Nephrology Practice Set

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Practice Set of Nephrology

1. Which of the following facts is true regarding Denosumab ?
(1) Denosumab is a monoclonal antibody which acts as RANKL inhibitor.
(2) The usual dose in post menopausal osteoporosis and glucocorticoid induced bone loss is 30 mg SC q6months.
(3) It is contraindicated in patients with CrCl < 30 ml/min.
(4) Hypocalcemia is the most common reported side effect.

2. A peritoneal dialysis patient presents with a 1-week history of abdominal pain. She has been on dialysis for 2 years and also has a history of coronary artery disease. Clinically, her abdomen is rigid and distended with absent bowel sounds, BP is 85/50 mmHg, pulse rate is 120/min and the dialysate appears very cloudy. Culture of the dialysis fluid reveals a mixed growth of Escherichia coli, Bacteroides spp. and Enterobacter spp. What is the most likely cause of this presentation ?
(1) Acute pancreatitis
(2) Diverticulitis
(3) Catheter related peritonitis
(4) Ulcerative colitis

3. An 85-year-old male patient came with CKD stege G5A0 due to lithium induced CTIN. His current eGFR is 9 ml/min and daily urine output is approximately 1 litre per day. He do not wishes for dialysis commencement and request for palliative care only. Which of the following fact best describes the outcome of active medical care without dialysis in such cases ?
(1) Less survival but fewer episodes of hospitalization and better quality of 3 life.
(2) Equivalent outcome and survival.
(3) Inferior physical health.
(4) Palliative care = is only recommended in patients with GFR 10-20 ml/min.

4. Which of following modality is least useful extracorporeal toxin removal therapy in poisoning ?
(1) Intermittent Hemodialysis.
(2) Charcoal Hemoperfusion.
(3) Exchange transfusion.
(4) Peritoneal dialysis.

5. Which of the following statement is most appropriate for refractory peritoneal dialysis peritonitis ?
(1) Failure of effluent to clear after 3 days of antibiotics.
(2) Failure of effluent to clear after 5 days of antibiotics.
(3) Failure of effluent to clear after 7 days of antibiotics.
(4) Failure of effluent to clear after 14 days of antibiotics.

6. A 45-year-old male who had terminal ileostomy for 5 years now presented with renal colic. Plain X-Ray KUB showed no stones. His investigations included: Na 138 meq/L, K+ 3.8 meq/L, HCO3- 17 meq/L, Albumin 3.9 gm/dl, Uric acid 7.4 mg/dl, Ca++ 9.8 mg/dl, Phosphate 4.1 mg/dl. Which of the following is the most likely cause of his symptoms ?
(1) Oxalate stone
(2) Uric acid stone
(3) Cystine stone
(4) Calcium phosphate stone

7. A 38-year-old man was referred for evaluation of renal impairment. He had suffered with gout for the past 10 years. His maternal grandfather had: died of kidney failure and his mother started dialysis when she was 56 years old. Examination was unremarkable. His BP was 143/82 mmHg. Investigations: serum K 2.7 mmol/L, serum creatinine 1.8 | mg/dl, eGFR 52 mL/min, serum urate 9 mg/dl, urinalysis blood trace protein 2+. Renal ultrasound scan normal sized kidneys with increased echogenicity and 7 a single 2 cm cyst in the right kidney. MRI abdomen multiple small cysts ranging from 3 mm to 2 cm in diameter in the corticomedullary junction What is the most likely diagnosis ?
(1) Autosomal dominant polycystic kidney disease
(2) Autosomal recessive polycystic kidney disease
(3) Medullary cystic kidney disease
(4) Nephronopthisis

8. Which of the following statements is not true for Calciphylaxis seen in maintenance hemodialysis patients ?
(1) Painful, symmetrical, sharply demarcated non healing ulcers.
(2) Hyperhosphatemia is an important predisposing factor.
(3) Distal extremity lesions have poor prognosis as compared to proximal ones.
(4) Histologically characterized by calcification, microthrombosis, fibrointimal hyperplasia of dermal small arteries.

9. A 56-year-old on CAPD for last 6 years presented with poor ultrafiltration. His baseline 2.5% PET showed D/P ratio of 0.62 and at 4 hours ultrafiltration volume was 450 ml. Which one of the following tests will help in establishing the diagnosis ?
(1) 4.25% Dextrose PET.
(2) CT abdomen with intra-peritoneal contrast.
(3) Do nothing; reassure the patient that everything is OK.
(4) Repeat 2.5% dextrose PET test.

10. Urease producing bacteria are associated with formation of
(1) Oxalate stone
(2) Uric acid stone
(3) Calcium stones
(4) Magnesium ammonium phosphate stones

11. An 18-year-old woman was referred for investigation of progressive generalized muscle weakness and lethargy. She was taking no regular medications. Examination was unremarkable. Her BP was 110/60 mmHg. Her body mass index was 19. Investigations serum K 2.7 mmol/L, serum bicarbonate 34 mmol/L, serum creatinine 72 µmol/L, estimated glomerular filtration rate (MDRD) > 90 ml/min, serum magnesium 0.60 mmol/L (N: 0.75-1.05), serum chloride 83 mmol/L, 24-hour urinary calcium 1.5 mmol (N: 2.5-7.5). What is the most likely diagnosis ?
(1) Bartter’s syndrome
(2) Gitelman’s syndrome
(3) Hypokalaemic periodic paralysis
(4) Liddle’s syndrome

12. The first hemodialysis session should remove urea level by
(1) 10%
(2) 20%
(3) 30%
(4) 50%

13. In transplant renal biopsy, isometric vacuolization of proximal tubule cells may be seen in all, except :
(1) Acute CNI toxicity
(2) Post IVIg administration
(3) Radio contrast media administration
(4) BK virus nephropathy

14. Which of the following drugs may be efficiently removed by dialysis?
(1) Lithium
(2) Digoxin
(3) Theophylline
(4) Phenytoin

15. Regarding peritoneal dialysis catheter function, which of the following statements is false ?
(1) Introducing the routine use of the laparoscopic technique for catheter insertion will improve early catheter survival more than carefully audited standard methods used by an experienced surgeon.
(2) Slow catheter drainage is most commonly a result of constipation.
(3) Pain on draining out is best solved in APD patients by use of tidal PD.
(4) Poor drainage associated with edema in the genital area indicates an inguinal hernia or patent processus vaginalis.

16. Intradialytic hemolysis may be caused by all of the following, except :
(1) Copper in the dialysate
(2) Residual formaldehyde
(3) Faulty dialysis pumps
(4) Heparin exposure

17. High-efficiency, post-dilution on-line Hemodiafiltration is associated with improved outcomes in chronic hemodialysis patients. High-efficiency on-line Hemodiafiltration is defined as :
(1) Blood flow rate > 300 ml/min
(2) Dialysate flow rate > 700 ml/min
(3) Effective treatment time > 300 minutes per treatment
(4) Delivered convection volume > 22 liters per treatment

18. A 31-year-old man was reviewed at a routine clinic visit having been undergoing continuous ambulatory peritoneal dialysis for 6 months. He felt well, had no specific complaints, and was Clinically euvolemic. He was using 4 x 1.5 L dextrose 1.36% exchanges. Investigations: serum creatinine 13.2 mg/dl, urine volume 220 mL/day, ultrafiltration volume 400 mL/day, Kt/V 1.28, creatinine clearance 42 L/week. What is the most appropriate management ?
(1) Change nocturnal exchange to icodextrin
(2) Increase volume of exchanges to 2L
(3) No change to dialysis regimen
(4) Reduce to 3 x 1.5L exchanges

19. For hemodialysis patients, sudden cardiac death (SCD) occurs more commonly at certain times in the dialysis schedule. Compared to the mid-week scheduled day off dialysis, SCD is more common ?
(1) During dialysis
(2) Within a few hours of dialysis
(3) In the 24 hours prior to the next dialysis session
(4) Immediately before dialysis on the longest inter-dialytic interval

20. A 35-years-old male diagnose case of anti GBM disease need to start on Therapeutic plasma exchange. Her weight is 70 kg, HCT is 0.45, and Blood volume is 70 ml/kg. What will be his calculated plasma volume ?
(1) 2695 ml
(2) 2515 ml
(3) 2780 ml
(4) 3010 ml

21. Which of the following drugs is most likely to be removed by high-flux hemodialysis ?
(1) Amlodipine [molecular weight (MW) = 567; volume of distribution (VD) = 21.0 L/kg; plasma protein binding > 95%)
(2) Clindamycin (MW = 476; VD =0.8 L/kg; plasma protein binding = 94%)
(3) Atenolol (MW = 266; VD = 1.1 L/kg; plasma protein binding =3%)
(4) Apixaban (MW = 460; VD = 0.3 L/kg; plasma protein binding =87%)

22. A 63-year-old has end stage renal disease secondary to hypertensive nephrosclerosis and has been undergoing treatment with continuous ambulatory peritoneal dialysis. His PD prescription consists of four exchanges of 2.5 L and he is currently anuric. At the time of his most recent assessment of peritoneal dialysis adequacy, the following parameters were obtained: Serum urea nitrogen 77 mg/dL, Dialysate urea nitrogen 72 mg/dL, Total ultrafiltration volume: 1000 mL, Volume of distribution of urea 40 L, Which ONE of the following represents the closest approximation of the weekly Kt/V urea ?
(1) 1.4
(2) 1.6
(3) 1.8
(4) 2.0

23. All of the following agents have been used as “catheter locks” for tunneled dialysis catheter for prevention of catheter related blood stream infection (CRBSI), except :
(1) 46.7% Citrate
(2) Absolute alcohol
(3) 1.35% Taurolidine
(4) 2% Betadene

24. Which of the following immunosuppressive agent is linked with infertility in male kidney transplant recipients ?
(1) Tacrolimus
(2) Belatacept
(3) Mycophenolate
(4) Sirolimus

25. Tocilizumab is an Anti IL-6 monoclonal antibody. In kidney transplant cases it has been successfully used in following conditions, except :
(1) As desensitization protocols in highly sensitized recipients.
(2) Treatment of chronic antibody mediated rejection.
(3) Treatment of acute cellular rejection.
(4) To counter-act cytokine storm syndrome in kidney transplant recipients with COVID-19 pneumonia.

26. Roxadustat, which is currently in phase-3 clinical trials, is likely to become an important tool for anemia management in patients with CKD. Which of the following statement is not true regarding this molecule ?
(1) The mechanism of action is to stabilize hypoxia-inducible factor (HIF) by inhibiting prolyl hydroxylase (PH).
(2) Most commonly used dosing frequency is three times a week as compared to daily dosing of other HIF pathway modulators.
(3) Roxadustat, may be associated with worsening of hypertension requiring a modification to antihypertensive medication.
(4) The agent was withdrawn from clinical trials recently due to high incidence of hematological malignancies with long term (> 2 years) use.

27. Which of the following statements regarding C4d deposition is NOT correct ?
(1) C4d is a fragment of C4 produced during the classic complement activation pathway.
(2) C4d deposition is known to cause severe graft injury in renal transplantation.
(3) C4d deposition in the peritubular capillaries correlates with the presence of circulating anti donor antibodies.
(4) C4d is highly stable and persists at the cell surface for a long time periods.

28. Which of the following elements of an apnea test would determine that a potential donor is NOT brain dead after removal from the respirator for 10 min?
(1) PaO2 > 100 mmHg
(2) Absence of chest movements
(3) PaCO2 < 40 mmHg
(4) PaO2 <50 mmHg

29. For sulfa-allergic patients, which of the following antimicrobial agents can be used for prophylaxis against Pneumocystis jiroveci in renal allograft recipients ?
(1) Linezolid
(2) Dapsone
(3) Ciprofloxacin
(4) Ganciclovir

30. Neutrophil Gelatinase Associated Lipocalin (NGAL) is a
(1) 13-kDa, low-molecular-weight cysteine protease inhibitor produced at a constant rate by all nucleated cells and eliminated exclusively by glomerular filtration.
(2) 18-kDa proinflammatory cytokine that is activated by caspase and is produced by renal tubule cells and macrophages.
(3) Type I transmembrane glycoprotein with an ectodomain containing a six-cysteine immunoglobulin-like domain, two N-glycosylation sites, and a mucin domain
(4) 25-kDa protein glycoprotein bound to matrix metalloproteinase-9 in renal epithelial cell

31. True about nail patella syndrome includes, all except :
(1) It is an autosomal dominant disease.
(2) Abnormal gene is located on long arm of chromosome 6.
(3) multiple osseous abnormalities primarily affect elbows and knees, and nail dysplasia.
(4) Approximately 5% of affected individuals develop severe CKD and will require renal replacement therapy.

32. Four weeks after arrival from Africa, a 24-year-old student presents with blood in his urine. Microscopic examination of his urine reveals the presence of eggs with terminal spines. He revealed that he had been working on his family’s rice fields for long time. The most likely etiologic agent of his complaint is
(1) Schistosomia haematobium
(2) Schistosomia mansoni
(3) Schistosomia Japonicum
(4) Amoebiasis

33. A 24-year-old man is diagnosed with Acute Myelogenous Leukemia (AML) and is treated with induction chemotherapy (cytarabine and daunorubicin). Despite intravenous hydration he develops oliguric acute kidney disease after 4 days of treatment. Which of the following statements is most correct ?
(1) His AKI is likely caused by infiltration of the kidney by AML.
(2) Hypercalcemia and hypokalemia are typical features in this setting.
(3) Calcium phosphate crystals are usually seen under urine microscopy in this setting.
(4) Recombinant uricase may be used to treat his AKI.

34. Regarding functions of normal kidneys, all of the following statements are true, except :
(1) Erythropoieten is secreted by peritubular cells in response to hypoxia.
(2) Hydroxylates 1-hydroxycholecalciferol to its active form.
(3) Locally produced prostaglandins have important role in maintaining renal perfusion.
(4) 90% of the erythropoietin comes from the kidneys and 10% from the liver.

35. Normal adult kidney; all are true, except :
(1) Its length is about 10-13 cm (about 3 vertebral bodies).
(2) The right kidney is usually few millimeters smaller than the left.
(3) Each kidney contains approximately 10 million nephrons
(4) Both kidneys receive about 20-25% of the cardiac output.

36. A 76-year-old man presents with confusion, dry mucous membranes, decreased skin turgor, fever, tachypnea, and a blood pressure of 142/82 mm Hg without orthostatic changes. The serum sodium concentration is 168 meq per liter, and the body weight is 68 kg. Hypermatremia caused by pure water depletion due to insensible losses is diagnosed, and an infusion of 5 percent dextrose is planned. How much fall in serum sodium is anticipated in this case after infusion of 1 litre 5% Dextrose solution ?
(1) 4.8 meq
(2) 5.4 meq
(3) 6 meq
(4) 6.4 meq

37. Micturating cystourethrogram, all are wrong, except :
(1) Not used in the diagnosis and assessment of the severity of vesicicoureteric reflux
(2) Usually used in conjunction with urodynamic studies.
(3) Not indicated in those with recurrent UTI.
(4) Not indicated in those with renal scars and not indicated in those with chronic renal failure of unknown cause.

38. Hyperlipidemia is not associated with which of the following drug in renal allograft recipients ?
(1) Mycophenolate mofetil
(2) Sirolimus
(3) Prednisolone
(4) Cyclosporine

39. What is the most common histological manifestation of HIV nephropathy ?
(1) Amyloidosis
(2) Collapsing variant of FSGS
(3) Perihilar FSGS
(4) FSGS-NOS

40. You are managing a man with long standing hypertension, diabetes, and chronic renal insufficiency. He has gradually developed anemia and edema and has recently developed hyperkalemia and acidosis as the time approaches when he will require hemodialysis. Which of the following statements is true regarding the etiology and management of these typical abnormalities associated with chronic renal insufficiency ?
(1) Sodium citrate as Alkali should not be administered to patients receiving aluminum containing phosphate binders.
(2) Alkali therapy can help treat the acidosis but is unlikely to improve the hyperkalemia.
(3) Hyperkalemia typically starts once GER is decreased below 30 ml/min.
(4) Failure to respond to erythropoietin therapy is most commonly the result of underlying anemia of chronic renal disease.

41. All of the following statements are not false in case of medullary sponge kidney (MSK), except
(1) Most cases of MSK are sporadic.
(2) It has a_ characteristic “Paint brush” picture on IVU.
(3) May be complicated with type 2 RTA.
(4) Nephrocalcinosis may be seen on the KUB film

42. Which of the following drug is not associated with development of Fanconi syndrome ?
(1) Ifosfamide
(2) Valproic Acid
(3) Tenofovir
(4) Pacitaxel

43. All of the following statements are not true regarding renal tubular acidosis type II, except :
(1) Acidosis may be corrected with 1-2 meq/kg/day of alkali therapy in most cases.
(2) Aminoaciduria is usually associated with sarcopenia.
(3) Most common cause is cystinosis.
(4) Hypercalciuria is profound.

44. Which of the following renal disease is classically not associated with low complement C3 levels ?
(1) aHUS.
(2) Post infectious glomerulonephritis
(3) Essential mixed cryoglobulinemia
(4) Shunt nephritis.

45. Which of the following statement is not true ?
(1) Minimal change disease is associated with HLD DR7, atopy and drugs.
(2) Membranous nephropathy is associated with HLA DR3, drugs and heavy metals.
(3) Association with liver disease has been documented in IgA nephropathy.
(4) Membraboproliferative glomerulonephritis type I is associated with C3 nephritic factor and partial lipodystrophy.