2014 module exam Flashcards
Which of the following can be used in clinics to estimate GFR?
A. Creatinine clearance
B. Serum Creatinine
A. Creatinine clearance
What is the most practical assessment of GFR?
A. Creatinine clearance
B. Serum Creatinine
B. Serum Creatinine
Which of the following can be used to detect changes in GFR?
A. Creatinine clearance
B. Serum Creatinine
B. Serum Creatinine
Which of the following has the lowest renal plasma clearance?
A. Na
B. K
C. Urea
A. Na
Which of the following happens in the thick ascending loop of Henle?
Reabsorption of Sodium and bicarbonate
Which of the following increases potassium secretion?
A. Increase expression of SGK-1 levels
B. Decrease flow at CD
C. Internalization of ROMK
D. ECF volume contraction
A. Increase expression of SGK-1 levels
What increases tonicity in the medullary interstitium?
Constriction of vasa recta by medullary pericytes
Choose the most appropriate answer
for the following events that
happen during volume contraction. Decreased release of ANP:
A. Decreased production of the renal dopamine
B. Increased stretch of the volume receptors
C. Decreased stretch of the atrial receptors
C. Decreased stretch of the atrial receptors
Choose the most appropriate answer
for the following events that
happen during volume contraction. Increased Na reabsorption by the proximal tubules:
A. Decreased production of the renal dopamine
B. Increased stretch of the volume receptors
C. Decreased stretch of the atrial receptors
A. Decreased production of the renal dopamine
Which structure of the kidney turns into cysts in autosomal recessive polycystic kidney disease?
Collecting ducts
A 40-year-old man presented with hypertension, hematuria, and testicular and pelvic pain. The testicular venous plexus was dilated (or the left testis was swollen). Obstruction of which of the following structures might be the cause?
A. left renal vein
B. left gonadal vein
A. left renal vein
A 57-year-old woman had a tan colored renal tumor with central stellate scar. What is the diagnosis?
A. Oncocytoma
B. Chromophobic RCC
A. Oncocytoma
A 70-year-old man with chills, fever, and dysuria presented with boggy tender prostate. On further investigation, urine culture was negative. What is the most likely diagnosis?
A. Acute bacterial prostatitis
B. Chronic abacterial prostatitis
C. Chronic bacterial prostatitis
D. Granulomatous prostatitis
B. Chronic abacterial prostatitis
A patient had a prostate cancer with a Gleason score of 9. What is the interpretation of that?
A. Highly aggressive tumor of the prostate
B. Well differentiated tumor
C. Metastasis to the bone
A. Highly aggressive tumor of the prostate
On histology, the prostate gland showed crowding, stratification, pleomorphism, and nuclear enlargement. What is the diagnosis?
Prostate intraepithelial neoplasia (PIN)
Which tumor is composed of fat, muscles, and blood vessels?
A. Angiomyolipoma
B. Papillary adenoma
C. Oncocytoma
A. Angiomyolipoma
An elderly patient presented with flank pain and fever, for which he required dialysis. A kidney biopsy was done which showed neutrophils inside the tubules. Which of the following is the most likely diagnosis?
A. Acute pyelonephritis
B. Chronic pyelonephritis
C. Acute interstitial nephritis
A. Acute pyelonephritis
Where does the largest drop in hydrostatic pressure take place in the kidney?
A. Afferent arteriole
B. Efferent arteriole
A. Afferent arteriole
Which of the following increases ADH secretion?
A. Late pregnancy
B. Heart failure
C. Positive Na balance
B. Heart failure
A 32-year-old woman with SLE, who had low hemoglobin, high MCV, and low reticulocyte count, has been on dialysis for 10 years. What is the most likely cause of her anemia?
A. Folate deficiency
B. Vitamin B12 deficiency
C. Iron deficiency
D. Vitamin D deficiency
A. Folate deficiency
Which testicular tumor is characterized by the presence of proliferating cytotrophoblasts and syncytiotrophoblasts?
A. Choriocarcinoma
B. Yolk sac tumor
A. Choriocarcinoma
Coarse/wide-spread C3 deposition in the peripheral basement membrane:
Acute post streptococcus infection
In severe volume contraction, what increases expression of UT-1 in IMCD?
ADH stimulation
A 45-year-old male was found with longitudinal and irregular edged laceration on his scalp along with multiple bruises. What is the most likely object that caused this lesion?
A. Serrated knife
B. wooden stick
C. broken neck bottle
D. A sharp knife
B. wooden stick
Where do you find the pelvic pain line?
Superior surface of the bladder
A 5-year-old child presented with recurrent urinary tract infections. What is the best imaging modality to diagnose vesicoureteral reflux (VUR)?
Micturating Cystourethrography (MCUG)
What is the best imaging modality to investigate renal stones?
A. CT of abdomen and pelvis B. Plain X-ray of abdomen and pelvis C. MRI of abdomen and pelvis D. Nuclear scanning of kidney E. Ultrasound of abdomen
A. CT of abdomen and pelvis
Which of the following may cause hyperkalemia?
A. Heavy exercise
B. Diarrhea
C. Insulin
A. Heavy exercise
In severe volume contraction, what causes the single effect?
ADH stimulation
Where does urine from the renal papillae drain into?
Minor calyx
A 10 year old boy presented with heavy proteinuria and edema. A kidney biopsy revealed a normal histology. On electron microscopy, there was complete effacement of foot processes. What is the most likely diagnosis?
Minimal change disease
Which of the following indicates that the cyst is benign and not malignant?
A. It was 5 cm in length and became 6 cm after 6 years
B. Irregular border
C. Calcification
A. It was 5 cm in length and became 6 cm after 6 years
Which of the following causes gynecomastia as a side effect?
Spironolactone
Which of the following is a non-germ cell tumor of the testicle?
A. Leydig cell tumor
B. Yolk sac tumor
C. Embryonal carcinoma
D. Seminoma
A. Leydig cell tumor
A 67-year-old male presented with straining when he passes urine, hesitancy, and terminal urine dribbling. On examination, he was found to have an enlarged prostate. Which of the following is likely to be a long-term complication because of his condition?
Cortical atrophy
If GFR is halved, what happens to serum creatinine?
Increased to less than double of normal
A 10-year child presented with acute hemorrhagic cystitis. What is the most likely causative agent?
Adenovirus
What stimulates H+ secretion during Acidosis?
A. Low intracellular pH B. Negative luminal charge C. Endothelin1 D. Angiotensin II E. Aldosterone
C. Endothelin1
What stimulates H+ secretion during Hypokalemia?
A. Low intracellular pH B. Negative luminal charge C. Endothelin1 D. Angiotensin II E. Aldosterone
A. Low intracellular pH
What stimulates H+ secretion during Volume contraction in the proximal tubule?
A. Low intracellular pH B. Negative luminal charge C. Endothelin1 D. Angiotensin II E. Aldosterone
D. Angiotensin II
What stimulates H+ secretion during Volume contraction in the distal tubules?
A. Low intracellular pH B. Negative luminal charge C. Endothelin1 D. Angiotensin II E. Aldosterone
E. Aldosterone
What will occur due to a loss of 1 liter of sweat during heavy exercise?
A. Plasma Na will decrease
B. Peritubular oncotic pressure will increase
C. Urinary Na increase
D. 67% of water is reabsorbed in PT
B. Peritubular oncotic pressure will increase
Which of the following drugs act on the early distal tubule?
Hydrochlorothiaziade
A 40-year-old man with chronic Hepatitis B infection developed Nephrotic syndrome. He has spikes in GBM. What is the ultrastructure abnormality seen under EM?
Subepithelial deposition
What is solvent drag?
Solutes dissolved in water are dragged with water during its reabsorption in the tubules
In patients with ADPKD, which of the following leads to formation of renal cysts?
A. one inherited mutation B. one sporadic mutation C. Two inherited mutations D. Two sporadic mutations E. One sporadic mutation and one inherited mutation
E. One sporadic mutation and one inherited mutation
A 56-year-old male started to take Captopril for the treatment of hypertension, but he suddenly developed acute renal failure. Which of the following is a contributing factor?
A. Bilateral renal artery stenosis
B. Decreased GFR
A. Bilateral renal artery stenosis
In extracellular volume contraction, which of the following decreases Na and water excretion?
A. Increase decarboxylation of L-Dopa to dopamine
B. insertion of NCC
C. Increases Na-K ATPase in the basolateral membrane
B. insertion of NCC
What is the treatment of choice for a 5 cm renal stone with a presentation of recurrent flank pain?
A. Percutaneous Nephrolithotomy (PCNL)
B. Medical therapy C. DJ-stunt
D. SWL
E. Ureteroscopy
A. Percutaneous Nephrolithotomy (PCNL)
What is the relative risk of CVD death among patients on dialysis compared to the general population?
A. 1-1.5 B. 2-3 C. 4-6 D. 7-9 E. >10
E. >10
What is the net filtration pressure if glomerular hydrostatic pressure is 60, oncotic pressure of bowman’s capsule is 0, bowman’s capsule hydrostatic pressure is 28, and oncotic pressure of plasma is 20?
A. 12
B. 40
C. 0
D. 32
A. 12
What is the free water clearance if the urine volume is 0.7 L, urine osmolarity is 1400, and plasma osmolarity is 265?
A. -3
B. 3
C. 3.7
D. -3.7
A. -3
Which of the following substances is an inhibitor of kidney stone formation?
Pyrophosphate/citrate
Which part of the nephron is responsible for creatinine secretion?
PCT
What stimulates the release of renin?
A. Increase Na that goes to the Macula Densa
B. Decrease the dilation of afferent arteriole
C. Decreased perfusion of the renal afferent arteriole
C. Decreased perfusion of the renal afferent arteriole
What happens in hypokalemia?
A. Paracellular route B. Increased NaCl reabsorption C. Increased activity of Na-K ATPase D. Sequestering of ROMK in the cytoplasm E. Opening of ROMK and BK channels F. Entry of K into cell G. Movement of mechanosensors of principal cells/PKD1/PKD2 activation
D. Sequestering of ROMK in the cytoplasm
(or what happens if K intake was increased? Insertion of
ROMK)
What happens when there is increased tubular flow?
A. Paracellular route B. Increased NaCl reabsorption C. Increased activity of Na-K ATPase D. Sequestering of ROMK in the cytoplasm E. Opening of ROMK and BK channels F. Entry of K into cell G. Movement of mechanosensors of principal cells/PKD1/PKD2 activation
G. Movement of mechanosensors of principal cells/PKD1/PKD2 activation
What is the main route for K reabsorption in PCT?
A. Paracellular route B. Increased NaCl reabsorption C. Increased activity of Na-K ATPase D. Sequestering of ROMK in the cytoplasm E. Opening of ROMK and BK channels F. Entry of K into cell G. Movement of mechanosensors of principal cells/PKD1/PKD2 activation
A. Paracellular route
Which of the following is used to diagnose BPH?
A. CT
B. MRI
C. Ultrasound
C. Ultrasound
People with cystinuria cannot reabsorb cysteine, ornithine, arginine, and lysine. Why does cysteine stones occur in these patients?
Low solubility of cysteine
Which tumor is associated with Von-Hippel Lindau disease?
A. Clear cell carcinoma
B. Oncocytoma
C. Renal papillary adenoma
A. Clear cell carcinoma
what will be the excretion rate of a substance that is freely filtered and secreted if Px=1 mg/ml, RPF=500 ml/min, creatinine clearance=90 ml/min, Tm for secretion = 80 mg/min?
A. 100
B. 170
C. 80
B. 170
Low dietary calcium increases the risk of which type of stones?
A. Oxalate
B. Lysine
C. Ornithine
A. Oxalate
The perinephric abscess in the right kidney drains down but not to the left kidney. What is the reason behind that?
A. Renal fascia is attached to blood vessels inferomedially
B. Thorocolumbar fascia attached to vertebrae
C. Pararenal fascia in the midline
D. Psoas fascia attached to BVs
A. Renal fascia is attached to blood vessels inferomedially
What is the embryological origin of the epithelium of the bladder wall?
A. Hindgut
B. Foregut
C. Para-axial mesoderm
D. Splanchnic mesoderm
A. Hindgut
A female presented with a UTI along with a perinephric abscess. The culture showed clusters of gram positive cocci. What is the causative organism?
S. Aureus
The clearance of which of the following equals half the clearance of inulin?
Urea
Which type of stones is associated with repetitive UTI?
Struvite stones
Which of the following structures continues as the ureter at the inferior pole of the kidney?
Renal pelvis
Which of the following conditions results in hyaline sclerosis of both afferent and efferent arterioles?
A. Diabetic nephropathy
B. Hypertension
A. Diabetic nephropathy
A surgeon wants to approach the kidney from the back, he drew two horizontal lines. At which level do these lines pass?
T11 – L3
A patient with spinal cord injury complaining of loss of sensation of filling, urgency to void, and inability to feel the distensibility of the bladder. Which of the following nerves is affected?
A. Parasympathetic S2-4
B. Pudendal nerve
C. Sympathetic T11-T12
A. Parasympathetic S2-4
A female has hemoptysis with progressive renal impairment. X-ray showed multiple nodules within the mid and lower zones of the lungs. There were RBCs and casts in the urine. What is the methods of diagnosis?
A. ASO titer
B. ANCA
C. Immunoglobulin electrophoresis
B. ANCA
Which of the following is the pathogenesis of acute post-streptococcal glomerulonephritis?
A. Type 4 hypersensitivity
B. Cross reactivity of the GBM antigen with the causative agent antigen
B. Cross reactivity of the GBM antigen with the causative agent antigen
What do you expect to find in the renal biopsy in a person developed renal insufficiency after taking a drug for 3 days?
A. Eosinophilic infiltration
B. Lymphocytic infiltration
C. Neutrophilic infiltration
A. Eosinophilic infiltration
What do you expect to find in the renal biopsy in a person developed renal insufficiency after taking a drug for 10 years?
A. Eosinophilic infiltration
B. Lymphocytic infiltration
C. Neutrophilic infiltration
B. Lymphocytic infiltration
What do you expect to find in the renal biopsy in a person with a UTI and bacteriuria?
A. Eosinophilic infiltration
B. Lymphocytic infiltration
C. Neutrophilic infiltration
C. Neutrophilic infiltration
A patient with a 20 years history of diabetes presented with fatigue and dizziness. His hemoglobin level was low, MCV was normal, reticulocyte count was normal, and creatinine level was high. What is the most likely cause of anemia in this patient?
A. Iron deficiency anemia
B. Folate deficiency
C. Decreased erythropoietin synthesis
C. Decreased erythropoietin synthesis
What is the mechanism by which amikacin causes acute renal failure?
Direct toxic action on the proximal tubular cells
Which of the following increases Na reabsorption in euvolemia?
A. Increased GFR
B. Decrease hydrostatic pressure in the peritubular capillaries
C. SNS activity on beta receptors
A. Increased GFR
In which of the following conditions do you find IgG deposits in the endocapillary, extracapillary, and mesangial compartments?
A. Dense deposits disease B. Acute post streptococcal nephritis C. FSGN D. MGN E. Lupus nephritis
E. Lupus nephritis
In which of the following conditions do you find C3 deposits in the endocapillary and mesangial compartments?
A. Dense deposits disease B. Acute post streptococcal nephritis C. FSGN D. MGN E. Lupus nephritis
B. Acute post streptococcal nephritis
A 10 years old boy presented with hematuria, proteinuria and severe acute renal failure 2 weeks after an upper respiratory tract infection. What pattern do you expect to find on light microscope?
A. Crescents formation
B. Endocapillary proliferation
A. Crescents formation
Which of the following congenital anomaly is characterized by deficient anterior abdominal wall and bladder wall?
Ectopia vesicae
What is the congenital anomaly that is responsible for weeping of urine from the umbilicus?
Patent urachus
How does ADH increase urine concentration?
Increases urea permeability
A patient presented with polyuria. Upon further investigation, his plasma osmolarity and urine osmolarity were low. After water deprivation test, his urine osmolarity increased. What is the cause of his condition?
A. Nephrogenic DI
B. Central DI
C. Psychogenic DI
C. Psychogenic DI
Which of the following transporters is involved in NaHCO3 reabsorption in PCT?
A. NHE-3
B. NCC
A. NHE-3
Effect of Angiotensin II on GFR:
A. Increases GFR by causing dilation of the renal afferent arteriole
B. Contraction of the smooth muscles of the renal afferent arteriole returning the GFR to normal
C. Decreases RPF while increasing the filtration fraction
C. Decreases RPF while increasing the filtration fraction
Effect of prostaglandin on GFR:
A. Increases GFR by causing dilation of the renal afferent arteriole
B. Contraction of the smooth muscles of the renal afferent arteriole returning the GFR to normal
C. Decreases RPF while increasing the filtration fraction
A. Increases GFR by causing dilation of the renal afferent arteriole
Effect of increased Na delivery to macula densa:
A. Increases GFR by causing dilation of the renal afferent arteriole
B. Contraction of the smooth muscles of the renal afferent arteriole returning the GFR to normal
C. Decreases RPF while increasing the filtration fraction
B. Contraction of the smooth muscles of the renal afferent arteriole returning the GFR to normal
Which of the following substances increases filtration while keeping kidney function the same?
A. Prostaglandins
B. Aldosterone
C. Angiotensin II
C. Angiotensin II
A patient with rheumatoid arthritis presented with edema in the peri-orbital area and pulmonary effusion. Upon further investigations, he had proteinuria. What do you expect to find under EM?
A. Fibrillary proteins
B. Subepithelial deposits
A. Fibrillary proteins
Which of the following is responsible for increased oxalate stones formation in Alanine- Glyoxalate Aminotransferase (AGT) mutation?
A. Mistargeting of AGT to peroxisome
B. Mistargeting of AGT to ER
C. Mistargeting of AGT to mitochondria
C. Mistargeting of AGT to mitochondria
How does hyperchloremia affect reabsorption of bicarbonate (or decreases bicarbonate concentration)?
A. It results in an electrochemical gradient that is not in favor of bicarbonate reabsorption
B. It will enhance the secretion of bicarbonate by “pendrin”
A. It results in an electrochemical gradient that is not in favor of bicarbonate reabsorption
In which parts of the urinary bladder is the mucous membrane tightly attached?
trigone
Patient A and patient B had low pH and low levels of HCO3-. Patient A had ingested H+A- acid while patient B had lost HCO3- through GI tract. The Cl- level in patient A was normal, while Cl- level in patient B was high. Which of the following best explains the difference in the level of Cl- in both patients?
A. In patient A decrease level of HCO3- was accompanied by an increase in A-
B. Loss of HCO3- in patient B affect the kidney’s ability to excrete chloride
A. In patient A decrease level of HCO3- was accompanied by an increase in A-
Which of the following is a cause of renal tubular acidosis?
Impaired HCO3- reabsorption
A newborn was found to have a distended abdomen following birth. Further investigations showed a membrane-like structure in the urethra. What is the most likely anomaly?
Posterior urethral valves (PUV)
