Renal

March 28, 2018 | Author: Osama Alhumisi | Category: Kidney, Kidney Disease, Chronic Kidney Disease, Nephrology, Medical Specialties


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Show questions one by one1. A normal kidney ….all are true except A. ? erythropoieten is secreted by peritubular cells in response to hypoxia B. ? hydroxylates 1- hydroxycholecalciferol to its active form C. ? renin is secreted from the juxta glomerular apparatus D. ? locally produced prostaglandins have a very important role in maintaining renal perfusion E. ? 90% of the erythropoietin comes from the kidneys and 10 % from the liver. 2. Normal adult kidneys…all are true except A. ? its length is about 11-14 cm (about 3 vertebral bodies) B. ? both kidneys rise and descend several centimeters during respiration C. ? each kidney contains approximately 10 million nephrons D. ? both kidneys receive about 20-25% of the cardiac output E. ? the right kidney is usually few centimeters lower than the left . 3. Causes of polyuria...all are true except A. ? excessive fluid intake B. ? hyperglycemia C. ? early stage of chronic renal failure D. ? tubulointerstitial diseases E. ? heavy smoking 4. Renal ultrasound examination.. all are true except A. ? its disadvantage is that it is highly operator dependent B. ? quick, rapid, cheap and non-invasive and often the only required method of renal imaging C. ? it can show the renal size, position, dilatation of the collecting system and other abdominal pathologies like cystic liver. D. ? in chronic renal failure, the density of the renal cortex is unfortunately decreased and there is loss of cortico-medullary differentiation. E. ? by utilizing the Doppler techniques, much information can be gained like the resistivity index 5. IVU is commonly used in clinical nephrology. All are true except A. ? risky in diabetes mellitus B. ? risky in myeloma C. ? risky in pre-existent renal disease D. ? the risk of contrast nephropathy can be reduced by avoiding dehydration and by giving diuretics E. ? The risk of contrast nephropathy can be reduced by using less hyperosmolar (yet expensive) contrast media 6. Disadvantages of IVU…all are true except A. ? time consuming B. ? needs and injection C. ? dependence on adequate renal function for good images D. ? risk of exposure to contrast media (allergic reaction, nephro-toxicity) E. ? unfortunately, poor definition of the collecting system on AP films 7. Anterograde pyelography ….which one is true A. ? it is the injection of a contrast media into kidney through the bladder and ureters B. ? it is usually done blindly C. ? much more difficult and hazardous in a non-obstructed kidney D. ? usually used in cases of glomerulonephritis E. ? poorly out line the collecting system 8. Micturating cystourethrogram …all are wrong except A. ? not used in the diagnosis and assessment of the severity of vesicicoureteric reflux B. ? usually used in conjunction with urodynamic studies C. ? it is part of the last stages of IVU D. ? not indicated in those with recurrent UTI E. ? not indicated in those with renal scars and not indicated in those with chronic renal failure of unknown cause 9. Renal angiography and venography …all are true except A. ? the main indication of renal angiography is the diagnosis of renal artery stenosis and renal hemorrhage B. ? therapeutic intervention may be undertaken at the same time of doing renal angiography like dilatation and stenting of renal artery stenosis and occluding and AV fistula C. ? unlike IVU, there is a risk of cholesterol athero-embolisation D. ? when compared to IVU, the risk is contrast nephropathy is lower E. ? renal venography mainly used in the diagnosis of renal vein thrombosis and renal cell carcinoma extension 10. Renal biopsy….all are indications except A. ? unexplained acute renal failure B. ? chronic renal failure with normal sized kidneys C. ? atypical childhood nephrotic syndrome D. ? isolated hematuria with normal looking RBCs E. ? nephrotic syndrome in adults 11. Contraindications to renal biopsy …all are true except A. ? severe hemophilia B. ? platelets count of 10000 /mm3 C. ? uncontrooled hypertension D. ? renal size less than 80% predicted E. ? biopsy from a single kidney is a relative contraindication 12. Causes of DARK urine …….all are true except A. ? all cases of porphyria B. ? intervertebral dics calicification with dark ears C. ? a Parkinsonian patient D. ? pulmonary TB patient E. ? massive crushing trauma pateint 13. Protienuria ……..are true except A. ? standard sticks usually Miss bence john's protein B. ? in myoloma it is due to protein Overflow rather than amyloidosis C. ? the majority of the daily excreted protein is Tamm Horesful mucoprotien D. ? albumin / creatinin ratio on a random urine sample is less than 2.5 in females and less than 3.5 in males E. ? Positive dipstick for protein may occur in fever per se 14. Acute renal failure…all are wrong except A. ? prerenal causes are uncommon B. ? 85% of intrinsic renal causes of acute renal failure are due to acute tubular necrosis C. ? underperfusion causes of acute renal failure are usually irreversible D. ? stones as a cause of acute obstructive uropathy are very common causes E. ? 15% of intrinsic acute renal failure is due to acute glomerulonephritis 15. Regarding prognosis in acute renal failure …all are true except A. ? in uncomplicated renal failure e.g. due to bleeding or drugs, the mortality is low B. ? serious infection complicating acute renal failure portends bad prognosis C. ? multiple end organ failure portends a poor prognosis D. ? complicated acute renal failure may have a mortality approaching 15- 30 % E. ? the outcome and prognosis is determined by the severity of the underlying disease and by complications rather than by renal failure per se 16. Rapid respiratory rate in acute renal failure may be due to all but one of the followings A. ? acidosis per se B. ? iv overload and pulmonary edema C. ? ARDS picture D. ? chest infection E. ? hyperkalemia 17. Anemia in the setting of acute renal failure is very common and usually multifactorial…all are causes except A. ? hemolysis B. ? excessive bleeding C. ? profound suppression of erythropoiesis D. ? drug induced E. ? hyperphophatemia 18. General urine examination (GUE) is one of the commonest investigations done every day ……all are true except: A. ? elevated urinary concentration of ascorbic acids gives a false negative results for bilirubin dipsticks B. ? elevated urinary concentration of ascorbic acids gives a false negative results for glucose dipsticks C. ? gross hematuria gives false positive results for protein D. ? significant glycosuria gives a falsely low specific gravity E. ? MESNA gives false positive results for ketone sticks 19. Urine Dipstick tests are commonly used in the medical ward side labs by nurses, juniors and senior house officers …….all are true except A. ? false negative results for nitrite may be due to short bladder transit time B. ? False negative results for nitrite may be due to infecting organisms lacking nitrates and nitrate reductase C. ? high urinary level of tetracycline gives false negative results for leukocyte esterase D. ? high urinary level ascorbic acid gives false negative results for nitrite E. ? medications which discolor urine will give false negative for nitrite 20. Specific gravity is measured in some clinical conditions like diabetes insipidus ……..do you know how it s measured? ….it is measured by all of the following methods except A. ? freezing point depression B. ? vapor pressure technique C. ? using a refractormeter D. ? using a hydrometer E. ? calorimetric reagent strips 21. In microalbuminuria ……all are true except A. ? is defined as prtienuria between 30-300 mg / day B. ? Is defined as proteinuria between 20-200 microgram / minute C. ? always protein dipstick negative D. ? improtant in the follow up of type II not type I diabetes mellitus E. ? persisrent proteinuria has been associated with the development of atherosclerorsis 22. Daily excretion of urinary protein…all are true except A. ? up t 150 mg /day is normal B. ? 300-500 mg/ day will be dipstick test positive C. ? more than 3.5 gram/day is called nephritic range proteinuria D. ? more than 2.5 gram/ day, a glomerular source is more likely than a tubular source E. ? between 0.5-2 gram/ day usually indicates a glomerular source 23. In diagnosing pre-renal failure...all of the followings when present are highly suggestive …except which one A. ? the history may be compatible eg excessive bleeding B. ? compatible clinical finding C. ? a progressive rise in blood urea and creatinin D. ? urine osmolality more than 500 mosm/ Kg E. ? fractional sodium excretion more than 2 24. In chronic renal failure …all are true except A. ? the commonest causes world wide are hypertension and diabetes B. ? urea frost is a useful early sign C. ? itching is multi factorial rather than due to hyperphosphatemia alone D. ? hypotension and dehydration may be seen E. ? in clinical practice, about 4-18 % of cases are of unknown or uncertain etiology 25. Although chronic renal failure is an irreversible process, there are many "reversible factors" that may accelerate the course …all of the following factors are true except A. ? nephrotoxic medications B. ? renal artery stenosis C. ? hypotension due to drug therapy D. ? any infection per se E. ? normal blood pressure 26. Endocrinal abnormalities are common in chronic renal failure …all of the following statements are true except A. ? hyperprolactenemia may be seen but unfortunately many cases don’t respond to bromocryptine B. ? the half life of insulin is shortened C. ? amenorrhoea is common in females D. ? loss of libido in both sexes is very common E. ? hypothyroidism like picture 27. In the management of chronic renal failure...all are true except A. ? hypertriglyceridemia is common and hypercholesteremia is almost universal in those who have significant proteinuria B. ? ACE inhibitors for hypertension have significantly been shown to retard the disease progression especially in diabetics C. ? profound protein restriction is unwise as this may produce malnutrition D. ? replacing sodium and chloride with high fluid intake should be avoided in all patients E. ? hypocalcemia is very common and should be corrected by vitamin D metabolites. 28. Regarding the prognosis of chronic renal failure …all are true except A. ? the commonest cause of death is vascular events B. ? 5 year survival of " home hemodialysis " patients is about 80% C. ? 5 year survival following renal transplantation is about 80% D. ? 5 year survival for "hospital hemodialysis " patients is about 60% E. ? 5 year survival for " CAPD patients is about 16% 29. In acute renal failure patient, you suggested that the patient needs renal replacement therapy in the form of hemodialysis …all of the followings are usually your target …except A. ? maintain a pre-dialysis blood urea concentration less than 15 mmol/L B. ? adequate control of potassium C. ? adequate control of phosphate D. ? achieving normal extra cellular fluid volume status E. ? each session of hemodialysis should be done every day 30. Renal artery stenosis…all are ture except A. ? the commonest casuse is atheromatous narrowing B. ? should suspected when the blood pressere is severe or of rapid onset or difficult to control C. ? fibromuscular dysplasia as a cause is commoner in young age group D. ? fibromuscular dysplasia usually does not cause complete occlusion and usually stabilizes once the patient stops growing E. ? surgical treatment is superior to medical treatment or angioplasty 31. In Alport's syndrome ………all are true except A. ? the second commonest inherited cause of renal disease B. ? usually autosomal recessive C. ? bilateral anterior lenticonus is the usual eye manifestation D. ? sensory neural deafness usually to high tone first. E. ? the pathological hallmark is progressive degeneration of the glomerular basement memberane 32. In adult polycystic kidney disease ….all are true except A. ? 85% of cases are due to mutation in PKD1 gene on chromosome 16 B. ? mitral and aortic regurgitations are frequent but rarely severe. C. ? 30% have an associated hepatic custs but disturbances in hepatic function is very rare D. ? 50 % will develop subarachnoid hemorrhage E. ? colonic diverticulae and abdominal wall hernias are well recognized associations 33. In adult poly cystic kidney disease ……..all are true except A. ? mean age of those who are heterozygous for PKD1 mutation to start dialysis is 57 years B. ? 50% of patient will never need chronic dialysis C. ? to screen a patient's relative, renal ultrasound as a screening method is less reliable in the 10-18 age group D. ? Urinary Tract Infections should be treated aggressively E. ? all patients will develop hypertension 34. In medullary sponge kidney …..all are true except A. ? it is sporadic not genetic B. ? has a characteristic picture on IVU C. ? the cysts are confined to the proximal tubules D. ? the prognosis is generally good E. ? nephrocalcinosis may be seen on the KUB film 35. Fanconi's Syndrome (Renal tubular acidosis type II)...All are true except A. ? glycosuria is present with normal blood sugar B. ? aminoaciduria does not result in malnutrition C. ? may be caused by Wilson's disease D. ? hypercalciuria is profound E. ? very large amounts of bicarbonate are need in the treatment 36. In Type I distal renal tubular acidosis …all are true except A. ? may cause osteomalacia in adults and rickets in children B. ? nephrocalcinosis is seen C. ? hypokalemia is present with normal anion gap metabolic acidosis D. ? imcomplete forms were never seen E. ? ability to form very acidic urine in the contest of systemic acidosis is the hallmark of the disease 37. Causes of hypocomlementemia in inflammatory nephritis includes all of the followings except A. ? SBE B. ? SLE C. ? shunt nephritis D. ? posrinfectious glomerulonephritis E. ? microscopic polyangiitis 38. Causes of rapidly progressive Glomerulonephritis…….all are true except A. ? SLE B. ? aggressive phase of certain inflammatory nephritis like IgA nephropathy C. ? Goodpasture's syndrome D. ? post-infectious glomerulonephritis E. ? memebranous nephropathy 39. In Gromerulopathies … all are true except A. ? minimal change disease is associated with HLD DR7, atopy and drugs B. ? membranous nephropathy is associated with HLA DR3, drugs and heavy metals C. ? assocition with liver disease has been documented in IgA nephropathy D. ? membraboproliferative glomerulonephritis type I is associated with C3 nephritic factor and partial lipodystrophy E. ? focal segmental glomerulosclerosis is associated with obesity, HIV infection and heroin abuse 40. In Goodpasture's syndrome …..all are true except A. ? it is an autoimmune disease against alpha 3 chain of type III collagen B. ? linear IgG deposition in the GBM is seen on immuno- flourescence staining of a renal biopsy specimen C. ? palsma pharesis may be used in the treatment D. ? lung hemorrhage is more common in smokers E. ? usually produces rapidly progressive crescentic glomerulonephritis 41. In Renal biopsy with immunoflourescence staining looking for immune deposits ….all are true findings of the suggested disease…except A. ? minimal change disease – non immune deposits B. ? focal segmental glomerulosclerosis-nonspecific trapping in focal scars C. ? membranous nephropathy –granular subendothelial IgG D. ? IgA nephropathy – mesangial IgA deposition E. ? type II membranoproliferative glomerulonephritis – intramembranous dense deposits 42. IgA nephropathy…the followings indicate a bad prognosis except A. ? male gender B. ? presence of hypertension C. ? absence of hematuria D. ? presence of renal impairment E. ? persistent proteinuria 43. Chronic interstitial nephritis may be caused by all of the followings except A. ? chronic exposure to ochratoxin B. ? chronic exposure to aristolochic acid C. ? Wilson's disease D. ? Hanta virus infection E. ? Chronic ingestion of phenacetin 44. In acute interstitial nephritis …all are true except A. ? the commonest cause is drug induced B. ? blood eosinophila is seen only in 30 % of cases, yet eosinophiluria is seen up to 70% of cases C. ? should be suspected in any non-oliguric acute renal failure D. ? predominant infiltration of the tubulo-intersitium with eosinophils on renal biopsy is more suggestive of a viral etiology E. ? the majority of drug induced acute interstitial nephritis will recover following drug withdrawal 45. Recurrent UTI is common in adult females …the followings are prophylactic measures adopted by females against recurrent UTI...Except A. ? fluid intake of at least 2 liters per day B. ? regular emptying of the urinary bladder C. ? local application of an antiseptic like cetrimide cream to the periurethral area before intercourse D. ? urinary bladder emptying before and after intercourse E. ? double micturition will worsen reflux nephropathy 46. Indications for intervention in renal calculi: A. ? if the patient is aneuric B. ? presence of infection upstream C. ? large stone that is unlikely to pass D. ? total obstruction of the pelvi-ureteric junction E. ? radiolucent stone 47. Risk factors for renal stone formation...all are true except A. ? hypercalciuria B. ? hyperoxaluria C. ? hypercitraturia D. ? hyperuricosuria E. ? cystinuria 48. In renal cell carcinoma ….all are true except A. ? hematruia is the commonest symptom B. ? 30% of cases present due to system metabolic effect of the tumor like fever, hypertension and abnormal liver function tests C. ? raised ESR is seen in 50 % of cases while amyloidosis is seen in only 2% of cases D. ? during surgical removal, the adrenal gland and local lymph nodes should be removed as well E. ? Radiotherapy is very effective in the treatment 49. In Renal cell carcinoma...All are true except A. ? more common in males B. ? adenocarcinoma is the commonest type C. ? the tumor is vascular and spread to the lungs and bones D. ? the tumor may be multicentric and or bilateral in some patients like Von Hippel Lindau E. ? the tumor may enlarge upon administration of progestins 50. In Drug and toxin induced renal disease …the following associations are true except A. ? NSAIDS and minimal change nephropathy B. ? ciclosporin and chronic interstitial nephritis C. ? lithium and nephrogenic diabetes insipidus D. ? cicplatin and renal loss of sodium E. ? aciclovir and crystal formation inside tubules
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