Renal System Practice Test Questions For Physician Assistant Exam

Last Updated on March 25, 2025

Renal System Practice Test Questions For Physician Assistant Exam PANCE. This sample quiz test consists of 20 multiple-choice questions on the Renal System. Try our free practice test for the Physician Assistant Exam preparation.

The official questions from the Renal System are 5%. The human urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra.

Renal System Practice Test Questions

Renal System Practice Questions
Physician Assistant Exam
Total Items: 20
Time Limit: NA

1) A patient in the intensive care unit has a fractional excretion of sodium (FeNa) <1%, low urine sodium concentration, and high BUN:Cr ratio (>20:1). Which type of acute kidney injury does this indicate?

A) Intrinsic (acute tubular necrosis)

B) Postrenal obstruction

C) Glomerulonephritis

D) Prerenal azotemia

E) Contrast-induced nephropathy

2) A 28-year-old male with a history of recurrent kidney stones is found to have hypercalciuria and hypercalcemia. His parathyroid hormone (PTH) level is inappropriately high. Which of the following is the most likely diagnosis?

A) Primary hyperparathyroidism

B) Secondary hyperparathyroidism

C) Tertiary hyperparathyroidism

D) Familial hypocalciuric hypercalcemia

E) Hypoparathyroidism

3) A 62-year-old male with a 50 pack-year smoking history presents with painless hematuria. Physical exam is unremarkable. Which of the following diagnoses must be ruled out first?

A) Urinary tract infection

B) Prostate cancer

C) Benign prostatic hyperplasia

D) Urolithiasis

E) Bladder cancer

4) A 54-year-old male with poorly controlled diabetes presents with persistent microalbuminuria. Which medication class is recommended to slow progression of diabetic nephropathy?

A) ACE inhibitors or ARBs

B) Thiazide diuretics

C) Beta-blockers

D) Calcium channel blockers

E) Nitrates

5) Individuals who suffer from chronic kidney disease should avoid a diet rich in which of the following?

A) Nightshade vegetables

B) Protein

C) Green vegetables

D) Wheat

E) Corn

6) A 35-year-old female presents with fatigue, pallor, and easy bruising. Laboratory tests show elevated creatinine, low platelets, and microangiopathic hemolytic anemia. Which of the following diagnoses is most likely?

A) Hemolytic uremic syndrome (HUS)

B) IgA nephropathy

C) Systemic lupus erythematosus (SLE)

D) Thrombotic thrombocytopenic purpura (TTP)

E) Disseminated intravascular coagulation (DIC)

7) A 50-year-old male complains of polyuria, polydipsia, and nocturia. Laboratory testing shows a low urine osmolality, low urine specific gravity, and high serum sodium. Water deprivation test does not increase urine concentration, but does respond to desmopressin. What is the most likely diagnosis?

A) Diabetes mellitus type 2

B) Psychogenic polydipsia

C) SIADH

D) Central diabetes insipidus

E) Nephrogenic diabetes insipidus

8) A 25-year-old male presents with severe right flank pain radiating to the groin, nausea, and hematuria. Which imaging modality is most appropriate first-line to evaluate suspected nephrolithiasis?

A) X-ray KUB (kidneys, ureters, bladder)

B) Ultrasound of the kidney/ureter

C) Noncontrast CT scan of the abdomen/pelvis

D) IV pyelogram

E) MRI abdomen

9) A 45-year-old male with hematuria has bilateral flank masses palpable on exam. Imaging reveals enlarged cystic kidneys. Which extrarenal manifestation is commonly associated with this condition?

A) Hepatocellular carcinoma

B) Cerebral “berry” aneurysms

C) Pancreatic cancer

D) Rheumatoid arthritis

E) Aortic aneurysm

10) Which of the following is commonly prescribed for treatment of hypokalemia?

A) Oral phosphorus

B) Oral calcium

C) IV phosphorus

D) Oral potassium

E) IV magnesium

11) A spot urine test uses a sample size of which of the following?

A) 10–20 mL

B) 45–60 mL

C) 120–150 mL

D) 40–50 mL

E) 90–100 mL

12) A 34-year-old female presents with dysuria, urinary frequency, and suprapubic pain for 2 days. She denies flank pain or fever. Urinalysis shows nitrites and leukocyte esterase positivity. Which of the following is the most appropriate initial treatment?

A) Hospital admission for IV fluids

B) Urinary analgesics only

C) IV ceftriaxone

D) Oral nitrofurantoin

E) Oral fluconazole

13) A 45-year-old female with longstanding hypertension has a sudden rise in serum creatinine. Renal ultrasound shows small kidneys bilaterally. Urinalysis is relatively benign. Which of the following is the most likely diagnosis?

A) Hypertensive nephrosclerosis

B) Lupus nephritis

C) Polycystic kidney disease

D) Diabetic nephropathy

E) Chronic pyelonephritis

14) A 70-year-old male presents with difficulty initiating urination and nocturia. Digital rectal exam reveals an enlarged, non-tender prostate. Serum creatinine is elevated. A renal ultrasound shows bilateral hydronephrosis. Which of the following is the most likely cause of his renal dysfunction?

A) Prerenal azotemia due to dehydration

B) Intrinsic renal failure (acute tubular necrosis)

C) Rapidly progressive glomerulonephritis

D) Minimal change disease

E) Postrenal obstruction from benign prostatic hyperplasia

15) A 55-year-old male presents with edema, hypertension, and frothy urine. Urinalysis reveals fatty casts. Which of the following syndromes is most likely?

A) Pyelonephritis

B) Minimal change disease (specifically)

C) Nephritic syndrome

D) Urinary tract infection

E) Nephrotic syndrome

16) Which of the following medications is used for the treatment of nephrotic syndrome?

A) Meloxicam

B) Naproxen

C) Piroxicam

D) ACE inhibitors

E) Ibuprofen

17) A 32-year-old male who recently returned from a hiking trip presents with fever, rash, eosinophilia, and acute kidney injury. He has been taking NSAIDs for joint aches. Urinalysis shows white blood cell casts. Which of the following is the most likely diagnosis?

A) Acute interstitial nephritis

B) Chronic pyelonephritis

C) Nephrotic syndrome

D) Acute tubular necrosis

E) Nephritic syndrome

18) A 62-year-old female presents with fatigue and pruritus. Labs reveal elevated alkaline phosphatase and mild bilirubin elevation. Imaging rules out biliary obstruction. Over time, she develops hyperlipidemia and xanthomas. Although this is a hepatobiliary disease, patients can also present with renal tubular acidosis. Which disease?

A) Primary biliary cholangitis (PBC)

B) Hemochromatosis

C) Autoimmune hepatitis

D) Wilson’s disease

E) Primary sclerosing cholangitis (PSC)

19) A 19-year-old female is found to have proteinuria (1 g/day) and hematuria with RBC casts on urinalysis. She has mild edema and hypertension. These findings suggest which of the following?

A) Pyelonephritis

B) Minimal change disease

C) Nephrotic syndrome

D) Prerenal azotemia

E) Nephritic syndrome

20) Which of the following conditions refers to serum sodium levels of <136 mEq/L?

A) Hypospadias

B) Hypokalemia

C) Hyphema

D) Hyponatremia

E) Hypotonia

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