Question

1. Martha’s first patient on the pediatric floor is a 12-year oldboy named Sam who is undergoing kidney dialysis treatment. Sam hasbeen on dialysis for the last week, and the treatments willprobably be discontinued because his kidneys are becoming fullyfunctional again. Martha questions Sam’s mother concerning hisillness. Three weeks ago, Sam had a sore throat, which kept himhome from school for two days but was not medically treated. Oneweek ago, Sam told his mother his urine looked red-brown and foamy.He was admitted to the hospital. Physical exam revealedcostovertebral tenderness and blood pressure of 135/90. Theurinalysis and other studies revealed the following:

Color: red-brown tinged
Specific gravity: 1.030
RBC’s: numerous RBC’s per high powered field
Protein: > 1g/24 hr
Casts: epithelial cells and RBC’s
BUN: 90 mg/dl
Creatinine: 4mg/dl
Creatine Clearance Test: 50 ml/min


a. What is your diagnosis?
i. Glomerulonephritis
ii. Cystitis
iii. Urinary obstruction
iv. Pyelitis

b. The etiology would be a(n):
i. Virus
ii. Bacteria
iii. Genetic or developmental anomaly
iv. Anatomic malfunction after birth


2. Fred suffers from chronic emphysema. His arterial blood gasresults are as follows: pH 7.30; bicarbonate 32 mEq/l; PCO2 50 mmHg. Which of the following best describe Fred’s condition?
a. Metabolic acidosis with respiratory compensation
b. Respiratory acidosis with metabolic compensation
c. Metabolic alkalosis with respiratory compensation
d. Respiratory alkalosis with metabolic compensation

3. Hypocalcaemia may develop in a patient with which of thefollowing conditions?
a. Chronic renal failure
b. Hyperparathyroidism
c. Thiazide therapy
d. Vitamin D overdose

4. Which of the following conditions would cause prerenalfailure?
a. Nephrotoxicity
b. Glomerulonephritis
c. Acute tubular necrosis
d. Hypovolemia

5. Abnormal serum laboratory findings common to patients with acuterenal failure are:
a. Increased potassium and BUN; decreased creatinine
b. Increased potassium and creatinine; decreased BUN
c. Decreased potassium; increased BUN and creatinine
d. Increased potassium, BUN and creatinine

6. In the diuretic phase of acute tubular necrosis (ATN), theclinician must be alert for which of the followingcomplications?
a. Fluid overload
b. Hypokalemia
c. Hypertension
d. Hypernatremia

7. The primary acid-base disorder associated with renal failureis:
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

8. Patients with acute renal failure may have all of the followingcomplications EXCEPT:
a. Peaked T wave EKG and pericarditis
b. Sinus tachycardia and ST elevation
c. Heart failure and Friction rub
d. Mitral insufficiency and Mobitz type II heart block

9. A patient’s glomerular filtration rate can be measure byevaluating:
a. Serum creatinine
b. Blood urea nitrogen
c. Serum osmolarity
d. Creatinine clearance

10. A patient taking medication that acts to block or inhibit theaction of aldosterone would:
a. Have high blood potassium levels
b. Have high blood sodium levels
c. Have high levels of circulating aldosterone
d. A, B, and C
e. A and C only

11. A patient exhibits the following signs and symptoms: Elevatedblood pressure, elevated blood glucose, muscle weakness, poor woundhealing, red cheeks, thin arms and legs with fat deposits in thetrunk, neck and face. The patient findings are consistentwith:
a. Addison’s Disease
b. Myxedema
c. Cushing’s disease or long-term high dose steroid use
d. Grave’s disease
e. Pheochoromocytoma

12. The MOST dramatic functional change that occurs in theendocrine system due to aging is
a. A decrease in blood and tissue concentrations of ADH andTSH
b. And overall decrease in circulating levels of mosthormones.
c. A decline in the concentration of reproductive hormones
d. And increase in the secretion of glucocortioids