COMSAE Renal and Urological Systems 2

Question 1

A 4-year-old child presents with massive proteinuria (5g/day), hypoalbuminemia, generalized edema, and hyperlipidemia. Biopsy shows effacement of foot processes on electron microscopy. What is the most likely diagnosis?

Accepted Answer

Minimal change disease

Answer

Minimal change disease is the most common nephrotic syndrome in children, showing normal light microscopy but effacement of podocyte foot processes on electron microscopy.

Question 2

On COMSAE, which medication should be held 24-48 hours before administration of iodinated contrast in a patient with chronic kidney disease?

Accepted Answer

Metformin

Answer

Metformin should be held before contrast administration in CKD patients because contrast-induced nephropathy can reduce metformin excretion, causing lactic acidosis.

Question 3

A 70-year-old man with BPH presents with urinary frequency, nocturia, weak stream, and post-void dribbling. Which medication class reduces prostate size by blocking testosterone conversion?

Accepted Answer

5-alpha reductase inhibitors (finasteride)

Answer

5-alpha reductase inhibitors block conversion of testosterone to dihydrotestosterone (DHT), the primary androgen driving prostate growth, thereby reducing prostate volume.

Question 4

Which stone type is most likely in a patient with recurrent urinary tract infections caused by urease-producing organisms like Proteus mirabilis?

Accepted Answer

Struvite (magnesium ammonium phosphate) stones

Answer

Urease-producing bacteria hydrolyze urea to ammonia, alkalinizing urine and promoting precipitation of struvite (MgNH4PO4) stones that can form staghorn calculi.

Question 5

A patient with nephrotic syndrome has serum albumin of 1.8 g/dL. Which complication is this patient at highest risk for due to loss of anticoagulant proteins?

Accepted Answer

Renal vein thrombosis

Answer

Nephrotic syndrome causes urinary loss of antithrombin III and protein C/S, creating a hypercoagulable state; renal vein thrombosis is the most classic complication.

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE - Comprehensive Osteopathic Medical Self-Assessment Examination Practice Test

COMSAE Renal and Urological Systems 2