MCQ-Renal

FRCPath Part1 Course

Renal pathology MCQ 1 In which of the following clinical situations is a needle biopsy of the kidney most useful?

A. Long standing diabetes with elevated serum creatinine B. Ureteric stones with suspected hydronephrosis C. Reflux nephropathy D. Isolated symptomless haematuria E. Systemic lupus erythematosus with impaired renal function F. Chronic renal failure and reduced kidney size MCQ 2 Which of the following is NOT a relative contraindication to renal biopsy?

A. B. C. D. E.

Uncontrolled hypertension Kidney size <8cm on scan Morbidly obese patient HIV positive patient Elevated prothrombin time

MCQ 3 Which of the following statements are incorrect?

A. Focal involvement means less than 50% of a glomerular tuft is affected.

B. Membranoproliferative pattern is characterised by capillary wall thickening due to mesangial interposition and duplication of glomerular BM. C. Mesangial hypercellularity is defined as presence of 3 or more mesangial cells per mesangial area.

D. Crescent formation occurs due to build-up of more than 2 layers of proliferating endothelial cells in the Bowman’s space MCQ 4 Which of the following is not part of the definition of nephrotic syndrome?

A. B. C. D. E.

Proteinuria >3.5gm/24 hours Active urinary sediments Hypoalbuminaemia Edema Hyperlipidemia

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FRCPath Part1 Course MCQ 5 A 25 year old female presented with fatigue, weight gain and puffiness of eyes. Investigations revealed proteinuria of 4gm/24 hrs, no haematuria, normal renal function and normal sized kidneys. Which of the following changes are unlikely on a renal biopsy?

A. B. C. D.

Diffuse thickening of basement membranes with spikes Crescents involving > 50% of glomeruli Segmental sclerosis of glomeruli Normal light microscopic appearance of glomeruli.

MCQ 6 Which statement is correct?

A. B. C. D. E.

Minimal change disease accounts for 20% of cases of primary nephrotic syndrome in children Spikes in membranous GN are best seen with a Masson’s trichrome stain.

FSGS shows selective proteinuria.

‘Kimmelstein-Wilson’ lesions are seen in Diabetic nephropathy Stage 4 membranous has recognizable deposits.

MCQ 7 A 20-year-old previously healthy man has been feeling tired for few days and passes ‘coca cola’ urine.

On physical examination his blood pressure was 155/90 mm Hg. Laboratory studies showed his serum creatinine 4.4 mg/dL and high titre of C-ANCA. Which of the following pathologic findings on renal biopsy is most likely to be present in this man?

A. Lack of fluorescence B. Mesangial IgA positivity on immunofluorescence C. Thickness of basement membrane more than 600nm.

D. Effacement of foot processes E. Vasculitis of medium sized artery MCQ 8 Which of the following is not true of IgA nephropathy?

A. Highest prevalence reported in southeast Asia.

B. The most common glomerular pattern is Mesangioproliferative GN C. IgA should be dominant or codominant immunoglobulin on immunofluorescence to make this diagnosis.

D. The vast majority (80%) of cases have a benign clinical course, with little or no progression to end stage renal disease.

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FRCPath Part1 Course MCQ 9 Which is the correct statement?

A. B. C. D. E.

Fibrin caps are seen in membranous nephropathy.

“Collapsing variant’ of FSGS shows proliferation of endothelial cells.

Mesangial IgA deposits are seen in Henoch Schonlein purpura nephritis.

IgA nephropathy is associated with Hodgkin’s lymphoma.

Goodpasture syndrome is more common than Wegener’s syndrome in renal biopsies.

EMQs Match the topic ( A,B....) with the appropriate conditions ( 1,2,3...)

The conditions can be used on more than one occasion EMQ 10 Options A. Subepithelial IgG hump-like positivity B. Linear membranous IgG positivity C. Subepithelial granular IgG deposits D. IgA mesangial positivity E. C1q peripheral and mesangial positivity Questions Anti GBM IgA nephropathy Membranous nephropathy Lupus nephritis Post-infectious nephropathy EMQ 11 A. In this condition the pathologist sees ‘fractured casts’ B. Clusters of neutrophils within tubular lumina is indicative of this condition C. The underground abnormality on this renal disease can be IBD, TB, osteomyelitis or RA. D. Onion skinning is seen in this renal condition.

E. Accumalation of nucleated cells in the vasa recta of the medulla, is a clue to this diagnosis.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Acute Tubular Necrosis Fibromuscular dysplasia Hyaline arteriosclerosis Hyperplastic arteriosclerosis Myeloma cast nephropathy Amyloidosis Pelvic lipomatosis Acute allergic nephritis Analgesic nephropathy Acute pyelonephritis Chronic pyelonephritis Acute tubular necrosis www.oxbridgemedica.com

FRCPath Part1 Course EMQ 3 Options A. This renal disease contains fibrils 8 to 10nm in diameter.

B. In this renal disease the EM identified fibrils are 20nm in diameter.

C. This renal disease contains fibrils 30 to 50nm in diameter.

D. Tubulo- reticular inclusions are seen in this condition E. Myeloid or ‘Zebra bodies’ are seen in lysosomes Questions 1. Minimal change GN 2. Mesangiocapillary GN 3. IgA nephropathy 4. Membranous GN 5. Diabetic nephropathy 6. Amyloidosis 7. Light chain deposition disease 8. Fibrilliary GN 9. Immunotactid GN 10. Congenital nephrotic syndrome 11. Alport syndrome 12. Rapid progressive GN 13. Thin membrane syndrome 14. Lupus nephritis 15. Fabry’s disease 16. Myeloma cast nephropathy

NOTES

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