The Renal Problem
Written Clinical Examination
1. A patient walks into your health clinic to consult you. You should initially establish which of the following four functions of a physician?
A. diagnosis
B. treatment
C. advice
D. rapport
2. The most cost-effective way of managing the problem of a legal suit (potential and actual) in a medical practice is
A. ordering all possible screening laboratory examinations
B. establishing good rapport with the patient and his relatives
C. asking all patients to sign a waiver of physician’s liabilities
D. securing a malpractice insurance
3. Which among the choices should be the proper sequence in the performance of tasks of a physician when managing a patient?
A. clinical diagnosis-paraclinical diagnosis-treatment-advice
B. clinical diagnosis-paraclinical diagnosis-advice-treatment-advice
C. clinical diagnosis-advice-paraclinical diagnosis-advice-treatment-advice
D. clinical diagnosis-advice-paraclinical diagnosis-treatment-advice
4. In the Philippines, the laymen’s concept of a “kidney problem” usually includes disorders on
A. kidney
B. ureter
C. bladder
D. urethra
E. all of the above
5. The more common presentation of “kidney problem” in the Philippines is in the form of symptoms referable
A. directly to the excretory system such as problem in urination
B. indirectly to the excretory system such as edema and renal hypertension
6. The more common disorders of the excretory system are those arising from
A. the system itself (primary)
B. outside the system (secondary) such as endocrine diseases affecting the kidney
7. A patient with a renal problem may be due to trauma. Which among the set of data is MOST STRONGLY suggestive of renal trauma?
A. history of trauma to the abdomen and pelvis (A&P)
B. history of trauma to the A&P with symptoms referable to the renal system
C. history of trauma to the A&P with signs referable to the renal system
8. Which among the following is an evident sign of injuries to the renal system in the presence of a history of trauma?
A. injuries to the back where the kidney is usually located
B. injuries to the pelvis
C. hematuria
D. dysuria
E. oliguria
9. Male patients with suspected injury to the urethra should
A. be catheterized right away
B. undergo investigation of the urethra first (such as urethrogram) before any manipulation
on the urethra
C. have a suprapubic cystostomy right away
D. have an intravenous pyelography
10. In the diagnostic evaluation of patients with nontraumatic renal problems, which among the areas of assessment takes the highest priority?
A. renal failure or not
B. acute or chronic condition
C. obstructive or nonobstructive nephropathy or uropathy
D. lithiasis or nonlithiasis cause
E. infectious or noninfectious disorder
11. The earliest sign of acute renal failure is
A. oliguria
B. fatigue
C. anemia
D. edema
E. hypertension
12. The most common clinical presentation of chronic renal failure is
A. anuria
B. oliguria
C. chronic fatigue
D. edema
E. hypertension
13. A reliable clue for renal failure in the ancillary diagnostic procedures is
A. azotemia
B. electrolyte derangements
C. shrunken kidneys on imaging
D. 500 cc of urine output during the last 24 hours
14. In the absence of renal failure, which among the areas of diagnostic assessment takes the highest priority in patients with NO history of trauma?
A. Acute or chronic condition
B. obstructive or nonobstructive nephropathy or uropathy
C. infectious or noninfectious disorder
D. parenchymal or tract disorder
E. malignant or nonmalignant disorder
15. The most common sign of acute obstructive uropathy is
A. sudden onset of severe colicky abdominal pain
B. oliguria
C. feeling of inadequate voiding
D. urgency
E. hesitancy
16. The most common sign of chronic obstructive uropathy is
A. severe colicky abdominal pain
B. anuria
C. feeling of inadequate voiding
D. palpable mass
E. dysuria
17. The most common cause of acute obstructive uropathy in the male is
A. urolithiasis
B. urethral stricture
C. benign prostatic hypertrophy
D. prostatic carcinoma
E. urinary bladder carcinoma
18. The most common cause of chronic obstructive uropathy in the male is
A. urolithiasis
B. urethral stricture
C. benign prostatic hypertrophy
D. prostatic carcinoma
E. urinary bladder carcinoma
19. The most common cause of obstructive uropathy (acute and chronic combined) in the male is
A. urolithiasis
B. urethral stricture
C. benign prostatic hypertrophy
D. prostatic carcinoma
E. urinary bladder carcinoma
20. The most common cause of obstructive uropathy in the female is
A. urolithiasis
B. urethral stricture
C. cervical cancer
D. radiation for cervical cancer
E. urinary bladder carcinoma
Questions 21-25
A. Ureteral pain
B. Kidney pain
C. Both
D. Neither
21. Dull, aching pain
22. Severe, colicky pain
23. Possible radiation toward the umbilicus
24. Possible radiation to the testicle or labium
25. Tenderness of costovertebral angle
26. In a patient presenting with a right lower quadrant abdominal pain,
1. You will suspect urinary tract infection if there is associated dysuria.
2. You will suspect acute appendicitis if there are NO symptoms referable to the urinary tract
or other organ/system.
3. You will do urinalysis if there are associated symptoms of dysuria.
4. You will do urinalysis even if there are NO associated symptoms of dysuria.
27. Which of the following statements is the strongest indication for a paraclinical diagnostic procedure?
A. You can NEVER be absolutely certain of your clinical diagnosis
B. You want to CONFIRM a clinical diagnosis which you are certain of
C. You want to DOCUMENT a clinical diagnosis which you are certain of
D. When you are NOT certain of your clinical diagnosis
Questions 28- 30
Match the content of the urine examination with the primary disease suspect.
A. Nephrotic syndrome
B. Acute glomerulonephritis
C. Urinary tract infections
D. Prostatic tumor
28. Pyuria
29. Hematuria
30. Proteinuria
31. In patients complaining of non-obstructive dysuria, the initial paraclinical or ancillary diagnostic procedure is
A. dipstick
B. urinalysis
C. urine culture
D. ultrasound
E. urethrogram
32. In patients suspected of urolithiasis, in the absence of renal failure, the most cost-effective DEFINITIVE diagnostic procedure is
A. urinalysis
B. KUB-IVP
C. renal scan
D. ultrasound
E. CT scan
33. In patients suspected of non-obstructive renal parenchymal disorder, in the absence of renal failure, the most cost-effective INITIAL diagnostic procedure is
A. urinalysis
B. KUB-IVP
C. ultrasound
D. CT scan
E. renal scan
34. In patients suspected of non-obstructive renal parenchymal disorder, in the absence of renal failure, the most cost-effective DEFINITIVE diagnostic procedure is
A. renal biopsy
B. KUB-IVP
C. ultrasound
D. CT scan
E. renal scan
35. Interpret the following report on dipstick method: +1 protein small blood small leukocyte
A. normal
B. abnormal
C. equivocal
36. Significant pyuria is considered to be present if on urinalysis
A. WBC =/> 5 hpf
B. WBC =/> 10 hpf
C. WBC =/> 15 hpf
D. WBC =/> 20 hpf
Questions 37-40
Interpret the following reports on urinalysis.
A. Normal
B. Abnormal
C. Equivocal
37. RBC - 4 hpf; WBC - 5 hpf; no casts
38. RBC - 5 hpf; WBC - 5 hpf; no casts
39. RBC - 2 hpf; WBC - 10 hpf; no casts
40. RBC - 5 hpf; WBC - 10 hpf; + casts
41. The most common organisms isolated in urinary tract infections is
A. E. coli
B. Chlamydia
C. gonococcus
D. pseudomonas
E. streptococcus
42. To be significant for a diagnosis of urinary tract infection, a urine culture should have a colony of at least
A. 10 (x3)
B. 10 (x4)
C. 10 (x5)
D. 10 (x6)
43. In patient suspected of bladder carcinoma, the most cost-effective diagnostic procedure is
A. cystoscopy and biopsy
B. ultrasound
C. cystogram
D. KUB-IVP
E. CT scan
44. In patients with a palpable mass suspected of prostatic carcinoma, the most cost-effective diagnostic procedure is
A. prostatic specific antigen
B. acid phosphatase
C. rectal exam
D. ultrasound
E. prostatic biopsy
Questions 45 -50
Match the renal related conditions with the principle of treatment.
A. Repair
B. Promote renal function
C. Control infections
D. Provide artificial kidney
E. Remove obstruction
45. End-stage renal disease with uremia
46. Urolithiasis
47. Trauma
48. Cystitis
49. Hypovolemia shock
50. Nephrotic syndrome
ROJ@17nov6