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Nephrology minimals, multiple choice
1. In obstructive uropathy A. The presence of polyuria rules out obstruction. B. The absence of hydronephrosis on ultrasound examination rules out urinary tract obstruction. C. Infection is a frequent complication. D. Hypertension is uncommon. E. Renal tubular acidosis (RTA), type IV, may occur. - ✔ce 2. Membranous nephropathy A. May occur as a result of a systemic illness or be a primary (intrinsic) disorder B. Merits an evaluation for malignancy when found in a patient older than 50 years C. Infrequently improves without treatment D. Does not recur in the transplanted kidney E. Is the most common cause of idiopathic nephrotic syndrome in adults - ✔ab 3. Features of magnesium depletion include A. Hypokalemia B. High serum parathyroid hormone levels C. Prolongation of the PR and QT intervals D. Amelioration of cardiac toxicity of cardiac glycosides E. Can occur with aminoglycoside administration - ✔acde 4. Which of the following statements is/are true about the renal hypoperfusion syndromes?
A. Salt avidity and hyperreninemia are usually observed. B. Effective circulating volume has a greater effect on systemic BP than does renin secretion in the setting of renal hypoperfusion. C. Occlusive disease causes renal hypoperfusion, elevated renin secretion, and hypertension in the setting of a normal effective circulating volume. D. Unilateral renal occlusive disease is not associated with azotemia if the contralateral kidney maintains normal function. E. Nephrotoxic agents (cyclosporine, amphotericin B, radiocontrast dyes) can cause acute renal vasoconstriction with renal hypoperfusion, increased salt avidity, and azotemia. - ✔abcde 5. Normal pregnancy is associated with: but GFR and renal blood flow does increase In the answers they said it was false A. Increased glomerular filtration rate and renal blood flow B. Respiratory alkalosis C. Hypouricemia D. Mild non anion gap-type metabolic acidosis E. Slight increase in BP - ✔bc 6. Which of the following statements is/are true concerning creatinine clearance? A. Creatinine clearance normally exceeds "true" measurements of GFR. B. Cimetidine and trimethoprim can block the secretory component of creatinine clearance. C. Urinary creatinine excretion is primarily influenced by the muscle mass in the steady state. D. The secretory component of creatinine excretion may become more apparent when serum creatinine concentrations are elevated. E. Creatinine clearance is linearly related to the serum creatinine concentration. - ✔abcd
✔abe 10. Which of the following statements is/are true concerning the anemia of end-stage renal disease (ESRD)? A. Erythropoietin deficiency is primarily related to the loss of renal mass. B. Iron deficiency and hyperparathyroidism are important causes of resistance to erythropoietin response. C. Overcorrecting the hematocrit (i.e., above 36%) can increase mortality in this population of patients. D. Increased release of oxygen from hemoglobin is an important factor in the adaptation to anemia in chronic renal failure. E. Erythropoietin reduces blood transfusion requirements and will reduce the incidence of iron-overload and transfusion-related infections in the ESRD population. - ✔abcde 11. Which of the following statements is/are true concerning chronic ambulatory peritoneal dialysis? A. Relatively reduced peritoneal surface limits the usefulness of this approach in children. B. Insulin-dependent diabetics have severe problems with glycemic control because of the large amounts of glucose absorbed from the peritoneal dialysate. C. Dialysis clearance of large molecules (molecular weight >800 kD) is enhanced with peritoneal dialysis. D. The overall dialysis efficiency is similar for hemodialysis and peritoneal dialysis if the duration of dialysis is considered (12 hours/week for hemodialysis vs. continuous dialysis with the peritoneal approach). E. Peritonitis is a common problem with continuous ambulatory peritoneal dialysis and is usually caused by gram-negative organisms. - ✔cd 12. Which of the following statements is/are true concerning tissue typing and renal transplantation? A. Siblings with the same biologic parents have a 25% chance of being human leukocyte antigen (HLA) incompatible.
B. By definition, a true biologic parent shares 1 HLA haplotype with each child. C. In vitro cytotoxicity tests do not predict rejection in the transplant setting. D. MHC class II antigens, expressed on B lymphocytes and vascular endothelial cells, are pivotal in the rejection process. E. Mandatory sharing of six antigen-matched cadaver kidneys with the best matched recipient will dramatically improve graft survival for nearly all transplant recipients. - ✔abd 13. Which of the following statements is/are true concerning cyclosporine? A. This agent has dramatically improved renal allograft survival. B. The use of more specific, targeted immunosuppressants (cyclosporine, OKT3) has reduced the incidence of opportunistic infections. C. Cyclosporine markedly slows the recovery from acute tubular necrosis (ATN) and potentiates the adverse effects of other nephrotoxic agents. D. Side effects of cyclosporine include nephrotoxicity, tremor, hyperglycemia, hypertension, and hyperkalemia. E. Calcium-channel blockers, including verapamil and diltiazem, increase serum concentrations of cyclosporine. - ✔abcde 14. Which of the following statements about membranoproliferative glomerulonephritis (MPGN) is/are true? A. MPGN does not recur after renal transplantation. B. This clinico-pathological entity occurs primarily in young adults. C. Hypocomplementemia may be severe. D. MPGN may be a primary (intrinsic) renal lesion or may occur in systemic illnesses, including hepatitis B antigenemia and other infections and systemic lupus erythematosus. E. The incidence of primary (intrinsic) MPGN is increasing. - ✔bcd 15. Which of the following statements about hemolytic-uremic syndrome (HUS) is/are true?
B. Normal-sized kidneys C. Anemia out of proportion to azotemia D. Sterile pyuria E. Papillary necrosis - ✔cde
- A 47 -year-old man has an excretory urogram for investigation of microscopic hematuria discovered on a routine urinalysis. He is apparently healthy and entirely without complaints. Kidneys are of normal size, with calcification of and collection of dye in dilated medullary structures. Serum electrolytes, blood urea nitrogen (BUN), creatinine, calcium, phosphorus, and uric acid are normal. Creatinine clearance is 103 mL/minute. Urinalysis reveals rare red blood cells and no protein. Which of the following is/are true of this patient? A. There is a significant chance that symptomatic renal stones will develop. B. There is a significant chance that he has hypercalciuria. C. He is likely to have impaired urine concentrating ability. D. His condition is likely to progress gradually to chronic ESRD. E. His children each have a 50% chance of experiencing the same condition. - ✔abc 20. A 32-year-old man has a 15-year history of diabetes; serum creatinine is 200 μmol/L. A diagnosis of diabetic nephropathy is established by renal biopsy. Which of the following is/are true of this patient? 1.(A) Angiotensin-converting enzyme (ACE) inhibitors are unlikely to help this condition at this time. 2.(B) He has a less than 30% chance of having hypertension at this time. C. He has a 50% chance of having the nephrotic syndrome at this time. D. Because of his age, nephropathy is likely to be his only major organ system diabetic complication to date. E. He is likely to experience ESRD requiring dialysis within the next 4 years. - ✔e
- A 57-year old woman presents to you for evaluation of malaise and edema. She has been previously healthy and takes no medicines. A comprehensive physical examination, including routine laboratory tests, was pelformed 3 months ago and was entirely normal. The patient reports these symptoms for a few weeks. She has noted no change in her urine volume but does note nocturia. Physical examination shows a mildly ill woman with hypertension and pedal edema. No other remarkable physical findings were noted. Laboratory studies show the following: Serum electrolytes Sodium 138 mEq/L Potassium 5.3 mEq/L Chloride 100 mEq/L Bicarbonate 18 mEq/L BUN 10 mmol/L Serum creatinine 440 μmol/L Hematocrit 31% WBC 9700/mm Erythrocyte sedimentation rate 40 mm./hour Urinalysis shows pH 5.5, 2+ protein, 10 to 20 RBCs/high power field (HPF), and rare RBC casts. Antinuclear antibodies, total hemolytic complement (CH5o), anti-str - ✔e
- A 57-year old woman presents to you for evaluation of malaise and edema. She has been previously healthy and takes no medicines. A comprehensive physical examination, including routine laboratory tests, was pelformed 3 months ago and was entirely normal. The patient reports these symptoms for a few weeks. She has noted no change in her urine volume but does note nocturia. Physical examination shows a mildly ill woman with hypertension and pedal edema. No other remarkable physical findings were noted. Laboratory studies show the following: Serum electrolytes Sodium 138 mEq/L Potassium 5.3 mEq/L Chloride 100 mEq/L Bicarbonate 18 mEq/L BUN 10 mmol/L Serum creatinine 440 μmol/L Hematocrit 31% WBC 9700/mm Erythrocyte sedimentation rate 40 mm./hour Urinalysis shows pH 5.5, 2+ protein, 10 to 20 RBCs/high power field (HPF), and rare RBC casts. Antinuclear antibodies, total hemolytic complement (CH5o), anti-str - ✔d 23. Which of the following is/are true of uremic acidosis?
A. Crystals seen on urinalysis confirm their formation in the kidney. B. Treatment of all patients with renal calculi should include a high fluid intake (minimum 2 L) if tolerated. C. Hexagon-shaped crystals in the urine are always pathologic. D. Magnesium ammonium phosphate crystals (struvite) are associated with urinary tract infections with urea-splitting organisms. E. Alkalinization of the urine with potassium citrate may be effective in preventing the formation of both uric acid and calcium stones. - ✔bcde 27. Which of the following statements about autosomal-dominant polycystic kidney disease (ADPKD) is/are true? A. ADPKD is the most common hereditary disease in the United States. B. Hepatic cysts support the diagnosis of ADPKD. C. Although half of the offspring of one affected parent will inherit the gene that produces ADPKD, expression of the disease is variable. D. Renal calculi are uncommon in ADPKD. E. Microscopic and macroscopic hematuria can occur. F. The incidence of intracranial aneurysms is higher in patients with ADPKD than in the general population. - ✔abcef 28. Episodic gross hematuria may be associated with which of the following: A. IgA nephropathy B. Cyclophosphamide therapy C. Analgesic nephropathy D. Sickle-cell disease E. Henoch-Schönlein's disease - ✔abcde 29. Clinical features of the syndrome of acute glomerulonephritis include
A. Hypertension B. Hypercholesterolemia C. RBC casts in the urinary sediment D. Edema E. Hypoalbuminemia - ✔acd 30. Causes of acute glomerulonephritis associated with hypocomplementemia include A. Systemic lupus erythematosus B. Membranoproliferative glomerulonephritis C. Wegener's granulomatosis D. Infective endocarditis E. Hemolytic-uremic syndrome - ✔abd 31. Disease states associated with profound salt retention along with low fractional sodium excretion include A. Acute glomerulonephritis B. Acute tubular necrosis C. Acute interstitial nephritis D. Hepatorenal syndrome (HRS) E. Hypovolemic shock - ✔ade 32. Common causes of ATN are A. ß-lactam antibiotics B. Aminoglycoside antibiotics C. Cholesterol embolic disease
- A 43-year-old man experienced cellulitis of his left lower extremity but resisted medical evaluation for nearly 10 days. When it did not improve, he saw his physician, who admitted him to the hospital. His admission serum creatinine was 100 μmol/L. He was treated with a 2-week course of 1V antibiotics that consisted of nafcillin, clindamycin, and gentamicin. Ten days into this treatment, a serum creatinine is obtained and is 320 μmol/L Renal ultrasound showed normal-sized kidneys without hydronephrosis. Possible causes of this patient's acute renal failure include A. ATN B. Acute glomerulonephritis C. Allergic interstitial nephritis D. A, B, and C E. Only A and C - ✔d
- A 43-year-old man experienced cellulitis of his left lower extremity but resisted medical evaluation for nearly 10 days. When it did not improve, he saw his physician, who admitted him to the hospital. His admission serum creatinine was 100 μmol/L. He was treated with a 2-week course of 1V antibiotics that consisted of nafcillin, clindamycin, and gentamicin. Ten days into this treatment, a serum creatinine is obtained and is 320 μmol/L Renal ultrasound showed normal-sized kidneys without hydronephrosis. On further evaluation, he was found to have a BP of 160/95, a decrease in urine output to less than 30 mL/hour, and a urinalysis that showed 2 + protein, 2 + hemoglobin, RBCs, and RBC and tubule epithelial cell casts. On the basis of these findings, the MOST likely diagnosis is: A. Gentamicin nephrotoxicity B. Post-infectious acute glomerulonephritis C. Hypersensitivity reaction to a ß-lactam antibiotic - ✔b 38. True statements regarding poststreptococcal glomerulonephritis include: . A. Serum complement, C3, and total hemolytic complement are usually low.
B. Poststreptococcal acute glomerulonephritis has an excellent prognosis for recovery. C. Glomerulonephritis can develop after either skin or pharyngeal streptococcal infections. D. A, B, and C E. Only A and C - ✔d 39. The MOST common intrinsic (primary) glomerular lesion is: A. Anti-glomerular basement membrane (GBM) glomerulonephritis B. Membranoproliferative glomerulonephritis C. Amyloidosis D. IgA nephropathy E. Focal and segmental glomerulosclerosis - ✔d
- A 45-year old black man presents with hilar adenopathy, pulmonary infiltrates, and erythema nodosum. On transbronchial biopsy, he is found to have noncaseating granulomas. Special stains of the tissue reveal no organisms. Potential clinical renal manifestations in this patient may include: A. Hypercalcemic nephropathy B. Hyposthenuria C. Granulomatous infiltration of the renal interstitium D. Immune complex-mediated glomerulonephritis E. A, B, C, and D F. None of the above - ✔e 41. The hypercalcemia of sarcoidosis A. Reflects extrarenal hydroxylation of 25-hydroxy-vitamin D
B. Is rarely bilateral C. Does not occur in native kidneys in renal transplant recipients D. Infrequently metastasizes unless the tumor size is >3cm E. None of the above - ✔d
- A 67-year-old white man is referred to you for evaluation of renal failure. Evaluation includes the following laboratory values: Serum laboratories Sodium 135 mEq/L Potassium 4.2 mEq/L Chloride 109 mEq/L Bicarbonate 24 mEq/L Glucose 5.6 mmol/L Calcium 2.7 mmol/L Phosphorus 1.4 mmol/L Albumin 4.0 g/dL Urine chemistries Creatinine clearance 55 mL/minute Urine protein 6.2 g/day Hematocrit 29% On the basis of data presented, the patient appears to have A. Acute glomerulonephritis B. Acute vasculitic lesion C. Reflux nephropathy D. Athero-embolic renal disease E. Nephrotic syndrome F. None of the above - ✔f
- A 67-year-old white man is referred to you for evaluation of renal failure. Evaluation includes the following laboratory values: Serum laboratories
Sodium 135 mEq/L Potassium 4.2 mEq/L Chloride 109 mEq/L Bicarbonate 24 mEq/L Glucose 5.6 mmol/L Calcium 2.7 mmol/L Phosphorus 1.4 mmol/L Albumin 4.0 g/dL Urine chemistries Creatinine clearance 55 mL/minute Urine protein 6.2 g/day Hematocrit 29% Tests to perform at this point to make a diagnosis might include A. Urine immunofixation electrophoresis B. Bone marrow aspiration and biopsy C. Serum immunofixation electrophoresis D. Urine protein electrophoresis E. A, B, and C F. A, B, C, and D - ✔e
- A 67-year-old white man is referred to you for evaluation of renal failure. Evaluation includes the following laboratory values: Serum laboratories Sodium 135 mEq/L Potassium 4.2 mEq/L Chloride 109 mEq/L Bicarbonate 24 mEq/L Glucose 5.6 mmol/L Calcium 2.7 mmol/L Phosphorus 1.4 mmol/L Albumin 4.0 g/dL Urine chemistries Creatinine clearance 55 mL/minute Urine protein 6.2 g/day Hematocrit 29%
Hemoglobin trace Sediment unremarkable Urine output over the past 12 hours was 60 mL. Which study do you perform now to assist with the diagnosis? A. Renal ultrasound B. Kidney biopsy C. Selective renal arteriogram D. 24-hour urine for protein and immunofixation electrophoresis E. None of the above - ✔a
- A 50-year-old woman presents with an abrupt decline in urine output and renal failure. Her only significant medical history is a hysterectomy 1 month earlier and chronic migraine headaches controlled with methysergide. She takes no other medications. The following data were obtained: Serum laboratories Sodium 130 mEq/L Potassium 6.2 mEq/L Chloride 99 mEq/L Bicarbonate 16 mEq/L Glucose 5.6 mmol/L Calcium 2.0 mmol/L Phosphorus 2.1 mmol/L Albumin 4.0 g/dL Creatinine 280 μmol/L Urine analysis PH 1. Protein trace Hemoglobin trace Sediment unremarkable Urine output over the past 12 hours was 60 mL. The patient receives treatment for the hyperkalemia. The fractional excretion of sodium was 1.3%. Repeat urinalysis was unchanged, and renal function did not improve with gentle hydration. A renal ultrasound demonstrated echogenic, normal-sized kidneys with minimal hydronephrosis bilaterally. No stones were ev -
✔b
- A 50-year-old woman presents with an abrupt decline in urine output and renal failure. Her only significant medical history is a hysterectomy 1 month earlier and chronic migraine headaches controlled with methysergide. She takes no other medications. The following data were obtained: Serum laboratories Sodium 130 mEq/L Potassium 6.2 mEq/L Chloride 99 mEq/L Bicarbonate 16 mEq/L Glucose 5.6 mmol/L Calcium 2.0 mmol/L Phosphorus 2.1 mmol/L Albumin 4.0 g/dL Creatinine 280 μmol/L Urine analysis PH 1. Protein trace Hemoglobin trace Sediment unremarkable Urine output over the past 12 hours was 60 mL. A CT scan of the abdomen demonstrated mild hydronephrosis of both kidneys with mildly dilated proximal ureters that were deviated medially and appeared to be extrinsically compressed at the level of the mid to lower ureter. The most likely diagnosis is: A. Obstruction related to kidney stones bilaterally - ✔c
- A 25-year-old man presents with a history of upper respiratory tract symptoms, followed by streaky hemoptysis and malaise. His BP is 140/90, and he has trace lower extremity edema. Pertinent laboratory results include a serum urea nitrogen of 14 mmol/L and creatinine of 320μmol/L. Urinalysis shows 2+ protein, 3+ blood, five to 10 RBCs/HPF, and rare RBC casts. Chest roentgenogram demonstrates opacities in both lung fields. The most likely diagnosis at this point is A. Wegener's granulomatosis B. Anti-GBM disease
