Free PA-CN Practice Questions

Question 1

Twelve days after starting dapagliflozin 10 mg daily for diabetic kidney disease, a 64-year-old man has an eGFR of 39 mL/min/1.73 m², down from 44. His pretreatment urine albumin-to-creatinine ratio was 680 mg/g. He remains on a stable dose of losartan. Blood pressure is 124/72 mm Hg without orthostasis, weight is unchanged, and potassium is 4.6 mmol/L. He feels well and has had no acute illness or NSAID exposure. How should the dapagliflozin prescription be handled?

Accepted Answer

Continue 10 mg daily with planned kidney-function monitoring.

Answer

Withhold it until the eGFR returns to the pretreatment value.

Answer

Reduce it to 5 mg daily because the eGFR is below 45.

Answer

Continue it but discontinue losartan to reverse the eGFR decline.

Question 2

During overnight automated peritoneal dialysis, a patient with no previous peritonitis develops cloudy effluent and new diffuse abdominal discomfort. A sample from a 45-minute dwell contains 78 leukocytes/µL, with 88% neutrophils. Temperature is 37.2°C and blood pressure is 128/76 mm Hg; there is no guarding or exit-site inflammation. Effluent has been sent for culture. The total cell count is below 100/µL. What should happen next?

Accepted Answer

Start intraperitoneal antibiotics covering gram-positive and gram-negative organisms.

Answer

Repeat the cell count after a two-hour dwell before deciding whether to give antibiotics.

Answer

Treat with intraperitoneal gram-positive coverage alone until the culture identifies an organism.

Answer

Arrange immediate catheter removal and temporary hemodialysis for this first episode.

Question 3

A patient with sepsis becomes progressively somnolent. Simultaneous studies show sodium 138 mmol/L, chloride 102 mmol/L, bicarbonate 12 mmol/L, albumin 4.0 g/dL, arterial pH 7.08, and PaCO₂ 42 mm Hg. The patient has not been intubated. Which interpretation accounts for both the chemistry panel and the arterial blood gas?

Accepted Answer

Anion gap 24 mmol/L; metabolic acidosis with superimposed respiratory acidosis.

Answer

Anion gap 12 mmol/L; metabolic acidosis with superimposed respiratory acidosis.

Answer

Anion gap 24 mmol/L; metabolic acidosis with appropriate respiratory compensation.

Answer

Anion gap 36 mmol/L; metabolic acidosis with superimposed respiratory acidosis.

Question 4

A previously healthy 9-year-old girl is recovering from palpable purpura over the buttocks and lower legs with ankle arthralgia after an upper respiratory illness. Platelets are 264,000/µL, creatinine is 0.45 mg/dL, blood pressure is normal for age, and urinalysis shows neither blood nor protein. Her joint symptoms and rash are resolving without treatment. Her parent asks whether anything further is needed to protect her kidneys. The appropriate plan is to:

Accepted Answer

Arrange serial blood pressure measurements and urinalyses despite the normal initial results.

Answer

Prescribe a short prednisone course to prevent nephritis before urinary abnormalities develop.

Answer

Obtain a kidney biopsy now to detect IgA deposition before renal symptoms become apparent.

Answer

End renal follow-up once the rash resolves unless gross hematuria or edema subsequently appears.

Question 5

Six months after kidney transplantation, a 48-year-old recipient has surveillance plasma BK polyomavirus DNA levels of 18,000 copies/mL and then 23,000 copies/mL two weeks later. Creatinine remains at the post-transplant baseline of 1.2 mg/dL. The recipient takes tacrolimus, mycophenolate, and prednisone. Immunologic risk is low, with no prior rejection or donor-specific antibodies. Which strategy best addresses these findings?

Accepted Answer

Reduce maintenance immunosuppression stepwise and follow plasma BK viral loads.

Answer

Continue the current regimen and start valganciclovir until the DNAemia clears.

Answer

Give pulse methylprednisolone for presumed rejection.

Answer

Obtain an allograft biopsy before reducing any immunosuppressant.

Question 6

Two routine assessments four months apart show eGFR values of 78 and 81 mL/min/1.73 m² and first-morning urine albumin-to-creatinine ratios of 480 and 520 mg/g. Both samples were obtained while the patient was well, without urinary infection or recent strenuous exercise. Which entry most accurately classifies the kidney disease?

Accepted Answer

Chronic kidney disease, category G2A3.

Answer

No chronic kidney disease because eGFR remains above 60.

Answer

Chronic kidney disease, category G2A2.

Answer

Chronic kidney disease, category G3aA3.

Question 7

At 31 weeks of gestation, a previously normotensive woman has blood pressures of 154/98 and 152/96 mm Hg four hours apart. Her platelet count has fallen from 240,000 to 86,000/µL, and creatinine has risen from 0.6 to 1.3 mg/dL. Urine protein-to-creatinine ratio is 0.12 g/g. AST, ALT, LDH, and bilirubin are normal, and the blood smear shows no schistocytes. There is no history of kidney or hematologic disease. How should this hypertensive disorder be classified?

Accepted Answer

Preeclampsia with severe features.

Answer

Gestational hypertension.

Answer

Preeclampsia without severe features.

Answer

HELLP syndrome.

Question 8

The dialysis nurse reports a three-week rise in venous pressures at an unchanged blood pump rate. Needle sites now bleed for about 20 minutes after treatment, and delivered urea clearance has fallen despite completion of every session. The upper-arm fistula is unusually pulsatile and does not collapse when the arm is elevated. Heparin dosing and platelet count are unchanged; the hand is warm and painless. The pattern is most consistent with:

Accepted Answer

Venous outflow stenosis.

Answer

Arterial inflow stenosis.

Answer

Excess systemic anticoagulation.

Answer

Access-associated distal ischemia.

Question 9

A 70-year-old man referred for a creatinine increase from 1.0 to 3.4 mg/dL has a urine protein-to-creatinine ratio of 4.7 g/g but an albumin-to-creatinine ratio of only 130 mg/g on the same specimen. The urine dipstick shows trace protein, microscopy is bland, serum albumin is 3.7 g/dL, and hemoglobin is 9.5 g/dL with a normal MCV. Which investigation most directly addresses the discrepancy between the urine protein measurements?

Accepted Answer

Serum free light chains with serum and urine immunofixation.

Answer

Serum anti-PLA2R antibodies and hepatitis B serologies.

Answer

Serum C3 and C4 concentrations with anti-double-stranded DNA antibodies.

Answer

A repeat first-morning albumin-to-creatinine ratio to quantify glomerular albumin loss.

Question 10

An overnight sodium result is 121 mmol/L in a malnourished patient admitted ten hours earlier with confusion, sodium 108 mmol/L and potassium 2.6 mmol/L. A result from four days before admission had shown sodium 109 mmol/L. After isotonic saline and potassium replacement, hypotension resolved and urine output increased to 350 mL/hour; the urine is now very dilute. Saline has already been stopped. The patient is alert. Which intervention best limits the neurologic risk at this point?

Accepted Answer

Give desmopressin and titrated intravenous 5% dextrose to relower sodium under close monitoring.

Answer

Observe without relowering sodium because the presenting neurologic symptoms have resolved.

Answer

Use desmopressin alone to maintain sodium at 121 mmol/L without reversing the increase.

Answer

Match the ongoing urine output with isotonic saline to prevent recurrent volume depletion.

Free PA-CN Practice Questions

Domain 1: Chronic Kidney Disease 20% of exam

Question 1

Question 2

Domain 2: Glomerular Disorders 6% of exam

Question 3

Domain 5: Systemic Disorders 6% of exam

Question 4

Domain 6: Kidney Transplantation 5% of exam

Question 5

Domain 7: Hypertension 10% of exam

Question 6

Domain 8: Renal Pathophysiology 14% of exam

Question 7

Question 8

Domain 10: End-Stage Renal Disease / Dialysis 17% of exam

Question 9

Question 10

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