Zombie TBL Questions

Question 1

Question: Which of the following complications is not usually associated with autosomal dominant polycystic kidney disease (ADPKD)?
a) Aneurysms
b) Fetal pulmonary hypoplasia
c) Kidney stones
d) Flank/kidney pain

Answer 1

B: Fetal pulmonary hypoplasia

Question 2

Question: A 52-year-old patient experiences acute kidney injury after being placed on an ACE inhibitor. She has a history of hypertension, hyperlipidemia, and chronic smoking. An abdominal bruit was noted on her last exam but never followed up on. What is the likely underlying cause of her AKI?

Answer 2

RAS

Question 3

Question: The “golfball on a tee” sign and “ring shadow” sign on renal imaging are classically associated with which disorder?

Answer 3

Analgesic nephropathy (papillary necrosis)

Question 4

Question: What can reduce the risk of nephrotoxicity in a CKD patient who must receive a procedure that utilizes IV contrast?

Answer 4

Administering normal saline IV before and after the procedure or discontinuing all other potentially nephrotoxic drugs

Question 5

A patient with 150 mg/d secretion of protein in the urine would fit what A category of chronic kidney disease?

Answer 5

A2

Question 6

Postinfectious glomerulonephritis is which type of glomerulonephritis?

Answer 6

Immune complex deposition

Question 7

Why is hypercoagulability seen in nephrotic syndrome?

Answer 7

Urinary loss of protein C, protein S, and antithrombin

Question 8

What medication has been shown to slow the progression of autosomal dominant polycystic kidney disease?

Answer 8

Tolvaptan (Samsca, Jynarque)

I think only jynarque technically works for ADPKD specifically

Question 9

What class of drugs is classically known for inducing AKI in patients with bilateral renal artery stenosis?

Answer 9

ACEs/ARBs

Question 10

What type of chronic kidney disease is associated with asymmetric kidneys
on imaging, displaying areas of thin atrophic parenchyma interspersed with enlarged
hypertrophic parenchyma?

Answer 10

vesicoureteral reflux (will consider chronic tubulointerstitial disease)

Question 11

What current set of criteria are most commonly used (and most preferred) to
score the severity of acute kidney injury?

Answer 11

KDIGO

Question 12

A pH of less than _____ in an AKI patient requires the start of urgent
hemodialysis.

Answer 12

7.1

Question 13

A patient in AKI is found to have dark brown urine with a positive urine dip for
blood, but no red blood cells are visible on microscopy. What is the most likely cause?

Answer 13

Myoglobinuria

Question 14

An ANCA level is helpful to diagnose which type of renal disease?

Answer 14

Pauci-immune GN

Question 15

What condition would preclude the use of IV fluids in a patient with prerenal azotemia?

Answer 15

Volume overload or acute decompensated HF

Question 16

In a patient with normally functioning kidneys and fluid volume excess, their urine osmolality should be:

Answer 16

Lower than usual

Question 17

When is the best time to administer oral phosphate binder medications?

Answer 17

With a meal

Question 18

A patient is found to have muscle weakness, hypotension, palpitations, and constipation. Their T wave on ECG tracing has diminished amplitude. What is their most likely electrolyte abnormality?

Answer 18

Hypokalemia

Question 19

Vasopressin Receptor Antagonists are most useful in the treatment of what electrolyte or acid-base disorder?

Answer 19

Hyponatremia

Question 20

This is produced by the liver as a waste by-product of protein breakdown:

Answer 20

Urea

Question 21

Compared to an average patient, a vegan’s serum creatinine should be:

Answer 21

Lower

Question 22

What type of nephron has the longest loop of Henle?

Answer 22

Juxtamedullary nephron

Question 23

The system of shifting osmolality of the urine filtrate and surrounding tissue that allows the body to concentrate fluids is best known as:

Answer 23

Countercurrent mechanism

Question 24

The specialized cells in the afferent arteriole that are the primary source of renin secretion are called:

Answer 24

JG cells

Question 25

The active form of vitamin D secreted by the kidneys is known as:

Answer 25

Calcitriol

Question 26

What is the gold standard for diagnosing renal artery stenosis?

Answer 26

Renal artery angiography

Question 27

What finding would you expect to see on the urinalysis of a patient with CKD? ○ RBC casts ○ Broad, waxy casts ○ WBC casts ○ “Muddy brown” casts

Answer 27

Broad, waxy casts

Question 28

What is the most common cause of chronic tubulointerstitial disease? ○ Vesicoureteral reflux ○ Obstructive uropathy ○ Analgesic nephropathy ○ Nephrocalcinosis

Answer 28

Obstructive uropathy

Question 29

What is the most common physical exam finding in Chronic Kidney Disease (CKD)?

Answer 29

HTN

Question 30

What is the most common cause of chronic nephrotic glomerular disease among US patients? ○ Diabetes mellitus ○ Hypertension ○ Alcoholism ○ Acute kidney injury

Answer 30

DM

Question 31

What is the most common primary glomerulonephritis worldwide? ○ Amyloidosis ○ Pauci-immune glomerulonephritis ○ Henoch-Schonlein purpura ○ Berger’s disease (IgA nephropathy)

Answer 31

Berger's disease/IgA nephropathy

Question 32

What part of the kidney contains glomeruli?

Answer 32

Renal cortex

Question 33

This portion of the nephron secretes protein-bound drugs:

Answer 33

Proximal tubule

Question 34

Creatine, the precursor to creatinine, comes from what source(s)?

Answer 34

* 50% liver * 50% diet

Question 35

A patient with a history of protracted vomiting who has been NPO with continuous NG suction for the last 48 hours develops agitation, dizziness, paresthesias, and muscle tetany. What acid-base disorder is most likely?

Answer 35

Metabolic alkalosis

Question 36

A patient with acute kidney injury develops symptomatic metabolic acidosis. What two primary modalities are considered for treatment of metabolic acidosis in AKI?

Answer 36

* Bicarb * Dialysis

Question 37

Which two lab values are used to stage CKD?

Answer 37

* GFR * Albuminuria

Question 38

In the CKD patient, HTN, volume overload, anemia, and accelerated atherosclerosis all increase the workload of the heart which can lead to this complication: ○ Cardiogenic shock ○ Left ventricular hypertrophy ○ Cardiac tamponade ○ Cardiac arrhythmias

Answer 38

LVH

Question 39

A 4-yr-old patient presents with a patchy, palpable rash on the lower extremities and buttocks. He also complains of belly pain, nausea, and says his knees hurt. 10 days ago, this patient was treated for strep throat. UA reveals hematuria and mild proteinuria. What is the most likely diagnosis? ○ Berger’s disease (IgA nephritis) ○ Minimal change disease ○ Henoch-Schonlein purpura ○ Post-streptococcal glomerulonephritis

Answer 39

Henoch-schonlein purpura

Question 40

Combination therapy with fibrates and statins in CKD patients increases the risk of what condition?

Answer 40

Rhabdomyolysis

Question 41

Which of the following is not a risk factor for CKD? ○ Smoking ○ High triglycerides ○ Proteinuria ○ Hypertension

Answer 41

High triglycerides

Question 42

Cinacalcet, used in patients with advanced CKD, acts primarily on which of the following organs? ○ Parathyroids ○ Liver ○ GI tract ○ Kidney

Answer 42

Parathyroid glands

Question 43

Which of the following medications would pose the greatest risk of later development of AKI? ○ levothyroxine ○ acetaminophen ○ amoxicillin ○ potassium

Answer 43

Amoxicillin

Question 44

A patient in acutely decompensated congestive heart failure has developed a significant elevation in serum BUN and Cr and a fall in eGFR over the last 24 hours. The most likely type of AKI present is:

Answer 44

Prerenal azotemia

Question 45

An AKI patient presents with potassium of 6.9 (normal: 3.5-5.0), weakness, palpitations, and EKG changes. What medication should be administered first to address the patient’s hyperkalemia?

Answer 45

IV calcium gluconate

Question 46

Hypernatremia is commonly a normal physiologic response to which of the following disease states? ○ Hyperuricemia ○ Dehydration ○ Constipation ○ Hypertension

Answer 46

Dehydration

Question 47

Rhabdomyolysis is most strongly associated with which form of acute kidney injury? ○ Acute glomerulonephritis ○ Acute prerenal azotemia ○ Acute tubular necrosis ○ Acute interstitial nephritis ○ Acute postrenal obstruction

Answer 47

ATN

Question 48

What is the GFR indication to begin dialysis in chronic kidney disease patients?

Answer 48

GFR of <= 10

Question 49

Which of the following would be the first step in treating a patient diagnosed with obstructive uropathy? ○ Administer Lasix (furosemide) ○ Perform a renal ultrasound ○ Remove obstruction ○ Administer antibiotics

Answer 49

Remove obstruction

Question 50

Levels of ________ are often elevated in CKD patients, leading to reduced iron absorption and decreased mobilization of iron from body stores.

Answer 50

Hepcidin

Question 51

Which organism is classically associated with postinfectious glomerulonephritis?

Answer 51

GABHS

Question 52

Which of the following would not be appropriate to treat the increased cardiac workload in CHF? ○ ACE inhibitor/ARB ○ Increased fluid intake ○ Sodium restriction ○ Furosemide (Lasix)

Answer 52

Increased fluid intake

Question 53

What is the most common complication of peritoneal dialysis?

Answer 53

Peritonitis

Question 54

A CKD patient presents to the clinic with bone pain in her wrists for a few weeks. On x-ray, “brown tumors” are seen. Her labs reveal an elevated phosphorus level. What is the most appropriate initial step in the management of this patient? ○ Start calcitriol (vitamin D) ○ Refer the patient for chemotherapy ○ Start oral phosphorus binders ○ Limit dietary phosphorus intake

Answer 54

Limit dietary phosphorus

Question 55

What is the most common complication of CKD? ○ Hyperkalemia ○ Hyperlipidemia ○ Hypertension ○ Bone disease ○ Anemia

Answer 55

HTN

Question 56

What is the most common presenting symptom of Berger’s disease (IgA nephritis)?

Answer 56

An episode of gross hematuria

Question 57

A 3-yr-old girl presents with severe edema and foamy urine. Labs reveal the presence of hyperlipidemia, severe proteinuria, and hypoalbuminemia. What is the best initial treatment? ○ Lisinopril ○ Prednisone ○ Calcium carbonate ○ Amoxicillin

Answer 57

Prednisone

Question 58

Which of the following is not typically associated with nephritic syndrome? ○ Oliguria ○ Hypertension ○ Hyperlipidemia ○ Hematuria

Answer 58

HLD

Question 59

Which of the following physical exam findings would be most associated with a diagnosis of uremia? ○ Fever ○ Increased appetite ○ Shortness of breath ○ Dysuria

Answer 59

SOB