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AMC MCQ · Nephrology

AMC Nephrology MCQ Practice — 100+ Questions for IMGs

AKI, CKD, electrolytes, glomerulonephritis and dialysis — AMC MCQ nephrology MCQs for IMGs.

131 questions in the full bank · 5 free samples below · Spaced repetition + AI explanations on the free tier.

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Why Nephrology matters in AMC MCQ

Nephrology contributes 6–9 questions to AMC MCQ, dominated by acute kidney injury (AKI), chronic kidney disease staging, electrolyte disturbances, glomerulonephritis, and renal replacement therapy. Australian examiners expect IMGs to confidently calculate eGFR, recognise pre-renal vs intrinsic vs post-renal AKI from the urea:creatinine ratio and urinalysis, and adjust drug doses accordingly.

Mostly Medicine’s renal bank is mapped to the KDIGO guidelines (used by the Australian and New Zealand Society of Nephrology), Therapeutic Guidelines: Kidney/Urinary, and the Caring for Australasians with Renal Impairment (CARI) recommendations. You’ll practise items on AKI staging by KDIGO criteria, the contrast-induced AKI prevention bundle, hyperkalaemia ECG changes and treatment ladder (calcium gluconate → insulin/dextrose → salbutamol → dialysis), SIADH versus cerebral salt wasting, the differential for nephrotic versus nephritic syndrome, and dialysis indications using the AEIOU mnemonic.

AMC renal vignettes typically pair a creatinine trend with electrolytes, urine output and fluid status, then ask for the next investigation or management. Practising 130+ Australian-aligned nephrology MCQs cements pattern recognition. Sign up free to unlock the full bank.

5 free Nephrology sample MCQs

Below are five sample questions taken straight from the Mostly Medicine nephrology bank. The correct answer is highlighted, with the worked explanation tucked inside a collapsed panel so you can self-test first.

Question 1AKI · medium

A 65-year-old man on ramipril and metformin has gastroenteritis for 3 days. His creatinine rises from baseline 95 to 310 μmol/L. What is the MOST important immediate step?

  1. A.Continue all medications and increase fluid intake orally
  2. B.Stop ramipril and metformin, IV fluid resuscitationCorrect
  3. C.Start haemodialysis
  4. D.Nephrology referral before any medication changes
  5. E.Give IV furosemide to increase urine output
Show explanation

Sick day rules: hold nephrotoxic/renal-excreting drugs during AKI — ramipril (can worsen AKI in dehydration) and metformin (risk of lactic acidosis). IV fluids for pre-renal AKI. 'SADMANS' drugs to hold: sulfonamides, ACEi, diuretics, metformin, aminoglycosides, NSAIDs, SGLT2i.

Question 2AKI · hard

A 70-year-old man on perindopril and furosemide for hypertension starts ibuprofen for knee pain. He presents with oliguria and creatinine rise from 110 to 280 µmol/L. This is the 'triple whammy'. What is the mechanism?

  1. A.ACEi reduces GFR; diuretic reduces perfusion; NSAID reduces afferent vasoconstriction
  2. B.ACEi blocks angiotensin II efferent constriction; diuretic reduces volume; NSAID reduces prostaglandin-mediated afferent vasodilationCorrect
  3. C.All three are direct nephrotoxins
  4. D.NSAID causes interstitial nephritis; ACEi causes tubular damage
  5. E.Triple whammy only relevant in diabetes
Show explanation

Triple whammy AKI: ACEi/ARB (blocks efferent arteriolar constriction via RAAS → reduces GFR) + diuretic (volume depletion) + NSAID (blocks prostaglandins that maintain afferent vasodilation in low-volume states) → critical reduction in GFR → AKI. Management: stop all three, IV fluids. ACEi/diuretic can usually be restarted after recovery. Avoid NSAIDs in elderly with CKD.

Question 3CKD · medium

A 55-year-old diabetic woman has CKD Stage 3b (eGFR 32 mL/min/1.73m²). Her BP is 140/88 on amlodipine. Urine ACR 85 mg/mmol. She is on metformin. Which medications should be addressed?

  1. A.Stop amlodipine — contraindicated in CKD
  2. B.Stop metformin (eGFR <30) + add ACEi/ARB for proteinuriaCorrect
  3. C.Continue all medications — no changes needed at eGFR 32
  4. D.Add diuretic for BP control
  5. E.Refer for dialysis immediately
Show explanation

CKD Stage 3b (eGFR 30–44): metformin should be stopped at eGFR <30 (risk of lactic acidosis). Review at eGFR <45 (reduce dose, more frequent monitoring). ACEi or ARB: first-line for proteinuric CKD (reduces ACR, slows progression). SGLT2i now approved for CKD with albuminuria (eGFR ≥20). Amlodipine is safe in CKD. Monitor K+ with ACEi/ARB.

Question 4Nephrotic Syndrome · medium

A 5-year-old boy develops periorbital oedema, ascites, and frothy urine. Urine protein 3+ (>3.5 g/day). Serum albumin 18 g/L. Cholesterol elevated. BP normal. No haematuria. What is the most likely diagnosis and treatment?

  1. A.IgA nephropathy — no treatment
  2. B.Minimal change disease — high-dose prednisoloneCorrect
  3. C.Focal segmental glomerulosclerosis — ciclosporin
  4. D.Membranous nephropathy — watchful waiting
  5. E.Henoch-Schönlein purpura — steroids
Show explanation

Nephrotic syndrome in children: most common cause is minimal change disease (MCD). Features: heavy proteinuria (>3.5 g/day), hypoalbuminaemia, oedema, hyperlipidaemia, no haematuria (unlike nephritic). Treat empirically with corticosteroids (prednisolone 60 mg/m²/day) — 90% respond. Biopsy only if atypical features or steroid resistance. MCD in adults: often paraneoplastic (Hodgkin's lymphoma).

Question 5Nephritic Syndrome · medium

A 28-year-old man has haematuria (red cell casts on urine microscopy), proteinuria 1.5 g/day, hypertension, and creatinine 180 µmol/L. He had pharyngitis 3 weeks ago. C3 is low, C4 normal. ASOT elevated. What is the diagnosis?

  1. A.IgA nephropathy (Berger's disease)
  2. B.Post-streptococcal glomerulonephritis (PSGN)Correct
  3. C.Lupus nephritis
  4. D.Anti-GBM disease (Goodpasture's)
  5. E.ANCA vasculitis
Show explanation

PSGN: 1–3 weeks after Group A strep throat infection (10 days if skin). Nephritic syndrome, low C3 (normal C4 — alternative complement pathway), elevated ASOT. Usually self-limiting. Treat BP, fluid balance. No specific therapy. Most recover fully. IgA nephropathy: haematuria 1–2 days after URTI (concurrent, not 3 weeks later), normal complement. SLE: low C3+C4. Anti-GBM: haemoptysis + renal failure.

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Nephrology FAQ

How is AKI staged in AMC MCQ?

KDIGO criteria: Stage 1 = creatinine ×1.5–1.9 baseline; Stage 2 = ×2–2.9; Stage 3 = ×3 or absolute creatinine ≥354 µmol/L, or RRT initiated. Urine output thresholds <0.5 mL/kg/h define each stage.

What electrolyte disturbances are high-yield?

Hyperkalaemia (ECG, treatment ladder), hyponatraemia (SIADH, cerebral salt wasting, hypovolaemic), hypercalcaemia of malignancy (IV fluids ± zoledronate), and hypomagnesaemia (often missed in refractory hypokalaemia).

Are dialysis indications tested?

Yes. AEIOU: Acidosis (refractory), Electrolytes (hyperkalaemia >6.5 unresponsive), Ingestion (lithium, salicylates, methanol), Overload (refractory pulmonary oedema), Uraemia (encephalopathy, pericarditis).

What about glomerulonephritis?

Distinguish nephritic (haematuria, hypertension, modest proteinuria — e.g. IgA, post-strep, anti-GBM) from nephrotic (proteinuria >3.5 g/day, hypoalbuminaemia, oedema — e.g. minimal change, FSGS, membranous, diabetic).

How many nephrology MCQs are free?

Five sample nephrology MCQs with explanations on this page. The full 130+ bank unlocks with a free Mostly Medicine account.