1. A 67-year-old man with Wegener's granulomatosis, previously treated with cyclophosphamide, is currently on azathioprine.
His vasculitis is well controlled. He was found to have microscopic haematuria on two occasions a month apart. Urine culture showed no growth. There is no proteinuria, abdominal pain, and a renal ultrasound is normal.
He has normal inflammatory markers and stable urea electrolytes and creatinine over the last year.
What is the next step in his management?
(Please select 1 option)
A. Cystoscopy
B. Prolonged urinary culture
C. Renal angiogram
D. Renal biopsy
E. Urine culture for TB
Answer: A
Cyclophosphamide causes haemorrhagic cystitis, and increases the risk of developing bladder cancer in the future. The risk increases with increasing doses of cyclophosphamide.
Renal biopsy is not indicated as there is no evidence of active renal vasculitis - normal inflammatory markers, stable creatinine.
Renal angiogram is used to investigate renal artery stenosis.
Renal tract TB is unlikely in the absence of proteinuria
Monday 12 March 2012
Thursday 8 January 2009
AKT Questions
1. A 33- year-old woman presents with a 6-month history of a progressively painful area in the upper outer quadrant of her right breast. She has been on oral contraception intermittently for nearly 15 years. Clinically, there is as area of moderate nodularity in the right breast but no discrete lesion is palpable. Select the single most likely diagnosis from the list below?
A. benign breast change
B. breast carcinoma
C. fibroadenoma.
D. haematoma
E. mondor's disease.
Answer: A
Painful nodularity of the breast (unilateral or bilateral) is characteristic of benign breast change (sometimes referred to as "abnormalities of normal development and involution" or ANDI, "fibroadenosis" or "fibrocystic changes"). It affects 1/3 of all women and often causes anxiety in premenopausal women. The symptoms can be cyclical and evening primrose oil provides symptomatic relief.
2. Which of the following statements about Crohn's disease is true?
A. active disease should be treated initially with mesalazine
B. antimycobacterial therapies are an effective treatment if used early
C. anti-TNF-α therapy is associated with remission rates of 80%.
d. Crohn's disease only affects the colon
E. patients should be referred early for surgery.
Answer: B
Mesalazine is no better than placebo in the management of active disease. Its main use is in prevention of relapse after surgery. Infliximab is an effective anti-TNF-α therapy in up to 80% of cases, but only 24% are steroid free. Surgery should be reserved for patients who do not respond to steroids, Methotrexate or Infliximab. Antibiotics should only be used for septic complications and perianal disease. Crohn' disease can affect any part of the GI tract from the mouth to the anus.
A. benign breast change
B. breast carcinoma
C. fibroadenoma.
D. haematoma
E. mondor's disease.
Answer: A
Painful nodularity of the breast (unilateral or bilateral) is characteristic of benign breast change (sometimes referred to as "abnormalities of normal development and involution" or ANDI, "fibroadenosis" or "fibrocystic changes"). It affects 1/3 of all women and often causes anxiety in premenopausal women. The symptoms can be cyclical and evening primrose oil provides symptomatic relief.
2. Which of the following statements about Crohn's disease is true?
A. active disease should be treated initially with mesalazine
B. antimycobacterial therapies are an effective treatment if used early
C. anti-TNF-α therapy is associated with remission rates of 80%.
d. Crohn's disease only affects the colon
E. patients should be referred early for surgery.
Answer: B
Mesalazine is no better than placebo in the management of active disease. Its main use is in prevention of relapse after surgery. Infliximab is an effective anti-TNF-α therapy in up to 80% of cases, but only 24% are steroid free. Surgery should be reserved for patients who do not respond to steroids, Methotrexate or Infliximab. Antibiotics should only be used for septic complications and perianal disease. Crohn' disease can affect any part of the GI tract from the mouth to the anus.
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