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Quiz
Fifth Year Workshop 2006
RENAL
A. HAEMATURIA
Match the following urine findings with the clinical scenario provided
( Each choice may be used more than once )A
� 1. Post strep nephritis
� 2. Schistosomiasis
� 3. Renal stones
� 4. Rhabdomyolysis
� 5. Analgesic NSAIDS abuse
� 6. Acute Haemolysis
� 7. Haemolytic uraemic
syndrome
� a. RBC' s + eosinophils
� b. No RBC's; +ve for myoglobin
� c. No RBC's; +ve for haemoglobin
� d. RBCcasts, crenated RBC's
� e. RBC only
B. RICKETSMatch the following biochemical findings with theclinical scenario provided
PTH = parathyroid hormone
TRP = Tubular reabsorption of phosph
� 1. Biliary Artesia
� 2. Chronic Renal Failure
� 3. ELBW / ExPrem on breast milk
� 4. Fanconis Syndrome,
� a. ↓Calcium;
low 25-OH Vit D
� b. ↓↓ phosp ; low/N
Calcium; low TRP
� c. ↓↓Calcium, ↑phosp, ↑PTH
� d. ↓phosp, ↓Calcium ↓7Dihydroxy Vit D,
C. CASE STUDY7yr old female from Northern Transkei visiting aunt in Cape
Town. Presents with Macroscopic Haematuria
� Examination
� Well grown; BP normal; No skin lesions; No abd. masses; Dipstix 4+ blood
U/S Bladder
Q 1-3
� 1. What is the diagnosis?
� 2. Describe what you might see on microscopy
� 3. What is the best time of day to collect urine sample?
D. U/S Case
Q 1-5
The above U/S represents a form of obstructive uropathy
� 1. What is level of obstruction
� 2. Name two other sites of obstruction involving the renal tract
� 3. Which of the above three types of obstruction holds the best prognosis
� 4. How might this condition present? Suggest 3 ways
� 5. What two important considerations in this condition determine management
E. Radiological Study
� This is a study of a 3 day old boy baby who presented with bilateral renal masses and respiratory distress
Q 1-4
� 1. What is radiological study is this
� 2. What condition does it represent
� 3. What is the immediate management in a neonate
� 4. What NB symptom should specifically be asked about if considering the
diagnosis.
F.Nephritic / Nephrotic Syndrome
Complete the following two tables
“Minimal Changes”Mephrotic Syndrome
Post-StreptococcalNephritic Syndrome
BLOOD UREA/CREATININE
SERUM PROTEINS –albuminalpha-2-globulinBeta globulin
BLOOD LIPIDScholesterol phospholipids triglycerides
FBC
X-Ray chest
“Minimal Changes”Mephrotic Syndrome
Post-StreptococcalNephritic Syndrome
PRECEDING INFECTION
ASO or anti-DNase B TITRE
COMPLEMENT(total, C3)
URINE – volumehaematuriaproteinuria castsculture
G. U/S Study
� The following is a renal ultrasound of a newborn baby with a palpable abdominal mass.
Q 1-5
� 1). Describe what you see
� 2). What is this condition called.
� 3). What do you expect the renal fx of this kidney to be and how would you confirm that
� 4). Name two potential, but rear complications
� 5) What is the natural progression
H. Antihypertensives and their site of action
� Fill in the ff diagram
� List of antihypertensive
� a.Atenolol
� b.Hydrochlorothiazide
� c.Prazocin
� d.Enalapril
� e.Hydrallazine
I. Hormones and the Kidney
� 1. List 3 hormones produced by the kidney and give its function
� 2. List 3 hormones acting on kidney give their site of production and their effect.
J. Complete the following table
distinguishing cause of renal failure
Pre-Renal Intra Renal
U-Na
FeNa
Specific gravity
Urine osmolality
Urea
K. Case Study
� A 2 year old boy presents to his local clinic with pallor, lethargy and oliguria 5 days after having suffered from a diarrheal illness during which he was very feverish and passed small amounts of fresh blood in his stool.
� On examination he is noted to have peteciae.
� His blood results show the following
� Hb 5 WCC 19,7 Plts 60 INR 1.O PTT 31/30 Creatinine 248 Urea 21 K+ 5.5
� 1. What is the diagnosis
� 2. What organisms could be responsible
� 3. What tests would you do to look for haemolysis
� 4. What is the likely course of the disease?
� 5. Does he require long term follow-up; Motivate your answer.
L. Glomerular Filtration Rate
A 3 year old girl 94cm in length weight
17kg has a creatinine of 200micromols
� 1. Calculate her GFR (glomerular filtration rate)
� 2. What does this tell you about her renal function ?
� 3. What would the GFR be if her creatinine was
a) 120b) 40
� 4.Draw a graph to demonstrate the relationship between Cr and GFR Creatinine
GFR
M. HaematologyMatch the following Haematological ab(N) with the clinical conditions provided
� 1.Haemolytic uraemic syndrome
� 2.Cystinosis
� 3. CRF
� 4. Nephrotic syndrome with relapse
� 5. Post Strep Glomerulomephritis
� a) Hb 10 WCC 9 Plts 340
� b) Hb 5,4 WCC 13 Plts 400
� c) Hb 7 WCC 30,4 Plts 63
� d) Hb 6 WCC 3,7 Plts110
� e) Hb 14,2 WCC 11 Plts 690
N. Case StudySee picture below
� This pt presented with lesions on the legs and buttocks and abdominal pain
� What is the diagnosis
� Name two other symptoms associated with this condition
� Name two bed-side tests that are NB in evaluating this patient
O. Illustrative CaseThe picture below represents a syndrome
� 1. Name the syndrome
� 2. What makes up the triad
� 3. Describe what the ureters may look like
� 4. What determines the prognosis in the neonatal age.
P. HYPONATRAEMIA / HYPERNATRAEMIA 2 cases
� Case 1
� 3 months old infant,exprem presents with a 2 day
� H/O cough and fast breathing
� O/E he is pale, lethargic and in marked respiratory distress
� biochemistry :
� Sodium 110 Chl 86 Bicarb 20 Urea 2 Cr 40
� Urinary Na+ 50
� Osmalolity 210
� What is the cause of the Hyponatraemia
� Case 2
� A 10 year old mentally retarded boy was admitted with a history of increasing drowsiness. He had undergone a hemispherectomy as treatment for intractable seizures.
� Na 165 Chl 130 Urea 22 Cr 180
Glucose 9,5
� a. What is his calculated osmolality
� b. What is the presumptive diagnosis
� c. What treatment should be instituted