Confusing question answers

[leviathan]

I do not agree with the answers posted for these questions. I figured I'd throw 'em out here and see if we can all disagree in unison!

 

1. What is the most common cause of idiopathic glomerulonephritis?

a. Post-streptococcal glomerulonephritis

b. Essential HTN

c. Membranous nephropathy

d. Acute tubular necrosis

e. IgA Nephropathy

 

2. What illness commonly presents with arthralgias, purpura, abdominal pain, microscopic hematuria, mild proteinuria, azotemia, and proliferative glomerulonephritis characterized by IgA deposits?

 

a. Henoch-Schonlein purpura

b. Membranous nephropathy

c. Acute tubular necrosis

d. Hyperkalemia

e. Multiple myeloma

 

3. A patient presents with a decreased level of consciousness and visual difficulties. Blood work reveals an anion gap of 22 and an osmolar gap of 24. Which of the following is most likely responsible?

a. Ethanol

b. Salicylates

c. Renal tubular acidosis type I

d. Methanol

e. Diabetic ketoacidosis

 

4.In acute pyelonephritis, which of the following is most commonly associated with bacteremic spread from a distant focus?

a. Escherichia coli

b. Proteus sp.

c. Staphylococcus aureus

d. Serratia sp.

e. Enterococcus sp.

[Fred]

Well, what are the answers you don't agree with???

 

Here is my take.

 

1. Poorly written question: something idiopathic does not, by definition, have a known cause. But nonetheless, I see where they are going.

I also assume we're talking adult medicine here...

The most common cause is Berger disease so my answer is E: IgA nephropathy.

 

2. This is classic Henoch-Schonlein so the answer is A.

A case could be made for E, albeit not a very strong case.

Amyloidosis from MM could explain the symptoms but they say "commonly" and you wouldn't see IgA deposits with MM.

 

3. Visual difficulties with ingestion of something in a question usually points towards methanol. The elevated anion gap and osmolar gap are also consistent with methanol. Ethanol also elevates the osmolar gap but wouldn't cause a rise in the anion gap, except associated with ketoacidosis... My answer here is still D, methanol.

 

4. I'm not sure I understand the meaning of the question.

Are they asking which of these cause APN when already bacteremic or which one is associated with bacteremia spreading from the kidney.

In the first case (bacteremic spread to the kidneys): C, S. aureus

In the other one (APN, then bacteremia): A, E.coli

 

 

Really curious to see what the posted answers were!!

[leviathan]

Well, what are the answers you don't agree with???

I'm trying not to reveal my answers so I don't bias anyone. Anyone else? Otherwise I'll post their "answers" tomorrow.

[cheech10]

Agree with Fred.

 

1 - E

2 - A

3 - D

4 - C

[leviathan]

Haha, all right. I agree with you guys on 3/4. They were trying to say the answers were the following:

 

#1 IgA Nephropathy (i'll get back to this in a second)

#2 Multiple myeloma (what?!)

#3 RTA Type 1 (with an anion gap and visual difficulties?!)

#4 Enterococcus (bloodborne dissemination?!)

 

As for #1, because it wanted idiopathic, I thought membranous glomerulonephritis would be the answer as it often has no identifiable cause. IgA nephropathy pretty much by definition has a known cause does it not?

 

PS - These questions and answers are from Toronto Notes. I'm not sure if there is any copyright issue but if there is, mods can remove it.

[Fred]

yeah...TO notes sucks sometimes...

 

I stand by my answers...

1. in adults IgA nephropathy is the most common. I checked one or two references and they said: the most common form of idiopathic GN is IgA...idiopathic referring to why the IgA deposits occur, I guess...

Membranous GN is the most common in kids...

 

2. MM? what?....it's textbook Henoch-Shonlein...

MM commonly presents with symptoms of anemia, bone pain, symptoms of hypercalcemia, tubular disease is more common than glomerular disease for renal involvment...

 

3. serioulsy....what gives?????

type 1 RTA results in a normal a-gap acidosis. And visual difficulties ??? the person who wrote this QandA clearly had some..and then some more..

 

4. Microbiology is so variable even from hospital to hospital so I'm gonna let this one pass....

 

 

I didn't use the questions in TO Notes because of this...

Guess the TO bunch aren't so bright afterall....just kidding...