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  • Question 1 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Correct

    • A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.

      Your Answer: Multiple myeloma

      Explanation:

      Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.

    • This question is part of the following fields:

      • Pathology
      • Renal
      4.8
      Seconds
  • Question 2 - Different portions of the renal tubule have varying degrees of water permeability. Which...

    Correct

    • Different portions of the renal tubule have varying degrees of water permeability. Which of the following renal sites is characterised by low water permeability under normal circumstances?

      Your Answer: Thick ascending limb of the loop of Henlé

      Explanation:

      Within the nephron of the kidney, the ascending limb of the loop of Henle is a segment of the loop of Henle downstream of the descending limb, after the sharp bend of the loop. Both the thin and the thick ascending limbs of the loop of Henlé have very low permeability to water. Since there are no regulatory mechanisms to alter its permeability, it remains poorly permeable to water under all circumstances. Sodium and chloride are transported out of the luminal fluid into the surrounding interstitial spaces, where they are reabsorbed. Water must remain behind because it is not reabsorbed, so the solute concentration becomes less and less (the luminal fluid becomes more dilute). This is one of the principal mechanisms (along with diminution of ADH secretion) for the production of a dilute, hypo-osmotic urine (water diuresis).

    • This question is part of the following fields:

      • Physiology
      • Renal
      10.9
      Seconds
  • Question 3 - A 45-year old gentleman presented to the emergency department at 5.00 AM with...

    Correct

    • A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?

      Your Answer: Ureteric calculus

      Explanation:

      A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.

    • This question is part of the following fields:

      • Pathology
      • Renal
      2.2
      Seconds
  • Question 4 - Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after...

    Correct

    • Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?

      Your Answer: Acute nephritic syndrome

      Explanation:

      Nephritic syndrome (or acute nephritic syndrome) is a syndrome comprising of signs of nephritis. Children between 2 and 12 are most commonly affected, but it may occur at any age. Predisposing factors/causes include:

      Infections with group A streptococcal bacteria (acute post-streptococcal glomerulonephritis).

      Primary renal diseases: immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, idiopathic rapidly progressive crescentic glomerulonephritis.

      Secondary renal diseases: subacute bacterial endocarditis, infected ventriculo–peritoneal shunt, glomerulonephritis with visceral abscess, glomerulonephritis with bacterial, viral or parasitic infections.

      Multisystem diseases.

      By contrast, nephrotic syndrome is characterized by only proteins moving into the urine.

    • This question is part of the following fields:

      • Physiology
      • Renal
      5.3
      Seconds
  • Question 5 - A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops...

    Correct

    • A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?

      Your Answer: Acidosis

      Explanation:

      Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.

    • This question is part of the following fields:

      • Physiology
      • Renal
      4
      Seconds
  • Question 6 - In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of...

    Correct

    • In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of the:

      Your Answer: Distal convoluted tubule

      Explanation:

      In the kidney, the macula densa is an area of closely packed specialised cells lining the region of the distal convoluted tubule (DCT) lying next to the glomerular vascular pole. The cells of the macula densa are sensitive to the ionic content and water volume of the fluid in the DCT, producing signals that promote renin secretion by other cells of the juxtaglomerular apparatus.

    • This question is part of the following fields:

      • Physiology
      • Renal
      3.2
      Seconds
  • Question 7 - A diabetic 58-year-old man, after the injection of radiographic contrast, has a decreased...

    Correct

    • A diabetic 58-year-old man, after the injection of radiographic contrast, has a decreased urine output and decreased level of consciousness. Which of the following conditions has he most likely developed

      Your Answer: Acute tubular necrosis

      Explanation:

      Acute tubular necrosis (ATN) involves damage to the tubule cells of the kidneys and is the most common cause of acute kidney injury. ATN in the majority of the cases is caused by ischaemia of the kidneys due to lack of perfusion and oxygenation but it may also occur due to poison or harmful substance. Contrast used for radiology may cause ATN in patients with several risk factors e.g. diabetic nephropathy. Symptoms may include oliguria, nausea, fluid retention, fatigue and decreased consciousness.

    • This question is part of the following fields:

      • Pathology
      • Renal
      7.8
      Seconds
  • Question 8 - Renin is secreted by pericytes in the vicinity of the afferent arterioles of the...

    Correct

    • Renin is secreted by pericytes in the vicinity of the afferent arterioles of the kidney from the juxtaglomerular cells. Plasma renin levels are decreased in patients with:

      Your Answer: Primary aldosteronism

      Explanation:

      Primary aldosteronism, also known as primary hyperaldosteronism or Conn’s syndrome, is excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels. Most patients with primary aldosteronism (Conn’s syndrome) have an adrenal adenoma. The increased plasma aldosterone concentration leads to increased renal Na+ reabsorption, which results in plasma volume expansion. The increase in plasma volume suppresses renin release from the juxtaglomerular apparatus and these patients usually have low plasma renin levels. Salt restriction and upright posture decrease renal perfusion pressure and therefore increases renin release from the juxtaglomerular apparatus. Secondary aldosteronism is due to elevated renin levels and may be caused by heart failure or renal artery stenosis.

    • This question is part of the following fields:

      • Physiology
      • Renal
      10.1
      Seconds
  • Question 9 - The presence of oval fat bodies in the urine is most likely to...

    Correct

    • The presence of oval fat bodies in the urine is most likely to be seen in which of the following conditions?

      Your Answer: Nephrotic syndrome

      Explanation:

      Nephrotic syndrome is associated with the presence of oval fat bodies on urinalysis due to increased proteinuria and lipiduria.

    • This question is part of the following fields:

      • Pathology
      • Renal
      5.7
      Seconds
  • Question 10 - Lack of findings in the bladder but presence of atypical epithelial cells in...

    Correct

    • Lack of findings in the bladder but presence of atypical epithelial cells in urinalysis is most often associated with which of the following conditions?

      Your Answer: Transitional cell carcinoma of renal pelvis

      Explanation:

      The presence of atypical cells in urinalysis without findings in the bladder suggests a lesion located higher up, most probably in ureters or renal pelvis. Transitional cell cancer of the renal pelvis is a disease in which malignant cells form in the renal pelvis and is characterised by the presence of abnormal cells in urine cytology.

    • This question is part of the following fields:

      • Pathology
      • Renal
      3.7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pathology (5/5) 100%
Renal (10/10) 100%
Physiology (5/5) 100%
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