Packrat - Renal Exam with Complete Solutions
1. Clinical Therapeutics/Urology/Renal
A 7 year-old boy wets the bed on most nights. Which of the following is the preferred
pharmacological agent to decrease the incidence of bed wetting episodes?
A. Imipramine (Tofranil)
B. Phenytoin (Dilantin)
...
Packrat - Renal Exam with Complete Solutions
1. Clinical Therapeutics/Urology/Renal
A 7 year-old boy wets the bed on most nights. Which of the following is the preferred
pharmacological agent to decrease the incidence of bed wetting episodes?
A. Imipramine (Tofranil)
B. Phenytoin (Dilantin)
C. Pramipexole (Mirapex)
D. Hyoscyamine (Urised) CORRECT ANSWER-(c) A. Imipramine is an anti-cholinergic and
when given before bedtime has been shown to decrease the incidence of bed wetting.
(u) B. Phenytoin is an anticonvulsant and is not used in enuresis.
(u) C. Pramipexole is a dopamine agonist used in the treatment of restless leg syndrome.
(u) D. Hyoscyamine is an anti-spasmodic used to treat overactive bladder.
2. Health Maintenance/Urology/Renal
Which of the following is used to monitor possible recurrence of prostate cancer?
A. Prostate specific antigen
B. Acid phosphatase
C. Transrectal ultrasound
D. Bone scan CORRECT ANSWER-(c) A. Increasing levels of prostate specific antigen are
consistent with progression of disease.
(u) B. Acid phosphatase levels may increase in prostate cancer, but are not as sensitive as
prostate specific antigen for recurrence of disease.
(u) C. Transrectal ultrasound is mainly used for staging of disease and not monitoring of
recurrence.
, Packrat - Renal Exam with Complete Solutions
(u) D. Radionuclide bone scan is used to detect bony metastases.
3. History & Physical/Urology/Renal
Which of the following signs and symptoms is typically noted in patients with acute cystitis?
A. Fever and chills
B. CVA tenderness
C. Flank pain
D. Frequency and dysuria CORRECT ANSWER-(u) A. Signs of systemic toxicity, such as
fever and chills, are absent in acute cystitis.
(u) B. CVA tenderness and flank pain are associated with acute pyelonephritis.
(u) C. See B for explanation.
(c) D. Irritative voiding symptoms, such as frequency and dysuria, are common in acute cystitis.
4. Diagnostic Studies/Urology/Renal
A 60 year-old patient presents with elevated blood pressure and peripheral edema. Laboratory
testing reveals a BUN of 58 mg/dl and a creatinine of 4.5 mg/dl, these results are unchanged
from six months ago. Urinalysis today is negative except for the following, specific gravity of
1.002, 2+ protein, and trace glucose. Which of the following laboratory findings would be most
consistent for this patient?
A. Hypercalcemia
B. Metabolic alkalosis
C. Hypokalemia
, Packrat - Renal Exam with Complete Solutions
D. Anemia CORRECT ANSWER-(u) A. In a patient with chronic renal failure, typical
laboratory findings include hypocalcemia, metabolic acidosis, and hyperkalemia.
(u) B. See A for explanation.
(u) C. See A for explanation.
(c) D. Anemia, due to low erythropoietin, is common in patients with chronic renal failure.
5. Clinical Intervention/Urology/Renal
A 27 year-old patient presents with crush injuries to both lower extremities after being involved
in an automobile accident. Within six hours of the accident, urine output has decreased to less
than 10 cc per hour. Within 24 hours the serum creatinine increased from 0.9 mg/dl to 2.9
mg/dl and serum CPK is now 12,000 U/L. In addition to a fluid challenge with normal saline,
which of the following is the most appropriate treatment as this time?
A. IV calcium chloride
B. Oral captopril (Capoten)
C. IV sodium bicarbonate
D. Oral sevelamer (Renagel) CORRECT ANSWER-(u) A. While hypocalcemia is common in
rhabdomyolysis and acute renal failure, treatment is not needed unless clinical signs such as
tetany are noted.
(h) B. The use of ACE inhibitors, such as captopril, may worsen renal function and are not
indicated in this case.
(c) C. Treatment of acute renal failure due to rhabdomyolysis is best accomplished with IV fluids
and forced alkaline diuresis.
(u) D. Sevelamer is a phosphate binder used to treat elevated phosphate levels in patients with
end stage renal disease.
, Packrat - Renal Exam with Complete Solutions
6. Clinical Therapeutics/Urology/Renal
A 35 year-old male presents with fever, perineal pain, and dysuria. On physical examination, the
patient is toxic- appearing, febrile, and his prostate is very tender to palpation. Laboratory
testing reveals leukocytosis, pyuria, and bacteriuria. Which of the following is the treatment of
choice for this patient?
A. Ampicillin and gentamicin
B. Ceftriaxone and doxycline
C. Trimethoprim-sulfamethoxazole
D. Nitrofurantoin CORRECT ANSWER-(c) A. Acute prostatitis is best treated acutely with
parenteral antibiotics, such as ampicillin and gentamicin.
(u) B. Ceftriaxone and doxycycline are used in the treatment of acute epididymitis due to
sexually transmitted infection.
(u) C. Trimethoprim-sulfamethoxazole can be used but is second line in toxic patients and is best
used after the patient is stable.
(u) D. Nitrofurantoin is used in the treatment of acute cystitis and not indicated in acute
prostatitis.
7. Scientific Concepts/Urology/Renal
Which of the following is the most common cause of acute epididymitis in men under the age of
40?
A. Chlamydia trachomatis
B. Ureaplasma urealyticum
C. Pseudomonas aeruginosa
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