Nephrology Practice Questions

Q: A 40-year-old male with known cirrhosis has serum bilirubin 2.5 mg/dL, albumin 3.0 g/dL, PT prolonged by 4 seconds, grade I ascites, and no encephalopathy. What is his Child-Pugh score class?

Class B (score 7–9). ***Class B (score 7–9)*** - The **Child-Pugh score** is calculated using five parameters: **bilirubin** 2.5 mg/dL = 2 points, **albumin** 3.0 g/dL = 2 points, **PT prolonged by 4 seconds** = 2 points, **grade I ascites** = 2 points, and **no encephalopathy** = 1 point. - Total score = 2+2+2+2+1 = **9 points**, which falls within the **Class B range of 7–9 points**, indicating moderate hepatic dysfunction. *Class A (score 5–6)* - This represents **well-compensated cirrhosis** with minimal hepatic dysfunction and the best prognosis. - The calculated score of **9 points** exceeds the upper limit of 6 for Class A classification. *Class C (score 10–15)* - This category indicates **decompensated cirrhosis** with severe hepatic dysfunction and poor prognosis, requiring a minimum score of **10 points**. - The patient's score of **9 points** falls one point below the threshold for Class C classification. *Class C (score 9–15)* - This is an **incorrect range** for Class C, as the standard Child-Pugh classification defines Class C as scores **10–15**, not 9–15. - The **lower boundary of Class C is specifically 10 points**, making this option factually inaccurate regarding Child-Pugh scoring criteria.

Q: A 78-year-old man with advanced renal disease has the ECG (lead II). What is the diagnosis?

Hyperkalemia. ***Hyperkalemia*** - **Advanced renal disease** leads to decreased potassium excretion, resulting in hyperkalemia with characteristic ECG changes including **peaked T waves**, **widened QRS complexes**, and **flattened P waves**. - Progressive hyperkalemia can cause a **sine wave pattern** on ECG, which is life-threatening and requires immediate treatment. *Hypercalcemia* - ECG findings include **shortened QT interval** and **ST segment depression**, not the changes seen in hyperkalemia. - Advanced renal disease typically causes **hypocalcemia** due to decreased **vitamin D activation** and **phosphate retention**. *Hypernatremia* - **Does not cause specific ECG changes** and is primarily a disorder of water balance rather than electrolyte disturbances affecting cardiac conduction. - More commonly presents with **neurological symptoms** like confusion and seizures rather than cardiac arrhythmias. *Pericarditis* - ECG shows **diffuse ST elevation** with **PR depression** in multiple leads, which differs from the hyperkalemia pattern. - Clinical presentation includes **chest pain** that worsens with inspiration and improves when sitting forward, along with a **pericardial friction rub**.

Q: A patient presents to a clinic with complaints of headache and fatigue. Lab data show serum sodium, 122 mEq/L; serum osmolality, 240 mOsm/L; urine osmolality, 455 mOsm/L. Which condition best correlates with these data?

SIADH. **Explanation:** The patient presents with **hypotonic hyponatremia** (Serum Na+ <135 mEq/L and Serum Osmolality <275 mOsm/L). The key to diagnosing the etiology lies in the **Urine Osmolality**. 1. **Why SIADH is correct:** In the presence of low serum osmolality, the body should normally suppress Antidiuretic Hormone (ADH) to excrete dilute urine (Urine Osm 100 mOsm/L, here 455 mOsm/L). The clinical picture of headache and fatigue is consistent with mild-to-moderate hyponatremia. 2. **Why other options are incorrect:** * **Diabetes Insipidus (Neurogenic & Nephrogenic):** These conditions are characterized by a lack of ADH effect, leading to **hypernatremia** and the excretion of large volumes of **dilute urine** (Urine Osm <200 mOsm/L). This is the opposite of the laboratory findings provided. * **Diabetes Mellitus:** Uncontrolled DM typically causes **hypertonicity** (due to hyperglycemia) and can lead to "translocational hyponatremia," where the serum osmolality would be high, not low. **NEET-PG High-Yield Pearls:** * **Diagnostic Criteria for SIADH:** Hyponatremia, low serum osmolality, inappropriately high urine osmolality (>100 mOsm/L), and **Urine Sodium >40 mEq/L** (euvolemic state) [1]. * **Common Causes:** Small cell lung cancer (paraneoplastic), CNS disorders (stroke, trauma), and drugs (SSRIs, Carbamazepine, Cyclophosphamide). * **Management:** Fluid restriction is the first-line treatment [2]. For severe symptoms, use 3% hypertonic saline, ensuring the correction rate does not exceed **8–10 mEq/L in 24 hours** to avoid **Osmotic Demyelination Syndrome (ODS)** [2].

Question 1

A 40-year-old male with known cirrhosis has serum bilirubin 2.5 mg/dL, albumin 3.0 g/dL, PT prolonged by 4 seconds, grade I ascites, and no encephalopathy. What is his Child-Pugh score class?

Accepted Answer

Class B (score 7–9)

Answer

Class A (score 5–6)

Answer

Class C (score 10–15)

Answer

Class C (score 9–15)

Question 2

Antibody-coated bacteria are characteristic of which one of the following conditions?

Accepted Answer

Glomerulonephritis

Answer

Pyelonephritis

Answer

Hypertension

Answer

Perinephric abscess

Question 3

A 36-year-old male presents with a complaint of passing dark-reddish urine. He states that yesterday he played basketball for 4 hours, which was the first time he had exercised in 4 months. He awoke this morning with sore muscles and discolored urine. Physical examination is unremarkable. The urine is reddish-brown in color; dipstick test for blood is positive, the pH is 5.1, the specific gravity 1.03. Microscopic examination of the urine reveals no red blood cells. What is the most likely etiology for this presentation?

Accepted Answer

Myoglobinuria

Answer

Hemolyzed blood in the urine

Answer

Ingestion of foods that contained red dye

Answer

Nephrolithiasis

Question 4

A 78-year-old man with advanced renal disease has the ECG (lead II). What is the diagnosis?

Accepted Answer

Hyperkalemia

Answer

Hypercalcemia

Answer

Hypernatremia

Answer

Pericarditis

Question 5

A patient presents to a clinic with complaints of headache and fatigue. Lab data show serum sodium, 122 mEq/L; serum osmolality, 240 mOsm/L; urine osmolality, 455 mOsm/L. Which condition best correlates with these data?

Accepted Answer

SIADH

Answer

Neurogenic diabetes insipidus

Answer

Nephrogenic diabetes insipidus

Answer

Diabetes mellitus

Nephrology — MCQs

Nephrology — MCQs

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