Deck 36: Alterations of Renal and Urinary Tract Function

Question 1

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

Answer 1

False

Question 2

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.

Answer 2

They are associated with chronic laxative use in women.

Question 3

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

Answer 3

Pons

Question 4

Complications of urinary obstruction include infection.

Question 5

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

Question 6

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

Question 7

Renal colic is the principal symptom of renal stones.

Question 8

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 in 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 9

In the formation of renal calculi, pyrophosphate, potassium citrate, and magnesium all:

A)inhibit crystal growth.
B)stimulate supersaturation of salt.
C)facilitate the precipitation of salts from a liquid to a solid state.
D)enhance crystallization of salt crystals to form stones.

Question 10

Azotemia is associated with a decrease in serum urea levels.

Question 11

Renal cell carcinoma arises from epithelial cells in the:

A)proximal tubule.
B)distal tubule.
C)nephron.
D)glomerulus.

Question 12

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

Question 13

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

Question 14

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

A)b-Adrenergic blocking medications
B)a-Adrenergic blocking medications
C)Parasympathomimetic medications
D)Anticholinesterase medications

Question 15

The most common causes of uncomplicated urinary tract infections are:

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

Question 16

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 17

Which statement is false about the usual causes of hypercalciuria? Hypercalciuria is usually attributable to:

A)hyperthyroidism.
B)intestinal hyperabsorption of dietary calcium.
C)bone demineralization caused by prolonged immobilization.
D)hyperparathyroidism.

Question 18

Smoking is a risk factor for bladder and kidney cancers.

Question 19

The most common type of renal stone is comprised of:

A)magnesium-ammonium-phosphate.
B)uric acid.
C)calcium oxalate.
D)magnesium phosphate.

Question 20

Bladder cancer is associated with gene mutation of:

A)c-erbB2.
B)HER2.
C)TP53.
D)myc.

Question 21

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

Question 22

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 23

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 elements is bacteriostatic.

Question 24

The kidney disorder characterized by hypoalbuminemia, edema, hyperlipidemia and lipiduria is:

A)nephrotic syndrome.
B)acute glomerulonephritis.
C)chronic glomerulonephritis.
D)pyelonephritis.

Question 25

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

A)Prerenal
B)Intrarenal
C)Postrenal

Question 26

Pyelonephritis is usually caused by antibody-coated:

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

Question 27

In glomerulonephritis, the glomerular cell walls are damaged by:

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

Question 28

Match the predisposing factors causing pyelonephritis to the pathology mechanism.
Movement of organisms from the 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 29

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 30

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

A)Prerenal
B)Intrarenal
C)Postrenal

Question 31

Anemia of chronic renal failure can be successfully treated with:

A)intrinsic factor.
B)vitamin B12.
C)Vitamin D
D)erythropoietin.

Question 32

Goodpasture syndrome is an example of:

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

Question 33

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

A)Prerenal
B)Intrarenal
C)Postrenal

Question 34

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 35

Clinical manifestations of a urinary tract infection in an 85 year old may include:

A)confusion and poorly localized abdominal discomfort.
B)dysuria, frequency, and suprapubic pain.
C)hematuria and flank pain.
D)pyuria, urgency, and frequency.

Question 36

Which abnormal lab value is found in glomerular disorders?

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

Question 37

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 (FENa) <1%
D)Urine sediment has no cells, some hyaline casts

Question 38

Which statement is false about the skeletal alterations caused by chronic renal failure? When the glomerular filtration rate (GFR) declines to 25% of normal

A)parathyroid hormone (PTH) is no longer effective in maintaining serum phosphate levels.
B)the parathyroid gland is no longer able to secrete sufficient parathyroid hormone (PTH).
C)there is impaired synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium.
D)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 39

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

A)Cystitis
B)Chronic pyelonephritis
C)Glomerulonephritis
D)Nephrotic syndrome

Question 40

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

A)nervous system
B)kidneys
C)muscle
D)liver

Question 41

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 42

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 43

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