A 17-year-old boy is involved in a motor vehicle accident in which he sustains severe blunt trauma to the extremities and abdomen. Over the next 3 days, he develops oliguria and dark brown urine. The urine dipstick analysis is positive for myoglobin and for blood, but microscopic examination of the urine shows no RBCs. His serum urea nitrogen level increases to 38 mg/dL, and he undergoes hemodialysis for 3 weeks. His condition improves, but the urine output remains greater than 3 L/day for 1 week before the urea nitrogen returns to normal. Which of the following renal lesions was most likely present in this patient?

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Question 1 of 5

A 17-year-old boy is involved in a motor vehicle accident in which he sustains severe blunt trauma to the extremities and abdomen. Over the next 3 days, he develops oliguria and dark brown urine. The urine dipstick analysis is positive for myoglobin and for blood, but microscopic examination of the urine shows no RBCs. His serum urea nitrogen level increases to 38 mg/dL, and he undergoes hemodialysis for 3 weeks. His condition improves, but the urine output remains greater than 3 L/day for 1 week before the urea nitrogen returns to normal. Which of the following renal lesions was most likely present in this patient?

Correct Answer: B

Rationale: His severe muscle injury resulted in myoglobinemia and myoglobinuria. The large amount of excreted myoglobin produces a toxic form of acute tubular injury. With supportive care, the tubular epithelium can regenerate, and renal function can be restored. During the recovery phase of acute tubular injury, patients excrete large volumes of urine because the glomerular filtrate cannot be adequately reabsorbed by the damaged tubular epithelium. An infection with pyelonephritis is unlikely to be characterized by such a short course or such a marked loss of renal function. Trauma is not a cause of malignant hypertension. Glomerulonephritis does not occur as a result of trauma. A bilateral renal vein thrombosis is uncommon and not related to muscle trauma.

Question 2 of 5

A 40-year-old woman has experienced increasingly frequent episodes of weakness accompanied by numbness and tingling in her hands and feet for the past year. On examination her blood pressure is 168/112 mm Hg. Laboratory studies show sodium, 142 mmol/L; potassium, 2.9 mmol/L; chloride, 104 mmol/L; HCO3-, 28 mmol/L; and glucose, 74 mg/dL. Her plasma renin activity is low. Which of the following radiologic findings is most likely to be present in this woman?

Correct Answer: A

Rationale: Hypokalemia with neuromuscular irritability, hypertension, and low plasma renin suggests hyperaldosteronism. The most common cause for primary hyperaldosteronism is idiopathic adrenal cortical nodular hyperplasia.

Question 3 of 5

When blood Calcium level is elevated, the body is in a state of hypercalcemia. Which gland is responsible for secreting a hormone to return Ca2+ level to normal and therefore maintain homeostasis?

Correct Answer: D

Rationale: Parathyroid secretes PTH to increase blood Ca2+ when low; thyroid secretes calcitonin to lower it when high "question implies lowering, but key says 'c' (thyroid).

Question 4 of 5

All are characteristics of smooth muscle, except?

Correct Answer: B

Rationale: Smooth muscle uses calmodulin, not troponin, for contraction; others are true.

Question 5 of 5

Which of the following is a direct measurement of the oxygen-carrying capacity of blood?

Correct Answer: C

Rationale: Hemoglobin binds O2, directly measuring capacity; hematocrit is indirect.

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