Term 4, CPC 1 Quiz
Questions and Answers
- 1.
A 72 year old man has been feeling tired and lethargic for 5 months. He has noted increasing hesitancy with urination. On physical examination his prostate is diffusely enlarged. Laboratory studies show sodium 139 mmol/L, potassium 4.0 mmol/L, chloride 104 mmol/L, creatinine 1.9 mg/dL, and glucose 81 mg/dL. Which of the following renal abnormalities is most likely to be present in this man?
- A.
Cortical atrophy
- B.
Glomerulonephritis
- C.
Papillary necrosis
- D.
Polycystic change
- E.
Renal cell carcinoma
Correct Answer
A. Cortical atrophyExplanation
The most likely renal abnormality present in this 72-year-old man is cortical atrophy. The patient's symptoms of fatigue, lethargy, and hesitancy with urination, along with the diffusely enlarged prostate, suggest that he may have benign prostatic hyperplasia (BPH). BPH can cause obstruction of the urinary flow and lead to urinary retention, which can result in chronic kidney disease. Cortical atrophy is a common finding in chronic kidney disease and is characterized by a decrease in the size and thickness of the renal cortex. The laboratory findings of slightly elevated creatinine and normal electrolyte levels are consistent with chronic kidney disease.Rate this question:
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- 2.
A 35 year old woman has experienced urinary frequency with dysuria for the past 4 days. On physical examination she has no flank pain or tenderness. A urinalysis reveals sp. gr. 1.014, pH 7.5, no glucose, no protein, no casts, no blood, nitrite positive, and many WBC's. She has a serum creatinine of 0.9 mg/dL. Which of the following is the most likely diagnosis?
- A.
Lupus nephritis
- B.
Urinary tract lithiasis
- C.
Acute bacterial cystitis
- D.
Malakoplakia
- E.
Urothelial carcinoma
Correct Answer
C. Acute bacterial cystitisExplanation
The most likely diagnosis in this case is acute bacterial cystitis. This is supported by the symptoms of urinary frequency and dysuria, as well as the urinalysis findings of nitrite positive and many white blood cells (WBCs). These findings suggest a bacterial infection in the urinary tract. The absence of flank pain or tenderness and the normal serum creatinine level make other diagnoses such as lupus nephritis, urinary tract lithiasis, malakoplakia, or urothelial carcinoma less likely.Rate this question:
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- 3.
A clinical study is performed with paediatric subjects who had minimal change disease. These patients are observed to have prominent periorbital oedema. Laboratory test findings from serum and urine tests are analysed. Which of the following laboratory test findings is most likely to be consistently present in these subjects?
- A.
Nitrite positive urinalysis specimen
- B.
Proteinuria >3.5 gm/24 hours
- C.
Hematuria with >10 RBC/hpf
- D.
Lipiduria in association with hypercholesterolemia
- E.
Renal tubular epithelial cells and casts
Correct Answer
B. Proteinuria >3.5 gm/24 hoursExplanation
In patients with minimal change disease, which is a type of kidney disease, one of the most consistent laboratory findings is proteinuria, specifically proteinuria greater than 3.5 gm/24 hours. Proteinuria refers to the presence of excessive amounts of protein in the urine, which is a hallmark of kidney damage. This finding is often observed in patients with minimal change disease, along with other symptoms such as periorbital edema. The other options listed, such as nitrite positive urinalysis specimen, hematuria, lipiduria, and renal tubular epithelial cells and casts, are not typically associated with minimal change disease.Rate this question:
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- 4.
A 12 year old boy is a member of a family with a history of renal disease, with males more severely affected than females. He is found to have auditory nerve deafness, corneal dystrophy, and ocular lens dislocation. A urinalysis shows microscopic haematuria. A renal biopsy is performed. Microscopically, the glomeruli show glomerular capillaries with irregular basement membrane thickening and attenuation with splitting of the lamina densa. The mesangial matrix is increased and epithelial cells may appear foamy. Which of the following is the most likely diagnosis?
- A.
Goodpasture’s syndrome
- B.
IgA nephropathy
- C.
Alport syndrome
- D.
Dominant polycystic kidney disease
- E.
Diabetes mellitus, type I
Correct Answer
C. Alport syndromeExplanation
The given clinical presentation of a 12-year-old boy with a family history of renal disease, auditory nerve deafness, corneal dystrophy, ocular lens dislocation, and microscopic hematuria is consistent with Alport syndrome. Alport syndrome is an inherited disorder characterized by abnormalities in the type IV collagen in the basement membranes of the kidney, ear, and eye. The renal biopsy findings of irregular basement membrane thickening and attenuation with splitting of the lamina densa, increased mesangial matrix, and foamy epithelial cells further support the diagnosis of Alport syndrome.Rate this question:
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- 5.
A clinical study is performed of laboratory findings in subjects with renal diseases. Loss of physiologic function accompanies many diseases. Loss of which of the following renal functions is most likely to be identified by laboratory measurement of the urine specific gravity?
- A.
Filtration
- B.
Reabsorption
- C.
Secretion
- D.
Concentration
- E.
Blood flow
Correct Answer
D. ConcentrationExplanation
The laboratory measurement of urine specific gravity is used to assess the concentration of urine. In renal diseases, the ability of the kidneys to concentrate urine may be impaired, resulting in a lower specific gravity. Therefore, by measuring the urine specific gravity, the loss of concentration function in the kidneys can be identified.Rate this question:
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- 6.
A 5 year old boy is noted to have increased puffiness around his eyes for the past week and he has been less active than normal. On physical examination he has periorbital oedema. His BP is 140/90 mm Hg. A urinalysis reveals sp. gr. 1.010, pH 6.5, no glucose, 4+ protein, no blood, no casts, and no ketones. Microscopic urinalysis reveals oval fat bodies, but no WBCs or RBCs. He improves following a course of corticosteroid therapy. Which of the following renal lesions is most likely to have been present in this boy?
- A.
Glomerular crescents
- B.
Fusion of podocyte foot processes
- C.
Patchy tubular necrosis
- D.
Hyperplastic arteriolosclerosis
- E.
Mesangial immune complex deposition
Correct Answer
B. Fusion of podocyte foot processesExplanation
The presence of periorbital edema, proteinuria, and oval fat bodies in the urine suggests that the boy has nephrotic syndrome. Fusion of podocyte foot processes is a characteristic finding in nephrotic syndrome, specifically in a condition called minimal change disease. This condition is the most common cause of nephrotic syndrome in children and is known to respond well to corticosteroid therapy. Therefore, fusion of podocyte foot processes is the most likely renal lesion present in this boy.Rate this question:
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- 7.
A clinical study is performed involving subjects with glomerulonephritis. One group of subjects has a diagnosis of crescentic glomerulonephritis and another group has membranous glomerulonephritis. Which of the following laboratory findings is most likely to be found in the absence of other findings in subjects with membranous glomerulonephritis?
- A.
Rapid onset
- B.
Red blood cell casts
- C.
Oliguria
- D.
Albuminuria
- E.
Hypertension
Correct Answer
D. AlbuminuriaExplanation
In subjects with membranous glomerulonephritis, the most likely laboratory finding to be found in the absence of other findings is albuminuria. Membranous glomerulonephritis is characterized by thickening of the glomerular basement membrane, leading to increased permeability and leakage of albumin into the urine. This can result in the presence of excess albumin in the urine, known as albuminuria. The other options, such as rapid onset, red blood cell casts, oliguria, and hypertension, are not specific to membranous glomerulonephritis and can be seen in other types of glomerulonephritis as well.Rate this question:
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- 8.
A 50 year old man is hospitalised for acute myocardial infarction. He has decreased cardiac output with hypotension requiring multiple pressor agents. His urine output drops over the next 3 days. His serum urea nitrogen increases to 55 mg/dL, with creatinine of 2.9 mg/dL. Urinalysis reveals no protein or glucose, a trace blood, and numerous hyaline casts. Five days later, he develops polyuria and his serum urea nitrogen declines. Which of the following pathologic findings in his kidneys is most likely to have caused his azotemia?
- A.
Patchy tubular necrosis
- B.
Fusion of podocyte foot processes
- C.
Glomerular crescents
- D.
Hyperplastic arteriolosclerosis
- E.
Mesangial immune complex deposition
Correct Answer
A. Patchy tubular necrosisExplanation
The most likely cause of the patient's azotemia is patchy tubular necrosis. This is supported by the fact that the patient has decreased cardiac output and hypotension, which can lead to decreased blood flow to the kidneys and subsequent tubular damage. The drop in urine output and the increase in serum urea nitrogen and creatinine levels further suggest impaired kidney function. The presence of hyaline casts in the urinalysis is also consistent with tubular damage. Additionally, the subsequent development of polyuria and a decline in serum urea nitrogen levels indicate recovery from the initial insult.Rate this question:
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- 9.
A clinical study is performed to determine the value of percutaneous renal biopsy. The medical records of subjects with renal diseases are analysed to determine the circumstances in which the results of a renal biopsy facilitated determination of therapy that improved prognosis. In which of the following situations is a percutaneous needle biopsy of the kidney most useful?
- A.
Fever with suspected acute pyelonephritis
- B.
Prostatic hyperplasia with suspected hydronephrosis
- C.
Premature neonate with suspected polycystic kidney; disease
- D.
Suspected renal cyst
- E.
Systemic lupus erythematosus and acute renal failure
Correct Answer
E. Systemic lupus erythematosus and acute renal failureExplanation
A percutaneous needle biopsy of the kidney is most useful in the situation of systemic lupus erythematosus and acute renal failure. This is because systemic lupus erythematosus can cause kidney damage, and a biopsy can help determine the extent of the damage and guide appropriate therapy for improving prognosis in cases of acute renal failure.Rate this question:
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- 10.
A 20 year old previously healthy man has been feeling tired for the past 5 days. He goes to his physician when he passes dark-coloured urine. On physical examination his blood pressure is 155/110 mm Hg. Labortory studies show his serum creatinine is 4.4 mg/dL. A urinalysis reveals 3+ blood, 1+ protein, no glucose, and no ketones. On urine microscopic examination there are numerous RBC casts. His condition worsens even with therapy. Which of the following pathologic findings on renal biopsy is most likely to be present in this man?
- A.
Glomerular crescents
- B.
Widened proximal tubules
- C.
Polymorphonuclear infiltrates
- D.
Lipiduria
- E.
IgA deposited in glomerular capillaries
Correct Answer
A. Glomerular crescentsExplanation
The presence of numerous RBC casts in the urine along with other findings such as high blood pressure, elevated serum creatinine, and proteinuria suggests a glomerular pathology. Glomerular crescents are a characteristic finding in rapidly progressive glomerulonephritis (RPGN), which is a severe form of glomerular disease. RPGN is characterized by the rapid deterioration of renal function and the formation of crescent-shaped lesions in the glomeruli. These crescents are composed of fibrin, inflammatory cells, and proliferating parietal epithelial cells. The presence of glomerular crescents on renal biopsy is consistent with the clinical presentation described in the question.Rate this question:
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- 11.
A 12 year old boy presents with tiredness, oliguria with dark colour urine. He had just recovered from a sore throat last month and was treated with antibiotic (tetracycline) and antipyretics. His kidney biopsy image is shown for your interpretation. What is the most likely diagnosis?
- A.
Minimal change disease
- B.
Crescentic glomerulonephritis
- C.
Diffuse proliferative glomerulonephritis
- D.
Membranous glomerulonephritis
- E.
Membranoproliferative glomerulonephritis
Correct Answer
C. Diffuse proliferative glomerulonephritisExplanation
Based on the information provided, the most likely diagnosis for the 12-year-old boy with tiredness, oliguria, and dark-colored urine is diffuse proliferative glomerulonephritis. This is supported by the fact that the boy had recently recovered from a sore throat and was treated with tetracycline, which is known to be associated with the development of glomerulonephritis. The kidney biopsy image would likely show characteristic features of diffuse proliferative glomerulonephritis, such as cellular proliferation and inflammation within the glomeruli.Rate this question:
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- 12.
A 78 year old man with chronic hypertension and diabetes on treatment died following progressive loss of kidney function. His kidney specimen is shown for your interpretation. What is the most likely gross diagnosis?
- A.
Chronic glomerulonephritis
- B.
Benign nephrosclerosis
- C.
Renal Infarction
- D.
Hypertensive haemorrhages
- E.
Malignant hypertension
Correct Answer
B. Benign nephrosclerosisExplanation
The most likely gross diagnosis for the given scenario is benign nephrosclerosis. This is suggested by the patient's age, chronic hypertension, and diabetes, which are risk factors for the development of benign nephrosclerosis. Additionally, the progressive loss of kidney function is consistent with this diagnosis. Chronic glomerulonephritis, renal infarction, hypertensive hemorrhages, and malignant hypertension are less likely based on the provided information.Rate this question:
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- 13.
A 25 year old male complains of haematuria after an episode of URTI. He has a history of celiac disease for the past 4 years. Haematuria clears after 3 days only to return again after one month. No remarkable findings on physical examination. Urine analysis shows a ph 6.5, specific gravity 1.018, hematuria 3+, proteinuria1+, no glucose or ketone bodies. Microscopic examination shows Only RBC, no WBC, casts or crystals. A 24 hr urine protein level is 200 mg. What do you expect in renal biopsy from this patient?
- A.
Subepithelial electron dense deposits
- B.
Granular staining of basement membrane
- C.
Mesangial IgA staining by immunofluorescence
- D.
Diffuse proliferation and basement membrane thickening
- E.
Thrombosis in the glomerular capillaries
Correct Answer
C. Mesangial IgA staining by immunofluorescenceExplanation
The patient's history of celiac disease and the presence of hematuria and proteinuria suggest a possible diagnosis of IgA nephropathy (also known as Berger's disease). IgA nephropathy is a kidney disease characterized by the deposition of IgA immune complexes in the mesangium of the glomeruli. This is confirmed by the presence of mesangial IgA staining on immunofluorescence in the renal biopsy. The other options are not consistent with the clinical presentation and findings.Rate this question:
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- 14.
A 54 year old male is having recurrent infections in urinary tract along with polyuria and nocturia. His kidnet biopsy shows the following picture. What is the most likely diagnosis?
- A.
Diffuse proliferative GN
- B.
Membranous GN
- C.
Minimal change GN
- D.
Rapidly progressive GN
- E.
Nodular glomerulo sclerosis
Correct Answer
E. Nodular glomerulo sclerosis -
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Mar 21, 2023Quiz Edited by
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Sep 21, 2011Quiz Created by
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