Medicine Nephrology MCQs/MRCP Final Exam Questions and Answers 2024 Graded A+.
52 views 1 purchase
Course
Medicine Nephrology MCQs/MRCP
Institution
Medicine Nephrology MCQs/MRCP
Medicine Nephrology MCQs/MRCP Final Exam Questions and Answers 2024 Graded A+.
Question 1 of 82
A 24-year-old woman is diagnosed as having nephrotic syndrome after
being investigated for proteinuria. A diagnosis of minimal change
glomerulonephritis is ade. What is the most appropriate initial t...
Medicine Nephrology MCQs/MRCP Final Exam Questions and Answers 2024 Graded A+ 1Question 1 of 82 A 24-year-old woman is diagnosed as having nephrotic syndrome after being investigated for proteinuria. A diagnosis of minimal change glomerulonephritis is ade. What is the most appropriate initial treatment to reduce proteinuria? A. Protein restriction in diet B. No treatment shown to effective C. Angiotensin-converting-enzyme inhibitor D. Diuretic E. Prednisolone --------------------------------------------------------------------------------------- E. Prednisolone Minimal change glomerulonephritis - prednisolone Angiotensin-converting-enzyme inhibitors may be used to reduce proteinuria in patients with heavy proteinuria or who have a slow response to prednisolone Minimal change glomerulonephritis ................................................ Minimal change glomerulonephritis nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults The majority of cases are idiopathic, but in around 10-20% a cause is found: • drugs: NSAIDs, rifampicin • Hodgkin's lymphoma, thymoma • infectious mononucleosis Features • nephrotic syndrome • normotension - hypertension is rare • highly selective proteinuria* • renal biopsy: electron microscopy shows fusion of podocytes Management • majority of cases (80%) are steroid responsive • cyclophosphamide is the next step for steroid resistant cases Prognosis is overall good, although relapse is common. Roughly: • 1/3 have just one episode • 1/3 have infrequent relapses • 1/3 have frequent relapses which stop before adulthood *only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus Medicine Nephrology MCQs/MRCP Final Exam 2024 2Question 2 of 82 A 45-year-old female with nephrotic syndrome develops renal vein thrombosis. What changes in patients with nephrotic syndrome predispose to the development of venous thromboembolism? A. Reduced excretion of protein S B. Loss of antithrombin III C. Reduced excretion of protein C D. Loss of fibrinogen E. Reduced metabolism of vitamin K --------------------------------------------------------------------------------------- B. Loss of antithrombin III Nephrotic syndrome ................................................ Triad of: • 1. Proteinuria (> 3g/24hr) causing • 2. Hypoalbuminaemia (< 30g/L) and • 3. Oedema Loss of antithrombin-III, proteins C and S and an associated rise in fibrinogen levels predispose to thrombosis. Loss of thyroxine-binding globulin lowers the total, but not free, thyroxine levels. 3Question 3 of 82 A 64-year-old female is brought to the Emergency Department by her family, who are concerned about her increasing confusion over the past 2 days. On examination she is found to be pyrexial at 38ºC. Blood tests reveal: Hb 9.6 g/dl Platelets 65 * 109/l WCC 11.1 * 109/l Urea 23.1 mmol/l Creatinine 366 µmol/l What is the most likely diagnosis? A. Wegener's granulomatosis B. Thrombotic thrombocytopenic purpura C. Haemolytic uraemic syndrome D. Idiopathic thrombocytopenic purpura E. Rapidly progressive glomerulonephritis --------------------------------------------------------------------------------------- B. Thrombotic thrombocytopenic purpura HUS or TTP? Neuro signs and purpura point towards TTP The combination of neurological features, renal failure, pyrexia and thrombocytopaenia point towards a diagnosis of thrombotic thrombocytopenic purpura Thrombotic thrombocytopenic purpura ................................................ Pathogenesis of thrombotic thrombocytopenic purpura (TTP) • abnormally large and sticky multimers of von Willebrand's factor cause platelets to clump within vessels • in TTP there is a deficiency of caspase which breakdowns large multimers of von Willebrand's factor • overlaps with haemolytic uraemic syndrome (HUS) Features • rare, typically adult females • fever • fluctuating neuro signs (microemboli) • microangiopathic haemolytic anaemia • thrombocytopenia • renal failure Causes • post-infection e.g. urinary, gastrointestinal • pregnancy • drugs: ciclosporin, oral contraceptive pill, penicillin, clopidogrel, aciclovir • tumours • SLE • HIV
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller DoctorReinhad. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $12.99. You're not tied to anything after your purchase.
