Week 10

Question 1

70 yr old male admitted with hx of recurrent heart failure and metabolic deraangements, has peripheral edema and metabolic alkalosis
- what drug?

Answer 1

• carbonic anhydrase inhibitor

Question 2

50 yr old buisnessman with hx of frequent episodes of renal colic w/ Ca containing stones. Work up shows high concentration of calcium salts in urine.
What diuretuc would be used?

Answer 2

• thiazide

Question 3

6o yr old businessman with advanced prostate cancer is admitted to the ED with mental obtundation. Electrolyte panel shows high serum calcium.
What diuretic?

Answer 3

• Loop and thiazide

Question 4

Describe method of reducing urine vol in pt with nephrogenic diabetes.

Answer 4

desmopressin- ADH agonist

Question 5

Describe a method for increasing water excretion in syndrome of inappropriate antiduretic hormone secretion

Answer 5

vasopressin/ADH inhibitor

Question 6

70 y/o female in the ICU for renal failure following recent hospitalization for MI. She has a past medical hx of type 2 DM and mild HTN> On examination shhe is lethargic, confused and with mild lower extremity edema.
- what are potential mechanisms of acute renal failure?

Answer 6

• Prerenal: due to decreased blood flow to kidneys (hypoperfusion) from heart failure
• Intrarenal: shift/progression from prerenal etiology
• Postrenal: due to obstruction of urinary tract downstream from kidney

Question 7

Explain the significance of protein and glucose in the urine.
- 2 different mechanisms

Answer 7

• underlying damage –> increase glucose in urine from oversaturated transporters
• most likely due to DM (underlying diabetic nephropathy)
  proteinuria = glomerular damage, possibly podocytes

Question 8

What is the cause of epithelial and pigmented casts in the urine?

Answer 8

• myoglobin or hemoglobin; blood from nearby vessels
• most of the time we will see casts from the epithelial cells sloughing from tubules into urine, especially from acute tubular necrosis

Question 9

How do you calculate FENa

Answer 9

((urine Na x plasma Cr) / (plasma Na x urine Cr)) x 100

Question 10

What is the difference in pH and HCO3 in acute vs chronic respiratory acidosis

Answer 10

• pH and HCO3 is lower in acute

- HCO3 is higher in chronic acidosis because there has been time for compensation

Question 11

two roles of the sacrum

Answer 11

support and reproduction

Question 12

what part of sacrum carries greatest load during normal walking

Answer 12

base

Question 13

How does SI joint change during pregnancy, especially when near full term?

Answer 13

looses, widens laterally, sacrum rotates slightly so that the coccyx clears the vault