Question 1

According to the National Kidney Foundation,which stage of chronic kidney disease (CKD)is characterized by a loss of 50% or more of normal renal function?&#10;A) stage 2&#10;B) stage 3&#10;C) stage 4&#10;D) stage 5

Accepted Answer

Stage 3 is evidenced as a moderately decreased glomerular filtration rate (GFR),with loss of 50% or more of normal renal function.Stage 4 is defined by a severely decreased GFR.Stage 5 is reflected by renal failure,wherein 75% or more of the approximately 2 million nephrons have lost function.

Question 2

Which of the following is the most classically described osseous change accompanying chronic renal failure?&#10;A) &#34;hair-on-end&#34; appearance&#10;B) &#34;cotton-wool&#34; appearance&#10;C) &#34;ground glass&#34; appearance&#10;D) &#34;swiss cheese&#34; appearance

Accepted Answer

The most classically described osseous change accompanying chronic renal failure is the triad of loss of lamina dura,demineralized bone (resulting in a "ground glass" appearance),and localized radiolucent jaw lesions (central giant cell granulomas also called brown tumors),the last from secondary hyperparathyroidism.

Question 3

Which of the following viruses has been reported to be transmitted nosocomially in dialysis centers in the United States?
1.hepatitis B
2.hepatitis C
3.human immunodeficiency virus (HIV)

A) 1, 2, 3
B) 1, 2
C) 2, 3
D) 1 only

1, 2

Accepted Answer

A 2002 national survey reported that among patients maintained on hemodialysis,the prevalence of hepatitis B surface antigen positivity was 1.0%; of hepatitis C seropositive status,7.8%; and of HIV seropositivity,1.5%.Although all three viruses constitute a reservoir of potential infection,only hepatitis B and hepatitis C have been reported to be trAnswermitted nosocomially in dialysis centers in the United States.

Question 4

Infective endocarditis occurs in 2% to 9% of patients receiving hemodialysis.The American Heart Association (AHA)2003 guidelines include a recommendation for prophylactic antibiotics before invasive dental procedures are performed on patients with intravascular access devices to prevent endarteritis or infective endocarditis.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true, the second statement is false.
D) The first statement is false, the second statement is true.

Accepted Answer

Infective endocarditis occurs in 2% to 9% of patients receiving hemodialysis.The American Heart Association (AHA)2003 guidelines include a recommendation for prophylactic antibiotics before invasive dental procedures are performed on patients with intravascular access devices to prevent endarteritis or infective endocarditis.

A) Both statements are true.
B) Both statements are false.
C) The first statement is true, the second statement is false.
D) The first statement is false, the second statement is true.

Question 5

Which of the following is the most common cause of end-stage renal disease (ESRD)?&#10;A) polycystic kidney disease&#10;B) diabetes mellitus&#10;C) hypertension&#10;D) chronic glomerulonephritis

Accepted Answer

The 4 most common causes of ESRD are diabetes mellitus (37%),hypertension (24%),chronic glomerulonephritis (16%),and polycystic kidney disease (4.5%).Other common causes,in decreasing order,are systemic lupus erythematosus,neoplasm,urologic disease,and acquired immunodeficiency syndrome (AIDS)nephropathy.Hereditary and environmental factors,such as amyloidosis,congenital disease,hyperlipidemia,immunoglobulin A nephropathy,and silica exposure,also contribute to the disease.

Question 6

Which of the following is an oral manifestation of kidney disease?&#10;A) increased salivary flow due to decreased renal filtration&#10;B) blue discoloration of the cheeks due to reduced hemoglobin-carrying capacity of red blood cells&#10;C) characteristic acetone-like odor of breath&#10;D) pallor of oral mucosa related to anemia

Accepted Answer

A common sign is pallor of the oral mucosa related to anemia.Salivary flow may be diminished,resulting in xerostomia and parotid infections.Red-orange discoloration of the cheeks and mucosa is caused by pruritus,and deposition of carotene-like pigments appears when renal filtration is decreased.Patients frequently complain of an altered or metallic taste,and saliva is altered in composition,has a higher pH,and may have a characteristic ammonia-like odor,which results from a high urea content.

Question 7

Which of the following tests is a measure of muscle breakdown and filtration capacity of the nephron?&#10;A) glomerular filtration rate (GFR)&#10;B) blood urea nitrogen (BUN)&#10;C) serum creatinine&#10;D) creatinine clearance

Accepted Answer

The serum creatinine level is a measure of muscle breakdown and filtration capacity of the nephron.The creatinine concentration is proportional to the glomerular filtration and tubular excretion rates,and this ratio commonly is used as the index of creatinine clearance in a 24-hour urine collection.BUN is a commonly used indicator of kidney function,but the BUN level is not as specific as creatinine clearance or serum creatinine level.

Question 8

Which of the following sequences correctly depicts the sequence of osseous changes observed in the patient with renal osteodystrophy?
1.osteosclerosis
2.osteomalacia
3.osteitis fibrosa

A) 1, 2, 3
B) 1, 3, 2
C) 2, 3, 1
D) 2, 1, 3

Accepted Answer

The progression of osseous changes is osteomalacia (increased unmineralized bone matrix),followed by osteitis fibrosa (bone resorption with lytic lesions and marrow fibrosis)and then osteosclerosis of variable degree (enhanced bone density).

Question 9

Failing kidneys are unable to concentrate and filter the intake of ________.&#10;A) sodium&#10;B) potassium&#10;C) iron&#10;D) phosphate

Accepted Answer

Failing kidneys are unable to concentrate and filter the intake of sodium,which contributes to the drop in urine output,development of fluid overload,hypertension,and risk for severe electrolyte disturbances and cardiac disease.

Question 10

How do most dialysis patients in the United States receive hemodialysis?&#10;A) continuous cyclic peritoneal dialysis (CCPD)&#10;B) chronic ambulatory peritoneal dialysis (CAPD)&#10;C) through an arteriovenous graft, usually placed in the forearm&#10;D) through a central catheter

Accepted Answer

More than 80% of the people who receive hemodialysis in the United States do so through a permanent and surgically created arteriovenous graft or fistula,usually placed in the forearm.Approximately 18% of patients receive dialysis through a temporary or permanent central catheter while the permanent access site is healing or when all other access options have been exhausted.The principal use of peritoneal dialysis is in patients in acute renal failure or in those who require only occasional dialysis.

Deck 12: Chronic Kidney Disease and Dialysis