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WorksheetsGEM 7.06
Total questions: 129
Worksheet time: 2hrs 9mins
Name
Class
Date
1.
Which of the following best describes the WHO definition of palliative care?
a)
A treatment approach aimed at prolonging life as long as possible
b)
An approach that seeks to hasten death in patients with advanced illness
c)
An approach focused on early identification, prevention, and relief of suffering
d)
Primarily the use of medications to control symptoms in terminal illness
e)
Only psychological and spiritual support for patients and families
2.
The “five priorities for care of the dying person” include all EXCEPT:
a)
Recognise
b)
Communicate
c)
Involve
d)
Support
e)
Diagnose
3.
Which of the following best differentiates palliative care from end-of-life care?
a)
End-of-life care applies only to cancer patients
b)
Palliative care is limited to the final few hours of life
c)
End-of-life care refers to the last 12 months of life
d)
Palliative care is provided only in hospices
e)
Palliative care always replaces disease-directed treatments
4.
Which of the following symptoms is NOT one of the five most common at end of life?
a)
Pain
b)
Breathlessness
c)
Agitation/Anxiety
d)
Hypertension
e)
Secretions
5.
Anticipatory “Just in Case” prescribing at the end of life typically includes all EXCEPT:
a)
Injectable opioid
b)
Midazolam
c)
Antiemetic
d)
Antisecretory agent
e)
Antibiotic
6.
A patient with advanced COPD and lung cancer is breathless and distressed. He is on a fentanyl patch. Which medication is most appropriate for acute relief?
a)
Ibuprofen
b)
Oramorph
c)
Diazepam
d)
Aspirin
e)
Paracetamol
7.
Which statement about “double effect” is correct?
a)
It is illegal to use medication that may shorten life under any circumstances
b)
It permits symptom treatment even if life may be shortened as an unintended consequence
c)
It requires patient consent in every case
d)
It refers only to surgical procedures
e)
It is the same as assisted dying
8.
Which professional is primarily responsible for prescribing “Just in Case” medications in the community?
a)
Physiotherapist
b)
GP
c)
Care worker
d)
Volunteer hospice staff
e)
Social worker
9.
Which of the following is NOT typically a sign of approaching death?
a)
Profound weakness
b)
Reduced oral intake
c)
New hypertension
d)
Altered breathing patterns
e)
Drowsiness
10.
Research shows that most people in England would prefer to die:
a)
In hospital
b)
At home
c)
In ICU
d)
In a hospice
e)
In a care home
11.
A 68-year-old man with advanced heart failure is deteriorating. Which factor most strongly supports recognising he is in the last days of life?
a)
Reduced or absent oral intake
b)
History of COPD
c)
NYHA Class IV symptoms
d)
Long-term oxygen use
e)
Presence of ankle oedema
12.
A patient with renal failure and dementia is on the GP's palliative care register. What does the “red” category in the Gold Standards Framework (GSF) RAG rating indicate?
a)
Patient is stable with no current needs
b)
Patient has increasing needs and is unstable
c)
Patient is in the dying phase requiring urgent intervention
d)
Patient has been discharged from specialist care
e)
Patient is no longer suitable for anticipatory prescribing
13.
A 72-year-old woman with metastatic cancer has a ReSPECT form completed. What is the most important element for accuracy?
a)
That it states “ward-based care” as ceiling of treatment
b)
That it reflects current clinical decisions and patient wishes
c)
That it is signed by any junior doctor available
d)
That it only focuses on CPR decisions
e)
That it specifies exact doses of anticipatory medications
14.
Which of the following is the most appropriate first-line treatment for terminal agitation at the end of life?
a)
Midazolam
b)
Haloperidol
c)
Morphine
d)
Diazepam
e)
Hyoscine butylbromide
15.
A patient with advanced COPD and lung cancer has noisy “ruttly” breathing, distressing his family. Which drug is most appropriate?
a)
Glycopyrronium
b)
Morphine
c)
Haloperidol
d)
Lorazepam
e)
Dexamethasone
16.
Which of the following is TRUE regarding place of death in England?
a)
Most people prefer to die in hospital, and around 70 % do
b)
Most people prefer to die at home, but around 50 % die in hospital
c)
Hospices are the most common place of death in the UK
d)
Care homes account for 70 % of deaths
e)
ICU is the preferred place of death for most patients
17.
A patient is in the last 48 hours of life. Which medication should usually be continued if already prescribed?
a)
Statins
b)
Antihypertensives
c)
Insulin for type 1 diabetes
d)
Bisphosphonates
e)
Iron supplements
18.
In communication with relatives at the end of life, which of the following is the most appropriate empathic response?
a)
“I know exactly how you feel.”
b)
“You’ll feel better soon.”
c)
“Seeing your husband in distress is clearly very upsetting for you.”
d)
“Don’t worry, we’ll sort everything in an hour.”
e)
“He’s comfortable, so there’s nothing to worry about.”
19.
Which intervention is MOST appropriate when a patient wishes to remain at home during their last days of life but their partner is struggling to cope?
a)
Arrange emergency hospital admission
b)
Involve night sitters or hospice at home support
c)
Discontinue anticipatory medications
d)
Avoid discussing prognosis to reduce distress
e)
Transfer patient to ICU for closer monitoring
20.
Which of the following best defines tubular reabsorption?
a)
Transport of substances from blood into tubular lumen
b)
Filtration of plasma into Bowman's capsule
c)
Transport of substances from tubular fluid back into circulation
d)
Selective removal of proteins from glomerular filtrate
e)
Active pumping of solutes into urine
21.
Approximately what percentage of filtered water is reabsorbed by the kidney?
a)
0.6
b)
0.7
c)
0.85
d)
0.99
e)
1
22.
The ascending limb of the loop of Henle is:
a)
Permeable to both water and solutes
b)
Permeable only to water
c)
Permeable only to solutes
d)
Impermeable to both water and solutes
e)
The main site of glucose reabsorption
23.
Which transport mechanism primarily drives glucose reabsorption in the proximal convoluted tubule?
a)
Simple diffusion
b)
Primary active transport via glucose ATPase
c)
Secondary active transport with sodium
d)
Facilitated diffusion without carriers
e)
Endocytosis
24.
Which glucose transporter has high affinity but low capacity in the proximal tubule?
a)
SGLT2
b)
SGLT1
c)
GLUT2
d)
GLUT4
e)
GLUT5
25.
Which process is responsible for excretion of penicillin in urine?
a)
Ultrafiltration
b)
Passive diffusion across collecting duct
c)
Tubular secretion of organic acids
d)
Secondary active transport with sodium
e)
Facilitated diffusion via GLUT
26.
Which nephron segment reabsorbs the majority of sodium, water, and glucose?
a)
Proximal convoluted tubule
b)
Descending limb of Henle
c)
Ascending limb of Henle
d)
Distal convoluted tubule
e)
Collecting duct
27.
What is the renal threshold for glucose excretion?
a)
Plasma glucose 2–3 mmol/L
b)
Plasma glucose 4–6 mmol/L
c)
Plasma glucose ~10 mmol/L
d)
Plasma glucose ~15 mmol/L
e)
Plasma glucose 20 mmol/L
28.
Why does a patient with CKD and a low GFR sometimes have glucosuria despite plasma glucose below the transport maximum (Tm)?
a)
Glucose ATPase is overactive
b)
Transporter proteins are absent
c)
Defect in reabsorption processes of proximal tubule
d)
Loop of Henle fails to reabsorb glucose
e)
Excessive secretion of glucose into filtrate
29.
Aldosterone primarily increases secretion of which ion in the distal nephron?
a)
Sodium
b)
Chloride
c)
Potassium
d)
Calcium
e)
Bicarbonate
30.
In a 70 kg adult male, approximately how much of the body's total water is intracellular?
a)
10 L
b)
17 L
c)
25 L
d)
30 L
e)
35 L
31.
Which best defines osmolarity?
a)
Osmoles per kg solvent
b)
Osmoles per litre of solution
c)
Concentration of impermeant solutes only
d)
Measure of tonicity across membranes
e)
Moles of solute per kg body weight
32.
Why is osmolality often preferred in biological calculations over osmolarity?
a)
Easier to measure in urine
b)
Independent of temperature and volume changes
c)
Considers only impermeant solutes
d)
Gives higher values in plasma
e)
Is equivalent to tonicity
33.
A red blood cell placed in a hypertonic solution will:
a)
Swell and burst
b)
Shrink and crenate
c)
Remain unchanged
d)
Increase intracellular solute uptake
e)
Undergo active sodium influx
34.
Which segment of the nephron is highly permeable to water but impermeable to sodium?
a)
Thick ascending limb
b)
Thin ascending limb
c)
Distal convoluted tubule
d)
Descending limb of loop of Henle
e)
Collecting duct
35.
What is the maximum concentrating ability of the kidney (medullary gradient)?
a)
600 mOsm/kg
b)
800 mOsm/kg
c)
1000 mOsm/kg
d)
1200 mOsm/kg
e)
1500 mOsm/kg
36.
Which process is primarily driven by the Na⁺-K⁺-2Cl⁻ symporter?
a)
Water reabsorption in descending limb
b)
Solute reabsorption in thick ascending limb
c)
Urea recycling in collecting duct
d)
Sodium reabsorption in proximal tubule
e)
ADH-mediated water reabsorption
37.
What is the role of the vasa recta in osmoregulation?
a)
Actively pumps sodium into interstitium
b)
Provides rapid blood flow to wash out solutes
c)
Removes water while preserving solutes
d)
Actively secretes urea
e)
Increases ADH release
38.
Which hormone increases both water reabsorption and urea permeability in the collecting duct?
a)
Aldosterone
b)
ADH (vasopressin)
c)
ANP
d)
Angiotensin II
e)
Renin
39.
Which mechanism best explains the countercurrent multiplier?
a)
Equal solute and water reabsorption in proximal tubule
b)
Recycling of urea between collecting duct and loop of Henle
c)
Active solute removal in ascending limb with water impermeability
d)
Slow blood flow in vasa recta
e)
Constant glomerular filtration rate
40.
Which of the following is the most important buffer system for maintaining blood pH?
a)
Phosphate buffer
b)
Protein buffer
c)
Bicarbonate--carbon dioxide buffer
d)
Ammonia buffer
e)
Sulphate buffer
41.
Which part of the nephron reabsorbs the majority of filtered bicarbonate?
a)
Collecting duct
b)
Distal convoluted tubule
c)
Proximal tubule
d)
Loop of Henle (ascending limb)
e)
Glomerulus
42.
Which renal process accounts for the majority of acid excretion in health?
a)
Direct hydrogen ion excretion with phosphate buffering
b)
Ammonium (NH₄⁺) excretion
c)
Sulphate excretion
d)
Bicarbonate secretion
e)
Aldosterone-mediated potassium excretion
43.
In metabolic acidosis due to diarrhoea, what happens to the anion gap?
a)
Increased
b)
Decreased
c)
Normal
d)
Variable
e)
Cannot be determined
44.
Which of the following is most commonly associated with a raised anion gap metabolic acidosis?
a)
Severe vomiting
b)
Chronic kidney disease (advanced)
c)
Thiazide diuretic use
d)
Adrenal insufficiency
e)
Ureteric diversion
45.
Which of the following is the most important cause of type A lactic acidosis?
a)
Metformin therapy
b)
Hypoperfusion/shock states
c)
Starvation
d)
Ethylene glycol ingestion
e)
Seizure recovery
46.
Which condition is the classic cause of metabolic alkalosis due to loss of gastric secretions?
a)
Severe diarrhoea
b)
Prolonged vomiting
c)
Chronic kidney disease
d)
Loop diuretics
e)
Addison's disease
47.
On ABG, which finding indicates a metabolic acidosis?
a)
pH < 7.35, bicarbonate low
b)
pH < 7.35, pCO₂ high
c)
pH > 7.45, bicarbonate high
d)
pH > 7.45, pCO₂ low
e)
pH < 7.35, bicarbonate high
48.
Which compensation occurs in metabolic alkalosis?
a)
Hyperventilation with ↓pCO₂
b)
Hypoventilation with ↑pCO₂
c)
Increased renal H⁺ excretion
d)
Increased bicarbonate reabsorption
e)
Increased ammonium excretion
49.
Which of the following causes metabolic alkalosis via mineralocorticoid excess?
a)
Addison's disease
b)
Primary hyperaldosteronism
c)
Advanced chronic kidney disease
d)
Metformin
e)
Ethylene glycol
50.
A patient's ABG shows: pH 7.32, PaCO₂ 7.0 kPa, HCO₃⁻ 28 mmol/L. Which diagnosis is most consistent?
a)
Pure metabolic acidosis
b)
Respiratory acidosis with metabolic compensation
c)
Respiratory alkalosis
d)
Mixed respiratory and metabolic alkalosis
e)
Metabolic alkalosis with respiratory compensation
51.
A 70-year-old man is admitted with diarrhoea and vomiting. On examination, his JVP is not visible, capillary refill is delayed, and BP is 95/60 mmHg. What is the most likely fluid status?
a)
Hypervolaemia
b)
Hypovolaemia
c)
Euvolaemia
d)
SIADH
e)
Fluid overload with oedema
52.
What is the normal range of JVP?
a)
2–4 cm
b)
5 cm
c)
5–10 cm
d)
<5 cm
e)
>10 cm
53.
Which hormone acts via V2 receptors to insert aquaporin-2 channels in the renal collecting duct?
a)
Aldosterone
b)
ADH (vasopressin)
c)
ANP
d)
Renin
e)
Angiotensin II
54.
Which of the following is the main determinant of volume status?
a)
Plasma potassium concentration
b)
Plasma osmolality
c)
Total body sodium content
d)
Glomerular filtration rate
e)
Plasma bicarbonate concentration
55.
A 65-year-old with lung cancer presents with hyponatraemia (Na 120 mmol/L). Plasma osmolality is 250 mOsm/kg, urine osmolality 600 mOsm/kg, urine Na⁺ 50 mmol/L. What is the most likely diagnosis?
a)
Hypovolaemia from vomiting
b)
SIADH
c)
Addison's disease
d)
Nephrotic syndrome
e)
Psychogenic polydipsia
56.
Which of the following is the most dangerous complication of correcting hyponatraemia too quickly?
a)
Pulmonary oedema
b)
Central pontine myelinolysis
c)
Cerebral oedema
d)
Heart failure
e)
Hypokalaemia
57.
In hypernatraemia due to cranial diabetes insipidus, which treatment is most appropriate?
a)
Intravenous normal saline
b)
Fluid restriction
c)
Desmopressin
d)
Thiazide diuretics
e)
Loop diuretics
58.
Which intravenous fluid is best for initial resuscitation in hypovolaemia?
a)
5 % dextrose
b)
0.9 % saline
c)
Albumin solution
d)
5 % dextrose with potassium
e)
Plasma exchange
59.
A 50-year-old man with heart failure presents with ankle oedema and raised JVP. What is the underlying mechanism of fluid retention?
a)
Increased plasma osmolality
b)
Over-secretion of ADH only
c)
Perceived hypovolaemia due to reduced effective circulating volume
d)
Primary renal sodium wasting
e)
Low dietary protein intake
60.
In a patient with hyponatraemia, which urine sodium result is most consistent with vomiting-induced hypovolaemia?
a)
Urine Na <20 mmol/L
b)
Urine Na >40 mmol/L
c)
Urine Na = 70 mmol/L
d)
Urine osmolality <100 mOsm/kg
e)
Urine Na = 150 mmol/L
61.
Which of the following best explains the mechanism of secondary hyperparathyroidism in CKD?
a)
Decreased 1α-hydroxylation of vitamin D
b)
Increased calcium absorption from the gut
c)
Suppressed phosphate retention
d)
Increased renal calcium reabsorption
e)
Excess calcitonin secretion
62.
A patient with CKD has normochromic, normocytic anaemia and ferritin of 450 µg/L. Which is the most likely cause?
a)
Functional iron deficiency due to high hepcidin
b)
Acute blood loss
c)
Vitamin B12 deficiency
d)
Haemolysis
e)
Myelodysplastic syndrome
63.
Which factor primarily explains why patients with CKD develop metabolic acidosis?
a)
Reduced ammoniagenesis in the proximal tubule
b)
Impaired distal acidification of urine
c)
Increased bicarbonate generation
d)
Excess lactate production
e)
Increased dietary acid intake
64.
Which uraemic complication is most closely linked to vascular calcification?
a)
Hyperphosphataemia
b)
Hypokalaemia
c)
Hypocalcaemia
d)
Iron deficiency
e)
Metabolic alkalosis
65.
Which of the following is the main mechanism by which proteinuria accelerates CKD progression?
a)
Tubular cell injury due to filtered proteins
b)
Reduction in glomerular blood flow
c)
Deposition of amyloid in glomeruli
d)
Increased aldosterone secretion
e)
Increased systemic calcium levels
66.
Which class of drugs has been shown to reduce proteinuria and slow CKD progression?
a)
ACE inhibitors
b)
Loop diuretics
c)
Calcium channel blockers
d)
Proton pump inhibitors
e)
Beta-2 agonists
67.
Which patient with CKD is at greatest risk of developing severe hyperkalaemia?
a)
On ACE inhibitor and spironolactone
b)
On loop diuretic therapy
c)
On phosphate binders
d)
On erythropoietin therapy
e)
On atorvastatin
68.
In CKD, which of the following is a recognised effect of high parathyroid hormone (PTH) levels?
a)
Reduced response to erythropoietin therapy
b)
Hypophosphataemia
c)
Increased risk of hypocalcaemia
d)
Increased bicarbonate retention
e)
Reduced triglycerides
69.
According to NICE guidelines, which statin is recommended for all patients with CKD?
a)
Atorvastatin 20 mg daily
b)
Simvastatin 40 mg daily
c)
Rosuvastatin 5 mg daily
d)
Pravastatin 40 mg daily
e)
Fluvastatin 80 mg daily
70.
By 2040, CKD is predicted to be which leading cause of death worldwide?
a)
5th
b)
10th
c)
15th
d)
20th
e)
25th
71.
Which diuretic inhibits carbonic anhydrase in the proximal tubule?
a)
Furosemide
b)
Bendroflumethiazide
c)
Acetazolamide
d)
Amiloride
e)
Tolvaptan
72.
Which diuretic is most likely to cause metabolic acidosis?
a)
Furosemide
b)
Acetazolamide
c)
Hydrochlorothiazide
d)
Spironolactone
e)
Bendroflumethiazide
73.
Which diuretic class is most potent in increasing sodium excretion?
a)
Thiazides
b)
Loop diuretics
c)
Carbonic anhydrase inhibitors
d)
Potassium-sparing diuretics
e)
Aquaretics
74.
Which electrolyte abnormality is typical of thiazide diuretics?
a)
Hyperkalaemia
b)
Hypermagnesaemia
c)
Hypercalcaemia
d)
Hypocalcaemia
e)
Hyponatraemia
75.
Which diuretic is most associated with ototoxicity?
a)
Furosemide
b)
Spironolactone
c)
Hydrochlorothiazide
d)
Amiloride
e)
Acetazolamide
76.
Which diuretic is indicated in the treatment of glaucoma?
a)
Amiloride
b)
Acetazolamide
c)
Spironolactone
d)
Bendroflumethiazide
e)
Furosemide
77.
Which potassium-sparing diuretic acts by blocking ENaC channels in the collecting duct?
a)
Amiloride
b)
Spironolactone
c)
Tolvaptan
d)
Bendroflumethiazide
e)
Furosemide
78.
Which complication is particularly associated with spironolactone?
a)
Ototoxicity
b)
Hypernatraemia
c)
Gynaecomastia
d)
Hypercalcaemia
e)
Tinnitus
79.
Which diuretic is most useful in treating nephrolithiasis due to hypercalciuria?
a)
Furosemide
b)
Acetazolamide
c)
Bendroflumethiazide
d)
Spironolactone
e)
Amiloride
80.
Which drug is a vasopressin V2 antagonist used to treat SIADH?
a)
Acetazolamide
b)
Furosemide
c)
Tolvaptan
d)
Spironolactone
e)
Amiloride
81.
Which diuretic causes profound hypokalaemia by strongly promoting K⁺ excretion?
a)
Furosemide
b)
Spironolactone
c)
Amiloride
d)
Tolvaptan
e)
Acetazolamide
82.
Which diuretic reduces intraglomerular pressure and has renal-protective effects in diabetic nephropathy?
a)
Bendroflumethiazide
b)
Dapagliflozin
c)
Spironolactone
d)
Furosemide
e)
Amiloride
83.
Which diuretic is most commonly implicated in hyponatraemia?
a)
Spironolactone
b)
Hydrochlorothiazide
c)
Amiloride
d)
Furosemide
e)
Tolvaptan
84.
Which mechanism explains why loop diuretics increase calcium excretion?
a)
Inhibition of ENaC channels
b)
Blockade of Na-K-2Cl cotransporter in thick ascending limb
c)
Inhibition of aldosterone receptors in collecting duct
d)
Inhibition of Na-Cl cotransporter in distal convoluted tubule
e)
Inhibition of carbonic anhydrase
85.
Which diuretic is associated with painful gynaecomastia in a patient with cirrhosis and ascites?
a)
Spironolactone
b)
Furosemide
c)
Bendroflumethiazide
d)
Tolvaptan
e)
Acetazolamide
86.
Which diuretic reduces the risk of calcium renal stones?
a)
Furosemide
b)
Spironolactone
c)
Hydrochlorothiazide
d)
Acetazolamide
e)
Tolvaptan
87.
A boxer misuses diuretics for rapid weight loss and develops tetany. Which abnormality best explains this?
a)
Hypocalcaemia due to loop diuretic abuse
b)
Hypercalcaemia due to thiazide abuse
c)
Hypernatraemia due to aquaretic abuse
d)
Hyperkalaemia due to spironolactone abuse
e)
Hypermagnesaemia due to loop diuretic abuse
88.
Which diuretic is most likely to worsen glucose tolerance and increase diabetes risk?
a)
Furosemide
b)
Hydrochlorothiazide
c)
Spironolactone
d)
Acetazolamide
e)
Tolvaptan
89.
A patient with SIADH is started on tolvaptan. Which major complication must be monitored?
a)
Hypernatraemia
b)
Hyponatraemia
c)
Hyperkalaemia
d)
Hypocalcaemia
e)
Hypokalaemia
90.
In CKD, which factor most directly increases volume of distribution (Vd) for acidic drugs such as phenytoin?
a)
Increased tissue binding
b)
Reduced albumin concentration
c)
Reduced intestinal absorption
d)
Enhanced renal secretion
e)
Increased hepatic metabolism
91.
Which pharmacokinetic change is most likely in a patient with CKD?
a)
Reduced oral absorption due to delayed gastric emptying
b)
Increased clearance of renally-excreted drugs
c)
Shortened half-life of most drugs
d)
Increased first-pass metabolism
e)
Increased protein binding of drugs
92.
A drug has a renal clearance of 400 mL/min. What does this indicate?
a)
It is poorly filtered due to protein binding
b)
It is filtered and secreted
c)
It is filtered and reabsorbed
d)
It is only secreted
e)
It is not cleared by the kidney
93.
Which statement about creatinine clearance is correct?
a)
It underestimates GFR because of tubular secretion
b)
It is unaffected by muscle mass
c)
It is a direct measure of renal plasma flow
d)
It is usually slightly higher than inulin clearance
e)
It is unreliable in all patients with kidney disease
94.
Which transporter is primarily responsible for secretion of acidic drugs such as penicillin in the proximal tubule?
a)
OCT (organic cation transporter)
b)
P-glycoprotein
c)
OAT (organic anion transporter)
d)
MDR1
e)
MATE1
95.
Which drug is most likely to have altered pharmacodynamics in CKD due to electrolyte imbalance?
a)
Morphine
b)
Warfarin
c)
Nifedipine
d)
Canagliflozin
e)
Loratadine
96.
In renal impairment, what happens to the half-life (t½) of a renally cleared drug if clearance decreases but Vd remains unchanged?
a)
It will decrease
b)
It will increase
c)
It will remain the same
d)
It will fluctuate
e)
It depends only on absorption
97.
A patient with renal impairment is prescribed gentamicin. Which is the most appropriate adjustment?
a)
Increase dose, same interval
b)
Reduce dose, same interval
c)
Same dose, reduce interval
d)
Loading dose then reduced maintenance dose
e)
Avoid monitoring drug levels
98.
Which drug characteristic would make dose adjustment in renal impairment most critical?
a)
Low protein binding
b)
High hepatic metabolism
c)
>50 % excreted unchanged in urine
d)
Short half-life
e)
Wide therapeutic index
99.
A patient is on long-term lithium therapy. Which mechanism explains increased lithium toxicity in CKD?
a)
Reduced tubular reabsorption of sodium leads to compensatory lithium reabsorption
b)
Increased protein binding of lithium in plasma
c)
Enhanced secretion of lithium via OAT transporters
d)
Increased first-pass metabolism
e)
Reduced intestinal absorption
100.
Which of the following is the most abundant intracellular cation?
a)
Sodium
b)
Calcium
c)
Magnesium
d)
Potassium
e)
Chloride
101.
Hyperkalaemia is defined as a plasma potassium level of:
a)
>3.0 mmol/L
b)
>3.5 mmol/L
c)
>4.5 mmol/L
d)
>5.5 mmol/L
e)
>6.5 mmol/L
102.
Which ECG change is most characteristic of early hyperkalaemia?
a)
U waves
b)
Flattened T waves
c)
Peaked T waves
d)
Prolonged QT interval
e)
ST depression
103.
What is the first-line emergency treatment for hyperkalaemia with ECG changes?
a)
IV insulin with dextrose
b)
IV calcium gluconate
c)
IV sodium bicarbonate
d)
IV furosemide
e)
Dialysis
104.
Which hormone promotes potassium uptake into cells?
a)
Cortisol
b)
Aldosterone
c)
Insulin
d)
Parathyroid hormone
e)
Vasopressin
105.
Which part of the nephron reabsorbs the majority of filtered potassium?
a)
Distal convoluted tubule
b)
Collecting duct
c)
Proximal tubule
d)
Loop of Henle
e)
Bladder epithelium
106.
Which nephron cell type is responsible for potassium secretion under normal conditions?
a)
Podocytes
b)
Principal cells
c)
α-intercalated cells
d)
β-intercalated cells
e)
Juxtaglomerular cells
107.
In metabolic acidosis, plasma potassium usually:
a)
Decreases due to cellular uptake
b)
Increases due to K⁺ shift out of cells
c)
Remains unchanged
d)
Falls because aldosterone rises
e)
Increases due to decreased dietary intake
108.
Which of the following causes hypokalaemia by increasing tubular flow and K⁺ secretion?
a)
Loop diuretics
b)
ACE inhibitors
c)
β-blockers
d)
Potassium binders
e)
NSAIDs
109.
Which best explains the “aldosterone paradox”?
a)
Aldosterone always increases potassium excretion
b)
Aldosterone always increases sodium excretion
c)
Aldosterone's effect on K⁺ secretion varies depending on sodium balance
d)
Aldosterone only regulates acid-base balance
e)
Aldosterone release is independent of plasma K⁺
110.
Which mechanism explains why β₂-adrenoceptor agonists lower plasma potassium?
a)
They stimulate Na⁺/K⁺ ATPase activity in skeletal muscle
b)
They increase aldosterone secretion
c)
They promote urinary potassium secretion directly
d)
They increase hepatic potassium uptake via gluconeogenesis
e)
They inhibit H⁺/K⁺ ATPase in intercalated cells
111.
In metabolic alkalosis, which is the most likely potassium disturbance?
a)
Hypokalaemia due to intracellular shift
b)
Hyperkalaemia due to intracellular shift
c)
Hypokalaemia due to reduced urinary excretion
d)
Hyperkalaemia due to reduced urinary excretion
e)
No change in potassium levels
112.
Which nephron transporter is inhibited by loop diuretics, leading to hypokalaemia?
a)
Na⁺-K⁺-2Cl⁻ cotransporter in thick ascending limb
b)
Na⁺-Cl⁻ symporter in early DCT
c)
ENaC in late DCT
d)
H⁺/K⁺ ATPase in α-intercalated cells
e)
Na⁺-K⁺ ATPase on basolateral membranes
113.
Which best explains potassium handling in the proximal tubule?
a)
Reabsorbed mainly via solvent drag and paracellular diffusion
b)
Secreted via ENaC channels
c)
Reabsorbed only by active transporters
d)
Secreted by ROMK and BK channels
e)
Reabsorbed exclusively via transcellular Na⁺/K⁺ ATPase activity
114.
A patient with diabetic ketoacidosis has plasma K⁺ of 6.0 mmol/L but total body potassium is depleted. What best explains this paradox?
a)
Acidosis causes H⁺ to enter cells and K⁺ to exit
b)
Osmotic diuresis increases K⁺ reabsorption
c)
Insulin deficiency causes K⁺ influx into cells
d)
Vomiting causes K⁺ retention
e)
RAAS activation reduces K⁺ secretion
115.
Which potassium channel in principal cells is directly responsible for secretion into the tubular lumen?
a)
ROMK
b)
Na⁺-Cl⁻ symporter
c)
H⁺/K⁺ ATPase
d)
Ca²⁺-activated BK channel
e)
ENaC
116.
In chronic kidney disease, hyperkalaemia occurs primarily because:
a)
Reduced distal nephron flow limits K⁺ secretion
b)
Increased aldosterone secretion
c)
Enhanced activity of β₂-adrenoceptors
d)
Increased proximal tubular reabsorption
e)
Increased GI secretion of potassium
117.
Which potassium abnormality is most likely in a patient on high-dose thiazides?
a)
Hypokalaemia from increased distal sodium delivery
b)
Hyperkalaemia from aldosterone suppression
c)
Hyperkalaemia from reduced tubular flow
d)
No change in potassium due to compensatory mechanisms
e)
Hypokalaemia from reduced proximal reabsorption
118.
Which of the following is the most direct stimulus for aldosterone secretion?
a)
Hyperkalaemia
b)
Hypocalcaemia
c)
Hyponatraemia
d)
Metabolic alkalosis
e)
Hypermagnesaemia
119.
In which clinical setting would you expect pseudohyperkalaemia?
a)
Delayed blood sample processing with haemolysis
b)
Diabetic ketoacidosis
c)
Addison's disease
d)
Chronic kidney disease
e)
Massive blood transfusion
120.
In advanced CKD (eGFR <15 ml/min), which solute's excretion is relatively preserved?
a)
Sodium
b)
Potassium
c)
Phosphate
d)
Creatinine
e)
Titratable acid
121.
Why are patients with CKD prone to nocturia?
a)
Associated bladder dysfunction
b)
Prostatic hypertrophy
c)
Anxiety causing urinary frequency
d)
Reduced capacity to concentrate urine
e)
Uraemic toxins cause incontinence
122.
Which hormone promotes phosphate excretion in CKD?
a)
Cholecalciferol
b)
Hepcidin
c)
Fibroblast Growth Factor-23 (FGF-23)
d)
Ferroportin
e)
Erythropoietin
123.
Which statement best explains why IV iron is often required in CKD-associated anaemia?
a)
Iron deficiency is very common
b)
Erythropoietin is too expensive
c)
Vitamin D deficiency reduces oral absorption
d)
Functional iron deficiency is common
e)
Oral iron causes constipation
124.
What best explains progression of CKD?
a)
Decreasing function of a fixed number of nephrons
b)
Progressive nephron loss with compensatory hyperfiltration injury
c)
Reduced renal blood flow
d)
Tubular obstruction
e)
Calcium precipitation in renal tissue
125.
Which statement is true regarding CKD epidemiology?
a)
CKD is rare globally
b)
Diabetes is less common than CKD
c)
Prevalence increases with age
d)
CKD is uncommon in wealthy countries
e)
Prevalence is falling worldwide
126.
What is the most common lipid abnormality in CKD?
a)
Hypercholesterolaemia
b)
Hypertriglyceridaemia
c)
Low HDL cholesterol
d)
Elevated LDL cholesterol
e)
Lipoprotein(a) elevation
127.
What is the main cause of anaemia in CKD?
a)
Chronic blood loss
b)
Folate deficiency
c)
Reduced erythropoietin production
d)
Bone marrow infiltration
e)
Hypersplenism
128.
Which drug class is now recommended for slowing CKD progression?
a)
Loop diuretics
b)
Thiazide diuretics
c)
SGLT2 inhibitors
d)
Beta-blockers
e)
Proton pump inhibitors
129.
Which factor increases risk of hyperkalaemia in CKD?
a)
Calcium supplements
b)
Vitamin D therapy
c)
ACE inhibitors
d)
Statins
e)
Beta-blockers
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