NR507 – Advanced Pathophysiology Final Exam
Review Questions Cham
1. In acute renal failure (ARF), the most favorable prognostic indicator is:
A. Low urine output despite diuretics
B. Good urine output in response to diuretics
C. Elevated BUN and creatinine
D. Presence of casts in the urine
Answer: B
Rationale: A good urine output response to diuretics indicates that the kidneys are still
able to respond, suggesting reversible injury.
2. The pathophysiology of acute pyelonephritis begins with:
A. Autoimmune destruction of glomeruli
B. Bacterial colonization and adherence to the urothelium
C. Obstruction of the ureter by stones
D. Decreased renal blood flow
Answer: B
Rationale: Pyelonephritis typically begins with bacterial colonization (often E. coli)
followed by adherence, invasion, inflammation, and renal injury.
3. Which urinalysis finding is most indicative of pyelonephritis rather than cystitis?
A. Pyuria
B. Bacteriuria
C. White blood cell casts
D. Hematuria
Answer: C
Rationale: WBC casts indicate renal parenchymal involvement (upper tract), whereas
cystitis is limited to the bladder.
4. A urine culture result that confirms a significant urinary tract infection is:
A. >10³ CFU/mL
B. >10⁵ CFU/mL
C. >10² CFU/mL
,D. >10⁶ CFU/mL
Answer: B
Rationale: Significant bacteriuria is traditionally defined as >10⁵ CFU/mL (>100,000
colony-forming units) in a clean-catch specimen.
5. Which imaging study is most helpful in diagnosing renal calculi?
A. KUB X-ray
B. Renal ultrasound
C. Non-contrast CT scan
D. MRI
Answer: C
Rationale: Non-contrast helical CT is the gold standard for detecting renal calculi,
identifying size, location, and composition.
6. Conservative management for a renal stone is indicated when the stone is:
A. >10 mm with severe obstruction
B. <5 mm and asymptomatic
C. Staghorn calculi
D. Any stone causing fever and sepsis
Answer: B
Rationale: Stones <5 mm often pass spontaneously and are managed conservatively
with pain control and hydration. Larger or symptomatic stones require intervention.
7. The most significant risk factor for chronic kidney disease (CKD) is:
A. Hypertension
B. Diabetes mellitus
C. Lupus erythematosus
D. Polycystic kidney disease
Answer: B
Rationale: Diabetes mellitus is the leading cause of CKD, accounting for nearly half of all
cases progressing to ESRD.
8. A patient with CKD has an eGFR of 25 mL/min/1.73 m². This corresponds to which
stage?
A. Stage 3
, B. Stage 4
C. Stage 5
D. Stage 2
Answer: B
Rationale: Stage 4 CKD is defined as eGFR 15–29 mL/min/1.73 m².
9. Which systemic complication is associated with decreased GFR in CKD?
A. Hypercalcemia
B. Hypokalemia
C. Hyperlipidemia
D. Metabolic alkalosis
Answer: C
Rationale: Decreased GFR leads to hyperlipidemia, anemia, hypertension, hyperkalemia,
hyperphosphatemia, and metabolic acidosis.
10. A patient with CKD is a candidate for dialysis based on which indication?
A. eGFR 50 mL/min
B. Symptomatic uremia
C. Mild anemia
D. Asymptomatic hyperparathyroidism
Answer: B
Rationale: Dialysis is indicated for symptomatic uremia, fluid overload, hyperkalemia,
and severe acidosis.
11. Which of the following is a warning sign of GERD requiring further evaluation?
A. Heartburn after a large meal
B. Odynophagia and weight loss
C. Regurgitation with bending
D. Self-limited sour taste
Answer: B
Rationale: Warning signs include dysphagia, odynophagia, weight loss, melena, early
satiety, and symptoms over age 50.
12. The primary pathophysiologic mechanism in GERD is:
A. Increased gastric acid production
Review Questions Cham
1. In acute renal failure (ARF), the most favorable prognostic indicator is:
A. Low urine output despite diuretics
B. Good urine output in response to diuretics
C. Elevated BUN and creatinine
D. Presence of casts in the urine
Answer: B
Rationale: A good urine output response to diuretics indicates that the kidneys are still
able to respond, suggesting reversible injury.
2. The pathophysiology of acute pyelonephritis begins with:
A. Autoimmune destruction of glomeruli
B. Bacterial colonization and adherence to the urothelium
C. Obstruction of the ureter by stones
D. Decreased renal blood flow
Answer: B
Rationale: Pyelonephritis typically begins with bacterial colonization (often E. coli)
followed by adherence, invasion, inflammation, and renal injury.
3. Which urinalysis finding is most indicative of pyelonephritis rather than cystitis?
A. Pyuria
B. Bacteriuria
C. White blood cell casts
D. Hematuria
Answer: C
Rationale: WBC casts indicate renal parenchymal involvement (upper tract), whereas
cystitis is limited to the bladder.
4. A urine culture result that confirms a significant urinary tract infection is:
A. >10³ CFU/mL
B. >10⁵ CFU/mL
C. >10² CFU/mL
,D. >10⁶ CFU/mL
Answer: B
Rationale: Significant bacteriuria is traditionally defined as >10⁵ CFU/mL (>100,000
colony-forming units) in a clean-catch specimen.
5. Which imaging study is most helpful in diagnosing renal calculi?
A. KUB X-ray
B. Renal ultrasound
C. Non-contrast CT scan
D. MRI
Answer: C
Rationale: Non-contrast helical CT is the gold standard for detecting renal calculi,
identifying size, location, and composition.
6. Conservative management for a renal stone is indicated when the stone is:
A. >10 mm with severe obstruction
B. <5 mm and asymptomatic
C. Staghorn calculi
D. Any stone causing fever and sepsis
Answer: B
Rationale: Stones <5 mm often pass spontaneously and are managed conservatively
with pain control and hydration. Larger or symptomatic stones require intervention.
7. The most significant risk factor for chronic kidney disease (CKD) is:
A. Hypertension
B. Diabetes mellitus
C. Lupus erythematosus
D. Polycystic kidney disease
Answer: B
Rationale: Diabetes mellitus is the leading cause of CKD, accounting for nearly half of all
cases progressing to ESRD.
8. A patient with CKD has an eGFR of 25 mL/min/1.73 m². This corresponds to which
stage?
A. Stage 3
, B. Stage 4
C. Stage 5
D. Stage 2
Answer: B
Rationale: Stage 4 CKD is defined as eGFR 15–29 mL/min/1.73 m².
9. Which systemic complication is associated with decreased GFR in CKD?
A. Hypercalcemia
B. Hypokalemia
C. Hyperlipidemia
D. Metabolic alkalosis
Answer: C
Rationale: Decreased GFR leads to hyperlipidemia, anemia, hypertension, hyperkalemia,
hyperphosphatemia, and metabolic acidosis.
10. A patient with CKD is a candidate for dialysis based on which indication?
A. eGFR 50 mL/min
B. Symptomatic uremia
C. Mild anemia
D. Asymptomatic hyperparathyroidism
Answer: B
Rationale: Dialysis is indicated for symptomatic uremia, fluid overload, hyperkalemia,
and severe acidosis.
11. Which of the following is a warning sign of GERD requiring further evaluation?
A. Heartburn after a large meal
B. Odynophagia and weight loss
C. Regurgitation with bending
D. Self-limited sour taste
Answer: B
Rationale: Warning signs include dysphagia, odynophagia, weight loss, melena, early
satiety, and symptoms over age 50.
12. The primary pathophysiologic mechanism in GERD is:
A. Increased gastric acid production
