COMSAE Renal and Urological Systems 2 — Questions and Answers
Question 1: A 4-year-old child presents with massive proteinuria (5g/day), hypoalbuminemia, generalized edema, and hyperlipidemia. Biopsy shows effacement of foot processes on electron microscopy. What is the most likely diagnosis?
- Minimal change disease (Correct answer)
- Focal segmental glomerulosclerosis
- Membranous nephropathy
- Membranoproliferative GN
Correct answer: Minimal change disease
Minimal change disease is the most common nephrotic syndrome in children, showing normal light microscopy but effacement of podocyte foot processes on electron microscopy.
Question 2: On COMSAE, which medication should be held 24-48 hours before administration of iodinated contrast in a patient with chronic kidney disease?
- Metformin (Correct answer)
- Lisinopril
- Furosemide
- Aspirin
Correct answer: Metformin
Metformin should be held before contrast administration in CKD patients because contrast-induced nephropathy can reduce metformin excretion, causing lactic acidosis.
Question 3: A 70-year-old man with BPH presents with urinary frequency, nocturia, weak stream, and post-void dribbling. Which medication class reduces prostate size by blocking testosterone conversion?
- 5-alpha reductase inhibitors (finasteride) (Correct answer)
- Alpha-1 blockers (tamsulosin)
- Anticholinergics
- Beta-3 agonists
Correct answer: 5-alpha reductase inhibitors (finasteride)
5-alpha reductase inhibitors block conversion of testosterone to dihydrotestosterone (DHT), the primary androgen driving prostate growth, thereby reducing prostate volume.
Question 4: Which stone type is most likely in a patient with recurrent urinary tract infections caused by urease-producing organisms like Proteus mirabilis?
- Struvite (magnesium ammonium phosphate) stones (Correct answer)
- Calcium oxalate stones
- Uric acid stones
- Cystine stones
Correct answer: Struvite (magnesium ammonium phosphate) stones
Urease-producing bacteria hydrolyze urea to ammonia, alkalinizing urine and promoting precipitation of struvite (MgNH4PO4) stones that can form staghorn calculi.
Question 5: A patient with nephrotic syndrome has serum albumin of 1.8 g/dL. Which complication is this patient at highest risk for due to loss of anticoagulant proteins?
- Renal vein thrombosis (Correct answer)
- Pulmonary embolism only
- Deep vein thrombosis only
- Arterial thrombosis only
Correct answer: Renal vein thrombosis
Nephrotic syndrome causes urinary loss of antithrombin III and protein C/S, creating a hypercoagulable state; renal vein thrombosis is the most classic complication.
Question 6: Which OMT technique is most appropriate to address Chapman's reflex points associated with renal dysfunction?
- Soft tissue/inhibitory pressure at anterior Chapman's point lateral to umbilicus (Correct answer)
- HVLA to lumbar spine
- Myofascial release of thoracolumbar fascia
- Muscle energy for lumbar somatic dysfunction
Correct answer: Soft tissue/inhibitory pressure at anterior Chapman's point lateral to umbilicus
Anterior Chapman's reflex points for the kidneys are located lateral to the umbilicus, and treatment involves gentle rotary friction or inhibitory pressure to normalize viscerosomatic reflexes.
COMSAE Renal and Urological Systems 2
A 4-year-old child presents with massive proteinuria (5g/day), hypoalbuminemia, generalized edema, and hyperlipidemia.
Biopsy shows effacement of foot processes on electron microscopy.
What is the most likely diagnosis?