Bioscience I - Exam 3

The given statement is false. Acute renal failure is a sudden and temporary loss of kidney function, which can be caused by various factors such as dehydration, medication side effects, or kidney injury. Unlike chronic renal failure, which is a long-term and progressive loss of kidney function, acute renal failure can be reversible with proper treatment and management. Therefore, acute renal failure does not necessarily lead to chronic renal failure.

An increase in ADH secretion will cause the kidneys to reabsorb more water from the urine, resulting in a decrease in urine output. ADH, or antidiuretic hormone, acts on the kidneys to increase their permeability to water, allowing more water to be reabsorbed back into the bloodstream. This leads to a decrease in the volume of urine produced, as more water is conserved by the body.

Ammonia is produced from the deamination of amino acids. Deamination is the process by which the amino group (-NH2) is removed from an amino acid, resulting in the production of ammonia (NH3) as a byproduct. This process occurs primarily in the liver and kidneys. Therefore, the statement "Ammonia is produced from deamination of amino acids" is true.

Nonoliguric acute renal failure refers to a condition where there is a normal or increased urine output of greater than 400 ml/day. This means that the kidneys are still able to produce and excrete a sufficient amount of urine, indicating that there is some level of functioning in the renal system. In contrast, anuric acute renal failure is characterized by a complete absence of urine output, while oliguric acute renal failure is characterized by a significantly reduced urine output. Therefore, the correct answer is nonoliguric, as this type of patient will maintain a urine output greater than 400 ml/day.

The tufts of capillaries in the glomerulus provide a large surface area. This is important because it allows for efficient filtration of blood and the removal of waste products and excess water from the body. By having a large surface area, more blood can be filtered at a time, increasing the efficiency of the filtration process.

Anuric acute renal failure refers to a condition where the patient has no urine output. This means that the kidneys are not producing any urine, leading to a complete absence of urine flow. This can be caused by various factors such as severe damage to the kidneys, obstruction in the urinary tract, or decreased blood flow to the kidneys. Anuric acute renal failure is a serious condition that requires immediate medical attention and intervention to prevent further complications.

In acute Oliguric renal failure, the kidneys are not able to adequately filter waste and excess fluid from the blood, resulting in a significant decrease in urine output. A normal urine output is typically around 1-2 liters per day. Therefore, a patient with acute Oliguric renal failure will have less than 400 ml of urine output per day.

As individuals age, their kidneys may experience a decrease in renal reserve, which refers to the ability of the kidneys to maintain normal function even under stressful conditions. This decreased renal reserve can make older individuals more susceptible to acute renal failure, a condition where the kidneys suddenly lose their ability to filter waste from the blood. Therefore, the statement that the risk for acute renal failure increases with age due to a decreased renal reserve is true.

In order to prevent acute renal failure following a large surgical procedure, it is most important to prevent sustained renal hypoperfusion. This is because sustained renal hypoperfusion, which refers to inadequate blood flow to the kidneys, can lead to ischemia and damage to the renal tissue. Without adequate blood flow, the kidneys are unable to effectively filter waste products and maintain electrolyte balance, leading to renal failure. Therefore, preventing sustained renal hypoperfusion is crucial in preserving kidney function and preventing acute renal failure.

During a cystoscopy procedure, the common peroneal nerve is most likely to be injured, resulting in foot drop and the inability to dorsiflex the right foot. The common peroneal nerve runs along the outer side of the knee and can be susceptible to injury during surgical procedures in this area. Damage to this nerve can lead to weakness or paralysis of the muscles that control foot movement and dorsiflexion.

Acute Renal Failure refers to a sudden inability of the kidneys to adjust urine volume and composition according to the body's homeostatic requirements. This condition can occur due to various factors such as kidney damage, decreased blood flow to the kidneys, or blockage in the urinary tract. It is characterized by a rapid decline in kidney function, leading to an accumulation of waste products and electrolyte imbalances in the body.

Approximately 20-25% of cardiac output flows through the kidneys. This means that a significant amount of blood is delivered to the kidneys, allowing them to perform their vital functions such as filtration, reabsorption, and secretion. The kidneys play a crucial role in maintaining fluid and electrolyte balance, regulating blood pressure, and removing waste products from the body. The percentage of cardiac output directed towards the kidneys highlights their importance in maintaining overall body homeostasis.

Atracurium would be the preferred muscle relaxant for a patient in renal failure because it is primarily metabolized by Hofmann elimination, which does not depend on renal function. This means that it can be safely used in patients with impaired kidney function without the risk of accumulation or prolonged effects. In contrast, Rocuronium, Pancuronium, and Succinylcholine are all eliminated through the kidneys and may have prolonged effects or increased risk of toxicity in patients with renal failure.

The lowest normal hourly urinary output for a patient weighing 80 kg would be 40 ml/hr. This means that the patient should be producing at least 40 milliliters of urine every hour. This is considered the minimum acceptable amount of urine output for a patient of this weight, indicating that their kidneys are functioning properly and adequately removing waste and excess fluid from the body.

Azotemia refers to the retention of nitrogenous waste products in the bloodstream. These waste products, such as urea and creatinine, are normally filtered out by the kidneys and excreted in urine. However, in cases of azotemia, the kidneys are unable to properly filter and eliminate these waste products, leading to their buildup in the blood. This can occur due to kidney dysfunction or damage, and it is often a sign of underlying kidney disease or other medical conditions. Symptoms of azotemia may include decreased urine production and the presence of protein in the urine.

The lithotomy position is not the optimal choice for a CHF (congestive heart failure) patient undergoing urological surgeries. This position involves the patient lying on their back with their legs raised and supported in stirrups. It is commonly used for urological procedures as it provides good access to the pelvic area. However, in a CHF patient, this position can lead to decreased venous return to the heart, increased workload on the heart, and potential fluid overload. Therefore, the lithotomy position is not the optimal choice for a CHF patient undergoing urological surgeries.

In chronic renal failure, the most lethal electrolyte imbalance is associated with high levels of potassium in the blood, known as hyperkalemia. The kidneys play a crucial role in maintaining potassium balance, and when they are not functioning properly, potassium levels can rise to dangerous levels. Hyperkalemia can lead to severe cardiac arrhythmias and even cardiac arrest, making it a potentially life-threatening condition. Therefore, monitoring and managing potassium levels is crucial in patients with chronic renal failure to prevent these complications.

The renal fascia is responsible for adhering the kidneys to the abdominal wall and other internal structures. It is a layer of connective tissue that surrounds and supports the kidneys, helping to keep them in place within the abdominal cavity. The renal fascia also provides protection to the kidneys and helps to maintain their position, preventing excessive movement or displacement.

The correct answer is that renal blood flow will decrease due to a decrease in MAP. In this scenario, the patient is hypotensive with a MAP of 60, which indicates low blood pressure. The kidneys rely on an adequate blood pressure to maintain renal blood flow. When the MAP decreases, it leads to a decrease in perfusion pressure in the kidneys, resulting in reduced renal blood flow. This decrease in renal blood flow can subsequently affect urine output.

Calcium would be most useful to administer in order to increase cardiac output in an ESRF patient. Renal failure can lead to electrolyte imbalances, including low calcium levels. Calcium plays a crucial role in regulating cardiac muscle contraction and maintaining normal heart rhythm. By administering calcium, it can help restore the balance of electrolytes and improve cardiac function, ultimately increasing cardiac output.

Erythropoietin is a hormone that is secreted by the kidneys. It plays a crucial role in the production of red blood cells. When the kidneys detect low oxygen levels in the blood, they release erythropoietin, which stimulates the bone marrow to produce more red blood cells. This hormone helps to maintain the oxygen-carrying capacity of the blood and is essential for proper functioning of the body. Insulin, glucose, and uric acid are not hormones secreted by the kidneys.

Blood is supplied to the glomerulus through a single afferent renal arteriole. The afferent arteriole brings blood into the glomerulus, where it then enters a network of capillaries known as the glomerular capillaries. These capillaries are responsible for filtration of waste products and excess fluid from the blood. After filtration, the blood exits the glomerulus through the efferent arteriole. So, the correct answer is that blood is supplied to the glomerulus through a single afferent renal arteriole.

The correct answer is to give a fluid challenge. A fluid challenge involves administering a bolus of intravenous fluids to assess the patient's response. In this case, the decreased urine output may indicate inadequate fluid volume, which can be addressed by giving a fluid challenge. This intervention will help determine if the low urine output is due to hypovolemia and if additional fluid resuscitation is needed. Monitoring the patient's response to the fluid challenge will guide further interventions if necessary.

Urea is the major product of metabolism excreted by the kidneys. It is formed in the liver through the breakdown of proteins and amino acids. Urea is then transported to the kidneys where it is filtered out of the bloodstream and excreted in urine. This process helps to remove waste products from the body and maintain the balance of nitrogen in the blood. Water, creatinine, and renin are also involved in kidney function, but they are not the major product of metabolism excreted by the kidneys.

A normal creatinine clearance is 110-150 ml/min. This range indicates that the kidneys are functioning properly and able to filter waste products, such as creatinine, from the blood. Creatinine is a waste product produced by muscles and is typically filtered out by the kidneys. A higher clearance rate suggests better kidney function, while a lower rate may indicate impaired kidney function. Therefore, a creatinine clearance of 110-150 ml/min is considered normal and indicates healthy kidney function.

The given answer "All the Above" is correct because the statement "How many costume changes does that dude go through?!" implies that the person in the video, Benny Lava, goes through multiple costume changes. Additionally, the statement "Now poop on them, Oliver!!!" suggests that there is a character named Oliver who is involved in the video. Therefore, both statements are true, making "All the Above" the correct answer.

The major function of the proximal tubule is to reabsorb sodium. This is an important process in the kidneys where sodium is actively transported from the tubule back into the bloodstream. This helps maintain the body's fluid and electrolyte balance. Sodium reabsorption in the proximal tubule is also coupled with the reabsorption of other substances such as glucose, amino acids, and water.

A person with anemia generally has a decrease in their O2 carrying capacity, which means that their blood is not able to carry as much oxygen as it should. In order to compensate for this decrease in oxygen, the body increases its Cardiac Output, which is the amount of blood pumped by the heart per minute. By increasing Cardiac Output, the body can try to deliver more oxygen to the tissues and organs despite the decreased O2 carrying capacity of the blood.

Advanced renal disease will cause a shift to the right in the oxyhemoglobin dissociation curve. This is because renal disease leads to a decrease in the production of erythropoietin, which in turn decreases the production of red blood cells. As a result, there is a decrease in the oxygen-carrying capacity of the blood. This shift to the right indicates that hemoglobin has a decreased affinity for oxygen, making it easier for oxygen to be released to the tissues.

Mannitol may be given to prevent ischemic renal injury. Mannitol is a diuretic that works by increasing urine output, which helps to flush out toxins and prevent the buildup of harmful substances in the kidneys. It also helps to maintain blood flow to the kidneys, reducing the risk of ischemic injury. Lasix is a diuretic that helps to remove excess fluid from the body but does not specifically prevent ischemic renal injury. Calcium chloride is used to treat low calcium levels and does not have a direct role in preventing renal injury. Nephrocaps is a dietary supplement for kidney health and does not have a specific preventive effect on ischemic renal injury.

When ADH output is high, it means that the body is releasing more antidiuretic hormone. This hormone helps to regulate water balance in the body by increasing water reabsorption in the kidneys. As a result, more water is retained in the body and less is excreted in urine. Therefore, urine volume is low. Additionally, because more water is being reabsorbed, the concentration of solutes in the urine increases, leading to a higher urine osmolality.

Tubular reabsorption is characterized by the movement of filtrate back into the blood from the renal tubule. This process occurs in the kidney's nephrons, where substances such as water, glucose, electrolytes, and amino acids are reabsorbed from the renal tubules into the bloodstream. This helps to maintain the body's balance of water and electrolytes, as well as reabsorb important nutrients. Tubular reabsorption is a crucial step in urine formation and plays a vital role in maintaining homeostasis within the body.

If the patient's urine output has not improved despite adequate hydration and a fluid challenge, the next intervention should be to give a dose of 20mg Lasix IV. Lasix, also known as furosemide, is a loop diuretic that can help increase urine output by promoting the excretion of excess fluid and sodium from the body. This intervention may help address the underlying cause of the decreased urine output and improve the patient's condition.

Decreasing respiratory rate would not be useful in managing intra-operative hyperkalemia because it does not directly address the underlying cause of hyperkalemia, which is an excess of potassium in the blood. Decreasing respiratory rate may affect carbon dioxide levels in the body, but it does not directly affect potassium levels. The other options, such as IV infusion of insulin, glucose, and bicarbonate, administration of calcium chloride, and hemodialysis, are all effective in managing hyperkalemia by either promoting the movement of potassium into cells or removing excess potassium from the body.

Loop diuretics such as furosemide work by inhibiting the reabsorption of sodium in the ascending limb of the loop of Henle in the kidney. This prevents the reabsorption of sodium, leading to increased excretion of sodium in the urine. By blocking sodium reabsorption, loop diuretics also cause increased excretion of water, chloride, and other electrolytes. This mechanism of action is what allows loop diuretics to have a potent diuretic effect and help in the treatment of conditions such as edema and hypertension.

Renal derangements refer to abnormalities or dysfunctions in the kidneys. The question asks for the cause of the greatest renal derangements that are readily detectable. The correct answer is "Glomerular function." The glomerulus is a part of the kidney responsible for filtering waste products and excess fluids from the blood. Any abnormalities or dysfunction in the glomerular function can lead to significant renal derangements, such as proteinuria, hematuria, or decreased renal function, which can be easily detected through various tests like urine analysis or blood tests.

During end stage renal failure, approximately 95% of functioning nephrons have been lost. This means that only a small percentage of the nephrons in the kidneys are still functioning properly. This severe loss of nephrons greatly impairs the kidneys' ability to filter waste products and maintain fluid balance in the body. As a result, patients with end stage renal failure often require dialysis or a kidney transplant to survive.

Disequilibrium Syndrome is the most likely explanation for Mr. Henri's symptoms. This condition occurs in dialysis patients and is characterized by neurological symptoms such as confusion and seizures. The low levels of BUN and sodium observed in his labs also support this diagnosis, as they can be indicative of fluid imbalance caused by the dialysis process. Natremic Epilepsy and CVA (stroke) are less likely explanations as they do not align with the symptoms and lab findings described. Hypoxemia, while a possibility, is not as likely as Disequilibrium Syndrome in this case.

During a transurethral resection of the prostate (TURP), regional anesthesia is commonly used. This involves blocking the sensory nerves in the lower part of the body to prevent pain during the procedure. The question asks about the level of sensory blockade needed, and the correct answer is T10. This means that the anesthesia should be effective at least up to the 10th thoracic vertebra. This level is chosen because it covers the sensory innervation of the lower abdomen, pelvis, and perineum, which are the areas involved in the TURP procedure.

Based on the given information, the most likely explanation for Mr. Govino's symptoms is TURP syndrome. TURP syndrome is a potential complication of transurethral resection of the prostate (TURP) procedure, where the absorption of irrigating fluid used during the surgery can lead to fluid overload and electrolyte imbalances. The symptoms of TURP syndrome can include headache, decreased oxygen saturation (as indicated by the decrease in sats from 98 to 92), and potentially other signs such as confusion, visual disturbances, and cardiovascular changes. Therefore, TURP syndrome is the most probable cause of Mr. Govino's symptoms in this scenario.

An increase in GFR (glomerular filtration rate) indicates an increase in the amount of blood being filtered by the kidneys per unit of time. This increased filtration rate would result in a more efficient removal of waste products from the blood, including urea nitrogen (BUN). As a result, there would be a decrease in BUN levels. Creatinine, on the other hand, is a waste product that is not reabsorbed by the kidneys, so an increase in GFR would lead to an increase in creatinine levels. Therefore, the correct answer is a decrease in BUN.

When a person undergoes surgery, especially in the case of a rotator cuff repair, there is a risk of kidney damage due to the use of anesthesia and the stress on the body. Creatinine is a waste product that is normally filtered out by the kidneys. An increase in creatinine levels in the lab results would indicate impaired kidney function, which is a potential complication of surgery. Therefore, it is expected to see an increase in creatinine levels in Mr. Jud's labs.

A patient with a bladder tumor that obstructs urine flow should not receive ESWL at this time because the procedure may cause further obstruction and potentially worsen the patient's condition. ESWL uses shock waves to break down kidney stones, but it may not be suitable for patients with bladder tumors as it can cause complications and hinder urine flow. Therefore, it is not recommended for this patient in order to avoid exacerbating the obstruction caused by the tumor.

The 24 hour creatinine clearance test is the most accurate lab test for assessing overall renal function and glomerular filtration rate (GFR). This test measures the amount of creatinine cleared from the blood by the kidneys over a 24 hour period. Creatinine is a waste product produced by the muscles that is filtered out of the blood by the kidneys. By measuring the amount of creatinine cleared, the test can provide an accurate assessment of how well the kidneys are functioning and the GFR. BUN (blood urea nitrogen) and serum creatinine levels can also provide some information about renal function, but the 24 hour creatinine clearance test is considered more accurate. A renal ultrasound, while useful for evaluating the structure of the kidneys, does not directly assess renal function or GFR.

Shivering is a physiological response to cold temperatures in order to generate heat and maintain body temperature. It involves rapid muscle contractions, which require energy in the form of oxygen. Therefore, shivering increases the body's oxygen consumption. The given answer of 300% suggests that shivering can increase oxygen consumption by three times the normal rate, indicating the significant energy demand of shivering to generate heat.

Isoflurane would be the ideal anesthetic agent for a patient with renal disease. This is because isoflurane has a low potential for renal toxicity compared to other volatile anesthetic agents. It undergoes minimal metabolism in the liver and is primarily eliminated through the lungs, making it a safer option for patients with impaired renal function. Additionally, isoflurane provides good anesthesia depth and rapid onset and recovery, making it suitable for various surgical procedures.

Renal blood flow refers to the amount of blood that passes through the kidneys in a minute. The correct answer of 1200 mL per minute suggests that this is the approximate amount of blood that flows through the kidneys in a minute. This value is within the normal range for renal blood flow, indicating that it is a reasonable estimate.

Hypotension is a common cardiovascular side effect associated with dialysis. During the dialysis process, excess fluid and waste products are removed from the body, which can cause a decrease in blood volume and subsequently lower blood pressure. This can lead to symptoms such as dizziness, lightheadedness, and fainting. Hypotension can occur due to rapid fluid removal, excessive ultrafiltration, or inadequate fluid replacement during dialysis. Monitoring and adjusting fluid levels during dialysis sessions can help prevent and manage hypotension in patients undergoing dialysis.

During extracorporeal shock wave lithotripsy (ESWL), the use of shock waves to break down kidney stones can cause various effects. Muscle relaxation and increased functional residual capacity (FRC) are expected effects of immersion during ESWL. Immersion in water helps in reducing muscle tension and increasing lung capacity. Vasodilation is also an expected effect as it helps in improving blood flow to the targeted area. However, hypoxemia in predisposed patients and hypotension are not expected effects of immersion during ESWL. Hypoxemia refers to low oxygen levels in the blood, which can be a result of impaired lung function or reduced blood flow, while hypotension refers to low blood pressure.

A normal specific gravity for urine is typically around 1.010 to 1.030. A specific gravity of 1.028 falls within this range, indicating that the urine is within the normal range of concentration. Specific gravity measures the density of urine compared to the density of water, and it can provide information about the concentration of solutes in the urine, such as waste products and electrolytes.