Internal-Medicine

162 8: Kidneys
28. A 74-year-old woman develops acute sepsis
from pneumonia and is admitted to the intensive
care unit because of hypotension. She is
started on antibiotics, and her blood pressure is
supported with intravenous normal saline.
Despite this she remains oliguric and develops
ARF. Her urinalysis has heme-granular casts
and the urine sodium is 56 mEq/L. Which of
the following is the most likely cause of her
ARF?
(A)
(B)
(C)
(D)
(E)
nephrotoxic antibiotics
acute infectious GN
acute tubular necrosis (ATN)
contrast nephropathy
cholesterol emboli
29. A pregnant woman develops hypertension,
edema, and proteinuria, at 34 weeks of gestation.
Which of the following is not a risk factor
for the development of this complication?
(A)
(B)
(C)
(D)
(E)
first pregnancy
diabetes mellitus
twin pregnancy
extreme of reproductive age
human immunodeficiency virus (HIV)
infection
30. A 30-year-old man presents with hematuria.
His examination is normal except for an elevated
blood pressure of 164/94 mm Hg. An
ultrasound of the kidneys reveals multiple
renal cysts in both kidneys. His father had a
similar condition. Which of the following is not
associated with this syndrome?
(A)
(B)
(C)
(D)
(E)
liver cysts
intracranial aneurysms
autosomal dominant inheritance
rheumatoid arthritis (RA)
progression to end-stage renal failure
31. A 15-year-old boy develops renal colic. The
stone is not recovered, but urinalysis reveals
hexagonal crystals, and a cyanide-nitroprusside
test on the urine is positive. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
cystinuria
thalassemia
hereditary glycinuria
primary hyperoxaluria
sarcoidosis
32. A 29-year-old man is stable 1 year post-kidney
transplant. Which of the following complications
of transplantation is the most likely cause
of death?
(A)
(B)
(C)
(D)
(E)
atherosclerotic disease
opportunistic infection
metabolic bone disease
lung cancer
lymphoma
33. A 37-year-old immunosuppressed patient with
renal failure develops sepsis. Which of the following
antibiotics, if used, would require a
major reduction in dosage?
(A)
(B)
(C)
(D)
(E)
erythromycin
doxycycline
tobramycin
isoniazid (INH)
amphotericin B
34. A 63-year-old woman presents for routine evaluation.
She has had diabetes for the past 12 years
with complications of neuropathy and retinopathy.
You decide to screen her for renal complications
of diabetes. Which of the following findings
is not compatible with diabetic nephropathy?
(A)
(B)
(C)
(D)
(E)
nephrotic range proteinuria
microalbuminuria
hypertension
red blood cell (RBC) casts in urine
renal tubular acidosis (RTA) type IV
35. A 24-year-old woman is dipstick positive for
blood in her urine. This is repeated twice
between menstrual periods and remains positive.
Microscopic evaluation reveals RBCs,
some of which are deformed and some in the
form of casts. Which of the following is the
most likely cause of the hematuria?