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  • Question 1 - Out of the following options, which malignancy has the highest potential for multicentricity?...

    Incorrect

    • Out of the following options, which malignancy has the highest potential for multicentricity?

      Your Answer: Adenocarcinoma of prostate

      Correct Answer: Transitional cell carcinoma

      Explanation:

      Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.

    • This question is part of the following fields:

      • Pathology
      • Renal
      19.2
      Seconds
  • Question 2 - Congenital anomalies of genitourinary tract are more common than any other system. Which...

    Incorrect

    • Congenital anomalies of genitourinary tract are more common than any other system. Which of the following anomalies carries the greatest risk of morbidity?

      Your Answer: Horseshoe kidney

      Correct Answer: Bladder exstrophy

      Explanation:

      Bladder exstrophy is the condition where the urinary bladder opens from the anterior aspect suprapubically. The mucosa of the bladder is continuous with the abdominal skin and there is separation of the pubic bones. The function of the upper urinary tract remains normal usually. Treatment consists of surgical reconstruction of the bladder and returning it to the pelvis. There can be a need for continent urinary diversion along with reconstruction of the genitals.

    • This question is part of the following fields:

      • Pathology
      • Renal
      17.7
      Seconds
  • Question 3 - A 23-year-old woman decides to donate a kidney through a kidney chain. Which...

    Correct

    • A 23-year-old woman decides to donate a kidney through a kidney chain. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

      Your Answer: Creatinine clearance

      Explanation:

      Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors is on the rise. Most problems encountered with live donation are associated with the donor. Firstly, there are the potentially harmful investigative procedures carried out in the assessment phase, the most hazardous being renal angiography, where there is cannulation of the artery and injection of a radio-opaque dye to determine the blood supply to the kidney. Secondly, there are the short-term risks of nephrectomy surgery. According to the literature, there is a mortality rate of between 1 in 1600 and 1 in 3000, but this is no more than is associated with any anaesthetic. In the initial postoperative period creatinine clearance may be decreased but this recovers fully over a few weeks to months. Long-term complications include prolonged wound pain.

    • This question is part of the following fields:

      • Physiology
      • Renal
      11.4
      Seconds
  • Question 4 - Glucose is the most important source of energy for cellular respiration. The transport...

    Correct

    • Glucose is the most important source of energy for cellular respiration. The transport of glucose in the renal tubular cells occurs via:

      Your Answer: Secondary active transport with sodium

      Explanation:

      In 1960, Robert K. Crane presented for the first time his discovery of the sodium-glucose cotransport as the mechanism for glucose absorption. Glucose transport through biological membranes requires specific transport proteins. Transport of glucose through the apical membrane of renal tubular as well as intestinal epithelial cells depends on the presence of secondary active Na+–glucose symporters, SGLT-1 and SGLT-2, which concentrate glucose inside the cells, using the energy provided by co-transport of Na+ ions down their electrochemical gradient.

    • This question is part of the following fields:

      • Physiology
      • Renal
      13
      Seconds
  • Question 5 - Urine specific gravity allows the assessment of which of the following renal functions?...

    Correct

    • Urine specific gravity allows the assessment of which of the following renal functions?

      Your Answer: Concentration

      Explanation:

      Concentrating ability of kidneys is assessed by measuring the urine specific gravity. Normal values of urine specific gravity fall between 1.002 and 1.030 g/ml.

    • This question is part of the following fields:

      • Pathology
      • Renal
      4.1
      Seconds
  • Question 6 - Glucose is not secreted by the kidneys, and is filtered without a limit....

    Correct

    • Glucose is not secreted by the kidneys, and is filtered without a limit. What is the transport maximum for glucose?

      Your Answer: 300 mg/dl

      Explanation:

      Transport maximum (or Tm) refers to the point at which increases in concentration do not result in an increase in movement of a substance across a membrane. Glucose is not secreted, thus excretion = filtration – reabsorption. Both filtration and reabsorption are directly proportional to the concentration of glucose in the plasma. However, reabsorption has a transport maximum of about 300 mg/dl in healthy nephrons, while filtration has effectively no limit (within reasonable physiological ranges). So, if the concentration rises above 300 mg/dl, the body cannot retain all the glucose, leading to glucosuria. Glucosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.

    • This question is part of the following fields:

      • Physiology
      • Renal
      9.7
      Seconds
  • Question 7 - Which of these substances is secreted by pericytes in the juxtaglomerular cells? ...

    Correct

    • Which of these substances is secreted by pericytes in the juxtaglomerular cells?

      Your Answer: Renin

      Explanation:

      The juxtaglomerular cells synthesise, store and secrete the enzyme renin in the kidney. They are specialised smooth muscle cells in the wall of the afferent arteriole that delivers blood to the glomerulus and thus play a critical role in the renin– angiotensin system and so in renal autoregulation.

    • This question is part of the following fields:

      • Physiology
      • Renal
      4.4
      Seconds
  • Question 8 -  A 45-year-old man presented to the doctor complaining of a flank pain and...

    Correct

    •  A 45-year-old man presented to the doctor complaining of a flank pain and episodes of haematuria. Abdominal ultrasound revealed a left renal mass and the patient underwent a nephrectomy. Histopathological pattern was triphasic with blastemal, epithelial, and stromal components. The pathologist suggested the tumour resulted from the lack of a tumour suppressor gene on chromosome 11. Which of the following tumours is the pathologist most likely suggesting?

      Your Answer: Wilms’ tumour

      Explanation:

      Wilms’ tumour is one of the most common malignant tumours of childhood but it can also rarely be found in adults. In biopsy, classical histopathological findings include the triphasic pattern composed by blastemal, epithelial, and stromal elements. First symptoms in children include an abdominal palpable mass, while in adults pain and haematuria are the most common complaints. Deletions of tumours’ suppressor genes on chromosome 11 are usually associated with Wilms’ tumour.

    • This question is part of the following fields:

      • Pathology
      • Renal
      41.7
      Seconds
  • Question 9 - A 7-year-old boy with facial oedema was brought to the hospital by his...

    Correct

    • A 7-year-old boy with facial oedema was brought to the hospital by his parents. Renal function is normal and urinalysis revealed the presence of a profound proteinuria. Which of the following is the most probable cause of these findings?

      Your Answer: Minimal-change disease

      Explanation:

      Minimal-change disease (MCD) refers to a histopathologic glomerular lesion, typically found in children, that is almost always associated with nephrotic syndrome. The most noticeable symptom of MCD is oedema, which can develop very rapidly. Due to the renal loss of proteins muscle wasting and growth failure may be seen in children. Renal function is usually not affected and a proteinuria of more than 40 mg/h/m2 is the only abnormal finding in urinalysis.

    • This question is part of the following fields:

      • Pathology
      • Renal
      18.4
      Seconds
  • Question 10 - Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated...

    Incorrect

    • Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated plasma renin are common findings in which of the following patients?

      Your Answer: A 6-year-old boy with albuminuria

      Correct Answer: A 45-year-old woman with scleroderma

      Explanation:

      Scleroderma, also known as systemic sclerosis, is a chronic disease of the connective tissue. Involvement of the kidneys occurs in patients with diffuse scleroderma, causing rapid onset of high blood pressure with hyperreninemia, thrombotic microangiopathy, and progressive renal failure.

    • This question is part of the following fields:

      • Pathology
      • Renal
      25.5
      Seconds
  • Question 11 - Which statement is correct regarding secretions from the adrenal glands? ...

    Correct

    • Which statement is correct regarding secretions from the adrenal glands?

      Your Answer: Aldosterone is producd by the zona glomerulosa

      Explanation:

      The secretions of the adrenal glands by zone are:

      Zona glomerulosa – aldosterone

      Zona fasciculata – cortisol and testosterone

      Zona reticularis – oestradiol and progesterone

      Adrenal medulia – adrenaline, noradrenaline and dopamine.

    • This question is part of the following fields:

      • Physiology
      • Renal
      19.2
      Seconds
  • Question 12 - A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes...

    Correct

    • A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes which is worst in the morning. Laboratory studies showed:

      Blood urea nitrogen (BUN) = 30 mg/dl

      Creatinine = 2. 8 mg/dl

      Albumin = 2. 0 mg/dl

      Alanine transaminase (ALT) = 25 U/l

      Bilirubin = 1 mg/dl

      Urine analysis shows 3+ albumin and no cells.

      Which of the following is the most likely diagnosis?

      Your Answer: Nephrotic syndrome

      Explanation:

      Nephrotic syndrome is a disorder in which the glomeruli have been damaged, characterized by:

      – Proteinuria (>3.5 g per 1.73 m2 body surface area per day, or > 40 mg per square meter body surface area per hour in children)

      – Hypoalbuminemia (< 2,5 g/dl) – Hyperlipidaemia, and oedema (generalized anasarca).

    • This question is part of the following fields:

      • Physiology
      • Renal
      9.7
      Seconds
  • Question 13 - A medical student is told a substance is freely filtered but is not...

    Correct

    • A medical student is told a substance is freely filtered but is not metabolised, secreted, or stored in the kidney. It has a plasma concentration of 1000 mg/l and its urine excretion rate is 25 mg/min, and the inulin clearance is 100 ml/min. What is the rate of tubular reabsorption of the substance?

      Your Answer: 75 mg/min

      Explanation:

      Reabsorption or tubular reabsorption is the process by which the nephron removes water and solutes from the tubular fluid (pre-urine) and returns them to the circulating blood. To calculate the reabsorption rate of substance Z we use the following equation: excretion = (filtration + secretion) – reabsorption. As this substance is freely filtered, its filtration rate is equal to that of inulin. So 25 = (100 + 0) – reabsorption. Reabsorption = 100 – 25 therefore reabsorption = 75 mg/min.

    • This question is part of the following fields:

      • Physiology
      • Renal
      7.3
      Seconds
  • Question 14 - 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
      32.8
      Seconds
  • Question 15 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Incorrect

    • 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: Systemic lupus erythematosus

      Correct 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
      31.1
      Seconds
  • Question 16 - A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following...

    Correct

    • A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following diuretics promotes diuresis by opposing the action of aldosterone?

      Your Answer: Potassium-sparing diuretic

      Explanation:

      The term potassium-sparing refers to an effect rather than a mechanism or location. Potassium-sparing diuretics act by either antagonising the action of aldosterone (spironolactone) or inhibiting Na+ reabsorption in the distal tubules (amiloride). This group of drugs is often used as adjunctive therapy, in combination with other drugs, for the management of chronic heart failure. Spironolactone, the first member of the class, is also used in the management of hyperaldosteronism (including Conn’s syndrome) and female hirsutism (due to additional antiandrogen actions).

    • This question is part of the following fields:

      • Physiology
      • Renal
      11.2
      Seconds
  • Question 17 - A 40-year old Caucasian male came to the hospital with complaints of fatigue...

    Correct

    • A 40-year old Caucasian male came to the hospital with complaints of fatigue and lethargy. On examination, he was found to have raised blood pressure. Urine examination showed >300 mg/dl proteinuria (4+) and 24-hour urine protein 3.5g. No glucose, blood, nitrites, urobilinogen or casts were present in urine. What is the most likely diagnosis?

      Your Answer: Membranous glomerulonephritis

      Explanation:

      Membranous glomerulonephritis or nephropathy, is a renal disorder with insidious course and usually affects people aged 30-50 years. 85% cases are primary (or idiopathic). The other 15% are secondary to autoimmune conditions like SLE, infections like malaria or hepatitis B, drugs like captopril and NSAIDs, or malignancies (particularly lung or colonic carcinoma). This disease is caused due to circulating immune complexes which are said to form by binding of antibodies to antigens in glomerular basement membrane. This antigens could be endogenous or derived from systemic circulation. This immune complex triggers the complement system, resulting in formation of membrane attack complex (MAC) on glomerular epithelial cells. This further results in release of proteases and oxidants which damage the capillaries making them ‘leaky’. Moreover, the epithelial cells also secrete a mediator to reduce nephron synthesis and distribution.

    • This question is part of the following fields:

      • Pathology
      • Renal
      24
      Seconds
  • Question 18 - 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
      27.9
      Seconds
  • Question 19 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Incorrect

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer: An increase in mean arterial pressure from 90 mmHg to 140 mmHg

      Correct Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Physiology
      • Renal
      13.5
      Seconds
  • Question 20 - Lack of findings in the bladder but presence of atypical epithelial cells in...

    Incorrect

    • 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: Squamous cell carcinoma of penis

      Correct 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
      16.9
      Seconds
  • Question 21 - A 78-year-old diabetic man undergoes renal function tests. Which of the following substances...

    Correct

    • A 78-year-old diabetic man undergoes renal function tests. Which of the following substances will be the most accurate for measuring glomerular filtration rate (GFR)?

      Your Answer: Inulin

      Explanation:

      Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal glomerular capillaries into the Bowman’s capsule per unit time. Clinically, this is often measured to determine renal function. Inulin was originally used as it is not reabsorbed by the kidney after glomerular filtration, therefore its rate of excretion is directly proportional to the rate of filtration of water and solutes across the glomerular filter. However, in clinical practice, creatinine clearance is used to measure GFR. Creatinine is an endogenous molecule, synthesised in the body, that is freely filtered by the glomerulus (but also secreted by the renal tubules in very small amounts). Creatinine clearance exceeds GFR due to creatinine secretion, and is therefore a close approximation of the GFR.

    • This question is part of the following fields:

      • Physiology
      • Renal
      4.6
      Seconds
  • Question 22 - A 49-year-old woman with acute renal failure has a total plasma [Ca2+] =...

    Correct

    • A 49-year-old woman with acute renal failure has a total plasma [Ca2+] = 2. 5 mmol/l and a glomerular filtration rate of 160 l/day. What is the estimated daily filtered load of calcium?

      Your Answer: 240 mmol/day

      Explanation:

      Calcium is the most abundant mineral in the human body. The average adult body contains in total approximately 1 kg of calcium of which 99% is in the skeleton in the form of calcium phosphate salts. The extracellular fluid (ECF) contains approximately 22 mmol, of which about 9 mmol is in the plasma. About 40% of total plasma Ca2+ is bound to proteins and not filtered at the glomerular basement membrane. Therefore, the estimated daily filtered load is 1.5 mmol/l × 160 l/day = 240 mmol/day. The exact amount of free versus total Ca2+ depends on the blood pH: free Ca2+ increases during acidosis and decreases during alkalosis.

    • This question is part of the following fields:

      • Physiology
      • Renal
      14.6
      Seconds
  • Question 23 - A 54-year-old woman with amyotrophic lateral sclerosis is diagnosed with respiratory acidosis. The...

    Incorrect

    • A 54-year-old woman with amyotrophic lateral sclerosis is diagnosed with respiratory acidosis. The patient’s renal excretion of potassium would be expected to:

      Your Answer: Stay the same

      Correct Answer: Fall, since tubular secretion of potassium is inversely coupled to acid secretion

      Explanation:

      Respiratory acidosis is a medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood’s pH (a condition generally called acidosis). Secretion of acid and potassium by the renal tubule are inversely related. So, increased excretion of H+ during renal compensation for respiratory acidosis will result in decreased secretion (or increased retention) of potassium ions, with the result that the body’s potassium store rises. An increase in K+ excretion would be associated with renal compensation for respiratory alkalosis. The filtered load of K+depends only on K+ plasma concentration and glomerular filtration rate, not on plasma pH.

    • This question is part of the following fields:

      • Physiology
      • Renal
      20.6
      Seconds
  • Question 24 - Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after...

    Incorrect

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

      Your Answer:

      Correct 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
      0
      Seconds
  • Question 25 - A 76-year-old woman is diagnosed with diabetes mellitus after a urine test revealed...

    Incorrect

    • A 76-year-old woman is diagnosed with diabetes mellitus after a urine test revealed she has glucosuria. Glucosuria may occur due to inadequate glucose reabsorption at:

      Your Answer:

      Correct Answer: Proximal convoluted tubule

      Explanation:

      Glucose is reabsorbed almost 100% via sodium–glucose transport proteins (apical) and GLUT (basolateral) in the proximal convoluted tubule. Glycosuria or glucosuria is a condition of osmotic diuresis typical in those suffering from diabetes mellitus. Due to a lack of insulin, plasma glucose levels are above normal. This leads to saturation of receptors in the kidneys and glycosuria usually at plasma glucose levels above 11 mmol/l. Rarely, glycosuria is due to an intrinsic problem with glucose reabsorption within the kidneys (such as Fanconi syndrome), producing a condition termed renal glycosuria.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 26 - A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most...

    Incorrect

    • A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most likely has:

      Your Answer:

      Correct Answer: Decreased baroreceptor firing rate

      Explanation:

      Baroreceptors are sensors located in the blood vessels of all vertebrate animals. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Acute dehydration results in decreased plasma volume and increased plasma osmolarity, since more water than salt is lost in sweat. The decrease in plasma volume leads to an inhibition of the baroreceptors and a lower firing rate. The increase in plasma osmolarity leads to increased ADH secretion and high plasma ADH levels, which increases water permeability of collecting duct cells. Therefore more water is reabsorbed by the kidneys and renal water excretion is low.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 27 - The proximal tubule is the portion of the ductal system of the nephron of the kidney which leads from Bowman's capsule to the loop...

    Incorrect

    • The proximal tubule is the portion of the ductal system of the nephron of the kidney which leads from Bowman's capsule to the loop of Henle. Which of the following is most likely to be seen in a sample of fluid leaving the proximal tubule?

      Your Answer:

      Correct Answer: It will have no amino acids

      Explanation:

      The proximal tubule is the portion of the duct system of the nephron leading from Bowman’s capsule to the loop of Henlé. The most distinctive characteristic of the proximal tubule is its brush border (or ‘striated border’). The luminal surface of the epithelial cells of this segment of the nephron is covered with densely packed microvilli forming a border which greatly increases the luminal surface area of the cells, presumably facilitating their reabsorptive function. Glucose, amino acids, inorganic phosphate, and some other solutes are100% reabsorbed via secondary active transport through co-transporters driven by the sodium gradient out of the nephron.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 28 - The renal cortex and medulla, if seen under the microscope, is lacking one...

    Incorrect

    • The renal cortex and medulla, if seen under the microscope, is lacking one of the following:

      Your Answer:

      Correct Answer: Squamous epithelium

      Explanation:

      Capillaries, Henle’s loop, collecting ducts, Bertin columns and type IV collagen in glomerular basement membrane are all structures present in the renal cortex or medulla. The squamous epithelium is the only one that is lacking in both the renal cortex and medulla, because normally it is not found above the outer urethra.

    • This question is part of the following fields:

      • Pathology
      • Renal
      0
      Seconds
  • Question 29 - In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial...

    Incorrect

    • In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial cells that:

      Your Answer:

      Correct Answer: Form the juxtaglomerular apparatus in combination with the macula densa and juxtaglomerular cells

      Explanation:

      The mesangium is an inner layer of the glomerulus, within the basement membrane surrounding the glomerular capillaries. The mesangial cells are phagocytic and secrete the amorphous basement membrane-like material known as the mesangial matrix. They are typically separated from the lumen of the capillaries by endothelial cells. The other type of cells in the mesangium are the extraglomerular mesangial cells which form the juxtaglomerular apparatus in combination with two other types of cells: the macula densa of the distal convoluted tubule and juxtaglomerular cells of the afferent arteriole. This apparatus controls blood pressure through the renin–angiotensin–aldosterone system.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 30 - Different portions of the renal tubule have varying degrees of water permeability. Which...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 31 - A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains...

    Incorrect

    • A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pre-eclampsia

      Explanation:

      Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 32 - In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of...

    Incorrect

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

      Your Answer:

      Correct 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
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  • Question 33 - Renin is secreted by pericytes in the vicinity of the afferent arterioles of the...

    Incorrect

    • 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:

      Correct 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
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  • Question 34 - Which part of the nephron would have to be damaged to stop the...

    Incorrect

    • Which part of the nephron would have to be damaged to stop the reabsorption of the majority of salt and water?

      Your Answer:

      Correct Answer: Proximal tubule

      Explanation:

      The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle. It is conventionally divided into the proximal convoluted tubule (PCT) and the proximal straight tubule (PST). The proximal tubule reabsorbs the majority (about two-thirds) of filtered salt and water. This is done in an essentially iso-osmotic manner. Both the luminal salt concentration and the luminal osmolality remain constant (and equal to plasma values) along the entire length of the proximal tubule. Water and salt are reabsorbed proportionally because the water is dependent on and coupled with the active reabsorption of Na+. The water permeability of the proximal tubule is high and therefore a significant transepithelial osmotic gradient is not possible.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 35 - A 55-year old lady underwent a major surgery for repair of an aortic...

    Incorrect

    • A 55-year old lady underwent a major surgery for repair of an aortic aneurysm. Her blood pressure was low throughout the intra-operative and the post-operative period, along with increasing serum creatinine and urea. Microscopic examination of her urine showed multiple granular and hyaline casts. What is the likely condition the patient is suffering from?

      Your Answer:

      Correct Answer: Acute tubular necrosis

      Explanation:

      The most common predisposing factor leading to acute tubular necrosis is ischemia, typically seen in hospitalized patients with low blood pressure.

    • This question is part of the following fields:

      • Pathology
      • Renal
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  • Question 36 - The presence of oval fat bodies in the urine is most likely to...

    Incorrect

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

      Your Answer:

      Correct 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
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  • Question 37 - A 60-year old gentleman visited his general practitioner complaining of high grade fever...

    Incorrect

    • A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?

      Your Answer:

      Correct Answer: White blood cell casts

      Explanation:

      Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.

    • This question is part of the following fields:

      • Pathology
      • Renal
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  • Question 38 - A diabetic 58-year-old man, after the injection of radiographic contrast, has a decreased...

    Incorrect

    • 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:

      Correct 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
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  • Question 39 - What is the normal glomerular filtration rate? ...

    Incorrect

    • What is the normal glomerular filtration rate?

      Your Answer:

      Correct Answer: 125 mL/min

      Explanation:

      The normal glomerular filtration rate (GFR) in humans is 125 mL/min. After the age of 40, GFR decreases progressively by about 0.4–1.2 mL/min per year.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 40 - A 35-year-old woman in her 37th week of pregnancy complains of urinary incontinence....

    Incorrect

    • A 35-year-old woman in her 37th week of pregnancy complains of urinary incontinence. She is most likely to have:

      Your Answer:

      Correct Answer: Stress incontinence

      Explanation:

      Urinary incontinence is the involuntary excretion of urine from one’s body. It is often temporary and it almost always results from an underlying medical condition. Several types include:

      – Stress incontinence is the voiding of urine following increased abdominal pressure e.g. laughing, coughing, pregnancy etc. It is the most common form of incontinence in women, most commonly due to pelvic floor muscle weakness, physical changes from pregnancy, childbirth and menopause. In men it is a common problem following a prostatectomy. Most lab results such as urine analysis, cystometry and postvoid residual volume are normal.

      – Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence are involuntary and inappropriate detrusor muscle contractions.

      – Functional incontinence – occurs when a person does not recognise the need to go to the toilet, recognise where the toilet is or get to the toilet in time. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity or unwillingness. t

      – Overflow incontinence – sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine.

    • This question is part of the following fields:

      • Physiology
      • Renal
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SESSION STATS - PERFORMANCE PER SPECIALTY

Pathology (5/10) 50%
Renal (16/23) 70%
Physiology (11/13) 85%
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