front 1 A renal biopsy shows generalized hyalinization of renal arterioles in a patient with chronic vascular injury. Which diagnosis best describes this finding? A) Nephrosclerosis B) Renal infarction C) Fibromuscular dysplasia D) Thrombotic microangiopathy | back 1 A. Nephrosclerosis |
front 2 A patient develops nephrosclerosis from long-standing vascular damage. Which risk factor is most strongly associated with this condition? A) Diabetes insipidus B) Hypertension C) Sickle trait D) Turner syndrome | back 2 B. Hypertension |
front 3 A patient with refractory hypertension is found to have renal artery stenosis. Which cause is most common overall? A) Fibromuscular dysplasia B) ADAMTS13 deficiency C) Atheromatous plaque D) Shiga-like toxin | back 3 C. Atheromatous plaque |
front 4 A young woman develops renal artery stenosis without significant atherosclerotic disease. Which cause is most likely A) Fibromuscular dysplasia B) Thrombotic thrombocytopenic purpura C) Horseshoe kidney D) Sickle nephropathy | back 4 A. Fibromuscular dysplasia |
front 5 A patient with suspected renal artery stenosis undergoes abdominal examination. Which physical finding may be present? A) Flank bruit B) Pericardial rub C) Pleural friction rub D) Pulsatile thyroid | back 5 A. Flank bruit |
front 6 Which paired disorders fall under thrombotic microangiopathy of the kidney? A) Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura B) Autosomal dominant polycystic kidney disease and focal segmental glomerulosclerosis C) Nephrosclerosis and fibromuscular dysplasia D) Pyelonephritis and acute tubular necrosis | back 6 A) Hemolytic uremic syndrome and thrombotic thrombocytopenic purpura |
front 7 A child develops bloody diarrhea after undercooked beef, followed by acute kidney injury and thrombocytopenia. Which mediator drives typical Hemolytic uremic syndrome? A) Autoimmune complement activation B) Shiga-like bacterial toxin C) ADAMTS13 mutation D) Atheromatous embolization | back 7 B. Shiga-like bacterial toxin |
front 8 A patient develops Hemolytic uremic syndrome without diarrheal illness, with complement-mediated injury from immune dysregulation. Which form is most likely? A) Typical HUS B) Atypical HUS C) TTP D) Sickle nephropathy | back 8 B. Atypical HUS |
front 9 A patient with thrombotic thrombocytopenic purpura has impaired cleavage of large vWF multimers. Which molecule is mutated or deficient? A) Factor H B) PKD1 C) ADAMTS13 D) Collagen IV | back 9 C. ADAMTS13 |
front 10 In typical HUS, Shiga-like toxin damages renal microvasculature. What is the inciting event? A) Endothelial dysfunction B) Platelet aggregation first C) Cyst epithelial proliferation D) Arteriolar hyalinization | back 10 A. Endothelial dysfunction |
front 11 In TTP, absent ADAMTS13 allows large vWF multimers to accumulate. What is the inciting event? A) Endothelial necrosis B) Platelet aggregation C) Ciliary dysfunction D) Papillary ischemia | back 11 B. Platelet aggregation |
front 12 In typical HUS, Shiga-like toxins inactivate which complement regulator? A) C3 convertase B) Factor H C) Factor B D) Properdin | back 12 B. Factor H |
front 13 A patient has fever, neurologic symptoms, microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Which diagnosis classically has this pentad? A) HUS B) TTP C) Nephrosclerosis D) ADPKD | back 13 B. TTP |
front 14 A patient with an inherited RBC disorder develops renal medullary injury and nephropathy. Which disorder is implicated? A) Hereditary spherocytosis B) Sickle cell disease C) Beta-thalassemia minor D) G6PD deficiency | back 14 B. Sickle cell disease |
front 15 A renal infarct is described as pale and wedge-shaped. Which feature best explains the color? A) Extensive collateral reperfusion B) Venous congestion C) Lack of collateral supply D) Hemorrhagic transformation | back 15 C. Lack of collateral supply |
front 16 Most renal infarcts are pale because arterial occlusion produces an anemic infarct. What color are they usually? A) Red B) White C) Brown D) Black | back 16 B. White |
front 17 A renal infarct caused by arterial occlusion shows preserved tissue outlines with dead cells. Which necrosis pattern is expected? A) Liquefactive necrosis B) Caseous necrosis C) Fat necrosis D) Coagulative necrosis | back 17 D. Coagulative necrosis |
front 18 A congenital renal anomaly is found in a patient with Turner syndrome. Fusion of renal poles has produced which condition? A) Horseshoe kidney B) Duplex collecting system C) Renal agenesis D) Medullary sponge kidney | back 18 A. Horseshoe kidney |
front 19 In horseshoe kidney, fusion most commonly involves which renal poles? A) Upper poles B) Lower poles C) Medial hila D) Lateral cortices | back 19 B. Lower poles |
front 20 A patient has autosomal dominant adult polycystic kidney disease. Which laterality pattern is expected? A) Unilateral only B) Bilateral C) Medullary only D) Segmental only | back 20 B. Bilateral |
front 21 Which gene-chromosome pairing is correct for autosomal dominant polycystic kidney disease? A) PKD1—4; PKD2—16 B) PKD1—16; PKD2—4 C) PKD1—13; PKD2—21 D) PKD1—6; PKD2—11 | back 21 B. PKD1—16; PKD2—4 |
front 22 In ADPKD, PKD1 encodes which type of protein? A) Calcium channel B) Metalloprotease C) Integral membrane protein D) Complement regulator | back 22 C. Integral membrane protein |
front 23 In ADPKD, PKD2 encodes which type of protein? A) Calcium channel B) Shiga receptor C) vWF protease D) Collagen scaffold | back 23 A. Calcium channel |
front 24 A patient with ADPKD develops cysts from altered tubular epithelial signaling. Which cellular structure is primarily defective? A) Podocyte slit diaphragm B) Tubular cilia C) Glomerular basement membrane D) Juxtaglomerular apparatus | back 24 B. Tubular cilia |
front 25 Cilia defects in ADPKD alter mechanosensation and calcium flux. What downstream process promotes cyst formation? A) Endothelial thrombosis B) Tubular epithelial growth C) Arteriolar hyalinization D) Papillary coagulation | back 25 B. Tubular epithelial growth |
front 26 A patient with ADPKD is evaluated for extrarenal findings. Which cardiac abnormality is associated? A) Aortic stenosis B) Mitral valve prolapse C) Pulmonary stenosis D) Tricuspid atresia | back 26 B. Mitral valve prolapse |
front 27 A patient with ADPKD has numerous extrarenal cysts. Which organ commonly contains these cysts? A) Liver B) Spleen C) Pancreas D) Thyroid | back 27 A. Liver |
front 28 A patient has refractory hypertension, a flank bruit, and renal hypoperfusion from arterial narrowing. Which diagnosis best fits? A) Nephrosclerosis B) Renal artery stenosis C) Horseshoe kidney D) Thrombotic microangiopathy | back 28 B. Renal artery stenosis |
front 29 A patient has innocuous cystic dilation of the collecting ducts on imaging. Renal function remains normal. Which diagnosis best fits? A) Medullary sponge kidney B) Nephronophthisis C) Multicystic renal dysplasia D) Hydronephrosis | back 29 A. Medullary sponge kidney |
front 30 Which comparison best distinguishes medullary sponge kidney from nephronophthisis? A) Sponge—ESRD; nephronophthisis—normal function B) Sponge—PCT cysts; nephronophthisis—pelvic dilation C) Sponge—normal function; nephronophthisis—impaired function D) Sponge—bilateral cancer; nephronophthisis—benign tumor | back 30 C. Sponge—normal function; nephronophthisis—impaired function |
front 31 A child develops medullary renal cysts that progressively impair renal function and eventually cause ESRD. Which diagnosis is most likely? A) Medullary sponge kidney B) Nephronophthisis C) Hydronephrosis D) ARPKD | back 31 B. Nephronophthisis |
front 32 Which demographic is most commonly affected by nephronophthisis? A) Elderly men B) Pregnant women C) Middle-aged smokers D) Children | back 32 D. Children |
front 33 Multicystic renal dysplasia differs from ADPKD because it may show which laterality pattern? A) Always unilateral B) Always bilateral C) Unilateral or bilateral D) Medulla only | back 33 C. Unilateral or bilateral |
front 34 A patient has progressive urinary outflow obstruction with dilated calyces and renal pelvis. Which condition results? A) Nephronophthisis B) Hydronephrosis C) Medullary sponge kidney D) Papillary RCC | back 34 B. Hydronephrosis |
front 35 A patient forms the most common type of kidney stone. Which stone composition is most likely? A) Uric acid B) Cystine C) Calcium oxalate D) Struvite | back 35 C. Calcium oxalate |
front 36 Calcium oxalate stones often nucleate in renal ducts in the presence of which compound? A) Uric acid B) Cystine C) Ammonium D) Magnesium | back 36 A. Uric acid |
front 37 A patient develops large magnesium ammonium phosphate stones after infection with urease-positive bacteria. Which urine environment favors these stones? A) Highly acidic urine B) Neutral urine only C) Glucose-rich urine D) Alkaline urine | back 37 D. Alkaline urine |
front 38 A patient with persistently acidic urine develops kidney stones from a compound insoluble at high acidity. Which stone is most likely? A) Struvite B) Calcium phosphate C) Uric acid D) Magnesium ammonium phosphate | back 38 C. Uric acid |
front 39 A patient has uric acid nephrolithiasis. Which urinary condition promotes stone formation? A) Acidic urine B) Alkaline urine C) Dilute urine D) Proteinuria | back 39 A. Acidic urine |
front 40 A patient with cystinuria develops recurrent nephrolithiasis. Which urinary environment favors cystine stones? A) Alkaline urine B) Acidic urine C) Neutral urine D) Dilute urine | back 40 B. Acidic urine |
front 41 A patient with primary hyperparathyroidism develops recurrent calcium kidney stones. Which mechanism best explains the risk? A) Increased calcium excretion B) Decreased oxalate formation C) Reduced bone resorption D) Increased uric acid solubility | back 41 A. Increased calcium excretion |
front 42 A renal mass prone to hemorrhage is identified as an angiomyolipoma. Which genetic disorder is associated? A) Von Hippel-Lindau disease B) MEN1 C) Neurofibromatosis type 1 D) Tuberous sclerosis | back 42 D. Tuberous sclerosis |
front 43 Which statement best characterizes renal angiomyolipomas? A) Benign but hemorrhage-prone B) Malignant lymphatic tumors C) Uric acid crystal tumors D) PCT-derived carcinomas | back 43 A. Benign but hemorrhage-prone |
front 44 A patient asks about the strongest modifiable risk factor for renal cell carcinoma. Which exposure is most important? A) Urease-positive infection B) Smoking C) Acidic urine D) Hyperkalemia | back 44 B. Smoking |
front 45 A familial cancer syndrome causes renal cell carcinomas through mutations in the VHL gene. Which syndrome is this? A) Tuberous sclerosis B) Li-Fraumeni syndrome C) Von Hippel-Lindau disease D) Lynch syndrome | back 45 C. Von Hippel-Lindau disease |
front 46 Clear cell renal cell carcinoma is strongly linked to mutation of which tumor suppressor gene? A) MET B) PKHD1 C) PKD2 D) VHL | back 46 D. VHL |
front 47 The VHL gene implicated in clear cell renal cell carcinoma is located on which chromosome? A) Chromosome 6 B) Chromosome 3 C) Chromosome 16 D) Chromosome 4 | back 47 B. Chromosome 3 |
front 48 A patient has papillary renal cell carcinoma. Which gene is classically mutated? A) MET B) VHL C) PKHD1 D) ADAMTS13 | back 48 A. MET |
front 49 The MET gene implicated in papillary RCC encodes signaling through which growth factor pathway? A) Vascular endothelial growth factor B) Hepatocyte growth factor C) Platelet-derived growth factor D) Epidermal growth factor | back 49 B. Hepatocyte growth factor |
front 50 Which nephron segment gives rise to RCC? A) Collecting duct B) Thick ascending limb C) Proximal convoluted tubule D) Distal convoluted tubule | back 50 C. Proximal convoluted tubule |
front 51 A renal tumor invades the renal vein early in its spread. Which dissemination route is characteristic of RCC? A) Peritoneal seeding B) Tubular extension C) Lymphatic spread D) Hematogenous invasion | back 51 D. Hematogenous invasion |
front 52 A patient has renal cell carcinoma found after urinalysis. What is usually the first sign? A) Hematuria B) Flank mass C) Weight loss D) Bone pain | back 52 A. Hematuria |
front 53 Which clinical triad suggests advanced renal cell carcinoma rather than early disease? A) Fever, rash, eosinophilia B) Polyuria, stones, cysts C) Hematuria, flank pain, mass D) Edema, hypertension, casts | back 53 C. Hematuria, flank pain, mass |
front 54 Which finding usually detects renal cell carcinoma earlier than the classic advanced triad? A) Palpable abdominal mass B) Severe flank pain C) Constitutional symptoms D) Incidental hematuria | back 54 D. Incidental hematuria |
front 55 A patient with renal cell carcinoma later develops systemic cancer symptoms. Which timing best matches the usual course? A) Before any urinary finding B) After hematuria is detected C) Before tumor formation D) Only with benign tumors | back 55 B. After hematuria is detected |
front 56 Which pairing best matches stone type with urine pH? A) Uric acid—alkaline B) Struvite—acidic C) Cystine—alkaline D) Struvite—alkaline | back 56 D. Struvite—alkaline |
front 57 Which stone pairing correctly contrasts radiographic visibility A) Calcium—radiopaque; uric—radiolucent B) Calcium—radiolucent; uric—radiopaque C) Cystine—always radiolucent D) Struvite—always invisible | back 57 A. Calcium—radiopaque; uric—radiolucent |
front 58 Which pairing best matches renal disease with hallmark clue A) Hydronephrosis—PCT tumor origin B) ARPKD—PKHD1 chromosome 6 C) Angiomyolipoma—VHL mutation D) Nephronophthisis—normal renal function | back 58 B. ARPKD—PKHD1 chromosome 6 |