page

OS214 2ND RENAL EXAM 1/5

renal 16 march 2006

sidmikelen

5. The ff is TRUE regarding patients with mild lower D. any of the above
urinary tract symptoms by IPSS Typical example of primary aldosteronism is an aldosterone-
secreting tumor. Renin is suppressed due to negative feedback
A. they have scores of less than 10 points
B. they will require drug treatment 41. The gene in VUR is
C. they are not at risk of developing prostate adenoCA A. nephrin
D. they should be advised to undergo annual DRE B. uroplakin III
Mild LUTS is IPSS grade <7-8. these people require supportive
management. Malignant transformation is always possible in NPH. C. podocin
D. nephrocalcin
Trans CAKUT
6. 32/M complains of bloody urine. On cytoscopy, a
papillary growth is seen arising from the urinary
bladder wall. The biopsy will reveal. 43. In a 7yo boy presenting with UTI, the best
A. Transitional cell CA diagnostic imaging modality is
B. Squamous cell CA A. KUB-UTZ
C. rhabdomyosarcoma B. retrograde pyelography
D. adenosarcoma C. KUB-IVP
Trans urologic emergencies. The most common histology for bladder D. VCUG
cancer in adults is transitional cell CA. Trans Interactive Session on UTI. For patients >5 y.o., the modalities
used are UTZ and DMSA.
13. In male catheterization, foley catheter should be
inserted up to 56. Which of the following can cause
A. urine flows out of catheter pseudohyponatremia
B. midway A. hyperglycemia
C. up to the hub B. hypergammaglobulinemia
D. 25cm C. hypertriglyceridemia
Trans urologic emergencies. In females, 5cm D. AOTA
Harrison’s p.255t: pseudohyponatremia can be caused by
hyperglycemia, hyperproteinemia, and hyperlipidemia
14. A patient with renal colic will NOT LIKELY
A. be restless 58. Which is NOT TRUE regarding hypernatremia?
B. present with urinary urgency and frequency A. All patients with hypernatremia are hyperosmolar
C. complain of nausea and vomiting B. It is always associated with dehydration
D. lie still because of severe pain C. it is not seen in normal adults with access to water
In renal colic, the patients are restless due to severe pain
D. NOTA
Sorry, I don’t know the answer but this might help: Trans Fluid &
28. Potter's syndrome is due to anomaly in Electrolyte Disturbances, Hypernatremia always represents
a. kidney ascent hyperosmolality [water loss or sodium retention]. It is never seen in
b. kidney induction an alert adult with access to water unless there’s an abnormal thirst
mechanism.
c. ureteral budding
d. ---
Potter’s syndrome is caused by absence of renal induction 59. In the treatment of hyperkalemia, the following
causes increased K+ entry into the cells:
30. A mutation in CAKUT gene X hinders the A. diuretics
interaction between ureteric bud and metanephric B. calcium gluconate
blastema. Abnormalities in this induction lead to C. β2 adrenergic agonists
a. dysplastic kidney D. cation exchange resins
Fluid & Electrolyte Disturbances, Trans last page & Harrison’s.
b. prune belly syndrome Diuretics increase K+ excretion. Calcium gluconate decreases
c. horseshoe kdney membrane excitability. Cation exchange resins are the K+:Na+
d. renal agenesis exchange and K+:Ca++ exchange. When administered parenterally
Trans CAKUT. No renal induction results in renal agenesis. or in nebulized form, β 2-adrenergic agonists promote cellular uptake
of K+.
36. What suggests a secondary hypertension?
a. onset at 40 years old 60. In patients with RTA, the anion gap is normal due
b. family history to:
c. unresponsive to medications in a previously A. hyperchloremia
stable hypertension B. hypernatremia
d. --- C. hyperkalemia
secondary hypertension is more common in the young. A strong D. hypercalcemia
history of hypertension in the family suggests essential hypertension Normal anion gap a.k.a. hyperchloremic anion gap

38. In a hypertensive crisis, the ff should be prioritized 61. Which of the following can cause hyperkalemia in a
A. lower BP with IV drugs patient with CRF
B. relief of dyspnea with IV drugs A. spironolactone
C. maintain patency of airways B. diuretic
D. control tachycardia C. calcium channel blocker
(I’m not sure but I think it’s A. According to the trans on HPN in D. α blockers
children and adolescents, severe symptomatic HPN should be Spironolactone is the diuretic of choice for CRF since it is
treated with IV antihypertensive drugs.) metabolized in the liver. It spares potassium causing hyperkalemia.

39. In primary aldosteronism, the plasma renin activity 62. LM 43/F with type 2 DM was referred for control of
(PRA) is BP. BP=170/100, PR=85/min, (-)edema. Which if the
A. suppressed following tests will you order to determine the level of
B. enhanced desirable BP for LM?
C. not affected A. CBC
 page
OS214 2ND RENAL EXAM 2/5

renal 16 march 2006

sidmikelen

B. serum potassium A. accumulation of advanced glycation end

C. 24hr creatinine clearance products
D. 24hr urinary albumin B. higher risk of Hepa C infection
(I’m not sure of this…) C. hypocomplementemia
D. dialysis dysequilibrium
(For 63-64) CE 23/F came in for nausea and vomiting. In PD, glucose is used to attract more water into the dialysate. These
She was diagnosed with Chronic GN since 2 years ago glucose are turned into AGEPs. All the rest are complications of HD
(both short and long-term)
and is on ARB. BP=140/90, PR=64/min, Wt=50 kg, (+)
mild edema, Hgb=120 g/L, serum creatinine=1.8
mg/dL, serum K=4.0 mEq/L. 70. Which is not an indication for acute dialysis?
A. intractable hyperkalemia
63. Which of the following is an appropriate B. intractable metabolic acidosis
management? C. severe hyponatremia
A. tranfuse blood and observe D. pulmonary edema
Trans on Dialysis.
B. Dialyze and transfuse
C. Look for causes of nausea and vomiting and treat 71. In which of the following conditions would
D. Give steroid and dialyze immunosuppressive medications be most likely needed
(Sorry I don’t know.…)
in the graft recipient
64 How will you treat CE’s hemoglobin A. transferring a kidney from one site to another in the
A. transfusion same individual
B. iron tablets B. a kidney donated from an identical twin
C. give erythropoietin C. a kidney from a fraternal twin sharing placental
D. NOTA circulation while in utero
(Again I’m don’t know… sorry. Based on the trans on chronic renal D. a kidney donated from an older sister
failure, give erythropoietin if Hgb is 10 g/dl, and transfuse if <10 g/dl. Trans transplantation immuno and therapeutics; the more identical,
Normal Hgb for females is 12-16 g/dl.) the less crossmatching, less rejection

65. The following diseases can present with normal 72. What is the likelihood that 2 siblings will have
sized kidneys in ESRD EXCEPT identical HLA
A. chronic GN A. 1%
B. polycystic kidney disease B. 25%
C. Amyloidosis C. 50%
D. DM D. 99%
Trans transplantation immuno and therapeutics. Mendelian
transmission.
66. 54/M with ESRD due to diabetic nephropathy
undergoes hemodialysis 3x/week, has computed Kt/V 73. What is the primary role of tissue crossmatching in
of 1.4 during his last hemodialysis session. He clinical transplantation
continues to work as a businessman and even plays A. to identify HLA match between donor and recipient
gold between dialysis days, and complains of no B. to detect recipient preformed antibodies against
particular symptoms on extensive review the donor graft
A. you would tell the patient that he is being C. to detect NK cells from the donor that may harm the
adequately dialyzed recipient
B. you would advise the patient that he will need to D. to identify if the donor kidney hitologically matches
increase his hemodialysis to daily in size with the donor kidney
C. you would consider continuing thrice weekly dialysis D. 99%
but increase the session lengths to 5 hours per session Trans transplantation immuno and therapeutics. Tissue
D. you would advise the patient that he no longer crossmatching primary role: detect preformed antibodies anti-HLA
needs to continue hemodialysis
K/DOQI hemodialysis guideline 4: Kt/V should be at least 1.2 74. Which cell is usually involved in the first signal
immune response to rejection with the antigen
67. Dialysis is able to partially compensate for which of presenting cell
the following native function of the intact kidney A. B lymphocytes
A. gluconeogenesis B. Helper T-cells
B. increasing erythropoietic activity C. natural killer cells
C. increasing 1α-hydroxylase activity D. CD8 T-cells
D. excreting metabolic wastes Trans transplantation immuno and therapeutics.

68. A stable hemodialysis patient’s last session yielded 75. Which of the following drugs used in
a computed Kt/V of 0.9 (you are confident that the Kt/V transplantation is a calcineurin inhibitor?
computation was properly done). He is on thrice a A. cyclcosporine
week hemodialysis. You would: B. basiliximab
A. lengthen the dialysis session C. azathioprine
B. use a lower blood flow rate during the session D. prednisone
C. shift to a dialyzer with a lower KoA Trans transplantation immuno and therapeutics. The other
calcineurin inhibitor is tacrolimus
D. tell the patient that he is being adequately dialyzed
lowering BFR would lower blood water clearance. Lowering KoA
would lower the amt of substance that can pass through the 76. In which of the following conditions will hematuria
membrane. The pt is not adequately dialyzed Kt/V should be at least be most commonly found
1.2
A. MCD nephrotic syndrome
B. myoglobinuria
69. Which of the following complications is expected C. kidney stone
more in peritoneal dialysis compared to hemodialysis
 page
OS214 2ND RENAL EXAM 3/5

renal 16 march 2006

sidmikelen

D. diabetic nephropathy A. amoxicillin

B. ceftriaxone
77. Which condition is commonly associated with low C. cefixime
C3 D. levofloxacin
A. poststreptoccocal GN E. cefuroxime
B. hypertensive nephropathy Trans Interactive session on UTI. Amoxicillin is not recommended
due to high incidence of resistance in the country.
C. IgA nephropathy
D. thin basement membrane
PSGN and MPGN both have activation of complement pathways in 84. Which is an unlikely cause of UTI
their pathogenesis thus there is consumption of complement A. Enterococcus faecalis
components B. Proteus mirabilis
C. Staphylococcus epidermidis
78. Which is more commonly associated with D. Staphylococcus aureus
glomerular hematuria than non-glomerular hematuria Harrison’s. A, B, D are all associated with UTI. Staph saprophyticus
A. high urine specific gravity is the other Staph species associated with UTI
B. proteinuria
C. clots in the urine 85. 35/F executive secretary, consults for a one day
D. intact RBCs in the urine history of high grade fever and chills associated with
Harrisons. Blood clot is almost never indicative of glomerular nausea, vomiting, and hypogastric discomfort. Past
bleeding; rather it suggests a postrenal source in the urinary history is unremarkable. Vital signs: BP=110/60,
collecting system. The RBCs of glomerular origin are often
HR=88/min, RR=16/min, temp=37.9°C. (-)crackles,
dysmorphic. Hematuria with dysmorphic RBCs, RBC casts, and
protein excretion >500mg/d is virtually diagnostic of (+)R CVA tenderness. What is the diagnosis?
glomerulonephritis. A. acute uncomplicated cystitis
B. acute uncomplicated pyelonephritis
79. Which condition is commonly associated with C. acute complicated pyelonephritis
upper respiratory occurring together with nephritis D. chronic pyelonephritis
A. diabetic nephropathy Trans Interactive session on UTI. Acute uncomplicated
pyelonephritis is seen in otherwise healthy females without clinical or
B. IgA nephropathy historical evidence of structural or functional urologic abnormalities.
C. post-strep nephritis Classic syndrome of chills, fever, flank pain, CVA tenderness,
D. Hepa B associated nephritis nausea, and vomiting.
Trans on hematuria: The clinical course of IgA nephropathy is
synpharyngitic. Emedicine article on Acute Post-strep GN: IgA
86. 25/F hospitalized for treatment of Staph aureus
nephropathy usually presents as an episode of gross hematuria
occurring during the early stages of a respiratory illness. Post-strep abscess of her left thigh. The wound is incised and
GN, there’s a latent period between the streptococcal infection and drained and she receives antibiotic therapy. She is
the development of clinical GN. improving and discharged home a week later, but the
next day she develops a fever. On PE, her temperature
80. Which of the ff urine culture results is NOT is 38.1°C and there is a diffuse erythematous skin rash
diagnostic of a UTI of her trunk and extremities, a urinalysis show sp gr
A. 105 colonies of Klebsiella pneumoniae via a clean 1.020, pH 6.5, 1+blood, 1+protein, no glucose, and no
catch midstream urine sample ketones. There are 10-20WBCs/hpf and 1-5 RBCs/hpf,
B. 102 colonies of Acinetobacter via suprapubic and a few eosinophils are noted on urine microscopic
aspirate examination. Which is the most likely diagnosis
C. 104 colonies of Proteus via midstream urine A. acute tubular necrosis
sample in a symptomatic child B. analgesic abuse nephropathy
D. 105 colonies of Escherichia coli via a catheterized C. drug-induced interstitial nephritis
specimen D. post-infectious GN
Midstream catch should yield ≥105 CFU Trans on Renal Patho. Diffuse erythematous skin rash probably
suggests an allergic reaction to the antibiotics that was given.
81. By clinical history, the symptom LEAST LIKELY to Eosinophils were also present which is characteristic of drug-induced
interstitial nephritis.
be associated with acute uncomplicated cystitis is
A. dysuria 87. 10/F brought to the physician because of
B. vaginal discharge increasing lethargy and passing dark-coloured urine for
C. back pain the past week. She has a sore throat 2 weeks prior. On
D. hematuria PE, she is afebrile with BP 140/90. Labs showed
E. urinary frequency serum creatinine=2.8mg/dL, BUN=24mg/dL. Urinalysis
(Sorry, I don’t know the answer... Trans Interactive Session on UTI.
The classic presentation of Acute Uncomplicated Cystitis (AUC) is shows dysmorphic RBCs. A renal biopsy is performed
dysuria, urinary frequency, and urgency. Also, in the case, there was and on microscopic exam glomerular hypercellularity
only suprapubic tenderness with no hematuria, vaginal discharge, with neutrophils present. EM shows subepithelial
and CVA tenderness.)
humps. Which of the following lab findings is most
likely to be present in this girl
82. The recommended duration of antibiotic treatment A. antibody to double stranded DNA
for acute cystitis in otherwise healthy women is B. anti-GBM antibody
A. 1 day C. positive C3 nephritogenic factor
B. 3 days D. elevated ASO titer
C. 7days Trans on Renal Patho. This patient has acute nephritic syndrome
D. 10 days and the prototype is acute post-streptococcal GN (sore throat 2
E. 14 days weeks prior, hematuria, glomerular hypercellularity with neutrophils,
Trans Interactive session on UTI subepithelial humps), which would result in elevated ASO titer.

83. The ff antibiotics are recommended empiric 88. 50/M noted passing darker urine for the past week.
treatment of acute uncomplicated pyelonephritis in the On PE, no abnormal findings. Urinalysis showed
Philippine setting EXCEPT pH=5.5, sp gr 1.013, 2+blood, no protein, no glucose.
 page
OS214 2ND RENAL EXAM 4/5

renal 16 march 2006

sidmikelen

Urine cytology showed atypical uroepithelial cells. A A. enlargement of the kidneys

urologist performs a cytoscopy and a fungating mass is B. normal findings
noted. He has 60 pack year history of smoking C. renal mass
cigarettes. Which of the following is the most likely D. pelveocaliectasia
diagnosis
A. adenoCA of prostate 95. In which of the ff cases would an IVP be the BEST
B. acute insterstitial nephritis imaging modality
C. bladder CA A. polycystic kidney disease
D. renal cell CA B. nephrolithiasis
Atypical uroepithelial cells tell us that it’s either urinary tract in origin. C. renal cell CA
Smoking is a risk factor for bladder CA
D. hydronephrosis
89. 30/F has severe skin problems associated with 96. Drug X is eliminated by the kidneys. It is filtered but
severe hypertension and acute renal failure. Renal not reabsorbed. If the patient is also receiving 40mg of
biopsy shows numerous glomerular crescents. Which if furosemide a day leading to an increase in daily urine
the ff abnormalities will most likely be seen in arterioles output of 50% above baseline, how will you adjust the
in the biopsy dose of Drug X
A. fibrinoid necrosis A. increase drug X by 25%
B. thickening of the muscle layer B. increase drug X by 50%
C. hyaline deposition C. increase drug X by 75%
D. fibrointimal thickening D. there is no need to adjust the dose
Trans on Renal Patho. Fibrinoid necrosis of arteries is seen in
malignant hypertension.
(For 97-100) Drug Y is 30% hepatic metabolism and
90. 52/M previously healthy has experienced episodes 70% renal excretion. Moreover, renal excretion is
of discomfort with urination for 3 mos. PE is normal. primarily due to filtration with negligible secretion and
Lab studies include a urinalysis that reveal no glucose, reabsorption. The GFR is decreased to 60% of normal
no protein, and 1+blood. Microscopic urine exam for Mr Juan dela Cruz and there is no change in
shows numerous RBCs, a few WBCs, no casts. Urine secretion and reabsorption. Hepatic metabolism is not
culture is negative. Plain film radiograph of the pelvis affected.
shows a rounded, radiopaque lesion in the region of
the bladder. Which of the ff lab test finding is most 97. What is the ratio of renal to hepatic clearance for
likely to be present in this man Mr Juan dela Cruz
A. proteinuria A. 0.9
B. elevated serum transaminases B. 0.8
C. hypercalciuria C. 0.7
D. RBC casts in urine D. 0.6
A and D are definitely wrong, because urinalysis revealed no protein
and there were no casts. Hypercalciuria may lead to stone formation, 98. What is the total systemic clearance of Mr Juan
so C might be the answer… but I’m not sure of this.
dela Cruz in comparison with the normal
A. 90% of normal
91. 5/M has UTI. You want to evaluate for B. 81% of normal
pyelonephritis. What is the BEST can to recommend C. 72% of normal
A. DTPA renal scan D. 60% of normal
B. DMSA renal scan Renal CL=GFR1=0.7,since GFR2=0.6GFR1
C. LASIX renal scan GFR2=0.42 -----> total CL=renal + hepatic=0.42+0.3=0.72
D. CAPTOPRIL scan
E. MAG3 renal scan 99. Assuming the same volume of distribution, what is
Trans Diagnostic Imaging Trans of Block B. DMSA renal scan is used the half life of Drug Y for Mr dela Cruz
to for cortical imaging to detect small focal lesions, acute
A. 111% of normal
pyelonephritis or cortical scars
. B. 123% of normal
C. 138% of normal
92. A renal transplant patient needs to have his renal D. 167% of normal
T1/2=(ln2)Vd/CL ----> Vd= T1/2(CL)/ln2
graft evaluated, how would you position the camera Since Vd is constant, T1/2a(CLa)/ln2= T1/2b(0.72CLa)/ln2
A. anterior Manipulate constants -----> T1/2b=T1/2a/0.72
B. posterior Therefore, T1/2b=1.38 T1/2a, where T1/2a is normal half-life
C. right lateral
D. left lateral
E. posterior oblique 100. If you want to maintain the same drug exposure
Kidneys in renal transplant patients are located within the peritoneum (AUC), how would you adjust the dose (hint: remember
not retroperitoneum.
the relationship of dose, AUC, and clearance)
A. decrease the dose in direct proportion to total
93. What exam will you request for if you are looking systemic clearance (e.g. If CL is 80% of normal, dose
for an adrenal pheochromocytoma in a young is 80% of normal)
hypertensive adult? B. increase the dose by the reciprocal of the total
A. KUB-IVP systemic clearance (e.g. if CL is 80% of normal, dose
B. ultrasound is 125% of normal)
C. CT scan C. decrease the dose to the square of % total systemic
D. renal angiogram clearance (e.g. if CL is 80% of normal, dose is 64% of
Trans Genito-Urinary Imaging.
normal)
94. What is the usual imaging finding in acute
pyelonephritis?
 page
OS214 2ND RENAL EXAM 5/5

renal 16 march 2006

sidmikelen

D. increase the dose by the square of the reciprocal of
% total systemic clearance (e.g. if CL is 80% of normal,
dose is 156% of normal)
II. Matching type
Sorry kung mejo kulang, mejo marami ang di
nakapass/nakalimot na kopyahin yung assigned sa
kanila. Nevertheless, sana malaking tulong na po ito.
Hi sa lahat ng friends namin.

A. Acute nephritis
B. Nephrotic syndrome
C. Acute renal failure
D. Chronic renal failure
E. Tubule defects

101. Aling Nene, 50yo fish vendor, brought to the ER

for a 5 day history of vomiting and diarrhea. She had
no urine output for the past 12 hrs. BP 70/50, HR
120/min, RR 28/min. urine shows RBCs with muddy
brown casts. Serum Na 125meq/L, K 2.5meq/L, Cl 90.
ABG shows pH 7.10, HCO3 15mmol/L, BUN 25mg/dL,
serum creatinine 5mg/dL (C) clue: acute oliguria/anuria

102. MD, 40yo hypertensive male, complains of

nausea and vomiting. His BP is 160/100. He is pale
with scratch marks over his extremities and trunk. UTZ
show bilaterally small kidneys. Serum creatinine
1000μmol/L (D) clue: pallor & bilaterally small kidneys

103. Manang, 60/F, is referred for pedal edema. She

has also been complaining of tingling sensations of her
hands and feet and easy fatigability, exertional
dyspnea, and orthopnea over the past year. PE shows
macroglossia and hepatomegaly. 24hr urine shows
7gms protein. Serum creatinine 1mg/dL (B) clue:
proteinuria >3.5 g & edema

A. Obstruction
B. Inflammation/Erosion
C. Neurogenic Bladder
D. Nephrolithiasis

104. Delilah, 22/F, consults for painful urination,

frequency, and urgency after coming from her
honeymoon. Urine shows many RBCs and WBCs. (B)
this is a case of UTI secondary to you know what

105. Lolo, 70/M, is admitted to the ER with anuria. Past

history reveals nocturia, frequency, and terminal
dribbling over the past several months. On PE a
hypogastric mass is palpated. On rectal exam, the
prostate is enlarged. Plain KUB revealed no localizing
signs. (A) BPH or prostate CA

Column A
106. cervical CA with bilateral pelvocaliectasia, creat
5mg%
107. CHF, BUN 40mg%, creat 1.5mg%
108. septic shock, FENa 2
109. liver cirrhosis, urine Na 5meq/L

Column B
A. pre-renal azotemia
B. intrarenal azotemia
C. post-renal azotemia

114. Chronic liver disease

A. furosemide
B. acetazolamide
C. Spironolactone
A is metabolized in the kidneys, thus can be given to those with liver
problems. (??) B is for glaucoma.

Hi to those who would benefit from this. The group

tried their best to answer this samplex TRUTHfully.