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Nephrology exam for FCPS part 1 with Dr Sohrab
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Nephrology exam for FCPS part 1 with Dr Sohrab
Nephology exam for FCPS part 1 with Dr Sohrab
1
Personal infomations
2
True and false
3
multiple choice
Name
*
Phone number
*
Email
Following factors increase GFR - a) SNS activation b) Constriction of afferent arteriole c) Dilatation of afferent arteriole d) Low albumin in plasma e) Capillary permeability
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Features of Pre-renal AKI -- a) Hypertension b) Urinary fractional Na<1% c) Urine osmalility low d) Tachycardia e) JVP raised
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding renal blood flow -- a) ANG-II constricts both afferent and efferent arterioles b) Nor-adrenalin constricts the afferent atrioles c) Prostaglandin constricts the renal tubule d) Adrenaline causes increase rate of blood flow e) Deopamine causes decrease renal blood flow
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Hormone act on renal tubule -- a) ADH b) Parathyroid c) Calcitonin d) Glucagon e) Ang II
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In case of IgA nephropathy -- a) Thematuria is d earliest sign b) Proteinuria is early feature c) Progress to end stage renal disease d) Asymptomatic presentations dominate in older adults e) Responds to immune suppressive therapy is poor
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In proximal renal tubular acidosis 5 a) There is hyperkalemia b) There is ↑ H secretion c) HCO3 reabsorption d) Causes normal anion gap e) Causes renal stone formation
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Diseases associated with low complement level a) Subacute bacterial endocarditis b) SLE c) Focal segmental glomerulonephritis d) Rapid progressive glomerulonephritis e) Cryoglobulinemis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Drugs causing glomerulonephritis -- a) Gentamycin b) NSAIDS c) Ciprofloxacin d) Lithium e) Penicillamine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Metabolic acidosis with increased anion gap can be found in a) Renal failure b) Renal tubular acidosis c) Lactic acidosis d) Diarrhea e) Diabetic ketoacidosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding post infectious glomerulonephritis -- a) More common with pharyngeal infection than skin infection b) Children are usually victims c) It is curable d) Associated with hypertension e) Not associated with hematuria
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Hypercalcemia causes -- a) Reduced entry of sodium into cells b) Reduced neuronal excitability c) Weakness and hypotonicity of muscles d) A prolonged QT interval e) Drowsiness, confusion and coma
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Substances mostly reabsorbed by PCT are a) Glucose b) HCO3 c) Amino acids d) NHA e) K+
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Juxta glomerular apparatus consist of a) Proximal convulatol tubule b) Afferent arterioles c) Efferent arterioles d) Macula dense e) Laci's cell
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Erythropoietin -- a) Released from peritubular capillary b) Released from macula dense c) Released from JG cells d) Released from Extra-glom rube cell & mesangial cells e) Released from laics cell
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
APCKD present with -- a) Vague discomfort b) HTN c) Renal failure d) UTI e) Hematuria
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding renal artery stenosis -- a) Increased size of both kidneys b) ACE is may be used to reduce nephropathy c) Receptor blocker (ARB) may improve symptoms d) Hypertension e) May cause pulmonary oedema
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A patient develops unconsciousness after hemodialysis. Possible causes are a) CVD Hypercalcemia c) Disequilibrium syndrome d) Hyperkalemia e) Hyponatremia
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Advantages of thiazide diuretics as antihypertensive drugs -- a) Proportional decrease of systolic & diastolic blood pressure b) Not affect regional blood flow c) Hyperglycemia occur d) Hypercalcemia occur e) Less chance of postural hypotension
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Microscopic hematuria be found in -- a) Membranous glomerulonephritis b) Infective endocarditis c) Papillary necrosis d) SLE e) Renal amyloidosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
In following conditions increase urea proportion to creatinine a) Severe hemorrhage b) Starvation c) Liver failure d) High protein diet e) Porphyrin rich diet
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Features of polycystic kidney disease -- a) Autosomal recessive b) Ratio of female > male c) Renal failure is common d) Diagnosis is made by ultra-sonogram e) Cyst may found in another organ
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Renal tubular acidosis -- a) Occurs only in proximal tubule b) Acidic urine c) Hyperchloremia d) Hypokalemia e) Metabolic alkalosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Renal clearance of a substance -- a) Is inversely related to its urinary concentration b) Is directly related to the rate of urine formation c) Is directly related to its plasma concentration d) Is expressed in units of volume per unit time e) Must fall in the presence of metabolic poison
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Filtration barrier-- a) Contains slit pore b) Provides podocytes c) Characterized by basement membrane d) Contains capillary endothelium e) Contains mesothelial cells
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Membranous nephropathy -- a) Common cause of nephrotic syndrome in adults b) Increase C3 level c) Deposition of IgG (subepithelially) d) Associated with HBV, malignancy e) Frank hematuria common
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A patient is advised for renal biopsy. Which of the following is not an contraindication?
Thrombocytopenia
Severe Anaemia
Uncontrolled hypertension
Kidneys<60% predicted size
Solitary kidney
A 50-year-oid female presents with acute chest pain and dyspnoea. She has past history of DVT. Examination reveals bilateral ankle oedema with 24-hour urine protein showing 8g/d. Which is the most likely explanation for these findings?
Factor V Leide
Reduced antithrombin activity
Reduced concentration of von Willebrand's factor
Reduced factor VIII
Reduced fibrinogen concentration
A 14-year-old comes to you with petechial rash, abdominal pain, arthralgia and hematuria, what is the most likely diagnosis?
IgA nephropathy
SLE
HSP
Microscopic polyangitis
Septicaemia
A patient presents with haematuria, he is a known case of sickle cell anaemia, Investigation shows pus cells plenty in urine RME but urine C/S shows no growth, Which investigation is most likely to confirm the diagnosis?
Intravenous pyelography
Intravenous urography
CT abdomen
Phase contrast microscopy
DMSA scan
A 25-year-old woman who is 20 weeks pregnant is diagnosed with pyelonephritis. She had suffered recurrent urinary infections since childhood and her family history reveals that her mother had a history of hypertension and had been told she had a kidney problem. Examination was normal and urea and creatinine were both normal. What is the most likely diagnosis?
ADPKD
Bladder outlet syndrome
Normal physiological urinary stasis of pregnancy
Reflux nephropathy
Renal stone disease
A 20-year-old male has been diagnosed with renal artery stenosis, which of the following would obtain best result for him?
Aspirin
Angioplasty
Antihypertensive
Statin
Smoking cessation
A 35-year-old lady comes to the emergency with acute confusional state with urine output 150ml/day, Investigation shows Hb-8 g/dL, Reticulocyte count 4.5%, Platelet count 100000/mm3, Which of the following should be started immediately?
Supportive therapy
Antibiotics
Plasma exchange
Eculizumab
Rituximab
A 70-year-old man is admitted to hospital complaining of a twelve-day history of loin pain, fevers and occasional rigors on examination, his temperature is 37.9°C. The renal function is normal. Urinalysis of a mid stream urine shows: White cell count >100/mm3 5 66% Red cell count >50/mm3, no organisms seen, with no growth. What would be your first investigation of choice?
IVU
CT abdomen
Renal USG
ANA
ECHO
Which of the following would suggest pre renal uraemia, not ATN?
Urine Na>40 mmol/L
Fractional Na excretion>1%
Dense granular cast
High urea creatinine ratio
Creatiine kinase increased
A CKD patient has been referred urgently to a nephrologist, which of the following would not be a criteria for referral?
Hypertension poorly controlled by one antihypertensive
ACR>30mg/mmol with non visible hematuria
eGFR<30mL/min/1.73m2
Rapid deterioration in renal function
Suspicion of renal involvement in multisystem disease
Which of the following is not an indication for dialysis in AKI or CKD?
Hyperkalaemia
Severe anaemia
Metabolic acidosis
Uraemic encephalopathy
Uraemic pericarditis
A patient presents to the emergency with viral encephalitis. He was started with aciclovir. Few days later, he presents with acute renal failure. What is the most likely mechanism of action?
Papillary necrosis
Tubular obstruction by crystal
Interstitial nephritis
Nephrocalcinosis
Acute tubular necrosis
A patient is suspected to have reflux nephropathy, which of the following investigation would not be useful?
USG of abdomen
Radionucleotide DMSA
Serial CT/MRI
Renal biopsy
Micturating cystourethrogram
A 25-year-old man presents with haematuria, haemoptysis, oedema and proteinuria. He has a past history of chronic obstructive airways disease and hypertension. Dipstick of his urine shows +3 blood and +3 protein; his blood results show a normal albumin. Which one of the following investigations would be the most appropriate for arriving at a diagnosis?
Anti-nuclear antibody estimation
Antistreptolysin O titre (ASO)
Chest X-ray
Renal biopsy
Renal ultrasound
A 72-year-old woman presents acutely unwell to the Emergency Department. She has had gastroenteritis for a few days and has now developed a nosebleed. Past medical history of note includes furosemide and ramipril prescriptions for systolic heart failure. A full blood count and film reveals evidence of red cell haemolysis and thrombocytopenia, and serum creatinine is 290 μmol/l. Which one of the following diagnoses fits best with this clinical picture?
Acute dehydration
Furosemide toxicity
Granulomatosis with polyangiitis
Haemolytic–uraemic syndrome (HUS)
Renal artery stenosis
A 46-year-old woman complains of dysuria and flank pain. She also describes night sweats and gradual weight loss over the past few months. Her blood pressure is 200/100 mmHg despite taking three antihypertensives. Urine microscopy shows leukocytes and red cells, but there is no significant bacterial growth. Renal ultrasound shows both kidneys to be 9 cm in bipolar length, with medullary calcification and mild hydronephrosis on the left. Which one of the following is the most likely cause of this presentation?
Acute pyelonephritis
Aristolochic acid nephropathy
Medullary cystic disease
Reflux nephropathy
Renal tract tuberculosis
A 28-year-old woman presents with muscle weakness and lethargy. Her plasma sodium is 138 mmol/l, potassium 2.1 mmol/l, bicarbonate 12 mmol/l and chloride 113 mmol/l. Creatinine is 62 μmol/l. She is diagnosed as having type I renal tubular acidosis (RTA). Which one of the following is the most significant clinical presentation of distal RTA (type I) that differentiates it from proximal RTA (type II)?
Metabolic acidosis is common
Potassium depletion occurs
Renal stone formation
There is failure to thrive
Urinary pH in type I can be lowered below 5.3 after ammonium chloride administration
A 65-year-old diabetic man presents with ascites and proteinuria. He is otherwise well. Full blood count shows mild iron deficiency anaemia but nothing else of note; in particular, his erythrocyte sedimentation rate (ESR) is not particularly elevated. A renal biopsy shows areas of mesangial apple-green birefringence on Congo red staining under polarised light. Which one of the following is the most probable diagnosis?
Amyloidosis
Focal glomerulosclerosis
Kimmelstiel–Wilson syndrome
Mesangioproliferative glomerulonephritis
Multiple myeloma
A 32-year-old woman complaining of painful hands is found to have hypertension, proteinuria and dipstick haematuria. Plasma creatinine is 147 μmol/l. Renal biopsy shows proliferative glomerulonephritis with occasional cellular crescents, and immunofluorescence shows diffuse granular staining for IgA, IgG, IgM, C3 and C4. Which one of the following is the diagnosis?
Post-streptococcal kidney disease
Lupus nephritis
Membranous nephropathy
Goodpasture’s disease
Systemic vasculitis
A 65-year-old man with congestive heart failure who has received an excess amount of furosemide is now found to have hypochloraemic alkalosis. He has a past medical history of ischaemic heart disease. Which of the following investigative results would be most characteristic of this disorder?
Expanded extracellular fluid volume
Fall in pa (CO2)
Hypokalaemia
Low serum bicarbonate level
Poor response to ammonium chloride
A 30-year-old man undergoes investigation for chronic upper urinary tract obstruction with intravenous urography. The patient should be informed about which one severe complication?
Bleeding
Contrast nephrotoxicity
Development of renal stones
Skin reaction
Ureter damage
A 28-year-old woman presents to the Emergency Department with flank pain and a 48- hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria, leukocytes, nitrites and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1°C and flank pain. Which of the following is the most likely diagnosis?
Acute glomerulonephritis
Nephrolithiasis
Ovarian cyst pain
Pelvic inflammatory disease
Pyelonephritis
A 50-year-old man has been diagnosed with renal carcinoma; his brother was diagnosed with the same condition 3 years ago. Which one of the following is the most likely inherited condition?
Alport syndrome
Gaucher’s disease
Tay–Sachs disease
Thrombotic thrombocytopenic purpura
von Hippel–Lindau disease
A 25-year-old woman who is 10 weeks’ pregnant attends for a routine check-up. She has no symptoms of urinary tract infection. Routine urine dipstick reveals blood and protein, and urine culture is positive for Escherichia coli. Which one of the following is the most appropriate course of action?
Do nothing and review at her next antenatal visit
Treat with nitrofurantoin
Treat with amoxicillin
Treat with ciprofloxacin
Repeat urine sample and treat if positive
A 70-year-old man with Parkinson’s disease is referred acutely by his GP having been found to have a creatinine of 746 mol/l. He was known to have normal renal function 2 years previously. On examination he has evidence of rigidity, resting tremor and postural instability; he appears to have bilateral small pupils. He has a postural blood pressure (BP) drop from 160/72 mm/Hg when supine to 138/60 mmHg when standing; his pulse rate is unremarkable. Ultrasound shows bilateral hydronephrosis and a full bladder. Which one of the following causes of obstructive kidney disease should be considered most likely given the history unless proven otherwise?
Benign prostatic hypertrophy
Neurogenic bladder
Papillary necrosis
Retroperitoneal fibrosis (RPF)
Ureteric obstruction
