Answer 33

300ml