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Thursday, 18 October 2012

Acute Renal Failure


Acute Renal Failure (AKI) – MCQs


1. Acute renal failure is defined as:
A. A slow decline in kidney function over years
B. Sudden and reversible loss of kidney function
C. Permanent damage to glomeruli
D. Kidney shrinkage over time
➡️ Answer: B. Sudden and reversible loss of kidney function


2. The most common cause of prerenal acute kidney injury is:
A. Glomerulonephritis
B. Obstruction of urinary tract
C. Hypovolemia
D. Nephrotoxic drugs
➡️ Answer: C. Hypovolemia

3. Which of the following is a postrenal cause of acute renal failure?
A. Dehydration
B. Renal artery stenosis
C. Bilateral ureteral obstruction
D. Acute tubular necrosis
➡️ Answer: C. Bilateral ureteral obstruction


4. Which of the following laboratory findings is most typical in AKI?
A. Decreased BUN and creatinine
B. Hypernatremia
C. Elevated serum creatinine
D. Decreased potassium
➡️ Answer: C. Elevated serum creatinine

5. The RIFLE criteria are used to:
A. Classify chronic kidney disease
B. Identify urinary tract infections
C. Classify severity of acute kidney injury
D. Measure dialysis adequacy
➡️ Answer: C. Classify severity of acute kidney injury
(RIFLE = Risk, Injury, Failure, Loss, End-stage kidney disease)


6. Oliguria is defined as urine output less than:
A. 100 mL/day
B. 500 mL/day
C. 400 mL/day
D. 1,000 mL/day
➡️ Answer: C. 400 mL/day

7. Which drug is nephrotoxic and can contribute to acute renal failure?
A. Paracetamol
B. Metformin
C. Aminoglycosides (e.g., gentamicin)
D. Beta-blockers
➡️ Answer: C. Aminoglycosides


8. Which electrolyte disturbance is commonly seen in AKI?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Hyponatremia
➡️ Answer: B. Hyperkalemia

9. Indications for dialysis in acute renal failure include all EXCEPT:
A. Severe hyperkalemia
B. Metabolic acidosis
C. Fluid overload unresponsive to diuretics
D. Mild proteinuria
➡️ Answer: D. Mild proteinuria


10. Which of the following is a hallmark of intrinsic (renal) AKI?
A. Low urine sodium (<20 mEq/L)
B. Fractional excretion of sodium (FeNa) >2%
C. Rapid improvement with fluid challenge
D. No casts in urine
➡️ Answer: B. Fractional excretion of sodium (FeNa) >2%

11. Which of the following is the most common cause of intrinsic AKI?
A. Acute tubular necrosis (ATN)
B. Glomerulonephritis
C. Urinary tract obstruction
D. Hypovolemia
➡️ Answer: A. Acute tubular necrosis (ATN)


12. Which of the following urine findings suggests acute tubular necrosis?
A. Hyaline casts
B. Muddy brown granular casts
C. Red blood cell casts
D. No casts
➡️ Answer: B. Muddy brown granular casts


13. Prerenal AKI is characterized by:
A. Decreased renal perfusion
B. Tubular epithelial cell injury
C. Obstruction of urine flow
D. Immune complex deposition

14. Which of the following is a common cause of postrenal AKI?
A. Nephrotoxic drugs
B. Renal artery stenosis
C. Kidney stones causing obstruction
D. Acute interstitial nephritis
➡️ Answer: C. Kidney stones causing obstruction


15. Fractional excretion of sodium (FeNa) is typically less than 1% in:
A. Intrinsic AKI
B. Prerenal AKI
C. Postrenal AKI
D. Chronic kidney disease
➡️ Answer: B. Prerenal AKI


16. What is the main goal in the initial management of prerenal AKI?
A. Start dialysis immediately
B. Correct underlying volume depletion
C. Administer nephrotoxic drugs
D. Restrict fluids aggressively
➡️ Answer: B. Correct underlying volume depletion

17. Which of the following medications should be avoided in patients at risk of AKI?
A. NSAIDs
B. ACE inhibitors (in volume depleted patients)
C. Aminoglycosides
D. All of the above
➡️ Answer: D. All of the above


18. In intrinsic AKI, the urine sodium concentration is generally:
A. Low (<20 mEq/L)
B. High (>40 mEq/L)
C. Zero
D. Variable
➡️ Answer: B. High (>40 mEq/L)


19. Which electrolyte abnormality in AKI can cause life-threatening cardiac arrhythmias?
A. Hypercalcemia
B. Hyperkalemia
C. Hyponatremia
D. Hypokalemia
➡️ Answer: B. Hyperkalemia


20. Which of the following is NOT an indication for emergent dialysis in AKI?
A. Severe metabolic acidosis
B. Volume overload refractory to diuretics
C. Asymptomatic mild elevation of BUN
D. Refractory hyperkalemia
➡️ Answer: C. Asymptomatic mild elevation of BUN


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