SeanWu25/NEJM-AI_Benchmarking_Medical_Language_Models huggingface dataset:
Subject: Acute Kidney Injury & Critical Care Nephrology

A 64-year-old man presents to his primary care practitioner with a history of weight loss, poor appetite, increasing lower limb edema, and worsening fatigue. Routine laboratory studies reveal Hb 7.5g/dl, BUN 97 mg/dl, creatinine 4.65 mg/dl, calcium 12.5 mmol/L, and albumin 2.6 g/dl. The patient is admitted to the hospital for further evaluation and is found to have a circulating IgG kappa paraprotein. He under-goes renal biopsy, and the results of analysis of the biopsy sample are consistent with a light chain crystalline cast nephropathy. Over the subsequent days, his AKI progresses, and he experiences oligoanuric AKI..
Question: Which ONE of the following is the most appropriate initial treatment for a patient with dialysis-dependent light chain crystalline cast nephropathy?
A.        A course of plasmapheresis
B.        Peritoneal dialysis
C.        Clone directed therapy of the paraproteinemia
D.        A course of high-cutoff hemodialysis
E.        Hematopoietic stem cell transplantation
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 45-year-old woman is referred to you for assessment of recurrent renal calculi and progressive CKD. She undergoes renal biopsy for further evaluation. The result of analysis of the biopsy specimen is notable for moderate tubulointerstitial ﬁbrosis, and the specimen shows reddish-brown crystals on hematoxylin and eosin staining that are birefringent under polarized light..
Question: Which ONE of the following is the most appropriate treatment for a patient with crystalline nephropathy due to 2,8-dihydroxyadeninuria?
A.        Intravenous ﬂuids and loop diuretic
B.        Infusion of sodium bicarbonate to alkalinize the urine
C.        Oral potassium citrate
D.        Low-purine diet and allopurinol
E.        Oral pyridoxine supplementation
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 42-year-old woman is admitted to gynecology with a tubulo-ovarian abscess complicating recent surgery for an ovarian tumor and is treated conservatively with clarithromycin. Four days into her clarithromycin course, she experiences dermatologic manifestations suggestive of Stevens-Johnson syn-drome and concurrently experiences acute sepsis (although she is not in septic shock) and AKI. Laboratory studies show serum sodium 138 mEq/L, potassium 6.0 mEq/L (no hyperkalemic wave changes in electrocardiography), chloride 117 mEq/L, serum HCO3- 18 mmol/L, BUN 57 mg/dl, and creatinine 3.1 mg/dl (raised from 1.2 mg/dl on admission). Over the previous 12 hours, her urine output was 0.47 ml/kg per hour. The result of urinalysis is unremarkable. Fractional excretion of sodium is 0.9%. The patient is transferred to the ICU because of imminent concerns that she may require KRT. She has remained hemodynamically stable when transferred to ICU, and laboratory studies are repeated on her arrival in the ICU 3 hours later, with sodium 139 mEq/L, potassium 5.9 mEq/L, chloride 117 mEq/L, total serum HCO3- 18 mmol/L, BUN 57 mg/dl, and creatinine 3.0 mg/dl..
Question: Which ONE of the following is the BEST option regarding treatment of this patient at this point in the KRT initiation strategy perspective?
A.        There are current indications to commence KRT immediately
B.        KRT should ideally be commenced within the next 12 hours
C.        Continue supportive medical management and step down back to ward-level care; patient is unlikely to require    KRT
D.        Close and frequent monitoring of clinical status and lab-oratory parameters in the ICU and initiate KRT if indication arises
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 61-year-old man is admitted to the ICU for postoperative recovery after a right-sided total hip replacement, which was completed as an emergency procedure after the patient sustained a traumatic fall at home. The patient had clinical deterioration in the ICU, where he became hemodynamically unstable, with mean arterial pressure (MAP) <65 mm Hg, and required inotropic support, which improved his MAP. Infection and inﬂammatory markers were only mildly raised since his ICU admission, and he did not have signs of pyrexia. No acute postsurgical wound complications were found. However, the patient experienced severe AKI, and urine output for the past 12 hours was 0.20 ml/kg per hour. Laboratory testing revealed serum sodium 132 mEq/L, potassium 6.3 mEq/L (no hyperkalemic wave changes in electrocardiography), chloride 110 mEq/L, total HCO3- 16 mmol/L, BUN 62 mg/dl, and creatinine 4.1 mg/dl (raised from 1.5 mg/dl on admission). The result of urinalysis was unremarkable. Fractional excretion of sodium was 0.8%. KRT initiation was recommended..
Question: Which ONE of the following is the BEST option for KRT initiation for this man, considering the most recent 2019 Kidney Disease Improving Global Outcomes “Controversies in AKI” Conference Report suggestions?
A.        Continuous kidney replacement therapy (CKRT) (24 hours/day)
B.        Intermittent hemodialysis (IHD) (4 hours x 3 days/week)
C.        Prolonged intermittent kidney replacement therapy (PIKRT) (8 hours/day)
D.        Peritoneal dialysis (commencing on short cycle times of 1–2 hours)
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

A 56-year-old woman who is morbidly obese, with a medical history of nonalcoholic fatty liver disease and primary hyperparathyroidism with parathyroidectomy a year ago, is admitted to the ICU with symptoms consistent with acute pancreatitis, where supportive medical management with intravenous ﬂuids, analgesia, and nutritional support were administered. Unfortunately, she has deteriorated clinically and experiences AKI. Urine output for the past 12 hours was 0.25 ml/kg per hour. Laboratory testing revealed sodium 141 mEq/L, potassium 6.4 mEq/L (no hyperkalemic wave changes in electrocardiography), chloride 111 mEq/L, total HCO3- 15 mmol/L, BUN 60 mg/dl, and creatinine 4.0 mg/dl (increased from 1.3 mg/dl on admission). The result of urinalysis is unremarkable, and fractional excretion of sodium is 0.9%. KRT initiation is recommended. Catheter access through ultrasound guidance is successfully obtained in the femoral site. Laboratory test results for clotting proﬁle have been within normal ranges throughout..
Question: Which ONE of the following is currently the BEST option for anticoagulation strategy in this patient during KRT?
A.        Regional citrate anticoagulation (RCA)
B.        Low molecular weight heparin (LMWH)
C.        Unfractionated heparin
D.        No anticoagulation required
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

A 55-year-old man presents to the emergency department with acute shortness of breath; a nasal swab for PCR for SARS-CoV-2 yields positive results. His medical history includes CKD, diabetes, and hypertension. Serum creatinine is 1.6 mg/dl, which is the patient’s baseline..
Question: Which ONE of the following statements is most accurate for this patient?
A.        Risk of AKI peaks within 24 hours after admission to the emergency department
B.        AKI occurrence is highly predictive of deteriorating respiratory status
C.        If patient is given invasive ventilation, he is more likely to need KRT
D.        Diabetes is the single most important risk factor for AKI
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

You have been consulted for renal replacement therapy management in a 45-year-old woman with severe COVID-19 admitted to the ICU. Her medical history includes obesity and dyslipidemia. The patient is intubated, has severe acute respiratory distress syndrome, and is currently anuric. Potassium is 5.7 mEq/L, and BUN is 122 mg/dl..
Question: Which ONE of the following statements is most accurate for this patient?
A.        Intermittent hemodialysis has been associated with worse renal outcome compared with continuous techniques
B.        Available data suggest that emergency start of peritoneal dialysis may associate with higher mortality, but could still be useful when limited dialytic resources are available
C.        Citrate anticoagulation is more efﬁcient than any form of heparin therapy in prolonging circuit half-life
D.        Circuit clotting rate may be higher than 30% even when anticoagulation is started
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 32-year-old woman comes to the emergency department after a positive result from nasal swab PCR testing for SARS-CoV-2. The patient has no respiratory symptoms, a chest x-ray shows scattered hazy opacities, and a urinalysis shows no glucose, 10 to 15 red blood cells, 3 to 5 white blood cells, 2+ proteins, and no ketones. She reports no urinary symptoms, her last menstruation ended 6 days ago, and her serum creatinine is 0.7 mg/dl..
Question: Which ONE of the following statements is most accurate for this patient?
A.        Urine abnormalities are uncommon in patients with COVID-19 without AKI and are highly predictive of glomerulonephritis
B.        Nephrotic-range proteinuria can be secondary to COVID-19 in patients who have high-risk APOL-1 alleles
C.        COVID-19 patients have higher risk of glomerulonephritis, including IgA nephritis and anti-GBM nephritis
D.        Diffuse microangiopathy is a frequent ﬁnding in autopsy and biopsy reports from COVID-19 patients
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 72-year-old man experiences severe dyspnea and cough 3 days after the onset of transient fever and myalgias and is diagnosed with COVID-19. He has a medical history of well-controlled diabetes and hypertension and has stage 3 CKD, with serum creatinine of 1.6 mg/dl, GFR of 45 ml/min per 1.73 m2, and estimated protein excretion of ~2.4 g/day. On presentation to the emergency department, his serum creatinine is 4.3 mg/dl, potassium is 5.9 mEq/L, and urine output is scant. His oxygenation declines overnight, and he requires invasive mechanical ventilation..
Question: Which ONE of the following has the greatest effect on mortality?
A.        AKI
B.        Diabetes
C.        Hypertension
D.        Proteinuria
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

A 45-year-old man with IgA nephropathy, obesity, and smoking history presents with positive COVID-19 results, dyspnea, fever, and cough. He is hypotensive in the emergency department and is given vasopressors. His baseline creatinine is 1.4 mg/dl; it is 2.9 mg/dl on presentation and increases progressively. He is given intermittent hemodialysis on day 5. His wife asks you whether he will require dialysis when he leaves the hospital..
Question: What percentage of patients require maintenance dialysis on discharge after being initiated in hospital for Covid-AKI?
A.        10% to 15%
B.        25% to 35%
C.        60% to 70%
Answer: B
Subject: Acute Kidney Injury & Critical Care Nephrology

A 71-year-old woman with a history of stage IV non–small cell lung cancer presents to an urgent care center for assessment and management of AKI. She has received three cycles of cisplatin 75 mg/m2, pemetrexed 500 mg/m2, and the checkpoint inhibitor nivolumab 10 mg followed by one cycle of nivolumab alone. She presented for her ﬁfth cycle of nivolumab when she was noted to have elevated serum creatinine. The patient's baseline serum creatinine after the last cycle of cisplatin and pemetrexed was 1.2 mg/dl. Her medical history is remarkable for hypothyroidism and dyspepsia. Her medications include levothyroxine 75 µg daily and omeprazole 20 mg twice a day. On admission, the patient reports some dysphagia to liquids but does not describe any nausea, vomiting, or diarrhea. She does not describe any lightheadedness or dizziness. Her BP is 146/80 mm Hg, pulse is 76, respiratory rate is 12/min. Her examination results are unremarkable. Urinalysis results are bland except for > 50 white blood cells per high-power ﬁeld. Urinary sodium is 56 mEq/L, and urinary creatinine is 26 mg/dl. Her basic metabolic proﬁle is as follows: sodium 136 mEq/L, potassium 4.4 mEq/L, chloride 105 mEq/L, carbon dioxide 20 mEq/L, BUN 32 mg/dl, creatinine 4.1 mg/dl, glucose 94 mg/dl, and calcium 8.4 mg/dl..
Question: What is the MOST likely cause of AKI in this patient?
A.        Cisplatin nephrotoxicity
B.        Pemetrexed nephrotoxicity
C.        Prerenal cause resulting from volume depletion
D.        Immunotherapy related to acute interstitial nephritis
Answer: D
Subject: Acute Kidney Injury & Critical Care Nephrology

A 63-year-old woman with a history of metastatic breast cancer, recently treated with the VEGF inhibitor bevacizumab 10 mg/kg every 3 weeks, received seven cycles, but it was discontinued 1 month ago because of progression of disease. The patient was given a cyclin-dependent kinase 4/6 inhibitor, abemaciclib 100 mg twice daily at that time, and now presents for routine follow-up care. She has no complaints and takes no other oral medications; however, she has been receiving denosumab 120 mg subcutaneously every 4 weeks for management of bone metastases. Her baseline serum creatinine was 0.8 mg/dl 1 month ago. The patient’s vital signs are within normal limits, and examination results are unremarkable. Her laboratory results are as follows: sodium 141 mEq/L, potassium 4.2 mEq/L, chlorine 108 mEq/L, bicarbonate 28 mEq/L, BUN 18 mg/dl, creatinine 1.5 mg/dl, glucose 105 mg/dl, urinalysis is bland, and random urine protein/creatinine ratio is 0.3..
Question: What should be the next step in the treatment of this patient?
A.        Kidney biopsy to rule out bevacizumab toxicity
B.        Stop denosumab
C.        Obtain cystatin C level, continue abemaciclib, and repeat laboratory studies in 1 week
D.        Stop abemaciclib
Answer: C
Subject: Acute Kidney Injury & Critical Care Nephrology

A 73-year-old woman who underwent hematopoietic stem cell transplantation 3 1/2 years ago for treatment of acute myelogenous leukemia presents to the clinic with new-onset edema. She reports the development of edema approximately 1 month ago, affecting her lower extremities up to her thighs and upper extremity involvement as well. Patient does not describe any nausea, vomiting, or diarrhea. She has been treated with tacrolimus and prednisone for management of liver graft-versus-host disease (GVHD) recently, but GVHD has resolved, her steroids were stopped, and the tacrolimus dose was tapered down to 0.5 mg daily with undetectable through levels about 6 weeks ago. Her medications include furosemide 20 mg daily, tacrolimus 0.5 mg daily, acyclovir 400 mg twice a day, and sulfamethoxazole-trimethoprim 800/160 mg three times a week. The patient’s BP is 138/72 mm Hg, pulse 82/min, and respiratory rate 12/min. The examination is remarkable for anasarca. Her laboratory results are as follows: sodium 137 mEq/L, potassium 4.4 mEq/L, chlorine 105 mEq/L, bicarbonate 27 mEq/L, BUN 18 mg/dl, creatinine 0.8 mg/dl, glucose 125 mg/dl, total protein 5.1 mg/dl, aspartate aminotransferase 52 mg/dl, alanine aminotransferase 34 mg/dl, albumin 2.0 mg/dl, white blood cells 5,400/µl, Hgb 9.8 g/dl, platelets 271,000/µl, urinalysis is bland except for 41 protein, spot urinary protein 4200 mg/dl, spot urinary creatinine 239 mg/dl..
Question: What is the MOST likely cause of this patient’s nephrotic syndrome?
A.        Membranous nephropathy secondary to kidney GVHD
B.        Transplantation-associated thrombotic microangiopathy
C.        Sinusoidal obstruction syndrome
D.        Sulfamethoxazole-trimethoprim
Answer: A
Subject: Acute Kidney Injury & Critical Care Nephrology

You are asked to see a 49-year-old man for AKI. He has a history of non-Hodgkin B cell lymphoma and was recently admitted for chimeric antigen receptor (CAR) T therapy. Two days after receiving CAR T therapy, he experienced a temperature of 39 degrees C and “total body muscle aches.” His creatinine increased from his baseline of 0.8 mg/dl to a current value of 2.1 mg/dl. He is oliguric but not anuric. On examination he is mildly confused and agitated and has mild basilar rales..
Question: Of the following, what are you MOST likely to see on analysis of urine sediment?
A.        Pigmented granular casts
B.        Dysmorphic red blood cells and red blood cell casts
C.        White blood cells and white blood cell casts
D.        Oxalate crystals
Answer: A
Subject: Chronic Kidney Disease

You are evaluating a 34-year-old man who has a serum creatinine of 2.8 mg/dl. Using this creatinine, the Modification of Diet in Renal Disease study equation estimates a GFR of 34 ml/min per 1.73 m2 if he is Black, and 27 ml/min per 1.73 m2 if he is not Black..
Question: He asks “Does my race make a difference?”


What would be the effect of removing the race component from currently used GFR estimating equations?
A. Increase in the proportion of Blacks meeting criteria for a diagnosis of CKD
B. Increase in the proportion of Blacks meeting GFR based eligibility for living kidney donation
C. Increase in the proportion of Blacks eligible for specific medications (e.g., metformin, SGLT2 inhibitors)
D. Decrease in the prevalence of CKD stages 4 and 5 among Blacks
Answer: A
Subject: Chronic Kidney Disease



A 49-year-old man with IgA nephropathy, eGFR 49 ml/min per 1.73 m2, and albumin-creatinine ratio (ACR) 750 mg/g asks you what his chances are of needing dialysis. Analyses from the Chronic Kidney Disease Prognosis Consortium (CKD-PC), a large international consortium of cohort studies, demonstrated which ONE of the following? A..
Question: Lower eGFR predicts ESKD and mortality among individuals with CKD, but not in the general
population
A. Lower eGFR predicts ESKD and mortality among individuals with CKD, but not in the general
B. Greater urinary albumin excretion predicts ESKD and mortality among individuals with CKD, but not in the general population
C. Lower eGFR and greater urinary albumin excretion predict ESKD and mortality among individuals with diabetes, but not among individuals without diabetes
D. Lower eGFR and greater urinary albumin excretion predict ESKD and mortality among individuals with and without diabetes
Answer: D
Subject: Chronic Kidney Disease



A meta-analysis of observational studies found that an increase in urinary albumin excretion over 2 years was associated with a greater likelihood of subsequent ESKD. The authors concluded that change in urinary albumin excretion could potentially be used as a surrogate end point for clinical trials of interventions to prevent ESKD..
Question: An accompanying meta-analysis of randomized controlled trials also found which ONE of the following?
A.        Results differed signiﬁcantly in studies using total protein excretion rather than albumin excretion
B.        Urinary albumin excretion is a valid surrogate end point
C.        Associations of change in albumin-creatinine ratio/protein-creatinine ratio (ACR/PCR) with all-cause and cardiovascular mortality were stronger than associations with ESKD in studies of individuals with existing CKD
D.        A change in urinary albumin excretion was found to be much less strongly associated with ESKD in patients treated with renin-angiotensin-aldosterone system (RAAS) inhibitors than in those treated with other methods of intensive blood pressure control
Answer: A
Subject: Chronic Kidney Disease



A meta-analysis of observational studies found 0.75 ml/min per 1.73 m2 per year lower rate of GFR decline (i.e., less steep decline) over a 2-year baseline period was associated with a 30% lower risk of ESKD in participants with baseline eGFR greater than or equal to  60 ml/min per 1.73 m2 (adjusted hazard ratio (HR) = 0.70; 95% CI, 0.68 to 0.72) and a 29% lower risk of ESKD in those with a baseline eGFR < 60 ml/min per 1.73 m2 (adjusted HR = 0.71; 95% CI, 0.68 to 0.74)..
Question: Which ONE of the following is true?
A.        The absolute difference in terms of incidence of ESKD (% of participants) with a treatment which causes a less steep decline in GFR would be expected to be similar for patient populations at low risk of ESKD and high risk of ESKD
B.        A meta-analysis of randomized trials conﬁrmed the utility of a decrease in eGFR slope as a potential surrogate end point for clinical trials of interventions to prevent ESKD
C.        A very large patient population (> 10,000 participants) would be required to demonstrate beneﬁt of an intervention for a study with a 0.75 ml/min per 1.73 m2 per year lower GFR decline over 2 years caused by the intervention
D.        Using a shorter baseline period to calculate GFR slope does not affect the ability to predict ESKD
Answer: B
Subject: Chronic Kidney Disease



A 67-year-old man with CKD stage G3A3 secondary to IgA nephropathy, and history of myocardial infarction is evaluated during a routine ofﬁce visit. His urinary ACR is 500 mg/g and he is receiving a stable dose of angiotensin-converting enzyme inhibitor. He is concerned about his risk for ESKD and wishes to delay dialysis as long as possible. He recently learned about the emerging new therapies for kidney disease treatments on a blog..
Question: Which ONE of the following treatment is supported by current evidence?
A.        Atrasentan 0.75 mg/d
B.        Dapagliﬂozin 10 mg/d
C.        Semaglutide 0.25 mg once a week
D.        Finerenone 20 mg/d
Answer: B
Subject: Chronic Kidney Disease



A 69-year-old man with stage 3 CKD has uric acid level of 5.9 mg/dl..
Question: Which ONE of the following statements is correct regarding the effect of allopurinol among CKD patients who are at risk of kidney disease progression but with normouricemia?
A.        Allopurinol has no effect on uric acid lowering and no effect on CKD progression
B.        Allopurinol lowers uric acid level and slows the rate of GFR decline
C.        Allopurinol lowers uric acid level but does not slow the rate of GFR decline
D.        Allopurinol lowers uric acid level and lowers the risk of ESKD
Answer: C
Subject: Chronic Kidney Disease



A 64-year-old woman with stage G3A3 CKD attributed to type 2 diabetes mellitus and hypertension is evaluated in follow-up. Her medications are metformin 500 mg twice daily, empagliﬂozin 10 mg daily, irbesartan 75 mg daily, and pravastatin 20 mg daily. On physical examination, the BP is 146/95 mm Hg, and the body mass index is 35 kg/m2. Laboratory results show HbA1c of 9%. She would like to discuss additional therapeutic options to optimize her glycemic control. You discuss the option of adding a glucagon-like peptide 1 receptor agonist (GLP1RA)..
Question: Which ONE of the following statements regarding evidence from randomized controlled trials of combining SGLT2i and GLP1RA compared with individual treatment is NOT correct?
A.        Combining SGLT2i and GLP1RA improves glyce-mic control
B.        Combining SGLT2i and GLP1RA results in better weight control
C.        Combining SGLT2i and GLP1RA has good safety proﬁle in outpatient settings
D.        Combining SGLT2i and GLP1RA lowers the risk of cardiovascular and renal adverse events
Answer: D
Subject: Chronic Kidney Disease



A 64-year-old man with CKD stage G4A1 comes to see you in the clinic after referral from his primary care physician. He asks you what he can do to slow his progression of CKD..
Question: Which of the following are associated with slower progression of CKD?
A.        Fragmented and less sleep duration
B.        Higher dietary animal protein intake
C.        High urine NGAL levels
D.        Use of allopurinol in patients with normal uric acid
E.        Increased intake of fruits and vegetables
Answer: E
Subject: Chronic Kidney Disease



A 49-year-old man is admitted with COVID-19, pneumonia, and AKI. Within 48 hours of admission, he is intubated and started on continuous venovenous hemoﬁltration. His family asks you what the chances are that he will require long term dialysis..
Question: In patients admitted with severe COVID-19 illness and AKI requiring dialysis, which ONE of the following was associated by multivariate analysis with requirement of dialysis at time of discharge from hospital?
A.        History of CKD
B.        Requirement of mechanical ventilation
C.        Requirement of pressor support
D.        History of cardiovascular disease
Answer: A