Renal Medicine
A 46-year-old woman presents to the emergency department with a three-week history of persistent vomiting. Her past medical history includes severe peptic ulcer disease and well-controlled Cushing's syndrome. She denies any haematemesis or melaena. The consultants suspect a pyloric outlet obstruction due to peptic ulcer disease.
In addition to a severe extracellular fluid volume deficit, what electrolyte disturbance is she likely to have?
Hypochloraemia, hypokalaemia and metabolic alkalosis
A 55-year-old lady is found in cardiac arrest with the following blood result: low Na+, raised k+, raised urea and creatinine. She is initially given IV calcium gluconate.
What does this medication do to the electrolyte levels?
No change
A 6-year-old boy weighing 28kg is admitted to the paediatric intensive care unit with severe meningococcal meningitis. Due to his level of consciousness he is intubated and receives ventilation via an endotrachael tube. As he is nil by mouth, the consultant asks you to prescribe his maintenance fluids for the following 24 hours. How much maintenance fluid should he be given over the next 24 hours?
1660ml
A 67-year-old man presents to the nephrology clinic complaining of progressive fatigue, shortness of breath, and weakness over the past months. He reports difficulty performing his activities of daily living and a decline in his quality of life. He has a past medical history of stage 4 chronic kidney disease, hypertension and diabetes. They suspect a diagnosis of anaemia of chronic disease secondary to his chronic kidney disease.
What is the next step in the management of this patient?
Check the iron status of the patient
A 54-year-old woman with a history of chronic kidney disease stage 3a and asthma returns to her GP for a follow-up. She is currently taking salbutamol and the maximum dose of ramipril. Her blood results reveal low eGFR and v.high urine albumin to creatinin ratio. What is the most appropriate medication to add to her regimen?
Dapagliflozin
The out-of-hours ward cover doctor is reviewing bloods for a patient being treated for AKI secondary to sepsis. Bloods reveal elevated K+, low bicarb, high urea, high creatinine.
The patient's serum potassium yesterday was 5.0.
On review, the patient's observations are within normal range and an A to E assessment reveals no concerning signs. The doctor arranges an ECG which shows sinus rhythm with no abnormalities.
What is the most appropriate next step in management to reduce the serum potassium level?
Begin insulin/dextrose infusion
A 59-year-old man is seen in the gastroenterology ward while receiving treatment for his alcoholic liver disease. He has been experiencing progressive distension of his abdomen over the last week and feels uncomfortable. Upon abdominal examination, there is shifting dullness. An ultrasound confirms the presence of mild ascites and also shows mild cirrhosis of the liver. His paracentesis showed an ascitic protein of 21g/L.
What should be the next most appropriate step in their management?
Prescribe Spironolactone
An 80-year-old man presents to ED with 3 days of vomiting and diarrhoea. He has tolerated only minimal oral intake for 3 days. The doctor suspects viral gastroenteritis and requests blood tests as follows: raised urea and creatinine, suggestive of AKI. Regular medications:
- Aspirin 75mg OD
- Atorvastatin 80mg OD
- Co-careldopa 25/100mg TDS
- Gliclazide 40mg OD
- Losartan 100mg OD
What is the most appropriate immediate action for the doctor prescribing the patient's regular medication?
Stop Losartan
A 68-year-old man with a history of chronic heart failure, hypertension, hypothyroidism and severe osteoarthritis presents to his local GP surgery. He is concerned as he has noticed a growth of the breast tissue around his nipples. He also describes experiencing increased urinary frequency and urgency.
He currently takes atorvastatin, ramipril, bisoprolol, levothyroxine, spironolactone, paracetamol and ibuprofen. His bisoprolol dose was increased 6 days earlier.
What is the most likely the cause of his new breast tissue growth?
Spironolactone
You are a foundation doctor working in the emergency department. Your patient, a 17-year-old male, is admitted generally unwell with vomiting and abdominal pain. His mother, who has accompanied him to the emergency department, reports he has not been well for some time, experiencing tiredness and excessive thirst.
His observations are as follows: respiratory rate 32 breaths per minute, saturations 96% on room air, heart rate 94 beats per minute, blood pressure 112/65 mmHg, temperature 36.9ºC, capillary blood sugar 32 mmol/L.
On examination, you note the patient has dry mucous membranes and reduced skin turgor. He also has a 'fruity' smell to his breath.
You decide to perform an arterial blood gas, the results are as follows: low pH, normal pCO2, normal pO2, low bicarb, normal sodium, normal chloride. How would you interpret the arterial blood gas result?
Metabolic acidosis with high anion gap
A 62-year-old man with hypertension attends his GP for blood pressure monitoring. The doctor measures the patient's blood pressure and it is 170/110 mmHg. The blood pressure is unresponsive to triple therapy so he is referred for specialist assessment where some blood tests are ordered.
The results are: high sodium, low K+, normal bicarb, high urea, high creatinine, normal GFR, high plasma renin activity
Renal artery stenosis
A 65-year-old male presents to an urgent care centre concerned that he is urinating less frequently. He reports urinating once in the past 10 hours and feels like he can't urinate now (despite wanting to). He has a past medical history of diabetes mellitus which is managed with metformin and chronic back pain which is managed with ibuprofen with PPI cover. He has no known allergies. Bloods are taken which show: Na+, K+, bicarb all within normal range, urea 7.1 (2.0-7.0), creatinine 200 (55-120). His creatinine previosly was 119. The general practitioner refers the patient to the emergency department for further investigation.
Out of the options listed, which is the correct classification?
AKI stage 1
A 55-year-old woman was admitted as an inpatient with urosepsis and an acute kidney injury (AKI). Throughout her admission, she has had recurrent severe hyperkalemia, that only transiently improve with insulin and dextrose infusions. She takes no regular medications and has no significant past medical history.
What would be an additional prescription to help prevent this recurrence?
Calcium resonium
A 45-year-old woman presents to the emergency department with complaints of oliguria for the last 3 days. She has a history of diabetes mellitus and hypertension. Important laboratory investigations are attached. Ultrasound of the urinary tract shows bilateral small kidneys. Normal Na+, high K+, low bicarb, high urea and creatinine, high calcium. What investigation result in this patient's history would help differentiate chronic kidney disease from acute kidney injury?
Ultrasound of the urinary tract
A 45-year-old woman with type 1 diabetes mellitus is reviewed in the diabetes clinic. Three months ago her blood tests were as followed: K+ 4.5, creatinine 116, eGFR 47.
At the time she was started on lisinopril to treat both the hypertension and act as a renoprotective agent. Lisinopril had been titrated up to treatment dose. Her current bloods are as follows: K+ 4.9, creatinine 123, eGFR 44. Of the following options, what is the most appropriate course of action?
No action