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Patho OB > Renal-Urinary-csv > Flashcards

Renal-Urinary-csv Flashcards

1
Q

which of the following is diagnostic of asymptomatic
bacteriuria

a. A more than 100,000 organisms/ml in a clean voided urine
b. Proteinuria of more than 300 mg/ml
c. Pus cells on urinalysis > 0-2/ ml
d. Positive kidney punch test

A

a. A more than 100,000 organisms/ml in a clean voided urine

Williams, pg 1027
A clean-voided specimen containing more than 100,000 organisms/mL is diagnostic

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2
Q

lower tract symptoms with pyuria accompanied by sterile
urine culture is highly indicative of which etiologic organism

e. Chlamydia trachomatis
a. E. coli
b. Chlamydia trachomatis
c. Klebsiella pneumoniae
d. Proteus sp.

A

e. Chlamydia trachomatis

Williams, pg 1028

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3
Q

differential diagnosis for acute pyelonephritis in a
pregnant woman include the following, EXCEPT:

A. Chorioamnionitis
B. Appendicitis
C. Gastroenteritis
D. Preterm labor

A

C. Gastroenteritis

Wiliams, pg 1028
The differential diagnosis (of acute pyelonephritis) includes: labor, chroioamnionitis, adnexal torsion, appendicitis, placental abruption, or infarcted leiomyoma. Also signs of sepsis syndrome

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4
Q

which of the following statements is CORRECT in the
management of a pregnant woman with acute
pyelonephritis

a. Establish a urine output of > 5 ml/hr with intravenous crystalloid solution
b. Repeat urine culture after 1-2 days of antimicrobial treatment
c. Repeat hematology and chemistry studies after 1 week afebrile
d. Discharge patient when 24 hrs afebrile and continue oral antibiotics to complete for 7-10 days

A

d. Discharge patient when 24 hrs afebrile and continue oral antibiotics to complete for 7-10 days

Williams, pg 1029
. Establish a urine output of > 50 ml/hr with intravenous crystalloid solution
. Repeat urine culture after 1-2 weeks of antimicrobial treatment
. Repeat hematology and chemistry studies after 48 hours afebrile

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5
Q

which of the following is contraindicated in the
management of nephrolithiasis in pregnancy

a. Extracorporeal shockwave lithotripsy
b. Ureteral stenting
c. YAG laser lithotripsy
d. Percutaneous nephrostomy

A

a. Extracorporeal shockwave lithotripsy

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6
Q

the hallmark of nephrotic syndrome is

a. Hypoalbuminemia
b. Heavy proteinuria
c. Hypercholesterolemia
d. edema

A

b. Heavy proteinuria

Williams, pg 1033
In addition to heavy urine protein excretion, the syndrome is characterized by hypoalbuminemia, hypercholesterolemia, and edema

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7
Q

Preeclampsia or eclampsia should be particularly differentiated from

a. Acute pyelonephritis
b. Nephrotic syndrome
c. Nephritic syndrome
d. Polycystic kidney disease

A

c. Nephritic syndrome

Acute nephritic syndromes during
pregnancy can be diicult to diferentiate
from severe preeclampsia or eclampsia (all conditions have hypertension)
(page 1032)

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8
Q

To prevent renal stone formation, which of the following is recommended

a. Ketogenic diet
b. Carbohydrate-free diet
c. Low calcium diet
d. Low sodium, low protein diet

A

d. Low sodium, low protein diet

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9
Q

Causes of acute kidney injury are the
following, EXCEPT:

a. Preeclampsia
b. Gestational diabetes
c. Hypovolemia in placenta previa
d. massive hemorrhage in abruptio
placenta

A

b. Gestational diabetes

acute renal ischemia is still often associated with severe
preeclampsia and hemorrhage . Particularly contributory are HELLP (hemolysis, elevated liver enzymes, low
platelet levels) syndrome and placental abruption . Septicemia is another frequent comorbidity. AKI is also common in women with acute fatty liver of pregnancy. Some degree of renal insuiciency was found in some . Another developed AKI from dehydration caused by severe hyperemesis gravidarum at 15 weeks. Other causes include thrombotic micro angiopathies (page 1036)

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10
Q

Most common cause (or form) of
acute glomerulonephritis

a. IgA nephropathy
b. poststreptococcal
c. SLE
d. HTN GN

A

a. IgA nephropathy

IgA nephropathy, also known as Berger
disease, is the most common form of acute
glomerulonephritis worldwide.

Acute Nephritic Syndromes:
poststreptococcal, infective endocarditis, SLE, antiglomerular basement membrane disease, IgA nephropathy (Berger disease), ANCA vasculitis, Henoch-Schonlein purpura, cryoglobulinemia, membranoproliferative and mesangioproliferative glomerulonephritis (1032

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11
Q

Nephritic syndrome, EXCEPT:

a. Lipids
b. Albumin
c. Pyuria
d. RBC

A

a. Lipids

The clinical presentation usually includes hypertension, hematuria, red-cell casts, pyuria, and proteinuria. Varying degrees of renal insuiciency and salt and water retention
result in edema, hypertension, and circulatory congestion (page 1032)

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12
Q

Common pathogen in acute pyelonephritis

a. Klebsiella granulomatis
b. Pseudomonas aeruginosa
c. Chlamydia trachomatis
d. Group B streptococcus

A

d. Group B streptococcus (E. coli is most common)

Bacteremia is demonstrated in 1 5 to 20 percent of these women. E coli is isolated from urine or blood in 70 to 80 percent of infections, Klebsiela pneumoniae in 3 to 5 percent, Enterobacter or Proteus species in 3 to 5 percent, and gram-positive organisms, including group B Streptococcus and Staphylococcus aureus in up to 10 percent of cases (page 1028)

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13
Q

Structural dilatation of the renal calyxes and ureter on the first trimester of pregnancy is likely due to the effect of this particular hormone

a. hCg
b. Estrogen
c. Progesterone
d. Human Placental Lactogen

A

c.Progesterone

Some dilatation develops before 1 4 eeks and likely stems from progesterone-induced relaxation of the muscularis. (page 1025-1026)

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14
Q

Pt has serum creatinine level of 0.7 mg/dL. What is the next step?

A

Nothing. This is normal in pregnancy

pg 1026
Vasodilation due to pregesterone induced relaxation of muscularis leads to increased filtration

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15
Q

Pt has had serial serum creatinine levels of 1.0, 1.2, 1.0 mg/dL. What is the first things suspected?

A

Intrinsic renal disease

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16
Q

Acute kidney damage cause & associated with, EXCEPT:

a. Diabetes
b. Hypermesis
c. Septicemia
d. Hypovolemia

A

a. Diabetes

17
Q

24 y/o G1P0 12 weeks, history N/V (3 days) weakness, skin & mucosa are dry. High risk for

a. Pyelonephritis
b. CRD
c. Acute kidney infection
d. Nephrolithiasis

A

a. Pyelonephritis

2nd trimester, nulliparity, young age, unilateral and right-sided, fever and shaking chills, aching pain, dehydration

18
Q

Nephritic syndrome, EXCEPT:

a. Lipids
b. Albumin
c. Pyuria
d. RBC

A

a. Lipids

The clinical presentation usually includes hypertension, hematuria, red-cell casts, pyuria, and proteinuria. Varying degrees of renal insuiciency and salt and water retention
result in edema, hypertension, and circulatory congestion (page 1032)

19
Q

Common pathogen in acute pyelonephritis

a. Klebsiella granulomatis
b. Pseudomonas aeruginosa
c. Chlamydia trachomatis
d. Group B streptococcus

A

d. Group B streptococcus

If this infection is suspected, a urine sample obtained by catheterization may be preferred to avoid obscuring contamination from the lower genital tract. The urinary sediment contains many leukocytes, frequently in clumps, and numerous bacteria. Bacteremia is demonstrated in 1 5 to 20 percent of these women. E coli is isolated from urine or blood in 70 to 80 percent of infections, Klebsiela pneumoniae in 3 to 5 percent, Enterobacter or Proteus species in 3 to 5 percent, and gram-positive organisms, including group B Streptococcus and Staphylococcus aureus in up to 10 percent of cases (page 1028)

20
Q

The good standard for the diagnosis of Asymptomatic bacteuria is Urine Culture.In the absence of urine culture this can be an alternative laboratory test for screening asympromatic bacteuria in pregnancy

a. urine dipstick leukocyte esterase
b. urine dipstick for nitrite test
c. Urine gram staining uncentrifuged sample
d. Urine dipstick for protein determination

A

a. urine dipstick leukocyte esterase

. Less expensive screening tests
such as the leukocyte esterase/nitrite dipstick are cost efective when the prevalence is <2 percent. Also, a dipstick culture technique has excellent
positive- and negative-predictive values (page 1027)

21
Q

Medical condition during or preceding pregnancy considered to be highly susceptible to the formation of asymptomatic infection or Bacteruria

a. Iron deficiency anemia
b. Hypertension
c. Diabetes mellitus
d. Collagen Vascular Disease

A

c. Diabetes mellitus

But even if pregnancy itself does not enhance these virulence factors, urinary stasis, vesicoureteral reflux, and diabetes predispose to symptomatic upper urinary infections (page 1026)

22
Q

In a study perform by Schieve et. Al. UTI when untreated is highly associated to the development of

a. Low birth weight infants
b. Pregnancy associated hypertension
c. Anemia
d. A and C only
e. A, B , and C

A

e. A, B, and C

reported urinary tract infection to be associated with greater risks for low-birthweight infants, preterm delivery, pregnancy-associated hypertension,
and anemia. (page 1027)

23
Q

. LBD, 16y/o,G1P0 on her 20 weeks AOG had her routine prenatal check up. Patient doesn�t complain of anything, there was no vaginal discharge on pelvic examination V/S BP: 100/60 mmHg, RR: 20, T:37.2C, PE: unremarkable for gravid woman, Urinalysis; WBC: 10-15hpf, RBC:0-2 hpf,urine nitrates negative, leukocytes esterase: negative, Urine culture:150,000cfu,CBC within normal limit 5. Based on the ff. data presented, what is the probable diagnosis?

a. Acute Uncomplicated Cystitis or Urethritis
b Acute Uncomplicated Pyelonephritis
c. Asymptomatic Bacteuria
d. Acute Glomeruonephritis

A

c. Asymptomatic Bacteuria

This refers to persistent, actively multiplying bacteria within the urinary tract in asymptomatic
women.

24
Q

When is the preferred AOG to screen Aymptomatic Bacteuria

a. 5-6 weeks
b. 8 weeks
c. 16 weeks
d. 24 weeks

A

d. 24 weeks

25
Q

Pyelonephritis is the leading cause of Septic Shock during pregnancy. In preterm and infant deliveries urosepsis may be associated with increased incidence of

a. Cerebral Palsy
b. Respiratory distress syndrome
c. Bronchopulmonary Leukomalacia
d. Necrotizing Enterocolitis

A

a. Cerebral Palsy

Urosepsis may be related t o a n increased incidence of cerebral palsy in preterm infants (page 1028)

26
Q

Acute Glomerulonepthitis has profound effect on pregnancy outcome, the worst perinatal outcome are seen in pregnant women with

a. Impaired renal function
b. Early onset-with severe features of Preeclampsia
c. Nephrotic-range proteinuria
d. A, C only
e. A, B, and C

A

e. A, B, and C

Although most of these women had normal renal function, half developed hypertension, a fourth
were delivered preterm. The worst perinatal outcomes were in women with impaired renal function, early or severe hypertension, and nephrotic-range proteinuria. Similar outcomes have been reported for pregnancies in
women with IgA nephropathy.

27
Q

What is the optimal screening test for Asymptomatic bacteuria in pregnancy?

a. Routine Analyisis
b. Urine nitrite determination
c. Urine culture
d. Urine leukocyte esterease

A

c. Urine culture

28
Q

Common signs and symptoms of cystitis except

a. Pyuria
b. Dysuria
c. Hematuria
d. Bacteuria

A

c. Hematuria

Cystitis produces dysuria, urgency, and frequency, but with few associated systemic indings. Pyuria and bacteriuria are usually found. Microscopic hematuria is common, and occasionally there is gross hematuria from hemorrhagic cystitis (page 1028)

29
Q

Best treatment for Chlamydia trachomatis:

a. Ampicillin
b. Aminoglycosides
c. Azithromycin
d. Amphotercin B

A

c. Azithromycin

30
Q

Clinical findings of acute pyelonephritis

a. Sudden onset of fever and chills
b. Left kidney is mostly affected
c. RUQ tenderness
d. N/V with bilious material

A

a. Sudden onset of fever and chills

Pyelonephritis i s unilateral and right-sided in more than half of cases, and it is bilateral in a fourth. Fever and shaking chills usually develop rather abruptly, and patients have aching pain in one or both lumbar regions. Anorexia, nausea, and vomiting may worsen dehydration. Tenderness usually can be elicited by percussion in one or both costovertebral angles.

31
Q

Which of the following regimen in pregnancy will promote nephrolithiasis

a. 1 cup of milk
b. 1 cup of salted peanuts
c. 1 cup of yogurt
d. _ cup of nonfat milk and 1 tab calcium carbonate 500mg

A

b. 1 cup of salted peanuts

32
Q

Hemodialysis is associated with

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

b. Acute Renal Disease

33
Q

Abdominal Mass found in

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

e. PCKD

34
Q

Anemia from Intrinsic Renal Disease is associated with

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

c. Chronic Renal Disease

35
Q

Proteinuria= >4100 mg

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

d. Nephrotic Syndrome

36
Q

Acute post-strep

a. Acute Glomerulonephritis
b. Acute Renal Disease
c. Chronic Renal Disease
d. Nephrotic Syndrome
e. PCKD

A

a. Acute Glomerulonephritis

Patho OB (12 decks)

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