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Med phys lab case studies - renal

Terms in this set (15)

11: A 42 y/o male pt comes to the clinic because of back discomfort (R-flank). He denies dysuria, urgency, nocturia or hematuria.

PE: Temp 98, P 90, RR 17, BP 110/60
HEENT: fundi benign, PERRLA, rest clear
Lungs: clear
Heart: rate regular, no abnormalities
Abdomen: clear
Extremities: no edema or acrocyanosis
Neurological: grossly intact

Which of the following is the most appropriate next step?
A. perform a more thorough physical exam
B. order a lumbar X-ray
C. order an IVP
D. ask if the pt requires analgesics
E. ask the pt to return in 2 weeks for re-evaluation
C. order an IVP
- intravenous pyelogram - shows abnormalities of urinary system including kidney

according to migs, C, D, and E are all acceptable answers

according to Lowy, C is the answer.
12: A 45 y/o female who has had slowly progressive renal failure is concerned about increasing numbness and a prickly sensation in her legs.

Examination reveals a loss of pinprick and vibration sensation below the knees, absent ankle jerks, and impaired pinprick sensation in her hands.

Lab studies, checked during her most recent clinic visit, indicate that the pt has a normocytic normochromic anemia and an elevated serum creatinine concentration of 790 mmol/L.

Which of the following is most likely to be recommended at this time?
A. a therapeutic trial of phenytoin
B. a therapeutic trial of pyridoxine
C. a therapeutic trial of cyanocobalamin
D. initiation of maintenance hemodialysis
E. neurologic referral for nerve conduction studies

1/2
D. initiation of maintenance hemodialysis

Due to serum creatinine being so high, this means urinary creatinine is very low
12: with respect to the pt and her renal failure, which of the following is least likely to be accurate?
A. development of advancing peripheral neuropathy is an indication for dialysis
B. delaying dialysis could allow development of irreversible motor defects
C. the early signs of uremic peripheral neuropathy are motor defects

2/2
C. the early signs of uremic peripheral neuropathy are motor defects

the early signs are SENSORY
- loss of pinprick SENSATION
13: A 29 y/o female presents to your office complaining of symptoms of extreme fatigue, no appetite, and bloody urine. She developed a sore throat 3 weeks ago, but did not have it examined or treated. Her 6 y/o daughter had the same sore throat 1 week before her. Her dr (over the phone) said, "viral infection, mother; do not worry about it". Three days ago she began to note blood in her urine and swelling of her hands and feet, and felt terrible. Her past health has been excellent and there is no family hx of significant illness. Her BP is 170/105mmHg and on examination significant edema of both lower extremities is noted. (BP one yr ago was normal)

What is the most likely diagnosis in this pt at this time?
A. hemorrhagic pyelonephritis
B. IgA nephropathy (Berger's disease)
C. poststreptococcal glomerulonephritis
D. hemorrhagic cystitis
E. membranous glomerulonephritis

1/5
C. poststreptococcal glomerulonephritis

from the URI - spread to glomerulus of kidney
13: which of the following is pathognomonic of the disorder described?
A. macroscopic hematuria
B. microscopic hematuria
C. macroscopic or microscopic hematuria
D. RBC casts
E. protein > 1.0g/24 hr

2/5
D. RBC casts

pathognomonic - specific to a disease

RBC only seen in this disease for nephritic syndromes
13: Approximately 4 weeks after the mother developed her symptoms, the daughter comes down with an illness characterized by swelling erythema and pain in a number of joints; bumps on both of her elbows, significant fatigue, fever, and skin rash. PE also reveals a grade III/IV pan systolic murmur and BP of 100/70mmHg.

Which of the following is the MOST likely diagnosis in the daughter's case?
A. juvenile rheumatoid arthritis
B. still's disease
C. post viral arthritis syndrome
D. rheumatic fever
E. autoimmune complex disease

3/5
D. rheumatic fever

presents like endocarditis
is a complication of untreated strep

disease that affects heart, joints, brain & skin
13: Which of the following statements regarding the prevention of the two conditions (mother's & daughter's) is most accurate?
(assume a 10 d course of penicillin in all choices)
A. The mother's condition is preventable by penicillin but the daughter's is not.
B. The daughter's condition is preventable by penicillin but the mother's is not.
C. Both the mother and daughter's conditions are preventable by penicillin.
D. Neither the mother nor daughter's conditions are preventable by penicillin.
E. prevention is variable with both conditions; penicillin can prevent both but it may also not prevent either.

4/5
C. Both the mother and daughter's conditions are preventable by penicillin.

penicillin can be used to treat rheumatic fever as well as poststreptococcal glomerulonephritis
13: which of the following is the treatment of choice for the condition described in the MOTHER?
A. penicillin
B. gentamicin
C. prednisone
D. all of the above
E. none of the above

5/5
E. none of the above

poststreptococcal glomerulonephritis is SELF-LIMITING, meaning it will go away on its own without treatment

penicillin is not wrong, but it does not treat the glomerulonephritis, just the strep.

prednisone is a steroid, which is not super effective
14: A 27 y/o female with a PMH of spina bifida presents to the ER with a 4 d hx of fever, chills, and bilateral CVA pain. She has an indwelling urinary catheter and describes to you "at least 12 of these episodes before this current one." She has been seeing the same family physician since birth and has been diagnosed as having "nervous bladder and kidney syndrome." He has prescribed her some OTC "kidney pills" in the past for these symptoms. She tells you that they "never really worked" and she has often found herself bed bound with symptoms for several weeks before the fever broke. You are the PA on shift in the ED and are somewhat skeptical about the nervous bladder and kidney syndrome.

On PE, pt is flushed. Temp 40C and she has intermittent shaking rigors. Shows CVA tenderness bilaterally and her abdomen is somewhat tender to palpation. Blood in the catheter bag.

Which of the following is the most likely diagnosis in this pt?
A. nervous bladder and kidney syndrome
B. acute hemorrhagic cystitis
C. acute urethritis
D. acute pyelonephritis
E. SBBSS

1/7
D. acute pyelonephritis

CVA tenderness & fever - immediately think of kidney infection
14: which of the following best describes the organism responsible for the above?
A. gram + coccus
B. gram + rod
C. anaerobic organism
D. fungal organism
E. gram - organism

2/7
E. gram - organism

most likely E. coli because she self catheterizes because of the spina bifida

gram + coccus = strep or staph
gram + rod = food borne illness
14: which of the following bacteria would NOT be a highly probable cause of this problem?
A. pseudomonas sp
B. klebsiella pneumoniae
C. enterobacter
D. group A beta-hemolytic streptococcus
E. proteus

3/7
D. group a beta-hemolytic strep

this would cause infection of the tonsils
- is a gram + coccus

klebsiella is rare to see, more probable in lung, but could be seen
14: the pt urine has been sent out for a urinalysis as well as for culture and sensitivity.

following the urinalysis and a urine specimen for C and S, which of the following would be considered the most appropriate treatment for the pt?
A. OTC urostat
B. ciprofloxacin 500mg tid po (outpatient)
C. septa DS two tabs bid po (outpatient)
D. IV fluoroquinolone (inpatient)
E. PO bactrim DS BID PO x 5d (outpatient)

4/7
D. IV fluoroquinolone (inpatient)

works faster - prevents infection of kidney to go into the blood

inpatient because of the severity
14: If this pt were to be experiencing a simple cystitis, which of the following symptoms is LEAST likely to be elicited on hx?
A. CVA tenderness
B. dysuria
C. frequency
D. hematuria
E. suprapubic tenderness

5/7
A. CVA tenderness

no CVA tenderness if just bladder infection (cystitis) - only CVA tenderness if the infection moves to the kidney
14: which of the following investigations should be performed on this pt, at this time? (acute pyelo pt)
A. serum BUN/creatinine
B. renal ultrasound
C. blood cultures
D. CBC & diff
E. all of the above

6/7
E. all of the above

all good work ups for an acute pyelo pt
14: which of the following is an inappropriate recommendation for a pt with calcium oxalate nephrolithiasis?
A. reduce intake of high-oxalate foods such as tea, spinach, nuts and chocolates
B. thiazide diuretics for refractory stone formers
C. reduce intake of high-calcium foods such as milk, ice cream
D. increase water intake

7/7
C. reduce intake of high-calcium foods such as milk, ice cream

no need - inappropriate recommendation

others will reduce stone formation, or prevent more from occurring
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