Free practice quiz
ABIM Nephrology Prep Course (Nephrology): free quiz
10 questions from the program. See your score right away, then unlock the explanation of every answer.
- Question 1 of 10
A 68-year-old man with CKD stage G3bA2, heart failure with reduced ejection fraction, and osteoarthritis presents with 3 days of lightheadedness after poor oral intake. He recently started lisinopril and has taken ibuprofen every 6 hours for knee pain. Blood pressure is 92/58 mm Hg. Serum creatinine increased from 1.8 to 3.0 mg/dL; urinalysis shows hyaline casts without hematuria. Which hemodynamic mechanism best explains the acute fall in GFR?
Hemodynamic AKI
NSAIDs block prostaglandin-mediated afferent dilation; ACE inhibitors block angiotensin II–mediated efferent constriction. In volume depletion and CKD, the combined effect lowers intraglomerular pressure and GFR. A describes angiotensin II excess, not RAAS blockade. A fits postrenal obstruction or cast nephropathy; this patient has bland urine with hypotension. A is incorrect because afferent dilation usually raises renal plasma flow and supports GFR rather than causing this AKI. Review Hemodynamic AKI — focus on drug effects on arteriolar tone.
Clinician Action: Diagnose hemodynamic AKI, order repeat chemistries/urine studies, treat by holding NSAID/ACE inhibitor and restoring volume, and escalate if hyperkalemia, pulmonary edema, or uremic complications occur. - Question 2 of 10
A 45-year-old woman is evaluated for recurrent vomiting, weakness, and metabolic alkalosis. Laboratory testing shows a serum bicarbonate concentration of 36 mEq/L. The nephrologist wants a urine measurement that can help guide the physiologic evaluation of her alkalosis. Which urine study is most appropriate?
A. Incorrect. FENa primarily helps frame AKI physiology and is not the preferred urine index for evaluating metabolic alkalosis.
B. Correct. Urine chloride is a key measurement in the physiologic evaluation of metabolic alkalosis and helps guide further assessment in the appropriate clinical context.
C. Incorrect. FEUrea is used as a complementary index in AKI evaluation rather than as the principal urine test for metabolic alkalosis.
D. Incorrect. The urine anion gap aids acid-base analysis but is not the principal urine index emphasized for evaluating metabolic alkalosis.
- Question 3 of 10
A 58-year-old patient with suspected SIADH develops rapidly progressive confusion and seizures in the setting of recently developed hypotonic hyponatremia. Examination suggests euvolemia, and urine is inappropriately concentrated. Which consideration should most strongly guide the immediate management approach?
A: Incorrect. Euvolemia is characteristic of SIADH but does not imply that severe symptomatic hyponatremia is clinically stable.
B: Correct. Treatment of SIADH-associated hyponatremia depends on acuity and symptoms. Rapidly progressive neurologic manifestations, including seizures, require urgent management rather than the approach used for stable, minimally symptomatic disease.
C: Incorrect. Identifying pulmonary or CNS precipitants is important, but investigation should not delay treatment of severe symptomatic hyponatremia.
D: Incorrect. Reversibility and underlying etiology influence treatment, but acute neurologic symptoms are critical determinants of immediate therapeutic urgency.
- Question 4 of 10
A 45-year-old patient presents with altered mental status after a suspected accidental ingestion of an unidentified chemical substance. Initial laboratory testing demonstrates metabolic acidosis with a substantially elevated anion gap. The patient has no known history of advanced kidney disease, and available testing does not indicate significant ketosis or lactate elevation. Which category of causes should receive particular attention in the differential diagnosis?
A. Incorrect. Gastrointestinal bicarbonate loss generally produces normal-anion-gap acidosis rather than the substantially elevated gap described.
B. Incorrect. Renal tubular acidosis is a normal-anion-gap mechanism and is less consistent with the laboratory pattern.
C. Incorrect. Gastrointestinal fluid loss causing bicarbonate depletion is another normal-gap mechanism and is not supported by the ingestion history.
D. Correct. Toxins are an important category of high-anion-gap metabolic acidosis. Suspected chemical ingestion, particularly without evidence supporting ketoacidosis, lactic acidosis, or advanced kidney failure, makes toxic exposure a priority in the differential.
- Question 5 of 10
A 74-year-old woman with a pelvic malignancy has an acute increase in serum creatinine and reduced urine output. Initial imaging does not reveal hydronephrosis, but the treating team continues to suspect a retroperitoneal obstructive process. Which management principle is most important in avoiding a preventable delay in care?
A: Correct. Hydronephrosis may be absent in retroperitoneal obstruction, and pelvic malignancy is a classic obstructive risk factor. Persistent suspicion warrants continued evaluation and timely escalation to urology or interventional radiology if urgent decompression is indicated.
B: Incorrect. Requiring visible hydronephrosis may delay recognition of obstruction that can occur without this finding.
C: Incorrect. Pelvic malignancy remains relevant to postrenal AKI, and retroperitoneal obstruction may lack hydronephrosis.
D: Incorrect. Once urgent decompression is indicated, exhaustive exclusion of unrelated AKI mechanisms should not delay escalation for a potentially reversible obstruction.
- Question 6 of 10
A 76-year-old man is hospitalized with AKI after a complicated infection. His kidney function has continued to deteriorate, and he develops new confusion that persists after other identified causes have been addressed. The treating team attributes the mental status change to symptomatic uremia. Serum potassium and arterial pH are currently within acceptable ranges. What is the most appropriate next step?
A: Incorrect. Hyperkalemia is only one of several independent indications for dialysis. It need not be present when symptomatic uremia has already developed.
B: Correct. Clinically significant uremic manifestations are a core indication for renal replacement therapy in AKI. Dialysis addresses retained uremic solutes associated with the patient's neurological dysfunction.
C: Incorrect. An acceptable arterial pH does not eliminate an established uremic indication. Dialysis decisions incorporate the entire clinical presentation rather than acid-base status alone.
D: Incorrect. No isolated creatinine threshold should supersede clinically significant complications. The patient's symptomatic uremia provides the relevant indication for treatment.
- Question 7 of 10
A 62-year-old man with advanced chronic kidney disease reports several weeks of nausea, fatigue, and generalized pruritus. During evaluation for new chest discomfort, he is diagnosed with pericarditis attributed to uremia. Which of the following is the most appropriate next step?
A: Incorrect. Conservative follow-up is insufficient when uremic pericarditis has developed because pericarditis is an urgent dialysis indication.
B: Incorrect. Treatment escalation in advanced CKD depends on clinical manifestations rather than an eGFR threshold alone.
C: Correct. Uremic pericarditis is a serious manifestation of advanced kidney failure and represents an urgent indication for dialysis, regardless of the patient's numerical eGFR.
D: Incorrect. Nausea and pruritus are recognized uremic manifestations, but treating these symptoms alone does not adequately address the urgent complication of pericarditis.
- Question 8 of 10
A 58-year-old man with advanced chronic kidney disease undergoes a bone biopsy during evaluation of unexplained skeletal abnormalities. Histologic assessment demonstrates markedly increased bone remodeling activity. Which renal osteodystrophy pattern best describes this finding?
A (Correct): High-turnover renal osteodystrophy is characterized by increased bone remodeling activity. Recognizing the turnover pattern is important because high-turnover and low-turnover disease have distinct management implications.
B (Incorrect): Low-turnover disease involves reduced rather than increased bone remodeling activity.
C (Incorrect): Mixed bone disease represents a distinct pattern rather than isolated increased turnover. The described finding most directly supports high-turnover disease.
D (Incorrect): CKD stage provides important clinical context but does not independently establish the bone turnover pattern.
- Question 9 of 10
A 29-year-old man presents with generalized edema and laboratory findings consistent with nephrotic syndrome. Following initiation of corticosteroid treatment, his proteinuria improves markedly. Which glomerular disease is most consistent with this clinical course?
A: Incorrect. Obesity is a recognized association with secondary FSGS. A marked corticosteroid response is more characteristic of minimal change disease than secondary FSGS.
B: Correct. Minimal change disease and FSGS can both produce nephrotic syndrome, but corticosteroid responsiveness is an important differentiating feature. Marked improvement with corticosteroid treatment favors minimal change disease.
C: Incorrect. APOL1-associated FSGS is an important alternative diagnosis, but this association does not make it the most characteristic explanation for a strongly steroid-responsive presentation.
D: Incorrect. Secondary FSGS can cause nephrotic syndrome, but the pronounced steroid response is more suggestive of minimal change disease.
- Question 10 of 10
A 58-year-old man presents with progressive dyspnea, blood-streaked sputum, and a rapid increase in serum creatinine over several days. Urinalysis demonstrates hematuria, and chest imaging reveals bilateral pulmonary opacities. Which diagnostic category should be prioritized in the initial evaluation?
A. Incorrect. An isolated pulmonary process does not adequately explain the concurrent rapid deterioration in kidney function and hematuria.
B. Correct. Pulmonary-renal syndrome is a classic presentation of ANCA-associated vasculitis and anti-glomerular basement membrane (anti-GBM) disease. Concurrent pulmonary manifestations and rapidly progressive kidney injury warrant urgent evaluation for these disorders.
C. Incorrect. Rapid renal deterioration occurring with pulmonary symptoms should not be presumed to represent unrelated stable kidney disease.
D. Incorrect. An isolated renovascular disorder does not provide the most coherent explanation for the combined pulmonary and glomerular presentation.
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