Case 3 Questions 1-10

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Question 1

In which section of the nephron is glucose reabsorbed?

  1. Proximal convoluted tubule
  2. Ascending loop of henle
  3. Descending loop of henle
  4. Distal convoluted tubule
  5. Collecting duct

The correct answer is option a Proximal convoluted tubule

A is correct as 100% of glucose is reabsorbed in the sodium/glucose co-transporter
b. No glucose is reabsorbed in the Ascending loop of henle
c. Incorrect as no glucose reabsorbed in the descending loop of henle
d. incorrect as no glucose is reabsorbed in the distal convoluted tubule
e. Incorrect as no glucose is reabsorbed in the collecting duct

Question 2

A 63 year old renal patient comes in for his routine review. You review his recent blood tests and note a GFR of 20. What stage of CKD is this patient in?

  1. 1
  2. 2
  3. 3
  4. 4
  5. 5

The correct answer is option d 4

Stage 4 is a GFR of between 15-29, as this patient is in
a. Incorrect as this would have a GFR of over 90
b. Incorrect as this would have a GFR of between 60-89
c. Incorrect as this would have a GFR of 30-59
e. Incorrect as this would have a GFR of under 15

Question 3

A patient attends the renal clinic complaining of fatigue. Upon checking their notes, you notice they have a GFR of 25. A set of blood tests reveals a low haemoglobin with a MCV of 87 (Normal range 80-100). What is the most likely cause of their anaemia?

  1. Iron deficency
  2. B12 deficency
  3. EPO deficency
  4. Haemolysis
  5. Myeloma

The correct answer is option c EPO deficency

C is correct as the anaemia is normacytic, this combined with the GFR of 25 suggests an EPO deficiency
a. Incorrect as iron deficiency would have a microcytic anaemia
b. Incorrect as B12 deficiency would have a macrocytic anaemia
d. incorrect as haemolysis is a macrocytic anaemia
e. Whilst this does have a normacytic anaemia it is not the most likely

Question 4

A 25 year old woman attends the surgery complaining of dysuria and urinary urgency. She also tells you she is 11 weeks pregnant. A urine dipstick test reveals leucocytes and nitrites, and you diagnose a urinary tract infection. What is the most appropriate first-line antibiotic to prescribe her? ​

  1. Amoxicillin
  2. Trimethoprim
  3. Nitrofirantoin
  4. Erythromycin
  5. Clindamycin

The correct answer is option c Nitrofirantoin

C. is correct as is recommended by the BNF in UTIs for pregnant patients
a. Amoxicillin is second line in UTIs for pregnant patients
b. Trimethoprim should be avoided in pregnancies
d. Erythromycin is not indicated first line in this instance
e. Clindamycin is not indicated first line in this instance

Question 5

Addison’s disease is an endocrine condition characterised by destruction of the entire adrenal cortex. Considering that aldosterone and cortisol are produced there and their effects on the kidney, what pattern of electrolyte abnormality is likely to be seen? ​

  1. Low Na, High K
  2. Low Na, High Cl
  3. High Na, Low K
  4. High Na, Low Cl
  5. High K, Low Cl

The correct answer is option a Low Na, High K

A is correct as less aldosterone is produced, and A lack of aldosterone means that it cannot act in the collecting duct of the kidney to reabsorb sodium and secrete potassium, leading to a low sodium and high potassium
b. The potassium increases, not Cl-
c. This is what would happen in hyperaldosteronism
d. Na+ would decrease, not increase
e. Na+ would decrease, not increase

Question 6

A patient is in the emergency department, generally unwell. On examination, they are disorientated, with a fast pulse and complaining of weakness. A set of bloods reveals a significantly raised potassium level. An urgent ECG is ordered. What is a characteristic feature seen on ECG of a hyperkalaemic patient?

  1. Flat T waves
  2. ST elevation
  3. Tall T waves
  4. ST depression
  5. Tall P waves

The correct answer is option c Tall T waves

As the increased potassium will increase T wave intensity, giving tented T waves
a. Incorrect, this is in hypokalaemia
b. Incorrect, This is seen in a STEMI
d. Incorrect this is seen in ischaemic heart disease and STEMIs
e. Incorrect as the T waves are tall, not the P waves, in hyperkalaemia the P waves are actually smaller

Question 7

What runs through the renal pelvis?

  1. The renal artery, renal vein and renal nerve
  2. Urine
  3. The renal artery and the renal vein
  4. The renal vain, the renal artery and the ureters
  5. Principle cells

The correct answer is option a The renal artery, renal vein and renal nerve

A is correct and is also the Renal hilum
b. This is not the most accurate answer as the urine runs through the ureters
c. Whilst correct, it is not the most correct as the renal nerve also travels through the hilum
d. False as the hilum does not contain the ureters
e. Incorrect, this is not the best answer due to the lack of detail

Question 8

Select the answer that correctly describes the layers of the glomerular filtration barrier, from capillary to urinary space​

  1. Glycocalyx – Fenestrae – Basement Membrane (rara interna – rara densa – rara externa) – Filtration slits
  2. Glycocalyx – Filtration slits – Basement Membrane (rara densa – rara interna – rara externa) – Fenestrae
  3. Glycocalyx – Fenestrae – Basement Membrane (rara externa – rara densa – rara interna) – Filtration slits
  4. Filtration slits – Glycocalyx – Basement Membrane (rara interna – rara densa – rara externa) – Fenestrae
  5. Filtration slits – Glycocalyx – Basement Membrane (rara externa – rara densa – rara interna) – Fenestrae

The correct answer is option a Glycocalyx – Fenestrae – Basement Membrane (rara interna – rara densa – rara externa) – Filtration slits

A is correct as this is the correct order of the layers of the glomerular barrier
b. Incorrect as the basement membrane is in the wrong order, as is the fenestrae and filtration slits
c. The basement membrane layers are in the wrong order
d. Fenestrae, filration slits and glycocalyx are in the wrong order
e. The basement membrane and filtration slits are in the wrong order

Question 9

Select the part of the juxtamedullary nephron in which basolateral aquaporin-1 channels are most abundant

  1. Proximal convoluted tubule
  2. Thin ascending limb of Loop of Henle
  3. Thick ascending limb of Loop of Henle
  4. Distal convoluted tubule
  5. Collecting duct

The correct answer is option a Proximal convoluted tubule

a is correct as this is where most of the water is reabsorbed here with that method
b. This area is impermeable to water
c. This area is impermeable to water
d. This area is using AQP 2
e. This has AQP 2, not AQP 1

Question 10

Select the substance which is released at the juxtaglomerular cells when GFR is decreased.

  1. Angiotensinogen
  2. Renin
  3. Angiotensin 2
  4. Adrenaline
  5. Angiotensin 1

The correct answer is option b Renin

Renin is correct as it increases the RAAS system to increase water retention
a. Incorrect as angiotensinogen is released from the liver
c. Incorrect angiotensin 2 is formed in the lungs due to the ACE enzyme
d. Adrenaline is released from the adrenal cortex, not the JG cells
e. Nitric oxide is released to cause vasodilation, increasing blood flow