THE NEPHROLOGY QUIZ & QUESTIONNAIRE: 2004

QUESTIONS

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I AM A NEPHROLOGY TRAINING PROGRAM DIRECTOR: YES ___; NO ___.

FLUID AND ELECTROLYTES: HALPERIN

CASE I.

QUESTION 1:

Which ONE of the following choices is the most likely cause of his metabolic acidosis?

A. Diabetic ketoacidosis

B. Alcoholic ketoacidosis

C. Starvation ketoacidosis

D. D-Lactic acidosis

E. Sugar-induced acidosis

CASE II.

QUESTION 2:

With regard to the increment in her P Na concentration in first 24-hours, which ONE of the following choices would be safest?

A. 0 mM

B. 4 mM

C. 8 mM

D. 12 mM

QUESTION 3:

Which ONE of the following initial therapies would be most effective in preventing a CNS complication?

A. Hypertonic saline alone

B. Normal Saline alone

C. Half-isotonic saline alone

D. Rapid bolus of normal saline (150 mM) plus furosemide

E. Normal Saline plus dDAVP

TRANSPLANTATION: DANOVITCH

CASE III.

QUESTION 4:

Which ONE of the following immunosuppressive regimens would be best for this transplant candidate?

A. Tacrolimus; mycophenolate mofetil; standard taper to low dose corticosteroids

B. Tacrolimus; sirolimus; rapid total corticosteroid withdrawal

C. Cyclosporine; mycophenolate mofetil; standard taper to low dose corticosteroids

D. Mycophenolate mofetil; sirolimus; standard taper to low dose corticosteroids

CASE IV.

QUESTION 5:

Which ONE of the following treatment options would you now recommend for this patient?

A. Because the morbidity and mortality of transplantation for this patient would be excessive, he should remain on dialysis

B. List the patient for combined kidney and pancreas transplant (SPK)

C. List the patient for deceased donor transplantation with consideration of pancreatic transplantation if clinical stability is sustained for 3-to-6 months following renal transplantation

D. A living donor transplantation from the patient's consenting one-haplotype matched brother should be recommended with consideration of pancreas transplantation after 3-to-6 months of stability

ESRD: BARGMAN

CASE V.

QUESTION 6:

Which ONE of the following options would be best for this patient?

A. Discontinue PD and begin permanent in-center hemodialysis

B. Continue PD but add polyglucose (Icodextrin) to the long daytime dwell

C. Continue PD but switch to an intermittent rapid-cycling regimen

D. Order an abdominal CT scan with intraperitoneal instillation of dye

CASE VI.

QUESTION 7:

Which ONE of the following courses of action would be LEAST appropriate in this setting?

A. Consider re-exploration of the neck for remnant parathyroid tissue

B. Consider discontinuing calcitriol and eliminating oral calcium

C. Consider discontinuing Coumadin or replacing it with another anticoagulant

D. Consultation should be sought from plastic surgery for wound care

GLOMERULONEPHRITIS: FALK

CASE VII.

QUESTION 8:

8. Given his most current status and therapeutic regimen, which ONE of the follow choices would now be his best therapeutic option?

A. Discontinue all immunosuppressive therapy

B. Continue oral cyclophosphamide for another six months

C. Convert the patient to methotrexate as immunomodulating therapy

D. Convert the patient to azathioprine or perhaps mycophenolate mofetil

CASE VIII.

QUESTION 9:

Given his past history and current status, which ONE of the following choices offers the best course of therapy for this man?

A. Continued supportive care without change in his medical regimen.

B. Institution of pulse methylprednisolone therapy every other month and alternate-day oral prednisone.

C. Institution of cyclophosphamide for 6 months.

D. High dose oral steroids for the next 2 years.

E. Institution of mycophenolate mofetil at a dose of 1 gram twice daily.