PATHOPHYSIOLOGY
EXAM 7

Your Name 

1.  A 23 yr old male presents to the ER with c/o severe sharp pain in the left side and back.  The pain was sudden onset and he also complained of nausea.  Ua was positive for blood.  Based on history and symptoms you would suspect:
   
   a. glomerulonephritis b. kidney stone c. UTI d. Early renal failure
   

2. What is the pathophysiologic reason for his nausea?
   
   a. neurologic response to severe pain b. associated GI inflammation c. deferred gall bladder disease d. metabolic acidosis
   

3. The most common type of renal stone is:
   
   a. magnesium b. seruvite c. calcium d. phosphate
   

4. A staghorn calculi:
   
   a. forms in the kidney pelvis and may extend into the calyces b. are the smallest of renal stones and are usually passed in the urine c. is another name for the calcium based kidney stone that is caused by gout d. b and c
   
   

5. Kidney stones can lead to an infection of the renal pelvis and interstitium called:
   
   a. pyelonephritis b. glomerulonephritis c. cystitis d. nephrotic syndrome
   

6.  Libby Baker a 63 yr old with a 15 yr diagnosis of moderately controlled DM and 10 yr history of hypertension presents in the clinic with edema in her hands, feet and face.  She reports that she is tired and “has no energy”.  Her BS is WNL, but her urine is positive for blood and protein.  What do you suspect?
   
   a. ureteral epispadias b. wilm's tumor c. chronic kidney failure related to diabetic nephropathy d. acute renal failure related to a severe UTI
   

7. What is generally the first sign of renal dysfunction in the diabetic patient?
   
   a. glucosuria b. proteinuria c. DKKA d. Neurogenic bladder
   

8. The best estimate of functioning renal tissue is:
   
   a. GFR b. Circulating ADH levels c. Volume of urine output d. Specific gravity of solute concentration of urine
   

9. Blood urea nitrogen levels ________  as glomerular filtration decreases:
   
   a. increase b. decrease c. remain unchanged
   

10. During aging renal function demonstrates:
    
    a. sharp decline in GFR and no change in renal blood b. sharp decline in renal blood flow and in GFR c. decrease in the number of nephrons d. increase in GFR leading to increased urine output
    

11. Mr. Boling a 69 yr old male presents to the MD office for a post-surgical check up.  He was diagnosed with BPH several yrs ago and had surgery 6 weeks ago.  His catheter was removed 4 weeks ago. He says that he has not felt well for the past week and has had back, side and groin pain along with increased urgency and burning with urination.  He noticed yesterday that his urine was pink tinged.  VS reveal fever, increased heart rate and UA shows bacteria and casts.  What do you suspect?
    
    a. prostatic cancer b. UTI related to recent indwelling catheter c. Kidney stone d. Nothing, this is normal in the post-operative period
    

12. What is a cast?
    
    a. accumulation of cellular precipitates from the renal tubules b. another name for WBC's in urine c. urine with a very low specific gravity d. normal urine cells found upon microscopic examination
    

13. A worried mother brings her 4 yr old into the clinic and says the child keeps needing to go to the bathroom and cries when urinating and c/o lower abdominal pain.  She only produces a small amount of urine  at each attempt and the urine has a strange odor.  The child has no other remarkable history. You suspect:
    
    a. Wilm's tumor b. Nephrotic syndrome c. Exostrophy of bladder d. Urinary tract infection
    

14. Which of the following is known to cause cystitis?
    
    a. Proteus b. Escherichia coli c. Klebsiella d. c and d e. a, b, and c  
    

15. Bubba a 19 yr old student was badly injured in a MVA a few days ago in a rural location.  He was trapped in the vehicle for over an hour and now is in ICU with Fractured pelvis, femur, ribs and shoulder.  He also sustained a tension pneumothorax and head injury.  In the ER he was in shock and still has a low BP despite fluids and medication  His hourly urine output has gradually declined. What pathophysiologic process should you consider?
    
    a. neurotoxicity of medications b. liver failure c. acute renal failure d. renal calculi
    

16. Bubba’s BUN rapidly elevated, he became hyperkalemic, and edematous.  He showed signs of CHF.  What other complications are possible for Bubba?
    
    a. diatrophy of renal tubules b. pneumonia and delayed wound healing c. malignant hypertension d. iatrogenic bladder
    

17. ____ may cause prerenal acute renal failure.
    
      a. hypotension b. hypovolemia c. cardiac insufficiency d. any of the above
    

18. Ms. Lewis a 43 yr old housewife c/o “not feeling well”, edematous hands and feet, and smokey colored urine.  She tells you that she had a strep throat 3 weeks ago.  Her VS are WNL except her BP was 130/80.  What renal problem do you suspect:
    
    a. pyelonephritis b. cystitis c. acute glomerulonephritis d. nephrotic syndrome
    

19. What component of her history and presenting symptoms is most indicative of this disorder?
    
    a. elevated BP b. edema c. general malaise d. recent strep infection
    

20. Goodpasture syndrome is an example of:
    
    a. rapidly progressive glomerulonephritis b. chronic glomerulonephritis c. chronic pyelonephritis d. acute pyelonephritis
    

21. In chronic renal failure plasma creatinine levels increase.  Creatinine is released constantly by ___ tissue and excreted by glomerular filtration.
    
    a  nervous b. muscle c. epithelial d. liver
    

22. Nutrition management in chronic renal failure excludes what type of diet?
    
    a. high carbohydrate b. low fat c. high protein d. liquid
    

23.  During dialysis most fat soluble vitamins are lost:
    
    a.  true b.  false c.  unable to determine
    

24. During dialysis most water soluble vitamins are lost:
    
    a.  true b.  false c.  unable to determine
    

25. Patients with renal neoplasms commonly present with:
    
    a. hematuria b. azotemia c. fever d. cystitis