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Select the ONE answer that is BEST in each case.
A 57-year-old man, otherwise fine, is found to have low serum sodium on routine laboratory testing. His serum osmolality is low, but his urine osmolality is >150 mOsm/kg. Which of the following is most likely to be found on further evaluation?
Intrathoracic lesions may be benign or malignant, and the latter may secrete a substance similar to vasopressin. Bronchogenic carcinoma is the most common intrathoracic lesion causing SIADH
See all quizzes of the Kidneys diseases at here:
|21. A 57-year-old man, otherwise fine, is found to have low serum sodium on routine laboratory testing. His serum osmolality is low, but his urine osmolality is >150 mOsm/kg. Which of the following is most likely to be found on further evaluation?
(A) massive edema
(D) elevated urea nitrogen
(E) an intrathoracic lesion
|22. A 78-year-old man is brought to the hospital because of nausea and vomiting. On examination he appears dry, his abdomen is soft, and the JVP is not visible. His laboratory tests reveal hypernatremia and his calculated free water deficit is approximately 3 L. In what part of the normal kidney is most of the water reabsorbed from?
(A collecting ducts
(B) proximal tubule
(C) distal tubule
(D) ascending loop of Henle
(E) descending loop of Henle
|23. A 64-year-old man is admitted for hematuria after slipping on an icy pavement. His physical examination is normal. A selective angiogram of the left kidney is shown in Fig. 8–2. Which of the following is the most likely diagnosis?
(A) renal cell carcinoma
(B) kidney contusion and laceration
(C) transitional cell carcinoma
|24. A 64-year-old man presents with symptoms of malaise, shortness of breath, edema, and no urine output for 24 hours. His past medical history is not significant, and his only medication is daily aspirin. On examination his JVP is 4 cm, heart sounds are normal, lungs are clear, and the abdomen is soft. A Foley catheter is inserted into his bladder for 200 cc of urine, which is sent for urinalysis. His urine output still remains low. Which of the following is the most appropriate initial diagnostic test?
(A) renal ultrasound
(B) blood cultures
(C) urine cultures
(D) inferior vena cavagram with selective renal venogram
(E) blood urea nitrogen (BUN)/creatinine ratio
|25. A 68-year-old woman develops new symptoms of burning when voiding. She has no fever, chills, or back discomfort. Her urinalysis reveals numerous white cells and bacteria. Which of the following medical comorbidities is most likely to coexist in this patient?
(C) diabetes mellitus
(E) analgesic drug use
|26. A 28-year-old woman presents with a recent episode of coughing up some blood, frequent nosebleeds, and now decreased urine output. A nasal mucosa ulcer was seen on inspection. Her urinalysis is positive for protein and red cells consistent with a GN. The CXR shows two cavitary lesions and her serology is positive for antineutrophil cytoplasmic antibodies (ANCA). Which of the following is the most likely diagnosis?
(A) Wegener’s granulomatosis
(B) bacterial endocarditis
(C) Goodpasture’s syndrome
(D) lupus erythematosus
(E) poststreptococcal disease
|27. A42-year-old man notices leg and facial swelling but no other symptoms. His examination is pertinent for 3+ pedal edema including periorbital edema. A 24-hour urine collection reveals 5 g of proteinuria. Which of the following is the most likely diagnosis?
(A) sickle cell disease
(B) medullary sponge kidney
(C) radiation nephritis
(D) staphylococcal infection
(E) amyloid disease
|28. A 74-year-old woman develops acute sepsis from pneumonia and is admitted to the intensive care unit because of hypotension. She is started on antibiotics, and her blood pressure is supported with intravenous normal saline. Despite this she remains oliguric and develops ARF. Her urinalysis has heme-granular casts and the urine sodium is 56 mEq/L. Which of the following is the most likely cause of her ARF?
(A) nephrotoxic antibiotics
(B) acute infectious GN
(C) acute tubular necrosis (ATN)
(D) contrast nephropathy
(E) cholesterol emboli
|29. A pregnant woman develops hypertension, edema, and proteinuria, at 34 weeks of gestation. Which of the following is not a risk factor for the development of this complication?
(A) first pregnancy
(B) diabetes mellitus
(C) twin pregnancy
(D) extreme of reproductive age
(E) human immunodeficiency virus (HIV) infection
|30. A 30-year-old man presents with hematuria. His examination is normal except for an elevated blood pressure of 164/94 mm Hg. An ultrasound of the kidneys reveals multiple renal cysts in both kidneys. His father had a similar condition. Which of the following is not associated with this syndrome?
(A) liver cysts
(B) intracranial aneurysms
(C) autosomal dominant inheritance
(D) rheumatoid arthritis (RA)
(E) progression to end-stage renal failure
|31. A 15-year-old boy develops renal colic. The stone is not recovered, but urinalysis reveals hexagonal crystals, and a cyanide-nitroprusside test on the urine is positive. Which of the following is the most likely diagnosis?
|32. A 29-year-old man is stable 1 year post-kidney transplant. Which of the following complications of transplantation is the most likely cause of death?
(A) atherosclerotic disease
(B) opportunistic infection
(C) metabolic bone disease
(D) lung cancer
|33. A 37-year-old immunosuppressed patient with renal failure develops sepsis. Which of the following antibiotics, if used, would require a major reduction in dosage?
(D) isoniazid (INH)
(E) amphotericin B
|34. A 63-year-old woman presents for routine evaluation. She has had diabetes for the past 12 years with complications of neuropathy and retinopathy. You decide to screen her for renal complications of diabetes. Which of the following findings is not compatible with diabetic nephropathy?
(A) nephrotic range proteinuria
(D) red blood cell (RBC) casts in urine
(E) renal tubular acidosis (RTA) type IV
|35. A 24-year-old woman is dipstick positive for blood in her urine. This is repeated twice between menstrual periods and remains positive. Microscopic evaluation reveals RBCs, some of which are deformed and some in the form of casts. Which of the following is the most likely cause of the hematuria?
(A) urinary tract stones
|36. A 63-year-old man becomes oliguric 2 days following an open cholecystectomy. Which of the following findings would suggest that prerenal ARF is a major factor in the etiology?
(A) postural hypotension
(B) fractional excretion of sodium is 3%
(C) specific gravity is 1.012
(D) the urine sodium is 30 mEq/L
(E) heme-granular casts on urine microscopy
|37. A 46-year-old woman with nausea and vomiting presents to hospital because of lightheadedness when standing and decreased urine output. She looks unwell; the blood pressure supine is 90/60 mm Hg and 80/60 mm Hg when standing. Her abdominal, heart, and lung examinations are normal. Which of the following laboratory values suggests prerenal azotemia in this patient?
(A) markedly elevated urea, unchanged creatinine
(B) unchanged urea, elevated creatinine
(C) little change in either creatinine or urea for several days after oliguria develops
(D) urea/creatinine ratio of 10
(E) urea/creatinine ratio of 25
|42. A 19-year-old girl develops sudden-onset nonbloody diarrhea. She was previously well and is not taking any medications or traveled anywhere recently. Her abdomen is soft and nontender on examination, and the anion gap is normal. (SELECT ONE)
(A) metabolic acidosis
|43. A 75-year-old man develops acute confusion and drowsiness after a dental procedure. He has a history of severe chronic lung disease due to smoking. Earlier in the day, he had a tooth extraction and afterwards was given acetaminophen with codeine (Tylenol # 3) for pain relief. (SELECT ONE)
(A) metabolic acidosis
|44. A 74-year-old woman has symptoms of shortness of breath on exertion and waking up at night. Her physical examination reveals a JVP at 8 cm, extra third heart sound, lung crackles, and pedal edema. She is started on furosemide 80 mg/day for heart failure, while further investigations are performed. (SELECT ONE)
(A) metabolic acidosis