Patho Final Study guide Questions And Answers 2022 Latest

Patho Final Study guide Questions And Answers 2022 Latest 1. What are the two main functions of the kidney Review diagram for anatomical structures - ANS-1. Filtration and collection Women are at a higher risk for the development of a UTI because of having a shorter urethra. True False - ANS-True Which of the following can help to prevent a UTI? Increase water consumption Use spermicides during sexual intercourse Taking more Vitamin D Douching to prevent the growth of bacteria - ANS-Increase water consumption A symptom of a lower urinary tract infection includes: Flank pain Urgency Decreased Urination Fever - ANS-Urgency Which of the following is true regarding a complicated urinary tract infection? It is usually asymptomatic Can be caused by a structural urinary tract disorder Bacteria is located mostly in the lower urinary tract Is associated with young adults - ANS-Can be caused by a structural urinary tract disorder Which of the following is a risk factor for the development of a urinary tract infection (UTI)? Perimenopause Frequent showering Marathon running Pregnancy - ANS-Pregnancy 1. Where do bacteria commonly come from in UTI's 2. Where can a UTI occur? 3. It is more common for women to develop a UTI especially when - ANS-1. Bacteria from the gut can invade the urinary epithelium to cause inflammation and infection 2. anywhere along the urinary tract such as the urethra, bladder, ureter, or kidney 3. pregnant, sexually active, during post-menopause with estrogen-deficiency and when being treated with antibiotics where the normal bacteria flora is diminished 1. Escherichia coli can bind to cells in the lower urinary tract and hide from the immune cells. The bacteria can form biofilms-what is this? 2. Describe the pathophysiology of a UTI that can lead to septic shock or bacterimia Note the diagram btw a male & female urinary tracts (who's is much shorter) - ANS1. A biofilm is any group of microorganisms that allow them to stick to one another and adhere to surfaces that help them survive. 2. First, bacteria enter and contaminate the lower urinary tract. This causes the colonization of bacteria in the urethra and the bladder. If the UTI progresses the bacteria can ascend to the kidneys and colonize there. At this point, the infection becomes an upper UTI. From there, if left untreated, the bacteria can spread into the circulation via the renal veins causing bacteremia UTI risk factors 1. For women, pregnancy is a risk factor. why? 2. The female ureter is shorter and 3. Post-menopausal women are also at risk because 4. Sexual intercourse is a risk factor especially if women use 5. Indwelling urinary catheterization is also a major cause of a UTI - ANS-1. During pregnancy, progesterone relaxes smooth muscle that causes stasis of urine, allowing the bacteria to colonize 2. allows for the entrance of bacteria into the urethra. 3. lack of estrogen results in vaginal and urethral dryness promoting an environment for bacteria growth. 4. spermicides 5. Fibrinogen accumulates on the catheter which provides an ideal environment for the attachment of uropathogens that then form biofils. This results in epithelial damage Lower vs. Upper Tract Disorders 1. Lower UTI's include what parts of the urinary tract 2. In a lower urinary tract disorder, the individual experiences (blank) Other common symptoms include 3. initially, a urine dipstick can be performed to identify hematuria, proteinuria, and the presence of nitrites. The presence of nitrites 4. an individual can have a negative urine dipstick but still have a UTI. If this is the case, then the NP can send the urine for a 5. On microscopic exam of the urine, a patient with cystitis will have - ANS-1. urethra (urethritis) or bladder (cystitis). In males, the cystitis may be associated with prostatitis. 2. urgency associated with burning on urination. frequency, dysuria, and suprapubic pain. The urine may also appear cloudy and have an odor. 3. is highly specific for bacterial infection 4. culture and sensitivity (C&S) test and microscopy 5. a white blood cell (WBC) count of greater than 5000 high power field (hpf) and hematuria 1. An infection of the lower urinary tract can progress to an upper urinary tract infection if the bacteria ascends from the bladder to the kidney. The condition is 2. The signs and symptoms of pyelonephritis include 3. Think of the symptoms of pyelonephritis in a classic triad: 4. if the infection has entered the circulation from the kidney via the renal vein 5. For the patient with pyelonephritis, the urine will present with - ANS-1. pyelonephritis. 2. all the symptoms associated with cystitis plus fever, flank pain, costovertebral angle (CVA) tenderness, nausea, and vomiting. Malaise is also a common complaint 3. vomiting, flank pain and fever 4. there can also be signs of shock 5. WBC casts Uncomplicated vs. Complicated Urinary Tract Infections (UTI) 1. A UTI may be classified as complicated or uncomplicated in terms of its severity. An uncomplicated UTI indicates that 2. In a complicated UTI, there is decreased - ANS-1. renal function is normal, urine results may confirm a UTI, but the patient denies symptoms, no antibiotic is prescribed 2. renal function and an abnormality in the renal tract Un-Complicated UTI 1. Occurs in the normal urinary tract 2. Responds well to 3. Ie: Simple cystitis in Complicated UTI 4. A UTI that extends beyond 5. Caused by 6. Infants and 7. Associated with: - ANS-1. the normal urinary tract 2. a short course of antibiotic therapy 3. non-pregnant women without any urologic abnormalities 4. the bladder 5. structural or functional urinary tract abnormalities or untreated UTI 6. pregnant mothers & older adults affected 7. indwelling catheters, renal calculi, diabetes, pregnancy 1. The most common organisms that cause a UTI is 2. A urinalysis is used to diagnose a UTI. If nitrites are present, this indicates 3. A urine culture may also be performed to determine infection. A positive culture indicates that there are greater than - ANS-1. Escherichia coli (80% of cases), Staphylococcus saprophyticus, Proteus Mirabilis, and Klebsiella. 2. the causative organism is gram negative 3. 100,000 colony forming units/ml. remember a UTI occurs when bacteria colonize, cling to the bladder well, form biofilms and overwhelm the immune system Using the Urinalysis to Diagnose a Urinary Tract Infection 1. some bacteria are unable to produce nitrites. this would be 2. The presence of nitrites is the most specific finding and has Differentiate between the UA of a complicated and uncomplicated UTI Protein Leukocyte Esterase Nitrites RBCs WBCs Casts - ANS-1. the case of Enterococcus bacteria 2. the highest positive predictive value. Complicated Protein + or - Leukocyte Esterase + Nitrites + or - RBCs + WBCs + > 100,000/hpf Casts + Uncomplicated Protein + or - Leukocyte Esterase + Nitrites + or - RBCs + or - WBCs + > 5000/hpf Casts None Remember a for a dx of UTI the pt needs to be presenting with symptoms Casts: are long cylindrical structures formed in the renal tubules due to the precipitation of Tamm-Horsfall mucoprotein 1. Muddy brown casts suggest 2. Waxy casts are suggestive of 3. Fatty casts are suggestive of 4. RBC casts suggest 5. WBC casts suggest - ANS-1. acute tubular necrosis 2. acute and chronic renal failure. 3. nephrotic syndrome 4. glomerulonephritis 5. interstitial inflammation RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal morphology of the RBC strongly suggests - ANS-glomerular disease. UTI Prevention, list patient education 1. most important 2. can help to acidify the urine 3. Urinate before and after 4. Encourage the female to avoid 5. Avoid the use of - ANS-1. Drink more water. 2. cranberry juice and vitamin C 3. sexual intercourse to remove bacteria from the urethral area. 4. holding urine for extended periods of time 5. hygiene sprays and spermicides because they alter the normal microbial flora Post UTI quiz - ANSA 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner. The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with: a. Upper UTI b. Complicated UTI c. Pyelonephritis d. Cystitis - ANS-d. Cystitis J.S. is an 80 -year-old patient who resides in a local nursing home. He recently became confused and then fell while ambulating. after the catheter was placed, the patient spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense, foul odor was noted in the urine. On examination of the flank area, the patient yelled out when touched. A urine culture was obtained and came back positive for nitrites and RBCs. Urine microscopy revealed >100,000 WBC/hpf and casts. Based on the information provided in the case, the patient can most likely be diagnosed with: a. Pyelonephritis b. Urinary obstruction c. Glomerulonephritis d. Simple UTI - ANS-a. Pyelonephritis Identify the major risk factor J.S. has that is associated with pyelonephritis: Select all that apply Dehydration Indwelling Foley catheter Fever Flank pain - ANS-Indwelling Foley catheter A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit. True False - ANS-True (pt could also have an STI) The urinalysis of a patient with a complicated UTI will show WBCs and casts True False - ANS-True Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are gram negative because of the presence of: RBCs. Casts. WBCs. Nitrites. - ANS-Nitrites. The NP would know that the patient most likely has an uncomplicated UTI because: The UTI responds well to a short course of antibiotic therapy. There is low-grade fever. The bacteria are contained within the bladder. Flank pain is present but minimal. - ANS-The UTI responds well to a short course of antibiotic therapy. A common organism that causes a urinary tract infection include: Methicillin Resistant Staphylococcus Aureus (MRSA). Staphylococcus saprophyticus. Syncytial virus. Streptococcus pneumonia. - ANS-Staphylococcus saprophyticus Pre-BPH quiz - ANSThe peripheral zone of the prostate is the largest zone. True False - ANS-True The patient most often develops symptoms of BPH when: A nodule forms on the prostate. The patient's PSA becomes elevated. The prostatic urethra becomes obstructed. The bladder becomes obstructed. - ANS-The prostatic urethra becomes obstructed. The purpose of straining in BPH is to overcome the obstruction encountered during urination. True False - ANS-True There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer. True False - ANS-False On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings? A soft-smooth prostate. A lack of pain on palpation. A hard nodule. A rubber-like quality of the prostate. - ANS-A hard nodule. Pathophysiology of BPH 1. In BPH, there is enlargement of the prostate gland by an increased number of benign cells. It is common in 2. The urethra passes through the - ANS-1. men over the age of 50 years (its normal and doesn't often lead to cancer) 2. prostate before reaching the penis. This portion of the urethra is called the prostatic urethra. 1. The prostate is covered by tough connective tissue and smooth muscle and can be divided into zones. The peripheral zone is 2. transitional zone. It contains approximately 5% of the prostate's glandular tissue and a portion of 3. The luminal cells also produce (PSA) which helps to 4. The basal and luminal cells of the prostate rely on - ANS-1. the largest zone and it is located in the outermost posterior area of the prostate. contains (75%) of the glandular tissue 2. the prostatic urethra. 3. liquefy the gel-like semen after ejaculation. This frees the sperm to swim 4. stimulation from the androgens for male sex hormones for survival The Cause of BPH 1. Dihydrotestosterone is produced in the prostate. This androgen is produced byenzyme 5 alpha-reductase which 2. After around the age of 30, men produce less testosterone but 5-alpha reductase activity increases resulting in Again, this is a normal process of aging. 3. By age 60, the majority of men will develop BPH and over 4. there is no risk for the male to develop cellular mutations that lead to prostate cancer. Instead, the entire prostate gland enlarges forming hyperplastic nodules. On palpation, they feel - ANS-1. converts testosterone into the more potent dihydrotestosterone 2. an increase in dihydrotestosterone. prostate cells respond to the increase in dihydrotestosterone by living longer and multiplying. That is the underlying cause of BPH. 3. 90% have it by the age of 85 years of age. 4. smooth, elastic, and firm. (not hard) 1. When the nodules and prostate tissue compress - ANS-1. the prostatic urethra, it becomes more difficult for urine to pass through. The urine builds up in the bladder and causes it to dilate. In response, the smooth muscle of the bladder will contract harder, which leads to bladder hypertrophy, Clinical Presentation of BPH 1. Symptoms of BPH may become prevalent when the prostatic urethra becomes obstructed. The male reports 2. List other classic symptoms - ANS-1. dribbling which is a weak and inconsistent urine stream 2. Straining, (dysuria) pain on urinating, as well as initiating urination (hesitancy). As urine accumulate in the bladder, it causes a constant sense of incomplete bladder emptying which increases the frequency of urination at night (nocturia). Diagnosis and Tx 1. BPH can be diagnosed by performing a (DRE). The NP palpates the (blank) of the rectum which lies along the posterior prostate. If enlarged, the NP can suspect. 2. Hard nodules palpated could 3. Elevated levels of (PSA) are found in BPH b/c 4. Treatment involves - ANS-1. (anterior wall), BPH 2. could be a sign of prostate cancer. 3. there are more healthy prostate cells around to produce it 4. 5-alpha reductase inhibitors- inhibit the conversion of testosterone to dihydrotestosterone and can help shrink the prostate gland. Alpha-1 antagonists may also be prescribed to bind to alpha-1 receptors in the smooth muscles in the bladder neck, prostate and urethra. This causes relaxes and allows urine to pass. Sometimes surgery is indicated. A transurethral resection of the prostate (TURP) Differentiate age-related symptoms that are both irritative and obstructive in nature. Match each symptom below as either irritative or obstructive. urgency that result from bladder hypertrophy and dysfunction urinary frequency nocturia postvoid dribbling incomplete emptying - ANS-Irritative urgency that result from bladder hypertrophy and dysfunction urinary frequency nocturia Obstructive postvoid dribbling incomplete emptying Post BPH quiz - ANSThe underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. True False - ANS-True Men who have BPH are prone to developing a UTI because: a. Ingested fluids do not adequately flush the kidneys. b. Stagnated urine in the bladder promotes bacterial growth. c. They have a low WBC count due to an infected prostate. d. The prostate is not a sterile environment - ANS-b. Stagnated urine in the bladder promotes bacterial growth. The action of a 5-Alpha-reductase inhibitor causes: Relaxation of the external sphincter. Reduction of the size of the nodule that is causing obstruction. Shrinkage of the prostate gland. Relaxation of the smooth muscle of the bladder neck. - ANS-Shrinkage of the prostate gland. The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. True False - ANS-True The location of the characteristic hyperplastic nodules of BPH is: In the periurethral zone. In the posterior prostate. In the zone immediately inside the rectum. In the anterior prostate zone. - ANS-In the periurethral zone. pre-quiz Renal Calculi - ANSRenal stones are formed when calcium and oxalate in the urine combine. True False - ANS-True The most common type of stone is: Uric acid stone. Cysteine stone. Calcium stone. Struvite stone. - ANS-Calcium stone. The type of stone that forms due to a urinary tract infection is: Struvite stone. Cysteine stone. Uric acid stone. Calcium Stone. - ANS-Struvite stone The gold standard for diagnosing a renal stone is a urinalysis. True False - ANS-False Renal calculi are typically confined to the bladder. True False - ANS-False Pathophysiology of Renal Calculi 1. Normally, there should not be stone formation in the urine. Our urine actually has 2. Urine contains calcium and oxalate. When the calcium and oxalate combine 3. Individuals get kidneys stone due to - ANS-1. inhibitors to prevent stone formation. These include citrate and magnesium. 2. it forms a stone. Citrate and magnesium will prevent the formation 3a. lack of water ingestion 3b. by increase of particles or solutes in the urine 3c. by decreased stone inhibitors present in the urine. 1. Stones that are <0.5 cm 2. Stones that are > 1.0 cm are likely 3. The most common sites of stone obstruction include: - ANS-1. pass through the urine to be eliminated without difficulty 2. to cause an obstruction. 3. ureteropelvic junction, intersection of ureter and iliac vessels, and the ureterovesicular junction-(most common) Types of Kidney Stones Calcium stones 1. This is the 2. forms from either 3. individual presents with 4. Treatment involves prescribing Struvite stones 5. occurs due to a 6. Urine presents with 7. Another name for this stone is - ANS-1. most common type of stone. 2. calcium and oxalate or calcium and phosphate. In some cases, individuals can form both 3. excess calcium in the urine (hypercalciuria) 4. a thiazide diuretic to excrete urinary calcium. 5. UTI, most often by proteus, klebsiella and serratia and enterobacter species 6. Ammonia -Urea, in the presence of urease converts to ammonia and a byproduct of CO2. makes the urine alkaline 7. the Staghorn stone. (has horn-like structures) It obstructs the renal calyx. Types of Kidney Stones Uric acid stone 1. This is the type of stone that is found in a 2. Individuals who are at risk for getting gout include those with 3. Uric acid stones are radiolucent, meaning 4. Treatment includes Cystine stone 5. This is a 6. It is caused by a genetic 7. This stone can also from - ANS-1. patient with gout 2. Leukemia and myeloproliferative disorder; those undergoing chemotherapy 3. that the stones cannot be seen on x-ray 4. hydration and increasing the alkaline of the urine by giving potassium bicarbonate. Or anti-gout medication. 5. rare type of kidney stone that is found mostly in children 6. renal tubule defect 7. Staghorn shaped stones. Clinical Presentation of Renal Calculi Regardless of the type of kidney stones, patients will present in a similar way. The symptoms include: 1. Renal colic: 2. occurs in 90% of individuals who have a kidney stone. While passing through the urinary tract, the stone will injure the urinary structures. It can also be associated with nausea and vomiting. - ANS-1. flank or costovertebral angle (CVA) pain. It is caused by the passing of the stone through the ureter with obstruction and spasm 2. Hematuria List the methods of diagnosis - ANS-1. urinalysis 2. X-ray of the kidney, ureter, and bladder (KUB) but not for Uric acid and cysteine stones * 3. The gold standard for diagnosing a renal stone is CT scan because all types of stones can be seen. 4. An ultrasound can be performed for those who cannot tolerate radiation (pregnancy) Overall Management 1. includes providing an analgesic 2. a non-invasive procedure, will be performed if the stone lodges on the way out 3. invasive and last resort - ANS-1. for pain and increased fluid intake to increase hydration. 2. Lithotripsy-breaks stones into fragments for passing 3. percutaneous nephrolithotomy. The NP also addresses prevention measures with the patient. Identify below which measures the NP should recommend. (select all) A high-sodium diet Adequate hydration A balanced diet Calcium restriction - ANS-Adequate hydration A balanced diet Post renal stone quiz - ANSThe most common stone found in the patient with gout is: Calcium stone. Struvite stone. Cystine stone. Uric acid stone. - ANS-Uric acid stone. At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone. True False - ANS-True Lithotripsy is an invasive procedure used to break up the stone True False - ANS-False Hematuria can be seen with kidney stones because: The patient becomes anemic when stones form. As WBCs increase, the RBCs also increase. The stone creates its own blood supply around it. The stone injures the urinary structures as it passes through them. - ANS-The stone injures the urinary structures as it passes through them. Renal colic is caused by the passing of the stone through the ureter. True False - ANS-True Urinary Incontinence Pre-quiz - ANSThe location of the internal sphincter is under the urogenital diaphragm. True False - ANS-False Which of the following actions will relax the detrusor muscle of the bladder? a. Activation of the muscarinic (M3) receptors by the sympathetic nervous system. b. Activation of the muscarinic (M3) receptors by the parasympathetic nervous system. c. Activation of Beta-2 receptors by the sympathetic nervous system. d. Inhibition of the Beta-2 receptors by the sympathetic nervous system. - ANS-c. Activation of Beta-2 receptors by the sympathetic nervous system. The levator ani muscle plays a major role in constriction of the external sphincter. True False - ANS-True When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict. True False - ANS-True The relay station in the brain that plays a major role in regulating micturition is: Pontine micturition center. Hypothalamic relay center. The frontal lobe. The cerebellum. - ANS-Pontine micturition center. Bladder Physiology 1. when the bladder is empty, 2. there are two ways to relax the detrusor muscle: 3. When the bladder is full 3a. What relaxes the internal and external sphyincters when the bladder needs to empty - ANS-1. there is detrusor muscle relaxation and internal and external sphincter constriction 2. Activation of Beta-2 receptors by the SNS AND Inhibition of the M3 receptors by the PNS 3. PNS inervation acts on M3 receptors. to cause constriction of the detrusor muscle (is needed to push urine out) 3a. SNS activates the alpha-1 receptors which leads to internal sphincter relaxation. AND SNS inhibits the pedendal nerve which relaxes the external sphincter. Which muscle has control over the bladder wall? Considered the most important muscle of urinary continence - ANS-Detrusor muscle 1. In summary, it is important to recognize that 2. Give two examples of somatic or voluntary innervation in bladder control - ANS-1. sympathetic, parasympathetic, and somatic actions work together to either fill or empty the bladder. 2. The pudendal nerve which involves voluntary control over the pelvic floor and external sphincter 1. Two factors typically lead to UI urinary incontinence - ANS-1. over-contraction of the detrusor muscle. This can cause overflow of the urinary system, causing the release of urine. With too much detrusor muscle contraction, the individual has the need to urinate that results in urge incontinence. The second factor is when the detrusor muscle relaxes too much. Too much over relaxation will impede urine flow by keeping urine in the bladder. This is termed overflow incontinence 1. Another issue that contributes to UI is 2. any of the normal nerve innervations that occur during micturition that are impeded can cause UI due to weakening of the detrusor muscle or lead to overcontraction, causing weakening of the internal and external sphincters List some transient causes - ANS-1. weakness in the internal or external sphincters 2a. Delirium: the individual may be unaware of the need to urinate 2b. (UTI): A UTI can result in frequency and urgency. 2c. Atrophic vaginitis: this is atrophy of the vaginal walls, bladder and urethra r/t estrogen deficiency 2d. Drugs: anticholinergics-prevent relaxation of bladder, Anti-Parkinson drugs: alpha-agonist, and antagonist drugs-An alpha-agonist will cause bladder over-contraction of the bladder leading to overflow incontinence; an alpha-antagonist will prevent the bladder from contracting that will lead to stress incontinence. Diuretics and ACE inhibitors increase the amount and frequency of urination that results in urge incontinence, Calcium channel blockers can prevent the internal and external sphincters from contracting sedatives and hypnotics may inhibit the individual's need to urinate. What is functional incontinence - ANS-Restricted mobility: the individual has the urge to urinate but is unable to ambulate to the bathroom (functional incontinence) Stress Incontinence 1. Stress incontinence is urine leakage that is associated with 2. In men, the main cause of stress incontinence is 3. In women, the major cause of stress incontinence is - ANS-1. abdominal pressure. Increased abdominal pressure occurs with coughing or sneezing 2. surgery, usually after a (TURP) 3a. hypermobility of the external sphincter. When this happens the levitar ani is above the sphincter because the sphincter has moved downward which allow the urine to leak through the sphincter with increased and pressure/coughing 3b. sphincter deficiency caused by vaginal atrophy. common in estrogen-deficiency post-menopausal women...