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A 19-year-old man is evaluated for proteinuria discovered during a routine sports preparticipation evaluation. He has been asymptomatic, has no other medical problems, and takes no medications. On physical exam, temperature is 36.6˚C, blood pressure is 110/72mmHg, pulse rate is 60/min, and respiration rate is 12/min. BMI is 18. The funduscopic, cardiopulmonary, and skin findings are normal. No peripheral edema is present. Hemoglobin: 150g/L Albumin: 41g/L Total cholesterol: 3.4mmol/L Creatinine: 61.9umol/L Glucose: 5.1mmol/L Total protein: 65g/L Spot urine protein-creatinine ratio: 0.8mg/mg Urinalysis: urine dipstick - protein 2+, blood - negative, glucose - negative, microscopic - rare hyaline cast, no cells or crystals. Which of the following is the most appropriate next diagnostic test? A) 24h urine protein excretion
B) Evaluate for orthostatic proteinuria C) Kidney biopsy D) Protein electrophoresis of the seru - correct answer ✅B) A 62-year-old woman is evaluated for acute oliguric renal failure. She was admitted to the hospital 7 days ago for sepsis due to methicillin-sensitive Staphylococcus aureus, intravenous cefazolin was begun and she quickly improved. Today, her urine output is 10mL/h. On physical exam, temperature is 37.5˚C, blood pressure is 138/88mmHg, pulse rate is 78/min, and respiration rate is 12/min. A macular erythematous rash is present over her anterior chest and abdomen. The remainder of the physical exam is normal. Day 1: Blood urea nitrogen: 2.9mmol/L Creatinine: 53.0umol/L Urinalysis: normal Day 7: Blood urea nitrogen: 7.1mmol/L
INR: 3.
Serum creatinine: 123.8umol/L Urinalysis: specific gravity 1.015, no protein, blood +1, 5-10 non-dysmorphic erythrocytes/hpf, no casts. On kidney ultrasound, the right kidney is 10.4cm and the left kidney is 9.0cm. No masses, cysts, or stones are identified. Which of the following is the most appropriate next management step? A) Cystoscopy B) Discontinuation of warfarin C) Kidney biopsy D) Repeat urinalysis in 3 months - correct answer ✅A) An 18-year-old man is evaluated in the ER after his mother found him unconscious in his bed at home. She reported that her son had gone to a party 24h ago, but she was not sure when he returned home. When she checked on him, he was unarousable. He has no significant medical history and takes no medications. In the ER, he is afebrile, blood pressure is 110/70mmHg, pulse rate is 50/min, and respiration rate is 6/min, he is intubated.
Creatinine: 282.9umol/L AST: 80U/L ALT: 46U/L Creatine kinase: 18,400U/L INR: 1. Complete blood count, alkaline phosphatase, bilirubin, and albumin are normal. Urine dipstick is 4+ positive for occult blood, negative for erythrocytes. Blood alcohol level is 174mmol/L. Toxicology testing is positive for opiates and cocaine. Bladder catheterization reveals only 30mL of brown urine. Which of the following is the most likely cause of the acute kidney injury? A) Hemolytic anemia B) Hemolyt - correct answer ✅D) A 72-year-old man is evaluated in the ER for a 2-day history of suprapubic abdominal pin. He has had difficulty urinating for the last 6 months, including urinary frequency and difficulty starting his urinary stream. He has nocturia four to five times per night. Medical history is otherwise nonsignificant, he takes no medications.
A 21-year-old woman is evaluated in the ER for a 2-day history of abdominal pain and bloody diarrhea. Before this episode she was healthy, and she takes no medications. On physical exam, she appears ill and pale; temperature is 38.5˚C, blood pressure is 97/70mmHg, pulse rate is 120/min, and respiration rate is 16/min. Bowel sounds are hyperactive, and the abdomen is tender without guarding. The remainder of the exam is normal. Hematocrit: 27% Platelet count: 42x10 9/L Blood urea nitrogen: 15.0mmol/L Creatinine: 283umol/L LDH: 1124U/L Urinalysis (microscopic and dipstick): normal The peripheral blood smear reveals schistocytes. Which of the following is the most likely diagnosis? A) Acute interstitial nephritis
B) Acute tubular necrosis C) Hemolytic uremic syndrome D) Rhabdomyolysis - correct answer ✅C) A 29-year-old woman comes for a follow-up office visit. Six months ago, she underwent double-lung transplantation for cystic fibrosis. She was diagnosed with Pseudomonas bronchitis 14 days ago and began oral ciprofloxacin and intravenous tobramycin at that time. Today, she states that her cough has resolved, she has not had fever, and she feels well. Additional medications are acyclovir, mycophenolate mofetil, prednisone, tacrolimus, and trimethoprim- sulfamethoxazole. On physical exam, temperature is 36.6˚C, blood pressure is 132/80mmHg, pulse rate is 90/min, and respiration rate is 18/min. Cardiopulmonary exam is normal. Cutaneous exam is normal. There is no asterisks. There is no edema. Hemoglobin: 120g/L Leukocyte count: 8.4x10 9/L Platelet count: 335x10 9/L Serum creatinine: 203.3umol/L (106.1umol/L 6 weeks ago)
Calcium: 2.5mmol/L Blood urea nitrogen: 37.5mmol/L Serum creatinine: 442umol/L (88.4umol/L 1 month ago) Urinalysis: specific gravity 1.022, pH 5, trac - correct answer ✅B) A 65-year-old man with a history of stage 4 chronic kidney disease and hypertension comes for a follow-up exam. Two days ago, he was discharged from the hospital after a 4-day stay for pneumonia. During his hospitalization, his blood pressure averaged 130/70mmHg and he was not exposed to radiocontrast agents. He was treated with ceftrixone and azithromycin; on discharge, these agents were discontinued and he began oral levofloxacin. Since his discharge, he has had nausea, vomiting, and anorexia. He believes that his urine output over the past day has been less than 500mL. Additional medication are lisinopril, calcium carbonate, and low-dose aspirin. On physical exam, temperature is 35.8˚C, blood pressure is 110/50mmHg standing and 100/80mmHg supine, pulse rate is 108/min standing and 96/min supine, and respiration rate is 16/min. The remainder of the exam is normal except for crackles heard at the base of the lungs - correct answer ✅C) A 55-year-old man with a 15-year history of T2DM and hypertension is evaluated during a new-patient visit. He reports no symptoms other than ankle edema. A
review of his medical records documents the presence of microalbuminuria 5 years ago. His medications are amlodipine, chlorthalidone, simvastatin, metformin, and glargine insulin. On physical exam, temperature is 37.1˚C, blood pressure is 150/95mmHg, pulse is 80/min, and respiration rate is 12/min. Cardiopulmonary exam is normal. He has trace pretibial edema. Potassium: 4.2mmol/L Creatinine: 186umol/L Urine protein-creatinine ratio: 1mg/mg The patient is prescribed losartan 25mg/d. He returns in 3 weeks for a repeat blood pressure check. The average of two blood pressure recordings is 145/88mmHg. The serum potassium level is 4.4mmol/L and the serum creatinine level is 177umol/L. Which of the following is the most appropriate next step in this patient's managem - correct answer ✅C)
examinations are normal. There is 3+ pitting edema of the lower extremities to the level of the thighs bilaterally. HA1c: 6.8% Albumin: 30g/L Serum creatinine: 97.2umol/L Urinalysis: protein +3, blood +2, 8-10 dysmorphic erythrocytes/hpf, 2- leukocytes/hpf, few erythrocyte casts Urine protein-creatinine ratio: 5.2mg/mg On kidney ultrasound, the right kidney is 12.2cm and the left kidney is 12.7cm. There is no hydronephrosis, and no kidney masses are s - correct answer ✅B) A 33-year-old woman comes for follow-up examination for a left fibular fracture due to a fall 1 week ago. She has hypertension and stage 5 chronic kidney disease treated with home hemodialysis. Medications are lisinopril, sevelamer, epoetin alfa, paricalcitol, and multivitamins. On physical exam, temperature is normal, blood pressure 130/70mmHg, pulse rate is 88/min, and respiration rate is 12/min. BMI is 29. Cardiopulmonary exam is
normal. An arteriovenous fistula is present in the left forearm. Except for a cast on her left leg, musculoskeletal exam is normal and reveals no bone pain. Hemoglobin: 103g/L Albumin: 35g/L Phosphorus: 1.9mmol/L Calcium: 2.1mmol/L Parathyroid hormone: 700ng/L ALP: 330U/L Which of the following is the most likely cause of this patient's bone disease? A) Adynamic bone disease B) Osteonecrosis C) Osteoporosis D) Secondary hyperparathyroidism - correct answer ✅D) A 55-year-old woman is found in an alleyway by paramedics. She is obtunded, hypotensive and tachycardic. Her breath smells of alcohol. Sodium: 135mmol/L
Carbon dioxide: 17mmol/L Urine electrolytes: Sodium: 40mmol/L Potassium: 10mmol/L Chloride: 30mmol/L Which of the following is the most likely cause of this patient's acid-base disorder? A) Diabetic ketoacidosis B) Renal tubular acidosis C) Laxative abuse D) Viral gastroenteritis - correct answer ✅B) A 61-year-old man is evaluated in the ER because of a 3-day history of cough productive of yellow sputum. He has chronic obstructive pulmonary disease and he routinely uses supplemental oxygen, 2L/min. He states that he is now short of breath at rest. Physical exam shows that he is using accessory muscles of respiration and pursed- lipped breathing. He has prolonged expiratory-to-inspiratory phase on exhalation and scattered wheezes. he has tachycardia and bilateral pitting edema of the extremities.
His oxygen saturation is 91% on supplemental oxygen. Chest radiograph shows changes consistent with emphysema, but is otherwise unchanged from baseline. His arterial blood gas values are PO2 59mmHg, PCO2 64mmHg, and pH 7.32. Other pertinent laboratory values include sodium 140mmol/L, chloride 100mmol/L, potassium 3.5mmol/L, and bicarbonate 32mmol/L. Which of the following acid-base disorders is most likely present? A) M - correct answer ✅B) A 28-year-old man is brought to the ER with the sudden onset of dyspnea following a stressful interview at work. On physical exam, temperature is 36.7˚C, heart rate is 99/min, respiration rate is 32/min, and blood pressure is 156/80mmHg. He is weak and in moderate respiratory distress. Cardiovascular and pulmonary examinations are normal. Sodium: 140mmol/L Potassium: 4.9mmol/L Chloride: 110mmol/L Bicarbonate: 22mmol/L
Serum creatinine: 247.5umol/L Sodium: 138mmol/L Potassium: 5.4mmol/L Chloride: 98mmol/L Bicarbonate: 14mmol/L Plasma osmolality: 336umol/kg Urinalysis: calcium oxalate crystals Arterial blood gas studies: pH 7.32, PCO2 29mmHg, PO2 80mmHg Which of the following is the most likely diagnosis? A) Alcoholic ketoacidosis B) Diabetic ketoacidosis C) Ethylene glycol poisoning D) Lactic acidosis - correct answer ✅C) A 39-year-old man is evaluated in the ER because of severe left flank pain and hematuria after playing softball. The pain is sharp and radiates to the groin. He vomited eight times before presentation. He has a non-obstructing, calcium- containing kidney stone at the ureteropelvic junction on the left side.
On initial evaluation, his blood pressure was 130/90mmHg, respiratory rate was 30/min and pulse rate is 110/min. Serum sodium: 141mmol/L Serum potassium: 4.0mmol/L Serum chloride: 100mmol/L Serum bicarbonate: 34mmol/L Arterial blood gases: pH 7.60, PCO2 36mmHg Which of the following best describes this patient's acid-base disorder? A) Metabolic acidosis and respiratory alkalosis B) Metabolic alkalosis C) Metabolic alkalosis and respiratory acidosis D) Metabolic and respiratory alkalosis E) Respiratory alkalosis - correct answer ✅D) A 66-year-old is evaluated in the ER for a 6-week history of dyspnea on exertion and a 3-day history of orthopnea. He reports no chest pain or palpitations He has a 45-pack-year history of cigarette smoking. He takes no medications.
