Question

1. Martha’s first patienton the pediatric floor is a 12-year old boy named Sam who isundergoing kidney dialysis treatment. Sam has been on dialysis forthe last week, and the treatments will probably be discontinuedbecause his kidneys are becoming fully functional again. Marthaquestions Sam’s mother concerning his illness. Three weeks ago,Sam had a sore throat, which kept him home from school for two daysbut was not medically treated. One week ago, Sam told his motherhis urine looked red-brown and foamy. He was admitted to thehospital. Physical exam revealed costovertebral tenderness andblood pressure of 135/90. The urinalysis and other studies revealedthe following:

Color: red-brown tinged
Specific gravity: 1.030
RBC’s: numerous RBC’s per high poweredfield
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 yourdiagnosis?
i. Glomerulonephritis
ii. Cystitis
iii. Urinary obstruction
iv. Pyelitis

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


2. Fred suffers from chronic emphysema.His arterial blood gas results are as follows: pH 7.30; bicarbonate32 mEq/l; PCO2 50 mm Hg. Which of the following best describeFred’s condition?
a. Metabolic acidosis with respiratorycompensation
b. Respiratory acidosis with metaboliccompensation
c. Metabolic alkalosis with respiratorycompensation
d. Respiratory alkalosis with metaboliccompensation

3. Hypocalcaemia may develop in a patientwith which of the following conditions?
a. Chronic renal failure
b. Hyperparathyroidism
c. Thiazide therapy
d. Vitamin D overdose

4. Which of the following conditions wouldcause prerenal failure?
a. Nephrotoxicity
b. Glomerulonephritis
c. Acute tubular necrosis
d. Hypovolemia

5. Abnormal serum laboratory findingscommon to patients with acute renal failureare:
a. Increased potassium and BUN; decreasedcreatinine
b. Increased potassium and creatinine; decreasedBUN
c. Decreased potassium; increased BUN andcreatinine
d. Increased potassium, BUN andcreatinine

6. In the diuretic phase of acute tubularnecrosis (ATN), the clinician must be alert for which ofthe following complications?
a. Fluid overload
b. Hypokalemia
c. Hypertension
d. Hypernatremia

7. The primary acid-base disorderassociated with renal failure is:
a. Respiratory acidosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Metabolic alkalosis

8. Patients with acute renal failure mayhave all of the following complicationsEXCEPT:
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 heartblock

9. A patient’s glomerular filtrationrate can be measure by evaluating:
a. Serum creatinine
b. Blood urea nitrogen
c. Serum osmolarity
d. Creatinine clearance

10. A patient taking medication that actsto block or inhibit the action of aldosteronewould:
a. Have high blood potassium levels
b. Have high blood sodium levels
c. Have high levels of circulatingaldosterone
d. A, B, and C
e. A and C only

11. A patient exhibits the following signsand symptoms: Elevated blood pressure, elevated blood glucose,muscle weakness, poor wound healing, red cheeks, thin arms and legswith fat deposits in the trunk, neck and face. The patient findingsare consistent with:
a. Addison’s Disease
b. Myxedema
c. Cushing’s disease or long-term high dosesteroid use
d. Grave’s disease
e. Pheochoromocytoma

12. The MOST dramatic functional changethat occurs in the endocrine system due to agingis
a. A decrease in blood and tissue concentrationsof ADH and TSH
b. And overall decrease in circulating levels ofmost hormones.
c. A decline in the concentration of reproductivehormones
d. And increase in the secretion ofglucocortioids