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  • Question 1 - A 75-year-old man with Parkinson’s disease has a serum creatinine of 746 μmol/l...

    Incorrect

    • A 75-year-old man with Parkinson’s disease has a serum creatinine of 746 μmol/l (60-120 μmol/l). He was known to have normal renal function two years previously. On examination, he has evidence of rigidity, resting tremor and postural instability. He appears to have bilateral small pupils. He has a postural BP drop from 160/72 mm/Hg when supine to 138/60 mmHg when standing. Ultrasound shows bilateral hydronephrosis and a full bladder.
      Which of the following is the most likely cause of obstructive renal failure in this patient?

      Your Answer: Benign prostatic hypertrophy

      Correct Answer: Neurogenic bladder

      Explanation:

      Neurogenic Bladder and Other Causes of Obstructive Renal Failure in Parkinson’s Disease

      Parkinson’s disease is often associated with autonomic dysfunction, which can lead to bladder problems such as urgency, frequency, nocturia, and incontinence. In some cases, these symptoms may be mistaken for benign prostatic hypertrophy, but it is important to consider the possibility of neurogenic bladder when risk factors are present. Multichannel urodynamic studies can help confirm the diagnosis and prevent complications such as post-prostatectomy incontinence. Other potential causes of obstructive renal failure in Parkinson’s disease include retroperitoneal fibrosis and renal papillary necrosis, which are rare but serious conditions that require prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Kidney And Urology
      40.8
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  • Question 2 - A 25-year-old woman presents with peripheral oedema and polyuria. Her pulse is 90/min...

    Incorrect

    • A 25-year-old woman presents with peripheral oedema and polyuria. Her pulse is 90/min and regular and her blood pressure is 130/80. A full blood count, liver function tests and urea and electrolytes are normal. Her serum albumin is 23 g/l (35 - 50 g/l).
      Select the single most appropriate NEXT investigation that should be performed.

      Your Answer: Renal ultrasound

      Correct Answer: Dipstick

      Explanation:

      Diagnosing Nephrotic Syndrome: The Importance of Proteinuria and Renal Biopsy

      Nephrotic syndrome is characterized by proteinuria (>3g/24 hours), hypoalbuminaemia (<30g/l), and oedema. To quantify proteinuria, a urine ACR or PCR or 24-hour urine collection is required. However, heavy proteinuria on urine dipstick is sufficient to confirm the need for a renal biopsy. Before a renal biopsy, a renal ultrasound is necessary to ensure the presence of two kidneys and confirm kidney size and position. Autoantibodies aid in diagnosis, but the initial confirmatory investigation is the dipstick. In children and young adults, minimal change glomerulonephritis is the most likely renal biopsy finding, which may be steroid responsive and has a good prognosis.

    • This question is part of the following fields:

      • Kidney And Urology
      26.1
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  • Question 3 - A 25-year-old man comes in with an inflamed glans and prepuce of his...

    Correct

    • A 25-year-old man comes in with an inflamed glans and prepuce of his penis. He has not been sexually active for six months and denies any discharge. He reports cleaning the area twice a day. He has no history of joint problems or skin conditions. Which of the following statements is accurate in this case?

      Your Answer: It is likely this is an allergic reaction

      Explanation:

      Balanitis: Causes and Management

      Balanitis is a common condition that presents in general practice. It can have various causes, but the most likely cause in many cases is an irritant reaction from excessive washing and use of soaps. Other common causes include Candida, psoriasis, and other skin conditions. If there is any discharge, swabbing should be done. If ulceration is present, herpes simplex virus (HSV) should be considered. In older men with persistent symptoms, Premalignant conditions and possible biopsy may be considered.

      The management of balanitis involves advice, reassurance, and a topical steroid as the initial treatment. Testing for glycosuria should be considered to rule out Candida. If the symptoms persist, further investigation may be necessary to determine the underlying cause. It is important to identify the cause of balanitis to ensure appropriate management and prevent recurrence. By understanding the causes and management of balanitis, healthcare professionals can provide effective care to patients with this condition.

    • This question is part of the following fields:

      • Kidney And Urology
      19.5
      Seconds
  • Question 4 - A 55-year-old woman presents to your clinic with a complaint of occasional urine...

    Incorrect

    • A 55-year-old woman presents to your clinic with a complaint of occasional urine leakage when she sneezes or coughs. She denies experiencing any urgency or abdominal pain, and her urine dipstick test is unremarkable. The patient has already attempted physiotherapy and received lifestyle recommendations, but she has declined surgical intervention at this time.

      What is the optimal course of action for managing this patient's condition?

      Your Answer: Oxybutynin

      Correct Answer: Duloxetine

      Explanation:

      It appears that this woman is experiencing stress incontinence, but there are no signs of urgency. She has already attempted to address the issue through lifestyle changes and pelvic floor muscle training, but is not interested in being referred to a specialist at this time. As an alternative, duloxetine may be worth trying. For urinary urgency, medications such as oxybutynin, solifenacin, and tolterodine can be used. However, amitriptyline is not effective for stress incontinence.

      Urinary incontinence is a common condition that affects approximately 4-5% of the population, with elderly females being more susceptible. There are several risk factors that can contribute to the development of urinary incontinence, including advancing age, previous pregnancy and childbirth, high body mass index, hysterectomy, and family history. The condition can be classified into different types, such as overactive bladder, stress incontinence, mixed incontinence, overflow incontinence, and functional incontinence.

      Initial investigation of urinary incontinence involves completing bladder diaries for at least three days, performing a vaginal examination to exclude pelvic organ prolapse, and conducting urine dipstick and culture tests. Urodynamic studies may also be necessary. Management of urinary incontinence depends on the predominant type of incontinence. For urge incontinence, bladder retraining and bladder stabilizing drugs such as antimuscarinics are recommended. For stress incontinence, pelvic floor muscle training and surgical procedures may be necessary. Duloxetine, a combined noradrenaline and serotonin reuptake inhibitor, may also be offered to women who decline surgical procedures.

      In summary, urinary incontinence is a common condition that can be caused by various risk factors. It can be classified into different types, and management depends on the predominant type of incontinence. Initial investigation involves completing bladder diaries, performing a vaginal examination, and conducting urine tests. Treatment options include bladder retraining, bladder stabilizing drugs, pelvic floor muscle training, surgical procedures, and duloxetine.

    • This question is part of the following fields:

      • Kidney And Urology
      29.4
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  • Question 5 - A 68-year-old man presents to the clinic for a consultation. He is worried...

    Incorrect

    • A 68-year-old man presents to the clinic for a consultation. He is worried about his recent visit to the renal clinic, where he was informed that he has bilateral renal artery stenosis. He is seeking advice on available treatments. Additionally, his blood pressure was found to be elevated.
      What is the initial management strategy?

      Your Answer: Surgical reconstruction of the renal arteries

      Correct Answer: Antihypertensive medication and lifestyle modification

      Explanation:

      Managing Renovascular Disease: Treatment Options and Lifestyle Modifications

      Renovascular disease, caused by atherosclerosis or fibromuscular dysplasia, can lead to resistant hypertension and ischaemic nephropathy, particularly in older individuals with diffuse atherosclerosis. Lifestyle modifications, such as smoking cessation, diabetes control, statins, aspirin, and adequate antihypertensive therapy, are crucial in reducing vascular risk. However, some patients may not tolerate ACE inhibitors or angiotensin II receptor antagonists, which are commonly used to preserve GFR.

      Oral anticoagulants are not recommended as a first-line measure. Instead, medication for blood pressure control, with or without intervention, is necessary to prevent or limit the progression of chronic kidney disease and alleviate other symptoms, such as refractory pulmonary oedema and angina. Percutaneous renal artery balloon angioplasty may be considered in patients with difficult-to-control hypertension or rapidly declining kidney function. Renal artery stenting is generally the first-line intervention for flash pulmonary oedema and severe hypertension. Surgical reconstruction of the renal arteries is reserved for patients with concomitant vascular disease, such as abdominal aortic aneurysm.

      In summary, managing renovascular disease requires a combination of lifestyle modifications and appropriate medical interventions to reduce vascular risk and alleviate symptoms.

    • This question is part of the following fields:

      • Kidney And Urology
      17.1
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  • Question 6 - Which test is helpful in diagnosing and tracking treatment progress for patients with...

    Correct

    • Which test is helpful in diagnosing and tracking treatment progress for patients with prostate cancer from the given options?

      Your Answer: Prostate-specific antigen

      Explanation:

      The Controversy Surrounding PSA Testing for Prostate Cancer

      The introduction of the prostate-specific antigen (PSA) test has led to increased awareness and earlier diagnosis of prostate cancer. However, the use of PSA testing for screening purposes remains controversial. While PSA is currently the best method for detecting localized prostate cancer and monitoring treatment response, it lacks specificity as it is also increased in patients with benign prostatic hypertrophy. Additionally, the effectiveness and cost-effectiveness of treating localized cancer is still uncertain.

      Bone scans at diagnosis are likely unnecessary for patients with a PSA below 20 ng/ml, as bone metastases are unlikely at this level. Repeated bone scans during treatment are also unnecessary unless there are clinical indications, as repeated PSA tests are just as effective and more cost-effective. Biopsies under transrectal-ultrasound control are now commonly used for diagnosing prostate cancer, with a PSA exceeding 4 ng/ml being the usual indication for biopsy.

      PSA is a protease produced exclusively by epithelial prostatic cells, both benign and malignant. It breaks down the high molecular weight protein of the seminal coagulum, resulting in more liquid semen. PSA testing is also useful for monitoring therapy in patients with prostate cancer.

      Overall, the lack of specificity of the PSA test, combined with a lack of knowledge about the epidemiology and natural history of prostate cancer, are reasons against instituting a national screening program.

    • This question is part of the following fields:

      • Kidney And Urology
      14
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  • Question 7 - A 28-year-old man presents with macroscopic haematuria and is found to have a...

    Incorrect

    • A 28-year-old man presents with macroscopic haematuria and is found to have a serum creatinine level of 160 µmol/l (60-120 µmol/l).
      Select from the list the single feature that would be most suggestive of a diagnosis of nephritic syndrome rather than nephrotic syndrome.

      Your Answer: Proteinuria >3.5 g/day

      Correct Answer: Oliguria

      Explanation:

      Understanding Nephrotic and Nephritic Syndrome: Symptoms and Causes

      Nephrotic syndrome is characterized by proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, while nephritic syndrome is defined by acute kidney injury, hypertension, oliguria, and urinary sediment. Both syndromes can be caused by various renal diseases and are a constellation of several symptoms.

      In nephritic syndrome, increased cellularity within the glomeruli and a leucocytic infiltrate cause an inflammatory reaction that injures capillary walls, leading to red cells in urine and decreased glomerular filtration rate. Hypertension is likely due to fluid retention and increased renin release. Examples of conditions causing nephritic syndrome include diffuse proliferative glomerulonephritis, IgA nephropathy, and lupus nephritis.

      Acute nephritic syndrome is the most serious and requires immediate referral to secondary care, while patients with nephrotic syndrome will also be referred but usually do not require acute admission.

    • This question is part of the following fields:

      • Kidney And Urology
      28.6
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  • Question 8 - You are seeing a 60-year-old gentleman who has presented with a three day...

    Incorrect

    • You are seeing a 60-year-old gentleman who has presented with a three day history of dysuria and frequency of urination. There is no reported visible haematuria. He has no history of urinary tract infections, however, he does report longstanding problems with poor urinary stream, hesitancy of urination, and nocturia.

      Clinical examination of his abdomen and loins is unremarkable and he has no fever or systemic upset.

      Urine dipstick testing shows:
      nitrites positive
      leucocytes ++
      protein ++
      blood ++.

      You diagnose a urinary tract infection, send a urine sample to the laboratory for analysis, and treat him with a course of antibiotics.

      You go on to chat about his more longstanding lower urinary tract symptoms. Following this discussion, he is keen to have a rectal examination and prostate-specific antigen (PSA) blood test. Digital rectal examination reveals a smoothly enlarged benign feeling prostate.

      Two days later, the laboratory urine results return confirming a urinary tract infection.

      When is the most appropriate time to perform a PSA blood test in this case?

      Your Answer: Postpone the test for at least 2 weeks

      Correct Answer: The test can be performed any time from now

      Explanation:

      Factors Affecting Prostate-Specific Antigen Blood Test

      The prostate-specific antigen (PSA) blood test is a common diagnostic tool used to detect prostate cancer. However, the test results can be influenced by various factors, including benign prostatic hypertrophy, prostatitis, urinary retention, urinary tract infection, old age, urethral or rectal instrumentation/examination, recent vigorous exercise, or ejaculation.

      It is important to note that the PSA test should be deferred for at least a month in individuals with a proven urinary tract infection. Additionally, if the person has recently ejaculated or exercised vigorously in the past 48 hours, the test should also be postponed. While some sources suggest delaying PSA testing for at least a week after a digital rectal examination, studies have shown that rectal examination has minimal impact on PSA levels.

      In summary, several factors can affect the results of the PSA blood test, and it is crucial to consider these factors before interpreting the test results accurately.

    • This question is part of the following fields:

      • Kidney And Urology
      59.5
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  • Question 9 - A 5-year-old boy presents with a history of poor urinary stream. He has...

    Correct

    • A 5-year-old boy presents with a history of poor urinary stream. He has no other obvious abnormalities.
      Select the single investigation from this list that would be most helpful in this case.

      Your Answer: Micturating cystourethrography

      Explanation:

      Common Causes of Urinary Tract Obstruction in Children

      Urinary tract obstruction in children can lead to a poor urinary stream, indicating a blockage in the urinary system. The most common cause of this condition in boys is posterior urethral valves (PUVs), which are folds of urothelium that obstruct the bladder. PUVs can range in severity, from life-threatening to asymptomatic, but can lead to end-stage renal disease in 30% of patients. Vesicoureteric reflux, the backward flow of urine from the bladder into the kidneys, is also common in PUV patients.

      Antenatal ultrasound has increased the diagnosis of PUVs, with most cases recognized during the second and third trimester. Delayed presentation can include urinary infection, enuresis, voiding pain or dysfunction, and an abnormal urinary stream. Neurogenic bladder, caused by a birth defect involving the spinal cord, can also lead to urinary retention, leakage, and infection. Urethral calculi and strictures are less common causes of urinary tract obstruction in children, but should still be considered in the differential diagnosis.

    • This question is part of the following fields:

      • Kidney And Urology
      12.6
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  • Question 10 - An 80-year-old patient presents with lower urinary tract symptoms. Which of the following...

    Incorrect

    • An 80-year-old patient presents with lower urinary tract symptoms. Which of the following statements about benign prostatic hyperplasia is not true?

      Your Answer: 5 alpha-reductase inhibitors typically decrease the prostate specific antigen level

      Correct Answer: Goserelin is licensed for refractory cases

      Explanation:

      The use of Goserelin (Zoladex) is not recommended for treating benign prostatic hyperplasia.

      Benign prostatic hyperplasia (BPH) is a common condition that affects older men, with around 50% of 50-year-old men showing evidence of BPH and 30% experiencing symptoms. The risk of BPH increases with age, with around 80% of 80-year-old men having evidence of the condition. Ethnicity also plays a role, with black men having a higher risk than white or Asian men. BPH typically presents with lower urinary tract symptoms (LUTS), which can be categorised into obstructive (voiding) symptoms and irritative (storage) symptoms. Complications of BPH can include urinary tract infections, retention, and obstructive uropathy.

      Assessment of BPH may involve dipstick urine testing, U&Es, and PSA testing if obstructive symptoms are present or if the patient is concerned about prostate cancer. A urinary frequency-volume chart and the International Prostate Symptom Score (IPSS) can also be used to assess the severity of LUTS and their impact on quality of life. Management options for BPH include watchful waiting, alpha-1 antagonists, 5 alpha-reductase inhibitors, combination therapy, and surgery. Alpha-1 antagonists are considered first-line for moderate-to-severe voiding symptoms and can improve symptoms in around 70% of men, but may cause adverse effects such as dizziness and dry mouth. 5 alpha-reductase inhibitors may slow disease progression and reduce prostate volume, but can cause adverse effects such as erectile dysfunction and reduced libido. Combination therapy may be used for bothersome moderate-to-severe voiding symptoms and prostatic enlargement. Antimuscarinic drugs may be tried for persistent storage symptoms. Surgery, such as transurethral resection of the prostate (TURP), may also be an option.

    • This question is part of the following fields:

      • Kidney And Urology
      29.7
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SESSION STATS - PERFORMANCE PER SPECIALTY

Kidney And Urology (3/10) 30%
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