Renal

Front 1

What % of patients requiring chronic dialysis develop pericarditis and what is the most common cause ?

Back 1

20%
75% s uraemic
25% is dialysis related

Front 2

Pericarditis of uraemia shows ST elevation

Back 2

FALSE. Because inflammatory cells do not penetrate into myocardium, typical changes are absent

if it is present, it mandates other causes including infection

Front 3

Treatment for pericardial effusion in haemodynamically stable patient with uraemia is

Back 3

Dialysis for 10-14 days and if not responsive, anterior periocardectomy

Front 4

Where is transplanted kidney felt

Back 4

Right or left lower quadrant of the abdomen and is easily palpale

Front 5

What are the two common cause of ARF after kidney implantation

Back 5

Acute rejection
Acute cyclosporine or tacrolimus toxicity

Front 6

What are the differential diagnosis for fever in post op renal transplant patient

Back 6

1. Infection associated with post op
NBB: opportunistic infection uncommon in the first post transplant month and usually occurs after 1st month and before the 1st post transplant year

Front 7

What is the prognostic marker for graft function

Back 7

Serum creatinine level

Front 8

Calcium administration in hyperkalaemia leads to

Back 8

effect in 1-3 min and lasts 30-60min

Front 9

Recommended dose of salbutamol for Hyperkalaemia

Back 9

10-20mg is recommended via nebuliser

Front 10

Role of NaHCO3 in hyperkalaemia

Back 10

Latest evidence suggest it has no effect to shift K into cell even after several hours
Adverse effect of Na and volume overload especially in renal compromise
No longer routinely recommended

Front 11

Most common cause of rhabdomyolysis

Back 11

Adult: Alcohol and drugs 80%
Children: Trauma, viral myositis and Connective tissue disorder

Can also occur in statin therapy but very very rare

Front 12

What bacteria and virus in insinuated in rhabdomyolysis

Back 12

Influenza type A and B
Legionella most frequently report bacterial cause

Front 13

Role of serum myoglobin and urinary myoglobin in rhabdomyolysis

Back 13

Poor role
It has short half life 1-3 hours and rapidly excreted thus will be absent in patients who presents late in the course of their illness

Front 14

Role of CK in rhabdomyolysis

Back 14

Useful as very long half life 1.5 days
Level greater than 5 TIMES THE NORMAL thought to be diagnostic

however degree of CK elevation does not predict development of renal failure. it has to do with co-morbidities including sepsis/dehydration/acute kidney injury

Front 15

Age group for Haemolytic Ureamic syndrome

Back 15

6 months to 4 years
one of the most common cause of ARF in children

Front 16

Two type of HUS

Back 16

Epidemic
- typical
- associated with shiga toxin producing E coli, shigella, strept pneumonia, HIV and is associated with diarrhoea

Sporadic not associated with diarrhoea and thought to be genetic link

Front 17

How % of HUS is associated with CNS irritability

Back 17

33%

Front 18

What are other symptoms HUS associated with?

Back 18

Fever 30%
Abdominal pain with bloody stool 89%

Front 19

Post streptoccocal glomerulonephritis diagnosis is made by

Back 19

Symptoms
- sudden onset of haematuria, oedema, HTN and renal insufficiency (Nephrotic syndrome in <5%)

Evidence of prior strept infection
- ASO titre 250U or higher suggestive of recent infection(elevated after pharyngeal infection but rarely after skin infection), more useful as a trend rather than one off measurement
- Throat culture (may represent carrier state)

Reduced C3 level (reduced in acute phase and returns to normal in 2 months). C4 is normal

Front 20

Diagnostic criteria for nephrotic syndrome

Back 20

Oedema
Hypoporteinemia with low albumin level
Proteinuria (3+ ot 4+ dipstick reading)
hyperlipidaemia

Microsopic haematuria is also present

Front 21

Complication of nephritic syndrome

Back 21

INfection
Thromboembolic event
This is because antibodies and coagulation factors are lost as protein in urine

Front 22

Causes of haematuria

Back 22

Haematologicla
Renal
- glomerular
- non glomerular
- macroscopic usually lower renal disease, microscopic usually kidney disease, red cell casts usually glomerular
Post renal

Front 23

Causes of painful haematuria

Back 23

UTI

Front 24

Causes of painless haematuria

Back 24

Neoplastic
Hyperplastic
Vascular

Front 25

Haematuria in patients with oral anticoagulation

Back 25

Up to 80% have underlying disease

Front 26

Causes of prostatitis

Back 26

Gram negative bacilli (E coli, proteus)
STD (gonorrhoea, chlamydia)

Prostatic massage with urine sample collection post is not recommended with acute bacterial prostatitis because it can precipitate bacteraemia

Front 27

Causes of chronic prostatitis

Back 27

Bacterial - recurrent urinary tract infection
Non bacterial

Front 28

Causes of UTI

Back 28

Uncomplicated: E coli 70-90%
Complicated: E Coli, Proteus, Klebseilla, enterococci, Group B strept (Strept agalactiae)

Front 29

What does chlamydia trachomatis urine culture like

Back 29

Culture negative pyuria

Front 30

What does pseudomonas UTI suggest

Back 30

it is a low virulence organism THUS normal host defence is altered secondary to incomplete voiding, vesicourteric reflux or voiding dysfunction

Front 31

What are the bacteria that does not cause positive nitrite

Back 31

Enterococcus
Pseudomonas
Acinectobacter

Thus it is specific but not sensitive

Front 32

Asymptomatic bacteriuria is diagnosed by

Back 32

>10^5 CFU/mL of a single bacterial species on two successive urine without symptoms

Common in Pregnant women 30% and nursing home patient 40% and those with IDC

Front 33

Do you treat asymptomatic bacteriuria in pregnant women

Back 33

Yes. IT reduces incidence of pyelonephiritis in pregnancy and it can precipitate acute pyelonephritis and more likely to develop bacteria/septic shock

Front 34

Do you screen pregnant women and nursing home patient for UTI

Back 34

 

Pregnant ladies YES

Nursing home patient

Only before urological procedures

Front 35

what % of women with UTi has gross haematuria

Back 35

30-40% secondary to haemorrhagic cystitis

Front 36

How do you tell between pyelonephiritis and uTI

Back 36

By presence of fevers/chills/nausea/vomiting/weakness
Flank pain/Costvertabral angle tenderess and renal tenderness can be associated with cystitis because of referred pain

Front 37

VUR is present in how many children with first UTI

Back 37

20-30% (versus 1% of genera paediatric population)

Front 38

Does children with UTI have family history

Back 38

YES!

Front 39

Does younger children with UTI have recurrence?

Back 39

Yes, up to 40%
They all occur within 2 years and these are associated with recurrence including young age at first UTI, urinary tract abnormalities and voiding dysfunction

Front 40

Who should get USS after Febrile UTI in 6 weeks

Back 40

Every child under the age of 6 months
Or any older children with history of previous UTI

Front 41

Who should get USS earlier than 6 weeks

Back 41

Atypical UTI in all children
- severe infection (sepsis, atypical bacteria, failure to respond to antibiotics within 48 hours)
- Abnormal anatomy (abdominal/pelvic mass, poor UO)

Front 42

Who gets Micturating cystourogram?
- Veiscoureteric reflux

Back 42

Decision to make this test individual
Only if US is abnormal

THis is because it is invasive and sitressing

Front 43

What is DMSA scanning for

Back 43

To pick up renal scarring 3-6 months of the UTI

Front 44

What age can you do SPA in

Back 44

under 2 years of age

Front 45

Intrisic renal failure can be divided into four category, What are the category

Back 45

Tubular

Glomerular

Interstitial

Small vessel disease

Front 46

What is the most common cause of intrisic renal failure

Back 46

ISchaemic secodnary to acute tubular necrosis

 

Front 47

What causes insterstitial nephritis

Back 47

Autoimmune

Infection

Infiltrative

Front 48

How does ACE inhibitors and NSAID cause renal failure

Back 48

Because glomerula filtration is affected by afferent glomerular arteriole (controlled by PG) and efferent glomerular arteriole (affected by angiotension II)

 

By decreasing this mediators, the kidney becomes very dependent on renal perfusion

Front 49

Is serum urea accurate marker of the clinical syndrome of uraemia?

Back 49

NO it is clinical syndrome

Front 50

What does different casts in urine analysis mean?

Back 50

Hyaline - pre and post renal failure

Granular - tubular injury

Red cell - glomerulonephritis

Front 51

What is the eGFR value that present high risk for developing contrast induced nephoropathy

Back 51

<60mL/min/1.73^2

Front 52

How do you prevent contrast induced nephropathy

Back 52

Fluid

- recommedned therapy but optimal fluid regiment not known

Front 53

What are the complication of the vascular access?

Back 53

Failure to provide adequte flow for dialysis (secondary to throbmosis or stenosis) 

Infection

Bleeding

Aneyrusm

vascular insuffciency to extremity distal to access

 

Front 54

How do you treat haemodialysis access block

Back 54

treated within 24 hours with clot removal. angioplasty or localised thrombolysis injection

Front 55

How does haemodialysis infection present

Back 55

Not typically with pain/erythema/swelling

Front 56

What can you give instead of Ca to stabilise membraine in digoxin toxicity

Back 56

Magnesium

Front 57

Causes of nephrotic syndrome

Back 57

Primary (only invoving kidney)

- usually children <5 yeasrs old

- usually minimal changes

- ARF usually rare

 

Secondary (umtisystem)