Roads to master , mrcp

Causes nephrogenic diabetes insipidus

• Hypercalcemia
• Hypokalemia
• Scd
• Lithium carbonate
• Amyloidosis,
• Myeloma
• Analgesic nephropathy
• Demecylocyline
• Methiciline
 Indication of urgent dialysis

• Uraemic pericarditis with effusion

• Pulmonary oedema
• Significant hyperkalemia
• Rapidly rising urea and creatinine.

1. High salt intake may cause fluid overload.

Aluminium should be avoided ( antacid)
• Acute tubular necrosis,
1. Accelerated hypertension, hypotension,
diabetes, liver failure, eclampsia,
aminoglysydies, cephalosporin, cisplatin,
amphotericin, ciclosporin.
• Nephrotic syndrome
• Oedema, proteinuria,hypoalbuminemia,hypercholesteramia,
renal vein thrombosis, bacterial infection.

• Complications; hyperlipidaemia ,hypoalbuminiemia,

associated hypocalcemia,prothrombtic tendency ( renal vein
thrombosis, DVT), ccf, pneumococal pneumonia, acute and
chronic renal failure.

•
 apkd
• Ad
• Chromosome 16
• Ass intracranial aneurysm, mitral valve
prolapse, abdominal hernia,pancreatic cyst.
50% esrf.
• Alport syndrome, basement membranes of
kidney and involve cochlea ( nerve deafness)
and eye( visual disturbance). Ad ar xlinked
recessive.
• O/e – deafness,visual disturbance,
haematuria, renal , nephrotic.
• Renal vein thrombosis – nephrotic syndrome,
haematuria, loin pain, renal failure,. Tx:
heparin/ warfarin.
• 3rd nerve palsy causes-
1. Neuroyphilis, meningovascular syphilis,
2. Dm
3. Myasthenia gravis
4. Opthalmic migraine
• Signs¹
• The signs of SIADH also vary a great deal depending on the rate of serum sodium concentration
change
• Decreased level of consciousness
• Cognitive impairment (short-term memory loss / disorientation / confusion)
• Focal or generalised seizures
• Brain stem herniation – severe acute hyponatraemia (coma / respiratory arrest)
• Hypervolaemia -pulmonary oedema / peripheral oedema / raised JVP / ascites
•
Neurogenic
• Desmopressin¹
• Vasopressin analogue
• Binds to v2 receptors on kidney allowing water to be reabsorbed
• Drug can be given orally, intranasally, parenterally or buccally
• Dose varies significantly between patients
• Serum osmolality and serum sodium need monitoring – can cause hyponatraemia or hypo-osmolality
 ECG
• V3 AND V4 – ANTERIOR
• RIGHT AXIS DEVIATION – RIGHT VENTRICULAR HYPERTROPHY
• II, III and Avf- Inferior
• If seen in all leads then they usually suggest the individual has hyperkalaemia. However if tall T waves are seen in a particular group
of leads it suggests early MI. The tall T waves are due to potassium leaking through the damaged membrane over the infarcted
area.
• If a rhythm is described as sinus it indicates that a P-wave precedes each QRS-complex. However a rhythm can still be irregular even
if it's sinus.
• Second degree - Mobitz Type 1 - Heart Block is a disease of the AV node. It is seen as progressive prolongation of the PR-interval
with associated regular dropping of the QRS complex.
• V1 & V2 –septal
• n normal individuals the PR-interval is between 0.12-0.2 seconds. A PR interval longer than this can suggest the presence of heart
block and a short PR-interval can suggest an accessory pathway between the atria & ventricles e.g. WPW syndrome
• Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to defects in the conduction system of the
heart.
• In atrial fibrillation the atria no longer conduct electricity from the SA in an orderly fashion. Therefore P-waves are lost. As a result
of disordered atrial activity only occasional waves of depolarisation pass through to the AV node and cause ventricular activation.
This causes the typical irregular rhythm.
• Leads V3 and V4 related to the anterior portion of the heart. Therefore ST elevation in these leads suggests an anterior infarct. The
anterior portion of the heart is supplied mainly by the left anterior descending artery therefore this is most likely to have been
affected.
• eads I, aVL, V5 and V6 -lateral
1. abnormally shortened PR-interval -uestion 18
Explanation:
2. A short PR-interval indicates abnormally short
conduction time between the atria and ventricles. This is
caused by the presence of an accessory pathway
between the atria and ventricles. Wolf parkinson white
syndrome is an example of this kind of disorder. In WPW
the an accessory pathway known as "the bundle of kent"
is present. Most individuals are asymptomatic however
there is a risk of sudden death without treatment.
• Question 1 Explanation:
• Testicular torsion is usually seen in adolescents and presents as sudden pain in the scrotum. On
physical examination the cremasteric reflex will be absent. It is caused by the twisting of the
spermatic cord containing the pampiniform plexus, vas deferens and testicular artery. The blood
supply is impaired leading to congestion and necrosis of the testicle. It is a surgical emergency.
1. Yolk sac tumour is the most common testicular tumour in boys. An elevated AFP and Schiller
Duval bodies (resemble glomerulus) are important features to differentiate from the other
types of testicular tumours.
2. Varicoceles are caused by the dilation of the spermatic vein due to increased venous pressure.
It is usually left sided because there is an elevated resistance to flow on the left side as the left
gonadal vein drains into the left renal vein compared to the right which drains into the inferior
vena cava. Sometimes it is associated with a left sided renal cell carcinoma. It causes scrotal
enlargement in adults with a classic ‘bag of worms’ appearance. It can lead to infertility due to
the increased temperature.
3. Condyloma acuminatum is characterized by the growth of benign genital warts. On histology,
there will be koilocytic change. This condition is caused by HPV type 6 or 11. Infection with
HPV is also a risk factor for development of squamous cell carcinoma of the penis.
• Most frequently occur in young men with
either Klinefelter syndrome or cryptorchidism.
Cryptorchidism is the failure of the testicle to
descend into the scrotum. Klinefelter
syndrome: a chromosomal abnormality (47
XXY) leading to dysgenesis of seminiferous
tubules causing testicular atrophy,
gynecomastia, infertility and eunuchoid body
shape.
1. The Gleason grading system is used to categorise prostate adenocarcinoma and focusses on architecture of the tumour. A score of 2 -10
is obtained; the higher the score, the worse the prognosis.
2. Prostatic cancer typically arises from the posterior lobe and on the periphery. This is why it is often asymptomatic as it does not
compress the urethra producing no urinary symptoms at an early stage. The prostate is located anterior to the rectum. Thus, on digital
rectal exam (DRE), a mass can be felt as the posterior and peripheral region is affected.
3. BPH is not premalignant. It is common in men over the age of 50. It occurs as a result of hyperplasia of the prostatic periurethral stroma
and glands.
4. A homogenous and painless mass with the absence of haemorrhage. On histology, findings include large cells in lobules with clear
cytoplasm ‘fried egg appearance’. Seminoma fits this description. It is the most common testicular tumour. It is malignant, metastasises
late, responds to radiotherapy and has an excellent prognosis.
5. Metastasis commonly involves the lumbar spine in late stages of the cancer creating osteoblastic lesions on the bone. It presents as
lower back pain. Serum alkaline phosphatase (ALP) will be raised as well as prostatic specific antigen (PSA).
6. Hypospadias is due to failure of the urethral folds to fuse resulting in an abnormal opening of the urethra on the inferior/ventral surface
of penis. Epispadias is the condition associated with the opening of urethra on superior/dorsal surface of penis, and it is linked with
bladder exstrophy.
7. Priapism is a prolonged and painful erection of the penis. Sickle cell disease, trauma and medications for erectile dysfunction e.g.
sildenafil are all potential causes of this condition. It requires prompt treatment to prevent ischemia. Treatment options include
phenylephrine injection, surgical decompression and corporal aspiration.
8. Cryptorchidism is where the person has undescended testis; it can involve one testicle or both. Testicles are formed in the abdomen
and descend into the scrotum during foetal development. Failure to descend, results in this abnormality. Affected persons have an
increased risk for development of germ cell tumours and infertility. Some cases self-resolve whereas orchiopexy is done to treat others.