Nokea
Acute kidney injury from postrenal etiology is caused by
- A. obstruction of the flow of urine.
- B. conditions that interfere with renal perfusion.
- C. hypovolemia or decreased cardiac output.
- D. conditions that act directly on functioning kidney tissue
Correct Answer: A
Rationale: The correct answer is A because acute kidney injury from postrenal etiology is caused by obstruction of the flow of urine, leading to back pressure and damage to the kidneys. Choices B and C relate to prerenal causes, affecting renal perfusion and volume status. Choice D refers to intrinsic renal causes, directly affecting kidney tissue function, not postrenal obstruction. Therefore, A is correct due to the nature of postrenal etiology.
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Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.)
- A. ADH deficiency
- B. ADH excess
- C. ADH insensitivity
- D. ADH replacement therapy
Correct Answer: A
Rationale: The correct answer is A: ADH deficiency. Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH), leading to excessive urine production and thirst. ADH is responsible for regulating water reabsorption in the kidneys. When ADH levels are low or absent, the kidneys cannot concentrate urine effectively, resulting in excessive urine output.
Explanation for why other choices are incorrect:
B: ADH excess would not lead to diabetes insipidus, as it would result in increased water reabsorption and concentrated urine.
C: ADH insensitivity refers to a condition where the body does not respond to ADH, but it does not cause diabetes insipidus.
D: ADH replacement therapy is actually a treatment for diabetes insipidus, not a mechanism for its development.
A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
- A. He will go into adrenal crisis.
- B. He will go into thyroid storm.
- C. His autoimmune disease will go into remission.
- D. Nothing; it is appropriate to stop the medication for 3 days.
Correct Answer: A
Rationale: The correct answer is A: He will go into adrenal crisis.
Rationale:
1. Glucocorticoids suppress the body's natural production of cortisol.
2. Abruptly stopping high-dose glucocorticoid therapy can lead to adrenal insufficiency.
3. Adrenal crisis can result in symptoms like weakness, fatigue, hypotension, and potentially life-threatening consequences.
4. This patient, being on high-dose glucocorticoid therapy, is at risk for adrenal crisis if he abruptly stops the medication.
Summary:
B: Thyroid storm is not related to abruptly stopping glucocorticoid therapy.
C: Autoimmune disease remission is unlikely to occur within 3 days of stopping medication.
D: It is not appropriate to stop high-dose glucocorticoid therapy abruptly, as it can lead to adverse effects like adrenal crisis.
The term used to describe an increase in blood urea nitrogen (BUN) and serum creatinine is
- A. oliguria.
- B. azotemia.
- C. acute kidney injury.
- D. prerenal disease.
Correct Answer: B
Rationale: The correct answer is B: azotemia. Azotemia refers to elevated levels of nitrogenous waste products like BUN and creatinine in the blood. This occurs when the kidneys are not functioning properly, leading to decreased filtration and excretion of waste products. Oliguria (A) is reduced urine output, not specific to elevated BUN and creatinine levels. Acute kidney injury (C) is a broader term for sudden loss of kidney function. Prerenal disease (D) typically refers to conditions affecting blood flow to the kidneys, leading to decreased kidney function, but it does not specifically describe the increase in BUN and creatinine levels.
Peritoneal dialysis is different from hemodialysis in that peritoneal dialysis
- A. is more frequently used for acute kidney injury.
- B. uses the patient’s own semipermeable membrane (peritoneal membrane).
- C. is not useful in cases of drug overdose or electrolyte imbalance.
- D. is not indicated in cases of water intoxication.
Correct Answer: B
Rationale: The correct answer is B because peritoneal dialysis uses the patient's own semipermeable membrane, the peritoneal membrane, to filter waste and excess fluid from the blood. This membrane allows for the exchange of fluids and solutes, making it an effective method for dialysis.
A is incorrect because peritoneal dialysis can be used for acute kidney injury.
C is incorrect as peritoneal dialysis can address drug overdose and electrolyte imbalance by removing toxins and balancing electrolytes.
D is incorrect as peritoneal dialysis can be used in cases of water intoxication by helping to remove excess fluid from the body.
Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?
- A. Blood glucose >1000 mg/dL
- B. Negative ketones in the urine
- C. Normal anion gap
- D. pH 7.24
Correct Answer: A
Rationale: The correct answer is A (Blood glucose >1000 mg/dL) because diabetic ketoacidosis is characterized by severe hyperglycemia. High blood glucose levels (>1000 mg/dL) are common due to insulin deficiency leading to increased glucose production.
B: Negative ketones in the urine would be incorrect as DKA results in ketone production, leading to ketonuria.
C: Normal anion gap would be incorrect as DKA typically presents with an elevated anion gap metabolic acidosis due to ketone accumulation.
D: pH 7.24 would be incorrect as DKA would present with a lower pH due to metabolic acidosis.