MED 2: CARDIO-RENAL QUIZZES SECTION A, AY 2012-2013

Quiz 1: Cardio - ACS

August 30, 2012

26. Dec. BP or hypotension

TRUE

1.

Characteristic of vulnerable plaque

THIN FIBROUS CAP

Quiz 2: Cardio - Heart Failure

September 6, 2012

2.

Non-modifiable risk factor

GENDER

1.

3.

TIMI scoring
INCREASED CARDIAC MARKERS

2.

ECG changes in UA/NSTEMI

ST SEGMENT DEPRESSION

3.

4.

4.

Case: 60 y/o male with substernal chest pain PTA

5.

Characteristic of STEMI?
PAIN STIMULATED BY
PROBLEMS

PAIN

FROM

GI

6.

6.

What should you do first?

ECG

7.

Which cardiac marker increases in 4-8 hours and

returns to normal by 72 hours?
CKMB

8.

Abnormality in V4-V6 is found in what location?

ANTEROLATERAL

9.

Definitive treatment of STEMI:

IMMEDIATE REPERFUSION
THROMBOLYSIS

BY

PCI

OR

10. What is the most common cause of out of hospital

death in STEMI?
VENTRICULAR FIBRILLATION
Features of UA/NSTEMI (true/false):
11. Found upon minimal exertion
TRUE
12. <10 minutes
FALSE
13. New onset
TRUE
14. Crescendo pattern
TRUE
Precipitating factors ofACS:
15. No trigger
TRUE
16. Emotional upset
TRUE
17. Moderate activity
TRUE
18. Oversleeping leading to obesity
TRUE
Relative Contraindications to Fibrinolysis:
19. Pregnancy
TRUE
20. Cerebrovascular hemorrhage at any time
FALSE
21. Suspected aortic dissection
FALSE
22. CPR >10 min
TRUE
Class I recommendation for use of early invasive strategy
in px with UA or STEMI
23. Sustained VTACH
TRUE
24. Ejection Fraction <40
TRUE
25. Equivocal stress test
FALSE

5.

7.

Predominant cause of heart failure in industrialized

countries?
CAD
Most useful index
EJECTION FRACTION
A cardinal symptom of heart failure
FATIGUE
The following patients with heart failure will need
treatment with anti-coagulation
PATIENTS WITH AF
Etiology of heart failure in high output disease
BERI BERI
Framingham criteria for the following CHF the
following is/are major criteria
CHOICES A & B (?)
Late consequence finding
ASCITES

True/False:
Left Ventricular Remodeling
Ellipitical Shape
FALSE
Increase in wall thinning
FALSE
Low end diastolic wall stress
FALSE
Importance of ECG
Assess cardiac rhythm
TRUE
Check if there was prior MI
TRUE
TRUE
TRUE
Precipitating triggers for acute decompensation
Verapamil
TRUE
Pregnancy
TRUE
Dieting
TRUE
The following are true regarding the management of
heart failure
Moderate exercise NYHA I-III is beneficial
TRUE
Na restriction w/ HF and normal EF
TRUE
ACE-I in Px w/ EF >40%
FALSE
Aldosterone antagonist used on all HF Px
FALSE
Quiz 3: Cardio - Hypertension, Metabolic Syndrome
September 13, 2012
A.I., a 60-year-old obese male smoker from Rizal sought
admission because of dyspnea. History started 20 years
PTA when he was diagnosed to have hypertension. He
took reserpine and hydralazine irregularly. At various
times his BP was noted to be 140-130/100-.BP
130mmHg.
Fifteen years PTA, he discontinued taking reserpine and
hydralazine and shifted to nifedipine 5mg BID He would
take sublingually if he feels he has high blood pressure.
Ten years PTA, he complained of chest pain on exertion
and palpitations. Upon consultation, he was noted to have
a BP of 170/100mmHg. ECG revealed anteroseptal wall

MED 2: CARDIO-RENAL QUIZZES SECTION A, AY 2012-2013

ischemia. Further workups showed hypercholesterolema,

hyperuricemia, and FBS 14. Waist circumference at that
time was noted to be 40 inches. His recorded BMI was 30.
He followed up intermittently while failing to carry out
various lab requests.
C

1. A.I. belonged to what stage of HTN when he

was 45 y/o?
A. prehypertension
B. Stage 1
C. Stage 2
D. isolated systolic HTN

2. According to JNC 7, the normal systolic BP is:

A. <120 mmHg
B. 120 mmHg
C. 130 mmHg
D. < 130 mmHg

3. If A.I was diagnosed with secondary HTN 20

yrs ago
A. Primary aldosteronism
B. Pheochromocytoma
C. Renal artery stenosis
D. Renal parenchymal disease

4. Which of the following set of laboratory tests

would be recommended for AI
A. Urinalysis, albumin excretion, 24
hour creatinine clearance
B. Serum NA, Ca, VMA
C. FBS, lipid profile, urinalysis
D. ECG, 2D echo

5. Which of the following antihypertensives that

AI took is a direct vaso
A. Reserpine
B. Captopril
C. Hydralazine
D. Metoprolol

6. Regarding the brain as an end organ in HTN

A. 80% of strokes are due to infarction
B. the incidence of stroke rises
progressivelyof greater than age 65
C. Dementia is mainly due to occlusion
of large cerebral vessel
D. Hypertensive encephalopathy is a
hypertensive urgency

7. This is the second most common cause of

Death in hypertensive patients
A. Renal failure
B. Cerebrovascular accidents
C. Pneumonia
D. Heart disease
8. Regarding the presence of proteinuria in HTN
A. It is not a significant finding in HTN
patients
B. Its presence in HTN patients even
w/a normal GFR is associated with
hihg risk of CV complications
C. It should be accompanied by dec
GFR to indicate inc risk
D. Thiazide diuretics will help dec
proteinuria
9. Regarding the role of insulin in HTN
A. It attenuates the activity of the SNS
B. It acts as a vasodilator in
hypertensive individuals

C. It acts as a physiologic
vasoconstrictor
in
normotensive
individuals
D. It is one of the causes of HTN in
patients w/metabolic syndrome

10. Regarding the treatment goals of HTN

A. reduce MAP by 25% within minutes
to 2 hours in patients with malignant
HTN
B. To institute therapy in patients with
SBP > 220 mmHg and DBP > 103
mmHg in cerebral infarction
C. To institute therapy only in patients
with SBP > 180 mmHgg and DBP >
130
mmHg
in
patients
with
hemorrhagic stroke
D. All of the above

True/False:
1. Major independent risk factor according to
ATP III
BP 150/90 mmHg
TRUE
Male aged 50
FALSE
HDL cholesterol of less than 45 mg/dL
FALSE
Cigarette smoking
TRUE
2.

Regarding the criteria for metabolic syndrome

TGA levels > 150 mg/dL
TRUE
A BP of 130/85 mmHg fits into the criteria
TRUE
BMI is one of the parameters according to ATP
III
FALSE
Fasting glucose of 100 mg/dL is one criterion
TRUE

3.

Major causes of secondary dyslipidemia

Chronic kidney disease
TRUE
Hyperthyroidism
FALSE (HYPOTHYROIDISM)
Diabetes insipidus
FALSE (DM)
Thiazide diuretics
TRUE

4.

Agents used to dec triglycerides

Niacin
TRUE
Statins
TRUE
Fish oil
TRUE
Fibrates
TRUE

5.

Adverse reactions
drugs
Myopathy
TRUE
Cholelithiasis
TRUE
Inc liver enzymes
TRUE
Severe flushing
TRUE

to

cholesterol-lowering

MED 2: CARDIO-RENAL QUIZZES SECTION A, AY 2012-2013

Quiz 4: Nephro Acute Kidney Injury

September 27, 2012

True/False
1. In AKI, the presence of urine output of <400
ml/day is associated with worse clinical
prognosis than when a patient is non-oliguric
TRUE

16. Dysuria, urgency and frequency unaccompanied

by significant bacteruria define acute urethral
syndrome
TRUE
17. Sterile pyuria can be a manifestation of
interstitial nephritis and genitourinary TB
TRUE

2.

Normal-sized or large kidneys on imaging is

pathognonomic of AKI ruling out CKD
FALSE

18. A urologic evaluation is usually indicated for

male patients with UTI
TRUE

3.

Anemia is common in AKI and responds well to

erythropoetin-stimulating agents
FALSE

4.

IV saline hydration has been shown to help

prevent radiocontrast-induced acute renal failure
TRUE

19. A 25-year-old non-pregnant married female with

a first episode of dysuria, frequency and
>100,000 colonies of E.coli on urine culture has a
complicated UTI
FALSE (UNCOMPLICATED UTI)

5.

When hemodialysis is indicated for a patient with

ARF, an AV fistula should be created
FALSE

6.

A helical CT scan without contrastd can detect

uric acid stones not seen on standard x-ray.
TRUE

7.

Low Ca++ diets may inc Ca++ stone formation

by reducing the amount of Ca++ in the intestine
to bind oxalate therby increaseing urine oxalate
levels
TRUE

8.

Urine citrate is an important inhibitor of calcium

crystallization.
TRUE

9.

Supplemental alkali is given to patients with uric

acid lithiasis
TRUE

20. A urinalysis showing pus cells of 20/hpf,

squamous cells of 10-15/hpf and few bacteria is
diagnositc of a UTI
FALSE
Quiz 5: Nephro Chronic Renal Failure, Uremia, Renal
Replacement Therapy
October 4, 2012
True/False
1. After unilateral nephrectomy significant cellular
proliferation occurs in the remaining kidney as a
compensatory response
FALSE
2.

GFR is related directly to serum creatinine

concentration and inversely to urine creatinine
FALSE

3.

In CKD, nocturia is a manifestation due to the

progressive inability to concentrate urine
TRUE

4.

A finding pathognomonic of CRF is normocytic,

normochromic anemia
FALSE (SEEN IN ACUTE RENAL FAILURE)

5.

A patient with GFR of >90 with persistent

proteinuria belongs to Stage 1 CKD
TRUE

6.

Augmented K+ excretion in the GI tract is a

mechanism that protects the body against
hyperkalemia among patients with CKD
TRUE

7.

Renal biopsy in a patient w/bilaterally small

kidneys is not advisable since pathology may just
show scarring and fibrosis
TRUE

8.

Chronic glomerulonephritis is the most frequent

cause of CKD
FALSE (DIABETIC NEPHROPATHY IS
MOST COMMON)

9.

RAS activation can aggraate the progressive loss

of renal function in CKD
TRUE

10. Urinating after sexual intercourse can help

prevent UTI
TRUE
11. Hematogenous spread of bacteria accounts for the
majority of cases of documented UTI
FALSE (ASCENDING)
12. Rapid correction of chronic hyponatremia can
cause neuronal swelling and ___ myelination
syndrome
FALSE (NEURONAL SHRINKAGE)
13. Type IV renal tubular acidosis is characterized by
a
combination
of
hyperkalemia
and
hypercholermic metabolic acidosis
TRUE
14. Pelvic tumors, calculi & urethral strictures are the
most common causes of urinary tract obstruction
in adults
TRUE
15. E. coli and Enterobacter species account for the
majority of patients with UTI
TRUE

MED 2: CARDIO-RENAL QUIZZES SECTION A, AY 2012-2013

10. There is an inc likelihood of dying form

cardiovascular disease rather than staring dialysis
or reaching Stage 5 as CKD progresses
TRUE

5.

HTN and nephrolithiasis are commonly seen in

patients with autosomal dominant polycystic
kidney disease
TRUE

11. Diabetic autonimic neuropathy is a risk factor for

hypotension during hemodialysis
TRUE

6.

More than 90% of DM Type 2 patients with

nephropathy have diabetic retinopathy
FALSE

12. Uremic pericarditis is an aboslute indication for

intensification of dialysis prescription in a patient
on dialysis
TRUE

7.

IgA nephropathy presents with episodes of

hematuria during or immediately following an
upper respiratory tract infection
TRUE

13. An AV fistula is usually created by anastomosing

the cephalic vein with the radial artery
TRUE

8.

High dose steroid is the mainstay of treatment for

acute poststreptococcal GN
FALSE

14. The most common cause of peritoneal dialysis

associated peritonitis are gram negative bacteria
FALSE (GRAM POSITIVE)

9.

Fluoroquinolones are among the first line agents

for treating infected renal cysts
TRUE

15. The current one-year survival rates for living

donor kidney transplant is around >90%
TRUE

10. Discontinuing the offending agent is the most

appropriate treatment for allergic interstitial
nephritis
TRUE

16. ESRD patients who undergo KT have similar life

expectancies as risk-matched patients who
remain on adequate dialysis
FALSE (HIGHER LIFE EXPECTANCY OF
PATIENTS WITH KT)

11. Patients with chronic tubulointerstitial nephritis

are frequently not markedly hypertensive nor
edematous
TRUE

17. The transplanted kidney is best anastomosed to

the recepients renal vein, renal artery and ureter
FALSE

12. The urine in early chronic TIN (tubulointerstitial

nephritis) is often dilute and isoosmotic to plasma
TRUE

18. Oral bicarbonate tablets are given to CKD

patients to raise their serum bicarbonate to 20-23
mmol/L
TRUE

13. Medical therapy for atherosclerotic renal artery

stenosis includes RAS blockade, statins, aspirin,
BP control and cessation of smoking
TRUE

19. Parathyroid hormone levels are typically high in

a CKD patient
TRUE

14. The level of unmeasured plasma anions is

normally 10-12 mmol/L
TRUE

20. CKD patients present with both increase bleeding

tendencies and increased susceptibility to
thromboembolism
TRUE

15. Diarrhea causes a high-anion gap metabolic

acidosis due to loss of bicarbonate
FALSE (LOSS OF BICARB = NORMAL
ANION GAP)

Quiz 6: Glomerulonephritis and Nephrotic Syndrome

October 11, 2012
True/False
1. The urinalysis of a patient with acute druginduced interstitial nephritis would show
dysmorphic RBCs
FALSE (NON-DYSMORPHIC)
2.

3.

4.

Heavy proteinuria, hypoalbuminemia and

hypercholesterolemia are observed in nephrotic
syndrome
TRUE
Microalbuminuria usully appears 10-15 years
after onset of DM
FALSE (5-10 YEARS)
Cellular crsecents on renal biopsy are commonly
seen in patients with autosomal dominant
polycystic kidney disease
TRUE

16. Concomitant respiratory alkalosis in a patient

with high AG metabolic acidosis should make
one suspect salicyliate-induced acidosis
TRUE
17. Acidosis of renal failure should be treated with
oral alkali replacement to maintain bicarbonate
levels between 20 and 24 mmol/L
TRUE
18. Impaired bicarbonate reabsorption in the
proximal tubule is associated with Type 1 renal
tubular acidosis
FALSE (TYPE 2)
19. Target bp for patients with proteinuric kidney
disease is 135/85 or less
FALSE (125/85 OR LESS)
20. Benign simple cysts occur with increased
frequency in subjects older than 60 years of age
TRUE