Multiple Choice Questions (MCQ)

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Category: Medicine--->Nephrology
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Question 16# Print Question

A 27-year-old alcoholic man presents with decreased appetite, mild generalized weakness, intermittent mild abdominal pain, perioral numbness, and some cramping ofhis hands and feet. His physical examination is initially normal. His laboratory returns with a sodium level of 140 mEq/L, potassium 4.0 mEq/L, calcium 6.9 mg/dL, albumin 3.5 g/dL, magnesium 0.7 mg/dL, and phosphorus 2.0 mg/dL. You go back to the patient and find that he has both a positive Trousseau and a positive Chvostek sign.

Which of the following is the most likely cause of the hypocalcemia? 

A. Poor dietary intake
B. Hypoalbuminemia
C. Pancreatitis
D. Decreased end-organ response to parathyroid hormone because of hypomagnesemia
E. Osteoporosis caused by hypogonadism

Question 17# Print Question

A 27-year-old woman presents to the emergency room with a panic attack. She appears healthy except for tachycardia and a respiratory rate of 30. Electrolytes include calcium 10.0 mg/dL, albumin 4.0 g/dL, phosphorus 0.8 mg/dL, and magnesium 1.5 mEq/L. Arterial blood gases include pH of 7.56, P CO2 21 mm Hg, and PO2 99 mm Hg.

Which of the following is the most likely cause of the hypophosphatemia? 

A. Hypomagnesemia
B. Hyperparathyroidism
C. Respiratory alkalosis with intracellular shift
D. Poor dietary intake
E. Vitamin D deficiency

Question 18# Print Question

 A 50-year-old diabetic woman presents for follow-up of her hypertension. Her blood pressure is 152/96 in the office today and she brings in readings from home that are consistently in the same range over the past month. Her current medications are amlodipine 5 mg daily and hydro-chlorothiazide 25 mg daily. The diuretic was added when she developed peripheral edema on the amlodipine; now she has only trace peripheral edema. A spot urine specimen shows 280 µg of albumin per mg creatinine (microalbuminuria is present if this value is between 30 and 300 µg/mg).

What would be the best next therapeutic step in this patient? 

A. Add clonidine
B. Add a beta-blocker
C. Increase the thiazide diuretic dose
D. Add an alpha-blocker
E. Add angiotensin-converting enzyme inhibitor or angiotensin receptor blocker

Question 19# Print Question

A 29-year-old man with HIV, on a highly active antiretroviral therapy (HAART) regimen including the protease inhibitor indinavir, presents with severe edema and a serum creatinine of 2.0 mg/dL. He has had bone pain for 5 years and takes large amounts of acetaminophen with codeine, aspirin, and ibuprofen. He is on prophylactic trimethoprim-sulfamethoxazole. Blood pressure is 170/110; urinalysis shows 4+ protein, 5 to 10 RBC, 0 WBC; 24-hour urine protein is 6.2 g. The serum albumin is 1.9 g/L (normal above 3.7).

Which of the following is the most likely cause of his renal disease? 

A. Indinavir toxicity
B. Analgesic nephropathy
C. Trimethoprim-sulfamethoxazole–induced interstitial nephritis
D. Focal glomerulosclerosis
E. Renal artery stenosis

Question 20# Print Question

A 60-year-old man is brought in by ambulance and is unable to speak. The EMS personnel tell you that a neighbor informed them he has had a stroke in the past. There are no family members present. His serum sodium is 118 mEq/L.

Which of the following is the most helpful first step in the assessment of this patient’s hyponatremia? 

A. Order a chest x-ray
B. Place a Foley catheter to measure 24-hour urine protein
C. Clinical assessment of extracellular fluid volume status
D. CT scan of head
E. Serum AVP (arginine vasopressin) level

Category: Medicine--->Nephrology
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