NMS Q&A Family Medicine

chap ter 18NephrologyExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A new patient enters a practice complaining of malaiseover a period of 10 days. The chemical profileand hemogram stand out in the finding of a serumcreatinine of 3.0 mg/dL and blood urea nitrogen(BUN) 60 mg/dL. In taking a medical history, thedoctor is alert to reversible causes of acute renal failure(ARF). Each of the following causes of ARF isreversible except for which one?(A) Fluid depletion(B) Toxic medications(C) Loop diuretics(D) Arteriolonephrosclerosis(E) Radiographic contrast media2 The preceding patient has a blood pressure (BP) of128/78, takes no long-term medications, has no historyof diabetes, and has a random blood sugar of95 mg/dL. The urinalysis showed a few hyaline castsplus significant number of red blood cells per highpowerfield (HPF) and a specific gravity of 1.010. Inreferring to a nephrologist, the primary doctor has inmind a possible renal biopsy. Each of the followingcould be an indication for renal biopsy except forwhich one?(A) Hematuria with glomerular filtration rate(GFR) 30 mL/minute(B) Proteinuria above 1 to 2 g/24 hours(C) Chronic renal failure (CRF) with large kidneys(D) ARF of unknown cause(E) Creatinine and BUN in uremic levels (see text ofprevious question) with longstanding diabetesand poorly controlled hypertension3 Each of the following may retard the rate of progressionof chronic renal disease except for which one?(A) Statin drugs(B) Low-protein diet(C) Control of hypertension(D) Control of diabetes(E) Metformin 500 mg bid4 A 25-year-old Caucasian man had experienced anupper respiratory infection in the past 10 days andnow complains of dyspnea, cough, and hemoptysis.A routine complete blood count (CBC) showshemoglobin 8 g/dL, mean cell volume 75 m 3 (normal80 to 96 m 3 ); urinalysis showing microscopichematuria with misshapen red cells and red cellcasts. Serum creatinine is elevated at 2.8 mg/dL. Sputumexamination shows hemosiderin-laden macrophages.Which of the following laboratory studiesis most likely to lead to the diagnosis of this condition?(A) Antineutrophil cytoplasmic antibody (ANCA)(B) Antiglomerular membrane antibodies(C) BUN(D) Antistreptolysin O antibodies (ASO)(E) Fasting blood sugar (FBS)5 Your 45-year-old type II diabetic weighs 240 lb(108.72 kg) at a height of 5 ft 10 in. (1.77 m). Youhave treated him with 500 mg of metformin thricedaily and 10 mg of glyburide twice daily. His glycohemoglobinthis week was measured at 8%. A 24-hoururine specimen reveals 250 mg of albumen. Whichof the following is the chief significance of thisfinding?(A) It constitutes microalbuminuria.(B) It is a normal finding.(C) It indicates nephrotic syndrome.(D) It is presumptive of pyelonephritis.(E) It indicates an evaluation for cancer.6 Which of the following pharmaceutical class protectsagainst decline in renal function in both diabeticand hypertensive individuals, independent ofdirect effects on either blood sugar or BP control?(A) Nonselective beta-adrenergic blocking agents(B) Beta-2 selective adrenergic blocking agents(C) Calcium channel blocking agents(D) Angiotensin-converting enzyme inhibitors(ACEIs)(E) Alpha-adrenergic blocking agents113