Renal Questions

Question 1

A 20-year-old man presents to the clinic with a painless mass in his left testicle. Ultrasound and serum tumor markers are performed and suggest testicular cancer. Which of the following is accurate patient education regarding testicular cancer?

a. Testicular cancer most commonly presents with a painful testicular mass
b. Testicular examination by a clinician is recommended for men with a history of contralateral testicular cancer
c. Testicular self-examination is not recommended for men with a history of cryptorchidism
d. Testicular self-examination is recommended for men at average risk of testicular cancer

Answer 1

b. Testicular examination by a clinician is recommended for men with a history of contralateral testicular cancer

Question 2

A 31-year-old man undergoes a scrotal examination, which reveals left-sided scrotal fullness that feels like a “bag of worms”. The mass does not transilluminate. Given the most likely diagnosis, which of the following components is most likely in the patient’s history?

a. Cryptorchidism
b. Infertility
c. Mass that increases in size when recumbent
d. Sudden, severe, unilateral pain and scrotal swelling

Answer 2

b. Infertility

Question 3

A 65-year-old man presents with a non-healing, nontender lesion on the glans penis that has progressively worsened over the last three months. He is uncircumcised. He reports an unintentional weight loss of 20 lbs in the past four months. Physical examination reveals deep ulceration of the glans with rolled borders. Biopsy of the lesion reveals abnormal squamous cells with keratinization and epithelial pearl formation. Which of the following is the most likely diagnosis?

a. Balanitis
b. Condyloma acuminata
c. Herpes simplex
d. Lichen planus
e. Penile carcinoma

Answer 3

e. Penile carcinoma

Question 4

A 45-year-old man presents with a nontender scrotal mass. He underwent childhood correction of cryptorchidism. Physical examination reveals a mass that does not transilluminate. Serum alpha-fetoprotein and beta-human chorionic gonadotropin are elevated. Which of the following is the most likely diagnosis?

a. Epididymitis
b. Hydrocele
c. Orchitis
d. Testicular cancer
e. Varicocele

Answer 4

d. Testicular cancer

Question 5

A 23-year-old man with paraplegia presents with edema and erythema of the glans and foreskin. He forgot to reduce the foreskin after self-catheterization this morning. Physical exam shows foreskin that cannot return to its normal position. What is the most likely diagnosis?

a. Angioedema
b. Balanitis
c. Paraphimosis
d. Phimosis

Answer 5

c. Paraphimosis

Question 6

Which of the following is the most common presentation of testicular cancer?

a. Epididymal tenderness
b. Hematuria
c. Painless testicular mass
d. Positive Prehn sign
e. Transilluminating mass

Answer 6

c. Painless testicular mass

Question 7

In a patient with recurrent priapism, what hematologic condition needs to be ruled out as a potential cause?

a. Idiopathic thrombocytopenic purpura
b. Pernicious anemia
c. Sickle cell anemia
d. Thalassemia major

Answer 7

c. Sickle cell anemia

Question 8

A 7-year-old girl presents to clinic with a diagnosis of horseshoe kidney diagnosed around time of birth. She is following up due to having several recent urinary tract infections. What would the next step in her management be?

a. Obtain a voiding cystourethrogram
b. Obtain an MRI scan
c. Order a CT scan
d. Perform a cystoscopy
e. Perform an ultrasound

Answer 8

a. Obtain a voiding cystourethrogram

Question 9

A 4-year-old girl has been found to have a Wilms Tumor and has metastatic disease on time of diagnosis, found on imaging. Where site on imaging would her metastases most likely be found?

a. Brain
b. Bone
c. Colorectal
d. Liver
e. Pulmonary

Answer 9

e. Pulmonary

Question 10

At what age should the Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), and testosterone should be checked for patients with cryptorchidism?

a. After one year of age
b. Immediately after birth
c. One to Four months
d. Seven days after birth
e. Six to twelve months

Answer 10

c. One to Four months

Question 11

A 2-month-old boy presents to clinic due to cryptorchidism. At what age do you recommend surgical orchidopexy be performed if descent had not occurred?

a. After five years of age
b. After two years of age
c. Immediately
d. One to Three months
e. Four to Six months

Answer 11

e. Four to Six months

Question 12

At what age do both communicating and noncommunicating hydroceles rarely spontaneously resolve and should be referred to a pediatric urologist or pediatric surgeon for elective closure?

a. Five
b. Four
c. One
d. Three
e. Two

Answer 12

e. Two

Question 13

A 75-year-old man presents to the office and is found to have bladder cancer. What was most likely his presenting symptom, as this is the most common symptom for his disease?
a. Bladder Pain
b. Frequency
c. Hematuria
d. Urgency
e. Weight loss

Answer 13

c. Hematuria

Question 14

A 42-year woman smoker presents to the clinic complaining of urgency, frequency, and bladder pain that is relieved with urination. She has a history of having kidney stones ten years ago. Her urinalysis is negative, and she has no flank pain. What is her most likely diagnosis?

a. Acute cystitis
b. Bladder cancer
c. Interstitial cystitis
d. Overactive bladder
e. Pyelonephritis

Answer 14

c. Interstitial cystitis

Question 15

A 65-year-old woman presents with leaking small amounts of urine whenever coughing or sneezing. She has immediate urinary leakage on in office Valsalva test. What type of incontinence is most likely?

a. Detrusor overactivity/urge incontinence
b. Functional
c. Overflow
d. Urethral incompetence/stress incontinence

Answer 15

d. Urethral incompetence/stress incontinence

Question 16

A 59-year-old man comes into the office complaining of filling like his bladder is not emptying well. He has a history of an enlarged prostate. He states he has has been dribbling urine after voiding and has the urge to go but can’t get there in time. You check a post void residual and note he has 450 ml of urine in his bladder but can’t void. You diagnose him with overflow incontinence. What is the first step in his treatment plan?

a. Bladder decompression with a catheter
b. Check a urinalysis
c. Perform a digital rectal exam (DRE)
d. Place him on an antibiotic such as Levofloxin (Levaquin)
e. Start him on Flomax

Answer 16

a. Bladder decompression with a catheter

Question 17

A 78-year-old woman presents with recurrent unpredictable episodes of abrupt urine leakage. She states that she often has an intense sensation to urinate but feels like she can never completely empty her bladder or get to the toilet in time. Her physical examination is unremarkable. A post-void residual urine level is normal. What is the most likely diagnosis?

a.Hemorrhagic cystitis
b. Stress incontinence
c.Urge incontinence
d. Urinary retention

Answer 17

c.Urge incontinence

Question 18

What type of incontinence has a variable presentation but occurs when urinary retention leads to bladder distention and leakage of urine from the urethra?

a. Mixed incontinence
b. Overflow incontinence
c. Stress incontinence
d. Urge incontinence

Answer 18

b. Overflow incontinence

Question 19

What is the initial form of treatment for all bladder cancers?

a. Chemotherapy
b. Cystectomy
c. External Beam Radiation
d. Immunotherapy
e. Transurethral Resection of the Bladder Tumor (TURBT)

Answer 19

e. Transurethral Resection of the Bladder Tumor (TURBT)

Question 20

What imaging method is used to primarily confirm bladder cancer?

a. CT scan
b. Cystoscopy
c. MRI
d. Ultrasound
e. X-ray

Answer 20

b. Cystoscopy

Question 21

A 15-year-old boy presents for examination after being hit in the groin during a football game. Examination reveals the absence of his right testicle, with no masses, transillumination, or surgical scars on either side of his scrotum. His left testicle is present, and although tender to palpation, is of appropriate size. Which of the following is your greatest concern?

a. hydrocele
b. penile cancer
c. spermatocele
d. testicular cancer

Answer 21

??

Question 22

A 64-year-old nursing home resident complains of pain and swelling of the penis. Examination reveals a swollen retracted foreskin with marked edema and mucopurulent drainage. What is the most likely diagnosis?

a. paraphimosis
b. penile carcinoma
c. Peyronie disease
d. phimosis

Answer 22

a. paraphimosis

Question 23

A patient 52 yo presents with new diagnosis of CKD stg III. BP is 140/85. creatinine =1.0, K = 4.5, GFR= 57, BG = 122. which of the following drugs is NOT indicated?

A- statin
B-ACE/ARB
C-SGLT2-I
D-GLP-1
E-Thiazide diuretic

What labs would you want to order?
What is LDL goal? BP goal? HgA1C goal?
Patient education? prevention?

Answer 23

E- thiazide diuretic

Patient should be on statin, ace/arb/sglt2-I; add on thiazide if he is still HTN; add on GLP-1 if he is not at A1C goal ( < 7.0) and or had proteinuria

Labs: Labs: UACR, HGA1C, FLP. If not done within last year , since stage III: PTH, Ca, CBC, phosph, vitamin D
Renal ultrasound would show : decreased renal cortical thickness < 6mm, small , echogenic kidney BIL
LDL goal < 100 ( MIT statin), BP goal < 130/80, HgA1c < 7.0
Prevention: don’t smoke, exercise, UTD on vaccines, education no high protein diet, hold ace/arb (metformin if was on) pre contrast
Consider ASA 81 daily if no bleeding risk given RF CAD

Question 24

Patient with CKD stage III presents with fatigue. Hgb 8.0 mg/dl. What do you do next ?

Start oral iron replacement
Start IV iron replacement
Give blood transfusion
Start erythropoietin

Answer 24

Next step is to consider etiology. May be anemia of chronic disease- but could be IDA, colon ca, gib. Need to check cbc w diff to now indexes
Hgb goal depends on underlying disease ( CAD) , baseline, +/- symptoms

Goal in most CKD patients Is keep Hgb > 11

Question 25

Common electrolyte changes in CKD: ↑ or ↓?

Potassium
Phosphate
Calcium
Magnesium

Answer 25

Potassium ↑
Phosphate ↑
Calcium ↓
Magnesium ↓

Question 26

When to refer to nephrology ?

Answer 26

GFR < 30
HTN refractory to 4 medications
Associated complications: secondary hyper parathyroid, hyperkalemia, hypercalcemia, non -iron def anemia, metabolic acidosis, worsening UACR

Question 27

A man with ckd stage 4, HTN, DM, and GERD presents to office complaints of dyspepsia. In addition to TLCs and weight management , which of the following is appropriate therapy ?

A- famotidine
B-omeprazole
C-oral calcium carbonate and magnesium hydroxide
D- sucralfate

Answer 27

Pepcid is ok. Do not want to use PPI,:ca/ mg containtng rx in ckd can lead to magnesium toxicity; sucralfate is indicated for PUD not gerd- and contains aluminum which can build in ckd patients

Question 28

A patient with diabetic kidney disease stage 3 presents for follow-up. VS: 140/88, 78,14,98.7, BMI 34.1. Current rx: lisinopril 10 mg po BID, metformin 875 mg po BID. Labs GFR 55ml/,min, HgA1c 7.0, stable electrolytes, + albumin on UA dip.

Which of the following is indicated?
a- increase ACE-I
B- atorvastatin 40 mg po hs
C- GLP-1
D- SGLT-2

In follow up GFR is 57ml/min with elevated UACR……

Answer 28

A- increase ace-I for improved BP control and reduce proteinuria
B-diabetes/ckd should be on MIT statin
C- GLP-1 indicated to reduce HgA1C, progression CKD, and decrease BMI/CAD risk
D- SGLT2- indicated to reduce HgA1c, progression CKD, decrease CAD risk

In follow up they are showing continued progression- want to make sure they are on max tolerated therapy- ( RAS, MIT, diet/exercise/weight/no tobacco; add Karendia ( non-steroidmal MRA) repeat labs in 3 months to include FLP, BMP, CBC, phosph, PTH,

Question 29

A patient with known stage iv CKD presents to ED with delirium. Creatinine 5.6, K 6.0, Mg 3.0. Which of the following is indicated?

Answer 29

Av fistula placement
Central line placement
Av graft placement
Peritoneal port placement

Question 30

Which of the following lab test is most specific to screen for renal osteodystrophy? How does CKD affect the following lab values ( increase/decrease?)

a- Vitamin D
b- PTH
c- phosphate
d-calcium

Answer 30

Vitamin D low ( not necessarily specific)
Low ca
Increased phosphate
Increased alk phos
Increased PTH- would be most specific for osteodystrophy

Question 31

A patient with CKD stage 3 presents in office with hyperkalemia and worsening GFR on pre-clinic labs. ( GFR today < 25) Which of the following is indicated?

A-Finerenone (Kerendia)
B- Kaexylate
C-Spironolactone
D-SGLT2-inhibitor

Answer 31

A- kerendia is contraindicated in hyperkalemia ( if they had DKD, stable renal function indicated to decrease progression of ckd)
B- kaexylate would need to recheck labs and reevaluate
C- spironolactone would increase K
D- SGLT2-I additive may help decline GFR

Question 32

Patient presents with new diagnosis of HTN and CKD. What is initial antihypertensive of choice?

Alpha2-agonists
Angiotensin-converting enzyme inhibitors
Beta-blockers
Calcium channel blockers
Vasodilators

Question 33

A patient with CKD stage III, HTN, DM, and CAD presents of office for routine ov. He is on multiple Rx. Physical exam is unremarkable except for BP 160/90. Which of the following is most likely cause of patients HTN ?
A. elevated BMI
B. advancing age
C. worsening renal function
D. noncompliance with rx

Answer 33

D. noncompliance with rx

Question 34

A patient with stage 3 CKD, HTN, DM presents in clinic for follow-up. Current Rx: metformin, Celebrex, lisinopril, amlodipine. Physical exam is unremarkable. Renal ultrasound shows bilateral renal cortical atrophy. CrCl is 28. Which of the following changes are indicated at this time?
A. start SGLT2-I
B. Stop metformin
C. stop Celebrex
D. stop lisinopril

Answer 34

• answer is to stop metformin ( crcl< 30) and Celebrex
  If no hyperK cont lisinopril to protect kidneys
  Sglt2-I use unless SE or CrCL, 20

Question 35

What is the treatment for pericarditis and uremia?

Answer 35

HD; AV fistula take up to 6 -12 weeks to develop, AV graft 2-3 weeks, peritoneal a few days- ; what is risk assoc with peritoneal? ( peritonitis and low protein)
What is preferred access? IJ

Question 36

Answer 36

The correct answer is Option (D), oral administration of ciprofloxacin. The patient’s symptoms, physical examination findings, and results of urinalysis are consistent with urinary tract infection, and Escherichia coli is the most likely pathogen. On the basis of the causative organism and the options presented, oral administration of ciprofloxacin is the most appropriate management of urinary tract infection in the patient described. Option (A), intramuscular administration of ceftriaxone, and Option (C), intravenous administration of vancomycin, are incorrect because these are not appropriate first-line therapies for uncomplicated urinary tract infection. Option (B), intravenous administration of gentamicin, is incorrect because this therapy is not appropriate initial management of uncomplicated urinary tract infection. In addition, because gentamicin is nephrotoxic, it should not be used in patients with chronic kidney disease. Option (E), oral administration of nitrofurantoin, is incorrect because it is contraindicated and is ineffective therapy for urinary tract infection in patients with stage 4 chronic kidney disease.

Question 37

Answer 37

The correct answer is Option (C), serum intact parathyroid hormone level. In the patient with stage 4 chronic kidney disease and corresponding abnormal laboratory values, the pathophysiologic response represents mineral bone disease and depletion of serum calcium. The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) recommends measurement of serum parathyroid hormone level and therapy for abnormal values to prevent and manage mineral bone disease. Option (A), erythrocyte sedimentation rate, and Option (B), serum C-reactive protein level, are incorrect because these are markers of inflammation and are not useful in diagnosing mineral bone disease. Option (D), serum thyroid-stimulating hormone level, is incorrect because this test is used for diagnosing primary and secondary hyperthyroidism and hypothyroidism, not mineral bone disease. Option (E), serum vitamin B12 level, is incorrect because this test would be appropriate if anemia secondary to vitamin B12 deficiency were suspected

Question 38

What is most common cause of nephrotic syndrome?

Answer 38

Diabetes mellitus is most common cause
It is a SECONDARY cause

Question 39

Pt with hx DM presents to clinic with edema, decreased energy and weight gain. Which of the following is finding is most specific to nephrotic syndrome?

A- Acanthocytes on urinalysis
B-oval fat bodies on UA
C- elevated ant streptolysin-o titer
D-RBC on UA
E- elevated BUN

Answer 39

Answer B : nephrotic syndrome- oval fat bodies (Maltese cross sign)
Answer A supports nephritic syndrome
Answer c, + antistrptolysin O titer support acute glomerulonephritis
Answer d nephritic syndrome ( glomerulonephritis)
Answer E can be ckd/aki

Question 40

A patient presents with stage II HTN and proteinuria on UA. Which is drug of choice to treat their HTN?

Lisinopril
Hctz
Furosemide
amlodipine

Question 41

Which of the following is a complication of nephrotic syndrome?

A- atrial fibrillation
B-cerebral aneurysm
C-deep vein thrombosis
D-cancer

Answer 41

Very important to think of nephrotic syndrome as a hypercoagulable state – especially when albumin is < 2.8- lower the albumin the increase the risk for clot; most VTE events occur within 6 months of diagnosis

Question 42

A 48-year-old man presents in clinic with a diagnosis of nephrotic syndrome and a deep vein thrombosis. Which of the following medications is most appropriate in the management of this patient?
a. Apixaban (Eliquis)
b. Dabigatran (Pradaxa)
c. Warfarin (Coumadin)
d. Lovenox

Answer 42

**c. Warfarin (Coumadin)- bc of fluctuating renal function/ gfr

Question 42

A 38-year-old woman with a long history of diabetes mellitus presents in the clinic with edema. She reports decreased energy, weight gain, and swelling in her face when she wakes up with pedal edema later in the day. She denies any changes to diet. Her daily medications include Glucophage 500 mg po BID which she has taken for 2 years. Which of the following findings supports a diagnosis of nephrotic syndrome?
a. Acanthocytes on urinalysis
b. Elevated antistreptolysin-O titer
c. Increased BUN
d. Increased Creatinine
e. Positive oval fat body on microscopic urinalysis

Answer 42

e. Positive oval fat body on microscopic urinalysis

Question 42

Which of the following is a treatment for nephrotic syndrome?
a. ACE-inhibitors
b. Albumin infusion
c. Calcium replacement
d. High phosphorus diet
e. High protein diet

Answer 42

a. ACE-inhibitors

Question 43

Which of the following is a complication of nephrotic syndrome?
a. Cancer
b. Cerebral aneurysm
c. Nephrolithiasis
d. Pleuritis
e. Renal vein thrombosis

Answer 43

e. Renal vein thrombosis

Question 44

A 46-year-old woman presents to clinic with swelling of her face, eyes, and hands. Urinalysis show moderate proteinuria and mild glycosuria. Microscopic findings include RBC casts, granular casts, and oval fat bodies. What is the initial treatment for this patient?

A.Lisinopril
B. Losartan
C. Cyclophosphamide
D. Metformin
E. Dapagliflozin

Answer 44

A.Lisinopril
treatment for nephrotic syndrome is ace i

Question 45

10 year -old presents with swelling and blood in urine for 24 hours. They are just recovering from a sore throat a few weeks ago which has resolved. Which UA is most likely?

A. Positive ketones and glucose
B. Positive nitrates, white blood cells, red blood cells
C. proteinuria, foamy urine, oval fat body
D. proteinuria, Hematuria, acanthocytes, RBC casts, E. tea-colored urine
F. Proteinuria, albuminuria

Answer 45

D- describes post infectious/streptococcal glomerulonephritis a nephritic syndrome

A- diabetes
B-uti
C-nephrotic syndrome
D-nephritic syndrome

Question 46

10 year -old presents with swelling and blood in urine for 24 hours. They are just recovering from a sore throat a few weeks ago which has resolved.

What test would confirm the diagnosis?

Antistreptolysin O-titer
Basic metabolic panel
Renal biopsy
Throat swab
Urinalysis

Answer 46

A- antistreptolysin confirms recent uri thus + strep
B- bmp would not confirm; if nephritic they may have change in create/gfr; in nephrotic usually create/gfr unchanged with decrease albumin/increase lipids
c. Renal bx would confirm either but not necessary
d. Throat swab if + for strep supports if they were untreated
e. UA a

Question 47

10 year -old presents with swelling and blood in urine for 24 hours. They are just recovering from a sore throat a few weeks ago which has resolved.
Which of the following treatments is indicated?

Antibx
Steroids
Loop diuretics
Anticoagulation therapy

Question 48

A 32-year-old woman presents to the clinic with hair loss, edema, fatigue, and bilateral knee pain for 2 months. She states if she is in the sun she turns bright red. On physical examination there is ill-defined erythema on the nose and cheeks which spares the nasolabial folds, diffuse thinning of the scalp hair, and 1+ pitting edema to bilateral legs. Laboratory studies reveal:
UA: 4+ proteinuria
Hgb 8.4
WBC 2.3
Plt 220
Creatinine 1.8
ESR 57
ANA: 1:160

Which of the following is the next best step in identifying the cause of her renal failure?
a. Anti-Ds-DNA antibodies
b. BUN, Creatinine, and Fractional excretion of sodium
c. Anti-histone antibodies
d. Renal Biopsy
e. Renal Ultrasound

Answer 48

**a- this patient has lupus; currently in a flare which is etiology of lupus nephritis

B- not likely to yield anything but this is a “normal” place to start work up of proteinuria
C-+ for drug induced lupus
D- bx would prove lupus nephritis but is not needed to make dx
E-US- not indicated; would check us to rule out obstruction; could tell you size of kidneys ( diabetic small, htn big)

Question 49

What is the most common cause of acute glomerulonephritis worldwide?
a. Cancer
b. IgA nephropathy
c. Minimal change disease
d. Systemic lupus erythematous
e. Vasculitis

Answer 49

b. IgA nephropathy

Question 50

An 8-year-old male presents to family clinic for dark urine. On physical exam, he has facial and pedal edema. Which of the following is most likely urine analysis findings?
A. proteinuria, lipiduria, glycosuria
B. RBC casts, acanthocytes, and hematuria
C. nitrites, leukocytes, hematuria
D. granular casts

What is likely in this child’s history?
Abdominal trauma
Recent antibiotics
Congenital bladder defect
Streptococcal infection

Answer 50

B is consistent with glomerulonephritis
A- nephrotic syndrome
C- hemorrhagic UTI
d. ATN

d child has most likely had strep which is the most common cause of glomerulonephritis in children- better prognosis in pediatric patient than adult
An antio-) titer would be +

Question 51

Which of the following distinguishes nephrotic syndrome from nephritic syndrome?
a. hypertension
b. edema
c. decrease glomerular filtration rate
d. hematuria

Answer 51

c. decrease glomerular filtration rate

Question 52

What is the first test in the workup for suspected renal artery stenosis?

What is the most accurate test in workup for renal artery stenosis?

Answer 52

Ultrasound
Most accurate is angiography

Question 53

A 48-year-old man presents for work up HTN refractory to 3 rx. Physical exam reveals renal artery bruit. Which of the following ultrasound findings supports diagnosis of fibromuscular dysplasia?

1- Dilation of the calyces
2-symmetrically contracted kidneys
3-reduced renal cortical thickness < 6mm
4-String of pearls sign

Answer 53

A- hydronephrosis- obstruction
B-renovascular HTN
C- ckd
*D- fmd