Nephrology — MCQs
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Evaluating a patient with nephrotic syndrome, which symptom would indicate severe progression of the disease?
Renal tubular acidosis with ABG value pH = 7.24 PO2=80; PaCO2= 36 Na = 131; HCO3 = 14 Cl= 90; BE = -13 Glucose = 135 the above ABG picture suggests –
40 years old male complains of loin pain since 1 month. Patient's complaint of pain has severely increased over last 2 hours and pain now radiates from loin and to groin and anterior thigh and patient is writhing in bed for comfort. What is the most probable etiology?
RIFLE criteria is used for diagnosis of
In a patient with nephrotic syndrome, which antibody is decreased?
Which of the following is a clinical abnormality of uremia?
What is oliguria?
Decrease in plasma osmotic pressure is cause of edema in?
Which of the following biomarkers is not typically involved in the diagnosis of acute kidney injury?
Which of the following is most commonly affected in Ormond's disease?
Nephrology Indian Medical PG Practice Questions and MCQs
Question 761: Evaluating a patient with nephrotic syndrome, which symptom would indicate severe progression of the disease?
- A. Mild proteinuria
- B. Hyperkalemia
- C. Hypertension
- D. Severe edema (Correct Answer)
Explanation: ***Severe edema*** - **Severe edema**, particularly **anasarca** (generalized body swelling), is a hallmark of severe nephrotic syndrome, indicating profound **hypoalbuminemia** due to massive urinary protein loss [1]. - The reduced intravascular oncotic pressure leads to fluid shifting into the interstitial space, causing significant and widespread swelling [1]. *Mild proteinuria* - While proteinuria is a diagnostic criterion for nephrotic syndrome, **mild proteinuria** does not indicate severe progression. - Severity is defined by **massive proteinuria** (typically >3.5 g/day in adults) [1]. *Hypertension* - **Hypertension** can be associated with nephrotic syndrome, particularly in cases with underlying renal disease or fluid overload. - However, it is not a direct measure of the severity of the nephrotic syndrome itself, but rather a complication or co-morbidity. *Hyperkalemia* - **Hyperkalemia** is more commonly associated with acute kidney injury or chronic kidney disease, where the kidneys cannot adequately excrete potassium [2]. - While nephrotic syndrome can sometimes lead to renal dysfunction, hyperkalemia is not a direct or primary indicator of the severity of the nephrotic syndrome's characteristic features (proteinuria, hypoalbuminemia, edema).
Question 762: Renal tubular acidosis with ABG value pH = 7.24 PO2=80; PaCO2= 36 Na = 131; HCO3 = 14 Cl= 90; BE = -13 Glucose = 135 the above ABG picture suggests –
- A. Metabolic acidosis (Correct Answer)
- B. Respiratory alkalosis
- C. Metabolic alkalosis
- D. Respiratory acidosis
Explanation: The ABG shows a pH of 7.24, indicating **acidemia** [1]. The HCO3 is 14 mEq/L, which is significantly **low**, and the base excess (BE) is -13 [1]. The PaCO2 of 36 mmHg is within the normal range, indicating no significant primary respiratory derangement [2]. The overall picture is consistent with an uncompensated or partially compensated **metabolic acidosis** [1][2]. ***Metabolic acidosis*** - The **low pH (acidemia)**, **low bicarbonate (HCO3)**, and **negative base excess (BE)** are direct indicators of metabolic acidosis [1]. - The **PaCO2 within normal limits** or slightly decreased suggests either no respiratory compensation or insufficient compensation for the metabolic derangement [1][2]. *Respiratory acidosis* - This would present with a **low pH** and an **elevated PaCO2** as the primary defect, which is not seen here (PaCO2 is normal) [1]. - Bicarbonate would typically be normal or elevated if compensated, not significantly decreased. *Respiratory alkalosis* - This would be characterized by an **elevated pH** and a **low PaCO2**, which is the opposite of the findings in this ABG [1]. - HCO3 would be normal or low if compensated. *Metabolic alkalosis* - This would present with an **elevated pH** and an **elevated HCO3**, which contradicts the given ABG values (low pH and low HCO3) [2].
Question 763: 40 years old male complains of loin pain since 1 month. Patient's complaint of pain has severely increased over last 2 hours and pain now radiates from loin and to groin and anterior thigh and patient is writhing in bed for comfort. What is the most probable etiology?
- A. Bladder calculus
- B. Ureteric calculus (Correct Answer)
- C. Vesico ureteric reflux
- D. Hydronephrosis
Explanation: ***Ureteric calculus*** - The sudden onset of **severe, colicky loin pain radiating to the groin and anterior thigh**, causing the patient to writhe in bed, is highly characteristic of **ureteric colic** due to a calculus [1]. - This pain pattern is due to the obstruction and spasm of the ureter as it tries to pass the stone, with referred pain along the genitofemoral and ilioinguinal nerves [1]. *Bladder calculus* - A bladder calculus typically causes **suprapubic pain**, **dysuria**, **frequency**, and sometimes **hematuria**, but usually not severe, radiating loin-to-groin pain. - Pain from a bladder stone is often worse during micturition and can be relieved by changing position. *Vesicoureteric reflux* - **Vesicoureteric reflux (VUR)** is a backward flow of urine from the bladder to the ureters and kidneys, most commonly causing **recurrent UTIs** and potentially **renal scarring**. - It typically does not present with the acute, severe, radiating pain described, which is classic for an acute obstruction [2]. *Hydronephrosis* - **Hydronephrosis** refers to the swelling of the kidney due to a buildup of urine, often caused by obstruction, but it is a *consequence* rather than the primary etiology in this acute presentation [2]. - While a ureteric calculus can cause hydronephrosis, the term itself describes the *result* of the obstruction, not the acute event causing the severe pain [2].
Question 764: RIFLE criteria is used for diagnosis of
- A. Acute kidney injury (Correct Answer)
- B. Acute splenic injury
- C. Acute liver injury
- D. Acute bowel injury
Explanation: ***Acute kidney injury*** - The **RIFLE criteria** (Risk, Injury, Failure, Loss, End-stage kidney disease) is a classification system specifically developed to define and stage **acute kidney injury (AKI)** based on changes in serum creatinine and/or urine output [1]. - It provides a standardized method for diagnosing AKI, allowing for consistent communication and research in nephrology. *Acute splenic injury* - **Splenic injury** is typically diagnosed based on **trauma history, imaging studies** (e.g., CT scan), and clinical signs like left upper quadrant pain and hypovolemia [2]. - There are no specific criteria like RIFLE for grading splenic injury, which is usually categorized by severity of laceration or hematoma [2]. *Acute liver injury* - **Acute liver injury** is diagnosed using criteria such as a rapid increase in **liver enzymes** (AST, ALT), **bilirubin**, and often signs of hepatic encephalopathy. - Classification systems for liver injury exist (e.g., King's College Criteria for acute liver failure), but RIFLE specifically pertains to kidney function. *Acute bowel injury* - **Acute bowel injury** (e.g., ischemic bowel, perforation) is diagnosed by **clinical presentation** (abdominal pain, signs of peritonitis), **imaging** (X-ray, CT scan), and sometimes **endoscopy**. - There are no standardized staging criteria like RIFLE for acute bowel injury.
Question 765: In a patient with nephrotic syndrome, which antibody is decreased?
- A. IgG (Correct Answer)
- B. IgE
- C. IgM
- D. IgA
Explanation: ***IgG*** - In **nephrotic syndrome**, the kidneys' glomerular basement membrane becomes highly permeable, leading to a significant loss of plasma proteins into the urine [1]. - **IgG** is the smallest and most abundant immunoglobulin, making it particularly susceptible to urinary loss due to its size, leading to decreased serum levels. *IgE* - **IgE** levels are not typically decreased in nephrotic syndrome; its primary role is in allergic reactions and parasite defense, and it is not significantly lost in urine. - While other proteins are lost, the relatively low concentration and functional role of IgE mean its depletion is not a characteristic feature of nephrotic syndrome. *IgM* - **IgM** is a large pentameric antibody and, due to its substantial size, it is generally retained in the bloodstream even when the glomerular filtration barrier is compromised in nephrotic syndrome [1]. - Its large molecular weight makes it less likely to be filtered and excreted in the urine compared to smaller proteins like albumin and IgG [2]. *IgA* - **IgA** exists as a monomer in serum and as a dimer in mucosal secretions. While smaller than IgM, it is still larger than IgG and is not characteristically decreased in nephrotic syndrome due to urinary loss. - Decreased IgA levels are more commonly associated with selective IgA deficiency, a primary immunodeficiency, rather than the non-selective protein loss of nephrotic syndrome.
Question 766: Which of the following is a clinical abnormality of uremia?
- A. All of the options (Correct Answer)
- B. Hyperphosphatemia
- C. Uremic frost
- D. Peptic ulcer
Explanation: ***All of the options*** - **Uremia** is a syndrome caused by the accumulation of **nitrogenous waste products** and other toxins in the blood due to failing kidneys. All listed options are recognized clinical abnormalities that can manifest in patients with uremia. [1] - This option correctly identifies that uremia can lead to a broad spectrum of clinical manifestations, including metabolic derangements like **hyperphosphatemia**, dermatological signs like **uremic frost**, and gastrointestinal issues like **peptic ulcers**. *Hyperphosphatemia* - **Hyperphosphatemia** is a common electrolyte imbalance in uremia because the kidneys are unable to adequately excrete phosphate. - Elevated phosphate levels contribute to **renal osteodystrophy** and metabolic bone disease in patients with chronic kidney disease. *Uremic frost* - **Uremic frost** is a dermatological manifestation of severe uremia, characterized by the deposition of **urea crystals** on the skin, particularly on the face and neck. - It occurs when urea concentrations in sweat exceed its solubility, leading to crystallization as sweat evaporates. *Peptic ulcer* - **Peptic ulcers** are more common in patients with uremia due to a combination of factors, including increased gastrin levels from impaired renal clearance, impaired mucosal defense, and increased acid secretion. [1] - The gastrointestinal system is significantly affected by uremia, leading to a variety of symptoms such as nausea, vomiting, and gastrointestinal bleeding. [1]
Question 767: What is oliguria?
- A. Excretion of less than 300 ml in 24 hrs
- B. Excretion of less than 500 ml in 24 hrs (Correct Answer)
- C. Excretion of less than 300 ml in 12 hrs
- D. Excretion of less than 100 ml in 24 hrs
Explanation: ***Excretion of less than 500 ml in 24 hrs*** - **Oliguria** is clinically defined as a urine output of less than **500 ml over a 24-hour period** in adults. [1] - This threshold is significant because it is generally considered the minimum urine volume required to excrete the daily obligatory solute load, preventing **azotemia**. *Excretion of less than 300 ml in 24 hrs* - While a very low urine output, this volume typically falls under the definition of **anuria** or severe oliguria, which is less than 100 ml/24 hours, or very close to it. [1] - It indicates a more profound impairment of kidney function than the standard definition of oliguria. *Excretion of less than 300 ml in 12 hrs* - This statement refers to a shorter time frame (12 hours) and does not align with the standard 24-hour definition used for **oliguria**. - A proportional output over 24 hours would be 600 ml, which is above the threshold for oliguria. *Excretion of less than 100 ml in 24 hrs* - This urine output level is specifically defined as **anuria**, indicating almost complete cessation of urine production. [1] - Anuria represents a more severe state of renal dysfunction compared to oliguria.
Question 768: Decrease in plasma osmotic pressure is cause of edema in?
- A. CHF
- B. DVT
- C. Nephrotic syndrome (Correct Answer)
- D. None of the options
Explanation: ***Nephrotic syndrome*** [2] - Characterized by **massive proteinuria**, leading to a significant decrease in plasma albumin levels which reduces plasma osmotic pressure [2]. - The resultant decrease in oncotic pressure causes **edema**, particularly in the periorbital and lower extremity regions [1][2]. *CHF* - Congestive heart failure (CHF) typically leads to **increased hydrostatic pressure** due to impaired cardiac output, not decreased plasma osmotic pressure. - Edema in CHF is more related to **fluid overload** rather than a decrease in protein levels. *DVT* - Deep vein thrombosis (DVT) causes localized edema due to **venous obstruction**, leading to increased hydrostatic pressure in the affected limb. - It does not primarily affect plasma osmotic pressure, instead causing **unilateral edema**. *None* - This does not provide a pathological condition associated with decreased plasma osmotic pressure causing edema. - There are known conditions, like **nephrotic syndrome**, that directly link decreased osmotic pressure to edema formation [1][2].
Question 769: Which of the following biomarkers is not typically involved in the diagnosis of acute kidney injury?
- A. Cystatin C
- B. NGAL
- C. KIM 1
- D. Micro RNA 122 (Correct Answer)
Explanation: Micro RNA 122 - **MicroRNA-122** is primarily a biomarker for **liver injury** [1] and not typically used in the diagnosis of **acute kidney injury (AKI)**. - Its expression is highly enriched in the liver and is released into circulation upon **hepatocyte damage**. *NGAL* - **Neutrophil gelatinase-associated lipocalin (NGAL)** is an early biomarker for **AKI**, found in both urine and plasma. - It rapidly increases in response to **renal tubular damage**, making it useful for early detection. *KIM 1* - **Kidney injury molecule-1 (KIM-1)** is a transmembrane protein expressed at very low levels in healthy kidneys but significantly upregulated in the **proximal tubular epithelial cells** during **AKI** [2]. - Its presence in urine is a strong indicator of **renal tubular injury**. *Cystatin C* - **Cystatin C** is a **glomerular filtration rate (GFR)** marker that increases in the blood earlier than creatinine in cases of **AKI**. - It is unaffected by muscle mass, age, or sex, making it a more reliable indicator of **renal function decline** in certain populations.
Question 770: Which of the following is most commonly affected in Ormond's disease?
- A. Aorta
- B. IVC
- C. Ureter (Correct Answer)
- D. Gonadal vessels
Explanation: Ureter - Ormond's disease, also known as **retroperitoneal fibrosis (RPF)**, is characterized by the development of a dense fibrous tissue mass in the retroperitoneum, most commonly encasing and compressing the **ureters**. - This compression can lead to **ureteral obstruction** and subsequent **hydronephrosis**. Aorta - While the aorta can be involved in retroperitoneal fibrosis, it is typically encased rather than directly affected in a way that causes primary aortic disease. - The **fibrotic process** can adhere to and surround the great vessels, but the ureters are more prone to symptomatic compression. IVC - The **inferior vena cava (IVC)** can also be compressed or encased by the fibrotic tissue in Ormond's disease. - However, **ureteral involvement** leading to obstruction is a more common and clinically significant presentation than primary IVC compression. Gonadal vessels - Although **gonadal vessels** course through the retroperitoneum, they are less commonly the primary structures affected or severely compromised by the fibrotic process compared to the ureters. - Their involvement is usually secondary to widespread retroperitoneal fibrosis rather than being the most commonly affected site.
Practice by Chapter
Acute Kidney Injury
Practice Questions
Chronic Kidney Disease
Practice Questions
Glomerular Diseases
Practice Questions
Tubulointerstitial Diseases
Practice Questions
Nephrotic and Nephritic Syndromes
Practice Questions
Urinary Tract Infections
Practice Questions
Renal Replacement Therapy
Practice Questions
Fluid and Electrolyte Disorders
Practice Questions
Acid-Base Disorders
Practice Questions
Kidney in Systemic Diseases
Practice Questions
Kidney Stones and Obstructive Uropathy
Practice Questions
Hypertension in Kidney Disease
Practice Questions
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