Indications for Dialysis (A.E.I.O.U)

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✅ Indications for Dialysis (A.E.I.O.U.) – MCQs

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1. The “A” in the AEIOU indications for dialysis stands for:
A. Acidosis
B. Anemia
C. Alkalosis
D. Ammonia overload
➡️ Answer: A. Acidosis

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2. The “E” in AEIOU stands for:
A. Electrolyte loss
B. Electrolyte imbalance (e.g., hyperkalemia)
C. Edema
D. Elevated creatinine
➡️ Answer: B. Electrolyte imbalance (e.g., hyperkalemia)

3. Intractable metabolic acidosis (e.g., pH < 7.1) is an indication for dialysis because it can cause:
A. Increased oxygen saturation
B. Muscle gain
C. Cardiac arrhythmias and respiratory failure
D. Enhanced drug clearance
➡️ Answer: C. Cardiac arrhythmias and respiratory failure

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4. Which condition under “I” in AEIOU is an indication for emergency dialysis?
A. Intestinal bleeding
B. Ingestion of toxins (e.g., lithium, ethylene glycol)
C. Irregular pulse
D. Irritable bowel
➡️ Answer: B. Ingestion of toxins (dialyzable substances)

5. Which electrolyte abnormality is an absolute indication for initiating dialysis?
A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Severe refractory hyperkalemia
➡️ Answer: D. Severe refractory hyperkalemia

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6. Oliguria is defined as urine output less than:
A. 100 mL/day
B. 400 mL/day
C. 1000 mL/day
D. 1500 mL/day
➡️ Answer: B. 400 mL/day

7. The “U” in AEIOU stands for:
A. Urticaria
B. Uric acid rise
C. Uremia
D. Unstable creatinine
➡️ Answer: C. Uremia

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8. Uremic complications that may indicate dialysis include all EXCEPT:
A. Pericarditis
B. Encephalopathy
C. Platelet dysfunction
D. Mild hypertension
➡️ Answer: D. Mild hypertension

9. A patient with severe uremia is likely to present with:
A. Elevated GFR
B. Improved appetite
C. Fatigue, confusion, pericardial rub
D. Bradycardia only
➡️ Answer: C. Fatigue, confusion, pericardial rub

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10. Dialysis is most urgently indicated in which of the following situations?
A. Elevated creatinine only
B. Mild acidosis
C. Severe fluid overload with pulmonary edema unresponsive to diuretics
D. Stable potassium of 5.0 mmol/L
➡️ Answer: C. Severe fluid overload with pulmonary edema unresponsive to diuretics

11. Which of the following is the most life-threatening complication of severe hyperkalemia that dialysis can treat?
A. Nausea
B. Diarrhea
C. Cardiac arrhythmias
D. Muscle twitching
➡️ Answer: C. Cardiac arrhythmias

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12. A patient presents with serum creatinine of 9.0 mg/dL but no symptoms. What is the next step?
A. Immediate dialysis
B. Monitor only symptoms and complications
C. Start antibiotics
D. Administer diuretics
➡️ Answer: B. Monitor only symptoms and complications
(Note: High creatinine alone isn’t an absolute indication for dialysis.)

13. Which of the following toxins is NOT typically removed effectively by dialysis?
A. Lithium
B. Ethylene glycol
C. Iron
D. Methanol
➡️ Answer: C. Iron

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14. A patient with severe uremic encephalopathy may present with:
A. Seizures, confusion, asterixis
B. Hypotension only
C. Hyperactivity
D. Normal mental status
➡️ Answer: A. Seizures, confusion, asterixis

15. Which condition is a classic sign of volume overload needing dialysis?
A. Ascites
B. Pulmonary edema
C. Pedal edema alone
D. Elevated creatinine
➡️ Answer: B. Pulmonary edema
(Especially when unresponsive to diuretics.)

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16. Dialysis should be initiated in acute kidney injury (AKI) when:
A. Creatinine exceeds 2.0 mg/dL
B. Urine output is normal
C. There is symptomatic uremia
D. Only when GFR is <5
➡️ Answer: C. There is symptomatic uremia

17. The “O” in AEIOU stands for:
A. Oliguria
B. Overload (volume/fluid overload)
C. Osmotic crisis
D. Onset of CKD
➡️ Answer: B. Overload (volume/fluid overload)

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18. One of the earliest signs of uremia is:
A. Coma
B. Anemia
C. Uremic frost
D. Loss of appetite
➡️ Answer: D. Loss of appetite

19. A dialysis indication due to ingestion includes which of the following agents?
A. Acetaminophen
B. Digoxin
C. Methanol
D. Warfarin
➡️ Answer: C. Methanol

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20. Which of the following statements is true about dialysis indications?
A. Creatinine level alone determines need for dialysis
B. Urine output must stop completely before starting dialysis
C. Dialysis is based on symptoms and biochemical derangements
D. GFR below 20 is always an emergency
➡️ Answer: C. Dialysis is based on symptoms and biochemical derangements

What Important Laboratory Tests Are Used To Monitor Dialysis Patients?

What Important Laboratory Tests Are Used To Monitor Dialysis Patients?

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✅ Laboratory Tests for Dialysis Patients – MCQs (Set 1)

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1. Which of the following tests is commonly used to monitor adequacy of dialysis?
A. Serum calcium
B. Hemoglobin
C. Kt/V
D. Serum creatinine
➡️ Answer: C. Kt/V

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2. What is the target hemoglobin (Hb) level for most stable chronic hemodialysis patients according to KDOQI?
A. 8–9 g/dL
B. 9–10 g/dL
C. 10–11.5 g/dL
D. Above 13 g/dL
➡️ Answer: C. 10–11.5 g/dL

3. Which of the following is monitored monthly to assess anemia in dialysis patients?
A. Urea reduction ratio (URR)
B. Parathyroid hormone (PTH)
C. Serum albumin
D. Hemoglobin (Hb)
➡️ Answer: D. Hemoglobin (Hb)

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4. Serum phosphorus levels are usually checked in dialysis patients to monitor:
A. Bone mineral disease
B. Liver function
C. Anemia
D. Infections
➡️ Answer: A. Bone mineral disease

5. Which of the following laboratory values helps assess nutritional status in dialysis patients?
A. Serum potassium
B. Serum albumin
C. Serum creatinine
D. C-reactive protein
➡️ Answer: B. Serum albumin

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6. Which test is used to evaluate the removal of small solutes like urea during dialysis?
A. Serum potassium
B. Kt/V or URR
C. Serum sodium
D. Hemoglobin
➡️ Answer: B. Kt/V or URR

7. Which of the following laboratory tests should be done at least quarterly in dialysis patients?
A. Iron studies
B. Blood cultures
C. Coagulation profile
D. Chest X-ray
➡️ Answer: A. Iron studies

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8. High levels of PTH (parathyroid hormone) in dialysis patients may indicate:
A. Anemia
B. Hyperkalemia
C. Secondary hyperparathyroidism
D. Fluid overload
➡️ Answer: C. Secondary hyperparathyroidism

9. Hyperkalemia in dialysis patients is most often monitored using which lab test?
A. Serum bicarbonate
B. Serum potassium
C. Serum calcium
D. Serum glucose
➡️ Answer: B. Serum potassium

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10. Transferrin saturation (TSAT) is used to assess:
A. Dialysis efficiency
B. Iron availability for erythropoiesis
C. Inflammation
D. Calcium balance
➡️ Answer: B. Iron availability for erythropoiesis

11. Which of the following lab tests is commonly elevated in chronic kidney disease and reflects nitrogen waste buildup?
A. Hemoglobin
B. Creatinine
C. Urea (BUN)
D. Bilirubin
➡️ Answer: C. Urea (BUN)

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12. The goal serum ferritin level in hemodialysis patients is typically:
A. <100 ng/mL
B. 200–500 ng/mL
C. >800 ng/mL
D. >1000 ng/mL
➡️ Answer: B. 200–500 ng/mL
(according to KDIGO/KDOQI guidelines)

13. An increase in serum bicarbonate levels post-dialysis reflects improvement in:
A. Hypokalemia
B. Metabolic acidosis
C. Anemia
D. Iron overload
➡️ Answer: B. Metabolic acidosis

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14. Which of the following tests is used to monitor bone turnover in dialysis patients?
A. Serum phosphate
B. Serum potassium
C. Serum calcium
D. Intact PTH (iPTH)
➡️ Answer: D. Intact PTH (iPTH)

15. Monthly monitoring of serum potassium is important to:
A. Manage bone disease
B. Prevent arrhythmias
C. Detect infection
D. Control anemia
➡️ Answer: B. Prevent arrhythmias

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16. What is the recommended frequency to check hemoglobin levels in stable dialysis patients?
A. Daily
B. Weekly
C. Monthly
D. Yearly
➡️ Answer: C. Monthly

17. What does low serum albumin in a dialysis patient usually suggest?
A. Adequate nutrition
B. Iron overload
C. Inflammation or malnutrition
D. Fluid overload
➡️ Answer: C. Inflammation or malnutrition

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18. A dialysis patient has consistently low TSAT and ferritin. This indicates:
A. Hyperparathyroidism
B. Iron deficiency
C. Protein-energy wasting
D. Erythropoietin resistance
➡️ Answer: B. Iron deficiency

19. Which blood marker is helpful in evaluating chronic inflammation in dialysis patients?
A. Ferritin
B. C-reactive protein (CRP)
C. Serum creatinine
D. Phosphate
➡️ Answer: B. C-reactive protein (CRP)

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20. Which laboratory value is most closely related to the risk of sudden cardiac death in dialysis patients?
A. Hemoglobin
B. Urea
C. Serum potassium
D. Albumin
➡️ Answer: C. Serum potassium

Interpretation Of Viral Testing In Dialysis Population

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✅ Interpretation of Viral Testing in Dialysis Patients – MCQs (Set 1)

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1. Which viral markers are routinely screened in dialysis patients?
A. HBsAg, Anti-HCV, Anti-HAV
B. HBsAg, Anti-HCV, HIV Ag/Ab
C. HBeAg, Anti-HBc, CMV IgG
D. Anti-HAV, Anti-HBs, EBV IgM
➡️ Answer: B. HBsAg, Anti-HCV, HIV Ag/Ab

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2. A dialysis patient tests positive for HBsAg. What does this indicate?
A. Past hepatitis B infection
B. Immunity to HBV
C. Current HBV infection (carrier or active)
D. Recent HBV vaccination
➡️ Answer: C. Current HBV infection (carrier or active)

3. Which result indicates immunity due to vaccination against hepatitis B?
A. HBsAg positive
B. Anti-HBc IgG positive
C. Anti-HBs positive (>10 mIU/mL)
D. Anti-HCV positive
➡️ Answer: C. Anti-HBs positive (>10 mIU/mL)

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4. A dialysis patient has Anti-HCV positive and HCV RNA undetectable. Interpretation?
A. Acute HCV infection
B. No exposure to HCV
C. Past HCV infection, resolved
D. Early infection not yet viremic
➡️ Answer: C. Past HCV infection, resolved

5. Which of the following markers is most definitive for detecting active Hepatitis C infection?
A. ALT/AST levels
B. Anti-HCV
C. HCV RNA PCR
D. HCV genotype
➡️ Answer: C. HCV RNA PCR

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6. In dialysis, a patient with positive Anti-HBs and negative HBsAg & Anti-HBc likely indicates:
A. Recent infection
B. Immunity from past infection
C. Vaccine-induced immunity
D. Immunosuppression
➡️ Answer: C. Vaccine-induced immunity

7. When should HBsAg be tested in dialysis patients per CDC recommendations?
A. Every 2 weeks
B. Every month
C. Every 6 months
D. Monthly for new patients, then every 6 months if negative
➡️ Answer: D. Monthly for new patients, then every 6 months if negative

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8. What should be done if a dialysis patient is newly diagnosed with active HBV (HBsAg+)?
A. No change in schedule
B. Isolate machine, cohort in HBV room
C. Repeat test in 1 month
D. Discontinue dialysis
➡️ Answer: B. Isolate machine, cohort in HBV room

9. HIV Ag/Ab combo tests in dialysis patients detect:
A. HIV antibodies only
B. HIV RNA
C. Both HIV p24 antigen and antibodies
D. HIV DNA
➡️ Answer: C. Both HIV p24 antigen and antibodies

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10. Anti-HBc (core antibody) positive and HBsAg negative indicates:
A. Acute infection
B. Vaccinated only
C. Resolved HBV infection
D. No exposure
➡️ Answer: C. Resolved HBV infection

11. A dialysis patient is HBsAg negative but Anti-HBc positive and Anti-HBs negative. What is the most likely interpretation?
A. Immunity from vaccination
B. Window period of infection
C. Resolved HBV infection
D. False-positive Anti-HBc
➡️ Answer: B. Window period of infection (possible but needs HBV DNA testing to confirm)

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12. A patient is Anti-HCV positive but has persistently normal ALT and AST. What should be done next?
A. Start treatment immediately
B. No action needed
C. Confirm with HCV RNA PCR
D. Test for HBsAg
➡️ Answer: C. Confirm with HCV RNA PCR

13. Which of the following hepatitis B markers would be expected to appear first in acute infection?
A. Anti-HBs
B. HBsAg
C. Anti-HBc IgG
D. HBeAg
➡️ Answer: B. HBsAg

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14. In the dialysis unit, which of the following is a criterion to classify a patient as HBV immune?
A. HBsAg positive
B. Anti-HBs <10 mIU/mL
C. Anti-HBs ≥10 mIU/mL
D. HBeAg negative
➡️ Answer: C. Anti-HBs ≥10 mIU/mL

15. What is the CDC-recommended interval for HCV testing in dialysis patients?
A. Every 3 months
B. Every 6 months
C. Annually
D. Every 2 years
➡️ Answer: C. Annually

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16. A dialysis staff member is accidentally exposed to a patient's blood. The patient is Anti-HCV positive. What is the next step?
A. Start antiviral treatment
B. Test the staff for HCV RNA
C. Wait for symptoms
D. Immediate HIV testing
➡️ Answer: B. Test the staff for HCV RNA (and baseline serology)

17. Which test confirms chronic HBV infection?
A. Anti-HBs ≥10 mIU/mL
B. HBsAg positive for more than 6 months
C. Anti-HBc IgM
D. ALT within normal limits
➡️ Answer: B. HBsAg positive for more than 6 months

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18. Which hepatitis virus has the highest risk of transmission in the dialysis setting?
A. HAV
B. HCV
C. HBV
D. HEV
➡️ Answer: C. HBV
(due to higher viral load and environmental stability)

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19. What is the appropriate action for a dialysis patient with reactive HIV antigen/antibody combo test?
A. Immediate isolation
B. Confirm with HIV-1 RNA or Western blot
C. Repeat the same test
D. Inform the patient directly without confirmation
➡️ Answer: B. Confirm with HIV-1 RNA or Western blot

20. The presence of Anti-HBc IgM in a dialysis patient suggests:
A. Past infection
B. Chronic infection
C. Acute or recent HBV infection
D. Vaccination-induced immunity
➡️ Answer: C. Acute or recent HBV infection