Transcript Renal revision masterclass

Renal Revision
Masterclass
Dr Vicki Levidiotis
May 10th 2010
Sem 8-9
Paper 2
Question 1
• The diabetes complication and control trial (dcct)
showed that strict glycaemic control ( hba1c
%<7%) did which of the following
A) prevented the progression of severe retinopathy
B) prevented the onset of macrovascular disease
C) reduced the prevalence of hypoglycaemic
episodes
D) reduced the progression of microalbuminuria
E) prolonged life in type 2 diabetes
• In the DCCT, intensive intervention resulted in a 63%
reduction in retinopathy progression, a 47% decrease in
development of severe non-proliferative diabetic
retinopathy, a 39% and 54% reduction in
microalbuminuria and macroalbuminuria, respectively,
and a 60% reduction in clinical neuropathy at 5 years.
• Aggressive early intervention before the manifestation of
complications yielded the best results. In both intensive
and conventional treatment groups in the DCCT, there
was approximately a 40% reduction in risk of
progression of retinopathy for each 10% proportional
reduction in hemoglobin A1c (HbA1c). At the conclusion
of the DCCT, participants learned about the results, and
all were encouraged and helped to adopt intensive
treatment.
Paper 2
Question 2
A 76 year old woman who lives in a nursing home has a
creatinine, urea and electrolytes drawn because she has
been nauseated. The results are as follows – Na 118
(NR 135-145), K 4.6 (NR 3.5-5), Urea 11.5 (NR 5-12),
Creatinine 0.08 (NR 0.05-0.10). What further clinical
information do you require to interpret this result
A– Blood pressure
B– Fluid status
C– Pulse rate
D– Temperature
E– Oxygen saturation
Question 3
A19 year old student presents to emergency with 2 week history of
polyuria, polydipsia, lethargy and a painful paronychia on her left 1st
digit. a finger prick glucose is 20 and this is confirmed on a serum
glucose as 21.7.
Which of the diabetes treatments would be suitable once she has been
stabilised?
A) actrapid tds, protaphane nocte
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B) protaphane nocte
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C) gliclazide 160mg bd
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D) metformin 1gram bd
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E) glimepiride
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F) mixtard 30/70 s/c bd
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G) insulin pump
Paper 2
• QUESTION 4
• An 18 year old receptionist presents with 2 days frequency and
dysuria. A urine dipstick shows
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1+ red blood cells
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1+ protein
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3+ white blood cells
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Empiric treatment is:
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a) ciprofloxacin
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b) trimpethoprim
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c) co-trimoxazole
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d) amoxycillen
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e) nitrofurantoin
QUESTION 5
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A subtotal thyroidectomy was performed 8 weeks ago on a 45 year old teacher with congenital
heart disease for uncontrollable “amiodarone induced thyroiditis”. He now presents to Endocrine
Clinic for a post operative review.
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He complains of fatigue, leg cramps and circumoral parasthesiae.
Electrolytes
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Serum Calcium 1.65 ( 2.13-2.62)
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Serum phosphate 2.20 ( 0.73 – 1.37)
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Alkaline phosphate 53 IU/L ( < 90)
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Serum Albumin
40 g/L ( 35-50)
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Urinary Calcium 2.1 mmol/day ( 3.7-6.2)
His current medications are-:
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Thyroxine 150mcg daily
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Amiodarone 200mg bd
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Coversyl 8mg daily
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Atenolol 100 mg daily
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Aspirin 100mg daily
Which of the following is the most likely diagnosis
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a) Hypoparathyroidism
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b) Hyperparathyroidism
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c) Osteomalacia
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d) Hypothyroidism
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e) Transient postoperative hypocalcaemia
QUESTION 5 part 2
Which of the following is the most appropriate initial
management?
a) Oral magnesium
b) Oral calcium carbonate and oral 1,25 dihydroxyvitamin
D3 ( Calcitriol)
c) Intravenous calcium gluconate
d) No treatment required
QUESTION 5 part 3
Which of the following is the most
appropriate long term management?
a) oral magnesium
b) Oral calcium carbonate and 1.25
dihydroxyvitamin D3 ( Calcitriol)
c) Intravenous Calcitriol
d) No treatment required
QUESTION 6
• Side effects of morphine include which
one of the following?
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a) renal failure
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b) myotonic jerks
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c) constipation
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d) aplastic anaemia
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e) cardiac arrhythmia
Paper 1
QUESTION1
A 24 year old male was admitted 2 days ago with acute pancreatitis.
His pain has been treated with a pethidine infusion.
Which one of the following is true regarding his pethidine infusion
a) Pethidine is metabolised to nor-pethidine which may cause seizures.
b) Pethidine has fewer side effects when compared to morphine
c) Pethidine has an oral bioavailability greater than 50%
d) Pethidine is a natural drug derived from the opium poppy
e) The dose of pethidine should be increased in the patient with renal
failure
Paper 1
QUESTION 2
• A 25 year old type I diabetic woman is brought to the ED
confused and drowsy. She had attended a party the
previous night and may have forgotten some of her
insulin doses. Her BP is 80/60, pulse 120 BPM and she
is afebrile. She has ketones in her urine and her capillary
blood glucose is 36 (NR <8). The most important
principal of her initial management is
a) – Lowering her blood glucose
b) – Replenishing her intravascular volume
c) – Correcting her acid base imbalance
d) – Correcting her Potassium status
e) – Treating an infection
Paper 3
Question 1
• A 30 year old lawyer has had type 1 diabetes for
20years. She has been on basal bolus actrapid
and bedtime protaphane most of that time. her
overall control has been poor with hba1c%
approximately 8.9%. Fortunately to date there
has been no evidence of diabetes complications.
She now wishes to become pregnant but knows
her control must be between 6-7%.
• Which treatment could you discuss with her to
achieve this?
Paper 3- Question 2
• A 80 year old retired gardener presents with a 2 year history of
pelvic pain localized to the left side. It is particularly bad at night but
has become an increasing problem during the day. Over the counter
analgesics have been unhelpful. He also complains of “getting old”
with a sore left shoulder and reduced hearing. His past history
includes diet controlled type 2 diabetes, hyperlipidaemia and gout.
There is no relevant family history.
His medications are –: Simvastatin 10mg
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Panandol,
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panadeine,
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non steroidal anti inflammatory drugs.(NSAIDS)
His examination is unremarkable.
Paper 3
• You arrange an x ray of his pelvis and the result is
shown. The left hemipelvis is sclerotic. The cortical bone
is thickened particularly in the region of the ileo-pectineal
line where the trabeculae are course.
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What is the most likely diagnosis?
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a) Osteoarthritis
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b) Fracture
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c) Avascular Necrosis of the Left Femoral Head
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d) Pagets Disease
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e) Sacro ileitis
Paper 3- Question 2 part 2
Biochemistry of the above condition would include:
a) Incr. Calcium , low phosphate, high PTH , incr
ALP
b) Normal Calcium, normal phosphate, normal
PTH, increased ALP
c) Normal Calcium , normal phosphate, low PTH ,
normal ALP
d) Low Calcium , High Phosphate, low PTH,
normal ALP
Paper 4- Question 1-part 1
Mr. Brown is admitted to the medical ward with community
acquired pneumonia.He is commenced on intravenous
antibiotics and chest physiotherapy, with oxygen therapy
via humidification. According to his fluid balance chart,
Mr. Brown has drunk 1 litre since his admission, 8 hours
ago. He has voided 3 times, to a total of 200mls.
Your first response is to
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a) examine the patient
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b) order blood tests
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c) question his nurse
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d) Take a urine test.
Paper 4- Question 1-part 2
On examination, you discover Mr. Brown
has a palpable bladder. He becomes very
uncomfortable as you palpate his lower
abdomen.
His most immediate problem is likely to be
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a) urinary tract infection (UTI)
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b) bladder tumour
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c) constipation
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d) acute urinary retention
Paper 4- Question 1-part 3
• The immediate management is
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a) more UTI specific antibiotics
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b) referral to surgeons
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c) urinary catheterization
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d) laxatives
Paper 4- Question 1-part 4
Halfway through the insertion of an indwelling
catheter, Mr. Brown becomes dyspnoeic and
distressed.
Your first action is to:
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a) Continue the procedure
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b) Sit the patient up
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c) Increase the oxygen concentration
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d) Call a Medical Emergency Team response
Paper 4- Question 1-part 5
Mr. Brown settles easily.
Your next decision should be to:
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a) Abandon the procedure
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b) Continue the procedure
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c) Reposition semi-recumbent and continue
the procedure after his distress settles
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d) Abandon the procedure and arrange for
Urology to insert a suprapubic catheter
Paper 4- Question 2
• The most appropriate method of reducing
indwelling catheter induced urethral meatus
irritation is
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a) oral analgesics
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b) topically applied anesthetic gel
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c) anchoring the catheter to the upper thigh
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d) hanging the drainage bag below the level
of the umbilicus.
Paper 4- Question 3
• The most common complication following
urinary catheter insertion is:
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a) urinary retention
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b) urinary tract infection
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c) urethral perforation
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d) haematuria