DISEASES OF THE KIDNEY AND GENITO-LIRINARY SYSTEM

1.
A F Total number of nephrons = I million
B F Efferent arterioles
C T From intralobular branches of renal
artery
D T And arcuate arteries
E F 10 mmHg

2.
A F 66% of filtered water is reabsorbed
B T And collecting ducts
C T But only 150 mg per day excreted in
urine
D F 66%
E F Afferent arterioles

3.
A F Almost all is passively absorbed
B T And in ascending limb of loop of
Henle
C F Active reabsorption process
D T Coupled with sodium reabsorption
E F 85% of bicarbonate is reabsorbed

4.
A T In part regulated by mineralocorticoid
B T If K+ is low, H+ is secreted
preferentially
C T Via renin-angiotensin system
D T ADH increases tubular permeability to
water
ET Permits urinary acidification

5.
A T Probably in tubular cells
B F 1,25-clihydroxycholecalciferol
C T Vasoclilatory actions; produced in
mesangium
D T As do many other tissues
E F Produced in adrenal cortex
6.
A F Immunoelectrophoresis required
B T Often with oedema and
hypoalbuminaernia
C F Greater when upright -'orthostatic
proteinuria'
D T But no red cells on microscopy
E T Microalbuminuria is a sensitive
predictor

7.
A F Moderate 500 mg - 2.5 g but rarely
more
B F Usually haernaturia
C T Complicating dehydration in infants
D T Commonest cause in childhood
E F No glomerular lesion

8.
A F Proteinuria is typical
B T Risk factors include diabetes mellitus,
NSAID usage and alcoholism
C F Typically proteinuria
D T Immune complex glomerulonephritis'
E T May be frank haematuria

9.
A T pH > 8 suggests infection
B T E.g. using urinary and plasma
creatinine
C T Assessed by ultrasound scanning
D F 33% is excreted within the first hour
E F Contrainclicated if kidneys are small

10.
A T More marked in children
B T Often with generalised oedema
C T With RBC casts
D F Non-selective and usually not
nephrotic
E F Suggests Clq esterase inhibitor
 deficiency

201
 11.
A F Typically painless
B T Transudates
C T Diagnostic prerequisites
D F May occur in chronic renal failure
E F Marked sodium retention - urinary
sodium < 10 mmol/L

12.
A F Tubulointerstitial damage only
B T And HIV
C T Usually detectable circulating immune
complexes
D T Presents with recurrent macroscopic
haematuria
E F Immunoglobulin light chain deposits

13.
A T With mesangial proliferation and
inflammatory infiltrate
B F But precipitating antigen unidentifiable
in most
C T Typically in children of school age
D T And chest X-ray infiltrates
E F Prognosis better in children

14.
A F Hypertension is typical
B F Tubular function normal
C T Classical' pathway activation
D T Or interstitial fibrosis
E T With RBC casts

15.
A F But can improve renal function if
severely impaired
B* F Can be of value if nephrotic
C F Often needed in oliguric phase
D T Sodium and water restriction
E T But drug treatment may-also be necessary

16.
A T But can occur at any age
B F Usually < 7 days
C T Minor proteinuria in the remainder
D T 20% have hypertension
E T Or focal segmental mesangial
proliferation

17
A T More common in females
B T Or nephrotic presentation
C F No specific treatment
D F 75% progress to renal failure
E F Hypocomplementaemia

18.
A F Acute nephritic or renal failure
B T Early dialysis is typically required
C F Occasional association
D T Epithelial crescent formation occurs
E F Only in the minority

19.
A T Removable by plasmapheresis
B T With linear IgG deposition
C T Usually with acute renal failure
D T Antibodies have pulmonary basement
membrane cross-reactivity
E F Limited response given prompt
therapy

20.
A T Uniform basement membrane
thickening
B T Or asymptomatic proteinuria
C T Hypertension in 30%
D F Poor prognosis
E F No specific treatment

21.
A F Children aged 3-15 years
B F Minor or absent
C F Selective proteinuria
D F Suggests an alternative cause
E T And atopy

22.
A F Diagnosis in children rarely requires
histological confirmation
B F Useful in management of oedema
C T Longer term steroids may be helpful
D T E.g. cyclophosphamide
E F Rarely, even in relapsing disease

23.
AT Increases in frequency with time
BT An immune complex nephritis
CT 20% focal, 15% membranous
DF Better prognosis
EF Rare as is CNS involvement

24.
A F Rheumatoid arthritis and bronchiectasis
B T Tubular insensitivity to ADH
C T Proximal or distal
D T Treatment does not retard progression
E T 56% die in renal failure

25.
A F Suggests acute pyelonephritis
B T And urinary frequency
C F Suggests an abnormality of the urinary tract
D T E coli in 75% of UTIs in the community
E F Trimethoprim or co-amoxyclav

26.
A T But ureteric obstruction may be a predisposing factor
B T With loin or epigastric pain
C F Typically unilateral but can be bilateral
D F Commonly found in chilren but not adults
E F Suggests perinephric abscess

27.
A F 5% cf. 40% in elderly females
B T And ureteric dilatation
C T 40% develop symptoms if untreated
D F Contrainclicated in early pregnancy
E F Teratogenic risk (a folate antagonist)

28.
A T Chronic infection predisposes to phosphate stone formation
B F Usually asymptomatic and presents with uraemia or hypertension
C T Recurrent infections can be difficult to prevent
D F Usually presents well before the age of 40 years
E T 'Salt-losing nephropathy'

29.
A F 20% of chronic dialysis patients
B T Other aetiological factors may also be important
C F Similar to ischaemic or tubulointerstitial nephritis
D F Reflux is often no longer demonstrable in adulthood
E T As a result of a 'salt-losing' nephropathy

30.
A F Typically normocytic or microcytic
B T Can improve with dialysis
C T Renal osteodystrophy with osteornalacia
D T Even haernorrhagic pericarditis with tamponade
E F Metabolic acidosis

31.
A T Hence polyuria; urinary diluting ability also impaired
B F Hyperphosphataernia
C F Hypocalcaemia
D T Resulting in hyperpnoea
E F Severe proteinuria diminishes as renal failure progresses

32.
A T Suggests severe hypertension
B F May indicate aetiology
C T Occurs in severe renal failure
D T Particularly secondary hype rparathyroid ism
E T Typically progresses from this level on

33.
A T And in elderly and diabetic patients
B F 2 L instilled four times daily
C F May also be preferable in patients with cardiac disease
D T ABO compatibility is essential
E F About 75% graft survival and 90% patient survival

34.
A F Remember 20% of acute renal failure is non-oliguric
B F Blood pressure is often decreased in pre-renal ARF
C F Suggests pre-renal uraemia
D F Suggests pre-renal uraemia
E F Haemoglobin is typically near-normal

35.
A T Unless severe associated illness and hypercatabolic state
B T And calcium gluconate if severe
C T Including estimated insensible loss
D F Contraindicated in renal impairment
E F An indication for urgent renal dialysis

36.
A T Removes and replaces one litre of filtrate per hour and facilitates TPN
B F Causes less haemodynamic
disturbance
C F Peritoneal dialysis is technically
easier and less traumatic
D T But also undertaken intermittently over 3-4 hours per day
E F May be more effective than PD

37.
A F Creatinine falls even more slowly
B F Restriction should be relaxed to
improve nutrition
C T And often potassium supplementation is also necessary
D F Increase fluid intake in parallel with renal losses
E F Usually resolves in about 4 weeks

38.
A T E.g. renal calculus
B F Anuria typically suggests obstruc
C F Intervention may avoid dialysis
D T Demonstrates obstruction of the pelvis or ureter
E F Post-obstructive diuresis occurs

39.
A T And fever
BF Eosinophilia is typical
C T And neutrophil or monocytic infiltrate
D F Typically resolves
E T E.g. penicillin or rifampicin

40.
A T Urine stasis and infection
B T Or radiotherapy for such cancer
C F Haematuria is common in either
D T aberrant vessel or neuromuscular defect
E F Typically painful

41.
A T Typically phosphate stones
B T Produces osteoporosis and
hypercalciuria
C F Hyperparathyroidism
D T Normocalcaemic hypercalciuria
E T Hypercalciuria with or without
hypercalcaemia

42.
A T Suggests total obstruction
B F Acidification with ammonium chloride may benefit
C F Decreases urinary calcium excretion by 30% in hypercalciuric patients
D F Decreases urinary urate and thereby may reduce oxalate stone formation
E F Fragmentation by lithotripsy and
endoscopic removal is possible

43.
A F Autosomal dominant
B T But liver function tests normal
C T And hypertension and UTI
D F Typically bilateral
E T 10% will have a subarachnoid haemorrhage

44.
A T Anion gap = plasma Na+- (Cl- + HC03)
B T Increased chloride preserves anion gap
C T Even in presence of systemic acidosi
D F GFR is normal
E F No features of uraemia
45.
A T And amphotericin
B T And vitamin D intoxication
C T And SLE
D T Also causes proximal type 2 RTA
E T And hydronephrosis

46.
A T Reduce dose in renal failure
B F Contraindicated due to catabolic effect on protein
metabolism
C T Digoxin toxicity is common given the half-life of 35 hours
in health
D T Hepatic metabolism but renal excretion of active
metabolites
E T Check plasma levels daily

47.
A T Occurs in 20% and due to increased interleukin release
B T Typically osteolytic metastases
C T Due to blood clot or direct tumour obstruction of ureter
D T Erythropoietin secretion
E F Suggests hepatoma

48.
A T An atonic bladder
B F Suggests spinal cord damage above conus medullaris
C F Suggests colovesical fistula or instrumentation
D F Suggests pelvic floor muscle weakness
E T An anticholinergic effect

49.
A F Typically transitional cell
B F Painless haernaturia is typical
C F Radiotherapy is of palliative benefit
D F Local spread occurs early and metastases late
E T And schistosomiasis

50.
A T As may benign prostatic disease
B T Or haernaturia
C F Hard with obliteration of median f u rrow
D T And may involve ureters
E F Osteosclerotic metastases

51.
A F Aged over 60 years
B T Sometimes precipitated by LITI
C F Associated with diminished androgen secretion
D T Elevation suggests prostatic carcinoma
E F Typically symmetrical

52.
A F Typically painless
B T Helps in the assessment of treatment response
C F Haernatogenous spread may occur
D IF Peak incidence aged 25-34 years
E T Chemotherapy if widespread disease