Endocrine block

Q1/ The general causative mechanisms for proteinuria

1. Glomerular proteinuria
2. Tubular proteinuria
3. Increase production of plasma protein

Q2/ The types of proteinuria

1. Micro X macroalbuminuria
2. Transient X fixed proteinuria
3. Glomerular X tubular proteinuria

Q3/The causes for transient proteinuria

• Temperature> 38.30C
• Exercise
• Dehydration
• Cold exposure
• Heart failure
• Seizure
• Stress

Q4/ Suggest ONE laboratory test that is more precise than the dipstick to detect proteinuria, justify its role in
diagnosing the patient.
Spot protein / creatinine ratio (UPr/UCr)

• It is more precise
• Is best performed on a 1st morning voided urine specimen to eliminate the possibility of
orthostatic proteinuria
• Ratio <0.5 in children less than 2 yrs. of age and <0.2 in children 2 yrs. and older suggest normal
protein excretion
• A ratio >3 suggest nephrotic range proteinuria

Q5/Explain that, timed 24-hr urine collections have largely been replaced by the spot protein –to- creatinine
ratio.
A/ although it Offers more precise information regarding UPr excretion, it is more cumbersome to obtain and
highly inaccurate.
GIT BLOCK1
Q1/ Perianal fistula stand for?
Chronic abnormal communication usually lined to some degree by granulation tissue , which runs outwards
from an internal opening in the anorectal lumen to an external opening on the skin of the perineum or buttock
( or rarely the vagina).
Q2/The causes that play role in the pathogenesis of perianal fistula
1. Perianal abscess /cryptgland infections
2. IBD: Crohn’s
3. Malignancy
4. TB/Actinomycosis
5. Diverticular disease

Q3/Park’s classification
A. Subcutaneous
B. Intersphincteric 70%
C. Trans –sphincteric 25%
D. Supra –sphincteric
E. Extra –sphincteric

Q4/The aim and type of surgical treatment for perianal fistula

Aim

• Define anatomy
• Eliminate tract
• Preservation of sphincter function

Treatment

• Perianal → fistulotomy vs fitulectomy

• Trans / extra /supra-sphincteric→complex treatment / advancement flap , fibrin glue , using
seton/ligation of Intersphincteric fistulous tract.

Q5/The pathogenesis of Pilonidal sinus formation

1. Blockage of hair follicle –folliculitis
2. Hair trapping
3. Abscess followed by sinus formation
4. Foreign body reaction
5. The sinus tract is cephald
6. Secondary lateral tracts.