Deck 34: Alterations of Renal and Urinary Tract Function

Question 1

A neurogenic bladder is a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder.

Answer 1

True

Question 2

The risk for urinary tract infection increases when the postvoided residual urine volume is at least _____ to _____ ml.

A) 30;45
B) 50;100
C) 150;200
D) 250;350
E) 400;500

Answer 2

150;200

Question 3

From which cells does renal cell carcinoma arise?

A) Proximal tubule epithelial cells
B) Distal tubule epithelial cells
C) Nephron epithelial cells
D) Glomerulus epithelial cells

Answer 3

Proximal tubule epithelial cells

Question 4

When the right kidney is obstructed,the nephrons in the left kidney increase in size to compensate.

Question 5

Smoking is a risk factor for bladder and kidney cancers.

Question 6

An alkaline urinary pH significantly decreases the risk of calcium phosphate stone formation whereas acid urine decreases the risk of uric acid stone.

Question 7

What do pyrophosphate,potassium citrate,and magnesium have in common in the formation of renal calculi?

A) They are all crystal growth-inhibiting substances.
B) They all stimulate supersaturation of salt that forms stones.
C) They all facilitate the precipitation of salts from a liquid to a solid state.
D) They all enhance crystallization of salt crystals to form stones.

Question 8

Considering the innervation of the circular muscles of the bladder neck,which classification of drug is used to treat bladder neck obstruction?

A) β-adrenergic blocking medications
B) -adrenergic blocking medications
C) Parasympathomimetic medications
D) Anticholinesterase medications

Question 9

Which neurologic disorder would be more likely to cause functional obstruction of the bladder outlet in addition to neurogenic detrusor overactivity?

A) Brain tumor
B) Traumatic brain injury
C) Cerebrovascular accident
D) Spinal cord injury

Question 10

Renal colic is the principal symptom of renal stones.

Question 11

What is the most common type of renal stone?

A) Magnesium-ammonium-phosphate
B) Uric acid
C) Calcium oxalate
D) Magnesium phosphate
E) Ammonium acid urate

Question 12

Lesions of the sacral segments S2 to S4 or the cauda equina are associated with urinary retention.

Question 13

In chronic renal failure,the glomerular filtration rate (GFR)is reduced below 20% before the disease begins to affect nonrenal organ systems.

Question 14

Azotemia is associated with a decrease in serum urea levels.

Question 15

Complications of urinary obstruction include infection.

Question 16

How does acute unilateral renal obstruction predispose people to hypertension?

A) The hydronephrosis that develops prevents any further blood from entering the kidneys,which results in an increase the systemic blood volume.
B) The reduced perfusion of the affected kidney activates the renin-angiotensin-aldosterone system,which causes constriction of peripheral arterioles.
C) The pain resulting from the renal obstruction stimulates the autonomic nervous system,causing vasoconstriction of peripheral arterioles.
D) The renal obstruction prevents the usual loss of sodium through the urine,causing retention of sodium and water,which increases blood volume.

Question 17

What part of the central nervous system coordinates the detrusor and urethral sphincter muscles during micturition?

A) Spinal cord between C2 and S1
B) Spinal cord between S2 and S4
C) Pons
D) Cauda equina

Question 18

Two clinical manifestations of nephrotic syndrome include decreased glomerular permeability and increased proximal tubule reabsorption.

Question 19

Which statement is false about the usual causes of hypercalciuria?

A) Hypercalciuria is usually attributable to hyperthyroidism.
B) Hypercalciuria is usually attributable to intestinal hyperabsorption of dietary calcium.
C) Hypercalciuria is usually attributable to bone demineralization caused by prolonged immobilization.
D) Hypercalciuria is usually attributable to hyperparathyroidism.

Question 20

Which statement is false about struvite stones?

A) They are more common in women than men.
B) They are associated with chronic laxative use in women.
C) They grow large and branch into a staghorn configuration in renal pelvis and calyces.
D) They are closely associated with urinary tract infections caused by urease-producing bacteria,such as Pseudomonas.

Question 21

A patient has hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day with albumin as the major protein.These data suggest the presence of which disorder?

A) Cystitis
B) Chronic pyelonephritis
C) Renal carcinoma
D) Nephrotic syndrome
E) Glomerulonephritis

Question 22

Which statement is false about the skeletal alterations caused by chronic renal failure?

A) When the glomerular filtration rate (GFR)declines to 25% of normal,parathyroid hormone (PTH)is no longer effective in maintaining serum phosphate levels.
B) When the glomerular filtration rate (GFR)declines to 25% of normal,the parathyroid gland is no longer able to secrete sufficient parathyroid hormone (PTH).
C) When the glomerular filtration rate (GFR)declines to 25% of normal,there is impaired synthesis of 1,25-vitamin D₃,which reduces intestinal absorption of calcium.
D) When the glomerular filtration rate (GFR)declines to 25% of normal,there is impaired synthesis of 1,25-vitamin D₃,which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone (PTH).

Question 23

Bladder cancer is associated with mutation of which gene?

A) c-erbB2
B) HER2
C) p53
D) myc

Question 24

MATCHING
Match the causes of acute renal failure with examples of specific disorders.
Acute tubular necrosis

A)Prerenal
B)Intrarenal
C)Postrenal

Question 25

Which urine characteristics below are indicative of acute tubular necrosis (ATN)caused by intrinsic (intrarenal)failure?

A) Urine sodium >30 mEq/L
B) Urine osmolality >500 mOsm
C) Fraction excretion of sodium (FE_Na)<1%
D) Urine sediment has no cells,some hyaline casts

Question 26

Which glomerular lesion is characterized by thickening of the glomerular wall with immune deposition of immunoglobulin G (IgG)and C3?

A) Proliferative
B) Membranous
C) Mesangial
D) Crescentic
E) Sclerotic

Question 27

Pyelonephritis is usually caused by antibody-coated:

A) bacteriA.
B) fungi.
C) viruses.
D) parasites.

Question 28

Anemia of renal failure can be successfully treated with:

A) intrinsic factor.
B) vitamin B₁₂.
C) iron.
D) erythropoietin.
E) folate.

Question 29

In glomerulonephritis,how are the glomerular cell walls damaged?

A) By ischemia
B) By lysosomal enzymes
C) By compression from edema
D) By lysis from complement

Question 30

Which are clinical manifestations of a urinary tract infection of a patient who is 85 years old?

A) Confusion and poorly localized abdominal discomfort
B) Dysuria,frequency,and suprapubic pain
C) Hematuria and flank pain
D) Pyuria,urgency,and frequency

Question 31

Which kidney disorder is characterized by hypoalbuminemia,edema,hyperlipidemia and lipiduria?

A) Nephrotic syndrome
B) Acute glomerulonephritis
C) Chronic glomerulonephritis
D) Pyelonephritis

Question 32

Considering host defense mechanisms,which element in the urine is bacteriostatic,if any?

A) High pH (alkaline urine)
B) High urea
C) High glucose
D) None of the above is bacteriostatic

Question 33

What is one of the most common causes of uncomplicated urinary tract infections?

A) Staphylococcus
B) Klebsiella
C) Proteus
D) Escherichia coli

Question 34

Creatinine is constantly released from _____ tissue and excreted primarily by glomerular filtration.

A) nervous
B) kidney
C) muscle
D) liver

Question 35

How does proteinuria cause edema?

A) Loss of plasma albumin from the distal tubules causes an obstruction the collecting tubules,causing urine to back up into kidneys and ultimately the systemic circulation.
B) Loss of plasma albumin decreases plasma volume,which prevents the stimulation of antidiuretic hormone (ADH)from the posterior pituitary.
C) Loss of plasma albumin decreases plasma volume,which turns off the renin-angiotensin-aldosterone system.
D) Loss of plasma albumin decreases the plasma oncotic pressure,which normally holds water in the capillaries.

Question 36

How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?

A) Glucose has an osmotic effect,which attracts water and sodium resulting in more dilute blood and a lower potassium concentration.
B) When insulin transports glucose into the cell,it also carries potassium with it.
C) Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell.
D) Increasing insulin causes ketoacidosis,which causes potassium to move into the cell in exchange for hydrogen.

Question 37

Which abnormal lab value is found in glomerular disorders?

A) Low creatinine
B) Low blood urea nitrogen (BUN)
C) Low immunoglobulin A (IgA)
D) Low serum complement

Question 38

Goodpasture syndrome is an example of:

A) antiglomerular basement membrane disease.
B) acute glomerulonephritis.
C) chronic glomerulonephritis.
D) immunoglobulin A (IgA)nephropathy.

Question 39

Which clinical manifestation of pyelonephritis is different from those of cystitis?

A) Difficulty starting the stream of urine
B) Spasmodic pain that radiates to the groin
C) Dysuria and frequency
D) Flank pain

Question 40

Which antibiotics are considered "major culprits" in causing nephrotoxic acute tubular necrosis (ATN)?

A) Penicillin,methicillin,and ampicillin
B) Vancomycin,bacitracin,and imipenem-cilastatin
C) Neomycin,gentamicin,and tobramycin
D) Cefazolin,ceftriaxone,and cefepime

Question 41

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Obstruction and stasis of urine contributing to bacteremia and hydronephrosis;irritation of epithelial lining with entrapment of bacteria

A)Kidney stones
B)Vesicoureteral reflux
C)Pregnancy
D)Neurogenic bladder
E)Female sexual trauma

Question 42

MATCHING
Match the causes of acute renal failure with examples of specific disorders.
Hypovolemia

A)Prerenal
B)Intrarenal
C)Postrenal

Question 43

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Impairment to the bladder interferes with normal bladder contraction causing residual urine and ascending infection

A)Kidney stones
B)Vesicoureteral reflux
C)Pregnancy
D)Neurogenic bladder
E)Female sexual trauma

Question 44

MATCHING
Match the causes of acute renal failure with examples of specific disorders.
Acute glomerulonephritis

A)Prerenal
B)Intrarenal
C)Postrenal

Question 45

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Chronic reflux of urine up the ureter and into the kidney during micturition contributing to bacterial infection

A)Kidney stones
B)Vesicoureteral reflux
C)Pregnancy
D)Neurogenic bladder
E)Female sexual trauma

Question 46

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Movement of organisms from urethra into the bladder with infection and retrograde spread to the kidney

A)Kidney stones
B)Vesicoureteral reflux
C)Pregnancy
D)Neurogenic bladder
E)Female sexual trauma

Question 47

MATCHING
Match the causes of acute renal failure with examples of specific disorders.
Renal vasoconstriction

A)Prerenal
B)Intrarenal
C)Postrenal

Question 48

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Dilation and relaxation of ureter with hydroureter and hydronephrosis

A)Kidney stones
B)Vesicoureteral reflux
C)Pregnancy
D)Neurogenic bladder
E)Female sexual trauma

Question 49

MATCHING
Match the causes of acute renal failure with examples of specific disorders.
Prostatic hypertrophy

A)Prerenal
B)Intrarenal
C)Postrenal