NMS Q&A Family Medicine

114 NMS Q&A Family Medicine7 Which of the following is the mechanism for developmentof hyperparathyroidism in renal failure?(A) Failure to retain calcium in the kidneys(B) Increased catabolism of osteoid matrix incancellous bone(C) Failure of absorption of calcium in thegastrointestinal tract(D) Faulty conversion of 25-hydroxy vitamin D, or25(OH)D, to vitamin D 3 , or 25(OH)2D(E) Renal retention of phosphates8 A 45-year-old African-American man has beentreated by you for cardiomyopathy and has had onesignificant bout of congestive heart failure. He is 50%overweight. Now he has become diabetic. You find onurinalysis an albumen-to-creatinine ratio of 200 mgof albumen to 1 g of creatinine (normal is 17 mg to250 mg). Which of the following laboratory studiesgives the most accurate measure of renal function ?(A) BUN(B) Serum creatinine(C) Creatinine clearance(D) Urinalysis(E) 24-hour measurement of urinary protein andcreatinine9 Renal failure may be caused by diabetes and hypertensionin about two-thirds of the cases. Regardlessof causation, as renal failure progresses and BUNand creatinine rise in the blood, anemia develops.Which of the following mechanisms accounts for theanemia associated with CRF?(A) Iron deficiency(B) Hemolysis(C) Hypovitaminosis B 12(D) Folic acid deficiency(E) Decreased production of erythropoietin10 You are considering ancillary imaging studies onyour 46-year-old male patient who has had gross andmicroscopic hematuria over a 1-week period. A helicalcomputed tomography (CT) scan without contrastshows no evidence of stone. Therefore, othercauses for hematuria, including cancer, must be considered.Each of the following constitutes a relative orabsolute contraindication for repeating the CT scanwith contrast, except for which one?(A) Multiple myeloma(B) Diabetes with serum creatinine level 2 mg/dL(C) CRF with creatinine level 5 mg/dL(D) Hypovolemia with BUN level of 45 mg/dL(normal level is 10 to 20 mg/dL), creatininelevel of 1.5 mg/dL (normal level is 1.4 mg/dL)(E) Suspected renal cell carcinoma11 In an adult patient, if there were a contraindicationto the use of contrast materials and a neoplasm weresuspected, which of the following would be the mostlikely choice of ancillary study to rule out neoplasm?(A) Magnetic resonance imaging(B) CT scan without contrast(C) Plain abdominal x-ray(D) Renal arteriography(E) Venography12 Which of the following is the precipitating mechanismof injury that leads to ARF after misguided useof a contrast medium in radiographic imaging?(A) Ischemia(B) Direct toxicity(C) Hypoxia(D) Autoimmunity(E) Dehydration13 A 55-year-old white man enters your practice with acomplaint of flank pains that have occurred on eitherside from time to time. He says that he was treated inanother city for hypertension over several years. Hesays he has had positive tests for blood in his urine inthe past but that no cause had ever been found. BUNlevel is elevated at 40 mg/dL (normal is 20 mg/dL)and creatinine is 1.8 mg/dL. A CBC is normal. Examinationof the abdomen reveals a mass deep in eachflank. Which of the following most likely accountsfor the clinical picture presented?(A) Carcinoma of the bladder(B) Renal cell carcinoma(C) Pancreatic cysts(D) Polycystic kidneys(E) Colorectal cancer14 A patient who is new to you is a 46-year-old whitewoman who complains of headaches over the past3 days and suspects it may be due to her BP. Her BP is230/120. Each of the following findings constitutes adiagnosis of malignant hypertension except for whichone?(A) Rising BUN and creatinine levels(B) Onset of dyspnea and orthopnea in the past 1 to3 days(C) A finding of papilledema(D) Systolic BP 220 mm Hg(E) Mental confusion15 A 45-year-old white man has type II diabetes andweighs 245 lb (111 kg) at a height of 5 ft 11 in. (1.8 m),despite your efforts to exhort him to lose weight overthe previous 2 years. However, for the past 3 months,he has complained of low-grade fever, abdominaldiscomfort, and lack of appetite. During this period,