amitdoc2b
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Hi guys.. these are different than my last post, I tried finding a bunch on my own but couldn't answer some.. ive posted those below..
I wanted to thank everyone who has helped me out with the NBME questions for this topic. But I still have some questions that were are unanswered and my exam is in 2 weeks! Can you please help me out with them? I wanted to understand also why it is the correct answer and I have been having trouble finding the reasoning behind these particular questions.
I've attached 3 files in this topic, I have to do it in separate replies cuz it only lets me attach one file at a time..
Thanks!!
Attached Files:
physio_1.JPG (101 KB, 184 downloads)
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| amitdoc2b
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here's the 2nd file
Attached Files:
physio_2.JPG (58 KB, 129 downloads)
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| amitdoc2b
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here's the third and final..
Attached Files:
physio_3.JPG (64 KB, 90 downloads)
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| dr_bilalahmad
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question 11.
C is the answer ace inhibitors decrease aldosterone,increase renin(due 2 loss feed back inhibition by aldosterone)and bradykinin will rise due 2 decrease in metabolism.
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| study_ing
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basically u have to understand that the stenosis causes decrease Bld flow to the ipsilateral kidney which in turn activates the renin-angio system and favors HTN.
to see if this indeed is the major contributing event, the level of reninn from the stenosed kidnay shud be higher than the unaffected one.
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| study_ing
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the "bulky' malodorous stool ud point towards fat malabsorption. hence the bonepain is due to VIT d deficiency. the profile to choose wud include low ca and phosphate. PTH levels wud RISE secondarily and ALP wud pbly be high too.
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| amitdoc2b
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thanx again study_ing...can anyone else please help on the rest of the questions??
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| giovanni83
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I answered like this:
section 1: C-A-A
section 2: B-F
section 3: C-E
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| giovanni83
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here is the explanation for question 35, section 2:
ADH, Aldosterone,AgII causes high pressure, so high afterload; ANP causes venous dilatation, so high preload, insulin doen't matter in this case.
The right answer should be Norepinephrine, it causes initially high heart frequency (like epinephrine)but later, with the sensory feedback, it causes low heart rate, and vasoconstriction periferally, but vasodilatation in kidneys and brain...
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| docarchana
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sorry giovanni. i think 35 is ANP. causes loss of water and decreases preload & afterload. i think u have gone too deep with ur explanation for NE (not usually the case for mle).
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| giovanni83
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you are right...
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| amitdoc2b
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docarchana wrote:
sorry giovanni. i think 35 is ANP. causes loss of water and decreases preload & afterload. i think u have gone too deep with ur explanation for NE (not usually the case for mle).
I thought ANP causes sodium and water retention, not water loss? Is ANP the same as ANF (Atrial Natriuretic Factor) - which activates cGMP, protein kinase G, then causes vasodiolation and na2+/water retention??
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| amitdoc2b
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giovanni83 wrote:
I answered like this:
section 1: C-A-A
section 2: B-F
section 3: C-E
In section 3 you said C?? Calcium oxalate is what causes renal calculi...you would want to reduce it no? I was thinking alkalinization because your urine is acidic and you want to neutralize it since you arent ingesting water or oxalate..what do u think?
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| giovanni83
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you are right again....it's alcalinization.....especially considering the factor that usually calcium calcoli are associated with urate calculi....
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| amitdoc2b
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giovanni83 wrote:
you are right again....it's alcalinization.....especially considering the factor that usually calcium calcoli are associated with urate calculi....
i did some research and now i confused myself. ok yes it if its calcium oxalate then the urine is acidic and requires alkalinization. but if its calcium phosphate or calcium carbonate its alkalinized urine and requires acidification. the question doesnt state which type of calcium it is?!? so whats the answer??
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| giovanni83
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Now I've got the solution: it's diuretic Tiazidics, the causes ipercalcemia and ipocalciuria!!
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| PatriciaLim
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thiazide cause hypercalciuria and inturn increase the rick of renal stones.
Oxalate diet increase risk too (calcium oxalate stone)
protein diet increase uric acid( hyperuricaemia increases risk as well)
restriction of fluid is high UNrecommended
So should be alkalization of urine
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| PatriciaLim
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Sorry someone said its ANP.
ANP increases atrial pressure, wont it also increase preload ?
What about angiotensin II
It decreases blood volume via renin and also increases GFR (vasoconstriction of the eff ?)
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| giovanni83
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Diuretics
Two different classes of diuretics interact with calcium in opposite ways—thiazide diuretics such as hydrochlorothiazide can raise calcium levels in the blood, while loop diuretics, such as furosemide and bumetanide, can decrease calcium levels. In addition, amiloride, a potassium-sparing diuretic, may decrease the amount of calcium excreted in the urine (and subsequently increase calcium levels in the blood), especially in people with kidney stones.
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| giovanni83
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sorry PatriciaLim but you are wrong....the right answer is Tiazides....read Harrison's internal medicine please...
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| PatriciaLim
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well, you said that thiazide rise calcium level while loops decrease calcium level right?
i dont understand why loops has to come into this question. Bcoz the option were for thiazide not loops???
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| giovanni83
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the answer is Tiazides, remember that you want less calcium in urine!!
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| dr_rani
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| smalldoc
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guys,i dont know much,but isnt renin secreted from t arteriole,so wud v not hve to measure its level in t renal vein?
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| Addicudo
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Section One ... Question 29 ... D is the right answer .. In RA Stenosis ... The Renin Inedx in the VEIN is a measure of the function of that Kidney .. !! http://www.nephrologychannel.com/ras/
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