NEPHROLOGY MCQS

BLOOD UREA isn't affected by tubular excretion. (MCQ)

CAUSES OF SPECIFIC GRAVITY Add…. SICKLE CELL ANAEMIA. (MCQ)

ACUTE PAPILLARY NECROSIS hematuria. (MCQ)

THE MEDULLA IS MORE LIKELY TO BE AFFECTED IN SCA (causes of nephrogenic DI)

DEFINITIONS:

1) AZOTEMIA only lab finding(no clinical manifestations)

2) UREMIA lab & clinical

3) ESRF????

4) CHRONIC RENAL DISEASE >6 MONTHS ****REMEMBER:ANY CASE OF A FEMALE WITH CRF…..DON'T FORGET TO ASK ABOUT THE 11 CITERIA OF SLE. (very important for the long case)

CAUSES OF BLEEDING TENDENCY 1) HEPARINE ADMINISTERATION DURING DIALYSIS

2) loss of clotting factors during dialysis

COMPLICATIONS OF HEMODIALYSIS??? BAD SHIP ???

B = brain edema-bleeding

A = amyloidosis-atherosclerosis-air embolism

D = dementia-depression

S = serousitis

H = hypotension

I = infection-IEC

P = pruritis-pseudogout

CAUSES OF RENAL FAILURE: ADD…

1) GOOD Pasture $

2) Vasculitis

3) Drugs penicillins-cephalo-sulphonamides-NSAIDs

PRE-RF VS. RENAL FAILURE ??? (V. IMP.)

1) PRE RENAL:

a) Good prognosis.

b) BUN/cr >20.

c) Na+ in urine <20mmol/l

d) Urine osmolarity(preserved function of the tubules)

e) Fraction Na + excretion in urine<1

f) Good response to fluids.

2) RENAL (TOTALLY THE OPPOSITE TO THE ABOVE)

CAUSES OF POST RF:

prostate ++

neurogenic bladder.

DD OF ARF + JAUNDICE: 1) MALARIA

2) G6PD

3) HU$

4) DISMATCHED BL. Transfusion

5) hepatorenal $

6) BILIRUBIN nephropathy

INVESTING OF ATN: BUN/Cr <20(MCQ)…since it's renal causes

p.38:add to the polyuric phase (UREA RETENTION =NATRIURETIC $)

CAUSES OF MINIMAL CHANGE ADD.. RIFAMPICINE

NIL $...REMEMBER:

N = NSAIDS I = idiopathic L = lymphoma

CAUSES OF FSGN HBV – PAN - IgA nephropathy - SLE(type III) – analgesics.

AMYLOIDOSIS enlarged kidneys…DD????

CAUSES OF RPGN Add… IgA nephropathy - SLE (TYPE 4)

GOOD PASTURE ARF

MEMBRABO-PROLIFERATIVE L/M is called "TRAM-TRACK appearance" (double contour or

splitting of the GBM) (very imp)

NEPHRITIC:

CL./P. Add…bilateral renal angle pain & tenderness. (esp. in children)

CAUSES Add… Bilharziasis

CAUSES OF CHRONIC TIN (MCQ) Stones

reflux

Wilson

KC$

Chronic transplant rejection

CAUSES OF ACUTE PYELONEPHRITIS: ADD…

BILHARZIASIS. (STRICTURES) - CONGENITAL STENOSIS OR NARROWING (ADDED BY DR.OSAMA 2010)

PENICILLINS & CEPHALOSPORINES safe in pregnancy in TTT of UTI.

M/C presentation of chronic pyelonephritis is ASYMPTOMATIc.

VUR isn't usually seen in adults.

URETERIC OBSTRUCYION causes:

cervical carcinoma

hematuria

pain

STONES:

REMEMBER:uric acid PPT also in renal parenchyma(MCQ)

ADPKD:

ASSOCIATED WITH hepatic-CVS-pancreatic anomalies

C/P Add…. associated with pancreatic cysts

RADIOLOGY?? must search for it in the CT scan.

DD DM nephropathy-amyloidosis kidney

REMEMBER: BERRY'S ANEURYSM IN??

IEC

ADPKD. (MCQ)

Sub-Dural Hge.

CAUSES OF RTA I???(EH ELI BYA3MELO???)

1) Lithium.

2) Hyperparathyroidism.

3) Sjogren.

4) chronic renal transplant rejection.

5) chronic pyelonephritis.

6) filtered HCO3- <10 & plasma level <10 meq /l

RTA IV??? CONSIDER IT EXACTLY ALDOSTERONE DEF.

serum k.

RTA II filtered HCO3->15 & plasma level=14-20meq/l

ALPORT'S: AR or XLR

degeneration in GBM

mutation in genes coding IV COLLAGEN

remember FANCONI $ CAUSES RICKETS

RVT (P.72)

CAUSES nephritic (membranous) - hypercoagulable state - abdominal trauma.

CL. /P loin pain – hematuria - HEAVY PROTEINURIA. (MCQ)

-COMPLICATIONS pulmonary embolism

INVESTIG U/s-duplex-MRA

TTT of the cause =anticoagulants

GLOMERULO-SCELROSIS IN: HTN-DM-F & S GN

RAS: young female…HTN ??? 1st line search for 2ry cause (SLE-RAS)

1) ATHEROSCLEROTIC: Old male.

Total occlusion is common.

Ischemic renal atrophy.

Bad prognosis.

Proximal stenosis.

2) FIBROPLASIA: young female

total occlusion is rare

ischemic renal is rare

good prognosis

middle or distal with beading appearance in U/s

REMEMBER:DD OF hypokalemic HTN???

DRUGS THAT BP

RENAL Diruetics.

ANALGESIC NEPHROPATHY M/C cause of Chronic TIN. ADD TO C/P nephritic. DRUGS CAUSING IDIOSYNCRACY??? NSAIDS – gold - penicillins – peniciilamin

HYPER-NEPHROMA:

ADD TO C/P presistant fever-disturbia in liver functions(MCQ)

REMEMBER CAUSES OF POLYCYTHEMIA in kidney???

REMEMBER PARAMALIGNANT $ HCC – hypernephroma - lung cancer-stomach cancer

ADD TO HEPATO-RENAL LINK:

IgA nephropathy common in alcoholics liver cirrhosis

LCF…bleeding tendency…ARF (pre-renal)

THE UPCOMING DATA IS FOUND IN LANGE & DAVIDSON"S MCQ

BUT THEY WEREN'T TAUGHT NEITHER IN ROUNDS NOR LECTURES:

1) PROSTATIC CANCER:

DRE best screening test while PSA best prognostic test SLOWLY PROGRESSIVE OBST. UROPATHY. LOCAL SPREAD along the lumbosacral plexus osteolsclerotic bone metastasis

2) RISK FACTORS FOR PRE-ECLAMSIA: 1st preg / hydatiform mole in 1st trimester / twin preg. extremes of age. DM. NOT HIV. (MCQ)

3) URINARY BLADDER CARCINOMA:

mainly TRANSITIONAL CELL (in EGYPT squamus cell)

PAINLESS HEMATURIA.

TTT radiotherapy.

SPREAD early local but late metastasis.

BENIGN PROSTATIC HYPERTROPHY: >60 ys old.

Acute urinary retention & hematuria.

Androgens.

normal serum acid phosphatase.

TESTICULAR TUMORS:

AGE 22-34

SEMINOMA painless

TTT. radio & chemo sensitive

TERATOMAS -FP &chronic gonadotrophins