Patho Final Study guide Questions And
Answers 2022 Latest
1. What are the two main functions of the kidney
Review diagram for anatomical structures -
... [Show More] 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... [Show Less]