J**b
发帖数: 182 | 1 1. Sarah is recovering from pneumonia. She is 93 and a resident of a local
nursing home, where she was diagnosed with behavioral and cognitive
disturbances. She is refusing food, drink and medication. Her BUN is 60
and her serum Creatinine is 1.0 . Her potassium level is 4.8.
Which of the following is most likely to be true?
A. Her serum creatinine is “normal” because her kidneys have not
been injured
B. Her renal function will return to normal with adequate rehydration
C. prerenal azotemia precludes associated renal injury
D. prerenal and post-renal causes of ARF must be addressed before
diagnosing acute tubular necrosis
E. Membranous glomerulopathy is likely
2. A patient with renal failure is displaced by a flood, and can’t get to
hemodialysis. The family asks about peritoneal dialysis as a bridge and you
explain:
A. Peritoneal dialysis requires sterile conditions such as hospital,
ICU or level-III nursing home
B. Peritoneal dialysis has lower risk of infection, syncope, pain and
hypotension than hemodialysis
C. Peritoneal dialysis will have to be done more frequently than
hemodialysis
D. Hemodialysis can often be delayed a month without extreme risk to
patient
E. only Hemodialysis can be used to raise bicarbonate level
3. Regarding the “triple slide” test, which of the following is true?
A. The first slide represents prostatic secretions
B. The final slide represents urethral sample
C. The middle slide requires manipulation of prostate
D. The first slide is the best for excluding upper tract infection
E. all 3 slides must be cultured to exclude lower urinary tract infection
4. Regarding post-streptococcal glomerulonephritis, which of the following
is true?
A. emergent dialysis indicated
B. 25% of patients with condition progress to end-stage renal failure
C. diuretics and antihypertensives contraindicated
D. circulating anti streptococcal antibodies seldom detected
E. physical exam and urine sediment adequate for diagnosis
A genial 38yo patient in your practice has been slowly gaining weight, as
you note on annual physical. His BP is up to 148/94, BMI is 36, and he
admits to going up “a size or two” in waistline. He has no dramatic
findings on exam, and is sent for routine labs. His random glucose is 160 (
normal 80-120) and glycohemoglobin is 7.2 (normal <6 ).
5. Assuming no allergies or cost or insurance company limitations, what
antihypertensive agent is ideal for this gentleman?
A. Clonidine (Catapres) to avoid palpitations and sedation
B. Spironolactone (Aldactone) to reduce vasomotor tone
C. Enalapril (Vasotec) for renal benefit and prevention of microhematuria
D. Nitroprusside for immediate correction of malignant hypertension
E. Diltiazem (Cardizem) for relief of flushing and constipation
6. He returns 2 weeks later for recheck and reports that his lips swell
and his throat itches when he takes the medication, and he has developed a
nagging cough. At this point you identify the syndrome as
A. T-cell mediated type IV hypersensitivity reaction
B. IgM mediated anaphylactic reaction
C. drug-induced angioedema
D. type II cytotoxic hypersensitivity reaction
E. minor and self-limiting, safe to continue medication
7. The same guy from the last 2 questions is switched to another
medication and his oral symptoms resolve. A month or so later he asks to
see you because “the flu”. He has had fevers and body aches, his urine
has been very dark and he feels sluggish, bloated and weak. Urine shows “3
+ blood” on dip as well as “3+ protein”. He has low grade fever and
body aches, skin is rough to touch, warm and tender. Of the following tests
, the MOST immediate and helpful would be.
A. Serum protein electrophoresis
B renal biopsy with immunofluorescent glomerular staining
C. examination of urine sediment
D. serum BUN, creatinine, protein, anti glomerular-basement antibody
E. complete blood cell count and differential
8. evidence of collecting system stasis:
A. White blood cell casts
B. Red blood cell casts
C. Muddy brown casts
D. Positive blood on dipstick
E. Hyaline cast
Thanks a bunch in advance! | J**b
发帖数: 182 | 2 9. 26yo WM reports weakness, tingling sensation in left leg, stumbling and
falls, involuntary urinary activity and dizziness. On exam he has nystagmus
and hyperreflexia, slurred speech and lid lag. Symptoms developed over the
last 3 days, but he recalls similar symptoms intermittently in the past.
In what order would you proceed with this patient, clinically?
A. arrange for LP, neurology consult, and serum protein
electrophoresis
B. begin empiric steroid therapy, schedule brain MRI and refer to
neurologist
C. start anticonvulsant, pain medication, and refer to nephrologist
D. hospitalize and start interferon therapy, then high dose steroids,
then plasmapheresis
E. hospitalize for LP and neurology evaluation prior to initiating
steroid therapy and interferon | J**b
发帖数: 182 | 3 这是我试着选的答案，如果哪位兄弟姐妹同意我的一个答案，答谢一个包子，指正一个
错误，2个包子。
1. Sarah is recovering from pneumonia. She is 93 and a resident of a local
nursing home, where she was diagnosed with behavioral and cognitive
disturbances. She is refusing food, drink and medication. Her BUN is 60
and her serum Creatinine is 1.0 . Her potassium level is 4.8.
Which of the following is most likely to be true?
A. Her serum creatinine is “normal” because her kidneys have not
been injured
B. Her renal function will return to normal with adequate rehydration
C. prerenal azotemia precludes associated renal injury
D. prerenal and post-renal causes of ARF must be addressed before
diagnosing acute tubular necrosis
E. Membranous glomerulopathy is likely
Answer: D | J**b
发帖数: 182 | 4 2. A patient with renal failure is displaced by a flood, and can’t get to
hemodialysis. The family asks about peritoneal dialysis as a bridge and you
explain:
A. Peritoneal dialysis requires sterile conditions such as hospital,
ICU or level-III nursing home
B. Peritoneal dialysis has lower risk of infection, syncope, pain and
hypotension than hemodialysis
C. Peritoneal dialysis will have to be done more frequently than
hemodialysis
D. Hemodialysis can often be delayed a month without extreme risk to
patient
E. only Hemodialysis can be used to raise bicarbonate level
Answer: C | J**b
发帖数: 182 | 5 3. Regarding the “triple slide” test, which of the following is true?
A. The first slide represents prostatic secretions
B. The final slide represents urethral sample
C. The middle slide requires manipulation of prostate
D. The first slide is the best for excluding upper tract infection
E. all 3 slides must be cultured to exclude lower urinary tract infection
Answer: C | J**b
发帖数: 182 | | J**b
发帖数: 182 | 7 10.A 40yo WM patient presents with severe pain to his back that started
earlier today. He is pacing restlessly in the exam room, clutching his flank
and groaning. Urinalysis shows red blood cells and crystals. He reports
that his pain has moved, over the last few hours, and now involves his
abdomen on the right side.
His pulse and his blood pressure are elevated and he has a low grade fever.
Before you jump to conclusions, you should eliminate other serious
conditions as followings:
A. Check a WBC count as a normal WBC count excludes appendicitis
B. Palpate the abdomen below the umbilicus and check pulses in wrists to
exclude aortic dissection
C. Send urine culture to exclude secondary infection
D. Withhold pain medication because patient is drug-seeking
E. Begin aggressive hydration to “flush out” the (presumed) stone and
prevent ATN
I am not sure is A or C. | J**b
发帖数: 182 | 8 11. characteristic of myoglobinuria:
A. White blood cell casts
B. Red blood cell casts
C. Muddy brown casts
D. Positive blood on dipstick
E. Hyaline cast
C or D? | J*********4
发帖数: 1274 | 9 11. characteristic of myoglobinuria:
A. White blood cell casts
B. Red blood cell casts
C. Muddy brown casts
D. Positive blood on dipstick
E. Hyaline cast
C or D?
======
D: dipstick can not differentiate myoglobin or hemoglobin, both of which
have heme.
C is not right because myoglobinuria does not necessarily, even though it
might, causes renal tubule necrosis | J*********4
发帖数: 1274 | 10 9. 26yo WM reports weakness, tingling sensation in left leg, stumbling and
falls, involuntary urinary activity and dizziness. On exam he has nystagmus
and hyperreflexia, slurred speech and lid lag. Symptoms developed over the
last 3 days, but he recalls similar symptoms intermittently in the past.
In what order would you proceed with this patient, clinically?
A. arrange for LP, neurology consult, and serum protein
electrophoresis
B. begin empiric steroid therapy, schedule brain MRI and refer to
neurologist
C. start anticonvulsant, pain medication, and refer to nephrologist
D. hospitalize and start interferon therapy, then high dose steroids,
then plasmapheresis
E. hospitalize for LP and neurology evaluation prior to initiating
steroid therapy and interferon
============
B. Diagnosis: multiple sclerosis
Acute exacerbation: steroid treatment, after acute phase use inteferon beta,
glatiramer..
Diagnosis, MRI for initial and is also the most accurate test. | J*********4
发帖数: 1274 | 11 10. C is better than A. Because C will give a definitive answer to whether
there is infection in the urinary tract or not. | J*********4
发帖数: 1274 | 12 一家之言, just for discussion
1. C, 2. C, 3.don't know 4. E, 5.C, 6.C, 7.B, 8.E
1. The old lady has dehydration, which causes pre-renal azotemia and
eventrually leads to renal tubule necrosis. The low creatinine is due to the
lack of muscle mass in old people, which underestimates the actual renal
insufficiency.
8. RBC cast indicates damage in GBM. Here is a paragraph from wiki
Hyaline casts
The most common type of cast, hyaline casts are solidified Tamm-Horsfall
mucoprotein secreted from the tubular epithelial cells of individual
nephrons. Low urine flow, concentrated urine, or an acidic environment can
contribute to the formation of hyaline casts, and, as such, they may be seen
in normal individuals in dehydration or vigorous exercise.
http://en.wikipedia.org/wiki/Urinary_cast#Hyaline_casts | J**b
发帖数: 182 | 13 多谢Jenny的详细答复，已转伪币答谢！
JJxb，您好：
您转给 JennyGao424,现金(伪币):150,收取手续费:1.5
同时附加了如下留言给 JennyGao424.
Thanks so much! | J*********4
发帖数: 1274 | |
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