Deck 25: Renal and Genitourinary Emergencies

Question 1

The nephron is composed of the following parts, EXCEPT:

A) Renal corpuscle
B) Proximal convoluted tubules
C) Loop of Henley
D) Renal calyx

Answer 1

Renal calyx

Question 2

The afferent arteriole in the glomerulus adjusts to pressure by either vasodilation or vasoconstriction. This process is called:

A) Sympathetic process
B) Switch mechanism
C) Negative feedback
D) Autoregulation

Answer 2

Autoregulation

Question 3

What is the normal glomerular filtration rate of an average adult?

A) 1000 mL per minute
B) 125 mL per minute
C) 600 mL per minute
D) None are correct

Answer 3

125 mL per minute

Question 4

A rapid and sudden deterioration of renal function, accompanied by azotaemia and anuria, is an indication of:

A) Chronic kidney injury
B) Acute kidney injury
C) Haematuria
D) All are correct

Question 5

When the kidneys sustain a prolonged ischemia secondary to low volumes of circulating fluid in the kidneys, there is a danger for:

A) Acute pyelonephritis
B) Urinary tract infection
C) Acute tubular necrosis
D) Pre-renal syndrome

Question 6

In an event of acute kidney injury, what is the initial priority?

A) Ensuring the kidneys are well perfused
B) Treating electrolyte imbalances
C) Fluid resuscitation
D) All are correct

Question 7

What medical emergency should you monitor in the event of acute kidney injury, which is a result of electrolyte imbalances?

A) Acute tubular necrosis
B) Hypocalcaemia
C) Hyperkalaemia
D) Hypernatremia

Question 8

What is the rationale of administering insulin to a patient experiencing hyperkalaemia in AKI, who does not have any history of diabetes?

A) Insulin shifts potassium intracellularly
B) Insulin allows sodium to replace high potassium levels
C) Insulin prevents hyperglycaemia
D) All are correct

Question 9

What are the important considerations in a patient presenting with AV fistula:

A) Frequent dressing
B) Preventing infection
C) Preventing leakage
D) All are correct

Question 10

Recurrent urinary tract infections could potentially cause an ascending infection, or a condition called:

A) Urinary calculi
B) Acute pyelonephritis
C) Acute kidney injury
D) Prostatitis

Question 11

At 0200 hours you are dispatched to a suburban residence for a 14-year-old male with severe abdominal pain, nausea and vomiting. On arrival you are shown to the patient, who appears to be in significant distress due to pain.The patient tells you that he woke up about 30 minutes ago with severe pain in his scrotum and lower abdomen with associated nausea and vomiting. He denies any trauma; being sexually active; urethral discharge; fever; dysuria; anorexia or diarrhoea. On examination his vital signs are within normal limits, the abdomen is soft and non-tender on palpation, afebrile.He is otherwise well with no significant medical history, no current medications and no allergies. Based on the clinical presentation, which of the following conditions should be foremost in the list of differential diagnoses?

A) Renal colic
B) Gastroenteritis
C) Testicular torsion
D) Urinary tract infection

Question 12

In relation to question 1 above, which of the following complications is most likely to occur if early treatment is not provided?

A) Post renal acute kidney injury
B) Sepsis
C) Infarction of a testis
D) Urinary retention

Question 13

In relation to question 1 above, the most appropriate pre-hospital management of the patient is:

A) Administer simple oral analgesia, such as paracetamol and/or NSAID, advise the patient to maintain his fluid intake to prevent dehydration and follow up with the general practitioner later today
B) Administer simple oral analgesia, such as paracetamol and/or NSAID, and advise the parents to transport the patient to the local emergency department
C) Administer simple oral analgesia, such as paracetamol and/or NSAID, and transport the patient to the emergency department
D) Administer inhaled and/or intravenous analgesia to achieve effective pain control; provide an appropriate anti-emetic and transport without delay to an appropriate emergency department

Question 14

Obstructive renal calculi can cause which type of acute kidney injury?

A) Postrenal
B) Prerenal
C) Intrarenal
D) Nephrotoxic

Question 15

All of the following are functions of the urinary system, EXCEPT:

A) Regulation of acid-base balance
B) Production, storage and excretion of urine
C) Regulation of platelet and red blood cell production
D) Removal of waste products

Question 16

Common emergencies encountered by paramedics that cause decreased perfusion such as hypovolaemia and cardiogenic shock can result in acute kidney injury

A) Intrarenal
B) Postrenal
C) Prerenal
D) Nephrotoxic

Question 17

You are dispatched to an 85-year-old female who has been found collapsed on the bathroom floor by family members who went to check on her.The patient states that she slipped and fell about 24 hours ago and was unable to get up due to a painful left hip, so has been lying on the tiled bathroom floor since. She has a probable fracture to the left hip but otherwise appears uninjured.You provide pain relief, some intravenous fluid to correct her dehydration, splint her hip and transport to the local emergency department.The next day you are dispatched to the hospital to transfer the patient to another hospital and when you walk into her room you observe that the urine collection bag contains brown coloured urine and the staff advise you that she has renal failure.The most likely reason for the brown coloured urine and renal failure is:

A) Rhabdomyolysis from a crush injury from being on the tiled floor for an extended period of time
B) Profound hypoperfusion secondary to dehydration
C) Urinary tract infection
D) Nephrotoxic renal failure secondary to medications

Question 18

A life-threatening electrolyte disturbance seen in patients with renal failure that results in ECG changes including peaked T waves, QRS prolongation and ventricular arrhythmia is:

A) Hypokalaemia
B) Hyponatraemia
C) Hypomagnesemia
D) Hyperkalaemia

Question 19

In relation to question eight above the pre-hospital management of life threatening presentations includes all of the following EXCEPT:

A) Intravenous calcium gluconate
B) Intravenous sodium bicarbonate
C) Potassium chloride
D) Nebulised salbutamol

Question 20

The most common complication of peritoneal dialysis is:

A) Hyperkalemia
B) Peritonitis and exit site infections
C) Dislodgement of the dialysis catheter
D) Ascites