8/10/2019 Urinary Tract Review

1/12

2013 URINARY

TRACT

SUMMER

REVIEW

Barbara

D.

Bosch,

M.D.

References

for

USMLE

Step 1-format questions (with

modifications):

Cataiano

E.

Appleton

&

Lanqe

Review of General

Pathology,

4th

ed. M cG raw

Hill

Medical, 2003.

Fenderson

BA , Strayer

DS , Rubin

R,

Rubin E. I llustrated

Q&A

Review

of

Rubin's

Pathology,

2n d

ed .

Lippincott Williams

&

Wilkins,

20 1

1

.

Goldberg

J.

Lanqe

Practice

Tests USMLE

Step

1,

2n d ed .

McGraw Hill

Medical,

2006.

Kettering JD ,

Fletcher

HM .

PreTest

Microbiology,

12th ed . McGraw

Hill

Medical,

2007.

King MW.

Lanoe

Q&A

USMLE

Step

1.

6th ed . McGraw

Hill

Medical, 2008.

Klatt EC, Kumar V.

Robbins

and Cotran Review

of

Pathology,

3rd

ed.

Saunders

Elsevier,

2010.

Klein

RM, Enders

GC. PreTest

Anatomy.

Histology

&

Cell

Biology,

3rd

ed.

McGraw

Hill

Medical,

2007.

Le

T,

Klein J, Shivaram

A.

First Aid

Q&A

for

the USMLE

Step

1.

McGraw

Hill

Medical, 2007.

Le

T,

Krause K,

Klein

J, Shivaram A. First

Aid

Cases for the

USMLE

Step

1. McGraw Hil l

Medical,

2006.

Mufson

M. PreTest

Pathophysiology,

3rd ed. M cG raw

Hill

Medical, 2005.

PreTest

Clinical

Vignettes

for the USMLE

Step

1.

4th

ed . McGraw

Hill Medical,

2008.

8/10/2019 Urinary Tract Review

2/12

2013 Urinary

Tract

Summer

Review;

Barbara

D. Bosch, M.D.

page

2

A

59 year-old

man

complains of

periorbital

edema and ankle

swelling

which have gradually been

getting

worse

over

the past few

months.

His

blood

pressure

is 120/80 mm

Hg.

Urinalysis

shows

4+

proteinuria,

but

no

cells

or casts. Serum albumin is moderately decreased, but blood

urea

nitrogen

(BUN)

and creatinine

are

normal.

Which

of the following is the

most

likely diagnosis?

A.

acute

proliferative

glomerulonephritis

B.

diabetic

nephropathy

C.

IgA

nephropathy

D. lupus nephritis

E. membranous

glomerulopathy

F. m inim al change

disease

A

52

year-old

woman who suffers

from diabetes melli tus

and

frequent

urinary

tract

infections presents

with

a

3-day

history

of

flank

pain,

undulating

fever an d

general

malaise.

A

CBC

shows

neutrophilic

leukocytosis

(16,000/mL).

Urine cultures

reveal

more than 100,000 bacterial colonies,

composed

predominantly

of

gram-negative rods. B lood

pressure

is 170/100 mm Hg, BUN

is

30

mg/dl_

(normal

7-18

mg/dL)

and creatinine

is

2.0

mg/dL

(normal

0.6-1.2

mg/dL). Fasting

serum glucose

is

19 0

mg/dL

(normal 70-1

10

mg/dL).

Urinalysis shows

2+

sugar an d

1+ protein.

Microscopic

examination

of

the

urine

sediment reveals

neutrophils an d

occasional

WBC

casts.

Which of the following is the best

diagnosis?

A.

acute

pyelonephritis

B.

acute tubular necrosis

C. diabetic glomerulonephropathy

D. nephrolithiasis

E. postinfectious

glomerulonephritis

A 7 year-old boy

is

recovering

from

impetigo.

Physical

exam

shows

a

few

honey-colored

crusts

on

his

face.

A

culture

of these

crusts

grows

group

A Streptococcus

pyogenes.

One

week

later,

he

develops

malaise

with

nausea

and a slight

fever

and passes

dark

brown

urine.

Laboratory

studies show

a

serum

antistreptolysin

O

titer of

1:1024. Which

of

the following

is the

most likely

outcome?

A.

chronic renal

failure

B. complete recovery without treatment

C.

development of

rheumatic

heart disease

D.

lower

urinary

tract

infection

E. progression

to

crescentic glomerulonephritis

A

72

year-old

woman is hospitalized

after

becoming

acutely

ill.

Despite

intervention,

she dies 9

days

later.

One

of

the

findings

at her autopsy is shown

in

the

accompanying photomicrograph.

Which

of the

following

condit ions could have

led to the changes

seen

in this

patient's

kidney

and was most

likely

the

reason for

her

hospitalization?

A.

myocardial infarction

B.

pyelonephritis

C.

renal cell

carcinoma

D.

sepsis

E.

shock

The

mother

of a

1

year-old bo y

palpates

a

mass

on the

right side

of the infant's

abdomen.

Microscopically,

the

lesion is

composed of

blastemal, stromal and

epithelial

tissues.

Which of

the

following

is

the

most

likely diagnosis?

A. angiomyolipoma

B. neuroblastoma

C.

renal cell carcinoma

D. urothelial

cell

carcinoma

E.

Wilms

tumor

8/10/2019 Urinary Tract Review

3/12

2013

Urinary

Tract Summer Review;

Barbara

D.

Bosch,

M.D.

page

3

A

25

year-old man

complains

of

intermittent

hematuria over

the

past 8

years.

Urinalysis

shows microscopic

hematuria.

Urine

cultures

are

negative.

A

renal biopsy (shown

in

the

image)

displays mesangial

proliferation

within some glomeruli,

whereas others

appear

normal. Immunofluorescence

staining

discloses

mesangial

deposition

of IgA . Which

of the

following

is

the

appropriate

pathologic

diagnosis?

A.

amyloid

nephropathy

B. crescentic

glomerulonephritis

C.

focal

proliferative

glomerulonephritis

D.

Kimmelstiel-Wilson disease

E.

membranous

glomerulonephropathy

A

63

year-old

man

has noted

increasing

back

pain

for

7

months. He

has

had three

respiratory

tract

infections

with

Streptococcus

pneumoniae within the

past year.

On

exam,

he

has

pitting edema to

his

thighs.

Lab studies show an elevated

total

serum

protein with a normal

albumin level; creatinine,

3.1

mg/dL (normal

0.6-1

.2

mg/dL); an d

glucose,

79

mg/dL (normal

70-110

mg/dL).

Urinalysis

shows

proteinuria

of

4

g/24

hr,

bu t no

glucosuria

or

hematuria.

Abdominal CT scan shows

enlarged

kidneys

without

cysts

or

masses.

A renal

biopsy

specimen

shows

deposits

of

amorphous

pink

material

within

the

glomeruli,

interstitium

and

arteries

with an

H&E

stain. Which of

the

following

diseases

is most

likely?

A.

analgesic nephropathy

B.

diabetes

mellitus

C. membranous glomerulonephropathy

D.

multiple

myeloma

E.

Wegener

granulomatosis

A

25

year-old

man presents to his doctor

with

a 2-day

history

of hemoptysis

and

blood

in

his

urine.

A

kidney

biopsy

is

obtained.

When

the

tissue is stained

with fluorescent

anti-IgG,

the

staining

reveals a

linear

pattern.

Which

of the

following is

the most

likely

diagnosis?

A.

acute

poststreptococcal

glomerulonephritis

B.

Alport

syndrome

C.

Goodpasture syndrome

D. IgA nephropathy

E. membranous

glomerulonephritis

A

46

year-old

woman

presents

with a 6-month

history

of

vague

upper

abdominal

pain after fatty

meals,

some

abdominal

distention

and

frequent

indigestion.

Physical

examination

shows

an

obese

woman (BMI

=

32

kg/m2)

with

right upper quadrant tenderness.

A

CT scan discloses gallstones

an d

an

ectopic

kidney.

Which of the

following

is

the

most common

location

of

an

ectopic

kidney?

A.

adjacent

to

the

gallbladder

B.

attached to

the

left

adrenal

gland

C.

fused

laterally

with

the

contralateral

kidney

D. pelvis

E.

posterior

epigastrium

A

65

year-old

man presents

with

a

recent

episode of

painless

hematuria. Vital signs

are

normal.

All

blood

tests and

urinalysis

are

normal,

except for

the

presence

of erythrocytes

in

the urine.

The

patient

smokes cigarettes but does not drink

alcoholic beverages.

Which of the

following

is

the most

likely

cause of

hematuria

in this

patient?

A.

acute

cystitis

B.

acute pyelonephritis

C. bladder calculi

D.

carcinoma of

the bladder

E.

prostatic carcinoma

8/10/2019 Urinary Tract Review

4/12

2013

Urinary Tract

Summer

Review; Barbara

D.

Bosch, M.D.

page

4

v

A

30 year-old

man with a

history

of drug addiction

presents

with

a

6-month

history

of

progressive swelling

in

his ankles

and

abdomen. Urinalysis shows

heavy

proteinuria

(>

4

g

per 24 hours),

bu t no evidence of

inflammatory

cells

or

iicavy

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uw

cviuciioc

ui

ii incuiin ictiui

y

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ui

,t?