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Pathophysiology The Biologic Basis for Disease 7th Edition Huether McCance Test Bank

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Pathophysiology The Biologic Basis for Disease 7th Edition Huether McCance Test Bank

ISBN-13: 978-0323088541

ISBN-10: 0323088546

 

Description

Pathophysiology The Biologic Basis for Disease 7th Edition Huether McCance Test Bank

ISBN-13: 978-0323088541

ISBN-10: 0323088546

 

 

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Chapter 39: Alterations of Renal and Urinary Tract Function in Children

 

MULTIPLE CHOICE

 

  1. The functional kidney is associated with which embryonic organ?
a. Metanephros c. Pronephros
b. Mesonephros d. Endonephros

 

 

ANS:  A

The functional kidney is associated with the metanephros. The kidney develops from three sets of structures: the pronephros (nonfunctional by the end of the embryonic period), mesonephros (nonfunctional), and metanephros (the functional kidney). Endonephros is not relevant to this process.

 

PTS:   1                    REF:   Pages 1376-1377 | Figure 39-1

 

  1. When does urine formation and excretion begin?
a. At birth c. By 6 months’ gestation
b. By 3 months’ gestation d. By 8 months’ gestation

 

 

ANS:  B

Urine formation and excretion begin by the third month of gestation.

 

PTS:   1                    REF:   Page 1377

 

  1. Compared with an adult, an infant has a greater content of extracellular fluid, as well as a greater rate of fluid exchange. What effect does this have on the fluid balance of a child compared with that of an adult?
a. Edema development is less of a problem.
b. Overhydration is not difficult to manage.
c. Daily fluid requirements are greater.
d. The control of dehydration is more difficult.

 

 

ANS:  D

An infant not only has a greater content of extracellular fluid, but infants also have a greater rate of fluid exchange. The adult takes in and excretes approximately 2000 ml of water daily, representing 5% of the total body fluid and 14% of the extracellular fluid. In contrast, the infant’s daily exchange of 600 to 700 ml of water represents 290% of the total body fluid or nearly 50% of the extracellular volume, making control of dehydration and overhydration more difficult. This fact makes the other options incorrect.

 

PTS:   1                    REF:   Page 1378

 

  1. What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis?
a. Hypospadias c. Hyperspadias
b. Epispadias d. Chordee

 

 

ANS:  A

Hypospadias is a congenital condition in which the urethral meatus is located on the ventral side or undersurface of the penis. This is the only term used for this condition.

 

PTS:   1                    REF:   Page 1378

 

  1. What initiates inflammation in acute poststreptococcal glomerulonephritis?
a. Lysosomal enzymes
b. Endotoxins from Streptococcus
c. Immune complexes
d. Immunoglobulin E (IgE)–mediated response

 

 

ANS:  C

The immune complexes initiate inflammation and glomerular injury in acute poststreptococcal glomerulonephritis. Antigen-antibody complexes are deposited in the glomerulus, or the antigen may be trapped within the glomerulus and immune complexes formed in situ. The other options are not involved in initiating inflammation in this situation.

 

PTS:   1                    REF:   Page 1381

 

  1. Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria?
a. Staphylococcus aureus c. Pseudomonas aeruginosa
b. Streptococcus d. Haemophilus

 

 

ANS:  B

AGN may be accompanied by a positive throat or skin culture for Streptococcus. AGN is not associated with any of the other options.

 

PTS:   1                    REF:   Page 1382

 

  1. What is the cause of smoky, brown-colored urine resulting from acute poststreptococcal glomerulonephritis?
a. Presence of red blood cells c. Slough from the collecting tubules
b. Presence of urobilinogen d. Protein in the urine

 

 

ANS:  A

The urine is usually smoky brown or cola-colored because of the presence of red blood cells. The other options are not correct statements regarding this condition.

 

PTS:   1                    REF:   Pages 1381-1382

 

  1. In immunoglobulin G (IgG) nephropathies such as glomerulonephritis, IgG is deposited in which location?
a. Juxtamedullary nephrons
b. Glomerulus basement membranes
c. Mesangium of the glomerular capillaries
d. Parietal epithelium

 

 

ANS:  B

Glomerulonephritis develops with the deposition of antigen-antibody complexes (IgG, immunoglobulin A [IgA], and C3 complement) in the glomerulus, or the antigen may be trapped within the glomerulus and immune complexes formed in situ. Immunofluorescence microscopy shows lumpy deposits of IgG and C3 complement on the glomerular basement membrane (see Figure 39-5). When considering IgG nephropathies, the only location of the IgG immunoglobulins is the correct option.

 

PTS:   1                    REF:   Page 1381

 

  1. What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic-uremic syndrome (HUS)?
a. Immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen, and remnants are excreted through the kidneys.
b. Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells.
c. Endotoxins from E. coli block the erythropoietin produced by the kidneys, which reduces the number of erythrocytes produced by the bone marrow.
d. Failure of the nephron to filter urea increases the blood urea nitrogen, which binds to erythrocytes that are subsequently destroyed by the spleen.

 

 

ANS:  B

In HUS, verotoxin from E. coli is absorbed from the intestines, the glomerular arterioles become swollen, and these narrowed vessels damage erythrocytes as they pass through. HUS is responsible for causing a cascade of effects, including lysis of glomerular capillary endothelial cells. The other options are not relevant.

 

PTS:   1                    REF:   Page 1383

 

  1. What is the first indication of nephrotic syndrome in children?
a. Periorbital edema c. Frothy urine
b. Scrotal or labial edema d. Ascites

 

 

ANS:  A

Onset of nephritic syndrome is insidious, with periorbital edema as the first sign of the disorder. None of the other options represent the first indication of nephritic syndrome in children.

 

PTS:   1                    REF:   Page 1384

 

  1. Bacteria gain access to the female urinary tract by which means?
a. Systemic blood that is filtered through the kidney
b. Bacteria traveling from the lymph adjacent to the bladder and kidneys
c. Bacteria ascending the urethra into the bladder
d. Colonization of the bladder when urine is static

 

 

ANS:  C

Urinary tract infections (UTIs) in girls occur as a result of perineal bacteria, especially Escherichia coli, ascending the urethra. None of the other options represent the means by which bacteria gain access to the female urinary tract.

 

PTS:   1                    REF:   Page 1386

 

  1. What causes vesicoureteral reflux to occur in children?
a. Children do not ask for help in urinating in a timely manner, and urine is forced up into the ureters.
b. The submucosal segment of a child’s ureter is short, making the antireflux mechanism inefficient.
c. The trigone lying between the opening to the ureters and the urethra is underdeveloped in children.
d. As the bladder fills in infants and children, it pulls the smooth lining of the transitional epithelium away from the ureters, making the reflux valves ineffective.

 

 

ANS:  B

Although reflux is considered abnormal at any age, the shortness of the submucosal segment of the ureter during infancy and childhood renders the antireflux mechanism relatively inefficient and delicate. The other options are not considered reasons for this reflux.

 

PTS:   1                    REF:   Page 1387

 

  1. What is the mechanism for developing Wilms tumor?
a. The development of a Wilms tumor involves tumor-suppressor genes located on chromosome 11.
b. Development involves an autosomal dominant inherited disorder involving the Y chromosome.
c. Wilms tumor is an autoimmune disorder.
d. The development of a Wilms tumor is a congenital anomaly.

 

 

ANS:  A

Wilms tumor–suppressor genes WT1 and WT 2 are located on chromosome 11. The other options are not considered relevant to the development of a Wilms tumor.

 

PTS:   1                    REF:   Pages 1385-1386

 

  1. Which anomaly is often associated with Wilms tumor?
a. Renal anaplasia c. Anemia
b. Aniridia d. Hypothyroidism

 

 

ANS:  B

Aniridia (lack of an iris in the eye) is an anomaly often associated with Wilms tumor. Approximately 10% of children who have Wilms tumor also have a loss of other important genes and therefore have a number of congenital anomalies. The other anomalies listed are not associated with a Wilms tumor.

 

PTS:   1                    REF:   Pages 1385-1386

 

  1. Which statement is false about the causes of enuresis?
a. A maturational lag may cause enuresis.
b. Enuresis may be related to increased light sleep.
c. Obstructive sleep apnea may be a symptom of enuresis.
d. Excessive nocturnal levels of vasopressin may cause enuresis.

 

 

ANS:  D

Children who do not have the normal nocturnal elevation of vasopressin produce a higher volume of urine with a lower osmolality. The other options are accurate statements regarding enuresis.

 

PTS:   1                    REF:   Pages 1388-1389

 

  1. When does an individual have their full complement of renal nephrons?
a. At birth c. At puberty
b. At 6 months of age d. Between the ages 18 and 21 years

 

 

ANS:  A

All the nephrons are present at birth, and their number does not increase as the kidney grows and matures.

 

PTS:   1                    REF:   Pages 1376-1377

 

MULTIPLE RESPONSE

 

  1. Which statements are true regarding the narrow chemical safety margin that infants demonstrate? (Select all that apply.)
a. The immaturity of tubules may diminish the response to antidiuretic hormone (ADH).
b. An immature tubular transport capacity impairs the excretion of potassium.
c. An immature tubular transport capacity impairs the reabsorption of bicarbonate.
d. The immaturity of tubules may diminish the response to aldosterone.
e. The safety margin begins to expand after 2 years of age.

 

 

ANS:  A, B, C, E

Because of a high hydrogen ion concentration, a limited ability to regulate the internal environment, and a lowered osmotic pressure, the infant’s renal system has a narrow chemical safety margin. The immaturity and smaller surface area of the tubules also may diminish the water reabsorption response to ADH. An immature tubular transport capacity means that the ability to excrete a potassium load, reabsorb bicarbonate, or buffer hydrogen with ammonia does not become efficient until approximately 2 years of age.

 

PTS:   1                    REF:   Page 1378

 

  1. The excretion of urea is low in infants because of which feature? (Select all that apply.)
a. Medullary nephrons with comparatively short loops at this stage of development
b. Immature tubular transport capacity, impairing the excretion of urea
c. High anabolic state
d. Dilute urine as a result of the immaturity of an infant’s glomeruli
e. Available protein used for physical growth

 

 

ANS:  C, E

Urea excretion is low in infants primarily because infants are in a high anabolic state and use their protein for growth. The other options are not involved in their low urea excretion.

 

PTS:   1                    REF:   Page 1378

 

  1. Which factors are involved in the development of hypospadias? (Select all that apply.)
a. Disruption in male hormones, including testosterone
b. Mutation of gene HP-1 (chromosome 16)
c. 5a-reductase mutations
d. Hormones administered for in vitro fertilization
e. Advanced maternal age

 

 

ANS:  A, C, D, E

The cause of hypospadias is multifactorial and related to disruptions in male hormones, including testosterone biosynthesis defects, 5a-reductase mutations, hormones administered for in vitro fertilization, advanced maternal age, and other environmental factors. A mutation of gene HP-1 (chromosome 16) is not relevant.

 

PTS:   1                    REF:   Page 1378

 

  1. Which cells of the inflammatory process are found in acute poststreptococcal glomerulonephritis? (Select all that apply.)
a. Immunoglobulin G (IgG)
b. Immunoglobulin A (IgA)
c. Complement C3
d. Immunoglobulin E (IgE)
e. Immune complexes

 

 

ANS:  A, B, C, E

Antigen-antibody complexes of IgG, IgA, and C3 complement are deposited in the glomerulus, or the antigen may be trapped within the glomerulus and immune complexes formed in situ. IgE is not relevant to this situation.

 

PTS:   1                    REF:   Page 1381

 

  1. Which symptoms are considered part of the nephrotic syndrome in children? (Select all that apply.)
a. Proteinuria
b. Pyuria
c. Hyperlipidemia
d. Edema
e. Hypoalbuminemia

 

 

ANS:  A, C, D, E

Nephrotic syndrome is a term used to describe a symptom complex characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Pyuria is not observed in this condition.

 

PTS:   1                    REF:   Page 1383

 

  1. Which statements are true regarding hemolytic uremic syndrome (HUS)? (Select all that apply.)
a. Microangiopathic hemolytic anemia characterizes HUS.
b. Thrombocytopenia is a comorbid condition.
c. Wilms tumors are often the trigger for HUS.
d. HUS is the most common community-acquired cause of acute renal failure in young children.
e. HUS is chronic in nature.

 

 

ANS:  A, B, D

HUS is an acute disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia and is the most common community-acquired cause of acute renal failure in young children. Wilms tumors are not necessarily associated with this disorder.

 

PTS:   1                    REF:   Pages 1382-1383

 

  1. What problems are commonly associated with the diagnosis of horseshoe kidneys? (Select all that apply.)
a. Hydronephrosis
b. Nephritis
c. Infection
d. Kidney stones
e. Pyuria

 

 

ANS:  A, C, D

Approximately one-third of individuals with horseshoe kidneys are asymptomatic, and the most common problems are hydronephrosis, infection, and stone formation. Nephritis and pyuria are not associated with this diagnosis.

 

PTS:   1                    REF:   Page 1378

 

  1. Which structural anomalies are associated with urinary tract malformations? (Select all that apply.)
a. Low-set ears
b. Prune-belly syndrome
c. Broad-bridged nose
d. Imperforate anus
e. Malformed lips

 

 

ANS:  A, B, D

Structural anomalies that are associated with urinary tract malformations include low-set, malformed ears; absent abdominal muscles (prune-belly syndrome); and imperforate anus or genital deviation. Anomalies of the either the nose or the lips are not generally associated with urinary tract malformations.

 

PTS:   1                    REF:   Page 1378

 

MATCHING

 

Match the kidney disorder with the corresponding descriptions.

______ A. Hemolytic-uremic syndrome

______ B. Henoch-Schönlein purpura nephritis

______ C. Renal dysplasia

______ D. Ureteropelvic junction obstruction

______ E. Polycystic kidney disease

 

  1. Is usually the result of abnormal differentiation of the renal tissues.

 

  1. Is an autosomal dominant inherited disorder.

 

  1. Fibrin-rich thrombi can be found throughout the microcirculation.

 

  1. Is the most common cause of hydronephrosis in neonates.

 

  1. Immunoglobulin A (IgA) nephropathy causes inflammation to glomerular blood vessels.

 

  1. ANS:  C                    PTS:   1                    REF:   Page 1380

MSC:  Renal dysplasia usually results from abnormal differentiation of the renal tissues.

 

  1. ANS:  E                    PTS:   1                    REF:   Page 1381

MSC:  Polycystic kidney disease is an autosomal dominant inherited disorder that occurs in approximately 1 in 1000 live births.

 

  1. ANS:  A                    PTS:   1                    REF:   Pages 1382-1383

MSC:  Hemolytic-uremic syndrome (HUS) results in fibrin-rich thrombi found throughout the microcirculation.

 

  1. ANS:  D                    PTS:   1                    REF:   Page 1380

MSC:  Ureteropelvic junction obstruction is the most common cause of hydronephrosis in neonates.

 

  1. ANS:  B                    PTS:   1                    REF:   Page 1382

MSC:  Henoch-Schönlein purpura nephritis, also known as anaphylactoid purpura, is an IgA nephropathy that affects the glomerular blood vessels, causing inflammation and damage to the vessel wall.