Renal and Urogenital Disorders Board Review Questions: Free CME Quiz

Renal and Urogenital Disorders CME Quiz courtesy of Med-Challenger Online Medical Education

This week's Med-Challenger free CME quiz - Renal and Urogenital Disorders - the quick quiz covers medications for diabetes that should be avoided in patients with chronic kidney disease; presentation, management, and disposition of a patient with an acute exacerbation of chronic renal failure; the most likely etiology of benign urinary retention in men; and current recommendations for obtaining urinary cultures prior to the first empiric antibiotic dose in patients who present with symptoms of urinary tract infection and qualify for treatment with antibiotics.

A free sample Renal and Urogenital Disorders question included below. The full Renal and Urogenital Disorders CME quiz is free online for a limited time. You can earn AMA CME credit - and now you can earn ANCC contact hours as well! Play now.

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Here's this week's sample CME board review question on renal and urogenital disorders:

An 88-year-old man with a history of diabetes, hypertension, and stage 4 chronic kidney disease presents with profound lethargy and periods of unresponsiveness.

A blood glucose level obtained on admission to the emergency room was 40 mg/dL.

Other laboratory findings included a creatinine level of 2.8 mg/dL and blood urea nitrogen of 48 mg/dL.

The patient became alert and talkative following the administration of 10% dextrose but required a continuous infusion of dextrose during the first eight hours of observation to maintain a blood glucose level in the mid-80 mg/dL range.

Neither the patient nor his family can provide his current medication list.

Question:

Which of the following medications is the most likely cause of this patient’s symptoms?

Answer Options:

Metformin

Glimepiride

Repaglinide

Sitagliptin

Acarbose

See the Answer:

The correct answer is:

Glimepiride

Educational Objective:

Recognize that certain medications for diabetes should be avoided in patients with chronic kidney disease.

Key Point:

Glimepiride should be avoided in patients with chronic kidney disease because it can lead to hypoglycemia.

Explanation:

Glimepiride is a second-generation sulfonylurea whose half-life is prolonged in patients with CKD and is most likely the medication causing this patient’s hypoglycemia.

Metformin should not be given patients with advanced kidney disease, not because of the risk of hypoglycemia but because of concern for lactic acidosis.

Repaglinide is a short-acting insulin secretagogue, is used especially in those with chronic kidney disease (CKD). It should be taken with meals to avoid hypoglycemia.

In this patient, given the need for a continuous infusion of dextrose to maintain an adequate blood glucose level, it is not likely that repaglinide can be implicated.

Sitagliptin is not known to cause hypoglycemia.

Acarbose inhibits the absorption of carbohydrates in the small intestine and no dosage adjustment is needed in patients with CKD.

References:

Center for Drug Evaluation and Research. FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. US Food and Drug Administration Home Page. Published November 14, 2017. Accessed February 13, 2018.

Abe M, Okada K, Soma M. Antidiabetic agents in patients with chronic kidney disease and end-stage renal disease on dialysis: metabolism and clinical practice. Curr Drug Metab. 2011;12(1):57-69.

Snyder RW, Berns JS. Use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease. Semin Dial. 2004;17(5):365-370.

Play the full Med-Challenger Quick Quiz for CME Credit:

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Every free board review "Question of the Week" is just a sampling of a larger set of free board review questions featured in Med-Challenger's latest CME Quick Quiz.

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