Renal Pathology

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Haczar
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266548
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Renal Pathology
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2014-03-15 17:24:30
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Renal Pathology
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  1. The mother of a 2-month-old Child palpates a mass on the left side of the child's abdomen. Vital signs are normal. A CT guided renal biopsy shows undifferentiated tubules surrounded by undifferentiated mesenchyme, smooth muscle, and Islands of cartilage. The mass is removed (shown in the image) and displays variably sized cysts. Which of the following is most likely diagnosis for the child's flank mass?



    A. Wilms Tumor
    B. Neuroblastoma
    C. Renal Dysplasia
    D. Medullary Sponge Kidney
    E. Infantile Polycystic Disease
    C. Renal Dysplasia
    (this multiple choice question has been scrambled)
  2. 38-year-old man presents with vague flank pain and describes the passage of blood clots in his urine. The physical examination reveals a bilateral flank and abdominal masses. Laboratory studies show elevated blood urea nitrogen and creatinine. Urine analysis reveals hematuria, proteinuria, and oliguria. A CT scan discloses bilaterally, massively enlarged kidneys. The patient subsequently develops and stage kidney disease and receives a renal transplant. The patient's kidneys are removed during surgery (shown in the image). What is the most likely diagnosis?



    A. Autosomal dominant polycystic kidney disease
    B. Medullary Sponge Kidney
    C. Autosomal recessive polycystic kidney disease
    D. Multicystic Renal Dysplasia
    E. Hydronephrosis
    A. Autosomal dominant polycystic kidney disease
    (this multiple choice question has been scrambled)
  3. A patient with autosomal dominant polycystic kidney disease carries an increased risk for which of the following abnormalities?

    A. Hepatic Cysts
    B. Renal Cell Carcinoma
    C. Horseshoe Kidney
    D. Transitional Cell Carcinoma of the Bladder
    E. Pulmonary Cysts
    A. Hepatic Cysts
    (this multiple choice question has been scrambled)
  4. A 46-year-old woman presents with a six-month history of vague upper abdominal pain after fatty meals, some abdominal distention, and frequent indigestion. Physical examination shows an obese woman (BMI= 32kg/m2) with right upper quadrant tenderness. A CT scan discloses gallstones and ectopic kidney. Which of the following is the expected location of the ectopic kidney?

    A. Fused laterally with the contralateral kidney
    B. Adjacent to gallbladder
    C. Posterior epigatrium
    D. Pelvis
    E. Attached to the left adrenal gland
    D. Pelvis
    (this multiple choice question has been scrambled)
  5. 12-year-old girl complains of swelling of her eyelids, abdomen, and ankles. She has been in good health until several months ago, where she gained some weight and noted swelling of her lower legs. And x-ray film of the chest shows bilateral pleural infusions, without evidence of lung disease. Urine analysis reveals heavy proteinuria (8g per 24 hours) without hematuria. A few percutaneous needle biopsy of the kidney discloses no morphologic abnormalities by light microscopy. Which of the following best describes the patient's medical condition?

    A. Nephrotic syndrome
    B. Hereditary Nephritis
    C. Membranous Glomerulopathy
    D. Amyloid nephropathy
    E. Focal segmental glomerulosclerosis
    A. Nephrotic syndrome
    (this multiple choice question has been scrambled)
  6. An eight-year-old boy presents with headaches, dizziness, and malaise. He was seen for a severe sore throat two weeks ago. Physical examination reveals facial edema. The blood pressure is 180/110 mmHg. A 24 hour urine collection demonstrates oliguria, and urinalysis shows hematuria. Which of the following best describes the patient's medical condition?

    A. Hereditary nephritis
    B. Membranous glomerulonephritis
    C. Minimal change nephritic syndrome
    D. Postinfectious glomerulonephritis
    E. Thin glomerular basement membrane nephropathy
    D. Postinfectious glomerulonephritis
    (this multiple choice question has been scrambled)
  7. One finding on microscopic urinalysis indicates that hematuria in the patient with postinfectious glomerulonephritis is caused by a renal process, rather than bleeding from another site in the urinary tract?

    A. Hemoglobin crystals
    B. Blood clots
    C. White blood cell casts
    D. Phagocytosed Hemoglobin
    E. Red blood cell casts
    E. Red blood cell casts
    (this multiple choice question has been scrambled)
  8. A 60-year-old man complains of chronic back pain and fatigue, excessive urination, and increased thirst. X-ray examination reveals numerous lytic lesions in the lumbar vertebral bodies. Laboratory studies show hypoalbuminemia, mild anemia, and thrombocytopenia. Urinalysis displays 4+ proteinuria. A monoclonal immunoglobulin light chain peak is demonstrated by serum electrophoresis. A bone marrow biopsy discloses foci of plasma cells, which account for 20% of all hematopoietic cells. A kidney biopsy is obtained (shown in the image). Which of the following is the most likely cause of the nephrotic syndrome in this patient?



    A. Amyloid Nephropathy
    B. Nodular Glomerulosclerosis (Kimmelstiel-Wilson disease)
    C. Membranous glomerulonephritis
    D. Crescentic Glomerulonephritis
    E. IgA nephropathy (Berger Disease)
    A. Amyloid Nephropathy
    (this multiple choice question has been scrambled)
  9. A 49-year-old man with a history of heavy smoking presents with a five-year history of shortness of breath and cough and production of a abundance foul-smelling sputum. A pulmonary work out the demonstrates chronic bronchiectasis. Laboratory studies reveal hypoalbuminemia and hyperlipidemia. Urinalysis shows heavy proteinuria (>4g per day). Which of the following is the appropriate diagnosis?

    A. Minimal change glomerulopathy
    B. Wegener granulomatosis
    C. Amyloid Nephropathy
    D. Berger disease (IgA neprhopathy)
    E. Focal segmental glomerulosclerosis
    C. Amyloid Nephropathy
    (this multiple choice question has been scrambled)
  10. A 12-year-old boy complains of swelling of his feet for the past three weeks. He is otherwise healthy, with no known previous illness. Vital signs are normal. Physical examination reveals pitting edema of the lower legs and a swollen abdomen. Urinalysis shows 4+ protein but no RBCs or WBC. Which of the following are the most likely diagnosis to consider in your evaluation of the patient?

    A. Henoch-Schonlein purpura, Lupus nephritis
    B. Wilms tumor, renal cell carcinoma
    C. Malignant Hypertension, renal vein thrombosis
    D. Pyelonephritis, actue tubular necrosis
    E. Minimal change disease, focal segmental glomerulosclerosis
    E. Minimal change disease, focal segmental glomerulosclerosis
    (this multiple choice question has been scrambled)
  11. A four-year-old girl presents with swelling of the legs and ankles. Physical examination reveals pitting edema of the lower extremities. Urinalysis shows 2+ proteinuria. The urinary sediment contains no inflammatory cells or red blood cells. Serum levels of BUN and creatinine are normal. The patients recovers completely after a course of corticosteroids. Which of the following pathologic findings might be expected in a urine prior to treatment with corticosteroids?

    A. Lipid droplets
    B. Red Blood cell casts
    C. Amyloid Casts
    D. Eosinophils
    E. White blood cell casts
    A. Lipid droplets
    (this multiple choice question has been scrambled)
  12. Any patients with minimal change nephrotic syndrome, electron microscopy of the renal biopsy specimen prior to treatment would most likely demonstrate which of the following abnormalities?

    A. Fusion of podocyte foot processes
    B. Duplication of capillary basement membranes
    C. Electron dense immune deposits in the capillary basement membranes
    D. Electron density mean deposits in the mesangium
    E. Loss of microvilli by the tubular lining cells
    A. Fusion of podocyte foot processes
    (this multiple choice question has been scrambled)
  13. A 44-year-old man complains of swelling of his legs and puffiness around his eyes. His abdomen has become protuberant and he feels shorts of breath. Physical examination reveals generalized edema and ascites. Total serum protein is 5.2g/dL, and albumin is 1.9 g/dL. Serum cholesterol is elevated at 530 mg/dL. There are 5g of protein in a 24-hour urine collection. The urinary sediment contains many halin casts but no RBCs or inflammatory cells. A renal biopsy stained by direct immunofluorescence for IgG is shown int he image. Which of the following is the mostly likely diagnosis?



    A. Membranoproliferative glomerulonephritis type I
    B. Membranous glomerulopathy
    C. Amyloid Nephropathy
    D. Minimal change disease
    E. Focal segmental glomerulonephritis
    B. Membranous glomerulopathy
    (this multiple choice question has been scrambled)
  14. The pathogenesis of nephron six syndrome and the patient with membranous glomerulopathy is characterized by which of the following mechanisms of disease?

    A. Subepithelial deposits of immune complexes
    B. Deposition of IgA in the mesangium
    C. Expansion of the glomerular basement membrane with PAS-positive glycoproteins
    D. Deposition of anti-glomerular basement membranes antibody
    E. Subendothelial deposits of immune complexes
    A. Subepithelial deposits of immune complexes
    (this multiple choice question has been scrambled)
  15. Deposition of Anti-glomerular basement membrane antibody is a feature of
    Goodpasture syndrome
  16. Deposition of IgA in the mesangium is a feature of:
    IgA nephropathy (Berger Disease)
  17. Subendothelial deposits of immune complexes is a feature of
    lupus nephritis and membranoproliferative glomerulonephritis
  18. The glomerular changes in the patient with membranous glomerulopathy are frequently seen in patients with which of the following systemic diseases?

    A. Wegener Granulomatosis
    B. Systemic Lupus erythematosus
    C. Scleroderma
    D. Amyloid nephropathy
    E. Goodpasture syndrome
    B. Systemic Lupus erythematosus
    (this multiple choice question has been scrambled)
  19. A 14-year-old girl presents with a five day history of hypertension, oliguria, hematuria. She is seen to be slick earlier for a severe throat infection with group A (B-hemolytic) streptococci. It kidney biopsy displays glomerulonephritis. Immunofluorescence staining for which of the following proteins would provide the strongest evidence that this patient's glomerulonephritis is mediated by immune complexes?

    A. Thrombin
    B. Fibrinogen
    C. Plasminogen
    D. Complement
    E. Hageman factor (clotting factor XII)
    D. Complement
    (this multiple choice question has been scrambled)
  20. A 28-year-old man complains of nasal obstruction, bloody nose, cough, and bloody sputum. A chest x-ray displays cavitated lesions and multiple nodules within both lung fields. Urinalysis reveals 3+ hematuria and red blood cell casts. Laboratory studies show anemia and elevated serum levels of C-ANCA. Referral is Osino fills are not increased. A renal biopsy exhibits focal glomerular necrosis with crescents and vasculitis affecting arterials and venules. Which of the appropriate diagnosis?

    A. Goodpasture Syndrome
    B. Churg-Strauss Syndrome
    C. Polyarteritis Nodosa
    D. Hypersensitivity Vasculitis
    E. Wegener Granulomatosis
    E. Wegener Granulomatosis
    (this multiple choice question has been scrambled)
  21. The following best describes the renal disease of a patient with Wegener Granulomatosis?

    A. Type I membranoproliferative glomerulonephritis
    B. Nephrotic syndrome
    C. Rapidly progressive glomerulonephritis
    D. Type II membranoproliferative glomerulonephritis
    E. Chronic nephritic syndrome
    C. Rapidly progressive glomerulonephritis
    (this multiple choice question has been scrambled)
  22. 30-year-old man with a history of drug addiction presents with a six-month history of progressive swelling in his hands and abdomen. Urinalysis shows heavy proteinuria but no evidence of inflammatory cells or RBCs. Laboratory studies reveal hyperlipidemia and hypoalbuminemia. Serum creatinine level is normal. The blood test for ANCA is negative. The patient responds well to treatment with corticosteroids, but he edema and proteinuria recur the following year. The steroid treatment is repeated with the same results. Upon the third recurrence of edema and proteinuria, the patients become steroid resistant. A renal biopsy is shown in the image. Which of the following is the most likely diagnosis for the patients glomerulopathy?



    A. Amyloidosis
    B. Diffuse proliferative glomerulonephritis
    C. Acute Glomerulonephritis
    D. Focal segmental glomerulosclerosis
    E. Crescentic glomerulonephritis
    D. Focal segmental glomerulosclerosis
    (this multiple choice question has been scrambled)
  23. 20-year-old woman is involved in an automobile accident and loses a large amounts of blood. In response to hypoxia, interstitial peritubular cells of the kidney would be expected to release which of the following hormones?

    A. Angiotensin
    B. Renin
    C. Angiotensinogen
    D. Erythropoietin
    E. Aldosterone
    D. Erythropoietin
    (this multiple choice question has been scrambled)
  24. 32-year-old man complains of recurrent hematuria since youth. The hematuria typically occurs following upper respiratory tract infections. Vital signs are normal. Urinalysis shows proteinuria, hematuria, and a few red blood cell casts. Laboratory studies disclose normal levels of BUN and creatinine. The ANA and ANCA tests are negative. Which of the following is the most likely diagnosis?

    A. Hereditary nephritis (alport syndrome)
    B. Berger disease (IgA nephropathy)
    C. Wegener granulomatosis
    D. Amyloid nephropathy
    E. Membranous glomerulopathy
    B. Berger disease (IgA nephropathy)
    (this multiple choice question has been scrambled)
  25. For the patient with Berger Disease, which of the following patterns of IgA Immunofluorescence would be expected in the renal biopsy?

    A. Subepithelial desposits
    B. Mesangial deposition
    C. Granular capillary membrane despoition
    D. Perivascular location
    E. Linear Basement membrane staining
    B. Mesangial deposition
    (this multiple choice question has been scrambled)
  26. A 25-year-old man complains of intermittent hematuria over the past eight years. Urinalysis shows microscopic hematuria. Urine cultures are negative. A renal biopsy (shown in the image) displays mesangial proliferation within some glomeruli, whereas others appear normal. Immunofluorescence staining discloses mesangial deposition of IgA. Which of the following is the appropriate pathologic diagnosis?



    A. Focal proliferative glomerulonephritis
    B. Membranous nephropathy
    C. Crescentic glomerulonephritis
    D. Nodular diabetic glomerulosclerosis
    E. Amyloid nephropathy
    A. Focal proliferative glomerulonephritis
    (this multiple choice question has been scrambled)
  27. An eight-year-old boy presents with headaches, dizziness, and malaise approximately two weeks after a severe sore throat. His mother describes puffiness of his face and darkening of his urine. She also notes that her son is passing less urine and that he is becoming increasingly short of breath. On physical examination, there is anasarca, hypertension (190/130), and tachycardia. The urine is scanty and brownish red. Urinalysis shows 3+ proteinuria. Microscopic examination of the year and discloses numerous RBCs, as well as occasional granular and red cell casts. A renal biopsy is stained by direct immunofluorescence microscopy for complement C3, and the results are shown. Which of the following best describes the pattern of immunofluorescence observed in this renal biopsy?



    A. Deposits limited to the mesangium
    B. Subepithelial and subendothelial deposits
    C. Dense deposits in glomerular crescents between epithelial cells
    D. Linear staining along the glomerular basement membranes
    E. Granular deposits along the perimesangial reflections
    B. Subepithelial and subendothelial deposits
    (this multiple choice question has been scrambled)
  28. Which of the following is the most likely cause of acute postinfectious glomerulonephritis in a patient with subepithelial and subendothelial deposits?

    A. Epstein-Barr virus
    B. Klebsiella sp.
    C. E. coli
    D. Group A (B-hemolytic) streptococci
    E. Staphylococus sp.
    D. Group A (B-hemolytic) streptococci
    (this multiple choice question has been scrambled)
  29. 30-year-old woman with systemic lupus erythematosus presents with oliguria. Laboratory studies show elevated serum levels of creatinine and BUN. Urinalysis reveals 4+ proteinuria and hematuria. The renal biopsy (shown in the image) exhibit's segmental endocapillary hypercellularity and thickening of the capillary walls, and 90% of the glomeruli appear hypercellular. Which of the following is the appropriate pathologic diagnosis?

    A. Crescentic glomerulonepritis
    B. Proliferative glomerulonephritis
    C. Focal segmental glomerulosclerosis
    D. Membranoproliferative glomerulonephritis, Type II
    E. Membranous nephropathy
    B. Proliferative glomerulonephritis
    (this multiple choice question has been scrambled)
  30. 35-year-old man with a history of smoking presents with hematuria and a bloody sputum. Over the next two days, he develops oliguria and renal failure, after which she is placed on dialysis. A renal biopsy is stained with florescein-conjugated goat antihuman IgG, and the results are show. Which of the following best describes the patter of direct immunofluorescence observed on the his photomicrograph?



    A. Peripheral granular humps
    B. Mesangial with a stalk predominance
    C. Discontinuous and peripheral
    D. Finely granular along the perimesangial reflections
    E. Linear along the glomerular basement membrane
    E. Linear along the glomerular basement membrane
    (this multiple choice question has been scrambled)
  31. A 54-year-old woman with squamous cell carcinoma of the lung develops bilateral pitting edema of the lower extremities. Laboratory studies show hyperlipidemia, hypoalbuminemia, and 4+ proteinuria. Urinalysis reveals no inflammatory cells or RBCs. Renal biopsy in this patient would most likely show which of the following patterns of glomerulopathy? 

    A. Membranous glomerulopathy
    B. Nodular glomerulosclerosis
    C. Minimal change glomerulopathy
    D. Berger disease (IgA nephropathy)
    E. Goodpasture syndrome
    A. Membranous glomerulopathy
    (this multiple choice question has been scrambled)
  32. A 30-year-old man with a history of smoking suddenly develops oliguria, hematuria, and hemoptysis. Serologic studies reveal antibodies to the glomerular basement membrane (GBM). A renal biopsy is shown. Which of the following pathologic changes is visible by light microscopy in this biopsy specimen? 



    A. Crescents in the urinary space
    B. Thrombi in glomerular capillaries
    C. Thickening of the GBM
    D. Mesangial cell proliferation
    E. Leukocytic infiltrates in the glomeruli
    A. Crescents in the urinary space
    (this multiple choice question has been scrambled)
  33. A 52-year-old woman who suffers from diabetes mellitus and frequent urinary tract infections presents with a 3-day history of flank pain, undulating fever, and general malaise. A CBC shows neutrophilic leukocytosis (16,000/μL). Urine cultures reveal more than 100,000 bacterial colonies, composed predominantly of Gram-negative microorganisms. Blood pressure is 170/100mmHg, BUN is 30mg/dL, and creatinine is 2.0 mg/dL. Fasting serum glucose is 190 mg/dL. Urinalysis shows 2+ sugar and 1+ protein. Microscopic examination of the urine sediment reveals neutrophils and occasional leukocyte casts. Which of the following is the most likely diagnosis? 

    A. Postinfectious glomerulonephritis
    B. Acute tubular necrosis
    C. Diabetic nephropathy
    D. Acute pyelonephritis
    E. Nephrolithiasis
    D. Acute pyelonephritis
    (this multiple choice question has been scrambled)
  34. A 22-year-old woman in the second trimester of pregnancy presents with flank pain, fever of 38.7°C (103°F), and chills. Hemoglobin is 13.4 g/dL, WBCs are elevated (13,500/μL with 78% neutrophils), and there are 265,000 platelets/μL. Physical examination reveals costovertebral angle tenderness. The urine shows numerous WBCs and WBC casts. Which of the following is the most likely diagnosis? 

    A. Endometritis
    B. Urethritis
    C. Cystitis
    D. Pyelonephritis
    E. Glomerulonephritis
    D. Pyelonephritis
    (this multiple choice question has been scrambled)
  35. Which of the following the most likely the cause of Pyelonephritis?

    A. Mycobacteria
    B. Immune complex deposition
    C. Human papillomavirus
    D. Gram-positive bacteria
    E. Gram-negative bacteria
    E. Gram-negative bacteria
    (this multiple choice question has been scrambled)
  36. A 50-year-old woman complains of severe headaches and dizziness. The patient has a history of repeated urinary tract infections. The blood pressure is 180/110mmHg. Laboratory studies show elevated levels of BUN (38 mg/dL) and creatinine (2.8mg/dL). A CT scan of the lower abdomen reveals small, irregularly shaped kidneys with deep coarse scars. A percutaneous renal biopsy is shown. Which of the following is the appropriate diagnosis? 



    A. Acute pyelonephritis
    B. Chronic pyelonephritis
    C. Tubulointerstitial nephritis
    D. Nephrosclerosis
    E. Acute tubular necrosis
    B. Chronic pyelonephritis
    (this multiple choice question has been scrambled)
  37. The pathogenesis of Chronic Pyelonephritis is related to which of the following conditions?

    A. Hypertension
    B. Anti-GBM disease
    C. Repeated bouts of acute pyelonephritis
    D. Chronic hepatitis B infection
    E. Amyloidosis
    C. Repeated bouts of acute pyelonephritis
    (this multiple choice question has been scrambled)
  38. 52-year-old woman presents with swelling of her ankles of six weeks in duration. Physical examination reveals an obese woman (BMI=32kg/m2) with pitting edema of the lower extremities and periorbital edema. Laboratory studies show hyperlipidemia and hypoalbuminemia. Urinalysis discloses 3+ proteinuria and 3+ glucosuria but no evidence of inflammatory cells or RBCs. A kidney biopsy stained with PAS (shown in the image) displays a prominent increase in the mesangial matrix, forming nodular lesions, and thickening of capillary basement membranes. Which of the following is the most likely pathologic diagnosis? 



    A. Amyloid nephropathy
    B. Acute glomerulonephritis
    C. Diabetic glomerulosclerosis
    D. Malignant nephrosclerosis
    E. Membranoproliferative glomerulonephritis
    C. Diabetic glomerulosclerosis
    (this multiple choice question has been scrambled)
  39. Which of the following serum abnormalities is expected in a patient with Diabetic Glomerulosclerosis?

    A. Hypergammaglobulinemia
    B. Hyperglycemia
    C. Hyperuricemia
    D. Hyperbilirubinemia
    E. Hypobilirubinemia
    B. Hyperglycemia
    (this multiple choice question has been scrambled)
  40. A 70-year-old diabetic woman presents with sudden onset of excruciating groin and flank pain. Physical examination shows pitting edema of the lower extremities. Laboratory studies reveal decreased serum albumin and increased serum lipids. Urine cultures reveal more than 100,000 bacterial colonies composed predominantly of Gram-negative microorganisms. Which of the following is the most likely diagnosis? 

    A. Acute tubular necrosis
    B. Crescentic glomerulonephritis
    C. Renal vein thrombosis
    D. Diabetic glomerulosclerosis
    E. Renal papillary necrosis
    E. Renal papillary necrosis
    (this multiple choice question has been scrambled)
  41. 40-year-old man with Alport syndrome presents with a 3-month history of headaches. His blood pressure is 165/100 mmHg. A urinalysis shows 3+ proteinuria and 2+ hematuria. Laboratory studies disclose elevated levels of BUN (48mg/dL) and creatinine (3.6mg/dL). This patient's renal disease is caused by mutation in a gene that encodes which of the following extracellular matrix proteins?

    A. Entactin
    B. Fibronectin
    C. Fibrillin
    D. Collagen
    E. Laminin
    D. Collagen
    (this multiple choice question has been scrambled)
  42. A 35-year-old man presents with fever and rash after beginning treatment with penicillin 2 weeks earlier for a sinus infection. Urinalysis shows 3+ hematuria, as well as mononuclear cells, neutrophils, and eosinophils. A percutaneous renal biopsy is shown. Which of the following is the most likely diagnosis? 



    A. Chronic pyelonephritis
    B. Focal segmental glomerulosclerosis
    C. Focal necrotizing glomerulonephritis
    D. Crescentic Glomerulonephritis
    E. Acute tubulointersitial nephritis
    E. Acute tubulointersitial nephritis
    (this multiple choice question has been scrambled)
  43. A 58-year-old man with a history of coronary artery disease, peripheral vascular disease, and a recent heart attack suddenly develops painless hematuria. He subsequently suffers a massive stroke and expires. The patient’s kidney at autopsy is shown. Which of the following is the most likely diagnosis? 



    A. Cortical infart
    B. Cortical abscess
    C. Malignant nephrosclerosis
    D. Chronic pyelonephritis
    E. Benign nephrosclerosis
    A. Cortical infart
    (this multiple choice question has been scrambled)
  44. A 36-year-old woman in the third trimester of pregnancy (gravida II, para I) presents to the emergency room with the sudden onset of severe vaginal bleeding. Ultrasound examination of the abdomen discloses abruptio placentae. A healthy neonate is delivered; however, the mother’s blood loss is uncontrollable. She becomes hypotensive and obtunded and subsequently dies of hypovolemic shock. The kidneys at autopsy are shown. Which of the following is the most likely diagnosis? 



    A. Renal Papillary necrosis
    B. Crescentic glomerulonephritis
    C. Bilateral renal cortical necrosis
    D. Acute tubulointerstitial nephritis
    E. Necrotizing glomerulonephritis
    C. Bilateral renal cortical necrosis
    (this multiple choice question has been scrambled)
  45. A 33-year-old woman in her third trimester of pregnancy (gravida I, para 0) is rushed to the emergency room after suffering a seizure. The patient is hypertensive and laboratory studies show that the patient manifests nephritic syndrome. What is the appropriate diagnosis? 

    A. Preeclampsia
    B. Malignant nephrosclerosis
    C. Eclampsia
    D. Crescentic glomerulonephritis
    E. Acute Tubular necrosis
    C. Eclampsia
    (this multiple choice question has been scrambled)
  46. A 60-year-old man undergoes resection of an abdominal aneurysm, which is complicated by massive hemorrhage. Two days after surgery, the patient develops acute renal insufficiency. He is placed on dialysis but suffers a massive heart attack and dies. Microscopic examination of the kidneys at autopsy reveals necrotic epithelial cells within the lumina of some tubules (shown in the image). The arrows identify enlarged, regenerative epithelial cells. What is the appropriate diagnosis? 



    A. Eosinophilic interstitial nephritis
    B. Fanconi syndrome
    C. Acute tubular necrosis
    D. Acute intersitial nephritis
    E. Polyarteritis nodosa
    C. Acute tubular necrosis
    (this multiple choice question has been scrambled)
  47. A 70-year-old obese woman (BMI = 34 kg/m2) presents with a 3-month history of progressive renal insufficiency. She has a longstanding history of hypertension. An intravenous pyelogram shows that both kidneys are small, and the pelves and calyces appear dilated. The patient subsequently suffers a massive stroke and expires. Examination of the kidneys at autopsy reveals symmetrically shrunken small kidneys, with a uniformly finely granular surface (shown in the image). Which of the following is the appropriate diagnosis? 



    A. Amyloidosis
    B. Tubulo interstitial nephritis
    C. Ischemic acute tubular necrosis
    D. Nephrosclerosis
    E. Hydronephrosis
    D. Nephrosclerosis
    (this multiple choice question has been scrambled)
  48. A 60-year-old man presents with acute renal insufficiency. He treated his garden last week with a number of herbicides and insecticides, some of which may have contained heavy metals. Laboratory studies confirm oliguria and increased levels of BUN (54 mg/dL) and creatinine (3.7 mg/dL). A renal biopsy is shown. What is the most likely diagnosis? 



    A. Acute tubular necrosis (ATN)
    B. Papillary necrosis
    C. Tubulointerstitial nephritis
    D. Rapidly progressive glomerulonephritis
    E. Bilateral cortical necrosis
    A. Acute tubular necrosis (ATN)
    (this multiple choice question has been scrambled)
  49. A 45-year-old man undergoes renal biopsy for evaluation of chronic renal failure. The patient is obese (BMI = 37 kg/m2) and admits to smoking two packs per day for 30 years. Physical examination reveals a blood pressure of 190/110 mm Hg. An echocardiogram shows conspicuous left ventricular hypertrophy. A renal biopsy discloses pathologic changes in small renal arteries, including “onion-skinning” and fibrinoid necrosis. The Congo red stain is negative. Laboratory studies show hematocrit of 40%, hemoglobin of 18.7 g/dL, serum cholesterol of 250 mg/dL, BUN of 45 mg/dL, and serum creatinine of 5.5mg/dL. Which of the following is the most likely underlying cause of chronic renal failure in this patient? 

    A. Malignant hypertension
    B. Amyloid nephropathy
    C. Congestive heart failure
    D. Chronic pyelonephritis
    E. Cushing syndrome
    A. Malignant hypertension
    (this multiple choice question has been scrambled)
  50. A 58-year-old man with a history of hyperlipidemia and high blood pressure presents to the emergency room for evaluation of headaches and blurred vision. His blood pressure is 200/115mmHg, and pulse is 95 per minute. Funduscopic examination reveals several small retinal microaneurysms and cotton-like zones of retinal edema and necrosis. Intravenous pyelography discloses small kidneys bilaterally. Renal arteriography shows stenoses of both renal arteries. Hypertension in this patient is caused by the renal release of which of the following hormones? 

    A. Aldosterone
    B. Renin
    C. Plasminogen
    D. Erythropoietin
    E. Angiotensin
    B. Renin
    (this multiple choice question has been scrambled)
  51. A 6-year-old child develops fever, abdominal pain, and bloody diarrhea. Several other children in the neighborhood had similar symptoms. The common feature was traced to eating hamburgers at a fast food restaurant. The clinical course is complicated by the development of acute renal failure. Which of the following is the most likely diagnosis? 

    A. Polyarteritis Nodosa
    B. Acute postinfectious glomerulonephritis
    C. Malignant hypertension
    D. Churg-Strauss syndrome
    E. Hemolytic uremic syndrome
    E. Hemolytic uremic syndrome
    (this multiple choice question has been scrambled)
  52. A 5-year-old girl presents with the sudden onset of diffuse arthralgias and skin rash. Physical examination shows a violaceous maculopapular rash on the lower torso. Urinalysis discloses oliguria and 2+ hematuria. Urine cultures are negative. This child’s clinical presentation is commonly associated with which of the following diseases? 

    A. Berger disease
    B. Polyarteritis Nodosa
    C. Goodpasture syndrome
    D. Hemolytic uremic syndrome
    E. Henoch-Schonlein purpura
    E. Henoch-Schonlein purpura
    (this multiple choice question has been scrambled)
  53. A 50-year-old man is found to have blood in his urine during a routine checkup. He is otherwise in excellent health, except for a mild microcytic, hypochromic anemia. An enlarged right kidney is found on X-ray examination, and CT scan reveals a renal mass of irregular shape, measuring 6cm in diameter. Which of the following is the most likely diagnosis? 

    A. Nephroblastoma
    B. Metastatic carcinoma
    C. Renal cell carcinoma
    D. Angiomyolipoma
    E. Wilms tumor
    C. Renal cell carcinoma
    (this multiple choice question has been scrambled)
  54. For a patient with Renal Cell Carcinoma, a fine needle aspiration of the renal mass shows glycogen-rich tumor cells. Molecular studies would most likely identify mutations in which of the following growth regulatory genes?

    A. PAX6
    B. ADPKD
    C. IGF-2
    D. WT1
    E. VHL
    E. VHL
    (this multiple choice question has been scrambled)
  55. The mother of a 12-month-old boy palpates a mass on the right side of the infant’s abdomen. The surgical specimen is shown. Microscopically, the tumor is composed of multiple elements, including blastemal, stromal, and epithelial tissues. Which of the following is the most likely diagnosis? 



    A. Wilms tumor
    B. Neuroblastoma
    C. Teratocarcinoma
    D. Renal Cell carcinoma
    E. Ganglioneuroma
    A. Wilms tumor
    (this multiple choice question has been scrambled)
  56. The parents of a 6-month-old girl palpate a mass on the left side of the child’s abdomen. Urinalysis shows high levels of vanillyl-mandelic acid. A CT scan reveals an abdominal tumor and bony metastases. Which of the following is the most likely diagnosis? 

    A. Immature teratoma
    B. Wilms tumor
    C. Ganglioneuroma
    D. Dysgerminoma
    E. Neuroblastoma
    E. Neuroblastoma
    (this multiple choice question has been scrambled)
  57. A 50-year-old man is found to have blood in his urine during a routine checkup. A CBC shows microcytic ,hypochromic anemia. An enlarged right kidney is found on X-ray examination. A CT scan reveals a renal mass of irregular shape measuring 5cm in diameter. The nephrectomy specimen is shown. This malignant neoplasm most likely originates from which of the following tissues in the kidney? 



    A. Lymphatics
    B. Renal papillae
    C. Glomeruli
    D. Renal tubules
    E. Juxtaglomerular cells
    D. Renal tubules
    (this multiple choice question has been scrambled)
  58. A 56-year-old woman presents with acute renal failure. A frozen section of a renal biopsy demonstrates birefringent, intratubular deposits of uric acid crystals (shown in the image). This finding suggests that the patient has been treated recently for which of the following underlying conditions? 



    A. Leukemia
    B. Ulcerative colitis
    C. Chronic hepatitis B
    D. Porphyria
    E. Rheumatoid arthritis
    A. Leukemia
    (this multiple choice question has been scrambled)
  59. A 46-year-old man with no past medical history presents with excruciating episodic (colicky) right flank pain. A renal stone is passed. In the United States, this stone is most likely composed of which of the following? 

    A. Calcium phosphate
    B. Magnesium ammonium phosphate
    C. Cystine
    D. Uric acid
    E. Calcium oxalate
    E. Calcium oxalate
    (this multiple choice question has been scrambled)
  60. A 75-year-old homeless man is brought to the emergency room in a coma. Upon admission to the hospital, the BUN is 74 mg/dL, and the creatinine is 6.5 mg/dL. He dies thereafter, and an autopsy reveals abnormal kidneys (shown in the image). The pathogenesis of this disease is most likely related to which of
    the following? 



    A. Systemic Hypertension
    B. Polycystic kidney disease
    C. Acute Pyelonephritis
    D. Amyloidosis
    E. Urinary tract obstruction
    E. Urinary tract obstruction
    (this multiple choice question has been scrambled)
  61. A 55-year-old man dies of chronic renal failure. Examination of his kidneys at autopsy reveals a “staghorn” calculus. Which of the following best describes the pathogenesis of this renal stone? 



    A. Infection
    B. Gout
    C. Hyperparathyroidism
    D. Hereditary cystinuria
    E. Hypercalcemia
    A. Infection
    (this multiple choice question has been scrambled)
  62. 36-year-old woman presents with advanced cervical carcinoma, and a CT scan shows widespread pelvic spread. If this condition is not surgically corrected, the patient’s kidneys will most likely develop which of the following conditions? 

    A. Staghorn calculi
    B. Acute vasculitis
    C. Tubulointerstitial nephritis
    D. Hydronephrosis
    E. Polycystic kidney disease
    D. Hydronephrosis
    (this multiple choice question has been scrambled)
  63. A 34-year-old man undergoing cisplatin-based chemotherapy complains of a 1-week history of increasing fatigue and headaches. He also reports seeing blood in his urine. Blood pressure is 150/100mmHg. Physical examination reveals diffuse purpura over his upper trunk and arms. Laboratory studies show elevated levels of BUN and creatinine, and 24-hour urinalysis reveals hematuria and oliguria. Urine cultures are negative. A CBC demonstrates severe anemia (hematocrit 28%) and thrombocytopenia (50,000/μL). The direct Coombs test is negative. A peripheral blood smear reveals schistocytes. Which of the following is the most likely cause of acute renal failure in this patient? 

    A. Polyarteritis nodosa
    B. Nephrotoxic acute tubular necrosis
    C. Thrombotic microangiopathy
    D. ANCA glomerulonephritis
    E. Henoch-Schonlein purpura
    C. Thrombotic microangiopathy
    (this multiple choice question has been scrambled)
  64. A 16-year-old black girl with sickle cell anemia presents to the emergency room because she is experiencing severe bone pain (avascular necrosis). An abdominal CT scan shows evidence of splenic infarcts. Which of the following renal diseases is a direct complication of this patient’s vasoocclusive disease? 

    A. Papillary necrosis
    B. Polycystic kidney disease
    C. Acute pyelonephritis
    D. Urolithiasis
    E. Urate nephropathy
    A. Papillary necrosis
    (this multiple choice question has been scrambled)
  65. 35-year-old woman with end-stage renal disease of unknown etiology is transplanted with a cadaver kidney. The patient develops oliguia shortly after transplantation and a renal biopsy shows immediate (hyperacute) rejection. Immunosuppression improves renal function. Which of the following represents the principle target for immune attack directed against this patient’s allograft? 

    A. Bacterial antigens
    B. B-Microglobulin
    C. Urothelium
    D. ABO antigens
    E. Glomerular basement membrane antigens
    D. ABO antigens
    (this multiple choice question has been scrambled)
  66. A 12-year-old girl complains of headaches and blurred vision. She has a history of high blood pressure, but is not currently taking medication. Her blood pressure is 160/95mmHg and pulse is 95 per minute. Funduscopic examination reveals small retinal microaneurysms and cotton-like zones of retinal edema and necrosis. She is hospitalized for further evaluation. Renal arteriography shows segmental stenoses forming multiple ridges that project into the lumen. What is the most likely cause of secondary hypertension in this young patient? 

    A. Buerger disease
    B. Giant cell arteritis
    C. Kawasaki disease
    D. Takayasu arteritis
    E. Fibromuscular dysplasia
    E. Fibromuscular dysplasia
    (this multiple choice question has been scrambled)
  67. A 50-year-old male with a long history of smoking has atypical epithelial cells seen in a urinalysis specimen, but cystoscopy is negative. What best explains this finding:

    A. Nodular glomerulosclerosis
    B. Transitional cell carcinoma of renal pelvis
    C. Squamous cell carcinoma of penis
    D. Acute interstitial nephritis
    E. Adenocarcinoma of prostate
    B. Transitional cell carcinoma of renal pelvis
    (this multiple choice question has been scrambled)
  68. The definition of the nephrotic syndrome is based upon the finding of:

    A. Renal tubular epithelial cells and casts
    B. Lipiduria in association with hypercholesterolemia
    C. Hematuria with >10 RBC/hpf
    D. No inflammation in a urinalysis specimen
    E. Proteinuria >3.5 gm/24 hours
    E. Proteinuria >3.5 gm/24 hours
    (this multiple choice question has been scrambled)
  69. A 19-year-old male notes hematuria and sees his physician, who also notes mild proteinuria. Additional examination, including audiometry, reveals only hearing loss. Which of the following findings is LEAST likely to be present:

    A. Visual problems
    B. Increased risk for renal failure in 10 years
    C. Immune complexes in the mesangium
    D. Other affected family members
    E. Basement membrane abnormalities
    C. Immune complexes in the mesangium
    (this multiple choice question has been scrambled)
  70. A hyperplastic arteriolosclerosis with fibrinoid necrosis, petechial hemorrhages, and microinfarcts seen in the kidneys in conjunction with a markedly elevated plasma renin is most consistent with which of the following patient histories:

    A. A 6 year old male with albuminuria
    B. A 15 year old male with recent streptococcal infection
    C. A 45 year old female with scleroderma
    D. A 56 year old male with an acute myocardial infarction
    E. A 62 year old female with end stage renal disease
    C. A 45 year old female with scleroderma
    (this multiple choice question has been scrambled)
  71. A neoplasm of the kidney that microscopically resembles an embryonic nephrogenic zone and may be due to a lack of a tumor suppressor gene on chromosome 11 is most likely a(an):

    A. Medullary fibroma
    B. Wilm's tumor
    C. Transitional cell carcinoma
    D. Angiomyolipoma
    E. Renal cell carcinoma
    B. Wilm's tumor
    (this multiple choice question has been scrambled)
  72. What is the pathologic/compensation mechanism for respiratory alkalosis?
    Pathologic = hyperventilation causes decreased pCO2

    Compensation = decreased reabsorption of bicarbonate
  73. Nephrotic or Nephritic

    Fatty cast, Hyperlipdiemia, increased risk of infections
    Nephrotic
  74. Nephrotic or Nephritic

    >3.5g/day of proteinuria 
    loss of antithrombin 3 leading to thromboembolism
    Nephrotic
  75. Nephritic or Nephrotic

    Hematuria
    periorbital edema
    minimal to moderate proteinuria
    Nephritic
  76. Nephritic or Nephrotic

    Acute Post-Streptococcal Glomerulonephritis
    Nephritic
  77. Nephritic or Nephrotic

    Berger disease (IgA glomerulonephropathy)
    Nephritic
  78. Nephritic or Nephrotic

    Membranous nephropathy
    Nephrotic
  79. Nephritic or Nephrotic

    Diabetic glomerulonephropathy
    nephrotic
  80. Nephritic or Nephrotic

    Minimal change disease
    nephrotic
  81. Nephritic or Nephrotic

    Amyloidosis
    Nephrotic
  82. Nephritic or Nephrotic

    Membranoproliferative glomerulonephritis
    • ITS BOTH!!
    • MMUUUUAAAHAHAHAHAHHAA
  83. Key finding: Granular muddy brown cast
    Acute tubular necrosis
  84. Pathology due to a combination of vasospasms and DIC. Associated with abruptio placentae and septic shock
    Diffuse cortical necrosis
  85. Pulseless disease
    Px presents with arthritis, fever, myalgias, skin nodules, night sweats
    Takayasu arteritis
  86. the only C-ANCA vasculitis that leads to ARI (acute renal injury)
    Wegener's Granulomatosis
  87. P-anca eosinophilia
    Churg-Strauss syndrome
  88. P-ANCA related to Hep B infection that spares the lung
    Polyarteritis Nodosa
  89. Most common kidney stone
    Calcium oxalate
  90. Composition of a Staghorn calculi
    Ammonium Magnesium Phosphate
  91. Tram-track appearance
    Membranoproliferative GN type 1
  92. Dense deposit associated with C3
    Membranoproliferative GN type 2
  93. Circulating anti-GBM antibodies with linear GBM staining for IgG with lung hemorrhage
    Goodpasture syndrome
  94. Circulating anti-GBM antibodies with linear GBM staining for IgG
    Anti-GBM glomerulonephritis
  95. - Circulating ANCA with little glomerular immunoglobulin staining
    - Without lung hemorrhage
    ANCA glomerulonephritis
  96. - Circulating ANCA with little glomerular immunoglobulin staining
    - Vasculities with no asthma or granulomas
    - p-ANCA
    Microscopic polyangitis
  97. - Circulating ANCA with little glomerular immunoglobulin staining
    - Granulomas and no asthma
    - c-ANCA
    Wegener Granulomatosis
  98. - Circulating ANCA with little glomerular immunoglobulin staining
    - Eosinophilia, asthma, and granulomas
    - p-ANCA
    Churg-Strauss Syndrome
  99. The glomerulus is slight enlarged and shows thickening of capillary walls with NO HYPERCELLULARITY. Immunofluorescence shows granular deposits of IgG outlining glomerular capillary loops
    membranous glomerulopathy
  100. Prominent increase in the mesangial matrix, forming nodular lesions. Dilation of glomerular capillaries is seen along with thickened capillary basement membranes
    Diabetic Glomerulosclerosis
  101. Amorphous acellular material expands the mesangial area and obstructs the glomerular capillaries. Under congo red stain, apple-green birefringence is seen.
    Amyloid nephropahty
  102. Electron micrograph demonstrates numerous sub-epithelial humps. Immunoflourescence micrograph demonstrates granular staining for C3 in capillary walls and the mesangium
    Acute postinfectious glomerulonephritis
  103. Glomerular lobulation is accentuated along with increased cells and matrix in the mesangium and thickening of capillary walls. Tram-Track appearance
    Type 1 membranoproliferative Glomerulonephritis
  104. Capillary wall thickening, Hypercellularity amd small cescents are evident. Electron microscope demonstrates thickening of basement membrane and intramembranous dense deposits. Immunofluorescence micrograph demonstrates bands of capillary wall staining and corsely granular mesangial staining for C3
    Type 2 Membranoproliferative Glomerulonephritis
  105. Segmental mesangial hypercellularity and matrix expansion caused by mesangial immune desposits of IgA
    IgA Nephropathy
  106. Linear immunofluorescence for IgG is seen along BGM. Bowman space is filled by cellular crescent and glomerular tuft is injured
    Anti-GBM basement membrane glomerulonephritis
  107. Segmental fibrinoid necrosis with focal disruption of GBM and crescent formation within the Bowman's space
    ANCA glomerulonephritis
  108. Pattern of glomerular infiltration of glassy aggregates ("hyaline thrombi") in the capillary lumina and subendothelial spaces
    Cryoglobulinemic glomerulonephritis

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