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  • Question 1 - A 66-year-old gentleman is seen in the Emergency Department complaining of muscle weakness...

    Correct

    • A 66-year-old gentleman is seen in the Emergency Department complaining of muscle weakness and lethargy. Admission bloods show the following: Na+ 138 mmol/L, K+ 6.6 mmol/L, Bicarbonate 15 mmol/L, Urea 9.2 mmol/L, Creatinine 110 µmol/L, An ECG is done which shows no acute changes. What is the most appropriate initial treatment to lower the serum potassium level?

      Your Answer: Insulin/dextrose infusion

      Explanation:

      Insulin/dextrose infusion will increase the activity of the sodium-potassium pump in the cells, which will in turn decrease serum potassium levels.

    • This question is part of the following fields:

      • Nephrology
      14.7
      Seconds
  • Question 2 - In diabetes, what is the most common finding on renal biopsy? ...

    Correct

    • In diabetes, what is the most common finding on renal biopsy?

      Your Answer: Glomerulosclerosis

      Explanation:

      Glomerulosclerosis is the scarring and hardening of the glomeruli known as diabetic glomerulosclerosis occurring in long-standing diabetes.

    • This question is part of the following fields:

      • Nephrology
      4.7
      Seconds
  • Question 3 - A 35-year-old gentleman presents to the Emergency Department with abdominal pain. This started...

    Correct

    • A 35-year-old gentleman presents to the Emergency Department with abdominal pain. This started earlier on in the day and is getting progressively worse. The pain is located on his left flank and radiates down into his groin. He has no history of this pain or any other condition. Examination reveals a gentleman who is flushed and sweaty but is otherwise unremarkable. What is the most suitable initial management?

      Your Answer: IM diclofenac 75 mg

      Explanation:

      Because of the patient’s presentation with flank pain that radiates to the groin, we are suspecting renal colic. We should follow guidelines for acute renal management and prescribe IM diclofenac for immediate relief of pain.

    • This question is part of the following fields:

      • Nephrology
      23.1
      Seconds
  • Question 4 - A 60-year-old gentleman is found dead in his apartment. He was known to...

    Correct

    • A 60-year-old gentleman is found dead in his apartment. He was known to be suffering from primary systemic amyloidosis. What is the most probable cause for his death?

      Your Answer: Cardiac involvement

      Explanation:

      Primary amyloidosis is characterised by abnormal protein build-up in the tissues and organ such as the heart, liver, spleen, kidneys, skin, ligaments, and nerves. However, the most common cause of death in patients with primary amyloidosis is heart failure.

    • This question is part of the following fields:

      • Nephrology
      14.5
      Seconds
  • Question 5 - You are reviewing a 70-year-old gentleman who has been suffering from multiple myeloma...

    Correct

    • You are reviewing a 70-year-old gentleman who has been suffering from multiple myeloma for the past 3 years. He presents with lethargy, muscle aches and pain in his lower back.   Arterial blood sampling reveals a metabolic acidosis. Serum potassium is 3.1 mmol/l (3.5–4.9), and urine pH is 5.1 (> 5.3).   What is the most likely diagnosis?

      Your Answer: Renal tubular acidosis-type II

      Explanation:

      This case is most likely RTA type II, due to decreased proximal bicarbonate reabsorption, which leads to metabolic acidosis, hypokalaemia, hyperchloremia, and <6 urine pH .

    • This question is part of the following fields:

      • Nephrology
      20.3
      Seconds
  • Question 6 - Which one of the following is a recognised cause of hypokalaemia associated with...

    Correct

    • Which one of the following is a recognised cause of hypokalaemia associated with hypertension:

      Your Answer: Liddle's syndrome

      Explanation:

      Liddle’s Syndrome is an autosomal dominant disorder that presents with hypertension usually in young patients, that do not respond to anti-hypertensive therapy and is later associated with hypokalaemia, low renin plasma, and low aldosterone levels as well. The other conditions listed do not present with hypertension and associated hypokalaemia.

    • This question is part of the following fields:

      • Nephrology
      5.3
      Seconds
  • Question 7 - A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for...

    Correct

    • A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for review. His blood tests show: Haemoglobin 11.2 g/dl (13.0 – 18.0 g/dL) MCV 87 fl (80 – 96 fL) Sodium 133 mmol/l (137 – 144 mmol/L) Potassium 4.3 mmol/l (3.5 – 4.9 mmol/L) Urea 19.1 mmol/l (2.5 – 7.5 mmol/L) Creatinine 267 μmol/l (60 – 110 μmol/L) Ferritin 150 μg/l (15 – 300 μg/L) C reactive protein <5 mg/l (< 10 mg/L)   What is the most appropriate management of his anaemia?

      Your Answer: Monitor haemoglobin, no treatment required at present

      Explanation:

      Because the patient has chronic kidney disease, we need to consider the associated adverse effects of trying to maintain normal haemoglobin levels (14-18g/dl in this patient) and instead only instigate therapy when the level falls below 11 g/dl. Thus, in this case we should just monitor the haemoglobin levels and not initiate therapy just yet.

    • This question is part of the following fields:

      • Nephrology
      20.2
      Seconds
  • Question 8 - A 15-year-old girl is referred to the paediatric unit with reduced urine output...

    Correct

    • A 15-year-old girl is referred to the paediatric unit with reduced urine output and lethargy. She has been passing bloody diarrhoea for the past four days. On admission she appears dehydrated. Bloods show the following: Na+ 142 mmol/L, K+ 4.8 mmol/L, Bicarbonate 22 mmol/L, Urea 10.1 mmol/L, Creatinine 176 µmol/L, Hb 10.4 g/dL, MCV 90 fl Plt 91 * 109/L, WBC 14.4 * 109/L, Given the likely diagnosis, which one of the following organisms is the most likely cause?

      Your Answer: E. coli

      Explanation:

      The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli.

    • This question is part of the following fields:

      • Nephrology
      21.9
      Seconds
  • Question 9 - A 20-year-old woman presents with weakness and is found to have a serum...

    Incorrect

    • A 20-year-old woman presents with weakness and is found to have a serum potassium of 2.2 mmol/l and pH 7.1.   Which of the following would be LEAST useful in differentiating between renal tubular acidosis Types 1 and 2?

      Your Answer: Urinary pH 6.5

      Correct Answer: Osteomalacia

      Explanation:

      Osteomalacia is a marked softening of the bones that can present in both type I and type II Renal Tubular Acidosis (RTA) and will thus not differentiate the two types in any case. The other measures will allow differentiation of the two types.

    • This question is part of the following fields:

      • Nephrology
      28.6
      Seconds
  • Question 10 - A 71-year-old woman with a medical history of a blood transfusion in the...

    Correct

    • A 71-year-old woman with a medical history of a blood transfusion in the early 1980s presents with a 10 month history of malaise and is noted to have impaired renal function. Her urine sediment reveals red cell casts. The results of immunological investigations are as follows: serum IgG 6.5 g/L (normal range 6-13), IgA 1.5 g/L (normal range 0.8-4.0), IgM 5.7 g/L (normal range 0.4-2.0), serum electrophoresis shows a faint band in the gamma region, complement C3 1.02 g/L (normal range 0.75-1.65), complement C4 <0.02 g/L (normal range 0.20-0.65), and rheumatoid factor 894 IU/L (normal range <40). Which of the following investigations is likely to be most important in making a definitive diagnosis?

      Your Answer: Cryoglobulins

      Explanation:

      The patient’s history of a blood transfusion and lab results showing a markedly low C4 (with normal C3), elevated rheumatoid factor, and elevated serum IgM is highly suggestive of hepatitis C-associated cryoglobulinaemic vasculitis. Testing for Cryoglobulins will confirm this suspicion.

    • This question is part of the following fields:

      • Nephrology
      6.7
      Seconds
  • Question 11 - A 20-year-old woman presents to casualty with flank pain and a 48 hour...

    Correct

    • A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1 °C and flank pain. What diagnosis fits best with this clinical picture?

      Your Answer: Pyelonephritis

      Explanation:

      The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.

    • This question is part of the following fields:

      • Nephrology
      13.6
      Seconds
  • Question 12 - Which of the following types of renal stones are said to have a...

    Correct

    • Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?

      Your Answer: Cystine stones

      Explanation:

      Only cystine stones are semi-opaque because they contain sulphur. All the other stones will appear either radio-lucent or radio-opaque.

    • This question is part of the following fields:

      • Nephrology
      6.5
      Seconds
  • Question 13 - Which one of the following statements is true regarding autosomal recessive polycystic kidney...

    Correct

    • Which one of the following statements is true regarding autosomal recessive polycystic kidney disease?

      Your Answer: May be diagnosed on prenatal ultrasound

      Explanation:

      Autosomal recessive polycystic kidney disease (ARPKD) is less common than ADPKD (dominant form) but can already present with symptoms and be diagnosed on prenatal ultrasound.

    • This question is part of the following fields:

      • Nephrology
      7.5
      Seconds
  • Question 14 - A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which...

    Correct

    • A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which was 320 μmol/L at her last clinic visit 3 weeks ago, is brought into the Emergency Department having been found collapsed at home by her partner. She is now fully conscious but complains of a headache.   What is the most likely diagnosis?

      Your Answer: Subarachnoid haemorrhage

      Explanation:

      One of the most important complications in patients with PKD is being affected by berry aneurysms that may burst, causing a subarachnoid haemorrhage, which seems to be the case in this patient.

    • This question is part of the following fields:

      • Nephrology
      7.6
      Seconds
  • Question 15 - A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine....

    Correct

    • A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine. He is not known to have any previous prostatic problems and denies any dysuria. Following a digital rectal examination, he is started on Finasteride and Tamsulosin. Three months later he presents to the emergency department with urinary retention and is catheterized, and a craggy mass is felt on rectal examination. He is referred to a urologist, and a prostatic ultrasound and needle biopsy are arranged, and prostate serum antigen (PSA) is requested. Which of the following factors is most likely to give a false negative PSA?

      Your Answer: Finasteride

      Explanation:

      Finasteride is often prescribed for patients with Benign Prostatic Hyperplasia (BPH) or enlarged prostate. However, it has been known to cause a decrease in Prostatic Specific Antigen (PSA) levels in patients with BPH, which may lead to false negatives in a case like this, where a palpable mass has been detected and malignancy is suspected.

    • This question is part of the following fields:

      • Nephrology
      6.7
      Seconds
  • Question 16 - A 41-year-old female is referred to medical assessment unit by her physician for...

    Correct

    • A 41-year-old female is referred to medical assessment unit by her physician for querying thrombotic thrombocytopenic purpura (TTP) after she presented with a temperature of 38.9C. Her subsequent urea and electrolytes showed deteriorating renal function with a creatinine 3 times greater than her baseline. What is the underlying pathophysiology of TTP?

      Your Answer: Failure to cleave von Willebrand factor normally

      Explanation:

      Thrombotic thrombocytopenic purpura (TTP) is characterised by the von Willebrand factor (vWF) microthrombi within the vessels of multiple organs. In this condition, the ADAMTS13 metalloprotease enzyme which is responsible for the breakdown of vWF multimer, is deficient, causing its build-up and leading to platelet clots that then decreases the circulating platelets, leading to bleeding in the patient.

    • This question is part of the following fields:

      • Nephrology
      12.9
      Seconds
  • Question 17 - A 22-year-old gentleman presents to A&E for the third time with recurrent urinary...

    Correct

    • A 22-year-old gentleman presents to A&E for the third time with recurrent urinary stones. There appear to be no predisposing factors, and he is otherwise well; urine culture is unremarkable. The urine stones turn out to be cystine stones.   What is the most likely diagnosis in this case?

      Your Answer: Cystinuria

      Explanation:

      Cystinuria is strongly suspected because of the recurrent passing of cystine stones and otherwise non-remarkable medical history of this young adult patient. Like Cystinuria, all the conditions listed are also inherited disorders, however, the other differentials usually present in the early years of childhood, usually with failure to thrive.

    • This question is part of the following fields:

      • Nephrology
      10.3
      Seconds
  • Question 18 - An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He...

    Correct

    • An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day.   ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.   What diagnosis fits best with this clinical picture?

      Your Answer: Nephrotic syndrome

      Explanation:

      Nephrotic syndrome usually presents with the symptoms in this patient: low albumin, abnormal cholesterol, increased urinary albumin excretion, oedema, and as a consequence, hypertension as well.

    • This question is part of the following fields:

      • Nephrology
      25.4
      Seconds
  • Question 19 - A 50-year-old gentleman with renal cell carcinoma has a haemoglobin of 19 g/dl....

    Correct

    • A 50-year-old gentleman with renal cell carcinoma has a haemoglobin of 19 g/dl. Which investigation will conclusively prove that this patient has secondary polycythaemia?

      Your Answer: Erythropoietin level

      Explanation:

      Erythropoietin (EPO) is used to distinguish between primary and secondary polycythaemia. Secondary polycythaemia can be caused by tumours in the kidney that may secrete EPO or EPO-like proteins.

    • This question is part of the following fields:

      • Nephrology
      8.5
      Seconds
  • Question 20 - A 41-year-old gentleman required high doses of intravenous diuretics after his renal transplant...

    Correct

    • A 41-year-old gentleman required high doses of intravenous diuretics after his renal transplant for the purposes of fluid management. Soon after administration he developed hearing loss, tinnitus, and vertigo.   Which diuretic is most likely to have caused this?

      Your Answer: Furosemide

      Explanation:

      Furosemide is a loop diuretic that is known to have significant ototoxicity side-effects although the mechanism is not fully known.

    • This question is part of the following fields:

      • Nephrology
      8.9
      Seconds
  • Question 21 - A 72-year-old woman is admitted with general deterioration and ‘off-legs’. On examination in...

    Correct

    • A 72-year-old woman is admitted with general deterioration and ‘off-legs’. On examination in the emergency department, she looks dry and uremic.   Investigations reveal:
      • K+ 7.2 mmol/L
      • Na+ 145 mmol/L
      • Creatinine 512 μmol/L
      • Urea 36.8 mmol/L
      Which TWO of the following measures are most appropriate in her immediate management?

      Your Answer: ECG & IV Calcium gluconate bolus

      Explanation:

      First and foremost, the patient should be put on ECG monitoring to identify the cardiac state, and because of the markedly raised serum potassium, a calcium gluconate bolus will have the immediate effect of moderating the nerve and muscle performance.

    • This question is part of the following fields:

      • Nephrology
      21.9
      Seconds
  • Question 22 - A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the...

    Correct

    • A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the most common problem that can arise in this case?

      Your Answer: Protein–calorie malnutrition

      Explanation:

      Protein-calorie malnutrition is observed in almost 50% of dialysis patients, contributing to increased morbidity and mortality. All the other complications listed can usually be prevented thanks to modern-day dialysis techniques.

    • This question is part of the following fields:

      • Nephrology
      7.8
      Seconds
  • Question 23 - A 61-year-old gentleman presents with pain in his right flank and haematuria. A...

    Correct

    • A 61-year-old gentleman presents with pain in his right flank and haematuria. A CT scan of the abdomen reveals a large 8 × 8cm solid mass in the right kidney and a 3 × 3cm solid mass occupying the upper pole of the left kidney. What is the most appropriate treatment for this patient?

      Your Answer: Right radical nephrectomy and left partial nephrectomy

      Explanation:

      This patient presents with the classic triad of renal carcinoma: haematuria, loin pain and a mass in the kidneys. Management will entail right radical nephrectomy because of the 8x8cm solid mass and a left partial nephrectomy of the 3x3cm solid mass.

    • This question is part of the following fields:

      • Nephrology
      31.7
      Seconds
  • Question 24 - Which of the following is most helpful in differentiating chronic from acute renal...

    Incorrect

    • Which of the following is most helpful in differentiating chronic from acute renal failure?

      Your Answer: Anaemia

      Correct Answer: Kidney size at ultrasound scan

      Explanation:

      The size of the kidneys on ultrasound would differentiate chronic from acute renal failures. Chronic renal failure is more associated with small-sized kidneys.

    • This question is part of the following fields:

      • Nephrology
      28.7
      Seconds
  • Question 25 - A 71-year-old female presents for investigation of fatigue and weight loss. Investigations reveal:...

    Correct

    • A 71-year-old female presents for investigation of fatigue and weight loss. Investigations reveal: Haemoglobin 9.0 g/dL (11.5-16.5) White cell count 2.0 x109/L (4-11 x109) Platelet count 250 x109/L (150-400 x109) Total protein 74 g/L (61-76) Albumin 28 g/L (37-49) Urea 16 mmol/L (2.5-7.5) Creatinine 250 mol/L (60-110) Plasma glucose 6.5 mmol/L (3.0-6.0) Urine dipstick analysis: Protein+ & blood+ Renal ultrasound: Normal Which one of the following investigations would be most appropriate for this patient?

      Your Answer: Plasma protein electrophoresis

      Explanation:

      This patient’s symptoms of anaemia, leukopenia, and elevated non-albumin protein concentration with fatigue and weight loss, point to myeloma. Thus plasma protein electrophoresis or Serum Protein Electrophoresis (SPE) is indicated when there is suspicion of myeloma.

    • This question is part of the following fields:

      • Nephrology
      34.5
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  • Question 26 - A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor...

    Correct

    • A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor for a review. His symptoms are currently well controlled; he is taking Ramipril 10mg, Spironolactone 25mg, Bisoprolol 10mg, and Furosemide 40mg. His main complaint is of painful gynaecomastia that he says has developed over the past 6 months. Physical exam reveals a blood pressure of 125/80 mmHg and no residual signs of cardiac failure. Renal function is unchanged from 6 months earlier, with stable creatinine at 125 µmol/l. Which of the following is the most appropriate next step?

      Your Answer: Change the spironolactone to eplerenone

      Explanation:

      Spironolactone is an aldosterone antagonist diuretic that is well-known to cause gynaecomastia because it increases testosterone clearance and oestradiol production. The patient’s primary complaint of gynaecomastia should immediately prompt discontinuation of spironolactone and replacement with Eplerenone, which lacks the antiandrogenic effects, and thus there is less risk of gynaecomastia.

    • This question is part of the following fields:

      • Nephrology
      13
      Seconds
  • Question 27 - A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed....

    Correct

    • A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed. When assessing his estimated glomerular filtration rate (eGFR), which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?

      Your Answer: Serum urea

      Explanation:

      A formula for estimating glomerular filtration rate (eGFR) is the Modification Diet of Renal Disease (MDRD) equation which takes into account the following variables: serum creatinine, age, gender, and ethnicity. Thus, serum urea is not required in this formula.

    • This question is part of the following fields:

      • Nephrology
      8.9
      Seconds
  • Question 28 - A 53-year-old gentleman presents with several months’ history of generalised swelling, fatigue, dyspnoea...

    Correct

    • A 53-year-old gentleman presents with several months’ history of generalised swelling, fatigue, dyspnoea and several episodes of haemoptysis. There is no significant past medical history and he did not take any regular medication. He smokes 20 cigarettes per day and drinks 14 units of alcohol per week. On examination, he is grossly oedematous and has ascites. Cardiorespiratory examination is unremarkable and there are no neurological signs or rashes. Investigation results are below: Haemoglobin (Hb) 10.2 g/dL, White cell count (WCC) 6.0 × 109/L, Platelets 380 × 109/L, Mean corpuscular volume (MCV) 90fl Na+ 145 mmol/L, K+ 3.7 mmol/L, Urea 8.2 mmol/L, Bilirubin 16 μmol/L, Creatinine 180 μmol/L, Albumin 22 g/l Aspartate transaminase 32 iu/l Alkaline phosphatase 120 iu/l Urinalysis: Protein +++ 24 h urinary protein excretion: 5g Chest radiograph: Enlarged right hilum Echocardiogram: Mild left ventricular impairment, no valve lesion Abdominal ultrasound scan: Normal-sized kidneys, no abnormality seen A renal biopsy was performed. What is it most likely to show?

      Your Answer: Thickened glomerular basement membrane with deposits of IgG and C3

      Explanation:

      Renal biopsy in this patient will most likely show thickened glomerular basement membrane with deposits of IgG and C3 as a result of membranous glomerulonephritis that has caused the nephrotic syndrome in this patient. Membranous glomerulonephritis in this case is most likely associated with an underlying bronchial carcinoma, consistent with the patient’s smoking history and physical presentation.

    • This question is part of the following fields:

      • Nephrology
      57.9
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  • Question 29 - A 63-year-old woman visits the diabetes clinic for review. She has had type-2...

    Incorrect

    • A 63-year-old woman visits the diabetes clinic for review. She has had type-2 diabetes for 9 years and is now on insulin therapy. She has diabetic nephropathy, as exemplified by hypertension and proteinuria (urinary PCR 155); a recent creatinine level was 205 μmol/l and eGFR 24 ml/min.   Which of the following options best fits her prognosis or management?

      Your Answer: Non-dihydropyridine calcium antagonists have no effect on proteinuria

      Correct Answer: Treatment with ARB or ACE-I may slow further deterioration in renal function

      Explanation:

      Treatment with ARB or ACE-I may slow further deterioration in renal function in this patient, as studies have shown that blocking of the RAS in type 2 diabetic patients improve renal function.

    • This question is part of the following fields:

      • Nephrology
      43.6
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  • Question 30 - A 58-year-old gentleman with a long history of gout presents with loin pain....

    Correct

    • A 58-year-old gentleman with a long history of gout presents with loin pain. Other past history of note includes an ileostomy after bowel surgery. There is no history of weight loss from malabsorption syndrome after his bowel surgery. Excretion urography reveals evidence of bilateral renal stones. What is the most likely composition of his renal stones?

      Your Answer: Uric acid stones

      Explanation:

      Uric acid stones will most likely be found in this case because of the patient’s long history of gout. Additionally, studies have shown that ileostomy patients have an increased risk for the development of uric acid stones.

    • This question is part of the following fields:

      • Nephrology
      32.6
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SESSION STATS - PERFORMANCE PER SPECIALTY

Nephrology (27/30) 90%
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