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RENAL module - 4th year > 2013 module exam > Flashcards

2013 module exam Flashcards

1
Q

Which part of the nephron is responsible for creatinine secretion?

A

PCT

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2
Q

Which parameter is used in clinics to estimate (or measure) GFR?

A

Creatinine clearance

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3
Q

Which of the following increases in nephrotic syndrome?

A. Serum creatinine level
B. Creatinineclearance
C. Albumin clearance
D. Cl clearance

A

C. Albumin clearance

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4
Q

Which of the following has the highest renal plasma clearance?

A. Glucose
B. K
C. Na
D. Albumin

A

B. K

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5
Q

Which event happens in the TALH?

A. 50% reabsorption of urea
B. Reabsorption of NaHCO3
C. Reabsorption of water

A

B. Reabsorption of NaHCO3

Note: Reabsorption of urea occurs in the proximal tubule. 15% of NaHCO3 reabsorption happens in TALH

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6
Q

Which of the following equals 50% of GFR?

A. Clearance of inulin
B. Clearanceofglucose
C. Clearance of urea

A

C. Clearance of urea

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7
Q

A patient had the following results: pH is low - HCO3 is low - Cl is high - PAG is normal – K is normal. What is the cause of his acid base disorder?

A. Proximal RTA
B. DistalRTA
C. Prolonged diarrhea

A

C. Prolonged diarrhea

Note: Both “A” and “C” were counted correct, but prolonged diarrhea is the most correct answer according to Dr. Zoran.

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8
Q

Which of the following inhibits ADH release?

A. Lithium
B. Earlypregnancy
C. Angiotensin II
D. Recumbent position

A

D. Recumbent position

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9
Q

Which of the following increases GFR?

A. Hypoalbuminemia in malnutrition
B. Low oncotic pressure in Bowman’s space
C. Alpha1agonists
D. Volume expansion

A

D. Volume expansion

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10
Q

Which of the following will be able to pass through the glomerular filtration barrier if it loses its negative charge?

A. Hemoglobin
B. Cl
C. HCO3
D. Albumin

A

D. Albumin

Note: Cl, HCO3, and other anions are so tiny that they can be filtered with the plasma water even though the GFB is negatively charged (So charge selectivity doesn’t apply to these ions).

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11
Q

What prevents hyperkalemia after a potassium-rich meal?

A

Increased expression of BK channel

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12
Q

A patient had the following ABG analysis: PaCO2 is high – pH is low - HCO3 is normal. What is his condition?

A. Vomiting
B. Pregnancy
C. Sedative overdose

A

C. Sedative overdose

Note: Sedative overdose -> Hypoventilation -> Acute respiratory acidosis (There is no metabolic compensation, that’s why HCO3 is normal)

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13
Q

What increases tonicity in the medullary interstitium?

A

Constriction of vasa recta by medullary pericytes

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14
Q

Which of the following is the most important molecular mechanism in the renal tubules for the
compensation of metabolic acidosis?

  1. Increased activity of Na+/H+ antiporter in the apical membrane
  2. Increased activity of Na+/K+ ATPase in the basolateral membrane
  3. Increased expression of carbonic anhydrase type IV in the apical membrane
  4. Increased activity of H+ ATPase in the apical membrane
A
  1. Increased activity of Na+/H+ antiporter in the apical membrane

Note: Both “A” and “D” were counted correct; however, choice “A” is the most accurate one according to Dr. Zoran.
To reabsorb HCO3- as a compensation for metabolic acidosis, hydrogen has to be secreted. HCO3- reabsorption occurs mainly in the PCT and TALH. The main transporter for

hydrogen secretion in these segments is Na+/H+ antiporter then H+-ATPase.
A small amount of HCO3- escapes reabsorption in the PCT and TALH so it will be reabsorbed in the DT and CD accompanied by H+ secretion.
Hydrogen secretion in these segments increases indirectly under aldosterone influence on the principal cells by activation of Na+/K+ ATPase.

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15
Q

Which of the following increases potassium secretion?

A

Increased tubular flow

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16
Q

A patient comes to the clinic complaining of polyuria and polydipsia. Urine osmolality=70, Plasma osmolality = 130, Urine volume = 6L. ADH levels were not detectable. What is the diagnosis?

A

Psychogenic diabetes insipidus

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17
Q

Which of the following is a cause of metabolic alkalosis?

A. Vomiting and hypochloremia
B. Hyperaldosteronism

A

A. Vomiting and hypochloremia

Note: The trick in this question is to apply the “2-hit theory” of acid-base disorders.

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18
Q

Which of the following is a cause of renal tubular acidosis?

A

Impaired HCO3- reabsorption

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19
Q

What is true about normal pressure natriuresis?

A. High pressure directly decreases Na reabsorption in PCT
B. Causessalt-insensitiveHTN

A

A. High pressure directly decreases Na reabsorption in PCT

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20
Q

What would occur due to a high sodium diet?

A. Fusion of NCC in the luminal membrane in PCT
B. Increased renal dopamine release
C. Increased blood pressure
D. Increased sodium delivery to the macula densa

A

B. Increased renal dopamine release

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21
Q

During exercise, even though there is an increase in cardiac output, renal blood flow does not increase. What keeps it constant?

A. Increased sodium delivery to the macula densa
B. Sympathetic activation of the kidneys

A

A. Increased sodium delivery to the macula densa

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22
Q

A patient had the following results: RPF= 550 ml/min, GFR = 110 ml/min, Glucose concentration in the plasma = 5 mg/ml
What is the clearance of glucose?

A. 0
B. 35
C. 175

A

B. 35

Note: Many students forgot to divide 175 mg/min (which is the amount excreted) by 5 mg/ml to get the clearance so re-read the question before choosing an answer to avoid such mistakes :)

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23
Q

Which of the following happens as a result of hypophosphatemia?

A. Decreased production of NH4+
B. Decreased excretion of free H+
C. Decreased excretion of H+ with titratable acids/buffers

A

C. Decreased excretion of H+ with titratable acids/buffers

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24
Q

What stimulates H+ secretion during hypokalemia

A. Low intracellular pH
B. Negative luminal charge 
C. Endothelin1
D. Angiotensin II
E. Aldosterone
A

A. Low intracellular pH

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25
Q

What stimulates H+ secretion during volume contraction

A. Low intracellular pH
B. Negative luminal charge 
C. Endothelin1
D. Angiotensin II
E. Aldosterone
A

D. Angiotensin II

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26
Q

Choose the most appropriate reason for Increased release of ANP during volume expansion.

A

C. Increased stretch of the atrial receptors

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27
Q

Choose the most appropriate reason for Reduction of Na reabsorption by the proximal tubules during volume expansion.

A. Increased production of the renal dopamine
B. Increased stretch of the volume receptors
C. Increased stretch of the atrial receptors
D. Increased ANGII
E. Increased ADH levels

A

A. Increased production of the renal dopamine

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28
Q

Salwa ran a marathon and sweated a lot. She had free access to water. Which of the following is true?

A. Inhibition of ANP release
B. Increased osmoreceptor volume
C. Na concentration in the plasma increases

A

A. Inhibition of ANP release

Note: Heavy sweating results in hypertonic hypovolemia.
Increased plasma osmolarity -> osmoreceptors shrink -> stimulate both ADH release & thirst -> plasma osmolarity and [Na] in plasma return back to normal.
Hypovolemia -> activation of RAAS and inhibition of ANP and renal dopamine release

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29
Q

Which of the following results in renin release?

A

Decreased stretch of afferent arterioles

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30
Q

A patient had the following data: pH is normal, HCO3- is normal, K+ is normal, Cl- is normal, plasma anion gap is high. What is the cause of his results?

A

Hyperalbuminemia

Note: There is no acid-base disorder.
Albumin is the major unmeasured anion that contributes to plasma anion gap.

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31
Q

Which of the following is an indicator of the ability of the distal segment to acidify urine (or net acid excretion)?

A. Low urine pH
B. Increased production of NH4+

A

B. Increased production of NH4+

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32
Q

What should be suspected in a male infant with unilateral agenesis of the kidney?

A

Single umbilical artery

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33
Q

What is the cause of postnatal death in an infant with bilateral kidney agenesis?

A

Pulmonary hypoplasia (or lung immaturity)

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34
Q

Which part is covered (or crossed) anteriorly by the peritoneum in both kidneys?

A. Jejunum
B. Suprarenalgland
C. Pancreas
D. Duodenum

A

A. Jejunum

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35
Q

Which of the following structures arises from metanephric blastema?

A. Glomeruli
B. Collectingduc

A

A. Glomeruli

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36
Q

Which structure can possibly be injured during approaching the kidney from the renal angle?

A. Liver
B. Diaphragm
C. Jejunum
D. Pancreas

A

B. Diaphragm

Note: The kidney is approached by cutting through posterolateral abdominal wall via the renal angle. All other structures in the choices are related to the kidney anteriorly.

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37
Q

Which of the following structures arises from metanephric blastema?

C. Glomeruli
D. Collecting duct

A

C. Glomeruli

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38
Q

Which of the following is a potential site for obstruction by ureteric stones at the sacroiliac joint?

A. Ureteropelvic junction
B. Ischialspine
C. Bifurcation of common iliac artery

A

C. Bifurcation of common iliac artery

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39
Q

What of the following is associated with Potter’s syndrome?

A

Oligohydramnios

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40
Q

Pain from the endodermal part of the bladder is referred to the hypogastric region via which nerve?

A. Sympathetic nerves
B. Pudendalnerve
C. Cavernousnerves

A

A. Sympathetic nerves

41
Q

What is the type of epithelium in the prostatic urethra?

A

Transitional epithelium

42
Q

Which structure of the kidney turns into cysts in autosomal recessive polycystic kidney disease?

A. Collecting ducts
B. PCT
C. LoopofHenle
D. DCT
E. Bowman's capsule
A

A. Collecting ducts

43
Q

Which structures compress the left renal vein in venous entrapment syndrome?

A. Superior mesenteric artery and aorta
B. Superior mesenteric artery and duodenum
C. Duodenum and aorta

A

A. Superior mesenteric artery and aorta

44
Q

Which structure should be lifted in order to remove a metastatic tumor next to the right renal artery (or to examine the hilum of the right kidney)?

A. Liver
B. Duodenum
C. Jejunum 
D. Pancreas 
E. Colon
A

B. Duodenum

45
Q

Which disease is characterized by proliferation of glands and stroma on histology?

A

BPH

46
Q

Grossly, the kidney was enlarged with suppurative exudate filling the pelvis, calyces and tubules. What is the diagnosis?

A

Pyonephrosis

Note: Pyonephrosis is one of the complications of acute pyelonephritis.

47
Q

Kidney autopsy showed gray white areas at the tip of the pyramids. What is the diagnosis?

A

Papillary necrosis

Note: This is another complication of acute pyelonephritis

48
Q

Imaging of the abdomen showed polycystic kidneys and intrahepatic and biliary cysts. Which gene is responsible for this disease?

A

PKHD1

49
Q

Imaging of the abdomen showed polycystic kidneys and intrahepatic and biliary cysts (It was exactly the same description as the previous question). Which gene product is responsible for these findings?

A

Fibrocystin/Polyductin

50
Q

A patient presented with a Tumor <1.5cm in the right kidney. The tumor is composed of complex branching papillary structures and cuboidal cells without atypia. What is most likely diagnosis?

A

Cortical adenoma

51
Q

An asymptomatic patient was found to have an incidental renal mass. On histology, cells have pink cytoplasm and abundant mitochondria. What is the type of the tumor?

A

Oncocytoma

52
Q

Which disease is characterized by diffuse thickening of the GBM (glomerular basement membrane) with intramembranous immune complex deposits?

A. Membranous GN
B. Membranoproliferative GN
C. Lupusnephritis

A

A. Membranous GN

Note: Keep in mind the difference between Membranous GN and MPGN.
MGN = Diffuse thickening of the GBM + deposits
MPGN = Double GBM (tram-track) + deposits + proliferation of cells

53
Q

A patient presented with boggy tender prostate. What is the most likely diagnosis?

A

Acute bacterial prostatitis

54
Q

On histology, the prostate gland showed crowding, stratification, pleomorphism, and nuclear enlargement. What is the diagnosis?

A. Prostatic carcinoma
B. PIN

A

B. PIN

55
Q

Which tumor is characterized by the presence of proliferating cytotrophoblasts and syncytiotrophoblasts?

A

Choriocarcinoma

56
Q

A 4th-year medical student :) hyperventilates everytime he comes to the PBL sessions. He was taken to the emergency room presenting with tingling, dizziness, and confusion. ABG analysis shows: pH is high, CO2 is low, HCO3 is normal. What is the diagnosis?

A. Acute respiratory alkalosis
B. Chronic metabolic acidosis
C. Mixed acid base disorder

A

A. Acute respiratory alkalosis

57
Q

Gross appearance of the kidney showed irregular coarse scars seen as fibrous depressions on the surface and deformed calyces. What is the diagnosis?

A

Chronic pyelonephritis

58
Q

What is expected in the histological appearance of chronic pyelonephritis?

A

Interstitial lymphocytic infiltration, fibrosis, and tubular atrophy and dilation

59
Q

A young male died after a road traffic accident. He had shock and extensive hemorrhage. What is the diagnosis?

A. Renal cortical necrosis
B. Acute tubular necrosis

A

A. Renal cortical necrosis

60
Q

What is the genetic mutation in WAGR syndrome?

A

WT-1

61
Q

An elderly patient presented with obstructive urinary symptoms and fever, which required dialysis. Kidney biopsy showed neutrophils inside the tubules. Which of the following is the most likely diagnosis?

A. Glomerular crescents
B. Acute pyelonephritis
C. Acute tubular necrosis

A

B. Acute pyelonephrit

62
Q

Which disease is characterized by a nodular prostate in the periurethral zone?

A

BPH

63
Q

What is the histological correlate of rapidly progressive glomerulonephritis?

A. Crescents within the glomerular capillaries
B. Tram-track appearance or splitting (doubling) of the capillary membrane

A

A. Crescents within the glomerular capillaries

Note: “Histological correlate” means a feature that is seen on histology and corresponds to RPGN regardless of the cause/subtype.
Choice “B” describes membranoproliferative glomerulonephritis (MPGN), which is one of the causes of nephrotic syndrome.
Some students were confused and chose “B” because MPGN was listed in the pathology note among the causes of “type 2 RPGN” but as I said, the question is about a characteristic diagnostic feature of RPGN.

64
Q

Which tumor is composed of fat, muscles, and blood vessels?

A. Angiomyolipoma
B. Renal cell carcinoma
C. Liposarcoma
D. Rhabdomyoma

A

A. Angiomyolipoma

65
Q

Inversin mutation switches Wnt signaling towards the noncanonical pathway, which causes cystic kidney disease with situs inversus. This describes which of the following conditions?

A. NPHP2
B. NPHP5
C. NPHP7
D. NPHP9

A

A. NPHP2

66
Q

The product of PKHD1, FPC (fibrocystin), interacts with which of the following proteins?

A. Polycystin-2 & Polycystin-1
B. P53

A

A. Polycystin-2 & Polycystin-1

67
Q

A 2-year-old female was diagnosed with Wilm’s Tumor as part of WAGR syndrome. What is the chromosomal abnormality in this syndrome?

A. Deletion of chromosome 11p
B. Gain of chromosome 11q
C. Deletion of chromosome 10p D. Deletion of chromosome 10q

A

A. Deletion of chromosome 11p

68
Q

Which tumor is characterized by tumor cells arranged around blood vessels?

A

Yolk sac tumor

Note: This is the description of Schiller-Duval bodies.

69
Q

Histopathological examination of the kidney revealed nodular sclerosis and hyaline arteriolosclerosis of the afferent and efferent arterioles. What is the diagnosis?

A

Diabetic nephropathy

70
Q

A 45-year-old man presented with severe edema in the lower limbs and abdomen, hypoalbuminemia, significant proteinuria, and hypercholesterolemia.
Kidney biopsy showed diffuse GBM thickening and spikes on electron microscopy. What is the diagnosis?

A

Membranous GN

71
Q

What is the gross description of seminoma?

A

Homogenous solid

72
Q

Which tumor is characterized by the presence of cartilage and fat in the testes?

A

Teratoma

73
Q

A patient was taking antibiotics for 3 days. He developed acute renal failure. What is the most likely cause?

A. Acute tubular necrosis
B. Acute tubulointerstitial nephritis (ATIN)

A

B. Acute tubulointerstitial nephritis (ATIN)

Note: ATIN caused by hypersensitivity to some drugs results in ARF immediately. Other nephrotoxic drugs take longer to cause ARF.

74
Q

Which tumor shows a triphasic pattern consisting of tubules, solid sheets of small round cells, and stroma?

A

Nephroblastoma

75
Q

Fetal autopsy revealed unilateral hydronephrosis. What is the most likely cause of this finding?

A

UPJ (ureteropelvic junction) obstruction

76
Q

Histopathological examination of the kidney revealed dilated tubules filled with hyaline casts. What is the diagnosis?

A

Chronic pyelonephritis

77
Q

Urine anion gap is used in the assessment of non-anion gap metabolic acidosis (normal PAG). What does a negative anion gap indicate?

A. Respiratory acidosis
B. Non-renal causes of metabolic acidosis
C. Mixed metabolic acidosis
D. GI loss of HCO3
E. Respiratory alkalosis
A

D. GI loss of HCO3

Note: Confirmed by Dr. Segun Mojiminiyi.

78
Q

Which of the following signifies pre-renal cause of renal failure?

A. Urine Na<20
B. UrineNa>20

A

A. Urine Na<20

79
Q

Which of the following laboratory findings is seen in patients with syndrome of inappropriate ADH?

A. UrineNa>20
B. FeNa<1%
C. Hypervolemia

A

A. UrineNa>20

80
Q

Which condition causes low urine calcium?

A. Malabsorption
B. Calcium stones
C. Hyperparathyroidism
D. Very high levels of vitamin D

A

A. Malabsorption

81
Q

A patient has high serum lipids and low plasma Na concentration. What does he have?

A

Pseudohyponatremia

82
Q

What causes hypokalemia?

A

Excess mineralocorticoids

83
Q

A 5-year-old child presented with recurrent urinary tract infections. What is the best imaging modality to diagnose vesicoureteral reflux (VUR)?

A. Micturating Cystourethrography (MCUG)
B. Ascending urethrography

A

A. Micturating Cystourethrography (MCUG)

84
Q

What is the best imaging modality to investigate recurrent renal colic pain?

A. Plain KUB
B. Ascending urethrography
C. CT KUB

A

C. CT KUB

85
Q

A 60-year-old patient developed drug-induced tubular flow obstruction, which drug was he using?

A. Acyclovir
B. Cyclosporine
C. Captopril

A

A. Acyclovir

86
Q

Which of the following drugs causes ototoxicity as a side effect?

A

Furosemide

87
Q

Which of the following is a possible side effect of Spironolactone?

A

Gynecomastia

88
Q

What is the effect of loop diuretics?

A. Increase Na reabsorption
B. Increase Ca excretion

A

B. Increase Ca excretion

89
Q

Which of the following is a selective aldosterone receptor antagonist with less hormonal side effects?

A. Amiloride
B. Spironolactone
C. Eplerenone

A

C. Eplerenone

90
Q

A 53-year-old man with history of kidney stones and hypertension. Investigations were done
(2 tables were provided showing various parameters in the serum and urine with normal ranges) Serum pH: Low
Na: Borderline high
K: Low (3.1) (Lower limit 3.5)
Cl: High (115) (Upper limit 110) Urine pH: Low (6) (Lower limit 6.5) What is the diagnosis?

A. RTA Type 3
B. RTAtype2
C. RTA type 1
D. RTA type 4

A

C. RTA type 1

Note: This is a case of hyperchloremic metabolic acidosis. Severe acidosis + kidney stones + hypokalemia = RTA type 1

91
Q

On antenatal US, the fetus had a normal left kidney while the right kidney showed dilated pelvis and
calyces with normal ureter. What is the most likely congenital abnormality (Surgery Q)?

A. Posterior urethral valve
B. Unilateral VUR
C. Unilateral UPJ obstruction

A

C. Unilateral UPJ obstruction

92
Q

A 25-year-old previously healthy male presented with passing dark urine that is not accompanied by any other symptoms. Tests upon hospitalization showed the following results:
BP: 155/90
Serum creatinine: double that of matched sex and age controls. Urine analysis: protein +3

Which of the following is the most likely histological appearance of his kidney on biopsy?

A. Glomerular crescents
B. Acutetubularnecrosis
C. IgM deposits along glomerular capillaries

A

A. Glomerular crescents

Note: ARF + proteinuria >2g = Glomerular disease (either crescentric (RPGN) or proliferative).
This scenario describes RPGN (The patient presented with nephritic syndrome and progressed rapidly to ARF).
Many students chose “C” which describes FSGS. It can cause some hematuria and HTN but most importantly it is a cause of nephrotic syndrome, which is not present in this case.

93
Q

Ultrastructure of the kidney revealed fibrils deposited in the mesangium. What is the diagnosis?

A. Amyloidosis
B. IgAnephropathy

A

A. Amyloidosis

94
Q

A patient presented with urinary tract infection associated with large staghorn stones in the kidney and alkaline urine. Gram negative organisms were isolated from his urine. What is the causative agent?

A. Klebsiella pneumoniae
B. Proteus mirabilis
C. S.saprophytics
D. C. trachomatis

A

B. Proteus mirabilis

95
Q

Mutation in which receptor is responsible for familial renal glucosuria?

A

SGLT2

96
Q

Mutation in which gene is responsible for cystinuria?

A

SCL3A1

97
Q

Mutation in which gene impairs HCO3 reabsorption (pRTA)?

A

SCL4A4

98
Q

What is the percentage of hypertension in patients with ESRD (or dialysis)?

A. 90-95%
B. 80-85%
C. 70-75%
D. 50%

A

A. 90-95%

99
Q

An elderly woman is on dialysis and has a history of heavy smoking. She died. What is the most likely cause of death?

A. Lung cancer
B. CVD
C. Sepsis
D. Dialysis related hypotension

A

B. CVD

Note: CVD accounts for >40% of deaths among dialysis patients.

RENAL module - 4th year (17 decks)

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