Comprehensive Dialysis Fellowship Entrance Exam Questions
Section 1: Continuous Renal Replacement Therapy (CRRT)
Question 1: A 45-year-old trauma patient in the ICU requires renal replacement therapy. Which CRRT modality uses the patient's blood pressure as the driving force and removes solute primarily through diffusion?
A. CVVH
B. CAVHD
C. CVVHDF
D. SCUF
Answer: B 1
Question 2: When reporting CRRT study results, which of the following is NOT a minimal reporting criterion according to the First International Consensus Conference?
A. Membrane/dialyzer/filter specifications
B. Patient's insurance status
C. Measure of severity of illness (e.g., APACHE II)
D. Anticoagulation protocol and monitoring
Answer: B 1
Question 3: What is the primary difference between CVVH and CAVH?
A. CVVH uses dialysate while CAVH does not
B. CVVH uses an external pump while CAVH relies on patient blood pressure
C. CVVH provides diffusive clearance while CAVH provides convective clearance
D. CVVH requires arterial access while CAVH uses venous access
Answer: B 1
Section 2: Vascular Access Management
Question 4: A 62-year-old hemodialysis patient presents with arm swelling, changes in access bruit, and prolonged bleeding after dialysis. These findings suggest:
A. Adequate access maturation
B. Thrombotic flow-related complications
C. Exit site infection
D. Normal post-dialysis changes
Answer: B 1
Question 5: According to KDOQI 2019 guidelines, an AV fistula that cannot be used successfully for dialysis by 6 months after creation despite interventions is termed:
A. Primary failure
B. Failure to mature
C. Access dysfunction
D. Delayed maturation
Answer: B 1
Question 6: A Brescia-Cimino fistula is constructed between which vessels?
A. Brachial artery and cephalic vein at the antecubital fossa
B. Radial artery and cephalic vein at the wrist
C. Ulnar artery and basilic vein at the forearm
D. Proximal radial artery and median cubital vein below the elbow
Answer: B 1
Question 7: Which measure is most effective in reducing bloodstream infections in hemodialysis patients with tunneled catheters?
A. Monthly catheter exchanges
B. Prophylactic systemic antibiotics
C. Catheter hub disinfection with antiseptic when accessed or disconnected
D. Daily exit site dressing changes
Answer: C 1
Section 3: Infection Control in Dialysis Units
Question 8: What is the recommended frequency for microbial testing of dialysis water according to AAMI standards?
A. Daily
B. Weekly
C. Monthly
D. Quarterly
Answer: C 1
Question 9: A hemodialysis patient develops influenza symptoms during treatment. What is the recommended oseltamivir dosing regimen?
A. 75 mg twice daily for 5 days
B. 30 mg initial dose, then 30 mg at every dialysis session for 5 days
C. 150 mg loading dose, then 75 mg daily
D. 30 mg daily for 10 days
Answer: B 1
Question 10: For prophylaxis of exposed hemodialysis patients during an influenza outbreak, the recommended oseltamivir regimen is:
A. 75 mg daily for 7 days
B. 30 mg initial dose, then 30 mg during each dialysis session for 7 days
C. 150 mg loading dose only
D. No prophylaxis recommended
Answer: B 1
Section 4: Anemia Management in CKD
Question 11: Which quality of life measurement scale is specifically validated for dialysis patients and evaluates 26 questions across five sections including physical symptoms, fatigue, and depression?
A. SF-36
B. Kidney Diseases Questionnaire (KDQ)
C. Sickness Impact Profile (SIP)
D. FACIT
Answer: B 1
Question 12: In the Sickness Impact Profile (SIP) used for ESRD patients, what does a lower score indicate?
A. Worse quality of life
B. Better quality of life
C. No change in quality of life
D. Need for hospitalization
Answer: B 1
Section 5: Symptom Management in Dialysis Patients
Question 13: According to KDIGO 2023 guidelines, which assessment tool uses a 5-point Likert scale and is specifically intended for chronic hemodialysis patients with a single treatment recall period?
A. Edmonton Symptom Assessment System: revised—Renal (ESAS-r:R)
B. Dialysis Symptom Index
C. Symptom Monitoring on Renal Replacement Therapy-Hemodialysis (SMaRRT-HD)
D. Leicester Uraemic Symptom Score
Answer: C 1
Question 14: The CHOICE Health Experience Questionnaire incorporates how many dimensions of health-related quality of life?
A. 8
B. 11
C. 13
D. 16
Answer: C 1
Question 15: Which nonpharmacologic intervention has demonstrated efficacy in reducing depression in dialysis patients according to KDIGO 2023?
A. Dietary sodium restriction
B. Cognitive behavioral therapy
C. Increased dialysis frequency
D. Fluid restriction
Answer: B 1
Question 16: What is the approximate prevalence of pain in patients with chronic kidney disease?
A. 20–30%
B. 40–50%
C. 58–60%
D. 75–80%
Answer: C 2
Section 6: CKD Management in Diabetes
Question 17: For a patient with type 2 diabetes, CKD, and eGFR of 35 mL/min/1.73 m² with urinary albumin of 250 mg/g creatinine, which medication class is recommended to reduce CKD progression?
A. ACE inhibitor only
B. SGLT2 inhibitor
C. Thiazide diuretic
D. Beta-blocker
Answer: B 1
Question 18: According to ADA 2024 guidelines, at what eGFR threshold should SGLT2 inhibitors be used for cardiovascular and renal protection?
A. ≥60 mL/min/1.73 m²
B. ≥45 mL/min/1.73 m²
C. ≥20 mL/min/1.73 m²
D. ≥10 mL/min/1.73 m²
Answer: C 1
Question 19: For patients with non-dialysis-dependent stage G3 or higher CKD, the target dietary protein intake should be:
A. 0.6 g/kg/day
B. 0.8 g/kg/day
C. 1.2 g/kg/day
D. 1.5 g/kg/day
Answer: B 1
Question 20: At what eGFR threshold should patients be referred to a nephrologist according to ADA 2024 guidelines?
A. <60 mL/min/1.73 m²
B. <45 mL/min/1.73 m²
C. <30 mL/min/1.73 m²
D. <15 mL/min/1.73 m²
Answer: C 1
Section 7: Pain Management in CKD
Question 21: What is the maximum recommended daily dose of acetaminophen for pain management in CKD patients?
A. 2000 mg
B. 3000 mg
C. 4000 mg
D. 5000 mg
Answer: B 2
Question 22: Which opioid medications are considered safest in CKD due to favorable pharmacokinetic profiles?
A. Morphine and codeine
B. Hydrocodone and oxycodone
C. Fentanyl and buprenorphine
D. Tramadol and meperidine
Answer: C 2
Question 23: For neuropathic pain in CKD, what is the recommended starting dose of gabapentin?
A. 50 mg at bedtime
B. 100–300 mg at bedtime with renal dose adjustment
C. 600 mg three times daily
D. 900 mg at bedtime
Answer: B 2
Question 24: Which class of analgesics must be strictly avoided in CKD patients?
A. Acetaminophen
B. Opioids
C. NSAIDs including COX-2 inhibitors
D. Gabapentinoids
Section 8: Fluid Management in Advanced CKD
Question 25: A 78-year-old patient with CKD stage 3b (eGFR 26 mL/min/1.73 m²) presents with peripheral edema. What is the appropriate starting dose of furosemide?
A. 10 mg once daily
B. 20 mg once daily
C. 40 mg twice daily
D. 80 mg once daily
Answer: B 3
Question 26: After initiating or adjusting loop diuretic therapy in CKD stage 4, when should electrolytes and renal function be rechecked?
A. 1 week
B. 2–4 weeks
C. 6–8 weeks
D. 3 months
Answer: B 3
Question 27: At what eGFR do complications of CKD, including volume overload, become progressively more common and severe?
A. <90 mL/min/1.73 m²
B. <60 mL/min/1.73 m²
C. <45 mL/min/1.73 m²
D. <30 mL/min/1.73 m²
Answer: B 4
Question 28: What is the most reliable clinical indicator of short-term changes in fluid status?
A. Blood pressure measurements
B. Serum sodium levels
C. Serial body weight changes
D. Urine output
Answer: C 4
Section 9: RAAS Blockade in CKD
Question 29: When initiating ACE inhibitor or ARB therapy in CKD, what magnitude of creatinine increase is acceptable and reflects hemodynamic effect rather than injury?
A. Up to 10%
B. Up to 20%
C. Up to 30%
D. Up to 50%
Answer: C 3
Question 30: The "triple whammy" combination that markedly increases acute kidney injury risk consists of:
A. ACE-I + ARB + diuretic
B. NSAID + ACE-I/ARB + diuretic
C. SGLT2i + ACE-I + diuretic
D. Beta-blocker + ACE-I + diuretic
Answer: B 3
Answer Key Summary: 1-B, 2-B, 3-B, 4-B, 5-B, 6-B, 7-C, 8-C, 9-B, 10-B, 11-B, 12-B, 13-C, 14-C, 15-B, 16-C, 17-B, 18-C, 19-B, 20-C, 21-B, 22-C, 23-B, 24-C, 25-B, 26-B, 27-B, 28-C, 29-C, 30-B