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A 4 year old boy has presented with sudden onset periorbital oedema, which has progressed to oedema across his entire body. He has been lethargic, with a poor appetite and his mum states that his urine has looked a bit ‘frothy’. On examination he has leukonychia. What is the most appropriate initial investigation for this presentation?

A Urine dipstick

B Renal ultrasound

C Renal biopsy

D U&Es

E Fasting glucose


A 22 year old medical student has presented to his GP because he is concerned that his urine is dark: he’s worried that he has a urine infection. He has also had lower abdominal pain and non-specific joint pain. He presented yesterday with a sore throat and headache. On urine dip you note microscopic haematuria, alongside proteinuria. What investigation would be diagnostic for the cause of his presentation?

A Renal ultrasound

B Urine protein: creatinine ration

C Antiglomerular basement membrane antibodies

D Renal biopsy



An 84 year old gentleman is seen on a medical ward round. He was admitted two weeks ago, ‘off legs’ with suspicion of a chest infection. This was treated successfully with antibiotics and he is close to discharge. He experienced a recurrence of longstanding shoulder pain two days ago, for which he was started on ibuprofen gel. You note that his U&Es, undertaken this morning are deranged. His creatinine is 185 (normal 60-120), which is an increase from 133 two days previously. He has only passed 100ml of urine in the past 24 hours, with zero urine output in the past 12 hours. He weighs 85kg. He had been clinically well until now, with a past medical history of COPD and osteoarthritis. He is apyrexial and is not tachycardic or tachypnoeic. What is the most likely cause of his Acute Kidney Injury?

A Sepsis


C Calculus

D Glomerulonephritis

E Pancreatitis


On the surgical ward, a 74 year old man has had a successful trial without catheter following a cholecystectomy. The nurse covering his bay has come to you to let you know that she had sent off a catheter specimen of urine yesterday, before the trial without catheter, which has come back positive for E. Coli. The patient himself has had no complaints of dysuria, urinary frequency or haematuria. He is apyrexial and oriented in place and time. What is the most appropriate action to take?

A Treat with trimethoprim

B Treat with nitrofurantoin

C Treat with fosfomycin

D Contact microbiology for advice

E Take no action


A 42 year old lady has presented with fever, shortness of breath, haemoptysis and haematuria. Her U&Es come back as: creatinine 253 (normal 60-120), urea 23 (normal 2.5-6.5), chloride 167 (95-110). She has patchy hilar consolidation on chest X ray. ESR is normal and anti-glomerular basement membrane antibodies are positive. What is the most likely cause of her severe renal failure?


B IgA Nephropathy

C Wegener’s Granulomatosis

D Goodpasture’s Syndrome

E Rheumatoid arthritis


An 88 year old man has been on the general medical ward for two weeks. Today he is complaining of bone pain. He has an extensive past medical history, including COPD, diabetes and hypertension. His most recent U&Es have come back as: creatinine 199 (normal 60-120), urea 17 (normal 2.5-6.5), chloride 177 (95-110). This has been a slow progression. His eGFR is 13. His other bloods include: corrected calcium 2.01 (normal 2.25-2.5 mmol/L), Calcitriol 25 (normal >50), Phosphate 2.2 (normal 0.8-1.4), PTH 70 (normal 10-55). Which of the following processes is causing the patient’s abnormal bloods, and therefore bone pain?

A Reduced renal excretion of phosphate

B Primary hyperparathyroidism

C Poor dietary intake

D Tumour Lysis Syndrome

E Reduced renal conversion of Vitamin D into calcitriol