Archives: Medical Student Finals

MSFinals-5697

A 30-year-old woman presents to the Renal Clinic for review. She has suffered from two recent urinary tract infections, and asymptomatic haematuria has been noted on urine dipstick testing on two separate occasions. She reports costovertebral angle tenderness on a few occasions in the past year. On examination, there is no residual tenderness today. Her blood pressure is 145/92 mmHg.
Investigations:
Investigation Result Normal value
Haemoglobin 119 g/l 115–155 g/l
White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
Platelets 256 × 109/l 150–400 × 109/l
Sodium (Na+) 145 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 100 μmol/l 50–120 µmol/l
Abdominal plain X-ray Multiple pre-calyceal calcifications
affecting both kidneys, with a
‘bunch of grapes’ appearance
Which of the following diagnoses fits best with this clinical picture?

MSFinals-5699

A 67-year-old retired bus driver presents to the Emergency Department with end-stage renal disease due to diabetic nephropathy. What is the most probable histological finding on kidney biopsy for this patient?

MSFinals-5700

A 35-year-old teacher is tested for compatibility to donate a kidney to his older brother, who has end-stage renal failure. To his joy, he is found to be a suitable match. The patient is then thoroughly counselled regarding the operative procedure, short- and long-term risks, and the implications of living with one healthy kidney. He is particularly interested to learn how his body will adapt to having only one kidney.
What will be decreased in the donor after the kidney transplant?

MSFinals-5677

A 40-year-old piano teacher presented to the Emergency Department with an acute kidney injury (AKI) and was referred to the renal team for urgent haemodialysis. Which of the following is not a reason for immediate dialysis?

MSFinals-5678

A 20-year-old man visits his GP clinic with a chief complaint of headaches. During the physical examination, no abnormalities are detected, but his blood pressure is found to be 178/90 mmHg. The doctor suspects a renal origin for the hypertension and wants to perform an initial screening test for renovascular causes. What is the most appropriate investigation for this purpose?

MSFinals-5679

A 63-year-old man presented with fever, body ache and pedal oedema for three months. He was taking oral diclofenac frequently for the aches. He had no other drug history and had not travelled recently.
On examination, there was sternal tenderness. His blood report revealed:
Investigation Result Normal range
Haemoglobin 76 g/l 135–175 g/l
White cell count (WCC) 9 × 109/l 4–11 × 109/l
Erythrocyte sedimentation rate (ESR) 134 mm/hr 0–10mm in the 1st hour
Platelets 280 × 109/l 150–400 × 109/l
Urea 13 mmol/l 2.5–6.0 mmol/l
Calcium 2.8 mmol/l 2.2–2.6 mmol/l
What is the most likely cause of renal failure in this case?

MSFinals-5680

A middle-aged woman with a history of renal cell carcinoma complains of swelling in both legs extending from the groin area and dilated veins around the belly button. What is the underlying mechanism responsible for these symptoms?

MSFinals-5674

A 52-year-old man with an acute kidney injury has developed fluid overload and treatment has been initiated. An ABCDE assessment is performed, and the findings are below:
Airway Patent, speaking but confused in conversation
Breathing Respiratory rate (RR) 24/min, SaO2 96% on 4 litres of O2/min, bibasal crackles heard on auscultation in the lower zones (up to mid-zones on admission)
Circulation Heart rate (HR) 112 bpm, blood pressure (BP) 107/68 mmHg, heart sounds disturbed by a friction rub, ECG shows sinus tachycardia
Disability Pupils equal and reactive to light, normal upper and lower limb neurology, Glasgow Coma Scale (GCS) 14 (E4 V4 M6)
Exposure Temperature 36.8°C
On initial bloods, the C-reactive protein (CRP) is within normal limits.
The results of initial arterial blood gas and serum urea and electrolytes are shown below:
Investigation Result Normal value
pH 7.28 7.35–7.45
pO2 10.7 kPa > 11 kPa
pCO2 5.7 kPa 4.5–6.0 kPa
Bicarbonate 20 mmol/l 22–26 mmol/l
Lactate 1.8 mmol/l < 2 mmol/l
Urea 53 mmol/l 2.5–7.8 mmol/l
Creatinine 729 µmol/l 50–120 µmol/l
Which one of the following is an indication for urgent dialysis in this patient?

MSFinals-5675

A 76-year-old woman is admitted to the hospital feeling generally unwell. She has also developed a fever and diffuse erythematous rash over the last few days. Urinalysis is positive for blood and protein, and blood tests show raised eosinophils and creatinine. Her General Practitioner started her on a new medication two weeks ago, but she cannot remember the name or what it was for.
Which of the following drugs would be safe to continue at present, given the suspected diagnosis?