front 1 Which renal disorder is most common in hospitalized patients? A) Acute tubular necrosis B) Acute interstitial nephritis C) Chronic pyelonephritis D) Polyomavirus nephropathy | back 1 A. Acute tubular necrosis |
front 2 During renal ischemia, which nephron regions are especially vulnerable to acute tubular injury? A) Glomerulus and collecting duct B) PCT and thick ascending limb C) DCT and thin descending limb D) Macula densa and podocytes | back 2 B. PCT and thick ascending limb These segments do a lot of active transport, so they need a lot of ATP and oxygen. Ischemia → ↓ oxygen → ↓ ATP → active transport fails → tubular cell injury/necrosis |
front 3 Which nephron segment is particularly vulnerable to toxic injury? A) Thick ascending limb only B) Collecting duct only C) Proximal convoluted tubule only D) Distal convoluted tubule only | back 3 C. Proximal convoluted tubule only The PCT reabsorbs a lot of filtered substances, so toxins can become concentrated inside these cells. |
front 4 A patient enters the earliest phase of acute tubular injury after an ischemic insult. Which change best fits the inciting phase? A) Polyuria with hypokalemia B) Infection risk with diuresis C) Stable BUN with alkalosis D) Oliguria with rising BUN | back 4 D. Oliguria with rising BUN ischemic insult → tubular injury begins → ↓ GFR/tubular function → ↓ urine output → BUN rises |
front 5 A patient with acute tubular injury has severe oliguria, rising BUN, metabolic acidosis, and hyperkalemia. Which phase is this? A) Recovery phase B) Maintenance phase C) Inciting phase D) Reparative diuresis phase | back 5 B. Maintenance phase Inciting phase = initial injury, oliguria starts, BUN rises |
front 6 A patient recovering from acute tubular injury develops increasing urine output and electrolyte wasting. Which complication becomes especially important? A) Hypokalemia B) Hyperkalemia C) Metabolic acidosis D) Rising BUN | back 6 A. Hypokalemia |
front 7 A patient recovering from acute tubular injury has rising urine output and impaired tubular function. Which additional risk increases during recovery? A) Hypertensive crisis B) Infection vulnerability C) Renal papillary necrosis D) Glomerular crescent formation | back 7 B. Infection vulnerability |
front 8 Inflammation involving renal tubules, interstitium, and renal pelvis is best termed what? A) Glomerulonephritis B) Nephrolithiasis C) Pyelonephritis D) Papillary necrosis | back 8 C. Pyelonephritis |
front 9 A woman develops pyelonephritis after untreated cystitis spreads upward. Which route most commonly causes pyelonephritis? A) Hematogenous seeding B) Ascending infection C) Autoimmune glomerular spread D) Direct renal trauma | back 9 B. Ascending infection Because bacteria usually start outside the body and enter the urinary tract from below. cystitis → bacteria ascend ureters → renal pelvis/kidney inflammation → pyelonephritis |
front 10 Most urinary tract infections are caused by organisms with which Gram stain and shape? A) Gram-positive cocci B) Gram-negative bacilli C) Acid-fast bacilli D) Gram-negative diplococci | back 10 B. Gram-negative bacilli |
front 11 Which organism set best matches common Gram-negative bacilli causing UTIs? A) Proteus, Klebsiella, E. coli B) Staph, Strep, Enterococcus C) Candida, Cryptococcus, Aspergillus D) Neisseria, Chlamydia, Mycoplasma | back 11 A. Proteus, Klebsiella, E. coli |
front 12 A patient develops pyelonephritis from hematogenous spread rather than ascending infection. Which patient type is most typical? A) Healthy adolescent B) Pregnant adult C) Immunosuppressed patient D) Athletic young adult | back 12 C. Immunosuppressed patient |
front 13 A hospitalized patient with a urethral catheter develops dysuria and fever. This device increases risk for which complication? A) UTI and possible pyelonephritis B) Polyomavirus nephropathy only C) Bile cast nephropathy D) Multiple myeloma nephropathy | back 13 A. UTI and possible pyelonephritis |
front 14 A child with vesicoureteral reflux develops recurrent ascending urinary infections. Reflux primarily increases risk for what? A) Gouty nephropathy B) Urinary tract infection C) Bile cast formation D) Amyloid kidney disease | back 14 B. Urinary tract infection |
front 15 A kidney biopsy from acute pyelonephritis shows inflammatory cells in tubules and interstitium. Which cell predominates? A) Macrophages B) Plasma cells C) Neutrophils D) Eosinophils | back 15 C. Neutrophils |
front 16 In acute pyelonephritis, which renal structure is typically spared despite tubulointerstitial inflammation? A) Glomerulus B) Renal pelvis C) Tubule D) Interstitium | back 16 A. Glomerulus Because pyelonephritis usually comes from an ascending UTI, so the infection enters the kidney from the urine side, not the blood-filtering side. urethra → bladder → ureter → renal pelvis → collecting ducts/tubules → interstitium |
front 17 A patient develops sloughed renal papillae during severe urinary infection. Which condition predisposes to papillary necrosis? A) Minimal change disease B) Diabetes mellitus C) Multiple myeloma D) Acute rheumatic fever | back 17 B. Diabetes mellitus |
front 18 Which additional risk set is associated with renal papillary necrosis? A) NSAIDs, sickle cell, obstruction B) Penicillins, IgE, eosinophils C) Proteus, giant cells, plasma cells D) HLA-B27, sacroiliitis, uveitis | back 18 A. NSAIDs, sickle cell, obstruction |
front 19 A pregnant patient develops fever, malaise, flank pain, and CVA tenderness. Pregnancy predisposes to which renal disorder? A) Polyomavirus nephropathy B) Bile cast nephropathy C) Acute tubular injury D) Pyelonephritis | back 19 D. Pyelonephritis |
front 20 A urinalysis in suspected pyelonephritis reveals many leukocytes. Which cast type would strongly support renal parenchymal infection? A) RBC casts B) Fatty casts C) WBC casts D) Bile casts | back 20 C. WBC casts |
front 21 A patient with recurrent kidney infections has deformed calyces, corticomedullary scars, and flattened papillae. Which diagnosis best fits? A) Acute tubular injury B) Chronic pyelonephritis C) Drug-induced interstitial nephritis D) Polyomavirus nephropathy | back 21 B. Chronic pyelonephritis |
front 22 A renal biopsy shows enlarged tubular epithelial nuclei with intranuclear inclusions and crystalline-lattice structures. Which diagnosis is most likely? A) Polyomavirus nephropathy B) Xanthogranulomatous pyelonephritis C) Acute pyelonephritis D) Bile cast nephropathy | back 22 A. Polyomavirus nephropathy polyomavirus infects tubular epithelial cells → viral replication inside nucleus → enlarged nuclei with inclusions |
front 23 A biopsy from chronic pyelonephritis shows chronic inflammatory infiltration. Which cell type predominates? A) Neutrophils B) Basophils C) Macrophages D) Mast cells | back 23 C. Macrophages |
front 24 A patient with recurrent Proteus infection develops renal inflammation containing giant cells, plasma cells, and foamy macrophages. Which diagnosis is likely? A) Acute tubular necrosis B) Xanthogranulomatous pyelonephritis C) Drug-induced AIN D) Polyomavirus nephropathy | back 24 B. Xanthogranulomatous pyelonephritis |
front 25 A patient with chronic pyelonephritis develops massive proteinuria from a secondary nephrotic process. Which syndrome can occur? A) Membranous nephropathy B) Minimal change disease C) Diffuse diabetic sclerosis D) Focal segmental glomerulosclerosis | back 25 D. Focal segmental glomerulosclerosis unlike acute, in chronic we have glomerular issues over time bc of kidney damage and scarring. |
front 26 After pyelonephritis, which condition is described as the second most common cause of acute kidney injury? A) Drug/toxin-induced TIN B) Renal artery stenosis C) Poststreptococcal GN D) Multiple myeloma | back 26 A. Drug/toxin-induced TIN |
front 27 A patient develops acute tubulointerstitial nephritis after starting antibiotics. Which drug class most commonly causes this? A) Loop diuretics B) Synthetic penicillins C) Beta blockers D) Calcium channel blockers | back 27 B. Synthetic penicillins |
front 28 A drug-induced acute interstitial nephritis biopsy shows an allergic-type inflammatory pattern. Which cells predominate? A) Neutrophils and monocytes B) Lymphocytes and mast cells C) Macrophages and eosinophils D) Plasma cells and basophils | back 28 C. Macrophages and eosinophils |
front 29 A patient develops fever and rash after starting a synthetic penicillin, followed by renal dysfunction. Which immunoglobulin is often elevated? A) IgA B) IgG C) IgM D) IgE | back 29 D. IgE synthetic penicillin → allergic interstitial reaction → fever/rash/eosinophils → kidney dysfunction |
front 30 A severe case of drug-induced acute interstitial nephritis can produce which urinary findings? A) Hematuria, proteinuria, leukocyturia B) Glycosuria, ketonuria, bilirubinuria C) Myoglobinuria, crystalluria, anuria D) Hemoglobinuria, chyluria, phosphaturia | back 30 A. Hematuria, proteinuria, leukocyturia |
front 31 A patient with malignancy develops tubulointerstitial nephropathy due to excess abnormal proteins. Which cancer is implicated? A) Renal cell carcinoma B) Multiple myeloma C) Acute leukemia D) Transitional carcinoma | back 31 B. Multiple myeloma |
front 32 A patient with severe liver disease develops pigmented casts in renal tubules. Which cast type is expected? A) RBC casts B) WBC casts C) Fatty casts D) Bile casts | back 32 D. Bile casts |
front 33 Which sequence best matches phases of acute tubular injury with major clinical changes? A) Recovery—hyperkalemia; inciting—polyuria B) Inciting—oliguria; maintenance—acidosis C) Maintenance—hypokalemia; recovery—anuria D) Inciting—infection; maintenance—diuresis | back 33 B. Inciting—oliguria; maintenance—acidosis |
front 34 Which pairing best distinguishes acute from chronic pyelonephritis? A) Acute—macrophages; chronic—neutrophils B) Acute—WBC casts; chronic—calyceal scarring C) Acute—crystalline lattice; chronic—IgE D) Acute—bile casts; chronic—papillary sparing | back 34 B. Acute—WBC casts; chronic—calyceal scarring |
front 35 Which pairing best matches renal disorders with characteristic associations? A) Polyomavirus—bile casts B) Xanthogranulomatous—Proteus infection C) Drug-induced AIN—low IgE D) Chronic pyelo—minimal proteinuria | back 35 B. Xanthogranulomatous—Proteus infection |
front 36 A patient with ascending renal infection has fever, flank pain, and leukocyturia. Which finding best localizes inflammation to kidney rather than bladder alone? A) Squamous epithelial cells B) Nitrite-positive urine C) White blood cell casts D) Low urine specific gravity | back 36 C. White blood cell casts |