may help2

[Anonymous]

Pharmacology 1-50
Nephrology 1-50

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1. The effects of which one of the following neuromuscular blocking drugs cannot be reversed by neostigmine (Prostigmin)?


A. Succinylcholine (Anectine)
B. Atracurium (Tracrium)
C. Vecuronium (Norcuron)
D. Rocuronium (Zemuron)


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2. Upon rapid intravenous administration of a standard single dose of phenylephrine (Neo-Synephrine), the blood pressure increases and the heart rate decreases. After intravenous administration of DRUG X, a subsequent dose of phenylephrine does not decrease heart rate, but the increase in blood pressure is unchanged. Which one of the following drugs could be DRUG X?


A. Atropine
B. Glycopyrrolate (Robinul)
C. Mecamylamine (Inversine)
D. All of the above


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3. All of the following statements concerning neuromuscular blocking drugs are true EXCEPT:


A. The duration of action of atracurium (Tracrium) is not prolonged in patients with renal insufficiency.
B. Rocuronium (Zemuron) lacks cardiovascular effects.
C. Succinylcholine (Anectine) can produce post-operative muscle soreness.
D. Vecuronium (Norcuron) produces surgical anesthesia.


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4. All of the following statements concerning the antihistamines are true EXCEPT:


A. The antihistamines represent a chemically diverse group of drugs that can competitively antagonize the interaction between histamine and the 5-HT1 receptors.
B. The toxicity of the "new" generation of antihistamines is not as well defined as that of the "old" antihistamines.
C. The "new" antihistamines are generally devoid of sedative effects.
D. Drug allergy to antihistamines does not occur.


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5. All of the following statements concerning the antihistamines are true EXCEPT:


A. The "old" antihistamines are common ingredients of OTC preparations.
B. The "new" generation of antihistamines is no more effective than the "old" antihistamines in the treatment of allergic reactions.
C. The antihistamines are nontoxic in overdoses.
D. The "old" antihistamines demonstrate significant antimuscarinic activity.


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6. All of the following statements concerning histamine are true EXCEPT:


A. Histamine and other autacoids can cause contraction of bronchiolar smooth muscle and relaxation of vascular smooth muscle.
B. Histamine is stored in vascular epithelial cells.
C. Asthmatic patients are especially sensitive to endogenously released histamine.
D. Histamine is a potent stimulator of gastric acid secretion.


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7. Antihistamines (H1-receptor antagonists) are active ingredients in all of the following over-the-counter (OTC) drugs EXCEPT:


A. Sleep and antianxiety aids
B. Anti-asthmatic preparations
C. Allergy remedies
D. Anti-motion sickness drugs


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8. Sympathomimetic drugs are active ingredients in all of the following OTC drug preparations EXCEPT:


A. Eye drops
B. Appetite suppressants
C. Anti-asthmatic preparations
D. Topical poison ivy treatments


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9. All of the following statements regarding the roles of the Food and Drug Administration (FDA) in regulating OTC drugs are true EXCEPT:


A. It is responsible for regulating advertising.
B. It periodically reviews the safety and efficacy of drugs contained in OTC preparations.
C. It periodically reviews the claims for therapeutic indications of OTC preparations.
D. The FDA reviews of OTC preparations have led to the disappearance of many unsafe or ineffective drugs from the OTC market.


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10. Epinephrine is the preferred treatment for anaphylactic shock because of its actions on all of the following receptors EXCEPT:


A. Beta-2
B. D-1
C. Beta-1
D. Alpha-1


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11. Which of the following sympathomimetics is appropriate for treatment of an acute attack of asthma?


A. Dobutamine (Dobutrex)
B. Clonidine (Catapres)
C. Phenylephrine (Neo-Synephrine)
D. Albuterol (Proventil)


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12. A 68-year old hospitalized patient presents to you with severe congestive heart failure with significant hypotension. You prescribe dopamine (Intropin) over dobutamine (Dobutrex) because:


A. Dopamine, but not dobutamine, increases cardiac output.
B. Dopamine, but not dobutamine, decreases renal blood flow.
C. Dopamine, but not dobutamine, increases total peripheral resistance.
D. Dopamine, but not dobutamine, activates ß1 receptors.


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13. Administration of which of the following drugs will change the effects of ephedrine on blood pressure from a pressor effect (increase) to a depressor effect (decrease).


A. Methoxamine (Vasoxyl)
B. Guanethedine (Ismelin)
C. Prazosin (Minipress)
D. Tyramine


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14. Carvedilol (Coreg) and metoprolol (Lopressor) are useful in the treatment of congestive heart failure, in part, because they:


A. Increase cardiac contractility
B. Decrease cardiac workload
C. Cause bronchodilation, relieving pulmonary edema
D. Increase total peripheral resistance


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15. Sympathomimetic drugs can be used for all of the following purposes EXCEPT:


A. Decreasing urinary retention
B. Stimulating cardiac output
C. Stopping premature labor
D. Treating nasal congestion


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16. All of the following statements about prazosin (Minipress) are true EXCEPT:


A. Administration usually increases heart rate only modestly.
B. It is used in the treatment of primary systemic hypertension.
C. Postural hypotension and syncope may be experienced with the first dose.
D. It blocks alpha and beta receptors.


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17. Timolol (Blocadren; Timoptic) is useful in the treatment of all of the following conditions EXCEPT:


A. Benign prostatic hypertrophy
B. Glaucoma
C. Myocardial infarction
D. Hypertension


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18. All of the following statements regarding ß-receptor antagonists are true EXCEPT:


A. Nadolol (Corgard) is a long-acting ß-receptor antagonist.
B. Labetolol (Trandate) is a combined a-ß receptor antagonist.
C. Betaxolol (Betoptic) is the only ß1 selective antagonist approved for treating glaucoma.
D. Propranolol (Inderal) is a selective ß1 receptor antagonist.


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19. Atropine poisoning is characterized by all of the following symptoms EXCEPT:


A. Delirium
B. Flushed skin
C. Bronchospasm
D. Dry skin and mouth.


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20. An intravenous injection of norepinephrine produces large increases in blood pressure and heart rate. After Drug Y, injection of norepinephrine produces a large decrease in blood pressure and a large increase in heart rate. Drug Y could be:


A. Metoprolol (Lopressor)
B. Phentolamine (Regitine)
C. Mecamylamine (Inversine)
D. Labetolol (Trandate)


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21. Pilocarpine, applied topically to both eyes of a rabbit, produces pronounced miosis. Drug Z, then applied to one of the eyes reverses the miosis and produces mydriasis. Drug Z could be:


A. Timolol (Timoptic)
B. Carbachol
C. Tropicamide (Mydriacil)
D. Brimonidine (Alphagan)


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22. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. The increase in skeletal-muscle strength in a myasthenia gravis patient following oral administration of therapeutic doses of both pyridostigmine (Mestinon) and atropine.
B. The increase in skeletal-muscle strength in a myasthenia gravis patient following oral administration of therapeutic doses of pyridostigmine alone.
C. A and B are equal or nearly equal.


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23. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Pupil diameter one week after a single topical application of tropicamide (Mydriacil) to the eye.
B. Pupil diameter one week after a single topical application of atropine to the eye.
C. A and B are equal or nearly equal.


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24. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Incidence of dry skin during treatment with prazosin (Minipres).
B. Incidence of dry skin during treatment with glycopyrrolate (Robinul).
C. A and B are equal or nearly equal.


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25. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Role of the sympathetic nervous system in the control of blood pressure.
B. Role of the parasympathetic nervous system in the control of blood pressure.
C. A and B are equal or nearly equal.


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26. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Duration of the decrease in intraocular pressure caused by a single topical application of pilocarpine to the eye.
B. Duration of the decrease in intraocular pressure caused by a single topical application of ecothiophate (Phospholine) to the eye.
C. A and B are equal or nearly equal.


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27. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Clinical value of physostigmine (Mestinon) in the treatment of a toxic psychosis produced by atropine.
B. Clinical value of edrophonium (Tensilon) in the treatment of a toxic psychosis produced by atropine.
C. A and B are equal or nearly equal.


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28. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Incidence of sedation caused by scopolamine.
B. Incidence of sedation caused by glycopyrrolate. (Robinul)
C. A and B are equal or nearly equal.


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29. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Role of the enzyme, catechol-O-methyltransferase, in terminating the neurotransmitter action of norepinephrine.
B. Role of active reuptake into sympathetic nerve terminals in terminating the neurotransmitter action of norepinephrine.
C. A and B are equal or nearly equal.


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30. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Pupil diameter thirty minutes after topical administration of both tropicamide (Mydriacil) and phenylephrine (Neo-Synephrine) to the eye.
B. Pupil diameter thirty minutes after topical administration of tropicamide (Mydriacil) alone to the eye.
C. A and B are equal or nearly equal.


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31. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Clinical efficacy of ipratropium (Atrovent) and terbutaline (Brethine) for the relief of bronchospasms associated with chronic obstructive pulmonary disease.
B. Clinical efficacy of ipratropium (Atrovent) alone for the relief of bronchospasms associated with chronic obstructive pulmonary disease.
C. A and B are equal or nearly equal.


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32. Quantitative Comparisons - Select "A" if A is greater than B; select "B" if B is greater than A.


A. Clinical efficacy of atropine for the prevention of motion sickness.
B. Clinical efficacy of scopolamine for the prevention of motion sickness.
C. A and B are equal or nearly equal.


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33. Preferred for obstetrical use.


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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34. Can produce hypersensitivity reactions.


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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35. Can produce blockade of motor axons to skeletal muscle.


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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36. Considered the prototype of the amide class.


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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37. High systemic concentrations can produce convulsions.


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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38. Possesses vasoconstrictor properties


A. Bupivacaine (Marcaine)
B. Lidocaine (Xylocaine)
C. Procaine (Novocain)
D. Cocaine
E. All of the above


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39. Administered orally once a day by drug abuse clinics to prevent withdrawal symptoms in opioid-dependent patients.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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40. Frequently used for general anesthesia.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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41. Low efficacy analgesic usually administered orally in combination with aspirin or acetaminophen.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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42. Highly effective OTC antidiarrheal drug.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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43. Produces analgesia by stimulating the release of enkephalins and endorphins.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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44. Available in a transdermal patch.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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45. Long-acting, orally effective analgesic with high maximum efficacy.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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46. Does not produce analgesia.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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47. Naturally occurring opioid alkaloid.


A. Codeine
B. Methadone (Dolophine)
C. Loperamide (Imodium)
D. Fentanyl (Innovar)
E. None of the above


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48. It is an antihistamine effective for preventing motion sickness.


A. Promethazine (Phenergan)
B. Ondansetron (Zofran)
C. Prochlorperizine (Compazine)
D. Scopolamine
E. None of the above


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49. It is supplied as a transdermal patch for preventing motion sickness for about 72 hours.


A. Promethazine (Phenergan)
B. Ondansetron (Zofran)
C. Prochlorperizine (Compazine)
D. Scopolamine
E. None of the above


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50. It is a 5-HT3 antagonist that is highly effective in preventing nausea and vomiting induced by cancer chemotherapy.


A. Promethazine (Phenergan)
B. Ondansetron (Zofran)
C. Prochlorperizine (Compazine)
D. Scopolamine
E. None of the above


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Pharmac ends !!



Nephrology ! <50 qns>

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1. Which of the following is/are true relative to the definition, diagnosis and prevalence of hypertension.

A BP cuff that is too small (i.e., encircles less than 80% of the upper arm) gives an erroneously low BP reading.
The upper normal BP value for a seven-year-old is 135/85.
African Americans experience a higher prevalence of hypertension than Caucasians, but appear to suffer less severe end-organ damage.
The prevalence of hypertension rises with age.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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2. Which of the following is/are true relative to the causes of high blood pressure:

Renal parenchymal disease is the single most common cause of persistent hypertension in the pre-adolescent population.
Environmental factors thought to raise BP include obesity, diabetes, high salt intake, physical inactivity and immoderate alcohol consumption.
Renal artery stenosis, renal parenchymal disease, endocrine disorders, pregnancy, and drugs, account for the majority of secondary hypertension.
A cause for hypertension can be identified in close to 95% of hypertensive adults, if diligently searched for.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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3. The work-up of a patient who is referred to you with established hypertension should include:

A thorough drug history.
Physical examination to include assessment of the skin.
Urinalysis, serum electrolytes and creatinine.
Assessment of left ventricular heart mass.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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4. The following is/are true regarding the treatment of essential hypertension:

The elderly usually require and tolerate larger doses of diuretics and beta blockers than younger adults.
Beta blockers should generally be avoided in those with reactive airway disease (asthma).
Beta blockers and angiotensin-converting enzyme (ACE) inhibitors should be avoided following myocardial infarction.
The slow reduction of medication (step-down therapy) can be attempted in those with essential hypertension who have been under good control for one year.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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5. Which statements are true regarding the increase in glomerular filtration rate (GFR) that occurs after birth?

Increased renal blood flow contributes to increased GFR in the neonate.
GFR increases immediately after birth, regardless of gestational age.
Redistribution of blood flow to the outer renal cortex increases GFR.
Renal vascular resistance increases while systemic vascular resistance falls after birth.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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6. Tubular reabsorption of _______________ increases with maturation.

Sodium
Bicarbonate
Potassium
Phosphate


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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7. A three month old infant born at full term weights 5 kg and has a length of 50 cm. The serum creatinine is 1.0. Which statements are true?

This infant has normal renal function.
Glomerulogenesis is complete.
Tubular maturation is complete.
This infant's glomerular filtration rate is approximately 22 mL/1.73 m2/min.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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8. The following statements about congenital nephrotic syndrome of the Finnish type are true.

It is caused by a mutation in the nephrin gene on chromosome 19.
Maternal alpha feto protein is increased in the second trimester.
Steroid therapy is useless.
Proteinuria is present prior to age three months.


A. Only choices 1, 2, and 3 are correct
B. Only choices 1 and 3 are correct
C. Only choices 2 and 4 are correct
D. Only 4 is correct
E. All choices are correct


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9. Factors contributing to renal vein thrombosis include all of the following EXCEPT:


A. Hemoconcentration
B. Increased antithrombin Ill levels
C. Increased platelet activation
D. High molecular weight fibrinogen


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10. Findings in atheroembolic renal disease include:


A. Renal failure
B. Eosinophilia
C. Hypocomplementemia
D. Livedo reticularis
E. All of the above


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11. The most likely diagnosis in a patient presenting with signs and symptoms of small vessel vasculitis, antineutrophil cytoplasmic antibodies (ANCA) in the blood and no evidence of asthma, eosinophilia or necrotizing granulomas is which of the following:


A. Henoch-Schonlein purpura
B. Cryoglobulinemic vasculitis
C. Microscopic polyangiitis
D. Necrotizing granulomatosis (Wegener's)
E. Churg-Strauss syndrome


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12. A 45-year-old physician has a long history of recurrent kidney stones. Because of his busy schedule as Chief of Medicine he has undergone 11 extracorporeal shock wave lithotripsy (ESWL) treatments to "get rid of the stones". He states that he can handle his stone problem quite well in this manner and that he has seen no reason to have a metabolic work-up. He noticed in recent months, however, that he has to urinate quite often, especially at night, that he has exertional dyspnea and that he is more fatigued than usual. All of the following statements apply to his situation, EXCEPT:


A. ESWL reduces stone activity.
B. ESWL can increase stone activity.
C. Repeated ESWL can cause hypertension and 2o heart failure
D. Repeated ESWL can cause renal insufficiency.
E. Despite a good response to ESWL, a metabolic evaluation is essential.


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13. Which therapeutic measures correlate best with the prevention of Calcium oxalate stones in patients with idiopathic hypercalciuria?


A. Extracorporeal Shock Wave Lithotripsy.
B. sustained alkalinization of the urine with bicarbonate.
C. a high sodium diet.
D. high dose vitamin C.
E. low sodium and normal protein intake, a high urine volume, thiazide diuretic.


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14. Which one of the following factors contribute to edema formation in congestive heart failure?


A. Effective arterial blood volume is increased due to renal salt and water retention.
B. Decreased effective arterial blood volume leads to increased aldosterone, ADH, and sympathetic nerve activity.
C. Total peripheral resistance is decreased due to splanchnic vasodilatation.
D. Decreased actual blood volume leads to activation of baroreceptors.
E. The renin-angiotensin system is suppressed.


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15. Which one of the following does not drive potassium into cells?


A. Insulin
B. Increased extracellular pH
C. Epinephrine
D. Increased extracellular sodium concentration
E. Aldosterone


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16. The clinical manifestations of hyperkalemia include all of the following except:


A. Predisposes to digitalis toxicity
B. Predisposes to ventricular fibrillation
C. EKG shows flattened P wave, peaked T wave, and widened QRS complex
D. Weakness
E. Predisposes to cardiac arrest


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17. Which one of the following statements is false?


A. The main cause of hypokalemia associated with vomiting is not loss of K+ in the vomitus.
B. Diuretics are one of the most common causes of hypokalemia.
C. Renal failure is a common cause of hyperkalemia.
D. Hyperkalemia in diabetes mellitus is at least partially due to inadequate aldosterone formation.
E. Copious watery diarrhea is frequently associated with hyperkalemia.


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18. An elderly woman develops a urinary tract infection, becomes confused, and does not eat or drink for three days at her nursing home. She is found to have a blood pressure of 70/50 mmHg (very low). Which one of the following intravenous fluids would you recommend?


A. One-half normal saline
B. Normal saline
C. 5% dextrose and water
D. Hypertonic saline
E. One-quarter normal saline


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19. Which one of the following statements about hypo- or hypernatremia is true?


A. A patient with frank symptoms of hypo- or hypernatremia should have his/her serum sodium concentrations rapidly (few hours) corrected back to normal levels.
B. The brain fully compensates for hypenatremia within 2-4 hours by making "idiogenic osmoles".
C. The symptoms of hyper- and hyponatremia are mainly due to central nervous system dysfunction.
D. Hyponatremia due to SIADH is most often due to underlying kidney or liver disease.
E. "Pseudohyponatremia" is as dangerous as true hyponatremia.


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20. Which of the following is NOT commonly found in chronic urinary obstruction?


A. Nocturia
B. No symptoms
C. Renal failure
D. Microhematuria with dysmorphic red cells
E. Polyuria


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21. A 23-year-old sexually active woman presents with urinary frequency and burning on micturition of 24 hours duration. Her urinalysis shows: Yellow, hazy urine. pH 6. No glucose. Protein trace, blood trace. 20-50 WBC/HPF, 10-20 RBC/HPF. 0-1 squamous epithelial cells and no bacteria. You prescribe trimethoprim/sulfamethoxazole tablets twice a day. The next day she feels much better but her urine culture report reads:"Staphylococcus saprophyticus 100,000 cfu/ml." Which of the following statements is true?


A. She has a bacterial UTI.
B. The urine sample was contaminated and the results from it are unreliable.
C. The hematuria likely signifies the presence of a stone or tumor.
D. The Staphylococcus saprophyticus is likely a skin contaminant.
E. The urinalysis is a laboratory error.


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22. A 58-year-old woman presents with hematuria and left flank pain. Renal ultrasound shows marked left hydronephrosis. Serum creatinine and CBC are normal. Which of the following is the most relevant diagnostic aid?


A. Renal biopsy
B. Renal arteriogram
C. Palpation for inguinal lymph nodes
D. Antinuclear antibody test
E. Pelvic examination and IVP


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23. A 26 year-old diabetic woman is seen in the ER for sore throat. Rapid strep test is positive for streptococcal pharyngitis and she was started on ampicillin 500 mg four times a day. Three days later, she develops hematuria associated with a low grade fever. On physical examination, she has a maculopapular rash and a temperature of 101oF. Laboratory studies show: serum creatinine 3.6 mg/dl, WBC 8,700 with 56% PMN, 25% lymphs, 3% monos and 15% eosinophils. Urinalysis: pH 6.2, protein 2+, blood 3+, 65 RBCs/HPF, 20-30 WBCs/HPF, 3-4 WBC casts/HPF. Hansel's stain is positive for eosinophils. The most likely diagnosis would be:


A. Diabetic nephropathy
B. IgA nephropathy
C. Acute interstitial nephritis
D. Acute pyelonephritis
E. Acute post-streptococcal glomerulonephritis


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24. Analgesic nephropathy can be associated with all of the following except:


A. Small kidney size by renal ultrasound
B. Nephritic sediment with RBC casts
C. Increased risk of transitional cell carcinoma
D. Tubulointerstitial fibrosis on renal biopsy
E. Urinary tract obstruction due to papillary necrosis on IVP


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25. Autosomal dominant polycystic kidney disease is associated with all of the following except:


A. Hypertension is very common
B. Ultrasound is very useful in establishing the diagnosis
C. Renal failure progresses slowly
D. The majority of the patients (>80%) have cerebral aneurysms
E. Lipid soluble antibiotics should be used when the cysts become infected


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26. A 10-month-old boy presents with status epilepticus. His intoxicated mother was unable to provide a history. The child quit seizing after being treated with diazepam. Exam revealed an obtunded child with tachypnea. Screening labs showed Na 140 mEq/L, K 5.5 mEq/L, total CO2 6 mEq/L, Cl 104 mEq/L, BUN 15 mg/dl, creatinine 0.6 mg/dl, glucose 40 mg/dl, Ca 9.5 mg/dl, Mg 1.4 mg/dl, PO4 5 mg/dl, serum osmolality 350 mosm/L. The arterial blood gas showed a pH of 7.0, PCO2 25 mmHg. The patient has a:


A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis


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27. The anion gap in the infant above is:


A. 25
B. 30
C. 36
D. None of the above


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28. What is his possible diagnosis:


A. Septic shock with lactic acidosis
B. Intoxication with methanol
C. Diabetic ketoacidosis
D. Bartter's syndrome


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29. An infant presents to a pediatrician for recurrent vomiting and failure to thrive. The child has been hospitalized by another primary care physician for recurrent dehydration. However, data are not available. Weight and length are below the fifth percentile. Exam shows a normal blood pressure with signs of mild dehydration. Reflexes are markedly increased. The child is hypotonic. Chemistry panel showed Na 140 mEq/L, K 2.2 mEq/L, CO2 50 mEq/L, Cl 78 mEq/L, BUN 20 mg/dl, creatinine 1.0 mg/dI, Ca 9.5 mg/dl, Mg 1.7 mg/dl, PO4 2.8 mg/dl. Arterial blood gas showed pH 7.54, pCO2 60 mmHg, urine chloride was 40 mEq/L and urinary calcium excretion was elevated. What is the nature of the acid-base disorder?


A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis


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30. The most likely diagnosis in this infant is:


A. Gitleman's syndrome
B. Bartter's syndrome
C. Renal tubular acidosis
D. Contraction alkalosis


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31. Which one of the following is clearly associated with autosomal recessive polycystic kidney disease?


A. Very large cysts throughout the kidney parenchyma, including cortex and medulla
B. Cerebral aneurysms
C. Gastrointestinal diverticulum
D. Congenital hepatic fibrosis


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32. Which one of the following is true regarding urinary tract infections (UTI) in children?


A. UTI are equally common in boys and girls.
B. UTI are more common in boys during the neonatal period .
C. UTI are always more common in girls throughout childhood.
D. UTI are almost never associated with vesicoureteral reflux in children.


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33. Hemolytic uremic syndrome in children


A. Is usually non-diarrheal.
B. Is most often associated with colitis from enterohemorrhagic E. coli.
C. Is always benign.
D. Is best treated with plasma infusions.


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34. Which one of the following regarding glomerular filtration rate (GFR) is true:


A. Creatinine clearance is seldom used as a marker of GFR in clinical medicine because it consistently under- estimates true GFR.
B. Two patients with identical serum creatinine concentration always have the same GFR.
C. In advanced renal failure (GFR <15 ml/min), 24-hour urea clearance is useful in conjunction with 24-hour creatinine clearance to estimate GFR.
D. For a given individual, an increase of serum creatinine from 8.0 mg/dl to 10.0 mg/dl represents a loss of greater number of nephrons than an increase of serum creatinine from 1.0 mg/dl to 2.0 mg/dl.
E. Muscle mass is the predominant determinant of creatinine clearance.


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35. A low blood urea nitrogen to serum creatinine ratio (<10:1) is seen in one of the following conditions:


A. administration of corticosteroids for arthritis
B. catabolic state during trauma
C. advanced liver failure
D. high protein diet
E. volume depletion from gastrointestinal bleeding


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36. Which of the following is most likely to be associated with high urinary sodium concentration (>40 mEq/L):


A. low salt intake in a normal subject
B. severe congestive heart failure
C. diarrhea in an otherwise normal adult
D. acute tubular necrosis


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37. In a patient with oliguria, which ONE of the following favors the diagnosis of acute tubular necrosis rather than pre-renal azotemia:


A. ratio of urine osmolality to plasma osmolality = 2.0
B. ratio of urine creatinine concentration to plasma creatinine concentration > 50
C. fractional excretion of sodium (FENa) > 2%
D. urinary sodium concentration <5 mEq/L


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38. A patient reports that he has noticed a decrease in urine output for five days. His BUN is 100 mg/dl and his serum creatinine is 7 mg/dl. Which of the following is LEAST useful in establishing the etiology of his renal failure:


A. urine sodium concentration
B. ultrasound of the kidneys
C. intravenous pyelogram
D. urinalysis
E. history and physical


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39. Which of the following is NOT an indication for urgent dialysis for a patient with renal failure:


A. asterixis and drowsiness
B. pulmonary edema resistant to diuretics
C. pericarditis
D. serum creatinine of 12 mg/dL
E. serum potassium of 9.0 mEq/L


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40. In the management of patients with chronic glomerulonephritis and chronic renal failure with a serum creatinine of 2.0 mg/dl, which of the following is true:


A. Angiotensin converting enzyme inhibitors are contraindicated because they are toxic to the kidneys in renal failure.
B. Dosage of medications often require adjustment.
C. Nonsteroidal anti-inflammatory agents (arthritis medications) can be used liberally because the chronically diseased kidneys are resistant to the toxic effects of these agents.
D. Superimposed urinary tract obstruction is of no consequence because the underlying kidney disease is glomerular in origin.
E. Severe sodium restriction is always necessary because the chronically ill kidneys cannot excrete sodium.


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41. The most common cause of end stage renal disease in the U.S.A. is:


A. hereditary nephritis
B. sickle cell nephropathy
C. post-infectious glomerulonephritis
D. renal cell carcinoma
E. diabetic nephropathy


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42. Which of the following is most commonly encountered in a patient with chronic renal failure and bone biopsy showing osteitis fibrosa cystica:


A. increased serum alkaline phosphatase level
B. markedly decreased serum phosphorus concentration
C. increased serum 1 ,25(OH)2D3 level
D. low parathormone level
E. increased serum calcium concentration


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43. Which of the following is the most common complication of advanced untreated renal failure:


A. erythrocytosis
B. platelet dysfunction favoring bleeding
C. increased peripheral nerve conduction
D. gastrointestinal tumors
E. hypotriglyceridemia


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44. In the evaluation of proteinuria, which of the following is false:


A. Proteinuria as detected by the dipstick methods is quite insensitive, and may miss albuminuria in early diabetic nephropathy.
B. The dipstick method may not detect Bence-Jones proteins in the urine.
C. A random urine sample for protein:creatinine ratio often suffices in following proteinuria in a patient under treatment, as long as there is no substantial change in muscle mass.
D. Similar to sodium, protein excretion in the urine is a good reflection of dietary protein intake.


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45. Based on the following data (BUN = 40 mg/dl, 24 urine volume = 2 liters, serum creatinine = 2 mg/dL, urine creatinine = 40 mg/dL, serum sodium = 150 mEq/dL, urine sodium = 15 mEq/L) the fractional excretion of sodium (FENa) can be calculated to be:


A. 0.2%
B. 0.5%
C. 5%
D. 20%
E. 50%


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46. Which one of the following statements is correct:


A. Diabetic nephropathy and proteinuria rarely develop after 10 years duration of diabetes.
B. Patients with type I diabetes and diabetic nephropathy do not have higher risk of death than those without diabetic nephropathy.
C. All patients with diabetic nephropathy have type I DM (diabetes mellitus).
D. Diabetes mellitus is the leading cause of ESRD in the U.S.A.
E. If a patient survives 40 years of DM without developing nephropathy, he or she is at extremely high risk of doing so in the future.


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47. Which one of the following statements is not correct?


A. Hyperglycemia leads to the accumulation of advanced glycosylation end products (AGE's) in tissues in patients with DM.
B. AGE's accumulation in tissues parallels the severity of renal disease.
C. Decreasing intraglomerular pressure preserves the structure and function of the glomerulus in diabetic patients.
D. AGE's are responsible for end organ damage seen in diabetes.
E. Hypertension does not add any significant risk for developing renal disease in diabetic patients.


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48. Which one of the following is correct:


A. Advanced diabetic nephropathy means development of microalbuminuria.
B. Normal urine albumin excretion in normal people varies between 400-500 mg/24 hr.
C. Microalbuminuria in diabetic patients predicts the development of frank proteinuria and ESRD.
D. Microalbuminuria in diabetic nephropathy patients doesn't become manifest until serum creatinine is higher than 2.0 mg/dL.
E. Once frank proteinuria is established, almost all patients reach ESRD within one year.


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49. Which one of the following is not correct:


A. All patients with type I diabetes of greater than 5 years duration should have an annual screen for microalbuminuria to identify this high risk population.
B. 90-95% of patients with diabetic nephropathy have diabetic retinopathy.
C. The absence of retinopathy should make one suspect a cause of proteinuria other than diabetic nephropathy.
D. Frank proteinuria after only 5 years duration of type I DM is unlikely to be secondary to diabetic nephropathy.
E. If the urinary albumin excretion rate is greater than 30 mg/24 hr in a single urine collection, this microalbuminuria does not need to be confirmed with additional collections since other causes of microalbuminuria (e.g., hypertension, CHF) are rare in di


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50. Regarding the management of diabetes mellitus, all of the following are correct EXCEPT:


A. Dialysis therapy, in patients with diabetic nephropathy and ESRD is not necessary until GFR is less than 5 ml/min.
B. Tight blood sugar control reduces the risk of developing diabetic nephropathy.
C. In diabetic patients with proteinuria and declining renal function, lowering the systemic blood pressure slows the rate of decline in renal function.
D. In patients with microalbuminuria, using ACE inhibitors decreases urine albumin excretion and rate progression to overt nephropathy.
E. Avoiding NSAIDs and radiocontrast media, and properly managing UTIs and neurogenic bladder, are important measures to preserve the remaining renal function in patients with established diabetic nephropathy.


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