KMU Past Paper Practice

Question:

A 58-year-old man with a 15-year history of type 2 diabetes has persistent albuminuria and a gradual fall in eGFR over several years. Blood pressure is also elevated. Which underlying disorder most likely accounts for his progressive chronic renal impairment?

Options:

Correct Answer: Diabetic kidney disease

Explanation: Long-standing diabetes with persistent albuminuria and progressively declining filtration strongly supports diabetic kidney disease as the cause of CKD.

Question:

A 61-year-old woman with CKD reports that she wakes several times each night to pass urine despite having no dysuria or excessive evening fluid intake. Which functional renal abnormality best explains this symptom?

Options:

Correct Answer: Reduced urinary concentrating ability

Explanation: Tubular damage in CKD reduces the kidney’s ability to concentrate urine, so patients may produce relatively dilute urine throughout the night and develop nocturia.

Question:

A 67-year-old man with advanced CKD develops generalized weakness. Serum potassium is markedly elevated despite no potassium supplementation. Which renal disturbance most directly accounts for this abnormality?

Options:

Correct Answer: Reduced renal potassium excretion

Explanation: Advanced nephron loss reduces the kidney’s capacity to excrete potassium. Severe hyperkalemia is clinically important because it can cause dangerous cardiac conduction abnormalities.

Question:

A 70-year-old man receiving hemodialysis develops dizziness and marked hypotension near the end of a treatment session. There is no fever or bleeding. Which mechanism is the most likely explanation?

Options:

Correct Answer: Excessive intravascular volume removal

Explanation: Rapid or excessive ultrafiltration during hemodialysis reduces circulating volume and is an important cause of intradialytic hypotension.

Question:

A patient using long-term peritoneal dialysis develops progressive nutritional deterioration despite an adequate diet. There is no evidence of active infection. Which dialysis-related process can contribute to this problem?

Options:

Correct Answer: Loss of protein into dialysate

Explanation: Proteins can cross into peritoneal dialysis fluid and be lost during drainage, contributing to nutritional problems in patients receiving long-term therapy.

Question:

A 65-year-old man with advanced CKD has markedly elevated urea and creatinine. Over several weeks he develops anorexia, nausea, pruritus and progressive difficulty concentrating. Which concept best accounts for the development of these systemic manifestations?

Options:

Correct Answer: Clinical syndrome from retained uremic substances

Explanation: Uremia refers to systemic manifestations caused by advanced renal failure and retention of metabolic products, rather than an isolated biochemical rise in nitrogenous waste.

Question:

A 60-year-old patient with irreversible kidney failure is referred for transplantation. During evaluation, an active malignant tumor is identified. Which approach is most appropriate?

Options:

Correct Answer: Defer transplantation while the malignancy is addressed

Explanation: Active malignancy must be considered before transplantation because postoperative immunosuppression may promote tumor progression. Suitability can be reassessed after appropriate management.

Question:

A man with end-stage kidney failure is otherwise suitable for transplantation, but evaluation demonstrates severe lower urinary tract obstruction. Which principle best supports successful transplantation?

Options:

Correct Answer: Correct the urinary tract problem before transplantation

Explanation: A functioning lower urinary tract is important for graft drainage. Significant obstruction should be corrected before transplantation to protect the new kidney.

Question:

Five days after renal transplantation, a patient develops increasing fluid drainage near the operative site and reduced urine reaching the bladder. Graft perfusion is preserved. Which surgical complication is most likely?

Options:

Correct Answer: Urinary leak from the transplant urinary anastomosis

Explanation: Urinary leakage is an early surgical complication related to the urinary tract anastomosis and may present with abnormal fluid drainage despite preserved graft blood flow.

Question:

A transplanted kidney has satisfactory blood flow after surgery but produces little urine and does not immediately provide adequate filtration. The patient temporarily continues to require dialysis. Which term best describes this situation?

Options:

Correct Answer: Delayed graft function

Explanation: Delayed graft function refers to failure of the transplanted kidney to establish adequate function immediately, sometimes requiring temporary dialysis after transplantation.

Question:

A renal transplant recipient develops new hyperglycemia several months after transplantation. He is taking a calcineurin inhibitor as part of maintenance therapy. Which drug is particularly associated with this metabolic complication?

Options:

Correct Answer: Tacrolimus

Explanation: Tacrolimus suppresses T-cell activation through calcineurin inhibition but is particularly associated with post-transplant hyperglycemia and diabetes.

Question:

A transplant recipient receiving maintenance immunosuppression develops leukopenia and thrombocytopenia without evidence of graft rejection. Which immunosuppressive drug can produce this complication through bone-marrow suppression?

Options:

Correct Answer: Azathioprine

Explanation: Azathioprine inhibits proliferating immune cells and can suppress bone marrow, producing leukopenia, anemia or thrombocytopenia.

Question:

A renal transplant recipient has received long-term maintenance treatment and later develops weight gain, reduced bone density and recurrent infections. Which component of the immunosuppressive regimen most likely contributes to this combination?

Options:

Correct Answer: Long-term corticosteroid therapy

Explanation: Prolonged corticosteroid exposure can cause weight gain, osteoporosis and increased susceptibility to infection as important treatment-related complications.

Question:

A healthy man wishes to donate a kidney to his brother. Medical evaluation shows a condition that would place the donor at substantial long-term health risk after nephrectomy. He remains strongly willing to donate. Which ethical principle most supports refusing donation?

Options:

Correct Answer: Non-maleficence

Explanation: Living donation should not expose a healthy donor to unacceptable medical harm. Respect for autonomy does not remove the transplant team’s duty to minimize avoidable harm.

Question:

A transplant program performs careful donor assessment before nephrectomy but has no organized system for monitoring living donors after surgery. Which weakness of the transplantation system is most evident?

Options:

Correct Answer: Inadequate long-term donor follow-up

Explanation: Ethical donor protection extends beyond the operation. Weak long-term follow-up can leave donor complications unrecognized and represents an important system-level deficiency.

Question:

A 29-year-old woman with end-stage kidney failure is receiving maintenance dialysis and becomes pregnant. Maternal biochemical control becomes more difficult and fetal growth requires close surveillance. Which management principle is most appropriate?

Options:

Correct Answer: Intensify dialysis with close maternal-fetal monitoring

Explanation: Pregnancy in a dialysis-dependent woman requires specialist care, and dialysis frequently needs intensification together with careful control of volume, biochemistry and fetal growth.

Question:

A 31-year-old woman with a stable renal transplant wishes to conceive. Her maintenance regimen includes sirolimus. Which pre-pregnancy approach is most appropriate?

Options:

Correct Answer: Replace sirolimus with a suitable regimen before conception

Explanation: mTOR inhibitors are generally avoided when pregnancy is planned. Immunosuppression should be adjusted before conception without exposing the graft to withdrawal-related rejection.

Question:

A renal transplant recipient asks when pregnancy would be safest to consider. Her graft function has recently fluctuated and she required treatment for rejection several weeks ago. Which principle should guide counseling?

Options:

Correct Answer: Plan pregnancy after graft stability and no recent significant rejection

Explanation: Pregnancy after transplantation should ideally be planned when graft function and blood pressure are stable and there has been no recent significant rejection.

Question:

Several weeks after kidney transplantation, a patient’s serum creatinine rises. Doppler imaging shows preserved graft perfusion, while ultrasonography demonstrates hydronephrosis of the transplanted kidney. Which complication is most likely?

Options:

Correct Answer: Ureteric obstruction

Explanation: Preserved perfusion with hydronephrosis points toward impaired urinary drainage rather than a vascular complication. Ureteric obstruction can therefore cause post-transplant graft dysfunction.

Question:

A 55-year-old man with type 2 diabetes has CKD with persistent albuminuria despite treatment of blood pressure and glycemia. His clinician considers adding another therapy specifically because of its kidney-protective role in suitable patients with diabetic CKD. Which drug class best fits this purpose?

Options:

Correct Answer: SGLT2 inhibitors

Explanation: In suitable patients with diabetic CKD, SGLT2 inhibitors provide kidney-protective benefit in addition to glucose-lowering effects and can help slow renal disease progression.