Nephrology 2-Questions (1) PDF

### **Chronic Kidney Disease (CKD)** **1. Which of the following is the most common cause of end-stage renal disease (ESRD)?\ **A. Autosomal dominant polycystic kidney disease\ B. Hypertension\ C. Glomerulonephritis\ D. Diabetes mellitus **Answer:** D. Diabetes mellitus\ **Explanation:** Diabetes...

### **Chronic Kidney Disease (CKD)** **1. Which of the following is the most common cause of end-stage renal disease (ESRD)?\ **A. Autosomal dominant polycystic kidney disease\ B. Hypertension\ C. Glomerulonephritis\ D. Diabetes mellitus **Answer:** D. Diabetes mellitus\ **Explanation:** Diabetes accounts for the majority of ESRD cases due to its progressive effects on kidney vasculature and filtration mechanisms. **2. What laboratory finding is characteristic of CKD?\ **A. Hypercalcemia\ B. Persistent proteinuria\ C. Hypokalemia\ D. Increased GFR **Answer:** B. Persistent proteinuria\ **Explanation:** Proteinuria is a hallmark of CKD, indicating glomerular damage. ### **Acute Kidney Injury (AKI)** **3. What is a common reversible cause of acute kidney injury?\ **A. Polycystic kidney disease\ B. Chronic use of NSAIDs\ C. Obstructive uropathy\ D. IgA nephropathy **Answer:** C. Obstructive uropathy\ **Explanation:** Obstruction can lead to AKI, and removing the blockage often restores kidney function. **4. Which of the following is most indicative of prerenal AKI?\ **A. Urine sediment with RBC casts\ B. FeNa \< 1%\ C. GFR \> 90 mL/min\ D. High urinary sodium concentration **Answer:** B. FeNa \< 1%\ **Explanation:** A low fractional excretion of sodium suggests prerenal causes due to decreased renal perfusion. ### **Glomerular Diseases** **5. Which of the following is associated with a \"cola-colored\" urine presentation?\ **A. Minimal change disease\ B. IgA nephropathy\ C. Focal segmental glomerulosclerosis\ D. Amyloidosis **Answer:** B. IgA nephropathy\ **Explanation:** IgA nephropathy often presents with gross hematuria following a URI, leading to \"cola-colored\" urine. **6. What is the hallmark finding of nephrotic syndrome?\ **A. Proteinuria \> 3.5 g/day\ B. Hyperkalemia\ C. Glomerular hematuria\ D. Oliguria **Answer:** A. Proteinuria \> 3.5 g/day\ **Explanation:** Nephrotic syndrome is characterized by significant protein loss in urine, hypoalbuminemia, and edema. ### **Polycystic Kidney Disease** **7. A patient with flank pain and hematuria is found to have multiple kidney cysts. What is the most likely genetic mutation?\ **A. PKD1 on chromosome 16\ B. PKD2 on chromosome 4\ C. COL4A5\ D. WT1 **Answer:** A. PKD1 on chromosome 16\ **Explanation:** PKD1 mutations account for most cases of autosomal dominant polycystic kidney disease. **3. Which glomerular disease is characterized by subepithelial \"hump-like\" deposits on electron microscopy?\ **A. IgA nephropathy\ B. Minimal change disease\ C. Post-infectious glomerulonephritis\ D. Membranous nephropathy\ **Answer:** C. Post-infectious glomerulonephritis\ **Explanation:** Post-infectious glomerulonephritis is typically caused by Group A Streptococcus and is characterized by subepithelial \"hump-like\" deposits on electron microscopy. **14. Which condition is associated with anti-glomerular basement membrane antibodies?\ **A. IgA nephropathy\ B. Goodpasture syndrome\ C. Lupus nephritis\ D. Minimal change disease\ **Answer:** B. Goodpasture syndrome\ **Explanation:** Goodpasture syndrome is characterized by anti-GBM antibodies causing glomerulonephritis and pulmonary hemorrhage. ### **Nephrotic Syndrome** **15. Which of the following is the most common cause of nephrotic syndrome in adults?\ **A. Minimal change disease\ B. Focal segmental glomerulosclerosis (FSGS)\ C. Diabetic nephropathy\ D. Amyloidosis\ **Answer:** C. Diabetic nephropathy\ **Explanation:** Diabetic nephropathy is the most common cause of nephrotic syndrome in adults due to long-standing hyperglycemia causing glomerular damage. **16. What is the characteristic finding in minimal change disease on electron microscopy?\ **A. Thickened glomerular basement membrane\ B. Subendothelial deposits\ C. Podocyte foot process effacement\ D. Crescent formation\ **Answer:** C. Podocyte foot process effacement\ **Explanation:** Minimal change disease shows effacement of podocyte foot processes, leading to proteinuria. ### **Renal Vascular Disease** **17. Which diagnostic test is best for confirming renal artery stenosis?\ **A. Renal biopsy\ B. Renal ultrasound with Doppler\ C. Serum creatinine\ D. Voiding cystourethrogram\ **Answer:** B. Renal ultrasound with Doppler\ **Explanation:** Doppler ultrasound is a non-invasive method to detect renal artery stenosis. **18. What is a classic clinical clue for fibromuscular dysplasia in renal artery stenosis?\ **A. Hypotension\ B. String-of-beads appearance on imaging\ C. Elevated serum potassium\ D. Crescent formation on biopsy\ **Answer:** B. String-of-beads appearance on imaging\ **Explanation:** Fibromuscular dysplasia presents with a \"string-of-beads\" appearance on imaging due to alternating areas of stenosis and dilation. ### **Cystic Kidney Diseases** **19. Which of the following conditions is associated with bilateral renal cysts and an increased risk of cerebral aneurysms?\ **A. Simple renal cysts\ B. Autosomal dominant polycystic kidney disease (ADPKD)\ C. Medullary sponge kidney\ D. Horseshoe kidney\ **Answer:** B. Autosomal dominant polycystic kidney disease (ADPKD)\ **Explanation:** ADPKD is associated with multiple renal cysts and an increased risk for cerebral aneurysms. **20. What is the first-line imaging modality for diagnosing polycystic kidney disease?\ **A. CT scan without contrast\ B. MRI of the abdomen\ C. Renal ultrasound\ D. Intravenous pyelogram\ **Answer:** C. Renal ultrasound\ **Explanation:** Renal ultrasound is the first-line, non-invasive diagnostic tool for detecting kidney cysts in suspected ADPKD. **20. Which of the following is the first-line treatment for fibromuscular dysplasia causing renal artery stenosis?\ **A. ACE inhibitors\ B. Percutaneous transluminal angioplasty (PTA) without stenting\ C. Beta-blockers\ D. Renal artery bypass surgery\ **Answer:** B. Percutaneous transluminal angioplasty (PTA) without stenting\ **Explanation:** PTA without stenting is the first-line treatment for fibromuscular dysplasia due to its high success rate and low complication risk. ### **Acute Kidney Injury (AKI)** **21. Which of the following lab findings is most consistent with acute tubular necrosis (ATN)?\ **A. FeNa \< 1%\ B. Muddy brown casts in urine\ C. Elevated BUN:Cr ratio (\>20:1)\ D. Hematuria with RBC casts\ **Answer:** B. Muddy brown casts in urine\ **Explanation:** Muddy brown granular casts are characteristic of ATN due to tubular epithelial cell injury. **22. A patient develops AKI after starting an ACE inhibitor. Which underlying condition is most likely?\ **A. IgA nephropathy\ B. Renal artery stenosis\ C. Diabetic nephropathy\ D. Polycystic kidney disease\ **Answer:** B. Renal artery stenosis\ **Explanation:** ACE inhibitors can reduce renal perfusion in patients with bilateral renal artery stenosis, leading to AKI. ### **Glomerular Diseases** **23. Which of the following conditions presents with nephritic syndrome and pulmonary hemorrhage?\ **A. Membranous nephropathy\ B. Goodpasture syndrome\ C. Lupus nephritis\ D. Minimal change disease\ **Answer:** B. Goodpasture syndrome\ **Explanation:** Goodpasture syndrome involves anti-GBM antibodies affecting the kidneys and lungs, causing glomerulonephritis and pulmonary hemorrhage. **24. Which disease is characterized by crescent formation on renal biopsy?\ **A. Minimal change disease\ B. Rapidly progressive glomerulonephritis (RPGN)\ C. Membranous nephropathy\ D. Diabetic nephropathy\ **Answer:** B. Rapidly progressive glomerulonephritis (RPGN)\ **Explanation:** RPGN is defined by crescent formation in the glomeruli, indicating severe glomerular injury. ### **Nephrotic Syndrome** **25. Which of the following is the most common cause of nephrotic syndrome in children?\ **A. Membranous nephropathy\ B. Minimal change disease\ C. Focal segmental glomerulosclerosis (FSGS)\ D. Diabetic nephropathy\ **Answer:** B. Minimal change disease\ **Explanation:** Minimal change disease is the most frequent cause of nephrotic syndrome in children and typically responds well to corticosteroids. **26. A renal biopsy reveals podocyte effacement without immune deposits. What is the most likely diagnosis?\ **A. Focal segmental glomerulosclerosis\ B. Membranous nephropathy\ C. Minimal change disease\ D. IgA nephropathy\ **Answer:** C. Minimal change disease\ **Explanation:** Podocyte foot process effacement on electron microscopy is characteristic of minimal change disease. ### **Cystic Kidney Diseases** **27. What is the most common cause of death in patients with autosomal dominant polycystic kidney disease (ADPKD)?\ **A. Cerebral aneurysm rupture\ B. Infection\ C. Cardiovascular disease\ D. Renal failure\ **Answer:** C. Cardiovascular disease\ **Explanation:** Cardiovascular complications, especially hypertension, are the leading cause of death in ADPKD patients. **28. Which imaging finding is diagnostic for medullary sponge kidney?\ **A. Bilateral cortical cysts\ B. Striated appearance of renal medulla with calcifications\ C. Enlarged kidneys with multiple cysts\ D. Horseshoe-shaped kidneys\ **Answer:** B. Striated appearance of renal medulla with calcifications\ **Explanation:** Medullary sponge kidney presents with cystic dilations in the collecting ducts, causing a striated appearance with calcifications. ### **Electrolyte and Acid-Base Disorders** **29. Which electrolyte abnormality is most commonly seen in chronic kidney disease?\ **A. Hypokalemia\ B. Hyperkalemia\ C. Hypercalcemia\ D. Hypophosphatemia\ **Answer:** B. Hyperkalemia\ **Explanation:** CKD leads to impaired potassium excretion, resulting in hyperkalemia. **30. What acid-base disturbance is typically seen in advanced CKD?\ **A. Respiratory alkalosis\ B. Metabolic alkalosis\ C. Metabolic acidosis\ D. Respiratory acidosis\ **Answer:** C. Metabolic acidosis\ **Explanation:** CKD impairs acid excretion, leading to metabolic acidosis. **31. Which of the following is the best initial imaging study for suspected obstructive uropathy causing AKI?\ **A. MRI of the abdomen\ B. Renal ultrasound\ C. Non-contrast CT scan\ D. Intravenous pyelogram\ **Answer:** B. Renal ultrasound\ **Explanation:** Renal ultrasound is the first-line imaging for obstructive uropathy due to its safety and ability to detect hydronephrosis. **32. Which medication can slow the progression of diabetic nephropathy?\ **A. Beta-blockers\ B. ACE inhibitors\ C. Calcium channel blockers\ D. NSAIDs\ **Answer:** B. ACE inhibitors\ **Explanation:** ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing the progression of diabetic nephropathy. **33. Which electrolyte abnormality is often seen in early CKD?\ **A. Hypernatremia\ B. Hypocalcemia\ C. Hypokalemia\ D. Hypercalcemia\ **Answer:** B. Hypocalcemia\ **Explanation:** Hypocalcemia in CKD is due to decreased activation of vitamin D and hyperphosphatemia. ### **Glomerular Diseases** **34. A patient presents with hematuria, hypertension, and red blood cell casts. What is the most likely diagnosis?\ **A. Nephrotic syndrome\ B. Acute tubular necrosis\ C. Nephritic syndrome\ D. Minimal change disease\ **Answer:** C. Nephritic syndrome\ **Explanation:** Nephritic syndrome is characterized by hematuria, hypertension, and RBC casts due to glomerular inflammation. **35. Which condition is most commonly associated with \"wire loop\" lesions on kidney biopsy?\ **A. IgA nephropathy\ B. Lupus nephritis\ C. Minimal change disease\ D. Goodpasture syndrome\ **Answer:** B. Lupus nephritis\ **Explanation:** \"Wire loop\" lesions are thickened capillary loops seen in lupus nephritis due to immune complex deposition. **36. Which of the following causes nephrotic syndrome and is associated with heroin use and HIV infection?\ **A. Minimal change disease\ B. Focal segmental glomerulosclerosis (FSGS)\ C. Membranous nephropathy\ D. IgA nephropathy\ **Answer:** B. Focal segmental glomerulosclerosis (FSGS)\ **Explanation:** FSGS is linked to HIV, obesity, and heroin use and leads to nephrotic syndrome. ### **Electrolyte and Acid-Base Disorders** **37. What is the treatment for hyperkalemia with ECG changes?\ **A. Sodium bicarbonate\ B. Calcium gluconate\ C. Kayexalate\ D. Loop diuretics\ **Answer:** B. Calcium gluconate\ **Explanation:** Calcium gluconate stabilizes the cardiac membrane to prevent arrhythmias in severe hyperkalemia. **38. Which acid-base disturbance is common in renal tubular acidosis?\ **A. Metabolic alkalosis\ B. Respiratory acidosis\ C. Metabolic acidosis\ D. Respiratory alkalosis\ **Answer:** C. Metabolic acidosis\ **Explanation:** Renal tubular acidosis leads to impaired acid excretion, resulting in metabolic acidosis. ### **Renal Vascular Disease** **39. Which of the following is the most common cause of renal artery stenosis?\ **A. Fibromuscular dysplasia\ B. Atherosclerosis\ C. Vasculitis\ D. Embolism\ **Answer:** B. Atherosclerosis\ **Explanation:** Atherosclerosis accounts for most cases of renal artery stenosis, especially in older adults. **40. Which imaging study shows a "string of beads" appearance in fibromuscular dysplasia?\ **A. Doppler ultrasound\ B. CT angiography\ C. MR angiography\ D. Conventional renal arteriography\ **Answer:** D. Conventional renal arteriography\ **Explanation:** Fibromuscular dysplasia shows a "string of beads" pattern on arteriography due to alternating stenosis and dilation. ### **Cystic Kidney Diseases** **41. A 45-year-old patient with hypertension and bilateral kidney enlargement is diagnosed with ADPKD. What is the next best step?\ **A. Start ACE inhibitors\ B. Schedule a nephrectomy\ C. Perform genetic testing\ D. Begin dialysis\ **Answer:** A. Start ACE inhibitors\ **Explanation:** ACE inhibitors help manage hypertension and slow the progression of kidney disease in ADPKD. **42. Which of the following is a common complication of autosomal dominant polycystic kidney disease (ADPKD)?\ **A. Pulmonary edema\ B. Hepatic cysts\ C. Renal artery thrombosis\ D. Renal infarction\ **Answer:** B. Hepatic cysts\ **Explanation:** Hepatic cysts are a common extrarenal manifestation of ADPKD. ### **Nephrolithiasis** **43. What is the most common type of kidney stone?\ **A. Uric acid\ B. Cystine\ C. Calcium oxalate\ D. Struvite\ **Answer:** C. Calcium oxalate\ **Explanation:** Calcium oxalate stones are the most common type of kidney stone. **44. Which condition predisposes patients to struvite kidney stones?\ **A. Hyperparathyroidism\ B. Recurrent urinary tract infections\ C. Dehydration\ D. Gout\ **Answer:** B. Recurrent urinary tract infections\ **Explanation:** Struvite stones are associated with urease-producing bacteria in chronic UTIs. ### **Dialysis and Renal Replacement Therapy** **45. Which of the following is an indication for initiating dialysis in CKD patients?\ **A. GFR of 40 mL/min\ B. Persistent hypocalcemia\ C. Volume overload unresponsive to diuretics\ D. Mild anemia\ **Answer:** C. Volume overload unresponsive to diuretics\ **Explanation:** Dialysis is indicated when volume overload cannot be managed with medical therapy. **46. Which complication is more common in peritoneal dialysis than hemodialysis?\ **A. Hyperkalemia\ B. Peritonitis\ C. Vascular thrombosis\ D. Anemia\ **Answer:** B. Peritonitis\ **Explanation:** Peritonitis is a common complication of peritoneal dialysis due to infection. ### **High-Yield Rapid Recall** **47. What is the most common cause of nephrotic syndrome in adults?\ **A. Minimal change disease\ B. Diabetic nephropathy\ C. Amyloidosis\ D. Membranous nephropathy\ **Answer:** B. Diabetic nephropathy\ **Explanation:** Diabetic nephropathy is the leading cause of nephrotic syndrome in adults. **48. Which nephritic syndrome is associated with low complement levels?\ **A. Post-infectious glomerulonephritis\ B. IgA nephropathy\ C. Goodpasture syndrome\ D. Minimal change disease\ **Answer:** A. Post-infectious glomerulonephritis\ **Explanation:** Low complement levels are typical of post-infectious glomerulonephritis. **49. Which glomerular disease is most commonly associated with hepatitis C infection?\ **A. IgA nephropathy\ B. Membranous nephropathy\ C. Membranoproliferative glomerulonephritis (MPGN)\ D. Minimal change disease\ **Answer:** C. Membranoproliferative glomerulonephritis (MPGN)\ **Explanation:** MPGN is commonly associated with chronic hepatitis C due to immune complex deposition. **50. Which nephrotic syndrome is associated with a \"spike and dome\" appearance on silver stain?\ **A. Minimal change disease\ B. Membranous nephropathy\ C. FSGS\ D. IgA nephropathy\ **Answer:** B. Membranous nephropathy\ **Explanation:** Membranous nephropathy shows a \"spike and dome\" pattern due to subepithelial immune complex deposition. ### **Acute Tubular Necrosis (ATN) and Acute Interstitial Nephritis (AIN)** **51. Which of the following is a typical cause of acute interstitial nephritis (AIN)?\ **A. Aminoglycosides\ B. NSAIDs\ C. Contrast media\ D. Rhabdomyolysis\ **Answer:** B. NSAIDs\ **Explanation:** NSAIDs can cause AIN due to hypersensitivity reactions, leading to inflammation of the renal interstitium. **52. Which finding is most suggestive of acute tubular necrosis (ATN)?\ **A. Eosinophiluria\ B. Red blood cell casts\ C. Muddy brown casts in urine\ D. Fatty casts in urine\ **Answer:** C. Muddy brown casts in urine\ **Explanation:** Muddy brown granular casts are characteristic of ATN, indicating tubular epithelial cell damage. ### **Nephrolithiasis (Kidney Stones)** **53. Which of the following increases the risk of calcium oxalate kidney stones?\ **A. Low calcium diet\ B. High sodium diet\ C. Alkaline urine\ D. Hyperuricemia\ **Answer:** B. High sodium diet\ **Explanation:** High sodium intake increases calcium excretion, raising the risk of calcium oxalate stones. **54. What is the first-line treatment for a 4 mm distal ureteral stone?\ **A. Surgical removal\ B. Extracorporeal shock wave lithotripsy (ESWL)\ C. Medical expulsive therapy with tamsulosin\ D. Ureteroscopy\ **Answer:** C. Medical expulsive therapy with tamsulosin\ **Explanation:** Tamsulosin relaxes ureteral smooth muscle, aiding the passage of small distal stones. ### **Electrolyte Imbalances** **55. Which electrolyte disturbance is most dangerous in tumor lysis syndrome?\ **A. Hypercalcemia\ B. Hyperphosphatemia\ C. Hyperkalemia\ D. Hypomagnesemia\ **Answer:** C. Hyperkalemia\ **Explanation:** Hyperkalemia in tumor lysis syndrome can lead to life-threatening cardiac arrhythmias. **56. What is the most common electrolyte abnormality in nephrotic syndrome?\ **A. Hypernatremia\ B. Hyponatremia\ C. Hyperkalemia\ D. Hypocalcemia\ **Answer:** B. Hyponatremia\ **Explanation:** Nephrotic syndrome causes sodium retention and dilutional hyponatremia due to hypoalbuminemia. ### **Renal Replacement Therapy** **57. Which type of dialysis allows for more flexibility and can be done at home?\ **A. In-center hemodialysis\ B. Continuous ambulatory peritoneal dialysis (CAPD)\ C. Nocturnal hemodialysis\ D. Intermittent peritoneal dialysis\ **Answer:** B. Continuous ambulatory peritoneal dialysis (CAPD)\ **Explanation:** CAPD allows patients to manage dialysis at home, improving independence and lifestyle. **58. Which of the following is a contraindication to kidney transplantation?\ **A. Polycystic kidney disease\ B. HIV infection\ C. Active malignancy\ D. Diabetes mellitus\ **Answer:** C. Active malignancy\ **Explanation:** Active malignancy must be treated before kidney transplantation due to the risk of cancer progression with immunosuppression. ### **Hypertension and Kidney Disease** **59. Which antihypertensive medication class is most effective in reducing proteinuria in CKD?\ **A. Beta-blockers\ B. ACE inhibitors\ C. Calcium channel blockers\ D. Diuretics\ **Answer:** B. ACE inhibitors\ **Explanation:** ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing CKD progression. **60. Which hypertensive emergency is characterized by acute renal failure and \"flea-bitten\" kidneys?\ **A. Preeclampsia\ B. Malignant hypertension\ C. Renal artery stenosis\ D. Primary hyperaldosteronism\ **Answer:** B. Malignant hypertension\ **Explanation:** Malignant hypertension can cause fibrinoid necrosis and microvascular injury, leading to \"flea-bitten\" kidneys. ### **Inherited Renal Disorders** **61. Which renal disease is associated with mutations in the type IV collagen gene?\ **A. Alport syndrome\ B. ADPKD\ C. Minimal change disease\ D. FSGS\ **Answer:** A. Alport syndrome\ **Explanation:** Alport syndrome results from mutations in type IV collagen, leading to glomerulonephritis, hearing loss, and ocular defects. **62. Which renal condition is associated with hematuria and hearing loss?\ **A. IgA nephropathy\ B. Alport syndrome\ C. Goodpasture syndrome\ D. Lupus nephritis\ **Answer:** B. Alport syndrome\ **Explanation:** Alport syndrome is characterized by hematuria and sensorineural hearing loss due to basement membrane abnormalities. ### **High-Yield Rapid Recall** **63. Which nephrotic syndrome is most associated with malignancy?\ **A. Minimal change disease\ B. FSGS\ C. Membranous nephropathy\ D. Diabetic nephropathy\ **Answer:** C. Membranous nephropathy\ **Explanation:** Membranous nephropathy is linked to solid tumors, especially lung and colon cancer. **64. Which type of glomerulonephritis commonly follows streptococcal pharyngitis?\ **A. IgA nephropathy\ B. Post-infectious glomerulonephritis\ C. Goodpasture syndrome\ D. Lupus nephritis\ **Answer:** B. Post-infectious glomerulonephritis\ **Explanation:** Post-infectious glomerulonephritis typically develops 1--3 weeks after a streptococcal throat infection. ### **Final High-Yield Questions** **65. Which glomerular disease shows \"tram-track\" appearance on light microscopy?\ **A. Membranous nephropathy\ B. FSGS\ C. MPGN\ D. IgA nephropathy\ **Answer:** C. MPGN\ **Explanation:** MPGN shows a \"tram-track\" appearance due to mesangial proliferation and basement membrane splitting. **66. What is the treatment for hyperphosphatemia in CKD?\ **A. Increase dietary phosphate\ B. Loop diuretics\ C. Phosphate binders\ D. ACE inhibitors\ **Answer:** C. Phosphate binders\ **Explanation:** Phosphate binders reduce serum phosphate levels and prevent secondary hyperparathyroidism in CKD. ### **Tubulointerstitial Diseases** **67. Which of the following is the most common cause of acute interstitial nephritis (AIN)?\ **A. Viral infections\ B. Bacterial infections\ C. Drug reactions\ D. Autoimmune diseases\ **Answer:** C. Drug reactions\ **Explanation:** Drugs like NSAIDs, antibiotics (especially beta-lactams), and proton pump inhibitors are the most common triggers of AIN due to hypersensitivity reactions. **68. Which urinalysis finding is characteristic of acute interstitial nephritis (AIN)?\ **A. Red blood cell casts\ B. White blood cell casts and eosinophiluria\ C. Muddy brown casts\ D. Fatty casts\ **Answer:** B. White blood cell casts and eosinophiluria\ **Explanation:** AIN is characterized by pyuria, white blood cell casts, and eosinophils in the urine. ### **Renal Tubular Acidosis (RTA)** **69. Which type of renal tubular acidosis (RTA) is associated with hypokalemia and nephrolithiasis?\ **A. Type 1 (Distal) RTA\ B. Type 2 (Proximal) RTA\ C. Type 3 RTA\ D. Type 4 RTA\ **Answer:** A. Type 1 (Distal) RTA\ **Explanation:** Distal RTA is associated with impaired hydrogen ion excretion, leading to alkaline urine, hypokalemia, and nephrolithiasis. **70. Which electrolyte abnormality is characteristic of Type 4 RTA?\ **A. Hypokalemia\ B. Hyperkalemia\ C. Hypocalcemia\ D. Hypernatremia\ **Answer:** B. Hyperkalemia\ **Explanation:** Type 4 RTA is associated with hypoaldosteronism or aldosterone resistance, leading to impaired potassium excretion and hyperkalemia. ### **Oncology and the Kidney** **71. Which paraneoplastic syndrome is associated with membranous nephropathy?\ **A. Small cell lung carcinoma\ B. Hodgkin lymphoma\ C. Non-small cell lung cancer\ D. Renal cell carcinoma\ **Answer:** C. Non-small cell lung cancer\ **Explanation:** Membranous nephropathy can be a paraneoplastic manifestation of solid tumors, including lung and colon cancers. **72. Which kidney cancer is associated with von Hippel-Lindau disease?\ **A. Wilms tumor\ B. Renal cell carcinoma\ C. Transitional cell carcinoma\ D. Oncocytoma\ **Answer:** B. Renal cell carcinoma\ **Explanation:** Von Hippel-Lindau disease is linked to an increased risk of clear cell renal cell carcinoma. ### **Urinary Tract Infections (UTIs) and Pyelonephritis** **73. What is the most common pathogen causing uncomplicated urinary tract infections (UTIs)?\ **A. Klebsiella pneumoniae\ B. Enterococcus faecalis\ C. Escherichia coli\ D. Proteus mirabilis\ **Answer:** C. Escherichia coli\ **Explanation:** E. coli is the most common cause of uncomplicated UTIs due to its ability to adhere to the uroepithelium. **74. Which imaging study is most appropriate for evaluating suspected renal abscess?\ **A. Renal ultrasound\ B. Non-contrast CT scan\ C. MRI abdomen\ D. Contrast-enhanced CT scan\ **Answer:** D. Contrast-enhanced CT scan\ **Explanation:** Contrast-enhanced CT is the gold standard for diagnosing renal abscess due to its superior visualization of renal structures. ### **Renal Trauma** **75. What is the most common cause of blunt renal trauma?\ **A. Penetrating injury\ B. Sports injuries\ C. Motor vehicle accidents\ D. Falls\ **Answer:** C. Motor vehicle accidents\ **Explanation:** Motor vehicle accidents are the leading cause of blunt renal trauma due to rapid deceleration injuries. **76. Which imaging modality is preferred for assessing renal trauma in a hemodynamically stable patient?\ **A. Abdominal X-ray\ B. Renal ultrasound\ C. CT scan with contrast\ D. MRI abdomen\ **Answer:** C. CT scan with contrast\ **Explanation:** Contrast-enhanced CT scan is the preferred imaging modality for evaluating renal injuries in stable patients. ### **Horseshoe Kidney and Congenital Anomalies** **77. Horseshoe kidney increases the risk for which of the following conditions?\ **A. Renal artery stenosis\ B. Wilms tumor\ C. Polycystic kidney disease\ D. Renal cell carcinoma\ **Answer:** B. Wilms tumor\ **Explanation:** Children with a horseshoe kidney have an increased risk of developing Wilms tumor, a pediatric renal malignancy. **78. Which test is used to diagnose vesicoureteral reflux in children?\ **A. CT scan\ B. Renal ultrasound\ C. Voiding cystourethrogram (VCUG)\ D. Intravenous pyelogram\ **Answer:** C. Voiding cystourethrogram (VCUG)\ **Explanation:** VCUG is the gold standard for diagnosing vesicoureteral reflux in pediatric patients with recurrent UTIs. ### **Rapid Review: High-Yield Topics** **79. Which renal pathology is characterized by Kimmelstiel-Wilson nodules?\ **A. Amyloidosis\ B. Diabetic nephropathy\ C. FSGS\ D. IgA nephropathy\ **Answer:** B. Diabetic nephropathy\ **Explanation:** Kimmelstiel-Wilson nodules are pathognomonic for diabetic nephropathy and represent nodular glomerulosclerosis. **80. Which finding is most specific for nephrotic syndrome?\ **A. Hematuria with RBC casts\ B. Proteinuria \>3.5 g/day\ C. Hypertension\ D. Hypokalemia\ **Answer:** B. Proteinuria \>3.5 g/day\ **Explanation:** Nephrotic syndrome is defined by significant proteinuria (\>3.5 g/day), hypoalbuminemia, and edema. **81. Which diuretic is most effective in treating edema in advanced chronic kidney disease (CKD) with GFR \< 30 mL/min?\ **A. Thiazide diuretics\ B. Loop diuretics\ C. Potassium-sparing diuretics\ D. Osmotic diuretics\ **Answer:** B. Loop diuretics\ **Explanation:** Loop diuretics (e.g., furosemide) remain effective at lower GFR levels and are used to manage fluid overload in advanced CKD. **82. Which medication is contraindicated in bilateral renal artery stenosis due to the risk of acute kidney injury?\ **A. Calcium channel blockers\ B. ACE inhibitors\ C. Beta-blockers\ D. Thiazide diuretics\ **Answer:** B. ACE inhibitors\ **Explanation:** ACE inhibitors can precipitate acute kidney injury in patients with bilateral renal artery stenosis by reducing glomerular perfusion pressure. ### **Renal Tubular Disorders** **83. Which inherited disorder causes kidney stones due to defective cystine transport?\ **A. Wilson\'s disease\ B. Cystinuria\ C. Alport syndrome\ D. Fabry disease\ **Answer:** B. Cystinuria\ **Explanation:** Cystinuria is a genetic defect in renal cystine transport, leading to recurrent cystine kidney stones. **84. Which electrolyte abnormality is characteristic of Bartter syndrome?\ **A. Hyperkalemia and metabolic acidosis\ B. Hypokalemia and metabolic alkalosis\ C. Hypernatremia and metabolic alkalosis\ D. Hypocalcemia and metabolic acidosis\ **Answer:** B. Hypokalemia and metabolic alkalosis\ **Explanation:** Bartter syndrome causes hypokalemia, metabolic alkalosis, and high renin/aldosterone levels due to defective sodium reabsorption in the thick ascending loop of Henle. ### **Obstructive Uropathy** **85. Which condition is the most common cause of hydronephrosis in adults?\ **A. Ureteral stricture\ B. Ureteral stones\ C. Bladder cancer\ D. Prostate hypertrophy\ **Answer:** D. Prostate hypertrophy\ **Explanation:** Benign prostatic hyperplasia (BPH) is the most common cause of urinary tract obstruction and hydronephrosis in older men. **86. Which imaging modality is most sensitive for detecting kidney stones?\ **A. Renal ultrasound\ B. MRI abdomen\ C. Non-contrast CT scan\ D. Intravenous pyelogram\ **Answer:** C. Non-contrast CT scan\ **Explanation:** Non-contrast CT is the most sensitive and specific imaging modality for detecting nephrolithiasis. ### **Paraneoplastic Syndromes and the Kidney** **87. Which paraneoplastic syndrome is most commonly associated with renal cell carcinoma (RCC)?\ **A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)\ B. Polycythemia\ C. Hypercalcemia due to PTHrP\ D. Cushing\'s syndrome\ **Answer:** B. Polycythemia\ **Explanation:** RCC can secrete erythropoietin, causing secondary polycythemia. **88. Which type of renal tumor is associated with tuberous sclerosis?\ **A. Oncocytoma\ B. Wilms tumor\ C. Angiomyolipoma\ D. Clear cell carcinoma\ **Answer:** C. Angiomyolipoma\ **Explanation:** Angiomyolipomas are benign renal tumors commonly associated with tuberous sclerosis. ### **Hematuria and Proteinuria Workup** **89. What is the most common cause of isolated microscopic hematuria in young adults?\ **A. IgA nephropathy\ B. Urolithiasis\ C. Alport syndrome\ D. Bladder cancer\ **Answer:** A. IgA nephropathy\ **Explanation:** IgA nephropathy (Berger disease) is the most common cause of isolated microscopic hematuria, often following an upper respiratory infection. **90. Which condition presents with \"tea-colored\" urine and is associated with low complement levels?\ **A. IgA nephropathy\ B. Lupus nephritis\ C. Post-infectious glomerulonephritis\ D. Alport syndrome\ **Answer:** C. Post-infectious glomerulonephritis\ **Explanation:** Post-infectious glomerulonephritis often presents with dark (\"tea-colored\") urine and low complement levels following streptococcal infection. ### **Renal Artery Stenosis** **91. Which clinical finding suggests renal artery stenosis in a hypertensive patient?\ **A. Bilateral pitting edema\ B. Resistant hypertension with an abdominal bruit\ C. Early-onset hypertension before age 20\ D. Hypokalemia\ **Answer:** B. Resistant hypertension with an abdominal bruit\ **Explanation:** An abdominal bruit and refractory hypertension suggest renal artery stenosis. **92. What is the best test to diagnose renal artery stenosis in patients with impaired renal function?\ **A. Renal biopsy\ B. CT angiography\ C. MR angiography without contrast\ D. Doppler ultrasound\ **Answer:** D. Doppler ultrasound\ **Explanation:** Doppler ultrasound is non-invasive and safe for patients with renal dysfunction. ### **Dialysis Complications** **93. Which of the following is the most common cause of death in patients undergoing dialysis?\ **A. Peritonitis\ B. Cardiovascular disease\ C. Hyperkalemia\ D. Stroke\ **Answer:** B. Cardiovascular disease\ **Explanation:** Cardiovascular disease is the leading cause of mortality in dialysis patients. **94. What is the most common complication of peritoneal dialysis?\ **A. Hyperkalemia\ B. Peritonitis\ C. Hypotension\ D. Catheter malfunction\ **Answer:** B. Peritonitis\ **Explanation:** Peritonitis is a frequent and serious complication of peritoneal dialysis due to bacterial contamination. ### **Renal Transplantation** **95. Which of the following medications is used to prevent organ rejection in kidney transplant recipients?\ **A. Prednisone\ B. NSAIDs\ C. Methotrexate\ D. Cyclophosphamide\ **Answer:** A. Prednisone\ **Explanation:** Prednisone is a cornerstone immunosuppressant used to prevent rejection in transplant patients. **96. Which viral infection is a common complication after kidney transplantation?\ **A. HIV\ B. Cytomegalovirus (CMV)\ C. Hepatitis B\ D. Epstein-Barr virus (EBV)\ **Answer:** B. Cytomegalovirus (CMV)\ **Explanation:** CMV infection is a common opportunistic infection in immunosuppressed transplant patients. ### **Genetic and Pediatric Renal Disorders** **97. What is the most common renal malignancy in children?\ **A. Renal cell carcinoma\ B. Wilms tumor\ C. Angiomyolipoma\ D. Nephroblastoma\ **Answer:** B. Wilms tumor\ **Explanation:** Wilms tumor (nephroblastoma) is the most common kidney cancer in children. **98. Which genetic disorder is associated with hematuria, hearing loss, and ocular defects?\ **A. Polycystic kidney disease\ B. Alport syndrome\ C. Fabry disease\ D. Cystinosis\ **Answer:** B. Alport syndrome\ **Explanation:** Alport syndrome is due to mutations in type IV collagen, causing hematuria, sensorineural hearing loss, and eye abnormalities. **99. Which of the following is the most common cause of death in patients with CKD?\ **A. Hyperkalemia\ B. Cardiovascular disease\ C. Stroke\ D. Infection\ **Answer:** B. Cardiovascular disease\ **Explanation:** Cardiovascular disease, driven by hypertension, dyslipidemia, and vascular calcification, is the leading cause of death in CKD patients. **100. Secondary hyperparathyroidism in CKD is caused by:\ **A. Hypercalcemia\ B. Hyperphosphatemia and vitamin D deficiency\ C. Increased erythropoietin production\ D. Decreased phosphate levels\ **Answer:** B. Hyperphosphatemia and vitamin D deficiency\ **Explanation:** Reduced phosphate excretion and impaired vitamin D activation in CKD lead to secondary hyperparathyroidism. ### **Renal Vascular Diseases** **101. Which clinical feature is most indicative of fibromuscular dysplasia in renal artery stenosis?\ **A. Abdominal bruit in a young female\ B. Resistant hypertension in an elderly male\ C. Hematuria with flank pain\ D. Proteinuria \>3.5 g/day\ **Answer:** A. Abdominal bruit in a young female\ **Explanation:** Fibromuscular dysplasia typically affects young women and presents with resistant hypertension and an abdominal bruit. **102. What is the hallmark angiographic finding in fibromuscular dysplasia?\ **A. String-of-beads appearance\ B. Tram-track pattern\ C. Corkscrew vessels\ D. Flame-shaped hemorrhage\ **Answer:** A. String-of-beads appearance\ **Explanation:** Alternating areas of stenosis and dilation in the renal arteries create a "string-of-beads" appearance. ### **Cystic Kidney Diseases** **103. What is the most common complication of autosomal dominant polycystic kidney disease (ADPKD)?\ **A. Acute renal failure\ B. Cerebral aneurysms\ C. Urinary tract infections\ D. Kidney stones\ **Answer:** D. Kidney stones\ **Explanation:** Kidney stones are common in ADPKD due to urinary stasis and structural abnormalities. **104. Which genetic mutation is more severe in ADPKD?\ **A. PKD1 mutation on chromosome 16\ B. PKD2 mutation on chromosome 4\ C. COL4A3 mutation\ D. WT1 mutation\ **Answer:** A. PKD1 mutation on chromosome 16\ **Explanation:** PKD1 mutations lead to a more severe and earlier onset of ADPKD compared to PKD2. ### **Glomerular Diseases (Nephritic vs. Nephrotic Syndromes)** **105. Which nephritic syndrome is characterized by anti-GBM antibodies?\ **A. Goodpasture syndrome\ B. Post-streptococcal glomerulonephritis\ C. Membranous nephropathy\ D. Lupus nephritis\ **Answer:** A. Goodpasture syndrome\ **Explanation:** Goodpasture syndrome is caused by antibodies targeting the glomerular basement membrane, leading to nephritic syndrome and pulmonary hemorrhage. **106. Which condition is characterized by large subepithelial immune deposits (\"humps\")?\ **A. IgA nephropathy\ B. Minimal change disease\ C. Post-infectious glomerulonephritis\ D. Membranous nephropathy\ **Answer:** C. Post-infectious glomerulonephritis\ **Explanation:** Subepithelial \"hump-like\" deposits are typical in post-infectious glomerulonephritis. ### **Dialysis and End-Stage Renal Disease (ESRD)** **107. Which vascular access has the lowest risk of infection in hemodialysis?\ **A. Tunneled catheter\ B. Non-tunneled catheter\ C. Arteriovenous fistula (AVF)\ D. Arteriovenous graft (AVG)\ **Answer:** C. Arteriovenous fistula (AVF)\ **Explanation:** AVFs have the lowest infection and thrombosis rates, making them the preferred access for long-term hemodialysis. **108. Which type of dialysis is associated with the highest risk of peritonitis?\ **A. In-center hemodialysis\ B. Home hemodialysis\ C. Continuous ambulatory peritoneal dialysis (CAPD)\ D. Intermittent hemodialysis\ **Answer:** C. Continuous ambulatory peritoneal dialysis (CAPD)\ **Explanation:** CAPD carries a higher risk of peritonitis due to the frequent handling of the dialysis catheter. ### **Acute Kidney Injury (AKI) and Prevention** **109. What is the best strategy to prevent contrast-induced nephropathy?\ **A. High-dose diuretics\ B. Hydration with isotonic saline\ C. Prophylactic antibiotics\ D. Use of loop diuretics\ **Answer:** B. Hydration with isotonic saline\ **Explanation:** Adequate hydration with isotonic saline before and after contrast exposure reduces the risk of contrast-induced nephropathy. **110. Which laboratory finding is consistent with prerenal AKI?\ **A. FeNa \> 2%\ B. FeNa \< 1%\ C. Muddy brown casts\ D. Hyperkalemia\ **Answer:** B. FeNa \< 1%\ **Explanation:** A fractional excretion of sodium (FeNa) \< 1% suggests prerenal AKI due to decreased renal perfusion. ### **Final High-Yield Concepts** **111. What electrolyte abnormality is most dangerous in CKD?\ **A. Hyperphosphatemia\ B. Hyperkalemia\ C. Hyponatremia\ D. Hypocalcemia\ **Answer:** B. Hyperkalemia\ **Explanation:** Hyperkalemia can cause fatal cardiac arrhythmias in CKD patients due to impaired potassium excretion. **112. Which condition is associated with \"basket-weave\" appearance on electron microscopy?\ **A. Alport syndrome\ B. IgA nephropathy\ C. Minimal change disease\ D. Lupus nephritis\ **Answer:** A. Alport syndrome\ **Explanation:** Alport syndrome shows a \"basket-weave\" pattern on EM due to mutations in type IV collagen affecting the glomerular basement membrane. ### **1. Chronic Kidney Disease (CKD) and End-Stage Renal Disease (ESRD)** - - - - ### **2. Acute Kidney Injury (AKI)** - - - - - ### **3. Glomerular Diseases** - - - - - - - ### **4. Electrolyte and Acid-Base Disturbances in CKD** - - - ### **5. Dialysis and Renal Replacement Therapy** - - - - - - - - ### **6. Polycystic Kidney Disease (PKD)** - - - ### **7. Renal Vascular Disease** - - - - ### **8. Nephrolithiasis (Kidney Stones)** - - - - ### **9. Glomerular Pathology Patterns on Biopsy (HIGH-YIELD)** - - - - - ### **10. High-Yield Genetic and Pediatric Renal Disorders** - - - ### **Most Tested Treatments and Management Strategies:** - - - - - ### **Top 5 Most Tested Topics (Must-Know for PANCE):** 1. 2. 3. 4. 5.