1.

The following diuresis is called oliguria:

a) <500 mL/h

b) >2.5 L in 24h

c) <100-300 mL/h

d) >300 mL/h

e) <0,5 mL/kg/h+

2. У 40-летнего больного, заболевшего ангиной, на 5-й день болезни появились отеки,

макрогематурия, повысилось АД. Наиболее вероятный диагноз:

a) 1. острый гломерулонефрит +

b) 2. острый пиелонефрит

c) 3. обострение хронического гломерулонефрита

d) 4. апостематозный нефрит

e) 5. амилоидоз почек

3. Острую почечную недостаточность могут вызвать главным образом антибиотики группы:

a) 1. пенициллинов

b) 2. макролидов

c) 3. Аминогликозидов+

d) 4. цефалоспоринов

e) 5. Фторхинолонов

4. У 45-летнего больного, слесаря, обнаружены гипертрофия околоушных, слюнных желез,

контрактура Дюпюитрена, протеинурия (2,5 г/л), гематурия (40-60 в поле зрения). Уровень
IgA в крови повышен. Наиболее вероятный диагноз:

5. 1. идиопатический IgA – нефрит +

6. 2. гломерулонефрит при геморрагическом васкулите

7. 3. гломерулонефрит алкогольной этиологии

8. 4. волчаночный гломерулонефрит

9. 5. хронический пиелонефрит

5. Ведущим клиническим признаком нефротического синдрома является:

 1. гематурия

 2. протеинурия более 3,5 г/сутки+

  3. артериальная гипертензия

 4. пиурия

 5. гипоизостенурия

6. A 82-year-old female with type 2 diabetes mellitus, hypertension, hyperlipidemia,

and CKD (serum creatinine, 2.3 mg/dL) has exertional chest pain consistent with

myocardial ischemia. A stress test is positive. Prior to cardiac catheterization,

she is given intravenous fluids and n-acetylcysteine to prevent contrast

nephropathy. The left anterior descending artery is stented, and she is started on

clopidogrel. Approximately 4 days later, she develops oliguria, azotemia

(creatinine 2.8 mg/dL), abdominal pain and has evidence of GI bleeding. Which of

the following is the most likely cause of AKI?

A) Cholesterol embolization to the renal arteries

B) Pre-renal azotemia

C) Ischemic acute tubular necrosis caused by hypotension during catheterization

D) Radiocontrast-induced nephrotoxicity

245. Оцените общий анализ мочи больного К., 18 лет. АД – 160\100 мм рт.ст. Удельный вес - 1027,
цвет- мясных помоев, белок- 2500 мг/л, плоский эпителий -3-4- в поле зрения лейкоциты - 4-5 в
поле зрения, эритроциты измененные - 40-50 в поле зрения, гиалиновые и зернистые цилиндры -
3-4 в поле зрения. На УЗИ почки нормальных размеров, чашечно-лоханочная система не
деформирована, эхоположительных признаков не выявлено. О каком заболевании можно
подумать? 1. Гломерулонефрите 2. Раке почки 3. Пиелонефрите 4. Мочекаменной болезни 5.
Цистите

246. Оцените общий анализ мочи больной Д., 32 лет. Удельный вес - 1015, цветжелтый, белок- 30
мг/л, плоский эпителий -3-4- в поле зрения, лейкоциты - 40-50 в поле зрения, эритроцит свежий,
неизмененный - 1 в поле зрения, цилиндры - 0, слизь, кристаллы - отсутствуют. На УЗИ выявлено
уплотнение чашечек в правой почке, . О каком заболевании можно подумать? 1.
Гломерулонефрите 2. Мочекаменной болезни 3. Пиелонефрите 4. Цистите 5. Уретрите

A patient with end-stage renal failure receiving regular chronic haemodialysis three
times per week, misses one session of dialysis because of a thrombosed arteriovenous
fistula.

Which one of the following serum values indicate that this patient requires urgent
haemodialysis?
A> Sodium 125 mmol/L (normal range: 135-145)
B> Potassium 8.0 mmol/L (normal range: 3.5-5.0)
C> Creatinine 800 umoL/L (normal range: 60-120)
D> Phosphate 2.1 mmol/L (normal range: 0.8-1.5)
E> Serum bicarbonate 19 mmol/L (normal range: 22-32)
A patient with end-stage renal failure receiving regular chronic haemodialysis three
times per week, misses one session of dialysis because of a thrombosed arteriovenous
fistula.

Which one of the following serum values indicate that this patient requires urgent
haemodialysis?

A> Sodium 125 mmol/L (normal range: 135-145)

B> Potassium 8.0 mmol/L (normal range: 3.5-5.0)
C> Creatinine 800 umoL/L (normal range: 60-120)
D> Phosphate 2.1 mmol/L (normal range: 0.8-1.5)
E> Serum bicarbonate 19 mmol/L (normal range: 22-32)

A 15 year old boy presents with a one-week history of facial and ankle swelling,
hypertension, blood and protein on dipstick testing of urine and impaired renal function.
he had tonsilitis 10 days previously. Renal and bladder ultrasound are normal.

Which of the following is the most likely underlying cause of these symptoms?

A> Infiltration of neutrophils in the kidney glomeruli

B> Deposition of immune complexes in the kidney glomeruli
C> Infiltration of T lymphocytes in kidney glomeruli
D> Autoantibodies binding to endothelial cells in kidney glomeruli
E> Natural killer cells invading the kidney glomeruli
A 15 year old boy presents with a one-week history of facial and ankle swelling,
hypertension, blood and protein on dipstick testing of urine and impaired renal function.
he had tonsilitis 10 days previously. Renal and bladder ultrasound are normal.

Which of the following is the most likely underlying cause of these symptoms?

A> Infiltration of neutrophils in the kidney glomeruli

B> Deposition of immune complexes in the kidney glomeruli
C> Infiltration of T lymphocytes in kidney glomeruli
D> Autoantibodies binding to endothelial cells in kidney glomeruli
E> Natural killer cells invading the kidney glomeruli
A 79 year old lady presents to hospital with confusion, vomiting and a serum creatinine
of 220 umol/L (normal range: 70-90 umol/L), with an estimated glomerular filtration rate
of 20 mL/min/1.73 m2

Which investigation result best indicates that she has an underlying chronic rather than
acute kidney disease?

A> reduced kidney size on renal ultrasound

B> Increased haemoglobin concentration
C> A disproportionate elevation in the serum urea compared to the serum creatinine
D> 1+ protein on the urine dipstick test
E> Urine output less than 500 mL in 24 hours
A 79 year old lady presents to hospital with confusion, vomiting and a serum creatinine
of 220 umol/L (normal range: 70-90 umol/L), with an estimated glomerular filtration rate
of 20 mL/min/1.73 m2

Which investigation result best indicates that she has an underlying chronic rather than
acute kidney disease?

A> reduced kidney size on renal ultrasound

B> Increased haemoglobin concentration
C> A disproportionate elevation in the serum urea compared to the serum creatinine
D> 1+ protein on the urine dipstick test
E> Urine output less than 500 mL in 24 hours
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A healthy male athlete aged 26 years starts taking frusemide (furosemide) to mask
abuse of performance-enhancing substances he is also consuming.

Which of the following is true about the cells on which the drug acts?

A> They are highly polarised epithelial cells

B> They are vascular smooth muscle cells
C> They are connective tissue cells
D> They are transitional epithelial cells
E> They are glomerular capillary cells
A healthy male athlete aged 26 years starts taking frusemide (furosemide) to mask
abuse of performance-enhancing substances he is also consuming.

Which of the following is true about the cells on which the drug acts?

A> They are highly polarised epithelial cells

B> They are vascular smooth muscle cells
C> They are connective tissue cells
D> They are transitional epithelial cells
E> They are glomerular capillary cells
Acute kidney injury can result from administration of a number of therapeutic or
diagnostic agents.

Which of the following classes of pharmaceuticals causes impaired renal function

through a direct effect on glomerular filtration?

A> Aminoglycoside antibiotics

B> Radiological contrast agents
C> Platinum-containing chemotherapy agents
D> Antibiotics derived from penicillin
E> Non-steroidal anti-inflammatory drugs
Acute kidney injury can result from administration of a number of therapeutic or
diagnostic agents.

Which of the following classes of pharmaceuticals causes impaired renal function

through a direct effect on glomerular filtration?

A> Aminoglycoside antibiotics

B> Radiological contrast agents
C> Platinum-containing chemotherapy agents
D> Antibiotics derived from penicillin
E> Non-steroidal anti-inflammatory drugs
A 55 year old man undergoes an abdominal ultrasound examination for epigastric pain
and is incidentally found to have a large prostate with an estimated volume of 63 cc
(normal range <30 cc). He has no lower urinary tract symptoms.

Which of the following is the most appropriate couse of action?

A> Conservative management

B> Further investigation with a computed tomography (CT) scan or magnetic imaging
(MRI) scan of the pelvis
C> Commence treatment with a 5-alpha reductase inhibitor
D> Transurethral resection of the prostate
E> Total prostatectomy
A 55 year old man undergoes an abdominal ultrasound examination for epigastric pain
and is incidentally found to have a large prostate with an estimated volume of 63 cc
(normal range <30 cc). He has no lower urinary tract symptoms.

Which of the following is the most appropriate couse of action?

A> Conservative management

B> Further investigation with a computed tomography (CT) scan or magnetic imaging
(MRI) scan of the pelvis
C> Commence treatment with a 5-alpha reductase inhibitor
D> Transurethral resection of the prostate
E> Total prostatectomy
A patient with end-stage renal failure receiving regular chronic haemodialysis three
times per week, misses one session of dialysis because of a thrombosed arteriovenous
fistula.

Which one of the following serum values indicate that this patient requires urgent
haemodialysis?

A> Sodium 125 mmol/L (normal range: 135-145)

B> Potassium 8.0 mmol/L (normal range: 3.5-5.0)
C> Creatinine 800 umoL/L (normal range: 60-120)
D> Phosphate 2.1 mmol/L (normal range: 0.8-1.5)
E> Serum bicarbonate 19 mmol/L (normal range: 22-32)
A patient with end-stage renal failure receiving regular chronic haemodialysis three
times per week, misses one session of dialysis because of a thrombosed arteriovenous
fistula.

Which one of the following serum values indicate that this patient requires urgent
haemodialysis?

A> Sodium 125 mmol/L (normal range: 135-145)

B> Potassium 8.0 mmol/L (normal range: 3.5-5.0)
C> Creatinine 800 umoL/L (normal range: 60-120)
D> Phosphate 2.1 mmol/L (normal range: 0.8-1.5)
E> Serum bicarbonate 19 mmol/L (normal range: 22-32)
Elevation of which of the following biochemical species is indicative of chronic renal
failure regardless of cause?

A> Bicarbonate
B> Calcitriol
C> Calcium
D> Glucose
E> Urea
Elevation of which of the following biochemical species is indicative of chronic renal
failure regardless of cause?

A> Bicarbonate
B> Calcitriol
C> Calcium
D> Glucose
E> Urea
A 75 year old man presents with end-stage kidney disease. He commences renal
dialysis but dies after two years

Which of the following is the most likely cause of death in such a patient?

A> Stroke
B> Heart disease
C> Infection
D> Malignancy
E> Hyperkalaemia
A 75 year old man presents with end-stage kidney disease. He commences renal
dialysis but dies after two years

Which of the following is the most likely cause of death in such a patient?

A> Stroke
B> Heart disease
C> Infection
D> Malignancy
E> Hyperkalaemia
A 73 year old ex-smoker presents with haemoptysis, dyspnoea and weight loss. His
chest X-ray shows a 4 cm opacity suggestive of lung malignancy. His serum sodium is
118 mmol/L (normal range 135-145)

Which of the following test results is most likely to be found in this situation?

A> Elevated serum chloride

B> Elevated serum osmolarity
C> Elevated serum uric acid
D> Elevated urine osmolarity
E> Elevated urine potassium
A 73 year old ex-smoker presents with haemoptysis, dyspnoea and weight loss. His
chest X-ray shows a 4 cm opacity suggestive of lung malignancy. His serum sodium is
118 mmol/L (normal range 135-145)

Which of the following test results is most likely to be found in this situation?
A> Elevated serum chloride
B> Elevated serum osmolarity
C> Elevated serum uric acid
D> Elevated urine osmolarity
E> Elevated urine potassium
A 70 year old woman has diabetic nephropathy. Her eGFR (estimated glumerular
filtration rate) is 12 mL/min/1.73m2. Her past medical history includes a mastectomy
and lymph node dissection for breast cancer six months ago and surgery one year ago
for a perforated colon due to diverticulitis requiring a colostomy. She lives independently
at home with her husband. On examination she looks tired but is otherwise well-looking.
She has decided that she wants renal replacement therapy.

Which of the following modalities of renal replacement would be most appropriate for
her?

A> Haemodialysis via an arteriovenous fistula

B> Haemodialysis via non-tunnelled dialysis catheter
C> Haemodialysis via tunnelled dialysis catheter
D> Kidney transplantation
E> Peritoneal dialysis
A 70 year old woman has diabetic nephropathy. Her eGFR (estimated glumerular
filtration rate) is 12 mL/min/1.73m2. Her past medical history includes a mastectomy
and lymph node dissection for breast cancer six months ago and surgery one year ago
for a perforated colon due to diverticulitis requiring a colostomy. She lives independently
at home with her husband. On examination she looks tired but is otherwise well-looking.
She has decided that she wants renal replacement therapy.

Which of the following modalities of renal replacement would be most appropriate for
her?

A> Haemodialysis via an arteriovenous fistula

B> Haemodialysis via non-tunnelled dialysis catheter
C> Haemodialysis via tunnelled dialysis catheter
D> Kidney transplantation
E> Peritoneal dialysis
A 27 year old man presents to the medical tent of a fun run feeling unwell and
complaining of feeling dizzy. His blood pressure is 90/60mmHg, heart rate 140 bpm and
regular. His jugular pressure is not visible when is lying flat.

Which of the following change in plasma hormones would you expect?

A> Elevation of angiotensin II

B> Elevation of atrial natriuretic factor
C> Elevation of dopamine
C> Suppression of aldosterone
E> Elevation of oxytocin
A 27 year old man presents to the medical tent of a fun run feeling unwell and
complaining of feeling dizzy. His blood pressure is 90/60mmHg, heart rate 140 bpm and
regular. His jugular pressure is not visible when is lying flat.

Which of the following change in plasma hormones would you expect?

A> Elevation of angiotensin II
B> Elevation of atrial natriuretic factor
C> Elevation of dopamine
C> Suppression of aldosterone
E> Elevation of oxytocin
An asymptomatic 61 year old man has an elevated prostate specific antigen level of 4.6
ng/mL (Normal Range: 0-4.0 ng/mL).

Which of the following factors most increases the likelihood that he has prostatic
carcinoma?

A. The level has risen by 0.2 ng/mL annually for 5 years

B. The free to total ratio is 8%
C. The free to total ratio is 28%
D. His father had prostate cancer
E. His prostate is significantly enlarged
An asymptomatic 61 year old man has an elevated prostate specific antigen level of 4.6
ng/mL (Normal Range: 0-4.0 ng/mL).

Which of the following factors most increases the likelihood that he has prostatic
carcinoma?

A. The level has risen by 0.2 ng/mL annually for 5 years

B. The free to total ratio is 8%
C. The free to total ratio is 28%
D. His father had prostate cancer
E. His prostate is significantly enlarged
A 75 year old man with a recent diagnosis of prostate cancer presents with nausea,
vomiting and anorexia. His creatinine is 0.70 mmol/L (Normal Range: 0.06-0.12
mmol/L).

Which of the following is the most likely cause of his renal failure?

A. Metastasis to the kidneys

B. Chemotherapy
C. Hypercalcaemia
D. Bladder outlet obstruction
E. Left ureteric obstruction
A 75 year old man with a recent diagnosis of prostate cancer presents with nausea,
vomiting and anorexia. His creatinine is 0.70 mmol/L (Normal Range: 0.06-0.12
mmol/L).

Which of the following is the most likely cause of his renal failure?

A. Metastasis to the kidneys

B. Chemotherapy
C. Hypercalcaemia
D. Bladder outlet obstruction
E. Left ureteric obstruction
A 56 year old man asks you, his General Practitioner, whether he should undergo
prostate cancer testing.
Which of the following statements regarding prostate cancer screening is true?

A. Men at this age are not at risk of developing prostate cancer so do not need
screening
B. Prostate cancer screening in this man is not recommended because he has no family
history
C. Screening is not recommended because it is much more expensive than breast
cancer screening
D. Surgical treatment of early prostate cancer results in a reduction in mortality
E. The PSA test does not detect the disease in an earlier stage
A 56 year old man asks you, his General Practitioner, whether he should undergo
prostate cancer testing.

Which of the following statements regarding prostate cancer screening is true?

A. Men at this age are not at risk of developing prostate cancer so do not need
screening
B. Prostate cancer screening in this man is not recommended because he has no family
history
C. Screening is not recommended because it is much more expensive than breast
cancer screening
D. Surgical treatment of early prostate cancer results in a reduction in mortality
E. The PSA test does not detect the disease in an earlier stage
Renal tubular acidosis can arise due to which of the following?

A. Increased reabsorption of bicarbonate in the proximal nephron

B. Increased secretion of hydrogen ions in the distal nephron
C. Reduced glomerular filtration rate
D. Impaired sodium reabsorption in the distal nephron
E. Impaired potassium reabsorption in the distal nephron
Renal tubular acidosis can arise due to which of the following?

A. Increased reabsorption of bicarbonate in the proximal nephron

B. Increased secretion of hydrogen ions in the distal nephron
C. Reduced glomerular filtration rate
D. Impaired sodium reabsorption in the distal nephron
E. Impaired potassium reabsorption in the distal nephron
Which of the following does normal sperm function require?

A. Supression of follicle stimulating hormone

B. Secretion of luteinizing hormone by the interstitial cells of Leydig
C. Maturation from spermatozoon to spermatid
D. Several days maturation in the epididymis
E. Storage in the vas deferens
Which of the following does normal sperm function require?

A. Supression of follicle stimulating hormone

B. Secretion of luteinizing hormone by the interstitial cells of Leydig
C. Maturation from spermatozoon to spermatid
D. Several days maturation in the epididymis
E. Storage in the vas deferens
A 76 year old man has been started on androgen deprivation therapy for the treatment
of metastatic prostate cancer.

What common side effects should he be warned about?

A. Insomnia
B. Balding
C. Osteoporosis
D. Low blood sugar levels
E. Weight loss
A 76 year old man has been started on androgen deprivation therapy for the treatment
of metastatic prostate cancer.

What common side effects should he be warned about?

A. Insomnia
B. Balding
C. Osteoporosis
D. Low blood sugar levels
E. Weight loss
A 45 year old woman presents with acute right loin pain with radiation to her right groin.
A plain abdominal X-ray demonstrates a 4 mm calcific lesion about the right sacro-iliac
joint.

What is the most appropriate initial management?

A. Trial of conservative management

B. Shock wave lithotripsy
C. Endoscopic extraction of the calculus
D. Medical stone dissolution therapy
E. Ureterolithotomy
A 45 year old woman presents with acute right loin pain with radiation to her right groin.
A plain abdominal X-ray demonstrates a 4 mm calcific lesion about the right sacro-iliac
joint.

What is the most appropriate initial management?

A. Trial of conservative management

B. Shock wave lithotripsy
C. Endoscopic extraction of the calculus
D. Medical stone dissolution therapy
E. Ureterolithotomy
A 65 year old man with Type 2 diabetes has been admitted to hospital for coronary
angiography prior to possible coronary artery bypass surgery. His blood pressure is
noted to be elevated and his creatinine is 0.18 mmol/L (Normal Range: 0.06 - 0.12
mmol/L).

Which class of antihypertensive agents would increase the risk of impairment of renal
function in the peri-operative period for this patient?

A. Calcium channel blockers

B. Alpha blockers
C. Beta blockers
D. Angiotensin-converting enzyme (ACE) inhibitors
E. Vasodilators
A 65 year old man with Type 2 diabetes has been admitted to hospital for coronary
angiography prior to possible coronary artery bypass surgery. His blood pressure is
noted to be elevated and his creatinine is 0.18 mmol/L (Normal Range: 0.06 - 0.12
mmol/L).

Which class of antihypertensive agents would increase the risk of impairment of renal
function in the peri-operative period for this patient?

A. Calcium channel blockers

B. Alpha blockers
C. Beta blockers
D. Angiotensin-converting enzyme (ACE) inhibitors
E. Vasodilators
Regarding the ureters, which of the following statements is NOT correct?

A. It commences at the distal end of the renal pelvis

B. It descends on quadratus lumborum muscle in the abdomen
C. It passes obliquely through the wall of the bladder
D. It drains into the bladder at the upper lateral aspect of the trigone
E. It is crossed anteriorly by the gonadal vessels in the abdomen
Regarding the ureters, which of the following statements is NOT correct?

A. It commences at the distal end of the renal pelvis

B. It descends on quadratus lumborum muscle in the abdomen
C. It passes obliquely through the wall of the bladder
D. It drains into the bladder at the upper lateral aspect of the trigone
E. It is crossed anteriorly by the gonadal vessels in the abdomen
A 75 year old man presents with a two-day history of lower abdominal pain and urinary
retention. He has a CT scan which is as shown. The plasma creatinine is 230
micromol/L.

Which of the following is most likely to apply in this situation?

A. Antibiotics will be an important part of his treatment

B. A renal biopsy will reveal the underlying diagnosis
C. He has a vesical calculus
D. He has neurogenic bladder
E. Renal function will improve following urethral catheterisation
A 75 year old man presents with a two-day history of lower abdominal pain and urinary
retention. He has a CT scan which is as shown. The plasma creatinine is 230
micromol/L.

Which of the following is most likely to apply in this situation?

A. Antibiotics will be an important part of his treatment

B. A renal biopsy will reveal the underlying diagnosis
C. He has a vesical calculus
D. He has neurogenic bladder
E. Renal function will improve following urethral catheterisation
Urea arises from the breakdown of which biochemical species?

A. Fat
B. Glucose
C. Glycogen
D. Protein
E. Uridine
Urea arises from the breakdown of which biochemical species?

A. Fat
B. Glucose
C. Glycogen
D. Protein
E. Uridine
A healthy male athlete aged 26 years starts taking frusemide (furosemide) to mask
abuse of performance-enhancing substances he is also consuming.

While taking this drug, which of the following is true about his renal function?

A. His ability to concentrate the urine is impaired

B. His distal secretion of potassium is reduced
C. His fractional excretion of sodium is reduced
D. His glomerular filtration rate is increased
E. His renin-angiotensin system is suppressed
A healthy male athlete aged 26 years starts taking frusemide (furosemide) to mask
abuse of performance-enhancing substances he is also consuming.

While taking this drug, which of the following is true about his renal function?

A. His ability to concentrate the urine is impaired

B. His distal secretion of potassium is reduced
C. His fractional excretion of sodium is reduced
D. His glomerular filtration rate is increased
E. His renin-angiotensin system is suppressed
A 45 year old man has noticed a recent onset of erectile dysfunction. He has well
controlled hypertension but is otherwise asymptomatic and has no abnormal physical
signs.

Which of the following is correct?

A. A prolactin secreting pituitary tumour can present in this manner

B. If all investigations are normal, weekly injection of testosterone is the treatment of
choice if he is unsuitable for treatment with sildenafil
C. It may be due to recent commencement of a beta blocker for the treatment of
his hypertension
D. Normal plasma testosterone, LH and FSH levels suggest that the impotence has no
organic basis
E. Treatment with sildenafil (viagra) is contraindicated if he is on a beta blocker
A 45 year old man has noticed a recent onset of erectile dysfunction. He has well
controlled hypertension but is otherwise asymptomatic and has no abnormal physical
signs.

Which of the following is correct?

A. A prolactin secreting pituitary tumour can present in this manner

B. If all investigations are normal, weekly injection of testosterone is the treatment of
choice if he is unsuitable for treatment with sildenafil
C. It may be due to recent commencement of a beta blocker for the treatment of his
hypertension
D. Normal plasma testosterone, LH and FSH levels suggest that the impotence has no
organic basis
E. Treatment with sildenafil (viagra) is contraindicated if he is on a beta blocker
In the female pelvis, which of the following is NOT correct regarding the ureters?

A. It passes posterior to the ovarian vessels

B. It passes posterior to the ovary
C. It passes lateral to the lateral fornix of the vagina
D. It passes superior to the uterine artery
E. It passes superior to the vaginal artery
In the female pelvis, which of the following is NOT correct regarding the ureters?

A. It passes posterior to the ovarian vessels

B. It passes posterior to the ovary
C. It passes lateral to the lateral fornix of the vagina
D. It passes superior to the uterine artery
E. It passes superior to the vaginal artery
A 15 year old boy presents with a one-week history of facial and ankle swelling,
hypertension, blood and protein on dipstick testing of urine, and impaired renal function.
He had tonsillitis 10 days previously. Renal and bladder ultrasound are normal.

What is he most likely to have?

A. IgA nephropathy
B. Minimal change glomerulopathy
C. Clear cell carcinoma of the kidney
D. Post-streptococcal glomerulonephritis
E. Rapidly progressive glomerulonephritis
A 15 year old boy presents with a one-week history of facial and ankle swelling,
hypertension, blood and protein on dipstick testing of urine, and impaired renal function.
He had tonsillitis 10 days previously. Renal and bladder ultrasound are normal.

What is he most likely to have?

A. IgA nephropathy
B. Minimal change glomerulopathy
C. Clear cell carcinoma of the kidney
D. Post-streptococcal glomerulonephritis
E. Rapidly progressive glomerulonephritis
A 23 year old woman becomes lost in the bush during a heatwave, and is found 12
hours after her water supply has run out.

Which of the following intravenous fluids would be most effective in restoring her
extracellular fluid volume?

A. 5% dextrose solution
B. 50% dextrose solution
C. 4% dextrose/N/5 saline solution
D. 0.9% sodium chloride solution
E. Isotonic potassium chloride solution
A 23 year old woman becomes lost in the bush during a heatwave, and is found 12
hours after her water supply has run out.

Which of the following intravenous fluids would be most effective in restoring her
extracellular fluid volume?

A. 5% dextrose solution
B. 50% dextrose solution
C. 4% dextrose/N/5 saline solution
D. 0.9% sodium chloride solution
E. Isotonic potassium chloride solution
A 23 year old woman becomes lost in the bush during a heatwave and is found 12
hours after her water supply has run out.

Which of the following changes in renal function would be expected?

A. Increased glomerular filtration rate

B. Impaired sodium reabsorption in the proximal tubules
C. Increased osmolality of fluid in the medullary collecting duct
D. Reduced action of aldosterone in the cortical collecting duct
E. Increased renal blood flow
A 23 year old woman becomes lost in the bush during a heatwave and is found 12
hours after her water supply has run out.

Which of the following changes in renal function would be expected?

A. Increased glomerular filtration rate

B. Impaired sodium reabsorption in the proximal tubules
C. Increased osmolality of fluid in the medullary collecting duct
D. Reduced action of aldosterone in the cortical collecting duct
E. Increased renal blood flow
Which of the following structures do NOT pass through the hilum of the kidneys?

A. Autonomic nerves
B. Lymph vessels
C. Major calyces
D. Renal artery or branches
E. Renal vein or tributaries
Which of the following structures do NOT pass through the hilum of the kidneys?

A. Autonomic nerves
B. Lymph vessels
C. Major calyces
D. Renal artery or branches
E. Renal vein or tributaries
Regarding the testis, which of the following statements is FALSE?

A. Leydig cells are located in the space between adjoining tubules

B. The most immature spermatogenic cells are called spermatocytes
C. Seminiferous epithelium consists of Sertoli cells and spermatogenic cells
D. Sertoli cells are supporting cells for the developing sperm
E. Leydig cells synthesize and secrete testosterone
Regarding the testis, which of the following statements is FALSE?

A. Leydig cells are located in the space between adjoining tubules

B. The most immature spermatogenic cells are called spermatocytes
C. Seminiferous epithelium consists of Sertoli cells and spermatogenic cells
D. Sertoli cells are supporting cells for the developing sperm
E. Leydig cells synthesize and secrete testosterone
A 35 year old woman presents with vaginal discharge and discomfort. On physical
examination, she is found to have inflammation of the vagina and vulva.

Which of the following is the most likely pathogen?

A. Neisseria gonorrhea
B. Lactobacillus
C. Gardnerella vaginalis
D. Candida albicans
E. Chlamydia trachomatis
A 35 year old woman presents with vaginal discharge and discomfort. On physical
examination, she is found to have inflammation of the vagina and vulva.

Which of the following is the most likely pathogen?

A. Neisseria gonorrhea
B. Lactobacillus
C. Gardnerella vaginalis
D. Candida albicans
E. Chlamydia trachomatis
The most common cause of chronic kidney disease amongst patients requiring dialysis
in Australia is which of the following?

A. Hypertension
B. IgA disease
C. Polycystic kidney disease
D. Type 1 diabetes
E. Type 2 diabetes
The most common cause of chronic kidney disease amongst patients requiring dialysis
in Australia is which of the following?

A. Hypertension
B. IgA disease
C. Polycystic kidney disease
D. Type 1 diabetes
E. Type 2 diabetes
An 86 year old man has metastatic prostate cancer. His urologist has recommended
androgen deprivation therapy.

Which of the following is the most common method of delivering this?

A. Antiandrogen
B. Bilateral orchidectomy
C. Estrogen therapy
D. Ketaconazole
E. LHRH agonist
An 86 year old man has metastatic prostate cancer. His urologist has recommended
androgen deprivation therapy.

Which of the following is the most common method of delivering this?

A. Antiandrogen
B. Bilateral orchidectomy
C. Estrogen therapy
D. Ketaconazole
E. LHRH agonist
A 54 year old woman is injured in a car accident and loses a large volume of blood
before she is taken to hospital four hours later. Despite resuscitation with intravenous
fluids and blood transfusion, her urine output remains low and her plasma creatinine
climbs steadily over the next 48 hours.

What is the likely pathophysiological explanation for these findings?

A. The glomerular filtration rate is rising

B. The renal tubules are damaged
C. The urine concentrating system is maximally activated
D. An inflammatory process is affecting the glomeruli
E. Renal blood flow has fallen to zero
A 54 year old woman is injured in a car accident and loses a large volume of blood
before she is taken to hospital four hours later. Despite resuscitation with intravenous
fluids and blood transfusion, her urine output remains low and her plasma creatinine
climbs steadily over the next 48 hours.

What is the likely pathophysiological explanation for these findings?

A. The glomerular filtration rate is rising

B. The renal tubules are damaged
C. The urine concentrating system is maximally activated
D. An inflammatory process is affecting the glomeruli
E. Renal blood flow has fallen to zero
A 70 year old man is rescued from a collapsed building after an earthquake, suffering
from extensive crush injuries. He passes very little urine over the next 48 hours.

Which of the following is suggestive of rhabdomyolysis as a cause of acute renal failure

in this patient?
A. A plasma creatine kinase level of 320 U/L (normal range <250 U/L)
B. A rising plasma calcium concentration in the days after the injury
C. A positive urine dipstick test for blood with no red cells on urine microscopy
D. Large numbers of red blood cells and white blood cells on urine microscopy
E. The development of severe hypertension in the days after the injury
A 70 year old man is rescued from a collapsed building after an earthquake, suffering
from extensive crush injuries. He passes very little urine over the next 48 hours.

Which of the following is suggestive of rhabdomyolysis as a cause of acute renal failure

in this patient?

A. A plasma creatine kinase level of 320 U/L (normal range <250 U/L)
B. A rising plasma calcium concentration in the days after the injury
C. A positive urine dipstick test for blood with no red cells on urine microscopy
D. Large numbers of red blood cells and white blood cells on urine microscopy
E. The development of severe hypertension in the days after the injury

A 51-year-old man is hospitalized 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 59 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 Podocyte foot process effacement

C Glomerular crescent formation

D Hyperplastic arteriolosclerosis

E Mesangial immune complex deposition

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 hematuria. 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 syndrome

B IgA nephropathy

C Alport syndrome

D Dominant polycystic kidney disease

E Diabetes mellitus, type I

A 43-year-old man has had increasing malaise for the past 3 weeks. On physical examination he has a
blood pressure of 150/95 mmHg and 1+ pitting edema of the lower extremities to the knees. Dipstick
urinalysis shows no glucose, blood, ketones, nitrite, or urobilinogen, and the microscopic urinalysis
reveals no RBC/hpf and only 1 WBC/hpf. Additional laboratory studies show a 24 hour urine protein of
4.1 gm. His serum creatinine is 3.5 mg/dL with urea nitrogen of 38 mg/dL. His hepatitis B surface antigen
is positive. Which of the following is the most likely diagnosis?

A Membranous nephropathy

B Systemic lupus erythematosus

C Acute tubular necrosis

D Diabetic nephropathy

E Post-streptococcal glomerulonephritis

A 20-year-old previously healthy man has been feeling tired for the past 5 days. He then passes dark-
colored urine. On physical examination his blood pressure is 160/90mm Hg. Laboratory studies show his
serum creatinine is 4.4 mg/dL and BUN 40 mg/dL. A urinalysis reveals pH 6, specific gravity 1.011, 3+
blood, 1+ protein, no glucose, and no ketones. On urine microscopic examination there are numerous
RBC casts. 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 Neutrophilic infiltrates

D Basement membrane thickening

E IgA deposited in glomerular capillaries

A 60-year-old woman is admitted with sudden onset of chest pain and is diagnosed with an acute
myocardial infarction. There is difficulty maintaining adequate blood pressure and tissue perfusion for 3
days. Her serum lactate becomes elevated. Her serum urea nitrogen increases to 44 mg/dL and
creatinine to 2.2 mg/dL. Granular and hyaline casts are present on microscopic urinalysis. Which of the
following renal lesions is most likely to be present in this situation?

A Chronic pyelonephritis

B Acute tubular necrosis

C Nodular glomerulosclerosis

D Renal vein thrombosis

E Minimal change disease

A 39-year-old woman is found to have a blood pressure of 160/110 mm Hg
while at a free health screening clinic. She feels fine and has had no major
medical problems in her life. An abdominal ultrasound reveals that the left
kidney is smaller than the right, but that neither is cystic and no masses
appear to be present. MR angiography reveals focal narrowing with thickening
and beading of the left main renal artery. A urinalysis reveals no abnormal
findings. She has an elevated plasma renin. Which of the following is the most
likely diagnosis?

A Diabetes mellitus

B Antiphospholipid syndrome

C Fibromuscular dysplasia

D Thrombotic thrombocytopenic purpura

E Cholesterol emboli syndrome

A 55-year-old man is found down and unconscious. On physical examination

he is afebrile. After catheterization, he passes a small amount of dark urine.
The urine dipstick test for blood is positive but no red blood cells are seen on
microscopic examination of the urine sediment. Which of the following is the
most likely diagnosis?

A Post-streptococcal glomerulonephritis

B Renal papillary necrosis

C Ureteral lithiasis

D Rhabdomyolysis

E Renal infarction

A 43-year-old woman has had increasing dyspnea for 8 years. She has no
cough or increased sputum production. On physical examination there is
bilateral hyperresonance to percussion in all lung fields. A chest x-ray reveals
increased lung volumes with flattening of the diaphragmatic leaves bilaterally.
The right heart border is prominent. A chest CT scan demonstrates decreased
attenuation in all lung fields, particularly lower lobes. Which of the following
laboratory findings is she most likely to have?

A Decreased serum ceruloplasmin

B Increased sweat chloride

C Positive urine nicotine

D Decreased serum alpha-1-antitrypsin

E Positive urine opiates

F Positive antinuclear antibody test

During a cardiac arrest, a 58-year-old man, a non-smoker, receives

cardiopulmonary resuscitative measures and is brought to the hospital, where
he is intubated. During the intubation procedure he suffers aspiration of
gastric contents. Over the next 10 days he develops a non-productive cough
along with a fever to 37.9°C. A chest radiograph reveals a 4 cm diameter
mass with an air-fluid level in the right lung. A sputum gram stain reveals
mixed flora. Which of the following conditions is he most likely to have?

A Squamous cell carcinoma

B Lung abscess

C Chronic bronchitis

D Bronchiectasis

E Bronchopulmonary sequestration
A study is performed reviewing medical records of adults presenting with
sudden onset of severe dyspnea. They were afebrile, with absent breath
sounds over an entire lung, and chest x-ray showing pulmonary atelectasis of
an entire lung. Which of the following conditions is most likely to produce
these findings?

A Aspiration of a foreign body

B Pulmonary embolism

C Squamous cell carcinoma

D Penetrating chest trauma

E Bronchiectasis

A 39-year-old man comes to the physician because of a 6-month history of

progressive shortness of breath. He has had

a cough productive of white sputum for 2 years. He smoked 1 pack of

cigarettes daily for 16 years but quit 10 years ago.

He is in mild respiratory distress with pursed lips and a barrel chest; he is

using the accessory muscles of respiration.

Breath sounds are distant and crackles are present in the lower lung fields
bilaterally. Pulmonary function tests show a

decreased FEV1:FVC ratio, increased residual volume, and decreased

diffusion capacity. An x-ray of the chest shows

hyperinflation and hypertranslucency of the lower lobes of both lungs. Which

of the following is the most likely
diagnosis?

(A) Asthma

(B) Bronchiectasis

(C) Chronic pulmonary fibrosis

(D) Cystic fibrosis