1) C – ANCA vasculitis treatment – prednisone and Cyclophosphamide. There is plasmapheresis in the choice . If they specifically ask for initial therapy, then prednisone and plasmapheresis could be considered. This patient did not have pulmonary hemorrhage and was not sick !
2) B – Fabry disease. This is an X linked recessive disease which predominantly affects male ! Deficiency of Alpha galactosidase A causes accumulation of sphingolipids(glycolipids and in this disease specifically galactoacylcerebrosidase) in blood vessels , nerves kidney and heart. The manifestations are neurological(pain and tingling in extremities, progressive CKD-especially in 3 decade, Cardiac hypertrophy, abdominal pain(accumulation of sphingolipids in blood vessels supplying intestines) and skin rash(especially around the umbilicus)
3) D – Sickle cell/Tylenol/NSAID combination should raise suspicion about papillary necrosis
4)A – Arterial line is negative pressure and is causes dialysis catheter to flatten out!
5) B – most common cause of intradialytic hypotension is diastolic dysfunction. I was tempted to choose pericardial effusion given the stem of the case .
6) E – Hyperglycemia- very common cause of PD ultrafiltration failure since it decreases the solute gradient dramatically!
7) C – Isolated scrotal swelling should raise concerns about patent processes vaginalis in a new PD patient
8) E -Gentamycin toxicity- hypomagnesemia
9) C – Cyclosporine toxicity causes hirsutism
10) B – Increased urine oxalate -pathogenesis for calcium oxalate stone in Chron’s disease
Hope the explanation helps!