Renal Questions

Patency of an AV fistula can be assessed by A. Auscultating a bruit B. Taking a BP of the fistula C. Examining the skin D. Drawing blood

A. Auscultating a bruit

How is CKD defined by the National Kidney Foundation? A. GFR < 60 or kidney damage for > 3 months B. GFR < 90 or kidney damage for > 3 months C. GFR < 60 or kidney damage for > 1 month D. GFR < 90 or kidney damage for > 1 month

A. GFR < 60 or kidney damage for > 3 months

Which of the following meds can cause acute interstitial nephritis? A. Amphotericin B. Cyclosporin C. Gentamicin D. Penicillin

D. Penicillin Amphotericin, cyclosporin, and gentamicin cause acute tubular necrosis!!!

Which of the following inheritance patterns is most likely seen in a patient with polycystic kidney disease? A. Autosomal dominant B. Autosomal recessive C. X-linked dominant D. X-linked recessive

A. Autosomal dominant Polycystic Kidney Disease Sx: asymptomatic, flank pain or hematuria PE: hypertension, palpable kidneys Diagnosis is made by ultrasound, may be incidentally discovered on imaging Most commonly caused by autosomal dominant disorder Treatment is BP control: ACEIs, ARBs Associated with increased risk for berry aneurysm and intracerebral hemorrhage Polycystic kidney disease is an autosomal dominant disorder characterized by bilateral multiple renal cysts and is caused by a mutation in the ADPKD1 and ADPKD2 genes.

A 65 year-old male with a 60 pack-year smoking history presents with painless hematuria for two days. He also complains of frequency and dysuria. He denies a history of recent upper respiratory tract infection. Which of the following is the most likely diagnosis? A. Bladder cancer B. Wegener's granulomatosis C. IgA nephropathy D. Benign prostatic hypertrophy

A. Bladder cancer IgA nephropathy typically presents after URI + hematuria and proteinuria Bladder cancer is associated with smoking and presents with painless hematuria

A 22-year-old woman presents to the clinic with dysuria, urinary frequency, and suprapubic pain. She denies vaginal discharge and vaginal pruritus. She has no systemic symptoms or flank pain. Which pathogen is most likely to be causing this condition? A. E. coli B. Klebsiella pneumoniae C. Proteus mirabilis D. Staph. saprophyticus

A. E. coli Cystitis Patient presents with low-grade fever, increased urinary frequency, dysuria, and suprapubic or abdominal pain Labs will show positive leukocyte esterase and nitrites Definitive diagnosis is made by urine culture Most commonly caused by Escherichia coli Treatment varies on age - adult, adolescents or pediatric Pregnancy: asymptomatic bacteriuria should be treated Complications: ↑ risk of preterm birth, low birth weight, perinatal mortality

Which of the following is a cause of acute kidney failure due to prerenal azotemia? A. Excessive diuresis B. Urinary tract obstruction C. Radiologic contrast media D. Aminoglycosides

A. Excessive diuresis Prerenal azotemia is due to renal hypoperfusion (hypovolemia) which can occur with intravascular volume depletion such as excessive diuresis, hemorrhage, and gastrointestinal losses.

What is the classic triad of RCC? A. flank pain, hematuria and palpable abdominal renal mass B. Fever, jaundice and RUQ pain C. Abdominal bruit, flank pain and fever D. Hematuria, fever and flank pain

A. Flank pain, hematuria, and palpable abdominal renal mass

A 22 year-old woman comes to the office because her urine is cola-colored and she has not urinated since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her blood pressure is 146/92 mmHG. On physical examination, she has edema of her face and hands. Which of the following is the most likely diagnosis? A. Glomerulonephritis B. Acute tubular necrosis C. Nephrolithiasis D. Diabetic nephropathy

A. Glomerulonephritis Glomerulonephritis presents with hematuria, cola-colored urine, oliguria, and edema of the face and eyes in the morning. Urinalysis reveals red blood cells, mild proteinuria and red blood cell casts. Glomerulonephritis can occur 1-3 weeks after a strep infection.

Which of the following is most frequently associated with renal cell carcinoma? A. Hematuria B. Inguinal pain C. Hypocalcemia D. Fever

A. Hematuria Gross or microscopic hematuria, flank pain, or mass is common in renal cell carcinoma (Triad)

A patient has been followed for 3 years with a continual decline in glomerular filtration rate (GFR). Currently the GFR is 10 ml/min and examination of the patient reveals a pericardial friction rub. Which of the following is the most appropriate intervention at this time? A. Hemodialysis B. Continue to observe C. Administration of high dose steroids D. Bilateral nephrectomy

A. Hemodialysis The patient has end stage renal disease and with the pericardial friction rub is in need of immediate hemodialysis.

What are common laboratory findings in renal osteodystrophy? A. Hyperphosphatemia, hypocalcemia, hyperparathyroidism, low vit D B. Hypophosphatemia, hypocalcemia, hyperparathyroidism, low vit D C. Hypophosphatemia, hypercalcemia, hyperparathyroidism, low vit D D. Hyperphosphatemia, hypocalcemia, hypoparathyroidism, low vit D

A. Hyperphosphatemia, hypocalcemia, hyperparathyroidism, low vit D

A 24-year old man is brought in by friends to the emergency department with acute onset of dizziness, headache, lethargy, nausea, and vomiting. He is unable to give a reliable history, but his friends report he is a heavy beer drinker and was probably using ecstasy at a party. A metabolic panel on admission is concerning for a serum sodium concentration of 120 mEq/L. He is admitted for further treatment. Which of the following is the best initial treatment? A. Hypertonic saline B. Mannitol C. Normal saline D. Vasopressin receptor antagonist

A. Hypertonic saline Hyponatremia Patient presents with nausea, vomiting, paresthesias, AMS Labs will show serum Na < 135 mEq/L Treatment is hypertonic saline for symptomatic patients Central pontine myelinolysis if corrected too fast

The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following? A. Increase in hydration B. Early treatment of UTI C. Limitation of calcium intake D. Use of probenecid

A. Increase in hydration Keeping the urine dilute is the most effective strategy to prevent crystal accumulation in the urine and the development of urinary stones.

In order to prevent the progression of diabetic nephropathy which of the following medications should be instituted? A. Lisinopril (Prinivil) B. Propranolol (Inderal) C. Verapamil (Calan) D. Hydrochlorothiazide (Diuril)

A. Lisinopril (Prinivil) All patients should be started on an ACE inhibitor to prevent the progression of proteinuria. ACE inhibitors appear to improve glomerular hemodynamics by decreasing glomerular pressure. Thiazide diuretics are not indicated for the treatment of microalbuminuria

A 63-year-old diabetic woman presents to the emergency department complaining of four days of severe, nonbloody diarrhea. Her temperature is 100.7°F, pulse 100 beats per minute, respirations 26 per minute, blood pressure 100/80 mm Hg, and fasting blood glucose 134 mg/dL. Arterial blood gas readings show a pH of 7.30, an arterial PCO2 of 30 mm Hg, and a serum HCO3 of 15 mEq/L. Which of the following accurately describes this patient's acid-base imbalance? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

A. Metabolic acidosis

Which of the following treatments of constipation should be used with extreme caution in patients who have chronic renal insufficiency? A. Milk of magnesia B. Psyllium (Metamucil) C. Ducosate sodium (Colace) D. Lactulose (Chronulac)

A. Milk of magnesia Patients with chronic renal insufficiency have difficulty excreting magnesium and hypomagnesemia almost always occurs in a patient with chronic renal insufficiency.

A newborn male infant is seen by the PA prior to discharge home. On examination it is noted that the meatal opening is on the dorsal surface of the penile shaft just behind the coronal sulcus. The testicles are descended bilaterally. This physical examination finding is called which of the following? A. Penile epispadias B. Penile hypospadias C. Glandular epispadias D. Glandular hypospadias

A. Penile epispadias This is a penile epispadias which can develop anywhere along the penile shaft to the pubic bone. It is caused by displacement of urethra/meatal opening on the dorsal surface of the penis. If the opening occurs in the glans penis then it would be a glandular epispadias. If this abnormality occurs on the ventral surface of the penis or glans penis then it is known as a hypospadias.

Which of the following agents can be used as a urinary analgesic? A. Phenazopyridine (Pyridium) B. Oxybutynin (Ditropan) C. Finasteride (Proscar) D. Imipramine (Tofranil)

A. Phenazopyridine (Pyridium)

Lab results for a post-operative oliguric patient reveals an increased BUN to creatinine ratio. The patient has a low fractional excretion of sodium (less than 1%). Which of the following is the most likely diagnosis? A. prerenal azotemia B. acute tubular necrosis C. acute glomerulonephritis D. obstructive uropathyobstructive uropathy

A. Prerenal azotemia Patients who have prerenal azotemia with otherwise normal kidneys will have severe sodium retention in order to help save fluid. The amount of sodium in the urine is therefore very low

What is a common microscopic U/A finding in CKD? A. RBC casts B. Broad waxy casts C. Fatty casts D. Muddy brown cell casts

B. Broad waxy casts Remember: Fatty casts = nephrotic syndrome, Muddy brown cell casts = ATN

A 67-year-old man with known chronic kidney disease is found to have a glomerular filtration rate of 50 mL/min per 1.73 m2 and an albumin to creatinine ratio of 30 mg/mmol. Based on the information provided, which of the following accurately represents the stage of his kidney disease? A. G2 B. G3a C. G4 D. G5

B. G3a

What is the major complication to peritoneal dialysis? A. Bleeding B. Peritonitis C. Hypotension D. Hyperglycemia

B. Peritonitis Remember: hypotension is a hemodialysis complication

A 26 year-old woman comes to the office for her first prenatal visit at 9 weeks gestation. During evaluation, her urinalysis reveals asymptomatic bacteriuria. Which of the following antibiotics is the preferred treatment in this patient? A. Doxycycline B. Trimethoprim C. Nitrofurantoin (Macrobid) D. Erythromycin

C. Nitrofurantoin Nitrofurantoin is an effective treatment of asymptomatic bacteriuria in the pregnant woman. Trimethoprim is a folic acid antagonist and should be avoided in the first trimester

A 15 year-old male patient presents with oliguria, hematuria, proteinuria, and fatigue following streptococcal pharyngitis 2 weeks ago. Which of the following is the most likely diagnosis? A. Acute pyelonephritis B. Acute glomerulonephritis C. Systemic lupus erythematosus D. Initial onset of type 1 diabetes mellitus

B. Acute glomerulonephritis Acute glomerulonephritis is a complication that can follow a streptococcal infection after 1 to 3 weeks.

A 35-year-old woman presents with pain with urination and urinary frequency. Vital signs are T 101.1°F, HR 90, BP 120/76 mm Hg, RR 16, and oxygen saturation is 99% on room air. She has costovertebral angle tenderness on examination. Which of the following is the most likely diagnosis? A. Acute cystitis B. Acute pyelonephritis C. Nephrolithiasis D. Pelvic inflammatory disease

B. Acute pyelonephritis Acute Pyelonephritis Sx: fever, dysuria, and flank pain PE: CVA tenderness Labs: UA + leukocyte esterase, nitrites, microscopy +WBCs, Gram stain, urine culture and susceptibility testing Most commonly caused by Escherichia coli Treatment depends on infection severity and community/host risk factors for resistant pathogens, options include fluoroquinolones, 3rd/4th gen cephalosporins, TMP-SMX. Critical illness or risk for multidrug resistant organisms: consider coverage for MRSA, VRE

A 65-year-old man with a history of diabetes and hypertension presents with severe nausea, vomiting, and diffuse abdominal pain. He was recently treated for enterocolitis caused by methicillin-resistant Staphylococcus aureus using vancomycin. Laboratory studies show elevated creatinine, hyperkalemia, hyperphosphatemia, and hypocalcemia. The blood urea nitrogen to creatinine ratio is 18:1. Two muddy casts are seen on urinalysis. Which of the following is the most likely diagnosis? A. Acute interstitial nephritis B. Acute tubular necrosis C. Glomerulonephritis D. Postrenal azotemia

B. Acute tubular nephrosis Acute Tubular Necrosis Most common cause of intrinsic kidney failure Types: ischemic and nephrotoxic Nephrotoxins: aminoglycosides > contrast agents Inability to concentrate urine (urine osmolality = serum osmolality) Granular muddy-brown casts

A male patient presents with hematuria. Upon further questioning the patient states that the hematuria occurs at the end of his urinary stream. Which of the following is the most likely source of blood? A. Renal pelvis B. Bladder neck C. Anterior urethra D. Ureter

B. Bladder neck Terminal hematuria, blood at the end of the urinary stream, suggests a bladder neck or prostatic urethral source. Total hematuria, blood throughout the urinary system, suggests a bladder or upper urinary tract source.

A 19 year-old patient was involved in a motor vehicle crash and brought to the emergency department fully immobilized. The patient sustained multiple blunt injuries to the chest and abdomen. During the trauma assessment, there was no blood at the urethral meatus and a Foley catheter was placed. The urine was positive for blood on the dipstick. Which of the following is the most appropriate diagnostic test? A. Retrograde urethrography B. CT scan of abdomen and pelvis C. Serum haptoglobin D. urine myoglobin

B. CT scan of abdomen and pelvis CT scan of abdomen and pelvis is indicated in blunt trauma including those resulting in hematuria or when renal injury is suspected.

What medication is used to stabilize the cardiac myocyte membranes in patients who are hyperkalemic? A. Albuterol B. Calcium gluconate C. Furosemide D. Insulin

B. Calcium gluconate Hyperkalemia History of kidney failure, DKA, rhabdomyolysis, tumor lysis Lethargy, weakness, paralysis PE will show bradycardia, hypotension, cardiac dysrhythmia ECG will show peaked T waves, prolonged PR, wide QRS Treatment is calcium gluconate, insulin, albuterol, bicarbonate

CKD patients are most likely to die from A. Pulmonary complications B. Cardiovascular complications C. Bleeding complications D. Neurological complications

B. Cardiovascular complications

A 35-year-old woman presents to the clinic with dysuria, urinary frequency, and flank pain. On exam, she has costovertebral angle tenderness. She is otherwise healthy, tolerating oral intake, and has normal vital signs. Urinalysis shows pyuria and nitrites. Which of the following is the recommended antimicrobial treatment? A. Ceftriaxone B. Ciprofloxacin C. Nitrofurantoin D. Vancomycin and meropenem

B. Ciprofloxacin Acute Pyelonephritis Sx: fever, dysuria, and flank pain PE: CVA tenderness Labs: UA + leukocyte esterase, nitrites, microscopy +WBCs, Gram stain, urine culture and susceptibility testing Most commonly caused by Escherichia coli Treatment depends on infection severity and community/host risk factors for resistant pathogens, options include fluoroquinolones, 3rd/4th gen cephalosporins, TMP-SMX. Critical illness or risk for multidrug resistant organisms: consider coverage for MRSA, VRE

A 70-year-old man with a history of cigarette smoking presents with painless gross hematuria. Urinalysis confirms hematuria. There is concern for bladder cancer. Which of the following is the best urologic workup for bladder cancer? A. Computed tomography of abdomen and pelvis B. Cystourethroscopy with cytology and computed tomography of abdomen and pelvis C. Cystourethroscopy with cytology and urine sediment examination D. Urine sediment examination and computed tomography of abdomen and pelvis

B. Cystourethroscopy with cytology and computed tomography of abdomen and pelvis Bladder Cancer Patient will be older History of smoking Painless hematuria Diagnosis is made by cystoscopy Most common type is urothelial (transitional cell) carcinoma

A urinalysis performed during a routine physical examination on a 43 year-old male reveals 1-2 hyaline casts/HPF. The remainder of the UA is normal. Based upon these results, the physician assistant should A. Collect a urine for culture and sensitivity B. Do nothing, since these casts are considered normal C. Refer the patient to a nephrologist D. Schedule the patient for a CT scan

B. Do nothing, since these casts are considered normal Hyaline casts are not indicative of renal disease. They can be found following strenuous exercise and with concentrated urine or during a febrile illness.

A 62-year-old man presents to his nephrologist for follow-up of his chronic hypertension. He is taking medications to control hypertension but continues to have climbing blood pressure readings at each follow-up visit. His laboratory studies are concerning for progressively-declining renal function. Today, his estimated glomerular filtration rate is < 40mL/min per 1.73 m2. Due to concern for ischemic renal disease, testing and treatment of any potential findings are discussed. Which of the following is the best first test to establish a diagnosis? A. Captopril renogram B. Duplex Doppler ultrasound C. Magnetic resonance angiography D. Renal arteriography

B. Duplex Doppler ultrasound Renal Artery Stenosis Causes: atherosclerosis, fibromuscular dysplasia Fibromuscular dysplasia: young women Refractory HTN Dx: MRA, doppler US, CTA, renal angiography Angioplasty Unilateral renal artery stenosis: ACEIs, ARBs Renal arteriography is gold standard for diagnosing renal artery stenosis however, it is invasive and requires sedation. It should only be used if there is high suspicion

A patient on acetazolamide for glaucoma complains of increasing shortness of breath. The patient denies cough, chest pain, or fever. Physical examination is unremarkable except for an increased respiratory rate of 30/minute. Labs include Na 132 mEq/L, K 5.6 mEq/L, Cl 120 mEq/L, and CO2 10 mEq/L. Arterial blood gas results are pH 7.18, pO2 98 mmHg, pCO2 22 mmHg, and HCO3 8 mEq/L. Based upon these results, what is the diagnosis? A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory alkalosis D. Respiratory acidosis

B. Metabolic acidosis Acetazolamide inhibits carbonic anhydrase which inhibits bicarbonate ion regeneration, with resulting normal anion-gap, hyperchloremic acidosis. Respiratory compensatory mechanisms lead to hyperventilation

A woman who is 20-weeks pregnant presents to your clinic with mild dysuria and increased urinary frequency. She is afebrile. Physical exam is negative for costovertebral angle tenderness. What is the best agent to treat this condition? A. Bactrim B. Nitrofurantoin C. Ciprofloxacin D. Ampicillin E. Penicillin

B. Nitrofurantoin This patient most likely has acute cystitis. The drug of choice to treat cystitis in pregnancy is nitrofurantoin or first generation cephalosporins. Bactrim is contraindicated in pregnancy!

A seven-year-old girl presents to general pediatrics condition with swelling - angioedema. She has never had symptoms like this before. She has no significant past medical history. Her vital signs are stable. Her physical examination is notable for 2+ pitting edema of the bilateral lower extremities. The remainder of her physical examination is within normal limits. She has no costovertebral angle tenderness. A dipstick urinalysis is significant for 3+ proteinuria. On renal biopsy and on microscopic urinalysis, what would one likely expect to find in this patient? A. Apple-green birefringence and no casts B. Podocyte effacement and fatty casts C. Spike and dome appearance with subepithelial deposits and RBC casts D. Positive Congo red stain and waxy casts E. Kimmelstiel-Wilson lesions and waxy casts

B. Podocyte effacement and fatty casts The most common cause of nephrotic syndrome in children is minimal change disease. Light microscopy and immunofluorescence reveal no changes in kidney architecture, but podocyte effacement can be seen on electron microscopy. Fatty casts may be seen in the urine. Treatment with steroids is initiated often even without a biopsy.

A 6 yo child comes to your office for a f/u appointment after having a bad case of impetigo last month. The rash is much improved, but the mom mentions that his urine has been looking darker than usual and she thinks his eyes are also a little puffy, especially in the morning after waking up. Which of the following is the most likely diagnosis? A. Membranous nephropathy B. Poststreptococcal glomerulonephritis C. anti-GBM nephritis D. minimal change disease

B. Poststreptococcal glomerulonephritis

A 24-year-old man presents to an urgent care with concerns for dark, almost cola-colored urine. He states that he has noticed swelling in his hands and feet as well. He reports he was sick recently with an upper respiratory infection two days ago. On physical exam, blood pressure is 145/92 mm Hg, temperature is 100.6°F, and he has 2+ pitting edema in his lower extremities. Which diagnostic test would confirm the suspected diagnosis? A. Basic metabolic panel B. Renal biopsy C. Renal ultrasound D. Urinalysis

B. Renal biopsy Glomerulonephritis Edema, HTN UA: RBC casts, proteinuria, hematuria Coca-cola urine Renal biopsy

A 54 year-old woman with history of lupus comes to the office with increasing significant peripheral edema over the past four days. Laboratory findings include marked proteinuria, hypoalbuminemia and hyperlipidemia. Which of the following diagnostic studies is the best for determining the cause of the proteinuria? A. Renal ultrasound B. Renal biopsy C. Cystoscopy D. Computed tomography scan

B. Renal biopsy Renal biopsy is performed in adults with new onset of nephrotic syndrome to determine the cause of the proteinuria and to guide management decisions.

Which of the following statements is accurate regarding the presentation of nephrotic syndrome? A. Hematuria is among the MC presenting symptom in adults with nephrotic syndrome B. The first sign of nephrotic syndrome is often swelling or edema C. The presence of deep venous thrombosis or pulmonary embolism suggests a diagnosis other than nephrotic syndrome D. Weight loss and hypotension are frequently present in adults with nephrotic syndrome

B. The first sign of nephrotic syndrome is often swelling or edema

A 25 year-old female presents with right lower quadrant pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There is right CVA tenderness and RLQ tenderness. Pelvic exam is unremarkable. Urinalysis reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and positive nitrates. Specific gravity is 1.022. Microscopic shows 102 RBCs/HPF, 50-75 WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is A. Acute salpingitis B. Nephrolithiasis C. Acute pyelonephritis D. Appendicitis

C. Acute pyelonephritis Acute pyelonephritis presents with flank pain, fever, and generalized muscle tenderness. Urinalysis shows pyuria with leukocyte casts.

A 7-year-old girl presents to her primary care clinic with her mother, who states she has noticed swelling around her daughter's eyes and feet in the mornings for the past week. Yesterday, her daughter stated that her urine was bubbly. The patient is in the 50th percentile for both height and weight. Physical exam reveals 1+ edema in her lower extremities bilaterally. Urine dipstick reveals 4+ protein. Which of the following is the most likely diagnosis? A. IgA nephropathy B. Malnutrition C. Minimal change disease D. Myxedema coma

C. Minimal change disease Nephrotic Syndrome PE: pitting edema Proteinuria > 3.5 HLD Fatty casts Minimal change disease: children, preceded by URI Rx: steroids

Which of the following statements is accurate about the treatment of nephrotic syndrome? A. Everyone with nephrotic syndrome should be on a high protein diet B. In adults with secondary nephrotic syndrome, ACEIs are largely contraindicated C. Minimal change nephropathy responds to prednisone in most cases D. Children with nephrotic syndrome receiving steroids are calcineurin inhibitors are more likely to achieve drug-free remission with rituximab

C. Minimal change nephropathy responds to prednisone in most cases

A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is A. CHF B. end-stage liver disease C. Nephrotic syndrome D. Malnutrition

C. Nephrotic syndrome Proteinuria, hyperlipidemia, and hypoalbuminemia are consistent with nephrotic syndrome

A 20-year-old patient presents to the clinic with dysuria, urinary frequency, and suprapubic pain for the past two days. The patient is afebrile and denies flank pain. The patient is diagnosed clinically with acute simple cystitis. Which of the following is a risk factor for acute simple cystitis? A. Circumcision B. Male sex C. Recent sexual intercourse D. Use of hormonal contraception

C. Recent sexual intercourse Cystitis Patient presents with low-grade fever, increased urinary frequency, dysuria, and suprapubic or abdominal pain Labs will show positive leukocyte esterase and nitrites Definitive diagnosis is made by urine culture Most commonly caused by Escherichia coli Treatment varies on age - adult, adolescents or pediatric Pregnancy: asymptomatic bacteriuria should be treated Complications: ↑ risk of preterm birth, low birth weight, perinatal mortality

A 75 yo woman is evaluated for 3 month hx of increasing fatigue. History is significant for CKD stage 4 and hypertension. On PE, BP =120/60, pulse = 75/min; other vitals are normal Labs: Hg = 9 Ferritin = 600 Transferrin serum iron saturation = 40% Which of the following is the most appropriate treatment? A. Blood transfusion B. Bone marrow biopsy C. Start erythropoietin-stimulating agent D. IV iron supplementation

C. Start ESA Remember: Ferritin should be at least 500 then we would start ESA

A 29 year-old male is involved in a motor vehicle crash. On the secondary survey it is noted that there is blood at the meatus and the patient is suspected of having a pelvic fracture. The patient is otherwise stable. Which of the following tests should be done to evaluate the urinary system? A. Voiding cystourethrogram (VCUG) B. Intravenous pyelogram (IVP) C. Urethrogram D. Renal Arteriography

C. Urethrogram A urethrogram is the only procedure that should be done to evaluate this type of injury as urethral integrity may have been compromised secondary to the pelvic fracture. Blood at the meatus is the most important finding of suspected urethral injury.

A 28 year-old female comes to the office with fever, flank pain, and dysuria for the past two days. Which of the following urinalysis results are suggestive of acute pyelonephritis? A. Hyaline casts B. Red cell casts C. White cell casts D. Granular casts

C. White cell casts White cell casts are indicative of renal infection or inflammation as seen in pyelonephritis or interstitial nephritis. Hyaline casts: normal Red cell casts: glomerulonephritis

A 64-year-old man presents for a routine physical. He states that he is not doing very well and, in fact, has not had a bowel movement in over a week. Upon further questioning, the patient notes that for about 4 months he has experienced significant back pain and finds that he is easily fatigued. His wife has remarked that he is unusually "pale." In addition to his lack of a bowel movement for the past week, the patient has also had a loss of appetite, has been urinating more than usual, and has had a depressed mood. Which of the following is the most likely cause of this patient's constipation? A. Hyperkalemia B. Hypermagnesemia C. Hypophosphatemia D. Hypercalcemia E. Hypocalcemia

D. Hypercalcemia This patient likely has multiple myeloma with resultant hypercalcemia, an electrolyte disturbance that can cause severe constipation. Hyperkalemia: peaked T waves, N/V, muscle weakness Hypermagnesemia: lethargy, weakness, paralysis Hypophosphatemia: diffuse muscle weakness, flaccid paralysis Hypocalcemia: Abdominal pain, muscle cramps

A 64-year-old man receiving inpatient treatment for an exacerbation of Crohn's disease suddenly develops tetany, convulsions, and delirium. He has had copious diarrhea for the previous two weeks. Of the following electrolyte disturbances, which is most likely responsible for this patient's symptoms? A. Hypercalcemia B. Hypernatremia C. Hypokalemia D. Hypomagnesemia

D. Hypomagnesemia Hypomagnesemia Malnutrition, alcohol use Hypocalcemia Hypokalemia ↑ QT interval, dysrhythmias Neuromuscular symptoms (e.g., tremor, tetany

A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment? A. Oral ciprofloxacin (Cipro) B. Oral trimethoprim-sulfamethoxazole (Bactrim) C. IV gentamicin (Garamycin) D. IV ceftriaxone (Rocephin)

D. IV ceftriaxone IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy

Which of the following is a normal physiologic response to an increase in serum acidity? A. Decreased metabolic generation of organic acids B. Decreased urinary ammonia excretion C. Increased intestinal excretion of non-volatile acids D. Increased respiratory CO2 elimination

D. Increased respiratory CO2 elimination Acute Respiratory and Metabolic Acidosis and Alkalosis (Normal ABG values pH: 7.35-7.45; PaCO2: 35-45; HCO3: 22-26) Respiratory Acidosis pH: < 7.35; PaCO2: > 45 mm Hg; HCO3: normal Respiratory Alkalosis pH: > 7.45; PaCO2: < 35 mm Hg; HCO3: normal Metabolic Acidosis pH: < 7.35; PaCO2: normal; HCO3: < 22 mEq/L Metabolic Alkalosis pH: > 7.45; PaCO2: normal; HCO3: > 26 mEq/L

62 yo woman evaluated for fatigue and weakness. She has CKD stage 4 and hypertension. She is on amlodipine only. On PE, BP is 135/85 mmHg: other vitals are normal. There is no jaundice. Labs: Hemoglobin: 8.5 Ferritin: 30 Transferrin serum iron saturation: 10% Which of the following is the most appropriate treatment? A. Blood transfusion B. Bone marrow biopsy C. Erythropoietin-stimulating agent D. iron supplementation

D. Iron supplementation Remember: we have to repleat iron stores before starting on ESA

A 54 year-old man comes to the urgent care because he was awoken suddenly from his sleep this morning with severe left flank pain radiating to his left testicle with associated nausea and vomiting. He is afebrile and vital signs are normal. He is constantly moving to find a comfortable position. On physical examination, left flank tenderness is noted with no direct testicular tenderness. Urinalysis reveals a pH of 5.5 and microscopic hematuria, but is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Acute epididymitis B. Appendicitis C. Diverticulitis D. Nephrolithiasis

D. Nephrolithiasis Nephrolithiasis usually presents as a sudden onset of colicky flank pain with associated nausea and vomiting. Urinalysis often reveals gross or microscopic hematuria.

A 30-year-old woman presents to the clinic with dysuria and urinary frequency for the past two days. She denies systemic symptoms, flank pain, vaginal discharge, or vaginal irritation. What is the best treatment for the most likely diagnosis? A. Cephalexin B. Ciprofloxacin C. Metronidazole D. Nitrofurantoin

D. Nitrofurantoin Cystitis Patient presents with low-grade fever, increased urinary frequency, dysuria, and suprapubic or abdominal pain Labs will show positive leukocyte esterase and nitrites Definitive diagnosis is made by urine culture Most commonly caused by Escherichia coli Treatment varies on age - adult, adolescents or pediatric Pregnancy: asymptomatic bacteriuria should be treated Complications: ↑ risk of preterm birth, low birth weight, perinatal mortality

Which of the following is the treatment of choice for a nursing home patient who has asymptomatic bacteriuria with no history of diabetes or structural abnormalities of the genitourinary tract? A. Ciprofloxacin (Cipro) B. Sulfamethoxazole-trimethoprim (Bactrim) C. Cephalexin (Keflex) D. No treatment is needed

D. No treatment is needed Asymptomatic bacteriuria is commonly seen in the geriatric population and no treatment is needed as long as the patient is not diabetic or has no structural abnormalities of the genitourinary tract.

Kidney post-transplant patients are at an increased risk of... A. Breast cancer B. Skin cancer C. Thyroid cancer D. Stomach cancer

B. Skin cancer

What is the most common presenting symptom in patients with nephrotic syndrome? A. Hypertension B. Tachycardia C. Hematuria D. Abdominal pain E. Edema

E. Edema

Which of the following radiographic findings is most consistent with renal osteodystrophy in a CKD patient? A. "Salt and pepper" appearance in the skull B. "Punched out" lesions in the pelvis C. "Sunburst pattern" in the leg D. "Fat pad" sign in the elbow

A. "Salt and pepper" appearance in the skull

A 48 year-old female presents to the clinic complaining of hematuria. The patient states that she was found to have hematuria during an insurance physical examination. The patient denies dysuria or frequency. She also denies pain in the abdomen, flank or meatus. She denies any history of previous nephrolithiasis. Urinalysis reveals the urine to be yellow and slightly hazy with a positive dipstick for hemoglobin. Microscopic reveals 5-7 RBCs/HPF without WBCs, bacteria, casts, or crystals. What is the next diagnostic study this patient should undergo? A. CT urography B. Intravenous pyelogram C. Abdominal ultrasound D. Cystoscopy

A. CT urography CT urography with and without contrast should be done to evaluate the upper and lower urinary tract for neoplasms, and benign conditions such as urolithiasis. This has replaced IVP for imaging of the upper tracts. Abdominal ultrasound will not help in this scenario and the role of renal ultrasound in evaluation of hematuria is unclear. Cystoscopy will help to assess the bladder and urethra but will not help with evaluation of the upper urinary tract.

Which of the following is the most common composition of kidney stones? A. Calcium oxalate B. Uric acid C. Struvite D. Calcium phosphate

A. Calcium oxalate

A 52 year-old patient presents with fatigue, complaints of paleness, anorexia, nausea, and weight loss. The patient also complains of numbness in his hands and feet and a recent occurrence of foot drop. He has a past history of diabetes and hypertension. Based on his clinical presentation, which of the following disorders is most likely to be responsible for this clinical picture? A. Chronic renal failure B. Middle cerebral artery occlusion C. Guillain-Barre syndrome D. Raynaud's phenomena

A. Chronic renal failure Patients with chronic renal failure will have accelerated atherosclerosis, hypertension, anemia due to lack of erythropoietin production, a tendency toward GI symptoms of anorexia, nausea, and weight loss, and neurological symptoms of peripheral neuropathy that occurs in a stocking and glove distribution along with peripheral motor impairment such as foot drop and restless legs syndrome. Diabetes and hypertension are risk factors for the development of chronic renal disease.

A 26 year-old sexually active woman has a 3-day history of dysuria, frequency, and urgency. She has a fever of 102 degrees F orally with shaking chills and right-sided costovertebral angle tenderness. Urinalysis reveals 10-20 RBCs/HPF, 30 WBCs in clumps/HPF, 3-4 WBC casts and 3+ bacteria. Which of the following is the treatment of choice for outpatient management? A. Ciprofloxacin B. Erythromycin C. Doxycycline D. Amoxicillin

A. Ciprofloxacin Treatment with a quinolone is first line treatment of pyelonephritis on an outpatient basis. If the patient were admitted then empiric treatment with Ampicillin and an aminoglycoside IV would be initiated until culture and sensitivity results were obtained.

A 30-year-old man presents to the emergency department with acute unilateral flank pain and gross hematuria. Nephrolithiasis is suspected. Which of the following is the most sensitive imaging study to diagnose nephrolithiasis? A. Computed tomography of the abdomen without contrast B. Intravenous pyelography C. Plain abdominal radiography D. Renal ultrasound

A. Computed tomography of the abdomen without contrast Nephrolithiasis Sx: flank pain radiating to groin PE: patient won't lie still, hematuria Diagnosis: noncontrast helical CT, most common location is the ureterovesical junction (UVJ) Most commonly caused by calcium oxalate Struvite: staghorn calculi, urease-producing bacteria Uric acid: radiolucent on X-ray, gout Cystine: children with metabolic diseases Treatment< 5 mm: likely to pass spontaneously> 5 mm: medical expulsive therapy (tamsulosin), urology consultation in certain cases> 10 mm: urology consultation, shock wave lithotripsy, ureteroscopy

What is the MCC of chronic kidney disease? A. Diabetes mellitus B. Glomerulonephritis C. Hypertension D. Polycystic kidney disease

A. Diabetes mellitus Chronic Kidney Disease Definition: permanent loss of kidney function > 3 months Most commonly caused by DM, HTN PE: uremic frost, HTN, pulmonary edema, pericardial rub, encephalopathy Complications: Volume overload Electrolyte imbalance (hyperkalemia, hyperphosphatemia, hypocalcemia) Normocytic anemia: ↓ EPO + anemia of chronic disease Secondary hyperparathyroidism, mineral bone disorder Acidosis Platelet dysfunction, bleeding Cardiovascular disease and dyslipidemia Increased risk of infection Stages - GFR (mL/min/1.73 m2) Stage 1: normal kidney function (eGFR ≥ 90) and ≥ 3 months of proteinuria Stage 2: mild reduction in kidney function (eGFR 60-89) and ≥ 3 months proteinuria Stage 3: moderate reduction in kidney function (eGFR 30-59) Stage 4: severe reduction in kidney function (eGFR 15-29) Stage 5: kidney failure (eGFR < 15) - requires dialysis or transplant for survival (ESRD)

An elderly appearing adult male patient is transported to the emergency room with unconsciousness for an underdetermined amount of time. There is no family and the only history is provided by the paramedics. The patient arouses to verbal and painful stimuli. VS: T-97.0 degrees F rectally, P-52 bpm, R-10, BP-95/60 mmHg. Physical examination is unremarkable except for ecchymosis across his extremities. A Foley catheter is inserted draining a small amount of dark brown urine. Urine dipstick reveals 4+ positive hemoglobin and protein. Microscopic urinalysis reveals no RBCs but many renal tubular epithelial cells and renal tubular casts. Drug screen is negative, blood alcohol is 2.5 mg/dL, and creatinine is 4.9 mg/dL. What is the most likely diagnosis? A. Rhabdomyolysis causing acute renal failure B. Obstructive uropathy causing ARF C. Ethanol ingestion causing ARF D. Methanol ingestion causing ARF

A. Rhabdomyolysis causing ARF Since the patient was found unconscious for an undetermined amount of time and the blood alcohol is elevated the patient has been in a state of prolonged immobilization resulting in muscle ischemia resulting in myoglobinuria. This is responsible for turning the dipstick positive without the RBCs seen on the urinary microscopy. The myoglobin causes an acute tubular necrosis resulting in the sloughing of the renal tubular epithelium. Obstructive uropathy does not cause acute tubular necrosis and occurs over time. Methanol ingestion causes visual symptoms, ethylene glycol causes renal failure.

Patients with recurrent urinary stone disease should be educated to maintain a diet restricted in A. Sodium and protein B. Carbohydrates and fat C. Bran D. Fluids

A. Sodium and protein Increased sodium intake will increase sodium and calcium excretion and increase monosodium and urate saturation. Protein also increases calcium, oxalate and uric acid excretion. All of these can lead to stone formation.

When should diabetic CKD patients initiate dialysis? A. eGFR < 15 or serum creatinine > 6 B. eGFR < 15 or serum creatinine > 8 C. eGFR < 10 or serum creatinine > 6 D. eGFR < 10 or serum creatinine > 8

A. eGFR < 15 or serum creatinine > 6 Remember: everyone else should initiate dialysis at eGFR < 10 or serum creatinine > 8

Which of the following signs and symptoms is typically noted in patients with acute cystitis? A. Fever and chills B. CVA tenderness C. Flank pain D. Frequency and dysuria

D. Frequency and dysuria Irritative voiding symptoms, such as frequency and dysuria, are common in acute cystitis.

A 30-year-old man presents to the emergency department with persistent vomiting and diarrhea for the past three days. The patients blood urea nitrogen is 30 mg/dL and his creatinine is 1.1 mg/dL. His prior creatinine level obtained by chart review was 0.7 mg/dL. What is the best treatment for this patients acute kidney injury? A. Albumin B. Intravenous fluids C. Loperamide D. Ondansetron

B. Intravenous fluids

A 66-year-old man managed for chronic kidney disease is admitted to the hospital for chest pain, and nephrology is consulted. He has not started dialysis yet but there is a plan in place for when he needs to start. He has been resistant to starting dialysis because it will be a treatment for the rest of his life. Before admission to the hospital, he was seen in the emergency department and had a normal ECG and unremarkable cardiac markers. Other screening studies demonstrated mild anemia, mildly elevated potassium and phosphates, and mild acidosis. He also has a small incremental decrease to his estimated glomerular filtration rate and an increase in his urinary albumin excretion. On physical exam, he has mild ascites and a pericardial rub is appreciated. A low-grade fever of 38.1°C is also noted. His vital signs are otherwise stable. An echocardiogram is ordered and notable for pericardial effusion. Which of the following is the most important next step? A. Aggressive diuretic treatment B. Hemodialysis C. NSAIDs D. Pericardiocentesis

B. Hemodialysis Uremic Pericarditis Associated with degree of azotemia Friction rub on exam Treatment: dialysis Abnormal ECG findings of diffuse ST and T wave elevations will be absent

a 79 yo woman evaluated for hyperkalemia. She was admitted to surgical ICU after having urgent partial colectomy for ruptured diverticulum with peritonitis. Her hx is significant for hypertension and CKD stage 4. PE: patient is intubated and mechanically ventilated. Vitals: temp = 102F, BP= 118/75 mmHg, Pulse = 101/min. Pt has abnormal EKG and urine sediment showing brown muddy casts. Which of the following is the most appropriate treatment? A. Continuous renal replacement therapy B. Hemodialysis C. IV furosemide D. Sodium bicarbonate

B. Hemodialysis (Pts vitals are more or less stable and is in stage 4)

What is NOT an absolute indication for dialysis? A. intractable metabolic acidosis B. High BUN levels C. Lithium overdose D. Uremic Pericarditis

B. High BUN levels Remember: AEIOU

A 50-year-old man presents to the emergency department with tetany. He is found to have low serum magnesium and normal serum calcium. Which of the following is the best treatment? A. Administer calcium and then reassess magnesium B. IV magnesium C. PO magnesium D. Replenish potassium and then reassess magnesium

B. IV magnesium Hypomagnesemia Malnutrition, alcohol use Hypocalcemia Hypokalemia ↑ QT interval, dysrhythmias Neuromuscular symptoms (e.g., tremor, tetany)

A 48-year-old male with a history of chronic alcoholism presents to the emergency department with complaints of fatigue, muscle cramps and weakness, and constipation. He reports that these symptoms have developed over the past several weeks, and he admits to currently drinking 750 ml of whiskey daily. Physical examination is significant for 1+ reflexes at the bilateral patellar tendons and absent reflexes distally at the bilateral Achilles tendons. A complete blood count, complete metabolic panel, and EKG are ordered. The patient's EKG is shown here. The results of the complete blood count and metabolic panel are pending. Which of the following is the best management for the most likely cause of this patient's condition? A. IV potassium alone B. IV magnesium and potassium C. Calcium gluconate followed by sodium bicarb, albuterol, insulin, and glucose D. Kayexalate and furosemide E. Hemodialysis

B. IV magnesium and potassium A chronic alcoholic presenting with hypokalemia is likely also hypomagnesemic. In order to achieve effective correction of potassium levels, both potassium and magnesium must be replaced.

A 9 year-old boy who has had cold-like symptoms for the past few days is brought to the clinic by his mother who states that her son had gross hematuria this morning. Prior to the cold-like symptoms the boy has been in excellent health. He is up-to-date on all of his immunizations. The patient does not have any edema, hypertension or purpura. Urinalysis reveals the urine to be cola-colored with a 2+ positive protein and 2+ hemoglobin. Microscopic analysis reveals 50-100 RBCs/HPF, no WBCs, bacteria, casts or crystals. What is the most likely diagnosis? A. Post-streptococcal glomerulonephritis (PSGN) B. IgA Nephropathy C. Minimal change disease (MCD) D. Membranous nephropathy

B. IgA nephropathy IgA nephropathy presents after an upper respiratory illness with deposition of IgA within the mesangium of the glomerulus. PSGN usually presents 2-3 weeks after a strep infection (pharyngeal or skin) and usually presents with nephritic symptoms

Which of the following accurately describes the presentation of renal cell carcinoma? A. Advanced disease at the time of diagnosis is rare B. Incidental findings on imaging are one of the most common presentations C. Most patients present with the triad of flank pain, palpable abdominal mass, and hematuria D. Right-sided varicocele is an atypical presentation in men

B. Incidental findings on imaging are one of the MC presentations The triad of flank pain, palpable abdominal mass and hematuria only occurs in 9% of cases Renal Cell Carcinoma History of smoking Flank pain, flank mass, hematuria Treatment is nephrectomy

In order to delay the progression of kidney disease in a diabetic patient with proteinuria, which of the following would you prescribe to treat patient's HTN? A. Atenolol B. Amlodipine C. Accupril D. Amiloride

C. Accupril (ACEI)

A 68-year-old woman is brought to the emergency room by her husband following confusion and lethargy of a week's duration. Two weeks ago she was diagnosed with small cell cancer of the lung but has not yet begun any chemotherapy regimens. She has a 30-pack year history of smoking. She does not take medications. Physical examination reveals decreased deep tendon reflexes symmetrically. Jugular venous pressure is normal, mucous membranes are moist, and no edema is present in the patient's extremities. CT scan of the brain reveals no abnormalities. Laboratory studies reveal the following: Sodium: 112 mEq/L Potassium: 4.0 mEq/L Chloride: 95 mEq/L Bicarbonate: 24 mEq/L BUN: 6 mg/dL Creatinine: 0.65 mg/dL Serum osmolality is 220 mOsm/kg and urine osmolality is 400 mOsm/kg. Which of the following is the most appropriate next step in management of this patient: A. Volume repletion with normal saline B. Administer demeclocycline C. Administer hypertonic saline D. Administer desmopressin E. Administer 5% dextrose in water (D5W) and furosemide

C. Administer hypertonic saline This patient presents with neurological symptoms and low sodium in the setting of recent small cell lung cancer diagnosis consistent with hyponatremia due to syndrome of inappropriate anti-diuretic hormone secretion (SIADH) that requires the administration of hypertonic saline.

Which of the following diagnostic findings in the urinary sediment is specific for a diagnosis of chronic renal failure? A. Hematuria B. Proteinuria C. Broad waxy casts D. Hyaline casts

C. Broad waxy casts Broad waxy casts in urinary sediment are a specific finding in chronic renal failure

A 38 year-old female presents with right flank pain for several days, shaking chills, fever to 102°F, and general malaise. The flank pain has been intermittently severe, and she has a history of kidney stones. Urinalysis reveals 3+ red blood cells, 3+ leukocyte esterase, trace protein and negative glucose. Which of the following findings would most likely be seen on a renal ultrasound? A. Small echogenic kidneys B. Cysts C. Hydronephrosis D. Capsular hemorrhage

C. Hydronephrosis Hydronephrosis, dilation of the collecting ducts, may be present due to a stone or other source of obstruction

A 27 year-old patient presents with crush injuries to both lower extremities after being involved in an automobile accident. Within six hours of the accident, urine output has decreased to less than 10 cc per hour. Within 24 hours the serum creatinine increased from 0.9 mg/dl to 2.9 mg/dl and serum CPK is now 12,000 U/L. In addition to a fluid challenge with normal saline, which of the following is the most appropriate treatment as this time? A. IV calcium chloride B. Oral captopril (Capoten) C. IV sodium bicarbonate D. Oral sevelamer (Renagel)

C. IV sodium bicarbonate Treatment of acute renal failure due to rhabdomyolysis is best accomplished with IV fluids and forced alkaline diuresis.

What is the MCC of acute glomerulonephritis in adults? A. poststreptococcal B. Minimal change disease C. IgA nephropathy D. Diabetes mellitus

C. IgA nephropathy

Which of the following acid-base imbalances is found in CKD? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis

A patient with CKD secondary to DM has developed chronic constipation. Which of the following should constipation medications be avoided? A. Ducosate sodium (colace) B. Lactulose C. Milk of magnesia D. Psyllium (Metamucil)

C. Milk of magnesia Remember: avoid magnesium!

Which of the following medications is most likely to cause acute tubular necrosis? A. Bactrim B. Acetaminophen C. Cephalothin D. Gentamicin

D. Gentamicin In hospitalized patients up to 25% of patients receiving aminoglycosides sustain some degree of acute tubular necrosis. Gentamicin is one of the most toxic aminoglycosides, streptomycin is the least nephrotoxic of the aminoglycosides.

What is NOT a laboratory finding in CKD? A. Hyperphosphatemia B. Hypermagnesemia C. Hyperlipidemia D. Hypercalcemia

D. Hypercalcemia

A 65 year-old patient presents with hypertension and peripheral edema. Urinalysis reveals pale urine, with a specific gravity of 1.002, 2+ protein, trace glucose, and is negative for red blood cells and leukocytes. Serum electrolytes include BUN of 58 mg/dl and creatinine of 4.5 mg/dl. These are unchanged from previous results obtained 3 months and 6 months ago. Of the following, what other laboratory abnormalities would you expect? A. Hypercalcemia B. Metabolic alkalosis C. Hypophosphatemia D. Anemia

D. Anemia Anemia of chronic disease is associated with chronic renal failure

What are the BP goals for CKD patients with albuminuria less than 30 mg/g? A. 130/80 B. 130/90 C. 140/80 D. 140/90

D. 140/90 mmHg Remember: albuminuria > 30 the BP goal is 130/80

Which of the following findings on urinalysis is most sensitive for acute cystitis? A. Hematuria B. Leukocyte esterase C. Nitrites D. Pyuria

D. Pyuria Hematuria (A) is a helpful finding because it is more common in cystitis than vaginitis, which is a common differential in women. However, it is not as sensitive as pyuria, which is present in more than 90% of cases of acute cystitis. Leukocyte esterase (B) is an enzyme released from white blood cells (leukocytes) in the urine. Leukocyte esterase can be identified on dipstick urinalysis and occurs in about 70% of cases of cystitis. Nitrites (C) are present when Enterobacteriaceae convert nitrates to nitrites. Nitrites are identified on dipstick urinalysis and occur in about 70% of cases of cystitis. Cystitis Patient presents with low-grade fever, increased urinary frequency, dysuria, and suprapubic or abdominal pain Labs will show positive leukocyte esterase and nitrites Definitive diagnosis is made by urine culture Most commonly caused by Escherichia coli Treatment varies on age - adult, adolescents or pediatric Pregnancy: asymptomatic bacteriuria should be treatedComplications: ↑ risk of preterm birth, low birth weight, perinatal mortality

Which of the following diagnostic findings is most likely to be found on urinalysis in a patient diagnosed with glomerulonephritis? A. Muddy brown casts B. Oval fat bodies C. Protein excretion of 3.2 g/day D. Red blood cell casts

D. Red blood cell casts Glomerulonephritis Edema, HTN UA: RBC casts, proteinuria, hematuria

A 60-year-old man presents to the clinic with painless gross hematuria. Cystourethroscopy, urinary cytology, and computed tomography of the abdomen and pelvis are performed. He is diagnosed with bladder cancer. Which of the following is a risk factor for bladder cancer? A. Black race B. Diet high in animal fat C. Heavy use of NSAIDs D. Smoking Cigarettes

D. Smoking Cigarettes Patient will be older History of smoking Painless hematuria Diagnosis made by cystoscopy

A 56 yo M is seen during routine eval for CKD stage 4. history is also significant for HTN. Medications are losartan, labetalol, furosemide and amlodipine. He has no symptoms and remains physically active. On PE: BP = 129/76 and pulse = 68/min; other vitals are normal. The PE = otherwise unremarkable. Labs: Hg = 11 (13.5-17.5) Bicarb = 19 (22-29) Creatinine = 3.1 (0.6-1.2) Phosphorus = 4 (2.7-4.5) Potassium = 5.1 (3.5-5.1) What should be added to slow down the progression of this patient's CKD? A. ACEI B. ESA C. Phosphate binder D. Sodium bicarbonate

D. Sodium bicarbonate

A 57 yo M patient is diagnosed with CKD. Pt's recent GFR = 25 mL/min. What stage of CKD is this? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

D. Stage 4 Remember: GFR Clock (picture)

A 65-year-old man with a history of end-stage renal disease presents to the ED stating he has been unable to complete his at-home peritoneal dialysis due to failure to pick up his supplies. He states he feels fine at the moment but is worried about missing three days of dialysis. His ECG is unremarkable, but serum potassium is 5.9 mEq/L. Which of the following treatments for hyperkalemia should be initiated in this patient? A. Administer insulin with glucose B. Administer intravenous calcium gluconate C. Administer polystyrene sulfonate D. Transfer to dialysis

D. Transfer to dialysis Hyperkalemia History of kidney failure, DKA, rhabdomyolysis, tumor lysis Lethargy, weakness, paralysis PE will show bradycardia, hypotension, cardiac dysrhythmia ECG will show peaked T waves, prolonged PR, wide QRS Treatment is calcium gluconate, insulin, albuterol, bicarbonate Administering insulin with glucose (A) and intravenous calcium gluconate (B) are treatments reserved for patients with severe hyperkalemia. Severe hyperkalemia is when serum potassium is greater than 6.5 mEq/L, severe symptoms are present, or patients present with ECG changes. The patient in the vignette above does not meet any of these criteria. Administering polystyrene sulfonate (C) is no longer recommended for the treatment of hyperkalemia due to limited efficacy and high risk of intestinal necrosis and perforation.

Which of the following urinalysis sedimentation findings is most suggestive of acute interstitial nephritis? A. Hyaline casts B. Muddy brown casts C. Red blood cell casts D. White blood cell casts

D. White blood cell casts Interstitial Nephritis Sx: fever, rash Labs: ↑Cr, eosinophiluria, WBCs, white blood cell casts Caused by medications (NSAIDS, antibiotics, PPIs, others), infections, autoimmune disorders Tx: discontinue offending medication, if kidney function does not improve consider biopsy and glucocorticoids

When should hypersensitive CKD patients initiate dialysis? A. eGFR < 15 or serum creatinine > 6 B. eGFR < 15 or serum creatinine > 8 C. eGFR < 10 or serum creatinine > 6 D. eGFR < 10 or serum creatinine > 8

D. eGFR < 10 or serum creatinine > 8

A 70-year-old male is diagnosed with multiple myeloma after several months of persistent back pain. One week after his diagnosis he presents to the ED with acute onset confusion, vomiting, and constipation. He produces 750ml of urine in one hour. His vitals are BP 150/90, HR 60, T 98.3, SpO2 98%. His EKG is shown here. What is the next best step in his management? A. Hydrochlorothiazide B. IV sodium bicarbonate C. IV normal saline and calcium carbonate D. Naloxone E. IV normal saline

E. IV normal saline This patient with multiple myeloma presents presents with symptoms concerning for hypercalcemia secondary to his malignancy. Treatments centers around volume replacement with isotonic normal saline.