Zombie TBL Questions Flashcards
Question: Which of the following complications is not usually associated with autosomal dominant polycystic kidney disease (ADPKD)?
a) Aneurysms
b) Fetal pulmonary hypoplasia
c) Kidney stones
d) Flank/kidney pain
B: Fetal pulmonary hypoplasia
Question: A 52-year-old patient experiences acute kidney injury after being placed on an ACE inhibitor. She has a history of hypertension, hyperlipidemia, and chronic smoking. An abdominal bruit was noted on her last exam but never followed up on. What is the likely underlying cause of her AKI?
RAS
Question: The “golfball on a tee” sign and “ring shadow” sign on renal imaging are classically associated with which disorder?
Analgesic nephropathy (papillary necrosis)
Question: What can reduce the risk of nephrotoxicity in a CKD patient who must receive a procedure that utilizes IV contrast?
Administering normal saline IV before and after the procedure or discontinuing all other potentially nephrotoxic drugs
A patient with 150 mg/d secretion of protein in the urine would fit what A category of chronic kidney disease?
A2
Postinfectious glomerulonephritis is which type of glomerulonephritis?
Immune complex deposition
Why is hypercoagulability seen in nephrotic syndrome?
Urinary loss of protein C, protein S, and antithrombin
What medication has been shown to slow the progression of autosomal dominant polycystic kidney disease?
Tolvaptan (Samsca, Jynarque)
I think only jynarque technically works for ADPKD specifically
What class of drugs is classically known for inducing AKI in patients with bilateral renal artery stenosis?
ACEs/ARBs
What type of chronic kidney disease is associated with asymmetric kidneys
on imaging, displaying areas of thin atrophic parenchyma interspersed with enlarged
hypertrophic parenchyma?
vesicoureteral reflux (will consider chronic tubulointerstitial disease)
What current set of criteria are most commonly used (and most preferred) to
score the severity of acute kidney injury?
KDIGO
A pH of less than _____ in an AKI patient requires the start of urgent
hemodialysis.
7.1
A patient in AKI is found to have dark brown urine with a positive urine dip for
blood, but no red blood cells are visible on microscopy. What is the most likely cause?
Myoglobinuria
An ANCA level is helpful to diagnose which type of renal disease?
Pauci-immune GN
What condition would preclude the use of IV fluids in a patient with prerenal azotemia?
Volume overload or acute decompensated HF
In a patient with normally functioning kidneys and fluid volume excess, their urine osmolality should be:
Lower than usual
When is the best time to administer oral phosphate binder medications?
With a meal
A patient is found to have muscle weakness, hypotension, palpitations, and constipation. Their T wave on ECG tracing has diminished amplitude. What is their most likely electrolyte abnormality?
Hypokalemia
Vasopressin Receptor Antagonists are most useful in the treatment of what electrolyte or acid-base disorder?
Hyponatremia
This is produced by the liver as a waste by-product of protein breakdown:
Urea
Compared to an average patient, a vegan’s serum creatinine should be:
Lower
What type of nephron has the longest loop of Henle?
Juxtamedullary nephron
The system of shifting osmolality of the urine filtrate and surrounding tissue that allows the body to concentrate fluids is best known as:
Countercurrent mechanism
The specialized cells in the afferent arteriole that are the primary source of renin secretion are called:
JG cells
The active form of vitamin D secreted by the kidneys is known as:
Calcitriol
What is the gold standard for diagnosing renal
artery stenosis?
Renal artery angiography
What finding would you expect to see on the
urinalysis of a patient with CKD?
○ RBC casts
○ Broad, waxy casts
○ WBC casts
○ “Muddy brown” casts
Broad, waxy casts
What is the most common cause of chronic
tubulointerstitial disease?
○ Vesicoureteral reflux
○ Obstructive uropathy
○ Analgesic nephropathy
○ Nephrocalcinosis
Obstructive uropathy
What is the most common physical exam finding
in Chronic Kidney Disease (CKD)?
HTN
What is the most common cause of chronic
nephrotic glomerular disease among US patients?
○ Diabetes mellitus
○ Hypertension
○ Alcoholism
○ Acute kidney injury
DM
What is the most common primary
glomerulonephritis worldwide?
○ Amyloidosis
○ Pauci-immune glomerulonephritis
○ Henoch-Schonlein purpura
○ Berger’s disease (IgA nephropathy)
Berger’s disease/IgA nephropathy
What part of the kidney contains glomeruli?
Renal cortex
This portion of the nephron secretes
protein-bound drugs:
Proximal tubule
Creatine, the precursor to creatinine, comes
from what source(s)?
- 50% liver
- 50% diet
A patient with a history of protracted vomiting who
has been NPO with continuous NG suction for the last 48 hours
develops agitation, dizziness, paresthesias, and muscle tetany.
What acid-base disorder is most likely?
Metabolic alkalosis
A patient with acute kidney injury develops
symptomatic metabolic acidosis. What two primary modalities
are considered for treatment of metabolic acidosis in AKI?
- Bicarb
- Dialysis
Which two lab values are used to stage CKD?
- GFR
- Albuminuria
In the CKD patient, HTN, volume overload,
anemia, and accelerated atherosclerosis all increase the
workload of the heart which can lead to this complication:
○ Cardiogenic shock
○ Left ventricular hypertrophy
○ Cardiac tamponade
○ Cardiac arrhythmias
LVH
A 4-yr-old patient presents with a patchy, palpable rash on the
lower extremities and buttocks. He also complains of belly pain, nausea, and
says his knees hurt. 10 days ago, this patient was treated for strep throat. UA
reveals hematuria and mild proteinuria. What is the most likely diagnosis?
○ Berger’s disease (IgA nephritis)
○ Minimal change disease
○ Henoch-Schonlein purpura
○ Post-streptococcal glomerulonephritis
Henoch-schonlein purpura
Combination therapy with fibrates and statins in
CKD patients increases the risk of what condition?
Rhabdomyolysis
Which of the following is not a risk factor for CKD?
○ Smoking
○ High triglycerides
○ Proteinuria
○ Hypertension
High triglycerides
Cinacalcet, used in patients with advanced CKD,
acts primarily on which of the following organs?
○ Parathyroids
○ Liver
○ GI tract
○ Kidney
Parathyroid glands
Which of the following medications would pose the
greatest risk of later development of AKI?
○ levothyroxine
○ acetaminophen
○ amoxicillin
○ potassium
Amoxicillin
A patient in acutely decompensated congestive heart
failure has developed a significant elevation in serum BUN and
Cr and a fall in eGFR over the last 24 hours. The most likely type
of AKI present is:
Prerenal azotemia
An AKI patient presents with potassium of 6.9 (normal: 3.5-5.0), weakness, palpitations, and EKG changes. What medication should be administered first to address the patient’s hyperkalemia?
IV calcium gluconate
Hypernatremia is commonly a normal physiologic response
to which of the following disease states?
○ Hyperuricemia
○ Dehydration
○ Constipation
○ Hypertension
Dehydration
Rhabdomyolysis is most strongly associated with which form
of acute kidney injury?
○ Acute glomerulonephritis
○ Acute prerenal azotemia
○ Acute tubular necrosis
○ Acute interstitial nephritis
○ Acute postrenal obstruction
ATN
What is the GFR indication to begin dialysis in
chronic kidney disease patients?
GFR of <= 10
Which of the following would be the first step in
treating a patient diagnosed with obstructive uropathy?
○ Administer Lasix (furosemide)
○ Perform a renal ultrasound
○ Remove obstruction
○ Administer antibiotics
Remove obstruction
Levels of ________ are often elevated in CKD
patients, leading to reduced iron absorption and
decreased mobilization of iron from body stores.
Hepcidin
Which organism is classically associated with
postinfectious glomerulonephritis?
GABHS
Which of the following would not be appropriate to
treat the increased cardiac workload in CHF?
○ ACE inhibitor/ARB
○ Increased fluid intake
○ Sodium restriction
○ Furosemide (Lasix)
Increased fluid intake
What is the most common complication of
peritoneal dialysis?
Peritonitis
A CKD patient presents to the clinic with bone pain in her wrists
for a few weeks. On x-ray, “brown tumors” are seen. Her labs reveal an
elevated phosphorus level. What is the most appropriate initial step in the
management of this patient?
○ Start calcitriol (vitamin D)
○ Refer the patient for chemotherapy
○ Start oral phosphorus binders
○ Limit dietary phosphorus intake
Limit dietary phosphorus
What is the most common complication of CKD?
○ Hyperkalemia
○ Hyperlipidemia
○ Hypertension
○ Bone disease
○ Anemia
HTN
What is the most common presenting symptom
of Berger’s disease (IgA nephritis)?
An episode of gross hematuria
A 3-yr-old girl presents with severe edema and foamy urine.
Labs reveal the presence of hyperlipidemia, severe proteinuria, and
hypoalbuminemia. What is the best initial treatment?
○ Lisinopril
○ Prednisone
○ Calcium carbonate
○ Amoxicillin
Prednisone
Which of the following is not typically associated
with nephritic syndrome?
○ Oliguria
○ Hypertension
○ Hyperlipidemia
○ Hematuria
HLD
Which of the following physical exam findings
would be most associated with a diagnosis of uremia?
○ Fever
○ Increased appetite
○ Shortness of breath
○ Dysuria
SOB
