Unit 4 Common Urologic Disorders

How is the pathophysiology of a urinary tract infection reflected in a patient's symptoms? Select all that apply.

-Inflammation of the kidneys in pyelonephritis results in pain and bleeding. (As the infection increases in the kidney, the pressure causes pain, destruction of kidney tissue, and bleeding into the urine.) -Systemic infection is more common with kidney infections than bladder infections. (Because of the kidney's rich blood flow, the kidneys when infected may "seed" bacteria into the bloodstream.) -Inflammation and ulceration of the bladder wall in cystitis results in pain and bleeding. (Infection of the bladder is associated with inflammation, swelling, ulceration, pain, and bleeding.)

Which statements correctly describe the pathophysiology of adult polycystic kidney disease? Select all that apply.

-Multiple cysts develop in both kidneys. (Polycystic kidney disease is characterized by the formation of multiple cysts in both kidneys.) -Other organs can be involved including the liver. (Patients with polycystic kidney disease may develop cysts in different organs including the liver.) -Chronic renal failure is a common complication of polycystic kidney disease. (Polycystic kidney disease commonly causes chronic renal failure.)

Which is the cause of the chronic pain in polycystic kidney disease?

Stretching of the kidney capsule due to cysts The cysts enlarge within the kidney, stretching the capsule resulting in pain and heaviness.

In a patient with urinary obstructive disease, which symptom is suggestive of kidney stones?

Testicular or labial pain (Ureteral stones are often associated with referred pain to the testicle or labia.)

In cystitis, blood is found in the urine. Due to which condition the blood originates?

The bladder wall may ulcerate and bleed.

Which statement is true regarding Wilms' tumors?

The tumors may occur with other congenital disorders. (Wilms' tumor is associated with other congenital disorders such as aniridia, the absence of the colored part of the eye.)

Which processes are involved in the pathophysiology of urinary obstruction related to prostatic hypertrophy? Select all that apply.

There is a hormonal imbalance between estrogen and testosterone. (The imbalance between estrogen and testosterone encourages growth of the prostate.) The urine continues to be produced, and pressure builds up, leading to hydronephrosis. (The prostate obstructs urine outflow, causing backpressure, hydronephrosis, and potential damage to the kidneys.)

Which statements about kidney stone disease are correct? Select all that apply.

-Stones tend to form when there is supersaturation of the urine. (Stones tend to form when there are excessive amounts of insoluble salts in the filtrate, a condition known as "supersaturation.") -Stones begin as tiny crystals and deposits build up on them, making them grow. (Once a tiny crystal forms, deposits continue to build up on this focus and eventually form a large mass.)

Which are accurate statements about urinary tract obstructions? Select all that apply.

-There is often a genetic predisposition to kidney stones. (There is thought to be some familial tendency to stone formation, probably related to inheriting metabolic traits.) -Urethral strictures may result from genital trauma or infections (Urethritis and trauma such as catheterization can lead to urethral strictures.) -Kidney stones may be triggered in patients by dehydration. (Dehydration can lead to increased stone formation due to concentration of crystals.) -There is often a genetic predisposition to benign prostatic hypertrophy. (There is often a family history of benign prostatic hypertrophy.)

How do infectious bacteria get into the urinary system? Select all that apply.

-Through the urethra (Bladder infections most often result from ascending infection through the urethra.) -Through the blood stream (Hematogenous seeding of the kidneys is one possible cause of pyelonephritis.)

Arrange the events in the pathophysiology of post-streptococcal glomerulonephritis in the correct sequence. Antigen-antibody complex (immune complex) formation Streptococcal infection Glomerular dysfunction Antibody formation Glomerular inflammation Immune complexes deposit in glomerulus

> Streptococcal infection > Antibody formation > Antigen-antibody complex (immune complex) formation > Immune complexes deposit in glomerulus > Glomerular inflammation > Glomerular dysfunction Post-streptococcal glomerulonephritis is an immune complex disease that starts with a streptococcal infection with the development of antigen-antibody complexes that become trapped in the glomeruli. There, they initiate a local inflammatory reaction that causes damage to the glomeruli.

Which pathophysiologic characteristics do kidney and bladder cancer have in common?

Both can metastasize to the liver. (Both tumor types can metastasize to various organs via the blood stream, and both cancers seem to spread to bone and liver.)

Which statement is correct about acute post-streptococcal glomerulonephritis (ASPGN)?

ASPGN affects children between the ages of 3 and 7 years. (This is the age of patients affected by ASPGN; it is typically not seen in adults.)

Which condition is the pathophysiology of nephrotic syndrome?

Abnormality of the glomerular capillaries with increased permeability (The glomerular capillaries become abnormally permeable, allowing marked proteinuria.)

Which conditions are likely to be present with pain? Select all that apply.

Acute cystitis (Acute cystitis is often complicated by pain.) Kidney stones (Kidney stones present with severe acute pain.) Pyelonephritis (Pyelonephritis presents as pain in the flank along with fever, with or without symptoms of bladder irritability.)

A man goes to his doctor with flank pain, fever, chills, nausea, and blood in his urine. He is sitting as still as possible. Which is likely the cause of his discomfort?

Acute pyelonephritis

Which statement is correct regarding non-poststreptococcal glomerulonephritis?

Average age is 53. (In post-Strep GN the average age of onset is 3-7 years, while in other forms of GN the average age is 53.)

Which statements about benign prostatic hypertrophy (BPH) are correct? Select all that apply.

BPH affects about 50% of men. BPH may be related to a hormonal imbalance. BPH can lead to obstruction of urinary flow. (If the enlarged prostate compresses the urethra, it can cause urinary outflow obstruction.)

Which bacteria are common causative organisms in infections of the urinary system? Select all that apply.

E. coli (E. coli is the most common causative organism of urinary tract infections.) Serratia (Serratia can cause urinary tract infections.) Pseudomonas (Pseudomonas can cause multi-drug resistant urinary infections in susceptible patients.)

Which symptoms would be suggestive of pyelonephritis? Select all that apply.

Flank pain Hematuria Fever and chills Nausea and vomiting

Which is the cause of polycystic kidney disease?

Genetic factor (Polycystic kidney disease is inherited as a genetic autosomal dominant disorder.)

Which signs and symptoms are consistent with Wilms' tumor? Select all that apply.

Hematuria Lung metastases Unilateral abdominal mass

Which symptoms are seen in a person with bladder cancer? Select all that apply.

Hypertension (Hypertension can be seen with kidney and bladder cancers.) Early cancer is often asymptomatic (Because the bladder stretches, early bladder cancer usually does not create symptoms.)

Why is pyelonephritis potentially more serious than cystitis?

Kidney infection can lead to sepsis and bacteremia. (Because of their rich blood supply, kidney infections can lead to release of bacteria into the blood stream.)

A man goes to his doctor with severe flank and testicular pain, nausea, vomiting, profuse sweating, pacing in the room, and blood in his urine. Which factor is likely causing his discomfort?

Kidney stone

Which occupations are more at risk for the development of bladder or renal cell cancer? Select all that apply.

Mechanics Hair dressers Rubber workers Leather (including shoe) workers

Match the trait with the disease. Trait: >Multiple tumors >Unilateral large abdominal mass >Can cause urinary outflow obstruction >Primary tumor arises from epithelium of tubules Disease: >Renal cell cancer >Wilms' tumor >Benign prostatic hyperplasia >Bladder cancer

Multiple tumors >Bladder cancer Unilateral large abdominal mass >Wilms' tumor Can cause urinary outflow obstruction >Benign prostatic hyperplasia Primary tumor arises from epithelium of tubules >Renal cell cancer

Which is the most common cause of bladder and kidney cancer?

Smoking (Smoking is the most common predisposing factor in bladder cancer and renal cell carcinoma.)

Which statements are correct regarding urinary tract infections (UTIs)?

UTIs are more common in females. (Urinary tract infections affect 6 million people annually.)