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Essentials of Nephrology

Essentials of Nephrology.

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Essentials of Nephrology

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  1. Essentials of Nephrology

  2. Chronic kidney disease (CKD) can be defined as:(A) Kidney damage as defined by pathologic abnormalities or markers in blood or urine for 1 mo(B) Kidney damage on imaging studies for 1 mo(C) Glomerular filtration rate (GFR) 60 mL/min per 1.73 m2 for 3 mo(D) Albumin to creatinine ratio of <30 mg of albumin to 1 g of creatinine for 3 mo

  3. Answer • (C) Glomerular filtration rate (GFR) 60 mL/min per 1.73 m2 for 3 mo

  4. Risk factors for CKD include which of the following?(A) Systemic lupus (B) Bladder outlet obstruction (C) Preeclampsia (D) All the above

  5. Answer • (D) All the above

  6. In glomerulosclerosis:(A) Intraglomerular pressure must be decreased to maintain function(B) The efferent arteriole constricts(C) GFR begins to decline early in disease process(D) The mesangium becomes thin

  7. Answer • (B) The efferent arteriole constricts

  8. When stratifying risk for cardiovascular disease in patients with normal GFR and macroalbuminuria, CKD should beconsidered a myocardial infarction equivalent.(A) True (B) False

  9. Answer • (A) True

  10. In the United Kingdom Prospective Diabetes Study, the _______ control group had better renal outcomes.(A) Blood pressure (BP) (B) Glycemic

  11. Answer • (A) Blood pressure (BP)

  12. Which class of antihypertensive agents appears most effective in improving renal outcomes?(A) Calcium channel blockers(B) Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)(C) Direct renin inhibitors(D) Beta-blockers

  13. Answer • (B) Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)

  14. A patient with CKD is started on an ACE inhibitor to control her BP. During the first 2 to 4 wk of therapy, a temporaryincrease in which of the following can be expected?(A) Serum potassium (B) Albumin to creatinine ratio(C) Serum creatinine (D) GFR

  15. Answer • (C) Serum creatinine

  16. What is considered an acceptable rise in the creatinine after starting and ACE inhibititor? • A. 10% • B. 20% • C. 30% • D 40%

  17. Answer • C. 30%

  18. Choose the correct statement about aliskiren.(A) Blocks renin activity(B) Should be used in combination with ACE inhibitor or ARB(C) Associated with better renal outcomes than ACE inhibitors or ARBs(D) No significant effect on BP control

  19. Answer • (A) Blocks renin activity

  20. Which of the following drugs is contraindicated in patients with serum creatinine >1.4 mg/dL?(A) Aliskiren (B) Amlodipene (C) Kayexalate (D) Metformin

  21. Answer • (D) Metformin

  22. Dietary modifications of patients with CKD should include the restriction of which of the following?(A) Protein (B) Phosphate (C) Salt substitutes (D) All the above

  23. Answer • (D) All the above

  24. Choose the correct statement about acute kidney injury.(A) Characterized by rapid rise in creatinine over 1 mo(B) Can be nonoliguric or oliguric(C) Anuria usually associated with good prognosis(D) Mortality rates lower in patients who require dialysis

  25. Answer • (B) Can be nonoliguric or oliguric

  26. Intrinsic renal problems that lead to acute kidney injury are most commonly caused by:(A) Pelvic cancer (B) Vomiting (C) Congestive heart failure (D) Medications

  27. Answer • (D) Medications

  28. Values for fractional excretion of sodium are often elevated by:(A) Diuretic use (B) Acute glomerulonephritis (C) Rhabdomyolysis (D) Sepsis

  29. Answer • (A) Diuretic use

  30. Which of the following findings on urinalysis with microscopy is most commonly indicative of acute interstitial nephritis?(A) Tubular epithelial cell casts (B) White blood cell casts (C) Red blood cell casts (D) Hyaline casts

  31. Answer • (B) White blood cell casts

  32. A urine dipstick can detect protein (albumin) at what level • A. >30 mg of protein (albumin) • B. >100 mg • C. >300 mg • D. >500 mg

  33. Answer • C. >300 mg

  34. Which of the following is not an independent indication for emergent hemodialysis?(A) Hyperkalemia(B) Uremic encephalopathy(C) Abnormal serum urea nitrogen and creatinine levels(D) Metabolic acidosis

  35. Answer • (C) Abnormal serum urea nitrogen and creatinine levels

  36. What is indicative of ATN • tubular epithelial cell casts • white cell casts without bacteria • ask nephrologist to look for >10% eosinophils), • red cell casts • Hyaline casts • oval fat bodies

  37. Answer • tubular epithelial cell casts

  38. What is indicative of Nephrotic Syndrome • tubular epithelial cell casts • white cell casts without bacteria • ask nephrologist to look for >10% eosinophils), • red cell casts • Hyaline casts • oval fat bodies

  39. Answer • oval fat bodies

  40. What is indicative of acuteinterstitial nephritis • tubular epithelial cell casts • white cell casts without bacteria • ask nephrologist to look for >10% eosinophils • red cell casts • Hyaline casts • oval fat bodies

  41. Answer • white cell casts without bacteria • ask nephrologist to look for >10% eosinophils

  42. What is indicative of glomerulonephritis • tubular epithelial cell casts • white cell casts without bacteria • ask nephrologist to look for >10% eosinophils), • red cell casts • Hyaline casts • oval fat bodies

  43. Answer • red cell casts

  44. Using diuretics to convert oliguric renal failure to nonoliguric renal failure may worsen mortality.(A) True (B) False

  45. Answer • (A) True

  46. Choose the correct statement about screening for proteinuria.(A) Can detect kidney disease even before changes in estimated glomerular filtration rate (eGFR) occur(B) Normal urinary protein to creatinine ratio <200 mg to 1 g(C) 24-hr urine collection is gold standard, but prone to error(D) All the above

  47. Answer • (D) All the above

  48. A patient with an eGFR measurement of 45 mL/min per 1.73 m2 would most likely be diagnosed with _______ chronickidney disease (CKD).(A) Stage 1 (B) Stage 2 (C) Stage 3 (D) Stage 4

  49. Answer • (C) Stage 3

  50. Prerenal is which of the following? • A. Anything that causes decreased effective renal perfusion: Hypovolemia, CHF, Renal Artery Stenosis, Sepsis, etc. Sometines contrast-induced nephropathy • B. ATN, AIN, Glomerulonephritides, etc • C. Obstruction (BPH, bladder stone, bilateral ureter obstruction

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