urinary tract review
TRANSCRIPT
-
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.
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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
pi
ulcii
luiid
t
y per
nuuioy,
uui
uw
cviuciioc
ui
ii incuiin ictiui
y
ucno
ui
,t?