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Nephrology II

8. Ultrasound Ravine criterion for 38-year-old

1. All of the following are CARDINAL features of patient with suspected ADPKD is fulfilled when:
Nephrotic Syndrome EXCEPT:  At least 4 cysts are found in each kidney
 Proteinuria > 3.5 g/24 hr  At least 1 cyst is found in each kidney
 Serum albumin < 3.5 g/dl  At least 2 cysts are found in each kidney
 Hypertension  At least 2 cysts are found in one kidney
 Hypercholesterolemia  At least 4 cysts are found in liver
 Peripheral edema +/- anasarca
9. Berger’s Disease:
2. Why nephrotic patients tend toward a  Is also called IgE nephropathy
hypercoagulable state?  Is the most common form of
 Because of the loss of clotting factors glomerulonephritis worldwide
 Because of the hypercalcemia  It occurs most frequently in the fifth or sixth
 Because of increased hepatic production of decade
fibrinogen  There is a female predominance of 4:1
 Because of increased hepatic production of α2-  Typically presents with an episode of acute
globulin renal failure
 A, C and D are correct
10. Poststreptococcal glomerulonephritis may present
3. The progression of renal disease in IDDM can be with all of the following EXCEPT:
divided into five stages. The correct sequence is:  Edema
 Silent stage, hyperfiltration-hypertrophy  Hematuria
stage, incipient nephropathy stage, overt  Hypotension
nephropathy stage, end-stage renal failure  Proteinuria
 Hyperfiltration-hypertrophy stage, silent stage,  Acute renal failure
incipient nephropathy stage, overt nephropathy
stage, end-stage renal failure 11. The rejection of allograft which occurs within
 Hyperfiltration-hypertrophy stage, incipient minutes to hours of engraftment as the result of
nephropathy stage, overt nephropathy stage, preexisting antibodies in the recipient directed
silent stage, end-stage renal failure against donor tissue is called:
 Hyperfiltration-hypertrophy stage, incipient  Accelerated rejection
nephropathy stage, silent stage, overt  Acute rejection
nephropathy stage, end-stage renal failure  Hyperacute rejection
 Silent stage, incipient nephropathy stage,  Subacute rejection
hyperfiltration-hypertrophy stage, overt  Chronic rejection
nephropathy stage, end-stage renal failure
12. The most common form of peritoneal dialysis in
4. The presence of diabetic retinopathy in diabetic use today is:
nephropathy:  Manual peritoneal dialysis
 Is observed in 20-40 % of patients  Intermittent peritoneal dialysis
 Is observed in more than 90 % of patients  Tidal peritoneal dialysis
 Is never observed  Continuous ambulatory peritoneal dialysis
 Strengthens the diagnosis  Continuous cyclic peritoneal dialysis
 B and D are correct
13. All of the following are absolute indications for
5. All of the following characterize chronic hemodialysis EXCEPT:
pyelonephritis EXCEPT:  Chronic glomerulonephritis
 Cortical scarring  Uremic pericarditis
 Calyceal dilatation  Severe Hyperkalemia
 Grossly edematous kidney  Diuretic unresponsive fluid overload
 Tubular atrophy  Intractable acidosis
 Interstitial fibrosis
14. The most ominous form of lupus nephritis,
6. Asymptomatic bacteriuria MAY NOT require commonly progressing to end-stage renal failure
specific treatment in: and often associated with severe extrarenal disease
 Diabetes is:
 Males  LN class I (normal)
 History of pyelonephritis  LN class II (mesangial)
 Pregnancy  LN class III (focal segmental proliferative)
 Abnormalities of the urinary tract  LN class IV (diffuse proliferative)
 LN class V (membranous)
7. All of the following characterize Autosomal
Dominant Polycystic Kidney Disease EXCEPT: 15. What kind of injections shouldn’t be done in
 ADPKD is slightly more severe in males than hemodialysed patients?
in females  I.m.
 Symptoms related to renal failure are rare on  I.v.
presentation  S.c.
 Hepatic cysts occur in more than 80 % of  All of the above
affected patients
 B and C are correct
 No specific medication for ADPKD is available
 Hematuria in ADPKD is usually treated

16. Which drugs shouldn’t be used inpatients with
renal disease? 24. The nephritic syndrome is best characterized by:
 Steroids  A bland urinary sediment
 Aminoglycosides  At least 3.5 g of proteinuria/24 hours
 ACEi  Anuria
 All of the above  Poliuria and hyperuricemia
 A and C are correct  Hematuria, RBC casts and proteinuria

17. High proteinuria, hypercalcemia and nephrotic 25. In order to appropriately dose patients with renal
syndrome are characteristic for: failure, the physician should:
 Myeloma multiplex  Consult a nephrologists
 Nephropathia IgA  Be guided by the serum creatinine
 Alport syndrome  Do a 24-hour creatinine clearance
 Nephrolithiasis  Use the Cockcroft-Gault formula
 Hydronephrosis  Dose as usual and use drug levels when
18. All of the following hormones are secreted by the
kidney EXCEPT: 26. Which of the following can cause an increase in
 Erythropoietin the BUN independent of renal function?
 1,25-dihydroxycholecalciferol  Infection
 Leukotrienes  Increased protein intake
 Angiotensin II  Corticosteroids
 Calcitonin  Volume depletion
 All of the above
19. What is the most common cause of heavy
proteinuria and nephrotic syndrome occurring 27. Which of the following statement about unilateral
after renal transplantation? urinary tract obstruction is often true?
 Diabetic nephropathy  It will cause acute renal failure
 Recurrent disease  It can be difficult to diagnose with ultrasound
 Injection  It is not easily detected clinically
 Chronic rejection  It does not lead to hydronephrosis
 Renal cysts
28. Management of urinary tract obstruction
20. When renal failure occurs in the setting of acute includes:
pyelonephritis, which of the following findings  Acute decompression of the urinary tract
should the physician consider in his or her  Emergency intravenous pyelogram to delineate
diagnosis? the exact anatomy
 Urinary tract obstruction  Fluid restriction
 Renal flow scan
 Volume depletion
 Urosepsis with acute tubular necrosis
29. Which of the following statements about a patient
 Papillary necrosis presenting with passage of a renal calculus is
 All of the above correct?
 An immediate metabolic workup should be
21. Conditions commonly present in a patient with initiated to determine the abnormality leading to
insulin-dependent diabetes mellitus at the time of stone formation
presentation include:
 The patient most likely has a uric acid stone
 polyuria due to glycosuria
 Most likely this patient will not have another
 A 20-50 % increase in the glomerular filtration acute stone episode
rate (GFR)
 Most likely the stone will be seen on a flat plate
 An increase in microalbuminuria of the abdomen
 An increase in kidney size
 All of the above 30. When evaluating a patient with chronic renal
failure (CRF), it is important to:
22. The best antihypertensive agent for a 28-year-old  Look for aggravating factors such as
insulin-dependent diabetic with hypertension and hypovolemia and obstruction
microalbuminuria would be:  Consider potentially remediable causes of CRF,
 Any agent that would adequately control blood such as malignant hypertension
pressure  Control blood pressure
 An agent taken once daily to increase the  Consider adjusting drug doses
likelihood of compliance
 All of the above
 A centrally acting α-blocker
 An angiotensin-converting enzyme inhibitor
 An α/β-blocker

23. Which of the following diagnostic techniques is

most useful in the setting of obstructive uropathy?
 Renal ultrasound
 Retrograde pyelography
 CT scanning
 Intravenous pyelogram