Pathology

Question 1

• Why is serum Cr not best prediction of GFR?
• Acute renal failure: Symptoms? (5) Reversible? Kidney size? Endocrine fx? Common causes? (3)
• Acute renal failure: Pre-renal: Common causes? (3) Tubule fx? BUN:Cr? Urine Na?
• Post renal: Cause?
• Renal: Causes? (6)
• Uremia? (6)

Answer 1

• Takes a big loss of kidney to see change
• Oliguria (s; preserved; high, low
• Obstructive
• ATN, precip. of organic compounds, AV, GN, drugs, infection
• Acidosis, H2O/Na retention, K+ arrhth., 2ndary parathyroid, azotemia (BUN and Cr high), Endo problems

Question 2

• Chronic renal disease: Stages? (5)
• Common causes? (6)
• H+ with CRD?
• Calcium, phosphate and PTH?
• Anemia due to? (4)
• Htx due to? (4)
• Bone density issues due to? (4)

Answer 2

• > 90, 60-89, 30-59, 15-29, t keep up
• Ca down, PO4 up, PTH up
• Low EPO, Low RBC lifespan, marrow fibrosis, incr. blood loss
• Incr. ECF, incr. RAAS, ANS dysfx., low vasodilators
• Low vit d, and Ca; high PTH and PO4

Question 3

• UTI: Most common location? Sometimes?
• Chronic issues increasing risk?
• Ascending bacteria?
• Hematogenous?
• Common virulence factors? (3)
• Host defense? (4)
• Papillary necrosis? Staghorn calc?
• Most common stone? Second?
• What is Pyonephrosis? Hydronephrosis?

Answer 3

• Lower GU (cystitis); upper GU (pyelonephritis)
• Obstruction, VUR, Chronic renal failure, htx
• Gram (-) rods; e.coli, proteus, pseudo, klebs
• Gram (+) cocci: Strep and staph
• Fimbria/P-pili; “O- antigens”; endotoxin
• Hydrokinetic, chemical, IgA/comp, PMN’s
• DM related; Proteus related
• Calcium oxalate; Mg ammonium phosphate
• Hydro= dilation of renal pelvis/calyces; pyo=pus in renal collecting system

Question 4

• Dialysis: Indications? (4) Starting early?
• Most common AV fistula? Catheter route? Which doesn’t need needles?
• Common complication with perotineal dial?
• When does risk of death drop for transplant?
• Warm ischemia? Cold?
• 3 types of deceased donor transplants?
• 2 types of rejection?
• 3 treatment types/ drugs?
• High cancer risks? (2)

Answer 4

• Vol overload, uremic, hyper k, pericarditis, x outcomes
• Radiocephalic, IJV–>SVC, Catheter
• Hernias
• 106 days
• Time until on ice; time on ice
• SCD = brain death; DCD = Cardiopulm. death; ECD = >60yo + 2/3 (Htx, Incr. Cr, stroke)
• B cell/comp or T cell
• Calcinuerin inhibitor = cyclosporin/tacrolimus; Prolif. inhib. MMF/sirolimus; Prednisone
• Hodgkins, NM skin cancer

Question 5

• 3 stages of development? Time period?
• What degenerates? Vessels come off? Mesonephric becomes? Paramesonephric becomes?
• 5-6 weeks bud? Comes off? Surrounded by?
• 8-9 weeks has? What develops next to collecting tubule?
• Meso? Meta?
• Urethra/bladder develop at?
• Kidney ascends from posterior to?

Answer 5

• Pronephros (3-4 wks), mesonepros (4wks-2mo’s), metanephros (5wks-maturity)
• Pronephros; Dorsal aorta; Epi, VD, Testes; Fallopian tubes/uterus
• Mesonephric duct; Uteric bud; metanephric blastema
• Primodial calyces; metanephric vescicle
• Duct; final kidney
• 10-12 weeks
• retroperitoneal

Question 6

• 3 layers of the bladder?
• 2 sphincters?
• Parasympathetic: Innervates? Activation = ? Nerves?
• Sympathetic: Inhibits? Increases tension of? Role? Nerves?
• Motor: 3 parts? Nerves?
• CNS: Chooses? Cortex? Cerebellum/ stem?
• Storage: Affterent? Efferent?
• Bladder? Urethra? (3)

Answer 6

• outer periteineum, SM with detrusor, inner mucosal
• External/ striated; intrinsic (bladder neck)
• Detrusor; detrusor activation/micturition; s2-s4, pelvic nerves
• Detrusor; SM of bladder; storage; T10-L2 hypogatric
• Bladder, pelvic floor, urethral sphincter; pudendal
• when to void; inhibit; facilitate
• Generated by filling of bladder; inhibit detrusor
• • para; - para, + symp and somatic

Question 7

• Micturition cycle? (5)
• Classes of incontenence? (3)
• Therapy? Drug? Effect?
• Stress incontinence is? Therapy? (2)
• Older male obstruction? Younger? Microscopic BPH with 80 yo? Enlargement? Sympotmatic?
• Moderate to severe incr. BP >50 yo?

Answer 7

• Incr. wall tension; Afferent cortical input; decreased pudendal nerve activity, external sphincter/pelvic floor relaxes, detrusor activates; prox. urethra opens; bladder contracts
• Stress, urge, overflow
• Anti-musc; oxybutynin; incr. SM relaxation for storage
• Invol. sudden loss of urine; estrogen/anti-agonists
• Prostate; stricture (trauma); 80%; 50%; 50% of those
• 25%