1- A 25-year-old man developed bilateral loin pain and frank haematuria. His symptoms had started 24 hours after developing a sore throat. His blood pressure was 138/88 mmHg. Urinalysis was positive for blood (4+) and protein (2+). What is the most likely diagnosis? 1) IgA nephropathy 2) microscopic polyangiitis 3) nephrolithiasis 4) post-streptococcal glomerulonephritis 5) septicaemia
2- A 70 year old female is admitted 12 hours after taking an overdose of aspirin. Investigations revealed: Serum sodium 138 mmol/L (137-144), Serum potassium 5.9 mmol/L (3.5-4.9), Serum bicarbonate 14 mmol/L (20-28), Serum urea 18.1 mmol/L (2.5-7.5), Serum creatinine 238 umol/L (60-110), Serum salicylate 1120 mg/L (8 mmol/L). What is the most appropriate treatment of this patient? 1) Haemodialysis 2) Haemofiltration 3) Intravenous sodium bicarbonate. 4) Peritoneal dialysis. 5) Urine alkalinization.
3- Which of the following is associated with Hyperuricaemia? 1) is usually due to an excess purine consumption 2) occurs in association with acute lymphoblastic leukaemia 3) in primary gout is inherited in an autosomal dominant manner 4) can be reduced with low dose aspirin therapy 5) can be treated with uricosuric drugs even in renal failure
4- A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110). What is the main factor that determines the choice of loading dose of digoxin in this patient? 1) Absorption 2) Apparent volume of distribution 3) Lipid solubility 4) Plasma half-life 5) Renal clearance
5- The following are complications of nephrotic syndrome with the exception of 1) acute renal failure 2) accelerated hypertension 3) hypocalcaemia 4) pneumococcal infection 5) venous thrombosis
7- A 44-year-old woman with type 1 diabetes mellitus has not attended the diabetic clinic for 5 years. Her HbA1c is 10.1%. Examination shows no abnormalities. Her hemoglobin level is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 mcm3. A blood smear shows normochromic, normocytic anaemia. Which of the following is the most likely cause? 1) acute blood loss 2) chronic lymphocytic leukaemia 3) erythropoietin deficiency 4) microangiopathic haemolysis 5) sideroblastic anaemia
8- A 60-year-old woman is admitted with sudden onset of chest pain and is diagnosed with an acute myocardial infarction. Her acute illness is complicated by low blood pressure and poor tissue perfusion for several days. Her serum lactate becomes elevated. Her serum urea and creatinine are noted to be increasing. Day 1 Day 2 Day 3 urea (mmol/L) 8 22 30 creatinine (µmol/L) 116 140 200 Granular and hyaline casts are present on microscopic urinalysis. The renal lesion that is most likely to be present in this situation is? 1) Acute tubular necrosis 2) Minimal change disease 3) Nodular glomeruloscerosis 4) Pyelonephritis 5) Renal vein thrombosis
9- A 25-year-old man developed bilateral loin pain and frank hematuria. His symptoms had started 24 hours after developing a sore throat. His blood pressure was 138/88 mmHg. Urinalysis was positive for blood (4+) and protein (2+). What is the most likely diagnosis? 1) IgA nephropathy 2) microscopic polyangiitis 3) nephrolithiasis 4) post-streptococcal glomerulonephritis 5) septicaemia
10- Which of the following concerning renal blood flow is true? 1) is 40% of the cardiac output at rest 2) can be measured using the Fick principle 3) is higher in the medulla than the cortex 4) is increased when renal nerves are stimulated 5) is decreased in response to hypoxia
11- What is the most likely outcome of minimal change nephropathy at 16 year of age? 1) a tendency to relapse 2) full renal recovery 3) permanent renal impairment 4) persistent hypertension 5) persistent proteinuria
12- Which of the following concerning the pH of urine is correct? 1) is a useful indicator of the acid/base balance of the blood 2) rises on a vegetarian diet 3) is determined by the concentration of ammonium 4) is lower than 5.5 in renal tubular acidosis 5) would be above 7.0 after prolonged and severe vomiting
13- A 2 week old male child is brought to casualty by his concerned parents with diarrhoea and vomiting. He is the first child of a young couple. Examination reveals few features besides obvious dehydration. He is noted to have a penile length of 3.5cms. Which of the following is the most appropriate inital treatment for this patient? 1) Cow's milk allergy is the most likely diagnosis 2) gluten-enteropathy should be excluded 3) Requires urgent treatment with oral steroids 4) Requires urgent treatment with IV normal saline 5) Rota virus gastroenteritis is the most likely diagnosis
14- Which one of the following statements regarding renal function is correct? 1) The daily solute excretion will lie between 75 and 300 mosmol 2) The permeability of the distal nephron to water increases in the presence of vasopressin 3) The rate of ammonium excretion in urine is inversely related to the rate of urinary hydrogen ion excretion 4) A ten minute period of hyperventilation will normally be expected to lead to an increased rate of bicarbonate excretion in urine 5) Sodium reabsorption in the tubules is mainly controlled by aldosterone
15- Which of the following are true of chronic renal failure in childhood? 1) is unlikely to be due to chronic pyelonephritis unless there is a clear history of an acute attack 2) if accompanied by renal osteodystrophy is likely to be associated with severe hypertension 3) is an unusual sequel of acute post-streptococcal glomerulo-nephritis 4) is the most common sequel to the nephrotic syndrome 5) is likely to be benefited by administration of corticosteroids
16- Acute renal failure may be distinguished from chronic renal failure by which of the following? 1) an increased urinary Na excretion 2) left ventricular hypertrophy on the ECG 3) hypophosphataemia 4) renal size on ultrasound scan 5) hyperkalaemia
17- Which one of the following statements is correct? 1) adult polycystic renal disease is inherited as an autosomal recessive trait 2) reflux nephropathy is inherited as an autosomal recessive trait 3) nephrogenic diabetes insipidus is inherited as an autosomal dominant trait 4) Alport's syndrome affects females more severely than males 5) medullary sponge kidney is typically not inherited but is a congenital condition.
18- Metastatic calcification in chronic renal failure: 1) unaffected by time on CAPD 2) rapidly reversed in all sites after parathyroidectomy 3) characteristically caused by calcium oxalate deposition 4) increased prevalence with time on haemodialysis 5) decreased by Vitamin D
19- A 33 year old male is receiving regular haemodialysis is noted to have a plasma potassium of 6.9 mmol/L (3.5-4.9) before a dialysis session. Although normally his potassium is less than 5.5 mmol/L. Which food combination from the dietary history would be most likely to cause the high potassium concentration? 1) Cereal, toast, biscuits. 2) Filter coffee, tea, boiled potatoes. 3) Milk, butter, plain yoghurt 4) Milk, ham, chicken. 5) Tomato, potato crisps, banana.
20- Which of the following features would be expected in acute tubular necrosis? 1) Proteinuria on urinalysis 2) Red cell casts on urinalysis 3) Urine plasma osmolality ratio is more than 1:1 4) Urinary sodium concentration greater than 30 mmol/l 5) Creatinine clearance would be expected to be normal 1 year after the initial insult.
21- In which of the following circumstances would the treatment of anaemia with erythropeitin still be expected to be effective? 1) Aluminium toxicity 2) Folate deficiency 3) Hyperkalaemia 4) Infection 5) Iron deficiency
22- A 66-year-old man has developed chronic renal failure with a serum urea of 60 mmol/L and creatinine of 650 micromol/L. Auscultation of the chest reveals a friction rub over the cardiac apex. He is most likley to have a pericarditis that is termed? 1) Constrictive 2) Fibrinous 3) Hemorrhagic 4) Purulent 5) Serous
23- Which of the following is characteristic of Bartter's Syndrome? 1) Secondary hyperaldosteronism 2) Hyperkalaemia 3) Metabolic acidosis 4) Reduced renal concentrating ability 5) Diarrhoea
24- Which of the following is NOT a recognised cause of acute tubular necrosis? 1) Rhabdomyolysis 2) Paracetamol poisoning 3) Hypovolaemia 4) Hypertension 5) Corticosteroid therapy
25- A 49-year-old woman has been an inpatient for the past 10 days for treatment of a bronchopneumonia. She has developed the onset of chills, fever, and skin rash over the past two days. A peripheral blood film reveals eosinophilia. On urinalysis she has ++ proteinuria. There is no past history of renal disease. Her hemoglobin A1C is normal. These findings would most strongly suggest which of the following diagnoses? 1) Acute serum sickness 2) Acute tubular necrosis 3) Drug-induced interstitial nephritis 4) IgA nephropathy 5) Post-streptococcal glomerulonephritis
26- Oliguria more likely to be due to prerenal failure than intrinsic renal failure if: 1) urine free of red blood cells or casts 2) urine:plasma urea ratio <3 3) urine osmolality <350 mOsm/l 4) in the presence of hypertension, raised JVP and good peripheral circulation 5) urinary sodium >10mM
27- A 30 year old man had a blood pressure of 150/100 mmHg. Clinical examination was normal. Which one of the following would suggest secondary hypertension? 1) 24 hour urinary protein excretion of 1.6g (<0.2) 2) A Creatinine clearance of 90 mL/min (70-140) 3) Left ventricular hypertrophy criteria on the ECG 4) The presence of arteriovenous nipping on fundoscopy. 5) Serum potassium of 3.9 mmol/L (3.5-4.9)
28- Which of the following statements regarding idiopathic membranous nephropathy is correct? 1) It characteristically presents in the second decade of life. 2) Progression to end-stage renal failure is rapid. 3) immune complex deposits are typically seen in the glomerular mesangium. 4) Males are twice as commonly affected as females. 5) The nephritic syndrome is a characteristic presentation.
29- In asymptomatic chronic renal failure: 1) there is increase in tubular excretion of urate 2) serum ionised [calcium] is normal 3) serum [phosphate] characteristically increased before GFR falls to 30ml/min 4) increase serum [alkaline phosphotase] mainly due to liver isoenzyme 5) decrease in blood pressure accompanied by increase in extracellular fluid
30- Anti-neutrophilic cytoplasmic autoantibodies: 1) positive only in Wegener's syndrome associated with renal disease 2) cause neutropenia in SLE 3) present in inflammatory bowel disease 4) increased in systemic lupus erythematosus 5) ANCA positive glomerulonephritis characteristically causes nephrotic syndrome
31- In chronic untreated renal failure which of the following findings is characteristic? 1) Metabolic alkalosis 2) Hypokalaemia 3) Hyperosmolar dehydration 4) Hypercalcaemia 5) Hypercalcinuria
32- A 46-year-old woman develops nephrotic syndrome and is awaiting further tests to establish the underlying aetiology. In which circumstance would corticosteroids be most effective in reversing the nephrotic syndrome? 1) Membranous nephropathy 2) Minimal change disease 3) Primary amyloidosis 4) Renal vein thrombosis 5) Mesangial IgA disease
33- Which of the following is true concerning a 68 year old male with type 2 diabetes diagnosed with type IV renal tubal acidosis? 1) Aminoaciduria would be expected. 2) Fludrocortisone treatment is effective 3) Increased Glomerular filtration rate is expected. 4) Increased urinary bicarbonate would be expected. 5) Normal renal handling of K+ and H+
34- Which of the following is least likely with the HLA complex? 1) Class I products recognised by CD8 2) Class II products used to activate CD4 3) polymorphism in Class I genes, but not Class II 4) multiple sclerosis associated with HLA DR2 5) HLA matching more important in kidney/pancreas transplant than liver transplant
35- The following are features of pseudohypoparathyroidism: 1) Increased urinary phosphate and cAMP with PTH infusion 2) Low serum PTH 3) Low serum calcium and low serum phosphate 4) Low serum calcium and high serum phosphate 5) Shortened 2nd and 3rd metacarpals
36- A 60-year-old man was diagnosed last year with adenocarcinoma of the lung, and a 4 cm mass lesion was treated with a right lower lobectomy. He now has an abdominal CT scan that reveals scattered hepatic mass lesions and hilar lymphadenopathy. For several weeks, he has had increasing malaise. A urinalysis reveals marked proteinuria, and a 24 hour urine protein collection is 2.7 g/24hr. His serum urea is 30 mmol/L (2.5 - 7.5) with creatinine of 450 µmol/L (60 - 110). A renal biopsy is performed, and there is focal deposition of IgG and C3 with a granular pattern. He is most likely to have which of the following conditions? 1) Goodpasture's syndrome 2) Membranous glomerulonephritis 3) Minimal change glomerulonephritis 4) Nodular glomerulosclerosis 5) Rapidly progressive glomerulonephritis
38- Which of the following is a feature of cystinuria? 1) accumulation of cystine in the kidney 2) a useful response to acidification of urine 3) autosomal dominant inheritance 4) excessive urinary arginine excretion 5) radiolucent urinary calculi
39- A 19-year-old female developed pleural effusions, ascites and ankle swelling. Her blood pressure was 112/76 mmHg. Investigations revealed: serum alanine transferase 17 U/L (5 - 15) serum total bilirubin 17 umol/L (1 - 22) serum albumin 21 g/L (34 - 94) serum total cholesterol 9.8 mmol/L (<5.2) What is the next most appropriate investigation? 1) Antinuclear antibody 2) Pregnancy test 3) Prothrombin time 4) Serum protein electrophoresis 5) Urinary protein estimation
40- A 15-year-old girl was seen by her family physician because of increasing lethargy. She had a recent history of the "flu". Biochemistry tests show that she has renal impairement. serum sodium 140 mmol/L (137 - 144) serum potassium 4.2 mmol/L (3.5 - 4.9) serum urea 28 mmol/L (2.5 - 7.5) serum creatinine 280 µmol/L (60 - 110) Her condition does not improve after several weeks on corticosteroid therapy, so a renal biopsy is performed. The biopsy demonstrates the presence of segmental sclerosis of 3 of 10 glomeruli identified in the biopsy specimen. Immunofluorescence studies and electron microscopy do not reveal evidence for immune deposits. What is the most appropriate advice to give regarding her condition? 1) She has an underlying malignancy 2) She may require a renal transplant in 10 years 3) She will improve if she loses weight 4) She will likely develop a restrictive lung disease 5) She will probably improve with additional corticosteroid therapy
41- Which ONE of the following is true concerning Antidiuretic hormone (ADH)? 1) Carbamazepine potentiates it's release 2) Ethanol potentiates it's release 3) It circulates in the blood bound to neurohypophysin 4) It is a cyclic octapeptide 5) It is synthesised in the posterior pituitary
42-A 30-year-old female presents with fevers, and a 3 month history of malaise. Results show: Creatinine 250micromol/l Complement C3 23 mg/dL (65 - 190) What is the likely diagnosis? 1) HIV nephropathy 2) Infective endocarditis 3) Membranous Nephropathy 4) Microscopic Polyangiitis 5) Minimal change nephropathy
43-Which one of the following biochemical abnormalities would fit with a diagnosis of Bartter's syndrome? 1) Hyperchloraemia 2) Hyperkalemia 3) Hypernatraemia 4) Hyperphosphataemia 5) Hypokalemia
44-A 35-year-old female presents with malaise, thirst and increasing nocturia over the last month. Six months ago she attended the Emergency Department with an episode of renal colic. One month previously her GP had noted an eruptive, painful, erythematous rash on the anterior shins, which was self-limiting. What is the likely cause of her symptoms? 1) Hypercalcaemia 2) Hyperglycaemia 3) Hypocalcaemia 4) Hypokalaemia 5) Hyperoxaluria
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