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Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acute Renal Failure
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Question 1#Print Question

A 62-year-old male presents to the hospital complaining of nonradiating back pain for the past 2 days. He has a past medical history of hypertension, hyperlipidemia, and chronic back pain for which he takes ibuprofen, atorvastatin, and hydrochlorothiazide. He mentions that he tried to take a few extra doses of analgesics which did not seem to help, and it seems like his regular water pill is not working either. His vitals are as follows:

  • Heart rate (HR) 110 bpm
  • respiratory rate (RR) 18/min
  • blood pressure (BP) 95/54 mm Hg
  • SpO2 98%
  • temp 37.3°C

and laboratory work as follows:

  • WBC 5.08 k/µL
  • hemoglobin (Hb) 14 g/dL
  • hematocrit (Hct) 37%
  • platelet (Plt) count 290 k/µL
  • Sodium (Na) 143 mmol/L
  • potassium (K) 4.3 mmol/L
  • CO 18 mmol/L
  • chloride (Cl) 109 mmol/L
  • BUN 30 mg/dL
  • serum creatinine (Scr) 2.0 mg/dL
  • Anion gap is 16 mmol/L

Which of the following etiologies for acute renal injury (AKI) should ALWAYS be excluded first?

a. Dehydration
b. Nonsteroidal anti-inflammatory overdose
c. Septic shock
d. Chronic anemia


Question 2#Print Question

A 35-year-old obese female with a past medical history of type 2 diabetes, chronic kidney disease (CKD) stage 3, chronic obstructive pulmonary disease (COPD), and deep vein thrombosis (DVT) is brought to the emergency room with acute-onset shortness of breath. She is on home oxygen for the COPD, warfarin, and subcutaneous insulin therapy. Her chest x-ray reveals hyperinflated lung fields, and CT angiogram did NOT reveal pulmonary embolism (PE). She was admitted and treated for COPD exacerbation. Serum creatinine is noticed to have increased to 2.6/dL from a baseline of 1.3 mg/dL with concern for contrast-induced acute kidney injury (CIAKI).

Which of the following strategies is MOST likely to prevent CI-AKI? 

a. Use of isotonic saline infusion before and after CT angiogram
b. Use of a lower-osmolality, lower-viscosity contrast agent
c. Use of V/Q scan to rule out PE
d. Use of N-acetyl cysteine (NAC) before and after the angiogram


Question 3#Print Question

A healthy 24-year-old male is admitted to the intensive care unit (ICU) for AKI and hyperkalemia. History is remarkable for a recent episode of sinusitis for which amoxicillin-clavulanate therapy was initiated. Physical examination is notable for a temperature of 37.6°C, skin rashes, and joint pain. Urine microscopy shows a few RBC’s and eosinophils. Laboratory results are given below:

  • WBC 12.5 k/µL
  • Hb 14.3 g/dL
  • Hct 38%
  • Plt 256 k/µL
  • and eosinophilia
  • Na 137 mmol/L
  • K 5.7 mmol/L
  • Cl 106 mmol/L
  • CO 22 mmol/L
  • BUN 18 mg/dL
  • Scr 2.3 mg/dL
  • glucose 176 mg/dL

What is the MOST appropriate next step in the management of this patient?

a. Add amikacin
b. Discontinue amoxicillin-clavulanate
c. Add vancomycin
d. Send patient for kidney biopsy


Question 4#Print Question

A 33-year-old muscular male is brought to emergency room after being rescued from under a collapsed concrete building. Physical examination reveals multiple lower extremity bone fractures and skin lacerations. CT scan is negative for traumatic brain injury. Vitals are as follows:

  • HR 110 bpm
  • BP 100/65 mm Hg
  • RR 20/min
  • SpO2 96%
  • temp 37.5°C

and laboratory parameters are as follows:

  • Hb 10 g/dL
  • Na 143 meq/L
  • K 4.0 meq/L
  • Cl 109 meq/L
  • creatine kinase (CK) 15 000 units/L

He has received a liter of lactated ringers so far. His urine output is dark brown and only 10 mL for the past hour.

Which of the following is the next BEST step in the management of this patient?

a. Administer 40 mg of furosemide
b. Administer 1 g/kg of mannitol
c. Administer 1 L of normal saline (0.9% NS)
d. Administer 50 meq of sodium bicarbonate


Question 5#Print Question

Which of the following statements is MOST ACCURATE regarding the pathophysiology behind bilateral obstructive nephropathy?

a. Glomerular filtration rate (GFR) is increased by increasing renal blood flow and decrease in tubular hydrostatic pressure
b. Sodium excretion is partially stimulated after relief of obstruction due to upregulation of atrial natriuretic peptide
c. Arterial blood gas will demonstrate a hypokalemic, metabolic alkalosis
d. Renal ultrasound is NOT a useful screening tool for obstructive uropathy due to low specificity




Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acute Renal Failure
Page: 1 of 2