Usmle Step1 Q&A Mukhtar
Usmle Step1 Q&A Mukhtar
Usmle Step1 Q&A Mukhtar
Show answer
Correct Answer: D
2. Which of the following is/are true relative to the causes of high blood
pressure:
1. Renal parenchymal disease is the single most common cause of persistent
hypertension in the pre-adolescent population.
2. Environmental factors thought to raise BP include obesity, diabetes, high
salt intake, physical inactivity and immoderate alcohol consumption.
3. Renal artery stenosis, renal parenchymal disease, endocrine disorders,
pregnancy, and drugs, account for the majority of secondary hypertension.
4. A cause for hypertension can be identified in close to 95% of hypertensive
adults, if diligently searched for.
Show answer
Correct Answer: A
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: B
Show answer
Correct Answer: A
7. A three month old infant born at full term weights 5 kg and has a length of
50 cm. The serum creatinine is 1.0. Which statements are true?
1. This infant has normal renal function.
2. Glomerulogenesis is complete.
3. Tubular maturation is complete.
4. This infant's glomerular filtration rate is approximately 22 mL/1.73
m2/min.
Show answer
Correct Answer: C
Show answer
Correct Answer: E
Show answer
Correct Answer: B
Show answer
Correct Answer: E
11. The most likely diagnosis in a patient presenting with signs and symptoms
of small vessel vasculitis, antineutrophil cytoplasmic antibodies (ANCA) in
the blood and no evidence of asthma, eosinophilia or necrotizing granulomas is
which of the following:
A. Henoch-Schonlein purpura
B. Cryoglobulinemic vasculitis
C. Microscopic polyangiitis
D. Necrotizing granulomatosis (Wegener's)
E. Churg-Strauss syndrome
Show answer
Correct Answer: C
manner and that he has seen no reason to have a metabolic work-up. He noticed
in recent months, however, that he has to urinate quite often, especially at
night, that he has exertional dyspnea and that he is more fatigued than usual.
All of the following statements apply to his situation, EXCEPT:
A. ESWL reduces stone activity.
B. ESWL can increase stone activity.
C. Repeated ESWL can cause hypertension and 2o heart failure
D. Repeated ESWL can cause renal insufficiency.
E. Despite a good response to ESWL, a metabolic evaluation is essential.
Show answer
Correct Answer: A
13. Which therapeutic measures correlate best with the prevention of Calcium
oxalate stones in patients with idiopathic hypercalciuria?
A. Extracorporeal Shock Wave Lithotripsy.
B. sustained alkalinization of the urine with bicarbonate.
C. a high sodium diet.
D. high dose vitamin C.
E. low sodium and normal protein intake, a high urine volume, thiazide
diuretic.
Show answer
Correct Answer: E
Show answer
Correct Answer: B
15. Which one of the following does not drive potassium into cells?
A. Insulin
B. Increased extracellular pH
C. Epinephrine
D. Increased extracellular sodium concentration
E. Aldosterone
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: E
18. An elderly woman develops a urinary tract infection, becomes confused, and
does not eat or drink for three days at her nursing home. She is found to have
a blood pressure of 70/50 mmHg (very low). Which one of the following
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: D
21. A 23-year-old sexually active woman presents with urinary frequency and
burning on micturition of 24 hours duration. Her urinalysis shows: Yellow,
hazy urine. pH 6. No glucose. Protein trace, blood trace. 20-50 WBC/HPF, 10-20
RBC/HPF. 0-1 squamous epithelial cells and no bacteria. You prescribe
trimethoprim/sulfamethoxazole tablets twice a day. The next day she feels much
better but her urine culture report reads:"Staphylococcus saprophyticus
100,000 cfu/ml." Which of the following statements is true?
A. She has a bacterial UTI.
B. The urine sample was contaminated and the results from it are unreliable.
C. The hematuria likely signifies the presence of a stone or tumor.
D. The Staphylococcus saprophyticus is likely a skin contaminant.
E. The urinalysis is a laboratory error.
Show answer
Correct Answer: A
22. A 58-year-old woman presents with hematuria and left flank pain. Renal
ultrasound shows marked left hydronephrosis. Serum creatinine and CBC are
normal. Which of the following is the most relevant diagnostic aid?
A. Renal biopsy
B. Renal arteriogram
C. Palpation for inguinal lymph nodes
D. Antinuclear antibody test
E. Pelvic examination and IVP
Show answer
Correct Answer: E
23. A 26 year-old diabetic woman is seen in the ER for sore throat. Rapid
strep test is positive for streptococcal pharyngitis and she was started on
ampicillin 500 mg four times a day. Three days later, she develops hematuria
associated with a low grade fever. On physical examination, she has a
maculopapular rash and a temperature of 101oF. Laboratory studies show: serum
creatinine 3.6 mg/dl, WBC 8,700 with 56% PMN, 25% lymphs, 3% monos and 15%
eosinophils. Urinalysis: pH 6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30
WBCs/HPF, 3-4 WBC casts/HPF. Hansel's stain is positive for eosinophils. The
most likely diagnosis would be:
A. Diabetic nephropathy
B. IgA nephropathy
C. Acute interstitial nephritis
D. Acute pyelonephritis
E. Acute post-streptococcal glomerulonephritis
Show answer
Correct Answer: C
24. Analgesic nephropathy can be associated with all of the following except:
A. Small kidney size by renal ultrasound
B. Nephritic sediment with RBC casts
C. Increased risk of transitional cell carcinoma
D. Tubulointerstitial fibrosis on renal biopsy
E. Urinary tract obstruction due to papillary necrosis on IVP
Show answer
Correct Answer: B
25. Autosomal dominant polycystic kidney disease is associated with all of the
following except:
A. Hypertension is very common
B. Ultrasound is very useful in establishing the diagnosis
C. Renal failure progresses slowly
D. The majority of the patients (>80%) have cerebral aneurysms
E. Lipid soluble antibiotics should be used when the cysts become infected
Show answer
Correct Answer: D
D. Respiratory alkalosis
Show answer
Correct Answer: A
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: B
31. Which one of the following is clearly associated with autosomal recessive
polycystic kidney disease?
A. Very large cysts throughout the kidney parenchyma, including cortex and
medulla
B. Cerebral aneurysms
C. Gastrointestinal diverticulum
D. Congenital hepatic fibrosis
Show answer
Correct Answer: D
32. Which one of the following is true regarding urinary tract infections
(UTI) in children?
A. UTI are equally common in boys and girls.
B. UTI are more common in boys during the neonatal period .
C. UTI are always more common in girls throughout childhood.
D. UTI are almost never associated with vesicoureteral reflux in children.
Show answer
Correct Answer: B
Show answer
Correct Answer: B
34. Which one of the following regarding glomerular filtration rate (GFR) is
true:
A. Creatinine clearance is seldom used as a marker of GFR in clinical medicine
because it consistently under- estimates true GFR.
B. Two patients with identical serum creatinine concentration always have the
same GFR.
C. In advanced renal failure (GFR <15 ml/min), 24-hour urea clearance is
useful in conjunction with 24-hour creatinine clearance to estimate GFR.
D. For a given individual, an increase of serum creatinine from 8.0 mg/dl to
10.0 mg/dl represents a loss of greater number of nephrons than an increase of
serum creatinine from 1.0 mg/dl to 2.0 mg/dl.
E. Muscle mass is the predominant determinant of creatinine clearance.
Show answer
Correct Answer: C
35. A low blood urea nitrogen to serum creatinine ratio (<10:1) is seen in one
of the following conditions:
A. administration of corticosteroids for arthritis
B. catabolic state during trauma
C. advanced liver failure
D. high protein diet
E. volume depletion from gastrointestinal bleeding
Show answer
Correct Answer: C
36. Which of the following is most likely to be associated with high urinary
Show answer
Correct Answer: D
37. In a patient with oliguria, which ONE of the following favors the
diagnosis of acute tubular necrosis rather than pre-renal azotemia:
A. ratio of urine osmolality to plasma osmolality = 2.0
B. ratio of urine creatinine concentration to plasma creatinine concentration
> 50
C. fractional excretion of sodium (FENa) > 2%
D. urinary sodium concentration <5 mEq/L
Show answer
Correct Answer: C
38. A patient reports that he has noticed a decrease in urine output for five
days. His BUN is 100 mg/dl and his serum creatinine is 7 mg/dl. Which of the
following is LEAST useful in establishing the etiology of his renal failure:
A. urine sodium concentration
B. ultrasound of the kidneys
C. intravenous pyelogram
D. urinalysis
E. history and physical
Show answer
Correct Answer: C
39. Which of the following is NOT an indication for urgent dialysis for a
patient with renal failure:
A. asterixis and drowsiness
B. pulmonary edema resistant to diuretics
C. pericarditis
Show answer
Correct Answer: D
Show answer
Correct Answer: B
41. The most common cause of end stage renal disease in the U.S.A. is:
A. hereditary nephritis
B. sickle cell nephropathy
C. post-infectious glomerulonephritis
D. renal cell carcinoma
E. diabetic nephropathy
Show answer
Correct Answer: E
Show answer
Correct Answer: A
Show answer
Correct Answer: B
Show answer
Correct Answer: D
45. Based on the following data (BUN = 40 mg/dl, 24 urine volume = 2 liters,
serum creatinine = 2 mg/dL, urine creatinine = 40 mg/dL, serum sodium = 150
mEq/dL, urine sodium = 15 mEq/L) the fractional excretion of sodium (FENa) can
be calculated to be:
A. 0.2%
B. 0.5%
C. 5%
D. 20%
E. 50%
Show answer
Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: E
50. Regarding the management of diabetes mellitus, all of the following are
correct EXCEPT:
A. Dialysis therapy, in patients with diabetic nephropathy and ESRD is not
necessary until GFR is less than 5 ml/min.
B. Tight blood sugar control reduces the risk of developing diabetic
nephropathy.
C. In diabetic patients with proteinuria and declining renal function,
lowering the systemic blood pressure slows the rate of decline in renal
function.
D. In patients with microalbuminuria, using ACE inhibitors decreases urine
albumin excretion and rate progression to overt nephropathy.
E. Avoiding NSAIDs and radiocontrast media, and properly managing UTIs and
neurogenic bladder, are important measures to preserve the remaining renal
Show answer
Correct Answer: A
51. A 22-year- old man presents with the complaint of recurrent blood in his
urine. He states that it usually occurs when he gets "the flu". He has no
other complaints and he has been in good health otherwise. He is not taking
any medication and has no drug allergies. Physical examination including B.P.
is normal and he has no edema. Urinalysis reveals trace proteinuria, several
dysmorphic RBCs and few RBC casts. BUN is 12 mg/dl and serum creatinine 0.6
mg/dl. Which one of the following is the most likely diagnosis?
A. Nephrolithiasis
B. Minimal change disease
C. IgA nephropathy
D. Focal segmental glomerulosclerosis
Show answer
Correct Answer: C
52. A 7-year-old girl presents with leg edema. She has no other complaint and
has been healthy up until now. She is not taking any medication and has no
known allergies. Physical examination shows 3+ leg edema. The rest of the
physical examination including B.P. is normal. Urinalysis reveals 3+
proteinuria , no RBC, WBC or any casts. BUN and serum creatinine are normal.
Serum albumin is 1.5 mg/dl. 24-hour urine collection shows 6.0 gram protein.
Which one of the following statements about her disease is true?
A. Renal biopsy will most likely reveal extensive crescent formation in the
glomeruli.
B. This is the most common cause of nephrotic syndrome in children.
C. She has about 90% chance of developing end stage renal disease.
D. This disease is highly resistant to steroids.
Show answer
Correct Answer: B
glomerulonephritis is true?
A. It occurs simultaneously with the throat infection.
B. It is associated with low serum complement levels.
C. It commonly progresses to end stage renal disease.
D. Steroids are often needed to treat the disease.
Show answer
Correct Answer: B
Show answer
Correct Answer: B
55. All of the following about systemic lupus erythematosus are true except:
A. It is an immune complex vasculitis process that may cause
glomerulonephritis.
B. Women are more commonly affected than men.
C. The glomerular lesions span a spectrum from normal glomeruli to diffuse
necrotizing crescentic glomerulonephritis.
D. Plasmapheresis is the best form of therapy.
Show answer
Correct Answer: D
Show answer
Correct Answer: C
57. A middle aged woman has active stone disease for many years. Her stones
are radioopaque, small and occur bilaterally. She has seen a Urologist for
this problem who performed a metabolic work-up that showed normal urinary Ca
and oxalate excretion. She had been treated, unsuccessfully, with a thiazide
diuretic, low sodium diet and high fluid intake. A stone analysis revealed
that her stones consisted of Ca-oxalate and a small amount of uric acid. Which
of the following treatments will likely be effective in the prevention of
further stones?
A. a low Ca diet
B. Allopurinol, a xanthine oxidase inhibitor
C. vitamin C supplement to acidify the urine
D. a high protein diet
E. none of the above
Show answer
Correct Answer: B
Show answer
Correct Answer: B
59. Generalized edema can occur in the setting of high, normal, or low serum
sodium concentration.
A. True
B. False
Show answer
Correct Answer: A
60. Generalized edema can occur in the setting of high, normal, or low
intravascular volume.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: A
62. The quality of the effective arterial blood volume (EABV) does always
positively correlate with the size of the extracellular volume (ECV).
A. True
B. False
Show answer
Correct Answer: B
63. In order to slow the progression to end stage renal disease in patients
with diabetic nephropathy or glomerulonephritis, Calcium channel blockers are
superior to angiotensin converting enzyme inhibitors.
A. True
B. False
Show answer
Correct Answer: B
64. The original disease that caused end stage renal failure does not recur in
the transplanted kidney because patients are treated with immunosuppressants.
A. True
B. False
Show answer
Correct Answer: B
Show answer
Correct Answer: D
66. Which of the following is incorrect relative to the causes of high blood
pressure:
A. Renal parenchymal disease is the single most common cause of persistent
hypertension in the pre-adolescent population
B. Factors thought to raise BP include obesity, high salt intake, physical
inactivity and immoderate alcohol consumption
C. Renal artery stenosis, renal parenchymal disease, endocrine disorders,
pregnancy, and drugs, account for the majority of secondary hypertension
D. A cause for hypertension can be identified in close to 95% of hypertensive
adults, if diligently searched for
Show answer
Correct Answer: D
67. The routine work-up of a patient who is referred to you with established
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: B
D. Phosphate
Show answer
Correct Answer: D
71. A three month old infant born at full term weighs 5 kg and has a length of
50 cm. The serum creatinine is 1.0. Which statement is false?
A. This infant has normal renal function
B. Glomerulogenesis is complete
C. Tubular maturation is incomplete
D. This infant's glomerular filtration rate is approximately 22 mL/1.73 m2/min
Show answer
Correct Answer: A
Show answer
Correct Answer: D
73. Factors contributing to renal vein thrombosis include all of the following
EXCEPT:
A. Hemodilution
B. Decreased antithrombin Ill levels
C. Increased platelet activation
D. High molecular weight fibrinogen
Show answer
Correct Answer: A
Show answer
Correct Answer: E
75. The most likely diagnosis in a patient presenting with signs and symptoms
of small vessel vasculitis, antineutrophil cytoplasmic antibodies (ANCA) in
the blood and evidence of asthma and eosinophilia is which of the following:
A. Henoch-Schonlein purpura
B. Cryoglobulinemic vasculitis
C. Microscopic polyangiitis
D. Necrotizing granulomatosis (Wegener's)
E. Churg-Strauss syndrome
Show answer
Correct Answer: E
76. A 45 year old physician has a long history of recurrent kidney stones.
Because of his busy schedule as Chief of Medicine he has undergone 11
extracorporeal shock wave lithotripsy (ESWL) treatments to "get rid of the
stones". He states that he can handle his stone problem quite well in this
manner and that he has seen no reason to have a metabolic work-up. He noticed
in recent months, however, that he has to urinate quite often, especially at
night, that he has exertional dyspnea and that he is more fatigued than usual.
All of the following statements apply to his situation, EXCEPT
A. ESWL increases stone activity
B. repeated ESWL decreases stone activity
C. repeated ESWL can cause hypertension and 2?heart failure;
D. repeated ESWL can cause renal insufficiency;
E. despite a good response to ESWL, a metabolic evaluation is essential.
Show answer
Correct Answer: B
77. Which therapeutic measures correlate least with the prevention of Calcium
oxalate stones in patients with idiopathic hypercalciuria?
A. low calcium diet;
B. sustained alkalinization of the urine with bicarbonate;
C. a high sodium and animal protein diet, low water intake
D. large quantities of cranberry juice;
E. low sodium and normal protein intake, a high urine volume, thiazide
diuretic;
Show answer
Correct Answer: C
Show answer
Correct Answer: B
79. Which one of the following does not drive potassium into cells?
A. Insulin
B. Increased extracellular pH
C. Epinephrine
D. Glucagon
E. Aldosterone
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: A
82. An elderly woman develops a urinary tract infection, becomes confused, and
does not eat or drink for three days at her nursing home. She is found to have
a blood pressure of 70/50 mmHg (very low) and her serum Na is elevated to 150
meq/L (NL up to 145). Which one of the following intravenous fluids would you
recommend?
A. One-half normal saline
B. Normal saline
C. 5% dextrose and water
D. Hypertonic saline
E. One-quarter normal saline
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: D
85. A 23 year old sexually active woman presents with urinary frequency and
burning on micturition of 24 hours duration. Her urinalysis shows: Yellow,
hazy urine. pH 6. No glucose. Protein trace, blood trace. 20-50 WBC/HPF, 10-20
RBC/HPF. 0-1 squamous epithelial cells and no bacteria. You prescribe
trimethoprim/sulfamethoxazole tablets twice a day. The next day she feels much
better but her urine culture report reads: "Staphylococcus saprophyticus
100,000 cfu/ml." Which of the following statements is true?
A. The antibiotic treatment should be continued
B. The urine sample was contaminated and the results from it are unreliable.
C. The hematuria likely signifies the presence of a stone or tumor.
D. The Staphylococcus saprophyticus is likely a skin contaminant.
E. The urinalysis is a laboratory error.
Show answer
Correct Answer: A
86. A 58 year old woman presents with hematuria and left flank pain. Renal
ultrasound shows marked left hydronephrosis. Serum creatinine and CBC are
normal. Which of the following is the least relevant diagnostic aid?
A. Renal biopsy
B. Renal isotope scan
C. Palpation for inguinal lymph nodes
D. CAT scan of abdomen
E. Pelvic examination and IVP
Show answer
Correct Answer: A
87. A 26 year-old diabetic woman is seen in the ER for sore throat. Rapid
strep test is positive for streptococcal pharyngitis and she was started on
ampicillin 500 mg four times a day. Ten days later, she develops hematuria,
edema and hypertension. Laboratory studies show: serum creatinine 3.6 mg/dl,
WBC 8,700 with 66% PMN, 25% lymphs, 3% monos and 5% eosinophils; Urinalysis:
pH 6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30 RBC casts/LPF. Hansel's stain
is negative for eosinophils. The most likely diagnosis would be:
A. Diabetic nephropathy
B. IgA nephropathy
C. Acute interstitial nephritis
D. Acute pyelonephritis
E. Acute post-streptococcal glomerulonephritis
Show answer
Correct Answer: E
88. Interstitial nephritis can be associated with all of the following except:
A. Small kidney size by renal ultrasound
B. Nephritic sediment with RBC casts
C. Increased risk of transitional cell carcinoma
Show answer
Correct Answer: B
89. Autosomal dominant polycystic kidney disease is associated with all of the
following except:
A. Hypertension is very common
B. Ultrasound is very useful in establishing the diagnosis
C. Renal failure progresses slowly
D. The minority of the patients have cerebral aneurysms
E. Lipid insoluble (water soluble) antibiotics should be used when the cysts
become infected
Show answer
Correct Answer: E
90. A 10 month old boy presents with status epilepticus. His intoxicated
mother was unable to provide a history. The child quits seizing after being
treated with diazepam. Exam revealed an obtunded child with tachypnea but a NL
blood pressure. Screening labs showed Na 140 mEq/L, K 5.5 mEq/L, total CO2 6
mEq/L, Cl 104 mEq/L, BUN 15 mg/dl, creatinine 0.6 mg/dl, glucose 40 mg/dl, Ca
9.5 mg/dl, Mg 1.4 mg/dl, PO4 5 mg/dl, serum osmolality 350 mosm/L. The
arterial blood gas showed a pH of 7.0, PCO2 25 mmHg. The patient has a:
A. Metabolic acidosis with NL anion gap
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
E. Metabolic acidosis with increased anion gap
Show answer
Correct Answer: E
C. 20
D. None of the above
Show answer
Correct Answer: D
Show answer
Correct Answer: D
Show answer
Correct Answer: B
D. Contraction alkalosis
Show answer
Correct Answer: C
95. Which one of the following is clearly associated with autosomal recessive
polycystic kidney disease?
A. Very large cysts throughout the kidney parenchyma, including cortex and
medulla
B. Cerebral aneurysms
C. Gastrointestinal diverticulum
D. Congenital hepatic fibrosis
Show answer
Correct Answer: D
96. Which one of the following is true regarding urinary tract infections
(UTI) in the neonatal period?
A. UTI are equally common in boys and girls
B. UTI are more common in boys
C. UTI are always more common in girls
D. UTIs never occur in neonates
Show answer
Correct Answer: B
Show answer
Correct Answer: E
98. Which one of the following regarding glomerular filtration rate (GFR) is
true:
A. Creatinine clearance is seldom used as a marker of GFR in clinical medicine
because it consistently underestimates true GFR
B. Two patients with identical serum creatinine concentration always have the
same GFR
C. In advanced renal failure (GFR <15 mI/mm), 24-hour urea clearance is useful
in conjunction with 24-hour creatinine clearance to estimate GFR
D. For a given individual, an increase of serum creatinine from 8.0 mg/dl to
10.0 mg/dl represents a loss of greater number of nephrons than an increase of
serum creatinine from 1.0 mg/dl to 2.0 mg/dl
E. Muscle mass is the predominant determinant of creatinine clearance
Show answer
Correct Answer: C
99. A high blood urea nitrogen to serum creatinine ratio (> 20:1) is seen in
one of the following conditions:
A. administration of 2 L iv normal saline
B. anabolic state
C. advanced liver failure
D. low protein diet
E. severe congestive heart failure
Show answer
Correct Answer: E
100. Which of the following is most likely to be associated with very low
urinary sodium concentration (< 10 mEq/L):
A. high salt intake in a normal subject
B. severe congestive heart failure
C. furosemide (powerful diuretic) administration
D. acute tubular necrosis
Show answer
Correct Answer: B
101. In a patient with oliguria, which ONE of the following favors the
diagnosis of pre-renal azotemia rather than acute tubular necrosis:
A. ratio of urine osmolality to plasma osmolality = 2.0
B. ratio of urine creatinine concentration to plasma creatinine concentration
< 20
C. fractional excretion of sodium (FENa) < 1%
D. urinary sodium concentration of 40 mEq/L
Show answer
Correct Answer: C
102. A patient reports that he has noticed a decrease in urine output for 5
days. His BUN is 100 mg/dl and his serum creatinine is 7 mg/dl. Which of the
following is LEAST useful in establishing the etiology of his renal failure:
A. urine sodium concentration
B. ultrasound of the kidneys
C. abdominal x-ray (KUB)
D. urinalysis
E. history and physical
Show answer
Correct Answer: C
103. Which of the following is an indication for urgent dialysis for a patient
with renal failure:
A. tiredness
B. dyspnea on exertion
C. sinus tachycardia of 110/min
D. serum creatinine of 12 mg/dL
E. serum potassium of 8.0 mEq/L
Show answer
Correct Answer: E
renal failure with a serum creatinine of 2.0 mg/dl, which of the following is
false:
A. angiotensin converting enzyme inhibitors are absolutely contraindicated
because they are toxic to the kidneys in renal failure
B. dosage of medications often require adjustment
C. nonsteroidal anti-inflammatory agents (arthritis medications) should not be
used liberally because the chronically diseased kidneys are sensitive to the
toxic effects of these agents
D. superimposed urinary tract obstruction may further aggravate renal
insufficiency
E. sodium restriction is not always necessary
Show answer
Correct Answer: A
105. The most common cause of end stage renal disease in the adult (in the
U.S.A.) is
A. hereditary nephritis
B. chronic glomerulonephritis
C. post-infectious glomerulonephritis
D. chronic pyelonephritis
E. none of the above
Show answer
Correct Answer: E
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
109. Based on the following data, the fractional excretion of sodium (FENa)
can be calculated to be: BUN = 40 mg/dl, 24 urine volume = 2 liters, serum
creatinine = 2 mg/dL, urine creatinine = 40 mg/dL, serum sodium = 150 mEq/dL,
urine sodium = 15 mEq/L
A. 0.2%
B. 0.5%
C. 5%
D. 20%
Show answer
Correct Answer: B
Show answer
Correct Answer: A
Show answer
Correct Answer: E
Show answer
Correct Answer: A
Show answer
Correct Answer: B
114. Regarding the management of diabetes mellitus, all of the following are
correct EXCEPT:
A. Dialysis therapy, in patients with diabetic nephropathy and ESRD is
necessary once the GFR is less than 15 ml/min
B. Tight blood sugar control increases the risk of developing diabetic
nephropathy
C. In diabetic patients with proteinuria and declining renal function,
lowering the systemic blood pressure slows the rate of decline in renal
function
D. In patients with microalbuminuria, using ACE inhibitors decreases urine
albumin excretion and rate of progression to overt nephropathy
E. Avoiding NSAIDs and radiocontrast media, and properly managing UTIs and
neurogenic bladder, are important measures to preserve the remaining renal
function in patients with established diabetic nephropathy
Show answer
Correct Answer: B
115. A 22 year old man presents with the complaint of recurrent blood in his
urine. He states that it usually occurs when he gets "the flu". He has no
other complaints and he has been in good health otherwise. He is not taking
any medication and has no drug allergies. Physical examination including B.P.
Show answer
Correct Answer: E
116. A 7 year old girl presents with leg edema. She has no other complaint and
has been healthy up until now. She is not taking any medication and has no
known allergies. Physical examination shows 3+ leg edema. The rest of the
physical examination including B.P. is normal. Urinalysis reveals 3+
proteinuria , no RBC, WBC or any casts. BUN and serum creatinine are normal.
Serum albumin is 1.5 mg/dl. 24 hour urine collection shows 6.0 gram protein.
Which one of the following statements about her disease is true?
A. Renal biopsy will most likely reveal extensive crescent formation in the
glomeruli
B. This is the least common cause of nephrotic syndrome in children
C. She has about 90% chance of developing end stage renal disease
D. This disease is highly responsive to steroids
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: C
119. All of the following about systemic lupus erythematosus are true except:
A. It is an immune complex vasculitis process that may cause
glomerulonephritis
B. Men are more commonly affected than women
C. The glomerular lesions span a spectrum from normal glomeruli to diffuse
necrotizing crescentic glomerulonephritis
D. Plasmapheresis is rarely indicated
Show answer
Correct Answer: B
Show answer
Correct Answer: C
121. A middle aged woman has active stone disease for many years. Her stones
are radioopaque, small and occur bilaterally. She has seen a Urologist for
this problem who performed a metabolic work-up that showed normal urinary Ca
and oxalate excretion. She had been treated, unsuccessfully, with a thiazide
diuretic, low sodium diet and high fluid intake. A stone analysis revealed
that her stones consisted of Ca-oxalate and a small amount of uric acid. Which
of the following treatments will likely be effective in the prevention of
further stones?
A. a low Ca diet
B. Allopurinol, a xanthine oxidase inhibitor
C. vitamin C supplement to acidify the urine
D. a high protein diet
E. none of the above
Show answer
Correct Answer: B
122. Which one of the following statements about diuretic action is false?
A. Amiloride inhibits apical sodium channels in the cortical collecting tubule
B. Spironolactone inhibits K+ secretion
C. Thiazides inhibit Na+/Cl- entry into the distal tubule
D. Furosemide acts primarily in the proximal tubule
E. Acetazolamide inhibits proximal tubule Na+ reabsorption by reducing
carbonic anhydrase activity
Show answer
Correct Answer: D
Show answer
Correct Answer: B
124. Generalized edema can occur only in the setting of low serum sodium
concentration.
A. true
B. false
Show answer
Correct Answer: B
125. Generalized edema can occur only in the setting of high intravascular
volume.
A. true
B. false
Show answer
Correct Answer: B
Show answer
Correct Answer: B
127. The quality of the effective arterial blood volume (EABV) never
correlates with the size of the extracellular volume (ECV).
A. true
B. false
Show answer
Correct Answer: B
128. In order to slow the progression to end stage renal disease in patients
with diabetic nephropathy or glomerulonephritis Calcium channel blockers are
inferior to angiotensin converting enzyme inhibitors.
A. true
B. false
Show answer
Correct Answer: A
129. The original disease that caused end stage renal failure does not recur
in the transplanted kidney because patients are treated with
immunosuppressants.
A. true
B. false
Show answer
Correct Answer: B
130. A 79 y/o diabetic woman is brought to the emergency room from a nursing
home because of changes in mental status, obtundation and confusion that began
2-3 days earlier. The patient blood tests show the following: serum sodium
148 meq/L (NL ~ 140), serum potassium 5.7 meq/L (NL 3.5-5.5), BUN 152 mg/dL
(NL 10-20), blood sugar 70 mg/dL (NL 74-12. Which one of the following changes
in serum levels is the most likely explanation for this patient changes in
mental status?
A. hypernatremia
B. hyperkalemia
C. azotemia
D. hypoglycemia
Show answer
Correct Answer: C
131. A 68 y/o, obese woman with type 2 diabetes mellitus x 2 years has had a
significant weight loss, pain in several ribs and her lower back. She has
ankle edema and is found to have lytic bone lesions on x-ray, normal blood and
urinary albumin levels, elevated serum calcium and creatinine, and abnormal
results on serum and urine protein electrophoresis. What is the most likely
diagnosis?
A. minimal change disease
B. lupus nephritis
C. multiple myeloma
D. diabetic nephropathy
Show answer
Correct Answer: C
Show answer
Correct Answer: B
133. Which one of the following kidney stones can be dissolved and their
formation prevented by lowering the urinary pH?
A. uric acid stones
B. calcium-oxalate stones
C. "Struvite" (triple phosphate or infection stones)
D. Cysteine stones
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: B
136. A patient with diabetes mellitus develops nephrotic syndrome. Which one
of the following makes membranous nephropathy a less likely diagnosis?
A. RBCs in the urine
B. 24 hour protein excretion of 12 grams
C. fundoscopic evidence of retinopathy
D. family history of diabetes
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: B
139. Two weeks ago, a 27 year-old man was admitted to the hospital because of
progressive fever and weight loss. He had a normal kidney function with a
serum creatinine of 1.2 mg/dL but was found to have positive blood cultures
(4/4) for alpha-hemolytic streptococci and therapy with ceftriaxone was begun.
You are asked to evaluate this patient after two weeks of therapy because
serum creatinine has risen to 3.5 mg/dL. His general condition has improved
(Tmax 37.2 C) but a diffuse maculopapular rash has developed on the trunk.
Repeat blood cultures are negative. The following laboratory results were
obtained: Serum creatinine 3.5 mg/dL; Serum electrolytes (mEq/L): Na 137, K
5.6, Cl 95, bicarb 18; Serum complement C3 150 mg/dL (normal 100-233), CH50
150 units/mL (normal 110-190). Urinalysis showed protein 1+, glucose negative,
blood 3+, many RBCs, WBCs, and WBC casts.
Which of the following is the most likely cause of the elevation in serum
creatinine?
A. Ceftriaxone-associated acute tubular necrosis
B. Glomerulonephritis secondary to subacute bacterial endocarditis
C. Acute interstitial nephritis
D. Intratubular crystal deposition
E. Renal emboli
Show answer
Correct Answer: C
140. Which one of the following disorders is associated with renal papillary
necrosis and irregular-shaped small kidneys?
A. Analgesic nephropathy
B. Diabetic nephropathy
C. Medullary sponge kidney
D. Primary hyperparathyroidism
E. Membranoproliferative glomerulonephritis
Show answer
Correct Answer: A
141. All of the following are features of chronic urinary tract obstructions
except:
A. nocturia
B. hypokalemia
C. acidemia
D. hypertension
E. azotemia
Show answer
Correct Answer: B
142. 80 year old diabetic male had nocturia 1-2 times per night for the last 3
years, but for the last couple of weeks he has to get up 3-4 times per night
to urinate. He is now seen in the emergency room with newly diagnosed renal
failure (serum creatinine 4.8 mg/dl), edema, fever, lower abdominal pain,
hyperkalemia, and hypertension. He has 3+ peripheral edema, normal albumin and
liver enzymes. The most appropriate initial diagnostic test step is
A. fractional excretion of sodium
B. 24 hour collection for creatinine clearance
C. renal ultrasound
D. bladder catheter insertion
E. urinalysis and urine culture
Show answer
Correct Answer: D
143. A patient has the following arterial blood gas results: pH 7.2, [H+] 63
and pCO2 47 mm Hg. The calculated [HCO3-] is:
A. 9 mmol/L
B. 18
C. 24
D. 30
E. 36
Show answer
Correct Answer: B
144. A patient has the following arterial blood gas and venous chemistries: pH
7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-] 108 mmol/L, [K+]
6 mmol/L. The calculated anion gap is:
A. 12 mmol/L
B. 20
C. 24
D. 26
E. 32
Show answer
Correct Answer: C
Show answer
Correct Answer: D
14
yang
Join Date: 04 Aug 2004
Post Count: 58
Posted on: Fri, 08 Oct 2004, 19:08:36
Post subject:
146. What type of compensation is expected with respiratory acidosis?
A. Renal compensation results in an increase in [HCO3-] and an increase in pH.
B. Respiratory compensation results in a decrease in pCO2 and a decrease in
pH.
C. Respiratory compensation results in a decrease in pCO2 and an increase in
pH.
D. Renal compensation results in an increase in [HCO3-] and a decrease in pH.
E. Respiratory compensation results in a decrease in pCO2 and a decrease in
pH.
Show answer
Correct Answer: A
147. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
148. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
Show answer
Correct Answer: A
149. A patient has the following test results. Blood testing shows the
following: pH 7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-]
122 mmol/L, [K+] 3.0 mmol/L. The urine pH was 7.0 and the urine net charge was
positive. The urinalysis showed no glucose or ketones. Which diagnosis is most
plausible:
A. Proximal renal tubular acidosis.
B. Distal renal tubular acidosis
C. Type IV renal tubular acidosis
D. Diabetic ketoacidosis
E. Methanol ingestion
Show answer
Correct Answer: B
150. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 5 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
Show answer
Correct Answer: E
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: E
154. A 75 year old woman develops altered mental status and a serum sodium
concentration that is markedly elevated at 165 mEq/L. She had surgery for a
hip fracture several days ago and her serum sodium concentration was normal at
the time of admission for the surgery. She is making about 200 ml of urine a
day. Her GFR is 50% of normal. She is only taking narcotics for pain and SQ
heparin. A Dobhoff tube was placed earlier today to start feeding, but she has
not received anything through it as of yet. The most likely cause of her
hypernatremia is which one of the following?
A. Renal insufficiency induced nephrogenic diabetes insipidus
B. Central diabetes insipidus due to her hip surgery
C. Administration of intravenous normal saline without administration of any
free water
D. Physical inability to reach water coupled with altered thirst due to pain
medications
E. Hyperaldosteronism
Show answer
Correct Answer: D
155. Which one of the following statements is true about edema formation?
A. It can only occur when effective arterial blood volume is reduced.
B. It can only occur in the setting of elevated circulating aldosterone and
vasopressin levels.
C. Increased vascular permeability to proteins is a common factor in most
cases of edema formation.
D. Effective arterial blood volume can not be reduced in the setting of high
actual blood volume.
E. Enhanced proximal and distal nephron sodium and water reabsorption is a
common feature of edema formation in the setting of reduced effective arterial
blood volume.
Show answer
Correct Answer: E
156. A patient is seen with marked edema and a 24 hr urine protein excretion
of 12 grams. The serum albumin concentration is modestly reduced and the blood
pressure is 180/120. GFR is 90% of normal. The edema formation in this patient
is most likely due to which one of the following?
A. Reduced GFR
B. Hepatic dysfunction
C. Peripheral vasodilation
D. An intrinsic renal defect in sodium and water excretion
E. Poor cardiac output
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: C
159. A 50 year old male with a 20 year history of diabetes is referred to you
for evaluation of serum creatinine of 4.0 mg/dl. He was seen by an
ophthalmologist last month and was told that his eyes were "clean" on
fundoscopic examination. Two months ago his serum creatinine was 1.0 mg/dl. On
examination his BP was 160/100 mm Hg. Fundus showed no evidence of diabetic
retinopathy. Urine analysis showed 2+ blood and 3+ protein on dipstick. Urine
microscopy showed dysmorphic RBCs. Which of the following statements is true?
A. The most likely diagnosis is diabetic nephropathy
Show answer
Correct Answer: B
Show answer
Correct Answer: B
161. A 70 year old male was admitted to the hospital for osteomyelitis. On
admission, his serum creatinine was 0.8 mg/dl. He was started on Clindamycin
and gentamicin iv and ibuprofen 600 qid for pain. He underwent surgical
debridement on day 2 of hospitalization. Seven days later his serum creatinine
was 3.0 mg/dl. Dipstick was negative for blood and protein. His urine
microscopy showed muddy brown casts and 1-3 RBCs and WBC per hpf. The most
likely diagnosis is
A. Postinfectious glomerulonephritis
B. Acute interstitial nephritis
C. Acute tubular necrosis
D. Dehydration
E. Multiple myeloma
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: B
164. Which of the following does NOT fall into the pre-renal causes of acute
renal failure?
A. Congestive heart failure
B. Sequestration of fluid in "third space" following extensive burn injury
C. Acute renal vasoconstriction from nonsteroidal anti-inflammatory drugs
D. Aminoglycoside nephrotoxicity
E. Acute gastrointestinal hemorrhage
Show answer
Correct Answer: D
165. Which of the following is TRUE regarding acute tubular necrosis (ATN)?
A. Large volume fluid resuscitation is helpful in all phases of ATN in
improving renal function
B. The duration of the oliguric maintenance phase of ATN can last as short as
24 hours and as long as 24 days; recovery in renal function is still possible
under these circumstances
C. Oliguria (less than 500 ml of urine per day) is a prerequisite for ATN
D. Transient polyuria (> 6 liters of urine per day) is a consistent feature
during the recovery from ATN
E. After an episode of ATN, the patient always recovers his/her renal function
completely
Show answer
Correct Answer: B
Show answer
Correct Answer: E
Show answer
Correct Answer: B
168. Which of the following does NOT mediate or exacerbate chronic renal
failure?
A. Matrix degradation in the glomeruli
B. Long term uncontrolled hypertension
C. Chronic usage of nonsteroidal anti-inflammatory agents
D. Loss of the majority of the nephron mass
E. Overactivity of angiotensin II locally in the glomeruli
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: C
173. Which one of the following is FALSE regarding the fractional excretion of
sodium (FENa)?
A. It provides a better indication of the avidity of the renal tubules to
reabsorb sodium than urinary sodium concentration alone
B. Its calculation requires the collection of a 24-hr urine sample
C. Its calculation requires a serum creatinine value
D. Its calculation requires a serum sodium value
E. It is often used clinically to aid in the diagnosis of pre-renal azotemia
Show answer
Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: A
Show answer
Correct Answer: E
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: A
Show answer
Correct Answer: A
Show answer
Correct Answer: B
184. T F The urine of a 32 y/o man with known cystinuria contains diagnostic
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: A
188. T F Nephrotic syndrome is a risk factor for the development of end stage
renal disease in patients with glomerulonephritis.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: B
190. A worried 20 year old woman comes to your office. Her mother and aunt
both developed renal failure at age 35-40, and her grandfather had idney
trouble?and died suddenly at age 40 after several years of severe headaches.
She wishes to become pregnant. Her exam and labs are entirely normal. A renal
ultrasound shows numerous bilateral cysts. You should:
A. Advise her that she has a recessive disease; if her husband has no cysts,
there is little chance that their children will have renal cysts
B. Advise her that her children have a 50% chance of having cysts, and that
the course is benign and poses no significant risk to her health
C. Begin testing for renal transplantation
D. Send her for a magnetic resonance angiogram (MRA) of the head
E. Perform a renal biopsy
Show answer
Correct Answer: D
D. 25 year old woman with alopecia, arthralgias, malar rash, and renal failure
Show answer
Correct Answer: C
192. A 40 year old man with arthritis has been using ibuprofen (nonsteroidal
anti-inflammatory) every 6 hours. He developed renal failure associated with
nephrotic range proteinuria. What is the most likely glomerular lesion in this
patient?
A. Membranoproliferative glomerulonephritis
B. Minimal change disease
C. IgA nephropathy
D. Diabetic nephropathy
E. Focal segmental glomerulosclerosis
Show answer
Correct Answer: B
193. A 62 y/o female patient with recurrent urinary infections and large,
bilateral "stag horn" calculi on KUB is likely to demonstrate what kind of
renal calculi
A. Calcium oxalate stones
B. Struvite (triple phosphate stones)
C. Calcium phosphate stones
D. Uric acid stones
Show answer
Correct Answer: B
Show answer
Correct Answer: B
195. The metabolic work-up of a 35 y/o male patient with very active kidney
stone disease demonstrates that he has calcium oxalate stones due to
idiopathic hypercalciuria. A marked reduction of dietary calcium intake is the
most effective form of preventive therapy.
A. True
B. False
Show answer
Correct Answer: B
196. A 47-year-old man who has had passed renal calculi on three occasions
over the previous six years presents with nocturia for four months, followed
by increasing lethargy. Laboratory results show sodium 134 mEq per liter,
potassium 5.6 mEq per liter, chloride 112 mEq per liter, bicarbonate 12 mEq
per liter. BUN 48 mg/dl and creatinine 4.0 mg/dl.
The most likely diagnosis is:
A. Obstructive uropathy.
B. Focal segmental glomerulosclerosis.
C. Chronic pyelonephritis.
D. Reflux nephropathy.
E. Polycystic kidney disease.
Show answer
Correct Answer: A
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
203. You discover hexagonal crystals and red blood cells in your patient
urine. The most likely diagnosis is:
A. Urinary infection with struvite calculi.
B. Cystinuria.
C. Hyperoxaluria.
D. Gout with hyperuricosuria.
E. Calcium oxalate nephrolithiasis.
Show answer
Correct Answer: B
204. A patient has the following arterial blood gas results: pH 7.25, [H+] 56
nM and pCO2 47 mm Hg. The calculated [HCO3-] is:
A. 9 mmol/L
B. 18
C. 20
D. 27
E. 36
Show answer
Correct Answer: C
205. A patient has the following arterial blood gas and venous chemistries: pH
7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 142 mmol/L, [Cl-] 108 mmol/L, [K+]
6 mmol/L. The calculated anion gap is:
A. 12 mmol/L
B. 20
C. 24
D. 26
E. 32
Show answer
Correct Answer: D
Show answer
Correct Answer: D
Show answer
Correct Answer: A
208. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder.
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
209. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
[HCO3-] 34 mmol/L. The patient has what disorder:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: A
210. A patient has the following test results. Blood pH 7.2, pCO2 20 mm Hg,
[HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-] 122 mmol/L, [K+] 3.0 mmol/L. The
serum phosphorous was 1.6 mg/dl (low) and the tubular reabsorption of
phosphorous was 60% (low). The urine pH was 6.0. The urinalysis showed trace
glucose but no ketones. Which diagnosis is most plausible:
A. Proximal renal tubular acidosis with renal Fanconi syndrome.
B. Distal renal tubular acidosis
C. Type IV renal tubular acidosis
D. Diabetic ketoacidosis
E. Methanol ingestion
Show answer
Correct Answer: A
211. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 2 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
Show answer
Correct Answer: E
212. Which disease rarely, if ever, progresses to end stage renal disease?
A. minimal change disease
B. focal and segmental glomerulosclerosis
C. anti-glomerular basement membrane antibody glomerulonephritis
D. IgA Nephropathy
E. membranous nephropathy
Show answer
Correct Answer: A
Show answer
Correct Answer: C
214. A patient with diabetes mellitus develops nephrotic syndrome. Which one
of the following makes diabetic nephropathy the most likely diagnosis?
A. RBCs in the urine
B. 24 hour protein excretion of 12 grams
C. fundoscopic evidence of retinopathy
D. family history of diabetes
Show answer
Correct Answer: C
215. Which drug is the least likely to reduce proteinuria in a patient with
nephrotic syndrome?
A. high dose prednisone
B. ACE inhibitor
C. calcium channel blocker
D. angiotensin receptor blocker
E. cyclosporine
Show answer
Correct Answer: C
Show answer
Correct Answer: A
217. Patients with nephrotic syndrome are at increased risk for developing
coronary artery disease.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: B
Show answer
Correct Answer: B
sodium concentration of 105 mEq/L should be treated with 1/2 normal saline to
raise the plasma sodium concentration gradually.
C. A patient with markedly altered mental status thought due to a plasma
sodium concentration of 105 mEq/L should have the plasma sodium concentration
corrected to normal levels over the next 24 hours.
D. An asymptomatic patient with a plasma sodium concentration of 110 mEq/L
does not need emergent treatment and can be treated with water restriction.
E. A patient with markedly altered mental status and a plasma sodium
concentration of 165 mEq/L should be treated with IV D5W with the goal being
to normalize the plasma concentration over the next 12 hours.
Show answer
Correct Answer: D
Show answer
Correct Answer: B
222. Which one of the following is FALSE with regards to diabetes insipidus?
A. Urine volume is typically large
B. Drugs are a common cause of nephrogenic diabetes insipidus
C. Central diabetes insipidus is commonly caused by trauma, surgery, or is
idiopathic
D. Plasma ADH concentration can be high in patients with nephrogenic diabetes
insipidus
E. Water restriction as a diagnostic maneuver generally can not distinguish
between central and nephrogenic DI
Show answer
Correct Answer: E
223. Which one of the following statements is correct with regards to the
physiology of renal water handling?
A. ADH release by the pituitary is primarily regulated by plasma osmolality
with relatively little contribution by plasma volume.
B. In order to make adequately concentrated urine it is not necessary to have
normal sodium reabsorption by the thick ascending limb.
C. In order to make adequate dilute urine the collecting duct must remain
impermeable to water.
D. ADH can increase urine osmolality by about 50-fold.
E. The thick ascending limb of Henle loop is permeable to water.
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
Show answer
Correct Answer: B
228. A 40 year old male has diabetes for the past ten years. His blood
pressure is consistently about 140/90 mm Hg. He has 700 mg of protein on a 24
hour urine collection. You want to start him on antihypertensive therapy.
Which of the following would be the best choice in this situation?
A. Beta blocker
B. Calcium channel blocker
C. Thiazide diuretic
D. ACE inhibitors
Show answer
Correct Answer: D
229. Which of the following is not a risk factor for PRIMARY hypertension?
A. African American race
B. High salt intake
C. Renal artery stenosis
D. Obesity
Show answer
Correct Answer: C
230. You are treating a 55 year old obese man for his hypertension who is
tired most of the day. The most likely secondary cause for his hypertension
is:
A. Sleep apnea
B. Cushing syndrome
C. Pheochromocytoma
D. Renal disease
Show answer
Correct Answer: A
231. A low blood urea nitrogen to serum creatinine ratio (<10:1) is most
likely seen in which of the following conditions:
A. catabolic state resulting from sepsis
B. prerenal azotemia
C. high protein diet
D. rhabdomyolysis (muscle breakdown) from ischemia
Show answer
Correct Answer: D
232. For a given individual, an increase of serum creatinine from 5.0 mg/dl to
10.0 mg/dl represents a loss of fewer nephrons than an increase of serum
creatinine from 1.0 mg/dl to 2.0 mg/dl.
A. true
B. false
Show answer
Correct Answer: A
233. Which of the following is most likely to be associated with high urinary
sodium concentration (>20 mEq/L):
A. low salt diet in a normal subject
B. severe congestive heart failure
C. diuretic treatment for edema associated with chronic renal failure
D. renal vasoconstriction from non-steroidal anti-inflammatory agents
Show answer
Correct Answer: C
Show answer
Correct Answer: B
235. Which one of the following is not a recognized mechanism of acute renal
failure:
A. decreased renal blood flow as a result of tubulo-glomerular feedback
B. tubular obstruction from casts
C. back-leak of solutes as a result of tubular epithelial cell damage
D. mesangial cell relaxation
Show answer
Correct Answer: D
236. In a patient with oliguria, which one of the following is most consistent
with acute tubular necrosis rather than pre-renal azotemia:
A. urinary sodium concentration = 3 mEq/L
B. ratio of urine osmolality to plasma osmolality = 1.0
C. ratio of urine creatinine concentration to plasma creatinine concentration
= 80
D. fractional excretion of sodium (FENa) = 0.2%
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: C
240. The most common cause of end stage renal disease in the U.S. is:
A. post-infectious glomerulonephritis
B. polycystic kidney disease
C. toxic nephropathy from antibiotics
D. sports injury of kidneys
E. diabetic nephropathy
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: B
145. What type of compensation is expected with metabolic acidosis?
A. Renal compensation results in an increase in [HCO3-] and a decrease in pH.
B. Respiratory compensation results in an increase in pCO2 and a decrease in
pH.
C. Renal compensation results in a decrease in [HCO3-] and a decrease in pH.
D. Respiratory compensation results in a decrease in pCO2 and an increase in
pH.
E. Respiratory compensation results in an increase in pCO2 and an increase in
pH.
Show answer
Correct Answer: D
Show answer
Correct Answer: A
147. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
148. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
[HCO3-] 34 mmol/L. The patient has what disorder:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: A
149. A patient has the following test results. Blood testing shows the
following: pH 7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-]
122 mmol/L, [K+] 3.0 mmol/L. The urine pH was 7.0 and the urine net charge was
positive. The urinalysis showed no glucose or ketones. Which diagnosis is most
plausible:
A. Proximal renal tubular acidosis.
B. Distal renal tubular acidosis
C. Type IV renal tubular acidosis
D. Diabetic ketoacidosis
E. Methanol ingestion
Show answer
Correct Answer: B
150. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 5 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
Show answer
Correct Answer: E
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: E
154. A 75 year old woman develops altered mental status and a serum sodium
concentration that is markedly elevated at 165 mEq/L. She had surgery for a
hip fracture several days ago and her serum sodium concentration was normal at
the time of admission for the surgery. She is making about 200 ml of urine a
day. Her GFR is 50% of normal. She is only taking narcotics for pain and SQ
heparin. A Dobhoff tube was placed earlier today to start feeding, but she has
not received anything through it as of yet. The most likely cause of her
hypernatremia is which one of the following?
A. Renal insufficiency induced nephrogenic diabetes insipidus
B. Central diabetes insipidus due to her hip surgery
C. Administration of intravenous normal saline without administration of any
free water
D. Physical inability to reach water coupled with altered thirst due to pain
medications
E. Hyperaldosteronism
Show answer
Correct Answer: D
155. Which one of the following statements is true about edema formation?
A. It can only occur when effective arterial blood volume is reduced.
B. It can only occur in the setting of elevated circulating aldosterone and
vasopressin levels.
C. Increased vascular permeability to proteins is a common factor in most
cases of edema formation.
D. Effective arterial blood volume can not be reduced in the setting of high
actual blood volume.
E. Enhanced proximal and distal nephron sodium and water reabsorption is a
common feature of edema formation in the setting of reduced effective arterial
blood volume.
Show answer
Correct Answer: E
156. A patient is seen with marked edema and a 24 hr urine protein excretion
of 12 grams. The serum albumin concentration is modestly reduced and the blood
pressure is 180/120. GFR is 90% of normal. The edema formation in this patient
is most likely due to which one of the following?
A. Reduced GFR
B. Hepatic dysfunction
C. Peripheral vasodilation
D. An intrinsic renal defect in sodium and water excretion
E. Poor cardiac output
Show answer
Correct Answer: D
Show answer
Correct Answer: B
following factors?
A. Hypokalemia
B. Triamterene or amiloride
C. Increased tubule fluid flow rate
D. Spironolactone
E. Acidemia
Show answer
Correct Answer: C
159. A 50 year old male with a 20 year history of diabetes is referred to you
for evaluation of serum creatinine of 4.0 mg/dl. He was seen by an
ophthalmologist last month and was told that his eyes were "clean" on
fundoscopic examination. Two months ago his serum creatinine was 1.0 mg/dl. On
examination his BP was 160/100 mm Hg. Fundus showed no evidence of diabetic
retinopathy. Urine analysis showed 2+ blood and 3+ protein on dipstick. Urine
microscopy showed dysmorphic RBCs. Which of the following statements is true?
A. The most likely diagnosis is diabetic nephropathy
B. This patient requires urgent kidney biopsy
C. The rate of raise in serum creatinine seen in this patient is typical of
diabetic nephropathy
D. here is no correlation between the presence of diabetic retinopathy and
nephropathy
E. Nephrotic range proteinuria is never seen in diabetes.
Show answer
Correct Answer: B
Show answer
Correct Answer: B
161. A 70 year old male was admitted to the hospital for osteomyelitis. On
admission, his serum creatinine was 0.8 mg/dl. He was started on Clindamycin
and gentamicin iv and ibuprofen 600 qid for pain. He underwent surgical
debridement on day 2 of hospitalization. Seven days later his serum creatinine
was 3.0 mg/dl. Dipstick was negative for blood and protein. His urine
microscopy showed muddy brown casts and 1-3 RBCs and WBC per hpf. The most
likely diagnosis is
A. Postinfectious glomerulonephritis
B. Acute interstitial nephritis
C. Acute tubular necrosis
D. Dehydration
E. Multiple myeloma
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: B
164. Which of the following does NOT fall into the pre-renal causes of acute
renal failure?
Show answer
Correct Answer: D
165. Which of the following is TRUE regarding acute tubular necrosis (ATN)?
A. Large volume fluid resuscitation is helpful in all phases of ATN in
improving renal function
B. The duration of the oliguric maintenance phase of ATN can last as short as
24 hours and as long as 24 days; recovery in renal function is still possible
under these circumstances
C. Oliguria (less than 500 ml of urine per day) is a prerequisite for ATN
D. Transient polyuria (> 6 liters of urine per day) is a consistent feature
during the recovery from ATN
E. After an episode of ATN, the patient always recovers his/her renal function
completely
Show answer
Correct Answer: B
Show answer
Correct Answer: E
Show answer
Correct Answer: B
168. Which of the following does NOT mediate or exacerbate chronic renal
failure?
A. Matrix degradation in the glomeruli
B. Long term uncontrolled hypertension
C. Chronic usage of nonsteroidal anti-inflammatory agents
D. Loss of the majority of the nephron mass
E. Overactivity of angiotensin II locally in the glomeruli
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: C
173. Which one of the following is FALSE regarding the fractional excretion of
sodium (FENa)?
A. It provides a better indication of the avidity of the renal tubules to
reabsorb sodium than urinary sodium concentration alone
B. Its calculation requires the collection of a 24-hr urine sample
Show answer
Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: A
Show answer
Correct Answer: E
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: A
Show answer
Correct Answer: A
Show answer
Correct Answer: B
184. T F The urine of a 32 y/o man with known cystinuria contains diagnostic
coffin lid-shaped crystals.
A. True
B. False
Show answer
Correct Answer: B
Show answer
Correct Answer: B
B. False
Show answer
Correct Answer: B
Show answer
Correct Answer: A
188. T F Nephrotic syndrome is a risk factor for the development of end stage
renal disease in patients with glomerulonephritis.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: B
190. A worried 20 year old woman comes to your office. Her mother and aunt
both developed renal failure at age 35-40, and her grandfather had idney
trouble?and died suddenly at age 40 after several years of severe headaches.
She wishes to become pregnant. Her exam and labs are entirely normal. A renal
Show answer
Correct Answer: D
Show answer
Correct Answer: C
192. A 40 year old man with arthritis has been using ibuprofen (nonsteroidal
anti-inflammatory) every 6 hours. He developed renal failure associated with
nephrotic range proteinuria. What is the most likely glomerular lesion in this
patient?
A. Membranoproliferative glomerulonephritis
B. Minimal change disease
C. IgA nephropathy
D. Diabetic nephropathy
E. Focal segmental glomerulosclerosis
Show answer
Correct Answer: B
193. A 62 y/o female patient with recurrent urinary infections and large,
bilateral "stag horn" calculi on KUB is likely to demonstrate what kind of
renal calculi
A. Calcium oxalate stones
B. Struvite (triple phosphate stones)
C. Calcium phosphate stones
D. Uric acid stones
Show answer
Correct Answer: B
Show answer
Correct Answer: B
195. The metabolic work-up of a 35 y/o male patient with very active kidney
stone disease demonstrates that he has calcium oxalate stones due to
idiopathic hypercalciuria. A marked reduction of dietary calcium intake is the
most effective form of preventive therapy.
A. True
B. False
Show answer
Correct Answer: B
196. A 47-year-old man who has had passed renal calculi on three occasions
over the previous six years presents with nocturia for four months, followed
by increasing lethargy. Laboratory results show sodium 134 mEq per liter,
potassium 5.6 mEq per liter, chloride 112 mEq per liter, bicarbonate 12 mEq
per liter. BUN 48 mg/dl and creatinine 4.0 mg/dl.
The most likely diagnosis is:
A. Obstructive uropathy.
Show answer
Correct Answer: A
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
203. You discover hexagonal crystals and red blood cells in your patient
urine. The most likely diagnosis is:
A. Urinary infection with struvite calculi.
B. Cystinuria.
C. Hyperoxaluria.
D. Gout with hyperuricosuria.
E. Calcium oxalate nephrolithiasis.
Show answer
Correct Answer: B
204. A patient has the following arterial blood gas results: pH 7.25, [H+] 56
nM and pCO2 47 mm Hg. The calculated [HCO3-] is:
A. 9 mmol/L
B. 18
C. 20
D. 27
E. 36
Show answer
Correct Answer: C
205. A patient has the following arterial blood gas and venous chemistries: pH
7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 142 mmol/L, [Cl-] 108 mmol/L, [K+]
6 mmol/L. The calculated anion gap is:
A. 12 mmol/L
B. 20
C. 24
D. 26
E. 32
Show answer
Correct Answer: D
Show answer
Correct Answer: D
Show answer
Correct Answer: A
208. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder.
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
209. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
[HCO3-] 34 mmol/L. The patient has what disorder:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: A
210. A patient has the following test results. Blood pH 7.2, pCO2 20 mm Hg,
[HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-] 122 mmol/L, [K+] 3.0 mmol/L. The
serum phosphorous was 1.6 mg/dl (low) and the tubular reabsorption of
phosphorous was 60% (low). The urine pH was 6.0. The urinalysis showed trace
glucose but no ketones. Which diagnosis is most plausible:
A. Proximal renal tubular acidosis with renal Fanconi syndrome.
B. Distal renal tubular acidosis
C. Type IV renal tubular acidosis
D. Diabetic ketoacidosis
E. Methanol ingestion
Show answer
Correct Answer: A
211. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 2 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
Show answer
Correct Answer: E
212. Which disease rarely, if ever, progresses to end stage renal disease?
A. minimal change disease
B. focal and segmental glomerulosclerosis
C. anti-glomerular basement membrane antibody glomerulonephritis
D. IgA Nephropathy
E. membranous nephropathy
Show answer
Correct Answer: A
Show answer
Correct Answer: C
214. A patient with diabetes mellitus develops nephrotic syndrome. Which one
of the following makes diabetic nephropathy the most likely diagnosis?
A. RBCs in the urine
B. 24 hour protein excretion of 12 grams
C. fundoscopic evidence of retinopathy
D. family history of diabetes
Show answer
Correct Answer: C
215. Which drug is the least likely to reduce proteinuria in a patient with
nephrotic syndrome?
A. high dose prednisone
B. ACE inhibitor
C. calcium channel blocker
D. angiotensin receptor blocker
E. cyclosporine
Show answer
Correct Answer: C
Show answer
Correct Answer: A
217. Patients with nephrotic syndrome are at increased risk for developing
coronary artery disease.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: B
222. Which one of the following is FALSE with regards to diabetes insipidus?
A. Urine volume is typically large
B. Drugs are a common cause of nephrogenic diabetes insipidus
C. Central diabetes insipidus is commonly caused by trauma, surgery, or is
idiopathic
D. Plasma ADH concentration can be high in patients with nephrogenic diabetes
insipidus
E. Water restriction as a diagnostic maneuver generally can not distinguish
between central and nephrogenic DI
Show answer
Correct Answer: E
223. Which one of the following statements is correct with regards to the
physiology of renal water handling?
A. ADH release by the pituitary is primarily regulated by plasma osmolality
with relatively little contribution by plasma volume.
B. In order to make adequately concentrated urine it is not necessary to have
normal sodium reabsorption by the thick ascending limb.
C. In order to make adequate dilute urine the collecting duct must remain
impermeable to water.
D. ADH can increase urine osmolality by about 50-fold.
E. The thick ascending limb of Henle loop is permeable to water.
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
volume.
C. Increased proximal tubule salt and water reabsorption contributes to edema
formation
D. Enhanced distal nephron salt and water reabsorption contributes to edema
formation.
E. Renal blood flow is often reduced in edema-forming states.
Show answer
Correct Answer: B
228. A 40 year old male has diabetes for the past ten years. His blood
pressure is consistently about 140/90 mm Hg. He has 700 mg of protein on a 24
hour urine collection. You want to start him on antihypertensive therapy.
Which of the following would be the best choice in this situation?
A. Beta blocker
B. Calcium channel blocker
C. Thiazide diuretic
D. ACE inhibitors
Show answer
Correct Answer: D
229. Which of the following is not a risk factor for PRIMARY hypertension?
A. African American race
B. High salt intake
C. Renal artery stenosis
D. Obesity
Show answer
Correct Answer: C
230. You are treating a 55 year old obese man for his hypertension who is
tired most of the day. The most likely secondary cause for his hypertension
is:
A. Sleep apnea
B. Cushing syndrome
C. Pheochromocytoma
D. Renal disease
Show answer
Correct Answer: A
231. A low blood urea nitrogen to serum creatinine ratio (<10:1) is most
likely seen in which of the following conditions:
A. catabolic state resulting from sepsis
B. prerenal azotemia
C. high protein diet
D. rhabdomyolysis (muscle breakdown) from ischemia
Show answer
Correct Answer: D
232. For a given individual, an increase of serum creatinine from 5.0 mg/dl to
10.0 mg/dl represents a loss of fewer nephrons than an increase of serum
creatinine from 1.0 mg/dl to 2.0 mg/dl.
A. true
B. false
Show answer
Correct Answer: A
233. Which of the following is most likely to be associated with high urinary
sodium concentration (>20 mEq/L):
A. low salt diet in a normal subject
B. severe congestive heart failure
C. diuretic treatment for edema associated with chronic renal failure
D. renal vasoconstriction from non-steroidal anti-inflammatory agents
Show answer
Correct Answer: C
Show answer
Correct Answer: B
235. Which one of the following is not a recognized mechanism of acute renal
failure:
A. decreased renal blood flow as a result of tubulo-glomerular feedback
B. tubular obstruction from casts
C. back-leak of solutes as a result of tubular epithelial cell damage
D. mesangial cell relaxation
Show answer
Correct Answer: D
236. In a patient with oliguria, which one of the following is most consistent
with acute tubular necrosis rather than pre-renal azotemia:
A. urinary sodium concentration = 3 mEq/L
B. ratio of urine osmolality to plasma osmolality = 1.0
C. ratio of urine creatinine concentration to plasma creatinine concentration
= 80
D. fractional excretion of sodium (FENa) = 0.2%
Show answer
Correct Answer: B
C. renal ultrasound
D. intravenous pyelogram
E. renal angiogram with contrast
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: C
240. The most common cause of end stage renal disease in the U.S. is:
A. post-infectious glomerulonephritis
B. polycystic kidney disease
C. toxic nephropathy from antibiotics
D. sports injury of kidneys
E. diabetic nephropathy
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: B
145. What type of compensation is expected with metabolic acidosis?
A. Renal compensation results in an increase in [HCO3-] and a decrease in pH.
B. Respiratory compensation results in an increase in pCO2 and a decrease in
pH.
C. Renal compensation results in a decrease in [HCO3-] and a decrease in pH.
D. Respiratory compensation results in a decrease in pCO2 and an increase in
pH.
E. Respiratory compensation results in an increase in pCO2 and an increase in
pH.
Show answer
Correct Answer: D
Show answer
Correct Answer: A
147. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
148. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
[HCO3-] 34 mmol/L. The patient has what disorder:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: A
149. A patient has the following test results. Blood testing shows the
following: pH 7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-]
122 mmol/L, [K+] 3.0 mmol/L. The urine pH was 7.0 and the urine net charge was
positive. The urinalysis showed no glucose or ketones. Which diagnosis is most
plausible:
A. Proximal renal tubular acidosis.
B. Distal renal tubular acidosis
C. Type IV renal tubular acidosis
D. Diabetic ketoacidosis
E. Methanol ingestion
Show answer
Correct Answer: B
150. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 5 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
Show answer
Correct Answer: E
B. Hypotonic saline
C. Hypertonic saline
D. 5% dextrose in water
E. water
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: E
154. A 75 year old woman develops altered mental status and a serum sodium
concentration that is markedly elevated at 165 mEq/L. She had surgery for a
hip fracture several days ago and her serum sodium concentration was normal at
the time of admission for the surgery. She is making about 200 ml of urine a
day. Her GFR is 50% of normal. She is only taking narcotics for pain and SQ
heparin. A Dobhoff tube was placed earlier today to start feeding, but she has
not received anything through it as of yet. The most likely cause of her
hypernatremia is which one of the following?
A. Renal insufficiency induced nephrogenic diabetes insipidus
B. Central diabetes insipidus due to her hip surgery
C. Administration of intravenous normal saline without administration of any
free water
D. Physical inability to reach water coupled with altered thirst due to pain
medications
E. Hyperaldosteronism
Show answer
Correct Answer: D
155. Which one of the following statements is true about edema formation?
A. It can only occur when effective arterial blood volume is reduced.
B. It can only occur in the setting of elevated circulating aldosterone and
vasopressin levels.
C. Increased vascular permeability to proteins is a common factor in most
cases of edema formation.
D. Effective arterial blood volume can not be reduced in the setting of high
actual blood volume.
E. Enhanced proximal and distal nephron sodium and water reabsorption is a
common feature of edema formation in the setting of reduced effective arterial
blood volume.
Show answer
Correct Answer: E
156. A patient is seen with marked edema and a 24 hr urine protein excretion
of 12 grams. The serum albumin concentration is modestly reduced and the blood
pressure is 180/120. GFR is 90% of normal. The edema formation in this patient
is most likely due to which one of the following?
A. Reduced GFR
B. Hepatic dysfunction
C. Peripheral vasodilation
D. An intrinsic renal defect in sodium and water excretion
E. Poor cardiac output
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: C
159. A 50 year old male with a 20 year history of diabetes is referred to you
for evaluation of serum creatinine of 4.0 mg/dl. He was seen by an
ophthalmologist last month and was told that his eyes were "clean" on
fundoscopic examination. Two months ago his serum creatinine was 1.0 mg/dl. On
examination his BP was 160/100 mm Hg. Fundus showed no evidence of diabetic
retinopathy. Urine analysis showed 2+ blood and 3+ protein on dipstick. Urine
microscopy showed dysmorphic RBCs. Which of the following statements is true?
A. The most likely diagnosis is diabetic nephropathy
B. This patient requires urgent kidney biopsy
C. The rate of raise in serum creatinine seen in this patient is typical of
diabetic nephropathy
D. here is no correlation between the presence of diabetic retinopathy and
nephropathy
E. Nephrotic range proteinuria is never seen in diabetes.
Show answer
Correct Answer: B
Show answer
Correct Answer: B
161. A 70 year old male was admitted to the hospital for osteomyelitis. On
admission, his serum creatinine was 0.8 mg/dl. He was started on Clindamycin
and gentamicin iv and ibuprofen 600 qid for pain. He underwent surgical
debridement on day 2 of hospitalization. Seven days later his serum creatinine
was 3.0 mg/dl. Dipstick was negative for blood and protein. His urine
microscopy showed muddy brown casts and 1-3 RBCs and WBC per hpf. The most
likely diagnosis is
A. Postinfectious glomerulonephritis
B. Acute interstitial nephritis
C. Acute tubular necrosis
D. Dehydration
E. Multiple myeloma
Show answer
Correct Answer: C
Show answer
Correct Answer: C
Show answer
Correct Answer: B
164. Which of the following does NOT fall into the pre-renal causes of acute
renal failure?
A. Congestive heart failure
B. Sequestration of fluid in "third space" following extensive burn injury
C. Acute renal vasoconstriction from nonsteroidal anti-inflammatory drugs
D. Aminoglycoside nephrotoxicity
E. Acute gastrointestinal hemorrhage
Show answer
Correct Answer: D
165. Which of the following is TRUE regarding acute tubular necrosis (ATN)?
A. Large volume fluid resuscitation is helpful in all phases of ATN in
improving renal function
B. The duration of the oliguric maintenance phase of ATN can last as short as
24 hours and as long as 24 days; recovery in renal function is still possible
under these circumstances
C. Oliguria (less than 500 ml of urine per day) is a prerequisite for ATN
D. Transient polyuria (> 6 liters of urine per day) is a consistent feature
during the recovery from ATN
E. After an episode of ATN, the patient always recovers his/her renal function
completely
Show answer
Correct Answer: B
Show answer
Correct Answer: E
Show answer
Correct Answer: B
168. Which of the following does NOT mediate or exacerbate chronic renal
failure?
A. Matrix degradation in the glomeruli
B. Long term uncontrolled hypertension
C. Chronic usage of nonsteroidal anti-inflammatory agents
D. Loss of the majority of the nephron mass
E. Overactivity of angiotensin II locally in the glomeruli
Show answer
Correct Answer: A
Show answer
Correct Answer: C
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: C
173. Which one of the following is FALSE regarding the fractional excretion of
sodium (FENa)?
A. It provides a better indication of the avidity of the renal tubules to
reabsorb sodium than urinary sodium concentration alone
B. Its calculation requires the collection of a 24-hr urine sample
C. Its calculation requires a serum creatinine value
D. Its calculation requires a serum sodium value
E. It is often used clinically to aid in the diagnosis of pre-renal azotemia
Show answer
Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: A
in patients with essential hypertension who have been under good control for
one year.
Show answer
Correct Answer: E
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: A
Show answer
Correct Answer: A
Show answer
Correct Answer: B
184. T F The urine of a 32 y/o man with known cystinuria contains diagnostic
coffin lid-shaped crystals.
A. True
B. False
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: B
Show answer
Correct Answer: A
188. T F Nephrotic syndrome is a risk factor for the development of end stage
renal disease in patients with glomerulonephritis.
A. True
B. False
Show answer
Correct Answer: A
Show answer
Correct Answer: B
190. A worried 20 year old woman comes to your office. Her mother and aunt
both developed renal failure at age 35-40, and her grandfather had idney
trouble?and died suddenly at age 40 after several years of severe headaches.
She wishes to become pregnant. Her exam and labs are entirely normal. A renal
ultrasound shows numerous bilateral cysts. You should:
A. Advise her that she has a recessive disease; if her husband has no cysts,
there is little chance that their children will have renal cysts
B. Advise her that her children have a 50% chance of having cysts, and that
the course is benign and poses no significant risk to her health
C. Begin testing for renal transplantation
D. Send her for a magnetic resonance angiogram (MRA) of the head
E. Perform a renal biopsy
Show answer
Correct Answer: D
Show answer
Correct Answer: C
192. A 40 year old man with arthritis has been using ibuprofen (nonsteroidal
anti-inflammatory) every 6 hours. He developed renal failure associated with
nephrotic range proteinuria. What is the most likely glomerular lesion in this
patient?
A. Membranoproliferative glomerulonephritis
B. Minimal change disease
C. IgA nephropathy
D. Diabetic nephropathy
E. Focal segmental glomerulosclerosis
Show answer
Correct Answer: B
193. A 62 y/o female patient with recurrent urinary infections and large,
bilateral "stag horn" calculi on KUB is likely to demonstrate what kind of
renal calculi
A. Calcium oxalate stones
B. Struvite (triple phosphate stones)
C. Calcium phosphate stones
D. Uric acid stones
Show answer
Correct Answer: B
Show answer
Correct Answer: B
195. The metabolic work-up of a 35 y/o male patient with very active kidney
stone disease demonstrates that he has calcium oxalate stones due to
idiopathic hypercalciuria. A marked reduction of dietary calcium intake is the
most effective form of preventive therapy.
A. True
B. False
Show answer
Correct Answer: B
196. A 47-year-old man who has had passed renal calculi on three occasions
over the previous six years presents with nocturia for four months, followed
by increasing lethargy. Laboratory results show sodium 134 mEq per liter,
potassium 5.6 mEq per liter, chloride 112 mEq per liter, bicarbonate 12 mEq
per liter. BUN 48 mg/dl and creatinine 4.0 mg/dl.
The most likely diagnosis is:
A. Obstructive uropathy.
B. Focal segmental glomerulosclerosis.
C. Chronic pyelonephritis.
D. Reflux nephropathy.
E. Polycystic kidney disease.
Show answer
Correct Answer: A
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: B
204. A patient has the following arterial blood gas results: pH 7.25, [H+] 56
nM and pCO2 47 mm Hg. The calculated [HCO3-] is:
A. 9 mmol/L
B. 18
C. 20
D. 27
E. 36
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Correct Answer: C
205. A patient has the following arterial blood gas and venous chemistries: pH
7.2, pCO2 20 mm Hg, [HCO3-] 8 mmol/L, [Na+] 142 mmol/L, [Cl-] 108 mmol/L, [K+]
6 mmol/L. The calculated anion gap is:
A. 12 mmol/L
B. 20
C. 24
D. 26
E. 32
Show answer
Correct Answer: D
Show answer
Correct Answer: D
pH.
D. Renal compensation results in an increase in [HCO3-] and an decrease in pH.
E. Respiratory compensation results in a decrease in pCO2 and a decrease in
pH.
Show answer
Correct Answer: A
208. A patient had the following laboratory results: pH 7.25, pCO2 62 mm Hg,
[HCO3-] 26 mmol/L. The patient has what acid base disorder.
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: D
209. A patient has the following laboratory results: pH 7.5, pCO2 45 mm Hg,
[HCO3-] 34 mmol/L. The patient has what disorder:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. None
Show answer
Correct Answer: A
210. A patient has the following test results. Blood pH 7.2, pCO2 20 mm Hg,
[HCO3-] 8 mmol/L, [Na+] 140 mmol/L, [Cl-] 122 mmol/L, [K+] 3.0 mmol/L. The
serum phosphorous was 1.6 mg/dl (low) and the tubular reabsorption of
phosphorous was 60% (low). The urine pH was 6.0. The urinalysis showed trace
glucose but no ketones. Which diagnosis is most plausible:
A. Proximal renal tubular acidosis with renal Fanconi syndrome.
Show answer
Correct Answer: A
211. A patient presents with the following test results. Blood test results
included pH 7.55, pCO2 50 mm Hg, [HCO3-] 42 mmol/L, [Na+] 140 mmol/L, [K+] 2.5
mmol/L [Cl-] 86 mmol/L. Urine test results included pH 8.0 and [Cl-] 2 mmol/L.
A urine drug screen is negative. The most likely explanation is:
A. Bartter syndrome
B. Renal tubular acidosis
C. Diabetic ketoacidosis
D. Diuretic treatment
E. Vomiting
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Correct Answer: E
212. Which disease rarely, if ever, progresses to end stage renal disease?
A. minimal change disease
B. focal and segmental glomerulosclerosis
C. anti-glomerular basement membrane antibody glomerulonephritis
D. IgA Nephropathy
E. membranous nephropathy
Show answer
Correct Answer: A
Show answer
Correct Answer: C
214. A patient with diabetes mellitus develops nephrotic syndrome. Which one
of the following makes diabetic nephropathy the most likely diagnosis?
A. RBCs in the urine
B. 24 hour protein excretion of 12 grams
C. fundoscopic evidence of retinopathy
D. family history of diabetes
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Correct Answer: C
215. Which drug is the least likely to reduce proteinuria in a patient with
nephrotic syndrome?
A. high dose prednisone
B. ACE inhibitor
C. calcium channel blocker
D. angiotensin receptor blocker
E. cyclosporine
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Correct Answer: C
Show answer
Correct Answer: A
217. Patients with nephrotic syndrome are at increased risk for developing
coronary artery disease.
A. True
B. False
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Correct Answer: A
Show answer
Correct Answer: B
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Correct Answer: B
Show answer
Correct Answer: D
Show answer
Correct Answer: B
222. Which one of the following is FALSE with regards to diabetes insipidus?
A. Urine volume is typically large
B. Drugs are a common cause of nephrogenic diabetes insipidus
C. Central diabetes insipidus is commonly caused by trauma, surgery, or is
idiopathic
D. Plasma ADH concentration can be high in patients with nephrogenic diabetes
insipidus
E. Water restriction as a diagnostic maneuver generally can not distinguish
between central and nephrogenic DI
Show answer
Correct Answer: E
223. Which one of the following statements is correct with regards to the
physiology of renal water handling?
A. ADH release by the pituitary is primarily regulated by plasma osmolality
with relatively little contribution by plasma volume.
B. In order to make adequately concentrated urine it is not necessary to have
normal sodium reabsorption by the thick ascending limb.
C. In order to make adequate dilute urine the collecting duct must remain
impermeable to water.
D. ADH can increase urine osmolality by about 50-fold.
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: A
Show answer
Correct Answer: D
Show answer
Correct Answer: B
228. A 40 year old male has diabetes for the past ten years. His blood
pressure is consistently about 140/90 mm Hg. He has 700 mg of protein on a 24
hour urine collection. You want to start him on antihypertensive therapy.
Which of the following would be the best choice in this situation?
A. Beta blocker
B. Calcium channel blocker
C. Thiazide diuretic
D. ACE inhibitors
Show answer
Correct Answer: D
229. Which of the following is not a risk factor for PRIMARY hypertension?
A. African American race
B. High salt intake
Show answer
Correct Answer: C
230. You are treating a 55 year old obese man for his hypertension who is
tired most of the day. The most likely secondary cause for his hypertension
is:
A. Sleep apnea
B. Cushing syndrome
C. Pheochromocytoma
D. Renal disease
Show answer
Correct Answer: A
231. A low blood urea nitrogen to serum creatinine ratio (<10:1) is most
likely seen in which of the following conditions:
A. catabolic state resulting from sepsis
B. prerenal azotemia
C. high protein diet
D. rhabdomyolysis (muscle breakdown) from ischemia
Show answer
Correct Answer: D
232. For a given individual, an increase of serum creatinine from 5.0 mg/dl to
10.0 mg/dl represents a loss of fewer nephrons than an increase of serum
creatinine from 1.0 mg/dl to 2.0 mg/dl.
A. true
B. false
Show answer
Correct Answer: A
233. Which of the following is most likely to be associated with high urinary
sodium concentration (>20 mEq/L):
A. low salt diet in a normal subject
B. severe congestive heart failure
C. diuretic treatment for edema associated with chronic renal failure
D. renal vasoconstriction from non-steroidal anti-inflammatory agents
Show answer
Correct Answer: C
Show answer
Correct Answer: B
235. Which one of the following is not a recognized mechanism of acute renal
failure:
A. decreased renal blood flow as a result of tubulo-glomerular feedback
B. tubular obstruction from casts
C. back-leak of solutes as a result of tubular epithelial cell damage
D. mesangial cell relaxation
Show answer
Correct Answer: D
236. In a patient with oliguria, which one of the following is most consistent
with acute tubular necrosis rather than pre-renal azotemia:
A. urinary sodium concentration = 3 mEq/L
B. ratio of urine osmolality to plasma osmolality = 1.0
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Correct Answer: B
Show answer
Correct Answer: C
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Correct Answer: C
C. blood pressure control does not influence the progression of renal disease
D. adjustment of medications is often necessary in order to avoid systemic
toxicity of the medications
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Correct Answer: C
240. The most common cause of end stage renal disease in the U.S. is:
A. post-infectious glomerulonephritis
B. polycystic kidney disease
C. toxic nephropathy from antibiotics
D. sports injury of kidneys
E. diabetic nephropathy
Show answer
Correct Answer: E
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: C
Show answer
Correct Answer: D
Show answer
Correct Answer: B
Show answer
Correct Answer: B