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1. A normal kidney .all are true except


A. ? erythropoieten is secreted by peritubular cells in response
to hypoxia
B. ? hydroxylates 1- hydroxycholecalciferol to its active form
C. ? renin is secreted from the juxta glomerular apparatus
D. ? locally produced prostaglandins have a very important role
in maintaining renal perfusion
E. ? 90% of the erythropoietin comes from the kidneys and 10
% from the liver.
2. Normal adult kidneysall are true except
A. ? its length is about 11-14 cm (about 3 vertebral bodies)
B. ? both kidneys rise and descend several centimeters during
respiration
C. ? each kidney contains approximately 10 million nephrons
D. ? both kidneys receive about 20-25% of the cardiac output
E. ? the right kidney is usually few centimeters lower than the
left .
3. Causes of polyuria...all are true except
A. ? excessive fluid intake
B. ? hyperglycemia
C. ? early stage of chronic renal failure
D. ? tubulointerstitial diseases
E. ? heavy smoking
4. Renal ultrasound examination.. all are true except
A. ? its disadvantage is that it is highly operator dependent
B. ? quick, rapid, cheap and non-invasive and often the only
required method of renal imaging
C. ? it can show the renal size, position, dilatation of the
collecting system and other abdominal pathologies like cystic
liver.
D. ? in chronic renal failure, the density of the renal cortex is
unfortunately decreased and there is loss of cortico-medullary
differentiation.
E. ? by utilizing the Doppler techniques, much information can
be gained like the resistivity index
5. IVU is commonly used in clinical nephrology. All are true except
A. ? risky in diabetes mellitus
B. ? risky in myeloma
C. ? risky in pre-existent renal disease
D. ? the risk of contrast nephropathy can be reduced by
avoiding dehydration and by giving diuretics
E. ? The risk of contrast nephropathy can be reduced by using
less hyperosmolar (yet expensive) contrast media
6. Disadvantages of IVUall are true except
A. ? time consuming
B. ? needs and injection
C. ? dependence on adequate renal function for good images
D. ? risk of exposure to contrast media (allergic reaction,
nephro-toxicity)
E. ? unfortunately, poor definition of the collecting system on AP
films
7. Anterograde pyelography .which one is true
A. ? it is the injection of a contrast media into kidney through the
bladder and ureters
B. ? it is usually done blindly
C. ? much more difficult and hazardous in a non-obstructed
kidney
D. ? usually used in cases of glomerulonephritis
E. ? poorly out line the collecting system
8. Micturating cystourethrogram all are wrong except
A. ? not used in the diagnosis and assessment of the severity of
vesicicoureteric reflux
B. ? usually used in conjunction with urodynamic studies
C. ? it is part of the last stages of IVU
D. ? not indicated in those with recurrent UTI
E. ? not indicated in those with renal scars and not indicated in
those with chronic renal failure of unknown cause
9. Renal angiography and venography all are true except
A. ? the main indication of renal angiography is the diagnosis of
renal artery stenosis and renal hemorrhage
B. ? therapeutic intervention may be undertaken at the same
time of doing renal angiography like dilatation and stenting of
renal artery stenosis and occluding and AV fistula
C. ? unlike IVU, there is a risk of cholesterol athero-embolisation
D. ? when compared to IVU, the risk is contrast nephropathy is
lower
E. ? renal venography mainly used in the diagnosis of renal vein
thrombosis and renal cell carcinoma extension
10. Renal biopsy.all are indications except
A. ? unexplained acute renal failure
B. ? chronic renal failure with normal sized kidneys
C. ? atypical childhood nephrotic syndrome
D. ? isolated hematuria with normal looking RBCs
E. ? nephrotic syndrome in adults
11. Contraindications to renal biopsy all are true except
A. ? severe hemophilia
B. ? platelets count of 10000 /mm3
C. ? uncontrooled hypertension
D. ? renal size less than 80% predicted
E. ? biopsy from a single kidney is a relative contraindication
12. Causes of DARK urine .all are true except
A. ? all cases of porphyria
B. ? intervertebral dics calicification with dark ears
C. ? a Parkinsonian patient
D. ? pulmonary TB patient
E. ? massive crushing trauma pateint
13. Protienuria ..are true except
A. ? standard sticks usually Miss bence john's protein
B. ? in myoloma it is due to protein Overflow rather than
amyloidosis
C. ? the majority of the daily excreted protein is Tamm Horesful
mucoprotien
D. ? albumin / creatinin ratio on a random urine sample is less
than 2.5 in females and less than 3.5 in males
E. ? Positive dipstick for protein may occur in fever per se
14. Acute renal failureall are wrong except
A. ? prerenal causes are uncommon
B. ? 85% of intrinsic renal causes of acute renal failure are due
to acute tubular necrosis
C. ? underperfusion causes of acute renal failure are usually
irreversible
D. ? stones as a cause of acute obstructive uropathy are very
common causes
E. ? 15% of intrinsic acute renal failure is due to acute
glomerulonephritis
15. Regarding prognosis in acute renal failure all are true except
A. ? in uncomplicated renal failure e.g. due to bleeding or drugs,
the mortality is low
B. ? serious infection complicating acute renal failure portends
bad prognosis
C. ? multiple end organ failure portends a poor prognosis
D. ? complicated acute renal failure may have a mortality
approaching 15- 30 %
E. ? the outcome and prognosis is determined by the severity of
the underlying disease and by complications rather than by renal
failure per se
16. Rapid respiratory rate in acute renal failure may be due to all but one of
the followings
A. ? acidosis per se
B. ? iv overload and pulmonary edema
C. ? ARDS picture
D. ? chest infection
E. ? hyperkalemia
17. Anemia in the setting of acute renal failure is very common and usually
multifactorialall are causes except
A. ? hemolysis
B. ? excessive bleeding
C. ? profound suppression of erythropoiesis
D. ? drug induced
E. ? hyperphophatemia
18. General urine examination (GUE) is one of the commonest
investigations done every day all are true except:
A. ? elevated urinary concentration of ascorbic acids gives a
false negative results for bilirubin dipsticks
B. ? elevated urinary concentration of ascorbic acids gives a
false negative results for glucose dipsticks
C. ? gross hematuria gives false positive results for protein
D. ? significant glycosuria gives a falsely low specific gravity
E. ? MESNA gives false positive results for ketone sticks
19. Urine Dipstick tests are commonly used in the medical ward side labs
by nurses, juniors and senior house officers .all are true except
A. ? false negative results for nitrite may be due to short bladder
transit time
B. ? False negative results for nitrite may be due to infecting
organisms lacking nitrates and nitrate reductase
C. ? high urinary level of tetracycline gives false negative results
for leukocyte esterase
D. ? high urinary level ascorbic acid gives false negative results
for nitrite
E. ? medications which discolor urine will give false negative for
nitrite
20. Specific gravity is measured in some clinical conditions like diabetes
insipidus ..do you know how it s measured? .it is measured by
all of the following methods except
A. ? freezing point depression
B. ? vapor pressure technique
C. ? using a refractormeter
D. ? using a hydrometer
E. ? calorimetric reagent strips
21. In microalbuminuria all are true except
A. ? is defined as prtienuria between 30-300 mg / day
B. ? Is defined as proteinuria between 20-200 microgram /
minute
C. ? always protein dipstick negative
D. ? improtant in the follow up of type II not type I diabetes
mellitus
E. ? persisrent proteinuria has been associated with the
development of atherosclerorsis
22. Daily excretion of urinary proteinall are true except
A. ? up t 150 mg /day is normal
B. ? 300-500 mg/ day will be dipstick test positive
C. ? more than 3.5 gram/day is called nephritic range
proteinuria
D. ? more than 2.5 gram/ day, a glomerular source is more likely
than a tubular source
E. ? between 0.5-2 gram/ day usually indicates a glomerular
source
23. In diagnosing pre-renal failure...all of the followings when present are
highly suggestive except which one
A. ? the history may be compatible eg excessive bleeding
B. ? compatible clinical finding
C. ? a progressive rise in blood urea and creatinin
D. ? urine osmolality more than 500 mosm/ Kg
E. ? fractional sodium excretion more than 2
24. In chronic renal failure all are true except
A. ? the commonest causes world wide are hypertension and
diabetes
B. ? urea frost is a useful early sign
C. ? itching is multi factorial rather than due to
hyperphosphatemia alone
D. ? hypotension and dehydration may be seen
E. ? in clinical practice, about 4-18 % of cases are of unknown
or uncertain etiology
25. Although chronic renal failure is an irreversible process, there are many
"reversible factors" that may accelerate the course all of the following
factors are true except
A. ? nephrotoxic medications
B. ? renal artery stenosis
C. ? hypotension due to drug therapy
D. ? any infection per se
E. ? normal blood pressure
26. Endocrinal abnormalities are common in chronic renal failure all of
the following statements are true except
A. ? hyperprolactenemia may be seen but unfortunately many
cases dont respond to bromocryptine
B. ? the half life of insulin is shortened
C. ? amenorrhoea is common in females
D. ? loss of libido in both sexes is very common
E. ? hypothyroidism like picture
27. In the management of chronic renal failure...all are true except
A. ? hypertriglyceridemia is common and hypercholesteremia is
almost universal in those who have significant proteinuria
B. ? ACE inhibitors for hypertension have significantly been
shown to retard the disease progression especially in diabetics
C. ? profound protein restriction is unwise as this may produce
malnutrition
D. ? replacing sodium and chloride with high fluid intake should
be avoided in all patients
E. ? hypocalcemia is very common and should be corrected by
vitamin D metabolites.
28. Regarding the prognosis of chronic renal failure all are true except
A. ? the commonest cause of death is vascular events
B. ? 5 year survival of " home hemodialysis " patients is about
80%
C. ? 5 year survival following renal transplantation is about 80%
D. ? 5 year survival for "hospital hemodialysis " patients is about
60%
E. ? 5 year survival for " CAPD patients is about 16%
29. In acute renal failure patient, you suggested that the patient needs
renal replacement therapy in the form of hemodialysis all of the
followings are usually your target except
A. ? maintain a pre-dialysis blood urea concentration less than
15 mmol/L
B. ? adequate control of potassium
C. ? adequate control of phosphate
D. ? achieving normal extra cellular fluid volume status
E. ? each session of hemodialysis should be done every day
30. Renal artery stenosisall are ture except
A. ? the commonest casuse is atheromatous narrowing
B. ? should suspected when the blood pressere is severe or of
rapid onset or difficult to control
C. ? fibromuscular dysplasia as a cause is commoner in young
age group
D. ? fibromuscular dysplasia usually does not cause complete
occlusion and usually stabilizes once the patient stops growing
E. ? surgical treatment is superior to medical treatment or
angioplasty
31. In Alport's syndrome all are true except
A. ? the second commonest inherited cause of renal disease
B. ? usually autosomal recessive
C. ? bilateral anterior lenticonus is the usual eye manifestation
D. ? sensory neural deafness usually to high tone first.
E. ? the pathological hallmark is progressive degeneration of
the glomerular basement memberane
32. In adult polycystic kidney disease .all are true except
A. ? 85% of cases are due to mutation in PKD1 gene on
chromosome 16
B. ? mitral and aortic regurgitations are frequent but rarely
severe.
C. ? 30% have an associated hepatic custs but disturbances in
hepatic function is very rare
D. ? 50 % will develop subarachnoid hemorrhage
E. ? colonic diverticulae and abdominal wall hernias are well
recognized associations
33. In adult poly cystic kidney disease ..all are true except
A. ? mean age of those who are heterozygous for PKD1
mutation to start dialysis is 57 years
B. ? 50% of patient will never need chronic dialysis
C. ? to screen a patient's relative, renal ultrasound as a
screening method is less reliable in the 10-18 age group
D. ? Urinary Tract Infections should be treated aggressively
E. ? all patients will develop hypertension
34. In medullary sponge kidney ..all are true except
A. ? it is sporadic not genetic
B. ? has a characteristic picture on IVU
C. ? the cysts are confined to the proximal tubules
D. ? the prognosis is generally good
E. ? nephrocalcinosis may be seen on the KUB film
35. Fanconi's Syndrome (Renal tubular acidosis type II)...All are true
except
A. ? glycosuria is present with normal blood sugar
B. ? aminoaciduria does not result in malnutrition
C. ? may be caused by Wilson's disease
D. ? hypercalciuria is profound
E. ? very large amounts of bicarbonate are need in the
treatment
36. In Type I distal renal tubular acidosis all are true except
A. ? may cause osteomalacia in adults and rickets in children
B. ? nephrocalcinosis is seen
C. ? hypokalemia is present with normal anion gap metabolic
acidosis
D. ? imcomplete forms were never seen
E. ? ability to form very acidic urine in the contest of systemic
acidosis is the hallmark of the disease
37. Causes of hypocomlementemia in inflammatory nephritis includes all of
the followings except
A. ? SBE
B. ? SLE
C. ? shunt nephritis
D. ? posrinfectious glomerulonephritis
E. ? microscopic polyangiitis
38. Causes of rapidly progressive Glomerulonephritis.all are true
except
A. ? SLE
B. ? aggressive phase of certain inflammatory nephritis like IgA
nephropathy
C. ? Goodpasture's syndrome
D. ? post-infectious glomerulonephritis
E. ? memebranous nephropathy
39. In Gromerulopathies all are true except
A. ? minimal change disease is associated with HLD DR7,
atopy and drugs
B. ? membranous nephropathy is associated with HLA DR3,
drugs and heavy metals
C. ? assocition with liver disease has been documented in IgA
nephropathy
D. ? membraboproliferative glomerulonephritis type I is
associated with C3 nephritic factor and partial lipodystrophy
E. ? focal segmental glomerulosclerosis is associated with
obesity, HIV infection and heroin abuse
40. In Goodpasture's syndrome ..all are true except
A. ? it is an autoimmune disease against alpha 3 chain of type
III collagen
B. ? linear IgG deposition in the GBM is seen on immuno-
flourescence staining of a renal biopsy specimen
C. ? palsma pharesis may be used in the treatment
D. ? lung hemorrhage is more common in smokers
E. ? usually produces rapidly progressive crescentic
glomerulonephritis
41. In Renal biopsy with immunoflourescence staining looking for immune
deposits .all are true findings of the suggested diseaseexcept
A. ? minimal change disease non immune deposits
B. ? focal segmental glomerulosclerosis-nonspecific trapping in
focal scars
C. ? membranous nephropathy granular subendothelial IgG
D. ? IgA nephropathy mesangial IgA deposition
E. ? type II membranoproliferative glomerulonephritis
intramembranous dense deposits
42. IgA nephropathythe followings indicate a bad prognosis except
A. ? male gender
B. ? presence of hypertension
C. ? absence of hematuria
D. ? presence of renal impairment
E. ? persistent proteinuria
43. Chronic interstitial nephritis may be caused by all of the followings
except
A. ? chronic exposure to ochratoxin
B. ? chronic exposure to aristolochic acid
C. ? Wilson's disease
D. ? Hanta virus infection
E. ? Chronic ingestion of phenacetin
44. In acute interstitial nephritis all are true except
A. ? the commonest cause is drug induced
B. ? blood eosinophila is seen only in 30 % of cases, yet
eosinophiluria is seen up to 70% of cases
C. ? should be suspected in any non-oliguric acute renal failure
D. ? predominant infiltration of the tubulo-intersitium with
eosinophils on renal biopsy is more suggestive of a viral etiology
E. ? the majority of drug induced acute interstitial nephritis will
recover following drug withdrawal
45. Recurrent UTI is common in adult females the followings are
prophylactic measures adopted by females against recurrent
UTI...Except
A. ? fluid intake of at least 2 liters per day
B. ? regular emptying of the urinary bladder
C. ? local application of an antiseptic like cetrimide cream to the
periurethral area before intercourse
D. ? urinary bladder emptying before and after intercourse
E. ? double micturition will worsen reflux nephropathy
46. Indications for intervention in renal calculi:
A. ? if the patient is aneuric
B. ? presence of infection upstream
C. ? large stone that is unlikely to pass
D. ? total obstruction of the pelvi-ureteric junction
E. ? radiolucent stone
47. Risk factors for renal stone formation...all are true except
A. ? hypercalciuria
B. ? hyperoxaluria
C. ? hypercitraturia
D. ? hyperuricosuria
E. ? cystinuria
48. In renal cell carcinoma .all are true except
A. ? hematruia is the commonest symptom
B. ? 30% of cases present due to system metabolic effect of the
tumor like fever, hypertension and abnormal liver function tests
C. ? raised ESR is seen in 50 % of cases while amyloidosis is
seen in only 2% of cases
D. ? during surgical removal, the adrenal gland and local lymph
nodes should be removed as well
E. ? Radiotherapy is very effective in the treatment
49. In Renal cell carcinoma...All are true except
A. ? more common in males
B. ? adenocarcinoma is the commonest type
C. ? the tumor is vascular and spread to the lungs and bones
D. ? the tumor may be multicentric and or bilateral in some
patients like Von Hippel Lindau
E. ? the tumor may enlarge upon administration of progestins
50. In Drug and toxin induced renal disease the following associations
are true except
A. ? NSAIDS and minimal change nephropathy
B. ? ciclosporin and chronic interstitial nephritis
C. ? lithium and nephrogenic diabetes insipidus
D. ? cicplatin and renal loss of sodium
E. ? aciclovir and crystal formation inside tubules

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