A 56-year-old man is brought to the Emergency Department with intense chest pain that radiates to his left arm and jaw. He also complains of feeling lightheaded. Upon arrival, his blood pressure is 104/60 mm Hg, pulse is 102/min, respiratory rate is 25/min, body temperature is 36.5°C (97.7°F), and oxygen saturation is 94% on room air. An electrocardiogram shows an ST-segment elevation in I, aVL, and V5-6. The patient is transferred to the cardiac interventional suite for a percutaneous coronary intervention. The patient is admitted to the hospital after successful revascularization. During his first night on the ICU floor his urinary output is 0.15 mL/kg/h. Urinalysis shows muddy brown casts. Which of the following outcomes specific to the patient’s condition would you expect to find?
ABlood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1
BUrinary osmolality 900 mOsmol/kg (normal: 500–800 mOsmol/kg)
CUrinary osmolality 550 mOsmol/kg (normal: 500–800 mOsmol/kg)
DFENa+ < 1%
EBlood urea nitrogen (BUN):Serum creatinine ratio (Cr) > 20:1
A 27-year-old man is brought to the emergency department 30 minutes after being shot in the abdomen during a violent altercation. His temperature is 36.5°C (97.7°F), pulse is 118/min and regular, and blood pressure is 88/65 mm Hg. Examination shows cool extremities. Abdominal examination shows a 2.5-cm entrance wound in the left upper quadrant at the midclavicular line, below the left costal margin. Focused ultrasound shows free fluid in the left upper quadrant. Which of the following sets of hemodynamic changes is most likely in this patient? Cardiac output (CO) | Pulmonary capillary wedge pressure (PCWP) | Systemic vascular resistance (SVR) | Central venous pressure (CVP)
A↑ ↓ ↓ ↓
B↓ ↓ ↑ ↑
C↓ ↓ ↓ ↓
D↓ ↓ ↑ ↓
E↓ ↑ ↑ ↑
On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks you which segment of the nephron is responsible for the majority of water absorption. Which of the following is a correct pairing of the segment of the nephron that reabsorbs the majority of all filtered water with the means by which that segment absorbs water?
ADistal convoluted tubule via passive diffusion following ion reabsorption
BDistal convoluted tubule via aquaporin channels
CThick ascending loop of Henle via passive diffusion following ion reabsorption
DProximal convoluted tubule via passive diffusion following ion reabsorption
ECollecting duct via aquaporin channels
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