Multiple Choice Questions MCQ

Question 62# Print Question

A 71-year-old man with chronic kidney disease stage 3 is reviewed in the cardiology clinic. He is known to have hypertension and ischaemic heart disease but a recent fasting glucose result confirmed he is not diabetic. A recent early morning urine result is reported as follows:

Albumin:creatinine ratio 5.2 mg/mmol

What is the most appropriate action?

A. Refer to a nephrologist

B. No action as not clinically significant

C. Obtain a 24-hour urine collection

D. Repeat using a late-evening sample

E. Arrange renovascular imaging

Question 61# You review a 65-year-old man with stage 5 chronic kidney disease in the renal outpatient clinic. He has recently been started on erythropoietin injections. Which one of the following is the main benefit this treatment?
A. Reduced proteinuria
B. Improved exercise tolerance
C. Reduced blood pressure
D. Improved renal function
E. Reduced long-term all-cause mortality
Correct Answer B: Erythropoietin treats CKD associated anaemia which in turn would improve exercise tolerance. It does not improve renal function. Erythropoietin: Erythropoietin is a haematopoietic growth factor that stimulates the production of erythrocytes. The main uses of erythropoietin are to treat the anaemia associated with chronic kidney disease and that associated with cytotoxic therapy. Side-effects of erythropoietin: Accelerated hypertension potentially leading to encephalopathy and seizures (blood pressure increases in 25% of patients) Bone aches Flu-like symptoms Skin rashes, urticaria Pure red cell aplasia* (due to antibodies against erythropoietin) Raised PCV increases risk of thrombosis (e.g. Fistula) Iron deficiency 2nd to increased erythropoiesis There are a number of reasons why patients may fail to respond to erythropoietin therapy: Iron deficiency Inadequate dose Concurrent infection/inflammation Hyperparathyroid bone disease Aluminium toxicity *The risk is greatly reduced with darbepoetin.

Question 63# Which one of the following types of glomerulonephritis is most characteristically associated with Wegener's granulomatosis?
A. Mesangiocapillary glomerulonephritis
B. Membranous glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Focal segmental glomerulosclerosis
E. Diffuse proliferative glomerulonephritis
Correct Answer C: Rapidly progressive glomerulonephritis, causes: Goodpasture's ANCA positive vasculitis Glomerulonephritides: Knowing a few key facts is the best way to approach the difficult subject of glomerulonephritis: Membranous glomerulonephritis: Presentation: proteinuria / nephrotic syndrome / chronic kidney disease Cause: infections, rheumatoid drugs, malignancy 1/3 resolve, 1/3 respond to cytotoxics, 1/3 develop chronic kidney disease IgA nephropathy - aka Berger's disease, mesangioproliferative GN: Typically young adult with haematuria following an URTI Diffuse proliferative glomerulonephritis: Classical post-streptococcal glomerulonephritis in child Presents as nephritic syndrome / acute kidney injury Most common form of renal disease in SLE Minimal change disease: Typically a child with nephrotic syndrome (accounts for 80%) Causes: Hodgkin's, NSAIDs Good response to steroids Focal segmental glomerulosclerosis: May be idiopathic or secondary to HIV, heroin Presentation: proteinuria / nephrotic syndrome / chronic kidney disease Rapidly progressive glomerulonephritis - aka crescentic glomerulonephritis: Rapid onset, often presenting as acute kidney injury Causes include Goodpasture's, ANCA positive vasculitis Mesangiocapillary glomerulonephritis (membranoproliferative): Type 1: cryoglobulinaemia, hepatitis C Type 2: partial lipodystrophy

Question 64# A 39-year-old woman with systemic lupus erythematosus presents for review in the rheumatology clinic. Dipstick urine on arrival at clinic shows protein ++. Further investigations reveal the following: Bicarbonate 22 mmol/l Urea 7.1 mmol/l Creatinine 134 μmol/l 24-hour urinary protein 2.6 g What is the renal biopsy most likely to show?
A. Diffuse proliferative glomerulonephritis
B. Mesangiocapillary glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Membranous glomerulonephritis
E. Minimal change disease
Correct Answer A: Diffuse proliferative glomerulonephritis is the most common and severe form of renal disease in SLE patients. SLE: renal complications: WHO classification: Class I: normal kidney Class II: mesangial glomerulonephritis Class III: focal (and segmental) proliferative glomerulonephritis Class IV: diffuse proliferative glomerulonephritis Class V: diffuse membranous glomerulonephritis Class VI: sclerosing glomerulonephritis Class IV (diffuse proliferative glomerulonephritis) is the most common and severe form. Management: Treat hypertension Corticosteroids if clinical evidence of disease Immunosuppressants e.g. azathiopine/cyclophosphamide

Question 65# A two-year old boy presents with an abdominal mass. Which of the following is associated with Wilm's tumour (nephroblastoma)?
A. Deletion on short arm of chromosome 12
B. Tuberose sclerosis
C. Beckwith-Wiedemann syndrome
D. Autosomal dominant polycystic kidney disease
E. Autosomal recessive polycystic kidney disease
Correct Answer C: Beckwith-Wiedemann syndrome is a inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm's tumour and neonatal hypoglycaemia. Wilms' tumour: Wilms' nephroblastoma is one of the most common childhood malignancies. It typically presents in children under 5 years of age, with a median age of 3 years old. Features: Abdominal mass (most common presenting feature) Painless haematuria Flank pain Other features: anorexia, fever Unilateral in 95% of cases Metastases are found in 20% of patients (most commonly lung) Associations: Beckwith-Wiedemann syndrome As part of WAGR syndrome with Aniridia, Genitourinary malformations, mental Retardation Hemihypertrophy Around one-third of cases are associated with a mutation in the WT1 gene on chromosome 11 Management: Nephrectomy Chemotherapy Radiotherapy if advanced disease Prognosis: good, 80% cure rate

Question 62# A 71-year-old man with chronic kidney disease stage 3 is reviewed in the cardiology clinic. He is known to have hypertension and ischaemic heart disease but a recent fasting glucose result confirmed he is not diabetic. A recent early morning urine result is reported as follows: Albumin:creatinine ratio 5.2 mg/mmol What is the most appropriate action?
A. Refer to a nephrologist
B. No action as not clinically significant
C. Obtain a 24-hour urine collection
D. Repeat using a late-evening sample
E. Arrange renovascular imaging
Correct Answer B: As he is not diabetic this result is not clinically significant. Chronic kidney disease: proteinuria: Proteinuria is an important marker of chronic kidney disease, especially for diabetic nephropathy. NICE recommend using the albumin:creatinine ratio (ACR) in preference to the protein:creatinine ratio (PCR) when identifying patients with proteinuria as it has greater sensitivity. For quantification and monitoring of proteinuria, PCR can be used as an alternative, although ACR is recommended in diabetics. Urine reagent strips are not recommended unless they express the result as an ACR. Approximate equivalent values: Collecting an ACR sample: By collecting a 'spot' sample it avoids the need to collect urine over a 24 hour period in order to detect or quantify proteinuria Should be a first-pass morning urine specimen If the initial ACR is greater than 30 mg/mmol and less than 70 mg/mmol, confirm by a subsequent early morning sample. If the initial ACR is greater than 70 mg/mmol a repeat sample need not be tested Interpreting the ACR results In non-diabetics an ACR greater than 30 mg/mmol is considered clinically significant proteinuria In diabetics microalbuminuria (ACR greater than 2.5 mg/mmol in men and ACR greater than 3.5 mg/mmol in women) is considered clinically significant

Your-Doctor Multiple Choice Questions (MCQ)

Your-Doctor
Multiple Choice Questions (MCQ)