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WorksheetsCKD MBD
Total questions: 25
Worksheet time: 13mins
A 55-year-old male with CKD G4 (eGFR 25 mL/min/1.73 m²) has a history of two fragility fractures in the past year. His serum phosphate is elevated, and PTH is progressively rising.
Question: Which of the following is the most appropriate next step in managing his bone disease?
Perform a bone biopsy to assess renal osteodystrophy.
B. Initiate bisphosphonate therapy without further testing.
Perform dual-energy X-ray absorptiometry (DXA) to assess fracture risk.
Start calcitriol therapy to lower PTH levels.
A 60-year-old female with CKD G5D (on hemodialysis) has a serum phosphate level of 6.5 mg/dL. She is currently on calcium-based phosphate binders.
Question: What is the most appropriate next step in managing her hyperphosphatemia?
Increase the dose of calcium-based phosphate binders.
Switch to a non-calcium-based phosphate binder.
Initiate calcitriol therapy to lower PTH levels.
Perform a bone biopsy to assess bone turnover.
A 45-year-old male with CKD G4 (eGFR 22 mL/min/1.73 m²) has a PTH level of 250 pg/mL (upper limit of normal for the assay is 65 pg/mL). His serum calcium and phosphate levels are within normal limits.
Question: What is the most appropriate management for his elevated PTH?
Start calcitriol therapy immediately.
Monitor PTH trends and evaluate for modifiable factors like vitamin D deficiency.
Initiate cinacalcet therapy to lower PTH.
Perform a parathyroidectomy.
A 50-year-old female with CKD G5D (on hemodialysis) has persistent hypercalcemia (serum calcium 10.8 mg/dL) and elevated PTH levels.
Question: What is the most appropriate dialysate calcium concentration for her?
1.00 mmol/L (2.0mEq/L).
1.25 mmol/L (2.5 mEq/L).
1.75 mmol/L (3.5 mEq/L).
2.00 mmol/L (4.0 mEq/L).
A 65-year-old male with CKD G5D (on hemodialysis) has low bone mineral density (BMD) and a history of fragility fractures. His PTH levels are persistently low.
Question: What is the most appropriate next step in managing his bone disease?
Initiate bisphosphonate therapy without a bone biopsy.
Perform a bone biopsy to assess bone turnover.
Start calcitriol therapy to increase PTH levels.
Increase dietary phosphate intake.
A 70-year-old male with CKD G4 (eGFR 28 mL/min/1.73 m²) has a serum phosphate level of 5.2 mg/dL. He consumes a diet high in processed foods.
Question: What is the most appropriate dietary recommendation for him?
Increase intake of animal-based proteins.
Limit dietary phosphate intake and focus on fresh, homemade foods.
Start calcium-based phosphate binders.
Increase intake of plant-based proteins.
A 58-year-old female with CKD G5D (on hemodialysis) has a serum calcium 8.0 mg/dL while on cinacalcet therapy.
Question: What is the most appropriate management for her hypocalcemia?
Increase dialysate calcium concentration to 1.75 mmol/L.
Administer intravenous calcium gluconate.
Monitor if asymptomatic.
Discontinue cinacalcet therapy.
A 52-year-old male with CKD G4 (eGFR 24 mL/min/1.73 m²) has a PTH level of 300 pg/mL. He has not been on Vitamin D Therapy.
Question: What is the most appropriate management for his vitamin D deficiency?
Start calcitriol therapy.
Correct vitamin D deficiency as for the general population.
Initiate paricalcitol therapy.
Perform a bone biopsy to assess bone turnover.
A 60-year-old male with CKD G5D (on hemodialysis) has a PTH level of 800 pg/mL. His serum calcium is 9.5 mg/dL, and phosphate is 5.8 mg/dL.
Question: What is the most appropriate PTH-lowering therapy for him?
Start Calcitriol
Start Cinacalcet
Start cinacalcet and calcitriol.
Parathyroidectomy.
A 45-year-old female, 6 months post-kidney transplant, has an eGFR of 40 mL/min/1.73 m² and a history of osteoporosis.
Question: What is the most appropriate management for her bone disease?
Perform a bone biopsy to assess bone turnover.
Initiate bisphosphonate therapy without further testing.
Measure BMD to assess fracture risk.
Start calcitriol therapy to prevent bone loss.
A 65-year-old male with CKD G5D (on hemodialysis) has been on aluminum-containing phosphate binders for 6 months.
Question: What is the most appropriate management for his phosphate control?
Continue aluminum-containing phosphate binders.
Switch to calcium-based phosphate binders.
Switch to non-calcium-based phosphate binders.
Start Cinacalcet
A 70-year-old male with CKD G4 (eGFR 26 mL/min/1.73 m²) has vascular calcification on a lateral abdominal radiograph.
Question: What is the most appropriate next step in managing his cardiovascular risk?
Initiate calcitriol therapy.
Perform a bone biopsy.
Check iPTH
Start bisphosphonate therapy.
A 50-year-old female with CKD G3b (eGFR 35 mL/min/1.73 m²) has stable serum calcium and phosphate levels but a progressively rising PTH.
Question: What is the most appropriate monitoring frequency for her PTH levels?
Every 3 months.
Every 6 months.
Every 12 months.
Only if symptoms develop.
A 60-year-old male with CKD G5D (on hemodialysis) has a serum calcium of 9.5 mg/dL and phosphate of 5.5 mg/dL.
Question: What is the most appropriate approach to managing his calcium-phosphate product?
Use the Ca-PO4 product to guide therapy.
Use levels of Calcum and PO4 to guide therapy
Get a DEXA Scan
Perform a bone biopsy.
A 55-year-old female with CKD G5D (on hemodialysis) is currently on a combination of Calcitriol, Cal Acetate and Cinacalcet. Her most recent Intact PTH is 1200 pg/mL and Calcium and Phosphate levels aer still unoptimal.
Question: What is the most appropriate next step in managing her hyperparathyroidism?
Increase the dose of cinacalcet.
Perform a parathyroidectomy.
Start Aluminum containing phosphate binder.
Switch to a non-calcium-based phosphate binder.
A 65-year-old male with CKD G4 (eGFR 24 mL/min/1.73 m²) has low bone mineral density and a history of fractures.
Question: What is the most appropriate use of bone turnover markers in his management?
Routinely measure bone-derived turnover markers.
Use bone-specific alkaline phosphatase to assess bone turnover.
Perform a bone biopsy instead of using markers.
Avoid using bone turnover markers.
A 70-year-old female with CKD G3b (eGFR 38 mL/min/1.73 m²) has osteoporosis and a high risk of fracture.
Question: What is the most appropriate management for her osteoporosis?
Initiate bisphosphonate therapy.
Perform a bone biopsy before starting treatment.
Start calcitriol therapy.
Monitor
A 22-year-old male with CKD G4 (eGFR 30 mL/min/1.73 m²) has hyperphosphatemia and normal serum calcium levels.
Question: What is the most appropriate phosphate-lowering therapy for him?
Calcium-based phosphate binders.
Non-calcium-based phosphate binders.
Dietary phosphate restriction alone.
Initiate calcitriol therapy.
A 65-year-old female with CKD G5D (on hemodialysis) has low PTH levels and adynamic bone disease on bone biopsy.
Question: What is the most appropriate management for her bone disease?
Initiate bisphosphonate therapy.
Start calcitriol therapy.
Avoid antiresorptive therapies
Perform a parathyroidectomy.
A 50-year-old male, 3 months post-kidney transplant, has an eGFR of 45 mL/min/1.73 m² and low bone mineral density.
Question: What is the most appropriate management for his bone disease?
Initiate bisphosphonate therapy.
Start calcitriol therapy.
Perform a bone biopsy.
Monitor without treatment.
A 60-year-old male with CKD G5D (on hemodialysis) has hyperphosphatemia and arterial calcification.
Question: What is the most appropriate phosphate-lowering therapy for him?
Calcium-based phosphate binders.
Non-calcium-based phosphate binders.
Dietary phosphate restriction alone.
Initiate calcitriol therapy.
A 55-year-old female with CKD G5D (on hemodialysis) has severe hyperparathyroidism (PTH 1500 pg/mL) and hypercalcemia.
Question: What is the most appropriate management for her hyperparathyroidism?
Start calcitriol therapy.
Initiate cinacalcet therapy.
Perform a parathyroidectomy.
Increase dialysate calcium concentration.
A 55-year-old female with CKD G5D (on hemodialysis) has hypophosphatemia (serum phosphate 2.0 mg/dL) and low PTH levels.
Question: What is the most appropriate management for her hypophosphatemia?
Increase dietary phosphate intake.
Start calcitriol therapy.
Perform a bone biopsy.
Monitor without treatment.
What is the role of fibroblast growth factor 23 (FGF23) in CKD-MBD?
It increases phosphate levels
It decreases phosphate levels
It increases calcium levels
It has no role in CKD-MBD
A 65-year-old male with Stage 4 CKD presents with hyperphosphatemia (serum phosphate 6.2 mg/dL). His dietary phosphate intake is already restricted. What is the most appropriate next step in managing his hyperphosphatemia?
Initiate high-dose vitamin D supplementation
Start a non-calcium-based phosphate binder
Increase calcium acetate dose to 3 times daily
Begin intravenous iron therapy
