Questions for CME: hemodialysis for the non-nephrologist.

1. Diabetes mellitus is now the most common cause of end-stage renal disease (ESRD). What percentage of ESRD cases is caused by diabetes?

a. 10%

b. 20%

c. 30%

d. 40%

5. 50%

2. ESRD is increasing in the elderly population. Currently, what percentage of all ESRD patients beginning dialysis are older than age 75?

a. 7%

b. 15%

c. 20%

d. 25%

e. 30%

3. Patients on chronic hemodialysis have a higher death rate than age-matched controls not on dialysis. Which of the following is the number one cause of death in patients on chronic hemodialysis?

a. Infection

b. Hyperkalemia 

c. Cardiovascular causes

d. Malignancy

e. Malnutrition

4. Which one of the following mechanisms is primarily responsible for the removal of small-molecular-weight uremic toxins like urea?

a. Ultrafiltration 

b. Convection

c. Solvent drag

d. Diffusion

e. B and C

5. In a patient on chronic hemodialysis, the blood urea nitrogen level in blood reflects which of the following factors?

a. Intake of dietary protein

b. Adequacy of hemodialysis

c. Left ventricular function

d. A and B

e. A, B and C

6. Which of the following parameters in a patient on chronic hemodialysis would be a marker of inadequate dialysis and prompt modification of the dialysis prescription?

a. Urea reduction rate of 76%

b. Kt/V of 1.5

c. Serum albumin of 4.2 mg/dL

d. Worsening peripheral neuropathy

e. Postdialysis blood pressure of 165/90 mm Hg

7. A patient with a glomerular filtration rate of 16 mL/min has a left forearm arteriovenous fistula placed. Two weeks later the patient returns complaining of severe pain in the left hand. On examination, the entire hand feels cool; there is diminished sensation in the fingertips and mildly decreased grip strength. There is a strong thrill and bruit over the fistula site and the incision has healed well.

The most likely cause of the patient's symptoms and clinical findings is:

a. Uremic peripheral neuropathy

b. Injury to the median nerve during fistula placement

c. Injury to the radial artery during fistula placement

d. Deep tissue infection

e. Steal phenomena due the fistula

8. A patient who has recently started hemodialysis presents to the emergency department with a fever to 39.2 degrees celsius with associated rigors. His last dialysis session was yesterday and was uncomplicated. He dialyzes through a recently placed tunneled dialysis catheter in his right internal jugular vein. On examination the patient has stable vital signs and his examination is significant for erythema and tenderness over the tunnel site of the dialysis catheter.

Appropriate therapy would include which of the following:

a. IV vancomycin, gentamicin, and catheter removal

b. IV vancomycin

c. IV vancomycin, fluconazole, gentamicin, and catheter removal

d. IV cefazolin and catheter removal

e. IV cefazolin and gentamicin

9. You are called emergently to the dialysis unit to see a patient who has developed the rapid onset of dyspnea and chest pain. The patient receives dialysis through a tunneled catheter in the left internal jugular vein. The dialysis nurse reports that she may have inadvertently allowed air to enter the catheter.

Emergent management of this patient should include the following:

a. Continuation of dialysis

b. Immediate cessation of dialysis and close monitoring

c. Placement of the patient in the left lateral decubitus position with the head down

d. Administration of high concentration, high flow oxygen

e. B, C, and D

10. Which of the following solutes is not found in the dialysate?

a. Sodium

b. Potassium

c. Chloride

d. Glucose

e. Phosphorus

Answers to CME Questions

1. D, 2. C, 3. C, 4. D, 5. D, 6. D, 7. E, 8. A, 9. E, 10. E