MEDICINE PRACTICE 8

                                SINGLE BEST OPTION SERIES
                INSTRUCTION: SELECT THE SINGLE BEST OPTION

1. The most likely cause of a chest radiogragh finding of 'Bat wing' appearance in a patient with a normal heart and acute renal failure is:

 a. Thrombotic thrombocytopaenic purpura
 b. Pneumocystis jiroveci pneumonia
 c. Haemolytic uraemic syndrome.
 d. Myeloma cast nephropathy.
 e. Pulmonary haemorrhage.

2. Wrong pairing of the cause acute renal failure / renal lesion and appropriate findings on investigation:

 a. Glomerulonephritis ---------- urinary casts/dysmorphic red cells
 b. Interstitial nephritis ---------- Urinary leucocytes
 c. Multiple myeloma ----------- Urinary casts and light chains
 d. Thrombotic microangiopathy--------- Haemolysis
 e. Hydronephrosis ----------------- small kidneys on ultrasound scan.

3. The most common cause of chronic kidney disease with features of absent or less severe anaemia is:

  a. Alport's syndrome
  b. IgA nephropathy
  c. Diabetes mellitus.
  d. Polycystic kidney disease.
  e. Renal artery stenosis.

4. 'Salt-wasting' chronic kidney disease (requiring a high sodium and water intake including supplements of    sodium salts to prevent fluid depletion and worsening of renal function) is not seen in patients with:

 a. Renal cystic kidney disease.
 b. Obstructive uropathy
 c. Reflux nephropathy
 d. Tubulo-interstitial diseases
 e. Primary glomerular diseases.

5. Disproportionate fluid retention in a patient with mild chronic kidney disease, sometimes leading to episodic pulmonary oedema suggest aetiology due to:

 a. Systemic lupus erythematosus.
 b. Renal artery stenosis.
 c. Goodpasture's disease.
 d. IgA Nephropathy.
 e. Alport's syndrome.

6. Which of the following about end stage renal disease is incorrect:

 a. Atherosclerosis is common and may be accelerated by hypertension.
 b. Medial vascular calcification accelerated by high phosphate levels,
 c. Left ventricular hypertrophy and hypercholesterolaemia occurs.
 d. Pericarditis which may lead to cardiac tomponade occurs
 e. Control of dyslipidaemia with statins slows the rate of progression of renal disease but not cardioprotective

7. Secondary hyperparathyroidism in the presence of hyperphosphataemia in patients with chronic kidney disease, classically cause a spectrum of renal osteodystrophy referred to as :

 a. Osteosclerosis
 b. Osteitis fibrosa
 c. Osteoporosis
 d. Osteomalacia
 e. Tertiary/autonomous hyperthyroidism.

 8. Which of the following is not an option when managing a patient with renal osteodystrophy?

 a. Giving calcium carbonate and aluminium hydroxide.
 b. Encouragement of milk, cheese and egg consumption.
 c. Parathyroidectomy.
d. 1α-hydroxylated vitamin D

 e. Polymer-based phosphate binders.

9. The most common cause of death in dialysis patients is:

 a. Infection
 b. Cardiovascular disease
 c. Pulmonary oedema
 d. Hyperphosphataemia.
 e. Autonomic neuropathy.

 10. The most accurate method of obtaining glomerular filtration rate is:

 a. MDRD equation.
 b. Cockcroft and Gault equation.
 c. Serum urea and creatinine.
 d. Using labelled EDTA
 e. Creatinine clearance.

                ANSWERS:
 1. e
 2. e
 3. d
 4. e
 5. b
 6. e
 7. b
 8. c
 9. b
 10. d.

                                        REMEMBER
” Some people sin by not working diligently for six days whereas, others – because of greed, unbelief or powerlessness- sin by working also on a day of rest and worship. Either way of breaking this   command results in poverty.”   By  Vishal Mangalwadi.