Chapter 28 - Acute Kidney Injury

1) Which of the following is the most common type of acute kidney injury (AKI) in the inpatient setting?
A. Prerenal AKI

B. Functional AKI

C. Pseudorenal AKI

D. Intrinsic AKI

E. Postrenal AKI

2) A 70-year-old long-term care resident is admitted to the hospital with nausea and vomiting. His
admission laboratory values are blood urea nitrogen (BUN) of 43 mg/dL (15.4 mmol/L), serum creatinine
(Scr) of 2.1 mg/dL (186 μmol/L), a fractional excretion of sodium (FeNa) of 0.5% (0.005), and hyaline
casts on urine sediment. The most likelyetiology of his AKI is:

A. Acute tubular necrosis

B. Bladder obstruction

C. Acute interstitial nephritis

D. Drug-induced AKI E. Volume depletion

3) A 56-year-old male presents to the hospital with prerenal acute kidney injury. Based on the Kidney
Disease: Improving Global Outcomes (KDIGO) classification system, which of the following parameters
should be used to determine the severity of his kidney injury?

A. Serum creatinine and blood urea nitrogen

B. Serum creatinine and urine output

C. Glomerular filtration rate and blood urea nitrogen

D. Blood urea nitrogen and urine output

E. Glomerular filtration rate and cystatin C

4) A 66-year-old (77-kg) man is admitted to the intensive care unit in septic shock. His serum creatinine
increased from a baseline of 1 to 2.6 mg/dL (88 to 230 μmol/L), and his blood urea nitrogen (BUN)
increased from 13 to 35 mg/dL (4.6 to 12.5 mmol/L) during the last 24 hours. His urine output in the last
24 hours was 25 mL. Per Kidney Disease: Improving Global Outcomes (KDIGO) classification, which stage
does this patient’s acute kidney injury belong to?

A. Stage I B. Stage II C. Stage III D. Stage IV E. Stage V

5) Which of the following laboratory markers would provide the earliest detection of acute kidney
injury?

A. Serum creatinine

B. Urine output
C. Blood urea nitrogen

D. Glomerular filtration rate

E. Neutrophil gelatinase–associated lipocalin

6) A 56-year-old woman with a history of stage 3 chronic kidney disease is scheduled for diagnostic
imaging requiring contrast dye administration. Her serum creatinine is 2.2 mg/dL (194 μmol/L); blood
urea nitrogen (BUN) is 30 mg/dL (10.7 mmol/L). Her complete blood count and electrolytes are all within
normal range. Which of the following medications would you recommend to decrease her risk of
contrast-induced nephropathy?

A. Dopamine infusion B. Isotonic saline infusion

C. Hemodialysis before and after the procedure D. Furosemide infusion E. Erythropoietin

7) Based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, which of the following
medications may be used to prevent contrast-induced nephropathy?

A. Ascorbic acid B. Fenoldopam C. Dopamine D. N-Acetylcysteine E. Nesiritide

8) A 67-year-old male with past medical history of congestive heart failure (CHF) and stage 4 chronic
kidney disease is admitted to the hospital with a CHF exacerbation. During his admission, he develops
significant volume overload. His primary team initiates furosemide 40 mg IV twice daily with little
improvement. What would be the best recommendation regarding the management of his volume
overload?

A. Change furosemide to bumetanide.

B. Add ethacrynic acid.

C. Increase dose of furosemide.

D. Change furosemide to hydrochlorothiazide.

E. Add bumetanide.

9) A 36-year-old male is diagnosed with acute interstitial nephritis (AIN) secondary to nafcillin
administration for methicillin-susceptible Staphylococcus aureus bacteremia. Which of the following
pathophysiologic processes is most likely to be involved in the development of AIN?

A. Glomerular damage secondary to severe inflammation

B. Tubular epithelial cell necrosis due to ischemia

C. Drug hypersensitivity reaction leading to interstitial inflammation

D. Decreased renal perfusion

E. Bladder outlet obstruction

10) FT is a 67-year-old male who developed acute tubular necrosis after undergoing cardiac surgery.
Which of the following pharmacotherapeutic interventions is most likely to reverse the renal injury in
this patient?
A. Isotonic saline hydration

B. Sodium bicarbonate hydration

C. Intermittent hemodialysis

D. Continuous renal replacement therapy

E. None of the above since supportive care is the mainstay of therapy

11) Compared with continuous renal replacement therapy, one of the main disadvantages of
intermittent hemodialysis is that:

A. It is associated with more hypotension.

B. It is not readily available at most hospitals.

C. It is more labor intensive.

D. It requires anticoagulation.

E. It requires continuous dialysis 24 hours/day.

12) AT is a 54-year-old female presenting to the emergency department with acute kidney injury (AKI)
secondary to dehydration. Her labs indicate the following: Na 133 mEq/L (133 mmol/L), K 5.8 mEq/L (5.8
mmol/L), Cl 101 mEq/L (101 mmol/L), CO2 22 mEq/L (22 mmol/L), PO4 5.3 mg/dL (1.71 mmol/L), Ca 7.8
mg/dL (1.95 mmol/L), BUN 33 mg/dL (11.8 mmol/L), and Scr 2.2 mg/dL (194 μmol/L). Which of the
following electrolyte abnormalities does AT have that are commonly found in patients with AKI?

A. Hypophosphatemia B. Hyperkalemia C. Hyponatremia D. Hypocalcemia

E. None of the above since electrolytes are usually unaffected

13) All of the following factors can make drug dosing a challenge in a critically ill patient with
established AKI except:

A. Presence of edema

B. Presence of residual nonrenal clearance

C. Need for constant reassessment of the patient’s renal function

D. Changes in the modality of renal replacement therapy

E. Presence of electrolyte abnormalities

14) In continuous renal replacement therapy (CRRT), the following statement is true regarding drug
clearance:

A. Increasing CRRT ultrafiltration rate will generally result in increased drug clearance.

B. Decreasing the CRRT ultrafiltration rate will generally result in increased drug clearance.

C. Decreasing the CRRT dialysate rate will generally result in increased drug clearance.
D. Increasing the CRRT dialysate rate will generally result in decreased drug clearance.

E. CRRT ultrafiltration and dialysate rate changes generally have no impact on drug clearance.

15) Which of the following medications is most likely to cause acute tubular necrosis in a 75- year-old
hospitalized patient?

A. Valsartan B. Acyclovir C. Furosemide D. Gentamicin E. Cefepime

Chapter 29 - Chronic Kidney Disease

1) A 63-year-old female with type 1 diabetes, hypertension, and an eGFR of 36 mL/min/1.73 m2 would
be classified as having what KDIGO stage of chronic kidney disease?

A. G2 B. G3a C. G3b D. G4 E. G5

2) Type 2 diabetic patients should be screened for microalbuminuria every:

A. Month B. 3 months C. 6 months D. 12 months E. 24 months

3) Metformin should be discontinued in a person with stable chronic kidney disease when his or her
eGFR is below which of the following?

A. 60 mL/min/1.73 B. 50 mL/min/1.73 m2 C. 40 mL/min/1.73 m2 D. 30 mL/min/1.73 m2

4) Recommended vaccines in a patient with stage 4 chronic kidney disease include:

A. Influenza B. Pneumococcal C. Hepatitis B D. Hepatitis A E. A, B, and C

5) ACE inhibitors and ARBs are the preferred agent in which of the following patients?

A. Diabetic with ACR >30 mg/g (>3 mg/mmol) B. Nondiabetic with ACR >30 mg/g (>3 mg/mmol)
C. Nondiabetic with urine protein excretion rate of 100 mg/24hr D. A and B E. All of the above

6) A 55-year-old male patient with diabetic kidney disease, an eGFR = 38 mL/min/1.73 m2, and a serum
potassium = 3.7 mEq/L (mmol/L) is started on ramipril 5 mg by mouth once daily. Two weeks later, his
eGFR is 28.5 mL/min/1.73 m2 and serum potassium is 5.2 mEq/L (mmol/L). Which of the following is the
most appropriate recommendation?

A. Repeat eGFR in 10 to 14 days.

B. Decrease ramipril to 2.5 mg by mouth once daily.

C. Advise dietary restriction of potassium. D. A and B. E. A and C.

7) What is the target blood pressure in a patient with kidney disease secondary to longstanding
hypertension with an ACR<30ml/min/1.73m2

A. 125/75 mm Hg B. 130/80 mm Hg C. 140/90 mm Hg D. 150/90 mm Hg E. 160/90 mm Hg

8) A 32-year-old patient with diabetic kidney disease on an ACEI becomes pregnant. The ACEI is
discontinued. Which of the following drugs has been shown to reduce proteinuria and is safe for use in
pregnancy?
A. Diltiazem B. Atenolol C. Spironolactone D. Eplerenone E. Aliskiren

9) Which of the following is the most common cause of resistance to therapy with an erythropoietic-
stimulating agent (ESA)?

A. Iron deficiency B. GI bleeding C. Hyperparathyroidism D. Folate deficiency

10) Which of the following is the primary stimulus for secretion of parathyroid hormone by the
parathyroid gland?

A. Vitamin D therapy B. Calcimimetic therapy C. Hyperphosphatemia D. Hypocalcemia

11) For which of the following IV iron agents is observation of the patient for at least 30 minutes
following administration recommended?

A. Iron dextran B. Sodium ferric gluconate C. Ferumoxytol

D. Iron sucrose E. Observation is recommended with all agents

12) Use of ESAs to target higher hemoglobin levels in the CKD population has been associated with
which of the following?

A. Decrease in mortality B. Improved survival

C. Decrease in quality of life D. Increase in cardiovascular events

13) A patient with stage 3 CKD has vitamin D deficiency with a 25-hydroxyvitamin D level of 12 ng/mL
(30 nmol/L). Which of the following agents would be most beneficial to correct this deficiency?

A. Calcitriol B. Doxercalciferol C. Ergocalciferol D. Paricalcitol

14) Which of the following is a potential advantage of using sevelamer carbonate as a phosphate-
binding agent compared with other available phosphate binders?

A. It is available in a powder formulation.

B. It is absorbed to a greater extent in the GI tract.

C. It is available as a chewable tablet.

D. It can be given IV or orally.

15) A patient with stage 3 CKD with a PTH of 180 pg/mL (180 ng/L; 19.3 pmol/L) and persistently low
calcium levels would most likely benefit from which of the following agents?

A. Cinacalcet B. Paricalcitol C. Calcitriol D. Doxercalciferol

Chapter 30 - Hemodialysis and Peritoneal Dialysis

1) The most commonly used treatment for end-stage renal disease is:

A. Continuous renal replacement therapy

B. Peritoneal dialysis
C. Renal transplantation

D. Hemodialysis

2) In comparison to HD, PD:

A. Is associated with higher clearance rates for both solutes and water

B. Enables closer monitoring of the patient

C. Is associated with a lower technique failure rate

D. May result in better preservation of residual renal function

3) Which of the following is the most important indication for initiation of chronic dialysis therapy?

A. Blood urea nitrogen concentration greater than 60 mg/dL (21.4 mmol/L)

B. Estimated glomerular filtration rate less than 25 mL/min/1.73 m2

C. Hyperphosphatemia

D. Persistent symptoms, such as nausea and uncontrolled hypertension

4) Because of lower rates of infection and thrombosis associated with its use, which of the following HD
vascular access is considered to be the most desirable to use clinically?

A. Arteriovenous graft B. Arteriovenous fistula C. Central venous catheter D. Venous catheter

5) Which of the following dialysis membranes is most likely to remove large molecular weight
substances during HD?

A. Conventional HD B. High-flux HD C. High-efficiency HD D. Peritoneal membrane

6) Which of the following statements is not true regarding PD?

A. In comparison to HD, PD is less efficient at removing solutes and water

B. During PD, there is counter current flow of blood and dialysate, which increases diffusion and
convection

C. Blood flow to the peritoneal membrane can be regulated, but to a lesser degree than blood flow
through a vascular access in HD

D. The peritoneal membrane functions as the semipermeable membrane

7) To provide adequate PD: A. Weekly Kt/V should exceed 1.7 for CAPD patients B. Daily Kt/V should
exceed 1.7 for CAPD patients C. Residual renal function is not considered an important factor in the Kt/V
D. Kt/V should be at least 2.0 for patients without residual renal function 8) RC is a 63-year-old patient
with ESRD receiving outpatient HD thrice weekly that experiences intradialytic hypotension. What
nonpharmacologic approaches should be considered to minimize RC’s intradialytic hypotension?

A. Stretching exercises B. Trendelenburg position

C. Encourage food and beverage intake during dialysis D. Increase the dialysate temperature
 9) The preferred route for antibiotics to treat peritonitis in PD patients is: A. IV, using dosing based on a
renal function of less than 15 mL/min/1.73 m2 B. IV, increasing the dose by 25% for patients with daily
urine output greater than 100 mL C. Intraperitoneally, with one large antibiotic dose given in one
exchange per day in CAPD patients D. Intraperitoneally, with the same antibiotic dosing used for CAPD
and APD patients 10) Which of the following is true regarding PD catheter-related infections?

A. Topical antibiotics and disinfectants are ineffective in preventing PD catheter-related infections

B. Vancomycin is the antibiotic of choice for gram-positive PD catheter-related infections

C. PD catheter-related infections that progress to peritonitis seldom need to have the catheter removed
D. Gram-positive organisms should be treated with an oral penicillinase-resistant penicillin or a first-
generation cephalosporin such as cephalexin

11) A 62-year-old male who receives regular HD for the past 3 years with an arteriovenous (AV) graft has
diminished blood flow through his AV graft. Which one of the following would be best to restore AV
graft blood flow for this patient?

A. Tenecteplase B. Heparin C. Alteplase D. 4% sodium citrate

12) AV graft blood flow for this patient has been restored and the nephrologist is discussing adding an
oral agent to prevent AV graft thrombosis in this patient. Which one of the following would be best to
recommend for this patient at this time?

A. Warfarin B. Aspirin C. Fish oil supplement D. No therapy

13) A 67-year-old female HD patient receiving regular HD for the past year has had several episodes of
symptomatic intradialytic hypotension that was being treated with midodrine. The patient complained
of tingling in her hands and feet and subsequently stopped taking midodrine. Which one of the following
would be best to recommend for this patient at this time?

A. Advise the patient to take midodrine as needed

B. Review vital readings and current medications for this patient

C. Initiate paroxetine 10 mg once daily on non-HD days

D. Initiate intranasal desmopressin acetate one spray three times a week

14) A 71-year-old female PD patient has been diagnosed with a catheter exit-site infection and empiric
antibiotic therapy needs to be initiated. Which one of the following would be best to recommend for
this patient at this time?

A. Vancomycin B. Rifampin C. Cephalexin D. Ciprofloxacin

15) The prevention of HD catheter exit-site infections requires a multistep approach that includes a
topical antibiotic applied to the exit-site and/or catheter tip. Which of the following agents may increase
the risk of fungal infections in PD patients?

A. Mupirocin ointment B. Gentamicin cream

C. Povidine-iodine solution D. Polysporin triple ointment

Chapter 31 - Drug-Induced Kidney Disease

1) The most common manifestation of DIKD is:

A. Proteinuria B. Pyuria C. Hematuria

D. A decline in the glomerular filtration rate (GFR) E. A reduction in tubular secretion

2) Regarding DIKD, all of the following are applicable except:

A. Temporal relationship with potentially toxic agent

B. The offending agent is rarely identified

C. Significant source of morbidity in the hospital setting

D. Abrupt and sustained reduction in GFR E. The most common presentation in the hospital setting is
acute tubular necrosis

3) Which of the following drugs would be the most likely culprit in a patient with newly diagnosed renal
intratubular obstruction?

A. Ibuprofen B. Losartan C. Amphotericin B D. Ciprofloxacin E. Acyclovir

4) Hemodynamically mediated kidney injury induced by angiotensin-converting enzyme inhibitors

(ACEI) involves all of the following except.

A. Enhanced efferent arteriolar constriction

B. Patients with renal artery stenosis at increased risk

C. Decrease in glomerular capillary hydrostatic pressure

D. Reduced glomerular ultrafiltration

E. None of the above

5) Which of the following drugs has been associated with chronic interstitial nephritis?

A. Cyclosporine B. Ifosfamide C. Lithium D. Streptozotocin E. All of the above

6) Which of the following drugs has been associated with collapsing glomerulosclerosis?

A. Propylthiouracil B. Aminoglycosides C. Pamidronate

D. Radiographic contrast media E. Hydralazine

7) The following renal structural–functional alteration is associated with exposure to radiographic

contrast media:

A. Allergic interstitial nephritis B. Intratubular obstruction

C. Glomerular sclerosis D. Acute tubular necrosis E. Papillary necrosis

8) All of the following strategies may be used to prevent radiographic contrast media nephrotoxicity
except:

A. Amifostine B. Acetylcysteine C. Low osmolality agents

D. Hydration E. Reduced doses of contrast

9) The preferred agent for preventing cisplatin-induced nephrotoxicity is:

A. Fenoldopam B. Amifostine C. Dopamine D. Acetylcysteine E. Mesna

10) All of the following drugs are linked to the development of ANCA-positive vasculitis except:

A. Hydralazine B. Allopurinol C. Warfarin D. Propylthiouracil E. Penicillamine

11) Each of the following statements regarding aminoglycoside-induced acute tubular necrosis is true
except:

A. Risk factors include prolonged therapy and increased age

B. It manifests as a gradual rise in serum creatinine 4 to 6 weeks after exposure to the drug

C. Patients typically present with nonoliguria, maintaining urine volumes greater than 500 mL/day

D. Toxicity of various aminoglycosides is related to cationic charge of the drug E. “Once-daily” dosing
may be one method to maintain antimicrobial efficacy while reducing nephrotoxicity

12) The preferred treatment for a patient with drug-induced minimal change glomerular injury
accompanied by interstitial nephritis is:

A. Amifostine B. Cyclophosphamide C. Pamidronate D. Prednisone E. Hydration

13) The signs and symptoms of penicillin-induced allergic interstitial nephritis include all of the following
except:

A. Rash, eosinophilia, pyuria

B. Fever, eosinophilia, reduced intraglomerular pressure

C. Fever, rash, eosinophilia

D. Elevated serum creatinine, rash, eosinophilia

E. Hematuria, proteinuria, oliguria

14) A 60-year-old woman with a 5-year history of NSAID use is prescribed enalapril and develops acute
kidney injury (AKI). What is the most likely cause of her AKI?

A. Acute allergic interstitial nephritis B. Chronic interstitial nephritis

C. Minimal change glomerular injury

D. Focal segmental glomerulosclerosis E. Hemodynamically mediated kidney injury

15) The calcineurin inhibitor cyclosporine has been implicated in which of the following?
A. Allergic interstitial nephritis B. Thrombotic microangiopathy

C. Chronic interstitial nephritis D. Hemodynamically mediated kidney injury E. All of the above

Chapter 32 – Glomerulonephritis

1) In a patient with nephrotic syndrome, which of the following is/are commonly observed
characteristic(s)?

A. Proteinuria B. Edema C. Hyperlipidemia D. Hypercoagulable stat

2) Which of the following is/are expected to reduce proteinuria when used for patients with
glomerulonephritis? A. Angiotensin-converting enzyme (ACE) inhibitors B. Angiotensin II receptor
blockers C. Nonsteroidal anti-inflammatory agents D. A and B only E. A, B, and C are expected to reduce
proteinuria 3) Which of the following parameters is often used to assess the risk for progressive decline
of renal function in patients with glomerulonephritis? A. Edema B. Proteinuria C. Hyperlipidemia D.
Coagulopathy E. Hematuria 4) Which of the following is the optimal target blood pressure in patients
with glomerular disease with GFR 300 mg/day? A. 130/80 mmHg B. 130/90 mmHg C. 140/80 mmHg D.
140/90 mmHg E. 140/70 mmHg 5) Anticoagulation therapy for thrombosis prophylaxis may be
considered for patients with which of the following glomerular diseases? A. Minimal-change
nephropathy B. Focal segmental glomerulonephritis C. Membranous nephropathy D. Immunoglobulin A
nephropathy E. Membranoproliferative glomerulonephritis 6) In pediatric patients presenting with
nephrotic syndrome, which of the following glomerular disease is likely? A. Minimal-change
nephropathy B. Focal segmental glomerulonephritis C. Immunoglobulin A nephropathy D. Membranous
nephropathy E. Membranoproliferative glomerulonephritis 7) Which of the following agents is often
used as first-line therapy for inducing remission in patients with recently diagnosed minimal-change
nephropathy? A. Steroid B. Cyclosporine C. Azathioprine D. Cyclophosphamide E. Mycophenolate
mofetil 8) Which of the following is correct regarding the use of cyclosporine for the treatment of
minimal-change nephropathy? A. Cyclosporine is often effective in inducing remission during relapse B.
Cyclosporine is useful for patients who are steroid dependent C. The disease-free period is not often
sustained after therapy discontinuation D. A and B only E. A, B, and C are correct 9) Which of the
following are risk factors associated with rapid renal function decline in patients with focal segmental
glomerulonephritis? A. Severe proteinuria B. High serum creatinine concentration at initial diagnosis C.
Initial steroid resistance D. Only A and B are correct E. A, B, and C are correct 10) Which of the following
has been shown by meta-analysis to reduce proteinuria in patients with IgA nephropathy? A.
Corticosteroids B. Cytotoxic agents C. Fish oil D. Antiplatelet agents E. Phenytoin 11) A patient with IgA
nephropathy who has normal renal function, isolated microhematuria, and proteinuria less than 1 g/day
should be: A. Observed closely without specific treatment B. Given fish oil C. Given steroid treatment D.
Given cytotoxic agents E. Given mycophenolate mofetil 12) Which of the following is/are commonly
considered when selecting the optimal treatment for patients with lupus nephritis? A. Disease activity
according to pathologic findings B. Duration of symptoms C. Extent of proteinuria D. A and B only E. A, B,
and C 13) Which of the following is considered to be protective against the onset of lupus nephritis,
relapse of the disease, as well as the development of ESRD and venous thrombosis? A. Steroid B.
Cytotoxic agent C. Cyclosporine D. Mycophenolate mofetil E. Hydroxychloroquine 14) Annual eye
examination for possible retinal toxicity should be conducted for patients receiving which of the
following therapy? A. Fish oil B. Cytotoxic agent C. Cyclosporine D. Mycophenolate mofetil E.
Hydroxychloroquine 15) Which of the following treatments is/are appropriate for poststreptococcal
glomerulonephritis? A. Antibiotic to reduce severity of disease B. Antibiotic to prevent the spread of
infection to family members C. Fish oil to prevent renal damage D. A and B only E. A, B, and C Chapter 33
- Drug Therapy Individualization for Patients with Chronic Kidney Disease 1) Which of the following is a
potential mechanism by which the volume of distribution of drugs is increased in patients with chronic
kidney disease (CKD)? A. Increased plasma protein binding B. Decreased tissue binding C. Increased fluid
retention D. Decreased fluid status 2) Unbound drug concentrations for drugs that have narrow
therapeutic range should be used to monitor therapy and make dose modifications in patients with CKD.
A. True B. False 3) Increased concentrations of albumin have been attributed to a reduction in plasma
protein binding of acidic drugs. A. True B. False 4) Which volume of distribution (VD) is increased in
patients with oliguric acute renal failure accompanied by fluid overload? A. Volume of the central
compartment (Vc) B. Volume of the terminal phase (Vβ) C. Volume of distribution at steady state (Vss)
D. Volume of distribution area (Varea) 5) Which of the following statements regarding drug metabolism
in patients with renal insufficiency is true? A. Nonrenal clearance of medications is not dependent on
whether the reduction in renal function is acute or chronic in nature B. Only OATP uptake activity is
reduced in patients with renal insufficiency and not an alteration in cytochrome P450 (CYP) activity C.
Metabolites of drugs may have pharmacologic activity similar to or dissimilar to that of the parent drug
D. Practical consequences of metabolite accumulation are easy to predict based on the current data
available 6) Which of the following statements regarding estimation of renal function is true? A.
Estimation of creatinine clearance (CLcr) or glomerular filtration rate (GFR) can be used in patients with
fluctuations in serum creatinine concentrations B. Measured CLcr or GFR, by urine collections, is the
quickest and most accurate method used to evaluate initial drug dosage regimens. C. Using the
modification of diet in renal disease (MDRD) equation resulted in similar drug dosing recommendations
compared to using the Cockcroft–Gault (C–G) equation. D. More data are available regarding the use of
C–G equation to guide drug dosing in CKD patients; thus, drug dosing recommendations should continue
to be based on CLcrestimated by C–G. 7) Based on recent dosage-adjustment guidelines and references,
which of the following CLcr ranges appropriately represents mild, moderate, and severe renal
insufficiency? A. Mild: 90 to 115 mL/min (1.50 to 1.92 mL/s), moderate: 60 to 89 mL/min (1 to 1.49
mL/s), severe: 30 to 59 mL/min (0.50 to 0.99 mL/s) B. Mild: 60 to 89 mL/min (1 to 1.49 mL/s), moderate:
30 to 59 mL/min (0.5 to 0.99 mL/s), severe: 10 to 30 mL/min C. Mild: 50 to 80 mL/min (0.84 to 1.34
mL/s), moderate: 20 to 49 mL/min (0.33 to 0.83 mL/s), severe: < 20 mL/min (< 50 mL/min (95%) B.
Atenolol (MW = 266; VD = 1.1 L/kg; plasma protein binding = 3%) C. Digoxin (MW = 781; VD = 4 to 7
L/kg; plasma protein binding = 20% to 25%) D. Vancomycin (MW = 1,449; VD = 0.47 to 1.1 L/kg; plasma
protein binding = 52% to 60%) 15) A 67-year-old, 72-kg man with a residual CLcr of 5 mL/min (0.08 mL/s)
is also receiving high-flux dialysis for 4 hours on Tuesdays, Thursdays, and Saturdays. He is to receive IV
gentamicin for a urinary tract infection and the first dose to be given is 150 mg after his hemodialysis
treatment. Calculate the concentration at the end of the 30-minute infusion (Cmax) and plasma
concentration prior to the next dialysis session (CbD), which is 44 hours away. The relationship between
gentamicin clearance (CL/F) and renal function is CL (mL/min) = 0.983 (CLcr). The VD of gentamicin is
0.23 L/kg. A. Cmax is 7.3 and CbD is 2.3 B. Cmax is 9.2 and CbD is 4.2 C. Cmax is 10.9 and CbD is 3.3 D.
Cmax is 15.3 and CbD is 6.3 Chapter 34 - Disorders of Sodium and Water Homeostasis 1) An 85-year-old
woman (weight, 55 kg [121 lb]; height, 5′4″ [163 cm]) presents to the emergency room (ER) with new
onset twitching and seizures likely due to abruptly developing hypovolemic hypotonic hyponatremia.
Her serum sodium concentration in the ER is 118 mEq/L (118 mmol/L). How many liters of 0.9% NaCl
would be needed to replace this patient’s sodium deficit? (Note: assume a desired serum sodium
concentration of 130 mEq/L [130 mmol/L].) A. 0.58 L B. 1.9 L C. 2.1 L D. 2.6 L 2) Usual doses of synthetic
vasopressin (DDAVP) will be most effective if the patient has which one of the following disorders? A.
Nephrogenic diabetes insipidus B. Central diabetes insipidus C. Heart failure D. Syndrome of
inappropriate antidiuretic hormone (SIADH) 3) A patient who was started on furosemide approximately
2 weeks ago presents with a significantly decreased blood pressure, increased heart rate, and significant
orthostasis. His serum sodium concentration is found to be 165 mEq/L (165 mmol/L). Which one of the
following would be the most appropriate initial fluid to administer to this patient? A. 0.9% NaCl B.
Dextrose 5% in water C. 3% NaCl D. 0.45% NaCl 4) A patient is admitted with a serum glucose
concentration of 900 mg/dL (50 mmol/L) and a serum sodium concentration of 125 mEq/L (125
mmol/L). He appears mildly dehydrated, but he has no obvious central nervous system-related
symptoms. This patient’s hyponatremia should be treated with administration of which one of the
following? A. 3% NaCl to replace the sodium deficit B. Dextrose 5% in water to replace the free water
deficit C. Insulin to correct the hyperglycemia and 0.9% NaCl to correct the hypovolemia D. 3% NaCl to
correct the hypovolemia and insulin to correct the hyperglycemia 5) Thiazide diuretics like
hydrochlorothiazide are most likely to cause which one of the following sodium disorders? A.
Hypovolemic hypernatremia B. Hypovolemic hyponatremia C. Hypervolemic hypernatremia D.
Hypervolemic hyponatremia 6) A patient is admitted to the ED with altered sensorium. Which one of the
following can be used alone to quickly approximate the serum osmolality? A. Serum sodium
concentration B. Serum potassium concentration C. Serum glucose concentration D. Serum blood urea
nitrogen concentration The following case is used for Questions 7, 8, 9: A.F. is a 71-year-old man
(weight, 65 kg) being evaluated for possible lung cancer after a mass was seen on a chest X-ray. Upon
physical exam, he has good skin turgor, no lower extremity edema, and appears well hydrated. He has
no complaints. Labs were drawn just before this clinic visit and were reported as follows: Glucose
93mg/dL; Uosm 395 mOsm/kg; UNa 29mEq/L; SNa =120mEq/L; SCl =89mEq/L; TCO2 =17mEq/L Calcium
6.9mg/L; albumin 2g/L; SK =2.4mEq/L; BUN = 23mg/L; SCr =0.8mg/dL In corresponding SI units: Glucose
5.2; Uosm 395; UNa 29; SNa =120; SCl =89; TCO2 =17 Calcium 1.73; albumin 20; SK = 2.4; BUN = 8.2; SCr
=71 7) What is the most likely cause of A.F.’s hyponatremia? A. Excess sodium excretion B. Nephrogenic
diabetes insipidus C. GI tract fluid losses. D. SIADH 8) The medical intern has never managed a patient
with severe hyponatremia like A.F. and asks your assistance in developing a plan. His serum sodium
concentration remains at 120 mEq/L (120 mmol/L). Which of the following is the maximum serum
sodium concentration which should be obtained in 6 hours if the serum sodium concentration is
increased at the maximum recommended rate? A. 123 mEq/L (123 mmol/L) B. 126 mEq/L (126 mmol/L)
C. 132 mEq/L (132 mmol/L) D. 140 mEq/L (140 mmol/L) 9) After about 2 weeks of fluid restriction, A.F.’s
sodium remains low. His physician would like to start him on demeclocycline for chronic management of
hyponatremia. Which of the following is the most appropriate plan for demeclocycline dosing? A. 300
mg once daily initially, increased to 300 mg 2 times/day after 7 days. B. 300 mg 3 times/day initially,
increased to 600 mg 3 times/day after 7 days. C. 300 mg 2 times/day initially, increased to 600 mg 2
times/day if the sodium concentration remains low after 24 hours. D. 300 mg 4 times/day, increased to
600 mg 4 times/day after 48 hours. 10) A 65-year-old man (weight, 80 kg [176 lb]) was started on
furosemide approximately 1 week ago for significant heart failure and pulmonary edema. He presents
today with a BP of 60/30 mm Hg, heart rate of 150 bpm, and significant orthostasis. His serum sodium
concentration is 170 mEq/L (170 mmol/L). Which of the following would be the most appropriate initial
intervention? A. A 1000-mL IV bolus of 5% dextrose in water (D5W) over 30 minutes B. A 1000-mL IV
bolus of 0.9% NaCl over 60 minutes A 500-mL IV bolus of 0.9% NaCl over 30 minutes D. A 500-mL IV
bolus of 5% dextrose /0.45% NaCl over 30 minutes 11) Which diuretic has the greatest ability to increase
the fractional excretion of sodium (FeNa)? A. Spironolactone B. Metolazone C. Furosemide D.
Hydrochlorothiazide 12) A 68-year-old man with severe heart failure currently lives at home with his
wife. His glomerular filtration rate is 60 mL/min (1 mL/s). His physician has progressively increased his
dose of furosemide to 120 mg every 6 hours to control his edema but without success. What is the most
appropriate change to his diuretic therapy at this time? A. Increase the furosemide dosage to 150 mg
every 6 hours B. Change to a continuous furosemide infusion C. Begin torsemide; discontinue
furosemide D. Begin metolazone; continue furosemide 13) A 36-year-old man’s bipolar disorder has
been treated with lithium for several years. He now reports that he has had to urinate more frequently
than normal over the past several weeks. This problem has gotten progressively worse and has been
accompanied by increased thirst. The patient’s serum sodium is 146 mEq/L (146 mmol/L), and his 24-
hour urine output is 5 L. Which of the following is the most appropriate treatment of this patient’s
condition? A. Intranasal desmopression 10 mcg once daily B. Amiloride 5 mg orally once daily C.
Dextrose 5% in water intravenously at 48 mL/h for 24 hours D. Water restriction to less than 1000
mL/day 14) A 61-year-old man (weight, 90.9 kg [200 lb]; height, 6'4″ [193 cm]) who has had vomiting
and diarrhea for 4 days is admitted for dehydration, and he fell this morning when he tried to get out of
bed. He has not been keeping fluids down for at least 48 hours. His serum sodium concentration on
admission was 124 mEq/L (124 mmol/L). What is his extracellular fluid (ECF) deficit? A. 2.2 L B. 4.4 L C.
9.5 L D. 16.5 L 15) Which one of the following drugs has the effect of producing a large volume of water
excretion without concomitantly affecting electrolyte excretion? A. Furosemide B. Chlorthalidone C.
Spironolactone D. Tolvaptan Chapter 35 - Disorders of Calcium and Phosphorus Homeostasis 1) A
common malignancy associated with hypercalcemia from PTH-related protein is: A. Breast B. Prostate C.
Leukemia D. Cervical E. Multiple myeloma 2) A 68-year-old female presents with a serum total calcium
of 13.1 mg/dL (3.28 mmol/L) secondary to primary hyperparathyroidism. Which of the following are
symptoms are associated with hypercalcemia? A. Dyspnea B. Weakness C. Polyuria D. Bradycardia E.
Weakness and polyuria 3) A 56-year-old male with Stage 4 prostate cancer presents to the emergency
department with profound weakness, abdominal pain with nausea and vomiting, and profound
dehydration. Laboratory analysis reveals: sodium 135 mEq/L (135 mmol/L), potassium 4.5 mEq/L (4.5
mmol/L), chloride 101 mEq/L (101 mmol/L), bicarbonate 24 mEq/L (24 mmol/L), serum creatinine 1.2
mg/dL (106 µmol/L) (baseline 1.0 mg/dL [88 µmol/L]) and BUN 40 mg/dL (14.3 mmol/L), total calcium
14.2 mg/dL (3.55 mmol/L). What is the most likely cause of his hypercalcemia? A. Primary
hyperparathyroidism B. Secondary hyperparathyroidism associated with kidney disease C. Bone
metastases D. Excessive endogenous Vitamin D production 4) Which of the following is the most
appropriate initial therapy for this patient? A. Hemodialysis with a low calcium bath B. High dose loop
diuretic C. Saline hydration D. IV bisphosphonate E. Subcutaneous calcitonin 5) A 65-year-old female
with her first episode of asymptomatic hypercalcemia secondary to metastatic breast cancer presents
with a serum calcium of 12.2 mg/dL (3.05 mmol/L). The decision is made to initiate therapy with an
agent that inhibits bone resorption. Based on the efficacy and toxicity profile of the following agents,
which would be the most appropriate to initiate in this patient? A. Glucocorticoids B. Ibandronate C.
Gallium nitrate D. Mithramycin 6) Which of the following would be the treatment of choice for a 80-
year-old female with osteoporosis and chronic hypercalciuria who has had several episodes of calcium
oxalate nephrolithiasis? A. Thiazide diuretic B. Calcium restricted diet C. Lithotripsy D. Calcium binding
exchange resin 7) A pharmacist counseling a patient on cinacalcet-induced hypocalcemia should include
which of the following? A. Itching B. Constipation C. Muscle spasms D. Polyuria 8) The most appropriate
therapy for hypocalcemia in a patient with advanced chronic kidney disease and elevated parathyroid
hormone would be: A. Ergocalciferol B. Calcium carbonate C. Calcium acetate D. Calcitriol 9) A 35-year-
old male is status post a parathyroidectomy and develops hungry bone syndrome with seizures and
tetany postoperatively. His ionized calcium is 1 mmol/L. Which of the following is the best initial
management? A. Calcium chloride 1 g IV B. Calcium carbonate 500 mg IV C. Calcium gluconate 2 g IV D.
Lorazepam 1 mg IV 10) A 65-year-old patient with chronic kidney disease stage 4 (estimated GFR 35
mL/min/1.73 m2 ). Her present medications include lisinopril 40 mg once a day, furosemide 80 mg twice
a day, and metoprolol succinate 50 mg once a day. She is scheduled to have a colonoscopy and she is
advised to purchase a sodium phosphate bowel preparation (Fleet Phospho-Soda). Which of the
following does not put her at increased risk for phosphate nephropathy or acute renal failure? A.
Chronic kidney disease B. Lisinopril therapy C. Metoprolol therapy D. Diuretic therapy 11) A 65-year-old
male on hemodialysis for 3 years is being treated for hyperphosphatemia. He has been on sevelamer
carbonate 800 mg three times a week a day and cinacalcet 90 mg once a day. He presents to a clinic
with tingling in his hands and around his mouth. Laboratory data include: corrected calcium 7.2 mg/dL
(1.80 mmol/L), phosphorus 6.8 mg/dL (2.20 mmol/L). The most likely cause of his tingling is: A.
Hyperphosphatemia B. Hypophosphatemia C. Hypercalcemia D. Hypocalcemia 12) Which of the
following would be the best choice for phosphate binder therapy in JM based on the above data? A.
Aluminum hydroxide B. Calcium acetate C. Lanthanum carbonate D. Sevelamer hydrochloride 13) A
patient presents to the emergency department obtunded and nonresponsive. A family member
describes the patient as a “raging alcoholic”. The patient has received several liters of IV B vitamins in
5% dextrose in water. Labs reveal: potassium 4.5 mEq/L (4.5 mmol/L), phosphorus 0.8 mg/dL (0.26
mmol/L), albumin 1.2 g/dL (12 g/L), and total corrected calcium 8.3 mg/dL (2.08 mmol/L). Which of the
following best describes the pathogenesis of his hypophosphatemia? A. Increased renal excretion B.
Extracellular fluid dilution C. Redistribution D. Binding to serum calcium 14) Myocardial dysfunction
related to hypophosphatemia is most likely caused by which of the following? A. Altered cardiac
conduction B. Depletion of cardiac ATP stores C. Myocardial cell apoptosis D. All of the above 15) Based
on the patient presentation and laboratory data in Question 13 what would be the most appropriate
phosphorus supplement to initiate? A. Potassium phosphate powder orally B. Sodium phosphate IV C.
Sodium phosphate solution orally D. Increase phosphorus content in his meals 16) An 85-year-old
hemodialysis patient who resides in a nursing home develops hypophosphatemia (serum phosphorus
1.1 mg/dL [0.36 mmol/L]) secondary to limited oral intake associated with advanced dementia. His other
laboratory data include: serum potassium 6.2 mEq/L (6.2 mmol/L) and total corrected calcium 8.5 mg/dL
(2.13 mmol/L). Which of the following is the best therapy to initiate in this patient? A. Neutra-Phos-K B.
K-Phos Neutral C. Neutra-Phos D. Potassium phosphate in his dialysis line Chapter 36 - Disorders of
Potassium and Magnesium Homeostasis 1) Which of the following is an appropriate first-line agent for
nonsymptomatic hyperkalemia? A. Albuterol B. Sodium polystyrene sulfonate C. Sodium bicarbonate D.
Insulin + dextrose 2) Which of the following drugs would be expected to result in hyperkalemia? A.
Hydrochlorothiazide B. Candesartan C. Furosemide D. Dopamine 3) A patient has the following
symptoms on presentation: lethargy, decreased deep tendon reflexes, and somnolence. She most likely
has which of the following conditions? A. Hypokalemia B. Hyperkalemia C. Hypomagnesemia D.
Hypermagnesemia 4) Which of the following is immediate first-line therapy for hyperkalemia associated
with ECG changes? A. Furosemide 40 mg orally B. Calcium gluconate 1 g IV C. Sodium bicarbonate 50
mEq (50 mmol) IV D. Regular insulin 10 units IV 5) Which of the following statements regarding IV
potassium is correct? A. The infusion rate should not exceed 10 mEq/h (10 mmol/h) in a peripheral line
B. IV potassium is preferred in all hospitalized patients C. Potassium should be diluted in dextrose 5%
water D. Continuous electrocardiogram (ECG) monitoring is always necessary when infusing potassium
6) A significant side effect of oral potassium preparations is: A. Hypomagnesemia B. Nephrolithiasis C.
Gastrointestinal (GI) upset D. Cholangitis 7) A patient presents with a Chvostek’s sign. He most likely has
which of the following conditions? A. Hypokalemia B. Hyperkalemia C. Hypomagnesemia D.
Hypermagnesemia 8) A patient presents with a peaked t-wave and widened QRS complex on ECG. He
most likely has which of the following conditions? A. Hypokalemia B. Hyperkalemia C. Hypomagnesemia
D. Hypermagnesemia 9) Your patient develops hyperkalemia (without ECG changes) as a result of severe
metabolic acidosis. Which of the following options is considered the first-line treatment option? A. IV
calcium gluconate B. Insulin + dextrose C. Albuterol D. Sodium bicarbonate 10) Which of the following
are limitations of magnesium replacement therapy? A. Intramuscular therapy is often painful and
intolerable to the patient B. Oral therapy can result in a high incidence of diarrhea C. Intravenous
infusion can result in flushing and hypotension D. All of the above Chapter 37 - Acid–Base Disorders

Chapter 57 - Diabetes Mellitus

1) Type 2 diabetes mellitus is characterized by:

A. Insulin resistance, obesity, and insulin deficiency

B. A majority of patients with TCF7L2 heterozygous allele

C. A decline in α-cell function and/or mass over time

D. High postprandial GLP-1 levels

E. A higher risk of celiac disease

2) Which of the following properly performed laboratory values would be diagnostic for diabetes
mellitus?

A. A fasting plasma glucose of 127 mg/dL

B. A random plasma glucose of 192 mg/dL after a meal, but the patient states they feel fine, sleep well,
and have gained 10 lb over the last 6 months

C. A plasma glucose of 141 mg/dL at 2 hours on a 75-g oral glucose tolerance test (OGTT)

D. A hemoglobin A1c value of 6.4%

3) An adolescent is newly diagnosed with diabetes mellitus. The father also has diabetes. He was
diagnosed when he was 27 years old after an employment screening and takes a sulfonylurea. What is
the etiology of their diabetes mellitus?

A. A TCF7L2 allele issue is likely B. Type 2 DM or mature-onset diabetes in the young (MODY)

C. DRQ2 or DRQ4 leading to type 1 DM D. Latent autoimmune diabetes in adults (LADA)

4) How is GLP-1 affected by type 1 DM?

A. Reduced postprandial levels. B. Resistance to its action at target tissues.

C. Absolute deficiency. D. There is no change.

5) A patient with poorly controlled type 2 diabetes mellitus with extreme insulin resistance is currently
on a total daily dose of 300 units of U-100 insulin. They are being transitioned to an equivalent total
daily dose of U-500 regular insulin divided into equal doses injected subcutaneously before each meal
three times a day. Choose thecorrectly written prescription(s).

A. U-500 regular insulin: inject 100 units (0.2 mL) subcutaneously three times daily before meals.

B. U-500 regular insulin: inject 100 units (20 units as measured by the unit markings of a U-100 syringe)
subcutaneously three times daily before meals.

C. U-500 regular insulin: inject 20 units subcutaneously three times daily before meals.

D. Both A and B are correct.

6) All of the following are effects of glucagon-like peptide 1 (GLP-1) agonists except:

A. Enhance insulin secretion in a glucose-dependent manner

B. Suppress inappropriately high postprandial glucagon secretion

C. Promote weight gain

D. Cause nausea and other adverse GI side effects E. Increase satiety and decrease gastric emptying

7) Which of the following dipeptidyl peptidase 4 (DPP-4) inhibitors does not require adjustment of dose
in renal insufficiency?

A. Linagliptin B. Sitagliptin C. Saxagliptin D. Alogliptin

8) A 65-kg patient with type 1 diabetes mellitus is taking insulin glargine 40 units at bedtime and
scheduled dose 8 units of insulin lispro three times a day before each meal plus additional lispro for
hyperglycemia. The patient has been consistently experiencing a marked increase in blood glucoses
(BGs) overnight. Despite usually having bedtime BGs in the 120 to 150 mg/dL range, the patient
consistently awakens with fasting BGs between 300 and 400 mg/dL. The next best step is to:

A. Increase the dose of insulin glargine to 45 units injected subcutaneously at bedtime.

B. Keep the dose of insulin glargine the same, but change the timing of the injection from bedtime to
morning.

C. Ask the patient about symptoms of nocturnal hypoglycemia and request they test some overnight
BGs at 2 or 3 AM.

D. Advise the patient to begin 4 units of insulin lispro with their bedtime snack.

E. Tell the patient to stop consuming their bedtime snack altogether.

9) An obese patient with type 2 diabetes mellitus is taking 86 units of insulin detemir per day along with
three scheduled doses of 28 units of insulin aspart before each meal (total daily dose of insulin = 170
units). You would like to advise them how to treat hyperglycemia by using additional insulin aspart.
Please determine their estimated correction factor.

A. 1 extra unit of insulin aspart will lower blood glucose by 8 mg/dL.

B. 1 extra unit of insulin aspart will lower blood glucose by 10 mg/dL.

C. 1 extra unit of insulin aspart will lower blood glucose by 15 mg/dL.

D. 1 extra unit of insulin aspart will lower blood glucose by 20 mg/dL.

E. 1 extra unit of insulin aspart will lower blood glucose by 50 mg/dL.

10) Please choose the correct statement.

A. New-onset type 1 diabetes can present at any age.

B. Type 2 diabetes is most often due to autoimmune destruction of pancreatic β cells.

C. The prevalence of type 2 diabetes decreases with age.

D. Type 2 diabetes accounts for about 80% of cases of diabetes.

E. Latent autoimmune diabetes of adulthood (LADA) usually responds to oral agents and does not
require insulin therapy.

11) All of the following are currently available and marketed insulin preparations except:

A. Detemir B. Glulisine C. Ultralente D. NPH

12) What is the preferred treatment option for an 18-year-old man with type 1 DM?

A. Metformin B. Basal and bolus insulin regimen C. Bedtime insulin NPH D. Exenatide

13) Which of the following is true regarding a 35-year-old woman with type 1 DM who has a concurrent
self-limiting illness?

A. Insulin sensitivity increases necessitating a decrease in insulin dose.

B. Frequent blood glucose monitoring is not necessary in this situation.

C. Sport drinks are preferred given their electrolyte and sugar content.

D. Glucose control is more challenging in type 1 DM patients compared with that in type 2 DM patients.

14) Which of the following is a typical distinction between diabetic ketoacidosis (DKA) and hyperosmolar
hyperglycemic state (HHS)?

A. HHS patients have higher plasma glucose concentrations than those with DKA.

B. HHS patients have lower effective serum osmolality than those with DKA.

C. Patients with HHS always present with ketonuria. D. HHS evolves much quicker than DKA.
15) Which of the following initial therapy options is best for a 60-year-old obese patient with type 2 DM
(HbA1c = 10%), hypertension, elevated triglycerides, and decreased HDL?

A. Basal and bolus insulin regimen B. Metformin monotherapy

C. Sitagliptin monotherapy D. Metformin plus another oral agent

16) Which of the following initial therapy options is best for an 84-year-old normal-weight patient with
type 2 DM (HbA1c = 7.8%)? She has a history of fourvessel bypass 8 years ago, hypertension,
dyslipidemia, and Parkinson’s disease, and has fallen twice in the last 6 months.

A. Lifestyle changes only. B. Metformin monotherapy.

C. Linagliptin monotherapy. D. All are initial therapy options.

Chapter 58 - Thyroid Disorders

1) Thionamides (methimazole and propylthiouracil) act by doing which of the following?

A. Interfering with thyroglobulin resorption into thyroid follicles

B. Inhibiting iodine incorporation into tyrosine residues

C. Inhibiting the sodium iodide transporter

D. Increasing thyroglobulin stores

E. Causing destruction of thyroid follicular cells

2) Which of the following is true regarding the medical treatment of hyperthyroidism?

A. Methimazole has a shorter half-life than propylthiouracil.

B. A common side effect of these agents is renal impairment.

C. Both propylthiouracil and methimazole are concentrated within the thyroid gland.

D. It takes 4 to 8 months of thionamide therapy before thyroid hormone levels begin to decrease.

E. Methimazole is strongly bound to plasma proteins.

3) The following statements about thionamides (propylthiouracil [PTU] and methimazole) are correct
except:

A. Methimazole can be administered once daily.

B. Methimazole and PTU reduce the stores of thyroglobulin within the thyroid gland.

C. PTU use is contraindicated during the first trimester of pregnancy.

D. Methimazole is considerably more potent than PTU.

E. The side effects of PTU and methimazole can include GI symptoms.

4) The following statements about thionamides (propylthiouracil [PTU] and methimazole) are correct
except:

A. Mild leukopenia can be seen with PTU, methimazole, and Graves’ disease itself.

B. Methimazole and PTU serve as substrates for the iodinating intermediate of thyroid peroxidase.

C. PTU may increase the efficacy of later treatment with radioactive iodine.

D. Methimazole is generally considered first-line therapy for hyperthyroidism.

E. The side effects of PTU and methimazole can include development of a rash.

5) Which of the following statements about radioactive iodine therapy of hyperthyroidism is incorrect?
A. Men are less likely to become hypothyroid after radioactive iodine therapy.

B. Treatment doses of radioiodine may be based on a fixed dose approach or a calculated dose
approach, using calculations based on thyroid gland size and iodine uptake and turnover.

C. Hypothyroidism generally occurs approximately 6 days after radioiodine administration.

D. Radioactive iodine therapy is contraindicated during pregnancy and lactation.

E. If a first dose of radioactive iodine is ineffective, a second radioactive iodine dose may be given.

6) Which of the following statements about thyroid hormones is correct?

A. T4 has a half-life of about a day. B. T3 is not usually chosen for treatment of

hypothyroidism because it has to be given subcutaneously.

C. T4 can be thought of as a prohormone as it is converted into the active hormone T3.

D. The thyroid gland produces mostly T3 and a small amount of T4. E. TSH concentrations are generally
not helpful when titrating a hypothyroid patient’s dose of thyroid hormone.

7) Which of the following is not a potential cause of hypothyroidism?

A. Hashimoto’s thyroiditis B. Radioactive iodine therapy

C. Pituitary failure D. β-Blocker therapy E. Overtreatment with thionamides

8) Which of the following is not true about levothyroxine (synthetic thyroid hormone)?

A. It has a half-life of 7 days, which allows it to be administered once daily.

B. It is active when taken orally.

C. It produces stable serum levels of both T4 and T3.

D. Its side effects can include hepatitis and agranulocytosis.

E. New steady-state levels of T4 are reached about 6 weeks after a levothyroxine dosage change.

9) Which of the following is not true about liothyronine (synthetic T3)?

A. It has a half-life of about 1 day, which means it has to be administered several times a day to maintain
steady levels of T3.

B. It has been used in combination with levothyroxine therapy.

C. It produces stable serum levels of both T4 and T3.

D. The side effects can include palpitations and insomnia.

E. It is not the treatment of choice for hypothyroidism.

10) Which of the following is not true regarding the use of recombinant hTSH (rhTSH)?

A. rhTSH can be used to prepare patients with thyroid cancer for diagnostic radioiodine whole-body
scanning.

B. rhTSH cannot be used to stimulate thyroglobulin production as part of the diagnostic testing of
patients with thyroid cancer.

C. Preparation with rhTSH avoids the morbidity of hypothyroidism.

D. rhTSH is given as an intramuscular injection.

E. Postthyroidectomy adjuvant radioiodine therapy can be delivered following rhTSH administration.

F. The sensitivity of diagnostic testing using radioiodine scanning and thyroglobulin measured after
withdrawal from thyroid hormone and after rhTSH are similar.

Chapter 59 - Adrenal Gland Disorders

1) Aldosterone is synthesized in the:

A. Zona glomerulosa

B. Zona fasciculata

C. Zona reticularis

D. Medulla

2) Glucocorticoids regulate their own secretion by inhibiting the pituitary secretion of:

A. Corticotropin-releasing hormone

B. Adre