Renal MCQs

1. AKI (Acute Kidney Injury) with normal size kidneys on U/S occur in:
a. Autosomal Dominant Adult Polycystic Kidney Disease
b. Bilateral Ureteric Obstruction
c. Primary Amyloidosis
d. Long Standing Diabetes Mellitus
e. Acute Interstitial Nephritis
2. In a young man with Nephrotic Syndrome due to MCD (Minimal
Change Glomerulonephritis) sudden onset oligouria & rise in serum
creatinine occur due to:
a. Acute Chest Infection
b. Measles
c. Renal Vein Thrombosis
d. Two tabs of Paracetamol
e. Heavy meal
3. Renal biopsy is relatively contraindicated in:
a. Single Kidney
b. CKD with normal size kidneys
c. Menstruating young lady
d. Unilateral Renal Artery Stenosis
e. In a bleeding patient with AKI (Acute Kidney Injury)
4. Milky urine i.e. urine white like milk, is characteristic of:
a. Proteinuria 40 grams/day
b. Primary Oxaluria
c. Phosphaturia
d. Acute GN
e. Diabetes Insipidus
5. In stage 3 CKD (Chronic Kidney Disease) the commonest cause of
death is:
a. Cardiovascular Disease
b. ESRD (End Stage Renal Disease)
c. Stroke
d. Anaemia
e. Acute on Chronic kidney disease
6. Renal dialysis is contraindicated in:
a. Hypotension
b. Severe anemia
c. Sepsis
d. Morbid Obesity
e. None of the above
7. Sterile pyuria occur in:
a. Acute tubular necrosis
b. Acute Crescentic Nephritis
c. Acute salicylate poisoning
d. Sickle Cell Anemia
e. Renal Stones
8. In a 55 years old male with Hypertension the following is a clue to
primary hypertension rather Renal Hypertension:
a. Proteinuria
b. Serum Creatinine = 2.5 mg/dL
c. Granular casts in urine
d. Urine specific gravity 1020
e. LVH (Left Ventriculr Hypertrophy) on ECHO
9. Pseudo hyperkalaemia occurs in:
a. Renal Artery Stenosis
b. Erythrocytosis
c. Sever Malaria
d. Addison’s Disease
e. Acute Rhabdomyolysis
10.Isolated Haematuria: (no HTN, no Pyuria, no Proteinuria) is a
characteristic of:
a. IgA Nephropathy
b. Membranous GN
c. Mesangio capillary GN
d. Diabetic Nephropathy
e. NSAID Abuse
11.In a young male patient with AKI the first step in management is:
a. Urine Analysis
b. I.V Furosemide high dose
c. I.V Methyl Prednisolone
d. Volume Status Optimization
e. Ultrasound study of the renal tract

12.End-stage chronic kidney disease with normal or large size kidney is

known to occur in all of the following EXCEPT:
a. Diabetic nephropathy
b. Obstructive uropathy
c. Amyloidosis
d. Chronic pyelonephritis
e. Autosomal dominant polycystic kidney disease

13.A 32 years old male presented to clinic with the clinical features of
nephrotic syndrome. Accordingly kidney biopsy was performed. The
diagnosis of minimal change disease was best confirmed by
a) Effacement of the foot processes on light microscopy
b) Absence of significant histological changes on histopathology
c) Proteinuria of more than 3.5 g/day
d) Normal serum creatinine and blood urea levels, despite his clinical
presentation
e) Presence of nephrotic range proteinuria and hypoalbuminemia
14.A 72 years old man presented to the emergency department
afebrile, irritable with bouts of confusion and having a palpable
tender lower abdominal mass. His blood tests showed a serum
creatinine of 4 mg/dl and a blood urea of 126 mg/dl. The most
appropriate step in management of this patient will be.
a) Doing an abdominal ultrasound
b) Preparing the patient for emergency hemodialysis
c) Urgent referral to the surgical unit as a case of acute appendicitis
d) Urgent rehydration with intravenous normal saline
e) Insertion of an indwelling Foley catheter
15.A 34 years old female presented to the emergency department with
dysuria, hesitancy and fever with rigors. Her blood pressure was
90/60 mmHg. Total white cell count showed leukocytosis of 18 000
mm3. The diagnosis of acute pyelonephritis will be best supported
by:
a) Ultrasound examination to visualize both kidneys, ureters and
bladder
b) Blood tests for urea and electrolytes
c) Blood culture and sensitivity
d) Urine microscopy
e) Kidney biopsy

16.A 54 years old patient was known to have to chronic kidney disease
due to chronic glomerulonephritis and planned for dialysis. He
presented to the emergency department with dyspnoea. His
investigations showed a serum creatinine of 18 mg/dl, blood urea
240 mg/dl, serum sodium 126 mmol/l and serum K 8.4 mmol/l. The
most appropriate immediate management is
a) Urgent referral for emergency hemodialysis
b) High doses of intravenous loop diuretic
c) Salbutamol nebulization
d) Intravenous calcium gluconate
e) Intravenous insulin
17.A 52 years old male was recently diagnosed as having End-stage
renal disease due to Adult Polycystic Kidney Disease and started on
dialysis. Despite all his family members look fine, he was worried
about his siblings and requested family screening. The best
appropriate procedure will be
a) Patients reassurance and family advice to avoid interrelated
marriages in the future
b) Genetic counseling for his wife
c) Testing the kidney function, urea and creatinine, for all family
members
d) Magnetic resonance imaging for all family members
e) Ultrasound abdomen scanning for those above 30 years of age
18.Which of the following ECG changes indicate dangerous
hyperkalemia:
a) Prolongation of the PR interval
b) Deformity of the QRS complex
c) Loss of the P wave
d) Tenting of P WAVE
e) Diminution of QRS amplitude

19.A 62 years old man with a long standing history of low back pain
and was on treatment. Presented to the emergency department
with epigastric pain and repeated coffee ground vomitus. His
investigations showed a normal CBC, serum creatinine of 4.5 mg/dl
and a blood urea of 136 mg/dl. Ultrasound scan of his abdomen
showed bilateral small kidneys. The most probable cause for his
kidney disease was
a. Hypertensive nephrosclerosis
b. Multiple myeloma and cast nephropathy
c. Analgesics induced chronic interstitial nephritis
d. Pre-renal acute kidney injury
e. Acute tubular necrosis
20.The most serious complication of rapid correction of
hypernatremia:
a) Central pontine myelinosis
b) Fluid overload
c) Cerebral edema
d) Heart failure
e) Cerebral hemorrhage

21.Contrast induced nephropathy is more common in :

a) Elderly patients
b) Patients with diabetes mellitus
c) Patients with preexisting renal impairment
d) Patients with hypovolemia
e) Patients receiving Nephro toxic medications

22.The commonest cause of anemia in chronic kidney disease is:

a) Blood loss from the GIT
b) nutritional deficiencies due to anorexia, nausea and vomiting
c) bone marrow suppression by uremic toxins
d) Erythropoietin deficiency
e) reduced red cell survival by toxin nitrogenous compounds

23.The most serious complication of nephrotic syndrome:

a) tendency to develop sepsis
b) pre renal failure
c) thromboembolic phenomena
d) hyperlipidemia
e) nutritional deficiencies
24.A well controlled 30 year old diabetic patient, presented with facial
puffiness & lower limbs edema, his BP 140/90 mmHg, fundoscopy
was normal. Investigations: blood sugar 2 hours after meal 130
mg/dl, serum creatinine 1mg/dl, 24 hours urinary protein 5 grams,
ultrasound showed bulky kidneys. Which of the following is in favor
of primary glomerular disease, rather than diabetic nephropathy:
a. Bulky kidneys on ultrasound
b. Blood sugar of 130 mg/dl
c. Urinary protein of 5 grams/24 hours
d. Normal fundal examination
e. Serum creatinine of 1mg/dl

25.In a normal urinalysis::

a) Albumin is the main excreted protein
b) Maximum specific gravity is 1040
c) pH is usually more than 7.3
d) 24 hours urinary protein is less than 150 mg/24 hours
e) Maximum osmolality is 1000 mosmol/kg

26.A 70 year old male patient diabetic & hypertensive with history of
congestive heart failure needs a CT for suspected abdominal
malignancy. His serum creatinine was 1.8 mg/dl, random blood
sugar was 200 mg/dl, which of the following has the highest risk for
inducing contrast nephropathy in this patient:
a) The presence of hypertension
b) The high blood sugar
c) History of congestive heart failure
d) The age of 70 years
e) serum creatinine of 1.8 mg/dl
27. A 60 years old female patient, known hypertensive on lisinopril
10mg once daily for five years, she is not diabetic, had congestive
heart failure, on furosemide 80mg morning and 40 mg evening, for
the last two weeks, presented to A&E with fatigue, confusion for
the last five days , and an attack of generalized tonic clonic
convulsions . Investigations revealed, blood glucose of 90 mg/dl,
blood urea 80mg/dl. Which of the following is the likely cause of
this deterioration:

a) uremic encephalopathy
b) Hypoglycemia
c) hypokalemia
d) hyponatremia
e) Hypocalcemia

28.A 55 year old man with a long standing history of diabetes,

hypertension and ischaemic heart disease presented to the
emergency department with palpitations. His ECG showed
tachyarrhythmia & tented T waves. Troponin was negative,
creatinine 2.0 mg/dl, and blood urea 80 mg/dl and serum potassium
7.5 mmol/l. He was admitted to the ICU; the best initial step in
management is:
a) Dialysis
b) Calcium resonium (ion-exchange resin)
c) Intravenous Calcium gluconate,
d) Intravenous glucose + insulin infusion
e) Sodium bicarbonate infusion
29.A 32 year old female, with history of Systemic Lupus Erythematosus
(SLE) on regular follow-up, was found to have two crosses of protein
in urine. An active glomerular disease (lupus nephritis) is best
supported by the presence of:
a) Proteinuria
b) Haematuria
c) Red blood cell casts in urine
d) A rising serum creatinine
e) Presence of glomerular sclerosis & capillary obliteration in renal
biopsy

30.In a patient with chronic kidney disease, what is the initial

abnormality that leads to renal osteodystrophy:
a) Hypocalcemia
b) Hyperphosphotemia
c) Secondary hyperparathyroidism
d) Vitamin D3 deficiency
e) Hypercalciuria

31.A 45 year old female, presented to the Emergency department with

bilateral loins pain and dysuria, OE she was ill, febrile & toxic.
Diagnosis of acute pyelonephritis is supported by:
a) Uncountable pus cells in urine
b) Protein in urine
c) Bacteriuria of more than 105 /CFU in urine culture
d) The presence of white cell casts in urine
e) A rising serum creatinine
32.A 20 year old girl received Amoxycillin for treatment of acute
tonsillitis. On the fifth day of treatment developed joints pain &
skin rash and noticed that her urine became less in amount. Urine
examination showed albumen +, uncountable RBCs &
eosinophiluria. Serum creatinine 1.8 mg/dl. The most likely cause
of her acute kidney injury is:
a) Lupus nephritis
b) Post streptococcal glomerulonephritis
c) Ig A nephropathy
d) Acute interstitial nephritis
e) Acute tubular necrosis
33.A 65 year old female patient with diabetic nephropathy, her serum
creatinine is 2.4mg/dl, serum uric acid of 8mg/dl she is obese. Which
treatment modality is more likely to slow the progression of her
chronic kidney disease:
a) Treatment of hyperlipidemia
b) Treatment of hyperuricemia
c) Control of blood pressure
d) Reduction of weight
e) Control of diabetes
34.Which ECG changes indicate severe degree of hyperkalemia:
a) QRS complex deformity
b) Prolongation of PR interval
c) Tented T wave
d) Disappearance of P wave
e) Diminution of the QRS complex amplitude
35.Which of the following is more likely to predispose to contrast
nephropathy:
a) Old age
b) Congestive heart failure
c) Impaired renal function
d) Diabetes mellitus
e) Hypertension
36.In a patient with chronic kidney disease, what is the initial
abnormality that leads to renal osteodystrophy:
a) Hypocalcemia
b) Hyperphosphotemia
c) Secondary hyperparathyroidism
d) Vitamin D3 deficiency
e) Hypercalciuria

37.A 70 year old man had a bout of polyuria (6 liters /day) for the last
week, presented with lethargy & confusion. His blood pressure was
140/90mmHg. Investigations showed blood urea 40mg/dl, serum
sodium 160mEq/l, serum potassium 4.5mEq/l, random blood
glucose 110 mg/dl; which of the following is the commonest cause
of death:
a) Congestive cardiac failure
b) Acute kidney injury
c) Intracerebral hemorrhage
d) Cerebral edema
e) Central pontine myelinosis

38.A 40 year old male presented with history of severe diarrhea &
vomiting for the last 3 days. On admission he was dehydrated and
his blood pressure was 80/60 mmHg. Investigations showed blood
urea & serum creatinine of 100mg/dl & 3.0mg/dl respectively.
Which of the following would be in favor of pre renal azotemia
rather than acute tubular necrosis:
a) Blood pressure of 80/60 mmHg
b) Urine osmolality of 350 mosmol/Kg
c) Urinary sodium of 10 mEq/l
d) Absence of protein & RBCs in urine
e) Specific gravity of urine 1.010
39.The decision to fast Ramadan in a patient with chronic kidney
disease Stage III, is based on:
a) Serum creatinine
b) Kidneys size on ultrasound
c) Urine osmolality
d) Blood pressure level
e) Patient age

40.The best treatment of end stage renal disease (ESRD) is:

a) Conservative treatment
b) Renal transplant
c) Haemodialysis
d) Peritoneal dialysis
e) Haemofiltration
41.Micro albuminuria:
a) is a predictor of cardiovascular disease
b) is of no significance in a healthy hypertensive
c) is irreversible
d) should not be looked for as routine in diabetics
e) can be detected by ordinary dip stick

42.in a male patient of 20 years old, with nephritic syndrome:

a. treatment should follow renal biopsy
b. expected to have renal insufficiency with normal GFR
c. non responsiveness to steroids indicates non responsiveness to
cyclophosphamide
d. minimal change nephropathy is unlikely if they are
hypertensive
e. had post streptococcal glomerulonephritis if ASO titer is raised
43.renal calcifications occur in:
a. pulmonary tuberculosis
b. autosomal dominant polycystic kidney disease
c. sarcoidosis
d. secondary hyper parathyroidism
e. sickle cell disease

44. Hypokalemia is more commonly expected with the use of:

a) furosemide
b) Amiloride
c) hydrochlorothiazide
d) bumetanide
e) acetazolamide

45. 18- year old female developed nephrotic syndrome and is awaiting
further tests to establish the underlying etiology In which of the
following disease entity would steroids be most effective in
reversing the nephrotic syndrome.
a) Membranous nephropathy.
b) Minimal change disease.
C ) Primary amyloidosis.
d) IgA nephropathy.
e) Rapidly progressive glommulonephritis.

46.Pyuria without Bacteriuria is known to occur in all the following

Except:
a. Renal tuberculosis.
b. Renal calculi.
c. Hypertensive nephrosclerosis.
d. Chronic interstitial nephritis.
e. Recent treatment with antibiotics.
47.Which one of the following does not assist in differentiating
between chronic kidney disease and acute kidney disease?
a. Hb of 6gm /dl
b. High serum phosphorus
c. Small size of the kidneys on ultrasound
d. High ESR
e. Low serum calcium

48.A 40 year old female with systemic lupus erythematosus (SLE) has
the following results: serum creatinine 2.5 md/dl, 24 hours urinary
protein 5.5 gm, renal biopsy showed class 4 (diffuse proliferative)
lupus nephritis. Which one of the following is best treatment?
a. High dose prednisolone
b. Prednisolone and azathioprine (Imuran)
c. Prednisolone and non-steroidal anti-inflammatory drugs
d. Prednisolone and cyclophosphamide
e. Prednisolone and chloroquine

49. Which one of the following is not correct about chronic

Haemodialysis:
a. It is usually started when the GFR is less than 15 ml/min
b. The best vascular access is arteriovenous fistula
c. It is done for 4 hours three times per week
d. It does not correct the anaemia of end-stage renal
disease (ESRD)
e. It is the best treatment of end-stage renal disease.

50.Proteinuria of 30 grams per 24 hours occurs in

a. Podocyte disease e.g. Minimal change disease, Focal Segmental
Glomerulonephritis
b. IgA glomerulonephritis
c. Hypertension
d. Polycystic kidney disease
e. Chronic pyelonephritis
51.The commonest cause of mortality in stage III Chronic Kidney
Disease is
a. Anaemia
b. Cardiovascular disease
c. Stroke
d. Peripheral vascular disease
e. Sepsis

52.The following drug is safe to prescribe in End Stage Renal Disease

(GFR < 15 mg/min) ***
a. Warfarin
b. Digoxin
c. Tetracycline
d. Quinolones
e. Sulphonamides.
53.Hypertension is the cause of Chronic Kidney Disease if the following
is found in the same patient.
a. Left ventricular hypertrophy
b. Proteinuria of more than 2.5 grams/24hour
c. Normal fundi
d. Pyuria
e. Hyaline casts in the urine

54. 75 year old male with a history of trauma presented with

headache, fluctuation in his level of consciousness, no risk factors.
The likely diagnosis:
a. cerebral haemorrhage
b. Thrombotic CVA
c. Hypertensive encephalopathy
d. Subdural haematoma
e. Arterio-venous malformation.
55. A 20–y-old female presented to ER with fever and joints pain. She
gave history of taking NSAIDs for joints pain around two weeks
prior to her presentation. Examination revealed BP = 140/80, T =
37.0°c, and Pulse rate = 80/min. Chest was clear, LAB: urine
analysis:- WBC 20 – 25/HPF no RBCs nor RBC casts, S. creatinine 3
mg/dL, Urea 60 mg/dL, Serum K: 4 mg/dL. The most likely cause of
acute renal failure(ARF) in this patient is:
a. Acute Tubular Necrosis
b. Acute Interstitial Nephritis
c. Acute Glomerular Nephritis
d. Pre-renal Azotemia
e. Rapidly progressive glomerulonephritis

56.A 65 years old male not known diabetic or hypertensive presented

ill, febrile, and tachycardic with reduced urine output. His
investigations showed a serum creatinine of 12 mg/dl, blood urea of
210 mmol/l and serum potassium of 7.8 mmol/l. The immediate
step in management is
a. 10 ml of 10% Calcium gluconate infused over 5 min
b. 50 ml of 50% dextrose plus 10 IU actrapid insulin infused over
15 min
c. 50 ml of Sodium bicarbonate (450 mmol) infused over 5
minutes
d. Salbutamol nebulizer 10 mg over 2-3 min
e. Urgent hemodialysis

57.A 68-year-old woman was analgesic for years for her left knee
osteoarthritis. She now has an elevated urea and creatinine, and
bilateral small kidneys; features consistent with chronic kidney
disease. Expected histological changes include
a. Glomerulosclerosis
b. Papillary necrosis and tubulo-interstitial inflammation
c. Cortical necrosis
d. Tubular necrosis
e. Nephrolithiasis
58.A 22 years young male, known stone former, his kidney function
two months back was normal. Presented with a left loin colic,
macroscopic hematuria and an elevated serum creatinine of 2.1
mg/dl
a. A family history of renal stones support the diagnosis of
calcium containing stones
b. The elevation in serum creatinine indicates that both kidneys
are obstructed
c. Elevated serum calcium is seen in almost all cases
d. Absence of hydronephrosis on ultrasound scan does not rule
out an obstructive uropathy
e. Contrast enhanced CT abdomen is the investigation of choice
in such patient

59. A 55 years old female was on long standing non-steroidal anti-inflammatory

drugs (NSAIDS) due to low back ache. Presented to the emergency department
with high grade fever and back pain. Her investigations showed a 24 hour urine
protein of 4 gm/day, serum calcium 12.4 mg/dl (range 8.1-10.4 mg/dl), serum
creatinine 4.8 mg/dl (0.4-1.2 mg/dl) and an Ultrasound scan with bulky
kidneys.
a. The presence of nephrotic range proteinuria and normal size kidneys
support the diagnosis of minimal change disease
b. Analgesic induced nephritis is the most likely diagnosis
c. A plain X-ray spine is mandatory to support the final diagnosis
d. Obstructive uropathy is the most likely cause of kidney disease in this age
group
e. History of dysuria will support the diagnosis of acute pyelonephritis
60.A 23 years old police trainee brought to the emergency department
with fever, generalized body aches, lower limb weakness and
passage of red urine. His urine analysis showed uncountable red
blood cells, serum creatinine was 4 mg/dl (0.4 - 1.4 mg/dl), whereas
his ultrasound scan showed bulky kidneys with preserved cortex
a. Kidney biopsy should be done on urgency
b. The presence of hematuria confirm the diagnosis of IgA
nephropathy
c. 24 hour urine protein is indicated to rule out nephritic
syndrome
d. ASO is essential to rule out post-streptococcal
glomerulonephritis
e. Serum creatinine kinase is mandatory to support the diagnosis

61.A 35 years old female with a history of recurrent joint pain and skin
lesions. Referred to nephrology clinic with a stable serum creatinine
of 4 mg/dl (0.4-1.2 mg/dl). The diagnosis of Systemic Lupus
Erythematosus (SLE) will be supported by
a. Presence of nephrotic range proteinuria
b. Low anti dsDNA titer
c. Presence of red cell casts in urine
d. Presence of erosive arthritis on X-ray hands and small joints
e. Presence of persistently low platelet count

62.A 19 year old female wishes to start a family but she is concerned as
her 50 year old mother had adult polycystic kidney disease (APKD).
Her examination revealed no specific abnormalities. The best test to
exclude out APKD in this woman
a. Genetic analysis
b. CT Abdomen and Kidneys
c. Isotope renography
d. Renal ultrasound
e. Urinalysis
63.At community levels basic screening for chronic kidney disease
(CKD) should include
a. Measurement of blood pressure
b. Urine for microalbuminuria
c. Urine for microscopic hematuria
d. Renal function tests
e. Ultrasound scanning of the kidneys

64. A 43 years old man, known case of end-stage renal disease.

Presented to the emergency department ill, oliguric, with uremic
symptoms, high renal parameters and electrolyte disturbances.
Accordingly, he had emergency dialysis. Parameters expected to
improve with dialysis sessions include:
a. Urine output
b. Anemia of chronic kidney disease
c. Hypocalcemia
d. Hyperphosphotemia
e. Metabolic acidosis

65.A 36 years old male presented to clinic with lower limb oedema,
proteinuria and hypoalbuminaemia. Further work-up showed all the
criteria for nephrotic syndrome (NS)
a. Minimal change disease is the most likely cause of NS in adults
b. Patient should immediately be started on steroids, and
recovery is the usual rule
c. Kidney biopsy is essential in adults with nephrotic syndrome
d. Effacement of the foot processes on light microscopy is the
only expected finding in minimal change disease
e. Sole treatment with Angitensin Converting Enzyme (ACE)
inhibitors is usually effective
66.In the treatment of hyperkalaemia
a. Diuretics effectively lower serum K
b. Excretion of K through the gut is facilitated by calcium
resonium
c. IV Calcium gluconate is given immediately as it rapidly excrete
K from the body
d. Dialysis is the treatment of choice
e. β receptor antagonists are given via a nebulizer

67.In patients with glomerulonephritis an active glomerular disease is

best supported by the presence of
a. Proteinuria
b. Haematuria
c. Red blood cell casts
d. Rising serum creatinine
e. Presence of tubular atrophy and interstitial fibrosis on kidney
biopsy
68.Anaemia in patients with chronic kidney disease is best treated with
a. Oral folic acid supplement
b. Oral Iron supplement
c. Erythropoeitin injections
d. Vitamin B12 injections
e. Regular dialysis

69.The diagnosis of a UTI in women is confirmed by

a. The presence of 5-8 pus cells/hpf in urine
b. The presence of protein in urine
c. The presence of < 105 CFU/mL in urine culture
d. The presence of white cell casts in urine
e. The presence of rising serum creatinine
70.In patients with acute kidney injury (acute renal failure)
a. The presence of postural hypotension supports a pre-renal
cause
b. IV furosemide is the main stay of treatment
c. UTI is the commonest precipitating cause in women
d. Unlike in those with chronic kidney disease, hyperkalaemia
does not occur
e. The kidneys are usually smaller than normal on ultrasound

71.In patients with adult polycystic kidney disease

a. Diagnosis is usually done at childhood
b. Almost all patients progress to end stage renal disease
c. The renal cysts can turn malignant
d. Ultrasound scan usually shows bilateral small kidneys with
multiple renal cysts
e. Family members screening is essential as it has an autosomal
dominant inheritance

72.AKI with normal size kidneys on U/S occur in:

a. Autosomal Dominant Adult Polycystic Kidney Disease
b. Bilateral Ureteric Obstruction
c. Primary Amyloidosis
d. Long Standing DM
e. Acute Interstitial Nephritis

73.In a young man with Nephrotic Syndrome due to MCD (Minimal

Change Glomerulonephritis) sudden onset oliguria & rise in s.
creatinine occur due to:
a. Acute Chest Infection
b. Measels
c. Renal Vein Thrombosis
d. Two tabs of Paracetamol
e. Heavy meal
74. Renal biopsy is relatively contraindicated in:
a. Single Kidney
b. CKD with normal size kidneys
c. Menstruating young lady
d. Unilateral Renal Artery Stenosis
e. In a bleeding patient with AKI
75. Milky urine i.e. urine white like milk, is characteristic of:
a. Proteinuria 40 grams/day
b. Primary Oxaluria
c. Phosphaturia
d. Acute GN
e. Diabetes Insibidus

76. Normal Anion Gap Metabolic Acidosis is characteristic of:

a. Type one(1) Renal Tubular Acidosis
b. DKA
c. Lactic Acidosis
d. Glycogen Storage Disease
e. AKI

77. In stage Three(3) CKD the commonest cause of death is:

a. Cardiovascular Disease
b. ESRD
c. Stroke
d. Suicide
e. Unknown

78. Renal dialysis is contraindicated in:

a. Hypotension
b. Severe anemia
c. Sepsis
d. Morbid Obesity
e. None of the above

79. Sterile pyuria occur in:

a. Acute interstitial Nephritis
b. Acute crescentic Nephritis
c. Acute salicylate poisoning
d. Sickle Cell Anemia
e. Renal Stones
80. In a 55 years old male with Hypertension the following is a clue to primary
hypertension rather Renal Hypertension:
a. Proteinuria
b. S. creatinine=2.5
c. Granular casts in urine
d. Urine specific gravity 1020
e. LVH on ECHO
81. Pseudo hyperkalaemia occur in:
a. Erythrocytosis
b. Renal Artery Stenosis
c. Sever Malaria
d. Addison’s Disease
e. Acute Rhabdomyolysis

82. A 61-year-old male was seen in the clinic. He has diabetes mellitus for 6 years
which is well controlled on oral hypoglycemic medication. His urinalysis is
normal. His serum creatin ine is 1.2 mg/dl and the blood urea is 40
mg/dl. His serum sodium is 135 and potassium is 4.8 mmol/liter. He is on
treatment with Losartan. His BP is 138/88. Which of the following is the correct
answer:
a. Restrict his dietary protein intake.
b. Add Amlodipine to his treatment.
c. Keep his treatment the same until his next clinic follow up
d. Add an Angiotensin converting enzyme inhibitor to his treatment.
e. add a thiazide diuretic to his treatment

83. End-stage chronic kidney disease with normal or large size kidney is known to
occur in all of the following except:
a. diabetic nephropathy
b. Obstructive uropathy
c. Amyloidosis
d. Chronic pyelonephritis
e. Autosomal dominant polycystic kidney disease
84. A 55-year-old female patient presented with persistent uncountable pus cells in
the urine with negative urine cultures. Which of the following is the most likely
diagnosis:
a. diabetic nephropathy
b. hypertensive nephrosclerosis
c. chronic glomerulonephritis
d. renal calculi-
e. lupus nephritis
85. A 30-year-old male has a serum creatinine of 2.5 mg/dl. Which of the following
is the most accurate test to confirm the diagnosis of chronic kidney disease and
not acute kidney injury (AKI) as the cause of his abnormal renal function:
a) Complete blood count
b) Urinalysis
c) 24-hour urinary protein excretion
d) Serum calcium and phosphorus values
e) Ultrasound examination of the abdomen

86. A 35-year-old male presented with abnormal renal function with serum
creatinine of 2.1 mg/dl. Which of the following will make the diagnosis of
interstitial nephritis more likely than glomerulonephritis:
a) urinary red blood cell casts
b) urinary white blood cell casts
c) 24-hour urinary protein excretion of 0.8 gm
d) blood pressure of 145/95
e) elevated serum uric acid

87. A 48-year-old male patient is known to have diabetes mellitus for 12 years and
hypertension for 6 years. He has chronic kidney disease with a serum creatinine
of 2.7 mg/dl. He has anaemia, hyperuricemia and hyperlipidemia. Which of the
following is the most important management item to slow progression of his
chronic kidney disease? :
a) control of his diabetes mellitus
b) control of his hypertension
c) treatment with allopurinol
d) control of his hyperlipidemia
e) correction of his anaemia

88. A 60-year-female is known to have diabetes mellitus for 10 years. She was found
to have abnormal renal function with a serum creatinine of 2.8 mg/dl. The
presence of which one of the following makes the diagnosis of diabetic
nephropathy the most likely cause of her abnormal renal function:
a) proteinuria
b) diabetic retinopathy
c) diabetic neuropathy
d) uncontrolled diabetes with high HbA1c
e) hyperlipidemia
89. In urine examination the presence of which of the following is the most accurate
indicator of glomerular disease:
a) granular casts
b) red cell casts
c) microhaematuria (microscopic haematuria)
d) macrohaematuria (macroscopic haematuria)
e) epithelial cells

90. A 55 years old man with a long standing history of diabetes, hypertension and
ischemic heart disease presented to the emergency department with
palpitations. His ECG showed tachyarrhythmia and ll tented T waves. His serum
troponin was negative, creatinine 2 mg/dl, blood urea 80 mg/dl and serum
potassium 7.5 mmol/l. He was admitted to the ICU; the best initial step in
management is:
a. Dialysis
b. Calcium resonium (ion-exchange resin)
c. IV Calcium gluconate
d. Intravenous glucose + insulin infusion
e. Sodium bicarbonate infusion

91. A 32 years old female with a past medical history of Systemic Lupus
Erythematosus (SLE), while on regular follow-up, she was found to have two
cross of protein in urine and thus refereed for further work-up. An active
glomerular disease (lupus nephritis) is best supported by the presence of
a. Proteinuria
b. Haematuria
c. Red blood cell casts in urine
d. A rising serum creatinine
e. Presence of tubular atrophy and interstitial fibrosis on kidney biopsy

92. A 52 years old man with chronic kidney disease (CKD IV), while on regular
follow-up at the out-patient-clinic he was found to have a normochromic
normocytic anaemia with a haemoglobin of 9 gm/dl. His anaemia will be better
corrected by
a. Oral folic acid supplements
b. IV Iron supplements
c. Erythropoietin injections
d. Regular Vitamin B12 injections
e. Regular dialysis therapy
93. Red Cell Cast in urine analysis is diagnostic of:
a. Acute Glomerulonephritis
b. Acute interstitial nephritis
c. AKI
d. Stage 111 Diabetic Nephropathy
e. IgA Nephropathy

94. Normal Anion Gap Metabolic Acidosis occurs in:

a. Renal Tubular Acidosis type - II
b. Stage 4 CKD
c. Mesangioproliferative GN
d. Salicylates poisoning
e. Lactic Acidosis

95. In a 70 years old male with membranous Nephropathy, the likely underlying
cause is:
a. Cancer Colon
b. leprosy
c. Urinary schistosomiasis
d. Anti-phospholipase receptor A2 Antibody Disease
e. SLE
96. Retinopathy in type 1 Diabetic nephropathy occurs in:
a. 100%
b. 90%
c. 80%
d. 70%
e. 60%
97. Absolute contraindication to kidney biopsy:
a. Solitary Kidney
b. Sepsis
c. INR 1.8
d. Proteinuria of 1gm
e. Kidney size of 8cm

98. In a Euvolemic patient hyponatremia is most likely due to:

a. a. Liver Cirrhosis
b. b. CKD stage 111
c. c. Inappropriate ADH secretion
d. d. DKA
e. e. Malnutrition
99. I n a patient with AKI rushed to ER the most important initial steps in
management are:
a. a. Volume establishment
b. b. Ultrasound of the renal tract to exclude obstruction
c. c. Renal profile
d. d. Dopamine infusion
e. e. Intubation

100. In a 25 years old male with sever Hypertension the following is a clue to a
secondary cause:
a. a. Positive family history
b. b. Skin Neurofibromatosis
c. C. cafe au lait
d. d. Ptylosis
e. e. Anal Pigmentation

101. Which one of the following statements is correct regarding acute renal
failure?
a. It is usually irreversible
b. Post-obstructive ARF is the commonest type of ARF
c. Urine analysis in pre-renal azotemia is normal
d. Acute Glomerular Nephritis is more common than Acute Tubular Necrosis
as a cause
e. Ultra sound usually shows large kidneys

102. All of the following are true about microalbuminuria EXCEPT;

a. Is a risk factor for nephropathy.
b. Is a risk factor for ischemic heart disease.
c. Is reversible with good metabolic control.
d. Is associated with Hyperlipidaemia.
e. Occurs only in diabetes mellitus.

103. a 30 years old female presented with menorrhagia. her tests were as follows:
HB 10 g/dl TSH : 36 IU (0.5-5) Free T4: 5 mmol/l (6-20)
The most appropriate management is:
a. Thyroxine
b. Bromocriptine
c. Prednisolone
d. Oestrogen containing pill
e. Hysterectomy
104. A 25-year old female patient presented with weight loss, lethargy and dark
buccal pigmentation, her BP was 90/60 mmHg and serum K level is 5.6 mEq/L. the
most likely diagnosis is:
a. Chronic renal failure
b. Addison's disease
c. Panhypopituitarism
d. Chronic steroid therapy
e. Decompensated liver disease

105. Red cell casts in the urine is diagnostic of:

a. Acute glomerulonephritis
b. Acute interstitial nephritis
c. Malignant hypertension
d. Acute kidney injury
e. Diabetic nephropathy

106. Isolated haematuria in a young healthy adult with a positive family history is
characteristic of
a. IgA nephropathy
b. Alport’s syndrome
c. Thin membrane disease
d. Henoch-Schonlein purpura
e. Mesangiocapillary glomerulonephritis

107. Early diabetic nephropathy stage 1 is characterized by:

a. Microalbuminuria
b. GFR 50 ml/min
c. Hypertension
d. Ankle swelling
e. Haematuria

108. The optimum blood pressure control in a patient with diabetes

a. 120/70
b. 130/80
c. 140/90
d. 100/60
e. 90/60

109. The following drugs can be used in stage 5 chronic kidney disease
a. Penicillin
b. Rifampicin
c. Digoxin
d. Warfarin
e. Cotrimoxazole
110. Hypokalaemia isa feature of:
a. Acute kidney injury
b. Rhabdomyolysis
c. Cushing’s syndrome
d. Hyperthyroidism
e. Renal tubular acidosis type IV

111. Urine analysis is NOT reliable in diagnosing

a. Diabetes mellitus
b. Renal tubular acidosis
c. Porphyria
d. Nephrotic syndrome
e. Diabetes insipidus

112. Which of the following is NOT helpful in detecting early chronic kidney disease?
a. Urine analysis
b. Estimated GFR
c. Kidney imaging
d. Blood pressure check
e. Brown ring of the nails

113. The following is an indication for dialysis :

a. Blood pH 7.4
b. Serum potassium 5.6 meg/l
c. Intractable chronic renal failure
d. Adult respiratory distress syndrome
e. Hypocalcaemia

114. A 38-year-old woman who had a resection of her terminal ileum for Crohn’s
disease 6 years ago presents with breathlessness and fatigue. She has a
hemoglobin concentration of 7 g/dL, MCV 110 fl (76-96), MCHC 30 gm%. The
most appropriate treatment for her anemia is:
a. Repeated blood transfusion
b. Vitamin B12
c. Folic acid
d. Iron.
e. Erythropoietin

115. Following an upper respiratory tract infection a 20 years old female

developed haematuria, arthralgia, skin rash and abdominal pain. The most
likely diagnosis to consider is:
a. rheumatic fever
b. Post streptococcal glomerulonephritis
c. Systemic lupus Erythematosus.
d. Cryoglobulinaemia
e. Henoch-Schonlein purpura
116. A 60 years old lady with long standing rheumatoid arthritis presented with
recurrent attacks of congested eyes with a dryness and itchy sensation. The
most likely cause for this is:
a. Hypercalcemia with corneal calcification
b. Corneal ulceration
c. Kerato-conjunctivitis sicca
d. Papillitis
e. Trachoma

117. Following a period of heavy alcohol intake a 50 years old man presented with
severe pain related to his first metatarsophalangeal joint. The first diagnosis to
consider is:
a. Gouty arthritis
b. rheumatoid arthritis
c. nodal osteoarthritis
d. psoriatic arthropathy
e. septic arthritis

118. In a young patient with severe metabolic acidosis secondary to diabetic

Ketoacidosis, on examination the expected respiratory pattern is :
a. Kussmaul’s breathing.
b. Cheyne-stokes Breathing.
c. Ataxic breathing.
d. Paradoxical breathing.
e. Rapid shallow breathing

119. Which of the following conditions is inherited as X-linked:

a. Thalassaemia major
b. Hereditary spherocytosis
c. G6PD deficiency
d. Sickle cell anaemia
e. Adult polycystic kidney disease
120. Thrombocytopenia caused by increased platelets destruction is associated
with:
a. Aplastic anaemia
b. Systemic Lupus Erythematosis
c. Megaloblastic anaemia
d. Acute leukaemia
e. Bone marrow infiltration with malignant cells
121. In a patient with advanced diabetic retinopathy, fundus examination may
show:
a. Hard exudates
b. Silver wiring
c. Papillodema
d. Arterio-venous nipping
e. Optic atrophy
122. A 50 years old patient with anaemia had the following blood test:
Hb 9.6 mg/dl MCV 69
MCH 20
A possible cause for his anaemia is:
a. GIT blood loss
b. Bone marrow aplasia
c. Hyper- spleenism
d. Vitamin B12 deficiency
e. Thyroid disease

123. Aquired immunodefincy syndrome (AIDS)

a. transmitted by repeated mosquito bites
b. Preventable by vaccination
c. Transmitted by droplets infection
d. Affect mainly sexually active adults
e. Transmitted during labour

124. The family history is most relevant in which of the following condition:
a. Tension headache
b. Ulcerative collitis
c. Willson disease
d. Hepatitis C liver disease
e. Chronic bronchitis

125. A patient with acute kidney injury presented with a serum potassium of
6.0mEq/l. The expected ECG finding is:
a) prolongation of PR interval
b) prolongation of QT interval
c) deformation of the QRS complex
d) tenting of T wave
e) disappearance of P wave

126. A 70- year- old man presented with drowsiness & confusion, investigations
showed blood sugar of 110 mg/dl, serum sodium 160 mEq/l & serum potassium
of 4.5 mEq/l .The usual cause of death in such case is:
a) acute renal failure
b) cerebral edema
c) thromboembolic complications
d) heart failure
e) cerebral hemorrhage
127. Fever, skin rash & eosinophilia with acute renal failure is seen in:
a) acute interstitial nephritis
b) acute pyelonephritis
c) Ig A nephropathy
d) Diabetic nephropathy
e) Post infectious glomeruonepheritis

128. Advising patients to take plenty of fluids is recommended in:

a) Autosomal dominant polycystic kidney disease (ADPKD)
b) Nephrotic syndrome
c) Acute kidney injury
d) Obstructive uropathy
e) Hypernatremia

133. The cause of mortality in chronic kidney disease is:

a) Sepsis
b) CNS infection
c) Cardiovascular disease
d) End stage renal disease (ESRD)
e) Liver disease
134. Which of the following features confirms that hypertension is the cause
rather than effect of chronic kidney disease:
a) Left ventricular hypertrophy
b) Hypertension less than 10 years
c) Proteinuria more than 3.5 grams in 24 hours
d) Granular casts in urine
e) Positive family history of renal disease

135. Which of the followings help in differentiating acute from chronic renal
disease:
a) Hemoglobin of 12 grams/dl
b) High ESR
c) Bilateral small kidneys on ultrasound examination
d) Serum calcium of 11mg/dl
e) Bilateral lower limbs edema
136. Proteinuria of 30 grams / day is indicative of:
a) podocyte disease
b) mesangio capillary glomrulonephritis
c) hypertension nepherosclerosis
d) chronic interstitial nephritis
e) chronic lead poisoning
 137. In a patient with long standing diabetes mellitus & chronic renal failure;
which of the following is the most important to support the diagnosis of
diabetic nephropathy:
a) urine examination for proteinuria
b) fundal examination for retinal changes
c) examination of the eye for diabetic cataract
d) examination for diabetic peripheral neuropathy
e) testing the blood for Hb A1c

138. 34 yrs old pt had a congenital kidney disease on left side and has renal
bruit on the right side. He presented with BP= 165/110, which drug you
avoid?
a) Labetolol.
b) Captopril
c) Propranolol
d) Chlorthalidone
e) Nitropruside

139. 72 yrs old patient presented to ER confused, irritable, but no fever.

O/E….lower abdominal mass and tenderness and have Cr=4 , Urea = 126.
What are you going to do?
a) U.S abdomen.
b) Urgent Haemodialysis.
c) Give him diuretics.
d) refer for surgery for appendicitis.
e) give him I.V fluid immediately as normal saline.

140. The best test to diagnose pt with fever , increased WBCs , loin pain and
vomiting as having pyelonephritis :
a) U.S both kidneys.
b) Blood culture and sensitivity.
c) Urine microscopy.
d) Renal function tests.
e) Renal biopsy.
141. The most appropriate step in management of a patient with acute renal
shut down after stabilizing is:
a) Ultrasound abdomen & pelvis
b) Blood chemistry
c) Urinalysis
d) Intravenous furosemide
e) Intravenous saline
142. A patient with diabetic nephropathy is better seen by:
a) Nephrologist
b) Diabetologist
c) Ophthalmolpgist
d) Diabetic nurse
e) All of the above
143. The most important factor to prevent progression of chronic kidney
disease is:
a) tight control of blood pressure
b) good hydration
c) avoidance of non steroid anti inflammatory drugs (NSAID)
d) Control of hyperlipidemia
e) Control of diabetes
144. The common cause of hematuria in Sudan is:
a) Urinary schistosomaisis
b) Glomerulonephritis
c) Renal stone
d) Vasculitis
e) NSAID

145. Sudden death in a 35 year old male with nephritic syndrome is:
a) Massive pulmonary embolism
b) Acute myocardial infarction
c) Acute renal failure
d) Sepsis
e) Dehydration

146. The best treatment of ESRD is:

f) Conservative treatment
g) Renal transplant
h) Haemodialysis
i) Peritoneal dialysis
j) Haemofiltration
147. Micro albuminuria:
f) is a predictor of cardiovascular disease
g) is of no significance in a healthy hypertensive
h) is irreversible
i) should not be looked for as routine in diabetics
j) can be detected by ordinary dip stick
148. sterile pyuria is seen in:
a) diabetes mellitus
b) sickle cell disease
c) partially treated urinary tract infection
d) urinary tuberculosis
e) all of the above

149. Haemodialysis is a useful modality of treatment in:

a) schizophrenia
b) lithum toxicity
c) hyper pyrexia
d) severe hypothyroidism
e) all of the above
d
A 76 year old male with a past medical history which included hypertension for 10 years,
congestive cardiac failure, a previous myocardial infarction and two transient ischaemic attacks.
His medication comprised captopril 12.5 mg bd, frusemide 40 mg od, aspirin 75 mg od and
Atorvastatin 40 mg od.

He was referred to hospital with a three day history of increasing dyspnoea. His shortness of
breath was exacerbated by exercise and by lying down, and was associated with an
unproductive cough.
On examination he was apyrexial, tachypnoeic, his BP 170/70 mmHg, apex beat displaced
laterally. He had bilateral lower limb oedema. A left sided femoral and a right sided carotid
bruit were heard. Chest examination noted bilateral basal crackles.

His investigations showed a normal blood count, his serum creatinine of 2.5 mg/dl, blood urea
86 mmol/l and normal electrolytes.

He was initially treated with IV frusemide and GTN infusion, and started to improve. On the
next day he suddenly became severely distressed complaining of right sided loin pain and
increasing dyspnoea. He was cold and clammy with a blood pressure of 220/120 mmHg, and
a tender right loin. His chest X ray showed a florid pulmonary edema, serum creatinine
increased to 3.6 mg/dl blood urea to 136 mmol/l.
.
1) State THE MOST LIKELY diagnosis and the cause of his acute deterioration
 Renovascular disease with flash pulmonary edema (8)
 Acute on chronic kidney disease with fluid overload (2)

2) State TWO investigation to establish the diagnosis

 Duplex / Doppler ultrasound of the renal vessels (3)
 MRA for the renal vessels (3)
 CT angiography (1)

3) Mention THREE important steps in management

 Withdrawal of ACE inhibitors (2)
 Urgent dialysis (2)
 Renal artery angioplasty with stenting (2)
 Reconstructive surgery (1)
An 28 year old young lady presented to the Emergency department with a 4 days history of
low grade fever, recurrent colicky abdominal pain and diarrhea with mucus and blood. In the
Emergency department she was ill looking dehydrated with a blood pressure of 90/40 mmHg.

Her investigations showed a Hb of 9.5 g/dl, WBC 16 000/mm3, Platelets 58 000 x 109/l, serum
creatinine of 3.6 mg/dl, blood urea 86 mmol/l, urine + protein and uncountable RBCs. Her
ultrasound scan of the abdomen revealed no significant abnormality.

The patient was admitted to hospital, started on rigorous IV fluids and antibiotics. Despite her
blood pressure was maintained, she continued to develop worsening abdominal pain and
remained to be oliguric with rising renal parameters and electrolyte disturbances.

1) State THE MOST LIKELY diagnoses

 Hemolytic uremic syndrome following gastroenteritis (8)

2) Mention TWO other possibilities

 Thrombotic throbocytopenic purpura (2)
 Acute tubular necrosis following sepsis and hypovolaemia (2)

3) State THREE investigation to establish the diagnosis

 Serum LDH (2)
 Peripheral blood picture for schistocytes (2)
 Coombs test (1)

4) Mention three important steps in management

 Thorough rehydration (1)
 Correction of electrolyte disturbances (1)
 Dialysis therapy (1)