NR507- ADVANCED PATHOPHYSIOLOGY FINAL EXAM WITH COMPLETE
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
Which statement is true regarding the nature of acute renal failure (ARF)?
A) It is always a permanent condition.
B) It is generally considered reversible if the underlying cause is treated.
C) It only affects patients with pre-existing diabetes.
D) It is characterized by a slow, progressive decline over years.
E) It never requires temporary dialysis.
Correct Answer: B) It is generally considered reversible if the underlying cause is treated.
Rationale: Acute renal failure (ARF) is defined by a sudden decline in kidney function.
Unlike chronic kidney disease, ARF is often reversible once the primary insult—such as
ischemia, toxins, or obstruction—is identified and corrected. The kidneys have a
remarkable ability to recover from acute tubular necrosis (ATN) if the basement
membrane remains intact.
Question 2
When determining the prognosis of a patient in acute renal failure, which of the following is a
positive clinical indicator?
A) Persistent anuria for more than 48 hours.
B) Development of metabolic acidosis.
C) Kidneys responding to a diuretic challenge with good urine output.
D) A steady increase in serum creatinine levels.
E) The presence of peaked T-waves on an EKG.
Correct Answer: C) Kidneys responding to a diuretic challenge with good urine output.
Rationale: A kidney that still responds to diuretics by producing urine indicates that the
tubular function is sufficiently preserved to interact with pharmacological agents. This
"diuretic response" is often used by clinicians as a prognostic sign that the kidneys are
functioning well enough to eventually recover from the acute insult.
Question 3
Which clinical finding is most indicative of Acute Pyelonephritis rather than simple cystitis
during a urinalysis?
A) Presence of nitrites
B) Hematuria
C) WBC casts
D) Presence of leukocyte esterase
E) Alkaline pH
, 2
Correct Answer: C) WBC casts
Rationale: While both cystitis (bladder infection) and pyelonephritis (kidney infection)
present with white blood cells in the urine, the presence of WBC casts is specific to the
kidney. Casts form in the renal tubules; their presence indicates that the inflammatory
process is occurring within the renal parenchyma, helping to distinguish upper UTI from
lower UTI.
Question 4
In a patient suspected of having complicated pyelonephritis, which of the following diagnostic
steps is required?
A) Only a dipstick urinalysis.
B) Blood cultures and urinary tract imaging.
C) A 24-hour urine collection for protein.
D) Renal biopsy.
E) Only a physical exam for CVA tenderness.
Correct Answer: B) Blood cultures and urinary tract imaging.
Rationale: Complicated pyelonephritis implies that the patient may have an obstruction,
abscess, or systemic spread. Therefore, blood cultures are necessary to rule out urosepsis,
and imaging (such as CT or ultrasound) is required to identify anatomical abnormalities or
stones that may be hindering recovery.
Question 5
What is the primary goal of treatment for a patient experiencing an acute episode of renal
calculi?
A) Immediate surgical removal of all stones regardless of size.
B) Managing acute pain and promoting the passage of the stone.
C) Restricting fluid intake to 1 liter per day.
D) Beginning lifelong dialysis.
E) Lowering blood pressure to 110/70 mmHg.
Correct Answer: B) Managing acute pain and promoting the passage of the stone.
Rationale: The immediate clinical priority for renal stones is pain management, often with
NSAIDs or opioids, followed by "medical expulsive therapy" (like alpha-blockers) to help
the stone pass. Reducing the size of the stone and preventing new ones are long-term goals,
but the acute phase focuses on pain and passage.
Question 6
Which of the following is considered the most significant risk factor for the development of
Chronic Kidney Disease (CKD)?
A) Systemic lupus erythematosus
B) Chronic alcohol consumption
, 3
C) Diabetes mellitus
D) Recurrent viral pneumonia
E) High fiber diet
Correct Answer: C) Diabetes mellitus
Rationale: Diabetes is the leading cause of CKD and ESRD worldwide. Chronic
hyperglycemia leads to non-enzymatic glycosylation of the basement membrane and
hyperfiltration injury, eventually resulting in glomerulosclerosis. Hypertension is the
second most common cause, and often exists concurrently with diabetes.
Question 7
A patient’s GFR is estimated at 110 mL/min/1.73m², but imaging shows structural kidney
damage. Which stage of CKD is this?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: A) Stage I
Rationale: Stage I CKD is defined by evidence of kidney damage (such as albuminuria or
structural changes on ultrasound) despite having a normal or even elevated Glomerular
Filtration Rate (GFR) of 90-120 mL/min.
Question 8
Which GFR range characterizes Stage II Chronic Kidney Disease?
A) > 90 mL/min
B) 60-89 mL/min
) 30-59 mL/min
D) 15-29 mL/min
E) < 15 mL/min
Correct Answer: B) 60-89 mL/min
Rationale: Stage II CKD represents kidney damage with a mild decrease in GFR,
specifically between 60 and 89 mL/min. At this stage, patients are often asymptomatic but
require close monitoring of risk factors like blood pressure and blood sugar.
Question 9
At which stage of Chronic Kidney Disease is the decrease in GFR considered "moderate," with a
range of 30-59 mL/min?
A) Stage I
B) Stage II
, 4
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: C) Stage III
Rationale: Stage III is a moderate decrease in GFR (30-59 mL/min). This is a critical clinical
turning point where complications like anemia, secondary hyperparathyroidism, and bone
disease often begin to manifest more clearly.
Question 10
A patient with a GFR of 22 mL/min is classified into which stage of CKD?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: D) Stage IV
Rationale: Stage IV involves a severe decrease in GFR (15-29 mL/min). Once a patient
reaches Stage IV, the progression to Stage V (End-Stage Renal Disease) is generally
considered inevitable, and the focus of care shifts to preparing for dialysis or transplant.
Question 11
What GFR level defines Stage V Chronic Kidney Disease (End-Stage Renal Disease)?
A) < 60 mL/min
B) < 30 mL/min
C) < 15 mL/min
D) 15-29 mL/min
E) Exactly 0 mL/min
Correct Answer: C) < 15 mL/min
Rationale: Stage V (ESRD) is defined by a GFR of less than 15 mL/min. At this point, the
kidneys can no longer maintain homeostasis, and the patient is dependent on renal
replacement therapy (dialysis or transplant) to survive.
Question 12
Which electrolyte abnormality, when accompanied by EKG changes such as peaked T-waves, is
an absolute indication for dialysis?
A) Hypercalcemia
B) Hyponatremia
C) Hyperkalemia
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
Question 1
Which statement is true regarding the nature of acute renal failure (ARF)?
A) It is always a permanent condition.
B) It is generally considered reversible if the underlying cause is treated.
C) It only affects patients with pre-existing diabetes.
D) It is characterized by a slow, progressive decline over years.
E) It never requires temporary dialysis.
Correct Answer: B) It is generally considered reversible if the underlying cause is treated.
Rationale: Acute renal failure (ARF) is defined by a sudden decline in kidney function.
Unlike chronic kidney disease, ARF is often reversible once the primary insult—such as
ischemia, toxins, or obstruction—is identified and corrected. The kidneys have a
remarkable ability to recover from acute tubular necrosis (ATN) if the basement
membrane remains intact.
Question 2
When determining the prognosis of a patient in acute renal failure, which of the following is a
positive clinical indicator?
A) Persistent anuria for more than 48 hours.
B) Development of metabolic acidosis.
C) Kidneys responding to a diuretic challenge with good urine output.
D) A steady increase in serum creatinine levels.
E) The presence of peaked T-waves on an EKG.
Correct Answer: C) Kidneys responding to a diuretic challenge with good urine output.
Rationale: A kidney that still responds to diuretics by producing urine indicates that the
tubular function is sufficiently preserved to interact with pharmacological agents. This
"diuretic response" is often used by clinicians as a prognostic sign that the kidneys are
functioning well enough to eventually recover from the acute insult.
Question 3
Which clinical finding is most indicative of Acute Pyelonephritis rather than simple cystitis
during a urinalysis?
A) Presence of nitrites
B) Hematuria
C) WBC casts
D) Presence of leukocyte esterase
E) Alkaline pH
, 2
Correct Answer: C) WBC casts
Rationale: While both cystitis (bladder infection) and pyelonephritis (kidney infection)
present with white blood cells in the urine, the presence of WBC casts is specific to the
kidney. Casts form in the renal tubules; their presence indicates that the inflammatory
process is occurring within the renal parenchyma, helping to distinguish upper UTI from
lower UTI.
Question 4
In a patient suspected of having complicated pyelonephritis, which of the following diagnostic
steps is required?
A) Only a dipstick urinalysis.
B) Blood cultures and urinary tract imaging.
C) A 24-hour urine collection for protein.
D) Renal biopsy.
E) Only a physical exam for CVA tenderness.
Correct Answer: B) Blood cultures and urinary tract imaging.
Rationale: Complicated pyelonephritis implies that the patient may have an obstruction,
abscess, or systemic spread. Therefore, blood cultures are necessary to rule out urosepsis,
and imaging (such as CT or ultrasound) is required to identify anatomical abnormalities or
stones that may be hindering recovery.
Question 5
What is the primary goal of treatment for a patient experiencing an acute episode of renal
calculi?
A) Immediate surgical removal of all stones regardless of size.
B) Managing acute pain and promoting the passage of the stone.
C) Restricting fluid intake to 1 liter per day.
D) Beginning lifelong dialysis.
E) Lowering blood pressure to 110/70 mmHg.
Correct Answer: B) Managing acute pain and promoting the passage of the stone.
Rationale: The immediate clinical priority for renal stones is pain management, often with
NSAIDs or opioids, followed by "medical expulsive therapy" (like alpha-blockers) to help
the stone pass. Reducing the size of the stone and preventing new ones are long-term goals,
but the acute phase focuses on pain and passage.
Question 6
Which of the following is considered the most significant risk factor for the development of
Chronic Kidney Disease (CKD)?
A) Systemic lupus erythematosus
B) Chronic alcohol consumption
, 3
C) Diabetes mellitus
D) Recurrent viral pneumonia
E) High fiber diet
Correct Answer: C) Diabetes mellitus
Rationale: Diabetes is the leading cause of CKD and ESRD worldwide. Chronic
hyperglycemia leads to non-enzymatic glycosylation of the basement membrane and
hyperfiltration injury, eventually resulting in glomerulosclerosis. Hypertension is the
second most common cause, and often exists concurrently with diabetes.
Question 7
A patient’s GFR is estimated at 110 mL/min/1.73m², but imaging shows structural kidney
damage. Which stage of CKD is this?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: A) Stage I
Rationale: Stage I CKD is defined by evidence of kidney damage (such as albuminuria or
structural changes on ultrasound) despite having a normal or even elevated Glomerular
Filtration Rate (GFR) of 90-120 mL/min.
Question 8
Which GFR range characterizes Stage II Chronic Kidney Disease?
A) > 90 mL/min
B) 60-89 mL/min
) 30-59 mL/min
D) 15-29 mL/min
E) < 15 mL/min
Correct Answer: B) 60-89 mL/min
Rationale: Stage II CKD represents kidney damage with a mild decrease in GFR,
specifically between 60 and 89 mL/min. At this stage, patients are often asymptomatic but
require close monitoring of risk factors like blood pressure and blood sugar.
Question 9
At which stage of Chronic Kidney Disease is the decrease in GFR considered "moderate," with a
range of 30-59 mL/min?
A) Stage I
B) Stage II
, 4
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: C) Stage III
Rationale: Stage III is a moderate decrease in GFR (30-59 mL/min). This is a critical clinical
turning point where complications like anemia, secondary hyperparathyroidism, and bone
disease often begin to manifest more clearly.
Question 10
A patient with a GFR of 22 mL/min is classified into which stage of CKD?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
E) Stage V
Correct Answer: D) Stage IV
Rationale: Stage IV involves a severe decrease in GFR (15-29 mL/min). Once a patient
reaches Stage IV, the progression to Stage V (End-Stage Renal Disease) is generally
considered inevitable, and the focus of care shifts to preparing for dialysis or transplant.
Question 11
What GFR level defines Stage V Chronic Kidney Disease (End-Stage Renal Disease)?
A) < 60 mL/min
B) < 30 mL/min
C) < 15 mL/min
D) 15-29 mL/min
E) Exactly 0 mL/min
Correct Answer: C) < 15 mL/min
Rationale: Stage V (ESRD) is defined by a GFR of less than 15 mL/min. At this point, the
kidneys can no longer maintain homeostasis, and the patient is dependent on renal
replacement therapy (dialysis or transplant) to survive.
Question 12
Which electrolyte abnormality, when accompanied by EKG changes such as peaked T-waves, is
an absolute indication for dialysis?
A) Hypercalcemia
B) Hyponatremia
C) Hyperkalemia
