FEN/GI/Renal Flashcards
Segment of nephron in which 90% of filtered bicarbonate is recovered.
A. Collecting duct
B. Distal tubule
C. Thick ascending loop of Henle
D. Thin descending loop of Henle
E. Proximal tubule
E. Proximal tubule
(Lucking Ch. 6)
Definitions of intra-abdominal hypertension and abdominal compartment syndrome
HTN: >10 mmHg
Compartment syndrome: >20 mmHg and signs of organ dysfunction
Abdominal perfusion pressure = MAP - bladder pressure, min 55 mmHg in adults recommended
Which of the following is true regarding creatinine as a measure of renal function?
A. Creatinine secretion into the ultrafiltrate is clinically insignificant
B. In a normal kidney, creatinine clearance underestimates GFR by 10– 20%
C. Plasma creatinine reaches adult levels shortly after the 2nd year of life
D. Plasma creatinine is unaffected by diet
E. There can be as much as a 50% decrease in nephron mass prior to any detectable increase in serum creatinine
E. There can be as much as a 50% decrease in nephron mass prior to any detectable increase in serum creatinine
(Lucking Ch. 6)
Which hormone regulates serum osmolality by controlling the insertion of water channels into the luminal membrane of the principal cells of the collecting ducts?
A. Aldosterone
B. Antidiuretic Hormone (ADH)
C. Atrial Natriuretic Peptide (ANP)
D. Erythropoeitin
E. Leptin
B. Antidiuretic Hormone (ADH)
(Lucking Ch. 6)
The diuretic which can cause hypercalciuria, leading to kidney stones and nephrocalcinosis, especially in premature infants.
A. Chlorathiazide
B. Furosemide
C. Mannitol
D. Metolazone
E. Spironolactone
B. Furosemide
(Lucking Ch. 6)
The type of acidosis which requires massive doses of bicarbonate to treat, but if untreated, is characterized by a mild to moderate acidosis with a high fractional excretion of bicarbonate. This type of acidosis can be associated with hypophosphatemia and rickets.
A. Acidosis due to stool bicarbonate loss
B. Distal RTA
C. Posthypocapnic acidosis
D. Proximal RTA
E. Type IV RTA
D. Proximal RTA
(Lucking Ch. 6)
Which of the following is true regarding urea and renal function?
A. Blood urea is increased during hypovolemia mainly due to hemoconcentration
B. Blood urea is increased during hypovolemia mainly due to increased reabsorption
C. Urea is freely filtered at the glomerulus and undergoes little reabsorption
D. Urea production is decreased during critical illness
E. Urea production is increased during states of increased anabolism
B. Blood urea is increased during hypovolemia mainly due to increased reabsorption
(Lucking Ch. 6)
A 2 year old male is transferred to the pediatric ICU from a referring institution with hypotension secondary to severe diarrhea and dehydration. His mother reports he has had diarrhea and fever for four days. He has had oral hydration with a pediatric rehydration solution and an appropriate dose of ibuprofen for fever every 6 hours. Vital sign are: pulse 167 beats per minute, blood pressure 109/67 mm Hg, respiratory rate of 44 breaths per minute. Examination reveals a lethargic child with cool extremities, delayed capillary refill and dry mucous membranes. Laboratory evaluation reveals: Sodium 141 mEq/L Chloride 121 mEq/L Potassium 5.9 mEq/L BUN 44 mg/dL Creatinine 4.2 mg/dL Bicarbonate 7 mEq/L Which of the following is most true regarding his decrement in renal function?
A. His BUN:creatinine ratio is reflective of hypovolemia and not intrinsic renal injury
B. His increase in creatinine is mainly due to hemoconcentration
C. His increase in creatinine is reflective of a 25% reduction in GFR
D. The acidosis is likely due to renal injury and renal loss of bicarbonate
E. The administration of ibuprofen likely impaired the kidney’s ability to compensate for decreased perfusion
E. The administration of ibuprofen likely impaired the kidney’s ability to compensate for decreased perfusion
(Lucking Ch. 6)
A 2 year old is admitted with pneumococcal sepsis and severe edema secondary to nephrotic syndrome. You are asked to estimate his GFR with the following information: Dry weight - 12 kg Height - 85 cm Plasma creatinine 1 mg/dl Urine output 2 ml/kg/hr Which of the following is the most accurate estimate of GFR?
A. 10 ml/min/1.73 m2
B. 25 ml/min/1.73 m2
C. 30 ml/min/1.73 m2
D. 35 ml/min/1.73 m2
E. An estimated GFR cannot be calculated with the above data
D. 35 ml/min/1.73 m2
(Lucking Ch. 6)
What is the most common cause of fulminant hepatic failure in infants?
A) Hepatitis A
B) Acetaminophen overdose
C) Metabolic disorders
D) Autoimmune Hepatitis B
C) Metabolic disorders
The etiology of ALF can be divided into several categories: metabolic, infective, toxic, autoimmune, malignancy-induced, vascular-induced, and undetermined. Etiology of ALF varies with age. In infants, metabolic disease is the most common cause whereas older children more frequently develop ALF from viral infections. In the neonatal period, galactosemia, hereditary fructose intolerance, tyrosinemia, neonatal hemochromatosis, and ornithine transcarbamy- lase (OTC) deficiency can present with hypoglycemia, coagulopathy, lactic acidosis, failure to thrive and irritability. Patients with urea cycle defects may present with an initial respira- tory alkalosis and severe hyperammonemia. Regardless of etiology, if liver failure is advanced, lactic acidosis is often present. Jaundice is frequently absent at presentation. Galactosemia and tyrosinemia type I may cause refractory coagulopathy in the infant with minimal other signs of liver failure. Symptomatic metabolic liver disease may present before the results of newborn screening are available.
Wilson’s disease is not seen in the newborn period but is the most common metabolic cause of
ALF in children older than 5 years of age. Worldwide, hepatitis A is the most frequent infectious cause of ALF due to its high prevalence in developing countries. Biliary atresia is the most common reason for pediatric liver transplantation.
(End of Year Wrap Up)
What is the most appropriate initial study to confirm a diagnosis of intussusception on a 15-month old infant?
A) Upright abdominal radiograph
B) Air or barium contrast study of the colon
C) Ultrasound of the abdomen
D) Double-contrast CT of the abdomen
E) Upper GI follow through stud
C) Ultrasound of the abdomen
Air or barium contrast studies of the colon have been considered the standard diagnostic test for intussusception. However, abdominal ultrasound is the preferred initial study of choice because of its high diagnostic sensitivity (98% to 100%) and specificity (88% to 100%), as well as the absence of radiation exposure and greater patient comfort. If a competent ultrasonographer has ruled out intussusception, no further imaging tests should be necessary. Ultrasound is also useful to evaluate the biliary duct, abdominal masses, and pathology related to the appendix.
Double-contrast CT can be used to investigate the cause of small bowel obstruction and to evaluate pancreatic, retroperitoneal, and pelvic pathology. It also can be used to assess the size and identify the location of an intra-abdominal mass and its relationship to other organs.
Upright abdominal radiographs and upper GI follow through studies have low sensitivity and specificity for a diagnosis of intestinal obstruction.
(End of Year Wrap Up)
What is the most appropriate initial therapy for management of acute GI bleeding caused by esophageal varices and portal hypertension in a hemodynamically stable patient?
A) Balloon tamponade with a Sengstaken-Blakemore tube
B) Octreotide infusion
C) Proton pump inhibitor to block gastric acidity
D) Emergency portocaval shunt surgery
E) Endoscopic ligation of sclerotherapy
B) Octreotide infusion
The Sengstaken-Blakemore tube has been used in adults to apply direct pressure via a balloon to temporarily occlude esophageal varices. More recently, medical and endoscopic therapy has been the focus, including the use of vasopressin, somatostatin and octreotide, all of which decrease portal pressure by decreasing splanchnic blood flow.”
Octreotide is effective in stopping acute variceal bleeding in apout 75% of patients. Some studies report medical and endoscopic therapies to be equivalent, although combination therapy may be superior. In children, octreotide infusion is often used to achieve initial hemostasis and optimize visualization for subsequent endoscopic ligation or sclerotherapy. Proton pump inhibitors are used to block gastric acidity and are part of the routine management of these patients.
Although emergency portocaval shunt surgery is an option, this procedure is associated with significant morbidity and mortality.
(End of Year Wrap Up)
What is the most appropriate goal for intragastric pH in patients with acute GI bleeding or those at risk for bleeding?
A) 2 to 3
B) 3 to 4
C) 4 to 5
D) 5 to 6
E) >6
E) >6
(End of Year Wrap Up)
What is the cause of hepatopulmonary syndrome?
A) Ventilator associated pneumonia
B) Intrapulmonary vasodilation and shunting
C) Aspiration pneumonia from variceal bleeding
D) Acute respiratory distress syndrome as a complication of fulminant hepatic failure
B) Intrapulmonary vasodilation and shunting
Hepatopulmonary syndrome is characterized by abnormal arterial oxygenation caused by intrapulmonary vasodilation and shunting in patients with liver disease or portal hypertension. Pulmonary histologic findings include dilated pulmonary arterioles and capillaries, and less commonly, pleural and pulmonary arteriovenous connections. Patients have Pa02 <80 mm Hg in room air and show increased alveolar-arterial (A-a) oxygen gradient but normal PaC02. Contrast enhanced echocardiography with agitated saline solution administered through a peripheral vein in the arm shows rapid appearance of bubbles in the left side of the heart within three to six cardiac cycles. Microbubbles (>10 um) do not pass through normal capillaries (<8 to 15 um). Progressive hepatopulmonary syndrome is an indication for liver transplant prior to development of severe hypoxemia.
(End of Year Wrap Up)
Which of the following proteins can be used to assess a patient’s nutritional status over the past 8 days?
A) Prealbumin
B) Retinal binding protein
C) Albumin
D) Transferrin
D) Transferrin
(End of Year Wrap Up)
Licorice ingestion impact on potassium
Causes hypokalemia - contains glycyrrhizic acid, has mineralocorticoid properties that can cause potassium wasting
How does heparin cause hyperkalemia?
Suppresses aldosterone, natriuresis, and potassium excretion
What is the impact on measured potassium level of leukocytosis and thrombocytosis?
Falsely elevated potassium level
Causes and distinguishing features of hyponatremia
