Block 14 Uti Glomerulonephritis Renal Fx Test
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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
Correct Answer
D. DExplanation
The most likely causative agent for the urinary tract infection in this 26-year-old female is a gram-negative rod that ferments glucose and lactose, reduces nitrate to nitrite, and does not produce urease. This is because option D is the only choice that fits all of these characteristics. Gram-negative rods are commonly associated with urinary tract infections, and the ability to ferment glucose and lactose helps identify the specific bacteria involved. The reduction of nitrate to nitrite is a characteristic of many urinary tract pathogens, and the absence of urease production helps differentiate between different types of bacteria.Rate this question:
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- 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
Correct Answer
B. Abstinence from intercourseExplanation
Abstinence from intercourse would surely reduce future recurrences of E. coli urinary infection. This is because the infection is likely being caused by the introduction of bacteria from the urethra into the urinary tract during sexual activity. By abstaining from intercourse, the woman can prevent the introduction of bacteria and reduce the risk of infection.Rate this question:
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- 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
Correct Answer
A. Chlamydia trachomatisExplanation
The most likely causative agent for the symptoms described is Chlamydia trachomatis. Chlamydia is a common sexually transmitted infection that can cause urethritis, leading to frequent and painful urination. The presence of white cells and absence of organisms on Gram stain is consistent with Chlamydia infection, as it is an intracellular bacterium that cannot be visualized using this staining method. Enterococcus faecalis, Escherichia coli, Proteus vulgaris, and Staphylococcus saprophyticus are not typically associated with this type of presentation.Rate this question:
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- 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
Correct Answer
D. A small obligate intracellular pathogenExplanation
The correct answer, "A small obligate intracellular pathogen," suggests that the causative agent being described is a small microorganism that can only survive and replicate inside host cells. This implies that the agent is likely a virus or an intracellular bacterium, as these types of pathogens are known to be obligate intracellular parasites. The other answer choices do not provide information about the agent's intracellular nature or pathogenicity.Rate this question:
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- 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
Correct Answer
B. NitriteExplanation
The test for nitrite will be negative if the agent causing the symptoms is Staphylococcus saprophyticus. Nitrite is produced by certain bacteria in the urinary tract when they convert nitrate to nitrite. However, Staphylococcus saprophyticus does not possess the enzyme required for this conversion, so the nitrite test will be negative. The other tests, such as catalase, culture, and leukocyte esterase, may still be positive in the presence of Staphylococcus saprophyticus infection.Rate this question:
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- 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
Correct Answer
E. UreaseExplanation
When Proteus infections cause kidney stones, it is due to the production of urease. Urease is an enzyme produced by Proteus bacteria that breaks down urea into ammonia and carbon dioxide. The ammonia produced raises the pH of the urine, making it more alkaline. This alkaline environment promotes the formation of kidney stones, specifically struvite stones, which are composed of magnesium ammonium phosphate. The presence of urease allows Proteus bacteria to survive and thrive in the urinary tract, leading to the formation of these stones.Rate this question:
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- 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
Correct Answer
C. Fimbrial M proteinExplanation
Fimbrial M protein appears to identify strains of Group A streptococcus which are most likely nephritogenic. This protein is found on the surface of the bacteria and is known to play a role in adherence to host cells and evasion of the immune system. Nephritis is often associated with an immune response to Group A streptococcus, and the presence of fimbrial M protein may contribute to the development of this condition.Rate this question:
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- 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
Correct Answer
B. MyoglobinuriaExplanation
The patient's complaint of passing dark-reddish urine, along with the presence of myoglobin in the urine (positive dipstick test for blood but no RBCs on microscopic examination), and the history of intense exercise after a period of inactivity, suggests the most likely etiology is myoglobinuria. Myoglobin is a protein found in muscle tissue, and its release into the bloodstream and subsequent excretion in the urine can occur after muscle injury or strenuous exercise. This can lead to the discoloration of urine. Hemolyzed blood in the urine would typically show RBCs on microscopic examination. Ingestion of foods with red dye would not cause positive dipstick test for blood. Nephrolithiasis would typically present with other symptoms such as flank pain.Rate this question:
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- 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
Correct Answer
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
Correct Answer
E. Malignant hypertensionExplanation
The most likely underlying cause of chronic renal failure in this patient is malignant hypertension. Malignant hypertension is characterized by severely elevated blood pressure, which can lead to damage in small renal arteries. The "onion-skinning" and fibrinoid necrosis observed in the renal biopsy are consistent with the pathologic changes seen in malignant hypertension. The patient's obesity, smoking history, and left ventricular hypertrophy are also risk factors associated with malignant hypertension. Additionally, the high hematocrit, hemoglobin, serum cholesterol, BUN, and serum creatinine levels further support the diagnosis of malignant hypertension.Rate this question:
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- 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
Correct Answer
C. C -
- 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
Correct Answer
A. BUN, serum and urine creatinine, urinalysis, and 24 hour urine proteinExplanation
The most helpful tests in establishing a diagnosis of renal failure are BUN (blood urea nitrogen), serum and urine creatinine, urinalysis, and 24-hour urine protein. BUN and creatinine levels are commonly used to assess kidney function, as elevated levels indicate impaired kidney function. Urinalysis can provide information about the presence of blood, protein, and other abnormalities in the urine. 24-hour urine protein measurement helps to assess the severity of proteinuria, which is a common finding in renal failure. These tests together can help in confirming the diagnosis of renal failure and determining the extent of kidney damage.Rate this question:
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- 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
Correct Answer
A. CystitisExplanation
The most likely diagnosis in this case is cystitis. Cystitis is an infection of the bladder, which can cause symptoms such as increased frequency, urgency, and pain during urination. The presence of bacteriuria, pyuria, and hematuria on urinalysis further supports this diagnosis. The suprapubic tenderness observed during the physical exam is also consistent with cystitis. Urethritis, pyelonephritis, and vaginitis are less likely as they do not typically present with all of the symptoms and findings described in the case.Rate this question:
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- 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
Correct Answer
C. CExplanation
Given the patient's symptoms and physical exam findings, along with the elevated BUN, creatinine, and proteinuria, the most likely diagnosis is acute glomerulonephritis. In acute glomerulonephritis, the urine sediment typically shows red blood cells (hematuria), red cell casts, and proteinuria. Therefore, on microscopic examination of the urine, one would expect to see red blood cells and red cell casts.Rate this question:
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.JPG "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 )")
.JPG "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:")
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