2011 module exam Flashcards
A 12-yr old boy presents with proteinuria and hematuria associated with periorbital puffiness, ankle edema, scrotal edema, and basal crepitations in the lungs. What is the most likely diagnosis?
- Post-strept glomerulonephritis
- IgA nephropathy
• Post-strept glomerulonephritis
Note: due to the presence of extensive edema and age, post-strept GN is thought to be the correct answer. The picture shows an actual case of post-strept GN; please note the age and presentation.
What structure is formed by the union of the major calyces?
Renal pelvis
What structure can be injured during resection of the kidney?
• Ilioinguinal nerve
What provides parasympathetic innervation for micturition?
• Pelvic splanchnic
What acts as a physical barrier in the glomerular basement membrane?
- Lamina Densa of basement membrane
- Lamina rara of basement membrane
- slit diaphragm
• Lamina Densa of basement membrane
What results from the failure of the collecting ducts to fuse with the tubular system of the nephron (renal vesicle)?
- Polycystic kidney
- Agenesis of the kidney
• Polycystic kidney
Which embryological structure will form the median umbilical ligament?
• Urachus
At which vertebral level are the horizontal lines of kidney Morris parallelogram drawn?
• T11 and L3
What are the extensions of the renal cortex into the renal medulla called?
• Renal columns
Which of the following describes the abnormality in horseshoe kidney?
• Fusion of the inferior poles of both kidneys
How does ADH help concentrate the medullary interstitium?
- Reduces blood flow in the vasa recta
- Increases permeability of CD to water
• Reduces blood flow in the vasa recta
Note: increasing the permeability of CD to water would concentrate urine not the interstitium
What increases the filtration through the glomerulus?
- Increased protein leakage
- Mesangial contraction
• Increased protein leakage
Note: proteins would pull water along with them increasing filtration
What increases potassium secretion in the distal tubule?
• Opening of ROMK channels
If someone is placed on a low potassium diet, he will probably develop hypokalemia. What would explain that?
• The kidney can’t reduce potassium excretion to less than 1%
Where does the largest drop in hydrostatic pressure take place in the kidney?
• Afferent arteriole
Which of the following increases GFR given all other factors are held constant?
• Increase in cardiac output
What stimulates renin release?
- Hypotension
- Alpha receptor agonist
- Beta antagonist
• Hypotension
What results in an increase in ANP synthesis and release?
Stretch of volume atrial receptors
Which of the following occurs in volume contraction?
• Increased activity of Na/K ATPase
Which of the following has the highest clearance?
- Penicillin
- Creatinine
- Urea
• Penicillin
Note: creatinine is filtered and slightly secreted while penicillin is filtered and completely secreted resulting in a higher clearance from blood
What characteristic facilitates diversion of blood from kidney to vital organs?
- Increased sympathetic outflow severely reduces blood flow to the kidney
- Renal blood flow is 40% of resting cardiac output
• Increased sympathetic outflow severely reduces blood flow to the kidney
Why would renal ischemia cause large rise in urea?
• large amount of blood is needed to be filtered through the kidney to excrete waste products
What is the key step involved in increased hydrogen reabsorption in the proximal tubule in volume contraction?
• Conversion of angiotensin I to angiotensin II
Which of the following is true regarding the thick ascending loop of Henle?
• Sodium is reabsorbed by Na-K-C-C symporter
Which of the following is an effect of angiotensin?
• Increased peritubular oncotic pressure
What is the main absorptive pathway for potassium in the proximal tubule?
• Paracellular pathway
Which characteristic explains a constant renal blood flow despite fluctuations in blood pressure?
• RBF is autoregulated
When someone increases his sodium intake to 140 mEq/day and maintains it for few days. What is likely to occur?
- Body weight gain of 1 Kg
- Increase in mean arterial pressure
• Body weight gain of 1 Kg
Leakage of what would increase if nephrin is defective in GBM?
• Albumin
What is the filtered load of substance x if Px = 0.05 mg/ml, clearance of
inulin = 110 ml/min, and x is 60% bound to albumin?
• 2.2 mg/min
Whatisthegainoffreewaterif:Uosm=1300,Posm=270,andV= 0.6 ml/min?
- -2.3L
- 2.3L
• -2.3L
A patient comes to the clinic complaining of polyuria and polydipsia. Uosm = 72, Posm = 110, V= 6. ADH levels were not detectable. What does he have?
- Psychogenic diabetes insipidus
- Central diabetes insipidus
• Psychogenic diabetes insipidus
If a substance is freely filtered and secreted. Px = 1, RPF = 600 ml/min, GFR = 110 ml/min, and Tm = 100. What is the amount excreted?
• 210 mg/min
Which of the following is associated with increased free water clearance?
• Suppressed ADH levels
Which of the following is associated with increased hydrogen secretion in the proximal tubule in metabolic acidosis?
• Endothelin
What increases hydrogen secretion in the distal tubule?
• Aldosterone
What takes place if someone is placed on high potassium diet?
• Opening of ROMK and BK channels
Which of the following is true regarding ADH ability to concentrate urine?
• It increases permeability of IMCD to urea
How does metabolic alkalosis develop in a patient with hyperkalemia?
• Aldosterone activates K/H exchanger as well as N/H exchanger in the distal tubule
A patient suffers from a severe myocardial infarction followed by congestive heart failure where his blood was sampled. Few days later he continues to suffer from a state of severe hypoperfusion where his blood was sampled for the second time.
What do you expect to detect in the first sample?
• Elevated plasma anion gap
Note: high anion gap metabolic acidosis resulting from increased
production of lactic acid immediately after hypoperfusion of tissues
What do you expect to detect in the second sample?
• High blood concentration of uric acid
Note: the persistence of the hypoperfusion results in renal failure and accumulation of waste products including uric acid
what is the condition in a patient with:
low blood pH, high PCO2, and normal [HCO3]?
- Acute sedative overdose
- Chronic obstructive pulmonary disease
• Acute sedative overdose
Note: the lack of metabolic compensation (normal [HCO3]) indicates an acute cause of respiratory acidosis; in COPD, the compensation would be very prominent (high [HCO3])
ABG in a patient was as follows: pH is low, PaCO2 is low, [HCO3] is low, anion gap was normal. What most likely explains his condition?
• Accidental ingestion of HCL
A history of a patient was given and is indicative of metabolic alkalosis; what is true regarding the compensatory mechanisms in this patient?
• The kidney stops producing new bicarbonate
A diabetic patient who developed metabolic acidosis and went into a coma; (ABG and acid-base profile of the patient were given (on calculation, urinary anion gap yielded a value of -2, and osmolal gap was high), and urine sodium was low. What is true regarding the compensatory mechanisms of this patient?
- Ammonium excretion has largely increased
- The low urinary anion gap indicates no acid excretion
• Ammonium excretion has largely increased
Note: both answers were pretty confusing, and it was difficult to choose between them. Hence, we asked Prof. Zoran who we thought had written the question, and his explanation was as follows:
Although the urinary anion gap is low, it doesn’t necessarily indicate no acid excretion because low urine sodium results in an apparent decrease in UAG (UAG = (Na + K) – Cl). In addition, since the osmolal gap reflects the amount of ammonium excretion (NH4 = osmolal gap/2) and is found to be high, the answer highlighted above is most likely to be the correct one.
A 10-yr old boy presented with heavy proteinuria and edema. A kidney biopsy revealed a normal histology. What is expected to show ultrastructuarlly?
• Complete effacement of foot processes
A renal mass was incidentally found in an asymptomatic patient. Microscopy revealed a tumor with abundant mitochondria. What is the most likely diagnosis?
• Oncocytoma
A renal tumor showed cells with perinuclear halo. What is it most likely to be?
• Chromophobe renal cell carcinoma
Which renal tumor would show abundant mitochondria and eosinophilic cytoplasm?
• Oncocytoma
What is expected to be seen in a patient with poststreptococcal glomerulonephritis?
• Neutrophils in glomerular capillary loops
Which gene is mutated in ARPKD?
• PKHD1
A patient presents to the clinic with colic pain. An x-ray was taken which showed a radio-opacity which later was found to be a stone. What is the composition of the stone most likely to be?
• Calcium oxalate
Which of the following features characterizes yolk sac tumors?
• Schiller-Duvall bodies
Which of the following tumors is not associated with intratubular germ cell neoplasia?
• Teratoma
Which of the following tumors is associated with Peutz-Jegher’s syndrome?
• Sertoli cell tumor
ABG in a patient was as follows: pH is normal, PaCO2 is normal, [HCO3] is normal. Which statement is true?
• On calculation, anion gap is found to be elevated
A patient was admitted to the OT to undergo brain surgery where he started to hyperventilate and fell unconscious. ABG: pH is high, PaCO2 is low, [HCO3] is low. What condition did he develop?
• Acute respiratory alkalosis
A patient with renal failure has chronic congestive heart failure and started to hyperventilate. His ABG was as follows: pH is high, PaCO2 is low, and [HCO3] is low. What is his condition most likely to be?
• Mixed respiratory alkalosis and metabolic acidosis
A patient had a nasogastric tube. The nurse noted that the NGT is draining a large amount of coffee ground secretions. His ABG was as follows: pH is high, PaCO2 is normal, [HCO3] is high. What did he develop?
• Uncompensated metabolic alkalosis
A patient came to the clinic and a mass was detected on rectal examination accompanied by hematuria. How can the diagnosis be confirmed?
• Transrectal ultrasound biopsy
What causes obstruction to flow of urine through the urethra?
• Nodular hyperplasia of the prostate
What confers a high risk for carcinoma of the prostate?
• High grade intraepithelial prostate neoplasia
What is a complication of benign prostatic hyperplasia?
• Hydroureter and hydronephrosis
A man was on a drug for 10 years and developed renal failure. What would the renal biopsy reveal?
• Lymphocytic infiltrate
A woman was using a drug for few days when she developed rash, eosinophiluria and renal failure. What is the most likely cause of her condition?
• Drug allergy
A man was found to have bacteriuria. What is expected to show histologically in the kidney?
• Neutrophilic infiltration
A patient was using a drug for 10 years. He developed renal failure. What can be seen in the renal biopsy?
• Lymphocytic infiltration
A man was using a drug for three days when he developed acute renal failure. What is expected to show histologically?
• Eosinophilic infiltrate
A 65-yr old man presents with hematuria without dysuria. A 2-cm sessile friable mass was found in the dome of the bladder?
- Tubulocystic glandular structures
- Pleomorphic urothelium with papillary folds
• Tubulocystic glandular structures
Note: The dome of the bladder is the typical site for adenocarcinoma of the bladder; the question was not of Dr. Salah’s, and it wasn’t in any of the notes either
A 35 yr-old woman presents with a 2-yr history of hematuria without hypertension or proteinuria. What is the most likely diagnosis?
- Thin membrane disease
- Lupus nephritis
• Thin membrane disease
A patient was found to have non elevated anion gap acidosis, and her urine sodium was < 10 mEq/L. what is the most likely cause of her acidosis?
• Diarrhea
A patient was found to have a high anion gap metabolic acidosis with wide osmolal gap. What is the most likely cause of his acidosis?
• Methanol poisoning
What is true regarding renal tubular acidosis?
• Distal RTA is associated with stone formatio
What would be a feature of a benign cyst?
• It has a homogenous content
A patient developed lower limb edema and ascites; there was no pulmonary edema or heart gallop. What would be the first step to manage him?
- Administer furosemide to reduce fluid overload
- Biopsy his kidney
- Tap his ascites
• Administer furosemide to reduce fluid overload
Which drug can be administered along with loop diuretics to preserve potassium balance?
• Amiloride
How would non-steroidal anti-inflammatory drugs (NSAIDs) result in acute renal failure?
• They cause increased intraglomerular resistance
Which drug can increase serum creatinine in hypertensive diabetic patients?
- Captopril
- cyclosporine
• Captopril
Which drug can form crystals in the renal tubules leading to obstruction of urine flow?
• Acyclovir
Which drug can cause rhabdomyolysis when used with cytochrome P450 inhibitors?
• Levostatin
A woman with urinary tract infection. Here urine was sampled and yielded a bacteria that do not produce nitrate. What is the most likely causative agent?
- Group B streptococci
- E. coli
• Group B streptococci
A patient was found to have a staghorn calculus, and his urine was found to be alkaline. What is the most likely associated infectious agent?
• Proteus mirabilis
Which of the following features is associated with formation of all types of stones?
• Reduced solubility of salts
Which transporter is mutated in patients with familial renal glycosuria?
• SGLT2
What predispose to nephrolithiasis in patients with cysteinuria?
• Reduced reabsorption of cysteine
• Reduced solubility of cysteine
• Reduced reabsorption of cysteine
