4Th Year Internal_Nephro Final Minimals

Front 1

2. Membranous nephropathy
A. May occur as a result of a systemic illness or be a primary (intrinsic) disorder
B. Merits an evaluation for malignancy when found in a patient older than 50 years
C. Infrequently improves without treatment
D. Does not recur in the transplanted kidney
E. Is the most common cause of idiopathic nephrotic syndrome in adults

Back 1

a,b

Front 2

1. In obstructive uropathy
A. The presence of polyuria rules out obstruction.
B. The absence of hydronephrosis on ultrasound exam¬ination rules out urinary tract obstruction.
C. Infection is a frequent complication.
D. Hypertension is uncommon.
E. Renal tubular acidosis (RTA), type IV, can occur.

Back 2

c,e

Front 3

3. Features of magnesium depletion include
A. Hypokalemia
B. High serum parathyroid hormone levels
C. Prolongation of the PR and QT intervals
D. Amelioration of cardiac toxicity of cardiac glyco¬sides
E. Can occur with aminoglycoside administration

Back 3

a,c,d,e

Front 4

4. Which of the following statements is/are true about the renal hypoperfusion syndromes?
A. Salt avidity and hyperreninemia are usually ob¬served.
B. Effective circulating volume has a greater effect on systemic BP than does renin secretion in the
setting of renal hypoperfusion.
C. Occlusive disease causes renal hypoperfusion, ele¬vated renin secretion, and hypertension in the
setting of a normal effective circulating volume.
D. Unilateral renal occlusive disease is not associated with azotemia if the contralateral kidney
maintains normal function.
E. Nephrotoxic agents (cyclosporine, amphotericin B, radiocontrast dyes) can cause acute renal
vasocon¬striction with renal hypoperfusion, increased salt avidity, and azotemia.

Back 4

all

Front 5

5. Normal pregnancy is associated with
A. Increased glomerular filtration rate and renal blood flow
B. Respiratory alkalosis
C. Hypouricemia
D. Mild non anion gap-type metabolic acidosis
E. Slight increase in BP

Back 5

a,b,c

Front 6

6. Which of the following statements is/are true concerning creatinine clearance?
A. Creatinine clearance normally exceeds "true" mea¬surements of glomerular filtration rate (GFR).
B. Cimetidine and trimethoprim can block the secre¬tory component of creatinine clearance.
C. Urinary creatinine excretion is primarily influenced by the muscle mass in the steady state.
D. The secretory component of creatinine excretion may become more apparent when serum creatinine concentrations are elevated.
E. Creatinine clearance is linearly related to the serum creatinine concentration.

Back 6

a,b,c,d

Front 7

7. Which of the following statements is/are true concerning urinary chloride excretion rates?
A. Urinary chloride excretion provides an index of ex¬tracellular fluid (ECF) volume.
B. Urinary chloride excretion is increased in metabolic alkalosis caused by excessive use of furosemide or thiazides.
C. Laxative abuse is associated with increased urinary chloride excretion.
D. Increased adrenocortical hormone activity increases urinary chloride excretion.
E. Vomiting is associated with increased urinary chlo¬ride excretion.

Back 7

a,b,d

Front 8

8. Which of the following statements is/are true concerning calcium-phosphate balance in chronic renal failure?. .
A. Increased circulating levels of parathyroid hormone (PTH) are observed because of reduced renal cata¬bolism and increased secretion.
B. Hyperphosphatemia reduces PTH secretion.
C. Extrarenal production of 25 (OH) vitamin D3 is in creased in chronic renal failure
D. 1,25-Dihydroxycholecalciferol increases gut absorp¬tion of calcium and phosphorus.
E. A normal calcemic response to PTH is not observed in chronic renal failure with 1,25-
dihydroxycholecal¬ciferol deficiency

Back 8

a,d,e

Front 9

9. Which of the following statements is/are true concerning "uremic" pericarditis?
A. A friction rub, pleuritic chest pain, and enlarged cardiac size are typical findings in uremic pericar¬ditis.
B. Hypotension, tachycardia, and raised jugular venous pressures are hallmarks of cardiac tamponade.
C. Aggressive dialysis can worsen "uremic" pericar¬ditis.
D. Volume overload can be improved by ultrafiltration in the setting of tamponade.
F. Emergent surgical intervention is indicated if the pericardial effusion causes hemodynamic compro¬mise.

Back 9

a,b,e

Front 10

10. Which of the following statements is/are true concerning the anemia of end-stage renal disease (ESRD)?
A. Erythropoietin deficiency is primarily related to the loss of renal mass.
B. Iron deficiency and hyperparathyroidism are impor¬tant causes of resistance to erythropoietin response.
C. Overcorrecting the hematocrit (i.e., above 36%) can increase mortality in this population of patients.
D. Increased release of oxygen from hemoglobin is an important factor in the adaptation to anemia in
chronic renal failure.
E. Erythropoietin reduces blood transfusion require¬ments and will reduce the incidence of iron-overload and transfusion-related infections in the ESRD pop¬ulation.

Back 10

all

Front 11

11. Which of the following statements is/are true concerning chronic ambulatory peritoneal dialysis?
A. Relatively reduced peritoneal surface limits the use¬fulness of this approach in children.
B. Insulin-dependent diabetics have severe problems with glycemic control because of the large amounts of glucose absorbed from the peritoneal dialysate.
C. Dialysis clearance of large molecules (molecular weight >800 kD) is enhanced with peritoneal di¬alysis.
D. The overall dialysis efficiency is similar for hemo¬dialysis and peritoneal dialysis if the duration of dialysis is considered (12 hours/week for hemodialy¬sis vs. continuous dialysis with the peritoneal ap¬proach).
E. Peritonitis is a common problem with continuous ambulatory peritoneal dialysis and is usually caused by gram-negative organisms.

Back 11

c,d

Front 12

12. Which of the following statements is/are true concerning tissue typing and renal transplantation?
A. Siblings with the same biologic parents have a 25% chance of being human leukocyte antigen (HLA) in¬compatible.
B. By definition, a true biologic parent shares 1 HLA haplotype with each child.
C. In vitro cytotoxicity tests do not predict rejection in the transplant setting.
D. MHC class II antigens, expressed on B lymphocytes and vascular endothelial cells, are pivotal in the re¬jection process.
E. Mandatory sharing of six antigen-matched cadaver kidneys with the best matched recipient will dramati¬cally improve graft survival for nearly all trans¬plant recipients.

Back 12

a,b,d

Front 13

13. Which of the following statements is/are true concern¬ing cyclosporine?
A. This agent has dramatically improved renal allo¬graft survival.
B. The use of more specific, targeted immunosuppres¬sants (cyclosporine, OKT3) has reduced the inci¬dence of opportunistic infections.
C. Cyclosporine markedly slows the recovery from acute tubular necrosis (ATN) and potentiates the adverse effects of other nephrotoxic agents.
D. Side effects of cyclosporine include nephrotoxicity, tremor, hyperglycemia, hypertension, and hyperka¬lemia.
E. Calcium-channel blockers, including verapamil and diltiazem, increase serum concentrations of cyclo¬sporine.

Back 13

all

Front 14

14. Which of the following statements about membrano¬proliferative glomerulonephritis (MPGN) is/are true?
A. MPGN does not recur after renal transplantation.
B. This clinicopathologic entity occurs primarily in young adults.
C. Hypocomplementemia may be severe.
D. MPGN may be a primary (intrinsic) renal lesion or may occur in systemic illnesses, including hepatitis B antigenemia and other infections and systemic lupus erythematosus.
E. The incidence of primary (intrinsic) MPGN is in¬creasing.

Back 14

b,c,d

Front 15

15. Which of the following statements about hemolytic-¬uremic syndrome (HUS) is/are true?
A. HUS may occur after gastroenteritis, especially verotoxin-producing Escherichia coli infections.
B. HUS has a particularly poor renal prognosis in children.
C. An HUS syndrome may occur with pregnancy or the use of oral contraceptive agents.
D. Important features of HUS include microangio¬pathic hemolytic anemia, thrombocytopenia, reduced haptoglobin levels, and minimal evidence of disseminated intravascular coagulation.
E. Relapse of HUS does not occur.

Back 15

a,c,d

Front 16

16. Which of the following is/are true of the nephrotic syn¬drome?
A. Plasma volume is usually increased.
B. It is usually associated with renal sodium wasting.
C. It occurs with either diffuse or focal forms of glomer¬ulonephritis.
D. The incidence of infection is increased.
E. Albumin infusions are of significant benefit for treat¬ment of hypoalbuminemia and edema

Back 16

c,d

Front 17

17. Which of the following is/are a direct result of chronic, but rarely acute, renal failure?
A. Elevated alkaline phosphatase from bone
B. Radiographic signs of renal osteodystrophy
C. Bilaterally small kidneys
D. Dilute urine with a high urine sodium
E. Hypertension

Back 17

a,b,c

Front 18

18. Which of the following is/are features of analgesic-¬associated nephropathy?
A. Equal gender distribution
B. Normal-sized kidneys
C. Anemia out of proportion to azotemia
D. Sterile pyuria
E. Papillary necrosis

Back 18

c,d,e

Front 19

19. A 47 -year-old man has an excretory urogram for investi¬gation of microscopic hematuria discovered on a routine urinalysis. He is apparently healthy and entirely without complaints. Kidneys are of normal size, with calcification of and collection of dye in dilated medullary structures. Serum electrolytes, blood urea nitrogen (BUN), creati¬nine, calcium, phosphorus, and uric acid are normal. Creatinine clearance is 103 mL/minute. Urinalysis re¬veals rare red blood cells and no protein. Which of the following is/are true of this patient?
A. There is a significant chance that symptomatic renal stones will develop.
B. There is a significant chance that he has hypercalciuria.
C. He is likely to have impaired urine concentrating ability.
D. His condition is likely to progress gradually to chronic ESRD.
E. His children each have a 50% chance of experiencing the same condition.

Back 19

a,b,c

Front 20

20. A 32-year-old man has a 15-year history of diabetes; serum creatinine is 200 µmol/L. A diagnosis of diabetic nephropathy is established by renal biopsy. Which of the following is/are true of this patient?
A. Angiotensin-converting enzyme (ACE) inhibitors are unlikely to help this condition at this time.
B. He has a less than 30% chance of having hyperten¬sion at this time.
C. He has a 50% chance of having the nephrotic syn¬drome at this time.
D. Because of his age, nephropathy is likely to be his only major organ system diabetic
complication to date.
E. He is likely to experience ESRD requiring dialysis within the next 4 years.

Back 20

e

Front 21

23. Which of the following is/are true of uremic acidosis?
A. Urine pH is usually greater than 6.0.
B. Hyperkalemia worsens acidosis by suppressing am¬monia production.
C. Anion gap acidosis develops only when the GFR falls below 20 mL/minute.
D. Renal ammonia production and excretion are low, considering the degree of acidosis.
E. Bicarbonate wasting is observed when isotonic bi¬carbonate is infused to restore the serum bicarbon¬ate to normal levels.

Back 21

b c d e

Front 22

24. Which of the following statements about aminoglyco¬side-induced tubule damage is/are true?
A. Functional abnormalities of tubule function may cause hypokalemia and hypomagnesemia.
B. Severe oliguric acute renal failure is the rule.
C. Toxicity is related to the dose of aminoglycoside and the duration of therapy.
D.Risk factors include patient age, baseline serum cre¬atinine concentration, and ECF volume depletion.
E. All aminoglycosides are equally nephrotoxic

Back 22

a c d

Front 23

25. Which of the following statements about pregnancy-¬induced hypertension (preeclampsia) is/are true?
A. Onset is associated with elevation of the serum uric acid level.
B. Nephrotic-range (>3.5 g/day) proteinuria can occur.
C. This syndrome typically occurs between 12 and 24 weeks of gestation.
D. GFR and renal blood flow are usually unchanged in preeclampsia.
E. Clinical manifestations of preeclampsia generally re¬solve within 6 weeks after delivery.

Back 23

a b e

Front 24

26. Which of the following statements about renal calculi is/are true?
A. Crystals seen on urinalysis confirm their formation in the kidney.
B. Treatment of all patients with renal calculi should include a high fluid intake (minimum 2 L) if tol¬erated.
C. Hexagon-shaped crystals in the urine are always pathologic.
D. Magnesium ammonium phosphate crystals (stru¬vite) are associated with urinary tract infections with urea-splitting organisms.
E. Alkalinization of the urine with potassium citrate may be effective in preventing the formation of both uric acid and calcium stones

Back 24

b c d e

Front 25

27. Which of the following statements about autosomal¬-dominant polycystic kidney disease (ADPKD) is/are true?
A. ADPKD is the most common hereditary disease in the United States.
B. Hepatic cysts support the diagnosis of ADPKD.
C. Although half of the offspring of one affected parent will inherit the gene that produces ADPKD, expres¬sion of the disease is variable.
D. Renal calculi are uncommon in ADPKD.
E. Microscopic and macroscopic hematuria can occur.
F. The incidence of intracranial aneurysms is higher in patients with ADPKD than in the
general popu¬lation.

Back 25

a b c e f

Front 26

28. Episodic gross hematuria may be associated with which of the following:
A. IgA nephropathy
B. Cyclophosphamide therapy
C. Analgesic nephropathy
D. Sickle-cell disease
E. Henoch-Schönlein

Back 26

all

Front 27

29. Clinical features of the syndrome of acute glomerulone¬phritis include
A. Hypertension'
B. Hypercholesterolemia
C. RBC casts in the urinary sediment
D. Edema
E. Hypoalbuminemia

Back 27

a c d

Front 28

30. Causes of the syndrome of acute glomerulonephritis associated with hypocomplementemia include
A. Systemic lupus erythematosus
B. Membranoproliferative glomerulonephritis
C. Wegener's granulomatosis
D. Infective endocarditis
E. Hemolytic-uremic syndrome

Back 28

a b d

Front 29

31. Disease states associated with profound salt retention along with low fractional sodium excretion include
A. Acute glomerulonephritis
B. Acute tubular necrosis
C. Acute interstitial nephritis
D. Hepatorenal syndrome (HRS)
E. Hypovolemic shock

Back 29

a d e

Front 30

32. Common causes of ATN are
A. -lactam antibiotics
B. Aminoglycoside antibiotics
C. Cholesterol embolic disease
D. Radiocontrast media
E. Vancomycin

Back 30

b d

Front 31

33. Risk factors for radiocontrast agent-induced acute re¬nal failure include
A. Volume depletion
B. Multiple myeloma
C. C. Hypercalcemia
D. Diabetes mellitus
E. Chronic renal insufficiency

Back 31

all

Front 32

34. Effective strategies for minimizing the risk of radiocon¬trast nephropathy in diabetic patients with renal insuffi¬ciency include
A. Low-dose dopamine infusion
B. Atrial natriuretic peptide infusion
C. Volume expansion with 0.45% saline solution
D. Intravenous furosemide
E. Intravenous mannitol

Back 32

c

Front 33

35. In the treatment of the nephrotic syndrome, interven¬tions that decrease urinary protein excretion include
A. Diltiazem
B. ACE inhibitors
C. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. -Adrenergic receptor antagonists
E. Low-protein diet

Back 33

a b c e

Front 34

39. The MOST common intrinsic (primary) glomerular le¬sion is
A. Anti-glomerular basement membrane (GBM) glo¬merulonephritis
B. Membranoproliferative glomerulonephritis
C. Amyloidosis
D. IgA nephropathy
E. Focal and segmental glomerulosclerosis

Back 34

d