AMC MCQ Renal and Endocrine Disorders 3 — Questions and Answers
Question 1: A 22-year-old man presents with frank haematuria 1-2 days after an upper respiratory tract infection. What is the most likely glomerular diagnosis?
- IgA nephropathy (Correct answer)
- Post-streptococcal glomerulonephritis
- Minimal change disease
- Goodpasture syndrome
Correct answer: IgA nephropathy
Synpharyngitic haematuria occurring concurrently with a URTI is characteristic of IgA nephropathy.
Question 2: A 5-year-old presents with periorbital oedema, heavy proteinuria, hypoalbuminaemia and a normal complement. What is the most likely cause of nephrotic syndrome in this child?
- Minimal change disease (Correct answer)
- Membranous nephropathy
- Focal segmental glomerulosclerosis
- Diabetic nephropathy
Correct answer: Minimal change disease
Minimal change disease is the commonest cause of nephrotic syndrome in children and is highly steroid-responsive.
Question 3: A 50-year-old woman with a thyroid nodule has a suppressed TSH and an increased radioactive iodine uptake confined to the nodule. What is this lesion most likely to be?
- Toxic adenoma (Correct answer)
- Papillary carcinoma
- Hashimoto thyroiditis
- Multinodular goitre
Correct answer: Toxic adenoma
An autonomously functioning ('hot') nodule with increased focal uptake and suppressed TSH is a toxic adenoma and is almost always benign.
Question 4: A type 1 diabetic presents drowsy with a blood glucose of 28 mmol/L, ketonaemia and a pH of 7.18. What is the most important first step in management?
- Intravenous isotonic fluid resuscitation (Correct answer)
- Intravenous bicarbonate
- Subcutaneous long-acting insulin
- Oral rehydration
Correct answer: Intravenous isotonic fluid resuscitation
Fluid resuscitation is the priority in diabetic ketoacidosis before and alongside an insulin infusion.
Question 5: A patient with end-stage renal disease on haemodialysis develops a potassium of 7.2 mmol/L with peaked T waves on ECG. What is the first agent to give for cardiac protection?
- Intravenous calcium gluconate (Correct answer)
- Intravenous insulin and dextrose
- Nebulised salbutamol
- Oral resonium
Correct answer: Intravenous calcium gluconate
Calcium gluconate stabilises the myocardium immediately, although it does not lower potassium.
Question 6: A 38-year-old woman has fatigue, hyperpigmentation, hyponatraemia, hyperkalaemia and postural hypotension. A short Synacthen test shows an inadequate cortisol rise. What is the diagnosis?
- Primary adrenal insufficiency (Correct answer)
- Secondary adrenal insufficiency
- Phaeochromocytoma
- Conn syndrome
Correct answer: Primary adrenal insufficiency
Hyperpigmentation with hyperkalaemia and a failed Synacthen test indicates primary adrenal (Addison) disease with high ACTH.
Question 7: A 70-year-old man with longstanding hypertension has bilateral small kidneys on ultrasound and proteinuria. What is the most likely underlying renal pathology?
- Hypertensive nephrosclerosis (Correct answer)
- Polycystic kidney disease
- Acute pyelonephritis
- Renal cell carcinoma
Correct answer: Hypertensive nephrosclerosis
Chronic hypertension causes nephrosclerosis with bilaterally shrunken, scarred kidneys.
AMC MCQ Renal and Endocrine Disorders 3
A 22-year-old man presents with frank haematuria 1-2 days after an upper respiratory tract infection.
What is the most likely glomerular diagnosis?