NEPHROLOGY

Question 1

Represents a stage of CKD where the accumulation of toxins, fluid, and electrolytes normally excreted by the kidneys leads to death unless the toxins are removed

Answer 1

end-stage renal disease

Question 2

The pathophysiology of CKD involves two broad sets of mechanisms of damage:

Answer 2

(1) initiating mechanisms specific to the underlying etiology
(2) hyperfiltration and hypertrophy of the remaining viable nephrons

Question 3

Most common inherited form of CKD

Answer 3

autosomal dominant polycystic kidney disease.

Question 4

The normal annual mean decline in GFR with age from the peak GFR (~120 mL/min per 1.73 m2) attained during _________ is _________ , reaching a mean value of _________ at age 70

Answer 4

the third decade of life
~1 mL/min per year per 1.73 m2
70 mL/min per 1.73 m2

Question 5

UACR above ________ in men and ________ in women serves as a marker not only for early detection of primary kidney disease, but for systemic microvascular disease as well

Answer 5

17 mg albumin/g creatinine

25 mg albumin/g creatinine

Question 6

Serves as a well-studied screening marker for the presence of systemic microvascular disease and endothelial dysfunction

Answer 6

presence of albuminuria

Question 7

T or F: The serum concentrations of urea and creatinine are readily measured complete surrogate markers for retained toxins in uremia

Answer 7

False. Accumulation of these two molecules themselves does not account for the many symptoms and signs that characterize the uremic syndrome in advanced renal failure

Question 8

T or F: CKD is associated with increased systemic inflammation

Answer 8

True

Question 9

The pathophysiology of the uremic syndrome can be divided into manifestations in three spheres of dysfunction:

Answer 9

(1) those consequent to the accumulation of toxins that normally undergo renal excretion;
(2) those consequent to the loss of other kidney functions,
(3) progressive systemic inflammation and its vascular and nutritional consequences

Question 10

Hyponatremia is not commonly seen in CKD patients but, when present, often responds to

Answer 10

Water restriction

As long as water intake does not exceed the capacity for renal water clearance, the ECFV expansion will be isotonic and the patient will have a normal plasma sodium concentration

Question 11

Medications that can inhibit renal potassium excretion and lead to hyperkalemia and must be cautiously used or avoided in CKD (2)

Answer 11

RAS inhibitors

Spironolactone and other potassium-sparing diuretics such as amiloride, eplerenone, and triamterene

Question 12

Certain causes of CKD can be associated with earlier and more severe disruption of potassium-secretory mechanisms in the distal nephron, out of proportion to the decline in GFR. These include conditions associated with (2)

Answer 12

Hyporeninemic hypoaldosteronism (diabetes)
Renal diseases that preferentially affect the distal nephron (obstructive uropathy and sickle cell nephropathy)

Question 13

Alkali supplementation may, in addition, attenuate the catabolic state and possibly slow CKD progression and is recommended when the serum bicarbonate concentration falls below

Answer 13

20–23 mmol/L

Question 14

These changes that may lead to bone disease in CKD start to occur when the GFR falls below

Answer 14

60 mL/min

Question 15

Hyperparathyroidism stimulates bone turnover and leads to

Answer 15

osteitis fibrosa cystica

Question 16

Bone histology shows abnormal osteoid, bone and bone marrow fibrosis, and in advanced stages, the formation of bone cysts, sometimes with hemorrhagic elements so that they appear brown in color

Answer 16

osteitis fibrosa cystica

Question 17

Brown tumor is also known as

Answer 17

osteitis fibrosa cystica

Question 18

A devastating condition seen almost exclusively in patients with advanced CKD that is heralded by livedo reticularis and advances to patches of ischemic necrosis, especially on the legs, thighs, abdomen, and breasts

Answer 18

Calciphylaxis

Question 19

The optimal management of secondary hyperparathyroidism and osteitis fibrosa in CKD is

Answer 19

prevention

Once the parathyroid gland mass is very large, it is difficult to control the disease

Question 20

These are agents that are taken with meals and complex the dietary phosphate to limit its GI absorption

Answer 20

phosphate binders such as calcium acetate, calcium carbonate, sevelamer and lanthanum

Question 21

Non-calcium-containing polymers that also function as phosphate binders; they do not predispose CKD patients to hypercalcemia and may attenuate calcium deposition in the vascular bed (2)

Answer 21

sevelamer and lanthanum

Question 22

Enhance the sensitivity of the parathyroid cell to the suppressive effect of calcium, and produces a dose-dependent reduction in PTH and plasma calcium concentration in some patients

Answer 22

calcimimetic drugs such as cinacalcet

Question 23

Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines recommend a target PTH level between

Answer 23

150 and 300 pg/mL

Question 24

Very low PTH levels in CKD are associated with these conditions (3)

Answer 24

Adynamic bone disease
Fracture
Ectopic calcification

Question 25

The leading cause of morbidity and mortality in patients at every stage of CKD

Answer 25

Cardiovascular disease

Question 26

The CKD-related risk factors in the increased prevalence of cardiovascular disease are (6)

Answer 26

anemia
hyperphosphatemia
hyperparathyroidism
increased FGF-23
sleep apnea
generalized inflammation

Question 27

The largest increment in cardiovascular mortality rate in dialysis patients is associated with (2)

Answer 27

congestive heart failure and sudden death

Question 28

2 strongest risk factors for cardiovascular morbidity and mortality in patients with CKD that are thought to be related primarily, but not exclusively, to prolonged hypertension and ECFV overload

Answer 28

Left ventricular hypertrophy and dilated cardiomyopathy

Question 29

The absence of hypertension in CKD may signify

Answer 29

poor left ventricular function

Question 30

T or F, The use of exogenous erythropoiesis-stimulating agents do not have effect on the blood pressure

Answer 30

False. It can increase blood pressure and the requirement for antihypertensive drugs

Question 31

The overarching goal of hypertension therapy in CKD is to

Answer 31

prevent the extrarenal complications of high blood pressure, such as cardiovascular disease and stroke

Question 32

In CKD patients with diabetes or proteinuria >1 g per 24 h, blood pressure should be reduced to

Answer 32

<130/80 mmHg

Question 33

First line of therapy in the management of hypertension in CKD

Answer 33

salt restriction

Question 34

Antihypertensive drugs that appear to slow the rate of decline of kidney function in a manner that extends beyond reduction of systemic arterial pressure and that involves correction of the intraglomerular hyperfiltration and hypertension

Answer 34

ARBs and ACEi

Question 35

Chest pain with respiratory accentuation, 2117 accompanied by a friction rub, is diagnostic of

Answer 35

pericarditis

Question 36

T or F: In patients with uremic pericarditis/effusion, hemodialysis should be performed with heparin

Answer 36

False. Because of the propensity to hemorrhage in pericardial fluid.

Question 37

Type of anemia in CKD

Answer 37

normochromic, normocytic

Question 38

Anemia in CKD can be observed in what stage of CKD

Answer 38

Stage 3

Question 39

Anemia in CKD is universal in what stage of CKD

Answer 39

Stage 4

Question 40

The primary cause of anemia in CKD

Answer 40

insufficient production of EPO

Question 41

Current practice in management of CKD is to target a hemoglobin concentration of

Answer 41

100–115 g/L

Question 42

Coexistence of bleeding disorders and a propensity to thrombosis is unique in patients with

Answer 42

CKD

Question 43

Subtle clinical manifestations of uremic neuromuscular disease usually become evident at what stage of CKD

Answer 43

Stage 3

Question 44

Peripheral neuropathy usually becomes clinically evident after the patient reaches what stage of CKD

Answer 44

stage 4 CKD

Question 45

Characterized by ill-defined sensations of sometimes debilitating discomfort in the legs and feet relieved by frequent leg movement

Answer 45

restless leg syndrome

Question 46

T or F: Evidence of peripheral neuropathy without another cause is an indication for starting renal replacement therapy

Answer 46

True

Question 47

A urine-like odor on the breath, derives from the break- down of urea to ammonia in saliva and is often associated with an unpleasant metallic taste

Answer 47

Uremic fetor

Question 48

A class of drugs that result in glucose lowering, accompanied by striking reductions in kidney function decline and in cardiovascular events

Answer 48

SGLT-2 inhibitors

Question 49

In advanced CKD, even on dialysis, patients may become more pigmented, and this is felt to reflect the deposition of retained pigmented metabolites called

Answer 49

urochromes

Question 50

Although many of the cutaneous abnormalities in CKD improve with dialysis, this particular manifestation is often tenacious

Answer 50

pruritus

Question 51

Pruritus in CKD may be caused by this electrolyte abnormality

Answer 51

hyperphosphatemia

Question 52

A skin condition unique to CKD patients consists of progressive subcutaneous induration, especially on the arms and legs

Answer 52

nephrogenic fibrosing dermopathy

seen in patients exposed to gadolinium contrast of MRI

Question 53

Stage of CKD that is contraindicated for exposure with gadolinium contrast

Answer 53

Stage 4-5

Stage 3 - precaution or minimize exposure

Question 54

The most useful imaging study in evaluation of CKD

Answer 54

Renal utrasound

Question 55

CKD causes with normal or increased kidney size on ultrasound (4)

Answer 55

DM nephropathy
Amyloidosis
HIV nephropathy
Polycystic kidney disease

Question 56

_____________ that has reached some degree of renal failure will almost always present with enlarged kidneys

Answer 56

Polycystic kidney disease

Question 57

In the patient with bilaterally small kidneys, renal biopsy is not advised because (3)

Answer 57

(1) it is technically difficult and has a greater likelihood of causing bleeding and other adverse consequences
(2) there is usually so much scarring that the underlying disease may not be apparent
(3) the window of opportunity to render disease-specific therapy has passed

Question 58

Contraindications to kidney biopsy (4)

Answer 58

bilaterally small kidneys
uncontrolled hypertension
active urinary tract infection
bleeding diathesis (including ongoing anticoagulation)
severe obesity

Question 59

favored approach for kidney biosy

Answer 59

Ultrasound-guided percutaneous biopsy

Question 60

In the CKD patient in whom a kidney biopsy is indicated (e.g., suspicion of a concomitant or super-imposed active process such as interstitial nephritis or in the face of accelerated loss of GFR), the bleeding time should be measured, and if increased,_________ should be administered immediately prior to the procedure

Answer 60

desmopressin

or brief run of HD without heparin

Question 61

The most important initial diagnostic step in approach to kidney disease management

Answer 61

to distinguish newly diagnosed CKD from acute or subacute renal failure

Question 62

Among the calcium channel blockers, ______ and_______ may exhibit superior antiproteinuric and renoprotective effects

Answer 62

diltiazem and verapamil

Question 63

Two human kidneys harbor nearly how many glomerular capillary tufts

Answer 63

1.8 million

Question 64

The glomerular capillaries filter how many liters of plasma water

Answer 64

120–180 L/d

Question 65

Humans with normal nephrons excrete on average how many mg of albumin in daily voided urine

Answer 65

8–10 mg

Question 66

Persistent glomerulonephritis that worsens renal function is always accompanied by (3)

Answer 66

interstitial nephritis
renal fibrosis
tubular atrophy

Question 67

T or F: Renal failure in glomerulonephritis best correlates histologically with the type of inciting glomerular injury

Answer 67

False. It best correlates histologically with the appearance of tubulointerstitial nephritis rather than with the type of inciting glomerular injury

Question 68

Glomerular diseases often present as microscopic hematuria except for these 2 conditions wherein gross hematuria is common.

Answer 68

IgA nephropathy

sickle cell disease

Question 69

Microalbuminuria is how much albumin in the urine?

Answer 69

30–300 mg/24 h

Question 70

Frank proteinuria is how much albumin in the urine?

Answer 70

> 300 mg/24 h

Question 71

Sustained proteinuria value

Answer 71

> 1–2 g/24 h

Question 72

Foaming urine on voiding is indicative of

Answer 72

proteinuria

Question 73

Class of proteinuria that is nonsustained, generally <1 g/24 h

Answer 73

benign proteinuria
sometimes called functional or transient proteinuria

caused by fever, exercise, obesity, sleep apnea, emotional stress, and congestive heart failure

Question 74

Proteinuria only seen with upright posture

Answer 74

orthostatic proteinuria

benign prognosis

Question 75

T or F: In children with minimal change disease (MCD), the proteinuria is non-selective and composed of albumin and a mixture of other serum proteins

Answer 75

False. selective, composed largely of albumin

Proteinuria in most adults with glomerular disease is nonselective, containing albumin and a mixture of other serum proteins

Question 76

Glomerular syndrome producing 1–2 g/24 h of proteinuria, hematuria with red blood cell casts, pyuria, hypertension, fluid retention, and a rise in serum creatinine associated with a reduction in glomerular filtration

Answer 76

acute nephritic syndrome

Question 77

If glomerular inflammation causes the serum creatinine rises quickly, particularly over a few days, this acute nephritis is called

Answer 77

rapidly progressive glomerulonephritis (RPGN)

Question 78

Pathologic equivalent of the clinical presentation of RPGN

Answer 78

crescentic glomerulonephritis

Question 79

When patients with RPGN present with lung hemorrhage from Goodpasture’s syndrome, antineutrophil cytoplasmic antibodies (ANCA)-associated small-vessel vasculitis, lupus erythematosus, or cryoglobulinemia, they are often diagnosed as

Answer 79

pulmonary-renal syndrome

Question 80

Describes the onset of heavy proteinuria (>3.0 g/24 h), hypertension, hypercholesterolemia, hypoalbuminemia, edema/anasarca, and microscopic hematuria

Answer 80

Nephrotic syndrome

Question 81

Only large amounts of proteinuria (>3.0 g/24 h) are present without clinical manifestations

Answer 81

nephrotic-range proteinuria

Question 82

Describes patients with vascular injury producing hematuria and moderate proteinuria

Answer 82

Glomerular–vascular syndrome

Affected individuals can have vasculitis, thrombotic microangiopathy, antiphospholipid syndrome, or, more commonly, a systemic disease such as atherosclerosis, cholesterol emboli, hypertension, sickle cell anemia, and autoimmunity

Question 83

The most common infectious causes of glomerulonephritis throughout the world (2)

Answer 83

subacute bacterial endocarditis
malaria and schistosomiasis

closely followed by HIV and chronic hepatitis B and C

Question 84

The kidney biopsy uses this stain to assess cellularity and architecture

Answer 84

hematoxylin and eosin (H&E)

Question 85

The kidney biopsy uses this stain to stain carbohydrate moieties in the membranes of the glomerular tuft and tubules

Answer 85

periodic acid–Schiff (PAS)

Question 86

The kidney biopsy uses this stain to enhance basement mem- brane structure

Answer 86

Jones-methenamine silver

Question 87

The kidney biopsy uses this stain for amyloid deposits

Answer 87

Congo red

Question 88

The kidney biopsy uses this stain to identify collagen deposition and assess the degree of glomerulo- sclerosis and interstitial fibrosis

Answer 88

Masson’s trichrome

Question 89

Ideal number of glomeruli that are reviewed individually for discrete lesions in kidney biopsy

Answer 89

20

Question 90

How many percent of glomeruli is involved in focal lesion? diffuse lesion?

Answer 90

<50%

>50%

Question 91

When cells in the capillary tuft proliferate, it is called

Answer 91

endocapillary

Question 92

when cellular proliferation extends into Bowman’s space

Answer 92

extracapillary

Question 93

formed when epithelial podocytes attach to Bowman’s capsule in the setting of glomerular injury

Answer 93

Synechiae

Question 94

develop when fibrocellular/ fibrin collections fill all or part of Bowman’s space

Answer 94

crescents

Question 95

acellular, amorphous accumulations of proteinaceous material throughout the tuft with loss of functional capillaries and normal mesangium in the glomerulus

Answer 95

sclerotic glomer- uli

Question 96

Histopathologic finding that is an ominous sign of irreversibility and progression to renal failure

Answer 96

Interstitial fibrosis

Question 97

prototypical for acute endocapillary proliferative glomerulonephritis

Answer 97

Poststreptococcal glomerulonephritis

Question 98

PSGN is common in what ages

Answer 98

2-14 years old

Question 99

Infection prior to development of PSGN and the cause

Answer 99

Skin and throat infections with particular M types of streptococci (nephritogenic strains) antedate glomerular disease

Question 100

Post- streptococcal glomerulonephritis due to impetigo develops ______ after skin infection and ________ after streptococcal pharyngitis

Answer 100

2–6 weeks

1–3 weeks

Question 101

On renal biopsy, this condition demonstrates hypercellularity of mesangial and endothelial cells, glomerular infiltrates of polymorphonuclear leukocytes, granular subendothelial immune deposits of IgG, IgM, C3, C4, and C5–9, and subepithelial deposits (which appear as “humps”)

Answer 101

poststreptococcal glomerulonephritis

Question 102

Acute nephritic syndrome with hematuria, pyuria, red blood cell casts, edema, hypertension, and oliguric renal failure, and manifests as headache, malaise, anorexia, and flank pain

Answer 102

PSGN

Question 103

Increased titers of these antibodies can help confirm the diagnosis of PSGN (3)

Answer 103

ASO (30%)
anti-DNAse (70%)
antihyaluronidase antibodies (40%)

Question 104

Kidneys have subcapsular hemorrhages with a “flea-bitten” appearance, and microscopy on renal biopsy reveals focal proliferation around foci of necrosis associated with abundant mesangial, subendothelial, and subepithelial immune deposits of IgG, IgM, and C3

Answer 104

Subacute bacterial endocarditis

Question 105

Predominant organism causing glomerulonephritis in subacute bacterial endocarditis

Answer 105

Staphylococcus

Question 106

The most common clinical sign of renal disease in lupus nephritis

Answer 106

proteinuria

Question 107

Antibodies that correlate best with the presence of renal disease in lupus

Answer 107

Anti-dsDNA

Question 108

the only reliable method of identifying the morphologic variants of lupus nephritis

Answer 108

renal biopsy

Question 109

Class of lupus nephritis with minimal mesangial

Answer 109

Class I

Question 110

Class of lupus nephritis with normal histology with mesangial deposits

Answer 110

Class I

Question 111

Class of lupus nephritis with mesangial proliferation

Answer 111

Class II

Question 112

Class of lupus nephritis with mesangial hypercellularity with expansion of the mesangial matrix

Answer 112

Class II

Question 113

Class of lupus nephritis with focal nephritis

Answer 113

Class III

Question 114

Class of lupus nephritis with focal endocapillary ± extracapillary proliferation with focal subendothelial immune deposits and mild mesangial expansion

Answer 114

Class III

Question 115

Class of lupus nephritis with diffuse nephritis

Answer 115

Class IV

Question 116

Class of lupus nephritis with diffuse endocapillary ± extracapillary proliferation with diffuse subendothelial immune deposits and mesangial alterations

Answer 116

Class IV

Question 117

Class of lupus nephritis with membranous nephritis

Answer 117

Class V

Question 118

Class of lupus nephritis with thickened basement membranes with diffuse subepithelial immune deposits; may occur with class III or IV lesions and is sometimes called mixed membranous and proliferative nephritis

Answer 118

Class V

Question 119

Class of lupus nephritis with sclerotic nephritis

Answer 119

Class VI

Question 120

Class of lupus nephritis with global sclerosis of nearly all glomerular capillaries

Answer 120

Class VI

Question 121

Class of lupus nephritis that describes focal lesions with proliferation or scarring, often involving only a segment of the glomerulus

Answer 121

Class III

Question 122

Class of lupus nephritis that have the most varied course

Answer 122

Class III

Question 123

Class of lupus nephritis that describes global, diffuse proliferative lesions involving the vast majority of glomeruli

Answer 123

Class IV

Question 124

Without treatment, this aggressive lesion has the worst renal prognosis among the classes of lupus nephritis

Answer 124

Class IV

Question 125

Class of lupus nephritis that describes subepithelial immune deposits producing a membranous pattern

Answer 125

Class V

Question 126

Patients with this class of lupus nephritis are predisposed to renal-vein thrombosis and other thrombotic complications

Answer 126

Class V

Question 127

Lupus patients with this class of lupus nephritis have >90% sclerotic glomeruli and ESRD with interstitial fibrosis

Answer 127

Class VI

Question 128

When do you do renal transplantation in renal failure from lupus?

Answer 128

Usually performed after ~6 months of inactive disease

Question 129

When anti-GBM disease present with lung hemorrhage and glomerulonephritis, they have a pulmonary-renal syndrome called

Answer 129

Goodpasture’s syndrome

Question 130

The target epitopes for the anti-GBM disease lie in the quaternary structure of

Answer 130

α3 NC1 domain of collagen IV

Question 131

T or F: In Goodpasture’s syndrome, hemoptysis is largely confined to smokers

Answer 131

True

Question 132

T or F: In Goodpasture’s sydrome, those who present with lung hemorrhage as a group do better than older populations who have prolonged, asymptomatic renal injury

Answer 132

True

presentation with oliguria is often associated with a particularly bad outcome

Question 133

Renal biopsies typically show focal or segmental necrosis that later, with aggressive destruction of the capillaries by cellular proliferation, leads to crescent formation in Bowman’s space

Answer 133

Goodpasture’s syndrome / anti-GBM disease

Question 134

Prognosis at presentation of anti-GBM disease is worse if (4)

Answer 134

• > 50% crescents on renal biopsy with advanced fibrosis
• serum creatinine is >5–6 mg/dL
• oliguria is present
• need for acute dialysis

Question 135

In the management of Goodpasture’s syndrome, aside from dialysis, patients with advanced renal failure who present with hemoptysis should still be treated for their lung hemorrhage with

Answer 135

Plasmapheresis

can be life-saving
8-10 treatments
accompanied by oral prednisone and cyclophosphamide in the first 2 weeks

Question 136

It is classically characterized by episodic hematuria associated with the deposition of IgA in the mesangium

Answer 136

IgA nephropathy

Question 137

Henoch-Schönlein purpura is distinguished clinically from IgA nephropathy by (4)

Answer 137

• prominent systemic symptoms
• a younger age (<20 years old)
• preceding infection
• abdominal complaints.

Question 138

An immune complex–mediated glomerulonephritis defined by the presence of diffuse mesangial Ig deposits often associated with mesangial hypercellularity

Answer 138

IgA nephropathy

Question 139

In IgA nephropathy, IgA deposited in the mesangium is typically polymeric and of what subclass

Answer 139

IgA1

Question 140

Recurrent episodes of macroscopic hematuria during or immediately follow- ing an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuria

Answer 140

IgA nephropathy

Question 141

T or F: IgA nephropathy is a benign disease for the majority of patients

Answer 141

True

Question 142

Renal failure seen in how many percent of patients with IgA nephropathy over 20–25 years

Answer 142

25–30%

Question 143

Treatment of IgA nephropathy

Answer 143

ACE inhibitors

steroid and immunosuppressive therapy have conflicting results in the studies
Tonsillectomy and fish oil have also been suggested in small studies to benefit select patients

Question 144

The 2 types of antibodies in ANCA small-vessel vasculitis

Answer 144

anti-proteinase 3 (PR3)

anti-myeloperoxidase (MPO)

Question 145

Vasculitis syndromes that are ANCA-positive and have a pauci-immune glomerulonephritis with few immune complexes in small vessels and glomerular capillaries (4)

Answer 145

Granulomatosis with polyangiitis
Microscopic polyangiitis
Churg-Strauss syndrome
Renal-limited vasculitis

Question 146

Induction therapy of ANCA small-vessel vasculitis (3)

Answer 146

Glucocorticoids

Rituximab or cyclophosphamide

Question 147

Recommended treatment in rapidly progressive renal failure or pulmonary hemorrhage in ANCA small-vessel vasculitis

Answer 147

Plasmapheresis

Question 148

Patients with this disease classically present with fever, purulent rhinorrhea, nasal ulcers, sinus pain, polyarthralgias/arthritis, cough, hemoptysis, shortness of breath, microscopic hematuria, and 0.5–1 g/24 h of proteinuria; occasionally there may be cutaneous purpura and mononeuritis multiplex

Answer 148

Granulomatosis with Polyangiitis

Question 149

Biopsy of involved tissue will show a small-vessel vasculitis and adjacent noncaseating granulomas.

Answer 149

Granulomatosis with Polyangiitis

Question 150

Renal biopsies during active disease demonstrate segmental necrotizing glomerulonephritis without immune deposits and have been classified as focal, mixed, crescentic or sclerotic

Answer 150

Granulomatosis with Polyangiitis

Question 151

Small-vessel vasculitis that is more common in patients exposed to silica dust and those with α1-antitrypsin deficiency, which is an inhibitor of PR3

Answer 151

Granulomatosis with Polyangiitis

Question 152

Αmong the ANCA small-vessel vasculitis, relapse is most common in

Answer 152

Granulomatosis with Polyangiitis

Question 153

Clinically, these patients look somewhat similar to those with granulomatosis with polyangiitis, except they rarely have significant lung disease or destructive sinusitis

Answer 153

Microscopic Polyangiitis

Question 154

Small-vessel vasculitis is associated with peripheral eosinophilia, cutaneous purpura, mononeuritis, asthma, and allergic rhinitis, often accompanied by hypergammaglobulinemia, elevated levels of serum IgE, or the presence of rheumatoid factor

Answer 154

Churg-Strauss Syndrome

Question 155

Lung inflammation, including fleeting cough and pulmonary infiltrates, often precedes the systemic manifestations of this small-vessel vasculitis by years; lung manifestations are rarely absent

Answer 155

Churg-Strauss Syndrome

Question 156

Small-vessel vasculitis and focal segmental necrotizing glomerulonephritis can be seen on renal biopsy, usually absent eosinophils or granulomas

Answer 156

Churg-Strauss Syndrome

Question 157

defined morphologically with dense deposits forming ribbons in the GBM

Answer 157

dense deposit disease

Question 158

sometimes called mesangiocapillary glomerulonephritis or lobar glomerulonephritis

Answer 158

membranoproliferative glomerulonephritis

Question 159

It is an immune-mediated glomerulonephritis characterized by thickening of the GBM with mesangioproliferative changes; 70% of patients have hypocomplementemia

Answer 159

membranoproliferative glomerulonephritis

Question 160

MPGN that is commonly associated with persistent hepatitis C infections, autoimmune diseases like lupus or cryoglobulinemia, or neoplastic diseases

Answer 160

Type I

Question 161

The most proliferative of the three types of MPGN

Answer 161

Type I

Question 162

Shows mesangial proliferation with lobular segmentation on renal biopsy and mesangial interposition between the capillary basement membrane and endothelial cells, producing a double contour sometimes called tram-tracking

Answer 162

Type I MPGN

Question 163

Low serum C3 and a dense thickening of the GBM containing ribbons of dense deposits and C3

Answer 163

type II MPGN, dense deposit disease

Question 164

Classically, the glomerular tuft has a lobular appearance; intramesangial deposits are rarely present and subendothelial deposits are generally absent. What type of MPGN?

Answer 164

Type II

Question 165

MPGN that has the least proliferation and is often focal; mesangial interposition is rare, and subepithelial deposits can occur along widened segments of the GBM that appear laminated and disrupted.

Answer 165

Type III

Question 166

MPGN that is secondary to glomerular deposition of circulating immune complexes or their in situ formation

Answer 166

Type I

Question 167

____ percent of patients with MPGN develop ESRD 10 years after diagnosis, and ____ percent have renal insufficiency after 20 years

Answer 167

50%

90%

Question 168

Characterized by expansion of the mesangium, sometimes associated with mesangial hypercellularity; thin, single contoured capillary walls; and mesangial immune deposits.

Answer 168

Mesangioproliferative glomerulonephritis

Question 169

Mesangioproliferative disease may be seen in what conditions (4)

Answer 169

IgA nephropathy
Plasmodium falciparum malaria
Resolving postinfectious glomerulonephritis
Class II nephritis from lupus

Question 170

Nephrotic syndrome classically presents with (6)

Answer 170

Heavy proteinuria
Minimal hematuria
Hypoalbuminemia
Hypercholesterolemia
Edema
Hypertension

Question 171

Minimal change disease is sometimes known as

Answer 171

nil lesion

Question 172

Renal biopsy shows no obvious glomerular lesion by light microscopy and is negative for deposits by immunofluorescent microscopy, or occasionally shows small amounts of IgM in the mesangium

Answer 172

Minimal change disease

Question 173

Electron microscopy demonstrates an effacement of the foot processes supporting the epithelial podocytes with weakening of slit-pore membranes.

Answer 173

Minimal change disease

Question 174

Presents clinically with the abrupt onset of edema and nephrotic syndrome accompanied by acellular urinary sediment. Average urine protein excretion reported in 24 h is 10 g with severe hypoalbuminemia.

Answer 174

Minimal change disease

Question 175

In minimal change disease, adults are not considered steroid-resistant until after ______ of therapy

Answer 175

4 months

Question 176

First-line therapy for minimal change disease

Answer 176

Prednisone

Question 177

Refers to a pattern of renal injury characterized by segmental glomerular scars that involve some but not all glomeruli

Answer 177

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Question 178

the clinical findings of FSGS largely manifest as

Answer 178

proteinuria

Question 179

The pathologic changes of FSGS are most prominent in glomeruli located at the

Answer 179

corticomedullary junction

so if the renal biopsy specimen is from superficial tissue, the lesions can be missed, which sometimes leads to a misdiagnosis of MCD

Question 180

T or F: Steroids and other immunosuppressive agents may be used in the treatment of both primary and secondary FSGS

Answer 180

False. There is no role for steroids or other immunosuppressive agents in secondary FSGS

Question 181

Accounts for ~20% of cases of nephrotic syndrome in adults, with a peak incidence between the ages of 30 and 50 years and a male to female ratio of 2:1

Answer 181

Membranous glomerulonephritis

Question 182

Most common cause of nephrotic syndrome in the elderly

Answer 182

Membranous glomerulonephritis

rare in children

Question 183

Uniform thickening of the basement membrane along the peripheral capillary loops is seen by light microscopy on renal biopsy

Answer 183

Membranous glomerulonephritis

Question 184

Immunofluorescence demonstrates diffuse granular deposits of IgG and C3, and electron microscopy typically reveals electron-dense subepithelial deposits

Answer 184

Membranous glomerulonephritis

Question 185

T or F: The stage of glomerular disease in membranous glomerulonephritis is predictive of its progression

Answer 185

False. degree of tubular atrophy or interstitial fibrosis is more predictive of progression than is the stage of glomerular disease

Question 186

Factors that are associated with worse prognosis in membranous glomerulonephritis (4)

Answer 186

Male gender
older age
hypertension
persistence of proteinuria

Question 187

Nephrotic syndrome that has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep-vein thrombosis

Answer 187

Membranous glomerulonephritis

Question 188

The single most common cause of chronic renal failure

Answer 188

Diabetic nephropathy

Question 189

A sensitive indicator for the presence of diabetes but correlates poorly with the presence or absence of clinically significant nephropathy

Answer 189

Thickening of the GBM

Question 190

Some DM nephropathy patients develop eosinophilic, PAS+ nodules called

Answer 190

nodular glomerulosclerosis or Kimmelstiel-Wilson nodules

Question 191

Microalbuminuria appears ____ years after the onset of diabetes

Answer 191

5–10

Question 192

Feature of DM nephropathy that is a potent risk factor for cardiovascular events and death in patients with type 2 diabetes

Answer 192

Microalbuminuria

Question 193

The absence of this condition in type 1 patients with proteinuria should prompt consideration of a diagnosis other than diabetic nephropathy

Answer 193

retinopathy

90% of patients with type 1 diabetes and nephropathy have diabetic retinopathy

Question 194

It usually takes ____ years for DM nephropathy to reach ESRD

Answer 194

10–20

Question 195

Specific pattern of renal injury caused by nephrotoxic light chain that causes renal failure but not heavy proteinuria or amyloidosis

Answer 195

cast nephropathy

Question 196

Specific pattern of renal injury caused by nephrotoxic light chain that produces nephrotic syndrome with renal failure

Answer 196

light chain deposition disease

Question 197

Result of primary fibrillar deposits of immunoglobulin light chains known as amyloid L (AL), or secondary to fibrillar deposits of serum amyloid A (AA) protein fragments

Answer 197

renal amyloidosis

Question 198

T or F. Primary and secondary amyloidosis may both present as nephrotic syndrom

Answer 198

True

Question 199

The treatment for primary amyloidosis that can delay the course of renal amyloidosis in about 30% of patients

Answer 199

melphalan

also autologous hematopoietic stem cell transplantation

Question 200

Characterized by glomerular accumulation of nonbranching randomly arranged fibrils.

Answer 200

Fibrillary-Immunotactoid Glomerulopathy

Question 201

Fibrillar/microtubular deposits of oligoclonal or oligotypic immunoglobulins and complement appear in the mesangium and along the glomerular capillary wall, and stain negative to Congo red

Answer 201

Fibrillary-Immunotactoid Glomerulopathy

Question 202

An X-linked inborn error of globotriaosylceramide metabolism secondary to deficient lysosomal a-galactosidase A activity, resulting in excessive intracellular storage of globotriaosylceramide

Answer 202

Fabry’s disease

Question 203

Presents in childhood in males with acroparesthesias, angiokeratoma, and hypohidrosis

Answer 203

Fabry’s disease

Question 204

Renal biopsy reveals enlarged glomerular visceral epithelial cells packed with small clear vacuoles containing globotriaosylceramide; vacuoles may also be found in parietal and tubular epithelia

Answer 204

Fabry’s disease

Question 205

Vacuoles of electron-dense materials in parallel arrays (zebra bodies) are seen on electron microscopy

Answer 205

Fabry’s disease

Question 206

Fabry’s disease renal biopsy reveal features of

Answer 206

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

Question 207

Urinalysis may reveal oval fat bodies and birefringent glycolipid globules under polarized light (Maltese cross)

Answer 207

Fabry’s disease

Question 208

Empiric and temporizing treatment for pulmonary-renal syndrome until results of testing are available (2)

Answer 208

plasmapheresis and methylprednisolone

Question 209

Classically, patients with this condition develop hematuria, thinning and splitting of the GBMs, mild proteinuria (<1–2 g/24 h), which appears late in the course, followed by chronic glomerulosclerosis leading to renal failure in association with sensorineural deafness.

Answer 209

Alport’s syndrome

Question 210

Approximately 85% of patients with Alport’s syndrome have an X-linked inheritance of mutations in the

Answer 210

α5 (IV) collagen chain on chromosome Xq22–24

15% of patients have autosomal recessive disease of the α3(IV) or α4(IV) chains on chromosome 2q35–37

Question 211

Τypically have thin basement membranes on renal biopsy, which thicken over time into multilamellations surrounding lucent areas that often contain granules of varying density—the so-called split basement membrane

Answer 211

Alport’s syndrome

Question 212

Characterized by persistent or recurrent hematuria and is not typically associated with proteinuria, hypertension, or loss of renal function or extrarenal disease

Answer 212

Thin basement membrane disease (TBMD)

Question 213

Thin basement membrane disease (TBMD) is also known as

Answer 213

benign familial hematuria

it usually presents in childhood in multiple family members

Question 214

Thin basement membrane disease (TBMD) is caused by a defect in what collagen

Answer 214

Collagen type IV

Question 215

Develop iliac horns on the pelvis and dysplasia of the dorsal limbs involving the patella, elbows, and nails, variably associated with neural-sensory hearing impairment, glaucoma, and abnormalities of the GBM and podocytes, leading to hematuria, proteinuria, and FSGS

Answer 215

nail-patella syndrome

Question 216

The syndrome is autosomal dominant, with haploinsufficiency for the LIM homeodomain transcription factor LMX1B

Answer 216

nail-patella syndrome

Question 217

On renal biopsy there is focal sclerosing glomerulonephritis with specific lucent damage to the lamina densa of the GBM, an increase in collagen III fibrils along glomerular capillaries and in the mesangium, and damage to the slit-pore membrane, producing heavy proteinuria not unlike that seen in congenital nephrotic syndrome

Answer 217

nail-patella syndrome

Question 218

Approximately ___ of glomeruli are normally sclerotic by age 40, rising to ___ by age 60 and ___ by age 80

Answer 218

10%
20%
30%

Question 219

The lesion associated with HIV-associated nephropathy is

Answer 219

FSGS

Question 220

HIV patients with FSGS typically present with nephrotic-range proteinuria and hypoalbuminemia, but unlike patients with other etiologies for nephrotic syndrome, they do not commonly have (3)

Answer 220

hypertension
edema
hyperlipidemia.

Question 221

The lesion associated with syphilis-associated nephropathy is

Answer 221

membranous glomerulonephritis

Question 222

Schistosoma that is most commonly associated with clinical renal disease

Answer 222

Schistosoma mansoni

Question 223

Most common kidney stone

Answer 223

Calcium oxalate

Question 224

2nd most common kidney stone

Answer 224

Calcium phosphate

Question 225

T or F. A UTI in the setting of an obstructing stone requires urgent intervention to reestablish drainage

Answer 225

True. A UTI in the setting of an obstructing stone is a urologic emergency

Question 226

The point at which the concentration product exceeds the solubility product

Answer 226

Supersaturation

Question 227

The most clinically important inhibitor of calcium-containing stones

Answer 227

Urine citrate

Question 228

The majority of calcium oxalate stones grow on calcium phosphate at the tip of the renal papilla forming

Answer 228

Randall’s plaque

Question 229

Dietary factors that are associated with an increased risk of nephrolithiasis (6)

Answer 229

• Animal protein
• Oxalate
• Sodium
• Sucrose
• Fructose

Question 230

Dietary factors associated with a lower risk of nephrolithiasis (4)

Answer 230

• Calcium
• Potassium
• Magnesium
• Phytate

Question 231

T or F. Higher dietary calcium intake is related to a higher risk of stone formation

Answer 231

False. Lower risk. May be due to a reduction in intestinal absorption of dietary oxalate that results in lower urine oxalate

Question 232

T or F. Supplemental calcium may increase the risk of kidney stone formation

Answer 232

True. May be due to the timing of supplemental calcium intake or to higher total calcium consumption leading to higher urinary calcium excretion

Question 233

T or F. Dietary oxalate is a strong risk factor for kidney stone formation.

Answer 233

False Dietary oxalate is a weak risk factor for stone formation, BUT urinary oxalate is a strong risk factor

Question 234

Vitamin C supplements will increase risk of what type of kidney stone?

Answer 234

Calcium oxalate

Question 235

Urine output which doubly increase the risk of stone formation

Answer 235

<1L/day

Question 236

T or F. Higher urine citrate excretion increases the risk of stone formation

Answer 236

False. Lower urine citrate

Question 237

Urine pH that promotes uric acid stones formation

Answer 237

≤ 5.5

Question 238

Urine pH that promotes calcium phosphate stone formation

Answer 238

≥6.5

Question 239

Formation of this stone is not influenced by urine pH

Answer 239

Calcium oxalate stones

Question 240

2 most common monogenic disorders that lead to stone formation

Answer 240

Primary hyperoxaluria

Cystinuria

Question 241

Sudden onset of unilateral flank pain then intensity of pain increase rapidly often accompanied by nausea and vomiting that radiate to ipsilateral testicle in men or ipsilateral labium in women

Answer 241

Renal colic

Question 242

2 most common presentation of acute stone event

Answer 242

• Renal colic

* Painless gross hematuria

Question 243

Nephrolithiasis mimic acute cholecystitis if stone is at the

Answer 243

right ureteral pelvic junction

Question 244

Nephrolithiasis mimic acute appendicitis if stone is at the

Answer 244

blocks the ureter as it crosses over the right pelvic brim

Question 245

Nephrolithiasis mimic acute diverticulitis if stone is at the

Answer 245

left pelvic brim

Question 246

T or F: Absence of hematuria exclude the diagnosis of stone

Answer 246

False

Question 247

Preferred imaging and highly sensitive for nephrolitiasis

Answer 247

Helical computed tomography

Question 248

Drugs that may increase the rate of spontaneous kidney stone passage

Answer 248

Alpha blocker

Question 249

Indications for urologic intervention (3)

Answer 249

•	Evidence of UTI
•	Low probability of spontaneous stone passage
o	Stone measuring ≥6 mm 
o	Anatomic abnormality
•	Intractable pain

Question 250

The least invasive option for nephrolithiasis

Answer 250

Extracorporeal shockwave lithotripsy (ESWL)

Question 251

Uses shock waves generated outside the kidney body to fragment the stone

Answer 251

Extracorporeal shockwave lithotripsy (ESWL)

Question 252

Serve as the cornerstone on which therapeutic recommendations for nephrolithisis are based

Answer 252

24-h urine collection

Question 253

The “gold standard” diagnostic test for nephrolithiasis

Answer 253

Helical CT without contrast

Question 254

For all kidney stone types, consistently _____ reduces the likelihood of crystal formation

Answer 254

diluted urine

Urine volume should be at least 2 L/d

Question 255

Antihypertensive drugs that can lower urine Ca in doses higher than those used to treat HPN

Answer 255

Thiazide diuretic (Most commonly chlorthalidone)

Question 256

The only strategy that reduces endogenous oxalate production

Answer 256

Avoiding high-dose Vit C supplements

Question 257

Supplemental alkali that may be given to kidney stone patients (2)

Answer 257

potassium citrate or bicarbonate

Question 258

2 main risk factors for uric acid stone formation

Answer 258

• Persistently low urine pH

* Higher uric acid excretion

Question 259

The focus for cystine kidney stone prevention

Answer 259

Increasing cystine solubility

Question 260

Medication that covalently binds to cystine (2)

Answer 260

Tiopronin

Penicillamine

Question 261

Preferred medication that covalently binds to cystine

Answer 261

Tiopronin

Question 262

AKA infection stones

Answer 262

Struvite

Question 263

AKA triple-phosphate stones

Answer 263

Struvite

Question 264

Struvite forms only when the upper urinary tract is infected with

Answer 264

urease-producing bacteria

Question 265

3 bacteria that most commonly cause struvite

Answer 265

• Proteus mirabilis
• Klebsiella pneumoniae
• Providencia species

Question 266

Urease produced by urease-producing bacteria hydrolyzes urea and may elevate the urine pH to

Answer 266

> 8.0

Question 267

Struvite stones may grow quickly and fill the renal pelvis causing

Answer 267

staghorn calculi

Question 268

2 management for staghorn calculi

Answer 268

Complete removal

Acetohydroxamic acid

Question 269

Imaging that is often used for long-term follow-up of nephrolithiasis

Answer 269

Plain abdominal radiography (KUB)

Question 270

The first tolerable and effective agent for the treatment of UTI

Answer 270

Nitrofurantoin

Question 271

The most common manifestation of UTI

Answer 271

Acute cystitis

Question 272

Refers to acute cystitis or pyelonephritis in nonpregnant outpatient women without anatomic abnormalities or instrumentation of the urinary tract

Answer 272

Uncomplicated UTI

Question 273

Prevalence of UTI during the neonatal period according to sex

Answer 273

male>female

Question 274

Prevalence of UTI after 50 years of age according to sex

Answer 274

male=female

Question 275

Prevalence of UTI between 1-50 years of age

Answer 275

female > male

Question 276

How many percent of women in the general population acquire at least one UTI during their lifetime

Answer 276

50–80%

Question 277

Independent risk factors for acute cystitis (3):

Answer 277

• Recent use of a diaphragm with spermicide
• Frequent sexual intercourse
• History of UTI

Question 278

Risk factors of UTI in healthy postmenopausal women (3):

Answer 278

• Sexual activity
• Diabetes mellitus
• Incontinence

Question 279

Factors independently associated with pyelonephritis in young healthy women (6)

Answer 279

• Frequent sexual intercourse
• New sexual partner
• A UTI in the previous 12 months
• Maternal history of UTI
• Diabetes
• Incontinence

Question 280

Independent risk factors of UTI recurrence in premenopausal women (5)

Answer 280

• Frequent sexual intercourse
• Use of spermicide
• New sexual partner
• First UTI before 15 years of age
• Maternal history of UTI

Question 281

Major risk factors of recurrent UTI in postmenopausal women (2)

Answer 281

• History of premenopausal UTI

* Anatomic factors affecting bladder emptying

Question 282

Most common cause of UTI in men

Answer 282

urinary obstruction secondary to prostatic hypertrophy

Question 283

UTI due to lack of circumcision is due to what organism

Answer 283

Escherichia coli

Question 284

Most common organisms causing UTI

Answer 284

enteric gram-negative rods (most common: E. coli)

Question 285

Most common route of infection in UTI

Answer 285

Ascending from the urethra to the bladder

Question 286

Hematogenous route is present in how many % of documented UTIs

Answer 286

<2%

Question 287

Hematogenous route of UTI is most commonly seen in these 3 organisms

Answer 287

• Salmonella
• S. aureus
• Candida

Question 288

The critical initial step in the pathogenesis of UTI among women

Answer 288

Colonization of the vaginal introitus and periurethral area with organisms from the intestinal flora

Question 289

Inhibition of ureteral peristalsis and decreased ureteral tone leads to this condition which is important in the pathogenesis of pyelonephritis in pregnant women

Answer 289

Vesicoureteral reflux

Question 290

The primary reason why UTI is predominantly an illness of young women rather than of young men

Answer 290

Distance of the urethra from the anus

Question 291

Virulence factor of E. coli that mediate binding to specific receptors on the surface of uroepithelial cells

Answer 291

Surface adhesins

Question 292

Virulence factor of E. coli described as hair-like protein structures that interact with a specific receptor on renal epithelial cells

Answer 292

P fimbriae

Question 293

Virulence factor of E. coli that is important in the pathogenesis of pyelonephritis and subsequent bloodstream invasion from the kidney

Answer 293

P fimbriae

Question 294

Play a key role in initiating E. coli bladder infection that mediate binding to mannose on the luminal surface of bladder uroepithelial cells

Answer 294

Type 1 pilus

Question 295

The most important issue to be addressed when a UTI is suspected is the

Answer 295

characterization of the clinical syndrome

Question 296

An indication that the upper urinary tract is involved in UTI

Answer 296

Unilateral back or flank pain

Question 297

An indication of invasive infection of either the kidney or the prostate

Answer 297

Fever

Question 298

Severe pyelonephritis is characterized by these clinical manifestations (5)

Answer 298

• High fever
• Rigors
• Nausea
• Vomiting
• Flank and/or loin pain

Question 299

the main feature distinguishing cystitis from pyelonephritis

Answer 299

Fever

Question 300

Fever in pyelonephritis typically exhibits this pattern

Answer 300

high spiking “picket-fence” pattern

Question 301

Complication of pyelonephritis seen in patients with diabetes that present as obstructive uropathy when sloughed papillae obstruct the ureter

Answer 301

Acute papillary necrosis

Question 302

A particularly severe form of the pyelonephritis that is associated with the production of gas in renal and perinephric tissues

Answer 302

Emphysematous pyelonephritis

Question 303

Emphysematous pyelonephritis occurs almost exclusively in what group of patients

Answer 303

Diabetic patients

Question 304

Occurs when chronic urinary obstruction (often by staghorn calculi) together with chronic infection causes this suppurative destruction of renal tissue

Answer 304

Xanthogranulomatous pyelonephritis

Question 305

Causes yellow coloration of kidney with infiltration by lipid-laden macrophages

Answer 305

Xanthogranulomatous pyelonephritis

Question 306

When to you suspect the abscess as complication of pyelonephritis?

Answer 306

when a patient has continued fever and/or bacteremia despite antibacterial therapy

Question 307

Presents as fever, chills, dysuria, frequency, and pain in the pelvic or perineal area in men

Answer 307

Acute bacterial prostatitis

Question 308

In women presenting with at least one symptom of UTI (dysuria, frequency, hematuria, or back pain) and without complicating factors, the probability of acute cystitis or pyelonephritis is

Answer 308

50%

Question 309

If vaginal discharge and complicating factors are absent and risk factors for UTI are present, then the probability of UTI is close to___, and no laboratory evaluation is needed

Answer 309

90%

Question 310

Combination of dysuria and urinary frequency (in the absence of vaginal discharge) increases the probability of UTI to

Answer 310

96%

Question 311

Laboratory tests that provide point-of-care information for UTI

Answer 311

Urine dipstick test

Urinalysis

Question 312

Only members of the family ______ convert nitrate to nitrite that can be detected in urine dipstick test

Answer 312

Enterobacteriaceae

Question 313

Enough ______ must accumulate in the urine to reach the threshold of detection

Answer 313

Nitrite

Question 314

Diagnostic gold standard for UTI

Answer 314

Urine culture

Question 315

In symptomatic women, colony count threshold of ______ can be diagnostic of UTI

Answer 315

≥10^2 bacteria/mL

Question 316

T or F. Men with febrile UTI for the first time should have imaging performed

Answer 316

True

CT or ultrasound

Question 317

Microbiologic criterion for asymptomatic bacteriuria

Answer 317

≥10^5 bacterial CFU/mL of urine

Question 318

The predominant multilocus sequence type found worldwide as the cause of multidrug-resistant UTI

Answer 318

E. coli ST131

Question 319

previously recommended as first-line treatment for acute cystitis

Answer 319

TMP-SMX

Question 320

Organisms that are intrinsically resistant to this nitrofurantoin (5)

Answer 320

• Proteus
• Pseudomonas
• Serratia
• Enterobacter
• Yeasts

Question 321

T or F. Nitrofurantoin may be used in the treatment of pyelonephritis

Answer 321

False

Question 322

Most fluoroquinolones are highly effective as short-course therapy for cystitis, except

Answer 322

moxifloxacin – may not reach adequate urinary levels

Question 323

Rare but potentially serious adverse effects of fluoroquinolones in >60 years of age

Answer 323

Increased risk of Achilles tendon rupture

Question 324

Widely used urinary analgesics but can cause significant nausea

Answer 324

Phenazopyridine

Question 325

First-line therapy for acute uncomplicated pyelonephritis

Answer 325

Fluoroquinolones

Oral ciprofloxacin (500 mg twice daily, with or without an initial IV 400-mg dose)

Question 326

UTI medications that are relatively safe in early pregnancy (3)

Answer 326

• Nitrofurantoin
• Ampicillin
• Cephalosporins

Question 327

2 drugs of choice for UTI in pregnancy

Answer 327

Ampicillin

Cephalosporins

Question 328

Standard of care for overt pyelonephritis in pregnancy

Answer 328

parenteral β-lactam therapy with or without aminoglycosides

Question 329

For acute bacterial prostatitis, what is the recommended treatment and duration?

Answer 329

fluoroquinolone or TMP-SMX

2-4 weeks

Question 330

For chronic bacterial prostatitis, what is the recommended treatment and duration?

Answer 330

fluoroquinolone or TMP-SMX

4-6 weeks

Question 331

For recurrent bacterial prostatitis, what is the recommended treatment and duration?

Answer 331

fluoroquinolone or TMP-SMX

12 weeks

Question 332

Treatment for xanthogranulomatous pyelonephritis

Answer 332

nephrectomy

Question 333

Initial treatment for emphysematous pyelonephritis

Answer 333

Percutaneous drainage

Elective nephrectomy on follow-up

Question 334

Treatment of asymptomatic bacteriuria is given only in (4)

Answer 334

• Pregnant women
• Persons undergoing urologic surgery
• Neutropenic patients
• Renal transplant recipients

Question 335

Accepted threshold for bacteriuria to meet the definition of CAUTI

Answer 335

≥10^3 CFU/mL of urine

Question 336

Risk factors for candiduria (3)

Answer 336

• ICU patients
• Those taking broad-spectrum antimicrobial drugs
• Those with underlying diabetes mellitus

Question 337

Therapy for candiduria is recommended for patients who (5)

Answer 337

• Have symptomatic cystitis or pyelonephritis
• Neutropenia
• Undergoing urologic manipulation
• Clinically unstable
• Low-birth-weight infants

(At high risk for disseminated disease)

Question 338

First-line regimen for Candida infections of the urinary tract

Answer 338

Fluconazole – (200–400 mg/d for 7–14 days)

Question 339

Three prophylactic strategies for recurrent UTI in women

Answer 339

Continuous therapy (6 months)
Postcoital therapy
Patient-initiated therapy

Question 340

Most common cause of bacterial cystitis

Answer 340

Escherichia coli

Question 341

An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks’ duration, in the absence of infection or other identifiable causes

Answer 341

INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME

Question 342

Ulcer in the bladder

Answer 342

Hunner lesion

Question 343

How many % of interstitial cystitis/bladder pain syndrome has Hunner lesion?

Answer 343

≤10%

Question 344

Most common site of interstitial cystitis/bladder pain syndrome

Answer 344

Suprapubic (80% of women) – most severe pain

Question 345

In 95% of patients, bladder filling exacerbates the pain and/or bladder emptying relieves it

Answer 345

interstitial cystitis/bladder pain syndrome

Question 346

Functional somatic syndromes that can accompany IC/BPS (3):

Answer 346

a. Gynecologic chronic pelvic pain
b. Irritable bowel syndrome
c. Fibromyalgia

Question 347

Oral medications for interstitial cystitis/bladder pain syndrome:

Answer 347

a. NSAIDs
b. Amitriptyline
c. Pentosan polysulfate

Question 348

Treatment of hunner lesion in interstitial cystitis/bladder pain syndrome:

Answer 348

Fulguration (solutions containing lidocaine, hyaluronic acid, or dimethyl sulfoxide can be instilled into the bladder)

Question 349

Normal points of narrowing are common sites of urinary tract obstruction (4)

Answer 349

• Ureteropelvic junction
• Ureterovesical junction
• Bladder neck
• Urethral meatus

Question 350

Most common cause of utinary tract obstruction in childhood

Answer 350

Congenital malformations

• Narrowing of the ureteropelvic junction
• Abnormal insertion of the ureter into the bladder

Question 351

Most common cause of bilateral hydronephrosis in boys

Answer 351

Posterior urethral valves

Question 352

Most common causes of urinary tract obstruction in adults (3)

Answer 352

• Pelvic tumors
• Calculi
• Urethral stricture

Question 353

Symptom that most commonly leads to medical attention in urinary tract obstruction

Answer 353

Flank pain

Question 354

Flank pain that occurs only with micturition is pathognomonic of

Answer 354

vesicoureteral reflux

Question 355

Partial bilateral UTO often results in (3)

Answer 355

1. Acquired distal renal tubular acidosis
2. Hyperkalemia
3. Renal salt wasting

Question 356

Struvite is made of what mineral/compound?

Answer 356

Magnesium ammonium phosphate

Question 357

Used for the diagnosis of vesicoureteral reflux and bladder neck and urethral obstructions

Answer 357

Voiding cystourethrography

Question 358

T or F. Even in obstruction without infection, immediate surgical intervention must be done to avoid complications

Answer 358

False. When infection is not present, surgery is often delayed until acid-base, fluid, and electrolyte status is restored

Question 359

Functional obstruction secondary to neurogenic bladder may be decreased with the combination of (2)

Answer 359

frequent voiding and cholinergic drugs

Question 360

Duration of obstruction wherein kidney function recovery is unlikely

Answer 360

After 8 weeks of obstruction

Question 361

Imaging performed after a prolonged period of decompression and to predict the reversibility of renal dysfunction

Answer 361

Renal radionuclide scan

Question 362

Total body water is composed of ____ intracellular, and ____ extracellular

Answer 362

2/3

1/3

Question 363

Extracellular fluid is composed of ___ plasma, and ___ interstitial edema

Answer 363

¼

3/4

Question 364

Fluid is returned from the interstitial space into the vascular system through the

Answer 364

Lymphatic system

Question 365

A parameter that represents the filling of the arterial tree and that effectively perfuses the tissues

Answer 365

Effective arterial blood volume

Question 366

Decrease effective arterial blood volume will _____ renin release

Answer 366

Increase

Decreased effective arterial blood volume -> diminished renal blood flow -> translated by the renal juxtaglomerular cells (specialized myoepithelial cells surrounding the afferent arteriole) into a signal -> increased renin release

Question 367

Specialized myoepithelial cells surrounding the afferent arteriole that detects diminished renal blood flow

Answer 367

juxtaglomerular cells

Question 368

Angiotensinogen is synthesized in the

Answer 368

Liver

Question 369

Angiotensin II has generalized vasoconstrictor properties, particularly on the

Answer 369

renal efferent arterioles

Question 370

Aldosterone acts on the _____ by _____

Answer 370

Collecting tubule

Enhances sodium reabsorption and potassium excretion

Question 371

RAAS effect on Na and water

Answer 371

Retention

Question 372

Arginine vasopressin is secreted by

Answer 372

posterior pituitary gland

Question 373

Arginine vasopressin secretion occurs in response to

Answer 373

increased intracellular osmolar concentration

Question 374

AVP stimulates what receptors

Answer 374

V2 receptors

Question 375

Site of action of AVP in the kidney

Answer 375

distal tubules and collecting ducts

Question 376

Action of AVP on the kidney

Answer 376

increases the reabsorption of free water

Question 377

Potent peptide vasoconstrictor released by endothelial cells

Answer 377

Endothelin-1

Elevated in patients with severe heart failure

Question 378

Stimulates release of ANP

Answer 378

Atrial distention

Question 379

ANP and BNP are stored in these sites respectively

Answer 379

Atrial myocytes

Ventricular myocytes

Question 380

Stimulates release of BNP

Answer 380

When ventricular diastolic pressure rises

Question 381

Effects of ANP and BNP on Na and water

Answer 381

Excretion of sodium and water

Augmenting glomerular filtration rate
Inhibiting sodium reabsorption in the proximal tubule
Inhibiting release of renin and aldosterone

Question 382

Primary alteration in the nephrotic syndrome causing edema

Answer 382

diminished colloid oncotic pressure

Question 383

Causes of edema in hepatic cirrhosis (4)

Answer 383

1. Hepatic venous outflow obstruction leading to increase splanchnic blood volume
2. Hepatic lymph formation
3. Hypoalbuminemia
4. Peripheral artery vasodilation

Question 384

Multiple peripheral arteriovenous fistulae result in reduced effective systemic perfusion and effective arterial blood volume and leading enhancing edema formation in this condition

Answer 384

Beriberi heart disease

Question 385

Edema develops or becomes intensified when famished subjects are first provided with an adequate die

Answer 385

Refeeding edema