What is an important risk of routine urinary catheterization in a patient with AKI?, A. Urinary tract infection, B. Increased glomerular filtration, C. Hyperthyroidism, D. Increased erythropoietin production, A patient develops AKI with difficulty urinating and a palpable distended bladder. Which imaging investigation is most appropriate?, A. Urinary tract ultrasound, B. Brain MRI, C. Echocardiography only, D. Chest radiography only, When no cause of AKI has been identified and urinary obstruction is possible, which investigation should be arranged?, A. Urgent urinary tract ultrasound, B. Routine bone radiography, C. Colonoscopy, D. Thyroid ultrasound, A patient develops AKI from urinary retention caused by benign prostatic hyperplasia. What is the priority intervention?, A. Relieve the urinary obstruction, B. Give unlimited intravenous fluid, C. Administer an NSAID, D. Restrict all oral intake, Which patient with obstructive AKI requires immediate urological or radiological referral?, A. A patient with an obstructed solitary kidney, B. A patient with stable chronic microscopic haematuria, C. A patient with uncomplicated cystitis and normal kidney function, D. A patient with normal urine output and normal imaging, A patient with AKI has a fractional excretion of sodium (FENa) below 1%. Which diagnosis does this finding generally support?, A. Pre-kidney AKI, B. Established chronic kidney disease only, C. Diabetes insipidus, D. Nephrotic syndrome only, Why may the fractional excretion of sodium be difficult to interpret in a patient who recently received a loop diuretic?, A. Loop diuretics increase urinary sodium excretion, B. Loop diuretics eliminate urinary sodium, C. Loop diuretics always cause anuria, D. Loop diuretics directly lower serum creatinine, A patient with suspected pre-kidney AKI recently received a loop diuretic. Which urinary index may be more useful than FENa?, A. Fractional excretion of urea, B. Urine glucose alone, C. Urine ketones alone, D. Urine bilirubin alone, A patient with AKI has a fractional excretion of urea below 35%. Which diagnosis does this support?, A. Pre-kidney AKI, B. Post-kidney AKI in every case, C. Chronic glomerulonephritis, D. Nephrotic syndrome, Which statement about the urea-to-creatinine ratio in AKI is correct?, A. It reliably identifies the exact cause of AKI, B. It should not be used alone to determine the cause of AKI, C. It always confirms urinary obstruction, D. It is unaffected by gastrointestinal bleeding and diet, A patient with severe AKI develops a blood pH of 7.10 that does not improve with medical treatment. What is the most appropriate next step?, A. Urgent nephrology referral for renal replacement therapy, B. Routine outpatient follow-up, C. No intervention, D. Increase nephrotoxic medications, A patient with AKI has persistent potassium of 6.9 mmol/L despite appropriate medical treatment. What is the most appropriate definitive management?, A. Renal replacement therapy, B. Oral iron supplementation, C. Increased potassium intake, D. Observation only, A patient with severe AKI develops pulmonary oedema that does not respond to medical treatment. What should be considered urgently?, A. Renal replacement therapy, B. Additional unrestricted intravenous fluid, C. NSAID treatment, D. Discharge without follow-up, A patient with severe AKI develops chest pain and a pericardial friction rub. What is the most likely complication?, A. Uraemic pericarditis, B. Acute cystitis, C. Renal colic, D. Nephrotic syndrome, A patient with severe AKI develops confusion, reduced consciousness and no other identifiable neurological cause. What is the most likely diagnosis?, A. Uraemic encephalopathy, B. Uncomplicated pre-kidney AKI, C. Acute cystitis, D. Nephrolithiasis, Which finding is an emergency indication for renal replacement therapy in AKI?, A. Refractory metabolic acidosis, B. Mild creatinine elevation without complications, C. Microscopic haematuria alone, D. Controlled hypertension, Which statement about initiating renal replacement therapy in AKI is correct?, A. It should be based only on one serum creatinine value, B. It should be based on the patient’s overall clinical, biochemical and fluid status, C. Every patient with stage 1 AKI requires immediate dialysis, D. Dialysis should begin whenever serum urea is slightly elevated, Which renal replacement modality is generally preferred for a haemodynamically stable patient with severe AKI?, A. Intermittent haemodialysis, B. Continuous renal replacement therapy only, C. No renal support under any circumstances, D. Routine peritoneal dialysis in every adult, Which renal replacement modality is generally preferred for a haemodynamically unstable patient with severe AKI?, A. Continuous renal replacement therapy, B. Rapid intermittent haemodialysis, C. No renal replacement therapy, D. Oral diuretic therapy only, Which statement about AKI severity is correct?, A. Higher-stage AKI is associated with higher mortality and a greater likelihood of requiring RRT, B. Stage 3 AKI has a better prognosis than stage 1 AKI, C. AKI severity has no relationship with mortality, D. Only chronic kidney disease affects long-term outcomes, Which long-term complication is more likely after an episode of AKI?, A. Chronic kidney disease, B. Improved kidney function above baseline in every patient, C. Permanent protection against future AKI, D. Reduced cardiovascular risk, Why should kidney function be reassessed after a patient recovers from AKI?, A. To evaluate kidney recovery and detect chronic kidney disease, B. Because every patient requires lifelong dialysis, C. To diagnose asthma, D. Because serum creatinine is unrelated to kidney function, A patient has recovered from an episode of AKI but has an eGFR of 28 mL/min/1.73 m². What is the most appropriate action?, A. Consider referral to nephrology, B. No further evaluation is necessary, C. Start an NSAID, D. Encourage unrestricted potassium intake, Which patient with AKI should be referred promptly to a nephrologist?, A. A patient with suspected glomerulonephritis, B. A patient with rapidly resolving mild dehydration and normal urinalysis, C. A patient with normal serum creatinine, D. A patient with normal urine output and no kidney injury, A patient meets KDIGO criteria for stage 3 AKI, even though severe complications have not yet developed. What is the most appropriate action?, A. Refer to nephrology, B. Discharge immediately, C. Stop monitoring kidney function, D. Give nephrotoxic medication, A patient with diabetes and chronic kidney disease requires an investigation using iodinated contrast. Which approach best reduces the risk of AKI?, A. Assess kidney function, review risk factors and optimize hydration, B. Give NSAIDs before contrast, C. Encourage dehydration before the procedure, D. Avoid checking serum creatinine, A trauma patient develops muscular pain, weakness, dark urine and an acute rise in serum creatinine. What is the most likely cause of the AKI?, A. Pigment-induced intrinsic kidney injury from rhabdomyolysis, B. Isolated urinary retention, C. Chronic glomerulonephritis, D. Diabetes insipidus, A patient with crushed muscles has dark urine. Urine dipstick is strongly positive for blood, but microscopy shows very few red blood cells. What does this suggest?, A. Myoglobinuria, B. Glomerular haematuria, C. Urinary tract infection, D. Normal urine, An older patient with bone pain, hypercalcaemia and monoclonal light chains develops AKI. Which mechanism may contribute to the kidney injury?, A. Intratubular precipitation of light chains, B. Increased erythropoietin production, C. Increased glomerular filtration, D. Reduced urine protein concentration, Which strategy is most appropriate for preventing AKI in a high-risk hospitalized patient?, A. Maintain adequate volume status and avoid unnecessary nephrotoxins, B. Give NSAIDs routinely, C. Ignore changes in urine output, D. Administer unrestricted potassium supplements, A 68-year-old man is admitted with pneumonia. His serum creatinine was 100 µmol/L three months ago, 112 µmol/L at admission and 128 µmol/L after 36 hours. His urine output is normal. Which interpretation is most accurate?, A. No AKI because creatinine has not reached 1.5 times baseline, B. AKI because creatinine increased by at least 26 µmol/L within 48 hours, C. Stage 2 AKI because creatinine increased by more than 20%, D. Chronic kidney disease because the urine output is normal, A patient’s baseline serum creatinine is 92 µmol/L. It increases to 180 µmol/L within five days. Urine output is 0.8 mL/kg/hour. What is the KDIGO stage?, A. No AKI, B. Stage 1 AKI, C. Stage 2 AKI, D. Stage 3 AKI, A patient’s baseline serum creatinine is 80 µmol/L. It increases to 172 µmol/L. Urine output is 0.2 mL/kg/hour for 25 hours. What is the final KDIGO stage?, A. Stage 1, B. Stage 2, C. Stage 3, D. The stage cannot be determined because the criteria disagree, A patient has produced no urine for 13 hours. Serum creatinine has increased from 100 to 145 µmol/L. What is the correct AKI stage?, A. Stage 1 because creatinine is less than 1.5 times baseline, B. Stage 2 because anuria has lasted longer than 12 hours, C. Stage 3 because anuria has lasted at least 12 hours, D. No AKI because creatinine has not doubled, A 50-kg woman produces 500 mL of urine during the last 24 hours. Her serum creatinine is unchanged. Which interpretation is correct?, A. She does not meet a urine-output criterion for AKI, B. She has stage 1 AKI, C. She has stage 2 AKI, D. She has stage 3 AKI, A 72-year-old patient has had vomiting and diarrhea for four days. He is hypotensive and clinically dehydrated. His urine is concentrated, and FENa is 0.6%. There is no haematuria, proteinuria or urinary obstruction. What is the most likely diagnosis?, A. Pre-kidney AKI due to hypovolaemia, B. Acute glomerulonephritis, C. Acute interstitial nephritis, D. Post-kidney AKI, A patient with heart failure develops AKI after receiving high-dose loop diuretics. FENa is 2.2%, but examination suggests reduced effective circulating volume. Which interpretation is most appropriate?, A. FENa definitively proves acute tubular necrosis, B. FENa may be unreliable because loop diuretics increase urinary sodium excretion, C. FENa definitively proves urinary obstruction, D. The patient cannot have pre-kidney AKI, A patient with suspected pre-kidney AKI received a loop diuretic 12 hours ago. FENa is 2%, while fractional excretion of urea is 28%. Which result more strongly supports the suspected diagnosis?, A. FENa of 2%, B. FEUrea of 28%, C. Both results exclude pre-kidney AKI, D. Neither result can be interpreted under any circumstances, A 35-year-old man with infective endocarditis develops AKI. Urinalysis shows protein and blood. Microscopy shows dysmorphic red blood cells and red-cell casts. Ultrasound shows no obstruction. What is the most likely category of AKI?, A. Pre-kidney AKI from dehydration, B. Intrinsic AKI from glomerular disease, C. Post-kidney AKI, D. AKI caused only by urinary catheter trauma, A woman develops an acute creatinine rise two weeks after beginning a new medication. She has fever, a generalized rash, arthralgia and leukocytes in the urine. There is no hypotension or obstruction. What is the most likely diagnosis?, A. Acute tubular necrosis, B. Acute interstitial nephritis, C. Pre-kidney AKI, D. Renal artery stenosis, An older patient with CKD and diabetes develops septic shock. He has received gentamicin and has prolonged hypotension. Ultrasound excludes obstruction. Which explanation is most accurate?, A. The AKI must have a single pre-kidney cause, B. The AKI is probably multifactorial, involving hypoperfusion and intrinsic tubular injury, C. The AKI is necessarily post-kidney, D. Gentamicin prevents acute tubular necrosis, A 76-year-old man presents with suprapubic discomfort, an enlarged palpable bladder, difficulty urinating and AKI. Which immediate intervention is most likely to be both diagnostic and therapeutic?, A. Urinary catheterization, B. Kidney biopsy, C. Intravenous calcium, D. High-dose NSAID administration, A patient with a single functioning kidney develops anuria. Ultrasound shows obstruction of that kidney’s ureter. What is the most appropriate next step?, A. Routine outpatient review, B. Immediate urological or radiological referral, C. Observe for 48 hours without intervention, D. Administer an NSAID and discharge the patient, An oliguric patient with AKI receives repeated intravenous fluid boluses without reassessment. He subsequently develops hypoxaemia, raised jugular venous pressure, peripheral oedema and bilateral lung crackles. What is the best explanation?, A. Persistent hypovolaemia requiring additional rapid fluids, B. Iatrogenic fluid overload causing pulmonary oedema, C. Acute interstitial nephritis, D. Isolated urinary infection, A patient with AKI has pulmonary oedema but remains haemodynamically stable. Which statement about loop diuretics is most accurate?, A. They should be used routinely to cure the underlying AKI, B. They may be used to manage volume overload but do not directly reverse kidney injury, C. They are contraindicated in every patient with AKI, D. They prevent the need for RRT in every patient, A patient with AKI has potassium of 6.3 mmol/L and peaked T waves. Which management principle is most appropriate?, A. Treat it as mild hyperkalaemia because potassium is below 6.5 mmol/L, B. Treat it as severe hyperkalaemia because ECG changes are present, C. Wait for potassium to reach 7 mmol/L before treatment, D. Give intravenous calcium as the only treatment because it removes potassium, A patient with stage 3 AKI has potassium of 6.8 mmol/L. After appropriate medical treatment, potassium falls to 5.4 mmol/L. He has no pulmonary oedema, severe acidosis or uraemic symptoms. Which statement is most accurate?, A. Emergency RRT is mandatory because the initial potassium was above 6.5 mmol/L, B. Emergency RRT is not automatically required because the hyperkalaemia responded to treatment, C. RRT must be initiated based only on the creatinine value, D. Every patient with stage 3 AKI requires immediate emergency dialysis, A patient recovers from AKI and is discharged. At follow-up, eGFR is 28 mL/min/1.73 m², and early-morning urine dipstick shows 1+ protein. Which management is most appropriate?, A. No further follow-up because the acute episode has resolved, B. Consider nephrology referral, C. Begin regular NSAID treatment, D. Advise the patient that future kidney risk has returned to normal

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