Medical intern examination

Acute glomerulonephritis is characterized by hematuria(65%), hypertension(75%), and edema(50%). The hematuria is usually grossly evident as tea-colored or cola-colored urine. In some children, however, the hematuria may be microscopic only. This clinical syndrome can be considered to present in many ways: acute nephritis with no or mild renal failure and acute nephritis with rapidly progressive renal failure or nephritis-nephrotic or subclinical form. DISEASES THAT USUALLY PRESENT AS ACUTE GLOMERULONEPHRITIS Acute poststreptococcal glomerulonephritis  Acute poststreptococcal glomerulonephritis (APSGN) is a common form of glomerulonephritis in childhood  Although poststreptococcal nephritis may happen at any age, the peak incidence occurs at age 7 years, with a slight predominance among boys. It is uncommon before age 3 years and in adults ETIOLOGY Poststreptococcal nephritis is the consequence of the host's immune response to a nonrenal infection with group...

EPIDEMIOLOGY Approximately 8% of girls and 2% of boys have a UTI by 11 years of age. In infants, boys are affected more than five times as often as girls.  After 12 months of age, UTI in healthy children usually is seen in girls. A short urethra predisposes girls to UTI. Uncircumcised male infants are at 5- to 12-fold increased risk for UTI compared with circumcised male infants. Obstruction to urine flow and urinary stasis is the major risk factor and may result from anatomic abnormalities, nephrolithiasis, renal tumor, indwelling urinary catheter, ureteropelvic junction obstruction, megaureter, extrinsic compression, and pregnancy. Vesicoureteral reflux, whether primary (70% of cases) or secondary to urinary tract obstruction, predisposes to chronic infection and renal scarring. Scarring also may develop in the absence of reflux The urinary tract and urine are normally sterile. Escherichia coli, ascending from bowel flora, accounts for 90% of first infections and 75% o...

Q1: Infection with which of the following is most likely to change to a chronic diarrhea? Shigella flexneri. Salmonella enteritidis. Yersinia spp. C. difficle. +++ Campylobacter jejuni. Q2: The following are features of small bowel diarrhea, except: Large volume stool. Central abdominal pain. Tenesmus. +++ Absence of blood in stool. Abdominal distension. Q3: The following are possible causes of malabsorption syndrome, except: Giardiasis. Chronic pancreatitis. Gluten induced enteropathy. Amoebiasis. +++ Prolonged obstructive jaundice. Q4: Which of the following therapeutic options takes the first priority in management of a patient with severe diarrhea? Giving a fluid challenge as soon as you assess the patient. +++ Immediate antibiotic therapy. Antispasmodics to relieve abdominal discomfort. Agents to suppress diarrhea. Sending a sample of stool for examination.

A 45 -year -old patient on hemodialysis has noted that his blood pressure is difficult to control. He is on regular erythropoietin, ferrous sulfate, vancomycin, and vitamin D. His blood pressure is 180 / 99 mm Hg. Which of the following is the most likely cause for the worsening control of his blood pressure? A. Erythropoietin B. Ferrous sulfate C. Vancomycin D. Vitamin D E. Uremia The correct answer is (A) Erythropoietin The patient most likely has a worsening of his blood pressure due to erythropoietin. This is seen in about 33 % of dialysis patients. A 36 year old asthmatic man on salbutamol 100 mcg inhaler once a day. Now he is concerned that his symptoms are worsening and his asthma is not as well controlled. Which single feature from the history would most support the man's concerns?  A -Chest tightness is brought on by cold weather.  B -Having to use the salbutamol inhaler every day.  C -Most breathless early in the morning.  D -Walking at night wi...

Q1: A 35 -year -old male patient presented with history of fever, fatigue, and joint pain for three weeks duration. He gave history of dental extraction two months ago. On examination: He looked ill, cardiac auscultation revealed an apical pan systolic murmur radiated to left axilla. The spleen was just palpable. A. What is the likely diagnosis and the underlying cardiac valve lesion? B. Mention 2 important investigations to confirm the diagnosis of his current ill ness. Comment on the expected results. C. What is your initial treatment of this patient? Answer: A. infective endocarditis, mitral regurgitation B. two important investigation: 1. Blood culture (3 -6 sets of blood culture ) should be taken prior to commencing. Aseptic technique is essential. Aerobic and anaerobic cultures are required. 2. E chocardiography: particularly trans -oesophageal for detecting and following the progression of vegetations, for assessing valve d amage and for detecting ab...