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Renal Pathology

Total questions: 50

Worksheet time: 1hrs 11mins

Name
Class
Date
1.

A 25-year-old man presents with hematuria, periorbital edema, hypertension, and hemoptysis. He has also experienced nausea, vomiting, fever, and chills. Serologic testing is positive for antiglomerular basement membrane antibodies. Which of the following is the classic histologic finding in this renal disease?

a)

Linear immunofluorescence

b)

“Lumpy-bumpy” immunofluorescence

c)

“Spike and dome” appearance of the glomerular basement membrane

d)

Subendothelial immune complex deposition

2.

Hematuria, azotemia, variable proteinuria, oliguria, edema, and hypertension

a)

Chronic renal failure

b)

Rapid progressive glomerulonephritis

c)

Nephrotic syndrome

d)

Nephritic syndrome

3.

Primary glomerulopathy, except:

a)

Minimal-change disease

b)

Postinfectious

c)

Wegener granulomatosis

d)

Dense deposit disease

4.

Which of the following is the EM finding in acute post streptococcal glomerulonephritis?

a)

Mesagial deposits

b)

Subepithelial humps

c)

Intramembranous deposits

d)

Subendothelial deposits

5.

The most clinical manifestation IgA nephropathy is:

a)

Proteinuria

b)

Hematuria

c)

Nephritic syndrome

d)

Nephrotic syndrome

6.

The morphologic lesion of rapidly progressing glomerulonephritis is:

a)

Segmental sclerosis

b)

Nodular sclerosis

c)

Epithelial crescents

d)

Wire loop lesions

7.

Clinically mesangial lesions in the glomeruli are usually manifested as:

a)

Proteinuria

b)

Hematuria

c)

Nephritic syndrome

d)

Nephrotic syndrome

8.

Patient sought consult for chest pain and hemoptysis associated with hematuria, and signs and symptoms of uremia. His blood pressure is elevated and he has grade III bipedal edema. As the clinician in charge, you suspect that he is suffering from an autoimmune disease in which antibodies against type IV collagen attack the basement membrane of the lungs and kidneys. On immunofluorescence renal biopsy would most probably reveal:

a)

Granular IgG and C3 in GBM and mesangium

b)

Linear IgG and C3

c)

Focal IgM or C3

d)

IgA in the mesangium

9.

Proteinuria is usually manifested as?

a)

Fruity urine

b)

Tea colored urine

c)

Ammoniacal urine

d)

Bubbly urine

10.

This pathology is characterized by distinctive combination of mesangial and endothelial proliferation, along

with thickening and duplication of the capillary basement membrane

a)

Amyloidosis

b)

Diabetic nephropathy

c)

Membranoproliferative glomerulonephritis

d)

Post-streptococcal glomerulonephritis

11.

Crescentic glomerulonephritis is most associated with:

a)

p-ANCA

b)

HIV

c)

Cytomegalovirus

d)

Cryoglobulin

e)

Nephritic factor

12.

A child was brought to your clinic complaining of hematuria. He had sore throat 5 days prior to consult. What do you expect to find on electron microscopy?

a)

discrete, amorphous, electron-dense deposits on the epithelial side of the membrane, often having the appearance of “humps"

b)

uniform and diffuse effacement of foot processes

c)

double contour” or “tram-track” appearance

d)

presence of electron-dense deposits predominantly in the mesangium

13.

Most important urinalysis finding in poststreptococcal glomerulonephritis

a)

RBC in urine

b)

Granular cast in urine

c)

Waxy cast in urine

d)

RBC cast in urine

14.

Which of the following GN usually present as nephritic syndrome?

a)

Minimal change disease

b)

Focal segmental glomerulonephritis

c)

Membranous glomerulopathy

d)

Acute post streptococcal glomerulonephritis

15.

A 20-year old female presented with malar rash, oral ulcers, protosensitivity and proteinuria with granules or casts, kidney biopsy was done showing a "wire loop abnormality" on light microscope with marked subendothelial immune complex deposition on electron microscope. What is the diagnosis?

a)

IqA nephropathy

b)

Goodpasture syndrome

c)

Focal segmental glomerulosclerosis

d)

Lupus nephropathy

16.

What is the most common and the most severe form of LUPUS NEPHRITIS ?

a)

Minimal mesanglial

b)

Mesanglial proliferative

c)

Focal proliferative

d)

Diffuse proliferative

17.

An 18-year old male noted recurrent painless hematuria after having bloody diarrhea and fever 2 weeks before. No other sign or symptom was noted. The most likely diagnosis is:

a)

IgA Nephropathy

b)

Minimal change disease

c)

Membranoproliferative glomerulonephritis

d)

Post-streptococcal glomerulonephritis

18.

Autosomal recessive, enlarged cystic kidneys at birth, Hepatic fibrosis is a known complication:

a)

Adult polycystic disease

b)

Medullary sponge kidney

c)

Simple cyst

d)

Acquired renal cystic disease

e)

Childhood polycystic kidney disease

19.

True about simple cysts, except:

a)

May be single or multiple and usually involve the cortex

b)

Translucent scent, lined by a gray, glistening, smooth muscle, and filled with clear fluid

c)

Main importance of cysts lies in their differentiation from kidney tumors

d)

On microscopic examination, it is composed of multilayer flattened cuboidal epithelium

20.

Result from renal fusion producing a U-shaped structure continous across the midline and anterior to the aorta and inferior vena cava

a)

Bile cast nephropathy

b)

Light chain deposition disease

c)

Ectopic kidneys

d)

Horshoe kidneys

21.

A 13 year old female presented with headache and decreased urine output after a 4 week history of skin infection. Which of the following is the most likely morphology of the kidney?

a)

linear GBM fluorescence for Ig and complement

b)

discrete subendothelial electron dense deposits

c)

granular deposits of IgG, IgM, and C3 in the mesangium and along the GBM

d)

GBM transformed into an irregular ribbon like, electron dense structure

22.

What is the mechanism of edema in nephrotic syndrome?

a)

Glomerular injury

b)

Increased capillary permeability to proteins

c)

Decreased protein absorption

d)

Tubulointerstitial disorder

23.

The most likely renal pathology in multiple myeloma is:

a)

Tubulo-interstitial nephritis

b)

Membranoproliferative glomerulonephritis

c)

Acute glomerulonephritis

d)

Focal segmental glomerulosclerosis

24.

Wire-loop capillaries are seen in which type of kidney disease?

a)

Lupus nephritis

b)

RPGN

c)

Diabetic nephropathy

d)

Polycystic kidney disease

25.

What is the most common and the most severe type of Lupus nephropathy?

a)

Type I

b)

Type II

c)

Type III

d)

Type IV

26.

Variant of Renal Cell Carcinoma which is made up of pale eosinophilic cells, often with a perinuclear halo, arranged in solid sheets with a concentration of the largest cells around blood vessels?

a)

Clear cell CA

b)

Papillary CA

c)

Chromophobe CA

d)

Collecting Duct CA

27.

Which of the following is true regarding dense deposit disease?

a)

Characterized by immune complex deposits in the glomerular basement membrance and activiation of classical pathway

b)

Highly responsive to treatment with immunosuppresive drugs such as pulse cyclophosphamide combined with steroids

c)

Diminished serum levels of factor B and properdin

d)

Dense materials are primarily deposited on the podocyte-GBM junction

28.

What is the most characteristic lesion of HIV associated nephropathy ?

a)

Capillary wall hyalinosis

b)

Duplication of the basement membrane

c)

Retraction of the entire glomerulus

d)

Diffuse mesangial proliferation

29.

What major fibril protein responsible for secondary amyloidosis on a chronic kidney disease patient on prolonged hemodialysis ?

a)

Amyloid light chain

b)

Beta microglobulin

c)

transthyretin

d)

calcitonin

30.

Foot process effacement associated with normal glomeruli by light microscopy makes this diagnosis:

a)

membranous nephropathy

b)

minimal change disease

c)

PSGN

d)

Berger disease

31.

A 27-year-old female with hypertension was found to have renal artery stenosis. What is the expected morphologic finding on examination?

a)

a concentrically placed atheromatous plaque with superimposed thrombosis

b)

eosinophilic granular change in blood vessel wall staining (+) for fibrin

c)

fibromuscular thickening involving the media of artery

d)

intimal thickening caused by proliferation of elongated, concentrically arranged smooth muscle cells

32.

A renal biopsy that shows hypercellular glomeruli on light microscopy, "starry sky" pattern of immunofluorescence and subepithelial immune complex humps on electron microscopy is most consistent with which of the following diagnosis?

a)

Rapidly progressive glomerulonephritis

b)

Acute poststreptococcal glomerulonephritis

c)

IgA nephropathy

d)

Membranoproliferative glomerulonephritis

33.

A 49-year-old woman is admitted to the hospital because of renal failure. She has had episodes of flank pain over the past 20 years. She has also had nocturia 2 to 3 times nightly for 10 years. Her blood pressure is 160/100 mm Hg. Examination shows pale mucous membranes. A mass is palpated in the right flank. Which of the following is the

most likely diagnosis?

a)

Horseshoe kidney

b)

Nephrolithiasis

c)

Papillary necrosis

d)

Polycystic kidney disease

34.

Renal cell carcinoma is MOST COMMONLY derived from cells of the:

a)

Glomerulus

b)

Proximal tubule

c)

Loop of Henle

d)

Distal tubule

35.

Variant of renal cell carcinoma which is made up of polygonal cells with abundant clear cytoplasm

a)

Chromophobe renal CA

b)

Papillary CA

c)

Medullar CA

d)

Clear cell CA

36.

Most common cause of Nephrotic Syndrome in adults:

a)

Membranous nephropathy

b)

Minimal-change disease

c)

Focal-segmental glomerulosclerosis

d)

Diabetes Mellitus

37.

Most common cause of Nephrotic Syndrome in children:

a)

Membranous nephropathy

b)

Minimal-change disease

c)

SLE

d)

Lymphoma

38.

Alport syndrome is a form of hereditary nephritis that i caused by mutations in genes encoding for what type of collagen?

a)

Type I

b)

Type II

c)

Type III

d)

Type IV

39.

Azotemia, hypocalcemia and huperparathyroidism are associated with:

a)

Acute renal failure

b)

Chronic renal failure

c)

Nephrotic syndrome

d)

Nephriitic syndrome

40.

Which is not associated with diabetic nephropathy?

a)

Kimmelsteil-Wilson disease

b)

Acute pyelonephritis

c)

Papillary necrosis

d)

Renal artery stenosis

41.

IgA deposit in mesangium can be appreciated by:

a)

Immunoflourescence microscopy

b)

Electron microscopy

c)

Light microscopy

d)

All of the above

42.

Nephritic factor dense deposits are related to?

a)

Membranoproliferative glomerulonephritis

b)

Lipoid nephrosis

c)

Focal segmental glomerulonephritis

d)

Acute post-streptococcal glomerulonephritis

43.

Associated with Proteus infection, also called Staghorn calculi:

a)

Calcium stiones

b)

Uric acid stones

c)

Struvite stones

d)

None of these

44.

A study of renal disease identifies patients with greater than 3.5g of protein in a 24-hour urine collection, but no RBCs or WBC's. Dysfunction involving which of the following cells most likely to be responsible for proteinuria?

a)

Endothelium

b)

Macula densa

c)

Mesangium

d)

Parietal epithelium

e)

Podocytes

45.

Which of the following tests is kost valuable in confirming Goodpasture's syndrome?

a)

Diffuse linear staining of GBM with IgG

b)

Granular lumpy bumpy deposits of IgG

c)

Urine culture for resistant E.coli

d)

Diffuse thickening of G on electron microscopy

46.

Nephritic syndrome is associated with:

a)

Lipoid nephrosis

b)

Goodpasture's disease

c)

Both

d)

Neither

47.

Renal cell carcinoma is associated with which characteristic(s)?

a)

Invades renal vein

b)

Clear cell type

c)

Both

d)

Neither

48.

Acute post-streptococcal glomerulonephritis is characterized by:

a)

Tubulorrhexis

b)

Thick basement membrane

c)

Both

d)

Neither

49.

Nephrotic syndrome is found in which disease?

a)

Diabetes Mellitus

b)

Membranous glomerulonephritis

c)

Both

d)

Neither

50.

The most common cause of acute pyelonephritis is (are)

a)

Entamoeba coli

b)

Staphylococcus aureus

c)

Both

d)

Neither