ITE Nephrology and Hypertension 4

Question 1

A 55-year-old man presents with serum creatinine of 3.2 mg/dL, hemoglobin of 8.8 g/dL, and ferritin of 210 ng/mL with transferrin saturation of 18%. He is on erythropoiesis-stimulating agents. What is the most appropriate next step for his anemia management?

Accepted Answer

Administer IV iron

Answer

Functional iron deficiency (low TSAT despite adequate ferritin) in CKD patients on ESA therapy should be corrected with IV iron to optimize erythropoiesis.

Question 2

A patient with end-stage renal disease on peritoneal dialysis develops cloudy peritoneal effluent. Peritoneal fluid cell count shows 350 WBC/µL with 85% neutrophils. What is the most likely organism?

Accepted Answer

Staphylococcus epidermidis

Answer

Coagulase-negative staphylococci (S. epidermidis) are the most common cause of peritoneal dialysis-associated peritonitis, typically from touch contamination.

Question 3

A 45-year-old woman with hypertension and no prior kidney disease presents with sudden onset severe headache, BP 220/130 mmHg, papilledema, and serum creatinine of 3.8 mg/dL (baseline 0.9 mg/dL). Peripheral blood smear shows schistocytes. What is the diagnosis?

Accepted Answer

Hypertensive emergency with thrombotic microangiopathy

Answer

Severe hypertension causing end-organ damage including microangiopathic hemolytic anemia represents hypertensive emergency with secondary TMA, distinct from primary TMA syndromes.

Question 4

A 60-year-old man with gout and CKD stage 3 has serum uric acid of 9.8 mg/dL. He has had 3 gout flares in the past year. What is the target serum uric acid level for urate-lowering therapy in this patient?

Accepted Answer

Below 6.0 mg/dL

Answer

ACR guidelines recommend a target serum uric acid below 6.0 mg/dL for patients on urate-lowering therapy, and below 5.0 mg/dL for those with tophi.

Question 5

A 50-year-old man is found to have BP of 150/95 mmHg on three separate occasions. He denies symptoms of sleep apnea but his wife confirms loud snoring and witnessed apneas. Which antihypertensive class has the most evidence for improving BP control in the setting of obstructive sleep apnea?

Accepted Answer

Aldosterone antagonists

Answer

Aldosterone excess is disproportionately common in resistant hypertension with OSA; spironolactone reduces BP in this population beyond CPAP therapy alone.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Nephrology and Hypertension 4