1. Which medication is most likely to produce inflammation of the bladder? A. alpha-methyldopa B. cyclophosphamide (*) C. gentamicin D. penicillin E. simvastatin 2. Which is most likely to cause a false-positive test for the presence of glucose in the urine? A. hypochlorite bleach (*) B. L-dopa C. megadose vitamin C D. renal glycosuria E. zinc administration for the common cold 3. The familiar "coffin lid" crystals in urine are composed of: A. calcium oxalate B. cysteine C. magnesium ammonium phosphate (*) D. tyrosine E. uric acid 4. What's a reasonable "upper limit for normal" for a count of red cells in the urinary sediment? A. there should be none at all B. 2 per high power field (*) C. 6 per high power field D. 50 per high power field E. all that matters is whether you see red cell casts 5. Acute mercury poisoning will most severely damage which portion of the kidney? A. glomerular capillary endothelium B. glomerular podocytes C. proximal tubule (*) D. renal medullary structures E. renal pelvis where urine is concentrated 6. Amyloid in the kidney is most likely to declare itself first by causing A. acute renal shutdown B. heavy proteinuria (*) C. red cell casts D. renal glycosuria E. hypertension 7. In bacterial endocarditis, you are most likely to see what pattern of immune complex deposition? A. coarsely granular (*) B. finely granular C. linear D. mesangial E. vessel walls only 8. In Henoch-Schonlein purpura with severe renal involvement and crescentic glomerulonephritis, the crescents themselves are most likely to stain positive for: A. C3 but not C4 as this is alternate-pathway B. fibrin (*) C. IgA D. IgE E. IgM 9. Which is a risk factor for both renal cell carcinoma and transitional carcinoma of the renal pelvis and bladder? A. alcohol abuse B. dye industry job C. mercury diuretics D. tobacco smoking (*) E. von Hippel-Lindau 10. Which glomerular lesion tends to become superimposed on most other kidney diseases as renal function begins to fail? A. diffuse glomerulosclerosis B. diffuse proliferative glomerulonephritis C. focal-segmental glomerulosclerosis (*) D. segmental necrotizing glomerulonephritis E. wire-loop nephritis 11. Which is NOT a risk factor for acute pyelonephritis? A. diabetes mellitus B. nephrolithiasis C. prostatism D. simple cysts (*) E. ureterovesical reflux 12. Patients with von Gierke's glycogen storage disease, or with Lesch-Nyhan syndrome, are likely to suffer kidney damage due to A. accumulation of storage product B. autoimmune interstitial nephritis C. immune complex deposition D. uric acid deposition (*) E. vascular stenosis 13. What is "Bright's riddle"? A. Why do most immune complex deposits appear on the far side of the GBM, away from where we'd think they formed? B. Why do patients with finely-granular kidneys tend to have (*) hypertrophied hearts? C. Why do patients with one narrow renal artery tend to be hypertensive and have a finely- granular kidney on the opposite side? D. Why is the excretion of urine so closely associated anatomically with the sex organs? E. Why would "bright" people try to ride a mechanical bull when they're drunk? 14. Very large subendothelial immune complex deposits suggest: A. Goodpasture's disease B. dense deposit disease C. diabetes D. lupus (*) E. shock kidney 15. "Masugi nephritis" is the classic animal model for A. acute tubular necrosis B. autoimmune interstitial nephritis C. anti-GBM disease (*) D. membranous glomerulopathy E. post-streptococcal glomerulonephritis 16. Which is LEAST LIKELY to develop into malignant hypertension? A. cocaine abuse B. hemolytic-uremic syndrome C. medullary sponge kidney (*) D. neglected "benign" high blood pressure E. scleroderma 17. Finely-granular immune complex deposits around the TUBULES is most suggestive of: A. acute tubular necrosis B. hemolytic-uremic syndrome C. lupus (*) D. medullary sponge kidney E. myeloma kidney 18. ONE KODACHROME. Bladder biopsy. A. carcinoma in situ B. hyperplasia (*) C. invasive carcinoma D. normal E. squamous cell carcinoma 19. ONE KODACHROME. Kidney. Your best diagnosis? A. acute tubular necrosis (*) B. autoimmune interstitial nephritis C. gout D. myeloma kidney E. pyelonephritis (acute) 20. TWO KODACHROMES. Kidney. Your best diagnosis? A. membranoproliferative glomerulonephritis B. membranous glomerulopathy C. mesangioproliferative suggestive of IgA nephropathy D. minimal change disease (*) E. post-streptococcal glomerulonephritis 21. ONE KODACHROMES. Kidney. Your best diagnosis? A. diabetes (*) B. diffuse proliferative glomerulonephritis C. hemolytic-uremic syndrome D. membranous glomerulonephritis E. Wegener's or polyarteritis 22. TWO KODACHROMES. Kidney. What is your diagnosis? A. acute tubular necrosis B. papillary necrosis C. renal cell carcinoma (*) D. renal cortical abscess E. Wilms tumor 23. THREE KODACHROMES. Kidney. This is most consistent with: A. Goodpasture's disease B. membranoproliferative glomerulonephritis type I (*) C. membranous glomerulopathy D. minimal change disease E. post-streptococcal glomerulonephritis 24. TWO KODACHROMES. What is the cause? A. amyloidosis B. atherosclerosis C. diabetes D. hypertension (*) E. uh, this is a normal kidney 25. THREE KODACHROMES. Kidney. What is your diagnosis? A. diffuse proliferative glomerulonephritis B. Goodpasture's disease C. membranoproliferative glomerulonephritis type I D. membranous glomerulopathy (*) E. minimal change disease 26. ONE KODACHROME. Kidney. Probably a case of... A. renal cell carcinoma B. renal cortical necrosis (*) C. simple cyst D. transitional urothelial cell carcinoma E. Wilms' tumor 27. TWO KODACHROMES. What is your diagnosis? A. autosomal dominant polycystic kidney disease B. autosomal recessive polycystic kidney disease (*) C. cystic renal dysplasia D. medullary cystic disease E. medullary sponge kidney 28. TWO KODACHROMES. Which is most likely? A. acute pyelonephritis B. diabetes C. membranous glomerulopathy D. polyarteritis nodosa (*) E. post-streptococcal glomerulonephritis 29. FOUR KODACHROMES. Your best diagnosis? A. diffuse proliferative glomerulonephritis (*) B. Goodpasture's disease C. membranoproliferative glomerulonephritis type I D. membranous glomerulonephritis E. minimal change disease 30. ONE KODACHROME. What is the most likely cause of this patient's interstitial nephritis? A. gout B. lupus C. NSAID nephropathy D. sarcoidosis (*) E. Sjogren's 31. ONE KODACHROME. Your best diagnosis? A. acute tubular necrosis B. gout C. myeloma kidney (*) D. syphilis E. tuberculosis 32. TWO KODACHROMES. Which is most likely? A. Goodpasture's disease B. IgA nephropathy (*) C. membranoproliferative glomerulonephritis D. membranous glomerulopathy E. minimal change disease 33. TWO KODACHROMES. Your best diagnosis, please! A. diffuse proliferative glomerulonephritis or lupus B. Goodpasture's disease (*) C. malignant hypertension D. membranous glomerulopathy E. membranoproliferative glomerulonephritis 34. ONE KODACHROME. What caused the hematuria? A. cryoglobulinemia B. diffuse proliferative glomerulonephritis C. IgA nephropathy D. thin GBM disease (*) E. tram track disease 35. TWO KODACHROMES. What is your best diagnosis? A. diffuse proliferative glomerulonephritis (*) B. membranoproliferative glomerulonephritis C. membranous glomerulonephritis D. mesangial proliferative glomerulonephritis, probably IgA. E. minimal change disease 36. TWO KODACHROMES. What will you call this? A. diabetic glomerulosclerosis B. focal-segmental glomerulosclerosis (*) C. membranoproliferative glomerulonephritis D. membranous glomerulonephritis E. minimal change disease BONUS ITEMS: 37. ONE KODACHROME. Why did the kidney shut down? [atheroembolization] 38. TWO KODACHROMES. Your best diagnosis. [acute pyelonephritis, accept "pyelonephritis"] 39. TWO KODACHROMES. Your best diagnosis. [angiomylipoma / tuberous sclerosis] 40. TWO KODACHROMES. Diagnose this kidney. [papillary necrosis] 41. TWO KODACHROMES. Diagnose this glomerular lesion. [dense deposit disease / membranoproliferative II] 42. ONE KODACHROME. What is the most likely histologic type for this kidney cancer? [transitional cell] 43. Why do patients who are recovering from acute tubular necrosis go through a diuretic phase, even if they are not overhydrated? [tubules intact but not yet able to resorb] 44. What is the principal component of "uremic frost", so familiar from the pre-dialysis era? [urea] 45. Briefly explain why the presence of a red cell cast in the urinary sediment is proof of glomerular hematuria. [any reasonable explanation] NAME: _________________________ 36 points maximum List who's sitting near you: UHS PATHOLOGY "Urinary System" 2002-2003 Instructions: You know the routine! No bathroom breaks during this exam. If you are in the first group, do not leave until we tell you that you may do so. Cool Beans! If medical school were easy, your degree would be worthless!