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NEPHROLOGY MCQ BANK-ENJOY
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06.20.08 (2 months ago)
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1. Which of the following is/are true relative to the definition, diagnosis and prevalence of hypertension.
1. A BP cuff that is too small (i.e., encircles less than 80% of the upper arm) gives an erroneously low BP reading.
2. The upper normal BP value for a seven-year-old is 135/85.
3. African Americans experience a higher prevalence of hypertension than Caucasians, but appear to suffer less severe end-organ damage.
4. The prevalence of hypertension rises with age.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
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.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: A
3. The work-up of a patient who is referred to you with established hypertension should include:
1. A thorough drug history.
2. Physical examination to include assessment of the skin.
3. Urinalysis, serum electrolytes and creatinine.
4. Assessment of left ventricular heart mass.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: E
4. The following is/are true regarding the treatment of essential hypertension:
1. The elderly usually require and tolerate larger doses of diuretics and beta blockers than younger adults.
2. Beta blockers should generally be avoided in those with reactive airway disease (asthma).
3. Beta blockers and angiotensin-converting enzyme (ACE) inhibitors should be avoided following myocardial infarction.
4. The slow reduction of medication (step-down therapy) can be attempted in those with essential hypertension who have been under good control for one year.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: C
5. Which statements are true regarding the increase in glomerular filtration rate (GFR) that occurs after birth?
1. Increased renal blood flow contributes to increased GFR in the neonate.
2. GFR increases immediately after birth, regardless of gestational age.
3. Redistribution of blood flow to the outer renal cortex increases GFR.
4. Renal vascular resistance increases while systemic vascular resistance falls after birth.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: B
6. Tubular reabsorption of _______________ increases with maturation.
1. Sodium
2. Bicarbonate
3. Potassium
4. Phosphate
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
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.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: C
8. The following statements about congenital nephrotic syndrome of the Finnish type are true.
1. It is caused by a mutation in the nephrin gene on chromosome 19.
2. Maternal alpha feto protein is increased in the second trimester.
3. Steroid therapy is useless.
4. Proteinuria is present prior to age three months.
A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct
Show answer
Correct Answer: E
9. Factors contributing to renal vein thrombosis include all of the following EXCEPT:
A. Hemoconcentration
B. Increased antithrombin Ill levels
C. Increased platelet activation
D. High molecular weight fibrinogen
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Correct Answer: B
10. Findings in atheroembolic renal disease include:
A. Renal failure
B. Eosinophilia
C. Hypocomplementemia
D. Livedo reticularis
E. All of the above
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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
12. 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 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.
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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.
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Correct Answer: E
14. Which one of the following factors contribute to edema formation in congestive heart failure?
A. Effective arterial blood volume is increased due to renal salt and water retention.
B. Decreased effective arterial blood volume leads to increased aldosterone, ADH, and sympathetic nerve activity.
C. Total peripheral resistance is decreased due to splanchnic vasodilatation.
D. Decreased actual blood volume leads to activation of baroreceptors.
E. The renin-angiotensin system is suppressed.
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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
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Correct Answer: D
16. The clinical manifestations of hyperkalemia include all of the following except:
A. Predisposes to digitalis toxicity
B. Predisposes to ventricular fibrillation
C. EKG shows flattened P wave, peaked T wave, and widened QRS complex
D. Weakness
E. Predisposes to cardiac arrest
Show answer
Correct Answer: A
17. Which one of the following statements is false?
A. The main cause of hypokalemia associated with vomiting is not loss of K+ in the vomitus.
B. Diuretics are one of the most common causes of hypokalemia.
C. Renal failure is a common cause of hyperkalemia.
D. Hyperkalemia in diabetes mellitus is at least partially due to inadequate aldosterone formation.
E. Copious watery diarrhea is frequently associated with hyperkalemia.
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 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
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Correct Answer: B
19. Which one of the following statements about hypo- or hypernatremia is true?
A. A patient with frank symptoms of hypo- or hypernatremia should have his/her serum sodium concentrations rapidly (few hours) corrected back to normal levels.
B. The brain fully compensates for hypenatremia within 2-4 hours by making "idiogenic osmoles".
C. The symptoms of hyper- and hyponatremia are mainly due to central nervous system dysfunction.
D. Hyponatremia due to SIADH is most often due to underlying kidney or liver disease.
E. "Pseudohyponatremia" is as dangerous as true hyponatremia.
Show answer
Correct Answer: C
20. Which of the following is NOT commonly found in chronic urinary obstruction?
A. Nocturia
B. No symptoms
C. Renal failure
D. Microhematuria with dysmorphic red cells
E. Polyuria
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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
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Correct Answer: D
26. A 10-month-old boy presents with status epilepticus. His intoxicated mother was unable to provide a history. The child quit seizing after being treated with diazepam. Exam revealed an obtunded child with tachypnea. 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
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
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Correct Answer: A
27. The anion gap in the infant above is:
A. 25
B. 30
C. 36
D. None of the above
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Correct Answer: B
28. What is his possible diagnosis:
A. Septic shock with lactic acidosis
B. Intoxication with methanol
C. Diabetic ketoacidosis
D. Bartter's syndrome
Show answer
Correct Answer: B
29. An infant presents to a pediatrician for recurrent vomiting and failure to thrive. The child has been hospitalized by another primary care physician for recurrent dehydration. However, data are not available. Weight and length are below the fifth percentile. Exam shows a normal blood pressure with signs of mild dehydration. Reflexes are markedly increased. The child is hypotonic. Chemistry panel showed Na 140 mEq/L, K 2.2 mEq/L, CO2 50 mEq/L, Cl 78 mEq/L, BUN 20 mg/dl, creatinine 1.0 mg/dI, Ca 9.5 mg/dl, Mg 1.7 mg/dl, PO4 2.8 mg/dl. Arterial blood gas showed pH 7.54, pCO2 60 mmHg, urine chloride was 40 mEq/L and urinary calcium excretion was elevated. What is the nature of the acid-base disorder?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Show answer
Correct Answer: B
30. The most likely diagnosis in this infant is:
A. Gitleman's syndrome
B. Bartter's syndrome
C. Renal tubular acidosis
D. Contraction alkalosis
Show answer
Correct Answer: B
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