Nephrology exam experience

So I had nephro exam yesterday. It was very frustrating, not because of the exam itself but because of the lack of information and organization.

According to Neptun, the exam starts at 8:30 at the 2nd department of internal medicine. At 8:20, we enter and ask the secretery where to wait. She said that we should wait outside the entrance to the “A” building, at the lower level. At around 8:45, an employee comes and gets the first student. The first students is inside at least 45 minutes, which of course worries us greatly.

However, turns out that their examiner dr. Tibor Kovács, had been late. The exam itself lasted just 5 minutes (short questions and answers), the remaining time was just waiting for him. The next student goes in, and the same happens. They’re inside for 30 minutes, 25 minutes of which were waiting for the examiner (again), and 5 minutes of exam.

However, there were two examiners for English program that day, dr. Kovács and dr. Botond Csiky. Csiky examined Hungarian students too and no one told us that he would examine some of us international students as well. Turns out that three of us were part of dr. Csiky’s exam list, but no one had told us.

I wait and wait, and at around 10:30 I get a message from a kind international student, who were wondering if I was going to show up for my nephro exam today, which made me very confused of course, as I was waiting where I’d been told to. He tells me that I should come up to the third floor and wait for my exam there, where dr. Csiky was examining other students. Turns out my turn had already passed but no one had thought of checking if I was waiting outside the entrance.

Anyway, after two students before me finish their exams, I go in to do my exam. He tells me to talk about acute nephritis. At first I didn’t understand what he meant, but soon I understood that he meant tubulointerstitial nephritis so I start talking about that.

I say that it’s the inflammation of the tubules and interstitium, causing a decline in kidney function. I mention the most common causes, the clinical features, the findings in the blood and urine, and the treatment. Basically most of what I’d written in my topic.

He then says “okay, talk about poststreptococcal glomerulonephritis”. I begin by saying that it’s not as common nowadays because of antibiotics, but that it can occur after other infections, which is becoming more common. He asks me where the infection can be. I say tonsillitis or pharyngitis, and he says “and?”. “Rheumatic fever?”. “Not really. A skin infection”. Of course. Should have thought about that.

I continue, talking about nephritic syndrome, how it can be diagnosed, the antistreptolysin (ASO) titer, etc. He asks me about the treatment. “You treat the underlying infection with antibiotics”, I reply. “And?”. “I’m not sure?”

“And then you wait.”

Okay, I guess?

He then says that it was excellent and that I get a 5. It probably took less than 4 minutes. It was a nice experience, although he did not really give any feedback underway, which was a bit worrying.

My next exam is anaesthesia and intensive care on Tuesday.

2 thoughts on “Nephrology exam experience”

  1. Out if pure curiosity how high should blood pressure (hypertension) be to cause chronic kidney failure and how many years of hypertension to cause ckd approx ?

    And is it possible to have normal gfr but proteinuria ? Thanks

    1. I don’t think there is a limit to how severe hypertension must be for kidney injury to occur, but I assume the risk increases with the severity. It does take many years for CKD to develop.

      It is possible to have normal GFR but proteinuria. This is less common but can be present in for example IgA nephropathy.

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