Quiz 38: Alterations of Renal and Urinary Tract Function
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1. How does progressive nephrons injury affect angiotensin II activity?
a. Angiotensin II activity is decreased.
b. It is elevated.
c. Angiotensin II activity is totally suppressed.
d. It is not affected.
2. Which mineral accounts for the most common type of renal stone?
a. Magnesium-ammonium-phosphate c. Calcium oxalate
b. Uric acid d. Magnesium phosphate
3. Regarding the formation of renal calculi, what function does pyrophosphate, potassium citrate, and magnesium perform?
a. They inhibit crystal growth.
b. Pyrophosphate, potassium citrate, and magnesium stimulate the supersaturation of salt.
c. They facilitate the precipitation of salts from a liquid to a solid state.
d. Pyrophosphate, potassium citrate, and magnesium enhance crystallization of salt crystals to form stones.
4. Hypercalciuria is primarily attributable to which alteration?
a. Defective renal calcium reabsorption
b. Intestinal hyperabsorption of dietary calcium
c. Bone demineralization caused by prolonged immobilization
5. Detrusor hyperreflexia develops from neurologic disorders that originate where?
a. Spinal cord between C2 and S1 c. Above the pontine micturition center
b. Spinal cord between S2 and S4 d. Below the cauda equina
6. Considering the innervation of the circular muscles of the bladder neck, which classification of drug is used to treat bladder neck obstruction?
a. -Adrenergic blocking medications c. Parasympathomimetic medications
b. -Adrenergic blocking medications d. Anticholinesterase medications
7. Renal cell carcinoma, classified as clear cell tumors, arises from epithelial cells in which structure?
a. Proximal tubule c. Nephron
b. Distal tubule d. Glomerulus
8. Bladder cancer is associated with the gene mutation of which gene?
b. Human epidermal growth factor receptor 2 (HER2)
9. What is the most common cause of uncomplicated urinary tract infections?
a. Staphylococcus c. Proteus
b. Klebsiella d. Escherichia coli
10. Which differentiating sign is required to make the diagnosis of pyelonephritis from that of cystitis?
a. Difficulty starting the stream of urine
b. Spasmodic pain that radiates to the groin
c. Increased glomerular filtration rate
d. Urinalysis confirmation of white blood cell casts
11. Considering host defense mechanisms, which element in the urine is bacteriostatic?
a. High pH (alkaline urine) c. High glucose
b. High urea d. High calcium
12. Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?
a. Confusion and poorly localized abdominal discomfort
b. Dysuria, frequency, and suprapubic pain
c. Hematuria and flank pain
d. Pyuria, urgency, and frequency
13. Pyelonephritis is usually caused by which type of organism?
a. Bacteria c. Viruses
b. Fungi d. Parasites
14. Which abnormal laboratory value is found in glomerular disorders?
a. Elevated creatinine concentration c. Elevated immunoglobulin A (IgA)
b. Low blood urea nitrogen (BUN) d. Low serum complement
15. Which glomerular lesion is characterized by thickening of the glomerular capillary wall with immune deposition of immunoglobulin G (IgG) and C3?
a. Proliferative c. Mesangial
b. Membranous d. Crescentic
16. Goodpasture syndrome is an example of which of the following?
a. Antiglomerular basement membrane disease
b. Acute glomerulonephritis
c. Chronic glomerulonephritis
d. Immunoglobulin A (IgA) nephropathy
17. A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence of which disorder?
a. Cystitis c. Glomerulonephritis
b. Chronic pyelonephritis d. Nephrotic syndrome
18. Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder?
a. Nephrotic syndrome c. Chronic glomerulonephritis
b. Acute glomerulonephritis d. Pyelonephritis
19. Which antibiotics are considered “major culprits” in causing nephrotoxic acute tubular necrosis (ATN)?
a. Penicillin and ampicillin c. Gentamicin and tobramycin
b. Vancomycin and bacitracin d. Cefazolin and cefepime
20. Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?
a. Urine sodium >30 mEq/L
b. Urine osmolality >500 mOsm
c. Fractional excretion of sodium (FENa) <1% d. Urine sediment has no cells, some hyaline casts 21. How are glucose and insulin used to treat hyperkalemia associated with acute renal failure? a. Glucose has an osmotic effect, which attracts water and sodium, resulting in more dilute blood and a lower potassium concentration. b. When insulin transports glucose into the cell, it also carries potassium with it. c. Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell. d. Increasing insulin causes ketoacidosis, which causes potassium to move into the cell in exchange for hydrogen. 22. Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue? a. Nervous system c. Muscle b. Kidneys d. Liver 23. Which statement is false concerning the skeletal alterations caused by chronic renal failure when the glomerular filtration rate (GFR) declines to 25% of normal? a. Parathyroid hormone is no longer effective in maintaining serum phosphate levels. b. The parathyroid gland is no longer able to secrete sufficient parathyroid hormone. c. The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium, is impaired. d. The synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone, is impaired. 24. Anemia of chronic renal failure can be successfully treated with which element? a. Intrinsic factor c. Vitamin D b. Vitamin B12 d. Erythropoietin 25. When the right kidney is obstructed, how will the glomeruli and tubules in the left kidney compensate? a. Increase in number c. Develop collateral circulation b. Increase in size d. Increase speed of production 26. What medical term is used to identify a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder? a. Neurogenic bladder c. Necrotic bladder b. Obstructed bladder d. Retrograde bladder MULTIPLE RESPONSE 27. In glomerulonephritis, what damages the epithelial cells resulting in proteinuria? (Select all that apply.) a. Ischemia b. Lysosomal enzymes c. Compression from edema d. Activated complement e. Altered membrane permeability 28. Which statements are true concerning struvite stones? (Select all that apply.) a. They are more common in women than in men. b. Struvite stones are associated with chronic laxative use in women. c. They grow large and branch into a staghorn configuration in renal pelvis and calyces. d. Struvite stones are closely associated with urinary tract infections caused by urease-producing bacteria, such as Pseudomonas. e. They are more common in men than in women. 29. Which statements are true regarding renal colic? (Select all that apply.) a. Renal colic results in mild-to-moderate pain. b. Pain originates in the flank area. c. Renal colic indicates the presence of renal stones. d. Pain radiated to the groin. e. Renal colic indicates obstruction of the renal pelvis or proximal ureter. 30. Which conditions related to the bladder would result from the effects of lesions of the sacral segments below S1? (Select all that apply.) a. Frequency b. Urge incontinence c. Bladder distension d. Urgency e. Urinary retention 31. What are considered risk factors for developing bladder and kidney cancers? (Select all that apply.) a. Cigarette smoking b. Hypertension c. Exposure to aniline dyes d. Below normal body weight e. Male gender 32. Which renal disorders are considered causes of intrarenal renal failure? (Select all that apply.) a. Acute glomerulonephritis b. Allograft rejection c. Tumors d. Acute tubular necrosis (ATN) e. Prostatic hypertrophy 33. Prerenal injury from poor perfusion can result from which condition? (Select all that apply.) a. Bilateral ureteral obstruction b. Renal vasoconstriction c. Renal artery thrombosis d. Hemorrhage e. Hypotension MATCHING Match the predisposing factors causing pyelonephritis to the pathology mechanism. ______ A. Kidney stones ______ B. Vesicoureteral reflux ______ C. Pregnancy ______ D. Neurogenic bladder ______ E. Female sexual trauma 34. Movement of organisms from the urethra into the bladder with infection and retrograde spread to the kidney 35. Dilation and relaxation of the ureter with hydroureter and hydronephrosis 36. Impairment to the bladder, interfering with normal bladder contraction and causing residual urine and ascending infection 37. Obstruction and stasis of urine, contributing to bacteremia and hydronephrosis; irritation of epithelial lining with entrapment of bacteria 38. Chronic reflux of urine up the ureter and into the kidney during micturition, contributing to bacterial infection