GU SAQ Questions

Questions were made by students on behalf of The Peer Teaching Society. We hope there are no mistakes but are
not liable for any false or misleading information.

1. Phil, a 58-year-old male presents to his GP with haematuria. On examination an abdominal mass is palpable.
You suspect renal cancer.

a) What is the most likely histological origin? (1 mark)

b) Name 2 further symptoms you would suspect this man to have. (2 marks)

c) It is further noted that Phil has hypertension, what is the most likely explanation for this? (1 mark)

2. A 76-year-old man presents with painless haematuria. He also states he has been feeling more tired and has
noticed his clothes are baggy despite eating more than normal.

a) Name 2 further symptoms that would indicate renal cell carcinoma (2 marks)

b) Name an investigation that would be used to stage his diagnosis (1 mark)

c) What scoring system is used to stage renal cell carcinoma (1 mark)

3. An anxious 27-year-old first time mum brings her 6-week-old baby boy Simon in for the 6 week GP check.
The GP notes a lump on the right testicle. The GP suspects a hydrocele.

a) Define a hydrocele (2 marks)

b) What is the first line management of a hydrocele? (1 mark)

c) Give one example of when surgery may be appropriate in this new born baby (1 mark)
4. A 16-year-old male comes into A and E with an acutely painful testicle. When asked he scores the pain 10/10
and on examination it is red, hot and swollen.

a) Name the most likely diagnosis (1 mark)

b) How would you investigate this diagnosis? (1 mark)

c) Name the first line treatment for this condition? (1 mark)

d) Name a complication of this condition? (1 mark)

5. A 28-year-old woman has recently given birth through a vaginal delivery and now is struggling to hold her
urine especially when coughing or laughing.

a) What is the name of this form of incontinence? (1 mark)

b) What muscle is the main muscle in the bladder wall which contracts when urinating? (1 mark)

c) In urge incontinence the muscle described in part (b) is overstimulated. What class of medication can be
used to counteract this? (1 mark)

6. a) Name 3 types of nephrotic syndrome. (3 marks)

b) What is the most common form of nephrotic syndrome in children? (1 mark)

d) What is the mainstay treatment for nephrotic syndrome? (1 mark)

7. Diuretics are common antihypertensive medications. Name 4 classes of diuretic describing how they exert
their effect. (8 marks)

Diuretic Class / Type Mechanism of action / target

8. a) Name 3 risk factors for chronic kidney disease (3 marks)

b) As CKD progresses kidney function begins to reduce, what hormone secretion might begin to reduce? (2
marks)

c) What is the first line treatment in CKD? Give an example (2 marks)

9. A 60yo patient is diagnosed with post streptococcal glomerulonephritis 3 weeks after recovering from
pharyngitis. He presents with a fever, nausea & vomiting, and dark urine. His BP is 160/100 mmHg. On
examination, there is swelling in his face and legs.

a) List 3 investigations that would have been done and its results? (3 marks)

b) What is the first line treatment of HTN for this patient? (1 mark)

c) Given that the patient’s age is 7 years old, what differential diagnosis would you consider? (1 mark)
10. Patient is tested positive for PKD 1 gene mutation. He has come in multiple times due to unexplained
blood in his urine.

HbA1c levels – 58 mmol/mol

BP 170/120 mmHg

Consultant has diagnosed him to have chronic kidney disease based on his urine (proteinuria &
haematuria), blood tests (high urea & creatinine levels) and reduced eGFR.
a) What does a positive PKD 2 gene mutation indicate? (1 mark)

b) What are 3 risk factors for CKD listed above? (3 marks)

c) List 3 some signs & symptoms picked up from a patient with chronic kidney disease. (3 marks)

11. 70yo patient brought to A&E following a fall at home. He was found on the floor, no obvious signs of
any injury to the head. X Ray shows a fractured neck of femur. Patient complains of severe pain from
loin to groin. Patient has a reduced GCS score and appears very tired.

DEXA scans indicate patient is osteoporotic. Abdominal CT scans revealed presence of a kidney stone
within the ureter.

a) What condition is the patient presenting with? (1 mark)

b) Due to the kidney stones, his U&E blood test came back deranged. What are the criteria to diagnose for AKI?
(10 marks) (HINT – Stage 1, 2, 3, loss, end stage; Give creatinine and urea levels)

c) Renal stones were a cause for this patient’s AKI. Name 1 pre-renal and 1 renal causes of AKI. (2 marks)

12. Acute kidney injury is the abrupt decline in renal function.

a) Name the 3 ways in which AKI can be classified. (3 marks)

b) Choose one of the classifications given in part (a) and list 3 conditions which fall into that category. (3 marks)

c) What ratio would be used to monitor renal function? (1 mark)

13. Patient has glomerulonephritis. As a doctor, you are required to investigate and find out which type it
is to provide the correct treatment and management.

Under immunofluorescence, you could identify Ig A deposits within the glomerulus & mesangial cells.

a) Which condition does this point to? (1 mark)

You double check your findings with a specialist and realised you had it wrong. There are no immune
complex deposits. Blood results shows ANCA positive.

b) Which condition does this point to? (1 mark)

c) What medications are given to patients with ANCA positive disease? (2 marks)

14. You are a foundation doctor working a night shift in A+E. A man presents to you with excruciating pain that
awoke him from his sleep. When you question him about his pain, he describes it as starting in his lower
back area but has now moved to his groin. He mentions that the pain is so intense, it is making him feel
nauseous and he cannot lie still. You suspect that this patient is suffering from renal colic due to a lodged
renal stone.

a) What are the three most common areas for a renal stone to become lodged? (3 marks)

b) Give 4 risk factors that would make someone more susceptible to renal stone formation. (4 marks)

c) Give 3 examples of what the patient could do in the future to prevent the recurrence of renal stone
formation. (3 marks)

15. Mr P is a 65-year-old man who has come into your GP clinic. He was reluctant to talk about what had
brought him in, but with some reassurance from the GP he revealed that he had been having trouble going
to the toilet. Mr P revealed that he had been waking up 6/7 times throughout the night to urinate with
urgency, however when he did he had a poor stream, and sometimes there was also blood in his urine.

a) What is the most likely diagnosis based on the clinical presentation? (1 mark)

b) Name 2 investigations you could conduct to diagnose Mr P. (2 marks)

 16. Miss D is a 28-year-old female who presents to A+E with the signs of severe sepsis. She has a past medical
history of diabetes and rheumatoid arthritis. From her presentation and the history that you obtain, you give
Miss D a diagnosis of Pyelonephritis.

a) What triad of symptoms most commonly present in someone with pyelonephritis? (3 marks)

b) What is the gold standard investigation for Pyelonephritis? (1 mark)

c) Name 2 bacteria that you would expect to find in pyelonephritis. (2 marks)

17. You are a doctor working in the GUM clinic at the Royal Hallamshire Hospital. A 23-year-old male arrives at
the clinic with complaints of urethral discharge and dysuria. He mentions he has had recent unprotected sex
after a night out. You ask for a first-pass urine sample and a urethral swab. The results confirm Neisseria
Gonorrhoeae.

a) What type of bacteria is Neisseria Gonorrhoeae? (2 marks)

b) In cases of sexually transmitted diseases, it is important to notify past and present sexual partners. Name 2
reasons partner identification is important. (2 marks)

c) What antibiotic would you give to treat the Neisseria gonorrhoeae? (2 marks)

Total Marks (99)

GU SAQ Answers

Question Answers
1. a) Renal cell carcinoma accounts for 90% of renal cancers. Other types are urothelial carcinoma,
transitional cell carcinoma, sarcomas and Wilms tumour in kids.

b) Other symptoms include: loin pain, anorexia, malaise, weight loss, varicocele, enlarged lymph
nodes

c) Due to renin secretion which causes an increase in blood pressure due to the RAAs system.

2. a) Loin pain, loin mass, varicocele, bilateral ankle oedema, pyrexia. If there are metastases then
haemoptysis, bone pain or pathological fracture can all be seen. Additionally in 30% of patients
there is normally a paraneoplastic syndrome which presents with anaemia, polycythaemia,
amyloidosis etc.

b) CT/MRI

c) TNM system

3. a) It is the abnormal collection of fluid within the remnants of the processus vaginalis.

b) Watch and wait i.e., expectant management as most resolve by the age of 2 years spontaneously

c) If there appears to be an inguinal hernia, then surgery would be appropriate.

4. a) Testicular torsion (red, hot and swollen is classical, they can also present with abdominal pain only
so this always needs to be excluded)

b) Clinical – there often isn’t time to do any imaging

c) Surgery, it is called a manual detorsion REMEMBER: time is testicle so this needs to be done ASAP

d) Infarction of the testicle, infertility although this is rare as there should be another functioning
testicle.

5. a) Stress incontinence

b) Detrusor muscle

c) Antimuscarinics e.g., oxybutynin

https://step2.medbullets.com/renal/120711/urinary-incontinence

6. a) Minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy,

amyloidosis, advanced renal disease e.g. diabetic glomerulonephropathy

b) Minimal change disease

c) Glucocorticoids. Adjuncts of ACE inhibitors and prophylactic anticoagulation

https://step2.medbullets.com/renal/120696/nephrotic-syndrome
7.
Diuretic Class / Type Mechanism of action / target
Thiazide Early distal tubule, inhibition of Na+ and Cl- cotransport
Loop Diuretic Loop of Henle, inhibition of the Na+/K+/Cl- cotransporter
K+ sparring diuretic Late distal tubule and collecting duct, inhibition of Na+
reabsorption and K+ secretion. Aldosterone sensitive channels
in principal cells.
Osmotic diuretic Proximal tubule, loop of Henle, collecting duct, inhibition of
water and Na+ reabsorption
Carbonic anhydrase Proximal tubules, inhibition of bicarbonate reabsorption
inhibitors

8. a) Older age, diabetes mellitus, hypertension, AKI, microalbuminuria, proteinuria, overweight/obesity,

smoking, alcohol, drug use.

b) Vitamin D, erythropoietin

c) ACE inhibitors – any drug ending in ‘-pril’ e.g. ramipril, captopril, enalapril. Aldosterone receptor
blockers e.g. candesartan are given if side effects felt. Eg. Dry cough from the production of
bradykinin.

9. a) Blood Tests – kidney function + eGFR

Urinalysis – blood & protein
Biopsy – presence of dead bacterial cell + antibodies causing inflammation in glomerulus
USS

b) What is the first line treatment of HTN?

> 55yo or Afro-Carribean, it is calcium channel blocker
Otherwise, give ACE-i

c) Minimal Change Disease

10. a) patient has a high risk of developing polycystic kidneys

b) Genetics
Family History
BP
Diabetes
Progressive AKI
Nephrotoxic Drugs
Vasculitis

c) Itchy
Tired,
Swelling in arms and legs
Increased need to pee
https://www.nhs.uk/conditions/kidney-disease/symptoms/

11. a) Hypercalcaemia – stones, bones, groans, moans

b)
 c) Renal stones were a cause for this patient’s AKI. Name 1 pre-renal and 1 renal causes of AKI.
Pre-Renal – Hypotension / dehydration / septic shock
Renal – Acute Tubular Necrosis / Post-streptococcal Infection

12. a) Pre-renal, renal / intrinsic-renal, post-renal

b) Any of the examples given in pre-renal, intrinsic, of post-renal

 c) Urea:creatinine ratio.

13. a) Ig A Nephropathy

b) Vasculitis / Pauci-Immune Necrotising Glomerulonephritis

c) Corticosteroids + Rituximab

14. a)
• Pelviureteric junction/ureteropelvic junction – where the renal pelvis connects to the ureter
• Pelvic brim – where the ureter crosses over the pelvic brim and the bifurcation of the common iliac
arteries
• Vesicoureteric junction/ureterovesicular junction – where the ureter connects to the urinary
bladder
Explanation: they are 3 anatomic sites at which the ureter becomes narrower, so stones are more likely
to get stuck here.

b) dehydration, infection, hypercalcaemia, hyperoxaluria, hypercalciuria, hyperuricaemia, primary

renal disease, drugs: diuretics, antacids, corticosteroids, aspirin, allopurinol, vitamin c, vitamin d;
diet: chocolate, tea, strawberries, rhubarb; gout, family history, anatomic abnormalities that
predispose to stone formation

Explanation: they all increase the likelihood of stone formation by increasing the concentration of
calcium/oxalate/phosphates. Renal stones main components are calcium oxalate, calcium phosphate
and uric acid. Each factor described above increases the likelihood of stone formation by increasing the
concentration of calcium, oxalate or phosphates.

c) maintain hydration, low calcium intake in the diet e.g. reduce levels of dairy, green leafy veg, fish
where you eat the bone e.g. sardines and food with fortified flour , low salt diet e.g. reduce the
 levels of processed meat, ready meals, reduce animal protein intake, reduce BMI, be
active/exercise
Explanation: they reduce the likelihood of stone formation by decreasing the amount of stone
components in the body.

15. a) Benign Prostatic Hyperplasia (BPH)

Explanation: BPH presents with lower urinary tract symptoms due to prostatic obstruction. This
includes frequency, nocturia, urgency, post-micturition dribbling, poor stream, hesitancy, overflow
incontinence, haematuria, bladder stones, incomplete emptying. On examination the patient would
also have an enlarged bladder and a smooth enlarged prostate on a DRE.

b)
• DRE – smooth enlarged prostate
• Serum Prostate Specific Antigen (PSA) – blood test
• Frequency charts to diagnose nocturia
• Mid-stream sample to exclude infection
• Transrectal ultrasound – assesses the size of the prostate
• Biopsy and endoscopy – to exclude malignant disease

16. a) Loin pain, fever, polyuria

b) Midstream urine sample: microscopy, culture and sensitivity – it allows you to identify bacteria in
the urine from any infection in the urinary tract, and identify the best way to treat it. Midstream
means that you don’t get the bacteria at the opening of the urethra.

c) Klebsiella spp., E.coli, enterococcus spp., Proteus spp., coag negative staphylococcus spp. KEEPS

Klebsiella – seen more commonly in pregnant women

Proteus – seen more commonly in those with structural abnormalities
E. Coli is the most common cause and is gram negative (stains pink on gram stain as it has a thinner
peptidoglycan wall)

17. a) Gram-negative diplococci bacteria. This will appear pink with gram stain and you will see 2
spherical shaped bacterium.

b) prevent the infection of others, prevent re-infection of the index patient, prevent
complications in asymptomatic contacts, it aids the identification of people less likely to
present for screening

c) ceftriaxone and azithromycin

Authors – Anna Durkin, Chris Salmon, Suhail Raihan, Paige Wilson

Editor – Chris Salmon csalmon3@sheffield.ac.uk