Nephrology Module 1

Which of the following factor is responsible for causing insulin deficiency in New Onset Diabetes Mellitus After Transplant (NODAT)?

Tacrolimus

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

CMV infection

Correct Incorrect Correct answer

Hepatitis C infection

Correct Incorrect Correct answer

An 18 year-old man had a renal transplant from his mother six months ago. Both the donor and recipient were negative for cytomegalovirus. He develops an intercurrent illness with fever and non specific aches and pains. There has been no documented history of acute rejection during the course of his transplant.

On examination, his temperature is 38.8C, blood pressure 105/60; he is well perfused and is otherwise well. His pharynx is slightly inflamed, but no pus is visible. Initial blood tests show stable renal function and normal white cell count.

What is the most likely cause for his infection?

Streptococcus pneumoniae

Correct Incorrect Correct answer

BK virus.

Correct Incorrect Correct answer

Cytomegalovirus

Correct Incorrect Correct answer

Epstein Barr virus

Correct Incorrect Correct answer

Pneumocystis jiroveci

Correct Incorrect Correct answer

In renal tranplant patients,what is the main cause of death with a functioning graft?

cardiovascular disease

Correct Incorrect Correct answer

lymphoma

Correct Incorrect Correct answer

CMV infection

Correct Incorrect Correct answer

Hepatitis C infection

Correct Incorrect Correct answer

Skin cancer

Correct Incorrect Correct answer

A 40 year old man has an abdominal CT performed to investigate his abdominal pain. The CT reveals bilateral renal cysts, 2 on the left and 3 on the right (various sizes 1-4cm). His father was diagnosed with the same in his late 30’s.

What is the most likely diagnosis?

Autosomal dominant polycystic kidney disease

Correct Incorrect Correct answer

Autosomal recessive polycystic kidney disease

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Simple cyst

Correct Incorrect Correct answer

Tuberous sclerosis

Correct Incorrect Correct answer

Von Hipple lindau disease

Correct Incorrect Correct answer

A 30 year old male patient has a generalized tonic-clonic seizure one week post renal transplantation. On examination, he is confused and drowsy with a blood pressure of 160/100.

Which of the following drug is most likely to be responsible for his deterioration?

cyclosporin

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mycophenolate

Correct Incorrect Correct answer

perindopril

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steroids

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morphine

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Which of the following patient group is most likely to benefit from renovascularization strategy following the diagnosis of renal artery stenosis?

None of the answers are correct.

Correct Incorrect Correct answer

Recurrent flash pulmonary oedema

Correct Incorrect Correct answer

Bilateral disease or stenosis of solitary kidney

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Recent onset or progressive renal failure

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Recent onset of accelerated HT

Correct Incorrect Correct answer

A 70-year-old man from Wellington is referred for investigation of proteinuria and impaired renal function. He has generalized osteoarthritis and developed chronic osteomyelitis of the right tibia after a fracture at the age of 20.

His only medication is indomethacin. Physical examination is unremarkable. Blood pressure is 122/66 mmHg. Urinalysis reveals 4+ proteinuria and 1+ glycosuria.

The following investigation results are obtained:

serum creatinine 0.25 mmol/L [0.06-0.12]
urine protein 2.90 g/day [<0.15]
serum albumin 35 g/L [35 – 50]
urine microscopy red blood cells 107-108 /mL [erythrocyte morphology suggests red cells are of glomerular origin]
blood glucose: random 6.1 mmol/L [3.5 -7.8], 2 hrs after 75 g oral glucose 8.1 mmol/L [<7.8], haemoglobin A1C 6.2% [<6.0%]

Renal ultrasound normal renal size and morphology.

Which of the following is the most likely diagnosis?

Amyloid nephropathy

Correct Incorrect Correct answer

Interstitial nephritis.

Correct Incorrect Correct answer

Diabetic nephropathy.

Correct Incorrect Correct answer

Focal sclerosing glomerulonephritis.

Correct Incorrect Correct answer

Epimembranous glomerulonephritis

Correct Incorrect Correct answer

Rapamycin (Sirolimus) can most likely cause the following side effect:

Hyperlipidemia

Correct Incorrect Correct answer

Nephrotoxicity

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Diabetes

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Hypersensitivity reaction

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Malignancy

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Which type of glomerulonephritis is less likely to recur post transplant and cause graft failure?

Post-streptococcal glomerulonephritis

Correct Incorrect Correct answer

IgA nephropathy

Correct Incorrect Correct answer

Mesangiocapillary glomerulonephritis Type 1

Correct Incorrect Correct answer

Focal and segmental glomerulosclerosis

Correct Incorrect Correct answer

Membranous glomerulonephritis

Correct Incorrect Correct answer

A 16-year-old teenager is taken to see the GP by his mother. For the past two days he has had a sore throat associated with blood in his urine. There is no significant past medical history. The GP suspects glomerulonephritis and refers the patient to hospital.

What would the renal biopsy show?

Mesangial hypercellularity

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Proliferation of endothelial cells

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No change

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Basement membrane thickening

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Capillary wall necrosis

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What is the haemoglobin range that should be targeted in patients with chronic renal failure who are not yet on dialysis?

110-120g/l

Correct Incorrect Correct answer

110-115 g/l

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130-150 g/l

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150-170 g/l

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Which of the following intervention would be most helpful in preventing contrast induced nephropathy?

No prophylaxis needed

Correct Incorrect Correct answer

1.26% Sodium bicarbonate

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0.9% sodium chloride

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0.45% sodium chloride plus 5% glucose.

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Oral acetylcysteine

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A 32-year-old woman presents to the rheumatology clinic with a 6-month history of joint pain, malar rash, and fatigue. She was recently diagnosed with Systemic Lupus Erythematosus (SLE) based on clinical features and positive serologies, including antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA). Given the systemic nature of her symptoms, a renal function assessment was initiated to evaluate for possible lupus nephritis.

Her laboratory tests reveal normal renal function with a serum creatinine of 90 micromol/L and no proteinuria or active urinary sediment on urinalysis. Despite her SLE diagnosis, her renal assessment does not indicate lupus nephritis at this time.

Considering this information, which of the following factor has the least impact on her future prognosis, especially in the context of proliferative lupus nephritis?

Caucasian population

Correct Incorrect Correct answer

Elevated serum creatinine at presentation

Correct Incorrect Correct answer

Failure to achieve remission

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High Chronicity index on biopsy

Correct Incorrect Correct answer

African american

Correct Incorrect Correct answer

The following interventions are all useful in preserving the residual renal function in patients with end stage renal failure, except?

Hemodialysis as initial dialysis modality.

Correct Incorrect Correct answer

Avoidance of hypovolemia

Correct Incorrect Correct answer

Renin-Angiotensin-Aldosterone System blockade

Correct Incorrect Correct answer

Avoidance of nephrotoxins

Correct Incorrect Correct answer

Prevention of PD associated peritonitis

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Which of the following feature is less specific to lupus nephritis relative to SLE without renal involvement?

nephritic syndrome

Correct Incorrect Correct answer

acute renal impairment

Correct Incorrect Correct answer

microscopic hematuria

Correct Incorrect Correct answer

proteinuria

Correct Incorrect Correct answer

lupus serology (DsDNA,C3,C4)

Correct Incorrect Correct answer

A patient has been diagnosed with lupus nephritis and has >50% glomeruli involved.

Which stage of lupus nephritis is this?

Stage IV

Correct Incorrect Correct answer

Stage I

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Stage II

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Stage III

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Stage V

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Which one of the following is NOT a consistent histological feature of proliferative lupus nephritis?

Macrophage infiltration

Correct Incorrect Correct answer

Subendothelial immune deposits/wire loops

Correct Incorrect Correct answer

Hypercellularity

Correct Incorrect Correct answer

Fibrinoid necrosis

Correct Incorrect Correct answer

Crescents

Correct Incorrect Correct answer

Which one of the following is NOT beneficial in the treatment of lupus nephritis?

Intravenous immunoglobulin

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Cyclophosphamide

Correct Incorrect Correct answer

Mycophenolate mofetil

Correct Incorrect Correct answer

Rituximab

Correct Incorrect Correct answer

Which of the following is least likely to occur with cyclophophamide toxicity?

Mononeuritis multiplex

Correct Incorrect Correct answer

Infertility

Correct Incorrect Correct answer

Herpes Zoster

Correct Incorrect Correct answer

Bladder toxicity

Correct Incorrect Correct answer

Malignancy

Correct Incorrect Correct answer

Mycophenolate mofetil is least likely to cause which of the following side effect?

Leukocytosis

Correct Incorrect Correct answer

Gastrointestinal upset

Correct Incorrect Correct answer

Leukopaenia

Correct Incorrect Correct answer

Infection

Correct Incorrect Correct answer

Malignancy

Correct Incorrect Correct answer

What is the drug of choice for refractory, relapsing lupus nephritis?

Rituximab

Correct Incorrect Correct answer

Cyclophosphamide

Correct Incorrect Correct answer

Corticosteroid

Correct Incorrect Correct answer

Mycophenolate

Correct Incorrect Correct answer

Azathioprine

Correct Incorrect Correct answer

Which of the following intervention is least likely to be beneficial in pauci immune rapidly progressive glomerulonephritis?

Tocilizumab

Correct Incorrect Correct answer

IV methylprednisone

Correct Incorrect Correct answer

Cyclophosphamide

Correct Incorrect Correct answer

Plasma exchange

Correct Incorrect Correct answer

Methotrexate

Correct Incorrect Correct answer

When do most patients with Type 1 diabetes develop microalbuminuria?

5-15 years

Correct Incorrect Correct answer

1-2 years of disease

Correct Incorrect Correct answer

30 years

Correct Incorrect Correct answer

More than 30 years

Correct Incorrect Correct answer

Never

Correct Incorrect Correct answer

The presence of overt nephropathy in Type 1 diabetes mellitus is commonly associated with following complication:

hypertension

Correct Incorrect Correct answer

ischaemic heart disease

Correct Incorrect Correct answer

gastroparesis

Correct Incorrect Correct answer

diabetic neuropathy

Correct Incorrect Correct answer

foot ulcer

Correct Incorrect Correct answer

What is the biochemical definition of macroalbuminuria in diabetic nephropathy in men [Mainly the Albumin Creatinine Ratio (ACR) and Albumin Excretion Rate(AER)]?

urine ACR of >300mg/g and AER of >300mg/24hrs.

Correct Incorrect Correct answer

urine ACR of >500mg/g and AER of >300mg/24hrs.

Correct Incorrect Correct answer

urine ACR of >150 mg/g and AER of >600mg/24hrs.

Correct Incorrect Correct answer

urine ACR of >250mg/g and AER of >200mg/24hrs.

Correct Incorrect Correct answer

urine ACR of >350mg/g and AER of >400mg/24hrs.

Correct Incorrect Correct answer

Which of the following intervention is less likely to slow the progression of diabetic nephropathy?

Increased protein intake.

Correct Incorrect Correct answer

Blood pressure control

Correct Incorrect Correct answer

Use of ACE inhibitors

Correct Incorrect Correct answer

Good glycaemic control

Correct Incorrect Correct answer

Smoking cessation

Correct Incorrect Correct answer

Which of the following medication has been proven to slow the progression of diabetic nephropathy in both Type 1 and Type 2 DM.

ACE-inhibitors

Correct Incorrect Correct answer

Amlodipine

Correct Incorrect Correct answer

spironolactone

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

Digoxin

Correct Incorrect Correct answer

The use of ACE inhibitors/ARBs in diabetic patients who are normoalbuminuric and normotensive are protective against which complication?

Diabetic Retinopathy

Correct Incorrect Correct answer

Renal histology changes

Correct Incorrect Correct answer

Development of microalbuminuria

Correct Incorrect Correct answer

Diabetic neuropathy

Correct Incorrect Correct answer

Ischaemic heart disease

Correct Incorrect Correct answer

A 42-year-old woman is six weeks post-renal transplant for focal segmental glomerulosclerosis. Following the procedure, she was discharged on a combination of tacrolimus, mycophenolate, and prednisone.

She now presents with five day history of feeling generally unwell with anorexia, fatigue and arthralgia. On examination her sclera are jaundiced and she has widespread lymphadenopathy with hepatomegaly.

Which of the following infection is she most likely to have?

Cytomegalovirus

Correct Incorrect Correct answer

Hepatitis C

Correct Incorrect Correct answer

Epstein-Barr virus

Correct Incorrect Correct answer

HIV

Correct Incorrect Correct answer

Hepatitis B

Correct Incorrect Correct answer

Which of the following is the main site of potassium reabsorption in the nephron?

Proximal convoluted tubule.

Correct Incorrect Correct answer

Descending limb of the Loop of Henle.

Correct Incorrect Correct answer

Ascending limb of the Loop of Henle.

Correct Incorrect Correct answer

Distal convoluted tubule.

Correct Incorrect Correct answer

Collecting duct.

Correct Incorrect Correct answer

A 16 year old teenager with severe bronchiolitis obliterans presents to the Emergency Department with increasing exercise intolerance over the previous week.

A capillary blood gas shows the following picture:

pH 7.29 [7.35 – 7.45]
pCO2 97 mmHg [36 – 44 mmHg]
Bicarbonate (HCO3-) 45 mmol/L [21 – 30 mmol/L]
Base excess +18 mmol/L [-3 – +3 mmol/L]

This result is most consistent with the following acid/base balance:

Acute on chronic respiratory acidosis

Correct Incorrect Correct answer

Acute respiratory acidosis.

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Chronic respiratory acidosis.

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Mixed metabolic and respiratory acidosis.

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Uncompensated metabolic acidosis

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Which of the following molecule is primarily reabsorbed in the proximal tubule of the nephron?

bicarbonate

Correct Incorrect Correct answer

potassium

Correct Incorrect Correct answer

calcium

Correct Incorrect Correct answer

urea

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sodium

Correct Incorrect Correct answer

Nephrology Module 1

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