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1. A 69 year old woman presents with itchiness of the perianal region. PR shows internal haemorrhoids. Anatomically how is this defined and how are they most commonly positioned?
Above the anorectal margin - at ,3, 7, 11 distributions around anus.
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2. A 69 year old woman presents with itchiness of the perianal region. PR shows external haemorrhoids. Anatomically how is this defined?
below the anorectal margin
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3. An autopsy of a 67 year old female shows Kimmelstiel Wilson nodules at the tips of glomerular lobules of the kidney. What are they likely to have had?
Diabetes - nodular glomerulosclerosis caused by this
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4. A 20 year old male presents with painful extremetis, red hyperkeratotic papules on skin, proteinuria and renal failure. What are you thinking of?
Fabry's syndrome
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5. A 38 year old woman presents with loin pain. Serum IgA levels are raised. IgA is deposited on the basement membrane. What are you worried about?
Mesangial Iga disease - this is focal and proliferative
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6. A 49 year old man with a history of benign hypertension dies whilst alone in his home. Autopsy shows fibrinoid necrosis of the afferent renal arterioles. What is the likely cause?
Malignant hypertension
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7. A 64 year old woman dies of an unrelated cause. Autopsy shows hyaline sclerosis of the arterioles and small arteries of the kidney. What is the likely cause?
Longstanding benign hypertension
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8. A 28 year old woman presents with a slight fever. Kidney biopsy shows cortical abscesses prominent on the subcapsular surface and medullary abscesses. What is the likely cause?
acute pyelonephritis
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9. A 31 year old woman is diagnosed with HUS by the renal team. You note anaemia. What kind of anaemia is she likely to be having?
Microangiopathic haemolysis - due to squeezing erythrocytes as they get through
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10. A 31 year old female is on ICU for hypovolaemic shock after pregancy. She dies 3 days later. On autopsy kidneys show renal infarction which is mainly the outer cortex, which is pale and acutely haemorrhagic. What kind of renal infarct is this?
Diffuse cortical necrosis
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11. A 87 year old woman with aortic valve diseae presents with normocytic anaemia. GI endoscopy shows a lesion in the right colon of apparent telengectasia. What might this be?
Angiodysplasia
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12. A 40 year old female presents with blood in her urine. anti-GBM is positive. The disease is proliferative. ?
What is the most likely diagnosis? - Goodpasture's disease
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13. A 29 year old male with a history of bowel cancer presents for colonoscopy. Colonoscopy shows 100+ adenomas and he opts for prophylactic colectomy. ?
Which gene is most likely to be involved and which pathway is it involved in? - APC genea tumour suppressor in the Wnt pathway
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14. A 55 year old male has a positive faecal occult blood on screening. He is concerned about his risk of bowel cancer. Colonoscopy shows a cauliflower-like growth. ?
what kind of bowel cancer is this and which part of the colon is it most likely? - polypoidright side
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15. A 55 year old male has a positive faecal occult blood on screening. He is concerned about his risk of bowel cancer. Colonoscopy shows a circumferential growth. ?
what kind of bowel cancer is this and which part of the colon is it most likely? - annularleft side
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16. A 55 year old male has a positive faecal occult blood on screening. He is concerned about his risk of bowel cancer. Colonoscopy shows a ulcerated lesion. ?
what kind of bowel cancer is this and which part of the colon is it most likely? - ulceratingleft side
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17. A 29 year old male with a history of bowel cancer presents for colonoscopy. Colonoscopy shows no adenomas, but he goes on to get carcinoma at the age of 34. ?
Which gene is most likely to be involved and which process is it involved in? - HNPCCDNA mismatch repair.
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18. a 59 year old man undergoes a laproscopy for investigation. Laproscopy shows a cystic lymphangioma. ?
What is the aetiology and prognosis? - developmental lymphoid abnormalitybenign
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19. A 47 year old man presents with irritable bowel symptoms. laproscopy shows retroperitoneal fibrosis. He has never undergone long term continuous ambulatory peritoneal dialysis. ?
what 2 drugs can cause this? - practolol, methysergide
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20. A 57 year old woman presents with tenderness and guarding of the abdomen. She has increased pulse and temperature. The surgical team diagnose portal pylephlebitis. LFTs are abnormal, jaundice is absent, RUQ is particularly tender. ?
What is the main cause of this and what is a major risk factor? - peritonitishypercoagulability
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21. A neonate presents with enlarged kidneys. Ultrasound shows cystic kidneys (12-16 x normal size) and cysts of the liver, pancreas and lungs. ?
what are the cysts composed of? - dilated tubules and collecting ducts
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22. A 31 year old woman is diagnosed with HUS by the renal team. What 4 conditions can be a risk factor for it?. ?
postpartum, oestragen therapy, infection (e.g. typoid), immunosuppression
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23. A 41 year old woman is diagnosed with HUS by the renal team. What 4 conditions can it be a complication of?. ?
Malignant hypertension, progressive systemic sclerosis, SLE, transplant rejection
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24. What are the 3 degrees of haemorrhoid?. ?
1. present in lumen but do not prolapse. Tend to bleed. 2. prolapse on defaecation, but spontaneously return. 3. remain prolapsed, can be digitally replaced.
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25. What part or fht eintestine are lymphomas most common in and what is the major predisposing factor?. ?
Small intestine - coeliac disease
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26. What are the 3 kinds of adenoma and which is most likely to undergo malignant transformation?. ?
villous, tubular, tubulovillous - villous are most likely to transform
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27. A 55 year old male has a positive faecal occult blood on screening. He is concerned about his risk of bowel cancer. ?
What are the 5 main risk factors for this? - high fat, high protein, low fibre diet; multiple adenomatous polyps, ulcerative colitis, FAP, pelvic radiotherapy
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28. What are the 3 risk factors for primary peritonitis?. ?
- Abdominal trauma, peritoneal dialysis, cirrhosis with ascites.
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29. A 57 year old woman presents with tenderness and guarding of the abdomen. She has increased pulse and temperature. ?
What is this and what 6 complications might you be concerned about? - secondary peritonitishypovolaemic shock, toxaemia, paralytic ileus, fibrous adhesions, abscesses, portal pylephlebitis.
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30. easter egg. ?
- mesenteric cysts are benign
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31. What congenital diseae is associated with unilateral kidney agenesis?. ?
- spina bifida
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32. What syndrome can occur with bilateral kidney agenesis?. ?
- potter's syndrome
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33. what abnormality is commonly associated with horseshoe kidney?. ?
- wilm's tumour
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34. Which 2 cystic diseases of the kidney can be early onset?. ?
- Medullary cystic disease, juvenile nephronophthisis
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35. At what age does adult polycystic kidney disease present and what 2 other features are often present?. ?
- 30sberry aneurysms, cysts of the liver, pancreas and lung
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36. A patient is diagnosed with medullary sponge kidney. ?
What is the main complication of this and where are the cysts located in the kidney? - renal stones predisposing to infectionrenal papillae
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37. A 20 year old male is diagnosed with nephronophthisis complex. ?
Where are the cysts located in the kidney and what are the 2 associated complications? - at the corticomedullary junctiontubular atrophy and interstitial fibrosis
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38. A 20 year old male is diagnosed with nephronophthisis complex. ?
What 2 forms exist? - juvenile nephronpthisis (presents at 11), medullary cystic disease (presents at 20)
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39. Name 3 examples of immune complex mediated glomerular disease. ?
- Systemic lupus erythematosus, henoch-schonlein purpura, infective endocarditis
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40. Is post-streptococcal glomerulonephritis more likely to cause nephrotic or nephritic syndrome?. ?
- Nephritic syndrome
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41. Is Goodpasture's syndrome more likely to cause nephrotic or nephritic syndrome?. ?
- Nephritic syndrome
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42. Is polyarteritis nodosa more likely to cause nephrotic or nephritic syndrome?. ?
- Nephrotic syndrome
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43. Is Wegener's granulomatosis more likely to cause nephrotic or nephritic syndrome?. ?
- Nephrotic syndrome
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44. Is malaria more likely to cause nephrotic or nephritic syndrome?. ?
- Nephrotic syndrome
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45. are urinary casts associated with nephritic syndrome or nephrotic syndrome?. ?
- Nephritic syndrome
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46. What type of nephritis is goodpasture's syndrome and what protein is targetted?. ?
Focal proliferative glomerulonephritis - type IV collagen
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47. What is the commonest cause of diffuse proliferative glomerulonephritis?. ?
Poststreptococcal
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48. What are the 4 main histological changes in diffuse proliferative glomerulonephritis?. ?
Immune complex deposition, neutrophil infiltration, endothelial cell proliferation, mild mesangial cell proliferation
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49. Which space does rapidly progressive glomerulonephritis occupy and what can be found there?. ?
Bowman's space - epithelial cells, macrophages, monocytes
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50. What are the 2 types of focal proliferative glomerulonephritis?. ?
primary: IgA disease and Goodpastures; secondary: IE, vasculitis, SLE etc
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51. What are 3 causes of membranoproliferative glomerulonephritis (apart from idiopathic). ?
SLE, infective endocarditis, malaria
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52. In membranous nephropathy, what part of the kidney is affected?. ?
The glomerular capillary basement membrane is uniformly thickened (often due to immunoglobulins) - note inflammation is NOT involved
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53. Which 3 infections can be associated with membranous nephropathy?. ?
Malaria, syphilis, hepatitis B
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54. What 4 malignancies are most likely to involve membranous nephropathy?. ?
Lung, breast and GI carcinoma, lymphoma
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55. Which 4 drugs are most likely to cause membranous nephropathy?. ?
Gold, mercury, penicillamine, captopril
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56. Which age group are most likely to be affected by membranous nephropathy?. ?
40-60
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57. What is the commonest cause of nephrotic syndrome in adults?. ?
Membranous nephropathy
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58. What glomerular disease is particularly likely in HIV?. ?
Glomerular sclerosis
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59. What glomerular disease is particularly associated with IgM?. ?
Focal segmental glomerulosclerosis
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60. What triad is involved in Alport's syndrome and how is it inherited?. ?
Triad: deafness, glomerulonephritis, ocular lesions - X linked mostly
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61. What is the commonest types of glomerulonephritis in adults?. ?
IgA nephropathy - this is proliferative
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62. Which 2 heavy metals can lead to acute tubular necrosis?. ?
Lead, mercury
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63. What triad defines haemolytic uraemic syndrome?. ?
thrombocytopaenia, haemolysis, acute renal failure
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64. What are the two mechanisms of renal infarction?. ?
Embolic infarction, diffuse cortical necrosis
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