RENAL DISEASE

14.

Approach to patient with renal disease:

84.1

Indications of chronicity of renal disease include:

i.) ii.) iii.) iv.) v.)

Long-standing hypertension Large size kidneys Renal osteodystrophy Specific renal biopsy findings Presence of casts in urinary sediment

84.2

Complications of nephritic syndrome include:

i.) ii.) iii.) iv.) v.)

Renal artery thrombosis Infections Protein malnutrition Vitamin D deficiency Drug toxicity due to increased protein binding

84.3

Risk factors for urinary tract infection in adults include:

i.) ii.) iii.) iv.) v.)

Post menopausal status Neurogenic bladder Reflux Unilateral ureteric obstruction Foleys catheter

84.4

Fanconi syndrome is usually acquired from:

i.) ii.) iii.) iv.) v.)

Amyloidosis Multiple myeloma Renal transplation Heavy metals Wegeners granulomatosis

15.

ACUTE RENAL FAILURE (ARF):

85.1 Causes of acute tubular necrosis include:

i.) ii.) iii.) iv.) v.)

Contrast dye Cephalosporins Muscle trauma SLE Pancreatitis

85.2 Complications of ARF include:

i.) ii.) iii.) iv.) v.)

Impaired K+ excretion High anion gap acidosis Hyperphosphatemia Hypercalcemia Paralytic ileus

85.3 In patients with ARF:

i.) ii.)

Only about of the patients have anuriaoliguria Those with preserved urine output have a better prognosis

iii.) iv.) v.)

Fever, skin eruption, and urinary eosinophils suggest vascular inflammatory disease Major complications of ARF may first appear during the recovery phase Dialysis is contraindicated if ARF is associated with active GI bleeding

16. CHRONIC RENAL FAILURE (CRF) AND UREMIA:

86.1

Endocrine consequences of CRF include:

i.) ii.) iii.) iv.) v.)

Secondary hyperparathyroidism Glucose intolerance Amenorrhea Impotence Disorders of ACTH axis

86.1.1

Match the following:

i.) ii.) iii.) iv.)

Guanidinosuccinic acid Large compounds middle molecules Urochromes PTH

v.)

Hypermagnesemia

1.) 2.) 3.) 4.) 5.)

Yellow skin pigmentation Uremic neuropathy Antacids and cathartics Platelets dysfunction Osteitis fibrosa cystica

86.2 Metabolic change of CRF include:

i.) ii.) iii.) iv.) v.)

Hypertriglyceridemia Hyperuricemia Increased 1, 25 dihydroxyvitamin D3 Increased PTH secretion Hypophosphatemia

86.3

Abnormalities of hemostasis in patients with CRF are characterized by:

i.) ii.)

Low platelet factor III activity Prolonged thrombin time

iii.) iv.) v.)

Prolonged bleeding time Prolonged PTT Platelet dysfunction

17. DIALYSIS AND TRANSPLANTION:

87.1 Patients on chronic dialysis may have:

i.) ii.) iii.) iv.) v.)

Accerelated atherosclerosis Sexual dysfunction Fatal dementia Disequilibrium syndrome Secondary polycythemia

87.2 Advantage of peritoneal dialysis include:

i.) ii.) iii.) iv.)

Safety Lack of need of blood access Less protein loss Less cardiovascular stress

v.)

Decreased rate of infections

87.3

Contraindications to kidney transplantation include:

i.) ii.) iii.) iv.) v.)

Advanced coronary artery disease Active infection Previous sensitization to donor tissue Active glomerulonephritis Previous abdominal major surgery

87.4

Complications of cyclosporins therapy include:

i.) ii.) iii.) iv.) v.)

Bone marrow suppression Nephrotoxicity Hepatotoxicity Hirsutism Osteoporosis

18. GLOMERULAR DISEASE:

88.1

Membranous glomerulonephritis: Mark T or F.

i.) ii.) iii.) iv.) v.)

Sub-epithelial IgG deposits are known feature It accounts for 15% of adult-nephrotic syndrome Blood pressure is normal Steroids have minimal effect or renal function The majority of patients progress to end-stage renal disease

88.2

In diabetic nephropathy:

i.) ii.) iii.) iv.) v.)

Retinopathy is nearly universal Tight glucose control may delay onset of nephropathy Mortality rates of patients on dialysis are high Successful transplantation is as frequent as in non-diabetics Restriction of dietary protein may speed decline of renal function

88.3

Pathologic changes in diabetic nephropathy include:

i.) ii.) iii.) iv.) v.)

Diffuse and/or nodular glomerulosclerosis Nephrosclerosis Linear IgG deposits Papillary necrosis Chronic pyelonephritis

88.4

In Goodpastures syndrome:

i.) ii.) iii.) iv.) v.)

Young females are usually affected Hemoptysis may precede nephritis Rapidly progressive renal failure is typical Linear IgG is present on lung biopsy Plasma exchange is contraindicated

88.5

Henoch-Scholein Purpura: Mark T or F.

i.) ii.) iii.) iv.) v.)

Occurs mainly in children Serum IgG is increased in of the patients Renal biopsy is useful for prognosis Treatment is symptomatic in most cases Decreased serum complement levels are characteristic

19.

RENAL TUBULAR DISEASE:

89.1

Drugs causing acute interstitial nephritis include:

i.) ii.) iii.) iv.) v.)

Sulfonamides Cimetidine Allopurinol Rifampicin NSAIDs

89.2

Metabolic causes of chronic interstitial nephritis include:

i.) ii.)

Hypercarrotinemia Hypertriglyceridemia

iii.) iv.) v.)

Hypercalcemia Hypokalemia Hyperuricemia

89.3

Renal manifestation of myeloma include:

i.) ii.) iii.) iv.) v.)

Hypercalcemia nephropathy Tubular defects Acute renal failure Chronic interstitial nephritis Proteinuria

89.4

In medullary sponge kidney:

i.) ii.) iii.) iv.) v.)

Proximal renal tubular acidosis is common Elderly patients make the majority of the cases Diagnosis is made by IVP Renal failure is common Hematuria and urinary infection is a common presentation

89.5

Polycystic kidney disease: Mark T or F:

i.) ii.) iii.) iv.) v.)

It is an autosomal dominant disease Males: females ratio is 3:1 It is associated with intracranial aneurysms Progressive azotemia occurs in most patients Dialysis and transplantation are routinely used in treatment

89.6

Feature of Bartters syndrome include:

i.) ii.) iii.) iv.) v.)

K+ wasting Occurs in 4th and 5th decade Autosomal recessive High rennin and aldosterone Often responsive to steroids

89.7

The following statements favor renal tubular

acidosis type I as compared to type II:

i.) ii.) iii.) iv.) v.)

Proximal tubules involvement Association with glucosuria,, aminoaciduria and phosphaturia Autosomal dominance Hypokalemia Association with diabetes mellitus

20. URINARY TRACT INFECTION (UTI):

90.1 The following are features of chronic pyelo-

nephritis:

i.) ii.) iii.) iv.)

Impaired renal function Pyuria with WBC casts IVP showing smooth Symptoms often minimal

v.)

Hypertension

90.2 Risk of papillary necrosis is increased with:

i.) ii.) iii.) iv.) v.)

Gout Sickle cell disease Alcoholism Paracetamol ingestion Pregnancy

21. RENOVASCULAR DISEASE:

91.1 Renal athero-embolism: Mark T or F.

i.) ii.) iii.) iv.) v.)

It is caused by cholesterol embolization Moderate to large renal vessels are affected Urinalysis is negative Urinary Na may be increased Heparin is contraindicated

91.2 The following are suggestive of renal artery stenosis:

a.) b.) c.) d.) e.)

Onset of hypertension < 30 or > 50 years old Hypokalemic alkalosis Malignant hypertension Early concentration of contrast on I.V.P. Ipsilateral suppression of renal vein renin with contralateral elevation

91.3 The following are seen with hemolytic-uremic syndrome:

a.) b.) c.) d.) e.) f.)

Irratic fever Thrombocytopenia Fibrin deposition leading to large vessel occlusion Microangiopathic hemolytic anemia Microangiopathic hemolytic anemia Fairly good prognosis

91.4 Eclampsia: Mark T or F.

a.) b.) c.) d.) e.)

Diagnosis can be made without development of seizures Glomular swelling cause renal insufficiency Coagulation abnormalities may occur It commonly occurs before 24 weeks of gestation MgSO4 should be avoided in severe cases

22. RENAL STONES:

92.1 Causes of calcium oxalate stones include:

i.) ii.) iii.) iv.) v.)

Hyperuricosuria Primary hyperparathyroidism Proximal RTA Hyperoxaluria Cyclic chemotherapy

92.2

Correct statements about struvite stones include:

i.) ii.) iii.) iv.) v.)

They form when infection with urea-splitting organisms present About 30% of these are associated with hypercalciuria Urine pH is 8-9 They are the most common cause of staghorn calculi Low purine diet allopurinol are indicated

92.3 Uric acid stones occur in patients with:

i.) ii.) iii.) iv.) v.)

Cushings syndrome Sarcoidosis Gout Ileostomy Myeloproliferative disorders

92.4 Cystinuria: Mark T or F.

i.)

It is an inherited disorder

ii.) iii.) iv.) v.)

It is a common cause of staghorn calculi Treatment includes urine alkalinzation Penicillamine ia a recognized therapy Mandelamine and venacidin are indicated treatment

23. URINARY TRACT OBSTRUCTION (UTO):

93.1

UTO is caused by:

i.)

Papillary necrosis

ii.) Ovarian tumors iii.) Benign prostatic hypertrophy iv.) Vesicoureteral reflux v.) Neurogenic bladder

93.2 The following statements are correct about UTO:

i.)

It is preponderant in females

ii.) iii.) iv.) v.)

Small residual urine confirms diagnosis Dilatation of ureters may be absent in retroperitoneal fibrosis Return of renal function depends in part on duration of obstruction Relief of severe bilateral obstruction is typically followed by diuresis lasting several hours

24. TUMORS OF THE URINARY TRACT:

94.1

Correct statements about tumors of the urinary tract include:

i.) ii.) iii.) iv.) v.)

Renal cell carcinoma is responsible for 50-55% of the cases Renal cysts in hemodialysis patients may become malignant Hypernephroma occurs typically in males in their sixth decade Percutaneous needle aspiration is relatively contraindicated Cure is occasionally achieved by excision of solitary metastasis

94.2

Risk factors for bladder (transitional cell) carcinoma include:

i.) ii.) iii.)

Smoking Chemical exposure Cyclosporin therapy

iv.) v.)

Schistosoma hematobium Recurrent UTI