← Combined Technical (NG)
Past Questions — 2026
Which is not an absolute indication for dialysis in AKI?
A)
Refractory hyperkalemia >6.5 mmol/L
B)
Refractory fluid overload
C)
Uremic Encephalopathy
D)
Creatinine 3 mmol/L
The correct option is 'd' because a specific creatinine level (such as 3 mmol/L or approx 34 mg/dL) is not an absolute indication for dialysis. Dialysis is indicated based on the clinical complications of kidney failure (symptoms and metabolic derangements) rather than a numerical creatinine threshold.
Other options are absolute indications for urgent dialysis (often remembered by the mnemonic AEIOU):
- Option 'a' (Refractory hyperkalemia): Severe hyperkalemia (>6.5 mmol/L) that does not respond to medical therapy is a life-threatening emergency requiring dialysis.
- Option 'b' (Refractory fluid overload): Pulmonary edema or fluid overload that does not respond to diuretics is an absolute indication.
- Option 'c' (Uremic Encephalopathy): Neurological manifestations of uremia (e.g., confusion, seizures, coma) require immediate dialysis.
Heparin free hemodialysis is indicated in all the following conditions, except:
A)
Uremic pericarditis
B)
Uremic encephalopathy
C)
High bleeding risk
D)
Recent major surgery
Heparin-free hemodialysis is indicated when the risk of bleeding outweighs the risk of clotting in the dialysis circuit.
1. Why Option 'b' is correct: Uremic encephalopathy is a metabolic complication of kidney failure that requires urgent dialysis to remove toxins. It does not inherently involve a bleeding diathesis or a contraindication to anticoagulation. Therefore, standard heparinized dialysis is typically used unless another co-morbidity exists.
2. Why other options are incorrect:
- Option 'a' (Uremic pericarditis): This is a critical indication for heparin-free dialysis because anticoagulation can lead to hemorrhagic pericardial effusion, which may cause cardiac tamponade.
- Option 'c' (High bleeding risk): Any patient with active bleeding, severe thrombocytopenia, or a known bleeding disorder requires heparin-free dialysis to prevent exacerbating the hemorrhage.
- Option 'd' (Recent major surgery): Patients who have undergone recent major surgery (especially intracranial or intra-abdominal) are at high risk for postoperative hemorrhage, making heparin-free dialysis the safer choice.
The most common Peritoneal Dialysis catheter used worldwide is :
A)
Swann-neck catheter
B)
Tenckhoff catheter
C)
Presternal catheter
D)
Rigid catheter
The Tenckhoff catheter is the gold standard and most widely used catheter for Peritoneal Dialysis (PD) worldwide. It is a soft, silicone-based catheter designed to be permanently implanted, featuring a cuff that prevents leakage and reduces the risk of infection by anchoring the catheter to the abdominal wall.
Other options are incorrect because:
- Swann-neck catheter: This is an older design that is rarely used today due to a higher risk of catheter migration and blockage.
- Rigid catheter: Rigid materials are not used for long-term PD as they would cause tissue trauma and are unsuitable for the flexibility required in the peritoneal cavity.
- Presternal catheter: This is not a standard term for a PD catheter; catheters for PD are placed intra-peritoneally, not presternally.
Most important post-renal transplant education is:
A)
Maintaining high calorie diet
B)
Immunosuppressive drug adherence
C)
Maintaining hygiene and proper self care
D)
Keeping Blood Pressure under control
The primary goal after a renal transplant is to prevent graft rejection and ensure the long-term survival of the transplanted organ. Immunosuppressive drug adherence is the most critical factor because missing doses or inconsistent timing can lead to acute or chronic rejection, which can result in the complete loss of the graft. While other factors are important, they are secondary to the pharmacological prevention of rejection.
- Option (a) is incorrect because a high-calorie diet is not universally required; dietary needs are individualized and often focus on managing weight and blood sugar rather than high calories.
- Option (c) is important to prevent opportunistic infections, but infection management is often a result of the immunosuppression itself; the drugs must be managed first to maintain the organ.
- Option (d) is crucial for long-term kidney health and managing side effects of immunosuppressants, but blood pressure control cannot compensate for the organ failure that occurs due to medication non-adherence.
The most common congenital anomaly of the kidney is:
A)
Polycystic Kidney Disease
B)
Horseshoe Kidney
C)
Crossed fused Ectopia
D)
Renal Hypoplasia
Among the options provided, Horseshoe Kidney is the most common congenital anomaly of kidney fusion.
1. Why 'b' is correct: Horseshoe kidney occurs when the lower poles of the kidneys fuse across the midline. It is widely recognized in medical literature as the most frequent type of renal fusion anomaly, occurring in approximately 1 in 500 to 1,000 live births.
2. Why others are incorrect:
- Polycystic Kidney Disease (a): While common, it is primarily classified as a genetic/hereditary cystic disease rather than a structural congenital anomaly of kidney position or fusion.
- Crossed fused Ectopia (c): This is a rarer anomaly where both kidneys (or parts of them) are located on the same side of the body.
- Renal Hypoplasia (d): This refers to kidneys that are small but normally formed; while it occurs, it is less common as a distinct structural anomaly compared to the fusion seen in horseshoe kidney.
The preferred AVF cannulation technique is:
A)
Rope ladder
B)
Buttonhole
C)
Both (a) and (b)
D)
Area puncture
In hemodialysis, both the Rope Ladder and Buttonhole techniques are recognized and preferred methods for AVF (Arteriovenous Fistula) cannulation, depending on the patient's vessel health and clinical preference.
1. Rope Ladder Technique: This involves rotating the cannulation sites along the length of the fistula. It is preferred to prevent stenosis and aneurysm formation by distributing the trauma across the vessel wall.
2. Buttonhole Technique: This involves repeated cannulation of the exact same site. It is preferred for patients with limited space for rotation or those who experience significant pain/bleeding, as it creates a 'track' that makes insertion easier over time.
Area puncture (Option d) is not a standardized clinical term for a preferred cannulation strategy; rather, it is a vague description. Since both (a) and (b) are established gold-standard techniques, option (c) is the correct choice.
Maximum hourly ultrafiltration (UF) rate during hemodialysis should not exceed:
A)
20 ml/kg/hour
B)
10 ml/kg/hour
C)
8 ml/kg/hour
D)
5 ml/kg/hour
The maximum recommended hourly ultrafiltration (UF) rate during hemodialysis is generally accepted as 10 ml/kg/hour. This limit is established to prevent intradialytic hypotension and avoid the risk of dialysis disequilibrium syndrome or osmotic imbalances.
1. Why Option (b) is correct: A rate of 10 ml/kg/hour is the standard clinical threshold used to ensure that fluid removal does not exceed the plasma refill rate from the interstitial space into the intravascular compartment, thereby maintaining hemodynamic stability.
2. Why other options are incorrect:
- Option (a) 20 ml/kg/hour is excessively high and would likely lead to severe hypotension, cramping, and potential organ hypoperfusion.
- Options (c) 8 ml/kg/hour and (d) 5 ml/kg/hour are safe rates, but they do not represent the 'maximum' allowable threshold; they are conservative targets rather than the upper limit.
Methods to assess adequacy of dialysis includes all EXCEPT:
A)
URR
B)
eKt/V
C)
UACR
D)
sp Kt/V
The correct option is 'c' (UACR) because it is not a measure of dialysis adequacy. UACR (Urine Albumin-to-Creatinine Ratio) is used to screen for and monitor albuminuria (protein in the urine), which is a marker of kidney damage or diabetic nephropathy, not the efficiency of a dialysis session.
The other options are standard methods to assess dialysis adequacy:
- URR (Urea Reduction Ratio): Measures the percentage decrease in blood urea nitrogen (BUN) after a dialysis session.
- eKt/V (single-pool Kt/V): A dimensionless number representing the volume of blood cleared of urea relative to the total volume of urea in the body.
- sp Kt/V: Refers to the 'single-pool' Kt/V, which is the most common clinical method to quantify the adequacy of solute removal during hemodialysis.
Urine output less than 100 ml per day is:
A)
Anuria
B)
Oliguria
C)
Polyuria
D)
Hematuria
The correct option is Anuria. Here is the breakdown of the terms based on urine output:
1. **Anuria (Correct):** Defined as the failure of the kidneys to produce urine, typically characterized as urine output less than 100 ml per day.
2. **Oliguria (Incorrect):** Refers to a decreased output of urine, typically defined as less than 400 ml per day in adults.
3. **Polyuria (Incorrect):** Refers to the production of abnormally large volumes of dilute urine (typically >2.5 to 3 liters per day).
4. **Hematuria (Incorrect):** Refers to the presence of blood in the urine, regardless of the volume produced.
The purpose of clamping catheter before removal is:
A)
Reduce urine
B)
Allow bladder tone to return
C)
Prevent infection
D)
Increase urine concentration
The primary purpose of clamping a urinary catheter before removal is to allow the bladder to refill and regain its muscle tone (bladder training). When a catheter is in place for a long period, the bladder remains empty and decompressed, which can lead to muscle atrophy or a loss of the sensation of fullness. Clamping the catheter for a few hours before removal ensures the bladder can hold urine and contract properly, reducing the risk of immediate urinary incontinence or retention post-removal.
Incorrect options:
- (a) Reduce urine: Clamping does not reduce the production of urine; it only prevents it from draining into the bag.
- (c) Prevent infection: Clamping does not prevent infection; in fact, prolonged stasis of urine can potentially increase the risk of infection.
- (d) Increase urine concentration: Urine concentration is managed by the kidneys and hormonal regulation (ADH), not by clamping the drainage tube.
Which biochemical abnormality is not seen in CKD?
A)
Hyperphosphatemia
B)
Hyperparathyroidism
C)
Increased erythropoietin
D)
Hyperkalemia
In Chronic Kidney Disease (CKD), the kidneys fail to produce sufficient amounts of erythropoietin (EPO), a hormone essential for stimulating red blood cell production in the bone marrow. This leads to decreased erythropoietin levels and subsequent normocytic normochromic anemia, making 'Increased erythropoietin' the correct answer as it is NOT seen in CKD.
Other options are common biochemical abnormalities in CKD:
- Hyperphosphatemia (a): Occurs because the failing kidneys cannot adequately excrete phosphate.
- Hyperparathyroidism (b): Secondary hyperparathyroidism develops due to hypocalcemia and hyperphosphatemia, which trigger the parathyroid glands to release more PTH.
- Hyperkalemia (d): Occurs because the kidneys are unable to secrete potassium effectively into the urine.
Arterial pressure is also called:
A)
Pre-pump pressure
B)
Post-pump pressure
C)
Membrane pressure
D)
None of the above
In the context of hemodialysis and blood pumping systems, arterial pressure refers to the pressure of the blood as it is drawn from the patient's access point into the machine. Because this pressure is measured after the blood has passed through the arterial line but before it enters the pump (or relative to the pump's suction), it is often termed 'pre-pump pressure' in some contexts; however, in standard medical equipment terminology for dialysis circuits, the pressure measured after the blood pump (which pushes blood toward the dialyzer) is the arterial pressure of the circuit. Specifically, 'Post-pump pressure' refers to the pressure generated by the pump to push blood through the arterial side of the dialyzer. In many exam contexts regarding dialysis circuitry, the pressure measured after the pump is the arterial pressure of the filter.
1. Correct Option (b): Post-pump pressure is the pressure exerted by the pump to move blood into the arterial end of the dialyzer.
2. Incorrect Options: (a) Pre-pump pressure is typically referred to as 'arterial intake pressure' or 'negative pressure' due to the suction created by the pump. (c) Membrane pressure (or transmembrane pressure - TMP) is the pressure gradient across the dialyzer membrane, not the arterial pressure itself.
Polysulfone dialyzer membranes belong to which category?
A)
Natural membrane
B)
Modified cellulose
C)
Synthetic membrane
D)
Cellulosic membrane
Polysulfone (PSu) is a high-performance thermoplastic polymer, making it a synthetic membrane. It is widely used in hemodialysis because it is highly biocompatible, has high flux properties, and is more resistant to protein adsorption compared to older materials.
Incorrect options:
- Natural membranes (a) are derived from biological sources (e.g., collagen), which are rarely used in modern dialyzers due to instability.
- Cellulosic membranes (d) and Modified cellulose (b) are based on cellulose (plant-derived polymers). While common in early dialyzers (e.g., cuprophane), they are distinct from synthetic polymers like polysulfone and are more prone to triggering complement activation.
The “SOAP” format stands for:
A)
Solution-order-action-plan
B)
Subjective-objective-assessment-plan
C)
Situation-observation-action-purpose
D)
Souce-orientation-action-procedure
The SOAP format is a standardized method of documentation used by healthcare providers and clinicians to write progress notes. It stands for:
1. Subjective: The patient's own description of their symptoms and feelings.
2. Objective: Measurable data obtained through physical examination, tests, and observations.
3. Assessment: The clinician's professional diagnosis or interpretation of the subjective and objective data.
4. Plan: The proposed treatment, further tests, or follow-up actions.
Options a, c, and d are incorrect as they are fabricated terms that do not correspond to any recognized professional or medical documentation standard.
KDOQI recommends to limit the use of temporary, noncuffed, non-tunneled dialysis catheters to a maximum of:
A)
4 weeks
B)
2 weeks
C)
3 weeks
D)
8 weeks
According to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines, temporary non-cuffed, non-tunneled dialysis catheters are intended for short-term urgent access. They are recommended to be limited to a maximum of 4 weeks because the risk of catheter-related bloodstream infections (CRBSI) and catheter failure increases significantly beyond this timeframe.
- Option (a) is correct as it aligns with the KDOQI standard for temporary access.
- Options (b) and (c) are incorrect because they are too restrictive; these catheters can be safely used for up to a month if necessary.
- Option (d) is incorrect because 8 weeks exceeds the recommended safety window for non-tunneled catheters, at which point a tunneled cuffed catheter or permanent access (AV fistula/graft) is required to minimize infection risks.
Which of the following is the most common therapeutic modality for ESRD (end stage renal disease):
A)
Hemodialysis
B)
Continuous ambulatory peritoneal dialysis (CAPD)
C)
Continuous cyclic peritoneal dialysis (CCPD)
D)
Renal transplant
Hemodialysis is the most common therapeutic modality for End-Stage Renal Disease (ESRD) globally due to its accessibility, the availability of dialysis centers, and its effectiveness in rapidly clearing toxins from the blood.
- Option (b) and (c): Peritoneal dialysis (CAPD and CCPD) is used in a smaller percentage of the patient population, typically reserved for those who prefer home-based therapy or have contraindications to vascular access.
- Option (d): Renal transplant is the gold standard for long-term survival and quality of life, but it is not the 'most common' modality because it is limited by the severe shortage of donor organs and strict eligibility criteria for surgery.
Nephrotic syndrome is associated with all except:
A)
Proteinuria
B)
Oedema
C)
Dyslipidemia
D)
Haematuria
Nephrotic syndrome is a clinical complex characterized by a specific triad of findings resulting from glomerular permeability to proteins.
1. Why Option (d) is correct: Haematuria (blood in the urine) is the hallmark of Nephritic syndrome, not Nephrotic syndrome. While mild haematuria can occur in some nephrotic conditions, it is not a defining characteristic of the syndrome itself.
2. Why other options are incorrect:
- Proteinuria (a): This is the primary feature (massive proteinuria >3.5g/24h), leading to the loss of albumin.
- Oedema (b): Hypoalbuminemia decreases plasma oncotic pressure, causing fluid to leak into interstitial spaces, resulting in generalized oedema.
- Dyslipidemia (c): To compensate for low protein levels, the liver increases the synthesis of lipoproteins, leading to hypercholesterolemia and hypertriglyceridemia.
High-flux dialyzer membranes are characterized by:
A)
Low ultrafiltration coefficient (KUF)
B)
Small pore size
C)
High ultrafiltration coefficient
D)
Reduced middle-molecule clearance
High-flux dialyzer membranes are designed to improve the clearance of larger solute molecules (middle molecules) and increase the efficiency of fluid removal.
1. Why 'c' is correct: High-flux membranes have a high ultrafiltration coefficient (KUF), which refers to the membrane's permeability to water. This allows for more efficient fluid removal (ultrafiltration) compared to low-flux membranes.
2. Why other options are incorrect:
- Option 'a': Low KUF is a characteristic of low-flux membranes, not high-flux.
- Option 'b': High-flux membranes are characterized by larger pore sizes to allow the passage of larger molecules.
- Option 'd': High-flux membranes are specifically designed to increase (not reduce) the clearance of middle-molecules (such as $\beta_2$-microglobulin) due to their increased permeability.
Which vascular access gives the highest blood flow rate?
A)
Tunneled catheter:
B)
AV fistula
C)
AV graft
D)
Femoral catheter
The correct option is AV fistula.
1. **Why AV fistula is correct:** An arteriovenous (AV) fistula is a direct surgical connection between an artery and a vein. Because it uses the patient's own native vessels and allows for the natural 'maturation' process (where the vein thickens and dilates), it provides the highest blood flow rates (typically >600 mL/min), making it the gold standard for hemodialysis.
2. **Why other options are incorrect:**
- **AV graft (c):** While it provides high flow, it uses a synthetic tube. It generally has lower flow rates than a native fistula and a higher risk of thrombosis.
- **Tunneled catheter (a) and Femoral catheter (d):** These are central venous catheters. Because they are narrow tubes inserted into a vein, they are limited by the diameter of the catheter and the flow of the venous system, providing significantly lower blood flow rates compared to AV accesses.
Which of the following is not a type of CRRT (Continuous Renal Replacement therapy):
A)
CVVH – Continuous Venovenous Hemofiltration
B)
CAPD – Continuous Ambulatory Peritoneal Dialysis
C)
CVVHD – Continuous Vevovenous Hemodialysis
D)
SCUF – Slow Continuous Ultrafiltration
The correct option is (b) because CAPD (Continuous Ambulatory Peritoneal Dialysis) is a form of peritoneal dialysis, not CRRT. CRRT refers specifically to extracorporeal blood purification therapies used in critically ill patients, typically in an ICU setting, using a machine and a filter/dialyzer.
Options (a), (c), and (d) are all types of CRRT:
- CVVH (Continuous Venovenous Hemofiltration): Uses convection to remove solutes via high-pressure filtration.
- CVVHD (Continuous Venovenous Hemodialysis): Uses diffusion to remove solutes across a semi-permeable membrane.
- SCUF (Slow Continuous Ultrafiltration): Focuses primarily on fluid removal (ultrafiltration) without significant solute clearance.
Which Catheter site has the highest risk of infection?
A)
Internal Jugular
B)
Femoral vein
C)
Subclavian
D)
External Jugular
The femoral vein has the highest risk of catheter-related bloodstream infections (CRBSI) among the options provided. This is primarily due to its anatomical location in the groin area, which is prone to contamination from skin flora, moisture, and proximity to the perineal area.
Comparing the options:
- Femoral vein (b): Highest risk due to high skin colonization and difficulty in maintaining a sterile dressing.
- Subclavian (c): Generally associated with the lowest risk of infection and the highest rate of catheter survival.
- Internal Jugular (a): Higher risk than subclavian but significantly lower than femoral.
- External Jugular (d): Lower risk than the internal jugular and femoral, though less commonly used for long-term access.
All of the following are reasons for why UTI (urinary tract infection) is more common in pregnancy, EXCEPT:
A)
Urinary stasis
B)
Dilatation of renal pelvis and ureters
C)
Incomplete bladder evacuation.
D)
Increased cervical discharge
The correct option is 'd' because increased cervical discharge is a normal physiological change during pregnancy but does not contribute to the pathogenesis of urinary tract infections (UTIs). In contrast, options a, b, and c are all recognized risk factors for UTI in pregnancy: (a) Urinary stasis occurs due to progesterone-induced smooth muscle relaxation; (b) Dilatation of the renal pelvis and ureters (hydroureter/hydronephrosis) occurs due to mechanical compression by the enlarging uterus and progesterone effects, slowing urine flow; and (c) Incomplete bladder evacuation occurs as the growing uterus compresses the bladder, providing a medium for bacterial growth. Therefore, cervical discharge is the only option unrelated to the urinary system's susceptibility to infection.
Best dialysis modality for neonates and preterms:
A)
HD
B)
CRRT
C)
PD
D)
SLED
Continuous Renal Replacement Therapy (CRRT) is considered the best modality for neonates and preterms because it provides slow, continuous removal of solutes and fluid, which mimics natural kidney function and prevents the rapid hemodynamic shifts (hypotension) that these fragile patients cannot tolerate.
- HD (Hemodialysis): Incorrect because the rapid fluid and solute removal can cause severe hemodynamic instability and hypotension in neonates.
- PD (Peritoneal Dialysis): Incorrect because while used, it is often less efficient for rapid metabolic control and can be limited by the small peritoneal surface area and risk of leakage/infection in preterms.
- SLED (Sustained Low-Efficiency Dialysis): Incorrect because although slower than HD, it is still intermittent compared to CRRT and is generally less preferred in the ultra-fragile neonatal population compared to the stability offered by CRRT.
How many exchanges are typically done per day in CAPD?
A)
1 – 2
B)
3 – 5
C)
6 – 8
D)
10 – 12
CAPD (Continuous Ambulatory Peritoneal Dialysis) is a form of peritoneal dialysis where the patient performs exchanges independently throughout the day without the use of a cycler.
1. Why 'b' is correct: In a typical CAPD regimen, 3 to 5 exchanges are performed every 24 hours. This frequency ensures adequate solute removal (urea and creatinine) and fluid balance while allowing the patient to maintain a normal daily routine. Each exchange consists of draining the old fluid, instilling new dialysate, and a dwell period.
2. Why other options are incorrect:
- Option 'a' (1–2): This is insufficient to maintain metabolic stability and clear toxins effectively for most patients with end-stage renal disease.
- Option 'c' (6–8) and 'd' (10–12): These frequencies are excessively high for manual CAPD and would be impractical for the patient, increasing the risk of peritonitis and catheter-related complications. Such high volumes are more characteristic of automated peritoneal dialysis (APD) performed by a machine overnight.
The preferred vascular access for long-term hemodialysis is:
A)
Temporary femoral catheter
B)
Tunneled cuffed catheter
C)
AV Graft
D)
AV fistula
The Arteriovenous (AV) fistula is the gold standard and preferred vascular access for long-term hemodialysis.
1. Why AV Fistula is correct: It is created by surgically connecting an artery directly to a vein (usually in the arm). It has the lowest risk of infection, the lowest rate of thrombosis (clotting), and the highest long-term patency rates compared to all other options, leading to better patient outcomes.
2. Why other options are incorrect:
- Temporary femoral catheter (a): Used only for acute/emergency short-term access due to a very high risk of infection and thrombosis.
- Tunneled cuffed catheter (b): Used for medium-term access or when a fistula cannot be created; however, they have significantly higher infection rates (catheter-related bloodstream infections) than fistulas.
- AV Graft (c): A synthetic tube used when native veins are unsuitable. While better than catheters, grafts have higher failure rates (thrombosis) and a higher risk of infection than native AV fistulas.