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Chapter25TheUrinarySystemExam
1. FillintheBlank/ShortAnswerQuestions

1)ThecapillarybedthatsurroundsthedescendingandascendingloopofHenleof
juxtamedullarynephronsiscalledthe________.
Answer:vasarecta
PageRef:968
2. 2)Urinecrystalsintherenalpelvisarecalled________.
Answer:renalcalculi
PageRef:986
3. 3)Theneedtogetupinthemiddleofthenighttourinateiscalled________.
Answer:nocturia
PageRef:991
4. 4)Theareabetweentheuretersandurethraiscalledthe________inabladder.
Answer:trigone
PageRef:986
5. 5)The________mechanismisthegeneraltendencyofvascularsmoothmuscletocontractwhen
stretched.
Answer:myogenic
PageRef:972
6. 6)Thepresenceofpusintheurineisaconditioncalled________.
Answer:pyuria
PageRef:985Tbl.25.2
7. 7)Sodiumlinkedwaterflowacrossamembraneiscalled________waterreabsorption.
Answer:obligatory
PageRef:975
8. 8)Explainhowfiltrationworksintheglomerularcapillaries.
Answer:Theglomerularcapillariesarefenestrated,allowingfairlylargemoleculestopassthrough.The
substancesmustpassthroughthebasementmembrane,wheretheyarefurtherselectedforsizebythe
filtrationslitsofthepodocytes.
PageRef:969,971
9. 9)Listthreesubstancesthatareabnormalurinaryconstituentsandprovidetheproperclinical
termforsuchabnormalities.
Answer:Abnormalurinaryconstituentsincludethefollowing(theclinicaltermforeachislistedin
parentheses):glucose(glycosuria),proteins(proteinuriaoralbuminuria),ketonebodies(ketonuria),
hemoglobin(hemoglobinuria),bilepigments(bilirubinuria),erythrocytes(hematuria),andleukocytes
(pyuria).
PageRef:985Tbl.25.2
10. 10)Explaintheroleofaldosteroneinsodiumandwaterbalance.
Answer:Aldosteronetargetsthedistaltubuleandcollectingductandenhancessodiumionreabsorption
sothatverylittleleavesthebodyinurine.Aldosteronealsocausesincreasedwaterreabsorptionbecause,
assodiumisreabsorbed,waterfollowsitbackintotheblood.
PageRef:978
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11. 11)Explainwhatismeantbythetermscotransportprocessandtransportmaximum.
Answer:Cotransportprocessreferstotheactivetransportofonesolute"uphill"(againstaconcentration
gradient)coupledtothe"downhill"(withaconcentrationgradient)movementofanotherduringtubular
reabsorption.Transportmaximumreflectsthenumberofcarriersintherenaltubulesavailableto"ferry"
aparticularsubstance.
PageRef:975976
12. 12)Humanscansurviveforaperiodoftimewithoutwaterthankstotheabilityofthekidneysto
produceconcentratedurine.Brieflyexplainthefactorsthatallowthistohappen.
Answer:Facultativewaterreabsorptiondependsonthepresenceofantidiuretichormone.Inthepresence
ofADH,theporesofthecollectingtubuleenlargeandthefiltrateloseswaterbyosmosisasitpasses
throughthemedullaryregionsofincreasingosmolarity.Consequently,waterisconservedandurine
becomesconcentrated.Thewaterthatpassesthroughtheseregionsisreabsorbedbythebodyinorderto
preventdehydration.
PageRef:981
13. 13)Listanddescribethreepressuresoperatingatthefiltrationmembrane,andexplainhoweach
influencesnetfiltrationpressure.
Answer:Glomerularhydrostaticpressureisthechiefforcepushingwaterandsolutesacrossthefiltration
membrane.Thehighertheglomerularhydrostaticpressure,themorefiltrateispushedacrossthe
membrane.Colloidosmoticpressureofplasmaproteinsintheglomerularblood,andcapsularhydrostatic
pressureexertedbyfluidsintheglomerularcapsule,drivefluidsbackintotheglomerularcapillaries.The
netfiltrationpressureequalsglomerularhydrostaticpressureminusthesumofcolloidosmoticpressure
ofglomerularbloodandcapsularhydrostaticpressure.
PageRef:969,971
14. 14)Inadditiontothereninangiotensinmechanism,therenalcellsproduceotherchemicals.
Namefour,andbrieflygivethemainfunctionofeach.
Answer:Renalcellsalsoproducechemicals,someofwhichactlocallyassignalingmolecules.These
chemicalsincludeprostaglandins(vasodilatorsand
vasoconstrictors),whichprobablyregulateGFRnitricoxide,apotentvasodilatorproducedbythe
vascularendotheliumadenosine,whichconstrictsrenalvasculatureandendothelin,avasoconstrictor
thatinhibitsreninrelease.
PageRef:972974
15. 15)Whatareaquaporins?
Answer:Aquaporinsarewaterfilledporesinwaterpermeableportionsoftheconvolutedtubulessuchas
thePCT.
PageRef:975
16. 16)Freshlyvoidedurinehasverylittlesmell,butshortlyaftervoidingitcangiveoffavery
strongsmell.Why?
Answer:Freshlyvoidedurineisrelativelysterilebutifitisallowedtostand,bacteriabegintometabolize
theureasolutestoreleaseammoniaandothersmellsdependingontheperson'sdiet.Afruitysmell
generallymeansthereisadiabetesproblem.
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17. ClinicalQuestions

1)Anoldermanseeshisdoctorforseverepaininhislowerabdominalorflankarea,elevated
temperature,andnausea.Exhaustivetestsruleoutabdominalobstructionsandinfections.Xrays
indicateashadowonhisrightureter.Diagnosehisproblem.Givesuggestedtreatmentand
prognosis.

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Answer:Thesymptomsindicateakidneystonethathasbeenpassedintotheureter.Treatmentwouldbe
IVtherapytoflushthestoneout,surgery,orultrasoundwavestoshatterthecalculi.Theprognosisisfor
completerecovery.Thereisapossibilityofkidneystonesformingagain.
PageRef:986
18. 2)Whatclinicaleffectswouldhighbloodpressurehaveonthekidneysofabedriddenpatient?
Answer:Thispatientwouldhaveamuchhigherglomerularhydrostaticpressureandwould
thereforelosemorefluidsthannormal.Becauseofthethreatofdehydration,thestaffshould
makesurethepatientdrinksplentyofwater.
PageRef:969,971
19. 3)ElevenyearoldHarryiscomplainingofaseveresorethroatandgetstostayhomefrom
school.Hispediatricianprescribesacourseofbroadspectrumantibiotics,andHarryfeelsmuch
betterwithinafewdays.However,sometwoweekslater,Harryhasadull,bilateralpaininhis
lowerbackandhisurineisasmokybrowncolor.OnthebasisofHarry'ssignsandsymptoms,
diagnosehisconditionandindicatetherelationship(ifany)betweenhispresentconditionand
hisearliersorethroat.
Answer:Harryisshowingthesymptomsofkidneyinflammation.Thesmokybrowncolorofthe
urineindicatesthepresenceofbloodorbile.Kidneyinflammationsusuallyresultfrominfections
eitherofthelowerurinarytractor,inHarry'scase,fromhisearlierinfectionofasorethroat.The
kidneyinflammationiscalledeitherpyelitis(involvesonlytherenalpelvisandcalyces)or
pyelonephritis(affectsthewholekidney).
PageRef:988
20. 4)Ellen,a47yearoldwomanwhohassufferedkidneydiseaseforseveralyears,hasbeen
diagnosedwithproteinuria.Herlegsandfeetaresoswollenthatshehasdifficultywalking.Her
handsandherleftarmarealsoswollen.Whatisproteinuria,andcouldthisconditionbeplaying
aroleinherswollenlimbs?
Answer:Proteinuriaisaconditioninwhichthepermeabilityoftheglomerularcapillariesis
increasedtosuchanextentthatlargeamountsofplasmaproteins(mostlyalbumin)passintothe
glomerularfiltrateandareexcretedintheurine.Iftheconditionissevere,thelossofplasma
proteinsmaydecreaseosmoticpressuresubstantially.Whenthishappensthereisatendencyfor
fluidtoleavethesystemicbloodvesselsandenterthetissuespace.ThisisthereasonforEllen's
swollenlimbs.
Diff:3PageRef:985
21. 5)Rachaelhasbeencomplainingoffrequentandburningurination.Shealsoreportedseeing
somebloodinherurine.Herphysiciansuspectscystitis.Whatiscystitis,andhowcanitcause
thesesymptoms?
Answer:ItispossiblethatRachaelhascystitis,aconditioninwhichthemucousmembrane
liningthebladderbecomesswollenandbleedingoccurs.Thisconditioniscausedbybacterial
invasionofthebladderorbychemicalormechanicalirritation.
PageRef:988
22. 6)Apatientis18yearsoldandhasacomplaintofpainfulurination,fever,chills,andbackpain.
Thisishersecondurinarytractinfection(UTI)within5months.HowcantheRNinstructthe
patientonpreventionofanotherUTI?
Answer:Escherichiacoliarenormalresidentsofthedigestivetractandgenerallycauseno
problemsthere,butthesebacteriaaccountfor80%ofallurinarytractinfections.Thenursecan
instructthepatientonproperhygienemeasures.Thenurseshouldalsoexplainthatsexually
transmittedinfectionscanalsoinflametheurinarytract,cloggingsomeofitsducts.
PageRef:988

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23. 7)A58yearoldwomancomplainsoflossofurinewhencoughingandsneezing,andduring
exercise.Shehashadthreechildren.Describethepossiblecausesofurinaryincontinencein
thispatient.
Answer:Stressincontinenceisfoundmostcommonlyinwomenwithrelaxedpelvic
musculaturedeprivedofestrogen.Stressincontinencemayoccurwithasuddenincreasein
intraabdominalpressuresuchascoughingorsneezing,whichforcesurinethroughtheexternal
sphincter.
PageRef:988
24. 8)Explainhowanangiotensinconvertingenzymeinhibitor(ACEinhibitor)suchascaptopril
wouldbeeffectiveasanantihypertensive.
Answer:AngiotensinIIisapotentvasoconstrictoractivatingsmoothmuscleofarterioles
throughoutthebody,causingmeanarterialbloodpressuretorise.ACEinhibitorsreduceblood
pressurebyinterruptingthereninangiotensinaldosteronesystem.
PageRef:972974
25. Ifyouhaveanyquestionsornoticeanymistakes,
Pleasemessageme.Iwilltrytoreplywithin48hours.
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