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The most common cause of end-stage renal disease in the United States is
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renal/GU
| Question | Answer |
|---|---|
| When performing a rectal examination, prostatic massage is contraindicated in | acute bacterial prostatitis |
| The most common cause of end-stage renal disease in the United States is | diabetic nephropathy |
| Urine examination showed alkaline pH and positive cultures for Proteus vulgaris. Large stones are seen in her right kidney. The probably chemical composition of this patient’s kidney stone will reveal which of the following? | magnesium-ammonium phoshate |
| A 58 yo w hypertension, hyperlipidemia, occasional gastritis, and mild osteoarthritis needs to be started on tamsulosin (Flomax) for symptomatic prostatic hypertrophy. Which of the following medications may result in an adverse reaction in this patient? | Amlodipine (Norvasc) |
| In which of the following cases would renal biopsy be most recommended? | recently diagnosed SLE, proteinuria and creat 1.7 |
| Which of the following is a cause of acute kidney failure due to prerenal azotemia? | Excessive diuresis |
| An increased BUN to creatinine ratio is seen in all of the following conditions EXCEPT: | chronic cirrhosis |
| In patients with hyperkalemia,removal of excess potassium can be achieved with: | oral sodium polystyrene sulfonate |
| The urine sodium level in pre renal azotemia is usually | <10 |
| BUN:Creatinine ratio is greater than 20:1 | prerenal azotemia |
| A 50 year old black female presents with Left sided CVA pain-temperature of 105 degrees and nausea and vomiting and pain on urination you should | admit begin IV hydration –obtain a urine culture and place on broad spectrum IV antibiotics |
| infrarenal aortic aneurysm, rising creatinine, abdominal discomfort and lower extremity erythema in a mottled net-like pattern | renal atheroemboli |
| Pre-renal azotemia is characterized by | BUN/creat ration >10:1 |
| The site of action of aldosterone in the Nephron is | distal tubule |
| Among the following choices, the most common hereditary renal disease is: | adult poly cystic kidney disease |
| Which of the following laboratory results or physical examination findings would be most consistent with a prerenal etiology of his renal insufficiency? | Urinary sodium of 8 mEq/L |
| Nephrotic range proteinuria in adults is defined as greater than: | 3.5 grams protein/24 hours |
| In patients with hypernatremia the water content of cells is: | decreased |
| In a patient with oliguric renal failure a standard treatment is to | give high dose diuretics to try to convert to non oliguric renal failure |
| A diagnostic finding in the urine of patients with acute interstitial nephritis is | eosinophiles |
| The most frequent electrolyte disturbance encountered in the hospitalized patient is | hyponatremia |
| All of the following are a cause of resistance (decreased response) to erythropoetin except | diabetes mellitus |
| A 28 year-old female comes to the office with fever, flank pain, and dysuria for the past two days. Which of the following urinalysis results are suggestive of acute pyelonephritis? | white cell casts |
| The most common type of kidney stone contains: | calcium oxalate |
| A 48 year-old male with a recent episode of nephrolithiasis comes to the office to discuss prevention of further urinary stone disease. Which of the following dietary recommendations can reduce recurrence of nephrolithiasis? | increase fluid intake |
| It is later discovered that the patient has bilateral renal artery stenosis. Which of the following do you suspect as the cause? | lisinopril (zestril) |
| Acute interstitial nephritis is most commonly caused by | reaction to pharmaceuticals esp antibiotics |
| Select the diagnostic finding that best distinguishes acute from chronic renal failure: | small kidney on renal ultrasound |
| The two most common causes of ESRD (renal failure) in the United States are: | Diabetes and HTN |
| A low serum Sodium (hyonatremia) is dangerous when the Sodium level is below: | 125 |
| What portion of the kidney reabsorbs the majority of glomerular ultrafiltrate? | proximal convoluted tubule |
| Staghorn calculi are composed of: | magnesium ammonium phosphate |
| Characteristic finding of chronic interstitial nephritis is | sterile pyuria |
| Find the TRUE statement about testicular cancer: | Inguinal orchiectomy is both diagnostic and therapeutic |
| Which of the following conditions is MOST likely to cause microscopic hematuria? | UTI |
| serum sodium of 125 mmol./L (135-147) can commonly be seen in all of the following clinical conditions EXCEPT: | Diabetes insipidus |
| Chronic infection with urea-splitting bacteria produces stones are composed of: | Mg ammonium phos |
| Correction of Anemia seen in CRF is best treated with | erythropoetin and IV iron |
| Select the primary site of action of Antidiuretic Hormone (ADH) in the nephron. | collecting duct |
| The treatment of choice for uncomplicated gonococcal urethritis is | ceftriaxone |
| pH 7.18, pO2 98 mmHg, pCO2 22 mmHg, and HCO3 8 mEq/L. B | metabolic acidosis |
| In industrialized countries, kidney stones most commonly are composed of: | calcium oxalate |
| Uremia is best described as | clinical disorder arising from renal failure |
| The site of action of anti diuretic hormone on the kidney is | collecting duct |
| Which of the following types of kidney stones occur secondary to infections due to urease-producing bacteria? | struvite |
| Labs include Na 132 mEq/L, K 5.6 mEq/L, and Cl 127 mEq/L. Arterial blood gas reaveals pH 7.28, PO2 98 mmHg, PCO2 22 mmHg, and HCO3 13mEq/L. What is the most likely acid-base status? | met acid |
| A patient develops acute renal failure. Which of the following would be a prerenal cause? | decreased cardiac output |
| Painless hematuria in male patient with history of tobacco use should always include which of the following in the differential diagnosis? | bladder cancer |
| Nephrotic syndrome includes which of the following combinations of clinical findings? | proteinuria, edema, hypoalbuminemia, hyperlipidemia |
| A chronic renal failure patient on dialysis presents to the E.D. pale with a hemoglobin of 6 gm. The expected etiology of the low hemoglobin would be? | epo deficiency |
| A 64 y/o Caucasian male with a history of hypertension, hyperlipidemia, and nephrolithiasis presents with a complaint of dark-colored urine. He has been taking Mevacor (lovastatin) for elevated cholesterol. | check cpm |
| Which of the following is the most common mechanism of post-renal azotemia? | obstruction |
| Hyperkalemia is characterized by a serum Potassium level | >5.0 |
| A 25-year-old patient presents with gross hematuria, flank pain, hypotension, and a palpable abdominal mass. What is the most likely diagnosis? | polycystic kidney disease |
| IV methicillin for a staphylococcal infection. 10 days later developed recurrence of fever and a mild rash. elevated creatinine and eosinophils on her peripheral blood smear. U/A reveals hematuria, pyuria, and WBC casts. Your diagnosis is: | interstitial nephritis |
| The anion gap can be used to characterize acid-base disturbances. A patient present with the following laboratory values: Na 140 Cl 120 HCO3 20. What is the patient's anion gap based on the available laboratory values? | 0 |
| The SIADH (syndrome of inappropriate ADH) is characterized by | slight expansion of body water and low serum sodium |
| Correction of the Anemia of CRF should begin when | Hematocrit falls below 33 (Hg B < 11 grams) |
| Which antihypertensive agent is best control BP and slow the progression of kidney disease in a patient with diabetes and microalbuminemia? | ACE-I |
| Select the type of kidney stone that is associated with fat malabsorption or jejuno-ileal bypass surgery: | calcium oxalate |
| A 40 year-old ♀ develops nausea, headache, and seizures 2 days after hysterectomy. Review of the medical record indicates patient has received hypotonic fluids IV since surgery. Labs: serum sodium 110 meq/L. Appropriate initial treatment would be: | hypertonic saline |
| Stimulus for ADH synthesis and release would be | increased osmolality and decreased extracellular volume |
| Select the TRUE statement regarding treatment of prostate cancer: | endocrine manipulation remains the primary treatment for patients with advanced disease |
| Euvolemic hyponatremia is associated with: | SIADH |
| About 3wk ago,had sore throat, but did not seek medical attention. Recently she noted some blood in her urine and some swelling in her hands and feet. On examination, she has significant edema of the hands and feet and her blood pressure is 159/94 mm Hg. | post-streptococcal glomerulonephritis |
| A 15 year-old male patient presents with oliguria, hematuria, proteinuria, and fatigue following streptococcal pharyngitis 2 weeks ago. Which of the following is the most likely diagnosis? | Acute Glomerulonephritis |
| In order to help delay the progression to kidney disease in a diabetic patient with proteinuria, which of the following would you consider using to treat the patient's concomitant hypertension? | ace-i |
| The following tests are essential in evaluating the patient with renal disease and should be done on every patient | Bun and creatinine & urinalysis |
| What glomerular structure is affected in virtually all diabetics, irrespective of the presence of proteinuria? | Mesangium |
| Select the intracellular cation with the highest concentration in normal cells: | potassium |
| increasing significant peripheral edema over the past four days. Laboratory findings include marked proteinuria, hypoalbuminemia and hyperlipidemia. Which of the following diagnostic studies is the best for determining the cause of the proteinuria | renal biopsy |
| A 50 year-old. with congestive heart failure. He states he is on hemodialysis and missed his last appointment. Lab notifies you that a K is 7.5meg/dL. All of the following would be part of his short term treatment until emergent dialysis except? | kayexalate PO |
| Serum osmolality is a term used to describe | sum total of all osmotically active particles in the blood |
| The effect of parathormone (PTH) on the kidney is to cause | B. increased Calcium reabsorption C. increased Phosphate excretion |
| The ideal Hemoglobin target range for patients receiving dialysis is: | 11-12 grams |
| A 73 year-old male with chronic renal failure due to longstanding hypertension and diabetes is being discharged from the hospital today. Which dietary recommendation should be made to prevent further complications and progression of his renal disease? | restrict dietary protein |
| A 34 year-old male presents with symptoms of painful urethral discharge. History reveals recent (7 days ago) intercourse with a new partner. A Gram stain is negative for intracellular diplococci. antibiotic of choice? | doxy |
| Initial lab results reveal a serum BUN 76 mg/dL, serum creatinine 4.4 mg/dL and potassium 7.8 mEq/L. An EKG reveals ventricular ectopy. Which of the following is the most appropriate initial intervention? | calcium gluconate |
| The most abundant extracellular cation is: | sodium |
| Halitosis (bad breath) is commonly found in Uremia-it is caused by | attempt at homeostasis by blowing out various toxins with respirations |
| Which of the following therapies are not beneficial in treating diabetic kidney disease: | beta blockers |
| The major intracellular cation is: | potassium |
| The most common cause of Nephrotic Syndrome in Adults is | membranous |
| Aldosterone has which of the following effects on the distal renal tubules? | Sodium Reabsorption |
| Polycythemia (erythrocytosis) can be seen in patients with: | renal cell carcinoma |
| The most important cause for an inadequate response to erythropoietin therapy in a dialysis patient is: | iron deficiency |
| An inpatient currently is receiving IV antibiotic treatment for acute pyelonephritis. Which of the following is an acceptable criterion for switching from IV to oral antibiotic therapy? | 24 hr after afebrile |
| All of the following types of renal stones are radiopaque EXCEPT: | uric acid |
| Select the form of glomerular disease that is the most common cause of nephrotic syndrome in adult: | membranous glomerulopathy |
| An increased BUN to creatinine ratio is seen in all of the following conditions EXCEPT: | chronic cirrhosis |
| Hypernatremia generally indicates | dehydration |
| The following diseases are likely to recur in a kidney transplant except for: | adult polycystic kidney disease |
| A 6 year-old boy is evaluated for nocturnal enuresis. You offer behavioral education and write a prescription for the treatment of choice. Because of that drug's potential side effect, the boy should eat plenty of foods containing? | salt |
| The serum electrolytes are normal, including serum sodium is 145 mEq/L. The preferred IV replacement fluid will be: | 0.9% NaCl |
| Hypertension, hematuria, and dependent edema are the classic symptomatic triad of what type of kidney disease? | nephritic syndrome |
| A useful (preferred) antihypertensive agent for control of BP in diabetic patients with CRF are | ACE-I |
| Which of the following is a cause of prerenal azotemia? | poor renal perfusion |
| The urine specific gravity is a measure of which of the following renal functions? | concentration |
| The predominant protein excreted in most renal disease states is: | albumin |
| A low serum Sodium (hyonatremia) is dangerous when the Sodium level is below: | 125 |
| The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following? | increase in hydration |
| The earliest signs of diabetic nephropathy include: | hyperfiltration and microalbuminuria |
| Urinalysis reveals crystals resembling coffin lids. KUB reveals a staghorn calculus in the right kidney. Which of the following is the best clinical intervention? | percutaneous nephrolithotomy |
| A 19 year old white female presents with her 4th episode of burning on urination in the last 4 months and relates no recent sexual activity appropriate treatment would be | culture, abc for 10=14 |
| Metabolic Acidosis is best described as | serum HC03<24 or anion gap >12 |
| The healthy adult excretes less than | 150 milligrams protein/24hr |
| In rhabdomyolysis induce Acute Kidney failure the ARF is caused by | free release of myoglobin into circulation |
| A 38 year-old male presents with a 5 day history of upper respiratory symptoms and now has hematuria. There is no family history of renal disease. Urinalysis shows 1+ protein, + blood with 30-50 RBCs; no WBCs. most likely diagnosis? | IgA nephropathy |
| The most abundant extracellular cation is: | sodium |
| Which of the following is an indication for urgent initiation of dialysis in a patient with acute renal failure? | seizures |
| Glomerular Filtration rate (GFR) in common practice is synonymous with | % kidney function |
| The 3 most common phases of ATN (acute tubular necrosis )are | oliguric, diuretic, recovery |
| Which of the following is NOT considered nephrotoxic? | clindamycin |
| The most common cause of nephrotic syndrome in children under 8 years of age is | lipoid nephrosis (nil disease) |
| The site of action of anti diuretic hormone on the kidney is | collecting duct |
| Acute rejection of the kidney is often seen | 7-10 days after transplant |
| The urine sodium level in pre renal azotemia is usually | <10 |
| Treatment of asymptomatic hyponatremia includes: | water restriction |
| In which of the following cases would renal biopsy be most recommended? | patient with recently diagnosed SLE, proteinuria, and creatinine 1.7 mg/dL |
| Which of the following complications may occur in a patient with advanced chronic kidney disease? | hypocalcemia |
| Diabetic nephropathy typically occurs after: | 15-20 years of diabetes |
| The renal artery arises from | abdominal aorta |
| Which of the following is an indication to initiate hemodialysis in a patient with renal failure? | uremic symptoms |
| Which of the following is often described as feeling like a "bag of worms" on testicular exam? | varicocele |
| A 68 year-old male has increasing serum creatinine. Which of the following is the next best step? | renal ultrasound |
| A 68 year-old woman comes to the office for evaluation of urinary incontinence. For the past few months, she has had an intense urgency to urinate, followed by leakage of urine. | Oxybutynin (Ditropan) |
| A chronic renal failure patient on dialysis presents to the E.D. pale with a hemoglobin of 6 gm. The expected etiology of the low hemoglobin would be? | epo deficiency |
| A 73 year-old male with chronic renal failure due to longstanding hypertension and diabetes is being discharged from the hospital today. Which dietary recommendation should be made to prevent further complications and progression of his renal disease? | restrict protein |
| The percentage of total body water compared to total body weight in a lean and fit& male patient is: | 60% |
| If the urine dipstick for blood is positive, but no red blood cells are seen by urine sediment microscopy, a diagnosis to strongly consider is: | myoglobinuria |
| A 35 year-old male presents to the ED with nausea and right flank pain with radiation to the right testicle. Urinalysis reveals 50-100 RBCs, 0-1 WBCs and many calcium oxalate crystals. Which of the following is the most appropriate intervention? | fluids and pain control |
| Correction of the Anemia of CRF should begin when | Hematocrit falls below 33 (Hg B < 11 grams) |
| The cells that form the main supporting structure of the glomerulus are called | mesangial cells |
| In patients with hypernatremia the water content of cells is: | decreased |
| Which of the following is most important in the treatment of a patient who has chronic kidney disease stage 2? | maintaining BP less than 130/80 |
| A patient present with a serum Sodium of 160 and signs of volume depletion it is likely that | lost both salt and water, but more water than salt |
| Which of the following can be used to treat chronic bacterial prostatitis? | levofloxacin (levaquin) |
| The most appropriate treatment for a 48 year old patient presenting with status seizure activity and a measured Na of 106 mEq/L would be? | 3% NS IV 50cc/hr x 3 hrs |
| What glomerular structure is affected in virtually all diabetics, irrespective of the presence of proteinuria? | mesangium |
| Select a drug that requires major dosage modification in patients with chronic renal failure: | gentamicin |
| In the normal individual, the daily excretion of sodium in the urine is determined mainly by which of the following? | amount of sodium in the diet |
| Which of the following components of the kidney plays a role in the production of HCO3 and is a major area for the maintenance of normal acid base homeostasis? | distal nephron |
| Select the TRUE statement regarding treatment of urinary tract infection: | Gonococcal urethretis generally should be treated with ciprofloxacin or cephalosporin with tetracycline added to the regimen for chlamydial infection |
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