Nephrology MCQ_Part 02

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Which of the following does not complicate pyelonephritis:
A. pyonephrosis
B. papillary necrosis
C. renal stones
D. perinephric abscess
E. renal cell carcinoma

Fanconi syndrome, a tubular functional disorder characterized by abnormal proximal tubular function, has all of the following characteristics except:
A. aminoaciduria
B. polyuria and polydipsia
C. glucosuria
D. phosphaturia and hypophosphatemia
E. excess bicarbonate loss and hence metabolic acidosis

Renal tubular carcinoma has all of the following characteristics except:
A. a disease of middle-aged and elderly individuals
B. a transitional cell neoplasm
C. metastases may affect a wide variety of organs
D. associated with the von Hippel Lindau tumor suppressor gene on chromosome 3p
E. the likelihood of metastases is strongly linked to the size of the tumor

EXPLANATIONS



MCQ 01 ANSWER

The Correct answer is E
Pyelonephritis is an ascending urinary tract infection that has reached pelvis of thekidney.It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys and may lead to chronic renal failure.
Papillary necrosis is complication of pyelonephritis.
Kidney stones formation or urolithiasis is comprised of calcium carbonate crystals in the presence of hypercalciuria and a common complication is chronic pyelonephritis.

MCQ 02 ANSWER

Correct answer is B
Fanconi syndrome is a generalized disorder of the Proximal Tubules. The defect can lead to glycosuria, aminoaciduria, phosphaturia, bicarbonaturia and excessive urinary loss of K+, Na+, Ca++, Mg++, uric acid and other organic acids.It may be inherited, or caused by drugs or heavy metals.
  • Clinical features
  • Polyuria, polydipsia and dehydration
  • Hypophosphatemic rickets (in children) and osteomalacia (in adults)
  • Growth failure
  • Renal tubular Acidosis
  • Hypokalemia
  • Hyperchloremia
  • Hypophosphatemia/phosphaturia
  • Glycosuria
  • Proteinuria/aminoaciduria
  • Hyperuricosuria
Causes
  1. Cystinosis(most common)
  2. Wilson's disease
  3. Lowe syndrome
  4. Galactosemia
  5. Glycogen storage diseases

MCQ 03 ANSWER

The Correct answer is B
Renal Carcinoma( hypernephroma/Grawitz tumour) originates in the epithelium of the proximal
tubule.
Epidemiology
* 90% renal cancers
* Mean age 55 years, male: female is 2:1

Risk factors
Cigarette smoking
Obesity
Positive family history
Hypertension
Dialysis patients with acquired cystic disease of the kidney
Patients with certain inherited disorders such as von Hippel-Lindau disease

Clinical features
* 50% incidental findings during abdominal imaging for other symptoms
* Haematuria, loin pain, abdominal mass, anorexia, malaise, weigh loss and Pyrexia of unknown origin
* Polycythemia or Anaemia,Hypertension
* Rarely, invasion of left renal vein compresses testicular vein causing a left varicocele
*Stauffer syndrome - paraneoplastic, non-metastatic liver disease
* Spread may be direct, via lymph nodes, or haematogenous (bone, liver, brain)
If tumour is confined to the renal parenchyma, the 5-year survival rate is 60-70%

Classification of Classification
* Clear cell carcinoma (associated with the loss of von Hippel Lindau tumor suppressor gene on chromosome 3p)
* Papillary carcinoma
* Chromophobe renal carcinoma
* Collecting duct carcinoma

Investigations
* Bloods – FBC (polycythemia from epo secretion), ESR, U+E, alk phos (bony metastasis)
* Urine – RBC, cytology
* Imaging – USS, CT/MRI, IVU
* Renal angiography if partial nephrectomy or palliation are being considered
* CXR – cannon ball metastasis


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Comments

2 comments to "Nephrology MCQ_Part 02"

Anonymous said...
May 23, 2010 at 8:22 PM

EBE

Anonymous said...
May 24, 2010 at 10:40 AM

cbd

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