renal

Question 1

what type of patients present with AKI

Answer 1

unwell patients with infection or following a surgery, above 65.

Question 2

The NICE guidelines (2019) criteria for diagnosing an acute kidney injury are:

Answer 2

Rise in creatinine of more than 25 micromol/L in 48 hours
Rise in creatinine of more than 50% in 7 days
Urine output of less than 0.5 ml/kg/hour over at least 6 hours

Question 3

name some of the risk factors that would predispose to developing acute kidney injury

Answer 3

Older age (e.g., above 65 years)
Sepsis
Chronic kidney disease
Heart failure
Diabetes
Liver disease
Cognitive impairment (leading to reduced fluid intake)
Medications (e.g., NSAIDs, gentamicin, diuretics and ACE inhibitors)
Radiocontrast agents (e.g., used during CT scans)

Question 4

name the stages of renal impairment

Answer 4

Pre-renal causes are the most common. Insufficient blood supply (hypoperfusion) to kidneys reduces the filtration of blood. This may be due to:

Dehydration
Shock (e.g., sepsis or acute blood loss)
Heart failure

Renal causes are due to intrinsic disease in the kidney. This may be due to:

Acute tubular necrosis
Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis

Post-renal causes involve obstruction to the outflow of urine away from the kidney, causing back-pressure into the kidney and reduced kidney function. This is called an obstructive uropathy. Obstruction may be caused by:

Kidney stones
Tumours (e.g., retroperitoneal, bladder or prostate)
Strictures of the ureters or urethra
Benign prostatic hyperplasia (benign enlarged prostate)
Neurogenic bladder

Question 5

what are some pre-renal kidney issues

Answer 5

insufficient blood flow-hypoperfusion, due to dehydration, heart failure, shock-sepsis, or acute blood loss.

Question 6

what are some Renal kidney issues

Answer 6

Due to intrinsic factors:
- Acute tubular necrosis
- Glomerulonephritis
Acute interstitial nephritis
Haemolytic uraemic syndrome
Rhabdomyolysis

Question 7

what are some post-renal kidney issues

Answer 7

obstruction to the outflow of urine away from the kidney, causing back-pressure into the kidney and reduced kidney function. This is called an obstructive uropathy. Obstruction may be caused by:

Kidney stones
Tumours (e.g., retroperitoneal, bladder or prostate)
Strictures of the ureters or urethra
Benign prostatic hyperplasia (benign enlarged prostate)
Neurogenic bladder

Question 8

name the common cause of intrinsic renal impairments and the diagnosis of it.

Answer 8

Acute tubular necrosis- this is due to ischaemia and poor perfusion of the epithelial cells of the renal tubules
Nephrotoxins-gent, radiocontrast agents or cistplatin

• Urinalysis- muddy brown cast, renal tubular epithelial cells may also been seen. they can regenerate quickly so this cause is reversible 1-3 weeks.

Question 9

Acute tubular necrosis cause of renal impairment is reversible. True or false?

Answer 9

True, epithelial cells are able to regenerate in 1-3weeks.

Question 10

What are urinalysis findings for AKI

Answer 10

-Leukocytes and nitrites - infection
- Protein and blood suggest acute nephritis, and infection
- glucose- diabetes

Question 11

other than urinalysis what other tool is used for diagnosing stages of AKI

Answer 11

Ultrasound of the urinary tract assesses for obstruction when a post-renal cause is suspected.

Question 12

what is the management for AKI prevention?
- consider causes of AKI

Answer 12

Avoiding nephrotoxic medications where appropriate
Ensuring adequate fluid intake (including IV fluids if oral intake is inadequate)
Additional fluids before and after radiocontrast agents

Question 13

what is the treatment plan for AKI with an (underlying cause)- consider medications, invasive management

Answer 13

Treating an acute kidney injury involves reversing the underlying cause avoiding medications that may worsen and also medications that may accumulate with reduced renal impairment.

IV fluids for dehydration and hypovolaemia
Withhold medications that may worsen the condition (e.g., NSAIDs and ACE inhibitors)
Withhold/adjust medications that may accumulate with reduced renal function (e.g., metformin and opiates)
Relieve the obstruction in a post-renal AKI (e.g., insert a catheter in a patient with prostatic hyperplasia)
Dialysis may be required in severe cases

TOM TIP: Calling ACE inhibitors nephrotoxic is incorrect. ACE inhibitors should be stopped in an acute kidney injury, as they reduce the filtration pressure. However, ACE inhibitors have a protective effect on the kidneys long-term. They are offered to certain patients with hypertension, diabetes and chronic kidney disease to protect the kidneys from further damage.

Question 14

Name some complications of AKI
(electrolytes)
(blood gas)

Answer 14

-fluid overload- heart failure and oedema
-metabolic acidosis
hyperkalemia
uraemia: leads to encephalopathy and pericarditis

Question 15

Define CKD and how long does it have to maintain to be considered as CKD.

Answer 15

Chronic kidney disease (CKD) describes a chronic reduction in kidney function sustained over three months. It tends to be permanent and progressive.

Question 16

Name some causes of CKD

Answer 16

Diabetes
Hypertension
Medications (e.g., NSAIDs or lithium)
Glomerulonephritis
Polycystic kidney disease

Question 17

What are the presentations of CKD. (consider the synthesis of kidney, fluid status

Answer 17

Mostly Asymptomatic,
Pallor due to Anemia: erythropoetin is the hormone synthesised by the kidney for RBC formation.
- Fatigue
- foamy urine
-nausea
loss of appetite
oedema
pruritus
hypertension
peripheral neuropathy

Question 18

what is the EGFR based on

Answer 18

The estimated glomerular filtration rate (eGFR) is based on the serum creatinine, age and gender. It estimates the glomerular filtration rate (the rate at which fluid is filtered from the blood into Bowman’s capsule).

Question 19

Which investigation tool is used for proteinuria

Answer 19

Quantified with a urine albumin:creatinine ratio (ACR).

Question 20

Which investigation tool is used for Haematuria

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Answer 20

Haematuria (blood in the urine) can be assessed with a urine dipstick or microscopy. Microscopic haematuria is when blood is identified on testing but not visible on inspection. Macroscopic haematuria refers to visible blood in the urine. Haematuria can indicate infection, malignancy (e.g., bladder cancer), glomerulonephritis or kidney stones.

Question 21

what tool can be used to look for obstruction in the kidneys

Answer 21

Renal ultrasound helps identify obstructions (e.g., kidney stones or tumours) and polycystic kidney disease.

Question 22

name some other investigations necessary to identify risk factors for CKD (consider common AKI causes)

Answer 22

Blood pressure (for hypertension)
HbA1c (for diabetes)
Lipid profile (for hypercholesterolaemia)

Question 23

what are the components to classifying CKD?

Answer 23

Estimated glomerular filtration rate (eGFR) is sustained below 60 mL/min/1.73 m2
Urine albumin:creatinine ratio (ACR) is sustained above 3 mg/mmol
The G score is based on the eGFR. The A score is based on the albumin:creatinine ratio.
Accelerated progression is a sustained decline in the eGFR within one year of either 25% or 15 mL/min/1.73 m2.
G5- UNDER 15
A3- ABOVE 30MG/MMOL

Question 24

What are the values of accelerated progression in CKD

Answer 24

Accelerated progression is a sustained decline in the eGFR within one year of either 25% or 15 mL/min/1.73 m2.

Question 25

what are the complications of CKD

Answer 25

Anaemia cardiovascular disease Renal bone disease end stage kidney diseases dialysis related complications peripheral neuropathy

Question 26

what tool 'equation' can be used to estimate risk of kidney failure requiring dialysis and how many years does it estimate?

Answer 26

The Kidney Failure Risk Equation can be used to estimate the 5-year risk of kidney failure requiring dialysis.

Question 27

The NICE clinical knowledge summaries (May 2023) suggest referral to a renal specialist when: (consider hypertension issues, dialysis, accelerated progression, EGFR ACR) (5)

Answer 27

(EGFR AND ACR- 100) eGFR less than 30 mL/min/1.73 m2 Urine ACR more than 70 mg/mmol Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months) 5-year risk of requiring dialysis over 5% Uncontrolled hypertension despite four or more antihypertensives

Question 28

Treating the underlying cause of CKD involves:

Answer 28

Optimising diabetic control Optimising hypertension control Reducing or avoiding nephrotoxic drugs (where appropriate) Treating glomerulonephritis (where this is the cause)

Question 29

What are the BP and ACR findings in patients under 80

Answer 29

The blood pressure target is less than 130/80 in patients under 80 with CKD and an ACR above 70 mg/mmol.

Question 30

Medications that help slow the disease progression in CKD are:

Answer 30

ACE inhibitors (or angiotensin II receptor blockers) SGLT-2 inhibitors (specifically dapagliflozin) | Decrease ACR RATIO

Question 31

Reducing the risk of complications in CKD involves (consider meds used to treat common cause of AKI: ## Footnote cardio input

Answer 31

Exercise, maintain a healthy weight and avoid smoking Atorvastatin 20mg for primary prevention of cardiovascular disease (in all patients with CKD)

Question 32

Management of complications of CKD involves: (blood gas impairment, blood status, renal bone disease)

Answer 32

Oral sodium bicarbonate to treat metabolic acidosis Iron and erythropoietin to treat anaemia Vitamin D, low phosphate diet and phosphate binders to treat renal bone disease

Question 33

Management of end-stage renal disease involves:

Answer 33

Special dietary advice Dialysis Renal transplant

Question 34

ACE inhibitors are offered to all patients with (consider common cause of AKI, ACR levels :

Answer 34

Diabetes plus a urine ACR above 3 mg/mmol Hypertension plus a urine ACR above 30 mg/mmol All patients with a urine ACR above 70 mg/mmol

Question 35

what electrolyte imbalance is associated with CKD and ACE inhibitors

Answer 35

hyperkalaemia- monitor serum potassium

Question 36

Patients with diabetes and CKD are offered what type of medications

Answer 36

Dapagliflozin is the SGLT-2 inhibitor licensed for CKD. It is offered to patients with: Diabetes plus a urine ACR above 30 mg/mmol Dapagliflozin is considered for patients with: Diabetes plus a urine ACR or 3-30 mg/mmol Non-diabetics with an ACR of 22.6 mg/mmol or above

Question 37

What type of anaemia does CKD cause and state the cause of this?

Answer 37

Healthy kidneys produce erythropoietin, a hormone that stimulates the production of red blood cells. CKD results in lower erythropoietin and a drop in red blood cell production. It causes a normocytic (normal sized) normochromic (normal colour) anaemia. treated with erythropoiesis-stimulating agents: recombinant human erythropoietin. Blood transfusions can sensitise the immune system (allosensitization), increasing the risk of future transplant rejection. Iron deficiency is treated before using erythropoietin. Intravenous iron is usually given, particularly in dialysis patients.

Question 38

what are the treatments for Anaemia in chronic kidney disease?

Answer 38

Anaemia may be treated with erythropoiesis-stimulating agents, such as recombinant human erythropoietin. Blood transfusions can sensitise the immune system (allosensitization), increasing the risk of future transplant rejection. Iron deficiency is treated before using erythropoietin. Intravenous iron is usually given, particularly in dialysis patients.

Question 39

How does CKD cause renal bone disease? consider the function of kidneys in bone synthesis

Answer 39

- high serum phosphate as a result of poor excretion - low vitamin D due to kidney's inability to metabolise vitamin D into active vitamin D which is essential for calcium absorption in the intestines and reabsorption in the kidneys. It is also responsible for regulating bone turnover and promoting bone reabsorption to increase the serum calcium level. Chronic kidney disease leads to less vitamin D activity and low serum calcium.

Question 40

what type of deficiency does CKD cause?

Answer 40

Chronic kidney disease leads to less vitamin D activity and low serum calcium.

Question 41

which glands are responsible for responding to low calcium serum as a result of VitD in CKD?

Answer 41

The parathyroid glands react to the low serum calcium and high serum phosphate by excreting more parathyroid hormone, causing secondary hyperparathyroidism. Parathyroid hormone stimulates osteoclast activity, increasing calcium absorption from bone.

Question 42

what is the term used to describe the increased turnover of bones without adequate calcium supply

Answer 42

osteomalacia

Question 43

***** occurs when the osteoblasts respond by increasing their activity to match the osteoclasts, creating new tissue in the bone. Due to the low calcium level, this new bone is not properly mineralised.

Answer 43

OSTEOSCLEROSIS

Question 44

What is the finding on spinal x-ray for patients with renal bone disease as a result of CKD.

Answer 44

Rugger jersey spine is a characteristic finding on a spinal x-ray. This involves sclerosis of both ends of each vertebral body (denser white) and osteomalacia in the centre of the vertebral body (less white). The name refers to the stripes found on a rugby shirt.

Question 45

what are 3 disease common conditions associated with renal bone diseases

Answer 45

-Osteoporosis can exist alongside renal bone disease and may be treated with bisphosphonates. Osteomalacia occurs due to increased turnover of bones without adequate calcium supply. Osteosclerosis occurs when the osteoblasts respond by increasing their activity to match the osteoclasts, creating new tissue in the bone. Due to the low calcium level, this new bone is not properly mineralised.

Question 46

Management of renal bone disease involves a combination of:

Answer 46

Low phosphate diet Phosphate binders Active forms of vitamin D (alfacalcidol and calcitriol) Ensuring adequate calcium intake

Question 47

why is there a raised ALP in CKD

Answer 47

Serum ALP level reflects bone activity, including bone turnover and bone metabolism. (CKD) patients, serum ALP level is commonly used as a surrogate marker for hyperparathyroidism and renal bone disease. Generally, an elevated serum ALP level indicates high-turnover bone disease in CKD

Question 48

what is the conditon that involves breakdown of skeletal muscles and release chemicals into the blood (injuries, immobility). Name the chemicals released and what does the cells udnergo

Answer 48

Rhabdomylolsis- Atopsosis Myoglobin pottasium phosphate CK

Question 49

name some causes of rabdomyolisis

Answer 49

Prolonged immobility, particularly frail patients who fall and spend time on the floor before being found Extremely rigorous exercise beyond the person’s fitness level (e.g., endurance events or CrossFit) Crush injuries Seizures Statins

Question 50

what are the signs and symptoms of rhabdomyolisis

Answer 50

Muscle pain Muscle weakness Muscle swelling Reduced urine output (oliguria) Red-brown urine (myoglobinuria) Fatigue Nausea and vomiting Confusion (particularly in frail patients)

Question 51

what investigation is first line used to investigate rhabdo. what are the pattern like. (what other investigations also used )

Answer 51

blood test- CK, it should be less than 150 U/L but in rhabdo it can exceed 100K it rises. it rises within 12 hours and remain elevated 1-3days then falls gradually. higher the CK indicates greater risk of kidney injury. ECG UEs

Question 52

what does -red-brown colour in urine indicates? its seen in the conditoin where there is a breakdown of skeletal msucles (myocytes)

Answer 52

myoglobininuria.

Question 53

what is the managment for rhabdomyolysis

Answer 53

Intravenous fluids are the mainstay of treatment to correct hypovolaemia and encourage filtration of the breakdown products. Treatment of complications, particularly hyperkalaemia, is also essential. Additional options that are debatable and have associated risks include: Intravenous sodium bicarbonate (to increase urinary pH and reduce the toxic effects of myoglobinuria) Intravenous mannitol (to increase urine output and reduce oedema)

Question 54

what does HUS mean and name the cause of it. what is the classic triad.

Answer 54

thrombosis in the blood vessels triggered by shiga toxins from either E.coli 0157 or shigella. microangiopathic haemolytic anaemia. the clots cause the red blood cells that pass through to rupture. aki- blood flow to the kidney is affected vt thrombi and damaged RBC. thrompocytopenia- formation of clots results in this.

Question 55

what is the presentation for HUS (10)

Answer 55

Jaundice- Haemolysis Pallor- Aneamia fever Abdo pain bruising hypertension lethargy haematuria confusion oliguria

Question 56

what is the management for HUS

Answer 56

medical emergency and requires hospital admission: treat hypertension, hypovalemia, severe aneamia, RF.

Question 57

what are the complications of hyperkalaemia:

Answer 57

arrythima, VF

Question 58

what are some causes of hyperkalemia

Answer 58

Rhabdomyolisis, medications such as ACE AKI CKD 4/5 Adrenal insufficiency tumor lysis syndrome

Question 59

what medications can cause hyperkalaemia

Answer 59

ACEi aldosterone antanogist NSAIDS ARBS

Question 60

Hyperkalemia on blood test may not be accurate. True or false

Answer 60

haemolysis can create falsely elevated pottasium (Pseudohyperkalemia)

Question 61

what are the ECG changes found

Answer 61

Tall peaked T-waves Prolonged PR interval Broad QRS complex flattened or P waves

Question 62

what is the management for hyperkalaemia for serum K below 6.5 without ECG changes

Answer 62

treat the underlying cause: treat AKI and stop medications that may contribute

Question 63

what are the values for normal mild moderate severe hyperkalemia

Answer 63

Normal: 3.5-5.3 mild 6.3-6 moderate 6-6.5 severe over 6.5

Question 64

when is it considered urgent treatment for hyperkalaemia (2)

Answer 64

ECG changes serum K over 6.5

Question 65

explain the use of treatment for hyperkalaemia (not for lowering serum K)

Answer 65

insulin and dextrose infusion and IV calcium gluconate: -insulin: drives pottasium from extracellular to intracellular Dextrose : insulin secretion can lead to hypo calcium gluconate: stabilise cardiac muscles and reduce risk of arrythmias

Question 66

what other main treatment for lowering serum potassium

Answer 66

-nebulised salbutamol- drives K into cells -oral calcium resonium- reduce K absorption in the GI. -sodium bicarbonate (in acidotic patient on renal device drives K into cells as it corrects the acidosis -Hameodialysis- on persistent cases

Question 67

what is polycystic kidney disease:

Answer 67

It's a genetic condition where healthy kidney tissue is replaced with fluid-filled cysts. The enlarged kidneys may be palpable on examination and it leads to renal failure.

Question 68

what genes are affected in autosomal dominant ADPKD

Answer 68

PKD1 gene on chromosome 16 (85% of cases) PKD2 gene on chromosome 4 (15% of cases)

Question 69

what are the extra-renal manifestation:

Answer 69

Cerebral aneurysms Hepatic, splenic, pancreatic, ovarian and prostatic cysts Mitral regurgitation Colonic diverticula

Question 70

what are some complications of ADPKD

Answer 70

hypertension gross haematuria if cyst rupture chronic loin/flank pain recurrent UTI Renal stones end-stage renal failiure

Question 71

What is ARPKD. when is the diangosis picked up on.

Answer 71

Its caused by a mutation in the polysystic kideny and hepatic disease 1 gene on chromose 6. it is more severe and rare than autodominant. diagnosed during antenatal scans with oligohydraminos. (reduced amniotic fluid volume due to reduced urine output.

Question 72

what is oligohydraminos

Answer 72

Oligohydramnios leads to underdevelopment of the fetal lungs (pulmonary hypoplasia) and respiratory failure shortly after birth. Patients may require haemodialysis within the first few days of life. They may have dysmorphic features, such as underdeveloped ear cartilage, low-set ears and a flat nasal bridge. End-stage renal failure usually occurs before reaching adulthood.

Question 73

what tool is used to diagnosis polycystic kidney disease.

Answer 73

Ultrasound and genetic testing.

Question 74

what tablet slows down the cyst development and progressional of renal failure in autosomal dominant PKD.

Answer 74

Tolvaptan- a vasopressin receptor antagnonsit.

Question 75

what are the management involved in ADPKD

Answer 75

√= Oligohydramnios leads to underdevelopment of the fetal lungs (pulmonary hypoplasia) and respiratory failure shortly after birth. Patients may require haemodialysis within the first few days of life. They may have dysmorphic features, such as underdeveloped ear cartilage, low-set ears and a flat nasal bridge. End-stage renal failure usually occurs before reaching adulthood.

Question 76

what is renal tubular acidosis and what are the causes of acidosis. RAAS(4)

Answer 76

type 1: distal tube cannot excrete H+ ions therefore PH high and serum pottasium high type 2 : proximal tubule cannot reabsorb bicarb so PH high and serum pottasium low type 4: (most common) low aldosterone or impaired aldosterone function so low urinary PH and high potassium. type 1 and 4 involves low excretion of hydrogen in distal tubules. bicrb and potassium same relationship

Question 77

how does type 4 RTA cause metabolic acidosis and hyperkalemia

Answer 77

Absence of alodsterone means less absorption of sodium and less secretion of potassium and hydrogen ions. therefore urine becomes acidotic still because ammonia is also made in the distal tube and act acts as a buffer there to neutralise for the acid present. However potassium supresses ammonia production and urine becomes acidotic. \ so you end uo with metabolic acidosis hyperkalemia and low urinary PH. Hormones such as aldosterone and angiotensin II can influence ammonia handling by the distal tubule. Aldosterone increases the activity of H⁺-ATPase in intercalated cells, enhancing H⁺ secretion and subsequent NH₄⁺ formation.

Question 78

what could be the cause of low aldosterone activity

Answer 78

adrenal insufficiency diabtetic neuropathy medications (ACEi spiro or epeleone.

Question 79

what is the relation between potassium and H+

Answer 79

They are interchangeable. therefore bicarb is used to treat hyperkalemia and neutralise the acididty.

Question 80

Name the drug used for aldosterone deficiency and the group

Answer 80

fludrocortisone (mineralocorticoid)

Question 81

what is glomerulonephritis

Answer 81

Glomerulonephritis describes the pathology that occurs in various diseases rather than being a disease. Treatment is targeted at the underlying cause and often involves supportive care and immunosuppression (e.g., corticosteroids).

Question 82

whats the difference between nephrotic and nephritic syndrome

Answer 82

nephrotic syndrome is when the gloemeruli do not filter properly the albumin. Nephritic syndrome is the inflamed glomeruli do not filter properly the RBC and so haematuria is seen in urine.

Question 83

what are the features of nephritic syndrome

Answer 83

haematuria oliguria proteinuria fluid retention but often less protein found than nephrotic. if the protein is higher the consider nephrotic syndrome

Question 83

what are the features of nephrotic syndrome

Answer 83

when basement membrane in the glomerulus become highly permeable and result in porteinuria. preoteinuria- frothy urine low albumin perirpheral odema hypercholestrolaemia

Question 84

what are the causes of nephrotic syndrome in adults and children

Answer 84

Adult- membranous nephropathy - focal segmental glomerulosclerosis, diabetes, infections -HIV HSP chidlren- idiopathic, treated sucessfully with steroids

Question 87

What is the primary purpose of shuffling flashcards?

Answer 87

To randomize the order of questions to enhance learning and retention.

Question 88

True or False: Shuffling flashcards can help prevent memorization of the order rather than the content.

Answer 88

True

Question 89

Fill in the blank: Shuffling flashcards is often used in __________ learning techniques.

Answer 89

active

Question 90

What method can be used to shuffle flashcards digitally?

Answer 90

Randomization algorithms

Question 91

Multiple Choice: Which of the following is NOT a benefit of shuffling flashcards? A) Improved recall B) Reduced boredom C) Increased memorization of order D) Enhanced engagement

Answer 91

C) Increased memorization of order

Question 92

What is a common tool used for shuffling flashcards?

Answer 92

Flashcard apps or software

Question 93

True or False: Shuffling flashcards is only useful for language learning.

Answer 93

False

Question 94

What effect does shuffling have on spaced repetition?

Answer 94

It can enhance the effectiveness by varying the order of review.

Question 95

Fill in the blank: The process of shuffling flashcards can help identify __________ knowledge gaps.

Answer 95

specific

Question 96

Multiple Choice: Which of the following is a recommended practice when using shuffled flashcards? A) Reviewing in the same order each time B) Mixing topics frequently C) Ignoring difficult cards D) Focusing solely on easy cards

Answer 96

B) Mixing topics frequently

Question 97

What is one psychological benefit of shuffling flashcards?

Answer 97

It keeps the learner engaged and attentive.

Question 98

True or False: Shuffling flashcards can lead to increased cognitive load.

Answer 98

True

Question 99

What is a potential downside of shuffling flashcards too frequently?

Answer 99

It may hinder the ability to build a structured understanding of the material.

Question 100

Fill in the blank: Shuffling cards can be particularly beneficial for __________ subjects.

Answer 100

conceptual

Question 101

What is the term for the technique of reviewing flashcards in a random order?

Answer 101

Shuffling

Question 102

Multiple Choice: Which of the following strategies complements the shuffling of flashcards? A) Cramming B) Spaced repetition C) Rote memorization D) Passive reading

Answer 102

B) Spaced repetition

Question 103

What is the ideal frequency of shuffling flashcards during study sessions?

Answer 103

At the beginning of each session or periodically throughout.

Question 104

True or False: Shuffling flashcards is a universally effective strategy for all learners.

Answer 104

False

Question 105

What is one way to shuffle physical flashcards?

Answer 105

Manually mix them by hand.

Question 106

Fill in the blank: Shuffling helps combat the __________ effect during learning.

Answer 106

serial position

Question 107

Multiple Choice: What is a common platform for creating and shuffling flashcards? A) Word processor B) Spreadsheet software C) Flashcard apps D) Presentation software

Answer 107

C) Flashcard apps

Question 108

What is the main cognitive process involved in learning from shuffled flashcards?

Answer 108

Active recall

Question 109

True or False: You should always shuffle flashcards before every review session.

Answer 109

False

Question 110

What should learners consider when deciding how often to shuffle their flashcards?

Answer 110

Their familiarity with the material and learning goals.