patho review

Question 1

1. Osteoporosis commonly occurs in patients with end-stage renal disease because of

Answer 1

Hyperparathyroidism.

Question 2

2. Which of the following categories doesn’t belong to the intrarenal disorders?

Answer 2

Belongs to Intrarenal Disorders:
* Congenital
* Neoplastic
* Infectious
* Obstructive
* Glomerular

Question 3

3. This test identifies gross abnormalities related to size, position, and shape (may show renal calculi).

Answer 3

KUB Xray ( Kidney, ureter and bladder)

Question 4

4. Which is incorrect about autosomal recessive forms of cystic kidney disease?

Answer 4

Cystic kidney diseases
Autosomal recessive forms
Ø Evident at birth
Ø Kidneys enlarged
Ø Respiratory distress or palpable kidneys on physical examination
Ø Severe systemic hypertension
Ø Liver problems
Ø Diagnosis: inheritance pattern with liver biopsy

Question 5

5. Which is false about Nephroblastoma (Wilms’ tumor)?

Answer 5

Nephroblastoma (Wilms’ tumor)
* Most common kidney cancer in children
* Clinical manifestations: identified by palpable abdominal mass; may also have abdominal pain, hypertension, and/or hematuria
* Treatment: nephrectomy, radiation therapy, and chemotherapy
* Excellent cure rate

Question 6

6. The following are normal protective mechanisms against infection in the Urinary tract, except.

Answer 6

Normal protective mechanisms against infection
Ø Acidic pH
Ø Presence of urea in the urine
Ø Men: bacteriostatic prostatic secretions
Ø Women: glands in the distal urethra secrete mucus
Ø Micturition: wash out pathogens
Ø Unidirectional urine flow, prevents reflux

Question 7

7. Which is incorrect about Acute pyelonephritis?

Answer 7

Acute pyelonephritis
* Infection of renal pelvis/parenchyma usually from ascending UTI
* Major risk factor: pregnancy
* Clinical manifestations: CVA tenderness (classic sign) accompanied by fever, chills, N/V, anorexia, which increases fever-induced dehydration
* Urosepsis: organisms in the bloodstream originating from a UTI
* Diagnosis: presence of WBC casts indicative of upper UTI
* Treatment: promptly managed with antimicrobials to avoid decreased renal function

Question 8

8. Which is incorrect about the consequences of complete obstruction in the Kidney?

Answer 8

Consequences:
Ø Hydronephrosis
Ø Decreased GFR
Ø Ischemic kidney damage because of increased intraluminal pressure
Ø Acute tubular necrosis (intrarenal acute renal failure)
Ø Chronic kidney disease

Question 9

9. Which is false about IgA nephropathy (Berger disease)

Answer 9

TRUE:
Ø Most commonly diagnosed
Ø Common in adults
Ø Upper respiratory or gastrointestinal viral infections
Ø Hematuria presents in 1 to 2 days
Ø Prognosis: variable, may progress to end-stage renal disease

Question 10

10. Which is false about Chronic glomerulonephritis?

Answer 10

TRUE:
* Assumes a progressive course ultimately developing into end-stage renal disease
o Sclerosis and fibrosis of kidney
* Present with persistent proteinuria, with or without hematuria, and slowly declining renal function
* Dialysis or kidney transplantation necessary

Question 11

11. Which is false about Nephrotic syndrome?

Answer 11

• Occurs because of increased glomerular permeability to proteins
• Urinary loss of 3 to 3.5 g of protein per day
• Proteinuria leads to hypoalbuminemia and generalized edema; decreased blood colloid oncotic pressure.
• Increase in liver activity can cause hyperlipidemia and hypercoagulability.
• Most common finding: edema
• Treatment: conservative symptom management
• Lipid-lowering agents
• Steroids
• Antihypertensives
• Management of underlying process when identified
• May resolve spontaneously, others progress to end-stage renal disease

Question 12

12. Which is false about Minimal change disease (MCD)?

Answer 12

• Previously called lipoid nephrosis
• Alteration in glomerular podocytes
• Sudden onset of edema, nephrotic levels of protein loss, and hypoalbuminemia
• Responds well to corticosteroids

Question 13

13. Concerning the Stages of chronic kidney disease, which is false?

Question 13

14. The most frequent initial symptom of bladder cancer is

Answer 13

Hematuria

Question 14

19. A ureterocele is

Answer 14

a cystic dilation of a ureter

Question 14

16. Urinary retention with consistent or intermittent dribbling of urine is called

Answer 14

Overflowing Incontinence

Question 14

18. A patient who has difficulty walking without assistance is incontinent of urine when help doesn’t get to her quickly enough. The term for this type of incontinence is

Answer 14

Functional

Question 14

20. Which group is at the highest risk for urinary tract infection?

Answer 14

Active sexually woman

Question 14

21. The difference between stress incontinence and urge incontinence is that stress incontinence

Answer 14

is caused by a pelvic floor muscle problem, whereas urge incontinence is caused by a problem with the detrusor muscle.

Question 15

17. The direct cause of stress incontinence is

Answer 15

Pelvic Muscle Weakness

Question 15

15. A patient has ureteral colic. The manifestation that requires immediate notification of the physician is

Answer 15

chills and fever.

Question 15

23. The following are complications of Chronic Kidney Disease, except;

Answer 15

Complications:
* Hypertension and cardiovascular disease
* Uremic syndrome
* Metabolic acidosis
* Electrolyte imbalances
* Bone and mineral disorders
* Malnutrition
* Anemia
* Pain
* Depression

Question 16

22. The normal post-void residual urine in the bladder is

Answer 16

less than 100 mL.

Question 17

24. About the management of Malnutrition in Chronic kidney disease, which of the following is incorrect?

Answer 17

Ø Calories, vitamins, calcium increased
Ø Sufficient carbohydrate and fat to meet energy requirements
Ø Limit dietary phosphorus, protein, sodium, potassium, and water/fluids depending on laboratory values and other clinical manifestations
Ø Limit diet factors that could increase cardiovascular risk
Ø Involving a dietitian is crucial.

Question 18

25. Which is incorrect about Peritoneal dyalisis?

Answer 18

Correct: Ø Peritoneum serves as the dialyzing membrane Ø Access: dialysis catheter surgically placed in abdomen Ø Types: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) * CAPD: exchanges performed by patients in their homes and without machines; instills in abdomen * CCPD: can also be done at home; uses a special machine (cycler); exchanges occur while sleeping

Question 19

26. Absence of menstruation is called

Answer 19

Amenorrhea

Question 20

27. Dysfunctional uterine bleeding (DUB) is due to

Answer 20

absent or diminished levels of progesterone.

Question 21

28. It is true that fibrocystic breast disease

Answer 21

may be exacerbated by methylxanthines

Question 22

29. A breast lump that is painless, hard, and unmoving is most likely

Answer 22

Carcinoma

Question 23

30. The HPV vaccine is recommended for 11- to 12-year-old girls but can be administered to girls as young as _____ years of age.

Answer 23

9

Question 24

31. The most common types of uterine tumors are known as

Answer 24

Leiomyomas (benign fibroid tumors)

Question 25

32. About Transplantation related to chronic kidney disease, which is false?

Answer 25

TRUE: Ø Potential option for patients with ESRD Ø Associated with a high degree of success Ø Allows for increased independence Ø Return to normal activities of daily living Ø Normal renal function Ø Antirejection drug therapy required: immunosuppressants

Question 26

33. Which is false about Chronic kidney disease in older adults?

Answer 26

TRUE: * Majority of patients diagnosed with CKD are older adults. * Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. * Dialysis for elderly is becoming worldwide. * Comorbid conditions of this population require complex care.

Question 27

34. Which is false about the diagnosis of Micropenis?

Answer 27

Ø Evaluate endocrine abnormalities Ø Measure serum testosterone, luteinizing hormone, and follicle-stimulating hormone Ø Prader-Willi syndrome and Kallmann syndrome (hypothalamic-pituitary axis) Ø Klinefelter syndrome (testicular disorder)

Question 28

35. Which is false about the Urethral Valve Abnormalities?

Answer 28

* Majority of abnormalities occur posteriorly and in distal prostatic urethra. * Common cause of urinary obstruction in male newborns and infants * Valves are mucosal folds that resemble thin membranes. * Valves cause obstruction when child attempts to void.

Question 29

36. The Clinical manifestations of Urethral Valve Abnormalities include all the following except ;

Answer 29

Ø Intrauterine renal failure causing: * Oligohydramnios (decreased amniotic fluid) * Pulmonary hypoplasia (incomplete lung development) * Stillbirth or extreme distress at the time of birth * Inability to void (normally void within 24 hours of birth) * Abdominal masses, such as palpable bladder or hydronephrotic kidneys * Varying degrees of azotemia or renal failure * Urinary ascites (extravasated urine in the peritoneum) * Floating bowel on x-ray

Question 30

37. All are secondary causes of erectile dysfunction, except

Answer 30

* Peripheral vascular disease: arterial insufficiency from obstruction, atherosclerosis, stenosis of arteries, vascular endothelial damage * Endocrine problems: diabetes, pituitary dysfunction (↓ luteinizing hormone, ↓ testosterone, ↑ prolactin) * Medications: antihypertensives, antihistamines, phenothiazines, some antidepressants * Trauma: penile fractures, pelvic fractures * Iatrogenic causes: aortoiliac vascular surgery, radical pelvic cancer surgery * Psychological causes

Question 31

38. Which false about the etiology of neoplasms of the Penis?

Answer 31

* Rare in the United States: <0.2% cancer cases * Phimosis resulting from chronic inflammation most common cause * Extremely low incidence in circumcised men * 97% squamous cell CA of the glans or inner surface of the foreskin * Metastasis occurs by lymphatic dissemination. * Four stages progressing in severity

Question 32

39. Which is false about Hypogonadism

Answer 32

* Incidence: 4 to 5 million * Cause: primary testicular failure * Androgen deficiency in the aging male (ADAM) or andropause o Causes erectile dysfunction (ED), loss of muscle tone, osteoporosis, and lipid metabolism changes * Diagnosis: serum testosterone level * Treatment: replace testosterone

Question 33

40. The ________ Inflammation of testis from trauma, reflux of sterile urine up the vas deferens or secondary to a bacterial infection

Answer 33

Epididymitis