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1 | |
A patient with lymphoma who is known to excrete 1.5 g urinary protein per day has a negative dipstick evaluation for urinary protein. The reason for the seeming inconsistency is |
| | A) | the size of the excreted protein is too small to be picked up by the test strip |
| | B) | the urine is not concentrated enough |
| | C) | only heavy chain sequences are recognized by the test strip |
| | D) | Tamm-Horsfall protein blocks the reaction between the secreted protein and the test strip |
| | E) | dipsticks preferentially detect albumin compared with immunoglobulin because albumin is negatively charged |
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2 | |
A 75-year-old female nursing home resident is brought to the emergency department because of increasing obtundation. She is found to communicate poorly. Brief physical examination reveals diminished skin turgor. Blood pressure is 100/60, pulse 120, respiratory rate 20, and temperature 37°C (98.6°F). Blood tests reveal the following serum electrolytes: sodium 160 mmol/L, potassium 5.0 mmol/L, bicarbonate 30 mmol/L, chloride 110 mmol/L. The most appropriate management at this time would include administration of 5% dextrose in |
| | A) | normal saline, 100 mL/h |
| | B) | normal saline solution, 250 mL/h |
| | C) | half normal saline, 100 mL/h |
| | D) | half normal saline, 200 mL/h |
| | E) | water, 150 mL/h |
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3 | |
A 45-year-old woman who has had slowly progressive renal failure begins to complain of increasing numbness and prickling sensations in her legs. Examination reveals loss of pinprick and vibration sensation below the knees, absent ankle jerks, and impaired pinprick sensation in the hands. Serum creatinine concentration, checked during her most recent clinic visit, is 790 mol/L (8.9 mg/dL). The woman's physician should now recommend |
| | A) | a therapeutic trial of phenytoin |
| | B) | a therapeutic trial of pyridoxine (vitamin B6) |
| | C) | a therapeutic trial of cyanocobalamin (vitamin B12) |
| | D) | initiation of renal replacement therapy |
| | E) | neurologic referral for nerve conduction studies |
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4 | |
In patients with chronic renal failure, which of the following is the most important contributor to renal osteodystrophy? |
| | A) | Impaired renal production of 1,25-dihydroxyvitamin D3 [1,25 (OH)2 D3] |
| | B) | Hypocalcemia |
| | C) | Hypophosphatemia |
| | D) | Loss of vitamin D and calcium via dialysis |
| | E) | The use of calcitriol |
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5 | |
A 23-year-old man has recurrent episodes of hematuria over the past year. Each of the episodes seems to be associated with an upper respiratory infection. Physical examination currently is normal. Urinalysis reveals a relatively bland sediment; dipstick is positive for both protein and blood. Renal biopsy most likely will reveal |
| | A) | extensive extracapillary proliferation on light microscopy |
| | B) | diffuse mesangial proliferation on light microscopy |
| | C) | autosomal dominant polycystic kidney disease |
| | D) | diffuse mesangial deposition of IgA on immunofluorescence |
| | E) | deposition of C3 in capillary walls on immunofluorescence |
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6 | |
A 72-year-old woman with rheumatic heart disease is being treated with ampicillin and gentamicin for enterococcal endocarditis. One week into the course she develops a morbilliform skin rash and fever. Laboratory evaluation is remarkable for a doubling of serum creatinine and blood urea nitrogen from their baseline values. Urinalysis dipstick is positive for blood, protein, and white cells. Ultrasonography reveals bilaterally enlarged kidneys. Based on the available data, the most likely cause of the patient's azotemia is |
| | A) | tubular necrosis caused by aminoglycoside |
| | B) | membranous nephropathy resulting from endocarditis |
| | C) | enterococcal pyelonephritis |
| | D) | cystitis |
| | E) | hypersensitivity reaction to ampicillin |
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7 | |
A 40-year-old woman who has never had significant respiratory disease is hospitalized for evaluation of hemoptysis. Urinalysis reveals 2+ proteinuria and microscopic hematuria. BUN concentration is 7.1 mmol/L (20 mg/dL), and serum creatinine concentration is 177 mol/L (2.0 mg/dL). Serologic findings include normal complement levels and a negative assay for fluorescent antinuclear antibodies. Renal biopsy reveals granulomatous necrotizing vasculitis with scattered immunoglobulin and complement deposits. The most likely diagnosis in this case is |
| | A) | mesangial lupus glomerulonephritis |
| | B) | Henoch-Schönlein purpura |
| | C) | microscopic polyarteritis |
| | D) | Wegener's granulomatosis |
| | E) | Goodpasture's syndrome |
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8 | |
Which of the following patients is most likely to develop destruction of renal papillae with concomitant tubulointerstitial damage? |
| | A) | A middle-aged man who has consumed "moonshine" alcohol distilled in an automobile radiator |
| | B) | An older man with early-stage prostate adenocarcinoma |
| | C) | A young adult woman with -thalassemia |
| | D) | An older woman who uses analgesics for chronic headaches |
| | E) | A middle-aged woman with her first episode of a urinary tract infection which is associated with pyuria, flank pain, and fever but responds well to a short course of oral antibiotics |
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9 | |
A 30-year-old woman with diabetic nephropathy received a cadaveric renal allograft. On the third post-operative day her serum creatinine concentration was 160 mol/L (1.8 mg/dL). She is being treated with cyclosporine and prednisone. On the sixth postoperative day she experiences a decrease in urine output from 1500 mL/d to 1000 mL/d; the serum creatinine concentration increases to 194 mol/L (2.2 mg/dL). Her blood pressure remains stable at 170/90 mmHg, and her temperature is 37.2°C (99°F). The best initial step in management would be to |
| | A) | decrease the dose of cyclosporine |
| | B) | obtain ultrasonography of the renal allograft |
| | C) | obtain a biopsy of the renal allograft |
| | D) | administer pulsed steroid therapy |
| | E) | administer an intravenous bolus of furosemide |
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10 | |
A 55-year-old man undergoes intravenous pyelography (IVP) as part of a workup for hypertension. A 3-cm solitary radiolucent mass is noted in the left kidney; the study otherwise is normal. The man complains of no symptoms referable to the urinary tract, and examination of urinary sediment is within normal limits. Which of the following studies should be performed next? |
| | A) | Repeat IVP in 6 months |
| | B) | Early-morning urine collections for cytology (three samples) |
| | C) | Selective renal arteriography |
| | D) | Renal ultrasonography |
| | E) | CT scanning (with contrast enhancement) of the left kidney |
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11 | |
Which of the following is a risk factor for carcinoma of the bladder? |
| | A) | Exposure to alcohol intake |
| | B) | Use of cyclophosphamide |
| | C) | History of renal carcinoma |
| | D) | Positive family history |
| | E) | Infestation with Schistosoma mansoni |
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12 | |
A 10-year-old girl complaining of profound weakness, occasional difficulty walking, and polyuria is brought to the pediatrician. Her mother is sure the girl has not been vomiting frequently. The girl takes no medicines. She is normotensive, and no focal neurologic abnormalities are found. Serum chemistries include sodium 142 mmol/L, potassium 2.5 mmol/L, bicarbonate 32 mmol/L, and chloride 100 mmol/L. A 24-h urine collection on a normal diet reveals sodium 200 mmol/d, potassium 50 mmol/d, and chloride 30 mmol/d. Renal ultrasound demonstrates symmetrically enlarged kidneys without hydronephrosis. A stool phenolphthalein test and a urine screen for diuretics are negative. Plasma renin levels are found to be elevated. Which of the following conditions is most consistent with the above data? |
| | A) | Conn's syndrome |
| | B) | Chronic ingestion of licorice |
| | C) | Bartter's syndrome |
| | D) | Wilms' tumor |
| | E) | Proximal renal tubular acidosis |
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13 | |
Normal serum complement levels would be seen in patients with hematuria, proteinuria, and hypertension resulting from which of the following? |
| | A) | Mixed essential cryoglobulinemia |
| | B) | Hepatitis C-associated membranoproliferative glomerulonephritis |
| | C) | Diffuse proliferative lupus nephritis |
| | D) | Henoch-Schönlein purpura |
| | E) | Poststreptococcal glomerulonephritis |
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14 | |
In acute renal failure, dietary protein should be restricted in which of the following? |
| | A) | All patients |
| | B) | All patients with BUN >100 |
| | C) | All patients with creatinine >10 |
| | D) | Only in patients who are well nourished on hospital admission |
| | E) | If azotemia is advanced and dialysis is not an option |
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15 | |
A 37-year-old man is admitted with confusion. Physical examination shows a blood pressure of 140/70 with no orthostasis, normal jugular venous pressure, and no edema. Serum chemistries are notable for sodium 120 mmol/L, K+ 4.2 mmol/L, bicarbonate 24 mmol/L, and uric acid 0.177 mmol/L (2 mg/dL). The most likely diagnosis is |
| | A) | hepatic cirrhosis |
| | B) | cerebral toxoplasmosis with SIADH |
| | C) | Addison's disease |
| | D) | significant gastrointestinal fluid loss |
| | E) | congestive heart failure |
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A 56-year-old diabetic woman with end-stage renal disease (ESRD) has been treated with peritoneal dialysis (prescription of four 2-L exchanges per day) for 6 years. She is 5 ft. 6 in. tall and weighs 70 kg (154 lb). The patient complains of anorexia, abdominal discomfort, fatigue, and insomnia. Medications include erythropoietin, calcium carbonate, metoprolol, and a water-soluble vitamin supplement. Laboratory studies are notable for hematocrit 38%, BUN 56 mg/dL, bicarbonate 14 meq/L, calcium 10.4 mg/dL, and phosphate 2.3 mg/dL.