FCPS IMM Nephrology MCQs: High-Yield Practice Questions & Prep

Sample FCPS IMM Medicine nephrology MCQs on nephrotic and nephritic syndromes, renal tubular acidosis, CKD, stones and acid-base disorders, with explanations.

Nephrology questions in IMM cover glomerular disease, renal tubular acidosis, chronic kidney disease and its complications, stones and acid-base interpretation. They reward a systematic approach more than memorisation. Below is a practice set with the reasoning shown.

Sample Nephrology MCQs

1. A patient ABG values of pH 7.66, HCO3 34, PCO2 34. What is the explanation for his ABGs?

A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Mixed respiratory + metabolic alkalosis ✅

Why: A very high pH with both a low PCO2 (respiratory alkalosis) and a high HCO3 (metabolic alkalosis) is a mixed alkalosis.

2. A 69-year-old female presents for the very first time in the emergency department with untreated CCF. Urinalysis and urine biochemistry are most likely to show which of the following?

A) Proteinuria
B) Decreased urine Na+ ✅
C) Decreased specific gravity
D) Increased urine Na+

Why: Low effective circulating volume in heart failure causes a pre-renal state with avid sodium retention, so urine sodium is low.

3. A young male was prescribed by a quack for weight gain and muscle strength; now he developed oliguria. Which of the following is the probable cause?

A) Acute interstitial nephritis
B) Glomerulonephritis
C) Acute tubular necrosis ✅
D) Papillary necrosis

Why: Anabolic/muscle-building agents and muscle breakdown can cause toxic or pigment-induced acute tubular necrosis, the commonest cause of intrinsic AKI.

4. A 16-year-old guy feels difficulty in hearing since childhood, and now presented with renal failure. What do you think he will have?

A) Nephritic syndrome
B) Nephrotic syndrome
C) Alport syndrome ✅
D) Anti-GBM disease
E) Down syndrome

Why: Sensorineural deafness with progressive nephritis in a young male is Alport syndrome (X-linked type IV collagen defect).

5. A patient presents with features of heart failure, proteinuria, hepatomegaly and decreased sexual function. Diagnosis?

A) Haemochromatosis
B) Amyloidosis ✅
C) Haemosiderin
D) Nephrotic syndrome

Why: Amyloid deposition in the heart (restrictive failure), kidney (proteinuria), liver (hepatomegaly) and autonomic nerves (impotence) fits systemic amyloidosis.

6. In a chronic kidney disease patient, the cause of renal osteodystrophy is:

A) Erythropoietin deficiency
B) Calcium deficiency
C) Proteinuria
D) Deficiency of 1,25 vitamin D ✅

Why: Deficiency of 1,25-dihydroxyvitamin D leads to hypocalcaemia and secondary hyperparathyroidism, producing renal osteodystrophy.

7. A diabetic patient presents to you with left flank pain for 3 days, she said that she had been passing blood with urine for the last 2 days, and now she has no urine output in the last 20 hours. What do you think the diagnosis is?

A) Acute tubular necrosis
B) Renal papillary necrosis ✅
C) Acute pyelonephritis
D) Acute interstitial nephritis

Why: Flank pain, haematuria and anuria in a diabetic suggests sloughed papillae causing ureteric obstruction, i.e. renal papillary necrosis.

8. A patient with acute MI developed oliguria and uraemia. His K levels are raised, BP 90/60, pulse 100/min, respiratory rate 35/min. Best treatment modality in this case?

A) Glucose and insulin
B) Dietary K restriction
C) K-sparing drugs
D) Peritoneal dialysis ✅

Why: A haemodynamically unstable patient tolerates peritoneal dialysis better than haemodialysis, which causes rapid fluid shifts and hypotension.

How to Approach Nephrology for IMM

Sort every glomerular vignette into nephrotic or nephritic first, then narrow by age and serology.
Use the anion gap and serum potassium to separate the renal tubular acidoses.
Know what each dialysis indication and each transplant complication looks like on a vignette.

Browse every Nephrology question on its own: Nephrology MCQs.

Keep Practising

These questions come from HighYield's FCPS IMM Medicine QBank, which holds over 2,400 clinical-vignette MCQs with an explanation for every answer. The first 20 questions are free in Tutor mode, so you can judge the explanation quality before unlocking the full bank.