Test 1 Review Questions Flashcards
The glomerular filtration barrier is composed of?
a. The capillary endothelium, basement membrane and juxtaglomerlar apparatus
b. Capillary endothelium, podocytes, and basement membrane
c. Podocytes, Hilum, and basement membrane
d. Capillary endothelium, podocytes, and juxtaglomerular
B
There are 3 major components of glomerular capillary wall accounting for the glomerular filtration (inside to out): Endothelial cells with fenestra, glomerular basement membrane (GBM), and Visceral epithelial cells (podocytes)
The glucose renal threshold is 160-180mg/dL. This represents the:
a. Concentration of glucose in the vasa-recta
b. Maximum range of glucose reabsorption in the renal tubule
c. Plasma concentration below which glucose is reabsorbed in the urine
d. Plasma level at the commencement of glucose reabsorption in the nephron
B
Threshold substance: almost completely reabsorbed by the renal tubules
except when normal plasma level is exceeded.
Glucose: high threshold substance, appears in urine when plasma
concentration exceeds about 160 to 180 mg/dL
Aldosterone is involved in \_\_\_\_ reabsorption and is released by the \_\_\_\_ of the adrenal cortex a. potassium/zona glomerulosa b. sodium / zona fasiculata c. potassium / zona fasiculata d. Sodium / zona glomerulosa
D
Aldosterone: secreted by the adrenal cortex (zona glomerulosa). Enhances
potassium ions/ sodium ion exchange in distal tubules of nephron. Increased
blood sodium, which in turn increases body water as water follows salt, raising
blood pressure. Release is triggered by angiotensin II, could contribute to
hypertension
The Order of cast degradations:
a. cellular> granular> waxy
b. cellular> hyaline> waxy
c. hyaline> cellular> waxy
d. hyaline>granular>waxy
A
Granular casts result either from the break down of cellular casts, or the
inclusion of aggregates of plasma proteins or immunoglobulin light chains.
Usually indicator of chronic renal disease. granular casts will break down into
waxy casts.
Green Brown urine would be expected to co-exist with physical exam finding:
a. Positive fluid wave test
b. Murphy’s sign
c. Caput medussa
d. Murphy’s punch
B
indicator of cholecystitis. Gallbladder / bile duct obstruction
CASE #1
Roy, a 43 year old sheet metal worked comes into your office with a complaint of
right shoulder pain. The pain has come on the last week and has gotten worse
(started as 3/10 and now is up to 7/10). Exacerbating factors include fatty meals
and alcohol use. Palliative factors include rest and fasting. He presents with
ictarus. he has seen no other doctors for this condition because his wife referred
him to your office. His urine is dark with yellow foam. Given Roy’s complaint and
urinalysis answer questions 6,7,8
Which of the following is suggested by the presence of bilirubin in the urine
a. Glomerulonephritis
b. Pyelonephritis
c. Liver or gallbladder (biliary) disease
d. Nephrosis
C
Icterus is a referral of jaundice which indicates involvement of the liver.
An elevated level of conjugated serum bilirubin implies, liver disease or
cholestatic disease
Direct bilirubin is considered conjugated or water soluble
a. True
b. False
A
normally, no detectable amounts of bilirubin are present in urine.
(in blood) bilirubin + albumin = unconjugated (indirect, non-H2O soluble)
Where does bilirubin come from?
a. breakdown of wbc
b. breakdown of platelets
c. breakdown of hemoglobin
d. all of the above
e. none of the above
C
RBC –> Spleen (lysis) –> hemoglobin is released
globulin, heme –> iron prohrine ring –> billiverdin –> bilirubin
What condition will cause increase urobilinogen?
a. Normal protein metabolism
b. Glomerular disease
c. Gout
d. Hemolytic anemia
D
normally present in low amount, peak level between 2-4 pm. Elevated in Liver
disease, intestinal obstruction, hemolytic anemia, and hemolysis
Martha, a 33 year old mother of four comes into your office with complaint of
numbness and tingling in both her legs. She is overweight. The numbness
(peripheral neuropathy) has been insidious in onset but has been getting
progressively worse. She reports that she seems to be having more urinary
tract infections (microangiopathies) over the last year than her whole life prior
to this year. She reports that she has constant thirst (polydipsia) even though
she drinks upward of 1 gallon of water per day. Answer 10,11,12
What is the diagnosis you would render based upon this urinalysis?
a. pyelonephritis
b. Diabetes insipidus
c. Diabetes mellitus
d. Addison’s disease
C
Ketone bodies can be determined in diabetes mellitus. Glucose is seen in DM
and congenital forms of glucosuria
Where is Martha’s problem?
a. the hypothalamus
b. the posterior pituitary gland
c. the adrenal medulla
d. down regulation of receptors
D
body is no longer sensitive to glucose
Which of the following accounts for ketones in this specimen?
a. By product of incomplete fat metabolism to make Acetyl CoA for Glycolysis
b. By product of protein metabolism to make Acetyl CoA for TCA
c. By product of carbohydrate metabolism to make Acetyl CoA for TCA
d. By product of incomplete fat metabolism to make Acetyl CoA for TCA
D
ketones are produced normally by the liver as part of fatty acid metabolism. in
normal states these ketones will be completely metabolized. if for any reason,
the body cannot get enough glucose for energy it will switch to using body fats,
resulting in a increase production of making them detectable in the blood and
urine
A 30 year old female presents to your office with back pain. She complains of
constant fatigue for a period of 2 months. She also reports more frequent urination
during that time. After an unrewarding physical yields no diagnostic clues, what would
a positive Beta HCG urine test tell you about her symptoms?
a. she has primary amenorrhea
b. these findings are consistent with the cause of the elevation of HCG
c. there is no clinical intervention needed at this time
d. all of the above are correct in this case
D
Renin is released by the _____ cells of the kidney in response to volume _____
a. Zona glomerulosa / overload
b. Zona facculata / depletion
c. Juxtaglomerular / overload
d. Juxtaglomerular / depletion
D
renin, an enzyme produced by the juxtaglomerular cells, is secreted and reacts
with the precursor angiotensinogen in the blood to convert into angiotensin I.
CASE #3
Joe is a 35 year old constriction worker with upper lumbar, lower dorsal pain. He
claims the pain wraps around his flank into his groin. He points out in the patient
history that his medical doctor is always after him to drink more water. He has not
seen his regular doctor because the construction Forman told him to come to your
office. He is an occasional drinker and eats a lot of meat and fast foot. he also
smokes 1-1.5 pack of cigarettes per day. His BMI is 33.
Which of the following is necessary for the formation of crystals that lead to this condition? a. Specific gravity of 1.030 b. Specific gravity of 1.005 c. High pH (above 7) d. Low pH (below 7) e. A and D are correct
E
factors that affect crystal formation is low pH in urine, high solute concentration,
and low kidney filtration rate
Which of the following physical exam producers would you expect to be positive?
a. Murphy’s punch
b. Psoas muscle test
c. Murphy’s sign
d. Presence of caput medusa
A
positive for nephritis. punch performed where the pain is originating
Which of the following is the most likely diagnosis for this patient? a. Gout b. Kidney stones DIAG 2735! Exam 1 c. Gall Stones d. Pheochromocytoma
B
calcium oxalate is an indicator. common in the urinary tract
Which of the following is included in the findings put the patient at risk for the correct diagnosis from question 17? a. smoking b. low pH c. High pH d. Drinking alcohol
D
Where does antidiuretic hormone work in the kidney?
a. Bowman’s capsule
b. Proximal tubule
c. Loop of Henley
d. Cortical collecting tubule and the collecting duct
D
antidiuretic hormone (ADH) aka vasopressin, released from the posterior pituitary
gland (neurohypophysis). regulates absorption of water in the collecting ducts.
make walls of ducts permeable to water. production of ADH is dependent on
body’s state of hydration. Insufficient ADH results in diabetes insipidus
CASE #4
Marco, a 40 year old fisherman, comes into your office with complain of neck pain.
He demonstrates diminished range of motion in all directions and has a positive
cervical compression test. He mentions in passing that lately his urine has been
looking rather red and he is curious about it but not concerned. He reports a sore
throat that went away spontaneously three weeks ago (21 days) . Answer
questions 20,21,22 based upon the urinalysis.
Where in the urinary tract is Marco’s problem?
a. Urethra
b. Bladder
c. Ureters
d. Kidney
D
Rapidly progressive (crescentic) Glomerulonephritis is a syndrome of the kidney disorders characterized by rapid loss of renal function, acute real failure, and death within months
