ADVANCED PATHOPHYSIOLOGY EXAM 4 NEWEST 2024 ACTUAL EXAM 100 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+

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ADVANCED PATHOPHYSIOLOGY EXAM 4

NEWEST 2024 ACTUAL EXAM 100 QUESTIONS

AND CORRECT DETAILED ANSWERS WITH

RATIONALES (VERIFIED ANSWERS) |ALREADY

GRADED A+

1. Acute unilateral renal obstruction and hypertension.

a. What amount of cardiac output to kidneys require?

i. at least 20-25?rdiac output – MAP

b. What does reduced perfusion of kidneys cause? (2)

i. Activation of the renin-angiotensin-aldosterone system (RAAS)

ii. constriction of peripheral arterioles

c. What is the most common type of renal stone?

i. Calcium oxalate

d. Passage of kidney stones can be extremely painful - what may they produce? Why?

i. “referred pain” to umbilicus area

ii. due to the sensory innervation of the upper part of the ureter arising from the 10th thoracic

nerve roots.

2. Urinary tract infections:

a. What are the two common clinical manifestations of a urinary tract infection in an older

adult?

i. confusion and poorly localized abdominal discomfort

b. Why can they be very difficult to diagnose?

i. due to vague symptoms.

3. Pyelonephritis

a. What is pyelonephritis?

i. An infection of one or both upper urinary tracts (ureter, renal pelvis, and kidney

interstitium)

b. What are the two most common underlying risk factors to pyleonphritis?

i. Urinary obstruction and reflux of urine from the bladder (vesicoureteral reflux)

c. Name 3 microorganisms usually associated with acute pyelonephritis:

i. E. coli

ii. Proteus

iii. Pseudomonas

d. How do pyelonephritis associated microorganisms increase the risk of stone formation?

i. They split urea into ammonia, making alkaline urine

4. Painful bladder syndrome/interstitial cystitis

a. What does PBS/IC include?

i. nonbacterial infectious cystitis (viral, mycobacterial, chlamydial, fungal)

ii. noninfectious cystitis (radiation, chemical, autoimmune, hypersensitivity)

b. What is the cause of PBS/IC?

i. The exact cause is unknown, but an autoimmune reaction may be responsible for the

inflammatory response

c. What 4 autoimmune reactions are included in the inflammatory response in PBS/IC?

i. Mast cell activation

ii. altered epithelial permeability

iii. Neuroinflammation

iv. increased sensory nerve sensitivity.

d. What is difficult when looking at s/s of cystitis and pyelonephritis?

i. Differentiating symptoms by clinical assessment alone

e. How is the specific diagnosis is established?

i. urine culture

ii. Urinalysis

iii. Clinical signs and symptoms

f. What indicates pyelonephritis, but are not always present in the urine?

i. White blood cell casts

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5. Glomerular disorders

a. What is reduced GFR during glomerular disease is evidenced by? (3)

i. elevated plasma urea

ii. creatinine concentration

iii. reduced renal creatinine clearance

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6. Acute glomerulonephritis

a. What does acute glomerulonephritis include?

i. renal diseases in which glomerular inflammation is caused by immune mechanisms that

damage the glomerular capillary filtration membrane

b. What parts of the glomerular capillary filtration membrane can be damaged in acute

glomerulonephritis?

i. Endothelium

ii. basement membrane

iii. epithelium (podocytes)

c. What are the classic symptoms of acute glomerulonephritis?

i. Sudden onset of hematuria including red blood cell casts and proteinuria (milder than

nephrotic syndrome

ii. In more severe cases, these symptoms are also accompanied by edema, hypertension,

and impaired renal function.

7. Nephrotic syndrome

a. What is seen in nephrotic system? (4)

i. The excretion of 3.0 g or more of protein (massive proteinuria) in the urine per day

ii. hypoalbuminemia (less than 3.0 g/dl)

iii. Hyperlipidemia

iv. peripheral edema

b. What is nephrotic syndrome the characteristic of?

i. glomerular injury

c. What are the [rimary causes of nephrotic syndrome?

i. minimal change disease (lipoid nephrosis)

ii. membranous glomerulonephritis

iii. focal segmental glomerulosclerosis

d. Where do secondary forms of nephrotic syndrome occur? (3)

i. systemic diseases including diabetes mellitus, amyloidosis, and systemic lupus

erythematosus

e. Where is Nephrotic syndrome also is seen with? (4)

i. certain drugs, infections, malignancies, and vascular disorders.

8. Acute Kidney injury

a. What do we know about the progression of AKI? (2)

i. Can be acute and rapidly progressive (within hours)

ii. the process may be reversible

b. What do we know about chronic kidney failure?

i. Can progress slowly into end-stage kidney failure over a period of months or years

c. What does Renal insufficiency refers to?

i. a decline in renal function to about 25% of normal or an eGFR of 25 to 30 ml/minute.

d. What is eGFR is extremely useful in?

i. Determining improvement or decline in kidney function!!)

e. What do you see (lab wise) in renal insufficiency?

i. Levels of serum creatinine and urea are mildly elevated.

f. Changes in serum creatinine level occur only if more than % of glomerular filtration is

lost and are often delayed by more than hours?

i. 50 ,24

g. What does diagnostic delays make more difficult? What does this contribute to (2)?

i. The implementation of early therapy - contributing to disease progression and mortality.

h. What are renal insufficiency patients prone to? (4)

i. Hyperkalemia

i. metabolic acidosis

ii. Hyperphosphatemia

iii. Fluid retention which may cause edema

i. What may you see with those in cardiac disease r/t renal insufficiency?

i. Symptoms of congestive heart failure develop in persons with cardiac disease. Nausea,

vomiting, and fatigue accompany uremia and electrolyte imbalances. Wound healing is

delayed, and the risk of infection, particularly pneumonia, is greater.

j. What does AKI commonly result from?

i. extracellular volume depletion and decreased renal blood flow

ii. toxic/inflammatory injury to kidney cells that result in alterations in renal function that may

be minimal or severe