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Medicine Nephrology MCQs/MRCP Final Exam Questions and Answers 2024 Graded A+.

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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...

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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

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