Renal & Urology Practice Questions

Question 1

A 38-year-old woman presents with recurrent episodes of severe abdominal pain and psychiatric symptoms. Her urine turns dark during attacks. Family history reveals similar episodes. What is the inheritance pattern?

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked recessive

Answer

X-linked dominant

Answer

Mitochondrial

Question 2

A 41-year-old man presents with progressive weakness in his hands and arms over 12 months. He has muscle fasciculations and hyperreflexia. EMG shows both acute and chronic denervation changes. What is the prognosis?

Accepted Answer

Poor with 3-5 year survival

Answer

Excellent with treatment

Answer

Good with supportive care

Answer

Variable depending on subtype

Answer

Stable with medication

Question 3

A 61-year-old man presents with progressive dyspnea and fatigue. Echocardiogram shows severe aortic stenosis with valve area $0.5\mathrm{cm}^2$. He develops syncope during exercise testing. What is the most appropriate management?

Accepted Answer

Urgent aortic valve replacement

Answer

Medical management

Answer

Balloon aortic valvuloplasty

Answer

Heart transplantation

Answer

ICD insertion

Question 4

A 65-year-old man presents with painless hematuria. Cystoscopy shows a bladder tumor. Histology confirms transitional cell carcinoma. What is the most important risk factor for this condition?

Accepted Answer

Smoking

Answer

Alcohol consumption

Answer

High-fat diet

Answer

Sedentary lifestyle

Answer

Family history

Question 5

A 29-year-old woman at 32 weeks gestation presents to the obstetric assessment unit with headache and right upper quadrant pain. She has no significant past medical history. Blood pressure is 168/112 mmHg. Blood tests show: haemoglobin 102 g/L, platelets 88 × 10^9/L, ALT 245 U/L, AST 312 U/L, bilirubin 34 μmol/L, creatinine 145 μmol/L (booking creatinine was 68 μmol/L), LDH 680 U/L. Urinalysis shows protein 3+. Peripheral blood film shows schistocytes. What is the most appropriate immediate management?

Accepted Answer

Commence IV labetalol, IV magnesium sulphate, and arrange immediate delivery

Answer

Commence IV magnesium sulphate and plan delivery within 24-48 hours

Answer

Commence plasma exchange for thrombotic thrombocytopenic purpura

Answer

Commence high-dose corticosteroids for HELLP syndrome

Answer

Transfuse platelets and arrange delivery once platelets >100 × 10^9/L

Question 6

A 38-year-old man with chronic kidney disease stage 5 (eGFR 10 mL/min/1.73m²) secondary to focal segmental glomerulosclerosis is being prepared for renal replacement therapy. He has preserved urine output of approximately 1500 mL per day. He works full-time as a teacher and wishes to minimize time spent on dialysis. Blood tests show: haemoglobin 108 g/L, potassium 5.1 mmol/L, phosphate 1.72 mmol/L, albumin 36 g/L. He has good manual dexterity and lives with his partner. Which renal replacement modality would be most appropriate to offer first?

Accepted Answer

Automated peritoneal dialysis (APD)

Answer

Continuous ambulatory peritoneal dialysis (CAPD)

Answer

In-centre haemodialysis three times weekly

Answer

Home haemodialysis

Answer

Pre-emptive renal transplantation

Question 7

A 71-year-old woman with type 2 diabetes and hypertension is admitted with sepsis secondary to pneumonia. On admission, her creatinine is 156 μmol/L (baseline 98 μmol/L two months ago). She is treated with IV fluids and antibiotics. On day 3, her creatinine rises to 298 μmol/L. Urinalysis shows: protein 2+, blood negative, leucocytes negative. Urine microscopy reveals muddy brown casts. Renal ultrasound shows normal-sized kidneys with no obstruction. What is the most likely diagnosis?

Accepted Answer

Acute tubular necrosis

Answer

Contrast-induced nephropathy

Answer

Acute interstitial nephritis

Answer

Pre-renal acute kidney injury

Answer

Atheroembolic renal disease

Question 8

A 48-year-old woman with no significant past medical history presents to the emergency department with a 6-hour history of severe right loin pain. CT KUB confirms a 5 mm stone at the right pelviureteric junction with mild hydronephrosis. She is afebrile. Blood tests show: white cells 9.2 × 10^9/L, CRP 8 mg/L, creatinine 78 μmol/L. Urinalysis shows blood 3+, leucocytes 1+, nitrites negative. She has been given adequate analgesia with diclofenac and morphine. What is the most appropriate next step in her management?

Accepted Answer

Discharge with analgesia, alpha-blocker, and follow-up in stone clinic

Answer

Admit for IV antibiotics due to obstructive pyelonephritis

Answer

Arrange urgent ureteroscopy and stone extraction within 48 hours

Answer

Insert percutaneous nephrostomy for decompression

Answer

Arrange extracorporeal shock wave lithotripsy (ESWL) within one week

Question 9

A 52-year-old woman presents to the emergency department with confusion and agitation. Her husband reports she has had watery diarrhoea for 5 days. She has a history of bipolar disorder treated with lithium for 15 years. Blood tests show: sodium 128 mmol/L, potassium 3.2 mmol/L, creatinine 245 μmol/L (baseline 85 μmol/L), lithium level 2.8 mmol/L (therapeutic range 0.6-1.0). ECG shows sinus tachycardia at 105 bpm. What is the most appropriate immediate management?

Accepted Answer

Stop lithium, give IV 0.9% saline, and arrange urgent haemodialysis

Answer

Stop lithium, give IV 0.9% saline, and recheck lithium level in 12 hours

Answer

Continue lithium, correct dehydration, and arrange gastroenterology review

Answer

Stop lithium, give hypertonic saline for hyponatraemia, then arrange dialysis

Answer

Stop lithium, give IV fluids, and start haemofiltration

Question 10

A 67-year-old man with chronic kidney disease stage 3a (eGFR 52 mL/min/1.73m²) secondary to diabetic nephropathy attends for annual review. He takes metformin, gliclazide, ramipril, atorvastatin, and aspirin. Blood tests show: HbA1c 64 mmol/mol, creatinine 128 μmol/L (stable from previous), potassium 5.4 mmol/L, bicarbonate 19 mmol/L. Urine albumin:creatinine ratio is 45 mg/mmol. Blood pressure is 138/82 mmHg. What is the most appropriate modification to his management?

Accepted Answer

Add SGLT2 inhibitor for renoprotection

Answer

Increase ramipril dose to maximize renoprotection

Answer

Stop ramipril due to hyperkalaemia and worsening renal function

Answer

Add sodium bicarbonate supplementation for metabolic acidosis

Answer

Add spironolactone for additional proteinuria reduction

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