Nephrology Flashcards
Which of the following increases the risk of nephrotoxin-associated AKI
a) Hyponatremia
b) Hypoalbuminemia
c) Hypercholesterolemia
d) Hyperuricemia
d) Hyperuricemia
Urinary finding of muddy brown granular cast is seen in…
a) Acute tubular necrosis
b) Pre-renal AKI
c) Intrinsic AKI
d) Post-renal AKI
a) Acute tubular necrosis
Which of the following causes of AKI is associated with intrinsic azotemia?
a) Malignant metastatic lesion
b) Sepsis/Infection
c) ACE inhibitor
d) Acute congestive heart failure
b) Sepsis/Infection
a) Malignant metastatic lesion – Postrenal
c) ACE inhibitor - Prerenal
d) Acute congestive heart failure – Prerenal
The diagnostic modality of choice in CKD patients to assess renal size:
a) Contrast Magnetic Resonance Imaging
b) IVP
c) Ultrasound of the kidney
d) Contrast CT scan of the kidney
c) Ultrasound of the kidney
In Cockcroft-Gault formula, which of the following data is used to estimate GFR?
a) Urine protein
b) Height
c) Weight
d) Urine creatinine
c) Weight
Which of the following tests is considered the basic examination in analyzing the causation of renal disease?
a) Serum creatinine
b) Serum osmolality
c) Urinalysis
d) Urine chemistry
c) Urinalysis
Which of the following is a finding of pre-renal azotemia?
a) FENa >1
b) Specific gravity >1.020
c) BUN/Creatinine ratio <20
d) Urine osmolality >500
Urine osmolality >500
The drug of choice in diabetic patients who present with hypertension and proteinuria
a) Losartan (angiotensin receptor blocker)
b) Atenolol (beta blocker)
c) Diltiazem (calcium channel blocker)
d) Clonidine (alpha-2 agonist)
a) Losartan (angiotensin receptor blocker)
The annual mean decline in GFR with age from the peak GFR of 120 cc/min/1.73m2 is…
a) 1 cc/min/kg/yr/1.73m2
b) 2 cc/min/kg/yr/1.73m2
c) 3 cc/min/kg/yr/1.73m2
d) 4 cc/min/kg/yr/1.73m2
a) 1 cc/min/kg/yr/1.73m2
Which of the following conditions is contraindicated in renal biopsy?
a) Acute Interstitial Nephritis
b) Idiopathic Nephrotic Syndrome
c) Acute Urinary Tract Infection
d) Acute Glomerulonephritis
c) Acute Urinary Tract Infection
Which of the following CKD conditions can provide a bilateral normal size kidney?
a) Chronic pyelonephritis
b) Amyloidosis related renal disease
c) Hypertensive nephrosclerosis
d) Chronic glomerulonephritis
b) Amyloidosis related renal disease
Which of the procedures can predispose ESRD patients to develop nephrogenic fibrosing dermopathy
a) Contrast magnetic resonance imaging
b) CT scan with contrast
c) Intravenous Pyelography
d) Renal DTPA scan
a) Contrast magnetic resonance imaging
Which of the following abnormal endocrine function is observed in CKD?
a) Increased tolerance to electrolyte loading
b) Decrease erythropoietin production
c) Increase vitamin D activation
d) Decrease half-life of insulin
b) Decrease erythropoietin production
RIFLE criterion that describes loss of renal function requires a persistent acute kidney injury or complete loss of renal function for more than…
a) 2 weeks
b) 3 weeks
c) 4 weeks
d) 5 weeks
c) 4 weeks
Which of the following conditions increases the risk of progressive CKD?
a) Hematuria
b) Pyuria
c) Hyperlipidemia
d) Hypercalcemia
c) Hyperlipidemia
Which of the following procedures provides information as to the function of both kidneys?
a) Differential Nuclear GFR
b) Magnetic Resonance Imaging
c) Compound Tomography
d) Intravenous Pyelography
a) Differential Nuclear GFR
At what CKD stage should patient be assessed for protein calorie malnutrition?
a) Stage 2
b) Stage 3
c) Stage 4
d) Stage 5
d) Stage 5
The following are the causes of anemia in CKD, EXCEPT:
a) Folate deficiency
b) Hypoparathyroidism
c) Chronic Inflammation
d) Iron deficiency
b) Hypoparathyroidism
Butterfly wing appearance in chest x-ray of a patient with chronic kidney disease connotes:
a) Pulmonary edema
b) Pulmonary fibrosis
c) Pulmonary embolism
d) Pulmonary Infarct
a) Pulmonary edema
Which of the following biomarkers is elevated in AKI following cardiopulmonary bypass?
a) Osteopontin
b) Cystatin C
c) Kidney Injury Molecule-1 (KIM-1)
d) Neutrophil gelatinase-associated lipocalin (NGAL)
d) Neutrophil gelatinase-associated lipocalin (NGAL)
In immune-mediated glomerulonephritis, the glomerular injury results from this mechanism:
a) Overexpression of autoantibodies
b) Formation of immune complexes in circulation which trap in glomerulus or in-situ formation
c) Aberrant expression of major histocompatibility complex molecules
d) Reactivity of circulation autoantibodies and autoantigens
b) Formation of immune complexes in circulation which trap in glomerulus or in-situ formation
What is the stage of DM Nephropathy in a 56 yr/o Female, with generalized edema, BP = 170/100, HBG= 120, urinary protein:creatinine ratio= 4, Serum creatinine= 0.8
a) 1
b) 2
c) 3
d) 4
e) 5
c) 3
Excessive proliferation of these glomerular cells results in crescent formation
a) Parietal epithelial cells
b) Endothelial cells
c) Subepithelial cells
d) Mesangial cells
a) Parietal epithelial cells
What is the characteristic of glomerular hematuria?
a) >3/hpf rbc
b) Uniform sizes red cells
c) Dysmorphic
d) Small and pale red cells
c) Dysmorphic
What are the expected histopathologic findings in a 28 y/o Female, with persistent hematuria for 1 year? BP= 110/70, (-) edema, urinalysis= rbc 10-15/hpf, (-) proteinuria, serum creatinine= 0.7 mg/dL
a) Effacement of foot processes
b) Predominant mesangial IgA deposits
c) Diffuse proliferative glomerulonephritis
d) Glomerular basement membrane = 215 nm
b) Predominant mesangial IgA deposits
What is the difference in clinical presentation of Acute Glomerulonephritis and RPGN?
a) High blood pressure
b) Tea colored urine and oliguria
c) Rapid deterioration of GFR
d) Edema
e) Hematuria and RBC cast
c) Rapid deterioration of GFR
Expected histopathologic findings in a 20 y/o male, with 1 week history of oliguria and tea-colored urine with PPE. BP-150/100, HR80/min, periorbital and grade 2 bipedal edema, several scars of pyodermas on both feet and legs, with urinalysis findings of rbcTNTC, pus cells- 1-3/lpf?
a) Evidence of densely packed deposits on the capillary wall
b) Prominent mesangial IgA deposits
c) Thickened glomerular basement membranes
d) Diffuse proliferation of endothelial, epithelial, and mesangial cells
d) Diffuse proliferation of endothelial, epithelial, and mesangial cells
What is the glomerular disease in a 22 y/o female, mentally retarded, deaf, and blind with hematuria since the age of 10 y/o. HGB= 102, Serum creatinine= 4.6 mg/dL, urinalysis= rbc 15-20/hpf, (+1) proteinuria
a) TBMD
b) Good Pasteur Syndrome
c) Alport Syndrome
d) Nail-Patella Syndrome
c) Alport Syndrome
In RPGN, modalities of treatment that will prevent antibody production and formation of circulating immune complexes causing glomerular injury?
a) Pulses of Methylprednisolone
b) Plasmapheresis
c) Immunoglobulin
d) Hemodialysis
b) Plasmapheresis
All but one are poor prognostic factors in adult patients who have Acute Post-streptococcal GN
a) EM findings of atypical humps
b) If findings of starry sky pattern
c) Heavy proteinuria >2 gm/day
d) Evidence of pre-existing renal disease
b) If findings of starry sky pattern
Which of the following statements is true with regard to the factors in the development of DM Nephropathy?
a) Diabetic retinopathy is present in 90% of cases of type 2 DM with nephropathy
b) Microalbuminuria is a potent risk factor in CV diseases among type 2 DM
c) Type 1 DM and microalbuminuria developed CV events before they progress to renal failure
d) Microalbuminuria is positive at the time of diagnosis of Type 1 DM
b) Microalbuminuria is a potent risk factor in CV diseases among type 2 DM
What is the target Ag in Anti-GBM disease which is normally present in the glomerulus and pulmonary alveolar basement membrane?
a) Antineutrophil cytoplasmic membrane
b) Podocin
c) Type IV collagen
d) CD2AP
c) Type IV collagen
What is the type of Primary RPGN in a 32 y/o female initial have fever, arthralgia, colds and cough, later developed to purpuric lesions and tea-colored urine with urinalysis findings of rbc- TNTC, rbc cast 1-3/lpf, proteinuria (+1), Serum creatinine- 6-8 mg/dL, ESR120 mm/hr, CRP- 500 mg/L, (+) ANCA?
a) Type I
b) Type II
c) Type III
d) Type IV
e) Type V
c) Type III
All but one affect the degree of proteinuria in patients with Nephrotic Syndrome:
a) Plasma concentration of albumin
b) Blood pressure control
c) Dietary protein intake
d) Intraglomerular pressure through RAAS
b) Blood pressure control
Increased thromboembolic tendency in the form of Renal Vein Thrombosis has increased the incidence to develop in Nephrotic Syndrome with what glomerular lesion?
a) Membranous GN
b) Minimal Change Disease
c) Focal Segmental Glomerulosclerosis
d) DM Nephropathy
a) Membranous GN
In a patient presenting with Nephrotic Syndrome, if the glomerular lesion is FSGS, what are the electron microscopy findings in all the glomeruli?
a) Projections of basement membrane-like material in the glomerular basement membrane
b) Diffuse epithelial foot process effacement
c) Numerous large subendothelial deposits
d) Thickened basement membrane
b) Diffuse epithelial foot process effacement
All but one are glomerular diseases that may recur during the transplant kidney
a) Lupus Nephritis
b) Anti-GBM Disease
c) FSGS
d) Membranous GN
a) Lupus Nephritis
FSGS = highest chance of recurrence and graft failure in transplanted kidney
A 20 y/o female, single, has recurrent episodes of gross hematuria noted after a respiratory tract infection for 1 year. No PPE, urinalysis revealed rbc- TNTC, (-) proteinuria. Serum creatinine- 0.8 mg/dL. The father has PTB. What is the glomerular disease?
a) TBMD
b) Acute Postrep GN
c) Nail-patellar Syndrome
d) IgA Nephropathy
d) IgA Nephropathy
In renal biopsy, what is the significance of staining the tissues for Masson’s trichrome stain?
a) Enhance basement membrane structures
b) Identify amyloid deposits
c) Stain CHO moieties in the basement membrane
d) To assess the cellularity of the glomerulus
e) Identify collagen deposits and the degree of glomerulosclerosis
e) Identify collagen deposits and the degree of glomerulosclerosis
Pulmonary-Renal Syndrome is seen in:
a) Fabry’s Disease
b) Good Pasteur’s Syndrome
c) Lupus Nephritis
d) Anti-GBM Disease
e) Amyloidosis
b) Good Pasteur’s Syndrome
The total body water of an elderly female 60 yrs. old weighing 60 kg
a) 27 liters
b) 30 liters
c) 36 liters
d) 42 liters
c) 36 liters
Insensible water loss includes water loss form:
a) Urine
b) Water as a byproduct of metabolism
c) Lungs
d) Feces
c) Lungs
Vomiting causes metabolic alkalosis because of:
a) Loss of gastric juice
b) Loss of HCO3, H, Na, K, and Cl
c) Electrolytes gained during vomiting
d) Compensatory loss of HCO3 from the stomach
b) Loss of HCO3, H, Na, K, and Cl
Normal Ringers lactate IVF can be substituted for NSS because it contains
a) 140
b) 154 Na
c) 139 Na
d) 145
c) 139 Na
The symptoms of hypovolemia include the following except:
a) Increased pulse rate
b) Low Hct
c) Orthostatic hypotension
d) Decreased urine output
b) Low Hct
Hyponatremia occurs in the following except:
a) Renal tubular acidosis
b) Postobstructive diuresis
c) Hyperaldosterone
d) Adrenal insufficiency
c) Hyperaldosterone
Drugs that increase arginine vasopressin include the following, except:
a) Hydrochlorthiazide
b) Morphines
c) Antidepressants
d) Carbamazepine
a) Hydrochlorthiazide
Hyponatremia with hypervolemia occurs in the following except:
a) Nephrotic syndrome
b) Syndrome of Inappropriate arginine vasopressin
c) Liver cirrhosis
d) CHF
b) Syndrome of Inappropriate arginine vasopressin
Hypernatremia can occur in:
a) Adrenal insufficiency
b) Hypoaldosteronism
c) Diabetes Mellitus
d) Cushing’s
Cushing’s
The Syndrome of Inappropriate Arginine Vasopressin or SIADH is characterized by:
a) Hyperuricemia
b) Urine osmolality of <100
c) Urine Na <40
d) Serum osmolality <280
d) Serum osmolality <280
The bulk of Potassium is in:
a) Skeletal structures
b) Interstitial spaces
c) Plasma
d) Muscle
d) Muscle
Hyperkalemia and hypertension can be due to:
a) Hypomagnesemia
b) Use of ACE Inhibitor or ARB
c) Bartter’s Syndrome
d) Liddle’s Syndrome
b) Use of ACE Inhibitor or ARB
The ECG finding in hypokalemia – U wave
a) ST depression
b) Prolonged QT and ST
c) Flattening of P wave
d) PR prolongation
a) ST depression
A patient with metabolic alkalosis has
a) pCO2 40 HCO3 <22
b) pCO2 35 HCO3 >26
c) pCO2 <45 HCO3 <22
d) pCO2 <45 HCO3 24
b) pCO2 35 HCO3 >26
Metabolic acidosis will cause the following EXCEPT:
a) Abdominal bloating
b) Fatigue
c) Nausea and vomiting
d) Labored breathing
a) Abdominal bloating
Metabolic acidosis and hypokalemia seen in
a) Prior diuretic use
b) Diarrhea
c) Bartter’s Syndrome
d) RTA
d) RTA
The following are complications of giving bicarbonate EXCEPT:
a) Hyponatremia
b) Worsen hypokalemia and hypocalcemia
c) Hyperosmolarity
d) Volume overload
a) Hyponatremia
Hypokalemia, metabolic acidosis, Urine Cl >20 can be seen in:
a) Villous adenoma
b) Vomiting
c) Congenital chlordiarrhea
d) Gitelman’s Syndrome
b) Vomiting
True of Liddle’s Syndrome
a) Blood pH shows metabolic acidosis
b) It is sporadic in occurrence
c) It is characterized by increased distal Na reabsorption and K secretion
d) Patients are normotensive
c) It is characterized by increased distal Na reabsorption and K secretion
Which statement is false?
a) Metabolic acidosis of the high anion gap variety plus either chronic respiratory acidosis or metabolic alkalosis represent a situation in which HCO3 may be normal or very high
b) Reciprocal changes in Chloride and HCO3 do not result in normal anion gap
c) Ketoacidosis can occur in alcoholic intoxication associated with volume depletion, hypokalemia, hypophosphatemia, hypomagnesemia
d) Normal values for HCO3, PaCO2, and pH do not ensure the absence of Acid-base disturbance
d) Normal values for HCO3, PaCO2, and pH does not ensure the absence of Acid-base disturbance
should be alkalosis
