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AFRAN Monthly Quiz - December 2022 - English Version
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Q1-  A 55 year old man had a renal transplant 2 years ago. He is on ciclosporin, prednisolone and tacrolimus. He now has several symptoms.  Which one of the following is a side effect of ciclosporin?



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1 point
Q2- A 68-year-old man is admitted to the Emergency Department with an acute myocardial infarction. He is hypotensive and sweating on admission, with a BP of 100/60 mmHg and pulse of 105/min. There is anterior ST elevation. Past history of note is hypertension, for which he receives ramipril 5 mg, indapamide 2.5 mg and amlodipine 5 mg. Within a few minutes of admission, he suffers a cardiac arrest. In total he receives CPR for 6 min before he regains his output. His BP is 95/60 mmHg, with pulse 100/min and regular. He later goes to the catheter lab where he is stented. Creatinine on admission is 135 micromol/l. What is the optimal initial intervention to prevent acute tubular necrosis?
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1 point
Q3- A 65-year-old woman presents to the clinic for ongoing management of congestive heart failure (CHF) from ischemic cardiomyopathy (ejection fraction 22%) and CKD G3bA2 from type 2 diabetes. She has been hospitalized repeatedly with hyperkalemia, AKI, and acute diastolic heart failure (ADHF), and lisinopril was finally discontinued after several attempts to maintain a dose of 2.5-5 mg/d. She is currently taking furosemide 40 mg twice daily and now reports slightly increased edema but no difficulty breathing. BP is 150/90 mm Hg, heart rate 70 beats per minute, and respiratory rate 13 per minute. Physical examination reveals an S3 gallop, clear lung fields, and pitting edema (2+). Serum potassium level is 5.6 mEq/L, total CO2 level is 40 mEq/L, and Scr is 1.7 mg/dL (150.2 umol/L) (at baseline). Arterial blood gas reveals pH 7.52, partial pressure of CO2 of 58 mm Hg (7.7 kPa), partial pressure of O2 of 95 mm Hg (12.6 kPa), and bicarbonate level of 44 mEq/L.
Which of the following is the next best step in management?  
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1 point
Q4-  A 60-year-old man with End-stage Liver Disease (ESLD) is admitted to the hospital with worsening ascites and dyspnea. He has a history of hepatitis C, esophageal varices, and CKD G3bA1. He is adherent to prescribed medications, including furosemide, spironolactone, and propranolol. BP is 100/60 mm Hg and heart rate 93 beats per minute. Physical examination reveals a tense, distended abdomen with dullness to percussion at both flanks. His lungs are clear, and there is no peripheral edema. Admission laboratory data include serum sodium level of 128 mEq/L, serum urea nitrogen level of 44 mg/dL (15.7 mmol/L), Scr of 1.9 mg/dL (167.9 umol/L) (at baseline), and urine sodium level <10 mEq/L.
Which of the following is the next best step in management?  
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1 point
Q5- A 58-year-old man was found to have proteinuria. He had been treated for colonic cancer 1 year previously. He had been adopted and was unaware of his family history.

On examination, his BP was 140/98 mmHg. Urinalysis showed protein 3+.

Investigations:

serum sodium 134 mmol/L (137–144)

serum potassium 4.3 mmol/L (3.5–4.9)

serum urea 6.0 mmol/L (2.5–7.0)

serum creatinine 125 µmol/L (60–110)

serum albumin 34 g/L (37–49)

 

urine protein: creatinine ratio 202 mg/mmol (<30)

A renal biopsy was performed.

What histopathological abnormality is most likely to be detected?

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1 point

Q6- A 59-year-old woman with hepatitis C–related

cirrhosis is admitted for management of increasing

ascites and leg edema that are resistant to diuretcs. A paracentesis is

performed and shows no evidence of spontaneous

bacterial peritonitis.

She developed oliguric acute kidney disease with a rise in the SCr from 1.4 mg/dl on admission to 3  mg/dl 2 days later. Diuretics are discontinued, and she is treated with albumin 1 g/kg for the next 2 days with no

improvement in kidney function or urine output.

On physical examination, the BP is 100/60 mmHg

and the pulse is 88/min.

 Laboratory studies

show albumin 2.6 g/dl, bilirubin

2.1 mg/dl, urine

albumin/creatinine ratio 15 mg/g, and fractional

excretion of sodium of 0.04%. The urinary

sediment shows a few hyaline casts and no

cells.

Ultrasound shows that the kidneys

are approximately 10 cm in size, and there is no

hydronephrosis.

Which ONE of the following is the MOST likely

diagnosis?
1 point
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