Nephro

Question 1

What drugs should be stopped in AKI

Answer 1

NSAIDs
ACE/ARB
Diuretics
Antibiotics e.g. aminoglycosides
Metformin
Lithium
Digoxin

Question 2

Investigations for prostate cancer

Answer 2

Multi-parametric MRI (first line)

Transrectal US (TRUS) prostate biopsy + grade

PSA, DRE

Question 3

Management for prostate cancer

Answer 3

Gleason score < 6 (low risk):
- active surveillance, lifestyle changes

Gleason score 7+ (medium/high risk):
- radical prostectomy
- radiotherapy
- anti-androgen therapy

Metastatic disease:
- chemotherapy
- anti-hormonal agents w.g. goserelin

Question 4

Investigations for UTI

Answer 4

Urine dipstick (not diagnostic in men, women > 65, catheterised patients)

MSU for:
- women > 65
- men
- pregnant women
- recurrent UTI
- haematuria regardless if visible

Always begin broad spec AB therapy immediately whilst waiting for MSU results in these patients

Question 5

What is diagnostic for nephrotic syndrome/mnemonic

Answer 5

Massive proteinuria (foamy urine)
Oedema
Hypoalbuminemia

Protein COALs
- Cholesterol high
- Oedema
- Albumin low
- Lipids high (fatty casts on microscopy)

Question 6

Muddy brown casts in MSU

Answer 6

Acute tubular necrosis

Question 7

White cell casts on urinalysis

Answer 7

Acute interstitial nephritis

Question 8

How does acute interstitial nephritis present

Answer 8

Rash, fever, arthralgia, eosinophilia, hypertension

Question 9

How does acute tubular necrosis present (stages)

Answer 9

Oliguric phase
Polyuric phase
Recovery phase

Question 10

Management of bladder cancer

Answer 10

Non-invasive: TURBT + chemo

Locally invasive: radical/partial cystectomy + lymph node biopsy

Non organ contained T3a/b:
Radical cystectomy + lymph node biopsy

Non organ contained T4a/b:
Chemo + radical cystoprostectomy

Metastatic: Chemo +/- radio/surgery

Question 11

Who gets a 7 day course of nitrofurantoin?

Answer 11

Men, pregnant women, symptomatic catheterised patient

Question 12

Name the types of nephrotic syndrome

Answer 12

Minimal changes disease
Membranous glomerulonephritis
Focal segmental glomerulosclerosis
Diabetic nephrology
Amyloidosis nephropathy

Question 13

What is minimal changes disease associated with?

Answer 13

Young age
Non-Hodgkin lymphoma
Infectious mononucleosis

Question 14

How does minimal changes disease present?

Answer 14

Nephrotic syndrome symptoms

Young age
Facial swelling
Eczema
Asthma

Question 15

What is the diagnostic/definitive investigation to discern between nephrotic syndromes?

Answer 15

Renal biopsy

Question 16

Corticosteroids as management for which nephrotic syndromes

Answer 16

Minimal changes disease
Focal segmental glomerulosclerosis

Symptomatic membranous glomerulonephritis (ACEi/ARB for all)

Question 17

First line investigation for testicular cancer

Answer 17

Ultrasound