๐ Instructions
How to Use: Click on any answer choice to see immediate feedback. Green indicates correct answers, red indicates incorrect answers. Each choice includes an explanation.
Coverage: Based on UDPA 641 Clinical Medicine III syllabus and NCCPA blueprint topics
Format: PANCE-style multiple choice questions with detailed explanations
๐งช Interactive Nephrology Quiz - 50 Questions
Question 1
A 45-year-old man presents with flank pain, nausea, and hematuria. CT scan shows a 6mm stone in the right ureter. What is the most appropriate initial management?
A) Immediate urological referral for lithotripsy
B) Conservative management with increased fluid intake and pain control
C) Emergency nephrostomy tube placement
D) Immediate surgical removal
Correct Answer: B
Explanation: Stones โค7mm have a high likelihood (>90%) of spontaneous passage. Conservative management with adequate hydration (>2L/day), pain control with NSAIDs or opiates, and medical expulsive therapy (alpha-blockers) is appropriate unless complications arise (infection, intractable pain, or solitary kidney).
Explanation: Stones โค7mm have a high likelihood (>90%) of spontaneous passage. Conservative management with adequate hydration (>2L/day), pain control with NSAIDs or opiates, and medical expulsive therapy (alpha-blockers) is appropriate unless complications arise (infection, intractable pain, or solitary kidney).
Question 2
A 28-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows >100,000 CFU/mL E. coli, positive nitrites, and WBC casts. What is the most likely diagnosis?
A) Cystitis
B) Pyelonephritis
C) Urethritis
D) Interstitial cystitis
Correct Answer: B
Explanation: WBC casts are pathognomonic for pyelonephritis, indicating upper urinary tract infection with involvement of the renal tubules. Cystitis would not produce casts since it's confined to the bladder. The presence of casts indicates kidney involvement.
Explanation: WBC casts are pathognomonic for pyelonephritis, indicating upper urinary tract infection with involvement of the renal tubules. Cystitis would not produce casts since it's confined to the bladder. The presence of casts indicates kidney involvement.
Question 3
Which of the following best defines Stage 3a CKD?
A) eGFR 45-59 mL/min/1.73mยฒ
B) eGFR 30-44 mL/min/1.73mยฒ
C) eGFR 15-29 mL/min/1.73mยฒ
D) eGFR <15 mL/min/1.73mยฒ
Correct Answer: A
Explanation: Stage 3a CKD is defined as eGFR 45-59 mL/min/1.73mยฒ. Stage 3b is 30-44, Stage 4 is 15-29, and Stage 5 is <15. Stage 3 represents moderate decrease in kidney function when complications begin to appear and nephrology referral should be considered.
Explanation: Stage 3a CKD is defined as eGFR 45-59 mL/min/1.73mยฒ. Stage 3b is 30-44, Stage 4 is 15-29, and Stage 5 is <15. Stage 3 represents moderate decrease in kidney function when complications begin to appear and nephrology referral should be considered.
Question 4
A 65-year-old man with BPH presents with urinary retention. Physical exam reveals a palpable bladder. What is the most appropriate immediate intervention?
A) Start alpha-blocker therapy
B) Bladder catheterization
C) Immediate TURP
D) Increase fluid intake
Correct Answer: B
Explanation: Acute urinary retention requires immediate bladder decompression via catheterization to prevent bladder injury, kidney damage, and patient discomfort. Alpha-blockers are helpful for chronic management but don't address acute retention. Surgery is not first-line for acute retention.
Explanation: Acute urinary retention requires immediate bladder decompression via catheterization to prevent bladder injury, kidney damage, and patient discomfort. Alpha-blockers are helpful for chronic management but don't address acute retention. Surgery is not first-line for acute retention.
Question 5
Which electrolyte abnormality is most commonly associated with rhabdomyolysis?
A) Hypernatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hyperphosphatemia
Correct Answer: B
Explanation: Rhabdomyolysis releases massive amounts of intracellular potassium, leading to life-threatening hyperkalemia. While hypocalcemia and hyperphosphatemia also occur due to muscle breakdown, hyperkalemia is the most dangerous and requires immediate treatment to prevent fatal cardiac arrhythmias.
Explanation: Rhabdomyolysis releases massive amounts of intracellular potassium, leading to life-threatening hyperkalemia. While hypocalcemia and hyperphosphatemia also occur due to muscle breakdown, hyperkalemia is the most dangerous and requires immediate treatment to prevent fatal cardiac arrhythmias.
Question 6
A 22-year-old man presents with sudden onset severe scrotal pain. Physical exam shows a horizontal lie of the left testicle with absence of cremasteric reflex. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Torsion of testicular appendix
D) Trauma
Correct Answer: B
Explanation: Classic signs of testicular torsion include sudden severe pain, horizontal lie (rather than vertical), high-riding testicle, and absent cremasteric reflex. This is a urological emergency requiring immediate surgical detorsion and orchiopexy within 6 hours for optimal salvage rates (>90%).
Explanation: Classic signs of testicular torsion include sudden severe pain, horizontal lie (rather than vertical), high-riding testicle, and absent cremasteric reflex. This is a urological emergency requiring immediate surgical detorsion and orchiopexy within 6 hours for optimal salvage rates (>90%).
Question 7
What is the most common cause of acute kidney injury in hospitalized patients?
A) Acute tubular necrosis
B) Prerenal azotemia
C) Post-renal obstruction
D) Acute glomerulonephritis
Correct Answer: B
Explanation: Prerenal azotemia due to volume depletion, hypotension, or decreased cardiac output accounts for approximately 60-70% of hospital-acquired AKI. It's often reversible if recognized and treated promptly with appropriate fluid resuscitation and hemodynamic support.
Explanation: Prerenal azotemia due to volume depletion, hypotension, or decreased cardiac output accounts for approximately 60-70% of hospital-acquired AKI. It's often reversible if recognized and treated promptly with appropriate fluid resuscitation and hemodynamic support.
Question 8
A urinalysis shows 3+ proteinuria. What is the threshold for significant proteinuria on a 24-hour urine collection?
A) >150 mg/day
B) >300 mg/day
C) >500 mg/day
D) >1000 mg/day
Correct Answer: B
Explanation: Normal protein excretion is <150 mg/day. Proteinuria is defined as >300 mg/day on 24-hour collection or protein/creatinine ratio >300 mg/g. Nephrotic range proteinuria is >3.5 g/day. Microalbuminuria is 30-300 mg/day specifically for albumin.
Explanation: Normal protein excretion is <150 mg/day. Proteinuria is defined as >300 mg/day on 24-hour collection or protein/creatinine ratio >300 mg/g. Nephrotic range proteinuria is >3.5 g/day. Microalbuminuria is 30-300 mg/day specifically for albumin.
Question 9
Which medication should be avoided in patients with severe CKD (eGFR <30)?
A) Metoprolol
B) Amlodipine
C) Metformin
D) Atorvastatin
Correct Answer: C
Explanation: Metformin should be avoided when eGFR <30 mL/min/1.73mยฒ due to increased risk of lactic acidosis from drug accumulation. The other medications can be used safely in CKD with appropriate dose adjustments if needed.
Explanation: Metformin should be avoided when eGFR <30 mL/min/1.73mยฒ due to increased risk of lactic acidosis from drug accumulation. The other medications can be used safely in CKD with appropriate dose adjustments if needed.
Question 10
A patient presents with oliguria, edema, and elevated creatinine. The fractional excretion of sodium (FENa) is 0.8%. What does this suggest?
A) Acute tubular necrosis
B) Prerenal azotemia
C) Post-renal obstruction
D) Acute glomerulonephritis
Correct Answer: B
Explanation: FENa <1% suggests prerenal azotemia, indicating intact tubular function with appropriate sodium conservation. FENa >2% typically indicates intrinsic renal disease like ATN. FENa 1-2% is indeterminate.
Explanation: FENa <1% suggests prerenal azotemia, indicating intact tubular function with appropriate sodium conservation. FENa >2% typically indicates intrinsic renal disease like ATN. FENa 1-2% is indeterminate.
Question 11
What is the most common type of kidney stone?
A) Calcium oxalate
B) Calcium phosphate
C) Uric acid
D) Struvite
Correct Answer: A
Explanation: Calcium oxalate stones account for approximately 80% of all kidney stones. Calcium phosphate (~10%), uric acid (~5-10%), and struvite (~2-3%) are less common. Stone composition affects treatment and prevention strategies.
Explanation: Calcium oxalate stones account for approximately 80% of all kidney stones. Calcium phosphate (~10%), uric acid (~5-10%), and struvite (~2-3%) are less common. Stone composition affects treatment and prevention strategies.
Question 12
A 35-year-old woman has recurrent UTIs. Which factor is most associated with increased risk in women?
A) Sexual activity
B) Caffeine intake
C) Exercise
D) Vitamin C supplementation
Correct Answer: A
Explanation: Sexual activity is the strongest risk factor for UTIs in women due to bacterial translocation from the perineum to the urethral opening during intercourse. Other risk factors include delayed post-coital voiding, diaphragm use, and spermicide use.
Explanation: Sexual activity is the strongest risk factor for UTIs in women due to bacterial translocation from the perineum to the urethral opening during intercourse. Other risk factors include delayed post-coital voiding, diaphragm use, and spermicide use.
Question 13
Which finding on urinalysis is most suggestive of glomerular disease?
A) WBC casts
B) RBC casts
C) Hyaline casts
D) Granular casts
Correct Answer: B
Explanation: RBC casts are pathognomonic for glomerulonephritis and indicate glomerular bleeding with cast formation in the tubules. WBC casts suggest pyelonephritis or interstitial nephritis. Hyaline casts are normal. Granular casts suggest tubular damage.
Explanation: RBC casts are pathognomonic for glomerulonephritis and indicate glomerular bleeding with cast formation in the tubules. WBC casts suggest pyelonephritis or interstitial nephritis. Hyaline casts are normal. Granular casts suggest tubular damage.
Question 14
A 70-year-old man with diabetes presents with erectile dysfunction. What is the first-line treatment?
A) Testosterone replacement
B) PDE-5 inhibitors
C) Intracavernosal injections
D) Vacuum erection devices
Correct Answer: B
Explanation: PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) are first-line therapy for erectile dysfunction in appropriate patients. They're particularly effective in diabetic ED. Contraindications include nitrate use and severe cardiac disease.
Explanation: PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) are first-line therapy for erectile dysfunction in appropriate patients. They're particularly effective in diabetic ED. Contraindications include nitrate use and severe cardiac disease.
Question 15
What is the most common cause of nephrotic syndrome in adults?
A) Minimal change disease
B) Focal segmental glomerulosclerosis
C) Membranous nephropathy
D) Diabetic nephropathy
Correct Answer: D
Explanation: Diabetic nephropathy is the leading cause of nephrotic syndrome in adults, especially in patients with longstanding diabetes. Among primary glomerular diseases, membranous nephropathy is most common in adults, while minimal change disease predominates in children.
Explanation: Diabetic nephropathy is the leading cause of nephrotic syndrome in adults, especially in patients with longstanding diabetes. Among primary glomerular diseases, membranous nephropathy is most common in adults, while minimal change disease predominates in children.
Question 16
A patient has a serum creatinine that increased from 1.0 to 1.5 mg/dL over 48 hours. This represents which stage of AKI according to KDIGO criteria?
A) Stage 1
B) Stage 2
C) Stage 3
D) No AKI
Correct Answer: A
Explanation: AKI Stage 1 is defined as a 1.5-1.9x increase in serum creatinine from baseline or โฅ0.3 mg/dL increase within 48 hours. This patient has a 1.5x increase (1.5/1.0), qualifying for Stage 1 AKI.
Explanation: AKI Stage 1 is defined as a 1.5-1.9x increase in serum creatinine from baseline or โฅ0.3 mg/dL increase within 48 hours. This patient has a 1.5x increase (1.5/1.0), qualifying for Stage 1 AKI.
Question 17
Which condition is most likely to cause post-renal AKI?
A) Sepsis
B) BPH with urinary retention
C) Rhabdomyolysis
D) Contrast nephropathy
Correct Answer: B
Explanation: BPH with urinary retention causes obstruction of urine flow, leading to post-renal (obstructive) AKI. Other options cause prerenal (sepsis) or intrinsic renal injury (rhabdomyolysis, contrast). Post-renal AKI requires bilateral obstruction or unilateral in a solitary kidney.
Explanation: BPH with urinary retention causes obstruction of urine flow, leading to post-renal (obstructive) AKI. Other options cause prerenal (sepsis) or intrinsic renal injury (rhabdomyolysis, contrast). Post-renal AKI requires bilateral obstruction or unilateral in a solitary kidney.
Question 18
What is the target blood pressure for patients with CKD and proteinuria?
A) <140/90 mmHg
B) <130/80 mmHg
C) <120/70 mmHg
D) <110/60 mmHg
Correct Answer: B
Explanation: Current KDIGO guidelines recommend a BP target of <130/80 mmHg for CKD patients with proteinuria to slow disease progression. ACE inhibitors or ARBs are preferred first-line agents for their renoprotective effects.
Explanation: Current KDIGO guidelines recommend a BP target of <130/80 mmHg for CKD patients with proteinuria to slow disease progression. ACE inhibitors or ARBs are preferred first-line agents for their renoprotective effects.
Question 19
A 25-year-old man presents with a painless testicular mass. What is the most appropriate next step?
A) Observation
B) Scrotal ultrasound
C) Antibiotics
D) Immediate orchiectomy
Correct Answer: B
Explanation: Any painless testicular mass in a young man should be evaluated with scrotal ultrasound to rule out malignancy. Testicular cancer is the most common solid malignancy in men aged 15-35. Never observe a solid testicular mass.
Explanation: Any painless testicular mass in a young man should be evaluated with scrotal ultrasound to rule out malignancy. Testicular cancer is the most common solid malignancy in men aged 15-35. Never observe a solid testicular mass.
Question 20
Which medication is first-line therapy for benign prostatic hyperplasia?
A) 5-alpha reductase inhibitor
B) Alpha-1 blocker
C) Anticholinergic
D) Beta-3 agonist
Correct Answer: B
Explanation: Alpha-1 blockers (tamsulosin, alfuzosin, doxazosin) provide rapid symptom relief by relaxing smooth muscle in the prostate and bladder neck. 5-alpha reductase inhibitors take months to work and are used for larger prostates.
Explanation: Alpha-1 blockers (tamsulosin, alfuzosin, doxazosin) provide rapid symptom relief by relaxing smooth muscle in the prostate and bladder neck. 5-alpha reductase inhibitors take months to work and are used for larger prostates.
Question 21
What is the most common complication of polycystic kidney disease?
A) Kidney stones
B) Hypertension
C) Urinary tract infections
D) Liver cysts
Correct Answer: B
Explanation: Hypertension occurs in 60-70% of PKD patients and is often the first manifestation of the disease, appearing before significant decline in kidney function. It's caused by activation of the renin-angiotensin system.
Explanation: Hypertension occurs in 60-70% of PKD patients and is often the first manifestation of the disease, appearing before significant decline in kidney function. It's caused by activation of the renin-angiotensin system.
Question 22
A patient presents with flank pain, fever, and pyuria. Blood cultures are positive for E. coli. What is the most likely diagnosis?
A) Cystitis
B) Pyelonephritis
C) Prostatitis
D) Epididymitis
Correct Answer: B
Explanation: The triad of flank pain, fever, and positive blood cultures with pyuria is classic for pyelonephritis. Bacteremia occurs in 15-20% of pyelonephritis cases. Cystitis rarely causes bacteremia or systemic symptoms.
Explanation: The triad of flank pain, fever, and positive blood cultures with pyuria is classic for pyelonephritis. Bacteremia occurs in 15-20% of pyelonephritis cases. Cystitis rarely causes bacteremia or systemic symptoms.
Question 23
Which lab finding is most consistent with prerenal azotemia?
A) BUN:Creatinine ratio >20:1
B) BUN:Creatinine ratio <10:1
C) Urine specific gravity <1.010
D) FENa >2%
Correct Answer: A
Explanation: In prerenal azotemia, enhanced urea reabsorption occurs while creatinine reabsorption remains constant, leading to a BUN:Creatinine ratio >20:1. Normal ratio is 10-15:1. This helps distinguish prerenal from intrinsic renal causes.
Explanation: In prerenal azotemia, enhanced urea reabsorption occurs while creatinine reabsorption remains constant, leading to a BUN:Creatinine ratio >20:1. Normal ratio is 10-15:1. This helps distinguish prerenal from intrinsic renal causes.
Question 24
What is the most common cause of hematuria in young adults?
A) Kidney stones
B) UTI
C) Glomerulonephritis
D) Bladder cancer
Correct Answer: B
Explanation: UTI is the most common cause of hematuria in young adults, especially women. The approach to hematuria varies by age and gender, with malignancy being more concerning in older patients, especially men >35 years old.
Explanation: UTI is the most common cause of hematuria in young adults, especially women. The approach to hematuria varies by age and gender, with malignancy being more concerning in older patients, especially men >35 years old.
Question 25
A patient with CKD develops bone pain and elevated parathyroid hormone. What mineral deficiency is most likely?
A) Calcium
B) Phosphorus
C) Vitamin D
D) Magnesium
Correct Answer: C
Explanation: CKD patients develop vitamin D deficiency due to decreased 1ฮฑ-hydroxylase activity in the kidneys, leading to secondary hyperparathyroidism and renal osteodystrophy. This begins when GFR falls below 60 mL/min/1.73mยฒ.
Explanation: CKD patients develop vitamin D deficiency due to decreased 1ฮฑ-hydroxylase activity in the kidneys, leading to secondary hyperparathyroidism and renal osteodystrophy. This begins when GFR falls below 60 mL/min/1.73mยฒ.
Question 26
Which antibiotic is first-line for uncomplicated cystitis in women?
A) Ciprofloxacin
B) Nitrofurantoin
C) Amoxicillin
D) Cephalexin
Correct Answer: B
Explanation: Nitrofurantoin is first-line therapy for uncomplicated cystitis due to low resistance rates and minimal effect on gut flora. Fluoroquinolones are reserved for complicated infections due to increasing resistance and side effects.
Explanation: Nitrofurantoin is first-line therapy for uncomplicated cystitis due to low resistance rates and minimal effect on gut flora. Fluoroquinolones are reserved for complicated infections due to increasing resistance and side effects.
Question 27
What is the most common cause of chronic kidney disease?
A) Hypertension
B) Diabetes mellitus
C) Glomerulonephritis
D) Polycystic kidney disease
Correct Answer: B
Explanation: Diabetic nephropathy accounts for approximately 40% of all cases of ESRD in the United States. Hypertension is the second leading cause at ~25%. The prevalence reflects the diabetes epidemic.
Explanation: Diabetic nephropathy accounts for approximately 40% of all cases of ESRD in the United States. Hypertension is the second leading cause at ~25%. The prevalence reflects the diabetes epidemic.
Question 28
A 60-year-old man has difficulty initiating urination and a weak stream. His PSA is 2.8 ng/mL. What is the most likely diagnosis?
A) Prostate cancer
B) Benign prostatic hyperplasia
C) Prostatitis
D) Bladder cancer
Correct Answer: B
Explanation: Classic obstructive symptoms of BPH with normal PSA (<4.0 ng/mL) in an older male. While prostate cancer can present similarly, the normal PSA makes BPH more likely. Further evaluation with DRE and symptom scoring would be appropriate.
Explanation: Classic obstructive symptoms of BPH with normal PSA (<4.0 ng/mL) in an older male. While prostate cancer can present similarly, the normal PSA makes BPH more likely. Further evaluation with DRE and symptom scoring would be appropriate.
Question 29
Which finding on renal ultrasound is most suggestive of chronic kidney disease?
A) Increased echogenicity
B) Hydronephrosis
C) Decreased kidney size
D) Renal cysts
Correct Answer: C
Explanation: Bilateral small kidneys (<9 cm in length) are characteristic of chronic kidney disease due to scarring and atrophy. Normal kidney length is 10-12 cm. Increased echogenicity also suggests CKD but is less specific.
Explanation: Bilateral small kidneys (<9 cm in length) are characteristic of chronic kidney disease due to scarring and atrophy. Normal kidney length is 10-12 cm. Increased echogenicity also suggests CKD but is less specific.
Question 30
What is the most common type of testicular cancer in men aged 15-35?
A) Seminoma
B) Non-seminomatous germ cell tumor
C) Lymphoma
D) Sarcoma
Correct Answer: B
Explanation: Non-seminomatous germ cell tumors (embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumor) are more common in younger men aged 15-35. Seminomas peak in the 30s-40s. Both have excellent cure rates with appropriate treatment.
Explanation: Non-seminomatous germ cell tumors (embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumor) are more common in younger men aged 15-35. Seminomas peak in the 30s-40s. Both have excellent cure rates with appropriate treatment.
Question 31
A patient with diabetes and CKD should be started on which medication to slow progression?
A) Calcium channel blocker
B) Beta-blocker
C) ACE inhibitor
D) Thiazide diuretic
Correct Answer: C
Explanation: ACE inhibitors (or ARBs) slow progression of diabetic nephropathy by reducing intraglomerular pressure and proteinuria. They should be used in diabetics with any degree of albuminuria, even if blood pressure is normal.
Explanation: ACE inhibitors (or ARBs) slow progression of diabetic nephropathy by reducing intraglomerular pressure and proteinuria. They should be used in diabetics with any degree of albuminuria, even if blood pressure is normal.
Question 32
What is the most common cause of acute scrotal pain in adolescents?
A) Testicular torsion
B) Epididymitis
C) Trauma
D) Torsion of testicular appendix
Correct Answer: A
Explanation: Testicular torsion has a bimodal distribution with peaks in neonates and adolescents (12-18 years). In adolescents, it's the most common cause of acute scrotal pain. Time is critical - salvage rates drop significantly after 6 hours.
Explanation: Testicular torsion has a bimodal distribution with peaks in neonates and adolescents (12-18 years). In adolescents, it's the most common cause of acute scrotal pain. Time is critical - salvage rates drop significantly after 6 hours.
Question 33
Which electrolyte abnormality is most dangerous in acute kidney injury?
A) Hypernatremia
B) Hyperkalemia
C) Hyperphosphatemia
D) Hypocalcemia
Correct Answer: B
Explanation: Hyperkalemia >6.5 mEq/L can cause fatal cardiac arrhythmias and requires immediate treatment in AKI. Treatment includes calcium gluconate for cardioprotection, insulin/glucose, and removal therapy (dialysis) if severe.
Explanation: Hyperkalemia >6.5 mEq/L can cause fatal cardiac arrhythmias and requires immediate treatment in AKI. Treatment includes calcium gluconate for cardioprotection, insulin/glucose, and removal therapy (dialysis) if severe.
Question 34
A woman has recurrent cystitis episodes. What is the best preventive measure?
A) Daily antibiotics
B) Cranberry supplements
C) Post-coital voiding
D) Increased vitamin C
Correct Answer: C
Explanation: Post-coital voiding helps flush bacteria from the urethral opening and is an effective, simple prevention strategy. Other measures include adequate hydration, proper hygiene, and avoiding spermicides.
Explanation: Post-coital voiding helps flush bacteria from the urethral opening and is an effective, simple prevention strategy. Other measures include adequate hydration, proper hygiene, and avoiding spermicides.
Question 35
What is the most appropriate screening interval for prostate cancer with PSA?
A) Annually starting at age 40
B) Every 2 years starting at age 50
C) Every 5 years starting at age 55
D) No routine screening recommended
Correct Answer: B
Explanation: Current AUA guidelines recommend discussing PSA screening with men aged 50-70 (45 for high-risk groups), typically every 2 years if screening is chosen. The decision should be individualized after discussing risks and benefits.
Explanation: Current AUA guidelines recommend discussing PSA screening with men aged 50-70 (45 for high-risk groups), typically every 2 years if screening is chosen. The decision should be individualized after discussing risks and benefits.
Question 36
Which medication can cause acute interstitial nephritis?
A) Metformin
B) NSAIDs
C) ACE inhibitors
D) Statins
Correct Answer: B
Explanation: NSAIDs are a common cause of acute interstitial nephritis, especially with prolonged use or in elderly patients. Other common causes include PPIs, antibiotics (penicillins, sulfonamides), and diuretics.
Explanation: NSAIDs are a common cause of acute interstitial nephritis, especially with prolonged use or in elderly patients. Other common causes include PPIs, antibiotics (penicillins, sulfonamides), and diuretics.
Question 37
A patient presents with cola-colored urine, facial edema, and hypertension following a strep throat. What is the most likely diagnosis?
A) Nephrotic syndrome
B) Post-infectious glomerulonephritis
C) IgA nephropathy
D) Lupus nephritis
Correct Answer: B
Explanation: Post-streptococcal glomerulonephritis presents 1-3 weeks after strep infection with the classic triad of hematuria (cola-colored urine), edema, and hypertension. Low complement levels support the diagnosis.
Explanation: Post-streptococcal glomerulonephritis presents 1-3 weeks after strep infection with the classic triad of hematuria (cola-colored urine), edema, and hypertension. Low complement levels support the diagnosis.
Question 38
What is the most common presentation of renal cell carcinoma?
A) Classical triad of flank pain, hematuria, and mass
B) Incidental finding on imaging
C) Fever and weight loss
D) Hypertension
Correct Answer: B
Explanation: Most renal cell carcinomas (>50%) are now discovered incidentally on abdominal imaging performed for other reasons. The classical triad of flank pain, hematuria, and palpable mass occurs in <10% of cases and usually indicates advanced disease.
Explanation: Most renal cell carcinomas (>50%) are now discovered incidentally on abdominal imaging performed for other reasons. The classical triad of flank pain, hematuria, and palpable mass occurs in <10% of cases and usually indicates advanced disease.
Question 39
Which condition is associated with "nutcracker" phenomenon?
A) Renal vein thrombosis
B) Left renal vein compression
C) Renal artery stenosis
D) Horseshoe kidney
Correct Answer: B
Explanation: Nutcracker syndrome involves compression of the left renal vein between the aorta and superior mesenteric artery, leading to left renal vein hypertension. It can cause hematuria, proteinuria, and left flank pain.
Explanation: Nutcracker syndrome involves compression of the left renal vein between the aorta and superior mesenteric artery, leading to left renal vein hypertension. It can cause hematuria, proteinuria, and left flank pain.
Question 40
What is the most common cause of nephrotic syndrome in children?
A) Minimal change disease
B) Focal segmental glomerulosclerosis
C) Membranous nephropathy
D) Diabetic nephropathy
Correct Answer: A
Explanation: Minimal change disease accounts for 90% of nephrotic syndrome in children under 10 years of age. It typically responds well to corticosteroid therapy and has an excellent prognosis.
Explanation: Minimal change disease accounts for 90% of nephrotic syndrome in children under 10 years of age. It typically responds well to corticosteroid therapy and has an excellent prognosis.
Question 41
A patient has recurrent calcium oxalate stones. Which dietary modification is most important?
A) Restrict calcium intake
B) Increase fluid intake
C) Restrict protein intake
D) Increase oxalate intake
Correct Answer: B
Explanation: Increased fluid intake (>2.5 L/day) is the most important intervention to prevent stone recurrence by diluting urine. Restricting calcium can actually increase oxalate absorption and stone risk.
Explanation: Increased fluid intake (>2.5 L/day) is the most important intervention to prevent stone recurrence by diluting urine. Restricting calcium can actually increase oxalate absorption and stone risk.
Question 42
Which condition can cause false elevation of serum creatinine?
A) Muscle wasting
B) Cimetidine use
C) Vegetarian diet
D) Female gender
Correct Answer: B
Explanation: Cimetidine blocks tubular secretion of creatinine, leading to falsely elevated serum creatinine levels without affecting actual kidney function. Trimethoprim and bactrim can have similar effects.
Explanation: Cimetidine blocks tubular secretion of creatinine, leading to falsely elevated serum creatinine levels without affecting actual kidney function. Trimethoprim and bactrim can have similar effects.
Question 43
What is the most appropriate initial imaging for suspected nephrolithiasis?
A) Intravenous pyelogram
B) Renal ultrasound
C) Non-contrast CT scan
D) MRI
Correct Answer: C
Explanation: Non-contrast CT scan is the gold standard for detecting kidney stones with 95% sensitivity and specificity. It can detect all stone types except indinavir stones and provides information about stone location and complications.
Explanation: Non-contrast CT scan is the gold standard for detecting kidney stones with 95% sensitivity and specificity. It can detect all stone types except indinavir stones and provides information about stone location and complications.
Question 44
A patient with ESRD on hemodialysis develops bone pain. Which lab abnormality is most likely?
A) Hypercalcemia
B) Hyperphosphatemia
C) Hypoparathyroidism
D) Vitamin D toxicity
Correct Answer: B
Explanation: ESRD patients develop hyperphosphatemia due to decreased excretion, contributing to renal osteodystrophy and bone pain. Management includes phosphate binders and dietary phosphate restriction.
Explanation: ESRD patients develop hyperphosphatemia due to decreased excretion, contributing to renal osteodystrophy and bone pain. Management includes phosphate binders and dietary phosphate restriction.
Question 45
Which finding suggests chronic rather than acute kidney injury?
A) Oliguria
B) Anemia
C) Elevated creatinine
D) Proteinuria
Correct Answer: B
Explanation: Anemia in kidney disease suggests chronic disease due to decreased erythropoietin production over time. Other chronic indicators include small kidneys on imaging, bone disease, and metabolic acidosis.
Explanation: Anemia in kidney disease suggests chronic disease due to decreased erythropoietin production over time. Other chronic indicators include small kidneys on imaging, bone disease, and metabolic acidosis.
Question 46
What is the most common cause of erectile dysfunction?
A) Psychological factors
B) Vascular disease
C) Neurologic disease
D) Hormonal abnormalities
Correct Answer: B
Explanation: Vascular disease (atherosclerosis) is the most common organic cause of ED, especially in older men with cardiovascular risk factors like diabetes, hypertension, and smoking. ED often precedes coronary artery disease.
Explanation: Vascular disease (atherosclerosis) is the most common organic cause of ED, especially in older men with cardiovascular risk factors like diabetes, hypertension, and smoking. ED often precedes coronary artery disease.
Question 47
Which medication should be used with caution in patients with renal artery stenosis?
A) Calcium channel blockers
B) Beta-blockers
C) ACE inhibitors
D) Thiazide diuretics
Correct Answer: C
Explanation: ACE inhibitors can precipitate acute kidney injury in bilateral renal artery stenosis by reducing efferent arteriolar tone and decreasing glomerular filtration pressure. Monitor renal function closely when initiating.
Explanation: ACE inhibitors can precipitate acute kidney injury in bilateral renal artery stenosis by reducing efferent arteriolar tone and decreasing glomerular filtration pressure. Monitor renal function closely when initiating.
Question 48
A patient presents with sudden onset of severe flank pain and gross hematuria after minor trauma. What is the most likely diagnosis?
A) Kidney stone
B) Renal cell carcinoma
C) Renal laceration
D) Renal vein thrombosis
Correct Answer: C
Explanation: Sudden onset severe flank pain with gross hematuria immediately after trauma suggests renal laceration requiring immediate evaluation with CT scan and possible surgical intervention depending on the grade of injury.
Explanation: Sudden onset severe flank pain with gross hematuria immediately after trauma suggests renal laceration requiring immediate evaluation with CT scan and possible surgical intervention depending on the grade of injury.
Question 49
What is the most common cause of urinary incontinence in elderly women?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence
D) Functional incontinence
Correct Answer: B
Explanation: Urge incontinence (overactive bladder) becomes more common with aging due to detrusor muscle instability and changes in bladder innervation. It's characterized by sudden urge followed by involuntary leakage.
Explanation: Urge incontinence (overactive bladder) becomes more common with aging due to detrusor muscle instability and changes in bladder innervation. It's characterized by sudden urge followed by involuntary leakage.
Question 50
Which serum marker is most useful for monitoring testicular cancer treatment response?
A) PSA
B) Alpha-fetoprotein
C) LDH
D) CEA
Correct Answer: B
Explanation: Alpha-fetoprotein (AFP) along with ฮฒ-hCG are tumor markers used to monitor non-seminomatous germ cell tumors. They're useful for staging, prognosis, and monitoring treatment response. LDH is also elevated but less specific.
Explanation: Alpha-fetoprotein (AFP) along with ฮฒ-hCG are tumor markers used to monitor non-seminomatous germ cell tumors. They're useful for staging, prognosis, and monitoring treatment response. LDH is also elevated but less specific.
๐ Study Resources
- KDIGO Guidelines: Latest chronic kidney disease and acute kidney injury guidelines
- AUA Guidelines: American Urological Association practice guidelines
- NCCN Guidelines: Cancer screening and treatment recommendations
- UpToDate: Evidence-based clinical decision support
- PANCE Review: Focus on high-yield nephrology topics
๐ฏ Final Score Summary
Complete all 50 questions to see your final performance analysis and study recommendations.