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Pance Renal System - Final Test Review (Qns & Ans) - 2025Pance Renal System - Final Test Review (Qns & Ans) - 2025Pance Renal System - Final Test Review (Qns & Ans) - 2025Pance Renal System - Final Test Review (Qns & Ans) - 2025
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I. Acid–Base Disorders (Questions 1–6)
D) Glomerulonephritis ANS: A Rationale: FeNa < 1% indicates prerenal azotemia due to reduced renal perfusion.
BUN:Cr ratio 10:1. Most likely AKI type? A) Intrinsic (ATN) B) Prerenal C) Postrenal D) GN ANS: A Rationale: BUN:Cr ~10:1 suggests intrinsic renal damage, common in severe burns.
Rationale: ESA targets 10–11.5 g/dL to minimize cardiovascular risks. IV. Congenital/Structural Renal Disorders (Questions 19–23)
A) Fibromuscular dysplasia B) Atherosclerosis C) Polycystic kidney disease D) Nephroblastoma ANS: A Rationale: Young females with flank bruit and hypertension often have fibromuscular dysplasia.
A) Fluid restriction B) IV hypotonic fluids C) High‐dose saline bolus D) Thiazide diuretics ANS: A Rationale: Volume‐expanded hyponatremia in CHF is managed with fluid restriction and diuretics. VI. Fluid Imbalances (Questions 30–34)
Rationale: Parkland (4 mL/kg/%TBSA) guides burn fluid resuscitation.
Rationale: Dialysis‐associated cystic changes increase RCC risk.
Acid-Base Disorders A 60-year-old male with COPD presents with confusion and headache. ABG: pH 7.28, PaCO₂ 56 mmHg, HCO₃⁻ 25 mEq/L. What is the most likely acid-base disturbance? A) Metabolic alkalosis B) Respiratory acidosis C) Metabolic acidosis D) Respiratory alkalosis ANS: B Rationale: The pH is low (acidosis), PaCO₂ is high (respiratory), HCO₃⁻ is normal. This is respiratory acidosis. A diabetic patient with Kussmaul respirations has lab values: pH 7.10, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L. Which is the primary disorder? A) Respiratory acidosis B) Metabolic acidosis C) Metabolic alkalosis D) Respiratory alkalosis ANS: B Rationale: The low HCO₃⁻ and low pH suggest metabolic acidosis, with compensatory decrease in PaCO₂.
Which of the following is LEAST likely to cause a normal anion gap metabolic acidosis? A) Diarrhea B) Renal tubular acidosis C) Lactic acidosis D) Carbonic anhydrase inhibitor use ANS: C Rationale: Lactic acidosis causes an increased anion gap; the others cause normal anion gap (hyperchloremic) acidosis. A patient with vomiting for 3 days develops pH 7.50, HCO₃⁻ 36 mEq/L, PaCO₂ 46 mmHg. What is the most probable diagnosis? A) Metabolic alkalosis B) Metabolic acidosis C) Respiratory acidosis D) Respiratory alkalosis ANS: A Rationale: Increased pH and HCO₃⁻ indicates metabolic alkalosis; PaCO₂ is elevated as a compensatory response. Which compensatory change would be expected in a patient with chronic respiratory alkalosis? A) Increased renal generation of HCO₃⁻ B) Increased renal excretion of HCO₃⁻ C) Decreased respiratory rate D) Renal retention of hydrogen ions ANS: B Rationale: Kidney will excrete more bicarbonate (HCO₃⁻) to compensate for respiratory alkalosis. Acute Kidney Injury (AKI) / Acute Renal Failure A 70-year-old man with heart failure develops decreased urine output, BUN/creatinine ratio 35:1, and FENa <1%. What is the most likely cause of his AKI?
to 4.0 mg/dL after IV fluids. His urine is brown. What is the probable etiology? A) Acute glomerulonephritis B) Rhabdomyolysis-induced ATN C) Prerenal azotemia D) Acute interstitial nephritis ANS: B Rationale: Brown urine after exertion indicates myoglobinuria from rhabdomyolysis leading to ATN. Chronic Kidney Disease (CKD) / End-stage Renal Disease (ESRD) Which electrolyte abnormality is MOST characteristic of advanced CKD? A) Hypophosphatemia B) Hypercalcemia C) Hyperphosphatemia D) Hyperaldosteronism ANS: C Rationale: Reduced phosphate excretion in CKD leads to hyperphosphatemia. A CKD patient presents with normocytic anemia. What is the most likely cause? A) Iron deficiency B) Vitamin B12 deficiency C) Erythropoietin deficiency D) Hemolysis ANS: C Rationale: EPO is produced by the kidney; deficiency causes normocytic anemia. A 58-year-old diabetic has proteinuria and declining GFR. Renal biopsy shows Kimmelstiel-Wilson nodules. What is the diagnosis? A) FSGS B) Diabetic nephropathy C) Minimal change disease
D) Amyloidosis ANS: B Rationale: Kimmelstiel-Wilson nodules are pathognomonic for diabetic nephropathy. Which is a recommended dietary modification for a patient with ESRD on dialysis? A) Increased potassium intake B) Increased phosphorus intake C) Restricted protein intake D) Restricted sodium intake ANS: D Rationale: Sodium restriction is essential to manage fluid overload and hypertension. Which of the following is NOT an indication for initiation of renal replacement therapy in CKD? A) Uremic encephalopathy B) Severe hyperkalemia C) GFR <60 mL/min alone D) Volume overload unresponsive to diuretics ANS: C Rationale: Dialysis is indicated by symptoms or severe complications, not by GFR alone unless <15 mL/min. Congenital or Structural Renal Disorders A neonate with a palpable abdominal mass and hypertension is diagnosed with bilateral enlarged, cystic kidneys. What is the most likely diagnosis? A) Multicystic dysplastic kidney B) Autosomal recessive polycystic kidney disease C) Horseshoe kidney D) Renal agenesis ANS: B Rationale: Bilateral cystic kidneys and early presentation suggest ARPKD.
Rationale: COL4A5 mutations cause Alport syndrome (hearing, eyes, hematuria). Electrolyte Disorders Rapid correction of chronic hyponatremia is most likely to result in which complication? A) Hyperkalemia B) Pulmonary edema C) Central pontine myelinolysis D) Nephrogenic diabetes insipidus ANS: C Rationale: Rapid sodium correction can cause osmotic demyelination syndrome. A patient presents with muscle weakness, peaked T waves, and new ECG changes. What is the first-line acute management? A) Loop diuretic administration B) Intravenous calcium gluconate C) Kayexalate D) Beta-2 agonist inhalation ANS: B Rationale: IV calcium stabilizes cardiac membranes in acute hyperkalemia. Which of the following causes hypokalemia via increased renal potassium wasting? A) Addison's disease B) Liddle syndrome C) Primary hyperaldosteronism D) ACE inhibitor therapy ANS: C Rationale: Aldosterone increases renal K+ excretion.
Which laboratory finding is most consistent with SIADH? A) Decreased plasma ADH B) Plasma osmolality <275 mOsm/kg, urine osmolality >100 mOsm/kg C) Hyperkalemia D) Hypocalcemia ANS: B Rationale: SIADH has low plasma osmolality and inappropriately concentrated urine. Which electrolyte abnormality is common in tumor lysis syndrome? A) Hypophosphatemia B) Hyperkalemia C) Hypouricemia D) Hypocalcemia ANS: B Rationale: Rapid cell lysis releases intracellular potassium. Fluid Imbalances A patient with cirrhosis and ascites is most prone to which type of fluid imbalance? A) Hypervolemic hypotonic hyponatremia B) Hypovolemic hypernatremia C) Isovolemic hypernatremia D) Hypovolemic hyponatremia ANS: A Rationale: Cirrhotics retain water, increasing total body water (hypervolemia) and diluting sodium (hypotonic hyponatremia). What is the recommended rate of serum sodium correction in severe symptomatic hyponatremia? A) <4 mEq/L in 24 hours B) <8 mEq/L in 24 hours C) <10 mEq/L in 24 hours D) <20 mEq/L in 24 hours ANS: B