Question 1

A 50-year-old male with a long history of smoking has atypical epithelial cells seen in a urinalysis specimen, but cystoscopy is negative. What best explains this finding:

A Adenocarcinoma of prostate

B Transitional cell carcinoma of renal pelvis

C Acute interstitial nephritis

D Nodular glomerulosclerosis

E Squamous cell carcinoma of penis

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Question 2

Chronic renal failure is diagnosed in a 65 year old female. The findings from urine dipstick testing show no protein, blood, glucose, nitrite, or ketones. However, the semi-quantitative sulfosalicylic acid test for urine protein is positive. The best diagnosis is:

A Minimal change disease

B Membranous glomerulonephritis

C Diabetes mellitus

D Multiple myeloma

E Systemic lupus erythematosus

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Question 3

A 60 year old male is found to have hematuria on urinalysis. He has experienced:

A Multicentricity with recurrence

B Polycythemia

C Cushing's syndrome

D Increased serum uric acid

E An abnormal karyotype

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Question 4

A 72-year-old male has been feeling tired and lethargic for months. The serum BUN is 110 mg/dl and serum creatinine 9.8 mg/dl. Which of the following findings is LEAST likely to provide an explanation for his condition:

A A large, nodular prostate is palpated on physical examination.

B The fasting serum glucose exceeds 150 mg/dl on two occasions.

C His blood pressure has been 170/105 mmHg for years.

D He has a brother with enlarged, cystic kidneys.

E A computed tomography scan reveals a large mass in the left kidney.

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Question 5

Which of the following is lacking in renal cortex and medulla:

A Capillaries

B Fenestrated endothelium

C Squamous epithelium

D Henle's loop

E Type IV collagen in glomerular basement membrane

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Question 6

All of the following are common etiologies for end-stage renal disease in adults EXCEPT:

A Adult (dominant) polycystic kidney disease

B Nodular glomerulosclerosis from diabetes mellitus

C Severe atherosclerosis from diabetes mellitus

D Multiple simple renal cysts in the cortex

E Systemic lupus erythematosus (SLE) with glomerulonephritis

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Question 7

The definition of the nephrotic syndrome is based upon the finding of:

A No inflammation in a urinalysis specimen

B Proteinuria >3.5 gm/24 hours

C Hematuria with >10 RBC/hpf

D Lipiduria in association with hypercholesterolemia

E Renal tubular epithelial cells and casts

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Question 8

A 19-year-old male notes hematuria and sees his physician, who also notes mild proteinuria. Additional examination, including audiometry, reveals only hearing loss. Which of the following findings is LEAST likely to be present:

A Other affected family members

B Basement membrane abnormalities

C Immune complexes in the mesangium

D Increased risk for renal failure in 10 years

E Visual problems

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Question 9

The urine specific gravity is a measure of which of the following renal functions:

A Filtration

B Reabsorbtion

C Secretion

D Concentration

E Blood flow

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Question 10

A hyperplastic arteriolosclerosis with fibrinoid necrosis, petechial hemorrhages, and microinfarcts seen in the kidneys in conjunction with a markedly elevated plasma renin is most consistent with which of the following patient histories:

A A 56 year old male with an acute myocardial infarction

B A 6 year old male with albuminuria

C A 62 year old female with end stage renal disease

D A 15 year old male with recent streptococcal infection

E A 45 year old female with scleroderma

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Question 11

A neoplasm of the kidney that microscopically resembles an embryonic nephrogenic zone and may be due to a lack of a tumor suppressor gene on chromosome 11 is most likely a(an):

A Angiomyolipoma

B Renal cell carcinoma

C Transitional cell carcinoma

D Wilm's tumor

E Medullary fibroma

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Question 12

A 5 year old child is noted by his mother to be lethargic for several weeks, and he appears to have some puffiness around his eyes. Dipstick urinalysis reveals no glucose, ketones, or blood, but he has 4+ protein present. Microscopic urinalysis reveals no casts, but oval fat bodies are seen. The most likely diagnosis is:

A BergerÕs disease

B Minimal change disease

C GoodpastureÕs syndrome

D Focal segmental glomerulosclerosis

E Membranoproliferative glomerulonephritis

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Question 13

The clinical complex of nephritic syndrome is usually characterized by all of the following findings EXCEPT:

A Acute onset

B Hematuria with red blood cell casts

C Some degree of oliguria

D Proteinuria of >3.5 g/day

E Hypertension

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Question 14

A 49-year-old male with a history of chronic alcoholism who drinks a gallon of antifreeze solution will most likely develop:

A Acute tubular necrosis

B Acute interstitial nephritis

C Rapidly progressive glomerulonephritis

D Acute pyelonephritis

E Chronic interstitial nephritis

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Question 15

In which of the following situations would a percutaneous needle biopsy of the kidney be most helpful and appropriate:

A Fever with suspected acute pyelonephritis

B Prostatic hyperplasia with suspected hydronephrosis

C Premature neonate with suspected polycystic kidney disease

D Suspected renal cyst

E Systemic lupus erythematosus and acute renal failure

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Question 16

A physician should be most concerned about the multicentric origin of malignancies in a patient with:

A Renal cell carcinoma

B Transitional cell carcinoma

C Adenocarcinoma of prostate

D Wilm's tumor of the kidney

E Squamous cell carcinoma of penis

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Question 17

You find that your 43-year-old African- American male patient has systemic hypertension with a blood pressure of 150/95. If this is not controlled, the most likely cause of death will be from:

A Intracerebral hemorrhage (stroke)

B Aortic aneurysm rupture

C Heart failure

D Renal failure

E Intracranial aneurysm rupture

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Question 18

Which of the following features is most characteristic of a rapidly progressive glomerulonephritis:

A Glomerular crescents

B Widened proximal tubules

C Polymorphonuclear infiltrates

D Lipiduria

E IgA deposited in glomerular capillaries

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Question 19

Malaise for several weeks prompts a 43 year old male to visit his family physician. Physical examination is normal, except for a blood pressure of 150/95 mmHg. Dipstick urinalysis shows no glucose, blood, ketones, nitrite, or urobilinogen, but he has 4+ proteinuria, and a 24 hour urine protein is 3.8 gm. Microscopic urinalysis shows no casts. The best diagnosis is:

A Membranous glomerulonephritis

B Systemic lupus erythematosus

C Amyloidosis

D Minimal change disease

E Post-streptococcal glomerulonephitis

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Question 20

A 60 year old woman is admitted for an acute myocardial infarction. There is difficulty maintaining adequate blood pressure and tissue perfusion for several days. Her serum lactate is elevated. Her serum BUN and creatinine are noted to be increasing. Granular and hyaline casts are present on microscopic urinalysis. The renal lesion that is most likely to be present in this situation is:

A Chronic pyelonephritis

B Acute tubular necrosis

C Nodular glomeruloscerosis

D Renal vein thrombosis

E Minimal change disease

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Question 21

A 50 year old man who was diagnosed at age 15 with type 1 diabetes mellitus is at risk for each of the following complications EXCEPT:

A Nodular glomerulosclerosis

B Arteriolar nephrosclerosis

C Papillary necrosis

D Glomerular crescents

E Diffuse glomerulosclerosis

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Question 22

Correct statements about minimal change disease include all of the following EXCEPT:

A It is the most common cause of nephrotic syndrome in children.

B By electron microscopy there is fusion of foot processes.

C Females are affected more frequently than males.

D Most patients recover without sequelae.

E Lipiduria may be present on urinalysis.

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Question 23

Fever for several days results in an emergency room visit for a 70 year old woman. She describes dull pain on palpation of her left lower back. She has burning dysuria. A complete blood count reveals an elevated WBC count with a left shift. Which of the following urinalysis findings would be most diagnostic for her renal disease:

A Broad renal casts

B Oval fat bodies

C Renal tubular epithelial cells

D White blood cell casts

E Proteinuria

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Question 24

A 53-year-old female has taken 2 gm of phenacetin a day for her arthritis pain for the past 3 years. She now has an increasing serum BUN and creatinine. Her kidneys are most likely to show:

A Papillary necrosis

B Focal segmental glomerulosclerosis

C Nephrocalcinosis

D Interstitial nephritis

E Arteriolosclerosis

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Question 25

Which statement regarding drug-induced interstitial nephritis is INCORRECT:

A It usually follows a generalized allergic reaction.

B Methicillin can cause it.

C Symptoms subside if the drug is stopped.

D Eosinophils may appear in the urine.

E It is more frequent with increasing dosage.

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Question 26

A 40 year old man has the sudden onset of severe right flank pain that comes in waves all night long. When he is seen in the emergency room, after waiting for two hours, he is exhausted. His urine specimen is examined by dipstick in the emergency room, and this reveals no ketones, glucose, protein, nitrite, or urobilinogen; however, blood is present, but few WBC's. The specific gravity is 1.015 and the pH is 5.5. The most probable diagnosis is:

A Benign prostatic hyperplasia

B Membranous glomerulonephritis

C Ureteral calculus

D Renal angiomyolipoma

E Transitional cell carcinoma of bladder

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Question 27

True statements concerning focal segmental glomerulosclerosis (FSGS) of the kidney include all of the following EXCEPT:

A End stage renal failure is uncommon.

B It is not as common as minimal change disease in children.

C There is effacement of podocytes plus segmental scarring.

D It tends to recur after transplantation.

E Less than half of patients have some response to corticosteroids.

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Question 28

All of the following statements regarding lesions of the urinary bladder are true EXCEPT:

A Bladder extrophy has an increased risk for malignancy.

B A persistent urachus may drain urine through the umbilicus.

C Interstitial cystitis may require a total cystectomy.

D Transitional cell papillomas do not recur.

E Cystitis cystica is a manifestation of chronic cystitis.

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Question 29

Which of the following is LEAST likely to contribute to risk for development of acute pyelonephritis:

A Benign prostatic hyperplasia

B Bladder calculi

C Infective endocarditis with septicemia

D Pregnancy

E Hypertension

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Question 30

Some patients with carcinoma or with chronic hepatitis B antigenemia deposit IgG and C3 in glomeruli resulting in:

A Membranous glomerulonephritis

B Rapidly progressive glomerulonephritis

C Nodular glomerulosclerosis

D Goodpasture's syndrome

E Membranoproliferative glomerulonephritis, type II

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Question 31

The congenital urinary tract anomaly that carries the greatest significance with the most morbidity for the patient is:

A Unilateral renal agenesis

B Bladder exstrophy

C Bilateral ureteral duplication

D Horseshoe kidney

E Medullary sponge kidney

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Question 32

Renal papillary necrosis is most likely to be a complication of all of the following conditions EXCEPT:

A A 55-year-old male with diabetes mellitus who develops a urinary tract infection

B A 60-year-old male who has ingested large quantities of acetaminophen and phenacetin

C A 19-year-old African-American male who has sickle cell anemia

D A 25-year-old pregnant female who has bacteriuria

E A 48-year-old male who has a blood pressure of 180/100

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Question 33

Which of the following renal lesions in a patient with diabetes mellitus would be most likely to result in the finding of white blood cell casts on urinalysis:

A Papillary necrosis

B Diffuse glomerulosclerosis

C Arteriolar nephrosclerosis

D Acute pyelonephritis

E Nodular glomerulosclerosis

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Question 34

Fetal ultrasound performed at 18 weeks gestational age reveals the lack of amniotic fluid, making imaging difficult. However, the sonographer finds bilaterally asymmetrically enlarged kidneys. No bladder can be visualized. The heart appears to have four chambers. There are club feet. The most likely diagnosis is:

A Bilateral WilmÕs tumor

B Dominant polycystic kidney disease

C Urethral atresia

D Hypospadias

E Multicystic renal dysplasia

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Question 35

The appearance of chills, fever, rash, eosinophilia, and proteinuria in a hospitalized patient would most strongly suggest:

A Post-streptococcal glomerulonephritis

B Drug-induced interstitial nephritis

C IgA nephropathy

D Acute tubular necrosis

E Acute serum sickness

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Question 36

Of the following causes for hypertension, the one LEAST amenable to surgical intervention is:

A Aldosterone secreting adrenal adenoma

B Fibromuscular dysplasia

C Pheochromocytoma

D Primary hyperparathyroidism

E Arteriolar nephrosclerosis

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Question 37

A 40-year-old male with hypertension, hematuria, malaise, nodular aneurysmal arterial dilations on renal angiography, and serum perinuclear anti-neutrophil cytoplasmic autoantibodies (P-ANCA) most likely has:

A Wegener's granulomatosis

B Fibromuscular dysplasia

C Vasculitis with systemic lupus erythematosus

D Polyarteritis nodosa

E Nodular glomerulosclerosis

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Question 38

Non-gonoccocal urethritis in a young sexually active male is most frequently due to:

A Human papilloma virus

B Hemophilus

C Chlamydia

D Treponema

E Herpes simplex

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Question 39

Which of the following findings is LEAST likely to be associated with a renal cell carcinoma:

A Hypercalcemia

B Metastases

C Precocious puberty

D Hematuria

E Hypertension

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Question 40

Oval fat bodies on urinalysis are most likely to be seen with:

A Ascending pyelonephritis

B Nephritic syndrome

C Nephrotic syndrome

D Obstructive uropathy

E Renal infarction

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Question 41

At autopsy, the kidneys of a premature infant who died soon after birth are markedly enlarged bilaterally and microscopically show numerous small radially arranged cysts. These findings are most consistent with:

A An autosomal dominant disease

B Additonal findings of hepatic cysts and hepatic fibrosis

C Concomitant presence of an imperforate anus

D Lack of ureteral development

E Papilloma of the bladder

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Question 42

If the urine dipstick test for blood is positive but no red blood cells are seen by urine sediment microscopy, a diagnosis to strongly consider is:

A Post-streptococcal glomerulonephritis

B Renal papillary necrosis

C Ureteral lithiasis

D Myoglobinuria

E Renal infarction

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Question 43

The major electron microscopic finding on renal biopsy of a 5-year-old boy with nephrotic syndrome who responded to corticosteroid therapy is:

A Fusion of foot processes

B Subepithelial electron dense deposits

C Duplication of glomerular capillary basement membranes

D Irregular thickening of the glomerular basement membranes

E Mesangial cell proliferation

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Question 44

A 70-year-old male with hematuria has a filling defect in the left renal pelvis on an intravenous pyelogram. This is most consistent with a lesion that led to:

A Polycythemia

B An elevated white blood cell count

C Nephrotic syndrome

D Hypertension

E Atypical cells on urine cytology

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Question 45

The finding of only 1-2 oxalate crystals per high power field on routine microscopic urinalysis of urine from a 22-year-old male most strongly suggests:

A Acute tubular necrosis

B Glomerulonephritis

C Polycystic kidney disease

D Oxalosis

E No underlying disease

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