2009 module exam

Question 1

Midway between transpyloric plane and intertubercular planes

Answer 1

Lower pole

Question 2

5 cm from midline on L1 vertebra spinous process

Answer 2

Hilum of kidney

Question 3

Surgery of the posterior surface of the kidney may affect

Answer 3

Ilioinguinal nerve

Question 4

A 25-year-old female with UTI. What is the disposing factor?

Answer 4

Short urethra

Question 5

Which acts as a physical barrier?

Answer 5

Lamina densa of basal lamina

Question 6

What establish the gradient of hypertonicity?

Answer 6

Loop of henle

Question 7

What forms the macula densa?

Answer 7

DCT

Question 8

What is the Renal Blood Flow if RPF = 600, and plasma is 60%

Answer 8

1000 ml

Question 9

What is RPF when creatinine clearance is 90 and normal FF?

Answer 9

450 ml

Question 10

Podocytes are derived from which layer?

Answer 10

Visceral epithelial layer

Question 11

What is mesangial contraction decrease?

Answer 11

Surface area

Question 12

What normally don’t affect filtration?

Answer 12

Hydrolic conduction

Question 13

Clearance of a substance calculation with Tm for secretion Q

Answer 13

30

Question 14

What does fractional excretion above 1 indicate?

Answer 14

Substance filtered and secreted

Question 15

A patient with lung crackles, dyspnea, chest pain, low blood pressure, heart sound S3 is heard. Creatinine levels were 190. What do we do next?

Answer 15

Urine Na+ level

Question 16

A patient ingested ethylene glycol

Answer 16

Necrosis of proximal tubules (nephrotoxic ATN)

Question 17

A patient with traffic accident developed hemorrhage and shock

Answer 17

Renal cortical necrosis

Question 18

A patient with severe dehydration

Answer 18

Necrosis of any part of the nephron (ischemic ATN)

Question 19

A patient with 3 days history of antibiotic usage

Answer 19

Eosinophils infiltration (hypersensitivy interstitial nephritis)

Question 20

A patient with 10 years of NSAIDs usage developed

Answer 20

Lymphocytic infiltration (analgesic nephropathy)

Question 21

Another question on analgesic nephropathy: associated with?

Answer 21

Lymphocytic infiltration

Question 22

NSAIDs can cause nephrotoxicity and acute renal failure by:

Answer 22

Alteration of intraglomerular dynamics

Question 23

Which drug is associated with ARF with renal artery stenosis?

Answer 23

Captopril

Question 24

Which drug causes ATN with hepatic failure?

Answer 24

Acetaminophen

Question 25

Endogenous immune complex

Answer 25

Membranous GN (doctor 9ala7 ygoul this is the answer, even though kan ako bele5tiyarat “cresentic GN” elle ehya elmfroo’9 tkon elejaba el9a7 la2ana anti-GBM disease ohwa eljawab, bs I don’t know lil amana :/)

Question 26

A 7-year-old child with nephrotic syndrome and normal histology

Answer 26

Fusion of foot cell processes

Question 27

Foot process fusion

Answer 27

Minimal change disease

Question 28

Pathogenesis of membranous GN

Answer 28

Complement activation

Question 29

What is a characteristic of diabetic glomerulosclerosis?

Answer 29

Kimmelstein Wilson lesion

Question 30

Deposition of C3 in peripheral GBM as humps

Answer 30

Post-infectious GN

Question 31

A patient with mesangial and endocapillary proliferation

Answer 31

Lupus nephritis

Question 32

What is mostly seen in post infectious GN?

Answer 32

Neutrophilic infiltration in capillary loops

Question 33

What is the most common risk factor of ESRD in Kuwait?

Answer 33

Diabetes

Question 34

What is the Relative Risk of CVD deaths due to dialysis in ESRD?

Answer 34

>10

Question 35

Which of the following occur in PCT?

Answer 35

80% reabsorption of HCO3-

Question 36

What is the mechanism of reabsorption of HCO3- in PCT S1?

Answer 36

Na-H exchanger

Question 37

Paracellular reabsorption of solutes in water

Answer 37

Solvent drag

Question 38

A patient increased his Na+ intake by 140 mEq/L. What is supposed to happen?

Answer 38

Increase water intake by 1 Kg

Question 39

A patient with low RBF, slightly changed GFR and increased FF. what is the cause?

Answer 39

Angiotensin II

Question 40

Which hormone is stimulated in volume expansion?

Answer 40

ANP

Question 41

Decreased levels of NaCl to macula densa causes - Afferent arteriole dilatation - Afferent arteriole constriction

Answer 41

- Afferent arteriole dilatation

Question 42

A 60-year-old patient underwent nephrectomy because of acute renal failure. After doing the surgery is GFR was 53, a year later it became 49. What is the reason behind that?

Answer 42

Chronic renal disease

Question 43

Dysfunction of podocytes

Answer 43

Proteinuria

Question 44

Failure of ureteric bud to contact the metanephric mesenchyme

Answer 44

Kidney agenesis

Question 45

What structure develops from the ureteric bud?

Answer 45

Collecting duct

Question 46

Failure of connection between renal vesicles and collecting system

Answer 46

Polycystic kidney

Question 47

Two ureters in one kidney because of partial ureteric buds - Bifid ureter - Double ureter - Ureter duplication

Answer 47

- Ureter duplication (kilhom kanaw mawjodeen m3na kilhom elmfrooth the same, bs this is the right answer for sure :/)

Question 48

What Increases AQP-2 in luminal cells?

Answer 48

Increase ADH secretion

Question 49

What increases renin?

Answer 49

Decrease afferent arteriolar pressure

Question 50

What decreases ANP?

Answer 50

Decrease stretch of atrial receptors

Question 51

What causes low ADH secretion?

Answer 51

Alcohol

Question 52

What causes low medullary interstitium osmolarity?

Answer 52

Low levels of urea transporter 1

Question 53

How is the ability of concentrating urine increased?

Answer 53

By reducing blood flow to vasa recta

Question 54

Which drug causes hyperglycemia?

Answer 54

Hydrochlorothiazide

Question 55

Which diuretic causes testicular atrophy?

Answer 55

Spironolactone

Question 56

Which drug is used to preserve K with other diuretics?

Answer 56

Amiloride

Question 57

Which drug inhibits stone formation?

Answer 57

Chlorothalidone

Question 58

Which cation is highest in ECF?

Answer 58

Na

Question 59

What causes hyperchloremic metabolic acidosis with normal Anion Gap?

Answer 59

RTA

Question 60

A patient with hypernatremia, urine osmolarity is less than 300

Answer 60

Diabetes insipidus

Question 61

Non-responsive to post-vasopressin with urine osmolarity 200

Answer 61

Complete nephrogenic DI

Question 62

Same person, later develops uremia and high creatinine

Answer 62

Acute renal failure (m3na elmfrooth with diabetes ay sha59 y7ooshah chronic renal failure, bs this is the answer, shlon? Madri :/)

Question 63

A patient eats 1000 mEq/L K+. After half an hour we the K level and it equals 5 which is normal. What is the reason?

Answer 63

Transcellular movement of K across the cells

Question 64

What stimulates NaHCO3 reabsorption in a volume depleted patient?

Answer 64

Angiotensin II

Question 65

What is the highest ADH stimulant?

Answer 65

Exercise in the heat with no water

Question 66

Median umbilical ligament is developed from

Answer 66

Urachus

Question 67

A malnourished patient cannot secrete NH4. When given I.V. phosphate solution he could. How?

Answer 67

Lack of phosphate prevents acidification of urine

Question 68

A direct clearance question calculation

Answer 68

150

Question 69

A medical student during his final exam. His Ph = 7.47, CO2 = 22, HCO3 = 21.

Answer 69

Acute respiratory alkalosis

Question 70

Patient with pH = 7.45, HCO3- = 30, CO2 = 45

Answer 70

Metabolic alkalosis with respiratory compensation

Question 71

There were two questions on metabolic acidosis and the way of the kidney to compensate, one of them was by increasing HCO-3 synthesis while the other one was by secreting more NH4 than normal. But we don’t remember the questions

Answer 71

-

Question 72

A patient with left loin pain. X-ray showed kidney stones, what would be typically be?

Answer 72

Calcium oxalate

Question 73

A patient with struvite stones with alkaline urine. What enzyme forms the stones?

Answer 73

Bacterial urease

Question 74

Which drug decrease the formation of uric acid stones?

Answer 74

Allopurinol

Question 75

What is the cause of metabolic disorder that cause cystinuria?

Answer 75

Defective amino acid transport

Question 76

A patient with abdominal pain recurrent of 3 years with high urine calcium

Answer 76

Kidney stones

Question 77

Metabolic disorder of lysine/cysteine/arginine will cause formation of which type of stones?

Answer 77

Cysteine stones

Question 78

What is the most common cause of community UTI?

Answer 78

E-coli

Question 79

When do you take a specimen for Schistosoma UTI?

Answer 79

Terminal portion of urine

Question 80

A 6-year-old patient with unilateral hydronephrosis and hydroureter

Answer 80

Vesicoureteral reflux

Question 81

What is the most common congenital anomaly in children?

Answer 81

Vesicoureteral reflux

Question 82

How do we evaluate urethral stricture?

Answer 82

Ascending urethrography

Question 83

A 23-year-old female with hypertension, what is the first modality of diagnosis?

Answer 83

Ultrasound

Question 84

What is the first modality in diagnosing a 60-year-old man with prostatit hyperplasia?

Answer 84

Ultrasound

Question 85

What is formed by the mesonephric duct?

Answer 85

Ductus deferens

Question 86

How is renin released by sympathetics?

Answer 86

B agonists

Question 87

A 60-year-old patient smoker with hemoptysis and rapidly progressive renal dysfunction

Answer 87

Cresents

Question 88

A 76-year-old man with paraplegia. What would cause UTI?

Answer 88

Neurogenic bladder

Question 89

Hyperplasia of which part of the prostate will lead to urinary obstruction?

Answer 89

Periurethral

Question 90

Which represents reaction to secretion from ruptured prostatic glands? 145- obstruction?

Answer 90

Granulomatous prostatitis

Question 91

Hyperplasia of stromal and epithelial cells

Answer 91

Nodular prostatic hyperplasia

Question 92

Which grade shows no glandular differentiation but with solid sheets and nests of tumors with central necrosis in Gleason

Answer 92

Grade 5

Question 93

A Gleason score of 5 would show you

Answer 93

What’s in grade 2 and 3 because the gleason score is the total of the two nearest grades for the tumor, so it would be showing us a well differentiated tumor...

Question 94

A patient with enlarged prostate but normal PSA

Answer 94

Benign prostatic hyperplasia

Question 95

In volume depletion, alpha intercalated cells will work under the effect of?

Answer 95

Aldosterone

Question 96

A patient with history of recurrent UTI with leukocytes expressed in the prostatic secretions

Answer 96

Chronic bacterial prostatitis

Question 97

What happens in the early distal tubule?

Answer 97

Na-Cl symporter

Question 98

Why there is no glucose in urine normally?

Answer 98

Because the filtered load is lower the Tm for glucose