Medicine PreTest Self-Assessment and Review by Robert S. Urban

Author:Robert S. Urban
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2016-04-13T04:00:00+00:00

Nephrology

Questions

269. A 76-year-old man presents to the emergency room. He had influenza and now complains of diffuse muscle pain and weakness. His medical history is remarkable for osteoarthritis for which he takes ibuprofen, and hypercholesterolemia for which he takes lovastatin. Physical examination reveals blood pressure of 130/90 with no orthostatic change. The only other finding is diffuse muscle tenderness. Laboratory data include

BUN: 30 mg/dL

Creatinine: 6 mg/dL

K: 6.0 mEq/L

Uric acid: 18 mg/dL

Ca: 6.5 mg/dL

Po4: 7.5 mg/dL

UA: large blood, 2+ protein. Microscopic study shows muddy brown casts and 0 to 2 RBC/hpf (red blood cells/high power field).

Which of the following is the most likely diagnosis?

a. Nonsteroidal anti-inflammatory drug-induced acute kidney injury (AKI)

b. Volume depletion

c. Rhabdomyolysis-induced acute kidney injury

d. Urinary tract obstruction

e. Hypertensive nephrosclerosis

270. A 20-year-old man presents with obtundation. His medical history is unobtainable. Blood pressure is 120/70 without orthostatic change, and he is well perfused peripherally. The neurological examination is nonfocal. His laboratory values are as follows:

Na: 138 mEq/L K: 4.2 mEq/L

HCO3: 5 mEq/L

Cl: 104 mEq/L

Creatinine: 1.0 mg/dL

BUN: 14 mg/dL

Ca: 10 mg/dL

Arterial blood gas on room air: Po2 96, Pco2 15, pH 7.02

Blood glucose: 90 mg/dL

Urinalysis: Normal, without blood, protein, or crystals

Which of the following is the most likely acid-base disorder?

a. Pure normal anion-gap metabolic acidosis

b. Respiratory acidosis

c. Pure high anion-gap metabolic acidosis

d. Combined high anion-gap metabolic acidosis and respiratory alkalosis

e. Combined high anion-gap metabolic acidosis and respiratory acidosis

271. A 23-year-old woman with no other medical history was diagnosed with hypertension 6 months ago. She was initially treated with hydrochlorothiazide, followed by the addition of lisinopril, followed by a calcium channel blocker, but her blood pressure has not been well controlled. She assures the provider that she is taking all of her medicines. On examination her blood pressure is 165/105 in each arm, and 168/105 when checked by large cuff in the lower extremities. Her pulse is 60. Cardiac examination reveals an S4 gallop but no murmurs. She has a soft mid-abdominal bruit. Distal pulses are intact and equal. She does not have hyperpigmentation, hirsutism, genital abnormalities, or unusual distribution of fat. Her sodium is 140, potassium 4.0, HCO3 22, BUN 15, and creatinine 1.5. Which of the following is the most likely cause of her difficult-to-control hypertension?

a. Primary hyperaldosteronism (Conn syndrome)

b. Cushing syndrome

c. Congenital adrenal hyperplasia

d. Renal artery fibromuscular dysplasia

e. Coarctation of the aorta

272. A 67-year-old man with a history of gout presents with intense pain in his right great toe. He has a complex medical history, including hypertension, coronary artery disease, congestive heart failure, myelodysplasia, and chronic kidney disease with a baseline creatinine of 3.2 mg/dL and a uric acid level of 10 mg/dL. His medications include aspirin, simvastatin, clopidogrel, furosemide, amlodipine, and metoprolol. What is the best therapy in this situation?

a. Colchicine 1.2 mg po initially, followed by 0.6 mg 1 hour later

b. Allopurinol 100 mg po daily, titrated to uric acid less than 6 mg/dL

c. Prednisone 40 mg po daily

d. Naproxen 750 mg po once followed by 250 mg po tid

e. Probenecid 250 mg po bid

273. The

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