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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


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


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


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


The Order of cast degradations:
a. cellular> granular> waxy
b. cellular> hyaline> waxy
c. hyaline> cellular> waxy
d. hyaline>granular>waxy


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


indicator of cholecystitis. Gallbladder / bile duct obstruction


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


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


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


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


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


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


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


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


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



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


renin, an enzyme produced by the juxtaglomerular cells, is secreted and reacts
with the precursor angiotensinogen in the blood to convert into angiotensin I.


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
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


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


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


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



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


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


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


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


What is Marco’s problem?
a. Pyelonephritis
b. Glomerulonephritis
c. Hydronephrosis
d. Diabetes mellitus


acute proliferative (post streptococcal, post infectious) glomerulonephritis
hematuria, oliguria, casts (RBC, and renal epithelial)
an immunopathological condition, manifested by nephritic syndrome, may
arise 14-21 days after exposure to beta-hemolytic group A streptococcus


22.If Marco’s specific gravity is fixed at current level, what does that indicate?
a. That his kidneys are no longer functioning
b. that he is dehydrated
c. that he has diabetes
d. Urinary tract infection



Madison, a 27 year old hairstylist, comes into your office with flank and low back
pain. her orthopedic examination is unrewarding (all negative results). During your
consultation she reports that she occasionally has painful urination and has been
running a low grade fever for about the last week. She denies sexual activity.
Answer questions 23,24,25,26 based upon the following laboratory report

What is Madison’s problem?
a. Pyleonephritis
b. Glomerulonephritis
c. Eating disorder
d. Hematuria


inflammation of kidney associated with bacterial infections. Low fever is sign of
bacterial infection. increased WBC associated


What organism is the most likely bacteria in this specimen?
a. Staph. Saprophyticus
b. E. Coli
c. Helicobacteria Pylori
d. Beta Hemolytic Strep


UTI: bacteria infection (80-85% E.Coli)


Where in the urinary system is Madison’s problem?
a. Ureters
b. Renal Cortex
c. Functional unit of the kidney
d. nonparenchymal cells of the kidney


making its way up from the site of infection. Like was from getting fecal matter
into the urinary tract from improper wiping.


26.At what pH would you expect to find E. Coli in the urine specimen?
a. 6.0
b. 6.5
c. 7.0
d. 7.24


would need an environment about 7.0 to survive


Otto is a 49 year old handyman with headaches. He comes into the Life University
outpatient clinic following a discussion he had at a spinal screening. History
reveals Otto is short of breath often, exercise does not seem to be a factor.
Physical examination reveals generalized edema and ascities. The urinalysis is
provided below. Answer 27 and 28 based on this information

27.Based upon presentation, and laboratory report, what is your diagnosis?
a. Nephritis syndrome (GMN)
b. Nephrotic syndrome
c. Nephrosis
d. Polycystic Kidney disease


clinical syndrome associated with increased permeability of glomeruli for
protein, predominately albumin. signs: heavy proteinuria, generalized edema,
hypoalbumineam, lipidemia, and urinary microscopic gat globules and fatty


Which of the following is possible precursor to Otto’s condition?
a. Pyelonephritis
b. Kidney stones
c. Glomerulonephritis
d. Nephrosis




The problem in an individual, usually an infant, where they cannot metabolize branch
chain amino acids is called?
a. Leschmania
b. Giardiasis
c. Maple Syrup urine disease
d. E. Coli nephrosis


caused by gene defect. patient can’t break down the amino acid leucine,
isoleucine, and valine.


John, a 24 year old cab driver comes to your office with complaints of low back
pain. When you x-ray his spine you notice the vertebrae are shaped like the letter
“H” aka Renoylds sign. John reports that he plays basketball an average of 3
times per week and that he often experiences chest pain when he overexerts and
frequently experiences joint pain. You ask him about his ethnicity and he claims
African descent. Upon questioning you note that he describes his urine as
frequently amber or orange. John urinalysis is provided below. Answer questions
30,21, and 32

What would be the cause of this problem?
a. genetic
b. acquired
c. autoimmune
d. hypercapnia


likely Alport syndrome, kidney disease (glomerulonephritis, clinically
manifested by nephritic syndrome)


What is the cause of increased Urobilingen in the specimen?
a. Increased WBC production
b. Increased RBC production
c. Increased RBC destruction
d. Decreased WBC destruction



What finding on the physical examination are likely to be present on this patient
during percussion of the abdomen?
a. Splenomegaly
b. Hepatomegaly
c. Enlarged abdominal aorta
d. Positive Murphy’s sign
e. A and B



Rosemary comes into your office complaining of neck pain and headache of
insidious onset over the last two months. Physical examination of his vision
reveals bitemporal hemianopsia. Upon questioning the patient she reports
frequent urination up to 20 times per day. Based upon the urinalysis provided
answer questions 33, 34,35

Where is the origin of Rosemary’s problem?
a. In the nephron
b. In the pancreas
c. In the posterior pituitary gland
d. In the cortical collecting tubules


Insufficient ADH results in diabetes insipidus. ADH is produced in posterior


What is Rosemary’s problem?
a. Diabetes Mellitus
b. Diabetes Insipidous
c. Cushing’s disease
d. Addison’s Disease


polyuria, and insufficient ADH, low specific gravity due to frequency


What history and lab values lead to this diagnosis?
a. The high specific gravity and glucose
b. Low specific gravity and polyuria
c. Absence of normal levels of ketones
d. Bitemporal hemianopsia and bilirubin



Marcellus Amos is a 45 year old, marginal neuro-diagnosis and subluxation
theories instructor with complaint of pelvic pain. He reports that he is single,
frequents prostitutes (male and female) he finds on the internet, and that in the
last week he has been noticing several red itchy and somewhat painful bumps
around his groin. He also mentions have this before and it has come and gone
several times, most recently 2 months ago. He notices this occurs more frequently
around final exam time. He reports during history he does not use protection and
has had multiple partners. Based on the urinalysis for Marcus please answer
questions 36, 37, and 38

What is the diagnosis for Mark’s condition?
a. Glomerulonephritis
b. Pyelonephritis
c. Lower urinary tract infection concomitant with a virus
d. Nephrotic syndrome



To what may we attribute Marcus’ problem?
a. Stress
b. Dehydration
c. Glomerulonephritis
d. Venereal disease (STD) / unprotected sex / poor choicesD



With all the symptoms what would you suspect causative agent is and what explains
the periods of exacerbation and remission?
a. syphilis / treponema palladium / reinfection
b. Ghonrrhea / gonococcus / reinfection
c. Herpes / Viral / Dorsal Root Ganglion
d. Trichamonas / lack of treatment


bumpy rash related.


Which of the following is the most common cause of metabolic Alkalosis
a. Vomiting (loss of H+)
b. Tyrosinuria
c. Maple syrup urine disease
d. Phenylketonuria


loss of ions


If a patient has RBC casts, mild to moderate proteinurea, and NO pitting edema you
a. Nephritic syndrome
b. Nephrotic syndrome
c. none
d. i dont care



41.If a patient has Fatty casts and 3.5 or more grams of protein and pitting edema you
would suspect?
a. Nephritic syndrome
b. Nephrotic syndrome
c. none
d. i dont care


associated with fatty casts and pitting edema.


Where is ADH made?
a. Adenohypophysis
b. Nuerohypohysis
c. Posterior pituitary
d. none of the above



Which value would be low in a patient with Gout?
a. Urine uric acid
b. Calcium carbonate
c. Calcium phosphate
d. Tripple phosphate


usually found in patients with Urinary tract infections


Which one of the following would make you suspect GMN in a urine sample?
a. glucose
b. protein
c. fate
d. cystitis


membraneous glomerulonephritis. signs: proteinuria, hematuria, darker urine, edema,
hypertension, oliguria


What is the most Immediate threat to the uncontrolled DM patient?
a. Demyelination of nerve fibers from lack of ATP
b. denaturation of enzymes due to catabolism of fatty acids
c. GMN
d. denaturation of enzymes due to catabolism of glucose
e. Kidney failure


characterized by thickening of the glomerular basement membrane and
leukocyte infiltration. usually presented by nephrotic syndrome, although some
cases by combine nephrotic-nephritic syndromes. immune complexes deposits
are found in the glomeruli. about 50% develop chronic renal failure


CASE #10
Sidney, a 54 year old dentist presents in your office with complaint of low back
pain for 1 weeks duration. He notices that in the last two months he seems to be
losing weight though he is not trying to do so. Please evaluate the provided
urinalysis and answer questions 46, 47, and 48

Ketones in the urine specimen in the absence of glucose tend to be indicative of
which of the following?
a. Diabetes mellitus
b. Diabetes insipidous
c. Starvation or fasting
d. Cushing’s disease



Since the patient is not dieting, which of the following must be a consideration in the
differential list on this patient?
a. Glomerulonephritis
b. cancer
c. cystinuria
d. hydropnephrosis



Which of the following could explain the patient’s laboratory finding if it were included
in the history?
a. Family history of diabetes insipidus
b. Patient is on the Adkins diet
c. Patient is psychotic
d. patient suffers from kidney stones


produces large amounts of ketons and is similar to body starvation


Which condition presents with the inability to metabolize branched chain amino acids
a. Phenoketonuria
b. alkaptonuria
c. maple syrup urine disease
d. homogentensic acid



Elevated HCG levels in the 24 hour urine specimen may indicated which of the
a. Diabetes Mellitus
b. Polycystic kidney disease
c. Pregnancy
d. Pancreatic duct obstruction by tumor or stone