Your-Doctor Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Nephrology
Page: 7

Question 31#Print Question

A 36-year-old African American man presents to the Emergency Department with new onset body swelling. He has a history of HIV and is taking antiretrovirals and trimethoprim–sulfamethoxazole for prophylaxis. His last CD4 count was 125 cells/mm3 . His temperature is 38.2°C, blood pressure is 168/98 mmHg, heart rate is 94 beats per minute, and respiratory rate is 24 breaths per minute. Laboratory workup reveals a creatinine of 1.8 mg/dL, and a urine dipstick shows 4+ protein.

What is most likely to be seen on renal biopsy under light microscopy?

a. Normal appearing glomeruli
b. Diffuse thickening of the glomerular basement membrane
c. Splitting of the glomerular basement membrane
d. Collapsed and sclerotic glomeruli surrounded by normal glomeruli

Question 32#Print Question

A 19-year-old college student develops fever, headache, and nuchal rigidity. Cerebrospinal fluid (CSF) cultures grow Neisseria meningitidis. She receives appropriate treatment, and her close contacts are given prophylactic antibiotic treatment. Her mother, who took this prophylactic treatment, developed a fever and maculopapular rash afterward. She is brought to the Emergency Department, and her laboratory values are shown below. 

  • Sodium   133 mEq/L
  • Potassium   5.4 mEq/L
  • Creatinine   2.1 mg/dL (baseline 1.0 mg/dL)
  • Urinalysis   WBC casts and eosinophils

Which of the following represents the likely antibiotic and complication that the mother experienced?

a. (A)
b. (B)
c. (C)
d. (D)
e. (E)

Question 33#Print Question

A 49-year-old woman is hospitalized for pneumonia. She is managed appropriately and laboratory values are drawn. She has no past medical history, and a complete blood count and chemistry panel from 1 year ago were normal. Her laboratory values from this hospitalization are shown below.

  • Sodium   136 mEq/L
  • Potassium   5.2 mEq/L
  • Chloride   105 mEq/L
  • Bicarbonate   20 mEq/L
  • Blood urea nitrogen 3  8 mg/dL
  • Creatinine   1.9 mg/dL
  • FENa   2.5%

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

a. Pyelonephritis
b. Renal ischemia
c. Acute interstitial nephritis
d. Embolic phenomenon
e. Acute tubular necrosis

Question 34#Print Question

A 48-year-old woman presents to your clinic complaining of excessive urination and constant hunger and thirst. She has no other complaints and no past medical history. Her family history is significant for hypertension, type 2 diabetes mellitus, and hyperlipidemia. She does not smoke but lives a sedentary lifestyle. On examination, she is afebrile with a blood pressure of 134/88 mmHg, heart rate of 84 beats per minute, and respiratory rate of 14 breaths per minute. The rest of her examination is normal. The patient is scheduled for a return visit to have fasting laboratory tests drawn. At her return visit, her blood pressure is 138/86 mmHg. Her fasting glucose is 156 mg/dL, and urine albumin-to-creatinine ratio is 200 mg/g.

What is the next step in management for this patient?

a. Encourage diet and lifestyle modifications
b. Admit the patient to the hospital for aggressive glucose control and diabetes education
c. Start an ACE inhibitor now
d. Start hydrochlorothiazide now, and add an ACE inhibitor if this fails to achieve the target blood pressure

Question 35#Print Question

A 28-year-old woman with Crohn disease presents to the Emergency Department with back pain that started last night. She describes a colicky pain that is located on the right side of her back and shoots down to her groin. The pain is also associated with nausea and vomiting. Her temperature is 37.3°C, blood pressure is 128/84 mmHg, heart rate is 98 beats per minute, and respiratory rate is 18 breaths per minute. The patient appears uncomfortable and has some right flank pain on palpation. A pelvic examination is performed and shows no cervical discharge or cervical motion tenderness. Her laboratory values show a normal hemoglobin and leukocyte count, a urine pregnancy test is negative, and a urine dipstick shows 2+ blood but is negative for nitrites or leukocyte esterase.

What is the most likely diagnosis?

a. Pyelonephritis
b. Nephrolithiasis
c. Appendicitis
d. Ectopic pregnancy

Category: Q&A Medicine--->Nephrology
Page: 7 of 8