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QUIZ KIDNEY
QUIZ 1
PATHOPHYSIOLOGY
Page 1 of 39
Which of the following options does not differentiate between acute kidney injury and chronic kidney disease?
Anemia
Subperiosteal bone absorption in radiographs.
Wide casts in urine
Small size of kidneys
Page 2 of 39
Prescribing which medicine without reducing effect on the filtration rate Glomerular (GFR) causes an increase in serum creatinine can
Digoxin
probenecid
Dopamine
Trimethoprim
Page 3 of 39
Which of the following drugs can lead to an increase in serum creatinine without a real decrease in GFR and no increase BUN?
Losartan
Diclofenac
Gentamicin
Cimetidine
Page 4 of 39
Which of the following factors affects the amount of disproportionate reduction is blood urea nitrogen (BUN) effective?
Corticosteroid drugs
Sepsis
Gastrointestinal bleeding
Liver disease
Page 5 of 39
In order to determine GFR, we request a 24-hour urine test for a person, which option should be considered to check the accuracy and correctness of complete 24-hour urine collection?
Measurement of sodium content in 24-hour urine sample
Measurement of potassium content in 24-hour urine sample
Measurement of creatinine content in 24-hour urine sample
Measurement The amount of urea in a 24-hour urine sample
Page 6 of 39
A 30-year-old man who has microscopic hematuria during employment tests is referred to a doctor. Ultrasound and normal kidney function tests. What is the first course of action for him?
Renal biopsy
Kidney nuclear scan
Urinary sodium examination
Abdominal and pelvic CT angiography
Page 7 of 39
45-year-old men due to nausea, vomiting, anorexia And the swelling of the legs was brought to the emergency room. In the examination, blood pressure is 150/100 and edema of the lower limbs is evident. Urea 140 and creatinine 5 have been reported in tests. Granular casts have been observed in the pathological examination of urinary sediment; Which of the following diagnoses is most likely for the patient?
Rhabdomyolysis
Allergic nephritis
Malignant high blood pressure.
Glomerulonephritis
Page 8 of 39
A 43-year-old man is evaluated with high blood pressure and decreased urine volume. In his initial tests, you notice an increase in plasma creatinine. Observing which of the following items in the urinary sodium of this patient is beneficial for the diagnosis of nephrotic syndrome?
dysmorphic RBC
WBC cast
RBC cast
oval fat body
Page 9 of 39
If there is RBC cast in urinalysis, which one? Which of the following diagnoses is less likely?
ATN
glomerulonephrit
vasculitis
pyelonephritis
Page 10 of 39
28-year-old men are transferred to Hospital after getting out of the rubble of the earthquake in the west of the country. In the initial tests, Serum Cr: 4mg/dl, K:6meq/L U/A: Blood 3+, Protein 2+ What is the cause of the patient's creatinine increase?
acute glomerulonephritis
acute tubular necrosis(ANT)
acute interstitial nephritis
pre renal azotemia
Page 11 of 39
– A 35-year-old man was diagnosed with acute kidney failure. A dirty brown granular cast is seen in the urinary slide, which of the following diagnoses? Is it relevant for him?
Interstitial nephritis
Glomerulonephritis
ATN
from the prerenal theme
Page 12 of 39
In a patient with acute kidney failure in deposits Urinary cysts of epithelial cells are reported .Which of the following diagnoses is relevant?
Interstitial nephritis
Acute pyelonephritis
Thrombotic microangiopathy
Acute tubular necrosis
Page 13 of 39
– A 53-year-old woman came to the hospital because of the stiffness of the skin on her hands and feet, which started about a month ago. He has given a history of suspected Raynaud's and has shortness of breath. 40 days ago, he underwent MRI of the heart with gadolinium to check the cause of shortness of breath. In the examination, he has sclerosis of the skin of the upper limb up to the middle of the arm and the lower limb up to the middle of the thigh. He does not have it. The previous tests are as follows: What is the most likely diagnosis?
Stiff skin syndrome
Scleromyxedema
Scleredema of Buschke
Nephrogenic systemic fibrosis
Page 14 of 39
The first and most important risk factor for failure Which of the following is acute kidney injury?
Previous chronic kidney failure
Diabetes
Old age
Chronic liver failure
Page 15 of 39
A 25-year-old lady referred to the following confession with dark colored urine pH= 6.5 WBC: 6-8 RBC= 10 – 15 Pro3+ dimorphic RBC= positive Leukocyte esterase test and nitrite test= Negative Which diagnosis is more likely?
Kidney stone
Acute Glomerulonephritis
Trauma
Menstrual bleeding
Page 16 of 39
A 23-year-old woman with no history of any particular disease has had swelling of her legs and around her eyes since a week ago. The urine is red and the blood pressure is 170/95. Edema has +2 in the legs. Other examinations are normal. In complete urine tests has ( protein: 3+, RBC: 20-25) U/A. Which of the following is more relevant?
Glomerulonephritis
Urinary tract infection
ureteral stone
Papillary necrosis
Page 17 of 39
A 50-year-old woman was hospitalized due to edema and hypertension. She has a history of type 2 diabetes since two years ago and is being treated with enalapril. The patient is oligouric and in the examination BP=160/90 mmHG and Bilateral edema of the lower limb has +2. In tests, Albumin = 2g/dl, creatinine = 1.7 BUN = 29mg/ dl and protein in urine is +2. Hematuria +1, RBC cast is seen. Which diagnosis is more likely?
Acute tubulointerstitial nephtitis
Acute Glomerunephritis
Acute tubular necrosis
Diabetic Nephropathy
Page 18 of 39
In which of the following cases is the hematuria of glomerular origin and it is necessary for the patient to be examined in terms of nephrology
The presence of a clot in the urine
Accompaniment of hematuria with proteinuria more than 2 grams per day
Accompanying hematuria with renal colic
Hematuria with burning and frequent urination
Page 19 of 39
Which is not one of the principles of treatment of all cases of glomerulonephritis
Control of hypertension
Corticosteroid prescription
Control of hyperlipidemia
Prescription of ACE inhibitors
Page 20 of 39
An 11-year-old child presented with severe edema. In tests FBS= 85 BUN= 10 Cr= 0.6 U/A= Pr= +4 RBC= 0-1 Serum Albumin = 2.7 C3= normal Which diagnosis is more likely?
MPGN
MGN
PSGN
MCD
Page 21 of 39
A 25-year-old female nurse who was referred due to swelling of the legs showed proteinuria of 3.5 grams per day and the results of a complete urine test of protein 4+ without any other disorders and Cr= 2mg/dl. She mentions the history of using indomethacin for several months for back pain. A kidney biopsy is performed. Which of the following findings is more likely in light microscopic examination?
Diffuse inflammatory cell infiltration in the glomerulus and fibrinoid necrosis
An increase in the thickness of the basement membrane and the presence of subendothelial deposits
Mesangial hypercellularity, increased mesangial matrix and the presence of sclerosis in glomeruli
It has a natural appearance in the light microscope
Page 22 of 39
A 36-year-old man came with edema, blood pressure 160/80mmhg and in tests Cr.. 3.5mg/dl BUN.. 45 K.. 5.5 Na.. 140 In the complete analysis of urine, protein 4+ and abundant WBC have been reported. In kidney biopsy, normal glomeruli and infiltration of inflammatory cells have been reported. IF is negative. Which of the following is important in differential diagnosis?
Indomethacin use
Lupus nephritis
Polyangittis with granulomatousis
Cotrimoxazole use
Page 23 of 39
A 40-year-old man was hospitalized due to bilateral edema and high blood pressure. He has no history of illness. In tests, BUN.. 18 Cr.. 1.6 Na.. 136 K.. 4.8 Albumin.. 2.8 U/A.. pro.. 3+ RBC.. 0-1 WBC.. 0-1 24 hour urine = 4g protein The patient underwent a kidney biopsy, which was seen as fading of foot processes in Electron Microscope and No pathological findings were reported in light microscopy. According to the above and the possible diagnosis, which of the following can be related to this disease
Hodgkin lymphoma
Multiple myeloma
AIDS
Sickle cell Anemia
Page 24 of 39
A 19-year-old man undergoes a kidney biopsy due to Anazark edema, and with the diagnosis of MCD, daily prednisolone treatment is started. The patient came in the third month of treatment with a complaint of nonimprovement of lower edema. In the experiments, he has proteinuria of 3 grams in 24 hours. Which treatment is suitable for him.
Continue to prednisolone
Cyclophosphamide pulse
Mycophenolate mofetil
Cyclosporines
Page 25 of 39
. A 20-year-old man was referred due to lower limb swelling. The patient gives a history of HIV infection that has not been followed up and treated. In tests Urine 24 hour protein… 10g/dl Serum Albumin… 2.5mg/dl What is the most likely cause of the patient's protein excretion?
Focal segmental glomerulosclerosis
Lupus nephritis class 2
Post streptococcal glomerulonephritis
Membranoproliferative glomerulonephritis
Page 26 of 39
A 35-year-old woman with a history of reflux nephropathy, with proteinuria of 3200 mg/24 hours and Cr.. 0.9 mg/dl. A kidney biopsy was done and the answer was FGFS. In physical examination, the patient's weight is 90 kg and blood pressure is 150/90. What is the treatment of choice for the patient?
Weight loss and ACE inhibitors
Prednisolone 0.5mg/kg and ACE inhibitors
Cyclosporines 5mg/kg and ARB drugs
Anti reflux surgery and ACE inhibitors
Page 27 of 39
A 45-year-old woman with FSGS 3 years ago was presented. Her blood pressure is 160/100 mmHG and proteinuria of 3700mg in 24 hours and Cr is 2.1mg/dl. Which drug is suitable for lowering blood pressure and prevent progressing of CKD in this patient
Loop diuretics
Beta blockers
Calcium blockers
ACE inhibitors
Page 28 of 39
A 41 year old man with history of heroine was hospitalized due to proteinuria. In tests, proteinuria is 5g in 24 hours and Cr is 2.1 mg/dl. In the biopsy prepared from the corticomedullary areas of the kidney, FSGS changes are evident along with endocapillary hypercellularity. Prescribing which of the following drugs is suitable for the treatment of this patient?
Prednisolone
Losartan
Cyclosporines
Cyclophosphamide
Page 29 of 39
A 45 year old woman with proteinuria of 4g and Cr of 0.8mg/dl undergo kidney biopsy. Focal segmental glomerulosclerosis was found in biopsy. Which treatment you suggest
Cyclosporines + losartan
Steroids + losartan
Losartan
Cyclosporines +steroids
Page 30 of 39
A 35-year-old man without edema and with normal blood pressure, presents with proteinuria of 4g in 24 hours is under investigation. Blood lipid levels are normal and Cr is 1.8mg/dl. Focal segmental glomerulosclerosis is found in biopsy. Which disease do you consider to be the cause of this condition?
Good pasture
Renal vessel embolism
Multiple myeloma
HIV infection
Page 31 of 39
The disease has been reported with increased creatinine in the context of HIV. Which of the following is an indicator of kidney involvement in this patient with HIV?
Kidney tubular obstruction
Small size Kidney
Presence of evidence of IgA nephropathy in kidney biopsy
Presence of nephrotic syndrome
Page 32 of 39
A 40-year-old man who is HIV positive is presented with general edema. Proteinuria in a urine of 24 hours is 5g. Which pathological condition is more favourable in kidney biopsy
MCD
Collapsing FSGS
MPGN
MGN
Page 33 of 39
A 60 year old woman is presented with edema of lower limbs. Patient's blood pressure is 120/80mmhg. In investigating tests, Cr is 0.8mg/ dl, protein in urine is 3.5g. In kidney biopsy with light microscope, spike shaped glomerular basement membrane is seen. All of following are first line treatment of the disease except
Enalapril
Low protein diet
Methyl prednisolone
Low salt diet
Page 34 of 39
A 50-year-old woman with colon cancer and proteinuria of 14g daily has severe shortness of breath and heart throbbing. Which diagnosis is more likely for likely for this patient
FSGS
Minimal Change Disease
MPGN
MGN
Page 35 of 39
A 50-year-old woman without prior history of diabetes and hypertension but with history of breast cancer with generalized edema is referred to emergency. In lab tests, urinary protein excretion is 8g in 24 hours. Which disease is the cause of proteinuria in this patient
Multiple myeloma
FSGS
IgA nephropathy
Membranous nephropathy
Page 36 of 39
In patient suffering from Autoimmune thyroiditis, which glomerulonephritis disease is more likely in this patient?
MCD
FSGS
MPGN
MGN
Page 37 of 39
Which of the following is the most important cause of renal vein thrombosis?
FSGS
MPGN
Diabetic Nephropathy
MGN
Page 38 of 39
In patients of Membranous nephropathy, all of the following are common excrept
Nephrotic syndrome
Microscopic hematuria
Normal blood pressure
Normal kidney functioning
Page 39 of 39
In a patient with membranous glomerulonephritis, in which of the following cases is early administration of rituximab indicated?
Asymptomatic patients
Decreased titer of antibody PLA2R
Proteinuria of more than 10g in a day
Blood pressure above 150/90 mmHg
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