B. cystine crystals

1. Faddists who consume a great deal of vitamin C can expect to have urinary sediments containing:
* A. calcium oxalate crystals

B. cystine crystals

C. red cell casts

D. white cell casts

E. uric acid crystals
2. Amyloidosis of the kidney is most likely to announce itself as
A. anuria

B. asymptomatic hematuria

C. nephritic syndrome

* D. nephrotic syndrome

E. oliguria
3. How many layers of transitional cell nuclei should you be able to count before you call a bladder mucosal biopsy "hyperplastic"?
A. more than 2

* B. more than 6

C. more than 10

D. more than 20

E. more than 60
4. In addition to the well-known diabetic ketoacidosis, finding abundant ketones in the urine should make you think of
* A. aspirin poisoning

B. bleach bottle collection

C. ethylene glycol (antifreeze) poisoning

D. Fabry's

E. vitamin enthusiast
5. No one knows why atheroembolization of the kidney causes a great increase in urinary sediment
A. basophils

* B. eosinophils

C. lymphocytes

D. phosphates

E. urates
6. Which finding in urine suggests that your patient has hepatorenal syndrome rather than acute tubular necrosis?
A. granular casts

B. hyaline casts

* C. low urine sodium

D. normal urine sodium

E. red cell casts

7. Common to all the hemolytic-uremic syndromes:

* A. damage to endothelium

B. pigment casts causing renal failure

C. recessive inheritance

D. resorption droplets in proximal tubules

E. red cell membrane lesions
8. A patient with anti-tubular basement membrane antibodies demonstrated on fluorescence very likely has these as a result of
A. cryoglobulinemia

B. Godpasture's

* C. lupus

D. old bacterial infection

E. Sjogren's
9. Acute tubular necrosis plus fusion of foot processes suggests renal disease caused by
A. chronic mild ischemia

B. cyclophosphamide

C. hantavirus

D. hepatorenal syndrome

* E. non-steroidal anti-inflammatory agents
10. It is almost impossible to get necrosis of the entire cortical regions of both kidneys in the absence of
A. atheroembolization

B. bacterial infection

* C. disseminated intravascular coagulation

D. other evidence of viral infection

E. type II or III immune injury
11. Hyalinization of both the afferent and efferent arteries of the glomeruli is most suggestive of
A. common hypertension

* B. diabetes

C. hemolytic-uremic syndrome

D. malignant hypertension

E. vasculitis
12. Rapidly-progressive glomerulonephritis without significant antibody demonstrable by immunofluorescence in the glomeruli is most suggestive of
A. anti-GBM disease

B. bacterial endocarditis

C. BK polyomavirus

D. Puumalavirus epidemic nephropathy

* E. vasculitis
13. Patients with thin GBM disease usually have
A. both nephritic and nephrotic syndromes

* B. lifelong hematuria without other problems

C. nephritic syndrome only

D. nephrotic syndrome only

E. renal cysts with normal urine
14. Which is LEAST LIKELY to give striking onionskin intimal hyperplasia of the small renal arteries / arterioles?
* A. diabetes

B. hemolytic-uremic syndrome

C. malignant hypertension

D. radiation damage

E. scleroderma
15. Mercury nephropathy features striking coagulation necrosis of the
A. distal tubules

B. mesangial cells ("mesangiolysis")

C. podocytes

* D. proximal tubules

E. urothelium
16. Medullary sponge kidney is most noteworthy as a cause of
* A. kidney stones

B. nephritic syndrome

C. nocturia

D. unexplained hematuria

E. unexplained proteinuria
17. Which is NOT a probable risk factor of renal cell carcinoma?
A. end-stage kidney disease

* B. exposure to hair dyes

C. tobacco smoking

D. von Hippel-Lindau disease

E. none of these are risk factors
18. The "natural weight loss" remedy "Aristolochia" causes
* A. bladder cancer

B. calcium stones

C. renal cell carcinoma

D. uric acid stones

E. Wilms' tumor
19. TWO PHOTOS. Patient found to have red cell casts in the urine. Which is the most likely cause?
A. acute post-streptococcal glomerulonephritis

B. bacterial endocarditis

* C. IgA nephropathy

D. membranoproliferative glomerulonephritis type I

E. Wegener's granulomatosis
20. TWO PHOTOS. Autopsy kidney. What caused these changes?
A. atheroembolization

* B. chronic pyelonephritis

C. common high blood pressure

D. hemolytic-uremic syndrome

E. malignant hypertension
21. ONE PHOTO. Urinary sediment showing
* A. calcium oxalate crystals

B. candida

C. red cell casts

D. squamous epithelial cells

E. white cell casts
22. ONE PHOTO. Two kidneys from the same patient, with a normal kidney in-between (from a different person of similar age, of course). What's the diagnosis?
A. acquired dialysis cystic disease

* B. autosomal dominant polycystic kidney disease

C. autosomal recessive polycystic kidney disease

D. metastatic carcinoma to the kidney

E. tuberous sclerosis with angiomyolipomas
23. TWO PHOTOS. Glomerulus. What is the diagnosis?
A. diffuse proliferative glomerulonephritis

B. membranous glomerulonephritis

* C. minimal change disease

D. thin GBM disease

E. no pathology
24. ONE PHOTO. Kidney from a young child. What is the diagnosis?
A. acquired dialysis cystic disease

B. autosomal dominant polycystic kidney disease

* C. autosomal recessive polycystic kidney disease

D. cystic dysplasia

E. medullary sponge kidney
25. ONE PHOTO. Urinary sediment. What do you see?
A. candida

B. fatty casts

C. hyaline casts

* D. magnesium ammonium phosphate crystals

E. squamous epithelium
26. THREE PHOTOS. H&E, C3 immunofluorescence, and electron micrograph. What is your diagnosis?
A. anti-GBM disease consistent with Goodpasture's

B. diffuse proliferative glomerulonephritis

C. focal-segmental glomerulosclerosis

D. membranoproliferative glomerulonephritis type I

* E. membranoproliferative glomerulonephritis type II
27. THREE PHOTOS. Silver stain, IgG immunofluorescence, and electron micrograph. What is your diagnosis?
A. diffuse proliferative glomerulonephritis

B. focal-segmental glomerulosclerosis

C. membranoproliferative glomerulonephritis type I

D. membranoproliferative glomerulonephritis type II

* E. membranous glomerulopathy
28. TWO PHOTOS. H&E and electron micrograph. What is your best diagnosis?
A. cryoglobulinemia

B. focal-segmental glomerulosclerosis

C. minimal change disease

D. membranous glomerulopathy

* E. post-streptococcal glomerulonephritis
29. TWO PHOTOS. H&E and IgG immunofluorescence. What is your diagnosis?
* A. anti-GBM disease

B. diffuse proliferative glomerulonephritis

C. membranous glomerulopathy

D. mesangioproliferative disease suggestive of IgA nephropathy

E. Wegener's or polyarteritis
30. TWO PHOTOS. Silver stain and electron micrograph. What is your diagnosis?
A. anti-GBM disease

B. IgA nephropathy

* C. lupus

D. minimal change disease

E. post-streptococcal glomerulonephritis

31. TWO PHOTOS. What is your diagnosis?

A. angiomyolipoma

B. Hurthle cell tumor

* C. renal cell carcinoma

D. renal cortical abscess

E. renal infarct
32. TWO PHOTOS. What caused these kidney changes?
A. amyloidosis

B. atheroembolization

* C. common hypertension

D. hemolytic-uremic syndrome

E. old pyelonephritis
33. THREE PHOTOS. Silver stain and two electron micrographs. What is the diagnosis?
A. diabetes

* B. membranoproliferative glomerulonephritis type I

C. membranoproliferative glomerulonephritis type II

D. membranous glomerulopathy

E. mesangial-proliferative glomerulonephritis consistent with IgA nephropathy
34. TWO PHOTOS. Kidney, prior to stripping of the capsule, and a closeup of one of the masses. What is the diagnosis?
* A. angiomyolipoma

B. bacterial infection

C. Hurthle cell tumor

D. lipoid nephrosis

E. renal cell carcinoma
35. TWO PHOTOS. Renal cortex. What is the diagnosis?
* A. acute tubular necrosis suggestive of shock kidney

B. ethylene glycol ingestion

C. mannitol effect

D. myeloma kidney

E. pigment nephropathy
36. TWO PHOTOS. PAS stain. Which is the most likely diagnosis?
A. atheroembolization

B. bacterial endocarditis

* C. diabetes

D. focal-segmental glomerulosclerosis, primary

E. old pyelonephritis
BONUS ITEMS:
37. TWO PHOTOS. Kidney. What is the diagnosis? Be specific.
[pyelonephritis / bacterial infection]

38. TWO PHOTOS. Kidney. Look closely, and suggest a diagnosis.

[any cause of acute nephritic syndrome / RPGN]

39. ONE PHOTO. Look closely. What is your best diagnosis? Make the call just on the morphology.

[papillary necrosis]
40. ONE PHOTO. Renal cortex. What is the diagnosis?
[chronic pyelonephritis / old scarring from infection / thyroidization]

41. TWO PHOTOS. Suggest a reasonable diagnosis.

[any cause of necrotizing glomerular disease, i.e., malignant hypertension, Wegener's, any other vasculitis]

42. What's the name of the still-mysterious illness in which we see unexplained inflammation of all three layers of the bladder wall, with increased tissue basophils? Your best answer, please.

[credit either for Hunner or interstitial cystitis]
43. What's a "glitter cell"?
[neutrophil is sufficient]

44. Explain briefly why people with Paget's osteitis deformans, severe anemia, or a dialysis arteriovenous shunt have elevated systolic and often lowered diastolic blood pressures.

[just show you know increased cardiac output]
45. Why are the angiotensin-converting enzyme inhibitors more effective than other antihypertensive medicines for slowing progression to renal failure? Suggest a reasonable mechanism.
[angiotensin II is responsible for ongoing sclerosis]

46. What do we mean by "renal glycosuria"? Give the mechanism, showing that you understand.

[fail to reabsorb glucose]
47. What do we mean by a "staghorn" kidney stone? Explain the term.
[extends into several calyces, like an antler]

48. What's the mechanism by which we know cranberry juice prevents and helps cure bladder infections?

[bacteria cannot grow fimbria / bind to mucosa / get washed out]

NAME: _______________________________

UHS Pathology

Renal

2003-2004

Instructions: You know the routine. If you have a question during the exam, please raise your hand. Do not phonate.

If you are in the first of two groups, leave the building with the rest of the exam group. No stragglers.
Have a safe holiday.


Good luck!