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Match the stage/GFR of kidney disease to when the symptoms appear

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Match the text
1 - GFR > 90ml/min
2 - GFR 60-89ml/min
3 - GFR 30-59ml/min
4 - GFR 15-29ml/min
5 - GFR < 15ml/min

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Ca absorption decreases, malnutrition, anaemia (erythropoietin deficiency), left ventricular hypertrophy
Uremic (azotemia) syndrome
PTH starts to increase
Serum TAGs increase, hyperphosphataemia, metabolic acidosis, hyperkalaemia
Microalbuminurea present

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none

Fatal ‘grey’ syndrome in neonates is caused by toxic levels of chloramphenicol. This is due to

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Underactive conjugation enzyme systems

Increased oxidation of the drug

Decreased volume of distribution

Increased rate of clearance

none

You would give a larger dose of furosemide to neonates compared to adults (Furosemide has 3x the volume of distrubution in neonates)

Select the correct answer(s).  

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Explanation

Neonates have a larger total body water Larger volume of distribution - so more drug needs to be given to get desired concentration

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True

False

none

Which are consequences of uremic syndrome (azotemia) due to CKD?

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Explanation

Uremic syndrome is when nitrogenous metabolites are not cleared from the body uremic toxins - any biologically active compounds retained due to kidney impairment

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Prone to infection - WBC impairment

Hypertension

Anorexia

Proteinuria

Peripheral and motor neurone neuropathy

Nausea/vomiting/diarrhoea

Haematuria

Osteoporosis

Encephalopathy

Hyperammonuria

none

Match the types of dehydration to their definitions

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Match the text
Isosmotic
Hyposmotic
Hyperosmotic

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Electrolyte loss > water loss
Water loss > electrolyte loss
Water loss = salt loss

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none

Describe how CKD can cause osteodystrophy

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In CKD there is a decrease in renal mass so you get a decrease in

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This results in a decrease in the renal excretion of

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The increase in plasma Pi stimulates

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levels to increase - this is responsible for stimulating kidneys to excrete more Pi. In CKD, the production of 1,25 VitD3

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VitD3 is responsible for regulating

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uptake, so less is reabsorbed in CKD. Low plasma Ca also stimulates the release of

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which causes Ca to be released from

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leading to osteoporosis. Ca release from bones increases Ca, but also Pi in the form of

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This precipitates, leading to

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of soft tissues and arteries.

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none

Which one of the following statements is correct regarding prescribing in the elderly?

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Elderly patients tend to take fewer drugs

The incidence of adverse drug effects decreases after the age of 65 years

Oral administration of drugs may be slower due to reduced GI blood flow

Elderly patients show greater compliance with dosing regimens

none

Total body water of neonates

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Explanation

Adult males - 60% Adult females - 50%

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80%

40%

75%

50%

60%

none

Describe how CKD leads to hypertension and ischaemia

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In CKD, there is reduced

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which causes the release of

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as the kidney detects low BP so tries to correct it. The release of this results in the release of angiotensin II and

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Angiotensin II causes

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and aldosterone causes

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reabsorption. This results in hypertension and peripheral and pulmonary

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There is ischaemic damage to the medulla so the kidneys lose the ability to produce

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urine.

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none

Put the steps of the pathogenesis of a UTI in order

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Match the Text
1
2
3
4
5
6
7
8
9
10
11

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Replicate rapidly and immune system subversion
Epithelial damage by bacterial toxins and proteases
To infect the kidneys:
Ascend the urethra
May cause bacteraemia
Biofilm formation
Ascend the ureter
Colonisation of the kidneys
Establish a base camp by colonising the periurethral skin - uropathogen e.g. E.coli from the gut
Most tissue damage is by bacterial toxins
Adhere to the urothelium, mediated by pilli and adhesins

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none

How does chronic kidney disease cause anaemia?

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The kidney is an important secretor of the hormone

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which is involved in the production of RBCs in bone marrow. During CKD, the kidneys stop secreting the hormone so you get normocytic

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anaemia. Symptoms include weakness and

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none

Which one of the following is not true regarding drug distribution in elderly patients?

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Explanation

Lean body mass decreases Body fat increases TBW reduced - loading doses often overshoot desired plasma conc. Plasma albumin are well maintained in healthy elderly people

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In healthy elderly patients plasma albumin levels are well maintained

Body fat decreases reducing the fat reservoir for lipid soluble drugs

TBW is reduced meaning loading doses of drugs often overshoot the desired plasma concentration

Lean body mass is less so standard dosing per Kg produces a higher plasma concentration

none

In neonates glomerular filtration, tubular secretion and absorption are low. How would this effect the dose of penicillin that you have been asked to administer to the patient?

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The dose would not change

You need to decrease the dose

You need to increase the dose

none

ECG appearance of hyperkalaemia

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Tall tented P waves

Flattened T wave

Flattened P waves

Narrow QRS complex

Tall tented T waves

Broad QRS complex

Inverted T waves

none

Bladder emptying can be incomplete due to Detrusor underactivity - a muscle that has contractions of reduced strength

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(0/0)

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False

True