Nphro - UO

Question 1

4 common sites of mechanical obstruction in the GUT

Answer 1

ureteropelvic junction
ureterovesical junction
bladder neck
urethral meatus

Question 2

obstruction above the level of the bladder

a. unilateral hydronephrosis
b. bilateral hydronephrosis
c. either

Answer 2

A

Question 3

obstruction below the level of the bladder

a. unilateral hydronephrosis
b. bilateral hydronephrosis
c. either

Answer 3

B

Question 4

Most common cause of bilateral hydronephrosis in boys

Answer 4

posterior urethral valves

Question 5

The following can cause urinary obstruction EXCEPT

a. congenital narrowing of the ureteropelvic junction
b. carcinoma of the colon and cervix
c. BPH
d. abnormalities in the pontine and sacral centers of micturition
e. AOTA
f. NOTA

Answer 5

F

Question 6

cauda equine syndrome

a. overflow incontinence
b. fecal incontinence
c. both
d. neither

Answer 6

C

Question 7

urinary retention as a consequence of

a. alphaadrenergic agents
b. cholinergic agents
c. both
d. neither

Answer 7

A; anticholinergic not cholinergic agent cause urinary retention

Question 8

Hydronephrosis in pregnancy is due to

Answer 8

progesterone

unilateral compression by the enlarged uterus

Question 9

unilateral compression by the enlarged uterus causes hydronephrosis in pregnancy. this is more often in the

a. right side
b. left side

Answer 9

A

Question 10

True about Urinary obstruction

a. flank pain occurs due to distention of the collecting system or renal capsule
b. degree of distension has greater effect than rate of distension
c. chronic obstruction is painful
d. azotemia rarely develops

Answer 10

A;

b. rate of distention greater influence
c. chronic - painless
d. azotemia develops when overall excretory function is impaired

Question 11

hemodynamic effects of acute urinary obstruction
RBF - 
GFR - 
medullary blood flow - 
vasodilator prostaglandins, NO -

Answer 11

RBF - increase
GFR - decrese
medullary blood flow - deccrease
vasodilator prostaglandins, NO - increase

Question 12

hemodynamic effects of chronic urinary obstruction
RBF - 
GFR - 
vasoconstrictor prostaglandins
RAAS -

Answer 12

RBF - decrease
GFR - decrease decrease
vasoconstrictor prostaglandins - increase
RAAS - increse

Question 13

What happens when obstruction is released? (in terms of hemodynamics)

Answer 13

slow increase in GFR

Question 14

Tubule effects in acute urinary obstruction
ureteral tubule pressures -
reabsorption of sodium, urea, water -

Answer 14

ureteral tubule pressures - increase

reabsorption of sodium, urea, water - increase

Question 15

Tubule effects in acute urinary obstruction
medullary osmolarity -
concentrating ability -
transport functions for sodium, potassium, hydrogen -

Answer 15

medullary osmolarity - decrease
concentrating ability - decrease
transport functions for sodium, potassium, hydrogen - decrease

Question 16

Tubule effects upon release of obstruction
tubule pressure -
solute load per nephron -

Answer 16

tubule pressure - decrease

solute load per nephron - increase

Question 17

clinical features of acute urinary obstruction

Answer 17

pain
azotemia
oliguria or anuria

Question 18

Clinical features of chronic ureteral obstruction

Answer 18

azotemia
hypertension
AVP-insensitive polyuria
Natriuresis
hyperkalemic hyperchloremic acidosis

Question 19

Clinical features after release of obstruction

Answer 19

postobstructive diuresis

potential for vol depletion electrolyte imbalance due to losses of Na K Phosphate Mg and water

Question 20

True of partial obstruction acute setting

a. downregulation of transporters
b. polyuria and dehydration
c. hyperkalemia and dRTA
d. mimic pre renal azotemia and high BUN/Crea

Answer 20

D

everything else for chronic

Question 21

pertinent findings in history for urinary obstruction

Answer 21

difficulty in voiding
pain
infection
change in urinary volume

Question 22

Treatment for recurrent UTI with a poor functioning kidney

Answer 22

nephrectomy

Question 23

medical tx of BPH

Answer 23

alphaadrenergic blockers

5 alpha reductase inhibitors

Question 24

treatment of neurogenic bladder

Answer 24

frequent voiding

cholinergic drugs

Question 25

true of post obstructive diuresis

a. massive polyuria after relief of bilateral obstruction
b. urine is usually hypotonic and contain traces of sodium, chloride, potassium, phosphate and magnesium
c. both
d. neither

Answer 25

A;

contain large amounts of sodium, chloride, potassium, phosphate, magnesium

Question 26

true of postobstructive diruesis

a. replace fluids in amounts equal the amount of urinary losses
b. more aggressive fluid management in hypovolemia, hypotension and/or electrolyte abnormalities
c. no danger of hypernatremia
d. use 0.90 saline

Answer 26

B

a. less
b. with danger
d. 0.45 saline