|
Renal stones: imaging
Type
|
Frequency
|
Radiograph appearance
|
Calcium oxalate
|
40%
|
Opaque
|
Mixed calcium oxalate/phosphate stones
|
25%
|
Opaque
|
Triple phosphate stones
|
10%
|
Opaque
|
Calcium phosphate
|
10%
|
Opaque
|
Urate stones
|
5-10%
|
Radio-lucent
|
Cystine stones
|
1%
|
Semi-opaque, 'ground- glass' appearance
|
Xanthine stones
|
<1%
|
Radio-lucent
|
3 3-Which one of the following is least associated with retroperitoneal fibrosis?
|
A.
|
Riedel's thyroiditis
|
|
B.
|
Previous radiotherapy
|
|
C.
|
Inflammatory abdominal aortic aneurysm
|
|
D.
|
Methysergide
|
|
E.
|
Sulphonamides
|
Retroperitoneal fibrosis
Lower back pain is the most common presenting feature Associations
Riedel's thyroiditis
previous radiotherapy
sarcoidosis
inflammatory abdominal aortic aneurysm
drugs: methysergide
|
A.
|
0.1 - 1 mg/day
|
|
B.
|
30 - 300 mg/day
|
|
C.
|
1 - 10 mg/day
|
|
D.
|
10 - 100 mg/day
|
|
E.
|
3 - 30 mg/day
|
Proteinuria
Microalbuminuria
defined as an albumin excretion of 30 - 300 mg/day
Albumin:creatinine excretion ratio (ACR)
used in clinical practice to quantify degree of proteinuria
first morning urine sample
urine albumin (mg) / creatinine (mmol)
normal ACR < 2.5
microalbuminuric range = 2.5 - 33
3 5-What percentage of cardiac output does renal blood flow accounts for:
|
A.
|
5%
|
|
B.
|
10%
|
|
C.
|
15%
|
|
D.
|
20-25%
|
|
E.
|
30-35%
|
Renal physiology
Renal blood flow is 20-25% of cardiac output
Renal cortical blood flow > medullary blood flow (i.e. tubular cells more prone to ischaemia
Which one of the following types of glomerulonephritis is most characteristically associated with streptococcal infection in children?
|
A.
|
Focal segmental glomerulosclerosis
|
|
B.
|
Diffuse proliferative glomerulonephritis
|
|
C.
|
Membranous glomerulonephritis
|
|
D.
|
Mesangiocapillary glomerulonephritis
|
|
E.
|
Rapidly progressive glomerulonephritis
|
Glomerulonephritides
Knowing a few key facts is the best way to approach the difficult subject of glomerulonephritis:
Membranous glomerulonephritis
presentation: proteinuria / nephrotic syndrome / CRF
cause: infections, rheumatoid drugs, malignancy
1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop CRF
IgA nephropathy - aka Berger's disease, mesangioproliferative GN
typically young adult with haematuria following an URTI
Diffuse proliferative glomerulonephritis
classical post-streptococcal glomerulonephritis in child
presents as nephritic syndrome / ARF
Minimal change disease
typically a child with nephrotic syndrome (accounts for 80%)
causes: Hodgkin's, NSAIDs
good response to steroids
Focal segmental glomerulosclerosis
may be idiopathic or secondary to HIV, heroin
presentation: proteinuria / nephrotic syndrome / CRF
Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis
rapid onset, often presenting as ARF
causes include Goodpasture's, ANCA positive vasculitis, SLE
Mesangiocapillary glomerulonephritis (membranoproliferative)
type 1: cryoglobulinaemia, hepatitis C
type 2: partial lipodystrophy
3 7-Which one of the following is least recognised as an indication for plasma
exchange?
|
A.
|
Guillain-Barre syndrome
|
|
B.
|
Churg-Strauss syndrome
|
|
C.
|
Myasthenia gravis
|
|
D.
|
Cerebral malaria
|
|
E.
|
Goodpasture's syndrome
|
Cerebral malaria is not a standard indication for plasma exchange. Exchange transfusions have been tried but it is generally only justified when peripheral parasitemia is greater than 10% of circulating erythrocytes. The role of blood transfusions remains controversial, as they are both expensive and potentially dangerous in many malaria areas
Plasma exchange
Indications for plasma exchange
Guillain-Barre syndrome
myasthenia gravis
Goodpasture's syndrome
ANCA positive vasculitis e.g. Wegener's, Churg-Strauss
TTP/HUS
cryoglobulinaemia
hyperviscosity syndrome e.g. secondary to myeloma
3 8-What is the most significant factor leading to the development of anaemia in patients with chronic kidney disease?
|
A.
|
Reduced absorption of iron
|
|
B.
|
Increased erythropoietin resistance
|
|
C.
|
Reduced erythropoietin levels
|
|
D.
|
Reduced erythropoiesis due to toxic effects of uraemia on bone marrow
|
|
E.
|
Blood loss due to capillary fragility and poor platelet function
|
Chronic kidney disease: anaemia
Patients with chronic kidney disease (CKD) may develop anaemia due to a variety of factors, the most significant of which is reduced erythropoietin levels. This is usually a normochromic normocytic anaemia and becomes apparent when the GFR is less than 35 ml/min (other causes of anaemia should be considered if the GFR is > 60 ml/min).
Anaemia in CKD predisposes to the development of left ventricular hypertrophy - associated with a three fold increase in mortality in renal patients
Causes of anaemia in renal failure
reduced erythropoietin levels - the most significant factor
reduced erythropoiesis due to toxic effects of uraemia on bone marrow
reduced absorption of iron
anorexia/nausea due to uraemia
reduced red cell survival (especially in haemodialysis)
blood loss due to capillary fragility and poor platelet function
stress ulceration leading to chronic blood loss
Management
the 2006 NICE guidelines suggest a target haemoglobin of 10.5 - 12.5 g/dl
determination and optimisation of iron status should be carried out prior to the administration of erythropoiesis-stimulating agents (ESA). Many patients, especially those on haemodialysis, will require IV iron
3 9-A patient with type 1 diabetes mellitus is reviewed in the nephrology outpatient clinic. He is known to have stage 4 diabetic nephropathy. Which of the following best describes his degree of renal involvement?
|
A.
|
Microalbuminuria
|
|
B.
|
End-stage renal failure
|
|
C.
|
Latent phase
|
|
D.
|
Hyperfiltration
|
|
E.
|
Overt nephropathy
|
The timeline given here is for type 1 diabetics. Patients with type 2 diabetes mellitus (T2DM) progress through similar stages but in a different timescale - some T2DM patients may progress quickly to the later stages
4 0-Each one of the following is associated with papillary necrosis, except:
|
A.
|
Acute pyelonephritis
|
|
B.
|
Tuberculosis
|
|
C.
|
Chronic analgesia use
|
|
D.
|
Syphilis
|
|
E.
|
Sickle cell disease
|
Papillary necrosis
Causes
chronic analgesia use
sickle cell disease
TB
acute pyelonephritis
diabetes mellitus
\\Features
fever, loin pain, haematuria
IVU - papillary necrosis with renal scarring - 'cup & spill'
41
-Renal cell carcinoma is least associated with which one of the following hormones?
|
A.
|
Erythropoietin
|
|
B.
|
Parathyroid hormone
|
|
C.
|
Growth hormone
|
|
D.
|
ACTH
|
|
|
E.
|
Renin
|
|
Do'stlaringiz bilan baham: |
