ITE Nephrology and Hypertension Questions and Answers

Question 1

A 68-year-old male in the ICU for septic shock develops a rise in serum creatinine from a baseline of 1.0 mg/dL to 3.5 mg/dL over 48 hours.
His blood pressure has required vasopressors.
A urinalysis is performed.
Which of the following findings would be most indicative of acute tubular necrosis (ATN) as the cause of his kidney injury?

Accepted Answer

Muddy brown granular casts

Answer

White blood cell casts and eosinophiluria

Answer

Red blood cell casts and dysmorphic red cells

Answer

Hyaline casts and a fractional excretion of sodium (FENa) <1%

Question 2

A 55-year-old man with stage 4 chronic kidney disease (eGFR 25 mL/min/1.73m²) presents for follow-up. His labs show a serum calcium of 8.2 mg/dL (low), serum phosphate of 5.8 mg/dL (high), and an intact PTH level of 450 pg/mL (high). According to the KDIGO guidelines for CKD-Mineral and Bone Disorder (CKD-MBD), what is the most appropriate initial intervention?

Accepted Answer

Initiation of an oral phosphate binder

Answer

Initiation of cinacalcet

Answer

Initiation of active vitamin D (calcitriol)

Answer

Referral for parathyroidectomy

Question 3

A 25-year-old male presents with gross hematuria and mild bilateral flank pain that began 2 days after the onset of an upper respiratory infection. His blood pressure is 150/95 mmHg. Urinalysis reveals numerous red blood cells, red blood cell casts, and 2+ proteinuria. What is the most likely diagnosis?

Accepted Answer

IgA nephropathy

Answer

Post-streptococcal glomerulonephritis

Answer

Minimal change disease

Answer

Membranous nephropathy

Question 4

A 60-year-old man with a history of alcohol use disorder is found to have a serum sodium of 112 mEq/L. He is lethargic but arousable. To minimize the risk of osmotic demyelination syndrome, which of the following represents the safest therapeutic goal for correction?

Accepted Answer

Limit the increase in serum sodium to no more than 6-8 mEq/L in the first 24 hours.

Answer

Increase serum sodium to 130 mEq/L within the first 24 hours.

Answer

Administer a 500 mL bolus of 3% hypertonic saline over one hour.

Answer

Increase serum sodium by 12-14 mEq/L in the first 24 hours.

Question 5

A 34-year-old female is diagnosed with hypertension, with blood pressures consistently around 160/105 mmHg despite therapy with two antihypertensive agents. She has no family history of hypertension. On physical examination, a faint bruit is audible in the right upper abdominal quadrant. Which of the following is the most appropriate next step to investigate the likely cause of her secondary hypertension?

Accepted Answer

Renal artery duplex ultrasound

Answer

24-hour urine collection for metanephrines

Answer

Overnight dexamethasone suppression test

Answer

Plasma aldosterone-to-renin ratio

Question 6

A patient with stage 5 CKD presents to the emergency department with altered mental status. Which of the following findings represents the most urgent indication to initiate hemodialysis?

Accepted Answer

Uremic pericarditis with a friction rub

Answer

Blood urea nitrogen (BUN) of 120 mg/dL

Answer

Serum creatinine of 9.0 mg/dL

Answer

Refractory peripheral edema