AMC MCQ Renal and Endocrine Disorders — Questions and Answers
Question 1: A 58-year-old man with type 2 diabetes has an eGFR of 45 mL/min and a urine albumin-to-creatinine ratio of 80 mg/mmol. Which medication class provides the strongest renoprotection in addition to glycaemic control?
- SGLT2 inhibitor (Correct answer)
- Sulfonylurea
- DPP-4 inhibitor
- Thiazolidinedione
Correct answer: SGLT2 inhibitor
SGLT2 inhibitors slow progression of diabetic kidney disease and reduce albuminuria independent of glucose lowering.
Question 2: A 30-year-old woman presents with hypertension, hypokalaemia and metabolic alkalosis with suppressed renin and elevated aldosterone. What is the most likely diagnosis?
- Primary hyperaldosteronism (Correct answer)
- Cushing syndrome
- Renal artery stenosis
- Liddle syndrome
Correct answer: Primary hyperaldosteronism
Suppressed renin with raised aldosterone causing hypertension and hypokalaemia is classic for primary hyperaldosteronism (Conn syndrome).
Question 3: A patient with chronic kidney disease stage 4 develops fatigue and a haemoglobin of 88 g/L with normal iron stores. What is the primary cause of this anaemia?
- Reduced erythropoietin production (Correct answer)
- Iron deficiency
- Folate deficiency
- Haemolysis
Correct answer: Reduced erythropoietin production
Failing kidneys produce insufficient erythropoietin, causing a normocytic normochromic anaemia.
Question 4: A 24-year-old presents with polyuria and polydipsia. After water deprivation the urine remains dilute, and it concentrates following desmopressin. What is the diagnosis?
- Central diabetes insipidus (Correct answer)
- Nephrogenic diabetes insipidus
- Primary polydipsia
- Osmotic diuresis
Correct answer: Central diabetes insipidus
A response to desmopressin indicates ADH deficiency, confirming central diabetes insipidus.
Question 5: A 65-year-old man on a thiazide diuretic presents confused with a serum sodium of 118 mmol/L and is clinically euvolaemic. What is the most appropriate initial management of asymptomatic chronic hyponatraemia?
- Fluid restriction and stop the offending drug (Correct answer)
- Rapid hypertonic saline bolus
- Aggressive normal saline infusion
- Desmopressin administration
Correct answer: Fluid restriction and stop the offending drug
Chronic mild hyponatraemia is managed with fluid restriction and removing the cause to avoid osmotic demyelination from overly rapid correction.
Question 6: A 45-year-old woman has weight gain, cold intolerance, constipation and a raised TSH with low free T4. What is the diagnosis?
- Primary hypothyroidism (Correct answer)
- Secondary hypothyroidism
- Subclinical hyperthyroidism
- Sick euthyroid syndrome
Correct answer: Primary hypothyroidism
A high TSH with low free T4 indicates primary thyroid gland failure.
Question 7: A patient presents with acute kidney injury, a urine output of 5 mL/hr, and a fractional excretion of sodium below 1%. What does this finding suggest?
- Pre-renal cause (Correct answer)
- Acute tubular necrosis
- Post-renal obstruction
- Acute interstitial nephritis
Correct answer: Pre-renal cause
A FENa below 1% indicates intact tubular sodium avidity typical of a pre-renal (hypovolaemic) cause.
Question 8: A 22-year-old man presents with frank haematuria 1-2 days after an upper respiratory tract infection. What is the most likely glomerular diagnosis?
- IgA nephropathy (Correct answer)
- Post-streptococcal glomerulonephritis
- Minimal change disease
- Goodpasture syndrome
Correct answer: IgA nephropathy
Synpharyngitic haematuria occurring concurrently with a URTI is characteristic of IgA nephropathy.
Question 9: A 5-year-old presents with periorbital oedema, heavy proteinuria, hypoalbuminaemia and a normal complement. What is the most likely cause of nephrotic syndrome in this child?
- Minimal change disease (Correct answer)
- Membranous nephropathy
- Focal segmental glomerulosclerosis
- Diabetic nephropathy
Correct answer: Minimal change disease
Minimal change disease is the commonest cause of nephrotic syndrome in children and is highly steroid-responsive.
Question 10: A 50-year-old woman with a thyroid nodule has a suppressed TSH and an increased radioactive iodine uptake confined to the nodule. What is this lesion most likely to be?
- Toxic adenoma (Correct answer)
- Papillary carcinoma
- Hashimoto thyroiditis
- Multinodular goitre
Correct answer: Toxic adenoma
An autonomously functioning ('hot') nodule with increased focal uptake and suppressed TSH is a toxic adenoma and is almost always benign.
Question 11: A type 1 diabetic presents drowsy with a blood glucose of 28 mmol/L, ketonaemia and a pH of 7.18. What is the most important first step in management?
- Intravenous isotonic fluid resuscitation (Correct answer)
- Intravenous bicarbonate
- Subcutaneous long-acting insulin
- Oral rehydration
Correct answer: Intravenous isotonic fluid resuscitation
Fluid resuscitation is the priority in diabetic ketoacidosis before and alongside an insulin infusion.
Question 12: A patient with end-stage renal disease on haemodialysis develops a potassium of 7.2 mmol/L with peaked T waves on ECG. What is the first agent to give for cardiac protection?
- Intravenous calcium gluconate (Correct answer)
- Intravenous insulin and dextrose
- Nebulised salbutamol
- Oral resonium
Correct answer: Intravenous calcium gluconate
Calcium gluconate stabilises the myocardium immediately, although it does not lower potassium.
Question 13: A 38-year-old woman has fatigue, hyperpigmentation, hyponatraemia, hyperkalaemia and postural hypotension. A short Synacthen test shows an inadequate cortisol rise. What is the diagnosis?
- Primary adrenal insufficiency (Correct answer)
- Secondary adrenal insufficiency
- Phaeochromocytoma
- Conn syndrome
Correct answer: Primary adrenal insufficiency
Hyperpigmentation with hyperkalaemia and a failed Synacthen test indicates primary adrenal (Addison) disease with high ACTH.
Question 14: A 70-year-old man with longstanding hypertension has bilateral small kidneys on ultrasound and proteinuria. What is the most likely underlying renal pathology?
- Hypertensive nephrosclerosis (Correct answer)
- Polycystic kidney disease
- Acute pyelonephritis
- Renal cell carcinoma
Correct answer: Hypertensive nephrosclerosis
Chronic hypertension causes nephrosclerosis with bilaterally shrunken, scarred kidneys.
Question 15: A 45-year-old man with a family history of renal failure has flank pain, hypertension, haematuria and bilateral enlarged kidneys with multiple cysts. What is the most likely diagnosis?
- Autosomal dominant polycystic kidney disease (Correct answer)
- Medullary sponge kidney
- Simple renal cysts
- Acquired cystic disease
Correct answer: Autosomal dominant polycystic kidney disease
Bilaterally enlarged cystic kidneys with a positive family history indicate autosomal dominant polycystic kidney disease.
Question 16: A 19-year-old woman is found to have a TSH of 8 mU/L with a normal free T4 and is asymptomatic. What is the appropriate management of this subclinical hypothyroidism?
- Repeat thyroid function in 2-3 months (Correct answer)
- Start lifelong thyroxine immediately
- Commence carbimazole
- Order a radioiodine scan
Correct answer: Repeat thyroid function in 2-3 months
Mildly raised TSH with normal T4 and no symptoms should be rechecked before deciding on treatment.
Question 17: A 68-year-old man on metformin undergoes a contrast CT and develops oliguric acute kidney injury 48 hours later. What is the most likely cause?
- Contrast-induced nephropathy (Correct answer)
- Rhabdomyolysis
- Glomerulonephritis
- Renal vein thrombosis
Correct answer: Contrast-induced nephropathy
Iodinated contrast can cause an acute tubular injury within 48-72 hours, especially in those with pre-existing renal impairment.
Question 18: A 30-year-old man with type 1 diabetes reports early morning sweating and headaches, with a fasting hyperglycaemia. Overnight readings show hypoglycaemia at 3am. What does this pattern describe?
- Somogyi phenomenon (Correct answer)
- Dawn phenomenon
- Insulin resistance
- Honeymoon period
Correct answer: Somogyi phenomenon
Nocturnal hypoglycaemia triggering counter-regulatory rebound morning hyperglycaemia describes the Somogyi effect.
Question 19: A 52-year-old woman is found to have an asymptomatic serum calcium of 2.85 mmol/L with an inappropriately normal PTH. What is the most likely diagnosis?
- Primary hyperparathyroidism (Correct answer)
- Malignancy-related hypercalcaemia
- Sarcoidosis
- Vitamin D deficiency
Correct answer: Primary hyperparathyroidism
A non-suppressed PTH in the face of hypercalcaemia indicates primary hyperparathyroidism.
Question 20: A young woman presents with hypertension, hypokalaemia and metabolic alkalosis but with LOW aldosterone and low renin. Genetic testing confirms a sodium channel mutation. What is the diagnosis?
- Liddle syndrome (Correct answer)
- Bartter syndrome
- Gitelman syndrome
- Conn syndrome
Correct answer: Liddle syndrome
Liddle syndrome is an inherited gain-of-function of the epithelial sodium channel causing hypertension with suppressed renin and aldosterone.
Question 21: A 60-year-old man with heart failure is started on an ACE inhibitor and his creatinine rises by 40% within a week. What is the most likely explanation?
- Bilateral renal artery stenosis (Correct answer)
- Acute tubular necrosis
- Acute interstitial nephritis
- Glomerulonephritis
Correct answer: Bilateral renal artery stenosis
ACE inhibitors reduce efferent arteriolar tone and precipitate a marked creatinine rise when renal perfusion depends on it, as in bilateral renal artery stenosis.
AMC MCQ Renal and Endocrine Disorders
A 58-year-old man with type 2 diabetes has an eGFR of 45 mL/min and a urine albumin-to-creatinine ratio of 80 mg/mmol.
Which medication class provides the strongest renoprotection in addition to glycaemic control?
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Sources & references
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