NEPHROLOGY QUESTIONS
1- middle ages patient had albumin creatinine ration of 30mg/dl without proteinuria, what is the next
step?
a. Do nothing Micro
b. Start ACE inhibitor Albuminuria 30 300 Moderate increased
c. Spirolacton Mslg
d. CCB
Answer is B
2- patient brought by his friend, unconscious, his friend gave history of drink something in the party
yesterday, O/E: unconscious, Labs: low Ca, calcium oxalate crystals in urine microscopy,rincreased
I
anion gap metabolic acidosis associated with a serum bicarbonate level 8 t likely
ingested substance?
a. Ethylene Glycol
b. Cocaine
c. Amphetamine
Answer is A
o
3- 14-year-old boy with generalized anasarca, proteinuria (picture of minimal change). What kind of
casts will you see in the urine?
a. Fatty
b. Waxy
c. Hyaline
Answer is
4- Patient with DM has history of diarrhea then develops muscle paralysis. On exam tender abdomen.
Potassium level is 2.8. What is the next level to check?
a. Urine potassium
b. Serum magnesium
c. Serum bicarbonate
Answer is B
5- IV drug user with history of axillary mass found to have proteinuria 1.5 g. Renal US shows kidney
size 13 cm. 17
Normal size
What is the diagnosis?
severe 0.5g 3.55 24
A. HIV nephropathy
B. FSGS Large kidney on us
C. Amyloid
Answer is B
6- Patient with history and lab picture consistent with multiple myeloma. She has renal impairment.
a What is the cause?
A. ATN
B. AIN
C. Hypercalcemia induced hypovolemia?
D. Other option
p from tight chains accumulation
Answer is C (most common cause of AKI in MM is cast nephropathy .so if it was an option it will be the
correct answer otherwise hypovolemia and hyper Caebecause they will accelerate tubular obstruction
7-
diagnosis?
A. Lupus nephritis
B. MPGN
Answer is A
8- Question about Long term analgesia with renal failure urine microcopy showed Leukocytes?
Answer: interstitial nephritis.
9- patient presented with left groin pain, O/E afebrile BP:120/70, mild tenderness in left flank
area. Normal urine analysis and CBC. Ultrasound showed 4 mm ureteric stone with mild
hydronephrosis. What is the treatment?
a. IV cephalexin
b. Increase IV fluid 5 mm D Nothing
c. Lithotripsy 10 mm Surgery
d. Percutaneous nephrostomy
Answer is B
6 o D Expo1Siutherapy
10- Urine dipstick detects which type of protein a-Gamma globulins
a. Albumin
b. Tom-horsefall
c. Low molecular weight protein
d. Bence jones protein
Answer is A
0
11- A disorders predisposing to renal stone formation does not include:
a. UTI
b. Prolonged immobilization
c. Hypoparathyroidism Not
d. RTA true
e. Cushing syndrome
Answer is C
O O
12- Old male with heavy proteinuria. All the following are causes except
a. Chronic GN
b. Amyloidosis
c. Multiple myeloma
Answer is C
o
13- Pt with H/O gout came with abdomen pain, found to have renal stone. Most likely cause?
a. Uric acid stone
uri
d
b. Calcium stone
Answer is A.
14-
a. Thiazide
b. Spirolacton
c. ACE
Answer is A
15- Which one is protective If decrease cause renal stone:
a. Citrate
b. Cysteine
c. Uric acid
d. Oxalate
Answer is A
Prevention of recurrent calcium stones (which are usually composed primarily of calcium oxalate) is
aimed at decreasing the concentrations of the lithogenic factors (calcium and oxalate) and at
increasing the concentrations of inhibitors of stone formation, such as citrate.
Increasing urinary citrate excretion is the goal in patients with low urine citrate since citrate inhibits
calcium stone formation by forming a poorly dissociable but soluble complex with calcium, thus
reducing the amount of calcium available for binding with oxalate or phosphate.
16- Elderly patient came with history of loin pain and fever, (±hematuria), on Exam there is
andwlocontrast
costophrenic angel tenderness, what is best investigation modality?
a. CT Abdomen and pelvis w
b. Renal US
c. Cystoscopy
d. IVU
Answer is A
Computed tomography (CT) scanning of the abdomen and pelvis (with and without contrast) is
generally the
study of choice to detect anatomic or physiologic factors associated with acute complicated UTI; it is
more
sensitive than excretory urography or renal ultrasound for detecting renal abnormalities predisposing
to or
caused by infection and in delineating the extent of the disease.
Renal ultrasound is appropriate in patients for whom exposure to contrast or radiation is undesirable.
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17- A patient came with classical obstructive urinary symptoms. He currently complaining of
urinary incontinence that he suddenly finds himself wet without a triggering event or symptoms,
no diurnal variation, what is the most likely mechanism of incontinence in this patient?
a. Stress incontinence
b. Urge incontinence
c. Overflow incontinence
d. Neurogenic bladder
Answer is C
18-
a. RBC casts
b. Granular casts
c. Hyaline casts
Answer is C
19- young patient presented with 9 gram protein in the urine, high creatinine and urea level
but normal C3, C4 This patient could have any of the following except:
SLE Nephritis (in flare c3 c4 will be low ) r
FSGS
Post-streptococcal GN
IgA GN
answer is C
>3.5 gram is nephrotic range without hematuria. PSGN is less likely+ its will be with low c3
20- Case 20-year-old male with edema, proteinuria, normal blood pressure and creatinine.
The best management?
a. Prednisolone
answer is A
21- long case of young male with proteinuria, and histologic lesion in electron microscopy is diffuse
effacement of the epithelial foot processes on kidney biopsy, what is the best Tx?
a. Prednisone
b. ACE
c. ARB
answer is A (case of MCD)
22- hemoptysis with renal involvement, what antibody will give the diagnosis?
a. anti-GBM antibodies
answer is A
23- obese young patient previously healthy, presented with HTN, generalized edema, and
proteinuria (8 gram/day), most likely diagnosis?
a. FSGS
b. Minimal change disease
c. Membranous GN
Answer is A
24- Pt has hemoptysis. RBCs casts in urine what is the most likely diagnosis?
a. Good pasture
Answer is A
O
25- Pt with pharyngitis after 24 hours present with hematuria what is the most likely diagnosis?
a. IgA nephropathy
b. RPGN
answer is A
o co
26- elderly patient with malignancy presented with nephrotic syndrome, what is the most likely
cause?
a. Minimal change
b. FSGS
c. Membranous GN
Answer is C
a. Wegner granulomatosis
true
O
27- All of the following cause low complements except?
ANCA related
b. MPGN
c. Post streptococcal GN
Litis
vasca
d. cryoglobulinemia
Answer is A
28- Hodgkin lymphoma presented with proteinuria, what is the diagnosis?
a. FSGS 0
b. Membranous GN
c. Minimal change disease
Answer is C
29- IgA nephropathy, all true except:
a. High serum IgA (found in 50% only and this finding is not specific neither has diagnostic or
prognostic value)
b. Low complement (it should be normal)
c. Develops 2-3 post URTI (1 to 3 days with no latency period)
d. Can present with intermittent macroscopic hematuria (true)
Answer is B and C
30- female with symptoms suggesting lung problem, with recurrent attacks of epistaxis, O/E new
lower extremities rash, chest x ray shows nodular lesions, urine dipstick shows +2 proteinuria and
hematuria, what is the best investigation:
a. Renal biopsy
b. P ANCA
c. Lung biopsy weg D Renal
Answer is A
Biopsy
O
31- sickle cell anemia causes renal pathology through all the following mechanism except?
a. FSGS
b. Papillary necrosis
c. Hematuria
O
d. Type 1 RTA
e. Loss of concentrating ability
All of them are true!! / I think the question written wrong
Answer is ?C < from the pervious years
O
32- all true regarding goodpasture syndrome except:
a. Linear shape deposits
b. Increase with smoking
c. Nephrotic range of proteinuria
d. Crescentic GN Notte
Answer is C
33- 18 year old girls presented with periorbital puffiness, lower limb edema, urine shows frothy urine,
4 G proteinuria. Renal biopsy done and showed fusion of podocytes. What is the treatment?
a. Prednisolone
b. ACEI
c. Cyclosporine
d. Cyclophosphamide
Answer is A
34- what type of nephrotic syndrome respond dramatically to steroid?
a. minimal change disease
Answer is A
35- patient on prednisolone for lupus nephritis, admitted for cholecystectomy, what is the next step?
C
a. Cancel surgery and do lithotripsy
b. Change prednisolone to cyclosporine 2 weeks before the surgery
c. Give hydrocortisone IV before surgery
d. Double prednisolone dose before surgery
Answer is C
36- a 38 year old female with lower respiratory symptoms and hemoptysis, urinalysis showed +2
protein and hematuria. Renal biopsy showed necrotizing vasculitis with scattered immunoglobulin and
complement deposits. What is the diagnosis?
a. Lupus nephritis
wa
b. Microscopy polyarthritis
c. Wegner granulomatosis
d. Good pasture syndrome
e. Henoch-schonlein purpura
Answer is C
O
37- 19 year old boy known to have membranous nephropathy on steroids. He suddenly developed
right flank pain and swelling in left testis. What is the next step?
a. Doppler ultrasound
b. Renal scan
c. Angiogram
d. Renal biopsy
Thrombosis D Doppler
e. Pelvic CT scan
Answer is A
38- 25 year old lady presented with pulmonary embolism, found to have positive anti DsDNA, high
creatinine, proteinuria, what is the most likely cause?
pm a. Amyloidosis
b. FSGS
c. Minimal change disease
d. Membranous nephropathy
Answer is D (it should be SLE with APL. yes membranous has high risk of VTE among GN, but
this is classical presentation of SLE )
39- case of wegners with hematuria and high creatinine with no pulmonary symptoms, renal biopsy
showed pauci immune crescentric GN. What is the treatment?
a. Steroid
b. Steroid and cyclophosphamide or
c. Steroid and plasmapheresis
Rituximab 1 plasmapharesis
d. Steroid and mycophenolate mofetil
Answer is B
o
a. Membranoproliefrative type 1 0
40- patient with nephritic syndrome and hepatitis C virus. What is the most likely diagnosis?
b. Membranous GN
c. Mesangiocapillary GN Type 1 D
HSV Cryagglobulineni
d. IgA nephropathy
Type 2 D Pagrtal lipodystrophy
Answer is A
a
41- 58y old man presents to the ER C/O SOB, hemoptysis, anorexia and Generalized fatigability,
arthralgia. he is found to have a purpuric rash, peripheral edema. CXR reveals diffuse opacification
o
investigation, Na 135, k 5, WBC 14.2, PLT 448, creat 200, normal liver function test which of the
following is the most likely diagnosis?
O
a. ANCA
b. Hepatitis c
c. Mixed cryoglobulinemia
d. Sepsis
e. Toxic shock syndrome
Answer is A
42- 50 y old woman has aware of passing dark urine dipstick shows Blood +++ Protein +, urine
microscopy shows dysmorphic red blood cells & red cells cast Which of the following most likely
explanation?
a. ATN
b. Amyloidosis
c. Cystitis
d. GN
e. Pyelonephritis
Answer is D
43- which of the following feature suggests Good pasture disease?
a. circulating C- ANCA
b. mesangial IgA deposition
c. presenting with nephritic syndrome
d. hemoptysis & pulmonary infiltrate is common finding
e. associated with HLA-DR3
answer is D
44- Patient developed sore throat then developed GN. What is the type of immune reaction?
a. Type I
b. Type II
c. Type III
d. Type IV
Answer is C
i
45- What is the electron microscope finding in patient with PSGN?
a. Sub epithelial hump
b. Endothelia deposits
c. Mesangial diffuse deposits
Answer is A
46- A 25-year-old black man is evaluated in the emergency department for swelling of the feet and
legs. He has a 5-year history of HIV infection for which he has refused treatment. On physical
examination, Vitals were in the normal range. BMI is 23. CVS examination is normal. Abdominal
examination is normal. There is 2+ presacral and +3bilateral lower-extremity edema. Laboratory
studies:
RNA viral load 120,000 copies/mL
Hepatitis B surface antigen(HBsAg)Negative
Antibodies to hepatitis C virus(anti-HCV)Negative VDRL Negative
Antinuclear antibodies Negative
Blood urea nitrogen 18 mg/dL (6.4 mmol/L)
Serum creatinine 1.1 mg/dL (97.
Urinalysis: 4+ protein; 2-3 erythrocytes/hpf; 1-2 leukocytes/hpf Urine protein-creatinine ratio 12
mg/mg Kidney ultrasound reveals bilaterally enlarged kidneys with patchy areas of increased density.
The renal veins are patent. Kidney biopsy is performed, and results are pending. Which of the
following is the most likely diagnosis?
a. Collapsing focal segmental glomerulosclerosis
b. IgA nephropathy
c. Membranous nephropathy
d. Post infectious glomerulonephritis
Answer is A
47- Patient known case of mitral valve prolapse with endocarditis presented with acute renal failure
the Mechanism: other have completeOzz
a. ATN
b. Interstitial nephritis started on AbI
c. Post infectious GN Urine Granular WBC cast
Answer is C Answer AIN
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infected-ventriculoatrial-shunt
a. Mesangial proliferation 0
48- IgA nephropathy all true except:
as per Driver
b. Immunoglobulin level helpful
c. Respond to steroid
d. High recurrence after transplant
Answer is B
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0
49- the commonest cause for pulmonary renal syndrome:
a. C-ANCA
b. IgA nephropathy
answer is A
Massive proteinuria
50- nephropathy? Normal or Largekidney
a. Rapid progression to ESRD FSGS collapsing
b. Membranous GN
P urea Pcr
???Answer is A (incomplete Q) Normtinsion
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50- Patient with membranous nephropathy developed flank pain. Testicular swelling Renal vein
thrombosis picture Next step is:
a. Doppler US
b. CT abdomen
c. MRI
Answer is A
51- Young patient took NSAIDS developed nephrotic syndrome with normal UA except protein 4+.
most likely diagnosis?
a. Minimal Change Disease
b. FSGN
As per Dr Naser
c. Membranous GN
Answer is A
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disease-in-adults#H10
52- A 45-year-old female with nephrotic syndrome develops renal vein thrombosis. What changes in
patients with nephrotic syndrome predispose to the development of venous thromboembolism?
a. Reduced excretion of protein S
0
b. Loss of antithrombin III
c. Reduced excretion of protein C
d. Loss of fibrinogen
e. Reduced metabolism of vitamin K
Answer is B
53- Patient in 40 years has proteinuria in nephrotic range with bland sediment what is the diagnosis?
a. FSGS
b. Minimal change
c. membranous glomerulonephritis
d. IGA nephropathy
Answer is A (most common nephrotic syndrome in adults)
54-
a. Steroids
b. mycophenolate mofetil
Answer is A
55-
a. ACEI + antiretroviral therapy
b. Steroids
Answer is A
56-
a. fusion of podocyte
Answer is A
57- Patient with hepatitis and GN + urine RBC?
DMembranous
Hep B
a. Membranous GN
b. Membranoproliefrative GN
c. Minimal change disease
Hep C DMPGNTypeI
Answer is B (if hep b > membranous: if hep c MBGN)
Hypouolemic
O
p
o
o
O O
Dysfunction of
NI B EL Cotransport
in loop of henle
Salt wasting Metabolic Alkalo
Hypokalemia
A Hypercalciuria
renin P Aldessteron
SIADCH D Rewstrfect
g
Rhum a
0
Hish K
O
0
o
O
O
D All cause Metabolicalkalosis
e
Hypervolemic
Hypotonic
hatremia
Pseudo
hyperkalemia
repeatele.ve
I
Endo
Addison
E NU Hypotonic Ecevolemic
f k
Metabolic Acidosis
co urine
Inability to concentrate
Uosm 200
O
watery Cnd during water deprerat
depravation No Ain Uosm
Noelfect
O O
O
0 O
0 0
N salt
restriction
a
NO PH 7.40 AG 1012
CO2 40 D D 21 MAGMA
HCOz 24 71 t Metabolic
Alkalosis
Metabolicalkalosis
Ep 2 1.5 110348 12
O
mPC0zl 5 Epco22312 176 28011,176 MA
as GD D 18 14 1.28
I D satiated
hypokalemia
Mim Type 2 Proximal Fanconi
0
HAGMA
MP z 48 7 ePCoz171
D D 23
18 1.2
Na 1k 0 Cl 11 103
121 23 0 93 15.6
124 0 108.6
15.40
176 5 MAGMA
mPCoz48 7
Ep 220
respiratory acidocis
R Alkalos
176 38 HAGMA
D D 28 3 9.3
72
M Alkalos
MAGMA
D Hyperkalemia
176 28
mpcozzo ERO H AG MA
D D 18
16
1.12
U
I
J t a
respiratorsacidosis MP 2 40
ep 2 261 2
Metabolic Alkalosis
mPcoz 5z g EPC02 49 1
I
0.7 37 24
49
AGM112 Alkalosis
Aspirin
0
C
Normalization
of
ABG
and severely
hypoxic
treatment Nottrue
Cardio
Notting
Oo
seizure p Rabedo
better to do EGG
Duplex US
CT Angio
for No rmal
MR Angio
f there is AII
O t
depends on
Gist
0
Hemato T
Not true
Nottrued
ftp.go.natecrona
Its
0 21
End
0
It
NIIretinopathy
Adrenal
D
8
Vaccination
O
relativeindication as per Naser
0
O o
OO
