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Clinical Review Quiz

Dialysis Modalities

Brian S. Rifkin, MD and Ursula C. Brewster, MD

Dr. Rifkin is a fellow in nephrology, and Dr. Brewster is an assistant professor of medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT.

The questions below are based on the article
“Dialysis Modalities”.

Choose the single best answer for each question.

1. Which of the following statements regarding when dialysis should be initiated in a patient with chronic kidney disease from diabetes is true?
  1. Dialysis should be initiated once the serum creatinine level reaches 3.5 mg/dL
  2. Dialysis should be initiated once the blood urea nitrogen level reaches 100 mg/dL
  3. Dialysis should not be initiated until symptoms of severe uremia develop
  4. Dialysis should be initiated earlier in a patient with diabetes than in a patient who does not have diabetes
  5. Dialysis should be initiated in all patients with an estimated glomerular filtration rate (GFR) of 15 mL/min regardless of symptoms
Click here to compare your answer.

2. Which of the following changes in hemodialysis prescription can be tried to improve the “dialysis adequacy” in a patient who is underdialyzed?

  1. Change to a dialyzer with a lower clearance coefficient (K)
  2. Decrease the blood flow
  3. Give midodrine with dialysis
  4. Increase the dialysis treatment time
  5. Increase the calcium level in the dialysis bath
Click here to compare your answer.

3. Which is the preferred hemodialysis access type for chronic dialysis patients?

  1. Arteriovenous fistula
  2. Arteriovenous graft
  3. Tenckhoff catheter
  4. Tunneled subclavian catheter
  5. Untunneled internal jugular catheter
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4. In a patient on continuous ambulatory peritoneal dialysis, which of the following will result from changing the dialysate from a 2.5% to 4.25% dextrose solution?
  1. Constipation
  2. Hypertension
  3. Hypoglycemia
  4. Improvement in solute clearance
  5. Increase in ultrafiltration
Click here to compare your answer.

5. Which of the following is an indication for urgent acute dialysis?

  1. Creatinine level of 10 mg/dL
  2. Heroin overdose
  3. Hypernatremia
  4. Serum pH of 7.2
  5. Uremic pericarditis
Click here to compare your answer.

6. Continuous venous-venous hemodialysis (CVVH/D) is the most appropriate dialysis modality in which of the following clinical scenarios?

  1. Diabetic ketoacidosis with renal failure
  2. Hepatic encephalopathy and renal failure
  3. Hyperkalemia and renal failure
  4. Hypertensive emergency with acute renal failure
  5. Severe uremia with pericarditis
Click here to compare your answer.


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