Block 14 Uti Glomerulonephritis Renal Fx Test

14 Questions | Total Attempts: 585

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Block 14 Uti Glomerulonephritis Renal Fx Test

CTL Week 8 - Urinary tract infections; renal tests; glomerulonephritis CTL Week 8 - Urinalysis and other tests for renal function


Questions and Answers
  • 1. 
    A 26-year-old female, married for 4 years, presents with her first urinary tract infection. What are the characteristics of the most likely causative agent? Choice Gram Reaction Morphology Ferments glucose Ferments lactose Reduces nitrate to nitrite Produces urease A positive cocci in clusters     no no B negative rods yes no yes yes C positive cocci in chains     no no D negative rods yes yes yes No E negative rods yes yes no no
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

  • 2. 
    A 30-year-old married woman came to the clinic with dysuria, urinary frequency, and back pain. The urine showed a positive dipstick for leukocyte esterase and grew > 105 E. coli. This was her 3rd episode of E. coli urinary infection in the past year.  What change in health/habits would surely reduce future recurrences?
    • A. 

      Use of a diaphragm or spermicide for contraception

    • B. 

      Abstinence from intercourse

    • C. 

      Drinking cranberry juice

    • D. 

      Getting pregnant

  • 3. 
    An 18 year-old develops frequent and painful urination and a mucopurulent discharge.  He is newly sexually active. A rapid diagnostic test indicates that there are white cells present but no organism is seen on Gram stain of the discharge. What is the most likely causative agent?
    • A. 

      Chlamydia trachomatis

    • B. 

      Enterococcus faecalis

    • C. 

      Escherichia coli

    • D. 

      Proteus vulgaris

    • E. 

      Staphylcoccus saprophyticus

  • 4. 
    How would you describe the above causative agent?
    • A. 

      A Gram nonstaining organism which produces a urease and requires a medium containing cholesterol

    • B. 

      A Gram negative bacterium that utilizes glucose but not lactose, reduces nitrate to nitrite without urease production.

    • C. 

      A Gram negative bacterium that utilizes glucose but not lactose, reduces nitrate to nitrite and produces urease.

    • D. 

      A small obligate intracellular pathogen

    • E. 

      A catalase-positive agent which will not reduce nitrates

  • 5. 
    A 15 year-old woman presents with urinary urgency and frequency with burning on urination. If the agent is Staphylococcus saprophyticus, which test will be negative?
    • A. 

      Catalase

    • B. 

      Nitrite

    • C. 

      Culture

    • D. 

      Leukocyte esterase

  • 6. 
    When Proteus infections cause kidney stones, it is due to the production of
    • A. 

      Coagulase

    • B. 

      Leukocyte esterase

    • C. 

      Sorbitol fermentation

    • D. 

      Nitrate reductase

    • E. 

      Urease

  • 7. 
    Which of these streptococcal markers appears to identify strains of Group A streptococcus which are most likely nephritogenic?
    • A. 

      Cell wall teichoic acids

    • B. 

      Endotoxin

    • C. 

      Fimbrial M protein

    • D. 

      Flagella

    • E. 

      Group A cell wall carbohydrate

  • 8. 
    A 41-year-old Caucasian man presents to his family physician with complaint of passing dark-reddish urine. He states that yesterday he played squash four hours in a row which was the first time he had exercised in six months. He awoke this morning with sore muscles and discolored urine. Physical examination is unremarkable. The urine is reddish-brown in color, dipstick test for blood is positive, the pH is 5.1, and the specific gravity is 1.030. Microscopic examination of the urinary sediment reveals no RBCs. What is the most likely etiology for this presentation?
    • A. 

      Hemolyzed blood in the urine

    • B. 

      Myoglobinuria

    • C. 

      Ingestion of foods that contained red dye

    • D. 

      Nephrolithiasis

  • 9. 
    A 47-year-old Caucasian male visits his family physician with complains of diminished visual acuity and headache. On questioning, the patient reports an approximately one-year history of polyuria and polydipsia. Physical examination reveals an obese man with blood pressure of 165/95 mm Hg. Laboratory investigations reveal blood glucose of 220mg/dL, serum creatinine of 1.9 mg/dL, serum albumin of 3.1 g/dL and proteinuria of 1.8 g/day. Which of the following images represents the most likely renal changes which can be found in this patient? (The slide shown in image C is stained with Picro-Mallory: RBCs – orange, fibrin – red, and collagen – blue.)
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 10. 
    A 45-year-old man undergoes renal biopsy for evaluation of chronic renal failure. The patient is obese (BMI = 37 kg/m2) and admits to smoking 2 packs per day for 30 years. Physical examination reveals a blood pressure of 190/110 mm Hg. An echocardiogram shows conspicuous left ventricular hypertrophy. A renal biopsy discloses pathologic changes in small renal arteries, including “onion-skinning” and fibrinoid necrosis. The Congo red stain is negative. Laboratory studies show hematocrit of 40%, hemoglobin of 18.7 g/dL, serum cholesterol of 250 mg/dL, BUN of 45 mg/dL, and serum creatinine of 5.5 mg/dL. Which of the following is the most likely underlying cause of chronic renal failure in this patient?
    • A. 

      Amyloid nephropathy

    • B. 

      Chronic pyelonephritis

    • C. 

      Congestive heart failure

    • D. 

      Cushing syndrome

    • E. 

      Malignant hypertension

  • 11. 
    The above patient was begun on Cefuroxime in the hospital.  He now has a BUN of 30 mg/dL (normal, 8-18 mg/dL) and a serum creatinine of 3.0 mg/dL (normal, 0.17-0.5 mg/dL).  His Urinalysis shows 2+ WBC’s. Which of the following would one find on microscopic evaluation of this urine? (See attached images )
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

  • 12. 
    During your internal medicine rotation you are asked to order laboratory test on a patient with suspected renal failure.  Which of the following tests are most helpful in establishing your diagnosis?
    • A. 

      BUN, serum and urine creatinine, urinalysis, and 24 hour urine protein

    • B. 

      BUN, serum and urine creatine, urinalysis, and 24 hour urine protein

    • C. 

      BUN, serum creatinine and protein, urinalysis, and albumin

    • D. 

      BUN, serum and urine creatinine, serum total protein, and albumin

  • 13. 
    A 25 year old woman complains of increased frequency, urgency and pain when urinating, a week after her honeymoon.  Physical exam reveals suprapubic tenderness.  Urinalysis reveals bacteriuria (>105-6 bacterial colonies per 1mL of cultured urine), pyuria (WBCs in urine) and significant hematuria. No casts were seen on microscopic examination. What is the most likely diagnosis?
    • A. 

      Cystitis

    • B. 

      Urethritis

    • C. 

      Pyelonephritis

    • D. 

      Vaginitis

  • 14. 
    A 36 year old woman complains of shortness of breath for one week.  Past history is significant for a “sore throat” one month ago.  Physical exam shows 2+ pedal edema, BP 170/98, lungs with bilateral basal crackles, and a respiratory rate of 22 breaths/min.  BUN is 40 mg/dL and creatinine is 4.0 mg/dL.  Her urine dipstick show 3+ protein.  On microscopic examination of her urine, one would expect to see:
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

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