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3rd Day Quiz Answer - Dr. Emad Magdy
This document contains a quiz with 10 multiple choice questions about various topics in nephrology and hypertension in pregnancy. For each question, the correct answer is identified and a brief explanation of the relevant concept is provided. The questions cover topics such as gestational hypertension, intradialytic phosphate kinetics, dialysis prescriptions in pregnancy, immunosuppressive drugs in pregnancy, membranous nephropathy, acute hypertension treatment in pregnancy, electrolyte abnormalities in acute myeloid leukemia, ANCA-associated vasculitis, factors associated with increased FGF23 in CKD, and the effects of estrogen on mesangial cells.
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3rd Day Quiz Answer - Dr. Emad Magdy
- 1. Quiz Answer EMAD MAGDYSHAWKY
- 2. 1- Gestational hypertensionis characterized by all of the following except: A. Hypertension that develops after 20 weeks gestation. B. Not associated with maternal end organ damage. C. Usually resolve after 6 months postpartum. D. Carries a 10% risk of progressing to preeclampsia.
- 3. Explanation 1. Gestational hypertension 2.Preeclampsia-eclampsia 3. Preeclampsia superimposed on chronic HTN 4. Chronic hypertension. Gestational hypertension • Newly elevated BP after 20 weeks gestation without evidence of maternal organ dysfunction. This should usually resolve by 12 weeks postpartum. • If persists beyond 12 weeks postpartum, the diagnosis is likely chronic/preexisting hypertension that has been masked by the physiologic decrease in BP that occurs in early pregnancy. • Women with gestational hypertension have a 10% risk of progressing to preeclampsia if they present after 36 weeks of gestation, but > 1/3 risk if they present before 32 weeks.
- 4. 2- Which oneof the following statements regarding intradialytic phosphate kinetics is CORRECT? A. Phosphate is removed throughout the dialysis session. B. Pre- and post-HD phosphate levels are similar. C. Phosphate levels decrease during the first 90–120 min, and then stabilize. D. Phosphate level decreases in those who take sevelamer compared to those who take calcium acetate.
- 5. Explanation Phosphate kineticsduring dialysis was studied in patients by several investigators. It was found that during the first 90–120 min into dialysis, serum phosphate levels decrease substantially by elimination into the dialysate and then stabilize. Stabilization occurs as a result of mobilization of phosphate from other compartments at a rate similar to its removal so that the plasma concentration of phosphate remains low (at stabilization level). Thus, B is incorrect and C is correct. Phosphate kinetics is not altered by food intake or phosphate binders (D is incorrect).
- 6. 3- Regarding dialysisprescription for an ESRD pregnant female, which of the following is more suitable? A. The higher the dialysate sodium, the better the outcome B. Dialysis in sitting position is preferred. C. PD is the preferred than HD. D. Higher doses of multivitamins may be needed, because they can be partially removed by intensive dialysis.
- 7. Explanation Water soluble vitaminsneed to be given at increased doses, because they can be partially removed by intensive dialysis.
- 8. 4- Which ofthe following immunosuppressive drugs is contraindicated in pregnancy? A. Prednisone B. Cyclosporine C. Azathioprine D. Mycophenolate mofetil
- 10. 5- Which ofthe following is most specific for primary Membranous nephropathy by immunofluorescence? A. C1q staining. B. Mesangial immunoglobulin staining. C. PLA2R positive staining. D. IgG3 and IgG1 rather than IgG4 staining.
- 11. Beck et al.,N Engl J Med 361, 11-21 (2009)
- 12. 6- Which ofthe following is not recommended for treating acute hypertension in pregnancy: A. Labetalol. B. Hydralazine. C. Nifedipine. D. Methyl-dopa.
- 14. 7- Whenreviewing chemistry panel of newly diagnosed patient with acute myeloid leukemia (AML), lethargic, complaining of flank pain, nausea and vomiting. You would expect to see which of the following: A. Serum potassium 4.5 mEq/L, phosphorus 8 mg/dl, uric acid 7 mg/dl, calcium 9 mg/dl, BUN 12 mg/dl. B. Serum potassium 6.5 mEq/L, phosphorus 8 mg/dl, uric acid 9 mg/dl, calcium 10 mg/dl, BUN 14 mg/dl. C. Serum potassium 4 mEq/L, phosphorus 9 mg/dl, uric acid 10 mg/dl, calcium 10 mg/dl, BUN 10 mg/dl. D. Serum potassium 7 mEq/L, phosphorus 12 mg/dl, uric acid 10 mg/dl, calcium 7 mg/dl, BUN 25 mg/dl.
- 15. Metabolic derangement resultingfrom massive destruction of malignant cells (spontaneous or treatment-related tumor necrosis or apoptosis), leading to electrolyte abnormalities and, consequently, renal, cardiac, and neurologic dysfunction and possibly death if left untreated Hyperuricemia Hyperkalemia Hyperphosphatemia Hypocalcemia.
- 16. 8- Regarding patientswith pauci-immune vasculitis, which one of the following statements is CORRECT? A. Only those patients with seropositive cANCA demonstrate severe glomerular pathology B. Only those patients with seropositive pANCA demonstrate severe glomerular pathology C. Only those patients with both cANCA and pANCA demonstrate severe glomerular pathology D. Patients with negative ANCA (either cANCA or pANCA) demonstrate as severe renal disease as those with positive ANCA
- 17. Explanation Pauci-immune vasculitiswith fibrinoid necrosis and active cellular crescents is usually associated with the presence of either cANCA or pANCA. However, ANCAs are absent in 5–30 % of patients with pauci- immune vasculitis and these ANCA-negative patients may have severe renal disease as ANCA-positive patients. If clinical findings are suggestive of pauci-immune vasculitis, a renal biopsy is indicated and the treatment should be the same as ANCA positive patients.
- 18. 9- Which oneof the following cardiovascular disorders has the highest correlation with increase FGF23 level in CKD patients: A. Vascular calcification. B. Valvular calcification. C. Myocardial infarction. D. Congestive heart failure.
- 19.
- 22. 10- The rateof progression of renal disease is lower in premenopausal women than postmenopausal women. Which one of the following effects of estrogen on mesangial cells in INCORRECT? A. It inhibits type IV collagen synthesis B. It inhibits oxidation of LDL C. It inhibits nitric oxide production D. It inhibits TGF-β-induced apoptosis
- 23. Explanation Estrogens haveseveral beneficial effects on mesangial cells. In vitro studies have shown that estrogens decrease type IV collagen synthesis by increasing collagenase activity, inhibit LDL oxidation, and reverse TGF- β-induced apoptosis. Also, estrogens inhibit mesangial cell proliferation. Estrogens increase nitric oxide synthesis, PGE2 and prostacyclin levels. Female rats have higher levels of nitric oxide than male rats, and ovariectomy abolishes these levels. Thus, option C is incorrect.