FLINDERS UNIVERSITY ADELAIDE AUSTRALIA

SCHOOL OF MEDICINE

NOVEMBER EXAMINATIONS 2000

FIRST YEAR BMBS

MMED 8124 RENAL
TIME:

Total time 1 hour 45 minutes (105 minutes)

MATERIALS ALLOWED IN THE EXAMINATION ROOM: A non-programmable

calculator with Log10 function, or log tables.

INSTRUCTIONS TO CANDIDATES:
1.
2.
3.
4.

Write your student number on each examination booklet.

Indicate on each booklet and marking slip which questions you have answered in that booklet.
Answer all questions.
Start answers to each question on a new page.

You are encouraged to make use of diagrams in your written answers.

This examination is designed to be completed in 105 minutes. The recommended time for each question
is indicated on the question papers. Marks assigned to each question are proportional to the
recommended time.

SECTION A
Minicase (Questions 1-8)
Part 1 (Questions 1-2)
15 minutes
Part 2 (Questions 3-4)
28 minutes
Part 3 (Questions 5-8)
17 minutes

60 minutes
Booklets will be collected at the end of this part.
Booklets will be collected at the end of this part.

SECTION B

Short Answer Questions (Questions 9-11)

30 minutes

SECTION C

Practical Examination (Questions 12-14)

A separate answer booklet will be provided.

15 minutes

continued next page

MMED8124 RENAL

NOVEMBER EXAMINATION

PAGE 1

SECTION A
Minicase (60 minutes)
Section A Part 1
Answer all questions
Write your answers in booklet marked Section A Part 1.
Start each question on a new page.

While you are working in a country hospital, Christine presents to you with fatigue, anorexia and itchy
skin. Christine is 40 years old and she and her husband run an 800 hectare sheep and wheat property
about 20km from the regional town.
Question 1
You suspect a renal problem. List and justify 4 hypotheses to explain these symptoms?
(4 minutes)
Question 2
What further information would you seek (history,physical,lab tests) and explain the rationale for each
piece of information?
(11 minutes)

END OF SECTION A, PART 1

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Answer books will be collected after this part

continued next page

MMED8124 RENAL

PAGE 2

NOVEMBER EXAMINATION

Section A Part 2
Answer all questions
Write your answers in booklet marked Section A Part 2.
Start each question on a new page.

Christine has two children, and has been an insulin-dependent diabetic since she was 8 years old. On
examination Christine is 175 cm tall, weighs 60kg with pitting oedema of her legs and a blood pressure of
170/110 mmHg.
A blood sample revealed the following results

Biochemistry
Na+
K+
HCO3ClCreatinine
Urea
Calcium

PO4
Albumin

mmol/l
137
5.2
16
102
0.50
52
2.0
2.8

Reference range
137-143
3.2-4.3
22 -31
102 - 111
0.09 - 0.12
3-8
2.0 - 2.5
0.1 - 1.35

22

39 - 47

Haematology
Haemoglobin

g/l
85

Reference range
135-175

A 24 h urine sample contained 4g of protein (normally <300mg)

Question 3
Estimate Christine's GFR from the given data and calculate her level of kidney function.
(3 minutes)
Question 4
Give a physiological explanation to explain each of these biochemical and haematological results. Which
of these results explains Christine's symptoms.
(25 minutes)

END OF SECTION A, PART 2

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Answer books will be collected after this part

continued next page

MMED8124 RENAL

PAGE 3

NOVEMBER EXAMINATION

Section A Part 3
Answer all questions
Write your answers in booklet marked Section A Part 3.
Start each question on a new page.

Question 5
In a context of renal failure explain why it is important to control Christine's blood pressure?
(5 minutes)
Question 6
What type of drug would you recommend to control Christine's blood pressure and explain the rationale
for its use?
(5 minutes)
Question 7
Explain what dietary measures you would recommend and explain the rationale?
(5 minutes)
Question 8
If the dietary measures are not followed what might be the consequences?
(2 minutes)

END OF SECTION A, PART 3

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GO ON TO SECTION B

continued next page

MED8124 RENAL

PAGE 4

NOVEMBER EXAMINATION

SECTION B
Short Answer Questions (30 minutes)
Answer all questions
Write your answers in booklet marked Section B.
Start each question on a new page.
Question 9
On the table below changes in either afferent or efferent arteriolar resistance are indicated with an
(increased resistance), ( decreasing resistance) or (no change).
Assuming a constant renal perfusion, what will be the effect of these changes on:
a) renal blood flow (RBF)
b) glomerular filtration rate (GFR)
c) filtration fraction (FF)
On the table provided, indicate your decision or or (no change)
Arteriolar resistance
Afferent
Efferent
RBF
GFR
FF
--------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------(10 minutes)
Question 10
Fill in the following table and state the form of acid base disorder.
pH
7.34
........
7.2
.......
7.47

HCO3
18
35
........
20
........

CO2
........
48
63
20
20

Disorder
...........................
...........................
...........................
...........................
...........................
(10 minutes)

Question 11
What is vesico-ureteric reflux? What complications might occur in a severe case in a child under 2 years
of age?
(10 minutes)

END OF SECTION B
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GO ON TO SECTION C
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MED8124 RENAL

NOVEMBER EXAMINATION

PAGE 5

SECTION C
Practical Examination (15 minutes)
Answer all questions
Write your answers in the special booklet marked Section C.

Question 12
Urine staining
Examine the urine staining photographs
Match the image or images that you would most like likely find in the following conditions.
a) glomerulonephritis.
b) urinary tract infection.
c) acute tubular necrosis.
d) person with kidney stones.
(5 minutes)
Question 13
Urodynamic assessment.
List 4 significant observations from this urodynamic assessment and state what you think has
happened to produce this profile.
(5 minutes)
Question 14
On the drawing of a nephron label the segments indicated and indicate where the 4 cells types
would be located.
(5 minutes)

END OF SECTION C

END OF EXAMINATION
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