OS 214 Renal Exam 2 Flashcards by Nash Silava

1-2: A 65 year old female who is known HPN for 10 years complaints of body weakness associated with one week history of anorexia, vomiting, and easy fatigability. She has sallow skin, with excoriations. BP 180/90 Hr 100/mn, RR-24. She also has pale palpebral conjunctivae, fine crackles on both lung fields and bipedal edema. Creatinine was 1200 umol/L.
1) Primary indication toinitiate hemodialysis in this patient would be:
A. Symptoms of body weakness, anorexia, vomiting and easy fatigability
B. Pale palpebral conjunctivae
C. BP of 180/90 mmHG
D. Sallow skin

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2) You immediately decided to initiate a 4hour hemodialysis in this patient after which she suddenly developed decreased sensorium and shallow breathing followed by a tonic clonic seizure. You should suspect this patient to have dialysis complication:
A. Disequilibrium syndrome
B. Hyperglycemia
C. Hypotension
D.muscle cramps

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3) Ultrafiltration in peritoneal dialysis is made possible by this component in the dialysis solution
A. Bicarbonate
B. Glucose
C. Mannitol
D. Acetate

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4) Measure of good dialysis adequacy for patient undergoing 3x a week hemodialysis
A. creatinine clearance of 90ml/min
B.BUN 100 mg/dl
C.URR 1.2

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5) This patient with CKD is not a good candidate for CAPD
A. Patient who is motivated and eager to understand his disease
B. Diabetic patient with recent abdominal surgery
C. Diabetic patient with poor vascular access
D. Patient with good eyesight

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6) An absolute pre-requisite prior to proceeding with kidney transplantation is a
A. Negative tissue mismatch
B. Haplotype match
C. DR antigen match
D. Zero mismatch

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7) A blood  type A+ patient can get a kidney for donors with the following blood type
A. A
B. A and O
C. A and AB
D. B and O

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8) A rejection episode happening within a week after kidney transplant is called
A. Hyperacute rejection
B. Acute rejection
C. Accelerated rejection
D. Chronic rejection

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9) A provisional diagnosis of brain death can be made in the presence of
A. Negative eye response on caloric tests
B. Only that background EEG waves seen
C. A negative apnea test
D. Any OTA

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10) The best long term kidney transplant outcome will be from a donor recipient pair with a
A. Full mismatch
B.1 haplotype match
C. 2 haplotype match
D. 3 haplotype match

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11) What do you see in a patient with acute rejection of allograft?
A. Decoy cells
B. Infiltrating leukocytes
C. Tubular atrophy
D. Interstitial fibrosis

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12) Immunosuppressive medication used for induction therapy include which of following?
A. Calcineurin inhibitor (CNIs)
B. Anti-thymocyte globulin (ATG)
C. Intravenous immunoglobulin (IVIg)
D. Rituximab
E. Antimetabolites

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13) A 40-year old female with FSGS has been on hemodialysis for the past 3 years. She is desirous of a kidney transplant and the only positive donor is her 43-year old brother. He is apprehensive about the procedure and is afraid he will eventually need dialysis himself if he donate a kidney and you advise him on the procedure, the benefits of the recipient, and the risks to himself as a donor. Which of the ff is incorrect following living organ donation?
A. He will not need to follow-up with a physician after the nephrectomy
B. The progression to end stage renal failure after organ donation is low
C. Donor nephrectomy is safe with low mortality rate of less than 0.3%
D. His remaining kidney will compensate for the loss of the donated kidney
E. Minimally invasive techniques for donor nephrectomy will shorten his hospital stay and enable him to return to work sooner

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14) The following are true of chronic allograft dysfunction EXCEPT
A. It is characterized by nonspecific interstitial fibrosis and tubular atrophy
B. It can lead to allograft failure and need for dialysis
C. May be due to repeated low-grade immune injury
D. Related to the chronic use of mTOR inhibitors

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15) Which of the following is the most common cause of mortality and morbidity in the first year after transplant?
A. Complications of diabetes
B. CV disease
C. Dyslipidemia
D. HPN
E. Infection

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16) A 55 year old male present with HPN and renal failure. UTZ shows multiple non-communicating cysts are likewise seen in the liver and pancreas. What would be your diagnosis?
A. Multiple simple cysts
B. Medullary sponge kidney
C. multicystic dysplastic kidney
D. Autosomal dominate polycystic kidney disease

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17) The best imaging modality for diagnosing vesicoureteral reflux is
A. VCUG
B. IVP
C. KUB UTZ
D. CT stonogram

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18) True of normal IVP
A. No bowel prep is needed
B. The ureters are visualized after 20 minutes
C. The renal parenchyma is visualized after 3 minutes
D. AOTA

No answer. C?

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19.) The typical appearance of the normal urinary bladder on ultrasound is
A. Anechoic with smooth walls and posterior sonic shadowing
B. Hyperechoic, with smooth calls and posterior sonic shadowing
C. Anechoic with smooth walls and posterior acoustic enhancement
D. Hyperechoic, with smooth calls and posterior acoustic enhancement

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20) These account for majority of “lucent” stones on plain radiographs but are still sufficiently dense to be seen on CT
A. Indinavir
B. Struvite
C. Uric acid
D. Xanthine

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21) What percentage of renal plasma flow is cleared by glomerular filtration and tubular secretion?
A. 20% by glomerular filtration and 80% by tubular secretion
B. 40% by glomerular filtration and 60% by tubular secretion
C. 60% by glomerular filtration and 40% by tubular secretion
D. 80% by glomerular filtration and 20% by tubular secretion

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22) Indications for renal scanning with radionuclides include
A. Assessment of blood flow to transplanted kidneys
B. Assessment of function of native kidneys
C. Evaluation of space occupying lesions
D. AOTA

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23.)Which of the following is excreted by glomerular filtration?
A. Tc99m DTPA
B. Tc99m MAG3
C.  Tc99m DMSA
D.  Tc99m GH

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24.) Which radiopharmaceutical can be used to determine effective renal plasma flow?
A.  Tc99m MAG3
B. Tc99m DMSA
C. Tc99m DTPA
D Tc99m Glucoheptonate

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``` 25) For visualizing intraparenchymal lesions in the kidneys, the radiopharmaceutical of choice is A. Tc99m DMSA B. Tc99m MAG3 C. Tc99m DTPA D. I-131 OIH ```

``` 26) Which zone of the prostate commonly gives rise to prostate adenocarcinoma? A. Central zone B. Peripheral zone C. Transition zone D. Anterior fibromuscular stroma ```

27) The following statement is TRUE regarding patients with mild lower urinary tract symptoms by IPSS A. They will require drug treatment B. They have scores of less than 10 points C. They are not at risk of developing prostate adenoCA D. They should be advised to undergo annual DRE

``` 28) The following LUT symptom is a component of the International Prostate Symptom Score A. Hesitancy B. Incontinence C. Terminal dribbling D. Feeling of retention post-void ```

29) This finding is consistent with benign prostatic hyperplasia A. Hard, sineguelas-sized prostate B. Prostate specific antigen of 8 ng/dL C. Symmetrical doughy prostate on DRE D. Smooth prostate with a small nodule on DRE

30) Alpha-adrenergic blockers are utilized to manage bladder outlet obstruction due to prostatic enlargement because they A. Shrink the prostate gland B. Increase the force of bladder contraction C. Relax the bladder neck and prostatic smooth muscles D. Counteract the effects of testosterone on the prostate

31) On imaging studies using contrast material, urologic tumors present as A. Filling defects B. Extravasation of dye C. Layering of contrast material D. Nonvisualization of the involved organ

``` 32) A 30/M undergoes surgery for a papillary growth in the urinary bladder wall. His histopathology report will probably be reported as A. Clear cell adenoCA B. Rhabdomyosarcoma C. Transitional cell CA D. Squamous cell CA ```

``` 33) The best treatment for a patient with hematuria and a solid renal mass on CT scan is A. Radical surgery B. Radiotherapy C. Chemotherapy D. Partial nephrectomy ```

34) For urothelial tumors, the T staging is dependent on A. Tumor size B. Depth of tumor invasion C. Degree of obstruction caused by mass effect D. Cellular differentiation of the tumor

``` 35) A 48/M presenting with a solid mass on the superior pole of the kidney on histopath was found to be a chromophobe mixed tumor. This tumor originates from the A. Proximal tubule B. Distal tubule C. Medullary collecting duct D. Cortical collecting duct ```

``` 36) A boy presenting with difficulty of voiding and a palpable balder diagnosed with phimosis should undergo A. Urethral catheterization B. Antibiotic treatment C. Circumcision D. Cystoscopy ```

``` 37) The most common mechanism of injury for ureteral trauma is A. Blunt trauma B. Iatrogenic C. Penetrating trauma D. Deceleration injury ```

``` 38) Disruption of the integrity of the urothelial lining due to trauma will manifest in radiographic studies as A. Filling defects B. Dye extravasation C. Layering of the contrast material D. High intensity densities ```

39) The pain of renal colic is commonly due to A. Renal ischemia B. Injury to the renal parenchyma C. Stretching of the renal capsule or urothelial lining D. Infection of the urothelium of the renal pelvis

40) A 16/M was brought to the ER for left scrotal pain. You will recommend immediate surgical consult if you elicit this PE finding A. Urethral discharge B. Enlarged tender erythematous scrotum C. Enlarged nontender scrotum with positive transillumination D. Epididymis palpated anterior to the testis and lying horizontally

``` 41) Which of the following medications is used as medical expulsive therapy for ureterolithiasis? A. Finasteride B. Tamsulosin C. Dutasteride D. K citrate ```

``` 42) The definitive treatment for patients diagnosed with xanthogranulomatous pyelonephritis is A. Nephrectomy B. Open stone surgery C. IV antibiotics for 2 weeks D. Percutaneous nephrolithotomy (PCNL) ```

``` 43) A 70/F diagnosed to have an acontractile bladder due to stroke has been on foley catheter for the past 2 years. Which of the following conditions can the patient develop in the future? A. Nephrolithiasis B. Ureterolithiasis C. Cystolithiasis D. Staghorn calculi ```

``` 44) The following dietary maneuver decreases urinary calcium oxalate crystallization A. Decreasing dietary sodium B. Decreasing calcium intake C. Vitamin C supplementation D. Decreasing citrate rich foods ```

``` 45) A 30/F was diagnosed to have an 8 mm upper pole stone, left kidney on abdominal UTZ as part of an annual PE one month ago. At that time she was asymptomatic until a few hours prior to consult, when the patient was awakened from sleep by severe left flank pain followed by urgency and pain in the labia on the left. What is your likely diagnosis? A. Pelveolithiasis left B. Ureterolithiasis middle third left C. Ureterolithiasis proximal third left D. Ureterovesical junction stone left ```

46) Urethreal catheterization should NOT be performed in this patient who cannot void A. A 65 year old man with a hard nodular prostate on DRE B. A 5 year old boy born with a ventrally located urethral meatus C. A 30 year old vehicular crash victim with blood at the urethral meatus D. A 55 year old man who has a history of gonoccocal urethritis and progressive difficulty in voiding

47) One should insert a urethral Foley catheter in males up to this level before inflating the balloon A. At the 25 cm level B. At the point where resistance is encountered C. At the junction between the drainage and inflation ports D. At the point when urine starts to come out of the cathether

``` 48) The urethral catheterization of men, the resistance point at 20 cm corresponds to the A. Urethrovesical junction B. External urethral sphincter C. Prostatic apex D. Bladder neck ```

49) The approach to UTI in a 25 year old male who develops the problem for the first time is A. Manage as complicated UTI B. Manage as acute uncomplicated UTI C. Treat first and then perform the imaging studies D. Treat only after extensive work up with imaging studies

``` 50) 21 year old female with history of frequency, dysuria, hematuria, later with fever and chills. This is her first episode. Your diagnosis would be A. Will wait for urinalysis B. Recurrent UTI C. Acute uncomplicated cystitis D. Acute uncomplicated pyelonephritis ```

``` 51) Effective duration of antibiotics for uncomplicated cystitis EXCEPT A. Nitrofurantoin for 3 days B. Fosfomycin single dose C. Ciprofloxacin for 3 days D. Beta lactams for 7 days ```

52) Initial step in the pathogenesis of UTI A. Attachment of the bacteria to the uroepithelium using their fimbriae or pili B. Internalization of bacteria into epithelial cells C. Exfoliation of bacteria into the urine D. Multiplication of bacteria

``` 53) The most common source of bacteria causing cystitis is the A. Urinary tract B. Respiratory tract C. Gastrointestinal tract D. Hematogenous route ```

``` 54) Characteristics of recurrent UTI causing RELAPSE A. Caused by a different organism B. Interval to recurrence > 2 weeks C. Original risk factors persist D. Suggests an uneradicated focus ```

``` 55) Risk factors for recurrent UTI in postmenopausal women A. Hot flashes B. Cystocoeles C. Hypertension D. Recurrent arthritis ```

``` 56) A 3 year old child comes in for low grade fever and abdominal pain. A clean-catch urine was collected for culture studies. Which of the following is definitive for UTI? A. Any growth of a single organism B. 50000 CFU of E. coli and Proteus C. 50000 CFU of Proteus D. 100000 CFU of E. coli ```

57) The most valuable imaging test for UTI in children

``` 58) An important risk factor to suspect CAKUT as the cause for UTI is A. High grade fever B. Recurrence rate C. Non-E coli infection D. Upper tract involvement ```

Answer: C (class says B)

``` 59) Which among the following symptoms has the highest probability of having UTI in verbal children? A. Abdominal pain B. Fever without a focus C. Dysuria D. Fever ```

``` 60) According to the 2010 Antibiotic Resistance Surveillance of the DOH, which among the following antibiotics will you not give due to its high resistance rate? A. Cefalexin B. Cefuroxime C. Co-amoxiclav D. Cotrimoxazole ```

``` 61) What is the most common cause of ESRD in children? A. Hemolytic uremic syndrome B. CAKUT C. SLE nephritis D. AKI ```

``` 62) The first excretory organ in mammalian embryos which develops the epididymis and ductus deferens in males and epoophoron and para-oophoron in females A. Pronephros B. Mesonephros C. Metanephros D. Cloaca E. Wolffian body ```

``` 63) The nephron (glomerulus and tubules) is formed during A. 1-4 weeks B. 5-6 weeks C. 8-9 weeks D. 10-36 weeks E. 48-52 weeks ```

``` 64) A KUB ultrasound was done which revealed hydronephrosis on the right kidney. Which of the following are your differentials A. Ureteropelvic junction obstruction B. Ureterovesical junction obstruction C. Vesicoureteral reflux D. AOTA ```

``` 65) Which of the following CAKUT was shown to have the shortest renal survival? A. Solitary kidney B. Horseshoe kidney C. Multicystic dysplastic kidney D. Bilateral hypodysplasia E. Posterior urethral valve ```

``` 66) According to the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, the major determinant of blood pressure value in children is A. Gender B. Height C. Age D. Weight ```

``` 67) Signs and symptoms that should alert the physician to the possibility of HPN in older children include all of the following EXCEPT A. Headache B. Epistaxis C. Bell’s palsy D. Leg tremors ```

68) 2/M newly diagnosed of Wilms tumor of the left kidney was advised for surgery. On preoperative clearance by the pediatric service, he was noted to have a BP of 140/90. The patient has normal renal function and good urine output. The most likely cause of this patient’s HPN is A. Ureteral stricture B. Familial HPN C. Tumor compressing the renal artery D. Associated catecholamine secreting adrenal tumor

``` 69) Majority of children with secondary HPN will have A. An endocrine cause B. Renovascular disease C. Coarctation of the aorta D. Impaired kidney function ```

70) Pharmacologic therapy of HPN should be initiated in children A. With stage 2 hypertension B. Presenting with target organ damage C. With prehypertension to prevent further damage D. Upon documentation of HPN of whatever cause on three separate occasions

71) Mr. Santos went to the outpatient clinic with a complaint of nape pains. He described nape pains that were episodic, localized at the back of his head, grade 3/10 in severity and was relieved with analgesics. PE showed BP of 150/80, HR 77, while on fundoscopy he had grade 2 retinopathy. Other PE findings were normal. Labs showed creatinine of 1.1 mg/dL, potassium of 4 mg/dL, HCO3 of 24 mg/dL, TSH

``` 72) What is the drug of choice for coarctation of the aorta? A. Calcium channel blocker B. Diuretic C. ACE inhibitor D. Beta blocker ```

``` 73) What is the percentage to diagnose a patient with renal artery stenosis? A. 50% B. 60% C. 75% D. 80% ```

``` 74) What is the best treatment for hypertensive patients with associated hypokalemia and metabolic alkalosis? A. Spironolactone B. Phenoxybenzamine C. Enalapril D. Minoxidil ```

75) Which of the following is TRUE regarding Cushing’s syndrome? A. There is decreased production of cortisol leading to elevated BP B. The excess glucocorticoid production activates the sympathetic nervous system C. HPN is accompanied by moon facies, buffalo hump, and abdominal striae D. AOTA

76) If the total clearance of a drug decreases, the time to reach steady state will be A. Longer B. Shorter C. The same

77-79. Digoxin is cleared 70% by renal excretion. The remaining 30% is via liver metabolism. The kidney function is decreased by 50% and protein binding and volume of distribution are unchanged. ``` 77) The half-life will A. Increase by 53% B. Increase by 153% C. Decrease to 65% D. Decreased by 65% E. Not change ``` ``` 78) The loading dose is A. Increased by 50% B. Increased by 65% C. Decreased by 50% D. Decreased by 65% E. Not changed ``` ``` 79) The maintenance dose is A. Increased by 35% B. Increased by 65% C. Decreased by 35% D. Decreased by 65% E. Not changed ```

A Answer: E Remember that the loading dose is related to Vd (volume of distribution) while the maintenance dose is related to Cl (clearance). Hence, whatever happens to Vd and Cl change the loading dose and maintenance dose respectively. C

80) If the overall renal clearance is greater than the clearance due to filtration, which of the following statement/s is/are TRUE? A. Filtration and secretion are the only processes operating B. Filtration and reabsorption are the only processes operating C. Filtration and secretion are present. Reabsorption may or may not be present D. Filtration and reabsorption are present. Secretion may or may not be present

``` 81) Mutations are seen in this type IV collagen in thin basement membrane disease A. Alpha 3 chains B. Alpha 3 and 4 chains C. Alpha 3, 4, and 5 chains D. Alpha, 3, 4, 5, and 6 chains ```

Answer: B – Alport syndrome, on the other hand, involves alpha 3, 4, and 5 chains

``` 82) Considered as the most common type of glomerulonephritis worldwide, this occurs in response to respiratory or GI exposure to bacteria, viruses, or food proteins A. IgA nephropathy B. Membranous glomerulopathy C. Post-infectious GN D. Membranoproliferative GN ```

83) A 63 year old presented with elevated serum creatinine and decrease in urine output. Renal biopsy shows 80% cellular crescents and linear staining in glomerular basement membrane for IgG. This patient has A. Type 1 rapidly progressive glomerulonephritis B. Type 2 (RPGN) C. Type 3 (RPGN) D. Type 4 (RPGN)

Answer: A – The keywords are type 1 – linear (anti-GBM ex. Goodpasture), type 2 – granular (SLE), type 3 (pauci-immune)

``` 84) “Spikes” formed by subendothelial deposits are seen in A. IgA nephropathy B. Membranous GN C. Post-infectious GN D. Membranoproliferative GN ```

``` 85) Uniform and diffuse effacement of foot processes is seen in minimal change disease and A. Membranous glomerulopathy B. Post-infectious GN C. Focal segmental glomerulosclerosis D. Membranoproliferative GN ```

``` 86) In this phase of acute tubular necrosis, hypokalemia and vulnerability to infection are seen A. Initiation phase B. Maintenance phase C. Recovery phase D. Healed phase ```

``` 87) Attenuation of tubule brush borders, sloughing of tubular epithelial cells, and hyaline casts are seen in these tubules due to toxic acute tubular necrosis A. Proximal convoluted tubules B. Loops of Henle C. Distal convoluted tubules D. Collecting tubules ```

88) Xanthogranulomatous pyelonephritis is characterized by the following A. Accumulation of foamy macrophages, plasma cells, lymphocytes, neutrophils, and occasional giant cells B. Resemblance to transitional cell carcinoma C. Strong association with E. coli infection D. Common form of chronic pyelonephritis

``` 89) The most significant risk factor for renal cell CA is A. Obesity B. Tobacco C. Exposure to asbestos D. Tuberous sclerosis ```

90) This feature in papillary adenoma is used as a prognostic feature A. 3 cm as cutoff size B. Papillary configuration C. Presence of multiple nodules D. Increased nucleus to cytoplasmic ratio

``` 91) Which of the following chromogens causes a false decrease in serum creatinine by interfering with the alkaline picrate assay (Jaffe reaction)? A. Acetoacetate B. Glucose C. Bilirubin D. Flucytosine ```

``` 92) Renal recovery from complete urinary tract obstruction is unlikely if obstruction is relieved after this number of weeks A. 2 B. 4 C. 6 D. 12 ```

93) 24/F consulted due to tea colored urine and joint pain. Meds: diclofenac 150/90 mmHg, BUN 10 mg/dL, creatinine 1.7 mg/dL, FENa 0.8%. Urinalysis 1.015, albumin +3, sugar -, WBC 10-15/hpf, RBC 20-30/hpf, RBC cast. What is the cause of the azotemia in this patient? A. Pre-renal azotemia B. Acute GN C. Acute interstitial nephritis D. Acute tubular necrosis

``` 94) Which of the following laboratory parameters is the most compelling indication for renal replacement therapy in AKI? A. BUN 60 mg/dL B. Creatinine 4 mg/dL C. Bicarbonate 18 mmol/L D. Potassium 7 mmol/L ```

95) What is the recommended biomarker for the early detection of contrast-induced AKI? A. BUN B. Cystatin C. Creatinine D. Neutrophil gelatinase associated lipocalin

``` 96) What is an approximate GFR of this 30 year old hypertensive with a creatinine of 2 mg/dL (?) who is being followed up at the renal clinic? A. 20 ml/min B. 30 ml/min C. 40 ml/min D. 50 ml/min ```

Answer: D – Note that (1/SCr) ~ GFR

``` 97) This is the histologic finding in end stage kidney disease A. Mesangial hypercellularity B. Glomerulosclerosis C. Tubular atrophy D. Arteriolar hyalinosis ```

``` 98) What will happen if you give sodium to a patient with CKD? A. Hypernatremia B. Hyponatremia C. Hypertension D. Hyperkalemia E. Hypokalemia ```

``` 99) Based on the KDIGO Anemia guideline 2012, hemoglobin correction should not be above A. 10 g/dL B. 10.5 g/dL C. 11 g/dL D. 11.5 g/dL ```

100) In chronic kidney disease, the antihypertensive agent of choice is one that controls BP effectively and also gives renoprotection by A. Blocking renin B. Optimizing potassium excretion C. Causing preferential afferent arteriolar vasodilation D. Causing preferential efferent arteriolar vasodilation

``` 101) Feature of postinfectious GN A. Edema B. Chest pain C. Dependent purpura D. Pulmonary hemorrhage ```

``` 102) Feature of nephrotic syndrome A. Gross hematuria B. Hypercholesterolemia C. Normal blood pressure D. ```

``` 103) ANA positive disease A. SLE B. Polymyositis C. Rheumatoid arthritis D. AOTA ```

``` 104) High titers are SLE specific and correlate with disease activity such as nephritis A. ANA B. Anti-dsDNA C. Anti-Sm D. Antihistone ```

``` 105) Suggestive of glomerular hematuria A. Absence of RBC casts B. Accompanying proteinuria C. Normal RBC morphology D. Negative urine culture ```

106) How can you explain the metabolic alkalosis seen in severe dehydration from diarrhea? A. Volume depletion increases aldosterone production B. Chloride depletion stimulates bicarbonate reabsorption C. Cellular dehydration increases the activity of the H+ATPase pump in the intercalated cell D. Volume depletion increases bicarbonate movement out of the red cell through the chloride shift mechanism

``` 107) What kind of acid-base problem do you expect when a mountain climber reaches the peak of Mt. Everest? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis ```

``` 108) This diuretic can be used to manage uric acid stones because of its ability to alkalinize urine A. Hydrochlorothiazide B. Spironolactone C. Acetazolamide D. Furosemide ```

``` 109) This diuretic is used for the management of nephrogenic diabetes insipidus A. Triamterene B. Acetazolamide C. Hydrochlorothiazide D. Bumetanide ```

``` 110) This diuretic has an antiandrogenic effect and causes gynecomastia as a side effect A. Spironolactone B. Amiloride C. Traimeterene D. Furosemide ```

``` 111) This diuretic is used for the scintigraphic evaluation of obstructive uropathy A. Furosemide B. Acetazolamide C. Hydrochlorothiazide D. Ethacrynic acid ```

``` 112) Which is NOT a loop diuretic? A. Furosemide B. Metolazone C. Bumetanide D. Ethacrynic acid ```

113-116. A 20/F rushes to the ER because of several episodes of diarrhea and vomiting. Her BP was 80 palpatory, HR 120/min, RR 24/min. She had poor skin turgor and dry buccal mucosa. Her creatinine was at 400 umol/l and ABG showed pH=7.2, pCO2 = 30 mmHg, HCO3=15 meq/L. Serum electrolytes show Na = 125 meq/L, K = 2 meq/L, Cl=83 meq/L, RBS = 100 mg/dL. ``` 113) Primary management of this patient would be A. IV fluid resuscitation B. Bicarbonate therapy C. Hemodialysis D. Loperamide ```

114) What is the acid base abnormality? A. High anion gap metabolic acidosis (HAGMA) B. Normal anion gap metabolic acidosis (NAGMA) C. High anion gap and normal anion gap metabolic acidosis D. High anion gap metabolic acidosis and metabolic alkalosis

115) TRUE regarding this patient’s hyponatremia A. There is pure water excess B. Patient lacks both salt and water C. This patient has pseudohyponatremia D. This patient has hypervolemic hyponatremia

``` 116) An EKG will likely show A. U waves B. Peaked T waves C. Widened PR interval D. Shortened QT interval ```

``` 117) The parameter that best differentiates RTA Type 4 from RTA Type 2 is A. Arterial blood gas B. Serum potassium C. Urine pH D. Urine anion gap ```

``` 118) Which parameter differentiates Gitelman’s syndrome from Bartter’s syndrome? A. Serum potassium B. Arterial blood gas C. Blood pressure D. Urine calcium ```

``` 119) This treatment for hyperkalemia redistributes potassium intracellularly A. Calcium gluconate B. Glucose-insulin solution C. Beta blocker D. Ion exchange resin ```

``` 120) A 24/M is admitted to the Neuro Intensive Care Unit following a craniotomy for cerebral hemorrhage sustained following a vehicular accident. At the NICU, he develops urine output that averages 400 ml/hour. His BP is 120/80, HR 90/min. Laboratories show serum Na of 160 meq/L, urine spgr is 1.002. What is the appropriate fluid management for his hypernatremia? A. Hypotnic saline solution B. Normal saline solution C. Pure water D. Lactated Ringer’s solution ```

121-125: A 35/M with a 15 year history of insulin dependent DM is admitted for abdominal pain. He has had on and off bipedal edema over the past year with the progressive blurring of vision. He is maintained on insulin and enalapril. Several days prior to consult he complained of abdominal pain resulting in poor food intake. He stopped his insulin. His BP is now 90/60 (supine) and 80/50 (standing), HR is 100. He has dry oral mucosa. His abdomen is soft but with a vague epigastric tenderness on palpation. There is bilateral ankle edema. His lab data are as follows: Serum Na 130 meq/L BUN 30 mmol/L K 6 meq/L RBS 250 mg/dL Cl 100 meq/L Creat 300 umol/L ABG pH 7.26 pCO2 23 mmHg HCO3 10 meq/L ``` 121) What is the acid-base disorder? A. High anion gap metabolic acidosis B. Normal anion gap metabolic acidosis C. Combined HAGMA and NAGMA D. Combined HAGMA and metabolic alkalosis ```

``` 122) Which of the following cannot account for his acid base disorder? A. Surreptitious vomiting B. Diabetic ketoacidosis C. Renal failure D. RTA type 4 ```

123) Which of the following statements is/are TRUE regarding the hyponatremia? A. This is a pure water excess problem B. This is simple hyperosmolar hyponatremia C. This patient patient has hypovolemic hyponatremia D. NOTA

``` 124) What initial fluid replacement would be most beneficial for this patient? A. Normal saline solution B. Hypertonic saline C. DS Lactated Ringer’s solution D. Hypotonic saline ```

``` 125) What drugs should this patient avoid for fear of worsening his hyperkalemia? A. Calcium channel blockers B. Aldosterone antagonists C. Loop diuretics D. Beta agonists ```