Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Questions - Random > Flashcards

Questions - Random Flashcards

1
Q
  1. In patients with chronic renal failure, what biochemical abnormality is responsible for fibroblast growth factor 23 elevation?
  2. Phosphate
  3. Calcium
  4. Parathyroid Hormone
  5. Vitamin D
  6. Magnesium
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. A 25 year old male with previous IgA nephropathy has received a HLA matched renal transplant from his brother. He remained stable on Tacrolimus, Prednisolone and Mycophenolate, with no history of acute rejection. Now, 7 years down the line, he has persistent proteinuria and hematuria. What is the most likely cause?
  2. CMV nephropathy
  3. Chronic allograft nephropathy
  4. De novo glomerulonephritis
  5. Recurrence of glomerulonephritis
  6. BK nephropathy
A

Recurrence of glomerulonephritis

No large studies defining risk of recurrence, but it is common.

Only predictor for recurrence was a longer time after transplantation

Possible risk factors

Use of living related donor kidney

HLA leukocyte antigen effect – specifically HLA-B35 or HLA-DR4

Good HLA match

Glucocorticoid withdrawal

High serum IgA concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Antibodies against phospholipase A 2 receptor (PLAR2) is characteristic of which glomerulonephritis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What medication is well known to cause acute interstitial nephritis?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the primary mechanism underlying acute tubular necrosis from pre renal causes?

  1. Hypoxia of the medulla
  2. Noradrenaline release
  3. Dilatation of the afferent capillary
  4. Dilatation of the efferent capillary
  5. Glomerular dilatation
A

Dilatation of the efferent capillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. A patient on azathioprine for Crohn’s disease now presents with renal colic. She has had small a small bowel resection in the past. Urine now shows +++ blood. What is the most likely component of the renal stone?
  2. Magnesium
  3. Struvite
  4. Oxalate
  5. Uric Acid
  6. Cysteine
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. A 67 year old diabetic male underwent a CABG 2 weeks ago, after being found to have triple vessel disease on an angiogram. This was complicated by a sternal wound infection requiring 10 days of intravenous Tazocin.

He now presents with worsening renal function and hypertension which is difficult to control. He noticed that he has mottling in his left foot and a palpable rash on his leg. Urine MCS performed revealed occasional hyaline casts with 1+ proteinuria. What is the most likely diagnosis?

  1. Drug induced leukocytoclastic vasculitis
  2. Glomerulonephritis
  3. Cholesterol emboli
  4. Acute interstitial nephritis
  5. Diabetic vasculopathy
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Oedematous patients often become refractory to loop diuretics. This is called ‘braking’. What is the mechanism of this?
  2. Down-regulation of receptors
  3. Tubular binding site issues
  4. Saturation of receptors
  5. Effect of atrial natriuretic peptide
  6. A subject of intense research of which the mechanism remains unknown
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Where does hydrochlorothiazide work in the nephron?
A

Distal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

At what level of the renal vascular system does autoregulation of renal blood flow occur?

  1. Afferent arteriole
  2. Glomerulus
  3. Efferent arteriole
  4. Arcuate artery
  5. Renal artery
A

Afferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adult Polycystic Kidney Disease (APKD) commonly causes renal cysts as well as renal impairment. Which of the following is the most common extrarenal manifestation of APKD ?

a. Hepatic cysts
b. Colonic diverticula
c. Cerebrovascular aneurysms
d. Valvular heart disease
e. Arachnoid cysts

A

a. Hepatic cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Type 4 renal tubular acidosis is most commonly seen in which condition?

A Diabetic nephropathy.

B Interstitial nephritis.

C Pseudohypoaldosteronism type 1.

D Sjögren’s syndrome.

E Systemic lupus erythematosus.

A

A Diabetic nephropathy.

Hyporeninemic hypoaldosteronism is most common in patients with mild to moderate renal insufficiency due to diabetic nephropathy or chronic interstitial nephritis, but can also occur with acute glomerulonephritis, and in patients taking nonsteroidal antiinflammatory drugs or calcineurin inhibitors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

QUESTION 62

The clearance of metformin exceeds glomerular filtration rate even at low GFRs due to active tubular secretion. Where in the nephron is metformin secreted?

A. Proximal tubule

B. Loop of henle

C. Distal tubule

D. Collecting duct

A

A. Proximal tubule

Metformin excreted exclusively by tubular excretion. This occurs primarily in proximal tubule through MATE1 and MATE2k transporters

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651676/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which one of the following cells are the first to be involved in renal allograft rejection?

A. B cells

B. T cells

C. NK cells

D. Dendritic cells

E. Macrophages

A

D. Dendritic cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A. Angiotensinogen

B. Angiotensin 1

C. Angiotensin 2

D. Aldosterone

E. Renin

F. Prorenin

G. Vasopressin

H. Atrial natriuretic peptide

  1. Synthesized in liver and is the sole substrate of renin?
  2. Arteriolar vasoconstrictor and increases salt reabsorption in proximal tubule?
A
  1. Synthesized in liver and is the sole substrate of renin?

Angiotensinogen

AKA renin substrate. Precursor to angiotensin. Synthesized in the liver. Cleaved by renin to become angiotensin I

  1. Arteriolar vasoconstrictor and increases salt reabsorption in proximal tubule?

Angiotensin 2

Converted by ACE.

Increases vasopressin release, aldosterone release and vasoconstriction

Na absorption in PCT

D. Aldosterone

Produced by zona glomerulosa in adrenal glands (mineralocorticoid)

Stimulated by low BP via RAAS and potassium levels (most potent)

Overall effect is to increase Na reabsorption and increase K excretion

E. Renin

Secreted from the kidneys Stimulated by three things:
Decrease in BP (detected by baroreceptors)
Decreased sodium delivery to the distal tubule sensed by the macula densa
Increased sympathetic activity

F. Prorenin - Precursor to renin

Converted to renin by juxtuloglomerular cells

G. Vasopressin AKA ADH

Synthesised in hypothalamus

Two functions - Increases water reabsoroption in the collecting ducts . Arterial vasoconstriction Stimulated by increased serum osmolality

H. Atrial natriuretic peptide

Secreted from atria. Activated in response to increase atrial stretch (hypervolaemic states) Decreases Na reabsortion, increases GFR, dilates afferent arteriole Inhibits renin secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

55y/o male with untreated Hepatitis B presents with recurrent abdominal pain and livedo reticularis. He has recurrent episodes of macroscopic haematuria associated with HTN (BP 190/90) and fevers. Renal Function is normal.

What is the most likely diagnosis?

A

PAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Question 97

30 year old female referred with asymptomatic hypertension (BP was 160/100 on ambulatory BP monitoring), clinical examination is significant for abdominal bruit.

Normal urinanalysis, normal Renal USS. History of recurrent UTI’s in childhood.

ANA negative

A

Renal artery stenosis (FMD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Question 8

Which of the following is the first pathophysiological change to occur in diabetic nephropathy?

A. Anaemia

B. Hyperkalaemia

C. Increased glomerular filtration rate

D. Reduced glomerular filtration rate

E. Microalbuminuria

A

C. Increased glomerular filtration rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Recombinant erythropoietin agents (EPO) are useful in the management of anaemia due to Chronic Renal Failure. What is the most common side effect seen with their useB.

A

Hypertension

20
Q

Cinacalcet MOA

A

Increases the sensitivity of calcium-sensing receptors on the parathyroid glands to extracellular calcium thus reducing secretion of parathyroid hormone and reducing serum calcium concentration.

21
Q

CKD-MBD mechanism

A

Phosphate retention with reduced GFR results in increased serum PO4 and suppresses vitamin D3 production (by production of FGF23)

Reduced vitamin D3 production leads to reduced calcium absorption and this plus high serum PO4 leads to low serum calcium

Calcium x PO4 increases favouring tissue deposition

PTH stimulated by low calcium, high PO4 and low vitamin D3

22
Q

Medications that inhibit aquaporin2 such as tolvaptan would be most likely to increase urinary excretion of what:

A Hydrogen

B Potassium

C Sodium

D Chloride

E Water

A
23
Q

In nephrotic syndrome, this causative glomerulonephritis is associated with the greatest risk of venothrombotic event.

A

Idiopathic membranous nephropathy (IMN)

24
Q

In which glomerulonephritis are anti-phospholipase A2 receptor (anti-PLA2R) antibodies commonly detected?

A
25
Q

Which glomerulonephritis is most likely to rapidly recur in a renal allograft?

A
26
Q

A diuretic that inhibits renal potassium secretion at the distal nephron by a mineralocorticoid-independent mechanism.

A
27
Q

A diuretic that works predominantly at the proximal tubule by enzyme inhibition

A

Acetazolamide

28
Q

A diuretic that inhibits apical sodium-chloride transporter in the distal convoluted tubule

A

Clorthalidone (Thiazide diuretic)

29
Q

Hep C, raised papules . raynauds phenomenon, LOW C4, normal C3

A

Cryoglobulinaemic GN

30
Q

Multiple myeloma - cause of kidney disease

A
31
Q

Most common cause for PD peritonitis

A
32
Q
A

prolonged dialysis, over a long period of time. They get joint involvement, carpal tunnel and joint cysts

33
Q

BP mx in HDX patients

A

Fluid restrict and salt restrict – best evidence in BP control in dialysis patients. Aim in dialysis patients is to optimise their dry weight

34
Q

Marker for high mortality in Hdx pts

A

Albumin levels highest risk for mortality in dialysis patients, Low BP carries higher risk of mortality also

7 x higher risk

35
Q

ESRF Hb target

Iron studies target

A

100-115

Target sats > 20, ferritin > 200

36
Q

2007B Q.

A 67-year old diabetic woman has end-stage renal failure managed by continuous ambulatory peritoneal dialysis. She presents with abdominal pain, low grade fever and cloudy dialysate. On examination she has mild generalised abdominal tenderness and uarding but does not appear particularly unwell. She is admitted tot e ward and started on Intra- peritoneal cephalexin. The subsequent day, her dialysate culture grows enterococci, E coli and Klebsiella species. The most appropriate management step is:

A. exploratory laparotomy.

B. add intraperitoneal Ampicillin.

C. removal of the Tenckhoff catheter.

D. intraperitoneal gentamicin.

E. change to intravenous antibiotics.

A

Answer A

Three organisms high risk

Gram +ve cocci and 2 x GNB

Tenkoff needs to come out as well

Switch to Iv Abx

Rest 6 weeks then re-insert and re-start if well

Dialysis via back up fistula

37
Q

Q. Which of the following confers a poor prognosis for a newly diagnosed lgA nephropathy?

Proteinuria 0.8g/day on diagnosis

Proteinuria 0.8g/day after 6/12 medical therapy

Proteinuria of 2.4g/day after 3/12 medical therapy

BP of 100/65

lgM staining on histology

A

GN - lgA •

Most common primary GN worldwide
Presentation can range from isolated haematuria to rapidly progressive GN, vasculitic rash lower limbs, usually synpharyngitic
Poor prognostic factors: obesity, older age, proteinuria >3g on diagnosis, proteinuria >lg persisting post 6/12 Rx
ACEi or ARB
Weight loss
Steroids for 6 months if >lg/day proteinuria after 3-6 months of supportive mx

Monitor for SEs, no RCT evidence, not for use with eGFR <50

• UPCOMING TRIALS: enteric coated/slow release steroids (gut absorption)

38
Q

2009B A 39 year old lady has been diagnosed with diffuse proliferative lupus glomerulonephritis on recent renal biopsy. Which pathological finding on biopsy is most associated with poor response to immunosuppressive therapy?

A. Wire loops

B. Crescents

C. Diffuse glomerular involvement

D. Advanced glomerulosclerosis

All five above are bad and associated poor response

Answer D - scar tissue which is irreversible

All five above are bad and associated poor response

Answer D - scar tissue which is irreversible

E. Tubulointerstitial immune deposits

A

All five above are bad and associated poor response

Answer D - scar tissue which is irreversible

39
Q

Recall altered Q. A 75 yo gentleman diagnosed with ANCA vasculitis underwent induction Rx with IV cyclophosphamide and corticosteroids 5 years ago, then treated for a relapse 2 years later with a further 6months of the same. He is currently in remission and maintained on azathioprine. He presents to his GP with a week h/o macroscopic haematuria. What is the next best investigation?

A. Cystoscopy

B. Urine MCS

C. Prostate examination

D. Renal biopsy

E. CT IVP

A

A. Cystoscopy

IV CYC –> haemorrhagic cystitis –> mx by MESNA and can also increase ur chances of getting bladder ca

Answer A. Cystoscopy (to rule out cancer)

No difference between PO and IV Cyclophosphamide –> but cumulative doses in PO is more than IV

40
Q

Q. An 11 yr old girl presents with ankle swelling and abnormal renal function. She is found to have pitting oedema with a BP of 150/90 and urine showing protein ++, haematuria +++. Microscopy reveals cellular casts and fragmented red cells. She had an URTI 6 weeks ago. Serum results show: Cr 120mmol/L [50-120] C3 0.4g/L [0.83-1.46] C4 0.23g/L [0.16-0.45] What is the most likely diagnosis?

  1. Minimal change disease
  2. Focal and segmental glmoerulosclerosis
  3. Membranoproliferative glomerulonephritis
  4. Post-infectious glomerulonephritis
  5. lgA nephropathy
A
41
Q

Q. The antibody target of the induction immunosuppression agent Basiliximab is

  1. L-5 receptor
  2. CTLA-4
  3. CD40
  4. CD25
  5. CD3
A
  1. CD25
42
Q

A. Tacrolimus
B. Cyclosporine
C. Azathioprine
D. Prednisolone
E. Mycophenolate mofetil
F. Basiliximab
G. Thymoglobulin
H. Everolimus

Which agent is most responsible for causing

  1. Gum hyperplasia
  2. Diarrhoea
  3. Alopecia
  4. Impaired wound healing
  5. Leukpenia
A
  1. Gum hyperplasia - Cyclosporine
  2. Diarrhoea - MMF
  3. Alopecia - Tacrolimus
  4. Impaired wound healing - Everolimus > Pred
  5. Leukpenia - Aza
43
Q

Post Tx Cx

A

Peri-op : antibody mediated (hyperacute), renal artery/vein thrombus, ATN

1-3 months: acute rejection (T cell mediated), recurrence of primary dx, high risk of BK virus

3m-1year: CNI toxicity, infections

>1 year: infections, CAN, malignancy

CAN = chronic ab mediated rejection - progressive fibrosis and scarring ?cause

44
Q

Renal Tx

Donor +ve, Reipent -ve –> management

A

Oral Valganciclovir

45
Q

2008B QUESTION 30 and 2009B Q80 You are caring for a 55-year-old man on haemodialysis. He is on the transplant waiting list and asks about his risk of developing cancer if he has a transplant. You note he is of Anglo-Saxon descent. Which of the following cancers is he most likely to develop over the ensuing ten years post-transplantation?

A. Carcinoma of the prostate.

B. Squamous cell carcinoma of the skin.

C. Non-Hodgkin’s lymphoma.

D. Chronic myeloid leukaemia.

E. Carcinoma of the colon.

A

Answer B

** Anglo-Saxon –> scared of sun, very high risk of skin cancers –> they need yearly skin checks

NHL also common - high risk in post transplant, especially associated with EBV

SCC > BCC > Lung

46
Q

2006 Q. Following kidney transplantation, which of the following is the most likely manifestation of BK virus infection?

A. Aplastic anaemia.

B. Pulmonary infiltrates.

C. Nephropathy.

D. Progressive multifocal leucoencephalopathy.

E. Systemic vasculopathy.

BK virus buzzword - in the urine

A

Answer C

Worsening renal fx –> check BK virus PCR + viral load (urine decoy cells) –> tx: reduce immunosuppression

Decoy cells

Nephrology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions