Exam - Renal - Pool 2

The Renal Problem

Specifics and Clinical Sciences and Related Topics

Pretest

Pretest Medicine

Pretest Pediatrics

Pretest Physical Diagnosis

Pretest Ob-Gyn

Pretest Pharmacology

Surgery, Metzler

Pretest Surgery

Surgery J&S

OB-GYN BRS

Pretest Medicine

Questions 348-350

A patient’s blood work shows the following: Na - 140 meq/L, K - 4.0 meq/L, BUN - 28 mg/dL, and creatinine 2.0 mg/dL. A 24-h urine collection with a total volume of 1400 mL shows a urine creatinine of 100 mg/dL, and urine Na of 70 meq/L.

348. Which of the following is a reasonable estimate of this patient’s glomerular filtration rate? (Assume 1 day = 1400 min)

A

A. 50 mL/min

B. 70 mL/min

C. 100 mL/min

D. 200 mL/min

E. 700 mL/min

349. The fractional excretion of Na (FE Na) is

A

A. 1.0%

B. 2.5%

C. 5.0%

D. 10%

E. 50%

350. Which of the following is the best estimate of this patient’s serum osmolality? (Assume Na, its accompanying anion, BUN [molecular weight 28], and glucose [molecular weight 180] are the major contributors.)

C

A. 140 mOsm/kg

B. 200 mOsm/kg

C. 300 mOsm/kg

D. 488 mOsm/kg

E. 1000 mOsm/kg

351. You are asked to evaluate a comatose patient in the emergency room. Serum electrolytes drawn on admission show the following: Na - 133 meq/L; K - 8.0 meq/L; Cl - 98 meq/L; HCO3 - 13 meq/L. An electrocardiogram shows a rhythm with absence of P waves, a widened QRS complex, and peaked T waves. Which would be the most appropriate initial step?

C

A. repeat electrolyte measurements and observe

B. attempt cardioversion

C. administer intravenous calcium gluconate

D administer hydrochlorothiazide, 25 mg orally

E. administer intravenous potassium chloride, 20 meq over 1 h

352. Glomerulonephritides associated with depressed levels of serum complement include

A

1. postinfectious glomerulonephritis (e.g., poststreptococcal glomerulonephritis)

2. membranoproliferative glomerulonephritis

3. lupus nephritis

4. IgA nephropathy

353. Multiple myeloma may be associated with

E

1. hypercalcemia

2. the Fanconi syndrome

3. distal renal tubular necrosis

4. low anion gap

354. True statements regarding adult polycystic kidney disease include

A

1. hypertension is a common finding

2. cerebral aneurysms may be seen in about 10% of the cases

3. the genetic defect in the majority of patients lies on chromosome 16

4. the disease is transmitted in an autosomal recessive pattern

355. True statements regarding polyarteritis nodosa (PAN) include which of the following?

B

1. renal arteriography can be helpful in the diagnosis of “classic” (macroscopic) PAN

2. hypertension is rare in classic PAN

3. PAN may be associated with high titers of antineutrophilic cytoplasmic antibody

4. steroid therapy is felt to be ineffective in PAN

356. True statements regarding poststreptococcal glomerulonephritis (PSGN) include

B

1. it is typically associated with infection by group A beta-hemolytic streptococcus

2. the latency from the infection to renal disease is typically 2 days

3. complement levels usually return to normal within 6 weeks

4. most children with PSGN progress to chronic renal failure

Questions 357-360

Match each patient with the most likely renal calculi

A. Calcium oxalate stones

B. Struvite (triple-phosphate0 stones

C. Cystine stones

D. Uric acid stones

357. Patient with a myeloproliferative disorder

D

358. Patient with Crohn’s disease

A

359. Patient with recurrent urinary tract infections by Proteus species

B

360. A 20-year-old man with recurrent stones; urinalysis shows many hexagonal crystals

C

Questions 361-364

In the following patients with the nephrotic syndrome, choose the likely finding on renal biopsy.

A. Focal and segmental areas of mesangial sclerosis

B. Diffuse mesangial deposition of acidophilic material with yellow-green birefringence on

Congo red staining

C. Normal glomeruli on light microscopy (LM) with fusion of foot processes noted on electron

microscopy (EM)

D. Diffuse thickening of the glomerular basement membrane on LM with subepithelial dense

deposits on EM

361. A 4-year-old child with proteinuria

C

362. A patient treated with penicillamine for 10 months

D

363. A 28-year-old HIV-positive patient

A

364. A patient with familial Mediterranean fever

B

Questions 365-368

Match each patient with the most likely set of electrolytes and blood gases.

Serum Electrolytes (meq/L) Arterial Blood Gas Urinary

PCO2 Chloride

Na K Cl HCO3 pH (mmHg) (meq/L)

A. 136 3.2 90 37 7.51 48 5

B. 136 3.1 113 16 7.32 32 -

C. 135 5.5 100 8 7.20 20 -

D. 143 2.9 97 36 7.50 47 50

365. Patient with diarrhea

B

366. Patient with diabetic ketoacidosis

C

367. Patient with vomiting

A

368. Patient with mineralocorticoid excess from an adrenal tumor

D

Questions 369-371

Match the diuretic with the physiological properties noted below.

A. Increases reabsorption of calcium

B. Inhibits the Na/K/2Cl carrier along the thick ascending loop of Henle

C. May induce a metabolic acidosis

D. Commonly causes hyperkalemia

E. None of the above

369. Furosemide

B

370. Acetazolamide

C

371. Hydrochlorothiazide

A

Questions 372-375

Match the drugs below with their characteristic nephrotoxic effect.

A. Allergic interstitial nephritis (AIN)

B. Nonoliguric acute tubular necrosis (ATN)

C. Crystalline nephropathy

D. Worsening azotemia in a patient with underlying renal insufficiency

E. Distal renal tubular acidosis

372. Gentamicin

B

373. Methicillin

A

374. Acyclovir

C

375. Tetracycline

D

5. A 15-year-old boy develops painless hematuria, myalgias, and malaise immediately following a viral respiratory infection. Renal biopsy reveals a focal and segmental proliferative glomerulonephritis with mesangial matrix increase and hypercellularity; immunofluorescence reveals diffuse staining for IgA and C3 in all mesangial areas. True statements about this boy’s condition include that

C

1. depressed levels of C3 and C4 are commonly found

2. subendothelial and subepithelial deposits are associated with more severe disease

3. early steroid therapy alters the natural history of the illness

4. after 25 years, 50% of patients will have developed end-stage renal disease

Pretest Pediatrics

279. The presence of drug-induced nephrotic syndrome should be most highly suspected in a proteinuric patient who has received which of the following drugs?

C

A. tetracycline

B. streptomycin

C. trimethadone

D. diazepam

E. chlorambucil

280. A newborn boy is noted to have a remarkably thin, wrinkled abdominal wall and undescended testes. Prune-belly syndrome comes to mind. The findings to confirm it include all the following EXCEPT

C

A. oligohydramnios

B. large bladder

C. thin-walled bladder and ureters

D. club feet

E. hypoplastic lungs

281. A 7-year-old boy suffers multiple injuries as a result of blunt abdominal trauma. All the following statements concerning the proper assessment and treatment of injuries are true EXCEPT that

C

A. most renal injuries can be managed nonoperataively

B. major vascular injuries require rapid surgical intervention

C. rupture of a full bladder is highly unlikely

D. traumatic hematocoele requires surgical exploration

E. prompt surgical repair is needed for most ureteral injuries

282. Correct statements concerning nephrogenic diabetes insipidus include each of the following EXCEPT

D

A. most North Americal patients are of common descent

B. it is probably inherited by an X-linked recessive mode

C. it is thought to be a consequence of an enzymatic or biochemical renal tubular abnormality

D. it results in progressive edema

E. excessive thirst is a symptom

283. The onset of chronic renal failure is likely to be associated with each of the following findings EXCEPT

B

A. growth retardation

B. oliguria

C. anorexia

D. muscle cramps

E. bone and joint pain

284. An exogenous substance that is used to measure glomerular filtration rate should be

C

A. physiologically active

B. capable of binding with plasma proteins

C. freely filterable at the glomerulus

D. secreted by the renal tubule

E. reabsorbed by the renal tubule

Questions 285-286

285. Physical examination of a baby boy shortly after birth reveals a large bladder and palpable kidneys. A diagnosis of posterior urethral valves was suspected prenatally when a sonogram showed an enlarged bladder and bilateral hydronephrosis. A voiding cystourethrogram performed on the baby demonstrated an area of obstruction and proximal dilatation of the posterior urethra. Associated features might include any of the following EXCEPT

E

A. oligohydramnios

B. sepsis

C. urinary tract infection

D. poor urinary stream

E. pulmonary hyperplasia

286. In spite of vigorous medical and surgical efforts, this child with a severe obstructive uropathy has a 20% reduction of glomerular filtration rate and elevated levels of serum urea nitrogen and creatinine. He is in chronic renal failure. He probably exhibits all the following EXCEPT

A

A. polycythemia

B. rickets

C. glucose intolerance

D. growth failure

E. neurodevelopmental delay

288. Funduscopic examination of a 13-year-old girl shows general and focal arteriolar narrowing. A hemorrhage is observed in the left retina, and sclerosis is present. Her blood pressure is 180/110 mmHg. This girl would be likely to exhibit all the following symptoms or signs EXCEPT

C

A. isolated facial nerve palsy

B. headache

C. hyporeflexia

D. norturnal wakening

E. left ventricular hypertrophy

289. A 2-year-old boy with undescended testes is referred to a urologist. Surgical correction will probably eliminate the risk of

C

A. testicular malignancy

B. infertility

C. torsion of testis

D. urinary tract infection

E. epididymitis

290. An Escherichia coli colony count of 2000/mm3 would be definite evidence of a urinary tract infection if the sampled urine

D

A. has a specific gravity of 1.008

B. has been taken from a catherized bladder and has a specific gravity of 1.022

C. is from an ileal-loop bag

D. is from a suprapubic tap

E. is the first morning sample

291. The findings one might expect in a 6-year-old boy with brown urine and healing impetigo include each of the following EXCEPT

E

A. hypertension

B. dyspnea

C. periorbital edema

D. hepatomegaly

E. polyuria

292. A 2-year-old boy develops bloody diarrhea shortly after eating in a fast-food restaurant. A few days later, he develops pallor and lethargy; his face looks swollen and his mother reports that he has been urinating very little. In diagnosing hemolytic-uremia syndrome, all the following laboratory test results would be expected EXCEPT

E

A. very low hemoglobin

B. decreased platelet count

C. urinalysis showing hematuria and proteinuria

D. stool culture growing E. coli 0157-H7

E. positive Coombs’ test

293. A 6-year-old girl is brought to the emergency room because her urine is red. Examination with a dipstick for heme is negative. Any of the following could be implicated EXCEPT

D

A. ingestion of blackberries

B ingestion of beets

C. phenolphthalein catharsis

D. presence of myoglobin

E. ingestion of Kool-Aid

294. Red cell cast in the urine from a 7-year-old child is LEAST likely to support a diagnosis of

D

A. systemic lupus erythematosus

B. acute poststreptococcal glomerulonephritis

C. Berger’s disease

D. membranous glomerulopathy

E. mesangiocapillary glomerulonephritis

295. A 5-year-old boy comes to the emergency room at midnight with a complaint of severe scrotal pain since 7 pm. There is no history of trauma. Your first step is to

A

A. call an appropriate surgeon immediately

B. order a radioisotope scan as an emergency

C. order a urinalysis and Gram’s stain for bacteria

D. arrange for an ultrasound examination

E. order a Doppler examination

296. During the first year of a child’s life, all the following increase EXCEPT

B

A. glomerular infiltration rate

B. nephron number

C. renal plasma flow

D. tubular reabsorptive capacity

E. tubular secretory capacity

297. A 7-year-old boy has crampy abdominal pain and a rash on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. He is most likely to be affected by

B

A. systemic lupus erythematosus

B. anaphylactoid purpura

C. poststreptococcal glomerulonephritis

D. polyarteritis nodosa

E. dermatomyositis

Questions 298-300

For each conditon listed below, match the categroy to which it belongs.

A. Aprimary renal tubular defect

B. Developmental structural abnormality

C. Metabolic disorder leading to renal damage

D. Multisystem disorder

E. Primary renal disease with multiple renal manifestations

298. Cystinuria

A

299. Wilson’s disease

C

300. Alport’s syndrome

E

Questions 301-306

A. Nephrotic syndrome

B. Acute glomerulonephritis

C. Both

D. Neither

301. Serum albumin concentration of 1.9 g/L

A

302. Edema

C

303. Need to carefully monitor and restrict water intake

B

304. Cured by diuretics

D

305. Hypovolemia

A

306. Commonly accompanied by hypertension

B

Pretest Physical Diagnosis

402. Nocturia may be due to all the following EXCEPT

B

A. coffee

B. atropine

C. alcohol

D. congestive heart failure

E. nephrotic syndrome

Questions 413-417

A. Ureteral pain

B. Kidney pain

C. Both

D. Neither

413. Dull, aching pain

B

414. Severe, colicky pain

A

415. Possible radiation toward the umbilicus

C

416. Possible radiation to the testicle or labium

A

417. Tenderness of costovertebral angle (CVA)

C

Questions 418-422

A. Prostatitis

B. Cystitis

C. Both

D. Neither

418. Urinary urgency

B

419. Dysuria

C

420. Hesitancy in starting the urinary stream

A

421. Reduced forced of urinary stream

A

422. Hematuria

B

Pretest Ob-Gyn

335. There are many different causes of urinary incontinence in the female. After stress incontinence, the most common cause of urinary leakage is

B

A. detrusor dyssynergia

B. unstable bladder

C. unstable urethra

D. urethral diverticulum

E. overflow incontinence

336. The most common cause of urinary incontinence in the menopausal patient is

D

A. anatomic stress urinary incontinence

B. urethral diverticula

C. overflow incontinence

D. unstable bladder

E. fistula

337. In a patient complaining of urinary incontinence, initial testing should include

C

A. urinalysis and culture

B. urethral pressure profiles

C. intravenous pyelogram

D. cystourethrogram

E. urethrocystoscopy

341. All the following statements regarding syphilis are true EXCEPT

B

A. syphilis is produced by the spirochete Treponema pallidum

B. spirochetes are diagnosed by phase-constrast microscopy

C. the classic finding in primary syphilis is a hard chancre

D. secondary syphilis is associated with a rash over the hands and feet

E. gummas are found in late syphilis

345. False positive Venereal Disease Research Laboratories (VDRL) tests have been associated with all the following EXCEPT

D

A. narcotic addiction

B. atypical pneumonias

C. old age

D. diabetes mellitus

E. leprosy

350. For the objective diagnosis of stress urinary incontinence, which of the following tests may be performed?

E

1. urine culture

2. urethrocystoscopy

3. cystometrography

4. physical examination including neurologic evaluation, Q-tip test, and stress test

351. Etiologies of urethral diverticula can include

E

1. bacterial infection during intercourse

2. urethral stricture

3. infection of the periurethral glands

4. trauma

353. In the treatment of stress urinary incontinence, the disadvantages of the Marshall-Marchetti-Krantz procedure compared with other surgical alternatives include

D

1. urinary retention

2. increased incidence of urinary tract infections

3. high failure rate

4. osteitis pubis

354. If ureteral injury is recognized at the time of surgery, which of the following procedures could be recommended?

D

1. a longitudinal slit should be made in the ureter below the injury and a polyethylene tube

threaded into the bladder

2. if the ureter is not severed, the site of injury should be drained intraperitoneally

3. if the ureter is severed, uretero-ureteral anastomosis should be attempted, regardless of the

location of the injury

4. if possible, the severed ureter should be implanted into the bladder

355. In a patient who complains of urinary incontinence, a cystometrogram is performed to

B

1. rule out an unstable detrusor

2. diagnose stress urinary incontinence

3. determine if a patient has normal bladder sensation

4. diagnose ureterovesical reflud

Pretest Pharmacology

361. Torsemide inhibits the Na-K-2Cl cotransporters that are located in the

B

A. collecting duct

B. ascending limb of the loop of Henle

C. descending limb of the loop of Henle

D. proximal tubule

E. distal convoluted tubule

362. Conrenone, which elicits a diuretic response, is a major biotransformation product of which of the following agents?

C

A. indapamide

B. chlorthalidone

C. spironolactone

D. amiloride

E. triamterene

363. Hyperkalemia is a contraindication to the use of which of the following drugs?

E

A. acetazolamide

B. chlorothiazide

C. ethacrynic acid

D. chlorthalidone

E. spironolactone

364. A reduction in insulin release from the pancreas may be caused by which of the following diuretics?

B

A. triamterene

B. chlorothiazide

C. spironolactone

D. acetazolamide

E. amiloride

365. Acute uric acid nephrophathy, which is characterized by the acute overproduction of uric acid and by extreme hyperuricemia, can best be prevented with

C

A. antidiuretic hormone (vasopressin, ADH)

B. cyclophosphamide

C. allopurinol

D. amiloride

E. sodium chloride

366. Idiopathic calcium urolithiasis can be treated by the administration of

D

A. ethacrynic acid

B. triamterene

C. furosemide

D. hydrochlorothiazide

E. bumetanide

367. A hospitalized patient, who has been maintained on parenteral alimentation for 3 weeks, develops weakness, tremors, agitation, and finally coma. The most likely fluid and electrolyte disturbance is

C

A. hyperkalemia

B. dehydration

C. hypomagnesemia

D. acidosis

E. hypercalcemia

368. The release of antidiuretic hormone (ADH) is suppressed by which of the following durgs to promote a diuresis?

D

A. guanethidine

B. acetazolamide

C. chlorothiazide

D. ethanol

E. indomethacin

369. Antidiuretic hormone (vasopressin) is used therapeutically for

C

A. increasing uterine contractility

B. treating nephrogenic diabetes insipidus

C. treating pituitary diabetes insipidus

D. treating polyuria caused by hypercalcemia

E. decreasing chest pain in refractory unstable angina

370. Conservation of potassium ions in the body occurs with which of the following diuretics?

C

A. furosemide

B. hydrochlorothiazide

C. triamterene

D. metolazone

E. bumetanide

371. spironolatone can be characterized by which one of the following statements?

B

A. It is biotransformed to an inactive product

B. It binds to a cytoplasmic receptor

C. It is a more potent diuretic than is hydrochlorothiazide

D. It interferes with aldosterone synthesis

E. It inhibits sodium reabsorption in the proximal renal tubule of the nephron

372. The distal tubule of the nephron is the principal site of action for which one of the following?

B

A. bumetamide

B. hydrochlorothiazide

C. ethacrynic acid

D. triamterene

E. amiloride

373. Which of the following agents causes a reduction in the hypertonicity of the medullary interstitium of the kidney?

E

A. metolazone

B. spironolactone

C. hydrochlorothiazide

D. mannitol

E. ethacrynic acid

374. An enhancement of the parathyroid hormone-mediated reabsorption of calcium in the distal tubule is caused by which of the following diuretics?

E

A. acetazolamide

B. furosemide

C. triamterene

D. bumetamide

E. hydrochlorothiazide

375. Mannitol may be useful in all the following procedures EXCEPT

C

A. treatment of elevated intracranial pressure

B. treatment of elevated intraocular pressure

C. treatment of pulmonary edema with congestive heart failure

D. diagnostic evaluation of acute oliguria

E. prophylaxis of acute renal failure

376. When furosemide is administered concomitantly with other drugs, all the following can occur EXCEPT

D

A. reduction of renal clearance of lithium

B. enhancement of ototoxicity of gentamicin

C. reduction of renal excretion of salicylates

D. augmentation of pressor action of norepinephrine

E. attenuation of neuromuscular blocking effect of tubocurarine

377. Adverse interactions may occur between thiazides and all the following drug groups EXCEPT

C

A. adrenal corticosteroids

B. anticoagulants (oral)

C. aminoglycosides

D. beta-adrenergic blockers

E. antidepolarizing skeletal muscle relaxants

378. Diuretic agents that indirectly cause an increased binding of digoxin to cardiac tissue Na, K -ATPase include all the following EXCEPT

C

A. hydrochlorothiazide

B. torsemide

C. amiloride

D. ethacrynic acid

E. indapamide

379. Properties of mannitol include all the following EXCEPT

B

A. retention of water in the tubular fluid

B. the ability to be metabolically altered to an active form

C. the capacity to be freely filtered

D. effectiveness as nonelectrolytic, osmotically active particles

E. the ability to resist complete reabsorption by the renal tubule

380. True statements about adverse reactions that apply to both hydrochlorothiazide and torsemide include all the following EXCEPT

D

A. they may produce hyperglycemia

B. they elevate blood levels of uric acid

C. they decrease blood pressure

D. they may cause hyperlipidemia

E. they lower serum levels of magnesium

381. Adverse reactions associated with furosemide include allthe following EXCEPT

E

A. hyperglycemia

B. tinnitus

C. fluid and electrolyte imbalance

D. hypotension

E. metabolic acidosis

382. Chlorothiazide increases the urinary excretion of all the following EXCEPT

C

A. potassium

B. chloride

C. calcium

D. sodium

E. magnesium

383. Correct statements regarding amiloride include all the following EXCEPT

E

A. it carries an increased risk of hyperkalemia when given with an ACE inhibitor

B. it is used in combination with furosemide

C. it exhibits mild diuretic activity

D. it inhibits sodium reabsorption

E. it is a prodrug

384. Adverse reactions associated with bothe acetazolamide and antibacterial sulfonamides include all the following EXCEPT

C

A. formation of urinary calculi

B. fever

C. metabolic acidosis

D. cyrstalluria

E. exfoliative dermatitis

385. Hydrochlorothiazide is clinically useful in the treatment of all the following EXCEPT

E

A. edema caused by congestive heart failure

B. edema induced by glucocorticoids

C. hypertension with or without edema

D. liver disease with ascites

E. glaucoma by reduction of intraocular pressure

Questions 386-388

For each of the diuretic agents below, choose the anatomic site in the renal nephron where the principal action of the agent occurs.

A. Proximal convoluted tubule

B. Descendng limb of loop of Henle

C. Ascending limb of loop of Henle

D. Distal convoluted tubule

E. Late distal tubule and collecting duct

386. Ethacrynic acid

C

387. Indapamide

D

388. Triamterene

E

Questions 389-391

The table shows the urinary excretion patterns of electrolytes of diuretic drugs. For each of the diuretic agents listed below, choose the urinary excretion pattern that the drug would produce.

Drug Na Cl K Ca HCO3 Mg

A. + + + - +/- +

B. + + + - 0 +

C. + + + + 0 +

D. + + - 0 + 0

E. + - + 0 + 0

+ = increase

- = decrease

0 = no change

+/- = increase dependent on dose

389. Triamterene

D

390. Torsemide

C

391. Bumetamide

C

Questions 392 - 394

Match each statement with the appropriate drug.

A. Amiloride

B. Mannitol

C. Furosemide

D. Acetazolamide

E. Spironolactone

392. The urinary excretion of chloride is decreased

D

393. Elevated intraocular and cerebrospinal fluid pressures are reduced

B

394. Chemically, this compound is a steroid

E

Surgery, Metzler

1. On arrival at the hospital, a 38-year-old male victim of an automobile accident complains of abdominal pain. Physical exam reveals pain above the symphysis pubis, pelvic instability, and no blood at the urethral meatus. The best test for diagnosis of bladder rupture is

C

A. cystoscopy

B. intravenous pyelogram

C. cystogram

D. failure of return of a measured quantity of fluid instilled

E. blood in the urine

2. Ureteral injuries are LEAST common as a result of

B

A. radical hysterectomy

B. penetrating or blunt trauma

C. abdominoperineal resection

D. ureteroscopy

E. radiation therapy of carcinoma of the cervix

Questions 10-11

A 45-year-old woman has recurrent renal calculi and has undergone multiple extracorporeal shock wave lithotripsy (ESWL) treatments.

10. Her stone disease may be related to all of the following EXCEPT

E

A. vitamin D metabolism

B. urea-splitting bacteria

C. immobilization

D. stenosis of ureteropelvic junction

E. hyperthyroidism

11. This patient now comes to the emergency room with a history of acute onset of intense right flank pain. Urinalysis shows 10 to 20 RBCs per high power field, and subsequent IVP showed evidence of right ureteral obstruction with a 6 x 12 mm filling defect but no evidenceof calculi on the kidney, ureter, and bladder (KUB). Which of the following urinary calculi is radiolucent?

B

A. calcium oxalate

B. uric acid

C. cystine stones

D. triple phosphate stones (struvite)

E. calcium phosphate

Questions 12-13

A 15-year-old male with a long history of intermittent right flank pain was admitted with a severe attack of pain, nausea, and vomiting. The IVP shows hydronephrosis of the right kidney.

12. The most common cause of hydronephrosis is

C

A. aberrant renal artery

B. calculus

C. functional disorder of the ureteropelvic junction

D. adhesions

E. valves

13. Treatment of congenital hydronephrosis is

C

A. nephrectomy

B. nephropexy

C. pyeloplasty

D. partial nephrectomy

E. internal drainage

15. Infection with which of the following organisms commonly predisposes to urinary stone formation?

B

A. Escherichia coli

B. Proteus vulgaris and Pseudomonas aeruginosa

C. Streptococcus faecalis

D. Mycobacterium tuberculosis

E. Bacillus typhosus

21. During a periodic health evaluation, a 67-year-old male is noted to have microhematuria. An IVP and cystogram is performed. These tests show radiologic features of benign hypertrophy of the prostate (BPH), which might include all the following EXCEPT

B

A. filling defect at the base of the bladder

B. calcification of the prostate

C. diverticula of the bladder

D. bladder stones

E. ureteric dilation

24. The transabdominal approach to the kidney is advisable in

C

A. calculous disease

B. tuberculosis

C. tumor

D. cystic disease

E. hydronephrosis

25. The best test for diagnosis of prostatis is

D

A. palpation only

B. urine culture

C. cystoscopy

D. microscopic examination of prostatic secretions

E. IVP

28. In a patient with gross hematuria, a radiolucent filling defect in the renal pelvis on intravenous pyelogram may be due to

E

A. nonopaque calculus

B. blood clot

C. tumor

D. extrinsic compression

E. all of the above

30. Which of the following correlates LEAST well with significant bladder outlet obstruction secondary to benign prostatic hypertrophy?

B

A. bladder wall trabeculation on cystoscopy

B. size of the prostate on rectal examination

C. peak urinary flow rate

D. residual urine

E. recurrent infections

31. Hypospadias is generally associated with all of the following EXCEPT

D

A. dystopic urethral meatus

B. hooded dorsal foreskin

C. ventral curvature or chordee of the penile shaft

D. upper urinary tract anomalies

E. flattened glans

34. In uncomplicated cystitis, the MOST common organism found on urine culture is

B

A. group B streptococcus

B. Escherichia coli

C. Klebsiella

D. Staphylococcus aureus

E. chlamydia

35. A 50-year-old woman is being evaluated for right flank pain. She has a history of calcium oxalate renal calculi. An IVP shows a 1-cm, nonobstructing stone in the right renal pelvis. The treatment of choice is

D

A. open surgical removal

B. dissolution therapy

C. percutaneous nephrostolithotomy

D. extracorporeal shock wave lithotripsy (ESWL)

E. ureteroscopic laser integration

36. Urodynamic studies to assess the neuromuscular function of the bladder and bladder outlet may include all of the following tests EXCEPT

D

A. urethral pressure profile

B. cystometrogram

C. uroflowmetry

D. dynamic cavernosometry

E. sphincter electromyography

37. In a patient with ureteral obstruction secondary to radiation fibrosis requiring immediate decompression, which of the following is the procedure of choice when retrograde catherization is not possible?

E

A. ureteral reimplantation

B. open nephrostomy

C. nephrectomy

D. cutaneous ureterostomy

E. percutaneous nephrostomy

38. Which of the following studies is NOT generally indicated in the evaluation of a patient with significant blunt trauma and gross hematuria?

B

A. retrograde cystography

B. cystoscopy

C. retrograde urethrography

D. infusion pyelography

E. CT scan

40. A 71-year-old female complains of recent onset of pneumaturia. A CT scan is consistent with, but not diagnostic of , a vesicoenteric fistula. The most common cause of vesicoenteric fistulae is

E

A. colorectal malignancy

B. iatrogenic

C. inflammatory bowel disease

D. bladder malignancy

E. sigmoid diverticulitis

41. Stress urinary incontinence in multiparous women may be successfully by all of the following EXCEPT

B

A. vaginal urethral suspension

B. anticholinergic medication

C. Marshall-Marchetti urethral suspension

D. sympathomimetic agents

E. anterior urethropexy

42. In cadaveric renal transplantation in adults, all of the following surgical techniques are commonly employed EXCEPT

A

A. intraperitoneal placement of the kidney

B.end-to-end renal artery to recipient internal iliac artery anastomosis

C. end-to-side renal vein to recipient external iliac vein anastomosis

D. end-to-side renal artery to recipient external iliac artery anastomosis

E. submucosal ureteral anastomosis to bladder

43. All of the following agents may be part of conventional immunosuppression in cadaver kidney recipients. Which one has been most responsible for improved graft survival statistics?

B

A. antilymphocyte serum (ALS)

B. cyclosporine

C. prednisone

D. azathioprine (Imuran)

E. OKT-3

44. The following signs and symptoms are commonly seen with acute renal transplant rejection EXCEPT

A

A. gross hematuria

B. graft tenderness

C. fever

D. decreased urine sodium

E. decreased renal function

45. Which of the following early or late complications of renal transplantation is seen with reasonable frequency in a busy transplant practice?

E

A. lymphocoele

B. pneumocystis carinii infection

C. renal transplant artery stenosis

D. lymphoma and skin cancers

E. all of the above

Questions 55 -58

A. interstitial cystitis

B. posterior urethral valves

C. congenital adrenal hyperplasia

D. duplicated ureter

E. torsion of appendix testis

55. Diagnosed by voiding cystourethrography

B

56. Metanephric duct

D

57. Dimethy sulfoxide treatment

A

58. Salt-losing tendency

C

26. All of the following findings suggest urethral injury EXCEPT

E

A. blood at the external urethral meatus

B. scrotal hematoma

C. absence of a palpable prostate on rectal examination

D. high-riding prostate on rectal examination

E. blood in the rectal lumen

34. Which is the most commonly injured intra-abdominal organ in blunt trauma?

C

A. liver

B. kidney

C. spleen

D. stomach

E. colon

Pretest Surgery

446. A patient who has a flaccid neurogenic bladder may benefit initially from all the following measures EXCEPT

D

A. being trained to void at timed intervals

B. self-catheterization

C. administration of bethanechol chloride

D. limiting fluid intake to less than 300 mL/day

E. transurethral resection of the bladder neck

447. All the following statements regarding hypospadias are correct EXCEPT

E

A. it is often associated with chordee (ventral curvature of the penis)

B. it is associated with undescended testes

C. it is the most frequent fusion defect of the male urethra

D. it is a hereditary disorder

E. the most common location is penoscrotal

449. A 36-year-old man presents to the emergency room with renal colic. A radiograph reveals a 1.5 cm stone. Which of the following statements regarding his disorder is correct?

A

A. Conservative treatment including hydration and analgesics will not result in a satisfactory

outcome

B. Serial KUB (kidney, ureter, bladder) radiographs should be used to follow this patient

C. The urinalysis will nearly always reveal microhematuria

D. When the acute event is correctly treated, this disease seldom recurs

E. Elevated BUN and creatinine are expected

454. True statements regarding carcinoma of the prostate include

B

1. it has a higher incidence among American Blacks than other American ethnic groups

2. a single microscopic focus of prostate cancer discovered on transurethral resection of the

prostate is indication for radical prostatectomy

3. it arises initially in the gland’s periphery

4. it commonly produces osteoclastic bony metastases

455. During the course of an operation on an unstable, critically ill patient, the left ureter is lacerated through 50% of its circumference. It the patient’s condition is felt to be too serious to allow time for definitive repair, alternative methods of management include

B

1. ligation of the injured ureter and ipsilateral nephrostomy

2. ipsilateral nephrectomy

3. placement of a catheter from the proximal ureter through an abdominal wall stab wound

4. placement of a suction drain adjacent to the injury without further manipulation that might

convert the partial laceration into a complete disruption

456. Genitourinary tuberculosis in a male patient is suggested by which of the following findings?

E

1. microscopic hematuria

2. pyuria without bacteriuria

3. unilateral renal calcification

4. painless swelling of the epididymis

457. A pedestrian is hit by a speeding car. Radiological studies obtained in the emergency room, including a retrograde urethrogram, are consistent with a pelvic fracture with a rupture of the urethra superior to the urogenital diaphragm. Management should consist of

B

1. immediate placement of a suprapubic cystostomy tube

2. immediate placement of a Foley catheter through the urethra into the bladder to align and

stent the injured portions

3. reconstruction of the ruptured urethra after 3 to 6 months to allow for reabsorption of the

pelvic hematoma

4. immediate exploration of the pelvis for control of hemorrhage from pelvic fracture and

drainage of the pelvic hematoma

Questions 195-199

A 27-year-old diabetic, hypertensive woman who has been receiving hemodialysis for 2 years is admitted to the hospital for cadaveric renal transplantation. She is blood type B and has had four transfusions of packed red cells over the preceding 6 months.

195. Which of the following factors would preclude transplantation?

A

A. positive crossmatch

B. donor blood type O

C. two-antigen HLA match with donor

D. blood pressure of 180/100 mmHg

E. hemoglobin level of 8.2 g/dL

196. On the 14th posttransplant day, the recipient’s temperature rises to 38.5C. The serum creatinine level, previously 1.0 mg/dL, is 1.6 mg/dL. Renal scan shows good perfusion with delayed excretion. Ultrasound reveals a mildly enlarged transplant kidney with a small fluid collection near the upper pole. The white blood cell count is 3800/mm3 and the platelet count is 65,000/mm3. Appropriate management at this time might include all the following EXCEPT

B

A. increased administration of prednisone

B. administration of azathioprine

C. administration of antilymphocyte globulin (ALG)

D. administration of OKT3

E. percutaneous needle biopsy of the graft

197. On the second postoperative day, the patient remains oliguric, but there is good perfusion on the renal scan and no hydronephrosis. The most commonly used immunosuppressive therapy at his time would be administration of

D

A. cyclosporine A alone

B. cyclosporine A and steroids

C. cyclosporine A, steroids, and azathioprine

D. OKT3 and steroids

E. cyclophosphamide and steroids

198. On the 40th postoperative day, the patient feels well but is somewhat hypertensive. She had been started on ketoconazole for oral candidiasis. The serum creatinine level is 2.0 mg/dL and the serum cyclosporine level is 275 ng/mL. There are no fluid collections found on ultrasound. Appropriate initial management at this time would be to

C

A. perform an immediate biopsy with management dependent on frozen section results

B. discontinue immunosuppression with a diagnosis of systemic candidal infection

C. decrease the cyclosporine and increase the prednisone

D. start OKT3

E. administer a bolus with intravenous steroids and plan biopsy in 3 days if there is no

improvement

199. On the 21st posttransplant day, the patient is being maintained on cyclsporine A, azathioprine, and prednisone. The serum creatinine level is 1.2 mg/dL, temperature is 39.5C, and ultrasound shows a normal-size kidney with a somewhat enlarged fluid collection at the upper pole. The renal scan is normal, white blood cell count is 13,500/mm3, and platelet count is 160,000/mm3. There is a hazy infiltrate on the left lower lobe on chest x-ray. The appropriate immediate therapeutic maneuvers would be

A

A. withhold azathioprine, maintain cyclosporine, decrease prednisone dosage, aspirate the fluid

collection, and perform bronchoscopy

B. withhold azathioprine and cyclosporine, decrease prednisone dosage, and perform transplant

nephrectomy with drainage of the fluid collection

C. continue azathioprine and cyclosporine, decrease prednisone dosage, aspirate the fluid

collection, and monitor serial antiviral antibody titers.

D. maintain immunosuppressive drugs, perform plasmapheresis with infusion of

granulocytes, and begin antibiotics

E. maintain immunosuppressive durgs, perform a bone marrow biopsy, and begin antibiotics.

Questions 200-201

A 24-year-old woman presents with lethargy, anorexia, tachypnea, and weakness. Laboratory studies reveal a BUN of 150 mg/dL, serum creatinine of 16 mg/dL, and a potassium of 6.2 meq/L. Chest x-ray shows increased pulmonary vascularity and a dilated heart.

200. Management of this patient would include all the following EXCEPT

D

A. peritoneal dialysis

B. creation of a forearm arteriovenous fistula

C. sodium polystyrene sulfonate (Kayexalate) enemas

D. a 100-g protein diet

E. renal biopsy

201.In the course of 3 month’s treatment, the patient’s congestive heart failure resolves, the lethargy and weakness diminish markedly, and she is able to return to work part-time. Family immune profile studies reveal that her mother and her father each are haplotype identical with regard to HLA antigens and that her sister is a six-antigen match. The patient at this time should be urged to

C

A. continue hemodialysis three times a week

B. undergo cadaveric renal transplantation

C. accept a kidney transplant from her sister

D. accept a kidney transplant from her father

E. accept a kidney transplant from her mother

203. The primary mechanism of action of cyclosporine A is inhibition of

D

A. macrophage function

B. antibody production

C. interleukin 1 production

D. interleukin 2 production

E. cytotoxic T-cell effectiveness

204. A mother notices an abdominal mass in her 3-year-old son while giving him a bath. There is no history of any symptoms, but his blood pressure is elevated at 105/85 mmHg. Metastatic workup is negative and the patient is explored. The mass is found within the left kidney. Which of the following statements concerning this disease is correct?

A

A. This tumor is associated with aniridia, hemihypertrophy, and cryptorchidism

B. The majority of patients present with an asymptomatic abdominal mass and hematuria

C. Treatment with surgical excision, radiation, and chemotherapy results in survival of less

than 60% even in histologically low-grade tumors

D. Surgical excision is curative and no further treatment is ordinarily advised

E. This tumor is the most common malignancy in childhood

-----------------------------------------------------------------------

Prostate

From Surgery, Review for New National Boards, J&S, 1995

487. Which of the following statements are NOT true regarding prostate carcinoma in a 95-year-old man?

B

A. presence of prostate carcinoma is 95% likely in the prostate of any 95-year-old man

B. treatment should be designed to prevent the spread of the disease

C. it is associated with an elevated prostate specific antigen

D. it typically follows an indolent course

E. management is by observation

From Surgery, Metzler, 1995

14. Localized carcinoma of the prostate is BEST treated by which of the following modalities?

D

A. bilateral orchiectomy

B. estrogens

C. orchiectomy followed by estrogens

D. radical prostatectomy

E. transurethral resection of the prostate

From Pretest Pathology, 1996

365. Carcinoma of the prostate tends to do all the following EXCEPT

D

A. be adenocarcinoma

B. arise in the posterior lobe

C. cause elevation of serum acid phosphatase

D. be estrogen-dependent

E. form osteoblastic metastases

362. Within prostatic glands, features consistent with prostatic intraepithelial neoplasia (PIN) include all the following EXCEPT

B

A. cellular crowding

B. absence of a basal cell layer

C. variation in nuclear size

D. nucleoli

E. hyperchromatism

Pretest Medicine

386. True statements concerning prostate cancer and its treatment include that

A

1. bone metastases are commonly both osteoblastic and osteolytic

2. 95% are adenocarcinoma

3. tumors are frequently multifocal

4. radiation therapy rarely causes impotence

--------------

Wilms’ Tumor

From Pretest Pathology, 1996

353. All the following abnormalities are associated with an increased incidence of Wilms’ tumor EXCEPT

E

A. aniridia

B. male pseudohermaphroditism

C. hemihypertrophy

D. renal medullary cysts

E. hypoplasia of radii

From Surgery Review for New National Boards, J&S, 1995

500-503

A. Wilms’ tumor

B. Neuroblasoma

C. Both

D. Neither

500. The younger, from newborn to 2 years old, the higher the incidence

B

501. Catecholamine secretion

B

502. Combination chemotherapy effective

A

503. Benign transformation with growth occasionally occurs

B

534. Wilms’ tumor is a malignant renal tumor about which of the following statements ONLY ONE is true?

B

A. If the tumor extends through the capsule of the kidney, survival is less than 50% following

therapy

B. Combination chemotherapy is a treatment recommended for nearly all patients as an adjunct

to surgery

C. Bilateral renal involvement is incurable

D. There are no recognized patterns of associated congenital anomalies

E. The tumor is not radiosensitive

536. Which of the following statements about pediatric neuroblastoma is true?

E

A. survival, compared stage for stage, is much better than for patients with Wilms; tumor

B. The older the patient is at diagnosis, stage for stage, the better the prognosis

C. Patients with osseous metastases have a 50% complete response rate to combined

radiation and chemotherapy

D. Remarkable improvements in treatment success rate for advanced stage disease have

progressed rapidly in the past decade from poor prognosis to better than even

chance of survival

E. rarely it may be ssen to mature with the growth of the infant, passing through neuroblastoma

to ganglioneuroma

From Surgery, Metzler, 1995

Wilms’ Tumor

16. The MOST common manifestation of Wilms’ tumor is

A

A. abdominal mass

B. loss of weight

C. hematuria

D. hypertension

E. pathologic fracture of bone

53. All of the following are true of Wilms’ tumor EXCEPT

E

A. may produce hypertension or hematuria

B. majority diagnosed between 1 and 4 years of age

C. cure rate over 80%

D. associated with aniridia and hemihypertrophy

E. survival not affected by histology

Neuroblastoma

54. All of the following are true of neuroblastomas EXCEPT

D

A. most diagnosed before 8 years of age

B. may produce proptosis, black eyes, or nystagmus

C. most secrete catecholamine byproducts

D. majority present with localized disease

E. tumor calcification common

-------

Genitourinary Tumors/Cancers

Sources:

Surgery, Metzler, 1995

Pretest Pathology, 1996

From Surgery, Metzler, 1995

Renal Function

Diagnosis

39. Which of the following provides the most accurate assessment of renal function?

B

A. blood urea nitrogen (BUN)

B. creatinine clearance

C. IVP

D. free water clearance

E. concentrating ability

Hematuria

Diagnosis

33. A patient with gross hematuria comes in for evaluation. Your differential diagnosis generally includes all of the following clinical disorders EXCEPT

C

A. cystitis in women

B. calculus disease

C. cancer of the prostate

D. cancer of the kidney

E. cancer of the bladder

Renal

7. During workup for microhematuria, an IVP shows aberrant renal pelvic architecture. Subsequent

computed tomography (CT) scan reveals a 4-cm intraparenchymal mass that enhances with contrast and is consistent with carcinoma. The statement BEST characterizing renal cell carcinoma is

A

A. it is more common in men

B. it usually does not have a capsule

C. it metastasizes predominantly by the lymphatic route

D. it may cause fever due to secondary infection

E. it is often bilateral

17. The MOST common symptom of a renal parenchymal tumor in an adult is

B

A. abdominal mass

B. hematuria

C. unexplained fever

D. anemia

E. hemoptysis due to metastases in the lung

20. In differentiating a renal cyst from a renal tumor, which of the following radiologic studies is MOST

definitive?

A

A. CT scan

B. retrograde pyelography

C. intravenous pyelogram (IVP)

D. renal scan

E. renal ultrasound

Bladder

6. A 65-year-old male with microscopic hematuria undergoes cystoscopy. Three 3-mm papillary lesions are found at the base of the bladder, and pathology of the biopsy returns as transitional cell carcinoma. These tumors are usually treated by

A

A. transurethral resection

B. segmental cystectomy

C. total cystectomy

D. radiotherapy

E. suprapubic cystostomy and fulguration

Questions 26-27

A 58-year-old male with a long history of cigarette smoking has transitional cell carcinoma of the bladder.

26. The MOST accurate technique for staging bladder tumor is

C

A. IVP

B. urine cytology

C. transurethral biopsy

D. bimanual examination

E. cystogram

27. Since initial diagnosis, the patient has had multiple recurrent superficial tumors and carcinoma in situ. These bladder tumors may be treated with all of the following topical agents. Response rates are BEST with

A

A. bacille Calmette-Guerin (BCG)

B. thio-TEPA

C. cis-platinum

D. mitomycin-C

E. doxorubicin

Retroperitoneal Fibrosis

9. The statement that BEST characterizes retroperitoneal fibrosis is

C

A. it involves females predominantly

B. it does not cause symptoms

C. it tends to cause ureteral obstruction

D. it involves only the lumbar area

E. it is sharply encapsulated

Prostate

14. Localized carcinoma of the prostate is BEST treated by which of the following modalities?

D

A. bilateral orchiectomy

B. estrogens

C. orchiectomy followed by estrogens

D. radical prostatectomy

E. transurethral resection of the prostate

Wilms’ Tumor

16. The MOST common manifestation of Wilms’ tumor is

A

A. abdominal mass

B. loss of weight

C. hematuria

D. hypertension

E. pathologic fracture of bone

From Pretest Pathology, 1996