Renal

Question 1

Signs in polycystic kidney disease

Answer 1

Bilateral flank masses - ballotable, possible to palpate above them, resonant on percussion
Evidence of renal replacement therapy
Transplant scar/nephrectomy scar
Anaemia
Polycythemia with plethoric facies
Palpable liver edge which is irregular and nodular
Less common - splenic cyst
Hypertension
Other - aortic regurg, mitral valve prolapse, left ventricular heave (HT), evidence of old stroke/CN3 palsy
Scar at the neck may suggest previous parathyroidectomy

Question 2

Differentiating spleen from polycystic kidney

Answer 2

Kidney - can get above it, can be balloted, resonant on percussion, does not move with respiration
Spleen - cannot get above it, cannot be balloted, dull on percussion, moves with respiration

Question 3

Extra-renal manifestations in PKD

Answer 3

Hypertension 
Cardiac - AR, MV prolapse, cardiomegaly (from HT, get heave)
Neuro - berry aneurysms 
Liver and pancreatic cysts 
Colonic diverticulae
Abdominal wall and inguinal hernias

Question 4

Treatment of PKD

Answer 4

Manage HT 
Treat anaemia 
Phosphate binders 
Vitamin D supplementation 
RRT

Question 5

Cardiac manifestations of PKD

Answer 5

HT, Valvular disease (AR, mitral valve prolapse)

Question 6

Causes of splenomegaly

Answer 6

Congestive - cirrhosis, heart failure, thrombus (portal vein, hepatic vein, splenic veins)
Haematological malignancy - CML and myelofibrosis produce massive splenomegaly, lymphomas and other leukaemias can produce moderate splenomegaly
Other myeloproliferative disorders - PR, ET
Haematologic - haemolytic anaemias
Infection - CMV, EBV, hepatitis, IE
Inflammatory - rheumatoid (Felty’s), sarcoid, SLE
Infiltrative - eg amyloid
Primary spenic disease (eg - splenic vein thrombosis)