PANCE PANCE Renal System 1 — Questions and Answers
Question 1: A patient with nephrotic syndrome has 4+ proteinuria and lipiduria. Which urinalysis finding is most characteristic?
- Oval fat bodies (Correct answer)
- WBC casts
- RBC casts
- Granular casts
Correct answer: Oval fat bodies
Oval fat bodies are characteristic of nephrotic syndrome due to lipiduria from massive glomerular protein loss.
Question 2: A 55-year-old presents with flank pain, gross hematuria, and a palpable mass. CT reveals a solid renal mass. What is the most likely diagnosis?
- Renal cell carcinoma (Correct answer)
- Transitional cell carcinoma
- Nephroblastoma
- Angiomyolipoma
Correct answer: Renal cell carcinoma
Renal cell carcinoma classically presents with the triad of hematuria, flank pain, and a palpable mass in adults.
Question 3: Which medication class is first-line for reducing proteinuria and slowing CKD progression in a patient with diabetic nephropathy?
- ACE inhibitors (Correct answer)
- Beta-blockers
- Calcium channel blockers
- Thiazide diuretics
Correct answer: ACE inhibitors
ACE inhibitors reduce intraglomerular pressure and proteinuria, slowing progression of diabetic nephropathy.
Question 4: A patient with CKD has a serum potassium of 6.4 mEq/L and peaked T-waves on ECG. What is the first intervention?
- IV calcium gluconate (Correct answer)
- Sodium bicarbonate
- Insulin with dextrose
- Sodium polystyrene sulfonate
Correct answer: IV calcium gluconate
IV calcium gluconate immediately stabilizes the cardiac membrane when ECG changes are present in hyperkalemia.
Question 5: Which lab pattern is most consistent with prerenal azotemia?
- BUN:Cr ratio >20:1 with urine sodium <20 mEq/L (Correct answer)
- BUN:Cr ratio <10:1 with urine sodium >40 mEq/L
- Muddy brown casts with urine sodium >40 mEq/L
- WBC casts with low urine osmolality
Correct answer: BUN:Cr ratio >20:1 with urine sodium <20 mEq/L
Prerenal azotemia shows a BUN:Cr >20:1 and low urine sodium as the kidneys avidly retain sodium to restore perfusion.
Question 6: A dialysis patient develops fever, chills, and hypotension during a hemodialysis session. What is the most likely cause?
- Catheter-related bloodstream infection (Correct answer)
- Air embolism
- Hemolysis
- Dialysis disequilibrium syndrome
Correct answer: Catheter-related bloodstream infection
Fever, rigors, and hypotension during dialysis most commonly indicate catheter-related bloodstream infection.
PANCE PANCE Renal System 1
A patient with nephrotic syndrome has 4+ proteinuria and lipiduria.
Which urinalysis finding is most characteristic?