OS 214 Renal Exam 2 Flashcards
1-2: A 65 year old female who is known HPN for 10 years complaints of body weakness associated with one week history of anorexia, vomiting, and easy fatigability. She has sallow skin, with excoriations. BP 180/90 Hr 100/mn, RR-24. She also has pale palpebral conjunctivae, fine crackles on both lung fields and bipedal edema. Creatinine was 1200 umol/L.
1) Primary indication toinitiate hemodialysis in this patient would be:
A. Symptoms of body weakness, anorexia, vomiting and easy fatigability
B. Pale palpebral conjunctivae
C. BP of 180/90 mmHG
D. Sallow skin
A
2) You immediately decided to initiate a 4hour hemodialysis in this patient after which she suddenly developed decreased sensorium and shallow breathing followed by a tonic clonic seizure. You should suspect this patient to have dialysis complication: A. Disequilibrium syndrome B. Hyperglycemia C. Hypotension D.muscle cramps
A
3) Ultrafiltration in peritoneal dialysis is made possible by this component in the dialysis solution A. Bicarbonate B. Glucose C. Mannitol D. Acetate
B
4) Measure of good dialysis adequacy for patient undergoing 3x a week hemodialysis
A. creatinine clearance of 90ml/min
B.BUN 100 mg/dl
C.URR 1.2
D
5) This patient with CKD is not a good candidate for CAPD
A. Patient who is motivated and eager to understand his disease
B. Diabetic patient with recent abdominal surgery
C. Diabetic patient with poor vascular access
D. Patient with good eyesight
B
6) An absolute pre-requisite prior to proceeding with kidney transplantation is a A. Negative tissue mismatch B. Haplotype match C. DR antigen match D. Zero mismatch
A
7) A blood type A+ patient can get a kidney for donors with the following blood type A. A B. A and O C. A and AB D. B and O
B
8) A rejection episode happening within a week after kidney transplant is called A. Hyperacute rejection B. Acute rejection C. Accelerated rejection D. Chronic rejection
C
9) A provisional diagnosis of brain death can be made in the presence of
A. Negative eye response on caloric tests
B. Only that background EEG waves seen
C. A negative apnea test
D. Any OTA
D
10) The best long term kidney transplant outcome will be from a donor recipient pair with a A. Full mismatch B.1 haplotype match C. 2 haplotype match D. 3 haplotype match
C
11) What do you see in a patient with acute rejection of allograft? A. Decoy cells B. Infiltrating leukocytes C. Tubular atrophy D. Interstitial fibrosis
B
12) Immunosuppressive medication used for induction therapy include which of following? A. Calcineurin inhibitor (CNIs) B. Anti-thymocyte globulin (ATG) C. Intravenous immunoglobulin (IVIg) D. Rituximab E. Antimetabolites
B
13) A 40-year old female with FSGS has been on hemodialysis for the past 3 years. She is desirous of a kidney transplant and the only positive donor is her 43-year old brother. He is apprehensive about the procedure and is afraid he will eventually need dialysis himself if he donate a kidney and you advise him on the procedure, the benefits of the recipient, and the risks to himself as a donor. Which of the ff is incorrect following living organ donation?
A. He will not need to follow-up with a physician after the nephrectomy
B. The progression to end stage renal failure after organ donation is low
C. Donor nephrectomy is safe with low mortality rate of less than 0.3%
D. His remaining kidney will compensate for the loss of the donated kidney
E. Minimally invasive techniques for donor nephrectomy will shorten his hospital stay and enable him to return to work sooner
A
14) The following are true of chronic allograft dysfunction EXCEPT
A. It is characterized by nonspecific interstitial fibrosis and tubular atrophy
B. It can lead to allograft failure and need for dialysis
C. May be due to repeated low-grade immune injury
D. Related to the chronic use of mTOR inhibitors
D
15) Which of the following is the most common cause of mortality and morbidity in the first year after transplant? A. Complications of diabetes B. CV disease C. Dyslipidemia D. HPN E. Infection
E
16) A 55 year old male present with HPN and renal failure. UTZ shows multiple non-communicating cysts are likewise seen in the liver and pancreas. What would be your diagnosis?
A. Multiple simple cysts
B. Medullary sponge kidney
C. multicystic dysplastic kidney
D. Autosomal dominate polycystic kidney disease
D
17) The best imaging modality for diagnosing vesicoureteral reflux is A. VCUG B. IVP C. KUB UTZ D. CT stonogram
A
18) True of normal IVP
A. No bowel prep is needed
B. The ureters are visualized after 20 minutes
C. The renal parenchyma is visualized after 3 minutes
D. AOTA
No answer. C?
19.) The typical appearance of the normal urinary bladder on ultrasound is
A. Anechoic with smooth walls and posterior sonic shadowing
B. Hyperechoic, with smooth calls and posterior sonic shadowing
C. Anechoic with smooth walls and posterior acoustic enhancement
D. Hyperechoic, with smooth calls and posterior acoustic enhancement
C
20) These account for majority of “lucent” stones on plain radiographs but are still sufficiently dense to be seen on CT A. Indinavir B. Struvite C. Uric acid D. Xanthine
C
21) What percentage of renal plasma flow is cleared by glomerular filtration and tubular secretion?
A. 20% by glomerular filtration and 80% by tubular secretion
B. 40% by glomerular filtration and 60% by tubular secretion
C. 60% by glomerular filtration and 40% by tubular secretion
D. 80% by glomerular filtration and 20% by tubular secretion
A
22) Indications for renal scanning with radionuclides include
A. Assessment of blood flow to transplanted kidneys
B. Assessment of function of native kidneys
C. Evaluation of space occupying lesions
D. AOTA
D
23.)Which of the following is excreted by glomerular filtration? A. Tc99m DTPA B. Tc99m MAG3 C. Tc99m DMSA D. Tc99m GH
A
24.) Which radiopharmaceutical can be used to determine effective renal plasma flow? A. Tc99m MAG3 B. Tc99m DMSA C. Tc99m DTPA D Tc99m Glucoheptonate
A
25) For visualizing intraparenchymal lesions in the kidneys, the radiopharmaceutical of choice is A. Tc99m DMSA B. Tc99m MAG3 C. Tc99m DTPA D. I-131 OIH
A
26) Which zone of the prostate commonly gives rise to prostate adenocarcinoma? A. Central zone B. Peripheral zone C. Transition zone D. Anterior fibromuscular stroma
B
27) The following statement is TRUE regarding patients with mild lower urinary tract symptoms by IPSS
A. They will require drug treatment
B. They have scores of less than 10 points
C. They are not at risk of developing prostate adenoCA
D. They should be advised to undergo annual DRE
D
28) The following LUT symptom is a component of the International Prostate Symptom Score A. Hesitancy B. Incontinence C. Terminal dribbling D. Feeling of retention post-void
D
29) This finding is consistent with benign prostatic hyperplasia
A. Hard, sineguelas-sized prostate
B. Prostate specific antigen of 8 ng/dL
C. Symmetrical doughy prostate on DRE
D. Smooth prostate with a small nodule on DRE
C
30) Alpha-adrenergic blockers are utilized to manage bladder outlet obstruction due to prostatic enlargement because they
A. Shrink the prostate gland
B. Increase the force of bladder contraction
C. Relax the bladder neck and prostatic smooth muscles
D. Counteract the effects of testosterone on the prostate
C
31) On imaging studies using contrast material, urologic tumors present as
A. Filling defects
B. Extravasation of dye
C. Layering of contrast material
D. Nonvisualization of the involved organ
A
32) A 30/M undergoes surgery for a papillary growth in the urinary bladder wall. His histopathology report will probably be reported as A. Clear cell adenoCA B. Rhabdomyosarcoma C. Transitional cell CA D. Squamous cell CA
C
33) The best treatment for a patient with hematuria and a solid renal mass on CT scan is A. Radical surgery B. Radiotherapy C. Chemotherapy D. Partial nephrectomy
A
34) For urothelial tumors, the T staging is dependent on
A. Tumor size
B. Depth of tumor invasion
C. Degree of obstruction caused by mass effect
D. Cellular differentiation of the tumor
B
35) A 48/M presenting with a solid mass on the superior pole of the kidney on histopath was found to be a chromophobe mixed tumor. This tumor originates from the A. Proximal tubule B. Distal tubule C. Medullary collecting duct D. Cortical collecting duct
D
36) A boy presenting with difficulty of voiding and a palpable balder diagnosed with phimosis should undergo A. Urethral catheterization B. Antibiotic treatment C. Circumcision D. Cystoscopy
C
37) The most common mechanism of injury for ureteral trauma is A. Blunt trauma B. Iatrogenic C. Penetrating trauma D. Deceleration injury
B
38) Disruption of the integrity of the urothelial lining due to trauma will manifest in radiographic studies as A. Filling defects B. Dye extravasation C. Layering of the contrast material D. High intensity densities
B
39) The pain of renal colic is commonly due to
A. Renal ischemia
B. Injury to the renal parenchyma
C. Stretching of the renal capsule or urothelial lining
D. Infection of the urothelium of the renal pelvis
C
40) A 16/M was brought to the ER for left scrotal pain. You will recommend immediate surgical consult if you elicit this PE finding
A. Urethral discharge
B. Enlarged tender erythematous scrotum
C. Enlarged nontender scrotum with positive transillumination
D. Epididymis palpated anterior to the testis and lying horizontally
D
41) Which of the following medications is used as medical expulsive therapy for ureterolithiasis? A. Finasteride B. Tamsulosin C. Dutasteride D. K citrate
B
42) The definitive treatment for patients diagnosed with xanthogranulomatous pyelonephritis is A. Nephrectomy B. Open stone surgery C. IV antibiotics for 2 weeks D. Percutaneous nephrolithotomy (PCNL)
A
43) A 70/F diagnosed to have an acontractile bladder due to stroke has been on foley catheter for the past 2 years. Which of the following conditions can the patient develop in the future? A. Nephrolithiasis B. Ureterolithiasis C. Cystolithiasis D. Staghorn calculi
C
44) The following dietary maneuver decreases urinary calcium oxalate crystallization A. Decreasing dietary sodium B. Decreasing calcium intake C. Vitamin C supplementation D. Decreasing citrate rich foods
A
45) A 30/F was diagnosed to have an 8 mm upper pole stone, left kidney on abdominal UTZ as part of an annual PE one month ago. At that time she was asymptomatic until a few hours prior to consult, when the patient was awakened from sleep by severe left flank pain followed by urgency and pain in the labia on the left. What is your likely diagnosis? A. Pelveolithiasis left B. Ureterolithiasis middle third left C. Ureterolithiasis proximal third left D. Ureterovesical junction stone left
D
46) Urethreal catheterization should NOT be performed in this patient who cannot void
A. A 65 year old man with a hard nodular prostate on DRE
B. A 5 year old boy born with a ventrally located urethral meatus
C. A 30 year old vehicular crash victim with blood at the urethral meatus
D. A 55 year old man who has a history of gonoccocal urethritis and progressive difficulty in voiding
C
47) One should insert a urethral Foley catheter in males up to this level before inflating the balloon
A. At the 25 cm level
B. At the point where resistance is encountered
C. At the junction between the drainage and inflation ports
D. At the point when urine starts to come out of the cathether
C
48) The urethral catheterization of men, the resistance point at 20 cm corresponds to the A. Urethrovesical junction B. External urethral sphincter C. Prostatic apex D. Bladder neck
B
49) The approach to UTI in a 25 year old male who develops the problem for the first time is
A. Manage as complicated UTI
B. Manage as acute uncomplicated UTI
C. Treat first and then perform the imaging studies
D. Treat only after extensive work up with imaging studies
B
