AFRAN Monthly Quiz - April 2022 - English Version
Quiz developed by:
Mohammed Abdel Gawad (Egypt), Mazhar Amirali (Tanzania), James Okpiri (Nigeria), Niakhaleen Keita (Senegal), Ala Lasfer (Algeria)


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Q1- A 56-year-old woman presented with swollen ankles. She had a 3-year history of back, knee and ankle pains for which she was taking ibuprofen 400 mg three times daily. There was no other significant past medical history and she was not taking any other regular medication. On examination, she was obese. Her BP was 164/84 mmHg. There was bilateral pitting oedema of the ankles, but no other abnormalities. Urinalysis showed protein 4+.Investigations:serum creatinine130 µmol/L (60–110)serum albumin26 g/L (37–49) urine albumin:creatinine ratio496.0 mg/mmol (<3.5) ultrasound scan of kidneys normal A renal biopsy was performed with difficulty because of her build. Renal tissue was present only in the sample sent for immunofluorescence (IF). The result of IF for IgG is positive. IF for complement C3 yielded a similar result. IF for other immunoglobulins and complement components was negative. What is the most likely diagnosis? *
1 point
Q2- A 58-year-old man was found to have proteinuria. He had been treated for colonic cancer 1 year previously. He had been adopted and was unaware of his family history. On examination, his BP was 140/98 mmHg. Urinalysis showed protein 3+. Investigations: serum sodium 134 mmol/L (137–144), serum potassium 4.3 mmol/L (3.5–4.9), serum urea 6.0 mmol/L (2.5–7.0), serum creatinine 125 µmol/L (60–110), serum albumin 34 g/L (37–49), urine protein: creatinine ratio 202 mg/mmol (<30). A renal biopsy was performed. What histopathological abnormality is most likely to be detected? *
1 point
Q3- A 34-year-old woman presents  with a  2-week history  of  increasing leg  swelling. There  are  no preceding  symptoms  and there  is  no past  medical  or  drug  history  of note. She  then develops  hand and facial  swelling. She  has  no rash, joint  pains  or  other  symptoms. On  examination she  has gross  pitting  oedema of  both legs, ascites  and facial, hand and sacral  oedema. Investigations  include  a  chest  X-ray  (CXR)  demonstrating  small bilateral pleural effusions. A  urine  dipstick shows  4+  proteinuria  and no blood. A  24-hour  urine  collection shows  3.8 g/24-hours  proteinuria. Her  serum  creatinine  is  66 μmol/l, albumin 16 g/l  and glucose  4  mmol/l. Her  cholesterol  is  10 mmol/l.   What  is  the  most  likely  diagnosis *
1 point
Q4- A 36–year-old banker  presents  to the clinic with a  3-week history of    leg  swelling. The  rest  of  the  history  is  unremarkable.  He  is  on no medication. Examination  confirms  pitting  oedema.  Blood pressure  is  128/70 mmHg with no postural  drop.  Investigations  include:   Sodium 121 mmol/l, Potassium 4.6 mmol/l, Urea 4.4 mmol/l, Creatinine 90 µmol/l, Albumin 17 g/l, Glucose 4.6 mmol/l, Plasma  osmolality 280 mOsmol/kg, 24 hour  urinary  protein 6.2 g. What  investigation  would  best  explain  this  patient’s  hyponatraemia? *
1 point
Q5- A 72-year-old man with hypertension, diabetes, and chronic kidney disease stage 5 is initiated on hemodialysis due to volume overload that is refractory to diuretic agents. Ten minutes into his first treatment, he reports generalized pruritus, dyspnea, and chest pain. He is also noted to have audible wheezing. His blood pressure is 85/46 mmHg (compared to 145/90 mmHg prior to the start of dialysis). A dialyzer reaction is suspected.                                                                      What are the appropriate next steps in the management of this patient? *
1 point
Q6- A 72-year-old woman with hypertension, diabetes, chronic kidney disease, and history of ischemic stroke is initiated on dialysis for nausea, decreased appetite, and hyperkalemia. Her predialysis laboratory values are notable for serum creatinine, 910 umol/L; blood urea nitrogen, 62 mmol/L; sodium, 125 mEq/L; potassium, 7.5 mEq/L; bicarbonate, 11 mEq/L; and glucose, 5.4 mmol/L. The dialysis prescription calls for a treatment duration of 2 hours, a blood flow of 400 mL/min, a dialysate flow of 800 mL/min, a standard sodium dialysate, and a target ultrafiltration of 2 liters. A low-efficiency dialyzer is used. Her dialysis is uneventful until the end of her treatment, when she reports a new onset of headache. Her blood pressure is 148/93 mmHg, which was stable throughout the treatment. She subsequently develops a seizure. Dialysis is stopped immediately. How could the prescription have been modified to reduce the risk of dialysis disequilibrium syndrome? *
1 point
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