Miscellaneous

Question 1

What is polycystic kidney disease?

Answer 1

Chronic condition characterised by numerous fluid-filled cysts in the kidney

Question 2

What is the mode of inheritence of polycystic kidneys?

Answer 2

Autosomal dominant

Question 3

How do polycystic kidneys present?

Answer 3

Haematuria

Abdominal pain

Polyuria/Nocturia/Oliguria

HTN

Recurrent UTIs

Renal stones

Features of chronic kidney disease

Question 4

What investigations are used in polycystic kidney disease diagnosis?

Answer 4

FBC

• Anaemia

CT

US

• Screening

Question 5

How is polycystic kidneys managed?

Answer 5

Patient education/genetic counselling

HTN treatment

Tolvaptan (vasopressin receptor 2 antagonist)

Transplant

Question 6

What are the extra-renal manifestations of polycystic kidney disease?

Answer 6

Liver cysts and hepatomegaly

Pancreatic and spleen cysts

Cerebral artery berry aneurysm/subarachnoid haemorrhage

Mitral valve prolapse

Mitral/tricuspid incompetence

Aortic root dilation

Aortic dissection

Question 7

What is the most common exta-renal manifestation of polycystic kidney disease?

Answer 7

Liver cysts

Question 8

What is renal artery stenosis?

Answer 8

Narrowing of the artery supplying the kidney

Question 9

What causes renal artery stenosis?

Answer 9

Atherosclerosis

Fibromuscular dysplasia

Scar formation

Question 10

What are the risk factors for renal artery stenosis?

Answer 10

Carotid artery disease

Coronary artery disease

Smoking

Peripheral vascular disease

Diabetes

Obesity

Question 11

How does renal artery stenosis present?

Answer 11

Difficulty to control BP and renal failure with ACEI

>BP

Renal bruit

Flash pulmonary oedema

Question 12

What investigations are used in renal artery stenosis diagnosis?

Answer 12

Renal US

MRA

Renal Doppler

Angiogram

Question 13

How is renal artery stenosis managed?

Answer 13

BP control

Renal balloon angioplasty and stenting

Question 14

Give complications of renal artery stenosis?

Answer 14

Malignant HTN

Chronic renal failure

Pulmonary oedema

Question 15

What can cause urethral strictures?

Answer 15

Iatrogenic

• traumatic placement of indwelling urinary catheters

STI

Hypospadias

Lichen sclerosus

Question 16

What causes metabolic acidosis with a normal anion gap?

Answer 16

Gastrointestinal bicarbonate loss/diarrhoea

Renal tubular acidosis

Drugs

• Acetazolamide

Ammonium chloride injection

Addison’s disease

Question 17

What causes metabolic acidosis with a raised anion gap?

Answer 17

Lactate

• Shock
• Hypoxia
• Sepsis

Ketones

• Diabetic ketoacidosis
• Alcohol

Urate

• Renal failure

Acid poisoning

• Salicylates
• Methanol

Question 18

What causes metabolic alkalosis?

Answer 18

Vomiting/aspiration

Diuretics

Liquorice, Carbenoxolone

Hypokalaemia

Primary hyperaldosteronism

Cushing’s syndrome

Bartter’s syndrome

Congenital adrenal hyperplasia

Question 19

What causes respiratory acidosis?

Answer 19

COPD

Decompensation in other respiratory conditions

• Life-threatening asthma
• Pulmonary oedema

Sedative drugs

• Benzodiazepines
• Opiate overdose

Question 20

What causes respiratory alkalosis?

Answer 20

Anxiety leading to hyperventilation

Pulmonary embolism

Salicylate poisoning

CNS disorders

• Stroke
• Subarachnoid haemorrhage
• Encephalitis

Altitude

Pregnancy

Question 21

Give medical indications for circumcision

Answer 21

Phimosis

Recurrent balanitis

Balanitis xerotica obliterans

Paraphimosis

Reduced risk of UTI, penile cancer and STIs

Question 22

What is a contraindication for circumcision?

Answer 22

Hypospadias is a contraindication in infancy as the foreskin is used in the repair

Question 23

What injury can also be seen in pelvic fractures?

Answer 23

Urethral injury

Question 24

Give post op complications of renal transplant

Answer 24

ATN of graft

vascular thrombosis

urine leakage

UTI

Question 25

When does hyperacute rejection of renal transplant occur?

Answer 25

Minutes to hours

Question 26

When does acute graft failure of renal transplant occur?

Answer 26

Less than 6 months

Question 27

When does chronic graft failure of renal transplant occur?

Answer 27

Over 6 months

Question 28

What is the NICE guidelines for IV maintenance fluids?

Answer 28

25-30 ml/kg/day of water and Approximately 1 mmol/kg/day of potassium, sodium and chloride and Approximately 50-100 g/day of glucose to limit starvation ketosis

Question 29

Give complications of haemodialysis

Answer 29

Site infection Endocarditis Stenosis at site Hypotension Arrythmia Air embolus Anaphylactic reaction to sterilising agents Disequilibration syndrome

Question 30

Give complications of peritoneal dialysis

Answer 30

Peritonitis * Staph epidermis * Staph aureus Catheter infection Catheter blockage Constipation Fluid retention Hyperglycaemia Hernias Back pain Malnutrition

Question 31

Give complications of renal transplant

Answer 31

DVT/PE Opportunistic infection Lymphoma Bone marrow suppression Recurrence of original disease Urinary tract obstruction Cardiovascular disease Graft rejection

Question 32

What is the NICE guidlines for resucitation fluids?

Answer 32

500mls 0.9% NaCl bolus over 15 minutes

Question 33

How is the anion gap calculated?

Answer 33

(sodium + potassium) - (bicarbonate + chloride)

Question 34

How is hyperacute rejection of renal transplant managed?

Answer 34

Removal of graft

Question 35

Give features of Alport's syndrome

Answer 35

Haematuria/nephritis Bilateal sensorineural hearing loss Visual problems

Question 36

What is the preferred method of access for haemodialysis and why?

Answer 36

Arteriovenous fistulas, due to lower rate of complications

Question 37

How long do arteriovenous fistulas take to develop?

Answer 37

6-8 weeks

Question 38

Give complications of arteriovenous fistulas

Answer 38

Infection Thrombosis, detected by absence of bruit Stenosis, presenting with acute limb pain Steal syndrome

Question 39

What do hyaline casts in urine suggest?

Answer 39

Normal urine Post exercise Fever Loop diuretics

Question 40

What do brown granular casts in urine suggest?

Answer 40

ATN

Question 41

What does bland urinary sediment suggest?

Answer 41

Prerenal uraemia

Question 42

What do red cell casts in urine suggest?

Answer 42

Nephritis/nephritic syndrome

Question 43

What do white cell casts in urine suggest?

Answer 43

AIN