Question 1: A 65-year-old male presents to the emergency room with complaints of decreased urine output, swelling in the legs, and fatigue. On examination, the patient appears pale, and there is mild hypertension. Laboratory tests reveal elevated serum creatinine and blood urea nitrogen (BUN) levels. Urinalysis shows muddy brown granular casts and proteinuria. Which of the following is the most likely diagnosis?
A) Chronic Kidney Disease (CKD)
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypertensive Crisis
E) Nephrotic Syndrome
QBankProAcademy.com
Explanation: The clinical presentation of decreased urine output, elevated creatinine and BUN, along with findings of muddy brown granular casts and proteinuria, is consistent with acute tubular necrosis, a common cause of AKI.
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Question 2: A 40-year-old female with a history of diabetes and hypertension presents with nausea, vomiting, and flank pain. She denies any recent illness or trauma. Laboratory tests reveal hyperkalemia, metabolic acidosis, and an elevated serum creatinine. An ultrasound shows bilateral kidney enlargement. What is the most likely diagnosis?
A) Pyelonephritis
B) Nephrolithiasis
C) Acute Kidney Injury (AKI)
D) Polycystic Kidney Disease
E) Glomerulonephritis
QBankProAcademy.com
Explanation: The combination of flank pain, kidney enlargement, and a positive family history in a patient with diabetes and hypertension suggests autosomal dominant polycystic kidney disease (ADPKD).
Question 3: A 70-year-old male presents with confusion, anorexia, and peripheral edema. Laboratory results reveal hyponatremia, hyperkalemia, metabolic acidosis, and elevated serum creatinine. A renal ultrasound shows bilaterally small, shrunken kidneys. Which of the following is the most likely diagnosis?
A) Dehydration
B) Acute Kidney Injury (AKI)
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Obstructive Uropathy
QBankProAcademy.com
Explanation: The clinical presentation, laboratory findings, and small, shrunken kidneys on ultrasound are consistent with advanced chronic kidney disease.
Question 4: A 55-year-old female with a history of rheumatoid arthritis is brought to the ER with complaints of joint pain, fever, and a recent rash. She has a known history of hypertension and is currently taking an NSAID for pain. Laboratory results reveal elevated serum creatinine and urinalysis shows hematuria, red cell casts, and proteinuria. What is the most likely diagnosis?
A) Lupus Nephritis
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypersensitivity Reaction
E) Nephrolithiasis
QBankProAcademy.com
Explanation: The patient’s history of rheumatoid arthritis, joint pain, fever, rash, elevated creatinine, and urinalysis findings are suggestive of lupus nephritis, a common renal complication in systemic lupus erythematosus.
Question 5: A 45-year-old male with a history of recent exposure to a nephrotoxic medication presents with fatigue, decreased urine output, and edema. Laboratory tests reveal elevated serum creatinine, hyperkalemia, and metabolic acidosis. Which of the following diagnostic tests is most appropriate to confirm the diagnosis?
A) Renal Ultrasound
B) Urinalysis
C) 24-Hour Urine Protein
D) Renal Biopsy
E) Serum Electrolyte Panel
QBankProAcademy.com
Explanation: In cases of acute kidney injury with a known nephrotoxic exposure, a renal biopsy is often necessary to confirm the specific underlying cause and guide treatment decisions.
Question 6: A 55-year-old female presents to the emergency department with complaints of decreased urine output, generalized swelling, and confusion. She has a history of heart failure and is taking multiple medications, including an ACE inhibitor. Laboratory tests show elevated serum creatinine, blood urea nitrogen (BUN), and hyperkalemia. Urinalysis reveals muddy brown granular casts and proteinuria. Which of the following is the most likely cause of her symptoms?
A) Chronic Kidney Disease (CKD)
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypertensive Crisis
E) Nephrotic Syndrome
QBankProAcademy.com
Explanation: The clinical presentation of decreased urine output, elevated creatinine and BUN, along with findings of muddy brown granular casts and proteinuria, is consistent with acute tubular necrosis, a common cause of AKI, especially in patients on ACE inhibitors.
Question 7: A 40-year-old male presents with fever, flank pain, and costovertebral angle tenderness. Laboratory tests reveal leukocytosis and pyuria. Urinalysis shows white blood cell casts. What is the most likely diagnosis?
A) Nephrolithiasis
B) Acute Kidney Injury (AKI)
C) Pyelonephritis
D) Glomerulonephritis
E) Hypertensive Crisis
QBankProAcademy.com
Explanation: The clinical presentation of fever, flank pain, and white blood cell casts in the urine suggests acute pyelonephritis, an inflammatory condition of the kidney often associated with infection.
Question 8: A 70-year-old male with a history of hypertension and type 2 diabetes presents with progressive fatigue, weakness, and peripheral edema. Laboratory results reveal elevated serum creatinine and urea. An ultrasound shows bilateral shrunken kidneys. Which of the following is the most likely diagnosis?
A) Dehydration
B) Acute Kidney Injury (AKI)
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Obstructive Uropathy
QBankProAcademy.com
Explanation: The clinical presentation, laboratory findings, and small, shrunken kidneys on ultrasound are indicative of advanced chronic kidney disease.
Question 9: A 55-year-old female with a history of lupus presents with joint pain, rash, and shortness of breath. Laboratory results reveal elevated serum creatinine and urinalysis shows hematuria, red cell casts, and proteinuria. What is the most likely diagnosis?
A) Lupus Nephritis
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypersensitivity Reaction
E) Nephrolithiasis
QBankProAcademy.com
Explanation: The patient’s history of lupus, joint pain, rash, elevated creatinine, and urinalysis findings are suggestive of lupus nephritis, a common renal complication in systemic lupus erythematosus.
Question 10: A 45-year-old male who recently started taking an angiotensin receptor blocker (ARB) for hypertension presents with fatigue, decreased urine output, and swelling. Laboratory tests reveal elevated serum creatinine and hyperkalemia. Which of the following diagnostic tests is most appropriate to confirm the diagnosis?
A) Renal Ultrasound
B) Urinalysis
C) 24-Hour Urine Protein
D) Renal Biopsy
E) Serum Electrolyte Panel
QBankProAcademy.com
Explanation: In cases of acute kidney injury with a known nephrotoxic medication exposure, a renal biopsy is often necessary to confirm the specific underlying cause and guide treatment decisions.
Question 11: A 65-year-old male presents with complaints of decreased urine output, swelling in the legs, and fatigue. On examination, the patient appears pale, and there is mild hypertension. Laboratory tests reveal elevated serum creatinine and blood urea nitrogen (BUN) levels. Urinalysis shows muddy brown granular casts and proteinuria. Which of the following is the most likely diagnosis?
A) Chronic Kidney Disease (CKD)
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypertensive Crisis
E) Nephrotic Syndrome
QBankProAcademy.com
Explanation: The clinical presentation of decreased urine output, elevated creatinine and BUN, along with findings of muddy brown granular casts and proteinuria, is consistent with acute tubular necrosis, a common cause of AKI.
Question 12: A 40-year-old female with a history of diabetes and hypertension presents with nausea, vomiting, and flank pain. She denies any recent illness or trauma. Laboratory tests reveal hyperkalemia, metabolic acidosis, and an elevated serum creatinine. An ultrasound shows bilateral kidney enlargement. What is the most likely diagnosis?
A) Pyelonephritis
B) Nephrolithiasis
C) Acute Kidney Injury (AKI)
D) Polycystic Kidney Disease
E) Glomerulonephritis
QBankProAcademy.com
Explanation: The combination of flank pain, kidney enlargement, and a positive family history in a patient with diabetes and hypertension suggests autosomal dominant polycystic kidney disease (ADPKD).
Question 13: A 70-year-old male presents with confusion, anorexia, and peripheral edema. Laboratory results reveal hyponatremia, hyperkalemia, metabolic acidosis, and elevated serum creatinine. A renal ultrasound shows bilaterally small, shrunken kidneys. Which of the following is the most likely diagnosis?
A) Dehydration
B) Acute Kidney Injury (AKI)
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Obstructive Uropathy
QBankProAcademy.com
Explanation: The clinical presentation, laboratory findings, and small, shrunken kidneys on ultrasound are consistent with advanced chronic kidney disease.
Question 14: A 55-year-old female with a history of rheumatoid arthritis is brought to the ER with complaints of joint pain, fever, and a recent rash. She has a known history of hypertension and is currently taking an NSAID for pain. Laboratory results reveal elevated serum creatinine and urinalysis shows hematuria, red cell casts, and proteinuria. What is the most likely diagnosis?
A) Lupus Nephritis
B) Dehydration
C) Acute Kidney Injury (AKI)
D) Hypersensitivity Reaction
E) Nephrolithiasis
QBankProAcademy.com
Explanation: The patient’s history of rheumatoid arthritis, joint pain, fever, rash, elevated creatinine, and urinalysis findings are suggestive of lupus nephritis, a common renal complication in systemic lupus erythematosus.
Question 15: A 45-year-old male with a history of recent exposure to a nephrotoxic medication presents with fatigue, decreased urine output, and edema. Laboratory tests reveal elevated serum creatinine, hyperkalemia, and metabolic acidosis. Which of the following diagnostic tests is most appropriate to confirm the diagnosis?
A) Renal Ultrasound
B) Urinalysis
C) 24-Hour Urine Protein
D) Renal Biopsy
E) Serum Electrolyte Panel
QBankProAcademy.com
Explanation: In cases of acute kidney injury with a known nephrotoxic exposure, a renal biopsy is often necessary to confirm the specific underlying cause and guide treatment decisions.
Question 15: A 60-year-old female with a history of hypertension and type 2 diabetes presents with complaints of generalized weakness, poor appetite, and swelling in her lower extremities. Physical examination reveals hypertension and pericardial friction rub. Laboratory tests show elevated serum creatinine and blood urea nitrogen (BUN) levels. Urinalysis indicates proteinuria and red blood cell casts. Which of the following is the most likely diagnosis?
A) Acute Kidney Injury (AKI)
B) Congestive Heart Failure
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Dehydration
QBankProAcademy.com
Explanation: The clinical presentation of hypertension, proteinuria, red blood cell casts, and elevated creatinine in a patient with a history of diabetes is consistent with chronic kidney disease.
Question 16: A 45-year-old male with a long history of uncontrolled hypertension presents with complaints of fatigue, nausea, and anorexia. Laboratory results reveal elevated serum creatinine, potassium, and metabolic acidosis. An ultrasound shows shrunken, echogenic kidneys. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI)
B) Hypertensive Crisis
C) Chronic Kidney Disease (CKD)
D) Dehydration
E) Nephrolithiasis
QBankProAcademy.com
Explanation: The clinical presentation of elevated creatinine, metabolic acidosis, shrunken kidneys on ultrasound, and a history of uncontrolled hypertension is indicative of advanced chronic kidney disease.
Question 17: A 55-year-old male with a history of chronic kidney disease secondary to polycystic kidney disease presents with worsening back pain and fever. Laboratory tests reveal leukocytosis and an elevated serum creatinine. An ultrasound shows enlarged, cystic kidneys. What is the most likely cause of his symptoms?
A) Acute Kidney Injury (AKI)
B) Pyelonephritis
C) Hypertensive Crisis
D) Dehydration
E) Nephrolithiasis
QBankProAcademy.com
Explanation: The clinical presentation of back pain, fever, leukocytosis, and enlarged cystic kidneys in a patient with polycystic kidney disease is suggestive of pyelonephritis, a common infection complication in such cases.
Question 18: A 70-year-old female presents with symptoms of anemia, fatigue, and difficulty concentrating. Laboratory tests reveal low hemoglobin levels, elevated serum creatinine, and a low glomerular filtration rate (GFR). A renal biopsy shows glomerular sclerosis and interstitial fibrosis. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI)
B) Nephrotic Syndrome
C) Dehydration
D) Chronic Kidney Disease (CKD)
E) Glomerulonephritis
QBankProAcademy.com
Explanation: The clinical presentation of anemia, elevated creatinine, low GFR, and findings of glomerular sclerosis and interstitial fibrosis on renal biopsy are consistent with chronic kidney disease.
Question 19: A 50-year-old male with a history of longstanding hypertension and tobacco use presents with hematuria and edema. Laboratory tests reveal elevated serum creatinine and urinalysis shows red blood cell casts and proteinuria. An ultrasound reveals normal-sized kidneys. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI)
B) Hypertensive Crisis
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Dehydration
QBankProAcademy.com
Explanation: The presence of hematuria, red blood cell casts, proteinuria, and normal-sized kidneys in a patient with a history of hypertension and tobacco use is indicative of hypertensive nephropathy, which can lead to dehydration-induced kidney injury.
Question 20: A 55-year-old male with a history of hypertension and diabetes presents with complaints of generalized weakness, poor appetite, and peripheral edema. Physical examination reveals hypertension and pericardial friction rub. Laboratory tests show elevated serum creatinine and blood urea nitrogen (BUN) levels. Urinalysis indicates proteinuria and red blood cell casts. Which of the following is the most likely diagnosis?
A) Acute Kidney Injury (AKI)
B) Congestive Heart Failure
C) Chronic Kidney Disease (CKD)
D) Nephrotic Syndrome
E) Dehydration
QBankProAcademy.com
Explanation: The clinical presentation of hypertension, proteinuria, red blood cell casts, and elevated creatinine in a patient with a history of diabetes and hypertension is consistent with chronic kidney disease.
Question 21: A 50-year-old male with a long history of uncontrolled hypertension presents with complaints of fatigue, nausea, and anorexia. Laboratory results reveal elevated serum creatinine, potassium, and metabolic acidosis. An ultrasound shows shrunken, echogenic kidneys. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI) B) Hypertensive Crisis C) Chronic Kidney Disease (CKD) D) Dehydration E) Nephrolithiasis
QBankProAcademy.com
Explanation: The clinical presentation of elevated creatinine, metabolic acidosis, shrunken kidneys on ultrasound, and a history of uncontrolled hypertension is indicative of advanced chronic kidney disease.
Question 22: A 65-year-old female with a history of chronic kidney disease secondary to polycystic kidney disease presents with worsening back pain and fever. Laboratory tests reveal leukocytosis and an elevated serum creatinine. An ultrasound shows enlarged, cystic kidneys. What is the most likely cause of her symptoms? A) Acute Kidney Injury (AKI) B) Pyelonephritis C) Hypertensive Crisis D) Dehydration E) Nephrolithiasis
QBankProAcademy.com
Explanation: The clinical presentation of back pain, fever, leukocytosis, and enlarged cystic kidneys in a patient with polycystic kidney disease is suggestive of pyelonephritis, a common infection complication in such cases.
Question 23: A 70-year-old male presents with symptoms of anemia, fatigue, and difficulty concentrating. Laboratory tests reveal low hemoglobin levels, elevated serum creatinine, and a low glomerular filtration rate (GFR). A renal biopsy shows glomerular sclerosis and interstitial fibrosis. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI) B) Nephrotic Syndrome C) Dehydration D) Chronic Kidney Disease (CKD) E) Glomerulonephritis
QBankProAcademy.com
Explanation: The clinical presentation of anemia, elevated creatinine, low GFR, and findings of glomerular sclerosis and interstitial fibrosis on renal biopsy are consistent with chronic kidney disease.
Question 24: A 45-year-old male with a history of longstanding hypertension and tobacco use presents with hematuria and edema. Laboratory tests reveal elevated serum creatinine, and urinalysis shows red blood cell casts and proteinuria. An ultrasound reveals normal-sized kidneys. What is the most likely diagnosis?
A) Acute Kidney Injury (AKI) B) Hypertensive Crisis C) Chronic Kidney Disease (CKD) D) Nephrotic Syndrome E) Dehydration
QBankProAcademy.com
Explanation: The presence of hematuria, red blood cell casts, proteinuria, and normal-sized kidneys in a patient with a history of hypertension and tobacco use is indicative of hypertensive nephropathy, which can lead to chronic kidney disease.
Question 26: A 60-year-old male with a history of end-stage renal disease (ESRD) on chronic hemodialysis presents with complaints of weakness, shortness of breath, and swelling in his legs. On examination, the patient appears pale and has elevated blood pressure. Laboratory tests show a hemoglobin level of 7.8 g/dL and an elevated serum potassium level. Which of the following interventions is most appropriate for managing his symptoms? A) Initiating peritoneal dialysis B) Adjusting the hemodialysis schedule C) Administering an erythropoietin-stimulating agent (ESA) D) Starting angiotensin-converting enzyme (ACE) inhibitors E) Referring for kidney transplantation
QBankProAcademy.com
Explanation: The patient’s symptoms and low hemoglobin level indicate anemia, which is common in ESRD. ESAs are often used to stimulate red blood cell production in patients on hemodialysis.
Question 27: A 45-year-old female with ESRD on hemodialysis presents with sudden chest pain, dyspnea, and hypotension during her hemodialysis session. An electrocardiogram (ECG) reveals ST-segment elevation in the anterior leads. Which of the following is the most likely diagnosis? A) Hemolysis B) Myocardial infarction C) Dialyzer reaction D) Hypervolemia E) Pulmonary embolism
QBankProAcademy.com
Explanation: The clinical presentation, ECG findings, and risk factors in a patient on hemodialysis suggest a myocardial infarction, which requires prompt evaluation and intervention.
Question 28: A 55-year-old male with ESRD on hemodialysis presents with severe pruritus and dry skin. He reports that the itching is interfering with his daily life. Which of the following is the most appropriate initial management? A) Initiate more frequent hemodialysis sessions B) Prescribe topical corticosteroids C) Recommend increasing fluid intake D) Start antihistamine therapy E) Adjust the hemodialysis membrane type
QBankProAcademy.com
Explanation: Uremic pruritus is common in patients with ESRD, and increasing the frequency of hemodialysis sessions can help in alleviating this symptom by more effectively removing waste products from the blood.
Question 29: A 70-year-old female on hemodialysis presents with sudden-onset visual disturbances and headache. An ophthalmic examination reveals arteriolar narrowing, flame-shaped hemorrhages, and cotton-wool spots. Which of the following is the most likely diagnosis? A) Diabetic retinopathy B) Hypertensive retinopathy C) Retinal detachment D) Macular degeneration E) Ocular migraine
QBankProAcademy.com
Explanation: The clinical presentation and ophthalmic findings are consistent with hypertensive retinopathy, a complication of uncontrolled hypertension often seen in patients with ESRD.
Question 30: A 50-year-old male on hemodialysis for the past 2 years presents with severe muscle cramps during dialysis sessions. These cramps are affecting his treatment compliance. Which of the following interventions is most appropriate for managing this symptom? A) Increasing dietary potassium intake B) Adjusting the dialysate calcium concentration C) Administering a nonsteroidal anti-inflammatory drug (NSAID) D) Initiating peritoneal dialysis E) Referring for kidney transplant evaluation
QBankProAcademy.com
Explanation: Muscle cramps during hemodialysis can be related to imbalances in calcium and other electrolytes. Adjusting the dialysate calcium concentration can often alleviate these symptoms.
Question 31: A 60-year-old male with end-stage renal disease (ESRD) on chronic hemodialysis presents with complaints of confusion, muscle weakness, and tingling in his extremities. Laboratory tests reveal a serum calcium level of 6.8 mg/dL and a phosphorus level of 8.5 mg/dL. Which of the following is the most likely diagnosis? A) Hypokalemia B) Hypercalcemia C) Hyperphosphatemia D) Hypoglycemia E) Metabolic acidosis
QBankProAcademy.com
Explanation: The clinical presentation, along with low serum calcium and elevated phosphorus levels, is indicative of hypercalcemia, a common complication in patients with ESRD.
Question 32: A 45-year-old female on hemodialysis presents with complaints of persistent headaches, nausea, and generalized weakness. Laboratory tests reveal a hemoglobin level of 10.5 g/dL and a serum ferritin level of 1500 ng/mL. Which of the following is the most likely diagnosis? A) Anemia of chronic disease B) Hemolysis C) Iron deficiency anemia D) Hemorrhage E) Thalassemia
QBankProAcademy.com
Explanation: The clinical presentation, along with a normal serum ferritin level, is suggestive of anemia of chronic disease, a common type of anemia in patients with ESRD.
Question 33: A 55-year-old male on hemodialysis for several years presents with a severe burning sensation and erythema at the site of his arteriovenous fistula. On examination, the site is warm to touch, swollen, and tender. Laboratory tests show an elevated white blood cell count. What is the most likely diagnosis?
A) Allergic reaction B) Cellulitis C) Hemolysis D) Phlebitis E) Fistula malfunction
QBankProAcademy.com
Explanation: The clinical presentation, including warmth, swelling, erythema, and tenderness at the fistula site, along with an elevated white blood cell count, is indicative of cellulitis, a common infection in patients with arteriovenous fistulas.
Question 34: A 70-year-old female on hemodialysis presents with persistent pruritus, dry skin, and mucosal bleeding. Laboratory tests reveal a prolonged bleeding time and low platelet count. Which of the following is the most likely diagnosis?
A) Uremic bleeding B) Thrombocytopenia C) Hemolysis D) Platelet dysfunction E) Iron-deficiency anemia
QBankProAcademy.com
Explanation: The clinical presentation, along with a prolonged bleeding time and low platelet count, is consistent with uremic bleeding, a common bleeding disorder in patients with ESRD.
Question 35: A 50-year-old male on hemodialysis for the past 3 years presents with severe muscle cramps during dialysis sessions. These cramps are affecting his treatment compliance. Which of the following interventions is most appropriate for managing this symptom? A) Increasing dietary potassium intake B) Adjusting the dialysate calcium concentration C) Administering a nonsteroidal anti-inflammatory drug (NSAID) D) Initiating peritoneal dialysis E) Referring for kidney transplant evaluation
QBankProAcademy.com
Explanation: Muscle cramps during hemodialysis can be related to imbalances in calcium and other electrolytes. Adjusting the dialysate calcium concentration can often alleviate these symptoms.
Question 36: A 65-year-old male on chronic hemodialysis presents with complaints of sudden-onset chest pain and shortness of breath during a dialysis session. He is diaphoretic, and an electrocardiogram (ECG) reveals ST-segment elevation in the anterior leads. Which of the following is the most likely diagnosis?
A) Hemolysis B) Myocardial infarction C) Dialyzer reaction D) Hypervolemia E) Pulmonary embolism
QBankProAcademy.com
Explanation: The clinical presentation, ECG findings, and risk factors in a patient on hemodialysis suggest a myocardial infarction, which requires prompt evaluation and intervention.
Question 37: A 45-year-old female on hemodialysis presents with persistent pruritus, dry skin, and mucosal bleeding. Laboratory tests reveal a prolonged bleeding time and low platelet count. Which of the following is the most likely diagnosis?
A) Uremic bleeding B) Thrombocytopenia C) Hemolysis D) Platelet dysfunction E) Iron-deficiency anemia
QBankProAcademy.com
Explanation: The clinical presentation, along with a prolonged bleeding time and low platelet count, is consistent with uremic bleeding, a common bleeding disorder in patients with ESRD.
Question 38: A 55-year-old male on hemodialysis for several years presents with a severe burning sensation and erythema at the site of his arteriovenous fistula. On examination, the site is warm to touch, swollen, and tender. Laboratory tests show an elevated white blood cell count. What is the most likely diagnosis?
A) Allergic reaction B) Cellulitis C) Hemolysis D) Phlebitis E) Fistula malfunction
QBankProAcademy.com
Explanation: The clinical presentation, including warmth, swelling, erythema, and tenderness at the fistula site, along with an elevated white blood cell count, is indicative of cellulitis, a common infection in patients with arteriovenous fistulas.
Question 39: A 70-year-old female on hemodialysis presents with complaints of confusion, muscle weakness, and tingling in her extremities. Laboratory tests reveal a serum calcium level of 6.8 mg/dL and a phosphorus level of 8.5 mg/dL. Which of the following is the most likely diagnosis? A) Hypokalemia B) Hypercalcemia C) Hyperphosphatemia D) Hypoglycemia E) Metabolic acidosis
QBankProAcademy.com
Explanation: The clinical presentation, along with low serum calcium and elevated phosphorus levels, is indicative of hypercalcemia, a common complication in patients with ESRD.
Question 40: A 50-year-old male on hemodialysis presents with complaints of persistent headaches, nausea, and generalized weakness. Laboratory tests reveal a hemoglobin level of 10.5 g/dL and a serum ferritin level of 1500 ng/mL. Which of the following is the most likely diagnosis?
A) Anemia of chronic disease B) Hemolysis C) Iron deficiency anemia D) Hemorrhage E) Thalassemia
QBankProAcademy.com
Explanation: The clinical presentation, along with a normal serum ferritin level, is suggestive of anemia of chronic disease, a common type of anemia in patients with ESRD.
Question 41: A 55-year-old female with end-stage renal disease (ESRD) on peritoneal dialysis presents with abdominal pain, cloudy peritoneal dialysis effluent, and a fever of 101°F (38.3°C). On examination, there is tenderness over the abdomen. Peritoneal fluid analysis shows an elevated white blood cell count with a predominance of neutrophils. Which of the following is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
QBankProAcademy.com
Explanation: The clinical presentation, including cloudy effluent, abdominal pain, fever, and peritoneal fluid analysis showing elevated white blood cells with neutrophils, is indicative of peritonitis, a common complication in peritoneal dialysis patients.
Question 42: A 45-year-old male with ESRD on peritoneal dialysis presents with episodes of severe muscle cramps, nausea, and confusion during exchanges. Laboratory tests show an elevated serum potassium level. Which of the following interventions is most appropriate to manage his symptoms?
A) Increasing dietary protein intake B) Initiating hemodialysis C) Adjusting the dwell time of exchanges D) Administering a potassium-binding resin E) Decreasing fluid intake
QBankProAcademy.com
Explanation: The patient’s symptoms and elevated serum potassium levels suggest hyperkalemia, a common issue in peritoneal dialysis patients. Administering a potassium-binding resin can help manage this condition.
Question 43: A 60-year-old male with ESRD on peritoneal dialysis presents with complaints of persistent back pain and cloudy peritoneal effluent. An X-ray shows calcifications along the peritoneal membrane. Which of the following is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Encapsulating peritoneal sclerosis D) Hernia E) Bowel obstruction
QBankProAcademy.com
Explanation: The clinical presentation, along with calcifications seen on imaging, is suggestive of encapsulating peritoneal sclerosis, a rare but serious complication in peritoneal dialysis patients.
Question 44: A 50-year-old female on peritoneal dialysis presents with a cloudy peritoneal dialysis effluent and abdominal discomfort. Laboratory tests reveal an elevated white blood cell count with an eosinophilic predominance. What is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Eosinophilic gastroenteritis E) Peritoneal eosinophilia
QBankProAcademy.com
Explanation: The clinical presentation, including cloudy effluent and an elevated white blood cell count with eosinophil predominance, is suggestive of peritoneal eosinophilia, a condition that can occur in peritoneal dialysis patients.
Question 45: A 70-year-old male on peritoneal dialysis presents with a decreased ultrafiltration rate, weight gain, and peripheral edema. Laboratory tests show hypervolemia. Which of the following is the most likely cause of his symptoms?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
QBankProAcademy.com
Explanation: The patient’s symptoms, including weight gain, edema, and hypervolemia, are suggestive of ultrafiltration failure, a common issue in peritoneal dialysis when the removal of excess fluid is inadequate.
Question 46: A 55-year-old female with end-stage renal disease (ESRD) on peritoneal dialysis presents with abdominal pain, cloudy peritoneal dialysis effluent, and a fever of 101°F (38.3°C). On examination, there is tenderness over the abdomen. Peritoneal fluid analysis shows an elevated white blood cell count with a predominance of neutrophils. Which of the following is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
QBankProAcademy.com
Explanation: The clinical presentation, including cloudy effluent, abdominal pain, fever, and peritoneal fluid analysis showing elevated white blood cells with neutrophils, is indicative of peritonitis, a common complication in peritoneal dialysis patients.
Question 47: A 50-year-old male with ESRD on peritoneal dialysis presents with episodes of severe muscle cramps, nausea, and confusion during exchanges. Laboratory tests show an elevated serum potassium level. Which of the following interventions is most appropriate to manage his symptoms?
A) Increasing dietary protein intake B) Initiating hemodialysis C) Adjusting the dwell time of exchanges D) Administering a potassium-binding resin E) Decreasing fluid intake
QBankProAcademy.com
Explanation: The patient’s symptoms and elevated serum potassium levels suggest hyperkalemia, a common issue in peritoneal dialysis patients. Administering a potassium-binding resin can help manage this condition.
Question 48: A 60-year-old male with ESRD on peritoneal dialysis presents with complaints of persistent back pain and cloudy peritoneal effluent. An X-ray shows calcifications along the peritoneal membrane. Which of the following is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Encapsulating peritoneal sclerosis D) Hernia E) Bowel obstruction
QBankProAcademy.com
Explanation: The clinical presentation, along with calcifications seen on imaging, is suggestive of encapsulating peritoneal sclerosis, a rare but serious complication in peritoneal dialysis patients.
Question 49: A 70-year-old male on peritoneal dialysis presents with a decreased ultrafiltration rate, weight gain, and peripheral edema. Laboratory tests show hypervolemia. Which of the following is the most likely cause of his symptoms?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
Explanation: The patient’s symptoms, including weight gain, edema, and hypervolemia, are suggestive of ultrafiltration failure, a common issue in peritoneal dialysis when the removal of excess fluid is inadequate.
Question 50: A 45-year-old male on peritoneal dialysis presents with a cloudy peritoneal dialysis effluent and abdominal discomfort. Laboratory tests reveal an elevated white blood cell count with an eosinophilic predominance. What is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Eosinophilic gastroenteritis E) Peritoneal eosinophilia
QBankProAcademy.com
Explanation: The clinical presentation, including cloudy effluent and an elevated white blood cell count with eosinophil predominance, is suggestive of peritoneal eosinophilia, a condition that can occur in peritoneal dialysis patients.
Question 51: A 55-year-old female on peritoneal dialysis presents with severe lower abdominal pain and bloating. She reports constipation and difficulty passing gas. Physical examination reveals abdominal distension and tympanic percussion notes. Which of the following is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Intra-abdominal hemorrhage
QBankProAcademy.com
Explanation: The clinical presentation, including lower abdominal pain, bloating, and constipation, is consistent with constipation, a common issue that can cause discomfort in peritoneal dialysis patients.
Question 52: A 60-year-old male on peritoneal dialysis presents with a cloudy peritoneal dialysis effluent and abdominal discomfort. Laboratory tests show an elevated white blood cell count with a predominance of eosinophils. What is the most likely diagnosis?
A) Peritonitis B) Exit-site infection C) Encapsulating peritoneal sclerosis D) Eosinophilic gastroenteritis E) Peritoneal eosinophilia
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Explanation: The clinical presentation, including cloudy effluent and an elevated white blood cell count with eosinophil predominance, is suggestive of peritoneal eosinophilia, a condition that can occur in peritoneal dialysis patients.
Question 53: A 70-year-old male on peritoneal dialysis presents with a decreased ultrafiltration rate, weight gain, and peripheral edema. Laboratory tests show hypervolemia. Which of the following is the most likely cause of his symptoms?
A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
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Explanation: The patient’s symptoms, including weight gain, edema, and hypervolemia, are suggestive of ultrafiltration failure, a common issue in peritoneal dialysis when the removal of excess fluid is inadequate.
Question 54: A 50-year-old female with end-stage renal disease (ESRD) on peritoneal dialysis presents with abdominal pain, cloudy peritoneal dialysis effluent, and a fever of 101°F (38.3°C). On examination, there is tenderness over the abdomen. Peritoneal fluid analysis shows an elevated white blood cell count with a predominance of neutrophils. Which of the following is the most likely diagnosis? A) Peritonitis B) Exit-site infection C) Catheter malfunction D) Constipation E) Ultrafiltration failure
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Explanation: The clinical presentation, including cloudy effluent, abdominal pain, fever, and peritoneal fluid analysis showing elevated white blood cells with neutrophils, is indicative of peritonitis, a common complication in peritoneal dialysis patients.
Question 55: A 60-year-old male with end-stage renal disease (ESRD) on hemodialysis presents with complaints of a painful, swollen, and warm left arm. On examination, there is erythema along the course of the left brachial artery shunt. Laboratory tests reveal an elevated white blood cell count. Which of the following is the most likely diagnosis?
A) Cellulitis B) Hematoma C) Shunt thrombosis D) Aneurysm E) Lymphedema
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Explanation: The clinical presentation of a painful, swollen, erythematous arm with an elevated white blood cell count suggests cellulitis, a common complication in patients with hemodialysis shunts.
Question 56: A 55-year-old female on hemodialysis for several years presents with bleeding from the site of her arteriovenous fistula (AVF) during dialysis. Physical examination shows active oozing of blood from the AVF needle insertion site. What is the most likely cause of the bleeding?
A) AVF infection B) Platelet dysfunction C) Hematoma D) Shunt stenosis E) Hypotension
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Explanation: Oozing from the AVF needle insertion site suggests platelet dysfunction, which can be a complication of hemodialysis, especially in patients with ESRD.
Question 57: A 45-year-old male with ESRD on hemodialysis presents with a cold, pale, and pulseless left arm following AVF needle insertion. Physical examination reveals severe pain and a lack of Doppler signals in the left radial and ulnar arteries. What is the most likely diagnosis?
A) Thrombosis B) Infection C) Hematoma D) Arteriovenous shunt malfunction E) Nerve compression
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Explanation: The clinical presentation of a cold, pale, pulseless arm with severe pain and absent Doppler signals in the arteries suggests thrombosis, a critical complication of AVF.
Question 58: A 70-year-old female on hemodialysis presents with complaints of frequent headaches and confusion during dialysis sessions. Laboratory tests reveal a low hemoglobin level and a high serum calcium level. What is the most likely cause of her symptoms?
A) Hypovolemia B) Dialyzer reaction C) Hypercalcemia D) Infection E) Hypotension
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Explanation: The clinical presentation, low hemoglobin, and high serum calcium levels suggest hypercalcemia, which can occur in patients during hemodialysis and lead to neurological symptoms.
Question 59: A 50-year-old male on hemodialysis presents with persistent pain, swelling, and bruising at the site of his AVF. On examination, the AVF bruit and thrill are absent, and there is a palpable pulsatile mass at the AVF site. What is the most likely diagnosis?
A) Infection B) Hematoma C) Stenosis D) Pseudoaneurysm E) Arteriovenous shunt malfunction
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Explanation: The clinical presentation, including pain, swelling, absence of bruit and thrill, and a palpable pulsatile mass, is indicative of a pseudoaneurysm, a complication of AVF in hemodialysis patients.
Question 60: A 65-year-old female with Stage 3 CKD presents with fatigue, nausea, and poor appetite. Laboratory tests reveal a serum potassium level of 6.5 mEq/L and elevated blood urea nitrogen (BUN) and creatinine levels. Which dietary modification is most appropriate for this patient?
A) Increase dietary potassium intake B) Limit dietary protein intake C) Increase dietary sodium intake D) Increase dietary phosphorus intake E) Increase dietary fluid intake
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Explanation: In patients with Stage 3 CKD, limiting dietary protein intake is essential to manage elevated BUN and creatinine levels, as it helps reduce the production of waste products and decrease the workload on the kidneys.
Question 61: A 55-year-old male with Stage 4 CKD presents with swelling in his legs and ankles. Laboratory tests show hypoalbuminemia and elevated blood pressure. What dietary modification is most appropriate for this patient?
A) Limit dietary sodium intake B) Increase dietary protein intake C) Increase dietary potassium intake D) Increase dietary calcium intake E) Limit dietary fiber intake
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Explanation: Limiting dietary sodium intake is crucial to manage edema and elevated blood pressure in patients with Stage 4 CKD, as it helps reduce fluid retention and maintain better blood pressure control.
Question 62: A 70-year-old male with Stage 5 CKD on hemodialysis presents with severe muscle cramps during dialysis sessions. Laboratory tests show a serum potassium level of 5.8 mEq/L. Which dietary modification is most appropriate for this patient?
A) Increase dietary potassium intake B) Limit dietary protein intake C) Increase dietary sodium intake D) Limit dietary phosphorus intake E) Limit dietary fluid intake
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Explanation: Patients on hemodialysis often experience hypokalemia due to potassium removal during dialysis. Increasing dietary potassium intake can help maintain normal serum potassium levels.
Question 63: A 45-year-old female with Stage 3 CKD presents with elevated phosphorus levels and itching. Laboratory tests also show a low serum calcium level. What dietary modification is most appropriate for this patient?
A) Increase dietary protein intake B) Limit dietary potassium intake C) Increase dietary sodium intake D) Limit dietary phosphorus intake E) Increase dietary fiber intake
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Explanation: For patients with elevated phosphorus levels and low serum calcium, limiting dietary phosphorus intake is essential to prevent complications associated with CKD, such as bone and skin issues.
Question 64: A 50-year-old male with Stage 4 CKD presents with persistent nausea and vomiting. Laboratory tests reveal metabolic acidosis with a low bicarbonate level. What dietary modification is most appropriate for this patient?
A) Limit dietary protein intake B) Increase dietary potassium intake C) Increase dietary sodium intake D) Increase dietary calcium intake E) Limit dietary phosphorus intake
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Explanation: In patients with metabolic acidosis and CKD, limiting dietary protein intake is recommended to reduce the production of acid in the body and help correct the acid-base imbalance.
Question 65: A 70-year-old male patient with multiple comorbidities presents with a chief complaint of fatigue and reduced urine output. Laboratory tests reveal a serum creatinine level of 3.5 mg/dL. Which diagnostic test is most appropriate to estimate his renal function?
A) Urine specific gravity B) Serum potassium level C) Serum albumin level D) Creatinine clearance E) White blood cell count
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Explanation: Creatinine clearance is a common test used to estimate renal function, especially when serum creatinine levels are elevated. It provides a measure of the glomerular filtration rate (GFR) and helps assess kidney function.
Question 66: A 35-year-old female presents with complaints of frequent urination, thirst, and unintentional weight loss. Laboratory tests reveal a serum creatinine level within the normal range. Which diagnostic test is most appropriate to estimate her renal function?
A) Urine specific gravity B) Serum potassium level C) Serum albumin level D) Creatinine clearance E) Hemoglobin A1c
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Explanation: In patients with normal serum creatinine levels, creatinine clearance can provide additional information about renal function. However, it is often used in conjunction with other tests, like the estimated glomerular filtration rate (eGFR), to assess kidney function more comprehensively.
Question 67: A 60-year-old male patient with known kidney disease presents with worsening renal function. His serum creatinine level has been steadily rising over the past year. Which diagnostic test can provide valuable information about his glomerular filtration rate (GFR)?
A) Urine specific gravity B) Serum potassium level C) Serum albumin level D) Creatinine clearance E) Radiographic imaging of the kidneys
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Explanation: Creatinine clearance is a valuable test to estimate the glomerular filtration rate (GFR), especially in patients with known kidney disease. It helps monitor changes in renal function over time.
Question 68: A 45-year-old female patient with hypertension and diabetes presents with complaints of frequent urination and increased thirst. Laboratory tests reveal an elevated serum creatinine level. Which diagnostic test is most appropriate to estimate her renal function?
A) Urine specific gravity B) Serum potassium level C) Serum albumin level D) Creatinine clearance E) HbA1c (Hemoglobin A1c)
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Explanation: Creatinine clearance is a useful test to estimate renal function, especially in patients with elevated serum creatinine levels. In patients with diabetes, it can help assess the impact of kidney function on glycemic control.
Question 69: A 50-year-old male patient with known kidney disease presents with a significant reduction in urine output and generalized swelling. Laboratory tests reveal a serum creatinine level of 5.2 mg/dL. Which diagnostic test is most appropriate to estimate his renal function?
A) Urine specific gravity B) Serum potassium level C) Serum albumin level D) Creatinine clearance E) Erythropoietin level
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Explanation: In patients with known kidney disease and elevated serum creatinine levels, creatinine clearance can provide important information about renal function, including the severity of kidney dysfunction.
Question 70: A 25-year-old male presents with a sudden onset of hematuria and periorbital edema. He reports recent upper respiratory tract infection symptoms. Urinalysis shows red blood cell casts. Which diagnostic test is most appropriate for confirming the diagnosis?
A) Serum creatinine level B) Urine protein/creatinine ratio C) Antinuclear antibody (ANA) test D) Streptococcal antibody titers E) Serum electrolyte panel
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Explanation: The clinical presentation of hematuria, periorbital edema, and red blood cell casts, following an upper respiratory tract infection, suggests poststreptococcal glomerulonephritis. Confirming the diagnosis typically involves assessing streptococcal antibody titers.
Question 71: A 40-year-old female presents with hypertension, proteinuria, and edema. Laboratory tests reveal hypoalbuminemia and hyperlipidemia. Which diagnostic test is most appropriate for evaluating her condition?
A) Serum creatinine level B) Urine protein/creatinine ratio C) Antinuclear antibody (ANA) test D) Complement levels (C3 and C4) E) Serum electrolyte panel
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Explanation: The clinical presentation, along with hypoalbuminemia and hyperlipidemia, is suggestive of nephrotic syndrome, which can be associated with various underlying causes, including glomerulonephritis. Complement levels (C3 and C4) can help determine if the condition is related to complement activation.
Question 72: A 30-year-old male presents with dark urine, facial puffiness, and fatigue. Laboratory tests reveal hematuria, proteinuria, and elevated serum creatinine levels. Which diagnostic test is most appropriate for further evaluation?
A) Urine protein/creatinine ratio B) Antinuclear antibody (ANA) test C) Streptococcal antibody titers D) Serum electrolyte panel E) Renal biopsy
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Explanation: The combination of hematuria, proteinuria, and elevated serum creatinine levels suggests glomerulonephritis. Renal biopsy is essential for a definitive diagnosis and to determine the underlying type and extent of renal damage.
Question 73: A 50-year-old female presents with recurrent urinary tract infections, lower back pain, and hematuria. Laboratory tests show pyuria and white blood cell casts in the urine. Which diagnostic test is most appropriate for evaluating her condition?
A) Serum creatinine level B) Urine protein/creatinine ratio C) Antinuclear antibody (ANA) test D) Complement levels (C3 and C4) E) Urine culture and sensitivity
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Explanation: The clinical presentation, including recurrent UTIs, hematuria, and white blood cell casts, suggests a possible underlying urinary tract infection. Urine culture and sensitivity testing can help identify the causative organism and guide appropriate treatment.
Question 74: A 35-year-old male presents with hypertension, oliguria, and periorbital edema. Laboratory tests reveal hematuria, proteinuria, and elevated serum creatinine levels. Which diagnostic test is most appropriate for assessing the underlying cause of his symptoms?
A) Urine protein/creatinine ratio B) Antinuclear antibody (ANA) test C) Complement levels (C3 and C4) D) Streptococcal antibody titers E) Renal ultrasound
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Explanation: The clinical presentation, along with hematuria, proteinuria, and elevated serum creatinine levels, suggests glomerulonephritis. Assessment of complement levels (C3 and C4) can help determine if complement activation is involved in the pathogenesis, which may be seen in some forms of glomerulonephritis.
Question 75: A 55-year-old male with advanced cirrhosis presents with ascites, jaundice, and oliguria. His laboratory tests reveal elevated serum creatinine and blood urea nitrogen (BUN) levels. Diagnostic tests show no evidence of structural kidney disease or obstruction. What is the most likely diagnosis?
A) Acute kidney injury (AKI) B) Chronic kidney disease (CKD) C) Hepatorenal syndrome (HRS) D) Urinary tract infection (UTI) E) Nephrotic syndrome
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Explanation: The clinical presentation of ascites, jaundice, oliguria, and elevated serum creatinine and BUN in a patient with advanced cirrhosis, along with the exclusion of other causes of renal dysfunction, is suggestive of hepatorenal syndrome (HRS).
Question 76: A 60-year-old female with liver cirrhosis secondary to chronic alcohol abuse presents with worsening ascites and rapidly declining kidney function. She has a history of recurrent bacterial infections. Laboratory tests show elevated serum creatinine and BUN levels. What condition should be considered in her diagnosis?
A) Acute kidney injury (AKI) B) Chronic kidney disease (CKD) C) Hepatorenal syndrome (HRS) D) Spontaneous bacterial peritonitis (SBP) E) Nephrotic syndrome
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Explanation: The patient’s history of recurrent bacterial infections and worsening ascites, along with elevated serum creatinine and BUN, should prompt consideration of spontaneous bacterial peritonitis (SBP) as a cause of renal dysfunction in cirrhotic patients.
Question 77: A 45-year-old male with end-stage liver disease presents with increased abdominal girth, generalized edema, and oliguria. Laboratory tests reveal elevated serum creatinine and BUN levels. Diagnostic imaging shows no signs of urinary tract obstruction. What is the most likely diagnosis?
A) Acute kidney injury (AKI) B) Chronic kidney disease (CKD) C) Hepatorenal syndrome (HRS) D) Urinary tract infection (UTI) E) Nephrotic syndrome
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Explanation: The clinical presentation of increased abdominal girth, edema, and oliguria in a patient with end-stage liver disease, along with elevated serum creatinine and BUN, is suggestive of hepatorenal syndrome (HRS).
Question 78: A 70-year-old male with cirrhosis presents with confusion, jaundice, and oliguria. Laboratory tests reveal elevated serum creatinine and BUN levels. Diagnostic tests rule out structural kidney disease or urinary tract obstruction. Which condition is most likely responsible for his renal dysfunction?
A) Acute kidney injury (AKI) B) Chronic kidney disease (CKD) C) Hepatorenal syndrome (HRS) D) Urinary tract infection (UTI) E) Nephrotic syndrome
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Explanation: The clinical presentation of cirrhosis, confusion, jaundice, and oliguria, along with elevated serum creatinine and BUN, is suggestive of hepatorenal syndrome (HRS) in the absence of other causes of renal dysfunction.
Question 79: A 50-year-old female with liver cirrhosis due to viral hepatitis presents with worsening ascites, hypotension, and oliguria. Laboratory tests show elevated serum creatinine and BUN levels. What condition should be considered in her diagnosis?
A) Acute kidney injury (AKI) B) Chronic kidney disease (CKD) C) Hepatorenal syndrome (HRS) D) Spontaneous bacterial peritonitis (SBP) E) Nephrotic syndrome
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Explanation: The clinical presentation of worsening ascites, hypotension, and oliguria in a patient with liver cirrhosis, along with elevated serum creatinine and BUN, suggests hepatorenal syndrome (HRS) in the absence of other causes of renal dysfunction.