Internal Medicine/ Nephrology

                                                                                 I.            Common Renal Presentations.

 

1.    Polyuria.

***) All of the following can cause polyuria, except: Q2012

A.    Hyperglycemia

B.     Diabetes insipidus

C.     Hypothyroidism

D.    Psychogenic

E.     Hypercalcemia

 

Answer: C* Hypothyroidism

 

***) Polyuria and polydipsia can be due to all of the following, except:

A.    Deficiency of arginine and vasopressin

B.     Deficiency of insulin

C.     Hypercalcemia

D.    Hyperkalemia

E.     Psychogenic causes

 

Answer: D* Hyperkalemia

 

***) Polydipsia and polyuria is caused by all of the following, except:

A.    Acute renal failure

B.     Diabetes insipidus

C.     Hypercalcemia

D.    Primary polydipsia (hysterical)

E.     Hyperkalemia

 

Answer: E* Hyperkalemia

 

***) Thirst and polyuria may be caused by all of the following, except:

A.    Hypercalcemia

B.     Diabetes mellitus

C.     Hypothyroidism

D.    Diabetes insipidus

E.     Hypokalemia

 

Answer: C* Hypothyroidism

 

                                                                                                                     II.            Renal Medicine.

 

1.    Urine.

***) All of the following can cause hematuria, except:

A.    Renal stone

B.     Renal tuberculosis

C.     Malignant hypertension

D.    Renal tubular acidosis

E.     Cystitis

 

Answer: D* Renal tubular acidosis

 

***) All of the following can cause hematuria, except:

A.    Prostate carcinoma

B.     Tuberculosis

C.     Stone

D.    Pregnancy

E.     Papillary necrosis

 

Answer: D* Pregnancy

 

***) Hematuria either macroscopic or microscopic is found in all of the following, except:

A.    Infective endocarditis

B.     Papillary necrosis

C.     Use of anticoagulants

D.    Amyloidosis

E.     Schistosoma haematobium infection

 

Answer: D* Amyloidosis

 

***) Recognized causes of macroscopic hematuria include all of the following, except:

A.    Glomerulonephritis

B.     Urinary tract infection

C.     Accelerated hypertension

D.    Exposure to cold

E.     Renal cysts

 

Answer: D* Exposure to cold

 

***) Recognized causes of macroscopic hematuria include all of the following, except:

A.    Glomerulonephritis

B.     Renal cyst

C.     Urinary tract infection

D.    Renal calculus

E.     Proximal tubular acidosis

 

Answer: E* Proximal tubular acidosis

 

***) Painless hematuria is the leading presentation of:

A.    Renal cell carcinoma

B.     Transitional cell carcinoma of the bladder

C.     Ureteric stone

D.    Pelvi-ureteric obstruction

E.     Ureterocele

 

Answer: D* Renal cell carcinoma

 

***) All of the following can cause proteinuria in excess of 3 grams per 24 hours, except:

A.    Membranous glomerulonephritis

B.     Malignant hypertension

C.     Diabetic nephropathy

D.    Obstructive uropathy

E.     Renal amyloidosis

 

Answer: D* Obstructive uropathy

 

***) The protein present in the greatest quantity in the urine of normal people is:

A.    Albumin

B.     Tamm-Horsfall protein

C.     Gamma globulin

D.    Amylase

E.     Bence-Jones protein

 

Answer: A* Albumin

 

***) All of the following statements are correct about routine urine examination, except:

A.    Specific gravity of 1015 is normal

B.     Red blood cell cast is normal finding

C.     One red blood cell is normal finding

D.    One white blood cell is normal finding

E.     Negative sugar is normal finding

 

Answer: B* Red blood cell cast is normal finding

 

2.    Urinary Tract Infections.

***) The commonest cause of urinary tract infection is:

A.    Proteus species

B.     Escherichia coli

C.     Klebsiella

D.    Pseudomonas

E.     Citrobacter species

 

Answer: B* Escherichia coli

 

***) The most definitive diagnosis for urinary tract infection is:

A.    Presence of 10 000 bacteria per ml in urine culture

B.     Presence of WBC in the urine

C.     Presence of WBC and protein in the urine

D.    Presence of 100 000 bacteria per ml in a properly collected urine by culture

E.     Presence of pain in the right loin

 

Answer: D* Presence of 100 000 bacteria per ml in a properly collected urine by culture

 

***) Regarding urinary tract infection all of the following are true, except:

A.    Frequency and foul smelling urine are presenting complaints

B.     First morning specimen voided is not suitable for colony count

C.     Fever

D.    Abdominal pain

E.     Nearly always causes pyuria

 

Answer: B* First morning specimen voided is not suitable for colony count

 

***) As regards recurrent urinary tract infection, one is correct:

A.    The commonest organism is Klebsiella

B.     Affects males more than females

C.     It is a common cause of chronic renal failure

D.    The aim of management is clinical cure

E.     Children are immune to develop this disease

 

Answer: C* It is a common cause of chronic renal failure

 

3.    Glomerulonephritis.

***) Which of the following urinary findings is most characteristic of glomerulonephritis: Q2012

A.    Hyaline cast

B.     Granular cast

C.     RBCs cast

D.    WBCs cast

E.     Epithelial cast

 

Answer: C* RBCs cast

 

***) Which of the following urinary findings is most characteristic of acute glomerulonephritis:

A.    Proteinuria

B.     Microhematuria

C.     Granular casts

D.    Erythrocyte casts

E.     Hyaline casts

 

Answer: D* Erythrocyte casts

 

***) Acute glomerulonephritis is characterized by all of the following, except:

A.    Hypercholesterolemia

B.     Edema

C.     Hematuria

D.    Oliguria

E.     Hypertension

 

Answer: A* Hypercholesterolemia

 

***) Acute glomerulonephritis may be associated with which one of the following:

A.    Glycosuria

B.     Elevated serum cholesterol

C.     Elevated serum complement

D.    Encephalopathy

E.     Hypercalcemia

 

Answer: C* Elevated serum complement

 

***) Complications of post streptococcal acute glomerulonephritis may include all of the following, except:

A.    Hyperkalemia

B.     Hypernatremia

C.     Encephalopathy

D.    Pulmonary edema

E.     Anuria

 

Answer: B* Hypernatremia

 

***) Which of the following is not associated with post streptococcal glomerulonephritis:

A.    Hematuria

B.     Fatty casts

C.     Red blood cell casts

D.    Edema

E.     Oliguria

 

Answer: B* Fatty casts

 

***) Manifestations of the nephritic syndrome include all of the following, except:

A.    Oliguria

B.     Hypertension

C.     Pulmonary edema

D.    Hematuria

E.     Peripheral neuropathy

 

Answer: E* Peripheral neuropathy

 

***) In which of the following diseases would you expect to find the nephritic syndrome:

A.    Pyelonephritis

B.     Acute glomerulonephritis

C.     Urinary tract infection

D.    Mild hypertension

E.     Amyloidosis

 

Answer: B* Acute glomerulonephritis

 

***) Criteria of the nephritic syndrome include one of the following:

A.    Proteinuria less than 3gm/24h

B.     Hypertension

C.     Pulmonary edema

D.    Hyperglycemia

E.     Lipiduria

 

Answer: A* Proteinuria less than 3gm/24h

 

4.    Nephrotic Syndrome.

***) The nephrotic syndrome is characterized by all the following, except:

A.    Edema

B.     Proteinuria

C.     Hypoalbuminemia

D.    Hyperlipidemia

E.     Hypertension

 

Answer: E* Hypertension

 

***) All of the following are features of nephrotic syndrome, except:

A.    Hypocholesterolemia

B.     Hypoalbuminemia

C.     Edema

D.    Heavy urinary protein loss

E.     Puffiness around the eyes

 

Answer: A* Hypocholesterolemia

 

***) All of the following can cause calcification in the renal tract, except:

A.    Shistosomiasis

B.     Hyperparathyroidism

C.     Tuberculosis

D.    Nephrotic syndrome

E.     Hydatid cyst

 

Answer: D* Nephrotic syndrome

 

5.    Acute Renal Failure.

***) In acute renal tubular necrosis all of the following are true, except:

A.    Proteinuria may be present

B.     BUN is usually increased

C.     Creatinine is usually increased

D.    Urine is usually hyperosmotic

E.     With prompt treatment recovery is expected in most cases

 

Answer: D* Urine is usually hyperosmotic

 

***) The following are recognized causes of acute renal failure, except:

A.    Goodpasture’s syndrome

B.     Hemolytic uremic syndrome

C.     Minimal change disease

D.    Scleroderma crisis

E.     Post infectious glomerulonephritis

 

Answer: C* Minimal change disease

 

***) Causes of acute renal failure include all the following except:

A.    Severe dehydration

B.     Severe burn

C.     Uncomplicated urinary tract infection UTI

D.    Severe hemorrhage

E.     Hemolytic uremic syndrome

 

Answer: C* Uncomplicated urinary tract infection UTI

 

***) Complications of acute renal failure include each of the following, except:

A.    Pulmonary edema

B.     Hyperkalemia

C.     Hypernatremia

D.    Encephalopathy

E.     Acidosis

 

Answer: C* Hypernatremia

 

***) A patient with acute renal insufficiency is likely to develop any of the following disturbances, except:

A.    Hypoalbuminemia

B.     Hyperkalemia

C.     Hypocalcemia

D.    Hypernatremia

E.     Hyperphosphatemia

 

Answer: D* Hypernatremia

 

6.    Chronic Renal Failure.

***) Complications of chronic renal failure include all of the following, except: Q2012

A.    Hypocalcemia

B.     Hyperphosphatemia

C.     Metabolic acidosis

D.    Hypernatremia

E.     Hyperkalemia

 

Answer: D* Hypernatremia

 

***) One of the following is not an absolute indication for dialysis in chronic renal failure patients: Q2012

A.    Hyperkalemia

B.     Hypercalcemia

C.     Pulmonary edema

D.    Metabolic acidosis

E.     Pericarditis

 

Answer: B* Hypercalcemia

 

***) The most common cause of chronic renal failure is:

A.    Glomerulonephritis

B.     Pyelonephritis

C.     Diabetes

D.    Analgesic nephropathy

E.     Amyloidosis

 

Answer: C* Diabetes

 

***) All of the following are complications of chronic renal failure, except:

A.    Hyperkalemia

B.     Alkalosis

C.     Anemia

D.    Hypertension

E.     Renal osteodystrophy

 

Answer: B* Alkalosis

 

***) Complications of chronic renal failure include all of the following, except:

A.    Peripheral neuropathy

B.     Pericardial involvement

C.     Hypercalcemia

D.    Anemia

E.     Proximal myopathy

 

Answer: D* Hypercalcemia

 

***) In chronic renal failure the serum concentration of the following substances is increased, except:

A.    Uric acid

B.     Calcium

C.     Urea

D.    Creatinine

E.     Phosphorus

 

Answer: B* Calcium

 

***) All of the following drugs are contraindicated in chronic renal failure, except:

A.    Tetracycline

B.     Nalidixic acid

C.     Nitrofurantoin

D.    Aspirin

E.     Methyldopa

 

Answer: E* Methyldopa

 

7.    Interstitial Nephritis & Nephrotoxins.

***) Interstitial nephritis may be caused by all of the following, except:

A.    Phenacetin

B.     Streptomycin

C.     Furosemide

D.    Digoxin

E.     Garamycin

 

Answer: D* Digoxin

 

8.    Polycystic Kidney Disease.

***) 50 years old male presented with hematuria, the examination was normal except for an elevated BP 164/95. US of the kidney reveal multiple renal cysts in both kidneys. His father had a similar condition. One of the following is not associated with the syndrome: Q2012

A.    Liver cysts

B.     Intracranial aneurysm

C.     Autosomal dominant inheritance

D.    Disseminated coagulopathy

E.     Progression to end stage renal disease

 

Answer: D* Disseminated coagulopathy

 

***) In the polycystic disease of the kidney presenting in adulthood all of the following are true, except:

A.    It is inherited as an x-linked

B.     It can cause hypertensive heart disease

C.     It is associated with cysts of the liver and pancreas

D.    It is associated with aneurysm of the circle of Wills

E.     It commonly cause microscopic hematuria

 

Answer: A* It is inherited as an x-linked