Nephrology

Question 1

The prevalence of diabetic nephropathy in Type 1 diabetes mellitus:
A) below 5%
B) 20–30%
C) 80–90%
D) it develops in all patients

Answer 1

B) 20–30%

Question 2

In diabetic patients treated with metformin, metformin should not be administered prior to any scheduled examination using contrast agent if eGFR <30 ml/min/1,73m2:
A) administration should be continued
B) administration should be suspended only on the day of the examination
C) administration should be suspended by two days prior to the examination
D) administration should be suspended by one week prior to the examination

Answer 2

C) administration should be suspended by two days prior to the examination

Question 3

The most important factor in the early diagnosis of diabetic nephropathy:
A) the appearance of hypertension
B) the appearance of microalbuminuria
C) the increase of serum creatinine level
D) the decrease of eGFR

Answer 3

B) the appearance of microalbuminuria

Question 4

Diabetic nephropathy is reversible:
A) even if eGFR is reduced
B) in the stage of macroalbuminuria
C) in the stage of microalbuminuria
D) even if the serum creatinine is increased

Answer 4

C) in the stage of microalbuminuria

Question 5

It is fundamental in the treatment of diabetic nephropathy to give:
A) renin–angiotensin–aldosterone system (RAAS) inhibitors
B) alpha-blockers
C) high-dose thiazide diuretics
D) direct vasodilator antihypertensives

Answer 5

A) renin–angiotensin–aldosterone system (RAAS) inhibitors

Question 6

The progression of diabetic nephropathy may be accelerated by:
A) euglycaemia
B) increased protein intake
C) reduced salt intake
D) antihypertensive therapy

Answer 6

B) increased protein intake

Question 7

In diabetic patients treated with metformin, metformin therapy can be continued after the contrast agent examination:
A) on the day of the examination
B) on the next day, irrespective of renal function
C) 48 hours after the examination, if GFR is below 30 ml/min/1,73m2
D) 48 hours after the examination, if GFR is above 30 ml/min/1,73m2

Answer 7

D) 48 hours after the examination, if GFR is above 30 ml/min/1,73m2

Question 8

Patients with Type 1 diabetes have to be screened for diabetic nephropathy:
A) upon establishing the diagnosis
B) approx. 5 years after the diagnosis was established
C) approx. 10-15 years after the diagnosis was established
D) approx. 20-30 years after the diagnosis was established

Answer 8

B) approx. 5 years after the diagnosis was established

Question 9

Patients with Type 2 diabetes have to be screened for diabetic nephropathy:
A) upon establishing the diagnosis
B) approx. 5 years after the diagnosis was established
C) approx. 10-15 years after the diagnosis was established
D) approx. 20-30 years after the diagnosis was established

Answer 9

A) upon establishing the diagnosis

Question 10

Diabetic nephropathy is likely to have developed in a diabetic patient with proteinuria
A) in the absence of diabetic retinopathy
B) if the patient has diabetic retinopathy but no haematuria
C) if the patient has diabetic retinopathy and haematuria
D) it is likely in all the above cases

Answer 10

B) if the patient has diabetic retinopathy but no haematuria

Question 11

Metformin is contraindicated in diabetic patients:
A) if the eGFR is below 30 ml/min
B) if the patient is obese
C) if the patient has hypertension
D) if the patient has thyroid disease

Answer 11

A) if the eGFR is below 30 ml/min

Question 12

Nephrotic syndrome is defined as:
A) significant proteinuria
B) hypalbuminaemia
C) predisposition to oedema
D) the concurrent presence of all three factors above

Answer 12

D) the concurrent presence of all three factors above

Question 13

In case of the presence of glomerular type red blood cells in the urine sediment:
A) renal stone is suspected, the patient should be referred first to urology examination
B) tumour is suspected, the patient should be referred first to urology examination
C) glomerular disease is suspected, the patient should be referred first to nephrology examination
D) uroinfection is suspected, the patient should be referred first to urology examination

Answer 13

C) glomerular disease is suspected, the patient should be referred first to nephrology examination

Question 14

Analgesic nephropathy:
A) is an acute kidney injury caused by NSAIDs
B) is a chronic kidney disease caused by NSAIDs
C) is a glomerulonephritis caused by NSAIDs
D) is an acute kidney injury caused by steroidal anti-inflammatory drugs

Answer 14

B) is a chronic kidney disease caused by NSAIDs

Question 15

Risk factors for acute kidney injury exclude:
A) old age
B) intravenous contrast agents
C) NSAIDs abuse
D) increased fluid intake

Answer 15

D) increased fluid intake

Question 16

In acute kidney injury, renal cause may be suspected in the case of:
A) isolated or marked increase of the serum carbamide nitrogen level
B) bladder retention
C) marked increase of the serum creatinine level in conjunction with less marked increase of the serum carbamide nitrogen level
D) decreased turgor of the skin and dry tongue

Answer 16

C) marked increase of the serum creatinine level in conjunction with less marked increase of the serum carbamide nitrogen level

Question 17

In the case of acute kidney injury and glomerular haematuria or the presence of RBC cylinders in the urine:
A) pre-renal causes should be searched
B) renal cause, e.g. acute glomerulonephritis is suspected
C) post-renal cause should be searched

Answer 17

B) renal cause, e.g. acute glomerulonephritis is suspected

Question 18

The most common cause of acute kidney injury out of the following:
A) pre-renal causes
B) renal causes
C) post-renal causes

Answer 18

A) pre-renal causes

Question 19

The most common causes of primary nephrotic syndrome:
1) membranous glomerulonephritis
2) minimal change disease
3) focal segmental glomerulosclerosis
4) IgA nephropathy

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 19

A) answers 1., 2. and 3. are correct

Question 20

In the case of glomerular type haematuria after respiratory infection the following pathology/pathologies may be suspected:
1) minimal change disease
2) IgA nephropathy
3) membranous glomerulonephritis
4) acute, post-streptococcal glomerulonephritis

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 20

C) answers 2. and 4. are correct

Question 21

If RAAS-inhibitor therapy was commenced for treating diabetic nephropathy, after the initiation, the following should be controlled:
1) serumcreatinine and eGFR
2) blood lipids
3) serum potassium level
4) RBC sedimentation rate

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 21

B) answers 1. and 3. are correct

Question 22

Causes of symmetrical leg oedema may be:
1) marked proteinuria e.g. in nephrotic syndrome
2) malnutrition, malabsorption
3) liver failure
4) peripheral artery disease

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 22

A) answers 1, 2 and 3 are correct

Question 23

A typical sign of systemic, vasculitis involving the kidneys may be:
1) acute kidney injury often accompanied by haematuria
2) urinary obstruction
3) appearance of purpura
4) concurrent presence of diabetic retinopathy

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 23

B) answers 1. and 3. are correct

Question 24

The most common cause of secondary hypertension:
1) Cushing syndrome
2) acromegaly
3) hyperthyreosis
4) hypertension of renal origin

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 24

D) only answer 4 is correct

Question 25

Choose the correct answers from the following statements characterising acute post-streptococcal glomerulonephritis.
1) the serum complement level decreases
2) the serum ASO titer decreases
3) oedema around the eyes can be observed
4) hypertension is never present

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 25

B) answers 1. and 3. are correct

Question 26

Choose the correct answers from the following statements suggesting causes of anaemia as a result ofchronic renal failure!
1) decreased erytropoietin production
2) decreased iron and B12 absorption
3) uraemic toxins depressing the bone marrow
4) increased life-span of RBC can be observed

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 26

A) answers 1., 2. and 3. are correct

Question 27

Out of the following, which ultrasound result indicates chronic kidney disease in an average-sized adult?
1) the length of kidneys is 80 mm
2) hyperreflective parenchyma
3) wave-like appearance of the surface
4) 12–14 mm thick parenchyma

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 27

A) answers 1, 2 and 3 are correct

Question 28

The following renal-replacement therapy modalities may be chosen in end-stage renal failure:
1) haemodialysis
2) peritoneal dialysis
3) kidney transplantation
4) cyclophosphamide therapy

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 28

A) answers 1, 2 and 3 are correct

Question 29

Causes of systemic leg oedema may be:
1) heart failure
2) decompensated liver cirrhosis
3) nephrotic syndrome
4) none of the above

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 29

A) answers 1., 2. and 3. are correct

Question 30

Which of the following may indicate renal involvement is SLE?
1) skin lesions
2) bacteriuria
3) neurological signs
4) proteinuria

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 30

D) only answer 4. is correct

Question 31

Which of the following factors may be responsible for the development of diabetic nephropathy?
1) glycation end products
2) hyperfiltration
3) genetic factors
4) decreased negative charge of the glomerular basal membrane

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 31

E) all 4 answers are correct

Question 32

When does bacteriuria require treatment in young female patients?
1) in the case of complaints suggestive of a urinary tract infection
2) in the case of leukocyturia
3) in pregnancy
4) if haematuria is also present

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 32

B) answers 1. and 3. are correct

Question 33

Which of the following can be used for measuring the glomerular filtration rate?
1) 24-hour endogenous creatinine clearance
2) clearance measured with an isotope
3) estimated GFR
4) concentrating ability test

A) answers 1., 2. and 3. are correct
B) answers 1. and 3. are correct
C) answers 2. and 4. are correct
D) only answer 4. is correct
E) all 4 answers are correct

Answer 33

A) answers 1., 2. and 3. are correct

Question 34

What characterises acute tubulointerstitial nephritis from among the following?
1) fever
2) eosinophilia/eosinophiluria
3) sterile pyuria
4) hypertension

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 34

A) answers 1, 2 and 3 are correct

Question 35

What characterises renovascular hypertension?
1) bruits are always noticeable with physical examination
2) angiography is always needed as the gold standard
3) it is the most common form of secondary hypertension
4) it most frequently develops on the grounds of atherosclerosis

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 35

C) answers 2 and 4 are correct

Question 36

Which of the following results indicate good prognosis in acute renal injury?
1) polyuria
2) anuria
3) urine specific gravity: 1005
4) urine specific gravity: 1012

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 36

B) answers 1 and 3 are correct

Question 37

Which of the following factors can attenuate the progression of chronic kidney disease?
1) RAAS inhibitor therapy
2) dietary protein restriction
3) regular blood pressure control
4) statin therapy

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 37

E) all 4 answers are correct

Question 38

Which of the following needs to be addressed in the conservative therapy of chronic renal failure?
1) anaemia
2) metabolic acidosis
3) hyperkalaemia
4) hyponatraemia

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 38

A) answers 1, 2 and 3 are correct

Question 39

Which antidiabetic can be given to patients with declined kidney function (eGFR<30 ml/min/1,73m2), including patients receiving dialysis therapy?
1) gliquidone
2) metformin
3) insulin
4) glimepiride

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 39

B) answers 1 and 3 are correct

Question 40

Which of the following can be used in the conservative treatment of hyperkalaemia?
1) insulin + glucose infusion
2) iv. calcium
3) furosemide and physiological saline infusion
4) ion-exchange resin

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 40

E) all 4 answers are correct

Question 41

It is important to know the patient’s kidney function when ordering a new medication, as the pharmacokinetics of several medications and thereby, the dosage depends on the kidney function.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 41

A) both are correct, there is a causal relationship between the two,

Question 42

Haematuria is the most common symptom in minimal change nephropathy, therefore the patient has to be protected from physical exercise/burden.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 42

E) both are incorrect

Question 43

In the case of non-dialysed patients with declined kidney function thiazide-type diuretics should be given for diuretic therapy, becauseat this stage loop-diuretics are ineffective.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 43

E) both are incorrect

Question 44

In patients over 50 suffering from membranous glomerulonephritis cancer screening is necessary, since in older age tumour antigen-containing immune complexes more frequently cause membranous glomerulonephritis.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 44

A) both are correct, there is a causal relationship between the two,

Question 45

Acute diffuse poststreptococcal glomerulonephritis is characterised by fever and inflammatory symptoms, therefore the patient has to be treated with antipyretics.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 45

E) both are incorrect

Question 46

The main symptom of patients with nephrotic syndrome is pyuria, therefore, changes causing obstruction to the urinary flow have to be looked for.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 46

E) both are incorrect

Question 47

In the case of diabetic kidney disease, RAAS-inhibitor therapy is given due to abnormal albuminuria, as RAAS-inhibitors decrease the intraglomerular pressure.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 47

A) both are correct, there is a causal relationship between the two,

Question 48

Stages of the renal alterations are similar in Type1 and Type 2 diabetes mellitus, as both types of diabetes mellitus develop as the result of severely damaged insulin production of the pancreas.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 48

C) the first is correct, the second is incorrect

Question 49

Nephropathy may be present at the time of the diagnosis in Type 2 diabetes, as diabetic nephropathy belongs to the so-called macroangiopathies.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 49

C) the first is correct, the second is incorrect

Question 50

In general practice, CKD-epi equation is used for estimating the kidney function, as its determination requires the collection of 24-hour urine sample.
A) both are correct, there is a causal relationship between the two,
B) both are correct, there is no causal relationship between the two,
C) the first is correct, the second is incorrect
D) the first is incorrect , the second is correct
E) both are incorrect

Answer 50

C) the first is correct, the second is incorrect

Question 51

Link the symptoms indicated by numbers with the most matching pathological clinical pictures (with capital letters).
A) renal anaemia
B) nephrotic syndrome
C) nephritic syndrome
D) uroinfection

INT - 10.59 - proteinuria above 3.5 g/day
INT - 10.60 - glomerular type haematuria
INT - 10.61 - pyuria + bacteriuria
INT - 10.62 - erythropoietin therapy

Answer 51

59- B
60- C
61- D
62- A

Question 52

Link the symptoms indicated by numbers with the most matching pathological clinical pictures (with capital letters)!
A) acute kidney injury
B) chronic renal insufficiency
C) both of the above
D) none of the above

INT - 10.63 - low glomerular filtration rate
INT - 10.64 - kidneys are of normal size or enlarged
INT - 10.65 - it develops unnoticeably, almost symptomless
INT - 10.66 - the kidneys’ concentrating ability is not disturbed

Answer 52

63- B
64- A
65- B
66- D

Question 53

Match the therapeutic possibilities marked by numbers with the clinical picture marked by capital letters in the treatment of which the given therapeutic possibility is the most appropriate treatment of choice.
A) renal anaemia
B) pre-renal acute kidney injury
C) severe acute kidney injury
D) nephrotic syndrome

INT - 10.67 - management of homeostatic/volume balance
INT - 10.68 - potassium-sparing diuretic
INT - 10.69 - erythropoietin
INT - 10.70 - dialysis

Answer 53

67- B
68- D
69- A
70- C

Question 54

Match conditions marked by numbers with the most appropriate concept!
A) cardiovascular progression
B) cardiovascular regression
C) early screening for cardiovascular disease
D) no increase in cardiovascular risk

INT - 10.71 - screening of albuminuria
INT - 10.72 - acute post-streptococcal glomerulonephritis
INT - 10.73 - decrease in GFR
INT - 10.74 - decreased proteinuria

Answer 54

71- C
72- D
73- A
74- B