Resident Name:

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CA1 Quiz#9 April Renal and
Transfusions
1. A 62-year-old man with chronic renal failure who is receiving dialysis three times weekly suffers
a fracture of the humerus in a fall. He is brought to the operating room for an open reduction of
the fracture on the evening of a day on which he missed his dialysis due to the injury. Expected
abnormalities in this patient include all of the following EXCEPT
A. metabolic acidosis
B. hyperkalemia
C. uremia
D. thrombocytopenia
E. hypervolemia

2. A previously healthy 25-year-old man suffers a ruptured spleen during a rugby game. During the
emergency splenectomy, he is given ten units of packed red blood cells. After achieving
hemostasis, an acceptable hematocrit value of 27%, and euvolemia via the administration of
normal saline, the most likely electrolyte abnormality is
A. hypercalcemia
B. hypermagnesemia
C. hypophosphatemia
D. hypokalemia?
E. hyperkalemia

3. A 59-year-old woman requires treatment for non-Hodgkinss lymphoma. Antineoplastic

chemotherapy with which one of the following agents may cause a peripheral neuropathy?
A. methotrexate
B. doxorubicin
C. busulfan
D. bleomycin
E. vincristine

4. A 36-year-old nurse in good health is stuck with a used needle during the unsuccessful
resuscitation of a homeless man with an unknown medical history. She is at potential risk of all
these diseases from exposure to a needle contaminated with blood or tissue from an infected
patient EXCEPT
A. Creutzfeldt-Jakob disease
B. hepatitis A
C. hepatitis C
D. cytomegalovirus
E. syphilis

5. An 80-year-old patient has a normal value of 1.0 mg / dL for serum creatinine. Compared with a
20-year-old patient of the same weight and with the same serum creatinine value, the 80-year-old
patient has approximately what fractional value of creatinine clearance?
A. 0.1
B. 0.2
C. 0.5
D. 0.7
E. 0.9?
Resident Name:
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CA1 Quiz#9 April Renal and
Transfusions

6. A 40-year-old alcoholic man with a massive gastrointestinal bleed is treated with a variety of
blood components. The blood component with the least risk of transmitting hepatitis C is
A. cryoprecipitate
B. fresh frozen plasma
C. packed red blood cells
D. frozen washed red blood cells
E. 5% albumin

7. A 79-year-old man with coronary artery disease develops acute kidney injury after a carotid
endarterectomy. The circulation to the kidney is
A. autoregulated over a mean arterial pressure range of about 80 to 160 mm Hg
B. not regulated by neural factors?
C. innervated by sympathetic nerves originating in T2 T3
D. not affected by epinephrine
E. constricted by prostaglandin E2

8. An elderly woman is brought into the hospital after being found on the floor of her apartment.
She is found to have prerenal failure and her urine will
A. be positive for nitrites
B. be concentrated
C. have a specific gravity of approximately 1.010
D. be excreted in large amounts
E. have a reddish tinge due to presence of red blood cells

9. A 26-year-old otherwise healthy female trauma patient is brought to the operating room with
massive injuries and requires multiple units of blood to attempt to maintain euvolemia. Which
one of the following statements about blood transfusions in her is correct?
A. A complete Cross-match is necessary for fresh frozen plasma (FFP).
B. Most platelet transfusions are given to treat dilutional thrombocytopenia after massive
transfusion.
C. Human error is the root cause of most fatal hemolytic transfusion reactions.
D. A unit of packed red blood cells should increase the hemoglobin level of 3 g / dL.
E. FFP transfusion should be guided by the INR value.

10. A 35-year-old woman with hyperparathyroidism undergoes a parathyroidectomy. Features of

hypocalcemia relevant to the perioperative period include all of the following EXCEPT
A. hypocalcemia predisposes to laryngospasm
B. hypocalcemia can present as change in mental status
C. hypocalcemia can lead to difficult to treat hypertension in the postoperative setting
D. one gram of calcium chloride solution provides three times the amount of elemental calcium
present in one gram of calcium gluconate
E. concentrated calcium solutions may be caustic to peripheral veins

11. Cryoprecipitate contains all of the following clotting factors EXCEPT

A. factor VIII
B. factor IX
C. factor XIII
D. von Willebrand factor
E. fibrinogen
Resident Name:
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CA1 Quiz#9 April Renal and
Transfusions

12. The treatment of a hemolytic transfusion reaction in a middle-aged female patient who received
blood during a surgical procedure may involve the immediate administration of all the following
EXCEPT
A. crystalloid intravenous fluids
B. furosemide
C. hydrocortisone
D. sodium bicarbonate
E. mannitol

13. An elderly man with urosepsis develops disseminated intravascular coagulation (DIC). Which
one of the following statements is FALSE regarding DIC?
A. DIC is usually due to the abnormal consumption of clotting factors.
B. DIC may be treated with heparin.
C. Gram-negative endotoxemia is a common cause of DIC.
D. Abnormalities in laboratory tests include a prolonged prothrombin time and decreased values
for platelet count and plasma fibrinogen.
E. Regardless of the etiology, therapy of DIC is directed toward replacement of clotting factors
and inhibition of the clotting cascade.

14. Which one of the following abnormalities does not cause a hypercoagulable state?
A. Factor V Leiden
B. Protein S deficiency
C. Protein C deficiency
D. Antithrombin III deficiency
E. Von Willebrand disease

15. You are called to see a 57-year-old patient in the recovery room with a serum potassium
concentration of 5.9 mEq / L after a colonic resection for colon cancer. Treatment of
hyperkalemia includes all of the following EXCEPT
A. elimination of exogenous sources
B. correction of cause of endogenous sources
C. administration of glucose with insulin
D. administration of acidifying solutions
E. administration of calcium gluconate

16. A 61-year-old woman who had a cadaveric kidney transplant seven years ago now presents for
knee replacement surgery. All of the following statements about immunosuppression are correct
EXCEPT
A. immunosuppression may occur with protein-calorie malnutrition
B. renal transplant recipients have a higher incidence of acute rejection and immunologic graft
loss than recipients of any other solid organ
C. opioids induce immunosuppression in part by decreasing natural killer cell activity and
antibody production
D. cyclosporine use after renal transplantation may cause hypertension, hyperlipidemia, and
accelerated atherosclerosis in renal transplant patients.
E. the most common cause of invasive fungal infections in immunocompromised patients is
Candida species
Resident Name:
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CA1 Quiz#9 April Renal and
Transfusions

17. When evaluating renal function in a 75-year-old healthy man undergoing preoperative assessment
for an elective orthopedic procedure, one must consider that
A. proteinuria is always pathological?
B. a specific gravity of 1.023 or greater demonstrates good concentrating function
C. BUN elevation is always indicative of renal dysfunction
D. less creatinine is produced by muscular persons
E. by the eighth decade of life, GFR is reduced by 85% in otherwise healthy adults

18. A middle-aged woman is found to have a plasma calcium concentration of 11 mg / dL while

undergoing a preoperative evaluation for an elective cholecystectomy. All of the following are
true about hypercalcemia in this patient EXCEPT
A. mild hypercalcemia as seen in this patient is usually asymptomatic
B. hypercalcemia decreases renal concentrating ability that can cause polyuria and polydipsia>
C. hypercalcemia can result in bradycardia and shortened QT intervals on ECG
D. primary hyperparathyroidism is an unlikely cause of her hypercalcemia??
E. if her parathyroid hormone level is suppressed, she is likely to have an underlying
malignancy as the cause of the hypercalcemia

19. Which one of the following statements is true regarding anion gap?
A. An anion gap of 12 mEq/L is considered abnormal.
B. Diabetic ketoacidosis is associated with a low anion gap.
C. Metabolic acidosis accompanying diarrhea has a normal anion gap.
D. Anion gap may be estimated by subtracting the serum chloride concentration from the serum
sodium concentration.
E. Acetazolamide therapy causes increased anion gap metabolic acidosis.

20. Physiologic compensation for anemia includes all of the following EXCEPT
A. increased plasma volume
B. increased cardiac output
C. increased levels of 2,3-diphosphoglycerate
D. bradycardia
E. increased minute alveolar ventilation