Acute Kidney Injury MCQs

The risk of statin induced myopathy is high when drugs like Erythromycin, anti fungals, immunosuppressive drugs and gemfibrozil is used along with statins, as these drugs interfere with the metabolism of statins. Statins will increase the drug levels of warfarin and digoxin too. Hence A,.B And C are right options. Reference: Harrison’s Principles of Internal Medicine, ch: 407, Pg: 3149

Women on oral contraceptives have a higher incidence of chlamydial endocervicitis. Vaginal warts are also common in these women. However, it is believed that human papillomavirus infection may occur even before the woman starts taking the pill, and that there is no actual increase in the risk of acquiring infection. Reference: Harrison's Principles of Internal Medicine 20 th edition Chapter:389 P page number :2814-15

The functional effects of hypokalemia on the kidney can include Na+-Cl- and HCO3 - retention, polyuria, phosphaturia, hypocitraturia, and an activation of renal ammoniagenesis. Bicarbonate retention and other acid-base effects of hypokalemia can contribute to the generation of metabolic alkalosis. Hypokalemic polyuria is due to a combination of central polydipsia and an AVP-resistant renal concentrating defect. Structural changes in the kidney due to hypokalemia include a relatively specific vacuolizing injury to proximal tubular cells, interstitial nephritis, and renal cysts. Hypokalemia also predisposes to acute kidney injury and can lead to end-stage renal disease (ESRD) in patients with long-standing hypokalemia due to eating disorders and/or laxative abuse. Reference: Harrisons Principles of Internal Medicine, 21 st Ed, Ch:53 Pg: 350

The question deals with neurolathyrism , due to ingestion of chick pea, containing the excito toxin beta oxalylamino L alanine causing spastic paraplegia. This disease is having high prevalence in chhattisgarh as the legume was consumed as staple food during the time of drought.

Drugs causing Cholestasis: anabolic steroids containing an alkyl or ethinyl group at carbon 17 azathioprine cetirizine cyclosporine Chlorpromazine Co amoxiclav Erythromycin estolate diclofenac estrogen febuxostat indinavir mercaptopurine methyltestosterone tamoxifen ticlopidine. Reference : Harrison's Principles of Internal Medicine , 21 st Ed, Ch: 340 Pg: 2587

The question deals with the various biologics used in RA and their mechanism of action. The chief biologicals are the anti TNFα agents, which are described in the previous question. Anakinra is anti IL-1. It has limited use in RA and is used in other autoinflammatory syndromes and Juvenile idiopathic arthritis or Still's Disease. Tocilizumab is anti IL6 antibody. Another agent is Sarilumab. IL-6 is the chief cytokine in Ra which leads to activation of osteoclasts. Rituximab is anti CD 20 antibody. It is used in seropositive RA, refractory to other biologics. Abatacept is a fusion protein consisting of CTLA-4 linked to IgG. It inhibits the co-stimulatory signal for CD4 cells. Reference: Harrison's Principles of Internal Medicine, 21st ed, Ch: 358, Pg: 2761

Thrombotic thrombocytopenia purpura (TTP) is a rare thrombotic microangiopathy, occurring due to a deficiency of a specific von Willebrand factor cleaving protein known as ADAMTS13 The diagnostic pentad includes acute kidney injury, altered mental state, low platelets, fever and microangiopathic haemolytic anaemia.Not all features are necessary to make the diagnosis Platelet transfusions are essentially contraindicated in the absence of serious bleeding. Treatment options include plasmapheresis as first line, fresh frozen plasmaadministration, steroids, rituximab and aspirin. Reference: Harrison 20 th 886

Aspirin is not used in gout as it decreases urate secretion . Aspirin has to be given in large doses for anti-inflammatory action. There are more potent anti-inflammatory drugs than aspirin. A, B and C are correct.