Pathophysiology - Nephrology practice test

A 45-year-old man presents with flank pain, hematuria, vomiting, and a fever of 101 F. Urinalysis shows 3+ blood, positive leukocytes, bacteria. CT abdomen/pelvis yields a large staghorn calculus. What is the most likely pH of the urine sample? A) 8.5 B) 7.0 C) 5.5 D) 6.2

A) 8.5

Which of the following is the most common type of kidney stone? A) Calcium oxalate B) Calcium citrate C) Uric acid D) Cystine

A) Calcium oxalate

A 17-year-old male patient is evaluated after it was noticed that his urine output was only 50 ml/24hrs. Immediately prior to this, he underwent a routine CT scan with contrast as part of a workup for hematuria. Family history is unremarkable. He does not smoke or drink alcohol. Vitals are currently within normal limits. Physical examination is unremarkable. His blood work reveals a blood urea nitrogen (BUN) of 45 mg/dl and a creatinine of 3.2 mg/dl. Fractional excretion of sodium is 4% and the urinary sodium excretion is 50 mEq/L. What part of the kidney is most affected by the patient's underlying condition? A) Corticomedullary junction B) Pelvic-ureteric junction C) Glomerulus D) Proximal convoluted tubule

A) Corticomedullary junction

A 54-year-old woman presents to the clinic with complaints of fever and right-sided flank pain for two days. She also reports blood in the urine. She had repeated urinary tract infections in the past. She does not smoke and drinks alcohol occasionally. She denies lower abdominal pain or any recent trauma. Her bowel habits are normal. On examination, she has right flank tenderness. CBC with differential shows anemia and leukocytosis. Urinalysis shows pyuria, bacteriuria, and hematuria. Urine culture is sent for further evaluation. Ultrasound abdomen shows an enlarged right kidney with a mass. Histology of the mass shows lipid-laden macrophages. What is the most common organism responsible for this condition? A) Escherichia coli B) Streptococcus pyogenes C) Staphylococcus aureus D) Staphylococcus epidermidis

A) Escherichia coli

An 84-year-old woman is evaluated in the emergency department for new onset of confusion and three days of fever and rigors. Medical history is significant for hypertension, diabetes mellitus, and hyperlipidemia. Medications are lisinopril, hydrochlorothiazide, metformin, and aspirin. The patient was diagnosed with urinary tract infection, and appropriate antibiotic therapy was initiated. She continued to have a fever on day five on antibiotics. CT of the abdomen and pelvis showed an abscess around the left kidney. What is the most frequently encountered causative organism in the abscess described? A) Escherichia coli B) Klebsiella pneumonia C) Candida albicans D) Staphylococcus aureus

A) Escherichia coli

A 67-year-old male patient is admitted to the intensive care unit (ICU) with sepsis secondary to pneumonia with severe respiratory distress. In the ICU he remains tachypneic and is placed on bilevel positive airway pressure (BIPAP) with an improvement of his work of breathing. On day two of ICU admission, serum creatinine has gradually increased since admission to 2.3 mg/dL from 1.2mg/dL. A urinalysis is performed with urine electrolytes and fractionated excretion of sodium (FENa) is calculated. Which of the following is most consistent with the diagnosis of prerenal failure? A) FENa less than 1 B) Creatinine of 2.3 C) BUN:Creatinine >50 D) FENa more than 2

A) FENa less than 1

In which electrolyte abnormality in the advanced stage would you expect to see a widening of the QRS and decreased P wave amplitude? A) Hyperkalemia B) Hypocalcemia C) Hypomagnesemia D) Hypercalcemia

A) Hyperkalemia

A reduction in the glomerular filtration rate in a hypovolemic patient will result in which of the following? A) Increased aldosterone and ADH secretion B) Increased urinary water and sodium C) Increased water and sodium excretion D) Decreased aldosterone and ADH secretion

A) Increased aldosterone and ADH secretion

A 65-year-old man is seen in the surgical intensive care unit three days post exploratory abdominal surgery for intestinal obstruction. He is currently intubated on a ventilator, has a nasogastric tube in place for gastric emptying, and has a urinary catheter with good urine output (1.5 L/24h). He receives an infusion of normal saline at 100 cubic centimeters/h. His nasogastric tube brings about one liter of gastric juice a day. He is on intravenous prophylactic antibiotics as the only medication at this time. On the physical exam, his blood pressure is 112/65 mmHg; his heart rate is at 98/min, and there are decreased bowel sounds. Laboratory data shows sodium of 138 mEq/L, chloride 92 mEq/L, potassium 3.2 mEq/L, bicarbonate 34 mEq/L, and creatinine 1.3 mg/dl. Urine electrolytes are measured and show sodium 158 mEq/L, potassium 35 mEq/L, and chloride 20 mEq/L. On the blood gas analysis, pH is 7.5, PaO2 95 mmHg, PaCO2 52 mmHg, and HCO3 33 mEq/L. What additional treatment may help the current condition of this patient? A) Intravenous pantoprazole B) Change intravenous fluid for lactated ringer at 100 cubic centimeter/hour C) Increase ventilation D) Acetazolamide infusion

A) Intravenous pantoprazole

A 50-year-old male presents with edema, hyperlipidemia, lipiduria, and heavy proteinuria. A histologic study reveals normal findings. He is referred to a nephrologist because his condition is worsening. Which of the following is the pathogenesis of this patient's condition? A) Loss of negative charges in glomerulus B) Necrosis of the tubular epithelium C) Glomerular endothelial cells necrosis D) Bilateral ureteral obstruction

A) Loss of negative charges in glomerulus

A 62-year-old man presents to the hospital with complaints of left-sided abdominal pain, hematuria, nausea, and anorexia. He denies fever, changes in bowel habits, and any history of trauma. His past medical history includes diabetes mellitus, chronic obstructive pulmonary disease, and hyperlipidemia. His current medications include glipizide, metformin, albuterol, and simvastatin. He smokes one pack of cigarettes a day but does not drink alcohol, or illicit drugs. The family history is remarkable for hypertension in father and breast cancer in mother. His vital signs are temperature: 98 F, blood pressure: 110/80 mmHg, pulse rate: 106/min, respiratory rate: 24/min, and oxygen saturation 97% on room air. The body mass index (BMI) is 31 kg/m2. A cardiopulmonary examination reveals normal heart sounds with bilateral equal air entry. The left flank is tender with no hepatosplenomegaly. Cranial nerves II to XII are intact. Initial labs reveal hemoglobin 13.5 g/dL, leucocytes 8,500/microL, and creatinine 1.1 mg/dL. Urinalysis reveals urine pH 4.5, 3+ red blood cells, and no white blood cells. Non-contrast CT scan of the abdomen reveals radiolucent stones in the lower pole of the left kidney. Which of the following conditions is responsible for the formation of such types of kidney stones? A) Low urine pH B) An increased concentration of urinary glycoproteins C) An increased concentration of urinary glycosaminoglycans D) Low Uric acid in the urine

A) Low urine pH

A 35-year-old female with a history of recurrent urinary tract infections presents with flank pain, hematuria, vomiting, and a fever of 101 F. Urinalysis is positive for blood, leukocytes, and nitrites. The urine pH is 8.5. A CT scan revealed a large staghorn calculus. Which of the following is the most likely composition of this patient's kidney stone? A) Magnesium phosphate B) Uric acid C) Calcium oxalate D) Calcium phosphate

A) Magnesium phosphate

A 10-month-old girl has had gastroenteritis with decreased urine output for three days. The parents report that she was difficult to arouse after her nap. On physical examination, she weighs 10 kg but had weighed 12 kg at her nine-month well-child visit. She is not tachycardic, and her blood pressure is normal. Moreover, her skin shows decreased turgor and feels doughy, and her fontanelle is sunken. Oxygen saturation is normal. Laboratories investigations have been drawn. Which of the following fluid should be used for hydration? A) Normal saline B) Half-normal saline C)Lactated

A) Normal saline

A 52-year-old male presents with fever and malaise. He develops acute kidney injury. Urinalysis is positive for hematuria and mild proteinuria. Chest-X ray is normal. Blood tests show low levels of C3 and C4. A kidney biopsy shows a linear deposition of IgG along the glomerular basement membrane and necrotizing crescent formation. Which of the following is the pathogenesis of this condition? A) Type II hypersensitivity B) Type IV hypersensitivity C) Type I hypersensitivity D) Type III hypersensitivity

A) Type II hypersensitivity

A 48-year-old male patient presents to the clinic for a follow-up visit with complaints of tingling sensations in the hands. He was diagnosed with diabetes mellitus type 2 three years ago and is currently under treatment. On presentation, he has a temperature of 98.6 F (37 C), a pulse rate of 72 bpm, a blood pressure of 130/85 mmHg, and a respiratory rate of 15 breaths/min. The physical examination does not demonstrate any significant findings. He has a hemoglobin of 12.2 g/dl, a white cell count of 4500 cells/microliter, and a platelet count of 300000 cells/microliter. His glycated hemoglobin level (HbA1c) is 7.5% (normal: 4%-5.6%). He complains of passing frothy urine often. The provider decides to evaluate the patient for a complication of diabetes. What is the next best step? A) Urinary albumin to creatinine ratio B) Fractional excretion of sodium C) 24 hours urinary excretion of proteins D) Fundoscopy

A) Urinary albumin to creatinine ratio

A 62-year-old man is evaluated in the hospital for persistent fever, dysuria, and flank pain. He was admitted 3 days ago for treatment of pyelonephritis because of nausea and vomiting. Her fever is persistent even after 96 hours despite treatment with IV ceftriaxone. Past medical history is insignificant. CT abdomen and pelvis showed a soft-tissue mass (20 Hounsfield unit) with a thick wall on the right kidney consistent with abscess. What is the most common cause of this abscess? A) Urinary tract infection B) Structural abnormality C) Bacteremia D) Surgical instrumentation

A) Urinary tract infection

A previously healthy 18-year-old woman is seen in your office complaining of a 3-day episode of "red urine," which has now resolved. She is frightened because this has never happened to her before. The patient also complains of severe pain and burning upon urination, and she is urinating more frequently than normal, up to 12 times per day. She and her boyfriend had sexual intercourse for the first time 1 week ago. What Is the Most Likely Diagnosis? A) Urinary tract infection B) Goodpasture's disease C) Bladder cancer D) Ureteral calculus E) IgA nephropathy

A) Urinary tract infection

A 52-year-old male presents to the emergency department with severe nausea, vomiting, and headaches. He appears to be confused and lethargic. Upon further evaluation of his history, it is revealed he has a current history of lung malignancy. On physical examination, he is unable to answer questions and is drowsy but arousable on painful stimuli. Laboratory evaluation reveals a serum calcium of 15.2 mg/dL. Which of the following is the next best immediate step in the management of this patient? A) Volume repletion with normal saline B) Administration of loop diuretics C) Administration of 5% dextrose D) Administration of zoledronic acid

A) Volume repletion with normal saline

A 17-year-old female presents with complaints of burning on micturition, urgency in urination, and bilateral flank pain. She has a history of diabetes and hypertension. On examination, she has a low-grade fever, a blood pressure of 150/90 mmHg, and her pulse is 120 bpm. Her serum creatinine is 3.2 mg/dl. How many colonies of bacteria/ml are usually required in a clean catch urinary specimen to verify it as the source of infection? A) 50,000/ml B) 10,000/ml C) 1,000/ml D) 500,000/ml

B) 10,000/ml

A 65-year-old patient with grand mal epilepsy is well controlled on phenytoin. He has recently started taking laxatives for constipation. He presents to the emergency department with muscle cramps and fatigue. His blood tests reveal a potassium level of 2.3 mEq/L. What is the correct dose and mode of administration of potassium chloride for this patient? A) 40 mEq over 4 hours intravenously B) Y-sited with the scheduled phenytoin dose C) 40 mEq rapid push through a peripheral IV D) 40 mEq rapid push through a central line

B) 40 mEq over 4 hours intravenously

A 16-year-old male patient presents with complaints of dark-colored urine for the last 3 days. He recently finished a course of oral antibiotics that were prescribed 10 days to treat strep throat infection. His vitals show a blood pressure of 145/90 mmHg, a pulse of 110 beats per minute, a respiratory rate of 22 breaths per minute, and a temperature of 100 F (37.7 C). On physical examination, there is mild periorbital edema. The oropharyngeal and neck examination are unremarkable. The urinalysis revealed mild proteinuria and red blood cell casts. Which of the following is the most likely diagnosis? A) Focal segmental glomerulosclerosis B) Acute post-streptococcal glomerulonephritis C) Minimal change disease D) IgA nephropathy

B) Acute post-streptococcal glomerulonephritis

A 65-year-old female presents to the clinic with complaints of flank pain for the past two weeks. She also complains of weight loss, anorexia, and pain during micturition. She had three episodes of urinary tract infections (UTIs) last year, which were treated with antibiotics. She denies fever or recent trauma. On examination, costovertebral angle tenderness is noted. Initial laboratory analysis shows a decreased hemoglobin level. Urinalysis reveals pyuria and bacteriuria. CT scan with contrast shows replacement of the normal renal tissue by multiple, hypoechoic areas of the dilated collecting system that is surrounded by an enhanced rim of contrast medium that results in a multiloculated appearance. What is the name of this sign seen on the CT scan of this patient?

B) Bear paw sign

A 60-year-old man is brought to the emergency department with complaints of right-sided abdominal pain, hematuria, and 3 episodes of vomiting. He denies fever, shortness of breath, diarrhea, constipation, and any history of trauma. His past medical history includes diabetes mellitus, hypertension, and hyperlipidemia, for which he takes metformin, losartan, and atorvastatin. He drinks 3-4 alcoholic drinks daily but does not smoke or use illicit drugs. His family history is not significant. His temperature is 98 F, blood pressure 140/90 mmHg, pulse 102/min, respiratory rate 26/min, and oxygen saturation 97% on room air. His BMI is 30 kg/m2. A cardiopulmonary examination reveals normal S1 and S2 with bilateral equal air entry. The right flank is tender with no hepatosplenomegaly. Cranial nerves II to XII are intact. Laboratory reveals hemoglobin 12.5 g/dL, leucocytes 7000/microL, and creatinine 0.9 mg/dL. Urinalysis reveals urine pH 5.0, 3+ red blood cells, but no white blood cells. The patient is given IV ketorolac, which resolves the patient's pain. Which of the following is the next best step in the management of this patient? A) Discharge with follow up in the clinic B) CT abdomen C) Intravenous urography D) Ciprofloxacin

B) CT abdomen

A woman status post colectomy is on intravenous (IV) ondansetron and 5% dextrose in water (D5W) and half normal saline. On postoperative day two, she becomes obtunded and is found to have the following labs: sodium 114 mEq/L, potassium 3.5 mEq/L, chloride 88 mEq/L, bicarbonate 22 mEq/L, blood urea nitrogen 4 mg/dL, and creatinine 1.3 mg/dL. Which of the following is the next best step in managing this patient? A) Order a loop diuretic B) Change the IV fluid to hypertonic saline. C) Change the IV fluids to Ringer's lactate. D) Order a head computed tomography (CT) scan

B) Change the IV fluid to hypertonic saline.

A previously healthy 25-year-old male presented to the ER due to an episode of red urine one hour ago. The episode occurred after finishing a session with his personal trainer that left him exhausted and with generalized muscle pain. He is alert and oriented and has unremarkable vital signs. The urine dipstick is positive for blood, but there is no evidence of red or white blood cells on the urine microscopy. He denies taking any medications or recent dietary changes. Which of the following is most likely responsible for his reddish urine? A) Early prostatic cancer B) Excess myoglobin in urine C) Urethral trauma while training D) Lower urinary tract infection

B) Excess myoglobin in urine

A 65-year-old female presents to the clinic with a five-day history of weakness, fatigue, muscle cramps, palpitations, and constipation. She has a past medical history of congestive heart failure and was recently started on a medication for fluid overload. Her blood pressure is 116/62 mmHg, pulse 100/min, respirations 15/min, and temperature 98 F (36.7 C). On examination, the patient has 3/5 muscle strength in bilateral upper and lower extremities. ECG shows diffuse flattening and inversion of T waves. Which of the following medications was the patient most likely recently prescribed? A) Lisinopril B) Furosemide C) Spironolactone D) Candesartan

B) Furosemide

A 16-year-old otherwise healthy female on no medications presents complaining of swelling and is found to have a BP of 150/93, periorbital edema, 3+ peripheral edema, normal cardiovascular exam, and the following lab values: Creatinine 0.7 mg/dL, albumin 2.2 g/L, Urinalysis 3+ protein, 0 RBC/HPF, 0 WBC/HPF, 1+oval fat bodies. Which of the following should be avoided? A) Low sodium diet B) High fat in diet C) High carbohydrate diet D) An ACE inhibitor

B) High fat in diet

A 36-year-old male presented to the ER due to sudden onset of severe left flank pain that radiates to the groin and does not improve with ibuprofen or postural changes. Vital signs are unremarkable. There is tenderness to percussion over the left flank. A CT scan revealed a stone in the left ureter. Which of the following is the most likely risk factor for stone formation in this patient? A) Hypouricemia B) Hypercalciuria C) Hypermagnesiuria D) Hypocalciuria

B) Hypercalciuria

A 65-year-old man presents to the clinic with a history of hematuria, fatigue, arthralgia, and rash for 1 week. The patient recently acquired an upper respiratory tract infection and is taking amoxicillin-clavulanic acid. Urinalysis is positive for eosinophils. Blood workup shows elevated blood urea nitrogen and creatinine levels. If a renal biopsy of this patient was obtained, what would be the most likely histological finding? A) Kimmelstiel-Wilson nodules B) Inflammatory cells C) Mesangial proliferation D) Tram tack appearance

B) Inflammatory cells

A 78-year-old male is admitted to the ER due to an acute confusional state. His blood pressure is 95/50 mmHg, heart rate 115 bpm, respiratory rate 24/min, and temperature 98 F. The abdominal exam is unremarkable. Lab tests show a serum sodium of 140 mEq/L, blood urea nitrogen (BUN) of 40 mg/dl, and serum creatinine of 1.5 mg/dl. The urinary sodium is normal. Which of the following is the most likely pathogenesis of this patient's condition? A) Benign prostatic hyperplasia B) Intravascular volume depletion C) Hepatorenal syndrome D) Intrinsic renal parenchyma injury

B) Intravascular volume depletion

Under which condition is there increased lactate production? A) Inflammation B) Ischemia C) Hypersensitivity reaction D) Infection

B) Ischemia

A patient with a history of diabetes mellitus type 1 presents to the ER with altered mental status and signs of dehydration. His breath smells like nail polish. He has a heart rate of 123 beats per minute, and a respiratory rate of 32 breaths per minute. Which of the following do you expect to find in his lab results? A) Low PaCO2, normal anion gap B) Low PaCO2, increased anion gap C) High PaCO2, increased anion gap D) High PaCO2, normal anion gap

B) Low PaCO2, increased anion gap

You receive a telephone call from a 32-year-old woman who complains of burning with urination over the past 12 hours. She also feels an intense need to urinate but reports difficulty voiding more than a small amount. She has experienced similar symptoms in the past and requests that you call in a prescription for antibiotics to her pharmacy. Your patient states that she had similar symptoms 6 months ago, which were diagnosed as a urinary tract infection. Her symptoms at that time resolved completely with antibiotic treatment. She denies any current vaginal irritation or discharge. She has had one male sexual partner for the past 2 years, does not use condoms, and has not had any sexually transmitted diseases. She denies fever, chills, nausea, vomiting, and back, pelvic, or abdominal pain. She does not have diabetes and is not pregnant. What Is the Most Likely Diagnosis? A) Urethrocystitis due to herpes simplex virus B) Lower urinary tract infection C) Vaginal candidiasis D) Pyelonephritis

B) Lower urinary tract infection

A 50-year-old male with alcohol use disorder presents to the emergency department with epigastric abdominal pain and shortness of breath. Physical examination reveals that the lungs are clear, there are no extra heart sounds, and the abdomen is distended and tender to deep palpation at the epigastrium without rebound, masses or hepatomegaly. Vital signs are blood pressure 90/60 mmHg, respiratory rate 22 breaths/min, and heart rate 100/min. Labs indicate a pO2 85, pCO2 29, pH 7.31, Na 140, K 4.2, Cl 105, and HCO3 14. Which of the following is this patient's acid-base disturbance? A) Mixed metabolic acidosis and respiratory alkalosis B) Metabolic acidosis, increased anion gap compensation C) Metabolic acidosis, normal anion gap D) Mixed metabolic acidosis and respiratory acidosis

B) Metabolic acidosis, increased anion gap compensation

Of the following, which drug is most appropriate for prophylactic treatment of female recurrent urinary tract infections? A) Sulfamethoxazole B) Nitrofurantoin C) Ceftriaxone D) Doxycycline

B) Nitrofurantoin

A male patient presents to the emergency department with complaints of nausea, vomiting, and left flank pain. The patient says that he feels pain during micturition, and his urine appears cloudy and reddish-brown. He is a known patient of hypertension and asthma, which are under control. Which of the following tests is the most sensitive and specific for making a diagnosis in this patient? A) Intravenous pyelography B) Non-contrast abdominal CT C) Renal ultrasound D) Plain x-ray of kidneys, ureters, and bladder

B) Non-contrast abdominal CT

A 36-year-old woman presents to the emergency department with left-sided flank pain. The pain is severe, located just below her left ribs, and has been constant for the past 12 hours. It does not radiate or change with position. She also reports a fever to 101°F and general malaise. The patient reports that her symptoms started approximately 1 day after she noticed a burning sensation when urinating. Associated symptoms included nausea and vomiting. Past medical history includes an uncomplicated pregnancy and a history of urinary tract infections. She does not smoke and does not use intravenous drugs. What Is the Most Likely Diagnosis? A) Renal infarct B) Pyelonephritis C) Musculoskeletal strain D) Nephrolithiasis

B) Pyelonephritis

A 70-year-old male presents to the emergency department with excruciating chest pain and moderate abdominal pain radiating between the scapulae. He is in severe distress. Vitals show BP 90/60 mmHg, pulse 110 bpm, afebrile, and respiratory rate of 20/min. His past medical history includes hypertension and smoking. Abdominal aortic rupture is suspected, so he is sent to the operating room for emergency repair. During the operation, there was severe blood loss, and he was transfused with six units of red blood cells and given 4,000 ml of normal saline in the ICU. A Foley catheter is placed in the OR. His urine output drops to 30 ccs per hour postoperatively. Which of the following is the most appropriate next step in management? A) Catheter removal B) Urinalysis C) Urine creatinine D) KUB radiograph

B) Urinalysis

A 16-year-old male patient presents with complaints of fever, sore throat, lethargy, and non- productive cough for the last ten days. Dark-colored urine is also present for the last five days. His vitals show a blood pressure of 145/90 mmHg, a pulse of 110 beats per minute, a respiratory rate of 22 breaths per minute, and a temperature of 100 F (37.7 C). On physical examination, there is mild periorbital edema. Urine analysis revealed proteinuria and red cell casts. Other laboratory investigations reveal a raised serum anti-streptolysin O and anti-DNase antibody titers. Ultrasonography of the kidney reveals a loss of corticomedullary differentiation. What is the most probable diagnosis? A) Rapidly progressive glomerulonephritis B) IgA nephropathy C) Acute post-streptococcal glomerulonephritis D) Nephrotic syndrome

C) Acute post-streptococcal glomerulonephritis

Which of the following conditions will most likely cause a hypervolemic hyponatremia? A) Diabetes insipidus B) Furosemide overdose C) Congestive heart failure D) Syndrome of inappropriate ADH

C) Congestive heart failure

A patient with a history of liver cirrhosis presents with oliguria and altered mental status. On physical exam, there is ascites and a pericardial friction rub. Urine microscopy does not show abnormalities. The BUN to creatinine ratio is 25:1. Which of the following is the cause of this patient's disorder? A) Atherosclerotic stenosis of the renal arteries B) Urine retention due to medications C) Decreased effective circulating volume D) Kidney damage due to circulating antibodies

C) Decreased effective circulating volume

A 50-year-old female complains of fever and right-sided flank pain and blood in her urine for two days. She has a history of recurrent urinary tract infections. The physical exam is significant for right flank and costovertebral angle tenderness. Blood work reveals anemia and leukocytosis. Urinalysis shows pyuria, bacteriuria, and hematuria. Which of the following is the most likely etiology of this patient's condition? A) Staphylococcus aureus B) Streptococcus pyogenes C) Escherichia coli D) Candida albicans

C) Escherichia coli

A 5-year-old boy had spent the day at an amusement park and was very exhausted when he came home. Now he suddenly has red urine. He is brought to an urgent care clinic where his urine and blood samples are taken. The urine dipstick is positive for blood, but the urine microscopy does not show any red or white blood cells. The child was given regular feeds throughout the day, but he did not drink any water while in the park. The child did not have a history suggestive of bleeding disorders in the past. He was also not on any medications. Which of the following is most likely responsible for his reddish urine? A) Ingestion of red dye in a drink B) Urinary tract infection C) Excessive exertion at the park D) Renal trauma while playing

C) Excessive exertion at the park

A 26-year-old male is brought to the emergency department with complaints of nausea and vomiting. He has also been experiencing drowsiness. He is a known case of type 1 diabetes mellitus. On presentation, he is afebrile, has a pulse rate of 92 bpm, a blood pressure of 90/70 mmHg, and a respiratory rate of 26 breaths/min. The physical examination does not reveal any abnormal findings, except for mild generalized abdominal pain. His blood sugar levels come out to be 400 mg/dl [normal: up to 7.8 mmol/L (140 mg/dL), 2 hours postprandial]. He has a Hb of 12.5 g/dl, a TLC of 7000/mm3, and a platelet count of 250,000/mm3. Urinary ketones on a urine dipstick test are noted to be 4+. Serum electrolytes include a sodium level of 138 mmol/L (normal: 135 mmol/L to 145 mmol/L), a potassium of 3.5 mmol/L (normal: 3.5 mmol/L to 5 mmol/L), and a chloride of 100 mmol/L (normal: 95 mmol/L to 105 mmol/L). The electrocardiography does not reveal any abnormal findings. Which of the following would most likely be found on the analysis arterial blood gas analysis in this patient? A) Combined high anion gap metabolic acidosis along with respiratory acidosis B) Respiratory alkalosis C) High anion gap metabolic acidosis D) Non-anion gap metabolic acidosis

C) High anion gap metabolic acidosis

A 65-year-old undergoes surgery, and his fluid is adequately replaced. He makes urine at 25 cc/hr. Postoperatively he receives 5% dextrose in water (D5W) with 0.45 percent normal saline at 150 cc/hr. What will be the most likely metabolic abnormality in this patient 24 hours after surgery? A) Metabolic alkalosis B) Hypokalemia C) Hyponatremia D) Hypernatremia

C) Hyponatremia

A patient presents to the ER with persistent vomiting, diarrhea, and fever for two days. He has a history of hypertension for which he is being treated with hydrochlorothiazide. He has mild confusion and complains of muscle cramps. His BP is 95/60 and his heart rate 120/min. Which of the following do you expect to find in this patient's lab tests? A) Hyponatremia and hypokalemia B) Hypernatremia and hyperkalemia C) Hyponatremia and hypokalemia D) Hyponatremia and hyperkalemia

C) Hyponatremia and hypokalemia

A 52-year-old woman was brought to the emergency department after being buried under a heavy overturned table. She was under the table for about 2 hours. She complains of pain in both thighs and buttocks. Her past medical history is significant for diabetes mellitus type 2 with peripheral neuropathy, rheumatoid arthritis, and hypertension. Currently, she is on insulin, gabapentin, prednisone, and lisinopril. On examination, both the thighs and buttocks are tender to touch, rigid with decreased capillary refill and peripheral pulses. Labs show elevated CPK of 12,000 units/L, serum creatine of 3 mg/dl. Pelvis and hip x-rays did not show any fracture. She was started on aggressive IV fluids but still has decreased urine output. Which of the following drugs is best used at this point to decrease solute overload and increase urine production? A) IV furosemide B) IV bicarbonate drip C) IV mannitol D) IV ringers' lactate

C) IV mannitol

A 52-year-old woman with a past medical history of hypertension presents to the clinic to establish as a new patient. She feels well and has no complaints. Physical examination is unremarkable. Current medications include lisinopril 10 mg/day and metoprolol 25 mg/day. A review of recent lab results shows a calcium level of 11.8 mg/dL (3.01 mmol/L), creatinine 0.8 mg/dL (79.58 umol/L), and albumin 4.0 g/dL. Vitamin D level and complete blood count are within normal limits. Outside labs are requested for comparison, and hypercalcemia is noted to have been present for the past three years, with values ranging from 11.0 mg/dL (2.74 mmol/L) to 11.9 mg/dL (2.97 mmol/L). The patient denies taking supplements, excessive dietary calcium intake, or a family history of hypercalcemia. What is the best next step in determining the etiology of this patient's elevated serum calcium? A) 24-hour urine calcium and creatinine B) Dual-energy x-ray absorptiometry (DEXA) scan C) Intact parathyroid hormone (iPTH) level D) Whole-body bone scan

C) Intact parathyroid hormone (iPTH) level

A 65-year-old man presents with dull abdominal pain for 3 weeks. The pain is in the right upper quadrant and is not related to movement, inspiration, or food. The patient describes the severity as 4/10. Past medical history is insignificant. There is a long history of smoking. Vital signs include blood pressure 135/80 mmHg, pulse 80 beats per minute, and temperature 37.3 C (99.1 F). Physical exam is significant for mild tenderness in the right lumbar quadrant. Laboratory workup is significant only for microscopic hematuria. CT scan shows a solid right renal mass with signs of necrosis and no macroscopic fat. What is the most common location of metastases given the most probable diagnosis? A) Brain B) Bone C) Lungs D) Liver

C) Lungs

A young otherwise healthy female on no medications presents complaining of swelling and is found to have a BP of 150/93, periorbital edema, 3+ peripheral edema, normal cardiovascular exam, and the following lab values: Creatinine 0.7 mg/dL, albumin 2.2 g/L, Urinalysis 3+ protein, 0 RBC/HPF, 0 WBC/HPF, and oval fat bodies. What should be the first diagnostic test ordered? A) Serum protein electrophoresis B) Renal ultrasound C) Measurement of urine protein to creatinine ratio D) Test for antineutrophil cytoplasmic antibodies (ANCA)

C) Measurement of urine protein to creatinine ratio

A 65-year-old female presented with the complaint of muscle weakness, fatigue, and decreased appetite for the past three days. She has a history of chronic hypokalemia, for which she had multiple visits to the emergency department due to severe muscle weakness. Her initial investigations revealed sodium 140 mmol/L, potassium 2.9 mmol/L, chloride 118 mmol/L, and bicarbonate 17 mmol/L. Her arterial blood gases (ABGs) showed pH 7.30, partial pressure of carbon dioxide 28 mmHg, and partial pressure of oxygen 120 mmHg. What is the acid-base disturbance in this patient? A) Respiratory acidosis with metabolic compensation B) Non-anion gap metabolic acidosis C) Metabolic acidosis with respiratory compensation D) Anion gap metabolic acidosis

C) Metabolic acidosis with respiratory compensation

A 55-year-old male with a past medical history of hypertension, hypothyroidism, and obstructive sleep apnea presents gastritis symptoms. His medications include amlodipine, levothyroxine, and pantoprazole. He started having low-grade fever after 15 days. He notices maculopapular rashes on his back and trunk. He did not observe any dysuria or a decrease in urine output. He did not have any cough, nausea, vomiting, diarrhea. His laboratory results revealed a rise in serum creatinine to 2.5 mg/dl from baseline 1.2 mg/dl. The rest of the other parameters were normal. He was admitted to the hospital for further workup and close monitoring. He was given some intravenous fluids for two days. His serum creatinine continued to rise even after the admission. A urine examination shows sterile pyuria. The imaging of kidneys was not significant for obstruction. A kidney biopsy was done on day 4 of hospitalization. His home medications were reviewed and were held except levothyroxine on day 5. His serum creatinine started improving after day 7 of hospitalization. He was discharged home on day 8 with resuming his amlodipine. What could be the histopathological findings in light microscopy consistent with his clinical scenario? A) Thickening of the glomerular basement membrane, spike and hole pattern of the glomeruli in the silver stain, and atrophy of the tubules. B) Neutrophilic infiltration of tubules and interstitial space, intratubular cellular cast present in 2 tubules. C) Mononuclear cells infiltration in tubules and interstitial space, scattered eosinophils in interstitial space, intratubular cellular cast in 4 tubules, and normal looking glomeruli. D) Dilated tubules with the thinning of brush borders of tubules, increased intratubular space, edematous interstitial space without cellular infiltration, and normal looking glomeruli.

C) Mononuclear cells infiltration in tubules and interstitial space, scattered eosinophils in interstitial space, intratubular cellular cast in 4 tubules, and normal looking glomeruli.

A 24-year-old man was brought to the emergency department by paramedics after being hit by a car. The incident happened 2 hours ago. The patient has both his lower extremities crushed and is complaining of severe pain in both legs. On admission, his blood pressure is 124/82 mmHg, and his heart rate is 92 beats per minute. On examination, both his thighs are swollen and tender. X-ray shows a fracture of both the femurs and urinalysis reveals massive hemoglobinuria. Abdominal and chest X-rays are normal. What would be the next appropriate step in the management of this patient? A) Blood transfusion B) Ultrasound of kidneys C) Normal saline with sodium bicarbonate D) Furosemide

C) Normal saline with sodium bicarbonate

A 17-year-old woman presents to the healthcare provider with a complaint of fatigue. She says that she always has been weak at times, but recently, the symptom seems to be more persistent. She has no nausea, vomiting or headaches. She does not have any particular digestive problems. On her physical exam, Her BMI is at 20 kg/m2. The blood pressure is 102/51 mmHg, heart sounds are normal, the chest exam is normal, and the abdominal exam is normal. Initial laboratory values include sodium of 142 mEq/L, chloride 95 mEq/L, potassium 3.1 mEq/L, and creatinine 0.8 mg/dl. Analysis of urine reveals no blood and no protein. Her urine electrolytes show sodium of 90 mEq/L, chloride 65 mEq/L, and potassium 31 mEq/L. What is the next step in the evaluation of this patient? A) Obtain a serum level of plasma renin activity and aldosterone B) Obtain psychiatry consult C) Obtain additional urinary electrolytes to evaluate calciuria D) Increase the salt intake and follow in one month

C) Obtain additional urinary electrolytes to evaluate calciuria

A 65-year-old African American male presents with complaints of multiple episodes of blood in his urine, frequent urination, and fatigue despite minimal activity for the past six months. He has a history of hypertension for more than 20 years, and for the past few years, his blood pressure has been poorly controlled despite taking medications. Currently, his blood pressure reading is 150/100 mmHg, his pulse rate is 62 beats per minute, his temperature is 98.7 F, respiratory rate is 18 breaths per minute, and his body mass index is 31 kg/m2. There are no significant findings on his physical examination. Initial tests are done, and his serum electrolytes show a calcium level of 12.5 mg/dl. An abdominal ultrasound is performed, and a 5 cm solid left renal mass is detected off the lower pole of the kidney. No similar findings are observed in the right kidney. Computed tomography (CT) scan confirmed the ultrasound findings but demonstrates no abnormalities in the rest of the abdomen. Assuming that all the following are possible, what is the most appropriate treatment for this patient? A) Radical nephrectomy B) Radiofrequency ablation C) Partial nephrectomy D) Chemotherapy

C) Partial nephrectomy

A 58-year-old man with a past medical history of chronic congestive heart failure, alcohol use, and poorly controlled hyperlipidemia is referred to the emergency department from an outpatient primary care clinic for an abnormal sodium level. Medications include metoprolol, furosemide, atorvastatin, and aspirin. A focused physical examination is unremarkable, and vital signs are within normal limits. Laboratory findings that were acquired as part of the initial diagnostic workup are listed in the attached image. Which of the following is most likely responsible for this patient's laboratory findings? A) Excess urinary losses B) Congestive heart failure C) Pseudohyponatremia D) Excess gastrointestinal losses

C) Pseudohyponatremia

Which of the following will most likely occur to a patient with bilateral renal artery stenosis if treated with ACE inhibitors? A) Increased urine output because of efferent artery vasodilation B) Increased urine output because of efferent artery vasoconstriction C) Reduced urine output because of efferent artery vasodilation D) Reduced urine output because of efferent artery vasoconstriction

C) Reduced urine output because of efferent artery vasodilation

A 47-year-old woman with a past medical history of poorly controlled diabetes, hyperlipidemia, and chronic alcohol use is hospitalized for altered mental status. On physical examination, the patient slurs her words and is visibly intoxicated. She appears clinically euvolemic, has normal vital signs, and unremarkable cardiorespiratory and abdominal examinations. Laboratory studies in the emergency department are notable for a serum glucose of 255 mg/dL (70 - 100 mg/dL), a serum sodium level of 125 mEq/L (135 - 145 mEq/L), and a serum osmolality of 292 mOsm/kg H2O (280 - 300 mOsm/kg H2O). What is the most appropriate next step in the management of this patient's hyponatremia? A) Measure urine sodium level B) Administer intravenous isotonic saline C) Repeat serum sodium measurement with direct ion-selective electrode potentiometry (DISE) D) No further workup is necessary

C) Repeat serum sodium measurement with direct ion-selective electrode potentiometry (DISE)

A 16-year-old male patient presents with the complaint of fever, sore throat, lethargy, and non-productive cough for the last 10 days. Dark-colored urine is also present for the last 5 days. His vitals show a blood pressure of 145/90 mmHg, a pulse of 110 beats per minute, a respiratory rate of 22 breaths per minute, and a temperature of 100 F (37.7 C). On physical examination, there is mild periorbital edema. Urine analysis reveals proteinuria and red cell casts. Other laboratory investigations reveal a raised serum anti-streptolysin O and anti-DNase antibody titers. Ultrasonography of the kidney reveals a loss of corticomedullary differentiation. What is the most appropriate initial step of management? A) Administer intravenous (IV) methylprednisolone B) Administer intravenous loop diuretics C) Restrict salt and fluid intake D) Plasmapheresis

C) Restrict salt and fluid intake

A 6-year-old female patient presents with swelling of the legs and face, particularly around the eyes. The child had a history of skin lesions with golden crusting three weeks back. She has used topical mupirocin ointment on it. The patient has no family history of renal diseases. On general physical examination, the blood pressure is 136/95 mmHg, and she has pedal edema. The urine analysis shows 7-9 white blood cells per high power field, 10-12 red blood cells per high power field, acanthocytes, and protein. The 24-hour urinary protein excretion is 1900 mg. The patient's serum creatinine is 3.7 mg/dl and blood urea nitrogen is 31 mg/dl. Which of the following treatments will help relieve this patient's symptoms? A) Metoprolol B) Verapamil C) Salt and fluid restriction D) Restriction of protein in the diet

C) Salt and fluid restriction

A 68-year-old African American male patient with poorly controlled diabetes mellitus presents with new-onset bilateral swelling in his feet. He is insulin-dependent and takes an angiotensin-converting enzyme (ACE) inhibitor. On examination, there is three-plus pitting edema of his lower extremities bilaterally. Blood work reveals a creatinine of 2.6 mg/dL and potassium 6 mEq/dL. Past medical records indicate that his creatinine has been the same over the last 2 years. The electrocardiogram (ECG) is normal. What is the most appropriate next step in management? A) Start immediate hemodialysis B) Start calcium acetate C) Start patiromer sorbitex calcium and furosemide D)Discontinue the ACE inhibitor

C) Start patiromer sorbitex calcium and furosemide

An 8-month boy is brought in by his parents with a fever for the past 12 hours. His mother reports decreased nursing but no emesis, diarrhea, or respiratory symptoms. His temperature is 39.4 C (102.9 F), and he is fussy but consolable. The physical exam is unremarkable. White blood cell count is 18,000/microliter with 9% bands. Urinalysis is needed as part of the workup of this infant. Which of the following is the most appropriate method for urine collection in this patient? A) Clean catch urine B) A bagged specimen C) Transurethral catheterization D) Condom catheter

C) Transurethral catheterization

A 33-year-old male presents to the emergency department with severe pain radiating from his left flank to his groin. The pain is colicky in nature. On exam, the patient appears to be in acute distress. He is tachycardic and diaphoretic and has left costovertebral tenderness. Urinalysis shows greater than 180 RBCs and 3+ blood. What is the best way to make the diagnosis? A) Cystoscopy B) Plain abdominal x-ray C) Unenhanced CT of abdomen and pelvis D) Intravenous pyelogram

C) Unenhanced CT of abdomen and pelvis

A 5-year-old male is brought in with facial puffiness. On examination, it is noted that there are many insect bite marks on his skin, some of which are infected. His father reveals that these are bed bug bites. The patient further describes that his urine has become frothy. What is the next step in management? A) Complete blood count and electron spin resonance B) Renal ultrasound C) Urinalysis D) Topical antibiotic for the skin infection

C) Urinalysis

A 30-year-old female presents to the emergency department with severe pain in her right groin. She appears pale and diaphoretic, and in wrenching into a basin. She reports that she has had similar pain with menses, but this pain is more severe, and usually does not have accompanying nausea or vomiting. She is unable to tolerate a physical examination due to pain and is pacing around the exam room. Her urine pregnancy test is negative, and urine dipstick shows 3+ blood. What is the next best step in the management of this patient? A) Antibiotics B) Diuretics C) Antiarrhythmics D) Analgesics

D) Analgesics

A 65-year-old woman presents with pain in her left flank that started two days ago. She also reports intermittent fever associated with the flank pain. On further questioning, she admits she has a burning sensation during urination and has been urinating more frequently than usual. She has been treated for diabetes mellitus type 2 for twenty years. Her blood pressure is 100/70 mmHg, heart rate 98/min, respiratory rate 16/min, and temperature 102 F (38.8 C). Examination demonstrates left flank and suprapubic tenderness with mild palpation. HgbA1c is 8%. Urinalysis shows 22 white blood cells per cubic millimeter. A urine culture is sent, and results are pending. What is the most appropriate next investigation for this patient? A) MRI of the abdomen and pelvis B) CT of the abdomen and pelvis without contrast C) Intravenous pyelogram D) CT of the abdomen and pelvis with contrast

D) CT of the abdomen and pelvis with contrast

A patient had abdominal surgery and received six units of blood. Postoperatively, she complains of numbness around her mouth and has carpopedal spasms. An ECG reveals a prolonged QT interval. A reduced level of which of the following is most likely responsible for these findings? A) Citrate B) Potassium C) Magnesium D) Calcium

D) Calcium

A 34-year-old patient is brought to the emergency room after being involved in a motor vehicle collision. Physical examination shows tenderness in the left upper arm and right calf. Dipstick urinalysis is positive for heme compounds. However, the microscopic examination fails to show red blood cells (RBCs). Which of the following is expected to be raised in this patient? A) Serum amylase B) Serum troponin C) Alkaline phosphatase D) Creatine kinase

D) Creatine kinase

A 34-year-old man comes to the emergency with the sudden onset of left flank pain, which radiates towards the groin. The pain is intermittent and waxes and wanes in intensity. It does not improve with the rest or change in posture. His vitals are BP 130/80mmHg, pulse 87/min, temperature 37.2 degrees Celsius, and respiratory rate 17 breaths per minute. On physical examination, there is mild tenderness to percussion over the left flank. Imaging reveals a stone in the middle of the right ureter. Which of the following can be the most common risk factor for stone formation in this patient? A) Hyperoxaluria B) Hyperuricemia C) Hypocalciuria D) Hypercalciuria

D) Hypercalciuria

A patient with longstanding diabetes mellitus type 2 and mild hypertension presents for a routine exam. Blood tests show a glomerular filtration rate (GFR) = 90 mL/min. Urinalysis is positive for mild hematuria and microproteinuria. Which of the following is the pathophysiologic basis behind this patient's condition? A) Rapid formation of glomerular crescents B) Diffuse renal interstitial calcifications C) Necrosis of 90 % of the nephrons D) Hyperfiltration of healthy nephrons

D) Hyperfiltration of healthy nephrons

Which of the following will most likely contribute to the anion gap metabolic acidosis seen in end-stage renal disease (stage V CKD)? A) High bicarbonate B) Hypocalcemia C) Hyperkalemia D) Hyperphosphatemia

D) Hyperphosphatemia

A patient with a history of resistant hypertension and a diagnosed suprarenal adenoma complains of fatigue, weakness, and muscle cramps. On physical exam, there are decreased bowel sounds and hypoactive deep tendon reflexes. Which of the following is the best explanation for these findings? A) Hyperkalemia secondary to hyperreninemia B) Hypokalemia secondary to hyperreninemia C) Hyperkalemia secondary to hyperaldosteronism D) Hypokalemia secondary to hyperaldosteronism

D) Hypokalemia secondary to hyperaldosteronism

A 62-year-old man presents as a new patient to an infectious disease clinic. He was recently discharged from the hospital following a complicated course of cryptococcal meningitis treated with intravenous amphotericin B. The patient reports an initial diagnosis of HIV at age 54 but denies any prior medical management due to financial strain. During his recent hospital stay, social workers coordinated follow-up as an outpatient to discuss the initiation of antiretroviral therapy. Laboratory studies to help determine the most appropriate combination of medications reveal a pH of 7.33, serum sodium of 137 mEq/L, serum chloride of 105 mEq/L, serum bicarbonate of 20 mEq/L, and urine anion gap of +19. The clinician reviews these results with the patient and explains that they likely represent an adverse effect of amphotericin B. What pathology of acid-handling is causing the decreased pH and bicarbonate levels in this patient? A) Increased acid production B) Increased acid excretion C) Impaired acid production D) Impaired acid excretion

D) Impaired acid excretion

A 65-year-old male develops supraventricular arrhythmias after undergoing open-heart surgery. The laboratory measurements indicate that the potassium levels are 6.4. After administering calcium, what is the next step in management? A) NaHCO3 B) Dialysis C) Kayexalate D) Insulin and glucose

D) Insulin and glucose

An 80-year-old female arrives from the nursing home obtunded. The nursing home reports she has been ill for about a week. On arrival, vital signs are notable for a blood pressure of 90/45 mmHg, heart rate of 110 bpm, respiratory rate of 25/min, and a temperature of 35 C. Labs show sodium of 140 mEq/L, blood urea nitrogen (BUN ) of 40 mg/dl, creatinine of 1.5 mg/dl, urine creatinine of 200 mg/dl, and urine sodium of 100 mEq/L A renal ultrasound is normal. Which of the following is the most likely the cause of her renal dysfunction? A) Intrinsic renal parenchyma injury B) Pyelonephritis C) Bladder neck obstruction D) Intravascular volume depletion

D) Intravascular volume depletion

A 45-year-old post-operative male patient complains of muscle twitching and excessive weakness. He is afebrile, has a pulse rate of 80 bpm, a blood pressure of 110/80 mmHg, and a respiratory rate of 14 breaths/min. The detailed physical examination does not reveal any significant findings. He has a Hb of 13 g/dl, a TLC of 4800/mm^3, and a platelet count of 280,000/mm^3. Serum electrolytes show a sodium level of 135 mmol/L (normal: 135-145 mmol/L), a potassium of 3.2 mmol/L (normal: 3.5 to 5 mmol/L), a chloride of 92 mmol/L (normal: 95 to 105 mmol/L), and a total calcium level of 9 mg/dl (normal: 8.5 to 10.2 mg/dL). His symptoms are attributed to hypokalemia. Under normal circumstances, which of the following mechanisms would accurately explain the balance of potassium transport in the body? A) It is freely filtered but neither secreted nor reabsorbed. B) It is secreted in exchange for sodium in the proximal tubule and reabsorbed in the distal tubule in exchange for hydrogen. C) It is actively reabsorbed by all segments of the nephron. D) It is reabsorbed proximally and secreted distally in exchange for sodium.

D) It is reabsorbed proximally and secreted distally in exchange for sodium.

A 19-year-old woman presents to the emergency department with complaints of dyspnea, hemoptysis, and oliguria for the last three days. The patient has a history of cough since once week and experienced an episode of cola-colored urine five days back. On general physical examination, she has tachypnea, tachycardia, with a blood pressure of 146/108 mmHg. The patient has swelling in both legs for five days. The blood urea nitrogen is 35 mmol/l and creatinine 1008 micromol/l. On urine dipstick analysis, protein is positive, and urine microscopy showed acanthocytes, RBCs, and WBCs. Serological tests revealed positive anti-GBM antibodies. ANA, c-ANCA, p-ANCA, hepatitis, and HIV serology are negative. The kidney biopsy of the patient is scheduled. Which of the following microscopic pattern will be most likely seen on immunofluorescence? A) Granular deposition of IgG and complement in mesangium and sub-epithelium B) No immune complex deposition Goodpasture syndrome is an autoimmune disease in which antibodies are formed against collagen type IV in the glomerular basement membrane and alveoli. The patient presents with pulmonary and renal symptoms. The renal symptoms include a nephritic syndrome-like picture. p-ANCA is positive in microscopic polyangiitis, and c-ANCA is positive in granulomatosis with polyangiitis. C) "Full house pattern" with diffuse deposition of IgM, IgG, IgA, complement and immune complexes in the mesangium and glomerular basement membrane D) Linear deposition of IgG and complement along the glomerular basement membrane

D) Linear deposition of IgG and complement along the glomerular basement membrane

Which of the following lab values do you expect in a patient with severe untreated diarrhea? A) Low blood pH and low chloride B) High blood pH and elevated chloride C) High blood pH and low chloride D) Low blood pH and elevated chloride

D) Low blood pH and elevated chloride

A patient is admitted to the ED after a car accident. His BP on admission was 70/50 and pulse 129/min. After 2 liters of normal saline the BP is 74/58. After emergency surgery the source of bleeding is controlled, and the BP normalizes. Two days after the surgery, the patient develops oliguria. Which of the following do you expect to find in the urinalysis? A) White blood cells casts B) Oval fatty casts C) Red blood cells casts D) Muddy brown casts

D) Muddy brown casts

A 4-year-old female is brought to the emergency department by her parents with the complaint of vomiting and unilateral flank pain for the last two days. Urinalysis shows hematuria and the presence of white blood cells. Which of the following is the best initial imaging study to confirm the diagnosis? A) MRI without contrast B) CT abdomen/pelvis without contrast C) X-ray (KUB) D) Renal ultrasound

D) Renal ultrasound

A 77-year-old man presents to the provider with a history of fatigue, arthralgia, and hematuria for five days. He reports that he had sinusitis one week before his presentation, for which he sought medical advice and was prescribed a course of amoxicillin-clavulanate. He says a rash appeared on his upper extremities four days ago. Physical examination reveals a rash on his upper extremities. A review of systems is otherwise unremarkable. Urine analysis characteristically shows eosinophils. What is the next step in the management of this patient? A) Azathioprine B) IV mycophenolate C) Intravenous (IV) corticosteroids D) Stop amoxicillin-clavulanate

D) Stop amoxicillin-clavulanate

A 45-year-old male without any past medical history presents a history of skin rases and low-grade fever. He had back pain for the last six months after a motor vehicle collision for which he was taking ibuprofen 400 mg almost daily. A laboratory test was ordered and revealed a rise in creatinine to 2.6 mg/dl. Urine was positive for leukocyte esterase, and urine microscopy revealed 20-25 leukocytes per field. There was microscopic hematuria but no proteinuria. Blood and urine culture turned out to be negative. He was hospitalized for further workup for acute kidney injury. His vitals were stable without any hypotension. There were no signs of volume depletion on physical examination. Ibuprofen was held while he was in the hospital. He had a kidney biopsy done on day 2 of the hospitalization. His renal function started improving after four days, and he was discharged on day 5 with a creatinine of 1.8 mg/dl. The primary histopathology finding was showing mononuclear infiltrates in tubules and interstitial space. He came after seven days of discharge from the hospital for the follow-up clinic visit, and his creatinine was found to be 1.4 mg/dl. He was asymptomatic during this visit. What intervention might have benefitted his renal recovery? A) Continue Ibuprofen and giving intravenous fluid challenge while in the hospital B) Giving diuretics on the day of admission C) Continue Ibuprofen and giving an antibiotic course D) Stopping Ibuprofen

D) Stopping Ibuprofen

A 16-year-old female presented to the emergency department due to worsening headaches and increased swelling in the bilateral lower extremities. She took antibiotics for an episode of the sore throat a month ago. Pertinent positive findings include blood pressure of 170/85 mm Hg and acute renal failure with a creatinine of 4.4 mg/dL (baseline creatinine of 0.7 mg/dL a month ago). Urinalysis revealed moderate blood, positive red blood cells, and 1+ protein. What would be the diagnostic finding on electron microscopy in this patient? A) Subendothelial humps B) Renal tubules C) Mesangial humps D) Subepithelial humps

D) Subepithelial humps

What is an early symptom in a patient with hypernatremia? A) Hypertension B) Myalgia C) Confusion D) Thirst

D) Thirst

A 65-year-old female patient presents to the emergency department complaining of a two-week history of weakness, fatigue, muscle cramps, palpitations, and constipation. She recently began experiencing confusion during the past two days. She has a past medical history of congestive heart failure and hypertension treated with furosemide and hydrochlorothiazide. Her medication regimen was recently adjusted at her appointment two weeks ago. Her blood pressure is 102/62 mmHg, pulse 92/min, respirations 15/min, and temperature 98.0 F (36.7 C). On examination, the patient has decreased muscle strength in the upper and lower extremities. Her heart rhythm is irregular, and an EKG is ordered, and serum studies are ordered. Her serum sodium is 136 mEq/L, potassium is 2.5 mEq/L, creatinine 1.1 mg/dL, and glucose 92 mg/dL. What is most likely to be seen on her EKG if her condition is not treated? A) Tall and pointed T waves B) ST-elevation C) Short QT interval D) Torsade de Pointes

D) Torsade de Pointes

A patient, who has required epinephrine to maintain adequate blood pressure after cardiopulmonary bypass, develops lactic acidosis without any indicators of hypoperfusion. Which type of lactic acidosis does this patient have? A) It is probably a laboratory error B) Both type A and type B C) Type A D) Type B

D) Type B

A patient is taking a calcium supplement to treat hypocalcemia. To facilitate absorption and utilization of the supplement, the patient may be taught to consume foods high in which of the following? A) Protein B) Magnesium C) Vitamin C D) Vitamin D

D) Vitamin D