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Revision MCQs

1. An individual has adult-onset diabetes. She has high levels of

glucose in the urine and is experiencing a brisk diuresis. The
appearance of glucose in the urine is a consequence of which of
the following processes in the proximal tubule?
a. Inhibition of Na+-K+-ATPase pump
b. Saturation of the Na+-glucose cotransporter
c. Saturation of the Na+-H+ antiporter
d. Stimulation of glucose secretion
e. Stimulation of glycogen breakdown
2. A hypertensive patient was placed on a diuretic to increase urine
output. This diuretic blocks sodium reabsorption in the distal
convoluted tubule. Which transporter will be blocked by this
a. Na+-glucose cotransporter
b. Na+-K+-ATPase pump
c. Luminal Na+ channels
d. Na+-K+-2Cl- cotransporter
e. Na+-Cl- cotranspoter
3. A 70-year-old woman presents to your office complaining of
lower extremity edema. Upon questioning, she states that she
eats too much salt and is not compliant with a recently
prescribed antihypertensive drug. The investigations revealed
normal renal and cardiac function and venous insufficiency in the
lower extremities. The first and best treatment option for this
patient includes:
a. Lifestyle measures alone
b. Lifestyle measures and support stockings
c. Diuretic therapy alone
d. Support stockings alone
e. Lifestyle measures and diuretic therapy
4. A 75 year old female patient has the following laboratory results:
Plasma Na 112meq/l, K 3.8meq/l, Cl 90meq/l, Bicarbonate
24meq/l, measured plasma osmolarity 230mosmol/l. All the
following could be a cause of her abnormalities except one:
b. Heart failure
c. Intravenous Mannitol perfusion
d. Hypothyroidism
e. Hypovolemia

5. Calculate the Osmolar Gap in a patient intoxicated with Methanol

with the following results: Na= 135 meq/l, BUN =28 mg/dL,
Glucose =180 mg/dL, Measured Plasma Osmolality = 320
a. 10
b. 20
c. 30
d. 40
e. 50
6. A 23-year-old man with previous history of insulin-dependent
diabetes mellitus presents for altered mental status, nausea and
dyspnea. Laboratory tests revealed the following: Na 140 meq/L,
K 5.4 meq/L, Cl 104 meq/L, bicarbonate 10 meq/L, plasma pH
7.28, PCO2 24 mmHg. Select, among the following, the acid-base
disturbance in this patient.
a. High anion gap metabolic acidosis
b. Normal anion gap metabolic acidosis
c. Metabolic alkalosis
d. Respiratory acidosis
e. Respiratory alkalosis
7. In evaluating hyponatremia all the following factors should be
taken into consideration except:
a. Volume status of the patient
b. Blood glucose level
c. Blood magnesium level
d. Urinary Na
e. Urinary osmolarity
8. You were consulted to discuss the following set of electrolytes:
plasma Na 135 meq/L, potassium 3.8 meq/L, Cl 115 meq/L,
bicarbonate 9 meq/L, PCO2 40 mmHg, arterial pH 6.97, urine Na
30 meq/L, K 20 meq/L and Cl 100 meq/L. What is the acid-base
disturbance in this patient?
a. Simple high anion gap (AG) metabolic acidosis (MA)
b. Simple hyperchloremic MA
c. Mixed hyperchloremic MA and respiratory acidosis
d. Mixed high AG MA and respiratory alkalosis
e. Mixed hyperchloremic MA and metabolic alkalosis
9. A 60-year-old man weighing 70 kg has an oat-cell carcinoma of
the lung and is admitted to the hospital with a 2-week history of
progressive lethargy and obtundation. The physical examination
is within normal limits except for the obtundation. The following
laboratory tests were obtained: plasma Na = 105 meq/L, K = 4

meq/L, Cl = 72 meq/L, bicarbonate = 21 meq/L, Plasma

osmolality = 222 mosmol/Kg, Urine osmolality = 604 meq/kg,
urine sodium = 78 meq/L. What is the most probable diagnosis?
b. Primary polydipsia
c. Hypothyroidism
d. Diarrhea
e. Cirrhosis
Concerning the pharmacokinetic properties of angiotensinconverting enzyme inhibitors, which of the following statements
is true?
a. Captopril is a prodrug
b. Lisinopril is a prodrug
c. Fosinopril has dual (renal and biliary) elimination
d. Lisinopril is highly bound to plasma proteins
e. They all undergo hepatic metabolism
Select the appropriate statement describing
dihydropyridine calcium-channel blocker use.
a. They are indicated in the treatment of supraventricular
b. They are contra-indicated in patients with asthma
c. They are absolutely contra-indicated in pregnant women
d. Their use may be associated with reflex tachycardia and
e. They are specifically indicated in patients with proteinuria
A 45-year-old man is presenting to your office for resistant
hypertension. The investigations revealed hypokalemia,
metabolic alkalosis, suppressed plasma renin activity and high
plasma and urine aldosterone concentration. The most probable
diagnosis is:
a. Liddles syndrome
b. Licorice ingestion
c. Renal artery stenosis
d. Low-renin essential hypertension
e. Primary hyperaldosteronism
Treatment with which one of the following antihypertensive
drugs is more frequently associated with cough?
a. Nifedipine
b. Furosemide
c. Captorpil
d. Propranolol
e. Verapamil

Select among the following drug combinations the one that
is least likely to cause side effects.
a. Angiotensin-converting enzyme inhibitor and calcium
channel blocker
b. Angiotensin-converting enzyme inhibitor and angiotensin II
receptor antagonist
c. Angiotensin-converting enzyme inhibitor and
d. Beta blocker and moxonidine
e. Beta blocker and non-dihydropyridine calcium channel
A 50-year-old man was referred to you for renal
dysfunction. Upon questioning, you realize that the patient
received a drug during the last week for acute viral infection and
that he started to notice nausea, flank pain, oliguria and dark
urine 4 days after the new drug has been started. Laboratory
tests reveal a serum creatinine at 5 mg/dl, urea at 150 mg/dl, red
blood cells and needle-shaped crystals in the urine. The most
probable diagnosis is:
a. Acyclovir-induced acute obstructive kidney injury
b. Non-steroidal anti-inflammatory drug-induced acute
interstitial nephritis
c. Penicillamine-induced nephrotic syndrome
d. Cyclosporin-induced thrombotic microangiopathy
e. Diuretic-induced pre-renal injury
Select among the following the clinical situation that is
least likely to be associated with a high risk for acute kidney
a. Diuretic use
b. Multiple myeloma
c. Baseline renal failure
d. Proteinuria
e. Volume overload

In IgA nephropathy, the deposits are located in:

The mesangium
In the basement membrane
On the Bowmans capsule

Fibrinoid necrosis in the renal arteries can be the
consequence of:


Cholesterol emboli
Malignant hypertension
Chronic infection
Acute tubular necrosis
Focal and segmental glomerulosclerosis is characterized


Sclerosis of all glomeruli

Partial sclerosis of a some glomeruli
Endocapillary proliferation
Thin basement membrane
Anomalies of the type IV collagen

Treatment with diuretics may be complicated by
contraction alkalosis. Which of the following diuretics is more
frequently associated with metabolic acidosis instead of
a. Bumetanide
b. Hydrochlorothiazide
c. Indapamide
d. Acetazolamide
A 45-year-old man presented to the emergency
department for renal colic. He was found to have calcium oxalate
stones in both kidneys. Which one of the following diuretics is
indicated in the treatment of calcium oxalate stones?
a. Furosemide
b. Spironolactone
c. Hydrochlorothiazide
d. Acetazolamide
Which one of the following beta-blockers is known for its
high potency AND beta-1 selectivity?
a. Bisoprolol
b. Nebivolol
c. Pindolol
d. Propranolol
Which one of the following antihypertensive drugs is correctly
linked to its most clinical relevant side effect?
a. Losartan lower extremity edema
b. Amlodipine cough
c. Furosemide hypercalcemia
d. Spironolactone hyperkalemia

24. A 30-year-old man was found to have hyperaldosteronism. The

investigations revealed bilateral adrenal hyperplasia. This patient
would be treated best with:
a. Furosemide
b. Surgical resection of both adrenal glands
c. Amiloride
d. Thiazide diuretic