Answer and Explanation 25

25.  C is the correct answer.  Gentle hydration with normal saline is preferred.  Hydrating the patient with hypertonic saline puts the patient at risk for pontine myelinolysis.  The patient may need a work up for SIADH if there is not a logical explanation for the hyponatremia.  We do not have enough information to prove she has Addison's disease.  This presents with low blood sugar, high potassium and low sodium.

Question 25

25.  Your patient is a 63 year old female that presents with weakness and dizziness.  Your workup reveals a sodium of 117.  She is very concerned about this causing her to seize because she has a history of seizure disorder.  Which of the following is the best therapy?

A. Bolus the patient with Hypertonic Saline

B.  Start working the patient up for SIADH

C.  Gentle hydration with normal saline

D.  Start the patient on aldosterone.  She clearly has Addison's Disease

Answer and Explanation 24

24. C is the correct answer.  This is common with CAPD patients.  Theses patients usually present with cloudy fluid, abdominal pain, and fever.  Pyelonephritis and acute on chronic renal failure will not give you cloudy fluid.

Question 24

24.  Your patient is a 67 year old peritoneal dialysis patient that comes in with abdominal pain, fever, and nausea.  Analysis of the peritoneal fluid reveals WBC 40,000 and a glucose of 88.  Which of the following is the most likely diagnosis?

A.  Acute on chronic renal failure

B.  Pyelonephritis

C.  Peritonitis

D.  Perforated Diverticulitis

Answer and Explanation 23

23.  C is the correct answer.  GI complications of uremia include nausea, vomiting, gastritis, and peptic ulcer disease.  Impotence is associated with uremia as is hyperkalemia.  Anemia is because of lower erythropoetin levels.

Question 23

23.  Which of the following has not been associated with a systemic manifestation of uremia?

A.  Impotence

B.  Anemia

C.  Constipation

D.  Hyperkalemia

Answer and Explanation 22

22.  C is the correct answer.  All of the following have been identified as causing renal failure:  CT scan IV dye, NSAIDS, Cisplatin, Ethylene glycol, ACE inhibitors, Rhabdomyolysis, Hyperuricemic Renal Failure, Hepatorenal Syndrome, and pregnancy.

Question 22

22.  All of the following have been identified as causes of renal failure except:

A.  Pregnancy

B.  Cisplatin

C.  Penicillins

D.  Rhabdomyolysis

Answer and Explanation 21

21.  B is the correct answer.  The stone is on the left.  You know this is a ureter stone as opposed to phlebolith because the kidney and collecting system is dilated on that side.  CREST syndrome has calcium deposits associated with it but usually does not give these findings associated on CT scan.  Amyloidosis usually has to be made by renal biopsy.  

Question 21

21.   Your patient is a 45 year old male that presents with flank pain, nausea and vomiting.  His CT scan is below.  What is his diagnosis?

A.  Phlebolith

B.  Ureter Stone

C.  Amyloidosis

D.  CREST Syndrome