Answer 10

10.  Choice B is the correct answer.  Renal angiography is considered the gold standard for diagnosis of renal vascular disease.  Renal vascular disease should be considered a correctable cause of secondary hypertension.  Plasma renin is only elevated 50-80 percent of the time in those with renal hypertension.  MRA of the Renal Arteries and Doppler Ultrasonography of the kidneys and renal arteries are considered less sensitive modalities for diagnosis of renal vascular disease.

Question 10

10.  Which of the following modalities is the best test to diagnose renal vascular disease?

A.  Plasma renin
B.  Renal angiography
C.  MRA of renal arteries
D.  Doppler Ultrasonography of the Kidneys and Renal Arteries

Answer 9

9.  Choice D is the correct answer.   Hypothermia not fever can cause hypokalemia.  Increase insulin availability to the cells can cause hypokalemia because taking glucose into the cell causes hypokalemia and drives it into the cell.  It is one of the treatments of hyperkalemia.  Alkalosis can cause hypokalemia because the cell is less permeable to keeping it inside when there is an acidic environment.  Increased beta adrenergic activity can cause it.  Albuterol is a treatment for hyperkalemia.  

Question 9

9.  Which of the following is not a cause of hypokalemia?

A.  Increased Beta Adrenergic activity
B.  Alkalosis
C.  Increased insulin availability to the cells
D.  Fever

Answer 8

8.  Choice C is the correct answer.  Diabetic ketoacidosis is still within the differential on this patient and needs to be considered.  With a glucose over 250, abdominal pain, nausea, and vomiting, ketosis can be a culprit.  The patient does not need a general surgery consult at this point, but needs to be admitted to the hospital for aggressive IV hydration and correction of the metabolic acidosis.  This patient should not be discharged.

Question 8

8.  Your patient is a 14 year old female who has been complaining of lower abdominal pain and vomiting for the last 2 days.  She has a history of IDDM.  She was sent to you from urgent care because she was found to have a WBC of 21.4 and was sent for a CT scan of her Abdomen and Pelvis to rule out appendicitis.  .  Her urine and pelvic exam are negative for any evidence of infection.  Her BMP is as follows Sodium 133, K 3.2, Cl 94, CO2, 13, BUN 25, Creatinine 0.5. Glucose 351.  Her CT scan came back normal, and she able to tolerate PO fluids and her abdominal exam is essentially benign.  Which of the following is the best management option?  

A.  Discharge the patient home her CT scan is normal and she can tolerate PO fluids
B.  Admit the patient for IV fluids
C.  Order a serum acetone and ABG
D.  Consult a general surgeon, the patient has a high WBC and needs to be observed

Answer 7

7.  Choice D is the correct answer.  Nephrotic syndrome is considered greater than 3.5 grams in 24 hours.  Hypoalbuminemia is considered less than 3.0 grams/dL.