BPM1 CPR

IMCQ 9
HCB + ANAT
KEY
 1. A 65-year-old man comes to the emergency room because of lightheadedness,
dizziness and malaise. Physical examination shows a low blood pressure (80/50 mm Hg).
The changes in the urinary filtrate brought about by the decreased blood pressure is
monitored by the cells shown in the attached image. Which of the following statements
best characterizes these cells?

A. Endothelial cells of afferent arterioles

B. Epithelial cells of the distal tubule
C. Epithelial cells of the proximal tubule
D. Extraglomerular mesangial cells
E. Modified smooth muscle cells of
afferent arteriole

SOM.1ai.BPM1.3.CPR.1.HCB.UR.0505
 2. A 49-year-old man presents to his physician with symptoms of frequent urination,
increased thirst and appetite. His blood works show high levels of blood glucose levels
and presence of sugars in the urine. Biopsy taken from his right kidney shows extensive
hyalinization of renal corpuscles and damage to the tubules. The epithelial cells of the
segment of nephron that reabsorbs all of this sugar from the filtrate is normally
characterized by which of the following features?

A. Presence of abundant Golgi

B. Presence of abundant aquaporins
C. Presence of extensive microvilli
D. Blunted microvilli
E. Well defined cell boundaries

SOM.1ai.BPM1.3.CPR.1.HCB.UR.0505
 3. An 87-year-old woman dies from renal failure, despite all
appropriate treatment. An autopsy specimen shows damage to the
renal corpuscles. The main finding was proliferation of the cell
shown in the attached image. Which of the following is a normal
function of these cells?

A. Filtration of molecules smaller than 70,000 Da

B. Phagocytosis of molecules trapped in filtration
barrier
C. Reabsorption of glucose
D. Signaling from macula densa to juxtaglomerular
cells
E. Synthesis and secretion of atrial natriuretic
factor

SOM.1ai.BPM1.3.CPR.1.HCB.UR.0505
 4. A 35-year-old man comes to the hospital with complaints of increased thirst,
weakness and dry mouth for a duration of 10 days. Physical examinations shows severe
dehydration. His urine output is about 9 liters/day. Investigations show that his serum
ADH levels are very low and is diagnosed to have diabetes insipidus. Which of the
following will be the effect of this disease on his kidneys?

A. Decreased rate of filtration by the glomerular capillaries

B. Decreased reabsorption of water by proximal convoluted tubules
C. Decreased sodium reabsorption by the thin loop of Henle
D. Decreased water reabsorption by the collecting ducts
E. Excessive secretion of water by the collecting ducts

SOM.1ai.BPM1.3.CPR.1.HCB.UR.0505
SOM.1ai.BPM1.3.CPR.1.HCB.UR.0516
 5. A 49-year-old woman comes to the emergency department because of the sudden
onset of pain to her right back and blood in the urine. Physical examination shows
diffuse abdominal tenderness. Urine analysis shows red blood cells. Renal angiography
of the right kidney shows an infarction affecting the region shown in the attached
image. The blood vessels supplying this region are most likely branches from which of
the following vessels?

A. Interlobar arteries
B. Arcuate arteries
C. Interlobular arteries
D. Afferent arterioles
E. Efferent arterioles

SOM.1ai.BPM1.3.CPR.1.HCB.UR.0516
 6. A 68-year-old woman comes to the emergency department because of fatigue and
swollen feet. Physical examination shows peripheral edema. Laboratory studies of the
blood show anemia. A renal biopsy is collected and the TEM is shown in the attached
image. Which of the following is the primary function of this cell type in a normal
nephron?

A. Filtration of blood in glomerulus

B. Reabsorption of calcium from the filtrate
C. Reabsorption of 100% of glucose from the filtrate
D. Reabsorption of water under the influence of ADH
E. Secretion of water into the filtrate

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 7. A 23-year-old man comes to the
emergency department because of nausea,
vomiting and intense bilateral flank pain.
Physical examination shows he is
diaphoretic with bilateral costovertebral
angle tenderness. An MRI of the patient’s
kidney is shown. Which of the following
best describes the embryonic origin of the
abnormal finding?

A. Complete bifurcation of the ureteric

bud of the left kidney
B. Incomplete bifurcation of the
ureteric bud of the right kidney
C. Fusion of the inferior pole of the kidneys SOM.1ai.BPM1.3.CPR.1.ANAT.UR.2.29. Describe
D. Failure of ascent of the kidneys the development of a discoid (pancake) and a
horseshoe kidney.
E. Migration and fusion of the left kidney to the right
8. A 44-year-old man comes to the emergency department because of
excessive weight loss, left sided flank pain and hematuria. Physical
examination shows pale mucous membranes and a left sided intra-abdominal
mass. CT scan shows a large multilocular mass that has within the parenchyma
of the kidney. Histological examination shows a renal cell carcinoma which
originated in the proximal convoluted tubules. Which of the following
embryonic structures is the source of the precursor cells of this cancer?

A. Pronephros
B. Mesonephros
C. Metanephric blastema
D. Metanephric diverticulum
E. Cloaca
SOM.1ai.BPM1.3.CPR.1.ANAT.UR.1.24. Describe the develop
ment of the kidney from the metanephric diverticulum and
the metanephric mass of mesoderm.
9. A 24-year-old man is brought to the emergency department after being hit
by a truck. On physical examination the patient is unconscious and there is
bruising of the skin over the left kidney. Vitals: BP 85/65, pulse rate 110, RR
22. A urinary catheter is passed which reveals severe hematuria. CT scan
shows a hematoma collecting between the renal capsule and the tissue that
lies directly external to it. What is the name given to this tissue?

A. Perirenal fat
B. Transversalis fascia
C. Renal fascia
D. Pararenal fat
E. Parietal peritoneum

SOM.1ai.BPM1.3.CPR.1.ANAT.UR.1.3. Describe the kidneys in relation to the renal

fascia, perirenal and pararenal fat.
10. A 56-year-old man comes to the emergency department because of
excessive weight loss, left sided flank pain and hematuria. Physical
examination shows pale mucous membranes and a left sided intra-abdominal
mass. CT scan shows a large multilocular mass that has infiltrated the
parenchyma of the kidney. During a postero-lateral approach to remove the
cancerous kidney, which of the following nerves is most likely at risk?

A. Greater thoracic splanchnic

B. Genitofemoral
C. Iliohypogastric
D. Femoral
E. Lateral femoral cutaneous
SOM.1ai.BPM1.3.CPR.1.ANAT.UR.1.1.
Describe the location of the kidneys and their relationship with
surrounding organs and ribs 11 and 12
11. A-20-year-old woman comes to the emergency department because of
nausea, vomiting and intense bilateral flank pain. Her pain intensifies when
she is in the upright position and alleviated when she lies down. MRI shows
significantly reduced amounts of perirenal and pararenal fat. The physician
suspects that her pain is most likely caused by the obstruction of the proximal
ureters caused by nephroptosis (the sudden "ectopic" descent of the kidney).
The visceral afferent fibers will most likely be referred to the cutaneous areas
supplied by which of the following dermatomes?

A. S2-S4
B. T5-T9
C. T11-L2
D. T1-T4
E. T10 SOM.1ai.BPM1.3.CPR.1.ANAT.UR.1.9. Describe the blood supply
, innervation and venous drainage of the kidney.
 12. A 57-year-old woman is admitted to the
hospital with severe pain radiating from the lumbar
region of the abdomen to the pubic symphysis on
the right. Ureteric obstruction is suspected and
confirmed by an intravenous pyelogram where
contrast material is introduced via the vascular
system (shown). Which of the following is the most
likely location of the urinary stone?
A. In the minor calyx
B. In the urethra
C. At the ureteropelvic junction
D. Midway in the ureter
E. At the ureterovesical junction

SOM.1ai.BPM1.3.CPR.1.ANAT.UR.3.11. List the sites of

constriction of the ureters and explain their relationship to
kidney stones.
 13. A 53-year-old woman is with a history of kidney disease is brought to the
emergency department because of abdominal pain and hematuria. Physical
examination shows a large abdominal mass. CT scan shows a large tumor on
the right kidney. During removal of the kidney, Which of the following should
the surgeon performing the surgery remember?
A. The left kidney lies a bit lower than the right one
B. The perirenal fat lies external to the renal fascia
C. The renal fascia does not surround the suprarenal gland
D. The left renal vein runs anterior to both the aorta and the left renal artery
E. The right renal artery is shorter than the left renal artery

SOM.1ai.BPM1.3.CPR.1.ANAT.UR.1.1.
Describe the location of the kidneys and their relationship with
surrounding organs and ribs 11 and 12.
14. A 56-year-old multiparous woman comes to the physician because of
passing small amounts of urine whenever she coughs or sneezes. Which of
the following muscles is most likely weakened to result in the patient's
symptoms?

A. Piriformis
B. Obturator internus
C. Rectus abdominis
D. Pubococcygeus
E. Coccygeus

SOM.1ai.BPM1.3.CPR.1.ANAT.UR.3.36. Define the term “stress

urinary incontinence” and explain which structures may be
injured during vaginal delivery to lead to this condition.
Key
1. B
2. C
3. B
4. D
5. E
6. C
7. C
8. C
9. A
10. C
11. C
12. C
13. D
14. D