Ouns a <0 Sr 1 10.yar-eld by brought tthe physica for wall examinaton He fe wal He ha no hor of sout rox : iss Fs 7-year bother was wrested for ephocc side yea apo He sat 5th percent or hight and 60th Peco or weight Hs temperaures J7C (9887), pulse 6 20m, sod Boba pessue 96/54 en He. Physical ‘harman shows n anormaltien ie prick shows T+ prot subsequent urna ofa ery morning sample = stow 008 negate ehacove gave Protanerstmnarine 03 (N93) ; cho flowing ise os aporoprae nex sep n managemend Repeat ware apse in yar eal uiasonography tid pote 24-hour wine poten cotecon Measure serum crestinme and ures mitogen (© sew nucearantodylelouns al oO p 1 10.yar-eld by brought tthe physica for wall examinaton He fe wal He ha no hor of sout rox — iss Fs 7-year bother was wrested for ephocc side yea apo He sat 5th percent or hight and 60th elem fr Weight Hs tempura 27 BEST), pulse 20m, aa blood peste 954 wen He Pia _ ‘harman shows n anormaltien ie prick shows T+ prot subsequent urna ofa ery morning sample ® stow = 008 negate ehacove agate qi eee aie ‘Froteinjereatmine rans 0.2 (N £02) 2 ee, ich oe ftoning se ost appropriate nex sep n managemend ee ee “2a c ~— “Repeating urine stick isthe most appropriate nex step nthe work-up of wansintprorinuri, This child fels well has ‘no history oF series less and Nasr lated proteinuria o urna, Moreover, there a normal unary Fetes feratime eta Colccty exe Blogs pon fou beri nto of pti mot Met sien roti Further slagrose steps ae not nested a tis mexa R ouns al 1 10.yar-eld by brought tthe physica for wall examinaton He fe wal He ha no hor of sout rox iss Fs 7-year bother was wrested for ephocc side yea apo He sat 5th percent or hight and 60th elem fr Weight Hs tempura 27 BEST), pulse 20m, aa blood peste 954 wen He Pia ‘harman shows n anormaltien ie prick shows T+ prot subsequent urna ofa ery morning sample stow 008 negate ehacove gave uote ssterse negate Eas ich oe ftoning se ost appropriate nex sep n managemend eee ae 2a ‘Repeating @ wine dptck the most appropriate nes step the work-up of wansent proteinuria This child fe wal, has ro nso of seus ies, and as rl Slated potetnura on wi. Morava, hele socal wry Fetes feratime eta Colccty exe Blogs pon fou beri nto of pti mot Met sien roti Further slagrose steps ae not nested a tis mex ney bop ot route part ofthe wors-up for protemuna, woul homer, be considered in neprat syarare Pros his th taeacoek deeacacdee eeiaaaeer or on alin deoaade this cea ateuane raat ee acneney bop ot route part ofthe wors-up for protemuna, woul homer, be considered in neprat syarare ‘etracory fo ster, persstene hematuao sustained hypertension, of fue ou vasa conauors ecm “Unie cae of Heroch-Scharem purpura Ths paint a terive wll anaes no evince of aceaneed eal eae, Issong tat ey ape is ot Apophis ve. qc denotymsronephross, mensureter,poNeystc knead other ructutl patron, This msging ay 1 Inacates me wock-up of preva vt chor Khe ease, The plete ibd ete hs no NSH of Mey ‘Ali rofl wou be lf nthe dire dageotof rphontc son cae Iperipet can bu sen Several fs entoats. Although ts part as abratn evden of proteus nt closet anepmre anDe broeraria (25 g/day, wich equvalent 10 = 3~ or = on a cipsick raging, 2 roan cestne ra of 21 on <0 ne) and tee ar no ther sighs of repro yore eg. edemn. Cnsequent, ipe pote suri tebe pre 24-hoar rine pott clection coed beh im forthe characterising th pein’ pottura Curent gure, ‘homer, recommenda snle-voi urn prot creatinine atom children because east acaure aa correlates wh the nour ue protein sy reatnne seated ae velately onsen ate of 19/28 Rous. See rete ie eles pone eg rl fet ered ea Woe Eel ent weal ry OD ‘of manor renal aut ery aeady known Acdtonaly caeltng the BUNCE rate cm alto los tothe cause oF ‘tere prerna, ns or posera. Ts patent stows no sis of AKI eos, erga 0 measuMg Serum aaaataaeenrt card abtOW Dra Ke +00 sce enmity moroneporess, megaureer, pave kh, another src! panos, maging ty ‘Inceata i he work-up of protamura wt chro dey cease, The save described Hee Ras no Mtr fdr (dees, making wrasound approprae ss me. ‘tpi plote would be hello serena! aagnsis of nephoue sarome Because mpariidema ct be Seen sear of ts elas. though tis patent hat abstr evden of potemura fs ntl. to a nphro ange Dretenes > 3.8 g/d, whens enualer to ~ 3+ or 4 onaipreck eaing, or ptenreminine ato ot 2 on st wie an hee ate no ote signs of neptune e, edema),Conseqenth i roles une fe prove 24-hour rine protein colecuon cous be elu in farher haaceraing thi pair's pote. Curent guidelines, a eel le nee ao eee ee erga the 24-hour urmeprotansuy creatine secreted aa relataly constant of 19/28 Rous ‘Serum cresting and BUN vals provide insight real funtion and cn be sed ro ep dnt aca iy nr KD ‘or manior senal acy ayy sales known Addon calclang Ye BUNCE rato can soe ls othe caus oF Dat reel Seto el oe en chs po oe fc De eer Creatine ard BUN would be unecessary ath mex Arca rtbody tars te an extent aspect of lagnonig atonmane colons sucht systemic ope ‘rytenatosis. Lops can cae mi rte, Wich een ns chil. Tpically, however ere is evidence of hematuria bad usta volvement, such a ama Yash acre Test, ardor fis Ts pate ceric wel, Mh no ‘ter igor symptoms sn rom lated poten, makipg a etemmune continuawos s <2 tim > 13 30-year-old woman comes tothe pysictan fr 2 follow-up examination. Two wesks ago she wat sean fr adusiment of her arnpetensive regimen an prescrbe sino because of persistently high blood pressure readings. A complete ‘lod cunt and el ron checked ter at vere wth the rrmal ima, On Queso, she has adage ra fequentneaseches ovr the lant month She has hypertern, type 2 cabtes melt, peste naan dase Sra perp Her meter hs ype ang hypertension, Crret mdlatns neue aml and ‘ydroctorshesge a mai doses, snap meson, nape, an ators. She has never snked ad ‘nk 1-2 glsses of nether erry og Shes 167 em fe 5 ich) and wes 81.5 eg (10 lo) i 20 kgm Re lod presare 170/11 mm Hg both ams, he ate 90a and fst a 12 tamination shows an obese patent and no athe abnormal abort tes Show: iemealobin 14 90 x poo meq o oo meat Ureamtogen 29mar3t Frown agate lich of flowing ine moe ley sano? Hyperthyridsm (E)) cushing’s syndrome.on at omns a ee > 20 kgm er lod resare 170/110. ig both a, heart ate 80mm ard rset ae 12 eerste ela ple near sees ecient omasiotin 1 gat Leukocyte count 7,80? = veo magi roo meait rotan negate hich af he ftlonng ite mot italy agro? eee ere (©) tipecnaem ©) Piety waren © bec iy ease (© cushy ynirome (©) Fovessuc ey aseae (© Real ary senosswos s 8 o 1s yareld woman comes tothe phyitan fr 2 fllon-up examination. Tuo weskt 290 ae nat sen for armen of 3p ‘her BREE ecinen an prescribed ROB be case of BSI HMI WU resins. complete Diced cour and renal function checked athe Ev ware wit te oral ns, On questonng, he nas had augue = ra faquentneaseches ovr the lab month Se hus hyperernn, type 2 abetes melt, peste naan dase 5 ra perp Her meter hs petri ana hypertension, Crret medleatons neue amore and ekocNoraazde at maximo doses, IOBE, mevfonmin, qlee, and strata, She has ver rok ond ‘nk 1-2 glsses of nether ere gh Shes 167 em (fe 5 ich) and wens 81. eg (10 lo) 20 kgm Re lod presare 170/11 mm Hg both atm, he fate 90a anders ae 12 Examinmion shows an obee patent ano ether ornate abet es show a iemealobin 14 90 a 20mg oma Prowin oat 5 Which of eflonng 1 te mos key leans? cae eee aa rea ace oe ‘patie 20circrongy indents obs pamear gree 2a 1()Obstacve seep aones baci sleep apres (OSA) cone cae of estan yperemion, headaches, nd fatigue, epecily in patient who Le cache: poumnele tbs romain tides ie taacdinesseise ies peamaninas sacoate abies‘Obstructive le pen (OS) sa common aun of resistant hypertnsen, headaches and fatigue, apelin patents ho ‘ye obese. However ths paent has na Mstor of slp esturbaces or snoring, suagestve of OS. ‘aiiough his pas emily istry puts bra higher isk of developing hpertylsm ae cause of hypertension, she ‘nas no absoaaed cca Teas (2, heat letance, weg oss, ety sheplessres, ius achyearSa ane TSH -cquse of 10-206of cases of secondary hypertension. lhough ti patient as ow yperedotoroniem, asso nessa in sesnne foloming the sdminnation of st ACE Inher maiates thar her high blood pressure hl he es ofa secondary cause of hyetaldesteronsm. Dabs nephopmy can rut in an create cretnne and hypertension mae contr Aah he pten ‘nes tot uncoated hypertension and betes, er area tests ineasing feral fancin were eral pro 2 he ‘idon of ar ACE nh. The nese meestinne parts wth abet nepropsty well taker psc ve eae 28 ‘oto! te couse of wo Weck. The sudden worsening of creatine afer the ation of sioptl suggests «diferent ‘untvng cause “Cushing syome can cause hypertension, obey, hyperglycemia ad hypipiena a see nhs patient Howes, she ows not have ik ators sggentve of Castings syndrome, sch ab exogenous trod se The sudden erseing of {restnne sf heaton of nnopl sungete eran uncering aur.© Ds al <2 + 0 > sHitn ofan ACE nha. The neem cestine in pants wth cabetcnapropsty uel takes pec ver eae 2h Tot ove the couse of wo meek. The sudden worsening of creatinine afer the 2daton of sinopl suggests a ieent ‘untvng cause “Cushing syome can cause hypertension, obey, hyperglycemia ad hypipiena a see nhs patient Howes, she ows not have ik ators sggentve of Castings syndrome, sch ab exogenous trod se The sudden erseing of {restnne sf heaton of nnopl sungete eran uncering aur. ‘tough pohvst Kay dsease can cuse hypertension, tis paler has no other neIngs ea MICOsCpI ematay ark pain ta suppor ths agnosis ‘eysrtersion dha fica conto hypokalemia, and an increase in crete» 208 afer adc an ACE oir re (races oF rer are stenos,Oeceases fea peruston a eal aay Sere cates he Fenangiotesn-aldosterone syst which une flere aterle cofeton a ereaed sod ad Water reenter ‘Ths avoregaetory recess mara lemeruar espa hyrosat presse and GFR, bu the nereased elimination of potest caused by losterone! oud fest hypokalemia while systemic Yasoconsvicton caused by angiotensin nd [NaH retertion would eu in hypertension. The sdminatation of ACE nha ( nnopi to patets th ena fer stoned he sutoreguatry mechan, roving a deessta im CFR aan eteate esnine 2 205 ‘ere The use ofa rec hyroeleotcde nth pair also contrbutes Yo a decease n lometla aon pressureBs al <2 tim > 1.40-yar-ld woman presente ther primary cre physan with 2 S.momth story of wazenng Mate comfort. Her ‘confers teeves by voli, She ois 10-15 mes pe a and wakes up 2-3 times per MHghE To voi. She as wet ad any oluntry sso urn. She as ed cating down on Mids and ang NSAIDS to reduce he ASME WE inal ree Her past mai history sigan or bipolar dire Shes aesuny ate wh her husband ut Fepons tha mercourse has ecenty become pamful Current meaiators elu Ihium, Her terperatre 37°C (867, pulse 65min and laod pressure 110/80 mmHg Exaination shows vendemsss we palpaton of ht uprapube reson Uonalyas shows Specie aa0y | 110 ‘008 regue ete regutve wee One Squamous eprel cs 2/npt | peculrascund shows 2 postod vestval wine 25 L.A cystoscopy Shows & normal wet an normal blader micas. Which of Tooung the most kay cages? 2a (@) urmary trac inecton (© Overactive cer © vrnary mtenson (© Babee nsinous ke> aos al <2 tim > |: 40.yarld woman erasers ther primary cre physian wth 2 ERIE itary of worsening SPER. Her ‘scoters REPT. She vos 10-75 mes per day and wakes up 2-5 times per MghE To voi. She as net ad any oluntary sso ure She as ied cating down on Mics ad aig NSAIDS to reduce he ASME WE inal ree Her past msi history agar! or polar disrer Shesaesuny ate wh Re husband ut ‘epoch ees ely Bane pan. orent mesiestins eae ebm, hr semper 3° (9537, pulse S65 min and whood pressures 110/80 mm Hg, Examination shows terdemess wo palpation of het suprapubic reson Uonalys shows ke Specie aa0y | 110 ‘008 regue ete regutve wee One Squamous eprel cs 2/npt | peculrascund shows 2 postod vestval wine 25 L.A cystoscopy Shows & normal wet an normal blader micas. Which of Tooung the most kay cages? “Ths patient as symptoms of chronic blader esconfor, creased urinary Requeny and suprapubl tenderness eerng a UT. However, hese eympion have occured fos monte and et une psc sega or uO ‘seas, por tte, Pal sexual intercourse (spre) sanather commen feature ef hs patents onion. Za inary racnfctons commonly cause suprapebic tenderness nd incase urinary feavetcy However, ths pater has @ regu unas ie nivats, Bacteria lekocyeestetace), Suggesting a nonnteious case fr hee Futhermore, her dacomfort's eleved during voicing, uke the sur that pal evocates wth a fection fhe aay watObDs wl <3 sa > negate urna in nates, bacteria, or leukocyte esterase, suggesting aroninfecious cuse fr Ne ysis Futhermore, her discomforts elev during voiding une the dura thet piel essoites wih an infection of the winery act Sets et er aoe cee el ec cert cri Hatin) ees ‘dtonaly noes suprapubic endenes nd de comfort raleved by vakdg. ich aay occurs n pat ith ‘overactive bidder, Frtermore,dspareunia noc pial roca wi overacve ladder Incrstal sts 05 2 cro, noninfectious aus fess wih an unknown elegy. Paves wth often presen with uprapube pam ad ncreaned urgeny frequency forge than B eels yspueuna ay een ths patient. another Common symptom. Ics agnor of excuson and oer cures fete rch UT Tot Bader matet mut be ed lout fst Some caters wine can have ulcerations and submocost Herre seen 0 estoscpi examination, though {he presence of ese Manas ot requed Tor aghoss,dcause UA, cStoSCOy, ah paswol sida lade a8 ‘er all armal IC remains the os kay explanation or er symptoms B) Urinary tact infections ‘Ath paints wth rary retro cam alte prevent wth suprapulc pte ad rina conten, hs wea ad normal posto rstual vlume chronic retention sual presents wth > 309 mL rsiualvelume Aéstnal ths stent asin ik tr for nary een suchas ecent surgery, amielerc mediation Seo peripheral ne ep=y Diabetes insu, which may be caused by Rhum use. are cndton tha can ola 1 pobwria and increased inary gency. dees rs pate also complains of suprapubic Bscomfort, an emmaioy conden amare ly aus of Her ‘ary symptoms atonal rine pec grevty ends ob very oe 1.003] 8 patents ith bets inpBs al ‘erm and has ben heathy since. Thee months ag, she nas Weated for «winery act fection wth rl eine He Temperaueis 2°¢ (10277), pls 144 ard blood pressure 85 /40.mm Hg Pycal examaaton shows M0 sbrormalies er leukoeyt count 14,000? rine prick sows Inkoeteetrae and ites eas oho \Wacs and gram-negative rods Une cure rests are pening awaited Rena utvasonograohy shows hvronephross of ‘he ft Kidney. Empires ntimcobal harapy insted following whic the paten’s synptms improve, Whkh the za @cwsesery (© Byram renalsncigraphy © | wedame erg (©) Scena sara ‘oon ourewoatehy= Ouns a e a ts wound cena erga tx2doy stoma xs (GST Cee ‘erm and has Ben uly since, Three months 390 she Tenperaueis 2°¢ (10277), pls s 144i ard blood pressures 45 40.mm He yc examination shows M0 ‘norman Her leakage out 1400 ene pick sown atc a ocean orar-egsve os rine care es ae para sae o = ‘elie Empl omni troy mtd along when We patents symptoms npr Wh the 2 In ten een 2 nd 24 mands est ey vesoweta rele WN) nda ay fhe fora we te RP sess prevesy contests response roe Berapy > #0 MOUS por we om ak or puNe OL Rinowgman tetan€ coon we cure nceaned ceinne les usonegahc endef ‘arnepros, wetre alate, fren arg. a 4a < eso of ting ages ote vessel son qpnopy na Ferment pn fo client severe or w Derirert UR However, WR stud tbe oper anit etry iene eee urea or ensrape repaan Be ‘oniseed. Intravenous pyeleraphy VP canes be used to AaaneseVUR since the contrast medium flows nan anterograde rection =o from ae tuaney othe ase.Cees eed ecm) paceman eater reverent eetareecmere erry econ etree period crema einartnCees eed ecm) paceman ote eater Poetry paler caer reverent eetareecmere erry econ etree period crema einartnouns a ‘AMAG-3 Scan iraric renal scrarap sma to lagnose winary wactcbstructon i chen, wc cn stm hydronepisis In chien, howe, # deen investigation must fist be peormed oul out YUR since URIS 2 mre ‘euros crow often then uct icon AAC say smothered te degree WIR beets ody tating indicated hen a secondary aus fer YUE suchas neuragent Badd function spect Ths ‘m5, spinal ord inary, or CXS orcs suggest neurogenic Bader dysfunction. diferent sts nate 0 fist llugrose VUR before assesment fr Seconda causes of VUR Gan be cnsdeed Inpatients with Us, aDMSA scan tate real emgrphy a inceted any ofthe folowing ae preset to antes he Sever of reralcracl scaring renal parenchymal normals on vi2Songrepy, nee serum crest, teattvough UT or sever WR grade HV, Tis paten hes air parenchymal anormal or an incesed ces, dd ot develop the Ul whom contucusantbite prophlans AHeren st ht can hagnove and ane the ‘every of WN mec st bn permed, Furter work-up orl ut VUR is ncate orth 1yeur-olf child wth ahatry of prevoualy confine UT and lratonographe esence f hyronephone.Vedingeyrturetirography WCU) ee degree procedure of hac to thagnose ad sss the Seetiy of WR after erp amibioveteapy nated and ace fein subsides. Ey flagross an management of VUR ate porarto preset eral flue secondary to eraser resulting Tom recut Infrtons. nid modersteVUR would be managed nth continuous anton propyl ehavora modicaton (3 times wong ana reularsurvllnce, Paes wth severe VUR shoul undergo sural ox estoscop repr theomuns al <1 +m > Inpatients with Us, aDMSA scan tate real emgrphy a inceted any ofthe folowing ae preset to antes he Sever of reralcracl scaring renal parenchymal normals on vi2Songrepy, nee serum crest, teattvough UT or sever WR grade HV, Tis paten hes air parenchymal anormal or an incesed ces, dd ot develop the Ul whom contucusantbite prophlans AHeren st ht can hagnove and ane the ‘every of WN mec st bn permed, Furter work-up orl ut VUR is ncate orth 1yeur-olf child wth ahatry of prevoualy confine UT and lratonographe esence f hyronephone.Vedingeyrturetirography WCU) ee degree procedure of hac to thagnose ad sss the Seetiy of WR after erp amibioveteapy nated and ace fein subsides. Ey flagross an management of VUR ate porarto preset eral flue secondary to eraser resulting Tom recut Infrtons. nid modersteVUR would be managed nth continuous anton propyl ehavora modicaton (3 times wong ana reularsurvllnce, Paes wth severe VUR shoul undergo sural ox estoscop repr the 9 -A.CT scan often used wo chagnose unary cle among ats, CT Scan i ot pial ued fr cagrosng pathologies ‘ssodoted with UR leg poster utr! ve) whch are more common aur of hyonepeais han uretericBs al far leary for 2 hours. Te nursing home side sys she i ot wan eget ou of bed his morning ana seared less ‘esponsive han Sua She as Alzhemers dotase,mypetersn ard aso of neptVohTAsh Seas ONC, ‘alartamne, memanene and rampr Her emperaure 385° (101.3, pulse 112m eSDItoy ee 5 16/mi, ld blood pressures 10878 i ig Phys exaination shows mld tandaress palpation of he lower bomen, On ‘Pema seus amination, shes onerted only to pert. abortoy sues hom Patel count 355,000/mm? wetones agate ree ihe we Ssihot hich of flowing i te mos iy aus! eganisn? Za @ estore con (© Perse mabe (© ereroeraus face (©) Peudomanas sericea “Ssaphvococeussanrophteas © Nebo parente ouns al ‘ard leary for 2 hours Te nrsibg home side sys se rox want co ge out of bed hie main and seerediess ‘esponive Wan Sua She has Alzhemers ease, ypertrsion and aston ‘Sheras avon, ‘alaramne, memartne and romp, Her temperature 38°C 001.7, pulse 5112 mi estoy ree 167m, lr blood pressure 10878 ri Pi Physical exainaton shows mld renderess 0 plpaton of he ower abdomen, On ‘Pema seus amination, shes onerted only to pert. abortoy sues hom Patel count 355,000/mm? Bo ig = 3. = = = hich of flowing i te mos ily aus! eganisn? “sft ay tars aa usoaied Gon Was acon (plaid na wove Wack/ od malo Eat Fy enna wh resting dem tara, asorerzton, The organism mos Ikey responsible produces Wess, “a 1 oe common cause of wnay wae infection (UT) ovr, a alas th most common cause of Cathete-asocaed UM. However : ol does nox case alkaline rn. doesn cause nephews mervoned itis pavers hse.Do eens with a inary act infection UT, akan ine (pH > 7, and an idling inary cathe are mos hey nected ith Proteus mai rable comets re in the ue io noni ch has an alin eect. takaed ue also fuer magheiam ammonium phosphate estate) precpates, whch can form keystones ately reser it thisperert rary wat infection (UT Monet toes not eause because entercoce are unable o reduce nitrate to mre, unary nin est would be negate cas of eterococeal UT ‘Pseedomonasserugnesais 2 common cause of cathete-essocaed wi Ut econ (UT, especaly Because of 5 ley of bois tha ae estan fo ato therapy. However, doesnot cause aka tine sergione dos at fommony ease repos, ether, which war maton nhs patents etry. “Suphyococosseproptyces 4 commen case of rina act fectons in young, sexual active women. are ot {andor catetencea puters Moreover 1 not YpIGyes0ete wt ane une or nearoitnass Furthermore because saphfecoce are unable to veduce nate oii, winery mie est woul be negate incase of staphocecal lebuots poeurona «commen cae of caeter-sasonated uty act nfecions (UT) andi lng acct i my sien arnary pt because produce lines amounts of west wich conor wes ino manera Hower i aot ‘Wpucallraronciared wih une sit lavals above S ands saruly casocianed with soqiurdiehdents, witch was mambonad'ia disOu nsw ‘hs patent By Urmary tact inectons _orocceu oan 2 canimen cae of ater attoiate urna act infections (7) Homeve, se ot eaute atkan wine. fecal does not cause nepho¥thss eter, Wen Was merOened nts Pater’ MStry. FUEETMOTE because enarcoce are unable o reduce nia to mth, nary nti est woul be agave cast terol UT ‘Pseudomonas sruginonis a cmmon cute of catheter sociated wie Hat fects (UT, especially Beaune 8 yo fom bone that ae ein to ation therapy. However, doce no eae ale ine 2 sorgiozs doe Nat ommoniy cause repvolnass ett, which was mntoned in his patents Ns “Stohyscoccrsanapnyncur is conmen cute af nay actiahetant in youn, revue weneh. earn al andor caeetaedpaiens. Moreover, 8 not Yplaly Socal wh alae wie or ephroltiass Furthemete, because staprfocce are unable wo Yeduce nate oie, way me est woul be negate in case of taprMocecal _lebots proumena 3 cemmen caus of ater serocatd uty ac nfctons (UT) andi ale ested nt ly ‘Htatne inary because peduces lined amour of urease whch converts ves ino aranona However 00 ‘ypc asso with ui ps ees above 8 and rary assoc wh repels, which was manioned in his tenes try While canot be emisy ued out. a ferent pathogen ore keynes pater‘ He as nad naea burn voring during this tine, Hees Hypertension, conic kaney dese end type 2 bees reli. Tee mort ago te underwent puttin ois et hd oe becuse anor-eaing cer He has smokd {pack of egrets dally for 48 years. Cire mediation inde bydochortheide, etopraa, and ine. Hi {emperature|s 394°C (10297), pulse 102m blood pressure 150/98 mm Hg and fespratins ae 18m Examination shows 41-0) rund cer on the sol of hs ght fot Tare costoverteba ng tenders on ‘ 140 meat c 102 mgt Hor 2s meq Urea mogen 55 maya Glucose tomar Le ana bo spe or utr and sensnty ets oan. when of me oowing she Most appropri nxt a @tovacencceximen wn navenous cvooxacn (© | Outpavenweatmane win wmethoprin-rtensthoxazole ee ra cign ge One ul enon ree mtogen Line and bod samples for utr and senstity ets osane, which of he folowing isthe most appropiate nxt Uisgiat rao meqie 102 meg t 25 mea es mgrat 100inoF stepin manage? 2a (escent retment wen invavenuseroFoxsen (©) Oupaten estment wth ol eveosscin © ompatent wearment oh winetoprin-slfanethoxzole (©) topsventeexmen wth nravenous gentamicin ©) ate hemes (F) Fectorm cF sean contrast ofthe absomenouns ul a Soe He has had nausea but no vorniting during this time, He has hypertension, and type 2 diabetes = es SoS Say La %Os al becuse ey ae a ge kof comatcations ike Uosept of eral abscess, patents win complicated pyloneonans IWiworequnciones ec cipro crac) for 10-1 3m Leofoxaci thrd-generavenfuoroqunlon) splay used In paves wth respratory nections, Which 5 nt te case hee Moreover, aber with completed pylonepils aque Rospral za for momtrig ani Wesonen ih Varieties Adetionly orl euge should be avosded in aunt patients Tpatbopin-sutaettonazoe Covrmoxazoe sa antflae anubouc used to Wea espiatony nfecions,gasuortesial eee alan eet efter Voce er eset recente pected Saad trmethepre-sulfamettonazae or 14 des, Complestespyelonephits wich sth ase er, requteshospalzton for Iontring snd V ani resent with anther ani. asdonaly, rl drags shouldbe said na nusesed patent ‘Cartan Gn arnopyense canbe used in combate wth a road-aecrm cphaoepei combat wt aanopencin and beta-actarrse- moors sa second-ineretmant option I compistedpylonenan'. HONE, ‘eotamcin is napratont and vod in nda wth choc Key sea Indcaon for hemody clude 20s, eleclveeabporalites hyperkalemia ingestons (of oxi) ovroad id, ad uremeSyerptoms, bch a sistant to medial manager (-S--0-). Wh is pate’ does have vere dey amie, .Ou Dew ae lero andor feng well ung this paid. He cre incessant wile passing wie, Tere isn family sty of fetus as eas dared at 37 wet gata ano preanany was Created ty mas aohyeannios, Mi a SFC 90227, pals 195 mon repratons are 69/mn, an Blood presse e559 hm Ho xamnaton shone open : “rvs and poster fonanates Tare is a mine ler seein tas extending 2-3 cm above the Symphy ecru sot tray bnpon itp wl nt ely bana he mt om co he akong @) Ureral venice Ww (D) Swipe! emplaraton of he weer © veseoetomy<7 iw > ouns al oO s 1312-dey-oldnentorn brought tthe ematgency department beaute of high-grade fue fr 3 day. He ha bee rox ad lear andor feng well ung this paid. He cre incessant wile passing wie, Tere isn family sty of serous ness He as devared at 27 eke gustan and pregnancy mas compat by mi i _ imurzatins are up-to-date He et the 25% percent fr length and 40% percentile or meg tempers a 39 (102.27, ple 165m. resprans ar 60min, and lod pressure 5/30 em Hg Examination SHON Open = “rvsir and poster foanlesTare a festending 23 em above the symphysis sectum aro thorpy ie egur Ts patent wil mart aly bara the most rom ach of te flown . Os at Ee ow) peers Za Seta the prefered raiment pon fr mest stro, Congenital matali whch caved by fled regression of the distal uretiral membrane, may preset neonates with nso ary Cbsvuctor, Such a ts pater’ Palpabie laoder on exam ana is istry of olgoryaamnios. Howe, meatal stenosis mest eqn acqures i, Secondary to etcumeino) ater han congentl, making ths dogo es kay ‘erm excson wn weal econetvcion is edn the Wesimen of wether Even hough uel ‘erica may eately present nth winery retention, t mar equey manfest wth ribbing, dura, ane spares Adule women or a5 acmplcaton of uetal surgery (ea, conecven of hypesrals. | Suburi transuthralinjction of estranomar sina in the estan of pate with severe vesicoureteal fin (UR Wie VURypealy mans wth eb urinary Wac infection, which Seen Bs part UR does ot usualy eee ee tht a edie a ChE ee.& ouns a ftuareua may arely pretnt win unary ratannon, mare equety mans wth lng, dua, an sparsunan dale women or as completion of urea sugary (eg, comecon of ypospai. ‘Subuetrc uansueaincton of Gextenomer i indcte nthe eaten opens wich severe vesicouetrl eux (UR. We vr aypcally manifest fete urinary tac infection whieh seen nthe patent, VUR doe ot uly use badder outtow abstraction as nated bythe mStar cf clgohyramicsané palpable aden his patent. Surgical reimplantation of he uterine n patente wh svete vsicoureterl fix (UR) Neonates th UR ‘ypaly present rth erie unary tact infections, a5 seen Ines paler However, since VUR doesnot case blade outow bsucon, he mst ef gohyaos ana the ning fa pals ae! on pial nam ae Ac constr WAM Dis rot essibe, eave techie tsueso meaty rat ats, Whe this neonste ikey des have poser wethvalOO Distal <7 + ino © Q 4 (oe. wile vu sypealy martes wth tebe ary Wanton we seen spat VU does at uy use Bader uttow abstraction as nated bythe stor cf elgohyramicsané palpable der nhs patent. Surgical reimplantation of he uterine n patente wh svete vsicoureterl fix (UR) Neonates th UR ‘ypaly present rth erie unary tact infections, a5 seen Ines paler However, since VUR doesnot case blade outow bsucon, he mst ef gohyaos ana the ning fa pals ae! on pial nam ae Ac constr WAM Dis rot essibe, eave techie tsueso meaty rat ats, Whe this neonste ikey des have poser wethval “This patent presen mth wosepss a palpable blade min lone abdominal mass and 2 Wry ef olgohyéamnios al of ice are esas of inary vac easton du to posto fetal ves Ure vale te pest abou 18,002 Ie bets, aking ther the most eammon enue fein Mat obstrcton im neborn bys The eater of hace cystoscopy nth prima vane abator.mos | 2yaarold gis bough tothe pyianBecane of igh gta eer and ying le pasing un. Fur months ‘ao se was rated fora feb wry act afecon wih cfxime, Tere smo fey ry of sro ness. Her Temperatures 29.70 (102.67) ata pues 123/min. Pyscal amination shows na eboormalies. Ui stk Shows “setouretnrorem ie snosn Wimots estan when of ne fllang ems patent mos eh Ye de 9” (© eal scaringa & ouns al a Ie brought othe piyaian becaue of high-grade fever and ying whl psting ne. Four mente rox ‘ose was grated fora feb wary actafecon wih ctxime, Tere sm fey try of seriou ess. Her emperaueis 28.°C (102.67) and pulses 123/mn rita examination shaws no abrormales ine suck stows Ieuoeyte esterase urls shows WECs, Ui ute sows Encherch cl sense tO TAME A voisng ‘stouretnraren ssn how eaten wien of te fllwng Ss paveR most eee GEeo9” “his ee patents scond fable winery act fsion and viding cytoretvogra is inciatd, The VEU shows D eseowecrarenox on trans 2a “ ‘Yue nox stsocated with he development of na cl carcinoma, Von Hippe-Lnde syndrome, an aos dominant ovate assocted woh fen cl accra Younger Pals, But patent Nas No aml MSL fers ‘coca wh hs dese pra cl ccinoms, bamangomal, or weed ep th att’ crn UT or \etangevstourethoaram. eens with UR ae ceased sk of developing hypertension, nt hypotension, due oral simon. Ts isk ‘patients with ves\couveterat reflun are at ineased risk for renal searrna, whieh thought to be trom the cowbinavion oroua < tia > eogrelw of rn ta tha kno ar ieeate ate of Plone. Searing maybe edace with popysce ‘abi, which prevent infections, nd surgical coven fr those with high-grade Vesicoureteral rf Paens with VOR ae ceased sk of developing hyatonepvoss, not Weer tens due o vated weer Desies Congentl mafooations ofthe female reproduce wat eq, bcomuate utes, Malin gene's) an result inftity, hich an be cagrered wth hysternalpingography. Although a fat ean Mtetcsaingeraphy may resemble ede Cetorethrgram oth procedure mec comrade nto tubular sacar sd take seal ay fe loner sbooren 2 ‘etcng estourethrogram des not deste the eproduciveSTuctwes sea, sualzes the briary Wat ad can laagrose VOR whic Is ot associate th erty. Ut sot asocted wth he development of nephrotic yom, send, the mos cormon cau of nepal yore hen minal change ducer 2 908 alles) the rige or wich unknown im mar care Siang she major rk factor or tanitonal all Bader canon, utc snuny present ap Hematol at ‘UR sot assoc wth he developmen of ranstorlcl ier cancer. Hower, Tnstonal el ladder carcinoma and WU could esltin the dissemination of malignant cls othe upp inary Hae.Bs al 15:16-yar-ld by brought tthe emerganydeparmant because of seer lf an paln apd nauea fr 3 hour The Bains alk ana adits towards soi He diks ripe gases o ed ea ever day. He as had Simi esodes ‘st abcomal pala a We past Hes mater ule has asa istey of domi pa Hs temperate 37-1 (98.87, pulse» 102 min and Blood pressures 108/72 mm ig Examination shows a sft andnontender andor. Left ‘casovertebal ange rendemess is present. An x-ay ofthe adomen shows ne anormal, A urinary cyanie ‘hropsie test post. Prher vation of thi pat mos italy 0 show which of te floning? ke (© [tombe yea oe wal Urinary of 7 (P) Revagon-shaped ayaa on waysouns al < stim > He drks multe ses of ced tea everday. He an ‘ot abcomal pain inte past. lee maternal ule asa sir istery ot domi pan Hs temperature te 27.1% {98.8 pune 102/mi, na Boos presure 108/72 mm Hg xaniation shows «20 and nomtenderddomen Le ‘oovertoral arge tenderness presen ay oe abdomen rem no ebro A Further evan of his patents most aly show which fhe folowing? Coley fank pan rast ts he gro eh contourera angle tnderet ls uggerve of wrote. Reent ‘alsin an adolescent th negate xe ndings is Suspcus of stu, 2a ‘ ‘ray the developments srongh assed with incetsed serum arc acd eval This overs aly young alt Mas rok tacos Yor creased un evs, Such as Leh Nyhan Sycome SIO Of gout, or mar HS sytem. | Aunty it of 7.8 nates alkaline wine, aking rine isan important pathophysokgcl fetus of com phosphate Sone uel sa re Mil est sees cana et wl pene: colcy eel ai, ey et Fathpaque and would tut appear om ary Moraover, ths Young thre heh pont does et have nian ik Fao for te development of atalne wine, such as ue use or inary at nection ‘is of calcium oxalate store frmaton cep: for abdominal pln with costoverebral tenderness, this pale has history bf tar intarmaory bowel asease symptoms leg darea er maabsoron) Adaionaly calcum eae Stones ae at& Om Deal <5 + 50> ‘eros for re developmen of alkaline rine, such at utee wee ora urinary tac ifeevon Serum ASCAS ar often presen m cern diseases causing bowel infammsto, parca Crohn esse which creases the "ska acum oxalate tne fomation Except for abdominal pln ith castovrena ederess Msp as Mo WSN other inflammatory boneldsese symptoms eg dren or maabsorton) Aastonalycalsum alate stones ate an Increased serum TH lees can use hyper which pedestal tone formation, Calum tones ae ‘roy say adopsqo, whereas pttent asx sone atmo vcsed ony, Puthrnee tt oun patent has noe ofthe common risk factors for parathyroid disease, such a5 previous neck radiation Ithum use, beng & postmenopausal wom weeasd serum PH eels wou tere be ue stat be presence of ammonia the rine, wich ean duet the went acy of mri Ste sonar peso "ath cocky atominal pin, 25 een here However, these stones ate asc radiopaque a would ppea on abomin! ‘ray. soecvr, stave stones woulé ne be expel wo feSu i a posve Une are nvoprusi USL Hexagon-shaped cysts on uinass neat cystn tones caused by cysts Cystine toes ae only poo radiopaque faeces ee meyer tlryty eeati e C7, beer Reet the pi icy spree et 2) Nephionuped < wr jm > ‘ture and he deserves a & oof 1 in incr He has aves and as voted once He haan eisoe ‘Emons ago for which ne ook naproxen Thee no pesondl of ama Mor of snus pes. Hels a second yeat redial stent and ns been consuming more cole ard enegy Sika tan arma ota ake el ty fr the Pat 2 cave coe not srk or crnc acon He aves na meleton. is temperature (2 7-9 9.) ple 38 “rd blood pressures 124/78 rn Hig. The amen sf and nntender, Examination othe ach shows no Cestovertal ange tenderness. The reinge ofthe searnatonshona no ebnormaltes, Una i unremarkable ‘cha flowing fete moe ily unsering cause of te ptr HymptOne 2a (@) tua ena eve (©) weeropehicwncton sbsiction| beouns al |5.25.yarold man comes tothe emetgany department beaut of the panicle in rox ‘ture and he eserbes i 8 ot of 1 ens He hs nause and hes voted once Me had snares ‘Emons ago fo which ne ook naproxen Thee smo person of ana Stor of snus pes. Hels a second yeat sty ake and ta for he past cay ie coe nots orn cone He ves no mecctors. he temperate 37-995." pute 8, {ar blood pressure 6124/78 Hg. The ddomen Sf and nontende. Examination ofthe bach Shows 0 ‘Sater pl tener The remo hc eto sealer ess arenas ‘cha flowing fete moe ily unsering cause of te ptr HymptOne C Coca ee 2a < Sra renal ce tenn pes ih uk pay nytae. Tough pets sh ADPKD cn a present win Aan pan eecancy oye rps, mortage, or fecion), hey aio tanto hve eay-onet herent. onal Insueency, anda pose emi hstry ef pohcrstc Key seas. Clomerula ga daposts ae sean ing nephrapaty (rer dat) gd nephropathy general presns ax spade hematurie 1-3 day allowing an upper espatry ifecion ertent Tak pal Seen a spasm Characters syrotom gk nephapay Postencr rata ves are uel grove ether prenatal ori he rat months of Me, Typiealy neonates wl present Symptons only apa ahs pation’ age‘lower rpal cyt are seen in patets wth dl ply dey nee. Though patents wth ADPAD can alae preset with flank pan econdary 0 est rupture, hemorhage, or fection), they a0 fend have eary-onsetmperenion, el Insuficeney, ai postve fami try ef poste Mey disease. Clomerlar ga epost ae seen ng nephropathy (ere seas gh nephropathy general presents a5 e.sodie Iematuria 3 dey allowing an upper espratry Wtecion. Iran Tak pal 2 Seen 25 par Ino Character symotm pk neptrapathy Fontan rata ves ae url lgpored ether prenatally orn he rst months of Me. Typlealy neonate wl paces ‘th recut UTIs seconaary to incase blader pressure and subsequent vescoueteral fin Would be ert or Symptons only appear ahs pains age. “Though mos cases of wstropec junction (UR) Obsuon ae gnosed ney hood, les saver cases may ly presen ea acultood wsualy ae tne ngastion of large aunts o cool cee Mase beeages nea tess nd nthe contest af Un, cause yeronopon athe age amount fume onthe th avon UP The manfest at eisai nk pam as Seen nis patent, ‘an ascening wnary act infection (pyetoneohnts) commonly causes untae flank pan but alo hh fevers Ieukoeross, tad apoattve une psc or Wace or nes, Though win Wat Obstctons neat te Uke naod of developing ‘relents, te abaens ofthese chuareintc cram and laboratory dings ake i goes wahBs al < tia > bring sensation whe miturangFve months ao, he mas iagosed wth high-grade non-Hodokin Iymhoma and & ‘eap vin vombost of mvt pope! vn, maciatonsViude pohcemoteray every 2 weske and «day Subcutaneous dose of low molecular weight heparin The at jl of chemotherapy nas? week ago. is tempera it °C GEE, pls 94 mn ana Boog pressure 119/76: Ha Examination show Baers els an nan Iphadenopathy,heptoplenomagay snd rsd siprapube tenderness. Laborstery sts show Hemoalbin rw2giat arta thromboplastin cme 55 seconds omen tine 1 seconds oNR=D) faces eon wee inet tol cate ihe acters cectsons 2a @ roramine sae (© Mecaptoctane slfonste (© Paster © cwrotexscr = (© omaretharooeouns al < tia > > ‘5.00 yar-ld man comes tothe physician Beaute of 2-day hat of lower abdominalpain. ands oem bring sensation whe mictaraing,Fve months ago, he mas iagnosed wth hgh-aade and Geap vein dombosis of hs ight pope! vein Hs means neue | ety 2 weeks and a daly Subcutaneous dose of low molecular weight heparin The at le of chemotherapy nab 2 week ago. is temperature it a °C OE EP, pls 94 mn ana Boog pressure i 110/76: Ha Examination show Dae Belay an nan = Iphadenopathy,heptoplenomagay snd rsd siprapube tenderness. Laborstery sts show Hemoalbin rw2giat Leakertes 4200! i. arta thromboplastin cme 55 seconds ban omen tine 1 Secon NR=) 2 oceans eon a wee inet ions pera Set acters cectsons w -Admintaton of which of the following mest ty te hae prevented th patient cent condition? ‘one ofthe most commonly used pelychemoterapy ‘eginens for high-grade non-Hedghin iymphomis a CHOF & P combination of eophoaphamde doverbian erste and predation Hemarthagi eat which pest ith Gear unm ac symptoms and hematss e 3 commen completion feclophorrhamie esp Za Protaine sulfates usd to west hear oedses, THs patients ecg heparin for wentment of hs dee vein ‘hrombons and heparin oven may eceaonally peta os hear Move, stad of om boring pain and Ssuna, otha symprms of blading dates, epstns, gum blads, men) woul be expecod ith hepann overdo.oune a eS tabosm of eyoprosphamide ges eo atx product called aren, whhs Scat nine, ACORN Ca USE hemerthagic tia by destroying the lesser urathehum. Sum 2-metcapoetane sulfonate (es) prevents emarhage tii by deserting srl ay ieaatng teary exertion fern, 2 oe rel teavenger adequate Itai and equert wlding ae further portant measures to prevent harorhae St rophvlanseaanstpemoragie ests Cprtlonacin oul have prevented a urinary act infection (UT), which ecu Fequely among patents ecg Immunosuporscan drugs, oer UT may presen wh lower abdomial pin, hematin yeu, and bate Howser, hematuria im Uist usualy merazope sh > 10 WSs hp are type son Earterua im hi patente most probably he rest ofan unclean cate as naeatee bye presence of enel als muri Leucovern ets le utd to prove aia deficiency aang pat ho eat chemotherapy wh antl agent, Sch mathoveratenatecal or ravenous metotoxete Can be ive to patent th advance NL to prev of eat rmiometastass ithe ban. Ts pale, However, has eydophosphamde-rcucedhematragi sti, hich cannot be revered by leucovorin esa luszoean rest prevent carotene nates who rca high coer of anthrzesine (2.9, Soxormion, ‘laanorbici ora sho scons caused by exovsatin of ject arraycines. Tis pain Sos wax have evidece of crsocoy or ctaeousnecoss, stead he has cyGophosphamige Induces hemorhage ests gu! Wh “Sescpaouates i sesblacton. beovanmes pamonnetTa wars inid Ghar opiate vecsnecio dean hvaecaeia on; med peceintions:onnt a < vis > optus agaist nemowhage ests Coprflonacin auld have presente urinary at fection UTI hich acu Fequetlyamang patents ecg hematuria n UTS is usually microscopic and > 10 WBCS fare typically Seen Bacteria this patients most probably the ‘es ofan unclean cc (as nena bye presence of ep sn Ui Levcovorn escueis used to preset aici dicency among paves who receive chemotherapy wh antflate gens, suchas mathoventenatheca or iteavencus retotonte fan be gent patent ith vanced NHL to ree West rcromstrtares inthe bain The pation, However, has eyophosphamade-Incured hemorrhage syst, ach cannot be revered by leucovorin eu Dextazoxane i use prevent cacowsiry in pats wh receive Nigh ose of avacyines eg, doxorubicin, esr treat ef eee eee etree of erie urine: Te pice oot ee ere Sf erotoeyorctaneous necon, ntead he ar ¢yoporphamige Induce hemarhage esti again wc Gexrazonaneisnefecve Moreover, pate with non-Hodgh ymphoma receive low doses of doxorubicin prophyadls th dexazonane would eretor bs nnecesay the paver. ‘Dexamethasone spicy used to prevent cemotherapy-inducd nausea and voting which equety occu i patents ‘ecening dotrabcn an eycophoscharde Tha pte owever, has emohane yas, wich a mare eectve [evened by adnate ret drouns al < 2ri0 > ‘an obese 62-year-old man come tothe phyektanbacaue of eos of rd rine cor he pat weak He sales had ‘eewrent headaches ad interment bury sion dig the past Pont He has berign prostatic pepsi. He works 135 an aenaunt at gus stator Te pate as smoked on pack of gues day for he st 40 eas He ds ot ‘Seok alaholCrrent mains rade tamsulosin is temperature 37-4 (98.47), ple 0) men and Bod prereure is 152/95 mm ho Examination sows hsned tice Criondnonny examination stows ne sbnormanes THe [bomen ssf and nnmtanar, Dal eal xanatin shows an eared prostate wth no nodules, nah shows ood 3 woe T-zihet hich of flowing ie os iy agosi? “a ® Nephron 1) lot nepeopacny “raneonal lace cacnana a ¢ Pyetnechs 1 @ 4> < 2ri0 > OUns a ‘an chase 62-year-old man comes tothe physican because of 3 episodes of over the past weak. He has ako had i rng the oast month. Meas benign poste hyperbasi He works “he patent has SHKEM on pack of cgaets daly forte lst 4 yeats. He des not ‘Seok lahat Current mations rade tmsclonn is temperature 37-4 (98.47) pls 0mm and Bead pressures 152/95 mm Ho. Examination hows (Cardopumonary examination shows ne abrermaes Tne [bomen ssf and nonmtenr, Dal eal xarnain shows an enlarged prostate wih no nodules, nah shows ood 3 1-2 ho Which of te flowing iste mos likey lagnosi? rots hematin in he abranes of RC cate on uae inate non-lameruar luca. The patent alo peers wh FS persion an feswes of pohethemi headache, facil plethora, bury Wionsuagesting an neased production of pina exynopasin PO) “a Nephron may preren wth Remstu at decribd et, Small keystones may ato be aymptomate Howser, the Clagrosis'unihey in «pavec with goss hematre bu fo smatoms of eal coc fe Sever aera and colic ak ar Nptvelmasis would as nt expan te patents paraneoplastic FO production Episod rom erature may be een ia patents with gh nephropathy. Ths condom commonly occur in chleen and young suit wtn an upper rept nerion a gurvertrte, bt tis else eaten cd at epor a ano anyon face Infection, Moreover, th nena ng nephropathy wSualy shows ed hood cel cass (ef glomerular immer, making te Sagrasis even es key ois pentomnes al <2 ja lnrecor. Moreover, ulnanass ng neprropaty usualy shows ed Blood cal cass (ue 1 glomerular ime, ‘making te agnosis sen ees ely nth pet Transtar cl cancer mos fequey presents th unin ct hematuria a een nhs patet Moreover, th patient Se ee ea ee ae ee eas symptoms of preneoplstic FO preducn, which generally nt asscted wih vanstonal cll erinoma. -elonephts is possible cause of haar ths patent he presence of residual une secondary t benign prostate elagemen coud nate cieased tek of cing uray Wat feo an pyelonephis. Howe 28a the hematuria conn te patet, the unnlss would pial show pyura and bare lo, psorapris would not clan te patents smptoms of poytema erates nota canon symptom femal oncocyoma and shoul as suspicion of alga addston, th benign tumor dots noc cause paraneoplastic smdomes hile age anlomyolnomas may esen wih Reratuta hh een ts BEEN, Dey ae mas commrly ssymptomati:Angamyelipama dont pel cau pereneaplste £2 or ein prosictin “Tis paven most ity has rena cel carcinoma RC). He present wh hematuria, WC He MBs Common symptom oF CEs wish re lad cela but no ants, suggesting a nglomerlar eae of hia emai, uch ab 2 eal tumor In aedton, Rt can cant paraneplste ryan, uch may help to expla he pens Mypertenion a ‘Respmmes of'peeyiionsia tn ave es oval ick faces ise RE ual ebeon, cmeteas, ocrapasional axpasure ve qussiiiel,Bs al ‘the morring and ile by bade, Ten dys age Ne had a ste toa hat eslved spomaneausy i terperatres IPCIGEEP, pels 103/mie, ar biood pressures Gb/S2 am Hg, eaminaon shows 2~ ating aera of the ower Leukeerte count ———_10500/mm? Peele count 480,000 mn? hoses 6? mat Sretnine Omar Blood agave hoes negate twee Ot ner Fay casts ies ‘Serum complemen concentrations awa the tren anes. Which te folowing the mes appropate NeXt Talat eapy (© Frese ey (© Arestepain Oe ©) Petrone wey ke Suwose Sra Srstine Seige. Bios sate Shee sesave tise eit Fates —— Protinerstmaerato 6.8202) ‘Serum complemen concentrations af wi the rafrence anes. Which 6 te olowing the mas epprepate NeXt Sefer La @ tarp eany (@) taal ieasenogy (©) Frosty (©) Amesveeasin of ©) Petione hem © teocacionany (© eros (GH) neat esay (©) cetootoroamaeeraoye ouns al < urine > Weerey pun ini ato penins ime Conor a RN Toner oe coca ere aoe egret 050/mnt aceon” lent cc one = come ce gana von a ‘Serum complemen concentrations af wat the tren anes. Which 6 te folowing the mes appreprate eX agen ‘The presence o edema, 4+ prota on ute epsck a pean resunine ato of 6. and ermal Complement evs ya ch under 6 yes fae shih suggestive of nero aydrore, which & most commonly eased by ma “a Prout potiutia > 05 9/day would worsen podocte damage ahi can cause loner Scarig) aswel a5 cause ‘ubulsnterstaltowcty. ACE nhhtrs eg etlpl and angiteain receptor Boche's ARB can decrease poteiuta and sepe Uieeeeeee zone bce icadt Sc lesies Vales Acinic Manco natok meee ed cathe amine eae maiomas al < aria > road proteinuria > 05 g/day woul worsen podocye damage which can cau lamer scarring at wel a8 cue ‘ubulsnterstaltowcty. ACE nhhtrs eg etlpl and angiteain receptor Boche's ARB can decrease poteiuta and ae therefore ote nly used mn pebens wih rctamurc kaneycsase, However, one exception mnmal range dsease, Inwhich compete remsson of proteinuria canbe achieved in mes paens by «een stein therapy. fst Uheray fo uneucefl anal may be considered, ene ultrascnography doesnot ave aoe inthe inal workup of npotsyome Because te morphology of the hey Ir urualy normal nd ulraronogaphy cannot sly ding etneen he glomerular patelogier that ungeae te vaoue uses of nephrotic syndrome Ine content of nephrotic sydrame,frosemie therapy Is most appropratenpaterts whe hae seer edema defined as ing edema of 3 and asces or pulmonary edema) end ae not chime epee though ts chilé has 3~ png eee Inthe ler is, he docs not have bom datertin, whch would suggest sca, rales or hypo, whieh nul ugget pulmonary edema Weteover, isthe pati hay har sme eg of plana lure caacton st shown By it Tivombveyosis ard elevated hemoglobin ve o heoconcervavon furosemide therapy wou be Mappropate becuse ul cause nypovolens stock and aut faa Talre Increased antstrapteyin O ter faonng att nfecon mould sugges agnosis af portaeptcoecl ‘Slomeslonephrte PSE, Hower, SEN Spal rele a site nape sym, whch wed preven with Hema, hypertension andor eece of eal fale egy increased creating) in aio old prtenua an eden, a a a ce Ceaoua 12 weak Host patents improve wit his eae alone, Edema shed be contol by Sedum rstiction, sufi tty Prete, and cater manoing of Mad iput and ouput I compete remission doesnt occ, hgh doses a Seok Immebaity,proshvactc low-dose heparin should also be consdere since the rik of thrombesis is hgher due toa loss of oF ‘rcvonin checacgrepy would be inated pats with suspect heat seas, which may presen with edema i the ower lente a rsa of congastve Het fre CHF, However, cram wh CHF woul ae Rave ther Fears sucha tathypnes. fale ote epatoregay act anor cides ofa uneyng her dete mura yas The appearance of penal edema tats worsen te moming lona wh nephate range protnua-) cles iat Cyclosprineis associated wth signa inmunosuppesson and can self cause ace (na flr. should ony be nsiere ie pats wi naphioncsyatome who ae Nt esponsive te ese heap, ano Chose wn Kequert ena bops 1 ndicaed for patents wn protmana and edema finial fers sugges adapnoss oth than minima Change seas. These cute featues of nephtc syndrme eg, hema hypertension ey rena fale an age oF “ 12 years t sptom ose, ana or non-espensveness 0 mMerapy, none efhich aot this ates gfe er a AS ele ep ye irae et el Ina tearm icon presenting with neptc sndome can, howe, beused in pacens wth equerrlpses of rephate syndrome whe ate depen det on fest heap to mara Yemsso. in such ass, CanOSpHaMe tetany< uri > Ounss |. yard man admit 0 he ntarev cae ant afar open abdominal sorte arcuryem par The att hat receive nts of packed vd od cl during the surgery. During the fst 24 hows Flowing the procedure, he has ‘ny pats 200 mk ot wine He as congestive heat fale and Mypertetsion, Curent meaatons nde ana, talap andspronolctone He apear i es tempetatue 37.1 (9887), plse i 110|man rept are 18min 4nd blood pressure 1s 110/78 mem Hg xamination Shows ey mucous membranes anc fat eck veins The remade of ‘he examination shows no abpomaltes.abortory sues show # rr crete level of 2.0 mq ard UN of $8 mg/al Ha serum creatnie and SUN an admission wre 2 gic and IB g/dl fexpectve, Further canton of ‘hi patent money rvelwbieh of he flionng ning? 2a testo cans (© tow orn socom beouns al < ui > > |. yard man admit 0 he ntarev cae ant afar open abdominal sorte arcuryem par The att hat x ‘ecient of peched ed ood cls daring the surgery. Outing the fst 24 hows lowing the procedure, he has = He has congestive heat ale and mypareaion. Curent medcations nce ata, [ralap ana spronolctone He apear i i tempetatue 37.1 (28.87), pls 110 man rept ate 19min Sha bie pressures 110,75 nm Ho xaminaton she "The emer ot {he examination shows no abnormal, Laboratory Suds show ae ‘patent mot iay orvelwbieh of he flionng ning? 19/dh,rerpectveh Further evaluator of “Than reser with faes of ace Keneynury AK one day aftr major suger (2 guia an aotami “The phys examination Suggesting hypovlemi) im combination wth a Ba crestinne rao» 20 suggest preveal “cause ns A 2a Ini causes of KI play mniest wih a decreased ue osmolarity (< 200 OSA) a6 te Mey oes te aby to pena. Homever, he BUM Creatine rte essed = 20°) npn wth nrins Aki cn he en cre couse (eceasa rea reabsorption THs patent's inciesea BUN Cresunine aio > 20,1) 15 more conssten wh eee AK | hich re eaberton = nerese & 8 \WBC casts are 2 pic fag in patents wth peloneps and ulcers eases, such 95 acte testi nephtls {nd rena pupil neon Felaneprsis mor comeranly manfets wth igh ever chil lan pain, cstvetebtal aie anders aed symp af ete dyer Feuency, or urgenr which ae san pnt Nou ‘ubulersaldseates commonly present th eeated levels of BUN and crete and ay rest in ce Ke itu, dona Sympions ear pao usual preant ls, the QUN/ resi ato Would a be ceased. iPeed eee tern peat eee eee Crete oecceees eerste cosPeed eee© Wl sal ‘Damage to any pat ofthe urinary act may estin hematuria Henaturs in combination wih cura snd azote s 2 typical ting epic Sratome However pats wih rep yore usually have features ef hyperemia led i to moderate ecema,hypertensi) aber han ype Paves with reenl ezotemia yay presen wha decreed unin acm conceation (< 10 mmol Toe of AK ts ese by Ink of (ag, uo dectesad perioperative ofl ake and neaopeative land lor) a subrasuor}) ‘educed rena persion, ater than ret damage tote nephrons. The faneysphySolog cl respond by rebsorog lage {erouns of soa hich she lowe by water 85a esse enced we Cn IW’ GMOUFSo SOHiNM ands oncenteated ony asl aout of water st Protein ent fom dct ey yur secancar to damage othe glomeruli (eg, glomenlaneprit abet rnephrpsty),camage othe tubules eg, Faron syndrome, of everpeducton of ow molecular eight pote (a ratio myeloma Paes wth ntsc AKI may also present wih olga and zotama 25 seen hee However stars of Iypeileia eg, edema) rate ha hypovolema ay mucous membranes aba Ma eck eins ns pale) wold Be ‘pected ne AK ashe Edney ore niet fecney remove ean ul fm he bey [Feo and coadianae | roar tage Noten | ayouns a < s+ i0 > |. 22-yarld man brought tthe emergency department 20 minutes fit ling control over he eye ad ang nie ‘rth parked ca The handlebar ofthe icc hit lower abdomen, On ara elec and rented. He pulse is Simi, respons ae 17 mi and biood essai 10/70 mm Hg Pulse oxmetyot fm a ShoNs an Oxy a “rember Te luna are ent urcutavon Carla examination shows ho sbnorsines. Te sboomen eft na : antander. Thre sno plc instil. Recta xaninain fs uremaabl complet blood coun, poxentn tne, Grdoeram concentrators of glove treating, and lel ae within the reference ange, Urine spats lly Inwavenouspyloatay le o G eonase cstooranhy OG +a ouns al 32 ysar-old an brought oth smargency department 29 minus afr lonng conil veri eye and cating (UG eth parked ca The hardeba ofthe icc hits ower abdomen, On ale alee and rented pulse Is Simi, respons ae 7 man and biood aressur is 110/70 mm Hg Pulse oxime ot (2am a ShoNs an Oxy [erie he igs ue dea usar, Car anaon sow we anor. TE ‘Theis Rectal examination Is umemarkable & compete blood cour, YetonbIn Ue, ur conceators ef ces, resting, and elctres ae within the relrence range. ine dipstk rly Spmroenate nex sep n management? 9 momo snomnh amt “a placement nce revel mjunes reqinna sual ena, urethral obstruction aCe Postal or prostate carer n whch transutealcameterzetonsconranclete otechncaly not possible MIroscp hema, 5 Seen ns patent, can In station, he patent har no lg of unary retro chat abdominal pin 3 palple sprue mas. Intravenous pyelograpy (MP) is wel fr eatin of pontierenal eae detection of eal toes oro ane pote Convast extravasation contas enhanced CT mages fe not elagnost. VP wes former a prterred imaging modaiy for ‘ea wauma, but CT has suplated WP es the malty of choice Furtheoe, hs patent does ot preset ith cna an fren rama ak pa) 29 at NP ould ot be nat aii antes hea tek ae seaete i aes ava meeneoateareoaaea unas eae aercderas namie aaaeeereee . idouns a < sti > ploator laparotomy afer BAT is cated n cases of unexpaned blood loss hypotension panes tha cant be Staized, Inpatients wih dee pesisting signs of petoea tat and/or evden of dapvagma rupture, 2nd pent weth eedence of feelin the abdominal cavity Howe, rar perme aed ately on Sn parameters End wou parforang fare lanes vss. This patent appears hemodyeameally abl wth no gs of ace biedng, Deron acon oF daohegmatierptre. Favens with lun abdominal aun GA) sh thie paten common presen ith meroreplcematuna atnenice ‘able and virerarkabe for furans emo pec sabi, bora pain these patients shouldbe observed nt ascatge win tclopcalToton-up ater apponimaey 2 weeks. egtadecstography is petocmed patents wih a suspected acer lesen once wea muri exclu ano 2 ley {pth ar bea lad inated npatnsweth gave hema fling Hunt Wau opt preser ng ith Imcoscopc hematuria an ape fracture, However, hs Dent presents on ath microscale Hamat whet SMS Pvc Mace Reroradecstogahy i teefore ne necessay fo ater eeatin ‘ACT sean wth conras of he absomen and pls the imanina modality of choice for evan abgomial mes {incoding those of the getouroary tac i patents wt sever lone pensratng eben Hower, tis patent Geeetnueetcsihy asec ceah ea eucecies che enicsacecoa: Mecaauasts Wes eres cee ees co eed iePotential intra-abdominal bleeding following blunt trauma , Patient hemodynamically stable? pe ey Low-grade injury High-grade injury Cre een heey blood ¥ 7 vy 4 t 4 Conservative Angiographic management ‘embolization PasayFevers wth lant abdominal erauma (GA) such tthe pater commonypeten wih merorcopl hata athertee Stable and urremarkabe for urter inure ea, nope sabi, abdominal pam, ese patents shoul be observed ul ascarge wi tclopcaloton-up ater approximate 2 weeks. 9 crore cstography is performed n patents wih 2 suspected Bader eson once rea ry exclu and/ot ley {athter as bee plas tated inpatients eth gave hematuria fling Hur Waume open present ng th pec factre Rogradecystography i therefore nt necessary fr further evaluation ° ‘ACT sean wth conrat of he absomen ac ple the imaging malty of choice for evaluating abominlnetes (incutng those of the gevtounay acd i patents th ere bono petting sbaorina aur: However. hs tent |semeaynamcaty sible and aly prserts wn mcoscopic Mamata BU wo abdomital pao Signs ass2caea nts, ‘making intraoral muty and blessing nlyein a Cues R Tk iraeCStecatay ha#hR Sel < ria > ‘5 1o-mont-od gil brought the physician by her mother beaut offer and tal forthe past 2 dye. The ‘moe ays thatthe g's avers have sled bad since the moms stared The patent has hal Some clea nasa ‘ecrtons ove the past wee, Two month ago, she wa rough to the eergeny department fora sng fbrle 50 percent for heaht and welght Her temperature 1s 381°C (102.37, pues 138/mm espraons are 26/min and ‘ood prassine 75/45 mm bg Cropharyngeal sxansnaion shows a ml postassl dip, Te remainder the me 228 mgt a 109 meat Roc 2h wwe Teo wecs hp Ausl au for eaptatony sylvia, nfluense A andinflserzs Danger is nga. Treatment ith acetaminophen co wich of lining i the most appropriate res step nthe management of ths patent? Za (@) obra a crf the abdomen keOuns wl Hemoglobin 12 Leukeqte count 6900/0? nd vas ney a oo meni Cresinine 0.5 gi no 12m wee Ye-20 WECM asl sna or respatorysycyc wus ntuenze A and inuerza 8 amie is nate. Treatment th acetaminophen eda nay course of cetue sated. Ure clare subsequey gona > 10? ely forming ants (CFU) of GH) ontain crate aden (8) Feo renal aber rsnans © | Ste weston treme ore (©) Pecan incense OVP) (©) so pops wh maton althoarle (© Peter iangqatewetourashy © oten-up no netsouns al < ria > | 1o-month-ol gl brought the physician by har motor beaute of fan unkabity for he past? aye The rox ‘moe ays thatthe g's avers have sled bad since te symptoms tard The patent has hal Some clea nasa aloe ee pase ope aoe ee ace ee 50 percent for heaht and welght Her temperature 1s 381°C (102.37, pues 138/mm espraons are 26/min and ‘ood prassine 75/45 mm bg Cropharyngeal sxansnaion shows a ml postassl dip, Te remainder the Cees ort abeany tee chr Leukerte aunt 6,000/mm! = ae mea 2 o Teoma eal abo reper vines and ifn antigen eg. Test ith ctarnohen & BEB wich of te Following isthe most —— est step inthe management ofthis patent? “hs 10-montheld gt presen wth fever and oul-emeling per. Thasefstres together with una poste for acs, mes, and sina bactena oggest urinary ac necven (UT “a‘An abdominal CT sant ud to dagnore congenital anomalies ofthe geitcurnar tact an ranaltmor. An abdominal CT 1s aso used wo diagnose causes of unary wact cbs ction tht May ot be picked u by abdominal 1s or ulvasonoaaphy Such tuna sens, ateteropehic junction seston, and smal mm) Fadler (gn nc a) stones a ‘hecdata ureter, However, the ate presentation wth ever, ertabty, and priate ta the pat has TL though Cr scan may rove clagnostly seul iforation about the Krys ina pater wh acute pelonentns ete Presence fe prnepvic abscess), abet frms of imaging can provide the Same oration without he sk of rasan renal and ble tasouns US) shou be peroneal fee iden wha conimes UT between the 985 of 2 baseline kidneys measreren forte asessment of renal fo. (rae cts apa rae-rotv peters sucha cal aned ally acre asics ar fc 2s ivavenos alos for peas UT. A Such wo cfanone steers nt eaued Inraverouspyelorapy VP) is ved to agnose wary act obstruction (UTD). UTO In 10-nont=od infant woud present Instead with poor urine stp and faire tri bot of wich ae ot pesnt th patent NP does noah aoeOmns al < ria > Intravenous pyeloraph VP suet lagnose urinary Hac obstruction (UTD). UTO na 10-month-ld mart woud present Insta with poor urine tp and afar to riba of wrch ae at resnt ts patent INP Goes ne Pay 2 oe | The goof comamuous arb ropa n pada UI te preven of el scering a arasu of ecutere Pelonehits. In cid younger than one year an een here, continous antiati prophylsis th TMP-SMX oF ‘rte inside te chi hat sree vescouratre ef rae) andor a reves cofrad Ui However this 1O-manth-ls cid hes febrl UT othe rst me, a the dere of vescoweeri fis know, ‘he admcation of anboue in sucha scenario woud cede the ik of uiary at colonisation by arbitra In entcran between 2 an 28 mont fags, vecingcsteurethragaphy (UCU) aly recommended fhe tine mssing Ioday revel ureter lation, hydroaphosi, ndo real caring. nhs age group, VCUG sal inated as an junc e rst neo maging ay ofthe along ate presenta pest conrad Ute to respond witin Culture and neeased ces levels ince ths eid does no meet an of ese citer VCUG Ina the most aporepnite ext stp ay case, VCUC Cont be pore ding a eneUT (as See here) ab should ly be perormed nce the Ina feb cha under 24 months o ge with 2 confined UT anatomical abnormalities ofthe rary act must aways beaa < vim > |5.25-yarld man brought tthe emergency department aftr being truck by acaran hour ago a he at eoting the Sec He di ot lose consciousness. Hei complaing of Ban this aM a eehead, and pes He abo haste we { una, but hasbeen unde too eo since he acide. He tales no medication. i temperature 27.'C 2627, ‘ace ard a 143 cm area of eecymoss ave sah eve Abdominal examination tows Suprapubl tenderness Tees {scam amoune of blond athe etal meacis-Tare sno cencl spinal tnderass, Musculoskeletal examination shows {endernes and ecchymonis oer ha ight dtl fear. An -ay ofthe ein sons afartare fhe pliers: A —— “Transvaal vrasonograp hy ale vprtegram ‘aoecopy “Conactenhance CT san ofthe samen OG eopertonelurasound> ouns ul |5.25-yarld man brought tthe emergency department aftr being truck by acaran hour ago a he at eoting the Sec He di ot lose consciousness. Hei complaing of Ban this aM a eehead, and pes He abo haste we { una, but hasbeen unde too eo since he acide. He tales no medication. i temperature 27.'C 2627, ‘ace ard a 113 cm area of eecymoss ave sah eve Abdominal examen tows Suprapubl tenderness Tees Theres no cerdcal spinal ndeiess Musculsteletl examination shows ‘cam anu ot ensernes and eccymonis over ha ight tl forearm hn ray ofthe pe bene f teerterhtomaemecmnsevn tn nei 2a “ ‘erorade ustream she beet maging et fer waking urtirlnures.oepatiet the nage wold met Healy Sho leakage of urine, neatng the locaton of he ear. Catheterzton Is bsouelyconanaetea gen usc For teal. a ‘Tansrecal ultrasonography i macated for evaligtng patents wh suspeces prostate cancer or rosttns buts net helpful est for evaluating retrain, ‘aiough vpyelogram may be ued forthe evaluation o ney jes, Is pale doesnt Rave ees suggesting 2 ‘beney nin, th a sgnfer lon lor, hemodynamic neal, an pelatral pain and hematoma. Adana, peloareohy nas bean large replaced by conras-enhanced CT asthe est agnostetest for KY MTS.onas a < via > ‘ranarectal raanootaphy ince for evaluating pains wth spaces prostate cancer or prottiebutle not help est for evaluating retrain, ‘atwugh vpyelogram may be ued forthe evaluation ney jess pale does ne Rave ees suggesting 2 ‘Geney nny nuh signer lon on, hemodrame insta. and plateral pain and hematoma. Aanay, prelorenhy nas bean large replaced by conras-enhanced CT asthe est agnostetest for MN MTS. cyrotcpy maybe inact for valuing pore blader ry, partelar hare eros hematuria anh patent 3 eve Hace However, urethral ny seul rs eld oe before further evahaton using CsOsCy ‘lough conras-enhance abdominal Ti recommended fr evlating Kidney inj, ths pati des ot have Features suggesting akin ir, such an ignfean bload los, emedynamie ratty, red plate pina hemor ‘ontact-enkenced sbdontnal Cr sant no suitable for easing uretral or ler nue. itoug eathetezaton eth a fle catheter routine media procedure, the spin ot pesence af aurea marys fn abealteconnandeton for aretha catetarzaton bares cra lee may worn Gh Mi. ‘8 reuopetenal lasound proves useful information fr evalsting several ipsses and conditions such 2 ihe ry of fru aneurysm. Ths pare doesnot have eaesSugasing Hey inuy, Sue a Slgeea Wood oss, emda tna. apolar! pts an bematome.ouns a < sia > ae ‘och ature an She describes eas 9 ov Of 1D in men She has had 2 epsodes of vomiing, She has ro stor of Sta elsoaes noe pas. shes 160 cm (S12 al and weighs 105 (2281), AMI 4 kgm Her temperate _ E7-70 (8,18) ples 36m, respirations ar 1m and blood pesure 11/76 mm Hh abdomen sf and al ‘eres mils tenéeress to palpation nthe rit loner questa owe sounds ae reduced The remade ofthe : ‘tarinaton shows no abnorvaltes, Harley coum is 7.400? lon-dove Cr scan ofthe abdomen ad pais ‘he flowing 1 te mos appropate mex steph marapemen? avacopord stock wave houpsy le o G OG +> aos al < sia > ‘obey tre an Se descbes eas 9 ov Of 1D in mens She has had 2 episodes of voming, she has ro story of Sleds nee pact shee 160 cn 2 a and weighs 104 hg (29 OMe 4 kgm Her temperature te E7-70 (8,18) ples 36m, respirations ar 1m and blood pesure 11/76 mm Hh abdomen sf and ‘eres mil tenéeress to palpation nthe rit loner questa oowel sounds ae reduced The remade ofthe ScmnRRRRRMNRRRRNEIIEE ve soscreeny ree te ‘he flloning 1 te mos appropate nex steph maraperen? “Ths morbiy sexe pater presents wth severe pera alc flank pan, vomiting, cstoveribal ng tenderness, and hemstna sugeste of wrolthass, The CT stan of te abdomen and pes confi an uncomplests lg In ‘he distal ight ue 2a ‘ sm) Ureterorenoscooy v eter To mm, and — une shock wave Itoensy- es effecove even m mori bese patents an, erefre econendabe ts paint ts aso Oe suggest vesoren pater wih uel toes whe dele gas ofall a Bo xacopotel shock wave toto i 2 rstine ezment option for petits wih ureteral stones > 10m Among he Incarvertions used te vetmant of welts, tte prcedut associated th the oust complication fae However, the stone via ultrasound and centering of the stone the shock wave Focus, which ae prerequisites fr extracargreal shock ave ouOD srw Serie ‘Por o te msenton of endoscopy, wreteoktotomy used tobe he standard testment for complex ureteral sons that 6 not pass spontaneous 0” pales wno developed spss. Today, howe, sual sone ero ling ‘absieannated or tradiuonl laparoscopic removal ony conser in rare cans wre terveonal methods. shock ‘eave itp, endoscopic one removal Mae fled afr oak oa nthe fre os beeaae of tga, empl Stones This patent has imple roud ston and no sins or smptons sugges of SDs es fet BOIENSCN, ‘achypnes) ha wuld jsut surgical sec, ‘a patns with uncomplicated wetaral stones 10m shold be offered ilo ponaneous stone passage uncer, cbseration Honea ths patent har a 12mm tone that suit pss sponanecu etl sertng screed ted ete Sen ni cog gers at Untied leet tr ape Ts ptr die at hee fv loukneyol er deuied VES on uh micetey, ich we! anger | iia at incon Furthermore wettl tenant inl recom mended pir wary weet! eve ‘haze duties may be nated pints th hypeelcura proximal teal tubule aedors wha develop rcutent lum-coraning wary stones 1s important to analyze the composton of stones in al ste sone pavers because Im many cases este gudance, dit changes, annual of meal Ueument eg, azide tutes, alopurta) CanBs al hnperenson, pe 2 cabetes melts, chronic obstuctv pumonery aes, ad benign presto hyperplasia He had Stoked ane pack of gues daly 4 yeas but gu | ye! ag, He does rot ink lato. ltt aamsion oe espa ma mediation rela Iiopel metlormin, atop, and tamsulosin He appears seat an eta Fe tempertiree39.% (103-17, ule 6105 mn respirations se 18 mm ane ood retire 11988 Ha he ‘oven pasn Eainatn so «tn hap yan to eer kee cant 15,00 mi Creatine 12 gh Laieacd 25 mgt ov= 05 -2.2 meq oe het Which of te flowing ite mos ily undesyng mechanism of his patent's cure condor? Za (@| word comaminaton © (© Pertonea amrnton imped eheolarveracon (© sleder out obstruction Inada acess formationOUns a < wim > e ee “hese dave 72-year-old man has fv and abdominal pan hat rox hypertension we 2 diabetes melita, chronic ostuctive pulmonary dsease and benign prosaic hyperplasia. Me had Stoked ane pack of cures Gay 40 yeas but gu | ye! ag. He does ro ink lato. ltt aamision oe _ espa ma mediation rela Iiopel metlormin, atop, and tamsulosin He appears seat an eta ® Hs temperatures 39°C (103.7, pulses 106m, respirations ae min and ood pressure 110/88 mm Ha He = ae eee ee = Leukeete count 19:00am? 2 Creatine 12 gh rs Laieacd 25 mgt ov= 05 -2.2 meq oe Veiner = Which of te flowing iste mos likey unetyng mechanism of his at “pata eetant wh fv tachyaria,hemedynamenetabity,aered mental statue and leuko, whieh are consistent wth sepsis Hs physical eam fincngs ane lero vas SuggES a pose Source finfcton. “a ‘Wound cantamination an sbisquen bactarema ot fungemia cn our ape, Howeve he patents icin ey and ron-enyteataus a wound infections uniounka So aS Impaired alveolar vention due to asec or paeumania commonly sen after srgey and can aus spss. Physical fr ead ye cee ee ere alae ey wae tet et ‘ould a0 Show insofar resprton such stachyone,dspnes, oY ough. Ths patent dos have catered Dlatrl hezing, ts probably rela wo Ms long-term tobacco se, While undeyng pneumonia cave aefirveruled eu, Peston «posible complication ofnta-abdomial inflammation eg 0 cele) or abdominal surgery. abet ‘th porto sully appar aul wh fre absorp guating, ado eboand tenderness They may 0 rave nausea an vomlong wien hs patent coe not have. ‘8200 out obsoucion (EO) ste mesial Xplanation forthe patent's uosepss Pre-existing Danignprestac trypan nth patient, one of the mst common eases f wary tet shatucion (UT the ery The hereon an occur spontancoul et potoperatiely (2. du fo manipulation afte wretha up aaron of the ty €atheten 800 wcll resets 5 lowe’ abdominal pin ad palable lower abaomira mas eto stron ofthe nity ude UTO increases he ik of ua act nec nae by tutes and eukocyuia is pave wh may 9 oeaoe 7 Cay + ptotectasis DS ieee ed hao i Ce Ee een ery pein per pean Leneos Ce ed Poy Pe Ee ena een ery pein per pean LenePeto 2 posible complcaon cf a-abdomialifanmation celeste abdominal surgery. avers Rave nausea an vomlomg, whieh hs patent oon not have. . ‘adder outlet obsoucton (00) 's the mostly explanation forte patent’ uosepss Pre-existing benign prostatic pepsi, asin thi paver, one ofthe mot cormon cust of urinary wee Obstruction (UT he ie. The brrecton an occur spantancoul et potopersiely (2. duo anpulaton afte wretha vpn nation of the ty Catheten. 800 NDI resents as lower aodoral pln a a alpable lower aboomiral mas eto dsteton ofthe nary Died UTO increases he sk of unary act necons (diated by kutocysis and leukocyte ns paver WIN May g By sores Inadominal abscess formation shoul be considered i a patient th postoperative abdominal an flowing abdominal Sugary. though at abcess cannot be dite ruled ut Ga of waging hs paens boro fags nate & Ne isouns al < rim > {51-yard hy 1 brought tthe phycctan because fly and por fatng that hepan 2 days ape. i mother ‘eports hae has ben ving mote than wuld this period He eased wo ea is Beaas that ocing ah has ‘actken mary Tod ot water sce a ne. He has ot vomited, Wen changing the boy agers marrige 1s ben ea He peas temperatures 36.0% 98.27) pulses 116/min and boos pressures 95/58: He, The boy ces when te loner abdomen spalpsted. Which of he allowing ithe most appropiate nxt za B) Fectorm ena uleaeouns kea ouns al < rim > | 1-ys-o y 1 brought the physica cant of eat rd por feng thst began 2 ye ap. He moe ‘eports hae ha ben ving mote than wuld this periods He eased wo ea is Deaas that ocing ah has actken mary fod ot water sce ta ne. He ha ot vomited, Wen changing the boys agers te narnng, he as ben ea i peas temperatures 362° (98.27) pulses 116mm and ood pressures 98/58" Ho, The boy ich of ee flwng she wos appropriate next sepia manasement? “This boy presens with tabi, poe feeding, Ston-smaing une signs of hematuria. ad loner abdominal pain ‘hase symptoms are suggestive of aria at econ UT 2a « | anal razon to evaluate the unary rac for conan that may predispose o UTS since in hilaen <2 yes {anti hrapy. Whe hi tent don pean at urna ac nfction he dove not hav eer ox oer neato fora ren uarouns, ‘Avoiding cyiouretrgram (VG fan maging method used to vlutevescoureteral refi VUR since VCUC ean Imasive method ard imelves exposure to alan, te method i ony date in chten wth eeurent Us, geneutnary normals, apical pathogens ad a Ms of por gtowe of hygerlarson. Tas pallet nas rove of tes natn. dean catch rine saree analy obtained in infant with suspected unary act infecton by stimulating urnaton eg. feeding te ile tapping fhe suprspube aes) ana ctting the ne during vaiing, Une raping or patie one Cultures indcated nes pti and obaring a clea eah win sarge would be a posse opin, However, the mato Ie commonly azsocted wt contntion, particular in fats ad ere tht ae wot ot aes euch ahs pati ete eer eee ea eee ceca . id‘voting cystouretroaram (¥CUG fan imagina method used evaluate escoureera refi (UR sce VCUG san Imasive meted ard moves exposure tao, the method i oy racated it che with eeren Ul, gentounary normalities, spiel pathogens nd a story of poor gro or hypertension Ths patent has rane a these estos ‘dean catch urine sample uta obtained in infant wth suspected unary act infcton by simustng urmaton feeding te chil tappina of the Suprepube ate) and caching the rie during wong Ue sain fo istiek end Clturesndcated ns patio, and oonring a ean can urine sae would be 3 possbe option, However, the meted {commonly ascited ith contamination partic in infants and ren thet are oot fet ane such ths pai. ‘ne negate sample can ue out UTI a postive sample des not sufi to confi the glagnoss an mate exe. A fete meta of ebtaning a rine sample's threo preted itis ate. ‘Tansurtralcateterzavon she prefered method of colectng aurie sample fer wins an culture citer who are otto waned sucha he pate. The mato ie ascacited wth loner rk of contamination th pte cl dein ommeras than other cameenly wed methods suchas bag arne samples or cea ath une sample ar generally "ith suprapube tenderess (uch a5 hs Cy), who ate vey key to Rave nny act nfo Cefiime and other third-peraon cephalosporins ae used afte herapeutc agent or vcorpicted winery nactonsn cen Cetame coud tetfore te ule forthe ene weatmen of his pent. Homeer,beore [Feo and coadianae | roar tage Noten | ayOunss < iw > ‘10-year-old woman comes tothe pyactan bacaue of savers headaches forthe pst 3 mothe. Tha headaches ae pulsating in naar ar he descroes therm 8/10 ins She has sed te emegancy department or Meats Twice the past mort, ding Be viSks, er ico pressure was ound be ele She Nas poles ovaan Soca Her eicatons elude metformin and ata omrcepine pl She 162 em (5 allan weighs 66 kg (09010 Bs 3208 kg, Her temperature (37°C (98.67, pulse 1 99/min and blood pressures 165/95 mm Ha. Examination shows hist. Ca/ciopimeary exertion shows re abnoinatis The abdomen sf and ronan. Amati rat a eat height ie Neste nein son at, Aa ee eet ‘etenepinnes are within he retrace range. An asominuitrageuna shows ah nce sed peak eet velocity ne Salpeter Acoaemuced Tse eda shear ec faloning isthe mos appropri nt ste in management be ‘aptop nrapy Oe Percataneous wansuminelanpoolsty with stent placeent amp and peicataneouswansluminal nglopasty witout stent placement alge and sara pate wth ave graf lal orton bypass wih avn grat 4a aos al < iw > {10-year-old moman comes tothe pytanbecae off “Ta headaches are pulsating n nature a se cess therm 58/70 n ins She has sted te emergency deDrtment fr headaches ‘cat he past mth ting bet Ws, her mood pressure was found owe elevated he tas pov oan Suen Her meicatons elude metformin and ata omraceptine pl She 162 2m (5 tla weigh 06 kg (990 6 ss 32.8 kame Her temperature 5 37° 58.7 pulses 99/min, and bled pressure Examination shows hist. Ca/siopimeary exertion shows ne abnoinatis The abdomen sof and ronan. | abdominal brat ahead on the pt sie Netlog examination shows to fol nding. Acomplte loos count, ze rerum coneotatons of elacealye, area aivagan a erate ae win the ference range, lea Fre ‘etenepinnes ate within he retrace range. An ssominuitrageuna shows ay nce ted ea eet velocity ne ‘Ss porton of oth enlatais Acontast-etharced CT Scan of te abdomen Shows ‘along the most appropiate rex step m management? ke ‘he patent’ gender and young age a5 wel ashe presence of distal nov lesions wih a sting-of beds appearance ‘he most aly case of eal ary sensi would be Movomuscula yl What wold Ue te mort eporopte the ot teeatmentina young patent whiners real etry tens duet omar pasa? ¢ SEU 29 ‘a ACE inhib such as enalapril reued To the conto person pales wa renal Tromuscuat ‘pple A revanclratonprocedte such an PTAia als ated pte pte 3 Young anahas severe teal nase Foner, sen pacement isnot recommene or el Hbrmiecl apie ae dees not contr any seanonl bent ‘nd mig a, make subsequent crcrenal bypass graing much more dificu should FTA prove inafetne ‘hv ACE nite sch ax eaptprl scarily eae forthe conta of hyperanion n patents wth eal bromutclar ‘yal Sut woud ony adress he symtoms tha as rom th condo, noth splits, hich egies 4 oneonns al Savin > ‘ercaaneouswarstuminlagiplsty (FTA tout tent placement indeed the ste vascularization procedure for ‘ena romascularepaia in pants th serere ltl renal Tbromuscuardyplaa, a sean hee tious ‘evstatatin procedures improv lon petre canta, adas have shaun hat hypertension past In 7owf atente ‘extensive ovemusclareysplse Medes ancnpertensv herapy woul therefore aso Ge reared m addon 03 evescuanaation proceaue, TA th stn placement is inated in pate wth nal artery stenosis due athetoseotic ease However, ‘eroscerote renal ana steoas, whe mere commen in le mal pire wih kaos such a obey oF Solin, wll tha 5-yea-ldferae pater alsa steric dzsse fends tml the posal rater han (sal Seamients, and peas a5 tubular steno lesion stead of a stong-f beads on angoaraoh. 2 ‘an ACE inhib suchas ramipril ndcte othe cont of peterson i pater wth vena remus Espasa n patents wh severe bls cseae, as sean here, PTA withou Stet placements 50 ndcted ands ned the He ena prone Set paces voted bec ties ee cai any bial eset i ck Irate runrauene snorra bypat gratens much mare ee, shal FA prveneer, ‘An ACE iio such ax ealpl i cert neat for the contol of peterson atts wih rena omar et nee eed fer ees cere secede een Umsucesfa Thee ae ess imase methods wih comparable come thet shouldbe atemptd rst.TA th stn placement is inated in pate wth nal artery stenosis due athetoseotic ease However, ‘eroscerote renal ana steoas, whe mere commen in le mal pire wih kaos such a obey oF Solin, wll tha 5-yea-ldferae pater alsa steric dzsse fends tml the posal rater han (sal Seamients, and peas a5 tubular steno lesion stead of a stong-f beads on angoaraoh. ‘an ACE inhib suchas ramipril ndcte othe cont of peterson i pater wth vena remus Espasa n patents wh severe bls cseae, as sean here, PTA withou Stet placements 50 ndcted ands ned the He ena prone Set paces voted bec ties ee cai any bial eset i ck ‘ake subsequent ortereral bypaegrafing much more ‘An ACE iio such ax ealpl i cert neat for the contol of peterson atts wih rena omar et nee eed fer ees cere secede een Umsucesfa Thee ae ess imase methods wih comparable come thet shouldbe atemptd rst. ‘oon ype grafing usualy reserved for sevre casts or thovs in whieh fstline heap is wsuccessul Thee ve less imrie metas with «compare outcome a shed be amped fs. Action, pas ring one would vot Sesuficen, at meses apeiypetensve therapy woul tl bema ever and chil forte pas 2 day, She ated a areca 3 days a9, whee she ae egg salad he derwent Suge for tora tostona year age Menses occur a regular 26-day ital ah at 5 ds Sn sexual ave Seth ak ptr ied es can etc He ry cc ed tng Shs Tc (#4 ta an weighs 725 kg (16010 Bu 275 kgm. She spears uncororale. Her temperaure 5 389°C (G27 pulses 101m, and Dood pressuets116/76'mm Hp The ngs are cla Co ascutaion. The gh oe Leukeote count 14200/mm? Pa 3ermeait ee 103 meg Crennine tamara Ghcowe pave eutooe esterase postive roc Ss nF wee sonss npr hich af flowing ite mot aly agro? @) ovanan weston ewe eoleest (©) casroemersGicove Lecco ate A Floming he meet Way agrasey Za 230,000/mm? 136 meq 3ermeait leva tamara pave postive negate Ss nF so-35 hot < 20> onan rion (© Ace ctcleesnes (© Genoa ©) ens (© sess appends (@) Pee nmammarry ease 6) HeananreeOuns a > e a {5 34-yearolé woman comes tothe emargency department bucause of shone a ever and chil forte past 2 doy, She ated a arbecie 3 days ago, whe she ae eg sald he wderwent Suge fort ova ston ayer age Menses occur a regular 26-day italy ah at $a Se sexual ave SSE petersenii ed tats SS Tc (Seam anslans 72.5 ko 16910) Bui 27 5 gm she apes uneorfraneHir (0027, pulses 101/min and ood pressures 176/76 mm The lungs ate cl Co ascaaion. The gh One ‘ada ane ht ane show seer enna fap. Poe carina shana na aboerrltee Laboratory hoa coun 1200 mn 2 e demealt S & 13mg Crsmnne }2maiat oe She agave & ec Snot hich af flowing te mot aly dagrens? “presence o tev cil, and ak in combine with eukocyua inate an ascending bacterial tection of he 2a De SS nnn‘Por ovarian torsion increases the risk of repeated torsion, which presents wth a sudden ose of unter ower abeminal pan wit nausea an vomiting. rower, nee ae fora oso, the patent’ Temperature and WEC COUN woul RE Seated. Additonal, the uray tat ot naled i oven tion, 0 rma el woul be unremerable "he patent has many ofthe symptoms of cute choles, sch a night upprsuadrant abdominal pan rasa 2ne Vomiting and fever, se als has several isk factors because she's female, overweight round #0 yes of ane and Premenopausa Howey, the case of coleestis, te unas would have shown negate leuko. esterase and Castors presets wth dares, nausea and vomiting, aa anomal ramping. Ths patent Sos ot have area, and er nls wou be normal in he cane of gatroentrt. along anther grote mors iy ‘he patents worl reste, with postive leukocyte etre ap elevated WECs ae constant wth wet, Homer, ets sted ote uretva and does nox wesen wth Fee, chil lank ai, nausee, er om ‘Wl tipi as fv and nous, she dows not prsen wth symptoms pel of ait appends such ax permed or epigestic pan that rogessy radiates othe ight loner quadrant ofthe abdomen, adoonaly although appends may cause pra on uta (Co aammaton sound atte would ot haves postive akc esterase tere Pia) nd acs woul Be are ‘Aihough thes patent's somal hnseary puts her ot ck of I, the condition preseats ith bateral lower abdensinal pain,oua a Castros presets wth dares, nausea and vorting, ad aoa apg. Ths patent Sos ot have arene, and her nls wou be normal he cave of gantrontent,malong anther gros morse ‘he patents wale rere, with pote leukocyte etre ap lest WBC, ae const with wet, Homer, Uretit smted o te uretra and doesnot present wth fer, cil, lank Dam, Use, or OMIM. ‘wilt patent as fv and nour, he dows not preven wih symptoms Apical of sat appends sch x pert oF epigestic pan that rogessiyadaes othe rile” quadrant of the abdomen Adana although apendis may cause pj on uta (ue Co aMammaton wound atte would Rot have «postive ukocyte esterase ere Pia and RCs woul be ae ‘ough hepato ena ntory puts er tk of FS, the conan resent wh seal lmarabaominl Pan, envastto his paves wntaeral nk pam, PD abo presets with cecal mation tenderness on cereal exam while this Puen has anormal cea exam, elope is the most hey dlagnoss based om the pat’ presentation and urn study resus loners presets ‘th symptoms simiar tourer (equehy,ugeny, nd nari ih adatinal ympors of lnk pan Fever or chil, nd naire of vermting Urinals shows potne lute etre and elevated nary Crproatssve loner adomina pan The surgery was performed wider qenerl anesthesia ed the pater was temporary ‘Catheeiud fr pertopertve ud balance. Several hour ter the sugey te pale Deano have desing ving Spans other woman an ses consoms inanestety He aoes not mace ara ane beer ocean. caret Imeicatons nde plocarpne ey ops. He sppetsuncoforabl and daphoetc His terpertureis 37.96 ‘ancenrabion of 13.9 9/2 esky coun of 9.000, tele count of 250,000/mm An temp Tecaneteriae te patent ransretay is unsucesulWhch of th folowing we moet ely undayng Case of hit La @ewmontess ‘dere etc of ploaine 5) cate posta ae 2 Newrogeni bdder le 4 beaos al < ri0 > a ‘one dy after undergaing tol knee pecan fo advanced degenertve ceca, 266yearol man hat x oem prootersve lower dona pai The surgery ws performed under general anesthesia and the paterc was emporatiy aeteied for pestopetatve Td buarce.Svera ours ate! the SUgey, the plet Began shave _ ene, noues and progress, dl lower abdominal pain He has Sjogren syndrome. Hes sevualy are ih hs we = Sra one other woman an ses conoms nanestentyHeaoes not mace ara ane beer ocean. caret = Imedcaions inde plocapne ey ops. He eppeasunconforable ards daphoe tc temperatures 37.9C (99.1), pulse 90 min and slood pressure 120/62 mv Hg nial exaraution shows sl RE ac itscyonartpspatin. abortry suis show 2 heraglobn ancenrabon of 15.9 9/c, eect Coun of 9.000, tet count of 250,000/mm An temp Whch ere folowing we mas hel undying aus os patents symptoms? “This paar as postoperative agua, lor abdoniral pay and 2 palpable plc mss tat lon pation, gain ate dreton Combed ng nat te ay etn Wat the mon ono ce 2a =@) arcmin Cystohtvasi i common ested ro ome nr een (Ren with CncUTEN UTD scondy ro unary ow formation ofbaader tones that become setely symptomatic egy ui {enign prostatic enlargement PEs by far the most commen cave of ker cut sbsrcton ad aca rnary retention In ager en. in some earn an ate nay te mcrae con Be he ntl peseravon ote. sen hee The pavent probably ad an undaing seyptomate prostate elagemen-The pipette cater Maly rested in eden of e Urinary tact obatrctonomnes wl < aria > ‘umber of rg that act an the autonome site can caue arte uray retenon by ahr decesing tus acy \psrasympattlyte agers) or increasing uttral sphincter tove Gyrapathomirete agen) Plocapine however, 3 rec Paasympatiomimetc agent thar would inzease descr acy, whch alias Dade emptying. This patent 0 takes filocrtneintrocsa which rakes hgh eel tht the rstertconentation of the doy would be hgh enon fo cae prostis i cul cause by a acti tection of te uri Wat and may aso mane with aca ny ‘eto. is patient real behavior and the tary fiauing eatatretion pt Rr a higher kor arnary tet ifectns, ace bacterel posta usully manfests wth sping fees, hls and gemel pa. The absence of Fer {td rora uae coe mae ie prostattis wy hee (Gets acer co pati tne fete eee rtoerc ernie a senate eee Ineeton ofan aeszed endoscope or catheter peter) the most cmon logy of utal tere Whe ie ene na otheteize wensurevaly dung surgery, takes more than Seefal huts for car ws of «weal titre {ofonm, Racurnt ures may ale cause wetral cure ecause the patent ae name of previous surgeries Neutogeic ler may manifest with cue winaty freon ands 2 common cause of ade utlow oasuucte, ‘pecan young men ans woman rel fom mut tothe cra revou system emul slot pal cre Inry, ske) ree perhetl nerves that supply ee blade eg. labtc neuropathy. Petoperateneregeic laser, Ioever, is eal ol seen folowing spinal anestesia and abomnopec surge, eer of ach can cae neural lamage resulting nip autonome ade” cant neurogenic ase gh to ects sequel of ota as not sucessful n this patient "ouns al < aria > ‘eae prota usualy cause by «bacterial infection ofthe unary wet an may aso manfest wth acute nny ‘etenon, whe is ptt’ sexual behav ad the histor of iain cateerzaton put him a higher ik or winty (st infections acts Baterel posta ually manfaxts wth splng fever chil and perineal pa The absence of fre ‘lana lnstocye count ake sat rotate wily oe Urtvalsoiur posible cause of acute unary reteton latogenc manpultion a muy rele arse Inserion ofan avesaed endoscope or catheter pacer the most common elegy of weal titre Wie is patent na catheters Wansrethraly using surgery. takes ore than several ur for aca tno fe etial ttre eee a ee eee ms es fae anys mete ‘euting catheterization or ecren wet nfecons, weal sticure san ul aaaros Neurogen bler my manfest wth acute urinary retention ands 2 common cause fader outlow oostucton, ‘speciliy in young me and woman rests om iu fo he cel rerveus system fe. multe Scere, spn cord inure stoke) ote peripheral nerves that supply the ade eg, diabetic neuropathy. Petaperatve neurogenic ade a sca oh oem raed esl iach aoe eee pit aes oes oe mee dlamape reson nimpared autonome le” conto reuroenebaader' ghy ult cca 5a Sequel ofa tee epacement In addon, a neurogenic acoe utow dbstucon would be corecable wih eae, whi eel aed Cancer of he potas gone he mot common malignancy Inman and shoud be aang the ferential dagnore ir rae paves presenting with blader outow obstruction. However, rostae cance not the mst hel nderig couse of {ate uray fteton. Flowing rele of Wis pelea distended Bade, a gal etl examination sould be proms o [Feo and coadianae | roar tage Noten | ayouns a < nr i0 > ‘eile olson where he mas the unvesrared passengers He Nas severe lower abdominal and ehcp. On ah hes let and ened Ws uses 25min respratons ate 22m and blood pressures 106/¢2 mm Hg Sczminton Shows lena escrepacy Ahestion of connnara pressure ove te pes shows no spongy esance or stabi ea ‘xamnaton unfemarate focused asessmet with sonography shoms no ie fd inthe abdomen. Theres no 2a Inaverouspyelgray eG ‘ososcopy Fesrorade wetooranhy i eal unratonagrpmy 41¢ beouns al < nr i0 > ‘30-year-old man brought tthe emergency department 25 minutes afr he was medina high-speed motor rox ‘eile olson where he was the unvesaned passengers He has severe ower abdominal and pec pi On aval he is Set and oemed. Ws uses 25min, resaratons ae 22m, an Wood pressures 106/¢2 mim Hg ccminon Sows lengereiscrepacy aphcation of connara pressure ove te pels shows no spongy esSance oF Msi ea eS tthe eft pave age eh of he folowing te mort ppraprae nett apn manapemen? ‘The presence oower abdominal pan and oss Namatua gether Wi a suspected pac Face indicates «posite ee cee Inraverouspyelegrapy can e used oases eal jy. The mos requent nation oY pyeoganhy as 2 alerts wth assoaate inure ea rib Race) or pam and ematma over the nk Becase renal rau ss lym {pater ower abdomunl pan an z pvc race, evaluation of he one rity act MUS TST Be Cones Cystoscopy inact for non-emergent cases of uneelone hemstura, but is not nated for vaumatic hematuria and ould att aurage we urinary act ‘era fiat of the pes prt final management for unstable pac atures. However, hs pte pels wat ‘able on exam an he ay showed fracture fee pee eg cht wl tates pie me& teome — & ll BE o could rhe damage te unary act " ‘era fiat of the pes prt final management for unstable pac atures. However, hs pte pels wat ‘able on exam an he ay showed fracture fee pee eg cht wl tates pie me ‘eroradeuctrorapy a -ne et anes formate aretha ry patents wh gros het Associated sgn ofa weil mr (eg blond 3 ee urethral meatus pennel hematoma pacers wr goss hematuria {0 oes sigs of wetia ity ch 48 hs pate a single tema Fle cathe placement ay be aterped ce {he catheter na placed sucessful ths patient. wrethal jury has urtualy Bee ued out ana further evluston sho eroaradecstoaraphy ir retroarade CT cstoraph sth prefered est used to lagose badder rupture, once tetra Imary as been excludes (by revagrae utewograpy sucessful oly cthetar ison. Certouniay C)tauma must Saye Be ued out i aves of waumatc pei rctr, pec hen males the uefa though th pate fracture doe not nls te pe bone the presnce of fs Rematui2oflg fr GU nay. When Cu damage Suspected the act shouldbe assessed Staring with he excertl genital ad progressing proximally, wetva~ iadéer “uetes heres en ultrasound has poor sensi fr renal wauma ad is ot indicated for uaumatcgentourinary ry. Adon {hs pater homer abdomial pl, ladder ruptveis amore key cause of waumate rss emu aa threo ‘eres mmedute vesigaton efor antessing the kde#hR ir because se hes oly hada urine output of $m of blue-nged ie since surgery. The operation wen smeathy ahd ear patency was checked va ferotadenjecuon a mete ue dye mod th saline Baugh the Foley came au and neaw menses, shes oterse Ney. she underwent 2 cesarean sectors 8 ands years ao, espe Hercenpatetare ls 374% (25.27, ple i 75min espaton re 16min, an blood pressures 128/76 en M9. She clay dressing ner aden rot ana my donde nthe ler quadrant Bedce shy pall Ererties are warm and wel perused ana apa refi brisk Laboratory stusles Show Leukoc count 6:300/mm? aaa 40 mgt “urea vogen 26 ayat “Blood * za (| Ader ble 30 mt of aca gers cons ogybene Onns a <5 o> Leukocyte cunt 6,200/mm? emiteent Sts Pateetcoune —250.000/mm* rao meqit 42 meat 2omey blader scan shows 250 mL of etaned wi, Which of th flowing ithe est es step the vation of his “a @) Aarne bows 50 mL of sees ges @ conan elegy © creck erly eae (©) reer stacey (© saris 209 ot W tose (©) etn te operating rom for emeaeney ser)a oe cent cette, ti because ne hes oy ada of ble-tnged ure since Surgery. The operation were meatier ear patency was checked va etrotadeinjecuon a methylene ive dye maxed th saline Baugh the Fly cate au and neaw menses, shes oterse Ney. she underwent 2 cesarean sectors 8 ands years ao, espe Hercenpatetare ls 374% (25.27, ple i 75min espaton re 16min, an blood pressures 128/76 en M9. She Zay dressing. er aedomane ran my donde ne tomar quaare He Hemealonin ures miogen “Blood Everts are warm and wel perused ana apa refi brisk Laboratory studies Show Leukoet count 6.2004 oagiat 40 mgt 25 mgrat eee ee Facer or ureters. cresnrine level ae normal an ways swverarkable. He blood pressure hs remained sath “a “ne sopenance of une retention on blader scan supgets an ostucive process bebecause spate has anal bood pressure, heat ae and etna eve, She does not need mavenous Hs. fue would nerene dey perfusion tery meressng urine prediing and eacerbuing th pate sendy about blade ana mcrease he rsk of yernephres ‘consul should ery be considered afer exhausting leer options. ‘cat mary retentions a common poslem mth pstperatve etna. After confining unary reterton by utrsound, he rust step to ec the Foley catheter, ich easy inked or bet curing postopeatnepeUen ase fe, When he Patient moved fom the operative ale othe sete) Uteasoud af the key would be apf f ulti yctonesbons wee suspected, Urata present san ‘ndjorshdominal pa at wall ae hematurs Faves wth hyronephons pest wth ing rane are may delay hypertension and fark oan Faroseruce, which meeases unary tpt, wows exacerate he stUaton By Increasing the aout of une Ine paces akeaay enseuctedbuscer.9 a eat unary etenton'e a zaman prot the postoperative etn. After canfing wnat retention by akrascund, he ust ste st deck the Foley cathe, hich seas inked or bet cing postoperate Seven Use” eg, when the len move rom he operate able ote sree). easound ote hes woul be uStu frolic hyatonesoss wee suspected. Ulta resent as Mark ‘sndjor abdominal pa ar well as Peat, Faberts wth hyaronephons present th ing retin ar may develop ypeerson and fark pam ‘hemi inaction fora etur 0 se operating oom is postoperatvehemorrage which canbe red ou becuEeBs al uring wth nator Two yas ago She was dagnosed wth caricl cance and was successfully ested witha ‘camoiation of adlaton ard cheoteaoy. She ha sytem pus wytmatosus anise a course (eepcopersielagel Semen atc wth lp pic wel re pte el sa ghee “onrseptin. eat smoke wo ace of clowetes sl fr 12 yes. carentmescton nce hotowshlroaune Her temperatures 38. 6797), pulses 64min, ad blood pressures 138/84 mm Hg. The ioman fle and theres fedress te pabuton over the pire, abort tues shove stele count 210,000/mm? tire Soonet foc veihot Protein napatie cho flowing i me moe ieyunderyingmachanim hs patent’ conten? za (© | Raden duced nfamion aint wanstormaton ‘Ascencng necton “dare of madiaion keOuns a < sim > o oman ‘Tw years ago, sre was agnosed wth cericl cance and was successfully ested witha ee ‘camoinaten of aceton ard chemaheray. se has strc lupus ervemetosus and ished a cours of = ‘elophonphamide 2 wecks ago She serualy ative wth multiple male and female pains and aes «dupa for @ ‘contraception he has smoked vo packs of cigarettes day for 12 years. Current medication nce = Iydroxychoroauine Her temperate is 36.64 (S77), pulse is 84min, end bod pressure 138) 4 mm Hg. The sy ‘biomen is sft and there tendemes te paleation over the ple region,tabratry suis show F Platelet count 210,000/mm? wae = ~ roc verhot em “spate presnts with disna and pec tenderness n combination wih micoscok hematuria, Pyuna, and @ postive ges sese symptoms inate ess recot 2a adane-nducednmmaton ofthe mucosa of the blader s the undervna mechani of adlabon cysts, Ts condton Tea poten conplication of radaherapy, hich was usd 0 reat eral cancer inthis pata. adaton sts can evenouney Spe aS ° ‘signe wanstvmaton of oon cass st common UNgyng mechan of ladder cance. ough caceningly raven patets hs Yung, Blas cane posible mths oman gen the presence fo ators ch 8 ‘king pec ration, snd ecaphourhanida ester. ewer ns ret ommros Spe 3 pate wh Bader Crema Is ares ros erature gee pan and dsurie hich ae Seen hs oan would be ver late ‘menferatons of ude cancer niece py anda posuve ne eet uggest an necvou ely “The most common cause of urinary wat infection (UTD ascending fection, Women havea high ik of conacting UTS ecaue they nate ashore uretiva which alloys bacteria that colonize the ala and pneu to atcand int the acer ‘eeorr tl worn ha srl fa fats or ech acre seal pariere und use tx apo hac aks the vaginal fora and makes users more prone tthe mead of Uropattogens 1 the lower wary Bac Ut eated ower Ucar asena the ureters oe ney, causing pytonepts Lower abgominal pln and sun canbe symptoms of pehic amstxy ease 1D which most ten ects de oa seal tant nection Sl) with Chum trachomatis Nese gonathocae Fy een ees ‘etl fom any inanmatory prover tn he peli nung ME. Moecher the fer nae patent har mle tx Parner and does noc use bare protection puts heat neasd sk of coating an ST. However, the absence of fever, Vaginal serge, of kukocyoss suggests aura) act fein fate a PD. Cycloohosohamide, which was used oat fate of syst lupus ervtemtosu In this pant, can so cause ace remornaic ss as el as on-herorMape cS). Aug pats Mamoeage ests Can pest With Fematurie nd sana ths presence fpyra and» pone nis est nce he ths patent symptoms ar de Infcton. Furtharmre, hemetnerapy-Inaiceé ests Bal OCC wn ROU Ga of ION.Lower abcominal pln and dysuna canbe symptoms a pec arwmatcy ease ID) which most ten ects de oa ‘eal transite nection St) with Chum tachamanr Noses gorarhoese Py at eh nee, ay ‘esl fom any nfanmatory proces rin he pes nung MI Mereorer, the fat hat ths patent Ras MUIR Sexual Parner and does not use baie protection puts heat meas ik of cnactng an STi However, te absence eve, ‘ginal achege or leukocytosis suggests a urnay tet infest the than PD. Cylophosphamid, which was used oueat flare fst lupus eytemstosu In this patent, can aso cause sce hemorthai tiie a ells on-herarhape tte) Ahough pate ath herarhage cat ca pest with ematur and era the preconc fpyta and = pore nis tet ncese he thie patert symptoms ar du Infection. Furthtmore, hematherapy-nduced ests Bly cers within Rows today of nfision nile nemategenous spread des not lay role inte pathogenesis of wopathogen css, pylons maybe caused byths mechanameapenalyn aeonstes an dug thers Homer in adaton to aboninal pai, sur pi, nd ‘iene, psanephitis aout manor wh Rgh fever chil cotovereba ange tracers, ane WEE ces On hina none of which ae presen in is ater ‘Neural bypersanety ene of he supaced mechan leading 1 ntl eye. ert ey an presen eh sure and pec an H Hannes les develo, nesta ets may aso preset wth mirscopi het a5 Sn here However ert tts sa non-itectous Geode that would not presert with pyura or ostine rite et Moreover by defntion, eral cyte chracterze by mpm lasting = 8 westBs al |5.28-yar-old woman comer tothe phyitan because of 4-day tory of loner abdominal anand pam wth atin. Five months ago, he was rated for gnococal ret he rcety moved n wth her nenywed sband he Sua ace wth er husband and ey co ot use Condom. Hat ony medicn an oral corracepte. Her femperstare's 371 (92.7¢) ana blond pester n 12074 mm Hg. Tere tenerness to palpation ve the pie ‘epion ee examinston shows on sogearing va an vagina. aborston soos nah Leukoc count 6:00/mm? wc sorhot Nemes postive Which of following ise mos ily caus! oganisn? “a never gonartoese ke (©) seprieccas eprops :) Kiebsta preumenae rors abs (© crore wacomouns al < vrim > Five months go, she was ested for gonococal revit he recey moved nw er need hsbaid hes eh er husband and Bey co ot use Condom. Het ony median an oral coraceptve. Het {emperor's 371 (92.7¢) ana blond peste n 12074 mm Hg. Theres tenerness to papain ve the pie Fagin eve examinaton shows anormal-sppearing ila an vagina abot Swe Show Leukoc count 6:00/mm? hich of flowing te mos ily caus! eganisn? “hip pretant wih dana and ienderat fo palpanon ovr the pala agin. thet fer, ogether mh ‘evatee WECS in the ing postve nes and bacteria re corset with ests “a ‘essere gorartoese may esd o sexual transite gentounmaty wat nection sch aretha, and pale Inflammatory seas, However des ot cause cs 9 “StphyococusSerophycs's pat ofthe normal fr ofthe fae geil wact and common cause of ests sexual Fete ery sew as yea te ed pe cree creed rant ete acpetal ane Or Pathogen mor cortman veal ue nhs goup of pats le, ie patent di avez ephyleoeal UTI unary Itrtes woul be negate Because tannyococl do not comer mira tone pycan basi of ay hit of lor abdominal pain ane SER. TS)ours a < via > “StphvococeosSarophycs spa ofthe normal for ofthe fae genital act and acon cEuse of cst. mseualy {civ young women, sich th pater ifs the second mas comon casa organism of communty-actaed cysts. Ore Pathogen b more cortman veal ven 9h gous of patent ls, this paint di vee taphyocoeal Tl unary fer would be negate Braute saphyocoel do not conver mat on ‘leu poeuroniae spa of he natural fra ofthe guntrointestina tact The capsule paacchaies of te bil [Poot nee uene tte Heteala pasuman ay ese narocamsifectine es, neamanise) se we 3 onenosocomial unary ac nections. Hens, sleds pravnoniae no the most common causave agen of UTIs thi panere ‘terorcen eas pat of enorme raf the non and ony rah eases UT Therefore an infection wh _ererococcu fecal ure this patent As, ths pabent dae enerococcal UT unary nes woud be negate because enarcoecl donot corer vate ont, ‘Proteus rab spar of he natural flora of te gastos rat nd can occasionally ause UTIs ts most Snort yrs uuatycamed by an atcencng hacer infcton fem he uetes aE cle te mot common cause Cleans overall causing = BON of eases of winay at ifectons (UT. Women ate satomialy predisposed wo Sts because thelr wets shorter and heal and gna egos are dese proximity, malig it mere hal ha bates right pred forthe nal region and enone the vaginas Sexual neroue fan important i atx ft cntacng UTL ence he term honeymoon es.onenosocomil unary vac fectns. Hone, sleds praumoniae no he most common causave agen of UTIs thi panere ‘terorcen eas pat of enorme raf the non and ony rah eases UT Therefore an infection wh _ererococcu fecal ure this patent As, ths pabent dae enerococcal UT unary nes woud be negate because enarcoecl donot corer vate ont, ‘Proteus rab spar of he natural flora of te gastos rat nd can occasionally ause UTIs ts most Snort yrs uuatycamed by an atcencng hacer infcton fem he uetes aE cle te mot common cause Cleans overall causing = BON of eases of winay at ifectons (UT. Women ate satomialy predisposed wo Sts because thelr wets shorter and heal and gna egos are dese proximity, malig it mere hal ha bates right pred forthe nal region and enone the vaginas Sexual neroue fan important i atx ft cntacng UTL ence he term honeymoon es. _chayoa trachomatis he mest common cae of enuly Warsmted genitourinary infection in the US such pues,Bs al ‘to engage m Wis day actnies Thee months ago, he Was Ueated for every Watt nfecton wih ‘umetopin-suamethoazol He has hypetansio, astm and ven owe bak pu. Cuter mescalons include Ipecac mtr Ueto Fa lms bxaranon shows conser por. Te resins the examination skows no aborts, abort, studies show Hemoglobin srg ytces sedimentation te 13 mm 5 Ne 135 magi Po sonal Ure mitogen si ngiat hove 70mg slur 5.8 marae Le umurs ate negawveUiveSound shows shrunken Waneys with regula! concours end pepllarycaCavens. Which fhe oloming is the most ely underng mechan ofthis patent's eal are? 2a @toecion wich a ait bacils Iohibion of potancin production (© Bees amount oF cam prosucson FT a TTSgn ge obns a eukoyte cunt [yey sedimentation rte 13 em 5 Ne 136 meait « some hucoee ro moi. twee 5 ner Une curs ate negtveUivesound shows shrunken Widnes with regular concours end pela caleicatons. Which fe folowing she mast ay uncering mechanism hs pavens eal are? “a (A econ th an soso ce © rntton freuen prcton (© bees oan of ih han proton (©) Pecptavon of age wet (©) MvC) gene mucaon (©) Mrpesensty reactionouns al < ia > |3.02-yar-ld man comes tothe physician Beaute of generalized ft gue and alae fr 2 months. He has bees unable x ‘o engage m Wis day atnies Thee months ago, he Was vested fore vnary Watt nfecton with a ‘umetopin-suamethoazol He has hypetnsor, astra and ven owe bak pu. Cuter mescalers ncuse IetocNratnede an lle! ler, ‘al signs ae within norma linge. fxariaton shows cone paler. Te remains te examination shows no snore, Aborto studies show Hemoglobin srg ytces sedimentation te 13 mm 5 Ne 135 magi Po sonal Ure mitogen si ngiat hove 70mg slur 5.8 marae eee Palani vee meee eee serene “This man has estues of tne dysfunction: fague, anemia, wena and elevated cearine He so hes tle pura {MACS nse urine wm neat cutures and utrsonograhy shows anges assoced wth hon Kidney dase, [Along thee fining, long-term ue of naroueh andthe aepen-ffene combination makes analgesic ‘ephropaty the mos key caares 2a ‘a (@)ilectionwthanacdfatbatss =Infection woh an aod-fst actus suchas rbereuoss can cause renal damage and subsequent cron ey disease. one’ tis pat oes no ave sk ars or berclsis eg, vve To areas where the cseases enemy , Me spetin prot or symptoms suggest athe disease. emopias, nigh sees, weight lo) Poracyeline enhance rena ood flow by lating real aplaner, nat prompant the medl of he Kidney. by mhibing prestciim preductor, nonsteroidal ar-alanmtory dogs NSAID) decrease rel boos flo. Afr probnged exposure S| tealgeri, especialy atalgete uses n combina, a the case er, patents develop renal peplay rere nd subsequent anoles nephropathy lebron Kidney dean) ‘xcs ight chan production most frequent essed wth rule myloma and systemic amos and cn cause Cuonichdrey seas CAD), Pants wih mule myeloma grasert wn eleate serum calum, pa feud skeet ‘tres invobemant, and anemia Ths patent hae normal sem aca vale The eto nae ack pan othe patent otc ona a course for et be tribute fo multe myeloma and is remas hay duet nro kine ass. ‘rugs such a5 avo ndnavi, methotete, an clretloxacn a potty Sli in wire and can precipitate in eal ube, outing up as ey that cause Ax wi day oa week Tas patent hasbeen smptomat Te 2 Monts and as ot bes exposed to ary drugs that commonly cause cryainduced 38 UC! is ne ofthe genes essed with autora dominant tubules Kidney ease (medullry atc Kidney Tinsseay oy csatoeey fe WGaSra romeo: ets vic cscs cat Dunys ee ood aly er Yai ee,Om Bsa & ow Excessive ight chan presucon most rquertassocted woh mute mjloma abd systemic amoioss ae can cause rome kre sare oD), Fataes wih mull mye graven th cleat serum acum, ph related stall Caseaseivcvemert an anemia This pater has normal erm calcu ees The chen ower back pam Mts stent foto ong a course orto be atrbutie fo mule melo and MS areas Waly ue CWOMC Raney aease ‘rugs such as cectow, nda, metoteate, an Cpretloxacn a poo soluble a wie and can peopel ‘bul, buling up as eet thr ease Akl tn day toa week Ths patent has Seen japtomate for? months and has rot ben exposed ary drugs tat comment cause rstal-nduced AI. ‘MUCI one ofthe genes astctatd wth asioteral dominant tubules Koay est edly tc Kdoey ticese, an exes rave deere. aint wth te eeese amt alae hives sang fami etary of ey ote hich mis pane dos ox. Utvascund cng sometimes, tut not ava, eva SL wn Ge ena edula Tis paet ‘A persone easton NSAIDS ora zlfonamide alot, sh ae TMF| SM, can cue AK he form of ‘tubules nepnics, which woul presen a5 2 apd decompensation nine futon, Pte ins incu feet, "ash and eosaphiia. This pauat dos not Nave ary of hase gs and MS 2-Morth MSL au suggests 2 mre