Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Nephrology
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Question 1# Print Question

A 54-year-old man presents to the hospital with a 3-day history of severe nausea, vomiting, and diarrhea. He has been unable to keep down substantial solids or liquids over the past few days and has become progressively weak. He also endorses subjective fevers and occasional abdominal pain. The patient’s medical history is significant for hypertension and chronic low back pain, for which he takes lisinopril and ibuprofen. He has a 4-year-old child that he picks up from daycare who has also had diarrhea. On examination, the patient is tachycardic with a blood pressure of 104/84 mmHg. He appears weak with dry mucus membranes. Routine laboratory values are drawn, which show a blood urea nitrogen (BUN) and creatinine of 40 mg/dL and 2.1 mg/dL, respectively. He denies any history of renal disease.

Of the following options, what would be most helpful in determining the etiology of this patient’s renal failure? 

A. Urine dipstick
B. Urine sodium
C. Fractional excretion of sodium (FENa)
D. Renal ultrasound
E. No further workup is necessary

Question 2# Print Question

A 68-year-old woman is brought into the Emergency Department because of severe difficulty breathing. She complains that for the past few days she has had a progressive fever and productive cough. She was diagnosed a few weeks ago with idiopathic focal segmental glomerulosclerosis (FSGS), and her other medical problems include hypertension and gastroesophageal reflux disease (GERD). Her vitals show a temperature of 38.3°C, blood pressure of 104/74 mmHg, heart rate of 98 beats per minute, respiratory rate of 22 breaths per minute, and oxygen saturation of 93% on room air. Her laboratory values are shown below.

  • Sodium 137 mEq/L
  • Potassium 4.9 mEq/L
  • Chloride 111 mEq/L
  • Bicarbonate 16 mEq/L
  • Blood urea nitrogen 36 mg/dL
  • Creatinine 1.2 mg/dL
  • Glucose 148 mg/dL
  • Albumin 2.1 g/dL

An arterial blood gas shows a pH of 7.29 and a PaCO2 of 32 mmHg.

Which of the following is the likely cause of this patient’s acid/base status?

A. Renal tubular acidosis
B. Hyperaldosteronism
C. Lactic acidosis
D. Excessive IV fluids

Question 3# Print Question

A 43-year-old Caucasian man comes to the physician because of fatigue and body swelling that has developed over the last few weeks. He has no significant medical history, and takes no medications. He does not smoke or drink alcohol, and exercises 3 times weekly. He is afebrile with a blood pressure of 128/86 mmHg, heart rate of 88 beats per minute, and respiratory rate of 16 breaths per minute. On physical examination, there is noticeable periorbital edema with diffuse edema of the extremities. His laboratory values are shown below.

  • Sodium 138 mEq/L
  • Potassium 4.5 mEq/L
  • Chloride 104 mEq/L
  • Bicarbonate 24 mEq/L
  • Blood urea nitrogen 8 mg/dL
  • Creatinine 0.9 mg/dL
  • Glucose 146 mg/dL
  • Albumin 2.8 g/dL
  • Urine dipstick 3+ protein

Which of the following is also likely to be present in this patient?

A. HIV infection
B. Hypercholesterolemia
C. S3 on cardiac auscultation
D. Hematuria

Question 4# Print Question

A 58-year-old man with congestive heart failure (CHF), hypertension, and dyslipidemia presents to his physician with low back pain. He complains that he was lifting a heavy box 1 week ago and felt sudden pain in his lower back. He denies any incontinence, lower-extremity weakness, or paresthesia. He has been taking acetaminophen and naproxen around the clock with little effect. His chronic medications include aspirin, carvedilol, furosemide, losartan, simvastatin, and niacin. There is some tenderness to palpation of the paraspinal muscles along the lower back, but the rest of the musculoskeletal and neurologic examinations are normal. Laboratory values are significant for a potassium of 5.2 mEq/L, a BUN of 42 mg/dL, and a creatinine of 1.9 mg/ dL (baseline 1.2 mg/dL). A urinalysis is unremarkable except for few hyaline casts.

Which of the following best represents the physiologic changes in the kidney that led to this patient’s acute kidney injury? (Note: GFR is glomerular filtration rate, IGP is intraglomerular pressure, AAT is afferent arteriole tension, and EAT is efferent arteriole tension.)

A. (A)
B. (B)
C. (C)
D. (D)
E. (E)

Question 5# Print Question

A 68-year-old man presents to the hospital with nausea, vomiting, muscle weakness, and palpitations. He has a history of ischemic cardiomyopathy and takes lisinopril, carvedilol, simvastatin, and aspirin. He recently started taking spironolactone due to an increase in heart failure symptoms. There are no recent changes in his diet, and he denies any chest pain or shortness of breath. His screening chemistry panel is shown below.

  • Sodium 135 mEq/L
  • Potassium 7.0 mEq/L
  • Chloride 101 mEq/L
  • Bicarbonate 24 mEq/L
  • Blood urea nitrogen 18 mg/dL
  • Creatinine 1.2 mg/dL
  • Glucose 145 mg/dL

Which of the following treatments is LEAST beneficial in the acute setting?

A. Insulin
B. Calcium gluconate
C. Sodium polystyrene sulfonate
D. Furosemide

Category: Q&A Medicine--->Nephrology
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