Quiz Answer - Dr. Emad Magdy MNDU 8

1. Quiz Answer
EMAD MAGDY SHAWKY

2. 1- Gestational hypertension is characterized by all of
the following except:
A. Hypertension that develops after 20 weeks gestation.
B. Not associated with maternal end organ damage.
C. Usually resolve after 6 months postpartum.
D. Carries a 10% risk of progressing to preeclampsia.

3. Explanation
1. Gestational hypertension
2. Preeclampsia-eclampsia
3. Preeclampsia superimposed on chronic HTN
4. Chronic hypertension.
Gestational hypertension
• Newly elevated BP after 20 weeks gestation without evidence of maternal organ
dysfunction. This should usually resolve by 12 weeks postpartum.
• If persists beyond 12 weeks postpartum, the diagnosis is likely chronic/preexisting
hypertension that has been masked by the physiologic decrease in BP that occurs
in early pregnancy.
• Women with gestational hypertension have a 10% risk of progressing to
preeclampsia if they present after 36 weeks of gestation, but > 1/3 risk if they
present before 32 weeks.

4. 2- Which one of the following statements regarding
intradialytic phosphate kinetics is CORRECT?
A. Phosphate is removed throughout the dialysis session.
B. Pre- and post-HD phosphate levels are similar.
C. Phosphate levels decrease during the first 90–120 min, and
then stabilize.
D. Phosphate level decreases in those who take sevelamer
compared to those who take calcium acetate.

5. Explanation
 Phosphate kinetics during dialysis was studied in patients by several
investigators.
 It was found that during the first 90–120 min into dialysis, serum
phosphate levels decrease substantially by elimination into the
dialysate and then stabilize.
 Stabilization occurs as a result of mobilization of phosphate from
other compartments at a rate similar to its removal so that the plasma
concentration of phosphate remains low (at stabilization level).
 Thus, B is incorrect and C is correct. Phosphate kinetics is not altered
by food intake or phosphate binders (D is incorrect).

6. 3- Regarding dialysis prescription for an ESRD pregnant
female, which of the following is more suitable?
A. The higher the dialysate sodium, the better the outcome
B. Dialysis in sitting position is preferred.
C. PD is the preferred than HD.
D. Higher doses of multivitamins may be needed, because they can be
partially removed by intensive dialysis.

7. Explanation
Water soluble vitamins need to be given
at increased doses, because they can be
partially removed by intensive dialysis.

8. 4- Which of the following immunosuppressive drugs is
contraindicated in pregnancy?
A. Prednisone
B. Cyclosporine
C. Azathioprine
D. Mycophenolate mofetil

10. 5- Which of the following is most specific for primary
Membranous nephropathy by immunofluorescence?
A. C1q staining.
B. Mesangial immunoglobulin staining.
C. PLA2R positive staining.
D. IgG3 and IgG1 rather than IgG4 staining.

11. Beck et al., N Engl J Med 361, 11-21 (2009)

12. 6- Which of the following is not recommended for treating
acute hypertension in pregnancy:
A. Labetalol.
B. Hydralazine.
C. Nifedipine.
D. Methyl-dopa.

14.  7- When reviewing chemistry panel of newly diagnosed patient with
acute myeloid leukemia (AML), lethargic, complaining of flank pain,
nausea and vomiting. You would expect to see which of the following:
A. Serum potassium 4.5 mEq/L, phosphorus 8 mg/dl, uric acid 7 mg/dl, calcium 9 mg/dl,
BUN 12 mg/dl.
B. Serum potassium 6.5 mEq/L, phosphorus 8 mg/dl, uric acid 9 mg/dl, calcium 10 mg/dl,
BUN 14 mg/dl.
C. Serum potassium 4 mEq/L, phosphorus 9 mg/dl, uric acid 10 mg/dl, calcium 10 mg/dl,
BUN 10 mg/dl.
D. Serum potassium 7 mEq/L, phosphorus 12 mg/dl, uric acid 10 mg/dl, calcium 7 mg/dl,
BUN 25 mg/dl.

15. Metabolic derangement resulting from
massive destruction of malignant cells
(spontaneous or treatment-related tumor
necrosis or apoptosis), leading to
electrolyte abnormalities and,
consequently, renal, cardiac, and
neurologic dysfunction and possibly
death if left untreated
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia.

16. 8- Regarding patients with pauci-immune vasculitis, which
one of the following statements is CORRECT?
A. Only those patients with seropositive cANCA demonstrate severe
glomerular pathology
B. Only those patients with seropositive pANCA demonstrate severe
glomerular pathology
C. Only those patients with both cANCA and pANCA demonstrate
severe glomerular pathology
D. Patients with negative ANCA (either cANCA or pANCA)
demonstrate as severe renal disease as those with positive ANCA

17. Explanation
 Pauci-immune vasculitis with fibrinoid necrosis and active cellular
crescents is usually associated with the presence of either cANCA or
pANCA.
 However, ANCAs are absent in 5–30 % of patients with pauci-
immune vasculitis and these ANCA-negative patients may have
severe renal disease as ANCA-positive patients.
 If clinical findings are suggestive of pauci-immune vasculitis, a renal
biopsy is indicated and the treatment should be the same as ANCA
positive patients.

18. 9- Which one of the following cardiovascular disorders has
the highest correlation with increase FGF23 level in CKD
patients:
A. Vascular calcification.
B. Valvular calcification.
C. Myocardial infarction.
D. Congestive heart failure.

19. Explanation

22. 10- The rate of progression of renal disease is lower in
premenopausal women than postmenopausal women. Which one of
the following effects of estrogen on mesangial cells in
INCORRECT?
A. It inhibits type IV collagen synthesis
B. It inhibits oxidation of LDL
C. It inhibits nitric oxide production
D. It inhibits TGF-β-induced apoptosis

23. Explanation
 Estrogens have several beneficial effects on mesangial cells. In vitro
studies have shown that estrogens decrease type IV collagen synthesis by
increasing collagenase activity, inhibit LDL oxidation, and reverse TGF-
β-induced apoptosis. Also, estrogens inhibit mesangial cell proliferation.
 Estrogens increase nitric oxide synthesis, PGE2 and prostacyclin
levels. Female rats have higher levels of nitric oxide than male rats,
and ovariectomy abolishes these levels. Thus, option C is incorrect.