MCQ Book Questions

Q60542. The pathogenesis of nephrotic syndrome in the patient described in Question 13 is best characterized by which of the following mechanisms of disease?

Q60543. The glomerular changes in the patient described in Question 13 are frequently seen in patients with which of the following systemic diseases?

Q60544. An 8-year-old boy presents with headaches, dizziness, and malaise approximately 2 weeks after a severe sore throat. His mother describes puffi ness 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 exam- ination, there is anasarca, hypertension (190/130 mm Hg), and tachycardia. The urine is scanty and brownish red. Urinalysis shows 3+ proteinuria. Microscopic examination of the urine discloses numerous RBCs, as well as occasional granular and red cell casts. A renal biopsy is stained by direct immunofl uo- rescence microscopy for complement C3, and the results are shown. Which of the following best describes the pattern of immunofl uorescence observed in this renal biopsy?

Q60545. Which of the following is the most likely cause of acute postinfectious glomerulonephritis in the patient described in Question 24?

Q60546. Which of the following is the most likely outcome of glomeru- lonephritis in the patient described in Question 24?

Q60547. A 20-year-old woman is involved in an automobile accident and loses a large amount of blood. In response to hypoxia, interstitial peritubular cells of the kidney would be expected to release which of the following hormones?

Q60548. A 32-year-old man complains of recurrent hematuria since his youth. The hematuria typically occurs following upper respi- ratory tract infections. Vital signs are normal. Urinalysis shows proteinuria, hematuria, and a few red blood cell casts. Labora- tory studies disclose normal levels of BUN and creatinine. The ANA and ANCA tests are negative. Which of the following is the most likely diagnosis?

Q60549. For the patient described in Question 21, which of the follow- ing patterns of IgA immunofl uorescence would be expected in the renal biopsy?

Q60550. A 54-year-old woman with squamous cell carcinoma of the lung develops bilateral pitting edema of the lower extremi- ties. Laboratory studies show hyperlipidemia, hypoal- buminemia, and 4+ proteinuria. Urinalysis reveals no infl ammatory cells or RBCs. Renal biopsy in this patient would most likely show which of the following patterns of glomerulopathy?

Q60551. A 30-year-old man with a history of smoking suddenly develops oliguria, hematuria, and hemoptysis. Serologic studies reveal antibodies to the glomerular basement mem- brane (GBM). A renal biopsy is shown. Which of the follow- ing pathologic changes is visible by light microscopy in this biopsy specimen?

Q60552. A 52-year-old woman who suffers from diabetes mellitus and frequent urinary tract infections presents with a 3-day history of fl ank pain, undulating fever, and general malaise. A CBC shows neutrophilic leukocytosis (16,000/μL). Urine cultures reveal more than 100,000 bacterial colonies, com- posed predominantly of Gram-negative microorganisms. Blood pressure is 170/100 mm Hg, BUN is 30 mg/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?

Q60553. A 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) exhib- its segmental endocapillary hypercellularity and thickening of capillary walls, and 90% of the glomeruli appear hypercellular. Which of the following is the appropriate pathologic diagnosis?

Q60554. A 35-year-old man with a history of smoking presents with hematuria and bloody sputum. Over the next 2 days, he develops oliguria and renal failure, after which he is placed on dialysis. A renal biopsy is stained with fl uorescein-conjugated goat antihuman IgG, and the results are shown. Which of the following best describes the pattern of direct immunofl uores- cence observed on this photomicrograph?

Q60555. Which of the following serum abnormalities is expected in the patient described in Question 36?

Q60556. A 70-year-old diabetic woman presents with sudden onset of excruciating groin and fl ank 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?

Q60557. A 40-year-old man with Alport syndrome presents with a 3-month history of headaches. His blood pressure is 165/100 mm Hg. A urinalysis shows 3+ proteinuria and 2+ hematuria. Laboratory studies disclose elevated levels of BUN (48 mg/dL) and creatinine (3.6 mg/dL). This patient’s renal disease is caused by mutation in a gene that encodes which of the following extracellular matrix proteins?

Q60558. A 22-year-old woman in the second trimester of pregnancy presents with fl ank 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. Physi- cal examination reveals costovertebral angle tenderness. The urine shows numerous WBCs and WBC casts. Which of the following is the most likely diagnosis?

Q60559. Which of the following is the most likely cause of the renal disease in the patient described in Question 32?

Q60560. 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 180/110 mm Hg. Laboratory studies show elevated levels of BUN (38 mg/dL) and creatinine (2.8 mg/dL). A CT scan of the lower abdomen reveals small, irregularly shaped kidneys with deep coarse scars. A percu- taneous renal biopsy is shown. Which of the following is the appropriate diagnosis?

Q60561. The pathogenesis of the renal disease in the patient described in Question 34 is related to which of the following conditions?