The Renal Problem
Pretest
AL Anatomy
7. In the male, obstruction of the ureter by ureteric stones occur most often at which of the following portions of this structure?
E
A. nearest the kidney
B. on the side wall of the pelvis
C. just superior to the ischial spine
D. just lateral to the ductus deferens
E. where it crosses the external iliac artery and the brim of the pelvis
10. All the following are correct concerning benign prostatic hypertrophy EXCEPT
D
A. nocturia
B. dysuria
C. urgency
D. extravasation of urine into the superficial perineal pouch
E. common in older men
14. All the following statements concerning benign prostatic hyperplasia are correct EXCEPT
D
A. it usually affects the “middle” lobe
B. it occurs with increasing frequency beyond the 5th decade of life
C. it frequently causes urethral obstruction
D. it is the second leading cause of death in men after age 75
E. it can be readily palpated digitally
15. All the following statements concerning cancer of the bladder are correct EXCEPT it
A
A. originates in the muscular coat
B. tends to be superficial
C. tends to be multiple
D. can be examined with a cystoscope
E. develops in the lining epithelium
Questions 11-15
Associate each of the following phrases with one of the conditions listed below.
A. Ectopia of the bladder
B. Hypospadias
C. Epispadias
13. Seen frequently in combination with epispadias
A
14. The urethra is located on the inferior aspect of the penis
B
15. The urethra is located on the dorsal aspect of the penis
C
Questions
A. Pelvic splanchnic nerve
B. Pudendal nerve
C. Inferior hypogastric plexus
D. Vagus nerve
1. Pain fibers from the pelvic portion of the ureter
C
2. Serves the emptying reflex of the urinary bladder
A
3. Impulses of pain due to an overstretched urinary bladder
C
4. Sympathetic innervation of the prostate gland
C
24. All the following statements concerning the urinary bladder are correct EXCEPT
C
A. when filled, it contains approximately 500cc of urine
B. it is attached to the base of the prostate gland in males
C. it lies on the uterus in females
D. it is enveloped in endopelvic fascia
E. it is bounded posteriorly by the rectovesical septum in males
25. In spite of its rounded form, the bladder is peaked anteriorly at its apex by the
D
A. broad ligament
B. suspensory ligament
C. frenulum pudendi
D. median umbilical ligament
E. interureteric fold
29. The vesical trigone is bounded by which of the following structures at its inferior (anterior) angle?
B
A. openings of the ureters
B. urethral aperture
C. interureteric fold
D. puboprostatic ligament
E. uvula
30. The arteries of the bladder are the superior and inferior vesical arteries that arise from which of the following arteries?
D
A. femoral
B. obturator
C. superior gluteal
D. internal iliac
E. aorta
31. All the following statements concerning the innervation of the bladder are correct EXCEPT
B
A. the inferior hypogastric plexus contributes to the vesical plexus
B. the parasympathetic innervation is provided by the vagus
C. the parasympathetic innervation serves the emptying reflex
D. afferent impulses are conducted along both the sympathetic and parasympathetic fibers
E. impulses of pain due to an overstretched bladder travel with the sympathetic fibers
32. All the following statements concerning the pelvic ureter are correct EXCEPT
D
A. it descends retroperitoneally on the side of the pelvic wall
B. it is approximately 12.5 cm long
C. it begins at the point where the ureter crosses the bifurcation of the common iliac artery
D. the lumen of the ureter is uniform throughout
E. it crosses medially the obturator nerve and vessels and the umbilical artery
33. In the female, the ureter has several relationships of special significance including
C
A. it is extraperitoneal
B. it forms the anterior and superior limits of the ovarian fossa
C. it is crossed obliquely by the uterine artery
D. it is in contact with the lateral fornix of the vagina
E. it crosses the cervix of the uterus
34. All the following structures are traversed by the male urethra EXCEPT the
C
A. prostate gland
B. sphincter urethrae muscle
C. superficial transverse perineus muscle
D. perineal membrane
E. penis
35. Most of the ducts of the prostate gland open into the
B
A. urethral crest
B. prostatic sinuses
C. seminal colliculus
D. prostatic utricle
E. ejaculatory duct
36. All the following statements concerning the membranous portion of the urethra in males are correct EXCEPT
C
A. it traverses the annular part of the sphincter urethrae muscle
B. it traverses the perineal membrane
C. it is the longest part of the urethra
D. the bulbourethral glands arelocated on either side of the membranous portion of the urethra
E. the wall of the membranous portion is thin
37. All the following statements concerning the female urethra are correct EXCEPT
E
A. it corresponds to the prostatic and membranous portions of the male
B. its external orifice is immediately in front of that of the vagina
C. it is behind the glans clitoridis
D it perforates the perineal membrane
E. it is characterized by the absence of urethral glands
57. All the following statements concerning pelvic splanchnic nerves are correct EXCEPT
D
A. they contain preganglionic parasympathetic fibers
B. they convey visceral afferents from the pelvic plexus to sacral segments of the spinal cord
C. they contribute to the formation of the inferior hypogastric plexus
D. they are branches of the sciatic nerve
E. they are known as nervi erigentes
63. Which of these structures is NOT a component of the bladder?
E
A. vesical trigone
B. detrusor muscle
C. pubovesical muscle
D. ureteric ostia
E. vesical sphincter
64. The male urethra traverses all the following structures EXCEPT the
B
A. prostate gland
B. ejaculatory duct
C. urogenital diaphragm
D. sphincter urethra
E. internal urethral orifice
85. Correct relations of the female ureters include which of the following?
B
A. they are equidistant from each side of the cervix
B. they cross the lateral fornix of the vagina
C. they cross above the broad ligament
D. they enter the bladder behind the vagina
E. they cross above the uterine artery
55. The right suprarenal vein drains into which of the following veins?
E
A. right renal
B. inferior mesenteric
C. superior mesenteric
D. portal
E. inferior vena cava
57. Which of the following structures is located in the renal column?
D
A. interlobular arteries
B. collecting tubule
C. arcuate arteries
D. interlobar arteries
E. minor calyx vein
Pretest Anatomy
150. The false capsule of the kidney (renal or Gerota’s fascia) separates paranephric and perinephric fat and prevents spread of renal infection to all the following location EXCEPT the
B
A. contralateral kidney
B. deep pelvics
C. infracolic compartment of the greater sac
D. lesser sac
E. supracolic compartment of the greater sac
151. The renal cortex is the site of all the following subunits of the juxtamedullary nephron EXCEPT the
A
A. descending limp of the loop of Henle
B. distal convoluted tubule
C. macula densa
D. renal corpuscle
E. proximal convoluted tubule
152. Molecules secreted into the circulation by the renal cortex include
C
A. aldosterone and antidiuretic hormone
B. angiotensinogen and angiotensin II
C. erythropoietin and renin
D. glucocorticoids and mineralocorticoids
166. The Blood supply to the ureters is derived from all the following arteries EXCEPT the
C
A. common iliac
B. gonadal
C. inferior mesenteric
D. inferior vesical
E. renal
Anatomy, Wilson
Anatomy
Neurogenic
187. A loss of urinary bladder function would involve damage to parasympathetic preganglionic nerve fibers that have their cell bodies in the
C
A. brain
B. lateral horn of all thoracic spinal cord levels
C. sacral spinal cord segments 2, 3, and 4
D. lateral horn of the spinal cord at the upper lumbar levels
E. lateral horn of all thoracic and upper three lumbar spinal cord levels
Cancer
189. From which of the following sites is primary cancer most likely to metastasize to the lung by venous spread?
C
A. ileum
B. appendix
C. kidney
D. transverse colon
E. sigmoid colon
191. Interruption of blood flow in the internal iliac artery would affect blood flow to each of the following EXCEPT the
C
A. medial thigh muscles
B. ductus deferens
C. lower abdominal wall and rectus abdominis muscle
D. urinary bladder
E. rectum
201. The deep perineal space in the male contains each of the following EXCEPT the
B
A. membranous urethra
B. prostate gland
C. bulbourethral gland
D. deep transverse perineus muscle
E. sphincter urethrae muscle
20. Each of the following characterizes the female urethra EXCEPT
C
A. it has mucosal glands
B. it is usually lined with stratified squamous epithelium
C. its lamina propria is thin and contains smooth muscle
D. it has a sphincter urethrae consisting of skeletal muscle
E. its muscular coat contains two layers of smooth muscle
51. The cortical labyrinth of the kidney contains
B
A. thin segments of Henle’s loop
B. proximal convoluted tubules
C. renal columns
D. papillary ducts
E. the peritubular vascular plexus
64. The glomerulus of the renal corpuscle has which of the following two blood vessels associated with it?
D
A. an artery and a vein
B. an afferent and an efferent vein
C. a glomerular artery and a glomerular vein
D. an afferent and an efferent arteriole
E. two capillaries
65. The urinary bladder is lined with
B
A. stratified squamous epithelium
B. transitional epithelium
C. pseudostratified squamous epithelium
D. simple squamous epithelium
E. cuboidal epithelium
72. In the kidney, one would expect to find glomeruli almost exclusively confined to the
A
A. cortex
B. renal pelvis
C. medulla
D. capsule
E. loop of Henle
103. That portion of the nephron unit whose cells have the most extensive brush border is the
D
A. ascending limp of the loop of Henle
B. distal convoluted tubule
C. collecting tubule
D. proximal convoluted tubule
E. arched collecting tubule
113. The central component of the unit membrane consists primarily of
B
A. potassium
B. phospholipid
C. calcium
D. smooth endoplasmic reticulum
E. proteins
124. Transitional epithelium prevents urine from leaking out of the bladder because of its
B
A. gap junctions
B. tight junctions
C. desmosomes
D. termal web
E. glycocalyx
129. Specializations of the surfaces of epithelial cells that permit the passage of low-molecular-weight particles through the cell membranes of contiguous cells are
A
A. gap junctions
B. tight junctions
C. desmosomes
D. not known to exist in mammalian tissues
E. junctional complexes
132. The smallest molecules in the blood not filtered by the kidney are probably held back by the
B
A. capillary endothelium
B. slit membrane of the podocytes
C. basal lamina of the capillary
D. basal lamina of the podocytes
E. parietal layer of Bowman’s capsule
140. Each of the following parts of the nephron are lined with simple squamous epithelium EXCEPT
A
A. the collecting tubule
B. the proximal convoluted tubule
C. Bowman’s capsule
D. the distal convoluted tubule
E. the thin loop of Henle
156. At the pole of the renal corpuscle, the juxtaglomerular cells are in direct contact with the
D
A. proximal tubule
B. loop of Henle
C. efferent arteriole
D. afferent arteriole
E. distal tubule
157. The distal convoluted tubule of the kidney differs histologically from the proximal tubule by
C
A. being more convoluted
B. having taller columnar cells
C. lacking a brush border
D. having a smaller lumen
E. having fewer cells in its wall
165. Which of the following segments of the nephron is essential for producing a hypertonic urine?
B
A. the proximal convoluted tubule
B. the thin segment of the loop of Henle
C. the distal convoluted tubule
D. Bowman’s capsule
E. the thick segment of the loop of Henle
172. Multinucleate cells are frequently associated with the
C
A. distal convoluted tubule
B. parotid duct
C. liver
D. gallbladder
E. esophagus
173. Podocytes are associated with which of the following parts of the urinary system?
E
A. distal convoluted tubule
B. urinary bladder
C. major calyces
D. thick limb of the loop of Henle
E. visceral layer of Bowman’s capsule
174. About 80% of the sodium and water filtered from the blood in the renal corpuscle is resorbed by the
D
A. thin limb of the loop of Henle
B. distal convoluted tubule
C. thick limb of the loop of Henle
D. proximal convoluted tubule
E. collecting tubule
180. The proximal convoluted tubule is actively involved in the resorption of each of the following EXCEPT
E
A. glucose
B. water
C. sodium
D. amino acids
E. high-molecular-weight proteins
181. Which of the following characterizes the prostate gland?
D
A. it serves as a storage gland for sperm
B. it is formed by six to eight simple tubular glands
C. it lacks a definite connective-tissue capsule
D. it is the main source of acid phosphatase in the semen
E. it is not affected by hormone levels
Physiology, Penney
338. The volume of plasma needed each minute to supply a substance at the rate at which it is excreted in the urine is known as the
B
A. diffusion constant of the substance
B. clearance of the substance
C. extraction ratio of the substance
D. tubular mass of the substance
E. filtration rate of the substance
339. Total renal blood flow of both human kidneys is what fraction of the resting cardiac output?
C
A. 5%
B. 10%
C. 25%
D. 40%
E. 50%
340. An increase in the osmolality of th extracellular compartment will
D
A. stimulate the volume and osmoreceptors, and inhibit ADH secretion
B. inhibit the volume and osmoreceptors, and stimulate ADH secretion
C. inhibit the volume and osmoreceptors, and inhibit ADH secretion
D. stimulate the volume and osmoreceptors, and stimulate ADH secretion
E. cause no change in ADH secretion
341. Which of the following combinations of data would lead you to suspect that a patient had the “syndrome of inappropriate antidiuretic hormone secretion” (SIADH)?
D
pOsm pNa mUOsm
mOsm/kg mEq/L mOsm/kg
A. 286 138 627
B. 263 126 52
C. 286 138 177
D. 263 126 426
E. 300 144 100
342. If the renal plasma flow is 600 mL plasma/min and the hematocrit is 40%, what is the renal blood flow (in mL/min)?
B
A. 1500
B. 1000
C. 960
D. 1200
E. 1800
343. The normal human glomerular filtration rate (GFR) is approximately (in mL/min)
C
A. 25
B. 50
C. 125
D. 300
E. 500
344. The role of the kidney in homoestasis may include which of the following?
E
A. secretion of certain hormones, such as angiotensin II, prostaglandins, and kinins in the
regulation of blood pressure
B. regulation of extracellular fluid composition
C. regulation of red blood cell formation
D. secretion of erythropoietin
E. all are correct
345. Body fluid compartments
C
A. do not include bone or cartilage matrices
B. account for less than 33% of total body water
C. fluctuate in size in response to environmental stress or disease
D. account for 40% of total body mass
E. A and C are correct
346. Which of the following is(are) true concerning the various fluid compartments of the body?
B
A. total body water and the fluid volumes of each compartment change very little from day to day
B. movement of water (loss or gain) is in proportion to the volumes of each compartment
C. ions annd their distribution have no effect on the volume of fluid compartments
D. in a steady-state condition, osmotic activity is very different for various body compartments
E. B and D are correct
347. The flow of fluid through the kidney
A
A. requires an arterial blood supply via the afferent arteriole
B. begins by entering a filtering unit called Bowman’s capsule
C. passes through the ducts of Bellini before exiting from the kidney
D. begins in the proximal convoluted tubule by filtration, followed by reabsorption and secretion
of the filtrate
E. A, B, and C are correct
348. Which is a feature of the glomerulus?
E
A. podocyte
B. fenestrated epithelium
C. slit membrane
D. foot processes
E. all are correct
349. Which of the following is(are) true regarding the Starling hypothesis for capillary exchange?
A
A. requires knowing the protein concentration in the proximal tubular fluid
B. can only be estimated for the kidney as a whole
C. describes how fast fluid crosses the glomerulus under a given filtration pressure
D. is the product of coefficient K divided by the algebraic sum of the glomerular capillary
hydrostatic, proximal tubular hydrostatic, glomerular capillary oncotic, and proximal
tubular fluid oncotic pressures
E. A and C are correct
350. Which of the following is true regarding glomerular filtration rate (GFR)-capillary flow?
B
A. at higher capillary flow rates, the net filtration pressure is reduced thereby lowering the GFR
B. at higher capillary flow rates, the plasma oncotic pressure is lower, net filtration pressure is
elevated, and GFR increases
C. GFR remains relatively constant because the mean hydrostatic capillary pressure remains
unaltered
D. when flow is increased the plasma oncotic pressure increases more over a given distance
along the capillary
E. B and D are correct
351.Which of the following does NOT increase the filtration coefficient K?
E
A. prostaglandins
B. norepinephrine (a vasoconstrictor)
C. angiotensin II
D. acetylcholine (a vasodilator)
E. all are correct
352. Which of the following classes of molecules are transported by the renal epithelia?
E
A. organic bases
B. aliphatic acids
C. aromatic acids
D. monovalent and polyvalent ions
E. all are correct
353. Processes involved in the transport of materials across the tubular epithelium are dependent upon
E
A. size of the molecules
B. concentrating gradient
C. lipid solubility
D. charge
E. all are correct
354. Characteristics of active transport systems include
A
A. molecular specificity
B. insensitivity to inhibitors
C. saturation at low concentrations
D. transport rate lower than normally would be predicted for a given lipid solubility and size
of a molecule
E. A and C are correct
355. Plasma threshold of a substance
C
A. is descriptive of a gradient-time system
B. means that over a small range of plasma concentrations excretion varies linearly
C. is descriptive of molecules that display tubular transport maximum (Tm) type characteristics
D. is the minimal plasma concentration at which reabsorption begins
E. A and C are correct
356. Gradient-time system characteristics include
D
A. no evidence of plasma threshold
B. excretion varies linearly
C. excretion remains constant over a wide range of infiltration rates
D. A and B are correct
E. all are correct
357. Renal function can be tested by infusing a secreted dye at progressively faster rates until saturation is achieved. Analyzing urine under these conditions
E
A. yields information on cardiovascular as well as tubular function
B. yields information on cardiovascular function
C. yields information on tubular function
D yields information on tubular function and tubular transport capacity
E. all are correct
358. According to the equation for net tubular transport rate (TR=filtration rate-excretion rate) if the transport rate is positive
B
A. secretion must have taken place
B. reabsorption must have taken place
C. excretion rate is in excess of filtration rate
D. solute must have been added to the glomerular filtrate
E. B and D are correct
359. The loops of Henle of the outer cortical nephrons
A
A. do not contribute to the medullary osmotic gradient
B. are functionally unimportant in the renal conservation of sodium and water
C. do not participate in the urinary diluting mechanism
D. do not play any important role in overall renal function and are simply unimportant
vestiges of evolutionary development
E. A and C are correct
360. In active transport, there must be
E
A. presence of carrier molecule
B. binding of solute to some membrane component
C. energy required for transport
D. directional sites in membrane pores
E. A, B, and C are correct
361. Under normal conditions in humans, the colloid osmotic pressure of the blood at the capillary level
C
A. is due primarily to presence of diffusible crystalloids
B. is balanced by capillary oncotic pressure
C. is balanced by capillary hydrostatic pressure
D. tends to inhibit the diffusion of appropriate substances for the nutritive needs of cells
E. A and C are correct
362. For those substances that are actively reabsorbed, the maximal amount that can be transported per unit time by the kidney tubules
E
A. depends on the maximum rate at which the transport mechanism itself operates
B. requires specific transport systems for each substance transported
C. is termed the tubular transport maximum
D. is dependent upon tubular load
E. A, B, and C are correct
363. Clearance ratios greater than 1 are most likely seen with substances which are
C
A. neither secreted nor absorbed
B. reabsorbed
C. secreted
D. bound to tubular proteins
E. none are correct
364. Solute particles move from the plasma of the renal glomerulus to the fluid in the Bowman’s capsule by
A
A. bulk flow
B. active transport
C. diffusion
D. renal flow
E. A and C are correct
365. Ammonia produced by the kidneys comes mainly from
B
A. glycine
B. glutamine
C. leucine
D. alanine
E. B and D are correct
366. Polyuria (diuresis), which occurs in the diabetic with a GFR =120 ml/min and blood sugar level =350 mg%, is indicative of
D
A. losses of water and sodium which can be prevented by administration of antidiuretic
hormone (ADH) and an aldosterone-like mineralocorticoid
B. diuresis due to reduced active transport of sodium out of the tubule because of diminished
activity of the sodium pump
C. a cellular and extracellular hydration due to water retention of the glucose; hence, diuresis
is “never” observed in a diabetic individual
D. an osmotic diuresis due to glucosuria and the water loss will exceed “salt loss”
E. B and D are correct
367. The “renal plasma threshold” for glucose will be decreased by
C
A. an increase in glucose Tm
B. a decrease in glomerular filtration rate
C. a decrease in tubular reabsorption
D. an increase in the slope of the glucose reabsorption curve
E. A and C are correct
368. The tonicity of the urine as it enters the renal collecting duct may be
B
A. isotonic
B. hypotonic or isotonic, but never hypertonic
C. hypotonic
D. hypertonic
E. hypertonic or isotonic, but never hypotonic
369. Extracellular dehydration results in
B
A. inhibition of the volume and osmoreceptors and increased ADH secretion
B. stimulation of the volume and osmoreceptors and increased ADH secretion
C. inhibition of the volume and osmoreceptors and decreased ADH secretion
D. decreased extracellular osmolality
E. B and D are correct
370. Of the following, which are CORRECTLYdefined or described?
E
A. filtration fraction: glomerular filtration rate divided by renal plasma flow
B. tubular maximum secretion: has a finite upper limit though exhibits a phenomenon
analogous to the threshold phenomenon for reabsorption
C. clearance ratio: renal clearance of one substance divided by the clearance of another
substance
D. effective renal plasma flow: volume of plasma flow supplied to the entire renal tissue
E. A, B, and C are correct
371. The juxtaglomerular apparatus
B
A. includes a long loop of Henle that dips into the medulla
B. participates in the control of aldosterone secretion through the renin-angiotension system
C. is involved in maintaining the normal balance of calcium in the body
D. functions as a sphincter around the distal tubules
E. B and D are correct
372. About 4 to 6 days after you place a “normal” patient on a low sodium diet to reduce his or her weight, which of the following will be observed?
B
A. plasma renin and aldosterone are below normal
B. plasma renin and aldosterone are above normal
C. plasma sodium concentration is below normal
D. plasma sodium concentration is above normal
E. B and D are correct
373. You have two patients (each weighing 80 kg), one of whom you give 1000 mL of distilled water (subject A), while the other you give 100 mL of isotonic saline (subject B). Both drink the fluid within the same length of time. Correct statements regarding subjects A and B include
C
A. subject A will have a smaller urinary output within 2 hours after the fluid intake
B. subject B has the greater increase in plasma volume
C. subject A has a greater change in plasma osmolality
D. subject B has the greater change in urine osmolality
E. none are correct
374. The substance(s) which makes up the greastes part of the reabsorptive “load” in the renal tubule is (are)
D
A. urea
B. glucose
C. potassium
D. sodium
E. glycine
375. The renal “countercurrent” mechanism is dependent upon the anatomic arrangement of the
E
A. loop of Henle
B. glomerulus
C. vasa recta
D. proximal tubule
E. A and C are correct
376. Secretion of aldosterone will result from
E
A. low extracellular potassium
B. low extracellular volume
C. high extracellular sodium
D. smoking, agitation, and stress
E. B and D are correct
377. Aldosterone secretion is controlled by levels of
A
A. angiotension II
B. plasma calcium
C. plasma bicarbonate
D. ADH
E. A and C are correct
378.
Questions 379-381
The following data were obtained in an 80-kg male patient during renal clearance tests.
Para-aminohipppuric acid (PAH) concentration in plasma 0.3 ug/mL
PAH concentration in urine 90.0 ug/mL
Inulin concentration in plasma 10.0 ug./mL
Inulin concentration in urine 0.6 ug/mL
pO4 concentration in plasma 0.5 uM/mL
pO4 concentration in urine 1.0 uM/mL
Hematocrit 40%
Urine flow 2 mL/min
379. The glomerular filtration rate in mL/min is
A
A. 120
B. 150
C. 180
D. 240
E. 400
380. The renal plasma flow in mL/min is
C
A. 100
B. 300
C. 600
D. 900
E. 1200
381. The renal blood flow in mL/min is
D
A. 100
B. 300
C. 600
D. 1000
E. 1200
Questions 388-395
A. Increases from normal average value
B. Decreases from normal average value
C. No change from normal average value
A patient develops an increase in mean systemic blood pressure and blood volume. Indicate how the increased blood pressure and volume would affect the following
388. Secretion of the juxtaglomerular cells of the kidney
B
389. Angiotension secretion
B
390. Adrenal cortex stimulation
B
391. Aldosterone secretion
B
392. ADH secretion
B
393. Na+ reabsorption
B
394. K+ reabsorption
A
395. H2O reabsorption
B
Questions 399-401
A. Increases from the normal average value
B. Decreases from the normal average value
C. No change from the normal average value
During the irreversible phase of hemorrhagic shock
399. Plasma protein concentration
A
400. Precapillary to post-capillary resistance ratio
B
401. Mean arterial blood pressure
B
Questions 402-406
A. 4%-5% of lean body mass
B. 12%-15% of lean body mass
C. 20%-24% of lean body mass
D. 40%-50% of lean body mass
E. 60%-70% of lean body mass
402. Total body water
E
403. Interstitial compartment water
B
404. Intracellular water content
D
405. Vascular (plasma) water content
A
406. Extracellular fluid
C
Questions 407-414
A. Increases from the normal average value
B. Decreases from the normal average value
C. No change from the normal average value
407. pCO2 of the plasma during respiratory acidosis
A
408. HCO3 concentration of the plasma during respiratory acidosis
A
409. pCO2 of the plasma during respiratory alkalosis
B
410. HCO3 concentration of the plasma during respiratory alkalosis
B
411. pCO2 of the plasma during metabolic acidosis
B
412. HCO3 concentration of the plasma during metabolic acidosis
B
413. pCO2 of the plasma during metabolic alkalosis
A
414. HCO3 concentration of the plasma during metabolic alkalosis
A
Pretest Pathology
334. All the following characteristics are associated with polycystic kidney EXCEPT
A
A. massive unilateral enlargement
B. autosomal dominant inheritance in adult form
C. autosomal recessive inheritance in childhood form
D. hepatic cysts in childhood form
E. possible association with berry aneurysms
336. A patient being investigated for hematuria and proteinuria has a renal biopsy that shows focal glomerulonephritis. All the following diseases can be associated with focal glomerulonephritis EXCEPT
E
A. bacterial endocarditis
B. anaphylactoid purpura
C. systemic lupus erythematosus
D. hereditary nephritis (Alport’s syndrome)
E. diabetes mellitus
339. Marked thickening of the glomerular basement membrane may be seen in
B
A. lipoid nephrosis
B. membranous glomerulonephritis
C. Goodpasture’s syndrome
D. acute pyelonephritis
E. chronic glomerulonephritis
342. An 18-month-old infant is evaluated for generalized tissue edema and ascites. Urinalysis shows numerous hyaline casts and lipid droplets. Total plasma protein and albumin are markedly decreased, whereas total lipids are increased. Statements applicable to nephrotic syndrome include that
B
A. the problem is hepatic, not renal
B. electron microscopy is diagnostic
C. light microscopy is diagnostic
D. exacerbations are uncommon
E. response to steroid therapy is poor
344. The renal biopsy of a 2-year-old child who has a history of abdominal pain and bloody diarrhea, followed by acute glomerulonephritis, Coombs’-negative severe hemolytic anemia, and renal failure shows evidence of glomerular fibrin deposition. The likely diagnosis might include
D
A. lupus erythematosus
B. acute poststreptococcal glomerulonephritis
C. lipoid nephrosis
D. hemolytic-uremic syndrome
E. bacterial endocarditis
346. Dilatation of the renal pelvis, clubbing of the calyces, and irregular reduction in parenchymal mass is most compatible with which of the following conditions?
C
A. cystic renal dysplasia
B. acute pyelonephritis
C. chronic pyelonephritis
D. acute glomerulonephritis
E. chronic glomerulonephritis
351. Correct statements about renal cell carcinoma include all the following EXCEPT that
B
A. it is sometimes associated with polycythemia
B. it is sometimes associated with tuberous sclerosis
C. it may produce glucocorticoids
D. it originates from proximal convoluted tubular cells
E. it occurs predominantly in the sixth decade
354. Malacoplakia of the urinary bladder is considered to be associated with
E
A. tuberculosis
B. urothelial carcinoma
C. schistosomiasis
D. staphylococcal infections
E. defects in phagocytosis
357. A urinary specimen from a very ill renal transplant patient shows an abnormal renal tubular epithelial cell with a large, intranuclear inclusion surrounded by a clear halo. The disease diagnosed is associated with all the following EXCEPT
E
A. interstitial pneumonitis
B. hepatitis
C. a herpes virus
D. gastrointestinal ulcers
E. detection of antigen in 1 to 3 weeks
335. A major role in the exclusion of albumin from the ultrafiltrate in th enormal human glomerulus is played by
D
A. sodium-potassium ATPase
B. parietal epithelium
C. endothelial fenestrations
D. proteoglycans
E. podocytes
337. A significant role in vascular permeability, particularly in the renal glomerulus, is played by
E
A. collagen type IV
B. desmin
C. fibronectin
D. podocytes
E. polyanions
338. Acute poststreptococcal glomerulonephritis usually does all the following EXCEPT
B
A. follow infection with group A beta-hemolytic streptococci
B. follow a streptococcal infection in less than 5 days
C. have a better prognosis in children than in adults
D. show low serum complement levels (hypocomplementemia)
E. exhibit elevation of antistreptolysin O (ASO) titer
340. All the following renal disorders are associated with the nephrotic syndrome EXCEPT
D
A. membranous glomerulonephritis
B. lipoid nephrosis
C. membranoproliferative glomerulonephritis
D. acute ubular necrosis
E. focal segmental glomerulosclerosis
341. A linear pattern of immunoglobulin deposition along the glomerular basement membrane that can be demonstrated by immunofluorescence is typical of
C
A. lupus nephritis
B. diabetic glomerulopathy
C. Goodpasture’s syndrome
D. Goldblatt’s kidney
E. renal vein thrombosis
343. A 10-year-old boy has a bout of ordinary upper respiratory infection followed within 36 h by an episode of hematuria. There are no joint symptoms, gastrointestinal symptoms, petechiae, or rashes. To confirm the suspicion of Berger’s disease, which of the following is indicated?
C
A. examination of urinary sediment
B. renal scan
C. renal biopsy immunofluorescence
D. creatinine clearance
E. intravenous pyelogram
345. An adult medical laboratory technician recovering from hepatitis B develops hematuria, proteinuria, and red cell casts in the urine. Which of the following would best describe the changes within the kidney in this patient?
C
A. Plasma cell interstitial nephritis
B. IgG linear fluorescence along the glomerular basement membrane
C. Granular deposits of antibodies in the glomerular basement membrane
D. Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits
E. Nodular hyaline glomerulosclerosis
347. Acute tubular necrosis (ATN) is a fairly common renal lesion and is associated with all the following EXCEPT
A
A. red cell casts in the urine
B. proteinuria
C. proximal tubular damage in toxic ATN
D. oliguria
E. acute renal failure
348. What is the correct treatment for a patient who has hypertension secondary to unilateral renal artery stenosis when the contralateral kidney shows severe arteriolonephrosclerosis?
D
A. ureteral reimplantation
B. removal of the kidney supplied by the stenotic artery
C. repair of the renal artery stenosis and ipsilateral nephrectomy
D. repair of the renal artery stenosis and contralateral nephrectomy
E. nonsurgical management
349. All the following renal disease cause hypertension EXCEPT
A
A. small, bilateral renal infarcts
B. renal artery arteriosclerosis
C. fibromuscular dysplasia of the renal artery
D. hydronephrosis
E. pyelonephritis
350. All the following statements are true of urinary calculi EXCEPT
B
A. they are more common in males
B. they are bilateral in 40% of cases
C. they are radiopaque in about 90% of cases
D. they may be associated with Pseudomonas infections
E. the incidence is increased in leukemia
355. A sexually active man who has had a negative evaluation for gonococcal infection and who complains of persistent dysuria but no other symptoms should be considered to have
D
A. prostatic hypertrophy
B. epididymitis
C. orchitis
D. nonspecific urethritis
E. renal stones
Questions 388-391
Match each disease with the pathologic finding that is most characteristic.
A. Malignant nephrosclerosis
B. Benign nephrosclerosis
C. Preeclampsia
D. Analgesic abuse nephropathy
E. Systemic lupus erythematosus
388. Hyaline arteriosclerosis
B
389. Swollen glomerular endothelial cells
C
390. Papillary necrosis
D
391. Arteriolar fibrinoid necrosis
A
Questions 392-395
Match the renal disorders with the pathologic findings with which they are most likely to be associated.
A. Hyalinized glomeruli
B. Splitting of the glomerular basement membrane
C. Diffuse thickening of capillary walls
D. Mesangial deposits and subepithelial “humps”
E. Linear IgG deposits
392. Membranoproliferative glomerulonephritis
B
393. Membranous glomerulonephritis
C
394. Poststreptococcal glomerulonephritis (PSGN)
D
395. Goodpasture’s syndrome
E
ROJ@17nov6