Medicine
Nephrology
A 28-year-old woman develops cola-colored urine 2 days after an upper respiratory infection. Which diagnosis is most likely?
A. IgA nephropathy
B. Poststreptococcal glomerulonephritis
C. Membranous nephropathy
D. Amyloidosis
Correct Answer: A
IgA nephropathy classically causes synpharyngitic hematuria occurring during or within a few days of a respiratory infection.
Medicine
Nephrology
A patient with edema has urine protein 5 g/day, hypoalbuminemia and hyperlipidemia. This pattern is called:
A. Nephrotic syndrome
B. Nephritic syndrome
C. Prerenal azotemia
D. Fanconi syndrome
Correct Answer: A
Heavy proteinuria, hypoalbuminemia, edema and hyperlipidemia define the nephrotic syndrome.
Medicine
Nephrology
Which change is expected shortly after starting an ACE inhibitor in bilateral renal artery stenosis?
A. Marked rise in creatinine
B. Severe hypoglycemia
C. Nephrotic-range proteinuria always resolves
D. Serum potassium always falls
Correct Answer: A
In bilateral renal artery stenosis, filtration depends on angiotensin II-mediated efferent arteriolar constriction, so ACE inhibition can sharply reduce GFR.
Medicine
Nephrology
A patient with autosomal dominant polycystic kidney disease should be counseled about increased risk of which extrarenal condition?
A. Intracranial berry aneurysm
B. Achalasia
C. Myasthenia gravis
D. Celiac disease
Correct Answer: A
ADPKD is associated with intracranial aneurysms, hepatic cysts and certain valvular abnormalities.
Medicine
Nephrology
A patient has recurrent kidney stones, hypercalcemia and elevated PTH. Which stone composition is most likely?
A. Calcium oxalate or calcium phosphate
B. Cystine only
C. Struvite only
D. Pure cholesterol
Correct Answer: A
Primary hyperparathyroidism increases urinary calcium and predisposes to calcium-containing renal stones.
Medicine
Nephrology
A man with CKD has pruritus, high phosphate, low calcium and elevated PTH. What mechanism best explains the high PTH?
A. Secondary hyperparathyroidism from CKD-mineral bone disorder
B. Primary adrenal failure
C. Thyrotoxicosis
D. Excess calcitonin
Correct Answer: A
Phosphate retention, reduced calcitriol and hypocalcemia stimulate secondary hyperparathyroidism in advanced CKD.
Medicine
Nephrology
A patient has metabolic acidosis with normal anion gap and urine pH persistently above 5.5. Which renal tubular acidosis is most likely?
A. Distal type 1 RTA
B. Proximal type 2 RTA
C. Type 4 RTA only
D. Respiratory acidosis
Correct Answer: A
Distal RTA reflects impaired distal hydrogen secretion, producing non-anion-gap acidosis with inappropriately high urine pH.
Medicine
Nephrology
Which indication is an accepted emergency reason to initiate dialysis in acute kidney injury?
A. Refractory pulmonary edema
B. Mild asymptomatic azotemia only
C. Creatinine 1.4 mg/dL alone
D. Microscopic hematuria alone
Correct Answer: A
Refractory volume overload causing pulmonary edema is a classic urgent indication for kidney replacement therapy.
Medicine
Nephrology
A patient with small-cell lung cancer has sodium 116 mmol/L, low serum osmolality, concentrated urine and appears euvolemic. What is the likely diagnosis?
A. SIADH
B. Diabetes insipidus
C. Primary hyperaldosteronism
D. Osmotic diuresis
Correct Answer: A
Hypotonic euvolemic hyponatremia with inappropriately concentrated urine is typical of SIADH.
Medicine
Nephrology
A patient with nephrotic syndrome suddenly develops flank pain and hematuria. Which complication should be suspected?
A. Renal vein thrombosis
B. Acute appendicitis
C. Ureteric reflux only
D. Pyelonephritis is impossible
Correct Answer: A
Nephrotic syndrome creates a hypercoagulable state and can be complicated by renal vein thrombosis.
Medicine
Nephrology
A diabetic patient has persistent albuminuria and hypertension. Which antihypertensive class is preferred for kidney protection when tolerated?
A. ACE inhibitor or ARB
B. Alpha blocker only
C. Short-acting nitrate
D. Hydralazine alone
Correct Answer: A
Renin-angiotensin system blockade reduces intraglomerular pressure and albuminuria in albuminuric diabetic CKD.
Medicine
Nephrology
Which urinary finding is most characteristic of glomerulonephritis?
A. Red blood cell casts
B. Fatty casts only
C. Hexagonal crystals
D. Broad waxy casts only
Correct Answer: A
RBC casts indicate bleeding within the nephron and strongly support a glomerular inflammatory process.
Medicine
Nephrology
A patient has oliguria after prolonged hypotension. Urinalysis shows muddy brown granular casts. What is the most likely diagnosis?
A. Acute tubular necrosis
B. Minimal change disease
C. Postrenal obstruction
D. Renal vein thrombosis
Correct Answer: A
Ischemic acute tubular injury commonly produces muddy brown granular casts after significant hypotension or shock.
Medicine
Nephrology
A patient with severe hyperkalemia has peaked T waves and QRS widening. Which treatment should be given first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral sodium bicarbonate only
C. Furosemide by mouth
D. Kayexalate alone
Correct Answer: A
Intravenous calcium rapidly stabilizes the cardiac membrane in hyperkalemia with ECG changes; other therapies then lower serum potassium.
Medicine
Gastroenterology & Hepatology
Which finding in a patient with acute upper GI bleeding most strongly indicates the need for urgent resuscitation before endoscopy?
A. Hemodynamic instability
B. Mild isolated dyspepsia
C. Normal hemoglobin on one early sample
D. History of constipation
Correct Answer: A
Airway, breathing and circulation stabilization take priority over diagnostic endoscopy in an unstable bleeding patient.
Medicine
Gastroenterology & Hepatology
A patient with painless jaundice, weight loss and a palpable nontender gallbladder most likely has obstruction from which condition?
A. Pancreatic head malignancy
B. Acute viral hepatitis
C. Peptic ulcer disease
D. Irritable bowel syndrome
Correct Answer: A
Courvoisier sign with painless obstructive jaundice suggests malignant distal biliary obstruction, classically from pancreatic head cancer.
Medicine
Gastroenterology & Hepatology
A cirrhotic patient develops rising creatinine without shock, nephrotoxic drugs or structural kidney disease. Which syndrome should be considered?
A. Hepatorenal syndrome
B. Acute glomerulonephritis
C. Diabetic ketoacidosis
D. Renal artery stenosis only
Correct Answer: A
Hepatorenal syndrome is functional kidney failure in advanced liver disease after other causes of acute kidney injury are excluded.
Medicine
Gastroenterology & Hepatology
A patient with suspected celiac disease is eating gluten. What is the preferred initial serologic test in most adults?
A. IgA tissue transglutaminase with total IgA
B. ANA only
C. p-ANCA only
D. Serum gastrin
Correct Answer: A
IgA tissue transglutaminase is the usual first serologic test, accompanied by total IgA to identify IgA deficiency.
Medicine
Gastroenterology & Hepatology
A 45-year-old man has iron overload, diabetes, bronze skin and cardiomyopathy. Which genetic disorder is most likely?
A. Hereditary hemochromatosis
B. Wilson disease
C. Alpha-1 antitrypsin deficiency
D. Gilbert syndrome
Correct Answer: A
Hereditary hemochromatosis causes systemic iron deposition affecting liver, pancreas, skin, heart and joints.
Medicine
Gastroenterology & Hepatology
A patient with chronic hepatitis B has cirrhosis. Which complication requires regular surveillance with liver ultrasound, with or without AFP according to local guidance?
A. Hepatocellular carcinoma
B. Acute appendicitis
C. Pancreatic pseudocyst
D. Achalasia
Correct Answer: A
Chronic hepatitis B with cirrhosis confers high HCC risk and warrants regular surveillance.