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1 | |
A 68-year-old female with stable coronary artery disease undergoes angiography of the right lower extremity for peripheral vascular disease. The patient is on warfarin for recurrent deep vein thrombosis, aspirin, lisinopril, metoprolol, and atorvastatin. Preangiography, she received a course of dicloxacillin for cellulitis 1 week ago. Three weeks after angiography the patient is evaluated for general malaise. Physical examination reveals a petechial rash and livedo reticularis on both lower extremities. Laboratory evaluation reveals that her creatinine has risen from 1.5 to 3.7 mg/dL. Other laboratory abnormalities include an ESR of 96 mm/h, leukocytosis, eosinophiluria, and a reduced third component of complement (C3). Urine sodium is 40 meq/L. Urinalysis reveals 1+ protein, 10 to 20 WBC/HPF, and 5 to 10 RBC/HPF with no casts. What is the most likely diagnosis? |
| | A) | Prerenal azotemia |
| | B) | Radiocontrast-induced acute renal failure |
| | C) | Drug-induced acute interstitial nephritis |
| | D) | Atheroembolic renal failure |
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2 | |
A 46-year-old male with HIV and severe penicillin allergy receiving zidovudine, indinavir, and stavudine presents with fever, nonproductive cough, and severe hypoxia. Chest x-ray reveals diffuse increased interstitial markings and a possible lobar consolidation in the left lower lobe. After appropriate evaluation, the patient receives levofloxacin, trimethoprim-sulfamethoxazole, and acyclovir. Initial serum creatinine is 1.6 mg/dL. On day 4, it has risen to 3.8 mg/dL and a normal serum potassium has risen to 7.1 mg/dL. Urinalysis reveals no casts, 10 to 20 WBC/HPF, and rare RBCs. Which drug is the most likely cause of renal failure? |
| | A) | Levofloxacin |
| | B) | Trimethoprim-sulfamethoxazole |
| | C) | Acyclovir |
| | D) | Indinavir |
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3 | |
A 43-year-old female presents with hypertension, edema, hyperlipidemia, and a deep venous thrombosis in her left leg. Which of the following is not necessary to diagnose the nephrotic syndrome? |
| | A) | Edema |
| | B) | Hypertension |
| | C) | 24-h urine albumin e3 g |
| | D) | Hyperlipidemia |
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4 | |
A patient with a serum sodium of 110 meq/L suffers grand mal seizures. CT scan of the head and lumbar puncture are normal. What is the immediate treatment of the hyponatremia? |
| | A) | Normal saline at 250 mL/h |
| | B) | 750 mL oral fluid restriction |
| | C) | 3% saline at 30 to 40 mL/h plus furosemide |
| | D) | Demeclocycline |
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5 | |
You are designing a dialysis unit with dietitians, nurses, and pharmacologists to provide the best possible care. Patients suffering from which of the following conditions will make up your largest population? |
| | A) | Chronic glomerulonephritis |
| | B) | Hypertension |
| | C) | Diabetes mellitus |
| | D) | Obstructive uropathy |
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6 | |
A 25-year-old female with diabetes mellitus presents with hypertension. The ideal target BP for pharmacologic control of hypertension is |
| | A) | <150/95 |
| | B) | <135/85 |
| | C) | <140/90 |
| | D) | <125/75 |
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7 | |
A diabetic male presents with hypertension and 24-h urine showing 200 mg of albumin. In a diabetic patient with microalbuminuria, the appropriate drug for treatment of hypertension to prevent progression of renal failure is |
| | A) | Beta blocker |
| | B) | Thiazide diuretic |
| | C) | Angiotensin converting enzyme inhibitor |
| | D) | Short-acting dihydropyridine calcium channel blocker for precise control (nifedipine) |
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8 | |
A 29-year-old male with HIV, on indinavir, zidovudine, and stavudine, presents with severe edema and a serum creatinine of 2.0 mg/dL. He has had bone pain for 5 years and takes large amounts of acetominophen with codeine, aspirin, and ibuprofen. He is on prophylactic trimethoprim sulfamethoxazole. Blood pressure is 170/110; urinalysis shows 4+ protein, 5 to 10 RBC, 0 WBC; 24-h urine protein is 6.2 g. What is the most likely cause of his renal disease? |
| | A) | Indinavir toxicity |
| | B) | Analgesic nephropathy |
| | C) | Trimethoprim sulfamethoxazole–induced interstitial nephritis |
| | D) | Focal sclerosis |
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