Let op: u kunt de vragen slechts eenmalig beantwoorden.

Voor het beantwoorden van de toetsvragen van de andere delen selecteert u deze pagina.

Klik hier om uw resultaten te bekijken.

NephSAP Module 2 Chronic Kidney Disease and Progression Pre toets

NephsapFeedback m.b.t. het resultaat kunt u direct na verzending inzien. De pre toets heeft geen invloed op het eindresultaat.

NephSAP is mede mogelijk gemaakt door financiële ondersteuning van
Sanofi-Aventis en Bristol Myers Squibb

1. A 47-yr-old African American man presents with edema. BP is 150/100 mmHg. He is found to have a serum creatinine of 2.8 mg/dl and a urinary protein excretion of 6 g/24 h. A renal biopsy shows FSGS. He is started on an angiotensin-converting enzyme inhibitor (ACEI; 20 mg/d lisinopril) and a loop diuretic (40 mg/d furosemide). One week later, his BP is 125/75 mmHg, his urinary protein excretion has decreased to 3 g/24 h, but his serum creatinine has increased to 3.2 mg/dl.

Which ONE of the following should be recommended?

A. Stop the ACEI, switch to a [H9252] blocker, and evaluate for renal artery stenosis.
B. Stop the loop diuretic.
C. Continue the current antihypertensives, and recheck serum creatinine in 1 wk.
D. Stop the ACEI and switch to an angiotensin receptor blocker.
E. Start steroids and cyclophosphamide to treat his glomerular disease.

2. A 37-yr-old African American woman presents with nephrotic syndrome. A kidney biopsy is diagnostic for FSGS. Her current estimated GFR by the abbreviated Modification of Diet in Renal Disease (MDRD) equation is 60 ml/min per 1.73 m2.

Which ONE of the following is the BEST predictor of her risk for progressing to ESRD?

A. The percentage of glomeruli with focal changes on biopsy
B. ACE genotyping for polymorphisms
C. The extent of tubulointerstitial disease on biopsy
D. The level of plasma renin activity
E. A family history of hypertension

3. A 72-yr-old Caucasian man with renovascular disease is admitted with unstable angina. His serum creatinine 1 mo before admission, when he was seen in your office for a scheduled appointment, was 2.5 mg/dl. A coronary angiogram demonstrates a 90% lesion in his left anterior descending coronary artery. He was treated with angioplasty and a stent.

Which ONE of the following choices is TRUE regarding his therapy?

A. He is at higher risk for restenosis compared with a patient with a normal serum creatinine.
B. Long-term survival is better with coronary artery bypass grafting than with angioplasty.
C. Medical therapy is more effective in improving long-term survival than is percutaneous coronary intervention.
D. The use of a platelet glycoprotein IIb/IIIa inhibitor should be avoided because of the increased risk for bleeding.
E. Coronary angiography and angioplasty should not be done because of the risk for acute renal failure.

4. The brother of a patient who has ESRD caused by polycystic kidney disease presents for an evaluation as a potential donor. He is a 50-yr-old Caucasian man without any significant medical history. He has no renal cysts on ultrasound. His BP is 125/70 mmHg. He is of average build and has no edema on physical examination. His urine dipstick analysis is negative for protein and blood. His serum creatinine is 1.2 mg/dl.

Assuming that there are no serum creatinine calibration issues, which ONE of the following statements is MOST correct concerning this individual's estimated GFR by the simplified four-variable MDRD equation?

A. It should be ignored and the Cockcroft-Gault estimated cre atinine clearance should be used to determine his eligibility as a kidney donor.
B. It would likely underestimate his GFR as measured by iothalamate clearance.
C. It would likely overestimate his GFR as measured by inulin clearance.
D. It would likely be an accurate estimate of his GFR as measured by iothalamate clearance.

5. A 45-yr-old Asian woman has chronic glomerulonephritis with advanced renal insufficiency. Her serum creatinine is 4.5 mg/dl, phosphate is 5.2 mg/dl, hemoglobin is 9.5 g/dl, and hematocrit is 29%. Her BP is 150/90 mmHg while on therapy with furosemide, amlodipine, and enalapril. Therapy with recombinant human erythropoietin is instituted.

Which ONE of the following statements is BEST regarding the correction of anemia in this patient?

A. It is likely to be associated with an acceleration of renal disease progression.
B. trong evidence (from controlled clinical trials) of a beneficial effect on cardiovascular morbidity and mortality is lacking.
C. It will likely significantly reduce the development of angiographicaly proven coronary heart disease.
D. Raising the hemoglobin level to normal will lead to regression of left ventricular hypertrophy
E. It is likely to reduce the rate of albumin excretion in the urine.