What is the most common cause of acute pyelonephritis resulting from an ascending infection from the lower urinary tract?

Correct Answer: C

Rationale: The correct answer is C. The most common cause of acute pyelonephritis from an ascending infection is a preexisting abnormality of the urinary tract. This abnormality can lead to urine stasis, making it easier for bacteria to ascend from the lower urinary tract to the kidneys. Choices A and B are incorrect because scarred kidneys and antibiotic resistance do not typically cause acute pyelonephritis. Choice D is incorrect as non-compliance with antibiotics may contribute to recurrent infections but is not the most common cause of pyelonephritis.

Correct Answer: A

Rationale: The correct answer is A: Reflex incontinence. This type of incontinence occurs due to a lack of voluntary control over the bladder, usually resulting from a spinal cord lesion. In this case, the thoracic spinal cord lesion is causing the incontinence. The fact that incontinence occurs equally during the day and night suggests a lack of awareness or sensation of bladder fullness, characteristic of reflex incontinence. Summary of other choices: B: Overflow incontinence is due to bladder overdistension and is commonly associated with conditions like BPH or spinal cord injuries at the sacral level. C: Functional incontinence is when a person is unable to reach the toilet in time due to physical or cognitive impairments. D: Incontinence after trauma is a broad term and does not specifically address the pattern of incontinence described in the question.

Correct Answer: D

Rationale: The correct answer is D. Stomatitis in CKD patients is often caused by iron salts, calcium-containing phosphate binders, and limited fluid intake. Iron salts and calcium binders can lead to mucosal irritation in the GI tract, exacerbating stomatitis. Limited fluid intake can cause dehydration, leading to oral mucosal dryness and vulnerability to stomatitis. A: High serum sodium levels do not directly cause stomatitis in CKD patients. B: Irritation of the GI tract from creatinine is not a common cause of stomatitis in CKD patients. C: Increased ammonia from bacterial breakdown of urea is more related to hepatic encephalopathy rather than stomatitis in CKD patients.

Correct Answer: C

Rationale: The correct answer is C because hoarseness can be caused by a large thyroid tumor pressing on the larynx, affecting vocal cord function. This physical obstruction directly interferes with the ability of the vocal cords to vibrate properly, leading to hoarseness. Increased capillary permeability (A) would not result in hoarseness. A secondary respiratory infection (B) may cause coughing or throat irritation, but not hoarseness specifically. A psychologic illness (D) would not directly cause hoarseness as it is a physical symptom related to the vocal cords.

Correct Answer: C

Rationale: Correct Answer (C): Check the flow to maintain a light pink drainage. Rationale: 1. Darker bladder drainage may indicate blood in the urine, which could be a sign of internal bleeding postoperatively. 2. Checking the flow allows you to assess the amount and color of drainage to ensure it stays light pink, indicating no significant bleeding. 3. Monitoring the drainage color helps in early detection of complications and prompt intervention if needed. Incorrect Choices: A: Calling the attending physician is not the initial action as it may delay necessary intervention. B: Irrigating with a piston syringe can disrupt the natural drainage pattern and should not be done without a healthcare provider's order. D: Ignoring the change in color as expected can lead to overlooking a potentially serious issue.