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NephSAP Module 2 Chronic Kidney Disease and Progression Post toets

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1. A 71-yr-old Caucasian man with history of diabetes, coronary artery disease, hypertension, and proteinuria is treated by a primary care physician with an angiotensin-converting enzyme inhibitor (ACEI) along with other medications that are appropriate for his medical conditions. The patient is referred to you and brings an Internet printout that refers to the risks and benefits of combining the ACEI with an angiotensin receptor blocker (ARB).

Which ONE of the following is correct for describing the effects of the combination of ACEI and ARBs compared with ACEI treatment alone?

A. The risk for cardiovascular death will be reduced.
B. There will be an increase in risk for allergic reactions.
C. The rate of renal disease progression will be slowed.
D. There is increased risk for hypotension and acute renal failure.
E. There will be a reduction in risk for sudden cardiac death.

2. A 72-yr-old African American man with a history of hypertension and pneumonia is found to have an elevated serum phosphorus concentration. The serum creatinine is elevated at 2.0 mg/dl, and the estimated GFR (eGFR) is reduced at 43 ml/min per 1.73 m2. The internist is surprised that hyperphosphatemia is present this early in chronic kidney disease (CKD), without a severely reduced GFR level.

Which ONE of the following is correct?

A. Most patients with stage 3 CKD have hyperphosphatemia.
B. The patient should be evaluated for hypoparathyroidism.
C. His race/ethnicity likely explains his hyperphosphatemia at this stage of CKD.
D. Early treatment with phosphate binders will delay the progression of his renal disease.
E. The Modification of Diet in Renal Disease (MDRD) Study equation markedly overestimates GFR in this range, thus explaining his hyperphosphatemia.

3. A 44-yr-old man consults you because he has read a report that links low birth weight with increased risk for subsequent kidney disease. He weighed [H11021]2500 g at birth and wonders whether he may have or be at risk for renal disease. He is being treated for hypertension with a dihydropyridine calcium channel blocker and has BP of 127/69 mmHg. He does not smoke but drinks a glass of red wine every night. The serum creatinine and urinalysis are found to be normal.

As you look to advise him, which ONE of the following statements is correct?

A. There is no established association between low birth weight and risk for subsequent renal disease.
B. Increased risk for early (first 14 years of life) ESRD is greater than increased risk for later ESRD.
C. Low birth weight increases renal risk in African American individuals more than in Caucasian individuals.
D. Men of low birth weight are far less likely to develop subsequent renal disease than women of low birth weight.
E. After adjustment for maternal age at birth, the association between low birth weight and renal risk is eliminated.

4. A 59-yr-old African American man is referred to you for resistant hypertension and elevated serum creatinine. The patient lives in a particularly poor area and has no medical insurance. His BP is found to be 141/86 mmHg while on a diuretic and a calcium channel blocker. The serum creatinine level is 2.0 mg/dl, and low-grade proteinuria is present.

Which ONE of the following statements is correct?

A. BP control in the United States is not significantly different between African American and other races.
B. Diuretics should be avoided in African American indivi duals with hypertension.
C. Neighborhood poverty affects African American indivi duals' risk for CKD but not Caucasian individuals' risk.
D. Neighborhood poverty does not affect risk for CKD.
E. The worse the severity of neighborhood poverty, the greater the augmentation of CKD risk for African American compared with Caucasian individuals.

5. A 52-yr-old man with diabetes, hypertension, congestive heart failure (CHF), and mild obesity has diminished eGFR (38 ml/min per 1.73 m2) and albuminuria. On examination his BP is 128/73 mmHg, the heart examination is positive for a fourth heart sound, and trace ankle edema is present. The patient is treated with several medications, including an ACEI. He would like to know whether his kidney disease has any effect on his risk for cardiovascular disease.

Which ONE of the following statements is correct?

A. CKD is associated with increased risk for cardiovascular events only when eGFR is [H11021]15 ml/min per 1.73 m2.
B. CKD and albuminuria each are independent risk factors for cardiovascular disease.
C. CKD increases risk for cardiovascular events as a group, excluding stroke.
D. Among patients with CHF, CKD does not affect risk for hospitalizations.
E. The addition of an ARB would reduce this patient's risk for subsequent cardiovascular events.

6. A 73-yr-old Caucasian man presents to a hospital with chest pain and is found to be having a new ST elevation myocardial infarction (MI). He has a history of hypertension, hypercholesterolemia, and CKD (eGFR 41 ml/min per 1.73 m2). The patient is taken to the cardiac catheterization laboratory within 80 min of hospital arrival, where is he found to have a culprit coronary artery lesion that is treated with angioplasty and stent placement. The patient recovers uneventfully, and his renal function does not deteriorate.

Which ONE of the following statements is correct regarding CKD and MI?

A. Given his CKD, he should not have undergone emergency cardiac catheterization.
B. His coronary angiography showing proximal culprit coronary lesions is typical for patients with CKD.
C. He should not receive aspirin treatment.
D. His CKD does not increase his risk for long-term mortality after MI.
E. Blocker therapy does not reduce risk for subsequent MI in patients with CKD.

7. A 55-yr-old Caucasian, obese man with hyper-tension and hypercholesterolemia is referred for elevated serum creatinine. His eGFR is 22 ml/ min per 1.73 m2, consistent with stage 4 CKD. Among his several medications, he is treated with a statin. His current total cholesterol and LDL and HDL cholesterol are well controlled, but the patient has occasional "aches" in his left calf when walking.

Which ONE of the following statements is correct concerning statin treatment in CKD?

A. His statin treatment will reduce his risk for cardiovascular morbidity.
B. The statin should be discontinued because of myopathy.
C. His statin therapy will likely lead to an improvement in his GFR.
D. He should be switched to treatment with a fibrate.

8. A 49-yr-old man with type 2 diabetes and hypertension has CKD with an eGFR of 37 ml/min per 1.73 m2. His medical history is notable for MI 3 yr earlier. The patient has no chest pain now, either at rest or with exertion. He is treated with aspirin, insulin, and metoprolol. His hemoglobin (Hb) A1c is 7.1%. His examination is notable for mild obesity and arcus senilis; the resting pulse is 62 bpm, and BP is 119/67 mmHg.

Which ONE of the following statements is correct regarding CKD and MI?

A. A. His beta-blocker should be discontinued because of his diabetes.
B. His aspirin therapy should be stopped.
C. Metformin should be added to improve glucose control.
D. His current regimen should be continued
E. Blocker therapy does not reduce risk for subsequent MI in patients with CKD.

9. A 70-yr-old woman with CKD caused by membranous nephropathy has an eGFR of 42 ml/min per 1.73 m2. Her BP is well controlled, and her total, HDL, and LDL cholesterol concentrations are within target ranges. She is concerned by reports that her kidney disease may increase the risk for heart disease and asks for your advice.

Which ONE of the following statements is correct in this regard?

A. Risk for heart disease in CKD is eliminated by aggressive BP and cholesterollowering treatment.
B. CKD predicts risk for cardiovascular events, but this relationship disappears after correction for traditional cardiovascular risk factors.
C. CKD is associated with increased risk for cardiovascular events, except for primary glomerular diseases.
D. CKD is established as a cause of accelerated atherosclerosis.
E. CKD is strongly and independently associated with increased cardiovascular risk.