Nephrology — MCQs

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: 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 765: 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 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: 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 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: True about Bartter's syndrome are all except?

A. Hyperkalemic alkalosis (Correct Answer)
B. Decreased K+ absorption from thick ascending loop of Henle
C. Autosomal recessive inheritance
D. Presents in neonate with ototoxicity have bartin gene mutation

Explanation: Hypokalemic alkalosis - Bartter's syndrome is characterized by **hypokalemia**, not hyperkalemia, due to impaired reabsorption of electrolytes in the loop of Henle. - The disorder typically leads to a **metabolic alkalosis**, but the key electrolyte disturbance is low potassium. *Autosomal recessive inheritance* - This statement is **true**; Bartter's syndrome is inherited in an autosomal recessive pattern. - It results from mutations in genes encoding transporters in the thick ascending limb of the loop of Henle. *Decreased K+ absorption from thick ascending loop of Henle* - This statement is **true**; Bartter's syndrome primarily involves a defect in the **Na+-K+-2Cl- cotransporter (NKCC2)** in the thick ascending limb. [1] - This leads to impaired reabsorption of sodium, potassium, and chloride, causing increased delivery of these ions to the distal nephron and subsequent potassium wasting. *Presents in neonate with ototoxicity have bartin gene mutation* - This statement is **true**; some forms of Bartter's syndrome, particularly type IV, are associated with mutations in the **BSND (barttin) gene**. - This mutation can lead to sensorineural **deafness (ototoxicity)** in addition to the renal manifestations, and often presents in the neonatal period.

Question 770: Which of the following primary kidney diseases is NOT typically associated with nephrotic syndrome?

A. Minimal change disease
B. Focal segmental Glomerulosclerosis
C. Membranous Glomerulopathy
D. IgA nephropathy (Correct Answer)

Explanation: ***IgA nephropathy*** - While it can cause **proteinuria**, it is more commonly associated with **hematuria** than nephrotic syndrome [1]. - It is characterized by **IgA-dominant immune complexes**, not primarily causing the massive protein loss typical in nephrotic syndrome [1]. *Membranous Glomerulopathy* - A leading cause of nephrotic syndrome, it presents with significant **proteinuria** and **edema** [1]. - Associated with the formation of **subepithelial immune complex deposits**, leading to nephrotic features [1]. *Minimal change disease* - The most common cause of nephrotic syndrome in children, leading to **massive proteinuria** [1]. - Characterized by **normal appearing glomeruli** on light microscopy and selective proteinuria [1]. *Focal segmental Glomerulosclerosis* - Also presents with **nephrotic syndrome**, causing significant **proteinuria** and renal impairment [1]. - Associated with focal, segmental sclerosis of the glomeruli seen on microscopy, contributing to nephrotic features [1].

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Acute Kidney Injury

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Chronic Kidney Disease

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Glomerular Diseases

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Tubulointerstitial Diseases

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Nephrotic and Nephritic Syndromes

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Urinary Tract Infections

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Renal Replacement Therapy

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Fluid and Electrolyte Disorders

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Acid-Base Disorders

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Kidney in Systemic Diseases

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Kidney Stones and Obstructive Uropathy

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Hypertension in Kidney Disease

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Nephrology — MCQs

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