Nephrology Quiz and Questionnaire

Abstract

SummaryPresentation of the Nephrology Quiz and Questionnaire has become an annual tradition at the meetings of the American Society of Nephrology. It is a very popular session judged by consistently large attendance. Members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. They can also compare their answers in real time using audience response devices with the answers of program directors of nephrology training programs in the United States through an Internet-based questionnaire. Topics presented here include fluid and electrolyte disorders, transplantation, and ESRD and dialysis. Cases representing each of these categories along with single best-answer questions were prepared by a panel of experts (the authors). The correct and incorrect answers then were briefly discussed after the audience responses and the results of the questionnaire were displayed. This article tries to recapitulate the session and reproduce its educational value for a larger audience-the readers of the Clinical Journal of the American Society of Nephrology. Have fun.Clin J Am Soc Nephrol 7: 1047-1052, 2012. doi: 10.2215/CJN.01720212Electrolytes Case 1: Biff F. Palmer (Discussant)A 65-year-man with known squamous cell carcinoma of the head and neck was referred for evaluation of hypomagnesemia. Approximately 1 year ago, he presented with a slowly enlarging left-sided neck mass and was subsequently diagnosed with squamous cell carcinoma primary to the head and neck region. He was started on a cisplatin-based chemotherapy regimen administered over the course of 6 months but was noted to have residual disease. Four months ago, he was started on therapy with cetuximab (an epidermal growth factor receptor blocker). Laboratory examination at that time was normal. Over the last 3 weeks, the patient has noted increasing generalized weakness. The patient had a 30-pack/y history of smoking and drank a six pack of beer daily. He was diagnosed with Barrett's esophagus 2 months ago and had been treated with pantoprazole (40 mg daily) since that time. One month ago, he was started on hydrochlorothiazide (12.5 mg daily) for treatment of hypertension. Physical examination showed a blood pressure of 142/78 mmHg with no orthostatic changes. The left-sided neck mass was no longer palpable. The remainder of the examination was only significant for mild generalized weakness in both upper and lower extremities. Laboratory data are shown in Table 1. Electrolytes Question 1Which ONE of the following is MOST likely to account for the electrolyte disturbances in this patient (Figure 1 has responses of program directors and attendees)?A. Hydrochlorothiazide B. Cetuximab C. Pantoprazole D. Cisplatin E. Ethanol Discussion of Question 1The central issue in this patient is the etiology of the hypomagnesemia, because hypokalemic metabolic alkalosis and hypocalcemia can potentially be the result of magnesium deficiency. Magnesium is a necessary cofactor for ATP, and magnesium deficiency can, ther...