More MRCP Part 2 questions

QUESTIONS ABOUT NEPHROLOGY

1) A cachectic 77-year-old man is admitted with NAUSEA NAD VOMITTING and is found to have blood investigations as below,
creatinine =520 micro mol/l
BU=15mmol/l
Na=145 mmol/l
K=5.2 mmol/l
He has been on a number of medications. Which of the following drugs need adjustment or should be avioded EXCEPT
A : Ibuprofen
B : Peridonpril
C : Allopurinol
D : Lansoprazole
E : Metformin

ANSWER: D

2)A 38-year-old woman with a renal transplant is established on cyclosporin, azathioprine and prednisolone to prevent transplant rejection, and enalapril and bendrofluazide for hypertension. After a 14-day course of ketoconazole for oesophageal candidiasis her creatinine is found to have increased from 100 mmol/L to 400 mmol/L.
Her deterioration in renal function is most likely attributable to:
A : hypertension poorly controlled on enalapril and bendrofluazide
B : nephrotoxic effects of ketoconazole
C : ciclosporin toxicity due to inhibition of ciclosporin metabolism by ketoconazole
D : transplant rejection due to induction of ciclosporin metabolism by ketoconazole
E : effect of enalapril on background of stenosis of artery supplying renal transplant.

ANSWER:C

3) A 22-year-old woman consults her general practitioner in the 10th week of her pregnancy.
She complains of fever and dysuria. There is no other significant history but direct questioning reveals a self-limiting rash in the past after taking penicillin. Her GP sends off a sample of urine that shows a significant growth of Gram negative bacilli. The organism is sensitive to the antibiotics listed below.
What is your next plan of action?
A : Give Ciprofloxacin
B : Avoid treatment since she may allergic to other antibiotics as well.
C : Cefaclor
D : Trimethoprim
E : Gentamicin

ANSWER: C

4)In type IV renal tubal acidosis


A there is normal renal handling of K+ and H+
B it is helped by fludrocortisone
C it is associated with an increased GFR
D it is associated with aminoaciduria
E there is increased bicarbonate in the urine

ANSWER: B

5)Which of the following is true concerning a 68 year old male with type 2 diabetes diagnosed with type IV renal tubal acidosis?


1 ) Aminoaciduria would be expected.
2 ) Fludrocortisone treatment is effective
3 ) Increased Glomerular filtration rate is expected.
4 ) Increased urinary bicarbonate would be expected.
5 ) Normal renal handling of K+ and H+

ANSWER: B

6)Recognised features of renal tubular acidosis include except:


A an inability to excrete hydrogen ions in type I renal tubular acidosis
B only occurs in patients with diabetes if Type IV
C a urine pH of less than six
D nephrocalcinosis
E hyperchloraemia

ANSWER: B

7)Features of distal type IV renal tubular acidosis include:

A Increased anion gap and aminoaciduria.
B Hyperchloraemic acidosis with hypokalaemia.
C Decreased GFR
D Normal renal excretion of hydrogen and potassium ions.
E Plasma bicarbonate concentrations usually less than 15 mmol/L (20-26).

ANSWER: C

8)The following symptoms occur in a patient with renal tubular acidosis EXCEPT:


A muscle cramps
B loin pain on micturition
C constipation
D dizzeness on standing up suddenly
E nausea and vomitting

ANSWER: E

9) Type 1 renal tubular acidoses is associated with EXCEPT:


A a urinary pH of less than 5.3 in the presence of systemic acidaemia
B nephrocalcinosis
C growth retardation
D Sjogren's syndrome
E chronic obstructive uropathy

ANSWER: A

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