Medicine
Nephrology
Which symptom makes hyponatremia an immediate neurologic emergency?
A. Mild chronic thirst
B. Isolated toenail changes
C. Seizure
D. Stable seasonal rhinitis
Correct Answer: C
Seizure or severe encephalopathy indicates symptomatic cerebral edema requiring urgent therapy.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Severe symptomatic hyponatremia?
A. Cardiac arrest
B. Osmotic demyelination from overly rapid correction
C. Infected obstructed kidney
D. Progression to ischemic acute tubular injury
Correct Answer: B
Rapid correction of chronic hyponatremia can cause severe neurologic injury.
Medicine
Nephrology
A patient is diagnosed with Severe symptomatic hyponatremia. Which is the most appropriate management principle?
A. Give controlled hypertonic saline with close sodium monitoring
B. Treat the underlying glomerulonephritis and control volume overload, hypertension and kidney complications
C. Stabilize the myocardium with IV calcium when ECG changes are present, shift potassium intracellularly and remove potassium
D. Provide analgesia and assess for obstruction, infection and need for urologic intervention
Correct Answer: A
Hypertonic saline is indicated for severe neurologic symptoms, with careful limits to avoid overcorrection.
Medicine
Nephrology
In a patient with suspected Severe symptomatic hyponatremia, which investigation or diagnostic approach is most appropriate at this stage?
A. Quantify proteinuria and evaluate for primary or secondary glomerular disease
B. Urinalysis with microscopy plus complement and serologic evaluation guided by the suspected cause
C. Immediate serum potassium confirmation when appropriate with continuous ECG monitoring
D. Serum osmolality, urine osmolality and urine sodium while emergency stabilization proceeds
Correct Answer: D
These tests help classify hyponatremia, but severe symptoms require immediate treatment.
Medicine
Nephrology
A patient has a very low serum sodium with seizure and confusion. What is the most likely diagnosis?
A. Chronic kidney disease (CKD)
B. Nephrotic syndrome
C. Severe symptomatic hyponatremia
D. Acute nephritic syndrome
Correct Answer: C
Neurologic symptoms in profound hyponatremia reflect cerebral edema and require urgent controlled treatment.
Medicine
Nephrology
Which treatment lowers serum potassium by shifting it into cells?
A. Intravenous calcium alone
B. Insulin given with glucose as appropriate
C. Oral iron
D. Vitamin B12
Correct Answer: B
Insulin stimulates cellular potassium uptake; calcium stabilizes myocardium but does not significantly lower potassium.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Severe hyperkalemia?
A. Cardiac arrest
B. Progression to ischemic acute tubular injury
C. Severe electrolyte or acid-base disturbance requiring dialysis
D. Hyperkalemia and metabolic acidosis
Correct Answer: A
Severe hyperkalemia can cause conduction block, ventricular arrhythmias and asystole.
Medicine
Nephrology
A patient is diagnosed with Severe hyperkalemia. Which is the most appropriate management principle?
A. Provide analgesia and assess for obstruction, infection and need for urologic intervention
B. Restore effective circulating volume and correct the underlying cause
C. Provide supportive care, stop nephrotoxins, optimize hemodynamics and manage fluid and electrolyte complications
D. Stabilize the myocardium with IV calcium when ECG changes are present, shift potassium intracellularly and remove potassium
Correct Answer: D
Emergency therapy has three goals: cardiac stabilization, temporary intracellular shift and definitive potassium removal.
Medicine
Nephrology
In a patient with suspected Severe hyperkalemia, which investigation or diagnostic approach is most appropriate at this stage?
A. Serum osmolality, urine osmolality and urine sodium while emergency stabilization proceeds
B. Noncontrast CT of the urinary tract in many nonpregnant adults when imaging is required
C. Immediate serum potassium confirmation when appropriate with continuous ECG monitoring
D. Volume-status assessment, urinalysis and serial kidney-function testing
Correct Answer: C
Cardiac monitoring is essential because ECG changes signal arrhythmia risk.
Medicine
Nephrology
A patient has advanced kidney disease with weakness and ECG conduction abnormalities. What is the most likely diagnosis?
A. Acute nephritic syndrome
B. Severe hyperkalemia
C. Severe symptomatic hyponatremia
D. Ureteric stone causing renal colic
Correct Answer: B
CKD impairs potassium excretion and can cause life-threatening hyperkalemia.
Medicine
Nephrology
Which urine finding most strongly supports a glomerular source of hematuria?
A. Red blood cell casts
B. Calcium oxalate crystals
C. Bacteria without pyuria
D. Glucose only
Correct Answer: A
Red-cell casts form within renal tubules and strongly indicate glomerular bleeding.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Acute nephritic syndrome?
A. Hyperkalemia and metabolic acidosis
B. Venous thromboembolism
C. Cardiac arrest
D. Rapid deterioration in kidney function
Correct Answer: D
Severe proliferative glomerulonephritis can progress quickly to kidney failure.
Medicine
Nephrology
A patient is diagnosed with Acute nephritic syndrome. Which is the most appropriate management principle?
A. Provide supportive care, stop nephrotoxins, optimize hemodynamics and manage fluid and electrolyte complications
B. Control blood pressure and kidney-risk factors, use kidney-protective therapy when indicated and avoid nephrotoxins
C. Treat the underlying glomerulonephritis and control volume overload, hypertension and kidney complications
D. Treat the underlying glomerular disease and manage edema, blood pressure, thrombosis risk and proteinuria
Correct Answer: C
Therapy depends on etiology and severity; urgent nephrology input is needed for rapidly progressive disease.
Medicine
Nephrology
In a patient with suspected Acute nephritic syndrome, which investigation or diagnostic approach is most appropriate at this stage?
A. Volume-status assessment, urinalysis and serial kidney-function testing
B. Urinalysis with microscopy plus complement and serologic evaluation guided by the suspected cause
C. Urinalysis with microscopy and assessment for ischemic or nephrotoxic exposures
D. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
Correct Answer: B
Urine sediment confirms glomerular bleeding while serology helps distinguish immune etiologies.
Medicine
Nephrology
A patient has hematuria, hypertension, reduced kidney function and red-cell casts. What is the most likely diagnosis?
A. Acute nephritic syndrome
B. Ureteric stone causing renal colic
C. Prerenal acute kidney injury
D. Acute tubular necrosis (acute tubular injury)
Correct Answer: A
Glomerular inflammation produces hematuria, red-cell casts, reduced GFR and often hypertension.
Medicine
Nephrology
Which combination is most characteristic of nephrotic syndrome?
A. Hematuria with red-cell casts only
B. Isolated glucosuria with normal protein
C. Hypernatremia with dilute urine only
D. Heavy proteinuria, hypoalbuminemia and edema
Correct Answer: D
The nephrotic pattern is dominated by heavy protein loss and low serum albumin.
Medicine
Nephrology
Which complication or major adverse outcome is particularly associated with Nephrotic syndrome?
A. Cardiac arrest
B. Osmotic demyelination from overly rapid correction
C. Venous thromboembolism
D. Infected obstructed kidney
Correct Answer: C
Loss of anticoagulant proteins and other prothrombotic changes increase thrombosis risk in nephrotic syndrome.
Medicine
Nephrology
A patient is diagnosed with Nephrotic syndrome. Which is the most appropriate management principle?
A. Treat the underlying glomerulonephritis and control volume overload, hypertension and kidney complications
B. Treat the underlying glomerular disease and manage edema, blood pressure, thrombosis risk and proteinuria
C. Stabilize the myocardium with IV calcium when ECG changes are present, shift potassium intracellularly and remove potassium
D. Give controlled hypertonic saline with close sodium monitoring
Correct Answer: B
Management is cause-specific with supportive measures to control edema and reduce kidney and cardiovascular complications.
Medicine
Nephrology
In a patient with suspected Nephrotic syndrome, which investigation or diagnostic approach is most appropriate at this stage?
A. Quantify proteinuria and evaluate for primary or secondary glomerular disease
B. eGFR plus urine albumin-to-creatinine ratio with evaluation of cause
C. Urinalysis with microscopy plus complement and serologic evaluation guided by the suspected cause
D. Immediate serum potassium confirmation when appropriate with continuous ECG monitoring
Correct Answer: A
Protein quantification confirms the syndrome and etiologic evaluation guides treatment.
Medicine
Nephrology
A patient has generalized edema, heavy proteinuria, hypoalbuminemia and hyperlipidemia. What is the most likely diagnosis?
A. Acute tubular necrosis (acute tubular injury)
B. Chronic kidney disease (CKD)
C. Acute nephritic syndrome
D. Nephrotic syndrome
Correct Answer: D
Heavy urinary protein loss causing hypoalbuminemia and edema defines the nephrotic pattern.