Your-Doctor Multiple Choice Questions (MCQ)

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Category: Medicine--->Nephrology
Page: 5

Question 21#Print Question

A 39-year-old woman is admitted to the gynecology service for hysterectomy for symptomatic uterine fibroids. Postoperatively the patient develops an ileus accompanied by severe nausea and vomiting; ondansetron is piggybacked into an IV of D5 ½ normal saline running at 125 cc/h. On the second postoperative day the patient becomes drowsy and displays a few myoclonic jerks. Stat labs reveal Na 118, K 3.2, Cl 88 HCO3 22, BUN 3, and creatinine 0.9. Urine studies for Na and osmolality are sent to the lab.

What is the most appropriate next step? 

a. Change the IV fluid to 0.9% (normal) saline and restrict free-water intake to 600 cc/d
b. Change the ondansetron to promethazine, change the IV fluid to lactated Ringer solution, and recheck the Na in 4 hours
c. Start 3% (hypertonic) saline, make the patient NPO, and transfer to the ICU
d. Change the IV fluid to normal saline and give furosemide 40 mg IV stat
e. Make the patient NPO and send for stat CT scan of the head to look for cerebral edema


Question 22#Print Question

You evaluate a 48-year-old man for chronic renal insufficiency. He has a history of hypertension, osteoarthritis, and gout. He currently has no complaints. His medical regimen includes lisinopril 40 mg daily, hydro-chlorothiazide 25 mg daily, allopurinol 300 mg daily, and acetaminophen for his joint pains. He does not smoke but drinks 8 oz of wine on a daily basis. Examination shows BP 146/86, pulse 76, a soft S4 gallop, and mild peripheral edema. There is no abdominal bruit. His UA reveals 1+ proteinuria and no cellular elements. Serum creatinine is 2.2 mg/dL and his estimated GFR from the MDRD formula is 42 mL/minute.

What is the most important element is preventing progression of his renal disease?

a. Discontinuing all alcohol consumption
b. Discontinuing acetaminophen
c. Adding a calcium channel blocker to improve blood pressure control
d. Obtaining a CT renal arteriogram to exclude renal artery stenosis
e. Changing the lisinopril to losartan




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