JAWAL-3LMNY

MCQs on Renal

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CASE SCENARIO ,,, A 48 year old Hispanic woman presents to your office complaining of persistent swelling of her feet and ankles, so much so that she cannot put on her shoes. She first noticed mild ankle swelling approximately 2-3 months ago. She borrowed a few diuretic pills from a friend; the pills seemed to help, but now she has run out. She also reports that she gained 20-25 lb over the last few months, despite regular exercise and trying to adhere to a healthy diet. Her medical history is significant for type 2 diabetes, for which she takes a sulfonylurea agent. She neither sees a doctor regularly nor monitors her blood glucose at home. She denies dysuria, urinary frequency, or urgency, but she does report that her urine has appeared foamy. She had no fever, joint pain, skin rashes, or gastrointestinal symptoms. Her physical examination is significant for mild periorbital edema, multiple hard exudates, and dot hemorrhages on funduscopic examination, and pitting edema of her hands, feet, and legs. Her chest is clear, her heart rhythm is regular without murmurs, and her abdominal examination is benign. She has diminished sensation to light touch in her feet and legs to mid-calf. A urine dipstick performed in the office shows 2+ glucose, 3+ protein, and negative leukocyte esterase, nitrates, and blood.

• What is the most likely diagnosis?
• What is the best intervention to slow the disease progression?

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MCQs on Renal

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CASE SCENARIO ,,, A 27 year old man presents to the outpatient clinic complaining of 2 days of facial and hand swelling. He first noticed swelling around his eyes 2 days ago, along with difficulty putting on his wedding ring because of swollen fingers. Additionally, he noticed that his urine appears reddish-brown and that he has had less urine output over the last several days. He has no significant medical history. His only medication is ibuprofen that he took 2 weeks ago for fever and sore throat, which have since resolved. On examination, he is afebrila, with heart rate 85 bpm and blood pressure 172/110 mmHg. He has periorbital edema: his funduscopic examination is normal without arteriovenous nicking or papilledema. His chest is clear to auscultation, his heart rhythm is regular with a nondisplaced point of maximal impulse (PMI), and he has no abdominal masses or bruits. He does have edema of his feet, hands, and face. A dipstick urinalysis in the clinic shows specific gravity of 1.025 with 3+ blood and 2+ protein, but it is otherwise negative.

• What is the most likely diagnosis?
• What is your next diagnostic step?

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MCQs on Renal

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CASE SCENARIO ,,, A 55 year old diabetic woman with end stage renal disease(ESRD),has been treated with peritoneal dialysis (prescription of four echanges,2 L exchange per day for 6 years,She is 80 kg

.The patient complains of nausea fatigue, abdominal discomfort, Medications include Erythropoetin, Calcium carbonate, water soluble vitamins. Lab studies showed hematocrite 38%, blood urea 160 mg/di, Serum creatinine 13 mg/dl, bicarbonate 14 meq/I, Calcium 10 mg/dl, Phosphate 2.3 mg/dl. Thlp most likely dlpgtnosis is:

 a) Mycobacterial peritonitis.
b) Dialysis dysequilibrium.
c) Uremia due to under dialysis,
d) Peritoneal carcinornatosis,
e) Diabetic ketoacidosis

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CASE SCENARIO ,,, A 58 year old man present with 2 weeks of progressive swelling in his legs, no other significant medical illnesses. He smokes 20 cigarettes per day and drinks 15 units of alcohol per week. No medications. on examination, marked pitting edema on both legs till groin. His pulse is 72/min ,regular and blood pressure 140/90. His JVP is not raised and heart sounds are normal. Examination of his respiratory, abdominal & neurological symptoms is normal. Investigations: Albumin18 g/l , 24h urinary protein 12.6g. What is your diagnosis ?

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T & F

Causes of nephrotic syndrome include:

1. Systemic lupus erythematosus

2. Diabete mellitus

3. Amyloidosis

4. Renal Tuberclosis

5. Polycystic Kidneys

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T & F

Life threatening complications of acute glomerulonephritis include:

A. Idiopathic epilepsy

B. Myocardial infarction

C. Hypertensive encephalopathy

D. Pulmonary oedema

E. Uraemia

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CASE SCENARIO ,,, 6 Year old boy  known to have nephrotic syndrome presented to the ER complaining of nausea, vomiting and falnk pain ,,, investigations shows high WBC , high D dimares, heamaturia & compromized renal function ,,, KUB shows enlarged renal size ,,, the nures jumped and called you in the mid-night you good student HEEEEEEEEEEEEEELP ME !!

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