rev

Question 1

which artery is associated with horse shoe kidneys?

Answer 1

inferior mesenteric artery - gets caught on ascent

commonest congenital abnormality

Question 2

lymphatics for testes

Answer 2

lumbar lymph nodes around aorta

Question 3

histological difference between PCT + DCT epithelium

Answer 3

both cuboidal epithelium BUT

PCT = thick brush border = microvilli (large surface area)

DCT = no microvillia

Question 4

what do juxtaglomerular cells secrete?

Answer 4

renin

juxtaglomerular cells = granular

Question 5

3 components of juxtaglomerular apparatus

Answer 5

mucula densa = sense NaCl conc
juxtaglomerulat cells
mesangial cells

Question 6

where actually is the juxtaglomerular apparatus?

Answer 6

specialised region where DCT passes adjacent to vascular pole of the SAME renal corpuscle

Question 7

histology of collecting ducts

Answer 7

simpler columnar

Question 8

histology of collecting ducts

Answer 8

simpler columnar

Question 9

histology of urine conducting system

Answer 9

transitional epithelium - urothelium

cells on luminal suface = umbrella cell (facet) - thick, provides IMpermeable barrier

below is lamina propria = smooth muscle

Question 10

how much of cardiac volume does the kidneys receive?

Answer 10

20% = 1 litre

Question 11

gain of NaCl effect on fluid compartments

Answer 11

gain NaCl = increase ECF + decrease ICF
(GID)

loss = opposite

Question 12

how much of the plasma entering glomerulus is filtered/leaves through efferent arteriole?

Answer 12

20% entering glomerulus is filtered

80% enters then leaves via efferent arteriole

Question 13

what is the charge of the basement membrane?

Answer 13

negatively charged

endothelium -> basement membrane -> podocytes
RBC barrier -> plasma protein barrier (PPB) -> PPB

Question 14

which forces act against net filtration pressure?

Answer 14

bowmans capsule HYDROstatic = 15mmHg

capillary ONCOTIC = 30

Question 15

net filtration pressure

Answer 15

10mmhg

(55+0)-(15+30) = 10

Question 16

affect of nictotine + alcohol on ADH release

Answer 16

nicotine stimulates ADH release

alcohol inhibits ADH release

Question 17

what conditions may present with resp acidosis?

Answer 17

(CO2 retention)

COPD, asthma, airway restriction

Question 18

what conditions may present with metabolic acidosis?

Answer 18

excess H+

sepsis, lactic acidosis, DKA

Question 19

what conditions may present with metabolic alkalosis?

Answer 19

(net loss of H or gain in HCO3)

vomiting, diuretics, hyperaldosteronism, hypokalaemia

Question 20

target saturations in COPD patient

Answer 20

88-92%

monitor ABG closely

Question 21

reduced anion gap causes

Answer 21

myeloma

hypoalbuminaemia

Question 22

raised anion gap causes

Answer 22

alcohol, kentones, Uraemia, DKA**

Isoniazid, Lactic acidosis
Ethylene glycol, Salicylate poisoning

Question 23

how does CKD cause secondary hyperparathyroidism? management ?

Answer 23

vit D os hydroxylated in kidney (impaired in CKD)
–> leads to reduced calcium absorption + 2nd hyperpara

in advanced CKD - serum phosphate rises, also increased PTH

Mx = alfacalcidiol, phosphate + phosphate binders

Question 24

foot process fusion on electromicroscopy

Answer 24

minimal change GN

complete remission with steroids

Question 25

glomerular crescents on biopsy

Answer 25

rapidly progressive GN

Question 26

positive congo red staining showing apple green befringence under polarised light

Answer 26

amyloidosis

Question 27

proteus UTIs

Answer 27

associated with formation of stones, foul smelling, burnt chocolate?

Question 28

pseudomonas aeruginosatreatment

Answer 28

ciprofloxacin - resistant to most others --> is a Cdiff risk drug gram neg bacillus - not a coliform

Question 29

which causative organisms of UTIs do NOT give a positive test?

Answer 29

enterococcus

Question 30

where does spironolactone act? side effects?

Answer 30

aldosterone antagonist that acts on CORTICAL COLLECTING DUCTS SE = hyperkalaemia + gynacomastia

Question 31

what brain abnormality can acute severe hyponatraemia cause?

Answer 31

cerebral oedema | thiazides inhibit dilution in DCT

Question 32

What is measured to obtain renal plasma flow?

Answer 32

para-amino hipuric acid (PAH) Renal plasma flow = (amount of PAH in urine per unit time) / (difference in PAH concentration in the renal artery or vein) Normal value = 660ml/min

Question 33

where is the greatest amount of sodium reabsorbed?

Answer 33

proximal CT - due to Na/k ATPase action -> msot filtered water is absorbed here too (osmosis)

Question 34

activity of zona glomerulosa in dehydrated state

Answer 34

increased (release aldosterone) increased activation of RAAS

Question 35

secretion levels of ADH in dehydrated state

Answer 35

increased secretion - increase water reabsorption in collecting duct

Question 36

drugs which can cause hypokalaemia

Answer 36

thiazide diuretics loop diuretics acetazolamide salbutamol (treatment of hyperkal)

Question 37

drugs which can cause hyperkalaemia

Answer 37

``` ACEi, ARBs spironolactone heparin ciclosporin amiloride K supplements ```

Question 38

Excessive production of which hormone in the adrenal can lead to hyper-androgenic effects such as hirsutism, deepening of the voice and increased libido? where is it produced?

Answer 38

dehydroepiandrosterone (DHEA) --> zona reticularis (androgen hormone that can be converted into the more biologically active testosterone)

Question 39

losartan drug type

Answer 39

ARB - stop in AKI

Question 40

what are the complication of diabetes neuropathy due to?

Answer 40

enzymatic glycosylation of the basement membrane

Question 41

AFP + HCG levels in seminomas

Answer 41

normal usually raised in teratomas + yolk sac tumours

Question 42

most common renal carcinoma in kids

Answer 42

Wilms tumour

Question 43

acetazolamide prescribed for glucoma has what affect on the kidney?

Answer 43

mild diuretic effect through inhibition of carbonic anyhydrase -> reduces reabsorption of sodium + therfore water in PCT

Question 44

staghorn calculi

Answer 44

composed of struvite urease producing bacteria - proteus (assoc with recurrent/chronic infections)

Question 45

where in the GI tract is the majority of water absorbed?

Answer 45

jejunum

Question 46

difference between loop + thiazide diuretics

Answer 46

both SE of hypokalaemia + hyponatraemia(diuretic excess) loop = increases Ca EXCRETION, may precipitate renal calculi formation thiazide = increases Ca resorption, used to control calculi formation