MCQ Book Questions

Q60562. 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 examina- tion of the abdomen discloses abruptio placentae. A healthy neonate is delivered; however, the mother’s blood loss is uncon- trollable. She becomes hypotensive and obtunded and subse- quently dies of hypovolemic shock. The kidneys at autopsy are shown. Which of the following is the most likely diagnosis?

Q60563. A 33-year-old woman in her third trimester of pregnancy (gravida I, para 0) is rushed to the emergency room after suf- fering a seizure. The patient is hypertensive and laboratory studies show that the patient manifests nephritic syndrome. What is the appropriate diagnosis?

Q60564. 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?

Q60565. A 58-year-old man with a history of coronary artery disease, peripheral vascular disease, and a recent heart attack sud- denly 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?

Q60566. 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. Physi- cal 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 fi bri- noid 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 5.5 mg/dL. Which of the following is the most likely underlying cause of chronic renal failure in this patient?

Q60567. A 58-year-old man with a history of hyperlipidemia and high blood pressure presents to the emergency room for evalua- tion of headaches and blurred vision. His blood pressure is 200/115 mm Hg, 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 arteriog- raphy shows stenoses of both renal arteries. Hypertension in this patient is caused by the renal release of which of the fol- lowing hormones?

Q60568. 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?

Q60569. A 5-year-old girl presents with the sudden onset of diffuse arthralgias and skin rash. Physical examination shows a viola- ceous maculopapular rash on the lower torso. Urinalysis dis- closes oliguria and 2+ hematuria. Urine cultures are negative. This child’s clinical presentation is commonly associated with which of the following diseases?

Q60570. A 70-year-old obese woman (BMI = 34 kg/m2) presents with a 3-month history of progressive renal insuffi ciency. She has a longstanding history of hypertension. An intravenous pyelo- gram shows that both kidneys are small, and the pelves and calyces appear dilated. The patient subsequently suffers a mas- sive stroke and expires. Examination of the kidneys at autopsy reveals symmetrically shrunken small kidneys, with a uni- formly fi nely granular surface (shown in the image). Which of the following is the appropriate diagnosis?

Q60571. A 60-year-old man presents with acute renal insuffi ciency. He treated his garden last week with a number of herbicides and insecticides, some of which may have contained heavy met- als. Laboratory studies confi rm 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?

Q60572. 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 examina- tion. A CT scan reveals a renal mass of irregular shape measur- ing 5 cm in diameter. The nephrectomy specimen is shown. This malignant neoplasm most likely originates from which of the following tissues in the kidney?

Q60573. A 56-year-old woman presents with acute renal failure. A fro- zen section of a renal biopsy demonstrates birefringent, intra- tubular deposits of uric acid crystals (shown in the image). This fi nding suggests that the patient has been treated recently for which of the following underlying conditions?

Q60574. A 46-year-old man with no past medical history presents with excruciating episodic (colicky) right fl ank pain. A renal stone is passed. In the United States, this stone is most likely com- posed of which of the following?

Q60575. 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 6 cm in diameter. Which of the following is the most likely diagnosis?

Q60576. For the patient described in Question 51, a fi ne-needle aspira- tion of the renal mass shows glycogen-rich tumor cells. Molec- ular studies would most likely identify mutations in which of the following growth regulatory genes?

Q60577. 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?

Q60578. 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?

Q60579. A 34-year-old man undergoing cisplatin-based chemotherapy complains of a 1-week history of increasing fatigue and head- aches. He also reports seeing blood in his urine. Blood pressure is 150/100 mm Hg. 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 dem- onstrates severe anemia (hematocrit 28%) and thrombocytope- nia (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?

Q60580. 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?

Q60581. A 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. Immunosup- pression improves renal function. Which of the following rep- resents the principle target for immune attack directed against this patient’s allograft?