NEPHROLOGY EXAM
1. A 40-year-old female had massive abnormal uterine bleeding and was brought to the
emergency room in shock. She denies any co morbidities and claims her annual company
checkup last week was normal. Her serum creatinine was noted at 4.4 mg/dl and she had only
100ml of urine for the past 24 hours. What stage of acute kidney injury does she have?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Ans: C
2. A 72-year-old diabetic and hypertensive female patient came in to the emergency
department due to shortness of breath and hypotension. Upon checking her vital signs, blood
pressure is 80/60 mmHg, temperature 37.8 C, respiratory rate of 25 and heart rate of 112
bpm. Venoclysis started and foley catheter was inserted with 300cc initial drain of urine. After
7 hours, no urine output was noted. The repeat serum creatinine was 235 from 112 umol/L.
What stage of acute kidney injury does the patient have?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Ans: B
3. All of the following are true regarding the definition of Acute Kidney Injury except
A. Increase in serum creatinine by >0.3 mg/dl within 48 hours
B. Increase in serum creatinine >1.5 times baseline which occurred within the prior 7 days
C. Urine volume <0.5 ml/kg/hr for 6 hours
D. All of the above
Ans: D
4. A man presents with nausea, vomiting, and left flank pain. He feels pain during micturition,
and his urine appears cloudy and reddish-brown. His history is significant for hypertension and
asthma, which are under control. Which of the following tests is the most sensitive and specific
for making a diagnosis
A. Plain X-ray of kidneys, ureters, and bladder
B. Renal ultrasound
C. Intravenous pyelography
D. Non-contrast abdominal CT
Ans: D
5. A 34-year-old man presents with the sudden onset of left flank pain, which radiates towards
the groin. The pain is intermittent and waxes and wanes in intensity. It does not improve with
rest or a change in posture. Vital signs are blood pressure 130/80mmHg, heart rate 87 bpm,
temperature 37.2 C (98.9 F), and respiratory rate 17 breaths/min. On physical examination,
there is mild tenderness to percussion over the left flank. Imaging reveals a stone in the middle
of the right ureter. Which of the following is the most common risk factor for stone formation?
A.Hypocalciuria
B.Hypercalciuria
C.Hyperuricemia
D.Hyperoxaluria
Ans: B
6. A 65-year-old man undergoes a laparotomy for resection of a gastrointestinal malignancy
followed by ileostomy. Intravenous normal saline is given at a rate of 100 mL/hr to compensate
for the excessive losses from the ostomy. Initially, his urine output is approximately 40 mL/hr
but drops to 20 mL/hr on post-op day 4. An arterial blood gas is remarkable for a pH of 7.21 and
PCO2 of 28 mmHg. Serum sodium is 130 mEq/L, potassium is 5.6 mEq/L, BUN is 90 mg/dL, and
creatinine is 3.0 mg/dL. Urine sodium is 35 mEq/L, and urinary creatinine is 90 mg/L. Which of
the following is the appropriate step in diagnosis?
A. Urine for dysmorphic RBCs.
B. Fractional excretion of sodium.
C. Ultrasound of abdomen and pelvis.
D. Renal biopsy.
Ans: B
7. Which of the following is the classic lesion of secondary hyperparathyroidism?
A. Adynamic bone disease
B. Calciphylaxis
C. Osteitis fibrosa cystica
D. Osteomalacia
Ans: C
8. A 64-year-old female complains of 4-week history of bilateral leg edema and bubbly urine.
Urinalysis revealed sugar trace, protein 4+, RBC 0-1/HPF, WBC 4-5/HPF. Positive for Hyaline cast
10 per coverslip. Serum albumin 1.5 g/dL, total cholesterol 500 mg/dl. Urine protein excretion is
10g per24?
A. Chronic kidney disease
B. Nephritic syndrome
C. Nephrotic syndrome
D. Mixed nephritic and nephrotic syndrome
Ans: C
9. Which of the following diseases has the highest reported incidence of renal vein thrombosis,
pulmonary embolism and deep vein thrombosis?
A. Membranoproliferative glomeruloneophritis
B. Rapidly progressive glomerulonephritis
C. Membranous glomerulonephritis
D. Focal segmental glomerulosclerosis
Ans: C
10. A 43-year-old seafarer consulted due to left flank pain, fever and vomiting. He was treated
as a case of pyelonephritis. He claims to have recurrent stones as well. Urine pH was 8. If the
urine was sent for culture and sensitivity, what would be the most likely organism?
A. E. coli
B. Proteus mirabilis
C. P. aeruginosa
D. Staphylococcus aureus
Ans: B
11. Who among the following patients should be treated with appropriate antibiotics given a
urinalysis of pH 7.5, specific gravity 1.020, WBC 45-50/HPF, RBC 25-30/HPF, few epithelial cells
and urine culture and sensitivity showing E. coli 100,000 cfu/ml?
A. Male patient
B. An elderly patient
C. A pregnant patient
D. A patient with Diabetes mellitus
Ans: C
12. A 53-year-old female was referred for evaluation due to progressive proteinuria and
azotemia for the last 5 years. On ultrasound, both kidneys were seen to be small-sized. What
was the mostl likely etiology of her kidney disease
A. Amyloidosis
B. Chronic glomerulonephritis
C. Diabetic nephropathy
D. HIV nephropathy
Ans: B
ALLERGOLOGY
1. A 28-year-old boy hiking in a forest is stung on his left foot and within minutes has itching
at the site of the sting. His condition worsens and he develops generalized hives, chest
tightness, and shortness of breath. He becomes unresponsive while being transported to
the emergency department and is cyanotic upon arrival. What immediate treatment is
most appropriate?
A. Evaluate ABC and then immediately administer epinephrine (1:1,000) 0.3-0.5 mL
intramuscularly.
B. Evaluate ABC and then immediately administer epinephrine (1:10,000) 0.3-0.5 mL
intramuscularly.
C. Evaluate ABC and then immediately administer epinephrine (1:1000) 0.3-0.5 mL
intravenously.
D. Evaluate ABC and then immediately administer epinephrine (1:10,000) 0.3-0.5 mL
intravenously.
Ans: A
2. A 38-year-old man develops severe itching and hives all over his body within a few minutes
after starting to eat at a restaurant and paramedics are called. His heart rate is 102 bpm,
and his blood pressure is 85/65 mmHg. Which of the following signs or symptoms warrants
urgent epinephrine administration?
A. Reduced blood pressure
B. B. Involvement of the skin mucosal surfaces
C. C. Severe itching with wheals on the body
D. D. Stomach pain, vomiting, and diarrhea
Ans: A
3. A 30-year-old female presents with a 6-month history of recurrent urticarial rash. The rash
resolves with residual pigmentary changes over 36 to 48 hours, accompanied by arthralgia.
Which of the following investigations is most likely to yield the diagnosis?
A. Skin prick test
B. Biopsy of involved skin for histology
C. Serum tryptase
D. Radiograph of the affected joint
Ans: B
