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Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Diagnosis and Monitoring in Renal Failure
Page: 2

Question 6#Print Question

A 42-year-old man with a history of insulin-dependent diabetes mellitus, hypertension, and end-stage renal disease on hemodialysis is admitted to the surgical ICU after a motor vehicle collision resulting in femur fracture and subdural hematoma. The patient is alert and oriented. His vital signs are:

  • blood pressure (BP) 185/100 mm Hg
  • heart rate (HR) 110 beats per minute
  • respiratory rate 12/min
  • SpO2 95% on room air

His blood work is significant for:

  • creatinine 4 mg/dL
  • urea 80 mg/dL
  • potassium 5.8 mEq/L

The patient states that he missed a dialysis session two days ago and that he was on his way to the dialysis center when he had the car accident.

Which of the following dialysis modalities is INAPPROPRIATE for this patient? 

A. Intermittent hemodialysis (iHD)
B. Continues renal replacement therapy (CRRT)
C. Sustained low efficiency dialysis (SLED)
D. Extended daily dialysis (EDD)


Question 7#Print Question

A 64-year-old male with a history of cirrhosis secondary to hepatitis C is being evaluated for abdominal pain. The patient reports worsening generalized abdominal pain and fever for the past 4 days. He denies hematemesis or melena. His BP was 110/60 mm Hg, and HR was 95 beats per minute. His physical examination is significant for icterus, ascites, and generalized abdominal tenderness. Laboratory analysis is notable for:

  • white blood cell count of 18 000/ µL
  • creatinine 1.1 mmol/L (baseline 0.8 mmol/L)
  • blood urea nitrogen 36 mg/dL
  • total bilirubin is >4.3 mg/dL

The patient received broad-spectrum antibiotics.

Which of the following drugs is MOST appropriate to administer to reduce risk for renal failure in this patient?

A. Terlipressin 1 mg IV bolus now and then every 6 hours plus 1 g/kg of albumin
B. Albumin 1.5 g per kg now and 1.0 g/kg on day 3
C. Midodrine 7.5 mg orally now and then every 8 hours plus 1 g/kg of albumin
D. Octreotide subcutaneous injection 100 µg now and then every 8 hours plus 1 g/kg of albumin


Question 8#Print Question

A 22-year-old man presented to the ED with vomiting, altered mental status, and fever. The patient’s roommate states that the patient has not been feeling well for 2 days, yesterday was complaining of fever and headache. This morning the patient had a new-onset seizure and altered mental status. The patient’s roommate is not aware of any history of drug abuse other than marijuana. In the ED, a CT scan was done and did not show any acute intracranial pathology. Urine toxicology screen was positive for cannabis. A lumbar puncture was done in the ED and resulted cell count consistent with viral meningitis/encephalitis. Cerebrospinal fluid herpes simplex virus (HSV) PCR and bacterial cultures were ordered, and results are pending. The patient was started on empirical vancomycin, ceftriaxone, and acyclovir. The patient was admitted to the ICU for monitoring. The next day, the patient’s mental status improved and the patient was transferred out of the ICU to the medical floor. The following day (48 hours after admission), the patient starts to have nausea, oliguria, abdominal, and flank pain. Repeated blood works were significant for:

  • creatinine 3.2 mg/dL
  • urea 56 mg/dL
  • potassium 5.3 mEq/L
  • sodium 142 mEq/L

Urine analysis shows white blood cells 5 cells/HPF, red blood cells 5 cells/HPF, protein 100 mg/dL, and crystals.

Which of the following is the MOST LIKELY cause of acute kidney injury (AKI)/failure in this patient?

A. Vancomycin
B. Synthetic marijuana
C. Acyclovir
D. Ceftriaxone


Question 9#Print Question

A 75-year-old male is in postoperative day 3 in the ICU status post liver resection. He was aggressively resuscitated with IV fluids in the perioperative period. Currently, he is mechanically ventilated and hemodynamically stable; however over the last 24 hours, his urine output has decreased significantly to 5 mL/h.

What is the best test to assess his AKI?

A. Serum urea/creatinine
B. Urine sodium
C. Renal ultrasound with Doppler
D. Abdominal CT scan




Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Diagnosis and Monitoring in Renal Failure
Page: 2 of 2