Renal

Question 1

phosphate proximal tubule reabsorption is increased by Na+/phosphate cotransporter and not PTH because

Answer 1

PTH decreases it by inhibiting active transport mechanisms in the proximal tubule. PTH increases reabsorption of Ca2+ and PO43- in the gut via vitamin D

Question 2

kidney stones and urine that produces a deep purple color with nitroprusside cyanide test is cystinuria and not hypophosphatemic rickets because

Answer 2

cyanide converts cystine to cysteine and a purple color is formed when nitroprusside binds to cysteine.

Question 3

electron dense subepithelial humps

Answer 3

poststreptococcal glomerulonephritis

Question 4

urine dipstick that show positivity for luekocyte esterase but not reactivity to nitrite contains Enterococcus faecalis and not proteus mirabilus because

Answer 4

enterobacter sp. (gram neg enteric rods: e coli, klebsiella, and proteus) are nitrite positive.

Question 5

a 65 yr old man with oligura, edema, hemoptysis, and glomerular crescents has Anti-glomerular dz and not lupus nephritis because

Answer 5

lupus nephritis is common in women at childbearing age.

Question 6

A tumor that has islands of stromal or epithelial cell and glomerular ortubular structures that does not cross the midline is a Wilms tumor and not neuroblastoma becuase

Answer 6

neuroblastomas can cross the midline and Wilm’s tumor (kidney) do not.

Question 7

normal glomeruli and interstitium with coagulative necrosis of distal portion of renal pyramids is most likely caused by DM and not milliary TB because (location and necrosis type)

Answer 7

papillary necrosis is most commonly caused by DM, acute pyelonephritis, chronic penacetin (derivative of acetaminophen) use, and sickle cell anemia. miliary TB causes whitish seedlike nodules on renal cortex and has caseting granulomas.

Question 8

given maximal urine osmolarity, plasma sodium, plasma potassium, plasma osmolarity, and minimum solute output; maximal urine osmolarity and minimum solute output is used to calculate the urine volume of a woman deprived of water for 24 hrs?

Answer 8

obligatory urine volume= solute load(amount)/maximal urine osmolarity (concentration-amt/vol)=urine volume
this is also equal to minimum water intake.

Question 9

correcting hyponatremia too quickly leads to basis pontis damage and not cerebellar penduncles because

Answer 9

compensation for hyponatremia is extrusion of solutes from intracellular stores. over correction can lead to central pontine myelinolysis or osmotic demylination syndrome. the cerebellar penduncles are not vulnerable to rapid overcorrection

Question 10

development of kidney

Answer 10

ureteric bus aka metanephric duct is diverticulum of mesonephric duct. grows to metanephric mass which becomes exceretory units of kidney. metanephros in turn induces metanephric duct to divide into calyces and CCTs of definitive kidney.

Question 11

hyperplastic arteriolitits

Answer 11

aka onion skinning of renal arterioles suggests malignant hypertension

Question 12

acetazolamide decreases NH4+ excretion and not K+ excretion because

Answer 12

it blocks carbonic anahydrase which causes intracellular conversion of CO2 and H2O to H2CO3 which automatically dissociates to HCO3- and H+. without it no H+ is formed and it can’t be excreted with NH3.

Question 13

blocking ADH receptors will cause a decrease in urine osmolarity but no change in electrolyte excretion because

Answer 13

ADH works only to reabsorb water in the CCT, it doesn’t effect the PCT where most of the ion are reabsorbed. pt will become hypervolemic and hyperosmotic.

Question 14

unchanged urine output after ADH administration, in the setting of hypernatremia can be caused type 2 DM and not hypoaldosteronism because

Answer 14

hypoaldsteronism will cause hyponatremia not hypernatremia. also DM leads to hyperglycemia leading to oversaturation of glucose reabsorption channels and increased ultrafiltrate oncotic pressure. ADH can no longer passively reabsorb water in CCT. instead RAS reabsorbs salt in an effort to maintain plasma vol.

Question 15

pseudomonas cause hot tub folliculitis not pneumonia in AIDS pt because

Answer 15

it causes UTIs, hot-tub folliculitis and infections in burn and CF pts. pneuomnia in AIDS is caused by histoplasm capsulatum, proteus, and ureaplasma (no cell wall related to mycoplasma)

Question 16

the early DCT and not the CCT has the lowest fluid osmolarity because

Answer 16

ADH can increase the CCT osmolarity to 1200-1400mOsm/L. the TAL and DCT are diluting segments

Question 17

pt with HTN, DM, and osteoarthritis and signs of acute interstitial nephritis is mostly due to ibuprofen and not metoprolol because

Answer 17

ibuprofen (NSAIDS) can lead to AIN. typical presentation-acute renal failure, fever, maculopapular rash, esinophilla

Question 18

give allopurinol and not acetylsalicyclic acid befoe starting chemo on a pt because

Answer 18

it is acitivated by xanthine oxidase and then in turn inhibits xanthing oxidase to decrease purine metabolism and decrease uric acid formation and uric kidney stones. acetylsalicylic acid is asprin at low doses can decrease uric acid secreton and cause hyperuricemia whereas at high doses it causes decrease in ureic tubullar reabsorption can cause uricosuria

Question 19

the most common effect of cyclosporine (IL-1/IL-2 production inhbitor=less macs and T cells) is

Answer 19

nephrotoxcity. most likely due to renal vasconstriction caused by reduction in thromboxane, and reduced PGs,

Question 20

what % of salt is excreted by kidney? what % by sweat and feces

Answer 20

95%; 5%

Question 21

Wilms tumor has embryonic glomerular structures and not abudant clear cells becuase

Answer 21

clear cells are associated with renal cell carcinoma

Question 22

thiazides increase Ca2+ serum levels and not carbonic anhydrase inhibitors because

Answer 22

thiazides inhbit NaCl reabsorption in DCT causing Ca2+ reabsobtion. mech not clear, maybe decreased Na in DCT causes increase Na/Ca channel acitivation in basolateral side

Question 23

pt with neurogenic bladder due to paraylsis should be treated with tolterodine and not prazosin beauase

Answer 23

tolterodine is a compeptive muscarinic receptor antagonist that blocks hyperactivation on these receptors in bladder. prazosin is an alpha blocker and would prevent symapathetic stimulation of external sphincter making the problem worse.

Question 24

captopril is an agent that can cause renal dysfunction and increased Cr and not ciprofloxacin because

Answer 24

captopril is an ACE inhibitor which blocks ANGII constriction of efferent arteriole to maintain GFR. ciprofloxacin has no effect on the things that can lead to prerenal azotemia (decreasd CO, decreased renal blood flow, and change in vascular resistance)

Question 25

desptie increasing MAP RPF and GFR are kept constant by a. art constriction and e art dilation and not a. art dilation and e. art constriction because

Answer 25

a. art dilation and e. art constriction would cause and increase in RBF and GFR.

the a art constrict and to increase resistance and maintain constant GFR and RBF. decreased renin production due to high BP causes dilation of e. art

Question 26

acute renal failure results in metabolic acidosis and not alkalosis because

Answer 26

in states of volume depletion the kidney (if normal) will absorb Na and waste K+ and H+. However in the state of renal failure the kidney is unable to maintain blood volume and thus Na+ will be reabsorbed and H+ and K+ can no longer be secreted resulting in metabolic acidosis. Note: the pt may still have elevated serum Na+ due to decreased plasma volume.

Question 27

pt with recent gasteroenteritis, dark urine, with normal renal function, C3 levels is likely to have mesangial IgA deposits and not crescent formation on histology because

Answer 27

Berger’s disease can present after a URI or acute gastroenteritis. RPGN would have decreased C3 levels as the crescents are formed from fibrin, plasma proteins (C3b), glomerular parietal cells, monocytes, and macrophages.

Question 28

thickening of walls of glomerular capillaries

Answer 28

“tram tracking” in membranoproliferative glomerular nephritis. MPGN

Question 29

nephrotic syndrome results in an increase in LDL and not HDL because

Answer 29

increased protein production in liver, abnormal lipid particle transport, and decreased lipid catabolism results in increases LDL, cholesterol, and triglyceride levels. HDL levels decrease.

Question 30

pt with polyuria and polydpsia and dilute urine despite overnight water restriction has nephrogenic DI and not DM because

Answer 30

with DM pt are able to concentrate their urine

Question 31

Goodpasture’s disease can lead to damage of lens of eye and not fascia because

Answer 31

the anti-GBM are directed against type VI collagen which is present in the lungs, kidneys, and lens of the eye

Question 32

type I collagen

Answer 32

bone, skin, tendon, dentin, fascia

Question 33

type II collagen

Answer 33

cartilage (hyaline cartilage), vitreous body of eye, and nucleus pulposus of intervertebral disks

Question 34

type X collagen

Answer 34

epiphyseal plates

Question 35

type III

Answer 35

skin, blood vessels, uterus, fetal tissue and granulation tissue

Question 36

newborn with clear fluid in umbilicus, pH 6.0, specific gravity 1.020, no leuks, no RBS, and no hemoglobin passes through the median umbilical ligament and not the medial umbilical ligament because

Answer 36

the fluid described is urine and the embryonic structure is the allantooic duct (urachus). normally the urachus obliterates and forms the median not medial umbilical ligament (from upper bladder to umbilicus). the medial umbilical ligmament is the adult derivative of the umbilical artery.
folds are parietal peritoneum that covers the ligaments.

Question 37

lateral umbilical fold

Answer 37

fold parietal peritoneum that covers inferior epigastirc artery and vein on inferior surface of anterior abdominal wall

Question 38

renal failure diet

Answer 38

control protein and phosphorus in pts diet, limit sodium and fluid intake. low protein and high carbs and moderate fat intake

Question 39

increasing net hydrostatic pressure (capillary pressure-pressure in Bowman’s space) and increasing plasma protein oncotic pressure is due to to constriction of e. arteriole and not dilation of afferent arteriole because

Answer 39

increasing net hydrostatic pressure would result from dilated afferent and constricted efferent. however the plasma protein oncotic pressure is an indication of filtration fraction (GFR/RBF). increasing oncotic pressure indicates an increased FF (more fluid is filtered while protein gets left behind). thus the RBF must have decreased which is due to efferent constriction. afferent dilation would have no effect on FF.

Question 40

plasma osmolarity

total body osmoles

Answer 40

(total body osmoles-urine osmoles)/ (total body water-urine volume)
=initial plasma osmolarity*TBW

Question 41

volume of fluid in a compartment

Answer 41

=amt of sustance given/concentration of substance in compartment
think volume of distribution=amt drug in body/plasma drug concentration.

Question 42

Group A Strep and not strep. pneumo can cause glomerularnephritis because

Answer 42

strep pneumo causes MOPS (meningitis, otitis media, pneumo, a sinusitis)
GAS cause-pharyngitis which can lead to rheumatic fever or glomerulonephritis.

Question 43

2 yr old body with gonadal dysgenesis most likely has Wilm’s tumor vs other kidney tumors because

Answer 43

WAGR syndrome-wilm’s tumor, anirida (absense of iris-colored portion of eye), genital abnormalties, and mental retardation

Question 44

ovoid hyailne masses with amorphous PAS-positive material in the periphery of the glomerulus

Answer 44

Kimmelsteil-Wilson nodules

Question 45

pt with DM2 and urinary incontinence should be given oxybutynin and not bethanechol because

Answer 45

bethanechol a muscarinic agonist would make her condition worse. oxybutynin and tolterondine are the the preferred anticholinergics to treat this condition.

Question 46

most stones develop and can cause?

Answer 46

renal pelvis; renal colic if small or acute pyelonephrtis if large

Question 47

pt with ADPKD is a increased risk for subarachnoid hemorrhage and not portal hypertension because

Answer 47

ADPKD is associated with berry aneurysms and hepatic cysts. ARPKD is associated with splenomegaly and liver fibrosis which can lead to portal hypertension.

Question 48

sodium reabsorption=

Answer 48

amt filtered-amount excreted in urine
amt filtered=Plasma concentrationGFR
amt excreted=urine concentrationurine flow rate

Question 48

sodium reabsorption=

Answer 48

amt filtered-amount excreted in urine
amt filtered=Plasma concentrationGFR
amt excreted=urine concentrationurine flow rate

Question 49

pt with minimal change disease is suffering from lymphokine production by T cells and not immune complex deposition because

Answer 49

immune complex deposition is associated with type III hypersensitivity (post=strep, henoch-schonlein pupura, SLE) whereas minimal change is associated with Hodgkin’s (non neoplastic T cells express cytokines) and T-cell lymphoma,