INTERNAL MEDICINE MCQs - NEPHROLOGY

1. Which one is CORRECT in the following description about acute post streptococcal
glomerulonephritis?
A. Nephritic strains were mostly seen in Group A streptococci Type 10
B. Commonly seen in children, female more than male
C. Total complement and C3 decreased and recovered to normal in 6-8 weeks
D. Glucocorticoid and cytotoxic drugs are necessary

2. A male patient with nephritic syndrome was found with asymmetrical edema of lower extremity, the
possible complication happened for him is:
A. Acute renal failure
B. Infecti on
C. Thrombosis
D. Protein malnutrition and dyslipidemia X

3. Which one is the most common route of urinary tract infection (UTI)
A. Descending infection
B. Ascending infection
C. Lymphatogenous infection
D. Direct extension from another organ

4. The etiology of acute kidney injury includes:

A. Decreased renal perfusion
B. Obstructive injury to the renal tubule
C. A Primary glomerular disease
D. Above all of them

5. A 25-year old woman has been hospitalized for treatment of Staphylococcus aureus abscess of her
left thigh complicating a puncture wound. The wound is incised drained and she receives antibiotic
therapy. She is improving and discharged home a week later, but the next day she develops a fever.
On physical examination, her temperature is 38.1’C and there is diffuse erythematous skin rash on
her trunk and extremities. A urinalysis shows sp gr 1.020, pH 6.5, 1+ blood, 1+ protein, no glucose
and no ketones. There are 10-20 WBCs/hpf and 1-5 RBCs/hpf, and a few eosinophils are noted on
urine microscopic examination. Which of the following is the most likely diagnosis?
A. Acute tubular necrosis
B. Analgesic abuse nephropathy
C. Drug-induced interstitial nephritis
D. Urinary tract infection

6. Chronic kidney disease stage 4 is defined as:

A. GFR 60 to 89ml/min (Stage 2)
B. GFR 30 to 59ml/min (Stage 3)
C. GFR 15 to 29ml/min (Stage 4)
D. GFR < 15ml/min (Stage 5)

7. The definition of proteinuria is:

A. Proteinuria < 150mg/24h
 B. Proteinuria < 200mg/24h
C. Proteinuria < 300mg/24h
D. Proteinuria < 500mg/24h

8. Which one is not correct description for the pathogenesis of anti-Glomerular basement membrane
disease in the following items?
A. Genetic susceptibility appears positively related to HLA-DRS15
B. HLA DR1 and DR7 appears to have protective effect
C. Anti-GBM Abs trigger cell mediated inflammatory response
D. Concentration of Abs directly correlate with disease activity

9. Which one is not correct in the following description about chronic glomerular nephritis?
A. 20-25% patients were developed from acute glomerular nephritis
B. Treatment of proteinuria and hematuria were main targets
C. Shown with sclerotic glomerular nephritis at final stage
D. Developing speed depends on different pathological types

10. Which one is NOT proper for the treatment of chronic nephritis?
A. Low protein diet + essential amino acids
B. Control hypertension (ACE, ARB)
C. Maintain balance of water, electrolytes, and acid-alkali
D. Steroids and immunosuppressive agents are indispensable

11. Latent glomerulonephritis could be from following pathological types EXCEPT:

A. Membranous nephropathy
B. Minor glomerular abnormalities
C. Slightly mesangial proliferative GN
D. Focal segmental proliferative GN

12. In the following descriptions for the clinical features of renal tubular acidosis, which one is NOT
correct?
A. Characterized by a decreased glomerular filtration rate
B. With a metabolic acidosis
C. Accompanied by hyperchloremia
D. Accompanied by a normal plasma anion gap

13. A female patient was shown with the frequency, dysuria and urgency of micturition, fever, flank
pain and increased white blood cells. This patient possibly caused:
A. Acute cystitis
B. Acute pyelonephritis
C. Chronic cystitis
D. Acute urethritis

14. The gold standard test for renal glomerular function is:
A. Serum creatinine
B. Blood urea nitrogen
 C. GFR
D. Uric acid

15. In KDOQI guidelines, chronic kidney disease can be diagnosed when kidney damage last for
A. ≥ 15 ddays
B. ≥ 1 month
C. ≥ 3 months
D. ≥ 6 months

16. In the United States, the most prominent cause of chronic kidney disease is:
A. Diabetes
B. Hypertension
C. Primary glomerulonephritis
D. Polycystic kidney disease

17. Interventions to slow the progression of kidney disease should be considered in all patients with
chronic kidney disease. Interventions that have been proven not to be effective include the following
EXCEPT:
A. Strict glucose control in diabetes
B. Strict Blood pressure control
C. Lipid-lowering therapy
D. Angiotensin-converting enzyme inhibitor

18. In patients with CKD and significant proteinuria, the target blood pressure is:
A. < 140/90mmHg
B. < 130/80mmHg (Protenuria <1g/24hour)
C. < 125/75mmHg (Protenuria >1g/24hour)X
D. <120/70mmHg

19. According to acute kidney Injury Network, AKI is defined as:

A. 0.3mg/dL increase in serum creatinine
B. 0.5mg/dL increase in serum creatinine
C. 1.5mg/dL increase in serum creatinine
D. 2mg/d: increase in serum creatinine

20. Which of the following is NOT an indication for urgent dialysis in a patient with renal failure
A. Asterixis and drowsiness
B. Pulmonary edema resistant diuretics
C. Pericarditis
D. Serum creatinine of 1.2mg/dL
E. Serum potassium of 9.0mEq/L

21. In the management of patients with chronic glomerulonephritis and chronic renal failure with a
serum creatinine of 2.0mg/dL, which of the following is true?
A. Angiotension converting enzyme inhibitor are contraindicated because they are toxic to the
kidneys in renal failure
B. Dosage of medication often require adjustment
 C. Non-steroidal anti-inflammatory agents (arthritis medications) can be used liberally because the
chronically diseased kidneys are resistant to the toxic effects of these agents
D. Superimposed urinary tract obstruction is of no consequences because the underlying
kidney disease is glomerular in origin
E. Severe sodium restriction is always necessary because the chronically ill kidneys cannot excrete
sodium

22. Which of the following is the most common complication of advanced untreated renal failure:
A. Erythrocytosis
B. Platelet dysfunction favoring bleeding
C. Increased peripheral nerve conductionIn the management for patients with
D. Gastrointestinal tumors
E. Hypotriglycemia

23. A 35 year old white man is referred to you for evaluation of microscopic hematuria detected on
routine testing. He has no history of hypertension, headaches or urinary tract symptoms. His father
and paternal aunt have polycystic kidney disease; they developed end-stage renal disease at ages 58
and 62 respectively but are currently doing well. The patient has recently married and is concerned
about risk to his future offspring. Blood pressure is normal. The kidneys are not palpable. Urinalysis
shows 8-10 RBCs/hpf and no proteins. Which of the following studies is most appropriate now?
A. Genetic analysis
B. Renal ultrasonography
C. Cerebral angiography
D. Intravenous urography

24. A 49-year old woman has had increasing malaise for the past 6 months. ON physical examination
there are no abnormal findings except for diminished sensation to pinprick and light touch in her
lower legs and feet. She is afebrile and normotensive. Laboratory studies show serum creatinine
4.5mg/dL, Urea nitrogen 42mg/dL, glucose 130mg/dL, and hemoglobin A1C 7.9%. A urinalysis
shows 1+ glucose, 1+ protein, no blood and no ketones. Urine microscopic examination shows 1
RBC/hpf and 1 WBC/hpf. Which of the following pathologic abnormalities is she most likely to
have in her kidneys?
A. Acute pyelonephritis
B. Acute tubular necrosis
C. Chronic glomerulonephritis
D. Hydronephrosis
E. Nodular tubular sclerosis

25. All of the following are the features of chronic urinary tract obstruction EXCEPT:
A. Nocturia
B. Hypokalemia
C. Acidemia
D. Hypertension
E. Azotemia
26. Which of the following imaging procedures should be avoided in a patient with severe chronic renal
failure?
A. Renal Ultrasound
B. Magnetic resonance imaging of the kidneys
C. Retrograde pyelogram
D. Radionuclide renal angiography
E. Intravenous pyelogram

27. Normal renal physiological function except:

A. Filtration and produce urine
B. Regulate the sodium and acid-base metabolism
C. Endocrinological function
D. Produce E2

28. The nephrotic syndrome is defined by hypoalbuminemia in amounts of

A. 35g
B. 30g
C. 25g
D. 20g

29. There are many different causes of secondary nephrotic syndrome, which is NOT?
A. Systemic lupus erythematosus
B. Primary nephritis
C. Leukemia
D. Cancer

30. Which is not the main treatment drug for nephrotic syndrome___
A. Steroid therapy
B. Cytotoxic agents
C. Sodium restriction and diuretics
D. Antibiotic therapy

31. The most common complication of nephrotic syndrome except ___

A. Bacterial infection
B. Hematuria
C. Acute kidney injury
D. Thromboembolism

32. The definition of Protenuria is___

A. Protenuria <150mg/24h
B. Protenuria <200mg/24h
C. Protenuria >300mg/24h
D. Protenuria <500mg/24h

33. Which one is NOT the proper treatment of chronic nephritis?

A. Low protein diet + essential amino acids
 B. Control hypertension (ACEI, ARB)
C. Maintain balance of water, electrolyte and acid-alkali
D. Steroids and immunosuppressive agents are indispensable

34. The cause of ________ failure is impaired blood supply to the kidney (Fluid volume deficit,
hemorrhage, heart failure, shock)
A. Prerenal
B. Intrarenal
C. Postrenal
D. Perirenal

35. Which of these drugs is nephrotic?

A. Diuretics
B. ACE inhibitors
C. NSAIDs
D. Sodium bicarbonate/ Potassium bicarbonate

36. Chronic kidney disease (CKD) is defined as kidney damage or GFR <60mL/min/1.73m2 lasting for
_____
A. ≥ 3 momnths
B. ≥ 6months
C. ≥ 1 month
D. ≥ 2 months

37. Acute kidney injury (AKI) is diagnosed as rapid reduction of kidney function test less than _____
A. 36 hours
B. 24 hours
C. 48 hours
D. 12 hours

38. Chronic kidney disease (CKD) is classified into 5 stages based on _____
A. Serum creatinine
B. Blood urea nitrogen (BUN)
C. GFR
D. Protenuria

39. Which one of the following is NOT the urine index for acute tubular necrosis
A. Sp Gr ≈ 1.010
B. Uosm <300
C. FEna <1%
D. FEUrea >50%

40. The functional unit of kidney that produces urine is called ____
A. Renal pelvis
B. Collecting dust
C. Nephron
 D. Neuron

41. The three main functions of the kidney are to filter out wastes and fluid, balance levels of chemicals
in the body, and _____
A. Regulate heartbeat
B. Produce hormones
C. Aid digestion
D. Balance blood sugar

42. The American Diabetes Association (ADA) recommends glycemic control of CKD patient, with the
goal of being an A1C concentration below:
A. 7%
B. 10%
C. 5%
D. 12%

43. Which of the following is the principle for treating chronic kidney disease?
A. Treatment of reversible cause of renal function
B. Preventing or slowing progression of disease
C. Treatment of complication of renal dysfunction
D. All of above

44. A 50 years old male with a 20 years history of diabetes is referred to you for evaluation of serum
creatinine of 4.0mg/dL. He was seen by and ophthalmologist last month and was told that his eyes
were “clean” on fundoscopic examination. Two months ago his serum creatinine was 1.0mg.dL. On
examination his BP was 160/100mmHg. Fundus showed no evidence of diabetic retinopathy. Urine
analysis showed 2+ blood and 3+ protein on dipstick. Urine microscopy showed dysmorphic RBCs.
Which of the following statement is TRUE?
A. The most likely diagnosis is diabetic nephropathy
B. The patient requires urgent kidney biopsy
C. The rate of rise in serum creatinine seen in this patient is typical of diabetic nephropathy
D. There is no correlation between the presence of diabetic retinopathy and nephropathy
E. Nephrotic range proteinuria is never seen in diabetes

45. Two weeks ago, a 27 year old man was admitted to the hospital because of progressive fever and
weight loss. He had a normal kidney function with a serum creatinine of 1.2mg/dL but was found to
have positive blood cultures (4/4) for alpha-hemolytic streptococci and therapy with ceftriaxone was
begun. You are asked to evaluate this patient after two weeks of therapy because serum creatinine
has risen to 3.5mg/dL. His general condition has improved (Tmax) 37.2’C) but a diffuse
maculopapular rash has developed on the trunk. Repeat blood cultures are negative. The following
laboratory results were obtained: Serum creatinine 3.5mg/dL; Serum electrolytes (mEq/L): Na 137,
K5.6, Cl 95, Bicarb 18; Serum complement c3 150mg/dL (normal 100-233), CH50 150units/mL
(Nromal 110-190). Urinalysis showed protein 1+, Glucose negative, Blood 3+, many RBCs, WBCs
and WBC casts. Which of the following is the most likely cause of elaevation in the serum
creatinine?
A. Ceftriaxone associated acute tubular necrosis
B. Glomerulonephritis secondary to subacute bacterial endocarditis
C. Acute interstitial nephritis
D. Intratubular crystal deposition
E. Renal emboli