a = new Array(234);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. Adenocarcinoma of prostate does not typically shed atypical cells into urine."
a[2] = f + "(B) CORRECT. The lack of findings in the bladder, but the presence of atypical cells, suggests that the lesion is located higher."
a[3] = f + "(C) Incorrect. Inflammatory changes may sometimes produce some degree of atypia, but the history of smoking strongly suggests that a neoplasm may be present."
a[4] = f + "(D) Incorrect. No atypical cells would be produced by this lesion."
a[5] = f + "(E) Incorrect. This lesion would be diagnosed by visual inspection."
a[6] = f + "(A) Incorrect. A positive ANA would be most indicative of an autoimmune disease such as SLE which does not lead to amyloid deposition."
a[7] = f + "(B) Incorrect. Hyperglycemia suggests diabetes mellitus, which is not typically associated with amyloid deposition."
a[8] = f + "(C) Incorrect. This very low CD4 count suggests a diagnosis of AIDS, but amyloid deposition is not seen with AIDS."
a[9] = f + "(D) CORRECT. The findings are consistent with renal amyloid deposition with multiple myeloma. The total protein is elevated from increased serum monoclonal immunoglobulin. Myeloma can produce lytic bone lesions and patients often develop infections with encapsulated bacteria. The excessive light chain production leads to amyloid deposition. Bence-Jones proteinuria is often present, but the dipstick is most sensitive for albumin, not globulins."
a[10] = f + "(E) Incorrect. This elevated PSA suggests a diagnosis of adenocarcinoma of the prostate, which is not associated with amyloid deposition."
a[11] = f + "(A) Incorrect. Proteinuria suggests a renal lesion, not a problem of the lower urinary tract."
a[12] = f + "(B) CORRECT. The findings suggest a bladder calculus. Most stones are composed of calcium with oxalate or phosphate. The calcium content makes them radiopaque, unlike pure uric acid stones that are radiolucent and which are not very common."
a[13] = f + "(C) Incorrect. Elevation of transaminases suggest liver disease. Rare cystine stones, which are radiolucent, may accompany severe liver disease."
a[14] = f + "(D) Incorrect. RBC casts come from the kidney, not the lower urinary tract."
a[15] = f + "(E) Incorrect. Hyperuricemia may be present in cases of gout, and uric acid stones may form, but they are radiolucent."
a[16] = f + "(A) CORRECT. The prostatic hyperplasia could lead to obstructive uropathy with hydronephrosis and eventual chronic renal failure."
a[17] = f + "(B) Incorrect. Obstructive uropathy can lead to an increased risk for infection with pyelonephritis, but not glomerulonephritis."
a[18] = f + "(C) Incorrect. Papillary necrosis is an uncommon complication seen with diabetes mellitus."
a[19] = f + "(D) Incorrect. Polycystic change in adults can accompany dominant polycystic kidney disease or chronic hemodialysis."
a[20] = f + "(E) Incorrect. Obstructive uropathy does not increase the risk for neoplasia."
a[21] = f + "(A) Incorrect. Lupus nephritis affects the kidney, not the bladder. With lupus nephritis, the urine sediment may contain RBCs, WBCs, RBC casts, and WBC casts."
a[22] = f + "(B) Incorrect. The passage of a urinary tract calculus is likely to be accompanied by marked pain and by hematuria."
a[23] = f + "(C) CORRECT. These are features of acute inflammation. There are no casts, because the infection involves the bladder, though such an infection could ascend to produce pyelonephritis. Urinary tract infections are more common in women because of the shorter urethra."
a[24] = f + "(D) Incorrect. Malakoplakia is a rare condition associated with chronic bacterial infection."
a[25] = f + "(E) Incorrect. Urothelial carcinomas are not likely to produce dysuria, and there is often hematuria."
a[26] = f + "(A) Incorrect. This autosomal dominantly inherited disease manifests in adulthood to produce chronic renal failure."
a[27] = f + "(B) Incorrect. A small number of cases of prostatic hyperplasia can lead to an obstructive uropathy with hydroureter and hydronephrosis, but not cysts."
a[28] = f + "(C) Incorrect. Atherosclerosis involving the kidneys, called nephrosclerosis, does not typically lead to development of cysts; the kidneys become smaller over time with nephrosclerosis."
a[29] = f + "(D) CORRECT. Simple renal cysts typically do not interfere with renal function. A few small cysts can be found in many older persons and are inconsequential. They will appear as incidental findings in radiographic studies."
a[30] = f + "(E) Incorrect. Urinary tract infections could produce pyelonephritis which heals to produce scarring, and the kidneys become smaller with time."
a[31] = f + "(A) Incorrect. A positive nitrite suggests urinary tract infection."
a[32] = f + "(B) CORRECT. This is the definition of nephrotic syndrome. A single urine specimen will not suffice for the definition of nephrotic syndrome (though it could be extrapolated, given the daunting task of 24 hour urine collection in children)."
a[33] = f + "(C) Incorrect. Red cells may be present with nephritis, but their presence does not define nephrotic syndrome."
a[34] = f + "(D) Incorrect. Lipiduria is often found with nephrotic syndrome, but does not define the condition."
a[35] = f + "(E) Incorrect. Conditions that lead to proteinuria may also damage tubular epithelium, but do not define nephrotic syndrome."
a[36] = f + "(A) Incorrect. Goodpasture syndrome leads to a crescentic glomerulonephritis and acute renal failure."
a[37] = f + "(B) Incorrect. IgA nephropathy is marked by immune deposits in the mesangium. It produces a nephritic pattern in young adults."
a[38] = f + "(C) CORRECT. Hereditary nephritis (Alport syndrome) is not associated with immune complexes, but with a genetic defect of type IV collagen production. In most families, it is inherited in an X-linked dominant pattern. Symptoms usually appear at ages 5 to 20, with overt renal failure between ages 20 to 50."
a[39] = f + "(D) Incorrect. In DPKD, the kidneys generally appear normal during childhood and young adulthood, and the large cysts tend to form in middle age and beyond. The glomeruli are not primarily affected."
a[40] = f + "(E) Incorrect. Renal disease with diabetes mellitus takes decades to develop. Nodular and diffuse glomerulosclerosis are the typical glomerular findings."
a[41] = f + "(A) Incorrect. Filtration is generally measured as the glomerular filtration rate, or GFR."
a[42] = f + "(B) Incorrect. One measure of reabsorption is the presence of glucose or protein in the urine. Only a small amount of protein should normally appear in urine, and no glucose should be present."
a[43] = f + "(C) Incorrect. Secretion is generally not measured."
a[44] = f + "(D) CORRECT. Renal concentrating ability is reflected by the specific gravity. In a person with normal concentrating capacity, less water intake is reflected by an increased specific gravity."
a[45] = f + "(E) Incorrect. Blood flow is not reflected by specific gravity. Blood flow can be measured by doppler ultrasound."
a[46] = f + "(A) Incorrect. Diabetes mellitus can produce a variety of renal diseases, among them hyaline arteriolosclerosis."
a[47] = f + "(B) Incorrect. Fibromuscular dysplasia typically affects the main renal arteries."
a[48] = f + "(C) Incorrect. Factor V Leiden mutation is one of the most common forms of inherited coagulopathy. Patients typically have a history of thrombosis starting at a young age. Hypertension is not a typical feature."
a[49] = f + "(D) Incorrect. Analgesic abuse can lead to papillary necrosis, interstitial fibrosis, and microangiopathy with basement membrane thickening."
a[50] = f + "(E) CORRECT. She has findings of severe, malignant hypertension. This is likely to complicate diffuse scleroderma, but not the more limited form of scleroderma--CREST syndrome."
a[51] = f + "(A) Incorrect. These are uncommon neoplasms unlikely to appear at a young age. They may be seen with tuberous sclerosis, or they may occur sporadically."
a[52] = f + "(B) Incorrect. Renal cell carcinomas are seen in middle aged to older adults. They usually have cells with clear cytoplasm (clear cell carcinoma pattern)."
a[53] = f + "(C) Incorrect. This tumor resembles the transitional epithelium of the urinary tract. They may arise in the pelvis of the kidney in adults."
a[54] = f + "(D) CORRECT. This is the classic age, histopathology, and location for Wilms tumor. These neoplasms, when treated properly, have a very good prognosis."
a[55] = f + "(E) Incorrect. These lesions are probably not true neoplasms. They are small, incidental lesions found at autopsy."
a[56] = f + "(A) Incorrect. Glomerular crescents suggest a rapidly progressive glomerulonephritis that would be characterized by a nephritic picture with hematuria."
a[57] = f + "(B) CORRECT. This is minimal change disease, the most common cause for nephrotic syndrome in children, and fusion of podocyte foot processes is the only pathologic finding present (on electron microscopy). Most patients respond to corticosteroid therapy."
a[58] = f + "(C) Incorrect. Patchy tubular necrosis is a feature of acute tubular necrosis that is not likely to be accompanied by the nephrotic syndrome."
a[59] = f + "(D) Incorrect. Hyperplastic arteriolosclerosis is a feature seen with malignant hypertension."
a[60] = f + "(E) Incorrect. Autoimmune diseases such as SLE, or diseases such as membranoproliferative glomerulonephritis, are more often nephritic than nephrotic and is much less common in children than minimal change disease."
a[61] = f + "(A) Incorrect. Most renal diseases that lead to nephritic syndrome have an acute onset. RBC casts in the urine indicate acute injury. A crescentic glomerulonephritis is typically a rapidly progressive glomerulonephritis."
a[62] = f + "(B) Incorrect. The acute injury with a nephritic syndrome leads to hematuria, and RBC casts are typical."
a[63] = f + "(C) Incorrect. Oliguria and azotemia (increase in BUN and creatinine) are typical for many different renal diseases, though they may be of varying degrees of severity."
a[64] = f + "(D) CORRECT. Proteinuria may be present with nephritic syndromes (characterized by RBCs spilled into the urine from the glomeruli), but it is usually not marked, as in nephrotic syndrome. Membranous glomerulonephritis typically produces nephrotic syndrome, while membranoproliferative glomerulonephritis leads to a nephritic syndrome."
a[65] = f + "(E) Incorrect. Most diseases leading to a nephritic or nephrotic syndrome produce hypertension as a clinical finding."
a[66] = f + "(A) CORRECT. He has findings of ischemic acute tubular necrosis from heart failure with hypotension. A clue is the >20:1 ratio of urea nitrogen to creatinine, which occurs early in the course, from prerenal azotemia. As the disease progresses, the ratio begins to approach 10:1, typical for renal diseases. ATN may also be produced by toxins such as ethylene glycol in antifreeze."
a[67] = f + "(B) Incorrect. Just about any glomerular disease with nephrosis is associated with podocyte foot process effacement. The disease with this change alone is minimal change disease."
a[68] = f + "(C) Incorrect. A rapidly progressive glomerulonephritis is not typically a result of ischemic injury to the kidney. Diseases such as Goodpasture syndrome and Wegener granulomatosis are more likely causes. Half are idiopathic."
a[69] = f + "(D) Incorrect. Hyperplastic arteriolosclerosis is a feature seen with malignant hypertension, not hypotension."
a[70] = f + "(E) Incorrect. Immune complex deposition is not a feature of hypotension, but is seen with diseases such as systemic lupus erythematosus."
a[71] = f + "(A) Incorrect. You should treat the acute infection. A urinalysis with microscopic exam and urine culture is indicated if you suspect a urinary tract infection."
a[72] = f + "(B) Incorrect. Physical exam with palpation of the prostate can help confirm this, along with an ultrasound of the prostate. Hydronephrosis can be documented with an intravenous pyelogram."
a[73] = f + "(C) Incorrect. Ultrasonography can help determine whether cystic kidneys are present. A family history also helps."
a[74] = f + "(D) Incorrect. Renal cysts should not be biopsied. Just a single cyst, or a few cysts, are usually incidental findings. There may be hemorrhage into a large cyst. Radiographic studies help to diagnose renal cysts."
a[75] = f + "(E) CORRECT. Therapy may depend upon determination of the severity and nature of the renal disease with SLE."
a[76] = f + "(A) Incorrect. Dilation of the ureters and renal pelves would suggest an obstructive uropathy with chronic renal failure, not polycythemia."
a[77] = f + "(B) CORRECT. The polycythemia suggests a paraneoplastic syndrome, and a renal cell carcinoma is a likely candidate for the primary lesion. The flank pain and hematuria can be explained by a renal cell carcinoma."
a[78] = f + "(C) Incorrect. A ureteral calculus is likely to produce excruciating pain as it passes through the urinary tract."
a[79] = f + "(D) Incorrect. Dominant polycystic kidney disease results in chronic renal failure. There may be occasional pain associated with hemorrhage or rupture of one of the cysts."
a[80] = f + "(E) Incorrect. Such a large mass could produce obstruction. It is possible for a large prostatic adenocarcinoma to do this, or a rhabdomyosarcoma in a child."
a[81] = f + "(A) Incorrect. This is a distinct possibility, but it is not the most common cause of death in hypertensive patients."
a[82] = f + "(B) Incorrect. Hypertension promotes atherosclerosis. The likelihood for rupture of an aortic aneurysm is based more on the size of the aneurysm (>6 to 7 cm)."
a[83] = f + "(C) CORRECT. Hypertension leads to cardiac enlargement, then dilation, and eventual failure. This is the most common outcome with untreated hypertension."
a[84] = f + "(D) Incorrect. Although hypertensive patients can develop end-stage renal disease, it is not as likely to be the cause of death as heart failure."
a[85] = f + "(E) Incorrect. Hypertension may contribute to rupture, but the presence of the aneurysm itself presents a risk, and no more than 1% of the population has such an aneurysm."
a[86] = f + "(A) CORRECT. Crescents are characteristic for a rapidly progressive glomerulonephritis; they form when there is leakage of fibrinogen into Bowman's space, with proliferation of epithelial cells to form the crescent."
a[87] = f + "(B) Incorrect. This is more typical for tubular injury, not glomerular injury."
a[88] = f + "(C) Incorrect. Such infiltrates are more typical for acute pyelonephritis, or in the case of a glomerulonephritis, a post-infectious GN such as post-streptococcal GN."
a[89] = f + "(D) Incorrect. This finding is more typical for minimal change disease."
a[90] = f + "(E) Incorrect. IgA deposition in the mesangium is more typical for Berger disease (IgA nephropathy), which can sometimes present as a rapidly progressive glomerulonephritis."
a[91] = f + "(A) CORRECT. Membranous GN is the most common cause for nephrotic syndrome in adults. Some cases are associated with underlying infections or malignancies, but in most cases the cause is unknown."
a[92] = f + "(B) Incorrect. In persons with a positive antinuclear antibody test, this would be high on the list."
a[93] = f + "(C) Incorrect. ATN has an acute onset following ischemic or toxic injury to the kidneys. It is unlikely to produce purely a nephrotic picture."
a[94] = f + "(D) Incorrect. He should have hyperglycemia and glucosuria if he were a diabetic with poor control leading to nephropathy."
a[95] = f + "(E) Incorrect. Post-infectious GN is not that common and more likely to be nephritic."
a[96] = f + "(A) Incorrect. Chronic pyelonephritis affects tubules and interstitium, but the time course suggests a relationship of renal disease to cardiac failure."
a[97] = f + "(B) CORRECT. Ischemia, typically in hypotensive hospitalized patients, is the most frequent antecedent to ATN, and MI's are common."
a[98] = f + "(C) Incorrect. Nodular glomerulosclerosis seen with diabetes mellitus can lead to proteinuria, but it develops over many years."
a[99] = f + "(D) Incorrect. The acute renal congestion seen with renal vein thrombosis may produce acute renal failure, but such thrombosis is not typically a complication of hypotension."
a[100] = f + "(E) Incorrect. Nephrotic syndrome is the result of minimal change disease, but it is not related to hypotension. The cause for minimal change disease is not known."
a[101] = f + "(A) CORRECT. This is a typical complication of long-standing diabetes mellitus. Microalbuminuria may preceed development of other abnormalities."
a[102] = f + "(B) Incorrect. Hyaline arteriolosclerosis may be seen with diabetes mellitus, but hyperplastic arteriolosclerosis is seen in conditions with malignant hypertension."
a[103] = f + "(C) Incorrect. This can be a complication of diabetic nephropathy, but it should be accompanied by red blood cells in the urine."
a[104] = f + "(D). Incorrect. This is an infrequent finding with diabetic nephropathy. A crescentic glomerulonephritis has a rapid onset and there are red blood cells in the urine."
a[105] = f + "(E) This is a typical complication with diabetes mellitus, but in this case no WBCs are present, as evidenced by the negative leukocyte esterase."
a[106] = f + "(A) Incorrect. Diabetes mellitus can produce large and small vessel disease. Larger vessels tend to be involved with atherosclerosis. The process is unlikely to be unilateral and produce a beaded pattern."
a[107] = f + "(B) Incorrect. Antiphospholipid antibodies are seen in some persons with coagulopathy who develop thromboses, which tend to resolve without a beaded pattern. Hypertension is not a typical finding."
a[108] = f + "(C) CORRECT. Fibromuscular dysplasia is an uncommon but surgically treatable cause for hypertension. The abnormal segment of artery can be treated with angioplasty or removed and replaced with a graft."
a[109] = f + "(D) Incorrect. Thrombotic microangiopathies involve the glomerular capillaries and are acute disease processes."
a[110] = f + "(E) Incorrect. Cholesterol emboli are very small and usually cause minimal problems. In some persons with marked aortic atherosclerosis with abundant cholesterol-rich plaque, multiple emboli can be released and cause acute renal failure.."
a[111] = f + "(A) Incorrect. These casts are typical for a more extensive tubular injury"
a[112] = f + "(B) Incorrect. Oval fat bodies can be seen with nephrotic syndrome."
a[113] = f + "(C) Incorrect. Renal tubular injury can result in shedding of tubular epithelial cells into urine."
a[114] = f + "(D) CORRECT. The WBC casts are most characteristic for an acute interstitital nephritis (acute pyelonephritis)."
a[115] = f + "(E) Incorrect. Triple phosphate crystals can be seen in association with infection, but they are not highly specific."
a[116] = f + "(A) CORRECT. She has analgesic abuse nephropathy which leads to papillary necrosis and tubular atrophy (though the renal columns are spared)."
a[117] = f + "(B) Incorrect. FSGN is an idiopathic condition in most cases (though it may appear with HIV or heroin nephropathy)."
a[118] = f + "(C) Incorrect. Nephrocalcinosis is seen with increased serum calcium."
a[119] = f + "(D) Incorrect. A wide range of drugs (other than analgesics) may produce an acute interstitial nephritis. Methicillin is a good example. The term acute interstitial nephritis is sometimes applied to acute pyelonephritis."
a[120] = f + "(E) Incorrect. Arteriolosclerosis is usually a result of hypertension."
a[121] = f + "(A) Incorrect. The timing is off for ATN, which should follow closely after an ischemic event such as can occur with sepsis and hypotension. A toxic ATN is unlikely from antibiotic therapy."
a[122] = f + "(B) Incorrect. Analgesic abuse leads to chronic renal failure without a nephritic picture or allergic reaction."
a[123] = f + "(C) CORRECT. This allergic response can occur following drug therapy with such antibiotic agents as methicillin, as well as some diuretics and NSAIDs. This allergic response is unrelated to the amount of drug and duration of therapy. This condition is treated by stopping the drug."
a[124] = f + "(D) Incorrect. HUS can follow enterohemorrhagic E. coli infection and produce a thrombotic microangiopathy, typically in children who have recently ingested poorly cooked hamburger."
a[125] = f + "(E) Incorrect. A post-infectious GN can lead to a nephrtic syndrome, but typically without allergic manifestations."
a[125.1] = f + "(F) Incorrect. A urinary tract infection should not cause allergic phenomena."
a[126] = f + "(A) Incorrect. BPH may result in urinary tract obstruction that favors infection, but these symptoms are more acute, and few WBC's are seen. Obstruction per se does not lead to calculus formation"
a[127] = f + "(B) Incorrect. Membranous GN typically produces a nephrotic syndrome without acute symptoms."
a[128] = f + "(C) CORRECT. These acute symptoms are typical for a calculus that is being passed."
a[129] = f + "(D) Incorrect. These rare tumors are slow growing and unlikely to produce acute symptoms."
a[130] = f + "(E) Incorrect. Though a TCC could result in hematuria, it is not likely to produce such acute symptoms."
a[131] = f + "(A) CORRECT. The findings point to focal segmental glomerulosclerosis (FSGS), which leads to chronic renal failure in half of cases. The lack of resolution with corticosteroid therapy and the progression to chronic renal failure is what sets FSGS apart from minimal change disease."
a[132] = f + "(B) Incorrect. Minimal change diseease, which can be seen as a cause for nephrotic syndrome in children, often responds to corticosteroid therapy. The only pathologic finding is podocyte foot process fusion by electron microscopy."
a[133] = f + "(C) Incorrect. Pulmonary fibrosis is most likely to accompany scleroderma, of conditions that can affect the kidney."
a[134] = f + "(D) Incorrect. Some cases of membranous glomerulonephritis, a common cause for nephrotic syndrome in adults, are associated with underlying malignancies."
a[135] = f + "(E) Incorrect. Obesity is a risk factor for development of type II diabetes mellitus, which produces nodular and diffuse glomerulosclerosis."
a[136] = f + "(A) Incorrect. Diabetes mellitus is not a risk for development of carcinoma. Diabetics are more likely to have infections of the lower urinary tract."
a[137] = f + "(B) Incorrect. Urinary tract infections do not increase the risk for urothelial carcinoma. Schistosomiasis (caused by S. hematobium) can affect the bladder and squamous cell carcinomas arise in some cases."
a[138] = f + "(C) Incorrect. Some drugs such as methicillin can lead to an interstitial nephritis of the kidney."
a[139] = f + "(D) CORRECT. He has a urothelial carcinoma of the urinary bladder, and smokers are at increased risk for this cancer. These cancers can be multiple and recurrent. Additional less common risk factors include exposure to aniline dyes and to beta-naphthylamine compounds. Drugs that increase the risk include phenacetin and cyclophosphamide."
a[140] = f + "(E) Incorrect. Tuberous sclerosis can be associated with development of angiomyolipomas of the kidney."
a[140.1] = f + "(F) Incorrect. Use of NSAIDS does not carry the risk for analgesic abuse nephropathy that phenacetin, acetaminophen, and aspirin use does. There is an increased risk for urothelial carcinoma with analgesic abuse nephropathy."
a[141] = f + "(A) Incorrect. Calcium oxalate crystals are quite common in small numbers in urine, even of persons without any renal disease."
a[142] = f + "(B) Incorrect. Cystine crystals are quite rare and can be seen with severe liver disease or with cystinuria."
a[143] = f + "(C) Incorrect. Calcium phosphate crystals are not typically associated with pyelonephritis and urinary tract infections."
a[144] = f + "(D) Incorrect. Uric acid stones form in acid urine and may be seen in some persons with hyperuricemia and gout."
a[145] = f + "(E) CORRECT. She has a staghorn calculus and acute pyelonephritis. These 'infection stones' are typically the 'triple phosphate' stones whose formation is aided by infection with urea-splitting bacteria such as <I>Proteus</I>."
a[146] = f + "(A) CORRECT. Most cases of membranous GN are idiopathic, but in some patients there is a history of an infection or a malignancy (usually lung) with antigenemia."
a[147] = f + "(B) Incorrect. RPGN is more typical for a disease such as Goodpasture's, with anti-glomerular basement membrane antibody."
a[148] = f + "(C) Incorrect. This is a long-term complication of diabetes mellitus."
a[149] = f + "(D) Incorrect. There is antiglomerular basement membrane antibody in Goodpasture syndrome."
a[150] = f + "(E) Incorrect. Dense deposit disease does not result from this mechanism."
a[151] = f + "(A) Incorrect. Lack of one kidney does not preclude survival. In fact, when present from birth, the remaining kidney will have the same mass as two kidneys."
a[152] = f + "(B) CORRECT. This is serious, and requires surgical repair. The exposed bladder predisposes to infection. There is a long-term risk for carcinoma, such as bladder adenocarcinoma or colonic adenocarcinoma."
a[153] = f + "(C) Incorrect. About one person in 160 will have partial or complete ureteral duplication. Most cases are asymptomatic, though there is an increased risk for infection."
a[154] = f + "(D) Incorrect. Horseshoe kidney can be part of syndromes with multiple anomalies, but the kidney functions normally, though there may be some degree of ureteral obstruction as the ureters pass over the connecting bridge of renal tissue."
a[155] = f + "(E) Incorrect. This is a very rare anomaly."
a[156] = f + "(A) Incorrect. Acute tubular necrosis may produce renal tubular casts, not WBC casts, and tissue should not slough into the collecting system."
a[157] = f + "(B) Incorrect. Aspergillosis at this site would be quite unusual."
a[158] = f + "(C) Incorrect. A calculus may form as a consequence of infection, but such stones are typically formed of magnesium ammonium phosphate."
a[159] = f + "(D) Incorrect. Hematomas are unlikely in and around the kidney expect with severe trauma."
a[160] = f + "(E) CORRECT. Papillary necrosis is a renal complication of diabetes mellitus, as in this case. Papillary necrosis may also be seen with analgesic abuse nephropathy, with sickle cell anemia, and with a severe acute pyelonephritis."
a[160.1] = f + "(F) Incorrect. Renal cell carcinoma will produce a mass lesion; it does not slough into the collecting system. Diabetes mellitus is not a risk for renal cell carcinoma."
a[160.2] = f + "(G) Incorrect. Urothelial carcinoma typically does not slough. Diabetes mellitus and infection is not a risk for urothelial carcinoma."
a[161] = f + "(A) Incorrect. The numerous WBC's in the renal tubules would form casts that would appear in the urine in association with acute pyelonephritis, and the patient is usually febrile. Increased numbers and severity of urinary tract infections are common with diabetes mellitus, but there is no evidence for it in this patient."
a[162] = f + "(B) Incorrect. Acute tubular necrosis may occur with ischemia from hypotension, which may occur with heart failure from ischemic heart disease, but there is typically an acute onset of renal failure with oliguria."
a[163] = f + "(C) Incorrect. Chronic glomerulonephritis is a term reserved for cases with no obvious underlying etiology for glomerular disease leading to renal failure. In this case, the patient has diabetes mellitus."
a[164] = f + "(D) Incorrect. Hydronephrosis is not a direct complication of diabetes mellitus. Hydronephrosis results from chronic urinary tract obstruction."
a[165] = f + "(E) Incorrect. This is a chronic process that is unlikely to lead to cast formation with WBC's."
a[165.1] = f + "(F) Incorrect. Membranous glomerulonephritis typically presents with nephrotic-range proteinuria. It is not related to diabetes mellitus."
a[165.2] = f + "(G) CORRECT. The classic lesion with diabetes mellitus is nodular glomerulosclerosis, which gradually reduces renal function. Diffuse glomerulosclerosis may also be present."
a[165.3] = f + "(H) Incorrect. Polycystic change does not occur with diabetes mellitus."
a[166] = f + "(A) Incorrect. Wilms tumor typically presents in childhood, not at birth, and bilaterality is uncommon."
a[167] = f + "(B) Incorrect. DPKD is typically a disease that results in renal failure later in adult life."
a[168] = f + "(C) Incorrect. Urethral atresia can result in an enlarged bladder and hydroureter with hydronephrosis. Cortical microcysts may be seen microscopically.."
a[169] = f + "(D) Incorrect. This congenital disorder of the penile urethra may produce obstruction with bladder dilation, hydroureter, and hydronephrosis with cortical microcysts."
a[170] = f + "(E) CORRECT. This is the most common cause for congenital polycystic kidneys, and it has a sporadic occurrence. It can be unilateral, or involve only a part of a kidney, in which case survival is possible."
a[171] = f + "(A) Incorrect. Post-streptoccocal GN appears weeks after the acute infection."
a[172] = f + "(B) CORRECT. These findings are typical for a drug-induced acute interstitial nephritis. The eosinophilia is seen with allergic phenomena (as in a drug allergy)."
a[173] = f + "(C) Incorrect. Berger disease (IgA nephropathy) is characterized by hematuria and often follows a 'flu-like' illness."
a[174] = f + "(D) Incorrect. ATN is not typically accompanied by signs of acute inflammation."
a[175] = f + "(E) Incorrect. Eosinophilia is not typical for serum sickness."
a[176] = f + "(A) Incorrect. Aldosterone secreting adrenal adenomas are usually small and easily removed at surgery."
a[177] = f + "(B) Incorrect. Renovascular causes for hypertension such as fibromuscular dysplasia can be surgically treated. The involved segment of renal artery can be removed and a graft placed at surgery."
a[178] = f + "(C) Incorrect. Pheochromocytomas that secrete catecholamines can be removed at surgery."
a[179] = f + "(D) Incorrect. Primary hyperparathyroidism can be due to parathyroid adenoma or hyperplasia. At surgery, a parathyroid adenoma can be removed, and 3 and 1/2 glands can be removed with hyperplasia. Parathyroid carcinomas are removed with more difficulty."
a[180] = f + "(E) CORRECT. Immunologic diseases of the kidney often produce glomerulonephritis, and renal damage often leads to hypertension."
a[181] = f + "(A) Incorrect. Benign nephrosclerosis is a slowly progressive disease that may not lead to overt hypertension or renal failure in all persons who have it. There is hyaline arteriolosclerosis."
a[182] = f + "(B) Incorrect. Fibromuscular dysplasia produces segmental fibrosis of the renal arteries. ANCA and ANA are negative."
a[183] = f + "(C) Incorrect. This is a complication of diabetes mellitus that affects the glomeruli and not arteries. ANCA and ANA are not positive with diabetic nephropathy."
a[184] = f + "(D) CORRECT. Classic polyarteritis nodosa often affects multiple organs, not just the kidney. The classic form of polyarteritis affects medium to small sized arteries."
a[185] = f + "(E) Incorrect. SLE is not typically associated with ANCA, though the ANA is usually positive, and the vasculitis of SLE does not typically produce arterial dilations."
a[185.1] = f + "(F) Incorrect. A thrombotic microangiopathy such as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome produces endothelial injury that mainly affects glomeruli."
a[185.2] = f + "(G) Incorrect. The ANCA is usually positive with Wegener granulomatosis, a necrotizing vasculitis of small vessels."
a[186] = f + "(A) Incorrect. HPV is most likely to affect epithelia of the genital tract with formation of condylomata and potential for dysplasia."
a[187] = f + "(B) Incorrect. <I>Hemophilus ducreyi</I> is the cause for chancroid, or 'soft chancre' of the genitals. This is one of the sexually transmitted diseases, though it is not as common in the US as in Africa."
a[188] = f + "(C) CORRECT. Now that tests for Chlamydia are routinely available, this organism has been found to cause more cases of urethritis than any other."
a[189] = f + "(D) Incorrect. T. pallidum is the cause for syphilis, which in the primary stage manifests as a hard chancre on genitalia."
a[190] = f + "(E) Incorrect. HSV can result in painful genital vesicles."
a[191] = f + "(A) CORRECT. This paraneoplastic effect can occur with renal cell carcinomas. The hypercalcemia is most likely related to elaboration of parathormone-related peptide (PTHrP) by the neoplasm."
a[192] = f + "(B) Incorrect. Catecholamines are typically produced by adrenal medullary pheochromocytomas, not renal cell carcinomas."
a[193] = f + "(C) Incorrect. Although renal cell carcinomas can produce hormone-like effects with a variety of paraneoplastic effects, they are not associated with viral infections or other conditions that produce hepatitis."
a[194] = f + "(D) Incorrect. Hyponatremia is seen with the syndrome of inappropriate anti-diuretic hormone (SIADH), which is a paraneoplastic effect that is most of the the result of bronchogenic carcinoma such as small cell anaplastic carcinoma."
a[195] = f + "(E) Incorrect. Aldosterone hypersecretion to produce hypokalemia most often occurs with adrenal cortical adenomas."
a[196] = f + "(A) Incorrect. WBC's are more characteristic of pyelonephritis, which is most often caused by bacterial urinary tract infection."
a[197] = f + "(B) Incorrect. Look for RBC's and RBC casts in the urine with a nephritic syndrome."
a[198] = f + "(C) CORRECT. Oval fat bodies appear with pronounced proteinuria and lipiduria."
a[199] = f + "(D) Incorrect. The obstruction tends to be chronic in nature, without a specific tubular cell injury."
a[200] = f + "(E) Incorrect. Infarction might lead to the presence of a few RBC's in the urine."
a[200.1] = f + "(F) Incorrect. Papillary necrosis often produces sloughing of a large enough portion of tissue that can be filtered out and grossly identified."
a[201] = f + "(A) Incorrect. Holoprosencephaly is most often seen with trisomy 13. It may be seen in infants of mothers with diabetes mellitus."
a[202] = f + "(B) CORRECT. This is a case of infantile autosomal recessive polycystic kidney disease."
a[203] = f + "(C) Incorrect. Polycystic disease often has specific inheritance patterns and is not typically accompanied by imperforate anus."
a[204] = f + "(D) Incorrect. Though cysts may form with urinary tract obstruction in fetal life, they are usually asymmetric and cortical."
a[205] = f + "(E) Incorrect. A papilloma is a rare neoplasm in adults that is typically very small."
a[206] = f + "(A) Incorrect. Although there may be lysed RBC's, a few RBC's are usually visible."
a[207] = f + "(B) Incorrect. The necrosis leads to the presence of at least some RBC's."
a[208] = f + "(C) Incorrect. Stones produce injury with hemorrhage and RBC's."
a[209] = f + "(D) CORRECT. The dipstick test is sensitive for both hemoglobin and myoglobin. Myoglobinuria may occur with rhabdomyolysis from muscle injury. Trauma, including prolonged immobilization in one position, may cause muscle injury."
a[210] = f + "(E) Incorrect. A few RBC's are often present with renal infarction."
a[211] = f + "(A) CORRECT. This is the typical (and only) pathologic finding for minimal change disease, the most common cause for nephrotic syndrome in children, but it can be seen at older ages, too."
a[212] = f + "(B) Incorrect. Such deposits are more typical for post-streptococcal glomerulonephritis."
a[213] = f + "(C) Incorrect. This finding is more typical of membranoproliferative glomerulonephritis type I."
a[214] = f + "(D) Incorrect. Minimal change disease is not accompanied by basement membrane thickening."
a[215] = f + "(E) Incorrect. Mesangial cells do not proliferate with minimal change disease."
a[216] = f + "(A) Incorrect. Polycythemia would be a paraneoplasatic effect expected with a renal cell carcinoma."
a[217] = f + "(B) Incorrect. Such a filling defect is unlikely to be an abscess, and there are no WBCs in the urine. He is afebrile."
a[218] = f + "(B) Incorrect. It is unlikely to be a calculus in the absence of crystals in the urine."
a[219] = f + "(D) Incorrect. Lesions of the pelvis are unlikely to be associated with autoimmune diseases."
a[220] = f + "(E) CORRECT. The mass is probably a urothelial carcinoma, and atypical cells would appear in the urine."
a[221] = f + "(A) Incorrect. An elevated serum glucose would suggest diabetes mellitus. Diabetic nephropathy tends to be a slowly progressive process. Glomerulosclerosis, nodular and/or diffuse, can occur."
a[222] = f + "(B) Incorrect. Anti-dsDNA is a feature of systemic lupus erythematosus, and lupus nephritis does not usually produce a hypercellular gloomerular disease."
a[223] = f + "(C) Incorrect. Anti-GBM is a feature of Goodpasture syndrome, a form of rapidly progressive glomerulonephritis."
a[224] = f + "(D) Incorrect.The C3 nephritogenic factor can be seen with some cases of membranoproliferative glomerulonephritis."
a[225] = f + "(E) CORRECT. This hypercellular glomerulus has many neutrophils, characteristic for a post-infectious glomerulonephritis, for which a nephritogenic strain of group A <I>Streptococcus</I> is a likely etiology."