WorksheetsCBL N - Week 41
Total questions: 22
Worksheet time: 30mins
Lol isn’t it funny that Jerry is STILL lactose intolerant in 2021?
Anyway, a 28-year-old pregnant woman presents to her PCP complaining of flank and back pain for the past three days. Associated symptoms include nausea, vomiting, frequency and urgency to void, as well as a burning sensation when voiding. CBC shows elevated white cells, specifically neutrophils, and urinalysis is positive for bacteria as well as TNTC leukocytes, elevated nitrite, and elevated leukocyte esterase. The patient is diagnosed with acute pyelonephritis, but the physician is curious as to the causative organism. She swabs the patient’s urethra for culture. What is she most likely to see on histology?
Gram-positive cocci in clusters
10 trillion mini-Jerry’s
Gram-negative bacilli that are oxidase negative and ferment lactose
Gram-negative bacilli that are oxidase negative and do not ferment lactose
Eosinophils
Match the disease with its correct characteristics.
(Enter answer as number followed by matched letter. Separate each number-letter pair with a space. i.e. 1F 2G 3H 4I 5J)
(a)
SpaceJam Alien is finally dragged out to play basketball with his friends after taking a weekly quiz. During the game, he wonders, “I wonder what my potassium levels are now compared to before.” Which of the following statements regarding his potassium levels is incorrect?
Higher, exercise will decrease body insulin levels which moves potassium from within the cells into the plasma
Higher, exercise will deplete ATP stores in the muscles that cause potassium channels to open and leave the muscle cell
Higher, he likely ate a lot of bananas before playing to avoid getting cramps
Higher, his body enters a slightly acidotic state during exercise, which promotes the K+/H+ exchanger to bring potassium into the serum.
Higher, exercise will cause increased aldosterone secretion which will increase serum potassium levels.
Nike GoneDasani is glad to see his friend, SpaceJam Alien, enjoying his time playing basketball. However, he suddenly gets a muscle cramp. Nike, being the amazing physician-in-training he is, suspects that his friend is hypocalcemic and injects a phosphate infusion intravenously. Which of the following sets of changes is most likely to occur?
A
B
C
D
E
While on her Ob/Gyn rotation in Savannah, Princess helps deliver a baby boy. She immediately notes his wrinkly skin, low set ears, and beaked nose and is concerned about his lung and kidney function. Which of the following likely led to this presentation?
Failure to form the pronephros in week 4
Bilateral agenesis of the metanephros leading to oligohydramnios after week 12
A genetic variant that leads to the production of cysts throughout the nephrons
Fusion of the kidneys and inability to ascend past the IMA
Back in Augusta, James is on his Peds rotation. A concerned mother brings in her 1-week-old baby girl stating “Every time she urinates, some drips out of her belly button. That’s not normal, right?” How can we explain this finding?
Excess fetal cortex present in the adrenal glands
Failure of the allantois to constrict
Failure of the cloaca to divide
Improper location of the genital tubercle in relation to the urogenital sinus
What would happen to the micturition reflex if the nerve roots were compressed by a tumor at the level of L2?
The reflex is lost because parasympathetic fibers are lost
The reflex is lost because somatic fibers are lost
The reflex is lost because sympathetic fibers are lost
The reflex remains unchanged because parasympathetic fibers are unaffected
The reflex would be hypoactive, leading to overflow incontinence
Philippe sustained a S2 spinal cord injury following a paragliding accident 12 years ago. He has flaccid paralysis, sensory loss, and absent reflexes distal to S2. What type of incontinence does he have?
Functional incontinence
Overflow incontinence
Stress incontinence
Urge incontinence
Dr. Margarine Alvin is having shoulder pain after experiencing a convulsive fit of laughing at his own jokes. What abdominal structure could he have injured that would explain referred shoulder pain?
Central diaphragm
Peripheral diaphragm
Stomach
Kidneys
Dr. “I Can’t Think Of Another Funny Name, How Do You Guys Do This Every Week” (yes, that is really his name, he’s just got a lot of middle names, don’t make fun of him) can never remember the differences between the left and right suprarenal glands. Please help him pick the correctly matched answer choice; you’re his last chance of passing this quiz.
Right – short and crescent-shaped
Left – short and square-shaped
Right – short and pyramidal-shaped
Left – long and pyramidal-shaped
How do the juxtamedullary and superficial cortical nephrons differ from each other?
The juxtamedullary nephrons have smaller glomeruli and lower GFR
The juxtamedullary nephrons work especially during periods of high activity
The superficial cortical nephrons have their glomeruli near the corticomedullary border
The superficial cortical nephrons are extra important for concentrating urine
Which one of these is the distal convoluted tubule? Choose all that apply.
b
c
d
e
f
A euvolemic patient goes 3 hours without drinking water. You expect water balance would be mostly maintained by increasing ADH via:
Baroreceptors, linearly
Osmoreceptors, linearly
Baroreceptors, exponentially
Osmoreceptors, exponentially
Minimum urine osmolarity is ~ 50mOsm/L and maximum urine osmolarity = ~1200 – 1400 mOsm/L. Obligatory volume loss is the minimum amount of urine volume needed to dissolve excess dietary solutes. To calculate obligatory volume loss, one would need to use the value for
blood osmolarity
minimum urine osmolarity
plasma osmolarity
maximal urine osmolarity
Select the false statement
an expanded extracellular fluid volume can lead to atrial natriuretic peptide release
congestive heart failure is associated with Na dysregulation
aldosterone strongly influences plasma Na concentration
renal sympathetic nerves can stimulate renin secretion from juxtaglomerular cells
Renal sympathetic nerves stimulate sodium reabsorption via a direct action on tubular epithelial cells and mediate effects through alpha-adrenoceptors, including reducing flow past the macula densa, thus increasing renin secretion. What is false regarding RAAS?
Angiotensin I causes aldosterone release
Angiotensinogen is acted upon by renin
ACE catalyzes the formation of angiotensin II
Aldosterone is released from the adrenal glands
ChrisAngle Teenwolf YangGang presents with the following serum labs: Na 135, K 3.0, Cl 103, Glucose 100, BUN 15, Cr 1. She has developed HTN over the recent months which she attributes to all the stress of keeping her banana business afloat during COVID. Which of the following findings would cause her physician to suspect a neoplastic cause? (Select all that apply)
Low renin
TTKG <2
Family history of Gitelman’s syndrome
She has been eating banana’s injected with insulin
Combination of loop diuretics and thiazide diuretics to address her HTN
Breyer’sIceCream HusdonBaysden decided to help out a local banana business stay afloat by purchasing way TOO many bananas. He has gotten board of just eating banana’s, and goes online to see what he can do with all these bananas. Unfortunately, he ends up discovering a “bananema”. Which is a banana smoothie with 4 bananas turned into an enema. He presents with the following labs: Na 135, K 6.5, Cl 103, Glucose 700, BUN 15, Cr 1. Which of the following would be consistent with his results? (select all that apply)
An EKG with peaked T waves
An EKG with U waves and ST depression
A history of diabetes mellitus
TTKG>7
TTKG<2
Kristine's arch-nemesis, Pristine Yhin brought to the emergency department with increasing confusion. She has a history of lung cancer and is currently undergoing chemotherapy and radiation therapy. Two weeks ago, she was started on hydrochlorothiazide and enalapril for hypertension. Pulse is 80/min, and blood pressure is 126/78 mm Hg. The physical examination is normal except for disorientation to time and place. Serum studies show a sodium level of 122 mEq/L, potassium of 3.9 mEq/L, and creatinine of 0.9 mg/dL. ADH level is in the low-normal range.
What is the most likely mechanism for her hyponatremia?
Mineralocorticoid deficiency
Decreased GFR
Hypovolemia
Decreased urinary diluting capacity
Neoplastic secretion of ADH
Jerry goes on a 2-day thirst strike after James refused to eat yogurt with him in mid-air during their first skydive. Following the thirst strike, Jerry doesn't feel well and is carried to the ED by CBL Group N. His blood pressure is 90/70 mm Hg, falling to 80/55 mm Hg when sitting up. Physical examination reveals he is disoriented with slurred speech. He cannot eat yogurt or drink fluids without gagging or spitting. Laboratory studies show a serum sodium level of 160 mEq/L, blood urea nitrogen of 45 mg/dL, and creatinine of 1.2 mg/dL. Intravenous fluid treatment leads to a serum sodium concentration of 141 mEq/L 2 hours later.
What is a likely result of his treatment?
Dehydration
Central diabetes insipidus
Cerebral edema
Demyelination of the pons
RBC lysis
Dr. Thai wants to know how fast a new drug, armadillol, is excreted by the kidney. The clinician obtains the following values: drug plasma concentration 80 mg/mL, drug urine concentration 500 mg/mL, and urine flow rate 10 mL/min. The patient's inulin clearance is found to be 100 mL/min. How is armadillol handled by the renal tubular system?
Equally secreted and absorbed
Neither secreted nor absorbed
Net reabsorption
Net secretion
For his next manuscript, Dr. Segar is studying the physiology of the renal system. He decides to evaluate kidney function by measuring the parameters used to evaluate filtration. Values obtained from a study participant are provided in the table.
The urinary flow rate is 4.0 mL/min.
Which of the following values best approximates the glomerular filtration rate (GFR) in this subject?
100 mg/mL
25 mL/min
2 mg/mL
320 mL/min
None of the above
