1. In pre renal azotemia there is
A. Decline in glomerular filtration
B. Intact tubular function
C. Both
D. Neither
2. Pre renal azotemia could result from
A. Decrease in circulating blood volume
B. Decrease in renal blood flow
C. Both
D. Neither
3. Acute tubular necrosis
A. Deterioration of glomerular function
B. Deterioration of tubular function
C. Both
D. Neither
4. Acute tubular necrosis can be the result of
A. Decrease in circulating blood volume
B. Exogenous Toxins
C. Both
D. Neither
5. Acute tubular necrosis is a diagnosis of exclusion
A. True
B. False
You need to exclude other defined renal syndromes that can present as acute renal failure.
6. Renal functional components are
A. Regulatory
B. Excretory
C. Endocrine
D. All of the above
7. Regulatory functions of kidney are
A. Volume of body fluids
B. Composition of body fluids
C. Both
8. Loss of renal regulatory function of Volume of body fluids could result in
A. Edema
B. Hypertension
C. Congestive heart failure
D. All of the above
9. Loss of renal regulatory function of Composition of body fluids could result in
A. Hyperkalemia
B. Metabolic acidosis
C. Hyperphosphatemia
D. All of the above
10. Loss of excretory ability is expressed by
A. Rising BUN
B. Rising Creatinine
C. Both
11. Rate of rise in BUN and Creatinine reflects
A. Degree of impairment of excretory renal function
B. Rates of generation of BUN and Creatinine
C. Both
12. Rate of rise of creatinine with impaired renal excretory function is high in
A. Acute GI bleed
B. Patient with sleep apnea syndrome
C. Both
D. Neither
Creatinine generation is proportional to muscle mass. Patients with sleep apnea syndrome are usually massively obese (hope also with increased muscle mass)
13. In average patient with acute renal failure the BUN rises about
A. 5-10 mg/dl/day
B. 10-15 mg/dl/day
C. 15-20 mg/dl/day
D. 20-25 mg/dl/day
14. A patient with acute renal failure has BUN rise of 45mg/dl/day . You should then consider
A. Acute GI bleed
B. Catabolic state
C. Both
D. Neither
15. Sonogram of kidneys can
A. Evaluate size
B. Assess calyceal system
C. Detect cysts and masses
D. All of the above
E. None of the above
16. Best radiological procedure to determine the size of the kidney in a patient with renal failure is
A. Plain x-ray abdomen
B. Sonogram
C. IVP
In a patient with renal failure, the quality of films obtained with IVP are poor and in addition radio contrast can be nephrotoxic.
17. Blood flow studies with radionucleotide method can
A. Determine presence or absence of flow
B. Can evaluate symmetry
C. Both
Poor for exact quantitation of rate of blood flow.
18. Patient with ATN. Renal blood flow evaluated by radionucleotide method. You are likely to see
A. Decreased renal blood flow
B. Increased renal blood flow
C. Normal renal blood flow
19. Presence of red cells in urine should raise suspicion of disease of
A. Glomeruli
B. Tubules
C. Ureters
D. Bladder
E. Non-specific
Only Red cell casts would localize the disease to glomeruli, otherwise red cells per se is non-specific.
20. Urine sediment contains lymphocytes and eosinophils. Consider
A. Glomerulonephritis
B. Pyelonephritis
C. Acute interstitial nephritis
21. Azotemia in the presence of normal urinary sediment is suggestive of
A. Tubular disease
B. Obstructive disease
C. SLE
D. Non diagnostic
22. Presence of red cells and white blood cells in urine rules out obstructive disease
A. True
B. False
23. In ATN glucose can be detected in the urine in the absence of hyperglycemia
A. True
B. False
A finding that reflects tubular injury.
24. Urine osmolality is close to that of serum in ATN
A. True
B. False
Reflects the defect in tubular function.
25. Patient is being investigated for acute renal failure. Spot check: urine concentration 40 meq/l. It is suggestive of
A. Glomerulonephritis
B. Congestive heart failure
C. ATN
D. Benign prostatic hypertrophy
If patient with CHF received diuretics then such a value can be encountered.
26. Patient with acute renal failure with high urine osmolality, fractional excretion of sodium less than 1 percent. Consider
A. Glomerulonephritis
B. Congestive heart failure
C. ATN
D. Benign prostatic hypertrophy
Findings consistent with pre renal azotemia.
27. Oliguria is considered present when the urine output is
A. < 100 ml/day
B. < 300 ml/day
C. < 500 ml/day
D. None of the above
28. Patients with ATN can have
A. Oliguria
B. Polyurea
C. Both
29. All of the following can give rise to total anuria except
A. Dissecting abdominal aortic aneurysm
B. Acute renal vein thrombosis
C. Severe cortical necrosis
D. Urinary tract obstruction
E. Acute interstitial nephritis
Total anuria narrows the diagnostic considerations. Severe acute glomerulonephritis can also lead to total anuria.
30. Functions of kidney can be maintained until the kidney has only
A. 50% of function
B. 30% of function
C. 10% of function
It is amazing how each organ fails only after significant loss of function. About 80-90% is in reserve, and the organ manifests failure only after the entire reserve is used up.
31. The nephrons that remain functional in the presence of disease act as
A. Partially damaged units
B. Normal units
C. Supernormal units
This defines "intact nephron hypothesis". Remaining nephrons adapt and display a normal or supernormal functional ability.
32. "Trade off hypothesis" refers to the adaptive changes mediated by stimuli generated outside and within the kidney
A. True
B. False
Adaptation to calcium and phosphate metabolism and the role parathyroid gland plays is a good example of this hypothesis.
33. Bleeding complication in chronic renal failure is due to
A. Increased platelets
B. Decreased platelets
C. Functionally abnormal platelets
This should be kept in mind when contemplating invasive procedures in this group of patients.
34. Type of anemia encountered in Chronic renal failure is
A. Megaloblastic anemia
B. Iron deficiency anemia
C. Pseudo iron deficiency anemia
D. Aplastic anemia
Most common anemia is that of chronic disease. However in chronic renal failure GI bleeding, Poor diet and malabsorption could contribute to anemia.
35. Pruritus in Uremia is due to
A. Elevated BUN
B. Micro crystallization of calcium in skin
C. Elevated phosphorous
D. None of the above
PTH itself may cause pruritus.
36. Patient in renal failure. The ratio of BUN to Creatinine is 30:1. Most likely diagnosis is
A. Obstructive disease
B. Glomerular disease
C. Pre renal disease
A rate higher than 20:1 is suggestive of pre renal azotemia. In renal disease there is usually a proportionate elevation of BUN and Creatinine.
37. A normal kidney in states of dehydration, can generate with maximum concentration, an urine osmolality in excess of
A. 500 mOsm/kg
A. 900 mOsm/kg
A. 1200 mOsm/kg
38. Patient in acute renal failure. Urine osmolality is 600 mOsm/kg. Most likely it is due to
A. ATN
B. Pre renal azotemia
A urinary osmolalty greater than 600 mOsm/kg is suggestive of pre renal azotemia. You need intact tubular function to achieve this. In ATN typically the urine osmolality is around 300-350 mOsm/kg .
39. Patient in acute renal failure. Urinary sodium is 40 mEq/L. Most likely the etiology for renal failure is
A. ATN
B. Pre renal azotemia
The tubular function is impaired in ATN and hence the urinary sodium excretion is increased. In pre renal azotemia where tubular function is intact, the urinary sodium typically falls below 20 mEq/L..
40. In patients with chronic renal failure, Hypertension develops in
A. 95% of patients
B. 50% of patients
C. 10% of patients
41. Normal size of kidneys by sonography
A. 10-12 cms in long axis
B. 7-9 cms in long axis
C. 14-16 cms in long axis
Very useful information. When below 9 cms, is suggestive of chronic renal failure. Kidneys larger than 14 cms, consider inflammatory, infiltrative diseases. Polycystic kidney, Hydronephroses and Tumors are large but they can be recognized by the echogenicity evaluation.