Multiple Choice Questions (MCQ)

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Category: Medicine--->Nephrology
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Question 6# Print Question

A 47-year-old HIV-positive man is brought to the emergency room because of weakness. The patient has HIV nephropathy and adrenal insufficiency. He takes trimethoprim-sulfamethoxazole for PCP prophylaxis and is on triple-agent antiretroviral treatment. He was recently started on spironolac-tone for ascites due to alcoholic liver disease. Physical examination reveals normal vital signs, but his muscles are diffusely weak. Frequent extrasystoles are noted. He has mild ascites and 1 + peripheral edema. Laboratory studies show a serum creatinine of 2.5 with a potassium value of 7.3 mEq/L. An EKG shows peaking of the T waves and QRS duration of 0.14.

What is the most important immediate treatment? 

A. Sodium polystyrene sulfonate (Kayexalate)
B. Acute hemodialysis
C. IV normal saline
D. IV calcium gluconate
E. IV furosemide 80 mg stat

Question 7# Print Question

An 85-year-old man who resides in a nursing home presents with a 3-day history of lower abdominal pain and increasing fatigue and lethargy. He is afebrile, his BP is 160/92, and RR 16. His lungs are clear and his heart examination normal. There is diffuse abdominal tenderness on palpation and a large area of fullness and dullness to percussion starting just below the umbilicus and extending to the suprapubic area. His serum sodium is 130 mEq/L, potassium 4.9 mEq/L, BUN 75 mg/dL, and creatinine is 3.5 mg/dL. His baseline BUN and creatinine were 25 and 1.3 respectively as recently as 1 month ago. A Foley catheter is placed and 1200 cc of urine is obtained.

What will be the likely clinical course for this patient with regard to his renal function? 

A. His creatinine will continue to rise slowly for 2 to 3 more days
B. His creatinine will return to 1.3 over the next week
C. He will require dialysis within 24 hours
D. He will produce minimal urinary output for at least 3 days
E. His renal function is unlikely to show any improvement in the future and 3.5 will be his new baseline

Question 8# Print Question

A 73-year-old man undergoes abdominal aortic aneurysm repair. The patient develops hypotension to 80/50 for approximately 20 minutes during the procedure according to the anesthesia record. He received 4 units of packed red blood cells. Postoperatively, his blood pressure is 110/70, heart rate is 110, surgical wound is clean, and a Foley catheter is in place. Over the next 2 days his urine output slowly decreases. His creatinine on post-op day 3 is 3.5 mg/dL (baseline 1.2). His sodium is 140 mEq/L, K 4.6 mEq/L, and BUN 50 mg/dL. Hemoglobin and hematocrit are stable. Urinalysis shows occasional granular casts but otherwise is normal. Urine sodium is 50 mEq/L, urine osmolality is 290 mosmol/L, and urine creatinine is 35 mg/dL. The FeNa (fractional excretion of sodium) based on these data is 3.5.

What is the most likely cause of this patient’s acute renal failure? 

A. Acute interstitial nephritis
B. Acute glomerulonephritis
C. Acute tubular necrosis
D. Prerenal azotemia
E. Contrast induced nephropathy

Question 9# Print Question

A 25-year-old man is referred to you because of hematuria. He noticed brief reddening of the urine with a recent respiratory infection. The gross hematuria resolved, but his physician found microscopic hematuria on two subsequent first-voided morning urine specimens. The patient is otherwise healthy; he does not smoke. His blood pressure is 114/72 and the physical examination is normal. The urinalysis shows 2+ protein and 10 to 15 RBC/hpf, with some dysmorphic erythrocytes. No WBC or casts are seen.

What is the most likely cause of his hematuria? 

A. Kidney stone
B. Renal cell carcinoma
C. Acute poststreptococcal glomerulonephritis
D. Chronic prostatitis
E. IgA nephropathy (Berger disease)

Question 10# Print Question

A 17-year-old man is brought to the emergency room with confusion and incoordination. He is uncooperative and refuses to provide further history. Physical examination reveals an RR of 30; the vital signs are otherwise normal as is the general physical examination. Laboratory values are as follows:

  • Na: 135 mEq/L
  • K: 2.7 mEq/L
  • HCO3 : 15 mEq/L
  • Cl: 110 mEq/L
  • Arterial blood gases: PO2 92, PCO2 30, pH 7.28
  • Urine: pH 7.5, glucose—negative
  • Ca: 9.7 mg/dL
  • PO4 : 4.0 mg/dL

Which of the following is the most likely cause of the acid base disorder? 

A. GI loss owing to diarrhea
B. Proximal renal tubular acidosis
C. Disorder of the renin-angiotensin system
D. Distal renal tubular acidosis
E. Respiratory acidosis

Category: Medicine--->Nephrology
Page: 2 of 5