Human Diseases 8th Edition Zelman

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 Zelman: HUMAN DISEASES: A SYSTEMIC APPROACH, 8e – MyTest (013343141X)

Human Diseases: A Systemic Approach, 8e (Zelman)

Chapter 10 Diseases of the Urinary System

10.1 Multiple-Choice Questions

1) The functional unit of the kidney is the _____.

A) glomerulus
B) loop of Henle
C) nephron
D) renal pelvis
Answer: C
Objective 1

2) The hormones _____ play an important role in the regulation of the nephron's ability to
reabsorb salt and water.
A) adrenocorticotropic hormone and oxytocin
B) aldosterone and antidiuretic hormone
C) estrogen and progesterone
D) testosterone and follicle-stimulating hormone
Answer: B
Objective 1

3) The _____ carries blood into the nephron and enters the glomerulus.
A) afferent arteriole
B) loop of Henle
C) ureters
D) urethra
Answer: A
Objective 1

4) Alterations in pH levels result in acidosis, which triggers _____.

A) hyperventilation
B) petechiae
C) seizures
D) tachycardia
Answer: A
Objective 1

5) The color of normal urine ranges from _____.

A) clear to white-colored
B) orange to brown
C) pale yellow to amber
D) light pink to red
Answer: C
Objective 1
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6) The color and volume of urine may indicate disease, for example diabetics produce _____.
A) large volumes of dark and concentrated urine
B) large volumes of pale and dilute urine
C) small volumes of dark and concentrated urine
D) small volumes of pale and dilute urine
Answer: B
Objective 4

7) In chronic kidney disease, the ability of the renal tubules to concentrate urine is _____.
A) absent
B) augmented
C) decreased
D) increased
Answer: A
Objective 4

8) Albumin in the urine can indicate _____ of the urinary tract, particularly the glomeruli.
A) congenital absence
B) infection
C) inflammation
D) obstruction
Answer: C
Objective 4

9) _____ consist of coagulated protein, blood cells, and epithelial cells.

A) Casts
B) Glomeruli
C) Kidney stones
D) Nephrons
Answer: A
Objective 4

10) A _____ examination enables visualization of the inside of the bladder and urethra.
A) CT
B) cystoscope
C) dialysis
D) MRI
Answer: B
Objective 4

11) A significant sign of acute kidney injury include oliguria, or _____.

A) high blood pressure
B) high urine output
C) low blood pressure
D) low urine output
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Answer: D
Objective 2

12) One symptom of kidney disease can be the odor of ammonia on the breath, which is caused
by the accumulation of _____ in the blood.
A) chloride
B) creatinine
C) nitrogen
D) urea
Answer: C
Objective 4

13) Because females have a shorter _____, the prevalence of UTIs is greater in females than in
males.
A) glomerulus
B) nephron
C) ureter
D) urethra
Answer: D
Objective 3

14) _____ is inflammation of the kidney.

A) Cystitis
B) Glomerulonephritis
C) Pyelonephritis
D) Urethritis
Answer: C
Objective 3

15) Pus in the urine is called _____, which makes the urine sample turbid or cloudy.
A) dysuria
B) hematuria
C) oliguria
D) pyuria
Answer: D
Objective 3

16) Lupus nephritis is an _____ disease of the kidney.

A) autoimmune
B) infectious
C) inflammatory
D) opportunistic
Answer: C
Objective 4

17) IgA nephropathy is an inflammatory disease resulting from IgA deposition in the _____.
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A) glomeruli
B) nephron
C) ureter
D) urethra
Answer: A
Objective 4

18) IgA nephropathy is a common cause of _____.

A) cystitis
B) glomerulonephritis
C) pyelonephritis
D) urethritis
Answer: B
Objective 4

19) Prevention of _____ requires prompt treatment for streptococcal infections.

A) ACE
B) GFR
C) GN
D) NS
Answer: C
Objective 4

20) Urinary calculi may cause no symptoms, unless they are larger than _____ in diameter.
A) 1/4"
B) 1/2"
C) 3/4"
D) 1"
Answer: A
Objective 4

21) To prevent kidney stones, or their reoccurrence, _____.

A) fluid intake and dietary calcium should be increased
B) fluid intake and dietary calcium should be reduced
C) fluid intake should be increased and dietary calcium reduced
D) fluid intake should be reduced and dietary calcium increased
Answer: C
Objective 4

22) _____ determines the ability of the kidney to clear creatinine.

A) ACE
B) GFR
C) GN
D) NS
Answer: B
Objective 4
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23) Decreased blood flow to the kidneys causes them to release _____, which acts on
angiotension.
A) antidiuretic hormone
B) erythropoietin
C) hemodialysis
D) renin
Answer: D
Objective 4

24) Some of the symptoms of hypertensive kidney disease can be managed by controlling _____
intake.
A) chloride
B) potassium
C) sodium
D) water
Answer: C
Objective 4

25) A kidney biopsy may be performed to determine the presence of _____ characteristic of
nephrotic syndrome.
A) glomeruli
B) lesions
C) Reed-Sternberg cells
D) sickled red blood cells
Answer: B
Objective 4

26) In chronic glomerulonephritis, an ultrasound or CT will reveal _____.

A) kidney cancer
B) kidney stones
C) large kidneys
D) small kidneys
Answer: D
Objective 4

27) _____ eventually becomes the chief sign of renal cell carcinoma.
A) Painful cystitis
B) Painful uremia
C) Painless glomerulonephritis
D) Painless hematuria
Answer: D
Objective 6

28) At least three different genes influence the occurrence of _____.

A) glomerulonephritis
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B) Lupus nephritis
C) nephrotic syndrome
D) Wilm's tumor
Answer: D
Objective 6

29) The _____ form of PKD affects children.

A) autosomal dominant
B) autosomal recessive
C) heterozygous
D) homozygous
Answer: B
Objective 7

30) In most cases of _____, signs and symptoms include recurrent kidney stones.
A) glomerulonephritis
B) hydronephrosis
C) medullary sponge kidney
D) polycystic kidney disease
Answer: C
Objective 7

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10.2 True/False Questions

1) The ureter drains urine from the urinary bladder to the outside.
Answer: False
Objective 1

2) A physical examination of a patient can reveal renal disease because the entire body is
affected.
Answer: True
Objective 2

3) Renal disease can be detected through analysis of the blood.

Answer: True
Objective 2

4) Acute kidney disease has three main causes: shock, tubular necrosis, and obstructed urine
flow.
Answer: True
Objective 2

5) In acute kidney injury, at first low blood pressure occurs, then hypertension.
Answer: True
Objective 2

6) Urinary tract infections are caused primarily by bacteria from the skin or colon.
Answer: True
Objective 3

7) One of the symptoms of pyelonephritis is sudden back pain that spreads over the abdomen.
Answer: True
Objective 3

8) Prevention for lupus nephritis includes drinking plenty of fluids and maintaining a normal
blood pressure.
Answer: False
Objective 4

9) IgA neuropathy is more common in women than in men.

Answer: False
Objective 4

10) Prevention of IgA nephropathy is not possible.

Answer: True
Objective 4

11) Acute post-streptococcal glomerulonephritis is caused by an antigen–antibody reaction.

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Answer: True
Objective 4

12) Urea and creatinine are nitrogen-containing waste products.

Answer: True
Objective 4

13) Chronic kidney disease is also related to long-term use of acetaminophen.

Answer: False
Objective 4

14) Hypertensive kidney disease is caused by atherosclerosis of the renal arteries.

Answer: True
Objective 4

15) The signs and symptoms of hypertensive kidney disease include the typical features of
systemic hypertension.
Answer: True
Objective 4

16) One of the symptoms of nephrotic syndrome include low blood pressure.
Answer: True
Objective 4

17) One transplanted kidney can replace the function of two nonfunctional kidneys.
Answer: True
Objective 5

18) Hydronephrosis is diagnosed with physical exam and a CT or ultrasound.

Answer: True
Objective 4

19) Chronic glomerulonephritis is a slowly progressing infection of the glomeruli.

Answer: False
Objective 4

20) Urinary incontinence is best thought of as a sign caused by underlying disease.

Answer: True
Objective 4

21) Renal cell carcinoma is a relatively common type of cancer.

Answer: False
Objective 6

22) Wilm's tumors have a genetic basis.

Answer: True
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Objective 6

23) In Wilm's tumors, cysts may number in the hundreds or thousands.

Answer: False
Objective 7

24) Medullary sponge kidney disease is present at birth, but is usually asymptomatic until
adulthood.
Answer: True
Objective 7

25) Kidney cancer increases significantly after age 60, and the incidence of bladder cancer
increases after age 70.
Answer: True
Objective 8

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10.3 Short-Answer Questions

1) The urinary system is comprised of two kidneys, two ureters, a urinary bladder, and a single
_____ that leads to the outside of the body.
Answer: urethra

2) The kidneys produce the substance _____, which regulates blood pressure.
Answer: renin
Objective 1

3) Urine from the collecting ducts of the nephrons eventually empties into the renal calyces and
renal _____ at the junction of the kidneys with the ureters.
Answer: pelvis
Objective 1

4) Following neural signals governing _____, the bladder empties urine into the urethra.
Answer: micturition
Objective 1

5) A significant sign of acute kidney injury is _____, a complete cessation of urine production.
Answer: anuria
Objective 2

6) _____, a condition of elevated blood potassium, can cause cardiac arrest.

Answer: Hyperkalemia
Objective 2

7) _____ is inflammation of the urinary bladder.

Answer: Cystitis
Objective 3

8) Cystitis is characterized by _____, a painful, burning sensation during urination.

Answer: dysuria
Objective 3

9) _____ is an inflammatory disease of the glomeruli.

Answer: Glomerulonephritis
Objective 4

10) Kidney stones, called urinary _____, occur in 9% of adults in the United States.
Answer: calculi
Objective 4

11) _____, the crushing of kidney stones, is effective for 20% of kidney stones.
Answer: Lithotripsy
Objective 4
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12) Renal _____ is the progressive loss of kidney function over time.
Answer: failure
Objective 4

13) The metabolic waste products are toxic if they accumulate in the blood, a condition known as
_____.
Answer: uremia
Objective 4

14) One of the diagnostic tests for renal failure is to test the glomerular _____ rate (GFR).
Answer: filtration
Objective 4

15) Diabetic _____ is due to inflammation of the glomerulus.

Answer: nephropathy
Objective 4

16) Also called _____ hypertension, hypertensive kidney disease is found in about 1 in 10 people
with systemic hypertension.
Answer: renovascular
Objective 4

17) Most cases of nephrotic syndrome are due to glomerulonephritis and _____.
Answer: diabetes
Objective 4

18) In _____, blood is removed from the body and passed through membranes where toxic
substances are removed from the blood and returned to the body.
Answer: hemodialysis
Objective 5

19) In _____ dialysis, dialyzing fluid is introduced into the abdominal cavity, where the cavity
lining acts as a dialysis filter membrane.
Answer: peritoneal
Objective 5

20) _____ is a condition of urine retention within dilated kidney tubules.

Answer: Hydronephrosis
Objective 4

21) Urinary _____ is a common disorder characterized by the loss of bladder control to varying
degrees.
Answer: incontinence
Objective 4

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22) _____ incontinence is unexpected flow of urine that occurs with coughing, sneezing,
laughing, or lifting.
Answer: Stress
Objective 4

23) _____ tumor is a malignant tumor of the kidney pelvis that develops in children.
Answer: Wilm's
Objective 6

24) If the urinary bladder must be surgically removed, an _____ conduit may be constructed to
store and evacuate urine.
Answer: ileal
Objective 6

25) _____ kidney disease is the development of numerous fluid-filled pockets of tissue within
the kidney.
Answer: Polycystic
Objective 7

10.5 Discussion Questions

1. Using the anatomical structures, describe the physiology and process of making urine.
Answer: The afferent arteriole carries blood into the nephron and enters the glomerulus, a network of
specialized selectively permeable capillaries, where blood is filtered into the surrounding glomerular
capsule. This filtrate contains fluid from plasma and some of its constituents. As the filtrate continues on
through the proximal renal tubule, renal look, and distal renal tubule, its composition is altered. Much
water is retained (absorbed into nearby capillaries), as are glucose and electrolytes. Acid and urea are not
reabsorbed. Instead, these are excreted and move with the filtrate to the collecting ducts, forming urine.
Normal urine does not contain blood cells, plasma proteins, or glucose.

2. Describe the risk factors and signs and symptoms of lower urinary tract infections: urethritis and
cystitis.
Answer: Risk factors include being female, having multiple sex partners, and having sexually transmitted
infectious diseases. The symptoms of urethritis include a discharge from the urethra, an itching sensation
at the opening of the urethra, and a burning sensation during urination. Cystitis is characterized by urinary
frequency, a sense of urinary urgency, and dysuria. Other symptoms include low fever and pressure with
pain in the lower back.

3. Describe what lithotripsy is and how it is performed.

Answer: In lithotripsy, sonic vibrations are applied externally, and focused internally, to crush the stones.
If performed while the patient is immersed in a tank of water, the procedure is called hydrolithotripsy. In
this technique, the partially submerged patient is subjected to sonic waves that shatter the hard stones into
sand-sized particles that can be eliminated with the urine.

4. Explain what hypertensive kidney disease is and its cause.

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Answer: Hypertensive kidney disease is caused by atherosclerosis of renal arteries and their small
branches within the kidneys. As these narrow, systemic blood pressure increases. The decreased blood to
kidney causes them to release renin, which triggers vasoconstriction and aldosterone secretion, resulting
in hypertension.

5. List the signs and symptoms of nephrotic syndrome.

Answer: A chief sign of nephrotic syndrome is edema of the ankles and around the eyes, and pleural and
genital edema. Symptoms include low blood pressure, lethargy, and anorexia. High lipid levels can lead
to premature atherosclerosis and is associated with complications.

6. Compare and contrast the difference between hemodialysis and peritoneal dialysis.
Answer: In hemodialysis, blood is removed from the body and passed through dialysis membranes where
toxic substances are removed from the blood and the blood returned to the body. For hemodialysis, a
patient typically must visit a clinic or hospital for dialysis treatment and stay for 3–6 hours during the
process. In peritoneal dialysis, dialyzing fluid is introduced into the abdominal cavity, where the
peritoneum or cavity lining acts as a dialysis filter membrane. The fluid draws toxic materials out of the
capillaries surrounding the body cavity, and after a suitable amount of time, the peritoneal fluid is
removed, along with its dissolved toxins. A bag may be attached externally to collect the fluid, permitting
the patient to remain mobile and providing more freedom and flexibility during treatment.

7. List the treatment options available for polycystic kidney disease.

Answer: There is no cure for polycystic kidney disease. Treatment is aimed at controlling high blood
pressure, pain, and infections that tend to arise in cysts. Surgery may be used to drain cysts, which can
relive pain temporarily. Eventually dialysis and a kidney transplant may be needed. Prevention is not
possible because of the genetic nature of polycystic kidney disease.

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10.4 Case Study

1) At age 48, Joe felt awkward about falling from his bicycle, especially without his helmet.
After an initial recovery he felt like his urination frequency had increased and he was often
thirsty. A physical exam revealed inadequate levels of ADH (vasopressin) in his system.

What is the disease in this case, and how may it be resolved?

Answer: The disease appears to be diabetes insipidus, in which the hypothalamus fails to
produce ADH or the posterior pituitary is unable to release the hormone. The cause may be
related to the trauma Joe had or may be idiopathic. The primary treatment is pitressin
(vasopressin) to prevent dehydration and electrolyte imbalance.

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