KMU Past Paper Practice

A 54-year-old woman has a baseline serum creatinine of 0.9 mg/dL. Five days after a severe systemic illness, her creatinine is 1.5 mg/dL. Her urine output remains approximately 1 mL/kg/hour. Which interpretation is most appropriate?

A 42-year-old man develops reduced renal perfusion after prolonged fluid loss. His renal tubules remain structurally intact. Which urinary response is most consistent with this stage of renal dysfunction?

A patient develops acute tubular injury after prolonged shock. Tubular epithelial cells detach from their basement membrane and accumulate within the lumen. Which combination contributes most directly to the subsequent reduction in GFR?

At autopsy, the kidneys of a patient who died during severe acute tubular injury are examined grossly. Which appearance would be most compatible with this acute process?

A 69-year-old man with longstanding hypertension develops slowly progressive renal impairment. At autopsy, both kidneys are reduced in size. Which additional gross feature would best support benign nephrosclerosis?

A 58-year-old man dies after a rapidly progressive hypertensive emergency with renal failure. The kidney surface shows numerous tiny cortical hemorrhages. Which gross description is most appropriate?

A 29-year-old woman has persistent severe hypertension without diabetes or generalized atherosclerotic disease. Imaging demonstrates narrowing of a renal artery. Which underlying vascular disorder is most likely in this age group?

A hospitalized patient develops AKI. A medicine that is predominantly eliminated by the kidneys is continued unchanged, and several days later the patient develops features of drug toxicity. What best explains this complication?

A 46-year-old woman has repeated vomiting for 3 days. She is dizzy on standing, has dry mucous membranes and serum sodium of 126 mmol/L with low serum osmolality. Which classification best fits this sodium disturbance?

A patient with marked peripheral edema and raised JVP has a serum sodium concentration of 124 mmol/L. Which mechanism best explains the low sodium concentration in this volume state?

A patient presents with marked hyperglycemia and a serum sodium concentration below the reference range. Serum osmolality is elevated rather than reduced. Which mechanism best explains the sodium result?

A woman with true sodium depletion has a total body water estimate of 36 L. Her measured serum sodium is 124 mmol/L and the selected desired sodium is 130 mmol/L. Using sodium deficit = TBW × (desired Na − measured Na), what is the estimated sodium deficit?

A 76-year-old man presents with hypernatremia, marked thirst, postural hypotension and poor peripheral perfusion. What should take priority before calculated free-water replacement is completed?

A patient develops elevated serum sodium after a substantial sodium load and is clinically volume expanded. Which classification best describes this disturbance?

A 39-year-old man has persistent diarrhea and develops hypokalemia. Renal function is normal and urinary potassium excretion is low. Which source of potassium loss is most likely?

A patient with marked potassium depletion develops generalized weakness, abdominal distension and markedly reduced bowel sounds. Which physiological consequence of the electrolyte disturbance best explains the abdominal findings?

A patient with severe symptomatic hypokalemia requires intravenous potassium replacement. Which administration practice presents the greatest immediate danger?

A patient with AKI has a markedly elevated serum potassium level, but the ECG does not show the expected classical abnormalities. Which interpretation is safest?

A patient with AKI has hyperkalemia together with significant metabolic acidosis. In addition to standard emergency measures, which treatment may help lower extracellular potassium particularly because acidosis is present?

A 65-year-old man presents to primary care with reduced urine output after an acute illness. Serum creatinine has risen, and his medication list includes a recently introduced potentially nephrotoxic drug together with other medicines cleared predominantly by the kidneys. Which medication-related action is most appropriate?