Objective Questions | Internal Medicine Practice Quiz
1 >>Normal serum complement levels would be seen in patients with hematuria, proteinuria, and hypertension resulting from which of the following? ?
- (A) Mixed essential cryoglobulinemia
- (B) Hepatitis C- associated membranoproliferative glomerulonephritis
- (C) Diffuse proliferative lupus nephritis
- (D) Henoch-Scho¨nlein purpura
2 >>In acute renal failure, dietary protein should be restricted in which of the following? ?
- (A) All patients
- (B) All patients with BUN > 100
- (C) All patients with creatinine>10
- (D) If azotemia is advanced and dialysis is not an option
3 >>A 56-year-old diabetic woman with end-stage renal disease (ESRD) has been treated with peritoneal dialysis (prescription of four 2-L exchanges per day) for 6 years. She is 5 ft. 6 in. tall and weighs 70 kg (154 lb). The patient complains of anorexia, abdominal discomfort, fatigue, and insomnia. Medications include erythropoietin, calcium carbonate, metoprolol, and a water-soluble vitamin supplement. Laboratory studies are notable for hematocrit 38%, BUN 56 mg/dL, bicarbonate 14 meq/L, calcium 10.4 mg/dL, and phosphate 2.3 mg/dL. The most likely diagnosis is ?
- (A) mycobacterial peritonitis
- (B) dialysis disequilibrium
- (C) uremia
- (D) peritoneal carcinomatosis
4 >>Which of the following maneuvers may lead to the development of hyperammonemia? ?
- (A) Protein restriction
- (B) A branched-chain amino acid- enriched protein mixture
- (C) The use of neomycin
- (D) The use of loop diuretics
5 >>Nephrocalcinosis can be associated with ?
- (A) the routine use of calcium-based phosphate binders
- (B) the routine use of aluminum-based phosphate bind ers
- (C) calcitonin-related peptide
- (D) Crohn’s disease
6 >>A 35-year-old man is in your clinic with the chief complaint of progressive lower extremity edema. On lab oratory analysis he is found to have a 24-h urine collection that is significant for 5.3 g of protein. Which of the following statements is true? ?
- (A) Lower serum lipid levels
- (B) An elevated serum calcium value is likely to be obtained
- (C) The patient has an increased risk of a hemorrhage
- (D) The patient has an elevated thyroxin level
7 >>A 72-year-old man develops acute renal failure after cardiac catheterization. Physical examination is notable for diminished peripheral pulses, livedo reticularis, epigastric tenderness, and confusion. Laboratory studies include (mg/dL) BUN 131, creatinine 5.2, and phosphate 9.5. Urinalysis shows 10 to 15 WBC, 5 to 10 RBC, and one hyaline cast per high-power field (HPF). The most likely diagnosis is ?
- (A) acute interstitial nephritis caused by drugs
- (B) rhabdomyolysis with acute tubular necrosis
- (C) cholesterol embolization
- (D) renal arterial dissection with prerenal azotemia
8 >>The hyperlipidemia of nephrotic syndrome is characterized by ?
- (A) elevation of all plasma lipids but no increase in atherogenesis
- (B) elevation of total cholesterol but no increase in atherogenesis
- (C) selective elevation of low-density lipoprotein (LDL) cholesterol with increased atherogenesis
- (D) no response to HMG-CoA reductase inhibitors
9 >>ACE inhibitors would be expected to slow the progression of renal insufficiency in which of the following conditions? ?
- (A) Analgesic nephropathy
- (B) Contrast dye- associated nephropathy
- (C) Chronic glomerulonephritis with > 1 g/d proteinuria
- (D) Autosomal dominant polycystic kidney disease (ADPKD)
10 >>Which of the following statements about polycystic kidney disease is true? ?
- (A) Polycystic kidney disease is an autosomal recessive disorder linked to a causative gene on the short arm of chromosome 16.
- (B) Erythropoietin levels are often low due to progressive renal failure.
- (C) Chronic diverticular disorder is a rare finding
- (D) Nephrotic-range proteinuria is an uncommon finding.
11 >>Which of the following medications commonly does not cause hypokalemia? ?
- (A) ?-Adrenergic agonists
- (B) Theophylline
- (C) Calcium channel blockers
- (D) Diuretic therapy
12 >>In patients with urinary incontinence, which condition puts them at highest risk for the development of hydronephrosis? ?
- (A) Alzheimer’s disease
- (B) Guillain-Barre´ syndrome
- (C) Normal-pressure hydrocephalus
- (D) Low-grade astrocytoma
13 >>Which of the following genetic abnormalities is associated with the development of hyperkalemia? ?
- (A) 11 ?-hydroxylase deficiency
- (B) Liddle’s syndrome
- (C) Bartter’s syndrome
- (D) Autosomal dominant polycystic kidney disease
14 >>Which of the following statements is true concerning acute poststreptococcal glomerulonephritis (PSGN)? ?
- (A) The latent period appears to be longer when PSGN is associated with cutaneous rather than pharyngeal infections.
- (B) Serologic evidence of a streptococcal infection can usually be found regardless of antimicrobial therapy
- (C) Antimicrobial therapy for streptococcal infection is without value once the presence of renal disease is established.
- (D) Long-term antistreptococcal prophylaxis is indicated after a prior documented case of PSGN.
15 >>Diseases involving the renal glomeruli are frequently encountered. Both humoral and cellular mechanisms play a part in the pathogenesis of glomerular injury. Which of the following glomerular diseases is associated with glomerulosclerosis as opposed to cellular proliferation? ?
- (A) IgA nephropathy
- (B) Diabetic nephropathy
- (C) Poststreptococcal glomerulonephritis
- (D) Henoch-Scho¨nlein purpura
16 >>A 45-year-old woman with a long history of asthma now presents with progressive lower extremity skin rash as well as renal insufficiency. On physical examination she is short of breath, with audible wheezing. Her skin examination reveals numerous raised papules, which are erythematous in color, on both lower extremities. The lesions are nonblanching and raised, with areas of necrosis. Which of the following statements is correct? ?
- (A) The peripheral white blood count is within normal limits.
- (B) Antineutrophilic cytoplasmic autoantibodies (ANCA) are found in a cytoplasmic distribution consistent with antiproteinase-3 (PR3-ANCA).
- (C) A history of a progressive lower extremity neuropathy is a rare finding
- (D) Patient has a history of coronary disease
17 >>A 46-year-old man with long-standing diabetes mellitus and ESRD is undergoing hemodialysis. He has completed his run of dialysis and you find him somewhat confused, with a blood pressure of 86/42. Which of the following factors most likely contributed to the postdialysis hypotension? ?
- (A) Reduced temperature dialysate
- (B) Concomitant use of antihypertensive therapy
- (C) Impaired autonomic response
- (D) Poor dietary intake during dialysis
18 >>A 56-year-old woman has had profuse watery diarrhea for 3 months. Laboratory studies of fecal water show the following: Sodium: 39 mmol/L Potassium: 96 mmol/L Chloride: 15 mmol/L Bicarbonate: 40 mmol/L Osmolality: 270 mosmol/kg H O (serum osmolality: 2 280 mosmol/kg H2O). The most likely diagnosis is ?
- (A) villous adenoma
- (B) lactose intolerance
- (C) laxative abuse
- (D) pancreatic insufficienc
19 >>A 24-year-old patient known to be infected with HIV- 1 presents with a 2-week history of intermittent bloody diarrhea, urgency, abdominal pain, and malaise. Stool culture for enteropathogenic organisms is negative, and analysis for ova and parasites is similarly unrevealing. The patient is taking no medication. The diarrheal symptoms do not respond to a course of trimethoprim-sulfamethoxazole. Colonoscopic examination reveals multiple areas of ulceration and mucosal erosion. Biopsy reveals the presence of cells containing a large, densely staining nucleus and abundant intracytoplasmic inclusions. The most appropriate therapy for this patient is ?
- (A) pentamidine
- (B) pyrimethamine
- (C) ganciclovir
- (D) acyclovir
20 >>A 45-year-old man says that for the past year he occasionally has regurgitated food particles eaten several days earlier. His wife complains that his breath has been foul-smelling. He has had occasional dysphagia for solid foods. The most likely diagnosis is ?
- (A) gastric outlet obstruction
- (B) scleroderma
- (C) achalasia
- (D) Zenker’s diverticulum