Genitourinary Medicine 2023

Question 1 of 81

Which patient most likely has prerenal acute kidney injury?

Patient B presents to the endocrine clinic for a diabetes check-up. A recent HbA1c value was 10.4%, and the patient is noncompliant with insulin use. Creatinine and BUN levels are chronically elevated.
Patient C presents to the emergency department after a motor vehicle collision. Surgery is performed for splenic laceration, with an estimated blood loss of 1,500 mL. On postoperative day 1, the patient has newly elevated creatinine and BUN levels.
Patient D presents to the clinic for a routine evaluation. The patient is training for a 10 km run and has been using 2,000 mg paracetamol daily for 4 weeks to help with soreness. Creatinine and BUN levels are chronically elevated.
Patient A presents to the clinic for a routine evaluation with a complaint of fatigue. There is a history of spinal cord injury causing urinary retention, and creatinine and BUN levels are chronically elevated.

Question 2 of 81

Which of the following can minimize the risk of acute tubular necrosis?

Treatment of a bacterial infection with an aminoglycoside
Volume expansion before and after radiocontrast for computed tomography
Treating chronic heart failure with diuretics
Giving packed red blood cells for fluid replacement in trauma

Question 3 of 81

Which of the following does NOT typically cause rapid progressive glomerulonephritis?

Lupus nephritis
Anti-basement membrane glomerular disease
ANCA-associated vasculitis
Diabetic nephropathy
IgA nephropathy

Question 4 of 81

Which of the following is used to describe the rate at which a substance is removed from the body by the kidneys?

Secretion rate
Clearance
Effective renal plasma flow
GFR

Question 5 of 81

Which of the following statements is true regarding hypertensive nephropathy?

It might be genetically associated with a gene that controls blood glucose levels.
Hypertensive nephropathy is a rare cause of end-stage renal disease.
The intimal thickening of renal arteries aggravates the progression of nephropathy.
White populations are at higher risk of developing hypertensive nephropathy.
It is typically associated with nephrotic-range proteinuria.

Question 6 of 81

Which of the following is differentiated from prerenal acute kidney injury using FENa?

Acute interstitial nephritis
Acute tubular necrosis
Vasculitis-induced kidney disease
Urinary obstruction

Question 7 of 81

patient presents with fever, eosinophilia, elevated creatinine, and proteinuria after starting penicillin for a Streptococcus infection. Which type of acute kidney injury is most likely?

Acute interstitial nephritis
Postrenal obstruction
Renovascular disease
Acute tubular necrosis

Question 8 of 81

Which medication is likely to exacerbate symptoms of urinary obstruction in a patient with benign prostatic hyperplasia?

Phenylephrine
Acetaminophen
Terazosin
Naproxen

Question 9 of 81

Which of the following is true regarding the staging of CKD?

It is intended to identify those at greatest risk for progression and complications.
A patient diagnosed with early-stage CKD has very little chance of disease progression.
A low glomerular filtration rate measurement is required to diagnose CKD.
Patients with stage 2 CKD should be treated with renal replacement therapy.

Question 10 of 81

What is the earliest clinical manifestation of diabetic nephropathy?

Azotemia
Increased glomerular filtration rate
Nephrotic-range proteinuria
Microalbuminuria
Hematuria

Question 11 of 81

hat effect can radiocontrast have on kidney function?

Urinary retention causing obstructive renal disease
Vasoconstriction of the afferent arteriole of the glomerulus, increasing serum creatinine levels
Acute tubular necrosis causing intrinsic renal disease
Change in biochemical metabolism affecting blood urea nitrogen serum levels

Question 12 of 81

Which of the following would be expected in tumor lysis syndrome?

Decreased phosphorus levels
Urine output of more than 2 L per day
Elevated uric acid levels
Red blood cell casts on urinalysis

Question 13 of 81

Which of the following may be seen on urine microscopy with cholesterol emboli-induced thrombotic angiopathy?

Bland sediment
Urate crystals
Cellular casts
Muddy brown casts

Question 14 of 81

Which of the following histopathological findings is associated with sarcoidosis?

Noncaseating granulomas
Necrotizing granulomatous inflammation
Polygonal clear cells filled with accumulated carbohydrates and lipids
Eosinophil-rich interstitial infiltrates
Nodular glomerulosclerosis

Question 15 of 81

Which histopathological finding is pathognomonic for diabetic nephropathy?

Noncaseating granuloma
Mesangial nodules
Eosinophilic-rich infiltrate
Thin glomerular basement membrane

Question 16 of 81

A patient is found to have an elevated serum creatinine level following a complicated femur fracture repair associated with severe blood loss. What is the most likely cause of acute kidney injury?

Diabetes mellitus type 2 glomerulonephropathy
Ischemic renal tubular necrosis
Rhabdomyolysis-induced kidney injury
Lupus-induced glomerulonephropathy

Question 17 of 81

Which of the following is NOT an expected cause of acute tubular obstruction?

Protein
Urate crystals
Excessive immunoglobulin light chains
Cellular debris from hyperkalemia

Question 18 of 81

Which of the following is NOT a common cause of obstructive uropathy in children?

Stenosis at the ureterovesical or ureteropelvic junction
Strictures
Horseshoe kidney
Urethral valves

Question 19 of 81

Which of the following is a known cause of atheroembolic kidney disease?

Cardiac catheterization
Pyelonephritis
Polycystic kidney disease
Benign prostatic hyperplasia

Question 20 of 81

Which of the following extrarenal manifestations is associated with hypertensive nephropathy?

Migratory joint pain
Posterior uveitis
Cotton wool spots on retinal examination
Malar rash
Ear canal ulceration

Question 21 of 81

A patient presents to the emergency department after a marathon complaining of significant muscle pain and “bloody” urine. What is the most likely cause of the urine color change?

Sports drink food dye
Red blood cells
Severe dehydration
Heme pigment

Question 22 of 81

What lab value would suggest cast nephropathy of the renal tubules related to multiple myeloma?

Elevated white blood cell count
Elevated immunoglobulin light chains
Elevated serum calcium
Elevated serum phosphorous

Question 23 of 81

Which of the following is the most likely symptom of benign prostatic hyperplasia?

Pain on urination
The feeling of incomplete voiding
Hematuria
Milky penile discharge

Question 24 of 81

Which of the following is true regarding protein excretion measurement using the protein-to-creatinine ratio?

It might overestimate proteinuria in men.
It is not reliable in monitoring the response to treatment.
It has low sensitivity to albumin.
It might overestimate proteinuria in women.
It is difficult to perform on a regular basis.

Question 25 of 81

Which of the following statements is true regarding the relationship between CKD and cardiovascular disease?

The association between CKD and cardiovascular events may be stronger among white individuals than African American individuals.
Uremic pericarditis is the leading cause of death in patients with stage 5 CKD.
The risk of cardiovascular events in patients with CKD can only be explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus.
Reduced GFR and proteinuria are both independently associated with an increased risk of cardiovascular events.

Question 26 of 81

patient is found to have an elevated serum creatinine level following a complicated femur fracture repair associated with severe blood loss. What is the most likely cause of acute kidney injury?

Lupus-induced glomerulonephropathy
Diabetes mellitus type 2 glomerulonephropathy
Ischemic renal tubular necrosis
Rhabdomyolysis-induced kidney injury

Question 27 of 81

Which of the following patients is most at risk for acute tubular necrosis?

A patient with mild to moderate dehydration after running 5 km on a 32°C (90°F) day
A patient with benign prostatic hyperplasia causing urinary retention
A patient with type 2 diabetes taking acetaminophen 500 mg for occasional headaches
A patient with spleen laceration requiring 4 units of packed red blood cells

Question 28 of 81

Which of the following is required for a diagnosis of chronic kidney disease (CKD)?

Oliguria (urine production less than 0.5 mL/kg/day)
Persistent evidence of kidney damage or a decrease in function for at least 3 months
Hematuria with dysmorphic red blood cells
Multiple cysts on renal imaging
Heavy proteinuria (protein excretion greater than 3.5 g/24 hours)

Question 29 of 81

Which comorbid condition is associated with autosomal recessive polycystic kidney disease?

Mitral valve prolapse
Colonic diverticulitis
Congenital hepatic fibrosis
Berry aneurysm
Chronic sinusitis

Question 30 of 81

Which of the following is involved in the pathogenesis of mineral and bone disorders seen in CKD patients?

Increased GFR
Decreased parathyroid hormone activity
Increased calcitriol activity
Inhibition of 1-alpha-hydroxylase
Decreased phosphatonin activity

Question 31 of 81

Which category of acute kidney injury is a kidney stone most likely to cause?

Prerenal
Postrenal
Acute interstitial nephritis
Acute tubular necrosis

Question 32 of 81

A man fell and broke his hip during the night and was not able to access his phone to call for help until the morning. He was noted to have dark urine with a FeNa concentration of >2% on admission, and he reported generalized pain in the hip region. Which of the following is most likely present?

Prerenal disease
Intrinsic renal disease
Postrenal obstruction
Normal kidney function

Question 33 of 81

Which of the following may cause calcium phosphate crystal deposition in the renal tubules?

Excessive intake of acetic acid
Methotrexate use
Bowel prep for colonoscopy
Recurrent gout

Question 34 of 81

Which of the following is NOT a complication of acute kidney injury?

Uremia
Chronic kidney disease
Decreased minute ventilation
Electrolyte abnormalities

Question 35 of 81

Which of the following is NOT a common indication to initiate dialysis?

Hyperkalemia
Volume overload
Refractory alkalosis
Uremic pericarditis

Question 36 of 81

What is the cause of anemia seen in patients with CKD?

Vitamin deficiency
Deficient globin synthesis
Decreased erythropoietin production
Excessive sequestration of red blood cells in the spleen
Red cell membranopathy

Question 37 of 81

To prevent acute kidney injury, treatment is ideally started at which of the following time points?

When damage is initiated
When urine output decreases
When the glomerular filtration rate increases
When creatinine level increases

Question 38 of 81

Which of the following may cause renal hypoperfusion despite increased ECF volume?

Heart failure
Diarrhea
Hemorrhage
Excessive sweating during exercise

Question 39 of 81

Which of the following is the most appropriate treatment for tumor-lysis-induced renal tubular obstruction?

Phosphorous binders
Dexamethasone
Kayexalate
Saline with allopurinol

Question 40 of 81

Which imaging test is best for identifying calculi?

Ultrasonography of the kidney
Abdominal computed tomography without contrast
Abdominal computed tomography with contrast
Abdominal X-ray

Question 41 of 81

Which of the following pairings is correct?

Hypertensive vasculopathy － Lymphocytic infiltrate
Sjögren syndrome － Mesangial nodules
Autosomal dominant polycystic kidney disease － Abnormality in polycystin-1
Vesicoureteral reflux － Inadequate closure of the junction between the bladder and urethra

Question 42 of 81

If a patient presents with true volume depletion, prerenal acute kidney injury, and a FENa value of <1%, which treatment is most appropriate?

Intravenous fluids
Diuretics
Vasopressor support
Albumin

Question 43 of 81

Which of the following is most suggestive of prerenal acute kidney injury?

Urine Na >20 meq/L
Peripheral edema with BUN:creatinine ratio < 15
Fractional excretion of sodium > 2%
BUN:Creatinine > 20:1

Question 44 of 81

What type of renal injury would be expected with elevated eosinophils on CBC, low serum complement levels, and bland sediment on urinalysis?

Acute tubular necrosis
Renal atheroembolic disease
Immunoglobulin light chain tubule obstruction
Allergic interstitial nephritis

Question 45 of 81

Which of the following statements regarding serum creatinine and GFR is true?

In the initial stages of renal failure, a small rise in serum creatinine reflects a marked change in GFR.
The relationship between serum creatinine and GFR is directly proportional and nonlinear.
The relationship between serum GFR and creatinine clearance is inversely proportional and linear.
Creatinine clearance slightly underestimates GFR because creatinine is moderately secreted by renal tubules.

Question 46 of 81

Which of the following would help distinguish between prerenal disease and acute tubular necrosis?

BUN-to-sodium ratio
Urine Na+ and FENa
Urine osmolarity
Urine specific gravity

Question 47 of 81

Which category of acute kidney injury is a kidney stone most likey to cause?

Acute interstitial nephritis
Prerenal
Acute tubular necrosis
Postrenal

Question 48 of 81

A woman is admitted for sepsis, related to a urinary tract infection, and is found to have acute tubular necrosis. Fourteen days after discharge, she is complaining of significant urine output of more than 3 L a day. What is the most likely cause of this polyuria?

Protein in the proximal tubule that is reabsorbed after recovery
Recovery of kidney function after the accumulation of solutes during intrinsic kidney disease
The urinary tract infection resolving
Serum creatinine levels stabilizing

Question 49 of 81

Which of the following causes obstruction in atheroembolic renal disease?

Radiocontrast exposure
Cholesterol emboli
Blood clot emboli
Immunoglobulin light chain accumulation

Question 50 of 81

Which of the following is considered a clinical marker of kidney damage?

Decreased creatinine
Hyaline casts on urinalysis
Decreased blood urea nitrogen
Albuminuria
Bilirubinuria

Question 51 of 81

Which of the following is NOT an important reason to measure GFR?

To stage chronic kidney disease
To assess acid/base status
To dose medications cleared by the kidneys
To evaluate patients with kidney disorders
To know when to avoid nephrotoxic medications

Question 52 of 81

Which of the following would decrease the glomerular filtration rate?

Action of a prostaglandin antagonist at the efferent arteriole of the glomerulus
Angiotensin II constriction of the efferent arteriole of glomerulus
Action of a prostaglandin antagonist at the afferent arteriole of the glomerulus
Angiotensin II vasodilation of the afferent arteriole of glomerulus

Question 53 of 81

Acute/allergic interstitial nephritis would most likely show which of the following on urinalysis?

White blood cell casts
No cellular debris or casts
Cellular debris and muddy brown casts
Red blood cell casts

Question 54 of 81

A young boy eats an undercooked hamburger at a barbecue and later develops diarrhea and bloody urine. Which of the following is most likely related to these symptoms?

Enterotoxigenic Escherichia coli infection
Shiga toxin-mediated hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
Complement-mediated thrombotic microangiopathy

Question 55 of 81

Which of the following statements is true regarding chronic kidney disease (CKD)?

A low glomerular filtration rate is a requirement to diagnose CKD.
A renal biopsy is necessary to diagnose CKD.
An echogenic kidney with thin cortices on ultrasonography is a marker of CKD.
A single abnormal glomerular filtration rate measurement is sufficient to diagnose CKD.

Question 56 of 81

Which hormone is involved in the pathogenesis of CKD?

Atrial natriuretic peptide
Angiotensin-II
Oxytocin
3-Dehydroretinol
Somatostatin

Question 57 of 81

Which of the following best describes prerenal acute kidney injury?

BUN:Cr ratio: 10:1; urine osmolality: 300 mOsm/kg; urine Na+: 9 mEq/L; Urine Cl-: 8 mEq/L; UA: Sediment without casts or cells
BUN:Cr ratio: 25:1; urine osmolality: 350 mOsm/kg; urine Na+: 12 mEq/L; urine Cl-: 13 mEq/L; UA: sediment with casts
BUN:Cr ratio: 25:1; urine osmolality: 525 mOsm/kg; urine Na+: 9 mEq/L; urine Cl-: 8 mEq/L; UA: sediment without casts or cells
BUN:Cr ratio: 10:1; urine osmolality: 100 mOsm/kg; urine Na+: 12 mEq/L; Urine Cl-: 13 mEq/L; UA: sediment with casts

Question 58 of 81

A patient presents with fever, eosinophilia, elevated creatinine, and proteinuria after starting penicillin for a Streptococcus infection. Which type of acute kidney injury is most likely?

Acute interstitial nephritis
Renovascular disease
Acute tubular necrosis
Postrenal obstruction

Question 59 of 81

Which of the following is a sign of thrombotic microangiopathy?

Livedo reticularis
Blue toe syndrome
Petechiae
Blood pressure > 180/120 mm Hg

Question 60 of 81

Which of the following explains why the serum creatinine level is a useful measure for estimating GFR?

Serum creatinine is sensitive to changes in GFR in the early stages.
Creatinine is freely filtered across the glomerulus and is neither reabsorbed nor metabolized by the kidneys.
Serum creatinine can be used to estimate the GFR in individuals with unstable kidney function.
Creatinine production remains constant among individuals with significant variations in muscle mass.

Question 61 of 81

Which of the following medications can increase serum creatinine without a change in overall kidney function?

Atorvastatin
Naproxen
Trimethoprim
Gentamicin
Valproate

Question 62 of 81

What effect can radiocontrast have on kidney function?

Vasoconstriction of the afferent arteriole of the glomerulus, increasing serum creatinine levels
Urinary retention causing obstructive renal disease
Change in biochemical metabolism affecting blood urea nitrogen serum levels
Acute tubular necrosis causing intrinsic renal disease

Question 63 of 81

Which of the following is most consistent with acute interstitial nephritis?

An increase in creatinine with cellular debris and muddy brown casts on urinalysis
White blood cell casts on urinalysis with the growth of bacteria on urine culture
An increase in serum creatinine after drug administration and white blood cell casts on urinalysis
An increase in the BUN:creatinine ratio after contrast administration for an angiogram

Question 64 of 81

A patient presents with elevated creatinine and schistocytes on a peripheral blood smear. Thrombotic thrombocytopenic purpura is suspected. What is the most appropriate treatment option?

Hydrocortisone
Plasma exchange
Eculizumab
Supportive care

Question 65 of 81

Which of the following variables is not used in the CKD-EPI equation?

Ethnicity
Serum creatinine
Age
Body mass index
Sex

Question 66 of 81

Why is stage 3 CKD subdivided into stages 3a and 3b?

Patients with stage 3b CKD have significant albuminuria, while patients with stage 3a CKD do not.
Patients with stage 3b CKD are diagnosed with end-stage renal disease (ESRD).
Patients with stage 3a CKD are at a significantly higher risk of death from cardiovascular causes.
Patients with stage 3b CKD are at a significantly higher risk of death from cardiovascular causes.
Patients with stage 3b CKD are candidates for renal replacement therapy.

Question 67 of 81

Which of the following is the most common cause of acute tubular necrosis?

Decreased renal perfusion
Urinary retention causing obstruction
Inadequate electrolyte intake
Decrease in angiotensin levels

Question 68 of 81

Which of the following would you expect to see on urine microscopy in a patient with acute tubular necrosis?

No cells or debris
Pigmented granular casts
Rouleaux red blood cells
White blood cell casts

Question 69 of 81

A patient is admitted to the hospital for glomerulonephritis, hemoptysis, and sinusitis. Which of the following is the most likely diagnosis?

Granulomatosis with polyangiitis
Churg-Strauss syndrome
Goodpasture syndrome
Henoch-Schonlein purpura

Question 70 of 81

Which of the following is a limitation of measuring protein excretion by using a 24-hour urine collection?

It can be performed only in the inpatient setting.
It has low sensitivity to albumin.
It can be influenced by variations in protein production throughout the day.
It might overestimate proteinuria in women.
It is difficult to perform on a regular basis.

Question 71 of 81

Which of the following is the most common cause of chronic kidney disease?

Systemic lupus erythematosus
Unresolved acute kidney injury
Diabetes mellitus
Polycystic kidney disease
Staghorn calculi

Question 72 of 81

Changes in NaCl concentration due to renal tubular injury are detected in which area of the nephron?

Macula densa
Descending loop of Henle
Proximal convoluted tubule
Distal convoluted tubule

Question 73 of 81

Which of the following is recommended for the treatment of interstitial nephritis if discontinuing the offending drug does not resolve the kidney injury?

Steroids
Calcium-channel blockers
Antibiotics
Diuretics

Question 74 of 81

Glomerular disease will most likely show which of the following on urinalysis?

Muddy brown casts
Urine sodium > 20 mEq/L
Red blood cell casts
Nephrotic-range proteinuria

Question 75 of 81

Which of the following statements is correct regarding GFR estimation equations?

These equations estimate GFR by incorporating muscle mass and creatinine clearance.
CKD-EPI provides an accurate estimate of GFR in patients with acute kidney injury.
The MDRD study equation is less accurate than the CKD-EPI equation when GFR is > 60 mL/min/1.73 m^2.
MDRD study equation has no clinical value when GFR is < 60 mL/min/1.73 m^2.

Question 76 of 81

Which of the following best describes the relationship between acute kidney injury (AKI) and chronic kidney disease (CKD)?

Unresolved AKI may lead to CKD.
AKI and CKD are two separate, mutually exclusive entities.
Pre-existing CKD decreases the risk of AKI.
AKI can slow the progression of pre-existing CKD.

Question 77 of 81

Which of the following patients would be diagnosed with stage II acute kidney injury?

Patient B: Weight: 100 kg (220.5 lb); creatinine level increased from 3.7–4.4 mg/dL; total urine output over 24 hours: 700 mL
Patient D: Weight: 100 kg (220.5 lb); creatinine level increased from 1.5–2.7 mg/dL; total urine output over 14 hours: 1,000 mL
Patient C: Weight: 100 kg (220.5 lb); creatinine level increased from 1.0–1.2 mg/dL; total urine output over 24 hours: 2,200 mL
Patient A: Weight: 100 kg (220.5 lb); creatinine level increased from 1.1–2.3 mg/dL; total urine output over 14 hours: 600 mL

Question 78 of 81

hich of the following would be expected in tumor lysis syndrome?

Decreased phosphorus levels
Red blood cell casts on urinalysis
Urine output of more than 2 L per day
Elevated uric acid levels

Question 79 of 81

Which of the following vasculitides is associated with hepatitis B?

Microscopic polyangiitis
Giant cell arteritis
Granulomatosis with polyangiitis
Polyarteritis nodosa

Question 80 of 81

Which of the following medications may cause acute kidney injury due to crystal precipitation?

Ibuprofen
Acyclovir
Ampicillin
Amphotericin

Question 81 of 81

What is the purpose of using angiotensin receptor blockers to treat patients with diabetic nephropathy?

Elevate serum creatinine level
Increase the glomerular filtration rate
Elevate serum potassium level
Increase the bradykinin level
Decrease glomerular capillary hypertension

Genitourinary Medicine 2023

Genitourinary Medicine 2023

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