1) Cuáles Cuáles son las principales principales duda duda del uso de creatinina creatinina plasmáti plasmática ca para calcular el índice de fltrado glomerular
a) en esta estadio dioss agudo agudoss no varia varia b) amputados, amputados, enfermos enfermos renales renales cronicos cronicos,, c) transp transplan lantad tados, os, desnut desnutrido ridos, s, obesos obesos d) sexo, exo, raza raza 2) Eectos Eectos tienen los cambios cambios selectivos selectivos de de la resistencia resistencia renal renal preglomerular y postglomerular en la racción de fltración
La presión hidrostática glomerular está determinada por tres variables, todas ellas bajo contr control ol sio siológic lógico: o: 1) pres presión ión arter arterial ial !) res resisten istencia cia arter arteriolar iolar afere afe rente nte,, " #) re resis sisten tencia cia art arteri eriola olarr efe efere rente nte$$ %l aum aument ento o de la pr presi esión ón arterial tiende a elevar la presión hidrostática glomerular ", por tanto, a aumentar el &'$ (in embargo, como se comentará despu*s, este efecto está amortiguado por mecanismos autorreguladores +ue mantienen una presión glomerular relativamente constante mientras uct-a la presión arterial$) %l aument aum ento o de la re resis sisten tencia cia en las art arteri eriola olass af afere erente ntess re reduc duce e la pr presi esión ón hidrostática glomerular " disminu"e el &'$ .or el contrario, la dilatación de las arteriolas aferentes aumenta la presión hidrostática glomerular " el &' (g$ !/01)$ La constricción de las arteriolas eferentes aumenta la resistencia al ujo de salida de los capilares glomerulares$ %sto aumenta la presión hidrostática glomerular, " mientras +ue el aumento de la resistencia eferente eferente no reduzca demasiado el ujo sangu2neo renal, el &' aumenta ligeramente (v$$ g$ !/01)$ in embargo, como la constricción arteriolar aferente tambi*n (v redu re duce ce el u ujo jo sa sang ngu2 u2ne neo o re rena nal, l, la fr frac acci ción ón de l ltr trac ació ión n " la pr pres esió ión n coloidosmótica glomerular aumentan a medida +ue la resistencia arteriolar eferente aumenta$ Luego si la constricción de las arteriolas eferentes es inte in tens nsa a (i (inc ncre reme ment nto o ma ma"o "orr de tr tres es ve vece cess de la re resi sist sten enci cia a ar arte teri riol olar ar eferente), el aumento de la presión coloidosmótica supera el incremento de la presión hidrostática capilar glomerular debido a la constricción arteriolar eferente$ 3uando esto ocurre, la fuerza neta de la ltración se reduce en realidad, lo +ue disminu"e el &'$ i aumenta la 45 " dismu"e la 4e disminu"e la 6&' 7898;<% 45 5;9%65 6&' 5;9%6= 7% 4% 5;9%6= L8'%4= 6&' 8 5;9%65 #> 7898;<% L5 6&' 3) Cuáles Cuáles son las principales principales uncione unciones s de los conductos conductos colectores colectores medulares y papilares en la regulación de la composición de la orina
%n presencia de adh, el agua " la urea salen de la luz para entrar en el intersticio$ La orina se torna hipertónica en presencia de adh la urea en el intersticio crea el gradiente de concentración en el intersticio de la medula interna$ 4) Cuál de los siguientes siguientes enunciado enunciados s es !" !"
a) La bomba de a0? mantiene elevadas las concentraciones de estos iones en el l2+uido intracelular b) el volumen del l2+uido intracelular es casi el doble del extra c) el agua e+uivale aproximadamente a @AB del peso corporal humano
d) el intercambio de l2+uido entre entre el espacio intersticial intersticial " el plasma origina la reabsorción neta en los capilares de la circulación general e) 5 #) Cuáles Cuáles son las siguientes siguientes afrmacion afrmaciones es describe describe me$or la respuesta respuesta a una carga de solución salina"
a) 5umento 5umento de volumen volumen extrace extracelular lular " de osmolar osmolaridad, idad, disminuc disminución ión del volumen intracelular b) 5umento 5umento del volumen volumen extrace extracelular lular e intracel intracelular, ular, disminuci disminución ón de la osmolaridad intracelular c) 8ncrement 8ncremento o del volumen volumen extracel extracelular, ular, del intrac intracelular elular " de la osmola osmolaridad ridad extracelular %) En comparació comparación n con el estado estado normal normal &cual &cual es el eecto eecto neto neto de la depuración de creatinina en una paciente 'ue acaba de ser sometido a nerectomía con reducción del #( en la masa renal" *uponga 'ue el individuo esta en e'uilibrio y 'ue no +a ocurrido +ipertrofa compensatoria de las nerona residuales
d) o se se mo modic dica a ,) -iga cuál cuál de los actores actores 'ue 'ue aparece aparece a continuació continuación n puede aumentar el índice de fltración glomerular
e) 8ncrement 8ncremento o del del coecie coeciente nte de ltrac ltración ión .) Cuál de los los siguientes siguientes enómeno enómenos s ocurre despu/s despu/s del aumento aumento selectivo en la resistencia arteriolar eerente"
a) 7escenso 7escenso de la ltrac ltración ión si aumenta aumenta por por encima de #x #x su valor norma normall 0) Cual es la la presión +idrostática +idrostática aproima aproimada da en los capilar capilares es glomerulares"
b) /A mmCg 1()
Entre ntre las ma mani nie est stac acio ione nes s clín clínic ica a de de la la se se enc encu uentr entran an
Ciperlipidemia, hipocalcemia, hiperfosfatemia, calcicaciones metastásicas 11)
El do dolor reeri erido a lo los ri rio ones se se pu puede ma mani niesta star en en5 3ara
externa del muslo 12)
4 me mecanismos 'u 'ue pu pueden ll llevar a lesión re renal
mecanismos inmunes, toxicos, hemodinamicos, obstructivos, infecciosos 13) -esc -escri ribi birr la la fsi fsiop opat atol olog ogía ía de la +ip +ipót ótes esiis de de und under erfl flll del del síndrome nerótico
d) el intercambio de l2+uido entre entre el espacio intersticial intersticial " el plasma origina la reabsorción neta en los capilares de la circulación general e) 5 #) Cuáles Cuáles son las siguientes siguientes afrmacion afrmaciones es describe describe me$or la respuesta respuesta a una carga de solución salina"
a) 5umento 5umento de volumen volumen extrace extracelular lular " de osmolar osmolaridad, idad, disminuc disminución ión del volumen intracelular b) 5umento 5umento del volumen volumen extrace extracelular lular e intracel intracelular, ular, disminuci disminución ón de la osmolaridad intracelular c) 8ncrement 8ncremento o del volumen volumen extracel extracelular, ular, del intrac intracelular elular " de la osmola osmolaridad ridad extracelular %) En comparació comparación n con el estado estado normal normal &cual &cual es el eecto eecto neto neto de la depuración de creatinina en una paciente 'ue acaba de ser sometido a nerectomía con reducción del #( en la masa renal" *uponga 'ue el individuo esta en e'uilibrio y 'ue no +a ocurrido +ipertrofa compensatoria de las nerona residuales
d) o se se mo modic dica a ,) -iga cuál cuál de los actores actores 'ue 'ue aparece aparece a continuació continuación n puede aumentar el índice de fltración glomerular
e) 8ncrement 8ncremento o del del coecie coeciente nte de ltrac ltración ión .) Cuál de los los siguientes siguientes enómeno enómenos s ocurre despu/s despu/s del aumento aumento selectivo en la resistencia arteriolar eerente"
a) 7escenso 7escenso de la ltrac ltración ión si aumenta aumenta por por encima de #x #x su valor norma normall 0) Cual es la la presión +idrostática +idrostática aproima aproimada da en los capilar capilares es glomerulares"
b) /A mmCg 1()
Entre ntre las ma mani nie est stac acio ione nes s clín clínic ica a de de la la se se enc encu uentr entran an
Ciperlipidemia, hipocalcemia, hiperfosfatemia, calcicaciones metastásicas 11)
El do dolor reeri erido a lo los ri rio ones se se pu puede ma mani niesta star en en5 3ara
externa del muslo 12)
4 me mecanismos 'u 'ue pu pueden ll llevar a lesión re renal
mecanismos inmunes, toxicos, hemodinamicos, obstructivos, infecciosos 13) -esc -escri ribi birr la la fsi fsiop opat atol olog ogía ía de la +ip +ipót ótes esiis de de und under erfl flll del del síndrome nerótico
La hipótesis clásica o tambi*n llamada hipótesis del underll postula +ue la retención de sodio en el es un fenómeno secundario a la disminución del volu volume men n arte arteri rial al efec efecti tivo vo (por (por ende ende el t*rm t*rmin ino o unde under rll ll)) " segui seguir2 r2a a la siguiente secuencia de eventos (gura 1): la p*rdida urinaria de prote2nas propia del , especialmente de alb-mina, producir2a hipoalbuminemia, +ue a su vez causar2a una disminución de la presión oncótica plasmática$ %sta disminución en la presión oncótica plasmática ocasionar2a un DimbalanceE en las fuerzas de tarling, produciendo la translocación de uido del espacio intravascular hacia el espacio intersticial, causando una disminución en el volumen volumen arterial arterial efectivo efectivo ", por consiguien consiguiente, te, hipovolemi hipovolemia a relativa relativa$$ %sta -ltima producir2a la activación del sistema renina0angiotensina0aldosterona renina0angiotensina0aldosterona " del sistema nervioso simpático, el incremento de la liberación de hormona antidiur*tica " la inhibición de la liberación l iberación del p*ptido natriur*tico auricular$ auricular$ La activación de todos estos sistemas producir2a la retención de sodio " agua por parte del riFón con la consiguiente aparición del edema$ in embargo, divers diversas as observ observaci acione oness experim experiment entale aless " cl2nic cl2nicas as reali realizad zadas as durante durante el transcurso de los aFos no apo"ar2an esta hipótesis$ 14) En la la ev evoluc oluciión de las glom glomer erul ulop opat atía ías s pri prima mari rias as pa part rtic icip ipan an los siguientes elementos ecepto
a) ist istem ema a del comp complem lemen ento to b) 5ctiv 5ctivaci ación ón de de linfo linfocit citos os t c) activació activación n del del sistema sistema renina0an renina0angiot giotensina ensina d) &act actor or trans transfor forman mante te beta beta e) 5 " b f) 3 " d 1#)
%n la nefropat2a diab*tica el daFo en glom*rulo es por:
5) %xpansión %xpansión de la matriz matriz extrac extracelula elularr b) .rotein teinur uria ia c) 7isminuci 7isminución ón de la expre expresión sión gen*tica gen*tica de de la nefrina nefrina d) Cipert Cipertens ensión ión intr intragl aglom omeru erular lar e) 6odas f) 5
1%) Con rela relac ción ión a la la cu cuál ál de las las sigu siguie ient nte es com compl plic icac acio ione nes s no no es causada por la EC"
5) 5%985 G) ;4 ;4=L =L86 8685 858 8 3) C65
7) C8.%4.545684=8789= %3;7548= %) 95L;64838= &) 6=75 ') 5 ( el hiperparatiroidimo causa urolitiasis, asi +ue todas estas son complicaciones de la %43) 1,) 6a densidad urinaria mide indirectamente la concentración de solutos y el e'uilibrio +ídrico 7 y para su valoración debemos tener en cuenta lo siguiente5
8ndica la cantidad relativa de solutos +ue contiene un volumen denido de orina$ %l HAB a IAB de estos solutos corresponde a la urea$ %l rango del valor normal en pediatr2a es mu" amplio: 1$AA# gJl a 1$A#A gJl$ Los valores inferiores corresponden a los reci*n nacidos " lactantes, +ue generalmente oscilan entre 1$AA gJl a 1$A1A gJl " para los niFos ma"ores de 1$A1A gJl a 1$A! gJl$ Los valores K1$A!# indican una capacidad de concentración urinaria normal$ Los valores 1$AA gJl corresponden a hipostenuria, +ue puede producirse por una alteración de los mecanismos de concentración tubular o tubulointersticial, como ocurre en la pielonefritis, en las nefritis tubulointersticiales, tubulopat2as, diabetes ins2pida nefrog*nica o en la insuciencia renal otra situación corresponde a la respuesta +ue ofrece el riFón cuando tiene la capacidad de concentración urinaria normal " existe sobrecarga h2drica en este caso, existe poliuria e hipostenuria (ingesta abundante de jugos diluidos, potoman2a o intoxicación h2drica)$ .or -ltimo, cuando existe deciencia de la hormona antidiur*tica, el volumen urinario supera los #$AAA mlJd2a " la densidad urinaria es cercana a 1$AAA gJl (diabetes ins2pida central)$ %l valor K1$A! gJl, como se observa normalmente en la primera orina del d2a, corresponde a una concentración
La proteinuria es factor de progresión de %43$ 9ecanismo molecular: $$
1.)
La gravedad de la proteinuria es un marcador pronostico de gran importancia en la %43$ Co" en dia conocemos +ue el incremento en la excrecion renal de proteinas es un factor relevante como inductor de dano renal " de progresion de la enfermedad M1!N$ %l incremento de la carga ltrada de proteinas determina +ue estas moleculas sean activamente reabsorbidas por las c*lulas del tubulo proximal, con su acumulacion en los lisosomas " la rotura nal de estas estructuras, con el desarrollo de una respuesta inamatoria en la zona tubulo0intersticial$ 5demas, la presencia de proteinas en la luz tubular estimula la sintesis en las celulas epiteliales de citocinas " factores de crecimiento, +uimiocinas " factores de transcripcion, +ue provocan la inltracion del intersticio renal por celulas inamatorias, la puesta en marcha de una reaccion inamatoria ", nalmente, el desarrollo de brosis M1#N M1@N$ 3on una amplia evidencia basada en estudios experimentales, el papel de la proteinuria como elemento patogenico de dano renal +ueda claramente constatado al analizar los numerosos estudios clinicos +ue demuestran +ue la reduccion de la excrecion urinaria de proteinas se asocia de forma consistente con un efecto benecioso sobre la progresion de la 7 M1N M1/N$ %n diabeticos, la proteinuria no es solo un excelente marcador de la gravedad de la nefropatia, sino +ue tambien se ha revelado como el mas potente predictor factor de progresion renal, asi como de mortalidad " riesgo$
%s tan importante su peso pronostico en la progresion de la enfermedad renal +ue se ha propuesto +ue la presencia de proteinuria se tenga en cuenta para la estraticacion del riesgo renal, clasicacion " estadicacion de la enfermedad renal crónica M1ON$ 5demas el cambio en la proteinuria tras el tratamiento es un factor predictor de progresion renal M1IN M!AN " de morbimortalidad M!AN$
10)
4 aplicaciones clínicas del renograma radioisotopico
%stá indicado en la valoración de la ltración glomerular, insuciencia renal, calculo de función renal diferencial, uropat2a obstructiva, trastornos vasculares renales, trasplante renal, urgencias urológicas, " comprobación de los resultados de la cirug2a$ 2() 8aciente con mieloma multiple actualmente cursa con síndrome nerótico7 El proteinograma electroor/tico característico será5
%l 9ieloma 9-ltiple es una neoplasia maligna de c*lulas plasmáticas, caracterizada por la producción masiva de una paraprote2na formada por inmunoglogulinas completas +ue contienen cadenas ligeras monoclonales Pappa o lambda, dependiendo del tipo de mieloma, " en el !AB de los casos sólo se producen cadenas ligeras, +ue son eliminadas por la orina (proteinuria de Gence0Qones)$ %sta -ltima tambi*n puede encontrarse en otras paraproteinemias, como la macroglobulinemia de RaldenstrSm, la amiloidosis, la gammapat2a monoclonal de signicado incierto o la enfermedad por cadenas pesadas Las grandes cantidades de cadenas ligeras monoclonales ltradas por el glom*rulo son las responsables de la lesión renal más t2pica de estos pacientes (r2Fón del mieloma), +ue se caracteriza por el depósito intratubular de grandes cilindros de cadenas ligeras, +ue ocasionan una atroa de los t-bulos " brosis intersticial$ %sta tubulopat2a sólo se produce cuando ha" proteinuria de Gence0Qones " su gravedad se relaciona directamente con la excrección neta en orina de cadenas ligeras$ 21)
6a turbide9 urinaria necesariamente indica inección urinaria 8 ( ) = (> ), " la presencia de espuma además de proteinuria puede ser producida por bilirrubinas, restos de semen en la uretra, normalmente eiste glucosuria en mínima cantidad 8 (> ) = ( )
22) La gamma grafía renal evalúan 1) Cantidad de corteza. corteza . Y haga un esquema gráfico de:
a) Exclusión renal izquierda No aarece el otro normal
2)Distribución de
b) insuficiencia renal crónica. Disminución del tama!o renal hio catación
c) Cidronefrona
con excreción renal lenta
Los .ac$ 3on Cematuria intensa pueden excretar hasta 1gr de prote2nasJ!@Cr, debido a la sangre en la orina
23)
Si al explorar al riñón a nivel de flanco izquierdo se ausculta soplo probablemente el paciente presentó Estenosis de arteria renal ! "emodin#micamente qu$ se esperaría encontrar "iertensión arterial reno#ascular.
24)
%n este caso los 8%35 estar2a indicadoT %n caso de armación o negación expli+ue Upor +ueT %stos medicamentos siguen siendo la piedra angular del tratamiento del control hipertensivo, preservación de la función renal " reducción de la morbi0mortalidad cardiovascular$ %ste grupo de medicamentos reducen la incidencia de eventos cardiovasculares e inducen
la regresión de la hipertroa ventricular iz+uierda además, se han asociado con una reducción de AB en la progresión de la insuciencia renal en pacientes, tanto diab*ticos como no diab*ticos$ %n pacientes con estenosis cr2ticas bilaterales se ha observado un s-bito deterioro de la función renal con el uso de estos medicamentos, la depleción de volumen mediado por diur*ticos o p*rdidas gastrointestinales, tambi*n pueden exacerbar la falla renal$ %sta situación debe hacer sospechar altamente en la posibilidad de estenosis de la arteria renal$ %l uso de estos medicamentos tiene nivel de evidencia 85 " 8G, respectivamente, en el tratamiento m*dico de la hipertensión renovascular$ 2#)
a$ b$ c$
-efna :;8 y
'lucosa: AJ1AA odio: AJ1A ;rea: AAJ1 d$ 3reatinina: 1AJ1
2%) •
•
•
•
3onvertir: #AO$#!mgJ7l (.9 COLESTEROL I$A mmolJl a mgJdL V 386.65g/mol) V .9 de um trigliceridoT TRIGLICÉRIDOS $A mmolJL a mgJdL 7eberia especicar cual V O,@1@1 mgJdL (.9 AC. ÚRICO /A$A micro molJL a mgJdL 1/I,11A# gJmol) V #!A x1A 0! mgJdl CALCIO IONICO A$I mmolJ a mgJdL
%n una evaluación de laboratorio se tiene los siguientes resultados: colesterol /$ m9olJL, triglicridos @ m9olJl, convertidos a mgJdL son: 3olesterol (x#I$/H), 6rigl (xII$H) a$ !AA$O " !/A mgJdL respectivamente b$ !IA$O " !IA mgJdL respectivamente 2,)
c7
2#(70 y 3%( mg;d6 respectivamente
d$ #AA$O " @AA mgJdL respectivamente e$ #A$O " @/A mgJdL respectivamente 2.)
a$
.ara una persona de HA Pg$ %l agua corporal total aproximadamente
es: #/ litros
b7
42 litros
c$ @I litros d$ @ litros e$ $5$ 20) .aciente acude a la emergencia con deshidratación severa por diarrea severa probablemente osmolaridad sangu2nea este: incrementada ( ), disminuida (>)$ La creatinina es de 1OA micro molJL " la urea de #A m molJL$ Caga un comentario acerca de la relación ureaJcreatinina$ La relación urea creatinina es de /$# lo +ue podr2a indicar una necrosis tuular aguda (relación ureaJcreatinina W1AJ1) a causa de la diarrea severa +ue originó una 845 prerrenal$ U3uál es la diferencia sobrehidrataciónT
3()
semiológica
entre
hipervolemia "
=G4%C87456538=: e conoce como hiperhidratación o 8ntoxicación por agua al s2ndrome " cuadro cl2nico +ue ocurre cuando ha" un hiperexceso de agua en el cuerpo$
5parece cuando se consume más agua de la +ue se puede eliminar$ %n condiciones normales, una persona sana en la +ue la hipósis, los riFones " el corazón funcionan sin problemas puede beber hasta H$ litros de agua al d2a, a razón de 1$ litros (máximo) por hora$ La hiperhidratación tambi*n se conoce como intoxicación por agua$1 ! # i se superan esos valores, se produce una excesiva dilución del sodio en la sangre (hiponatremia) " se deja de producir la hormona antidiur*tica$ %n casos extremos, con niveles de sodio inferiores a 1AA mmolJl, se pueden producir edemas cerebrales irreversibles, comas, o incluso morir por sobrepresión del cerebro al bulbo ra+u2deo, "a +ue el cerebro " su anexos son los +ue más se ven afectados$ %n ocasiones, la hiperhidratación está relacionada con el uso de drogas, en particular con el *xtasis$ C8.%4X=L%985: e conoce como hipervolemia al trastorno hidroelectrol2tico consistente en un aumento anormal del volumen de plasma en el organismo$ Ysta puede ser provocada por insuciencia renal, insuciencia hepática, 833, s2ndrome de secreción inadecuada de hormona antidiur*tica o por una terapia con l2+uidos intravenosos inadecuada$ %l aumento de volumen del plasma provocará por consiguiente un aumento de peso, cu"as consecuencias pueden llegar a ser ingurgitación venosa, aumento en el gasto card2aco, edema agudo de pulmón, convulsiones o edema perif*rico$ 5 su vez, la hipervolemia puede traer consigo variaciones en la concentración del plasma (trastornos de osmolaridad), como la hipernatremia o la hiponatremia$ = variaciones en la composición, como pueden ser los trastornos del potasio, trastornos del e+uilibrio ácido0base " trastornos primarios respiratorios (acidosis o alcalosis respiratoria) U3uál de las siguientes armaciones en relación con la membrana basa glomerular (9G') es falsaT a$ %s una estructura laminar formada por colágeno de tipo 8X, proteoaminoglucanos, laminina " entact2na$ b$ %n ella se pueden diferenciar tres áreas: lámina densa, lámina rara interna " lámina rara externa$ c$ %stá revestida en su exterior por un endotelio " internamente por los podocitos$ d$ %l ant2geno de 'oodpasteur se localiza en la región 538 de la cadena α# del colágeno tipo 8X e$ La disposición particular de la 9G' contribu"e a delimitar el mesangio glomerular$ 32) U3uál de las siguientes armaciones en relación al aparato "uxtaglomerular es falsaT a$ e localiza en el mesangio glomerular b$ Las c*lulas musculares aferente contienen gránulos de renina$(c*lulas grnulares +ue contienen granulos +ue podr2as corresponder a renina o a su precursor) c$ Las terminaciones adren*rg2cas son abundantes d$ 8nterviene en el control de la presión arterial e$ La mácula densa es un segmento del t-bulo distal$(está ubicada al nal de la rama ascendente del asa de henle) 33) U%n cuál de las siguientes situaciones aumenta el ltrado glomerularT a$ Cipotensión b$ =bstrucción urinaria c$ %mbarazo d$ 'lomerulonefritis extracapilar 31)
e$ insuciencia cardiaca U3uál de las siguientes sustancias se reabsorbe en el t-bulo renal mediante un mecanismo de transporte activoT odio ;rea 3loro 6odas ellas inguna de ellas
34)
a$ b$ c$ d$ e$
UZu* mecanismos de transporte existen en el t-bulo próximal renalT %l intercambiador a[0C[ %l cotransporte a[0aminoacidos$ %l cotransporte a 0fosfatos 4espuestas 5 " G 4espuestas 5, G " 3
3#)
a$ b$ c$ d$ e$
U3uál de estas armaciones es falsa en relación al t-bulo contorneado distal renalT La reabsorción de a[ está mediada por te bomba a[ ?[ 056.asa %s poco permeable al agua " casi insensible a la hormona antidiur*tica (57C),excepto en su parte más terminal Los aminoácidos se reabsorben de forma activa La aldosterona favorece la secreción de ?[ " te reabsorción la reabsorción de a[ La$ 5ldosterona potencia la secreción de iones C[
3%)
a$ b$ c$ d$ e$
U3uál de los siguientes factores interviene en el mantenimiento del balance glom*rulo tubular " regula la reabsorción de sodioT %l sistema nervioso colinergico La perfusión intrarenal de catecolaminas provoca vasodilatación " aumenta la excreción de sodio Las prostaglandinas renales aumenta la reabsorción$ de sodio Las fuerzas de tarling peritubulares (presión oncotica e hidrostáticas) 6odas las respuestas son ciertas
3,)
a$ b$ c$ d$ e$
5l evaluar a un paciente deshidratado, el m*dico debe tener en cuenta +ue: La ta+uicardia es un signo dedigno de hipovolemia $La hipotensión postural es un signo dedigno de hipovolemia La se+uedad de piel " mucosas es un indicador valioso para evaluar el grado de hidratación de los niFos$ \ " 3 son ciertas 6odas son ciertas
3.)
a$ b$ c$ d$ e$
%n los estados de hiperh2dratación +ue cursan con edemas " disminución del volumen efectivo circulante se observa: 5umento de la facción de ltración b$ 7isminución de la presión oncotica 5umento ele la presión hidrostática peritubular 7isminución de la reabsorción prox2mal de agua " sal 6odas son ciertas
30)
a$ c$ d$ e$
%n la cirrosis hepática se observa una disminución del volumen efectivo circulante debido a diversos factores, U3uál de las siguientes armaciones con respecto a estos factores es falsaT a$ e observan anomal2as de las fuerzas de tarling en la circulación hepatoesplácnica b$ Las f2stulas arteriovenosas determinan +ue el volumen plasmático existente sea 4()
relativamente inadecuado c$ %xiste una disminución del volumen sangu2neo total d$ e produce trasudación de solutos " l2+uidos a la cavidad abdominal e$ 6odas son falsas 8ndi+ue de &iltración 'lomerular es: !! mlJmin 1AA mlJmin 1! mlJmin IA mlJmin inguno
41)
a$ b$ c$ d$ e$
on est2mulos para la liberación de 4enina todos, %>3%.6=$ %stimulación b adren*rgica 3oncentración alta de sodio tubular 7isminución del ujo sangu2neo 4enal .*ptido 5trial atrur*tico Cipotensión
42)
a$ b$ c$ d$ e$ a$ b$ c$ d$ e$
on funciones del 4iFón %>3%.6=: 2ntesis de %ritropo"etina$ Cidroxilaación de 7# 2ntesis de .rostaglandinas$ 2ntesis de .*ptido 5trial atrur*tico$ 2ntesis de Gicarbonato$
a$ b$ c$ d$ e$
%l 5gua 3orporal 6otal de un recien nacido de @ ?g de peso es: !AAml !!AAml #AAAml !AAAml inguno
43)
44)
i a V 1@! m%+Jl, 'lucosa V !AA mgJdl ;rea V /A mgJdl , la =smolaridad s*rica será: a$ !II m9olJL b$ #A m9olJL c$ #Am9olJL d$ #AA m9olJL e$ inguno$ 4%) La =smolalidad %xtracelular fundamentalmente controla: a$ 6ransporte activo b$ 6ransporte pasivo c$ Cidratación celular d$ Galance iónico transcelular e$ inguno$ 4,) La causa más frecuente de una hiponatremia ormovólemica es: a$ 8$3$3$ b$ efropat2a perdedora de sal c$ 8C57 d$ 7iabetes 8ns2pida e$ inguno$ 4#)
4.)
a$ b$ c$ d$ e$
%l tratamiento de una Ciponatremia Cipervol*mica es: 4eponer d*cit de a$ ;so de diur*ticos 4estringir agua 7iálisis inguno$
a$ b$ c$ d$ e$
on factores reguladores del 9etabolismo del .otasio, todos %>3%.6=: .*rdida digestiva de ?$ %+uilibrio 5cido0Gase 5ldosterona 56. asa del ? 8nsulina %l tratamiento de elección de la CipoPal*mia es: 'luconato de 3alcio 8nsulina 7extrosa1AB 4eto de .otasio ?a"axalate
a$ b$ c$ d$ e$
.aciente con d*cit de ! grJl de 5lb-mina , es de esperar una 3alcemia de: 1!$I mgJdl 11$! mgJdl H$!mgJdl 1@$! mgJdl inguno
a$ b$ c$ d$
%l signo de 6rouseau se presenta en: CiperPal*mia Ciponatr*mia Cipocalc*mia Ciperfosfor*mia$
40)
a$ b$ c$ d$ e$ #()
#1)
#2)
#3)
a$ b$ c$ d$ e$ #4)
a$ b$ c$ d$ e$
Los Gifosfonatos act-an: 7isminu"endo la excreción renal de 3alcio 8ncrementando la absorción intestinal de 3alcio 7isminu"endo la 4esorción o sea de 3alcio 8ncrementa la excreción renal de 3alcio inguno$ on Gu]er $ %>3%.6=: C3A#0C!3A@ C#0C@ A@^C!A@ Cb .roteinato i a V 1A m%+Jl, ? V $A m%+Jl, 3lV 11 m%+Jl, C3A# V !A m%+J1, el 5nión '5. será: 1 lA !A I !
##)
a$ b$ c$ d$ e$
La causa más com-n de 5lcalosis 9etabólica es: Ciperventilación Cipoxia 7epleción de volumen obredosis de C3A# inguno
#%)
a$ b$ c$ d$ e$
.aciente con ventilación mecánica asistida, con diagnóstico de 5cidosis 4espiratoria descompensada, el tratamiento será: a$ 5umentar el volumen vital b$ 8ncrementar la frecuencia respiratoria c$ 7isminuir el volumen vital #,)
d$ 7isminuir la frecuencia respiratoria e$ inguno #.)
%numere A# mecanismos de regulación del %+uilibrio C2drico
%numere A# indicaciones del uso de 7extrosa al B a$ b$ c$ %() .aciente con d*cit de potasio de 1$ m%+Jl, indi+ue el tratamiento correcto (.reparado, 7osis, Xelocidad " 6iempo de infusión) #0)
%1)
.aciente con un incremento del pC en A$1I, el .otasio s*rico esperado
será: %2) .aciente con acidosis metabólica descompensada, 5nión '5. bajo con d*cit de Gicarbonato de 1A m%+J1 " peso de A ?g$ La indicación de reposición de bicarbonato correcta será: %3) %l coeciente de ;& del 4iFón normal es: " la fracción del excreción del a es de:$ La cantidad neta transferida (6x) por los t-bulos es igual a: %#) %l punto doloroso venoureteral ubicado en el borde inferior de la 1!_ costilla, por fuera del borde externo del cuadro lumbar, corresponde a: a$ costo vertebral b$ costo muscular c$ lumbocostal del 'u"on d$ punto de surraco e$ $5$ %4)
Los signos urenicos podr2an ser, excepto: a$ vómitos b$ hemorragia c$ prurito d$ lumbalgia e$ intolerancia a la glucosa %,) La nefritis por anticuerpo antiCX', ocurre en ! fases, consistiendo en: a$ 1_ fase: b$ !_ fase: %.) .aciente varón de /A aFos con historia de 79 [ C65 de larga data$ .revio a este cuadro 3reatinina 1@! micromolesJL, ;rea 1A$ mmolJL$ actualmente re+uiere diálisis de apo"o$ .regunta: a) La 79 [ C65 se considera como antecedentes: 8 (>) = ( ), expli+ue por+ue ambos son factores de progresión de la enfermedad renal, además de +ue tambi*n pueden ser causas primarias de daFo renal$ b) 3omente el grado de función renal: $ $$$ %0) %ntre los tóxicos renales endógenos capaces de provocar insuciencia renal aguda se encuentran: a$ C%9='L=G85(hemolisis), tmb mioglobina %%)
b$ c$ d$ e$
Cipereaieem2a 9tpemricetnia 4espuestas 5 " G 4espuestas \, G " 3 ,() 6odos los siguientes son signos de insuciencia renal crónica$ %xcepto: a$ 5nemia b$ 3alambres musculares c$ .riapismo d$ .rurito e$ Cematomas espontáneas %l principal factor implicado en la g*nesis de la anemia en los pacientes ur*micos es: 7isminución de la vida media eritrocitarta$ 7isminución de la eritopo"es2s por v2a uremia$ &erropenia 7*cit de ácido fólico 7efecto de producción de eritropo"etina
,1)
a$ b$ c$ d$ e$
UZu* tipo de afectación renal se puede observar en el lupus eritema toso sist*micoT a$ efropat2a proliferativa focal o d2fusa b$ efropat2a membranosa c$ 4iFón normal d$ europat2a mesangial e$ 6odas ellas son posibles ,3) %s causa de lumbalgia aguda continua, excepto: a$ 8nfarto renal b$ Cidronefrosis aguda c$ 'lomerulonefritis aguda d$ Cipertroa compensadora e$ Cematoma perineal ,2)
on manifestaciones neurovegetativas del cólico renal los siguientes, excepto: a$ 6a+uicardia b$ .alidez c$ =liguria " a veces anuria d$ Cipertensión e$ udoración ,#) %n relación con el sedimento urinario, Ucuál de las siguientes armaciones es verdaderaT a$ La presencia de leucocituria es sinónimo de infección del tracto urinario b$ La eosinoluria es un$ hallazgo caracter2stico d* la ne2ropat2a diab*tica c$ Los cil2ndros hialinos son espec2cos de las infecciones de la v2a urinaria d$ Los cilindros hematicos son caracter2sticos de inamación$ aguda de los t-bulos e$ Los cristales de cistina son hexagonales ,%) U3uál de los siguientes microorganismos puede dar lugar a una infección urinariaT a$ %scherichia coli$ b$ taph"lococcus áureus c$ taph"lococcus saproph"ticus d$ 3andida albicans e$ 6odos ellos$ ,,) La causa más frecuente de infección urinaria recidivante en$ el varón adulto es: a$ 4eujo vesicoureteral b$ Litiasis renal ,4)
c$ 9egaureter cong*nito d$ Xejiga neurógena e$ .rostatitis 3rónica$ ,.) e entiende por `s2ndrome nefr2tico agudo` la asociación de: a$ Cematuria, proteinuria, insuciencia renal e hipertensión$ b$ .roteinuria, oliguria, edemas e insuciencia renal c$ .roteinuria, edemas, oliguria "Jo hipertensión transitoria$ d$ Cematuria, insuciencia renal, edemas "Jo hipertensión transitoria e$ =liguria, hipertensión renal e hipertensión transitoria ,0)
c$ d$ e$
4especto al s2ndrome nefrótico, U+u* armación es falsaT e dene como una proteinuria superior a #$gJ!@hJ1$H#m!, acompaFada de hipoalbuminuria edemas e h2perlipemia$ 6raduce un aumento anormal de la permeabilidad de la membrana basal para las prote2nas del plasma$ La presencia de edemas es obligada para el diagnostico$ La hiperlipemia no es un hallazgo constante$ .uede estar causado por enfermedades renales mu" diversas$
a$ b$ c$ d$ e$
U3uál de las siguientes puede ser causa de s2ndrome nefróticoT Lupus eritematoso sist*mico Cipotiroidismo Linfoma 3aptopril 6odas ella
a$ b$
.()
%n relación con la protanur2a, U+u* armación es falsaT a$ La proteinur2a ortostática suele ser inferior a ! gJ!@ horas b$ La proteinuria glomerular se caracteriza, por un elevado porcentaje de alb-mina c$ La lisozimuria entra dentro de la categor2a de proteinur2a por sobrecarga d$ La proteinuria permanente no siempre es patológica e$ La proteinuria asociada a la insuciencia card2aca, es de tipo transitorio .2) Los .ac$ 3on Cematuria intensa pueden excretar hastade prote2nasJ!@Cr, debido a la sangre en la orina$ .3) %l edema refractario tiene m-ltiples causas (mencione #): a$ 3irrosis hepática b$ Lesión tubular c$ 9alabsorción de las drogas diur*ticas por edema intestinal 5 su vez en el edema refractario el descenso de las cifras de alb-mina s*rica por debajo de ! grJdL se puede asociar a respuesta diur*tica pobre, cu"a razón es debido a$$ .4) 7iferencia semiológica entre edema nefrótico " nefr2tico: $$$ $$$ $$$ $$$ .1)
%L edema refractario es debido a diferentes factores, excepto: 7isminución o retraso en la absorción intestinal de los medicamentos 7isminución de la entrada de diur*ticos a la luz tubular 4eabsorción distal de sodio disminuida 3irrosis hepática 7isminución de la llegada de a[ al asa de Cenle .%) Los depósitos inmunocomplejos caracter2sticos en la glom*rulo esclerosis focal " segmentariba ('%&) es: c$ 8g 9 " 3# d$ 8g ' " 3# e$ 8g 9 " 3@ f$ 8g ' " 3@ .#)
f$ g$ h$ i$ j$
%n la glom*rulo nefritis rápidamente progresiva: a$ 6ambi*n es llamado glomerulonefritis mesangial capilar: X ( ) & ( ) b$ %l marcado patológico es fusión de podocitos c$ .uede llevar a insuciencia renal 6erminal dentro de ..) relacionar ambas columnas: .,)
@A$ @1$
1$ 'lomerulonefritis de cambios m2nimos !$ .-rpura de Cenoch hoenlin #$ %nfermedad de Gerger @$ 'lomerulonefritis membranosa $ 'lomerulonefritis focal " segmentaria /$ 'lomerulonefritis post treptocócica H$ 'ranulomatosis de Regener I$ Lupus eritematoso sistemico O$ 'lomerulonefritis membrana proliferativa 1A$ 'lomerulonefritis rápidamente progresiva 11$ 5rteritis de 6aPa"asu 1!$ 2ndrome de 3hurg0trauss 1#$ 1@$ 1$ 1/$ 1H$ 1I$ 1O$ !A$ !1$ (# !) 7epósito de 8g 5 !!$ (1A) 2ndrome de 'oodpasture !#$ (/) 3ursa con hematuria e hipertensión !@$ ( ) !AB presentan hematuria !$ (I) HB presentan hipocomplementemia !/$ (O) La histopatolog2a es mu" variada !H$ ( ) .roteinuria0Cematuria asintomática !I$ () 5 la inmunoorescencia 8g9 " 3# son positivos !O$ (1) 5sociados a neoplasias #A$ (1!) 5sociados a asma bron+uial #1$ #!$ .0) e consideran diur*ticos de alta efectividad "Jo diur*ticos potentes a: a$ 5milorida " %spironolactona b$ &urosemida " Gumetamida c$ 9anitol " la ;rea d$ 3lortalidona " la Cidroclorotiazida e$ 5cetazolamina " 7iclorfenamida 0() .aciente varón de aFos, talla 1A cm$ acude a la consulta pediátrica por presentar edema, hematuriaV !A0!x3, mas crenocitos !A B, diuresis !@ hrs$V #AA cc$ 3alcule lo siguiente: a$ .roteinuria en mgJm!Jh: ##$ b$ 3reatinina estimada: #@$ c$ 7iuresis en mLJm!Jh: #$ d$ 7epuración de 3reatinina: 01) .aciente varón de aFos, tallaVO!cm, .roteinuria VA$Igr en !@h, volumen urinario #AAcc en !@h$ 3alcule lo siguiente: #/$ a$ .roteinuria en mgJm!Jh: #H$ b$ 7iuresis en mLJm!Jh: #I$ c$ %stimar la creatinina s*rica: #O$ d$ %stimar el tamaFo renal: La acidez titulable como: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
02)
se
dene
@!$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $ 3apacidad de 6amponar iones C[ depende de:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @#$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @@$ 03) 9encione los @ principales sistemas reguladores del volumen del li+uido corporal: @$ a) @/$ b) @H$ c) @I$ d) @O$ d) A$ 1$ %n la multiplicación contracorriente un paciente con disminución de vigesta de prote2nas, U %n +ue medida alterar2a la capacidad de concentración del riFónT (%xpli+ue brevemente) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " la osmolaridad m2nima +ue alcanza es de $$$$$$$$$$$$$$$$$$, " la máxima es de $$$$$$$$$$$$$$$$$$$$ !$ 04) .aciente varón de /A aFos con historia de 79 " C65 de larga data$ 3ursa con creatinina 1HH #$ u9olJlt, urea ! mmolJLt$ 7e pronto aparece en emergencia " re+uiere diálisis de irgencia$ @$ .regunta: $ 5) 8mpresión diagnóstica actual de: /$ 0 .robable etiolog2a (mencione A1)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ H$ 0 5lteración de función renal (mencione A1)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ I$ G) La disociación -reaJcreatinina probable en este caso es debido a (mencione A!): O$ 0 /A$ 0 0#) %n uno de los conversatorios realizados, se conclu"ó en los siguientes diagnósticos: /1$ 'lomeruloesclerosis focal " segmentar2a ('%&) [ hipotiroidismo, .regunta: /!$ 5) U%xiste relación entre el hipotiroidismo " la '%&T 8 ( ) = ( )$ %n caso armativo /#$ %xpli+ue$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ /@$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ G) U 5 la microscopia con inmunouorescencia (8&) +ue elementos se encontrara depositadosT$$$$ /$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 0%) %n las alteraciones del medio interno (llene los espacios en blanco): 5) 8;&838%385 35478535: La densidad " osmolalidad habitualmente esta$$$$$$$$$$$$$$$$$$$$$$$$ //$ 9ientras +ue la natremia " la potasemia esta$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ G) %n la 3844=8 C%.\6835: %xiste una $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " $$$$$$$$$$$$$$$$$$$ /H$ 7e aldosterona,esto depende de$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$" disminución del catabolismo hepático$ /I$ 3) %n la cetoacidosis diab*tica, la primera medida +ue debe realizarse es$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ /O$ 0,) Los diur*ticos de asa tipo furosemida en pacientes ur*micos, se puede utilizar a grandes HA$ dosis$ %xpli+ue por+ueT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ H1$ 0.) %n el diagnóstico nefrotico el organismo es insuciente para evitar la hipoalbuminemia$ %n diálisis peritoneal existe p*rdida de prote2nas en forma abundante, sin embargo no ocurre a+uella situación$ H!$ %xpli+ue Upor+ueT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ H#$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
H@$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ H$ H/$ 00) .aciente varón de #/ aFos con diagnóstico de 843$ 9oderado0avanzado (7ep$ creatinina #A mlJmin HH$ ), peso /A Pg$ 4e+uiere amiPacina a dosis estricta$ (&4$ A$O/)$ 5) 3alcule la dosis de carga: HI$ HO$ IA$ G) 7osis de mantenimiento: I1$ I!$ I#$ 3) %n caso de intoxicación$ %xpli+ue el "Jo los mecanismos de daFo renal: I@$ I$ 1(() %n 'estación " 4iFón: 5) La caracter2stica hispatológica a nivel renal es:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ G) .aciente con 8436 de conrmarse el embarazo el tratamiento alternativo del paciente seria por+ueT$ I/$ IH$ 3) %n el caso anterior comente sobre el pronóstico de la función renal del reci*n nacido: II$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ IO$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$ 1(1) %n el taponamiento cardiaco$ %xpli+ue en +ue consiste el: 5) igno de ?usmaul:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ OA$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$ O1$ G) .ulso .aradojal:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1(2) .aciente mujer de ! aFos con nefropat2a diab*tica 888$ e hospitaliza con cuadro s*ptico a foco O!$ pulmonar " anasarca " durante su estancia hospitalaria presenta tetania$ .5 1AJOAmmhg$ &3 O#$ :IIx, polipneica$ Xol$ ;rinario @AccJ!@ hr$ O@$ Lab$ 3reatinina HOu9olJlt -rea #!m9olJLt 'lucosa 1!m9olJlt .C : H$@I, a[ 1#!m9olJlt O$ 3alcio total : HmgJdl 3a: #mgJdl alb-mina !$gJdl$ O/$ .regunta: 5) 7iagnóstico desde el punto de vista nefrológico: OH$ OI$ OO$ G) 3alcular el calcio total real: 1AA$ 1A1$ 1A!$ 3) %xiste alteración del 3aT U%xpli+ue por+ueT$ 1A#$ 1A@$ 1A$ 7) 3omentario acerca de la función renal " .ronóstico$ 1A/$ 1AH$ 1AI$ 1AO$ %) Zue tiempo aprox$ 7emora en pasar del estadio 8X a X: 11A$ 111$ 11!$ 11#$
.aciente mujer de aFos, ingresa con edema generalizado .5: IJ/AmmCg$ .eso 1I Pg 11@$ proteinuria !@h:IAAmg, Xol$ urinario: #AAcc$ 6alla 11A cm$ 11$ 3alcule: 5) Xolumen urinario en mlJm!Jhr$ 11/$ 11H$ 11I$ G) 3reatinina esperada$ 11O$ 1!A$ 1!1$ 3) 7ep$ creatinina$ 1!!$ 1!#$ 7) .roteinuria : mgJm!Jhr$ 1!@$ 1!$ %) 6amaFo 4enal$ 1!/$ 1!H$ 1(4) .ac varon de @ aFos / meses con cuadro de faringoamigdalitis a repeticion$ 8ngresa con diagnostico .5$ OAJA mmCg$ %xcresion de orina leuc$ I01Axc, hematies 1!01@x, crenocitos #AB, 3#: #! mgJdt, 3@: IAmgJdt$ 1!I$ e inicia corticopterapia inicialmente con buena respuesta posteriormente presenta recaidas frecuentes 5l momento .5: 1#AJI mmCg " se torna cortiresistente por lo +ue es necesarioi continuar tratamiento con ciclosporina 5$ 1!O$ .roblemas: 1) %xpli+ue el diagnostico " comente las posibilidades de alteracion histopatologica$ 1#A$ !) .lan de trabajo 1#1$ 1#!$ #) .ronostico$ 1##$ 1#@$ @) %xpli+ue el mecanismo de acción de la ciclosporina 5 " mencione # 459$ a) b) c) 1#$ 1(#) .ac$ Xarón de 1@ aFos hospitalizado por anasarca al examen .5$ 1AAJ/A mmCg, &3$ 1A@> , &3:!!> palidez moderada, acitis a tensión con estrias atrocas , lesiones dermicas eritemato0descamativas multiples en tronco " miembros inferiores compatible con proriasis gutala, vol$ ;rinario IA 33J!@Crs, 3#$ OH mgJdl, Cto #!B, creatinina 1/H umolJlt urea: #! mmolJlt proteinograma electroforetico en orina H B, electroforesis en sangre 8g'[ 38+[ 3#[ 1#/$ .4%';65: 1$0 .lantee las posibilidades diagnosticas$ 1#H$ 1#I$ !$0 3omente el hematocrito del paciente$ 1#O$ 1@A$ #$0%stablece la función renal " comentario de la relación -rea J creatinina 1@1$ 1@!$ @$0%xiste relación causa efecto entre la afectación renal " la proriasisT 1@#$ 1@@$ $06ratamiento$ 1@$ 1@/$ 1@H$ 1@I$ 1(%) %l aclaramiento de los alimentos " sus metabólicos por la diálisis esta sujeto a los principios generales del transporte difusivo " convectivo$ 1@O$ 7epende de las caracter2sticas del fármacos como(mencione dos): 1(3)
1A$ 11$ 1!$ 1#$ 1@$ 1$ 1/$ 1H$
$$ $$ 6ambi*n depende de las caracter2sticas de la diálisis (mencione dos): $$ $$ &actores espec2cos del paciente(mencione dos): $$ $$ 1I$ 1(,) Las toxinas ur*micas disminu"en la anidad de ciertos medicamentos por la albumina$ Los fármacos ácidos como: 1O$ 1/A$ 1/1$ 1(.) on est2mulos para la liberación de 4enina todos, %>%.6=$ 1/!$ 1/#$ a$0 %stimulación G adren*rgica 1/@$ b$0 3oncentración alta de sodio tubular 1/$ c$0 7isminución del ujo sangu2neo 4enal 1//$ d$0 .*ptido 5trial atrur*tico 1/H$ e$0 Cipotensión 1/I$ 1(0) on funciones del riFón$ %>%.6=: 1/O$ 1HA$ a$0 2ntesis de %ritropo"etina 1H1$ b$0 Cidroxilacion de 7# 1H!$ c$0 2ntesis de prostaglandinas 1H#$ c$0 2ntesis de .*ptido 5trial atrur*tico 1H@$ c$0 2ntesis de Gicarbonato$ 1H$ 11() %l agua corporal 6otal de un reci*n nacido de @?g de peso es: 1H/$ 1HH$ a$0 !AAml b$0 !!AAml c$0 #AAAml 1HI$ d$0 !AAAml e$0 ninguno 1HO$ 111) i a V1@!m%+Jl, 'lucosa V !AAmgHdl ;reaV/AmgJdl, 1IA$ la =smolaridad s*rica será : 1I1$ 1I!$ a$0 !IIm9olJl b0 #Am9olJl c$0 #Am9olJl 1I#$ d$0 #AAm9olJl e$0 ninguno 1I@$ 112) La =smolaridad %xtracelular de una Ciponatremia ormovólemica es: 1I$ 1I/$ a$0 6ransporte activo b$0 transporte pasivo 1IH$ c$0 Cidratación celular d$0 Galance 8ónico transcelular 1II$ e$0 ninguno$ 1IO$ 113) on factores reguladores de metabolismo del .otasio, todos %>%.6=: 1OA$ 1O1$ a$0 .erdida digestiva de ? b$0 e+uilibrio 5cido0 base$ 1O!$ c$0 5ldosterona d$0 56. asa del ? e$0 insulina 1O#$ 114) %l tratamiento de elección de la CipoPalem2a es: 1O@$ a$0 'luconato de 3alcio b$0 8nsulina c$0 7extrosa 1AB 1O$ b$0 reto de potasio e$0 ?a"axalate 1O/$ 11#) .aciente con d*cit de !grJl de 5lb-mina, es de esperar una 3alcemia de : 1OH$ a$0 1!$ImgJdl a$0 11$!mgJdl a$0 H$!mgJdl 1OI$ a$0 1@$!mgJdl a$0 ninguno$ 1OO$ 11%) Los Gifosfonatos act-an: !AA$ a$0 7isminu"endo la excreción renal de 3alcio !A1$ b$0 8ncrementando la 5bsorción intestinal de 3alcio
!A!$ c$0 7isminu"endo la 4esorción ósea de calcio !A#$ d$0 8ncrementa la excreción renal de calcio !A@$ e$0 ninguno$ !A$ !A/$ 11,) on Gu]er$ %>%.6=$ !AH$ a$0 C3=#0C!3=@ b$0 C#0C@ c$0 =@0C!=@ !AI$ d$0 Cb e$0 .roteinato !AO$ 11.) 2 a V 1Am%+Jl, ?V$A m%+Jl, 3lV 11m%+Jl, C3=#V !Am%+Jl !1A$ el 5nion '5. será: !11$ !1!$ a$0 1 b$01A c$0 !A d$0 I e$0 ! !1#$ 110) Las causas mas comunes de 5lcalosis 9etabólica es: !1@$ a$0 Ciperventilación b$0 Cipoxia c$0 7eplecion de Xolumen !1$ e$0 obredosis de C3=# e$0 inguno !1/$ 12() .aciente con ventilación mecánica asistida, con diagnostico de 5cidosis 4espiratoria !1H$ descompensada, el tratamiento será: !1I$ a$0 5umentar el volumen tidal !1O$ b$0 8ncrementar la frecuencia respiratoria !!A$ c$0 7isminuir el volumen tidal !!1$ d$0 7isminuir la frecuencia respiratoria !!!$ e$0 ninguno$ !!#$ 121) 9ar+ue con (X) si es verdadero " con (&) si es falso: a$ ( ) La 6&'$.x W =x X corresponde a la glucosa$ !!@$ ( ) La vasopresina además de agente contráctil de las c*lulas mesangiales, tambi*n tiene efecto mitognico$ b$ %l coeciente de ultraltracin (?X&) del riFón normal es$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1$ La circulación renal, U .or+ue se considera como un verdadero sistema portaT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 122) 5cidez titulable se dene como: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ i$ La capacidad de 6amponar iones C[ depende de:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 123) %n la multiplicación contracorriente un paciente con disminución de ingesta de prote2nas, U %n +ue medida alterar2a la capacidad de concentración del riFónT (%xpli+ue brevemente) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !!$ " la osmolaridad m2nima +ue alcanza es de $$$$$$$$$$$$$$$$$$, " la máxima es de $$$$$$$$$$$$$$$$$$$$ 124) 5 +ue se llama polianion glomerular $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " el $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ está considerado como regulador hemodinámico o de la ltración glomerular$ 12#) %n la circulación 4enal .or +ue se considera como un verdadero sistema porta $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " a+ue se llama fracción de ltración $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 12%) %n el s2ndrome de hematuria proteinuria mencione: a$ ;na causa de este s2ndrome: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ Las cifras de proteinuria deben ser: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 12,) 5 +ue se llama sedimento 6elescopadoe indi+ue una patolog2a en la +ue se encuentre: !!/$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 12.) 5 +ue se llama 4iFon vicariante " cual es la diferencia con el 4iFon CipoplásicoT:
!!H$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 120) .ac$ Xaron de /A aFos, ingresa a emergencia en coma con diagnóstico de 845$ .5 1/AJ1AA mmCg, &3 1AI >, edemas " diuresis de #IA mlJ!@ Crs, pC H,!, C3=# V I me+JL, por consiguiente re+uiere tratamiento parenteral, ;d$ cuenta con dextrosa de diferentes concentraciones, hipersodio, Palium, bicarbonato$ 8ndi+ue el tratamiento considerando:a) las calor2as m2nimas,b).repare una, c) volumen, d) corrija el bicarbonato " nalmente e) comente el uso del nifedipino en este caso: !!I$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 13() .ac$ 3on criterios de '9.$ 5 la inmunouorescencia se encuentra positivo para 8g 5, 8g ', 8g 9, 3#, 3@$ .lantee una posibilidad diagnostica$ !!O$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !#A$ 131) Los 8%35$ %stan indicados en efropatia en fases tempranas por+ue: a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ b$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ 132) 7iagnostico diferencial entre 845$ pre 4enal " 4enal: !#1$ .re renal 65 a$ =smolaridad urinaria $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ b$ odio urinario $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ c$ 8ndice de falla renal $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ d$ &%a $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ !#!$ 133) .aciente con reacción transfusional por incompatibilidad 5G3, 5 nivel renal producirá: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " +ue actitud terape-tica tomaria ;d$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " en el caso de no respuesta $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 134) .ara hacer el diagnostico diferencial entre 845 vrs$ 843 4eagudizada, cuales serian las caracter2sticas de la bio+u2mica renal: !##$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !#@$ 13#) %l signo .atognomónico de la pre 3lampsia es la $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " mencione A# factores de riesgo 1) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ #) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 13%) %n hipocalemia en +ue consiste el signo de: a$ 3hevosteP$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ 6rousseau: $ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !#$ %l %?' caracter2stico es: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !#/$ 13,) ;sted está con paciente varon pre escolar de aFos, cu"a talla es OA cm$ .roteinuria IAAA mg, en orina de #AA mlJ!@ hrs$ 3alcule: a$ La diuresis en ml J m! J hr$: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ La proteinuria en mg$Jpor m! J hr$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ c$ La creatinina esperada: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ d$ La depuración de creatinina: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ e$ Los tamaFos renales para su edad J talla: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
!#H$ 13.) .ac$ con mieloma m-ltiple actualmente curso con s2ndrome nefrótico$ %l proteinograma clectofor*tico caracter2stico será: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !#I$ 130) %n el s2ndrome nefrótico el organismo es insuciente para evitar la hipoalbunemia$ %n diálisis peritoneal existe p*rdida de proteinas, sin embargo no ocurre a+uella situación: %xpli+ue por+ue$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 14() %xiste relacion 8%9.4% entre hipoalbunemia " edema : 8 ( ) = ( )$ !#O$ %n caso de armación o negación expli+ue por +ue: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !@A$ 141) %xiste Cipocalcemia en la 843, " s2ndrome nefrótico$ %xpli+ue la diferencia de producción en cada uno de ellos: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !@1$ !@!$ 142) La proteinuria es factor de progresión de 843$ %xpli+ue el mecanismo molecular : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 143) La relación ureaJcreatinina es: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " mencione A! causas de disociación: i$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ ii$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !@#$ 144) %n pac$ con 845$ +ue re+uieren apo"o dial2tico, cual es la diferencia entre hemoltración " hemodialltración: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " en caso de pac, en anasarca cual de los procedimientos indicar2a ;d$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " por +ue $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$ 14#) %n la protección renal$8ndi+ue por +ue mecanismos lo realiza: a$ Los diur*ticos a altas dosis: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ 9anitol: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$ c$ .entoxilina $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ !@@$ 14%) 7%&85: a$ Xida media de un medicamento$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $ b$ Giodisponibilidad$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ c$ 4eaccion adversa a medicamentos (459)$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !@$ 14,) %n la prescripción de fármacos en pac$ con insuciencia renal, es imprescindible conocer: a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ b$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ c$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ !@/$
.ac$ Xaron de #/ aFos con diagnostico de 843$ 9oderada avanzada(dep$ de creatinina #A mlJmin), peso /A ?g, re+uiere 5miPacina a dosis estrictas (&r$ A,O/)$ a$ 3alcule la dosis de carga: !@H$ !@I$ b$ 7osis de mantenimieto: !@O$ !A$ !1$ !!$ !#$ !@$ 140) % pac$ .ediátricos con soindrome nefrotico resistentes al tratamiento convencional, una de las alternativas es combinar corticoides " ciclofosfamida$ %n caso de este ultimo a veces presenta complicaciones severas (indi+ue A#)$ a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ c$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !$ 1#() .ac$ 9ujer de 11 aFos, proced$ 7e .to 9aldonado, con s2ndrome nefrotico " recibe corticoides desde hace 1A meses por recaidas frecuentes$ 5ctualmente cursa con proceso gripal, prioteinuria 11, mgJm!Jhr$ hematuria en forma esporádica, .5 OAJ/A mmCg$ .4%';65: a$ 7ena +ue es pac$ 4eacaedor frecuente: !/$ !H$ b$ .lantee el plan de trabajo: !I$ !O$ !/A$ c$ .osibilidades diagnosticas:(examenes +ue solicitaria " +ue esperaria encontrar: laboratorio histopatologia, etc)$ !/1$ !/!$ !/#$ !/@$ !/$ d$ 5ctitudes terape-ticas: !//$ !/H$ !/I$ e$ .ronostico: !/O$ !HA$ !H1$ 1#1) 9encione A# criterios den urgencia dial2tica: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ 1#2) .aciente mujer de H! aFos con diagnostico de sepsis a foco respiratorio " urinario, 7X3$ 6rombótico presenta pesistentemente a[ entre 11A011 m%+Jlt, a pesar de varias correcciones$ 9ucosas orales hidratadas, no edema signo del pliegue negativo$ L5G=456=48= 8&=495: creatinina 1A u9olJlt, -rea: !! molJlt, osmolalidad urinaria HA m=smolJlt$ a$ .lantea la posibilidad etiológica del trastorno iónico: b$ .rescriba la corrección del sodio (considere volumen, concentración, tiempo de corrección) !H!$ 1#3) .ac$ Xarón de #! aFos, con 6%3 grave producto de un accidente automovil2sticocursa con poliuria$ 5l momento de la evaluación está hidratado, [ 1/I m%+Jlt osmolalidad urinaria @AA m=smolJlt [ urinario $ #A mmolJlt$ .L56%%: a$ ;na posibilidad diagnostica: 14.)
!H#$ !H@$ b$ La corrección del [ (indicando volumen, tipo de solución, concentración " tiempo de correccion) c$ 3alcule el anion 'ap: 1#4) %n la multiplicación contracorriente un paciente con disminución de inigesta de prote2nas, U %n +ue medida alterar2a la capacidad de concentración del riFónT (%xpli+ue brevemente) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !H$ " %n la circulación 4enal .or +ue se considera como un verdadero sistema porta $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " a+ue se llama fracción de ltración $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !H/$ 1##) 5 +ue se llama sedimento 6elescopadoe indi+ue una patolog2a en la +ue se encuentre: !HH$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1#%) 5 +ue se lla 4iFon vicareante " cual es la diferencia con el 4iFon Cipoplastico: !HI$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$ 1#,) .ac$ 3pn criterios de '.$ 5 la inmunouorescencia se encuentra positivo para 8g 5, 8g ', 8g 9, 3#, 3@$ .lantee una posibilidad diagnostica$ !HO$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1#.) %n endocarditis bacteriana$ 9encione A! tipos de glomerilonefritis con el +ue se relacionan: i$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ ii$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ !IA$ 1#0) Los 8%35$ %stan indicados en efropatia en fases tempranas por+ue: a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1%() 7iagnostico diferencial entre 845, pre 4enal " 4enal: !I1$ .re renal 65 a$ =smolaridad urinaria $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ b$ odio urinario $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ c$ 8ndice de falla renal $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ d$ &%5 $$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ !I!$ 1%1) .ara hacer el diagnostico diferencial entre 845 vrs$ 843 4eagudizada, cuales serian las caracter2sticas de la bio+u2mica renal: !I#$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !I@$ 1%2) %l .atognomónico de la pre 3lampsia es la $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " mencione A# factores de riesgo 1) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !) $$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ #) $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1%3) %n hipocalemia en +ue consiste el signo de: a$ 3huosteP$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$
b$ 6rousseau: $ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !I$ %l %?' caracter2stico es: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !I/$ !IH$ 1%4) %xpli+ue el mecanismo de proteinuria dependiente de la activacion de neutrólos " macrófagos: $$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1%#) %n el s2ndrome nefrotico el organismo es insuciente para evitar la hipoalbunemia$ %n diálisis peritoneal existe perdida de proteinas sin embargo no ocurre a+uella situación: %xpli+ue por+ue$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1%%) %xiste relacion siempre entre hipoalbunemia " edema : 8 ( ) = ( )$ !II$ %n caso de armación o negación expli+ue por +ue: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !IO$ 1%,) %l colesterol total " lipoprote2nas L7L se incrementa cuando está $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$ " las fracciones +ue se incrementan cuando la albumina está entre 1, 1,A g J dl$ %s: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !OA$ 1%.) %xpli+ue en forma es+uemática el mecanismo molecular de la G65$ %n la 843$ !O1$ !O!$ !O#$ !O@$ 1%0) La proteinuria es factor de progresión de 843$ %xpli+ue el mecanismo molecular : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 1,() La relación urea creatinina es: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " mencione A! causas de disociación: i$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ ii$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !O$ 1,1) %n pac$ 3on 845 +ue re+uieren apo"o dial2tico, cual es la diferencia entre hemoltración " hemodialltración: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " en caso de pac, en anasarca cual de los procedimientos indicar2a ;d$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " por +ue $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$ 1,2) %n la protección renal indi+ue por +ue mecanismos lo realza: a$ Los diur*ticos a altas dosis: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ 9anitol: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$ c$ .entoxilina $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$ !O/$ 1,3) 7%&85: a$ Xida media de un medicamento$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $ b$ Giodisponibilidad$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$
c$ 4eaccion adversa a medicamentos (459)$0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !OH$ d$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ !OI$ 1,4) .ac$ Xaron de #/ aFos con diagnostico de 843$ 9oderada avanzada(dep$ de creatinina #A mlJmin), peso /A ?g, re+uiere 5miPacina a dosis estrictas (&r$ A,O/)$ a$ 3alcule la dosis de carga: !OO$ #AA$ b$ 7osis de mantenimieto: #A1$ #A!$ #A#$ #A@$ #A$ #A/$ 1,#) % pac$ .ediátricos con soindrome nefrotico resistentes al tratamiento convencional, una de las alternativas es combinar corticoides " ciclofosfamida$ %n caso de este ultimo a veces presenta complicaciones severas (indi+ue A#)$ a$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ b$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ c$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ #AH$ 1,%) .aciente mujer de @ aFos procedente de .uerto 9aldonado, con diagnóstico de s2ndrome nefrótico " recibe corticoides desde hace 1A meses por reca2da frecuentes$5ctualmente cursa con proceso gripal, proteinuria #AmgJm!Hhr$,hematuria en forma esporádica$.5$ 1!AJOAmmCg$.lantee: a) Las posibilidades diagnósticas: #AI$ #AO$ b) %xámenes auxiliares ( +ue esperar2an aumentarT) #1A$ #11$ c) 5ctitud terap*utica: #1!$ #1#$ d) .ronóstico: 1,,) %n vasculitis " 4iFón a) %n glomerulonefritis de kegener para el tratamiento de las formas graves " fundamentalmente a+uellas +ue cursan con insuciencia renal grave, el tratamiento elegido es$ (a) (b) #1@$ b) %n el caso anterior la ciclofosfamida se considera como pauta estandar, sin embargo tiene efectos indeseables como: (a) (b) (c) #1$ #1/$ #1H$ 1,.) 9encione A# criterios den urgencia dial2tica: $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$
%n cuanto a la hematuria, mar+ue con (X) si es verdadero " (&) si es falso: #1I$ ( ) 5l examen microscópico se observa como `disco redondo` de color amarillo rojizo$ #1O$ ( ) %n las orinas hipotónicas se `hinchan`$ #!A$ ( ) Los acantocitos tiene formas espiculadas mu" delgadas #!1$ ( ) %n cálculos vesicales se pueden encontrar crenocitos$ 1.() e consideran factores de progresión de los nefropatias crónicas, excepto: #!!$ a) Cipertensión arterial$ #!#$ b) 7islipidemia$ #!@$ c) .roteinuria$ #!$ d) Cematuria #!/$ e) efritis t-bulo intersticiales 1.1) La enfermedad de Gerger, se caracteriza por depósitos de: #!H$ a) 8g5 #!I$ b) 8g' #!O$ c) 8g9 ##A$ d) 5 " b son correctos ##1$ e) inguna es correcta ##!$ 1.2) %l L%$ (lupus eritematoso sistemático) a nivel renal, produce: ###$ a) %nfermedad glomerular con cambios m2nimos$ ##@$ b) 'lomerulonefritis mesangial$ ##$ c) 'lomeruloesclerosis focal " segmentaria$ ##/$ d) 'lomerulonefritis membranoproliferativa$ ##H$ e) 6odas las anteriores 1.3) 7iferencia entre %;4%8 e 83=68%385 ;485485 1.4) %n relación a biopsia renal$ 9ar+ue con (X) si es verdadero " (&) si es falso: ##I$ ( ) %s un examen no invasivo en nefrolog2a ##O$ ( ) La hidronefrosis es contraindicación relativa$ #@A$ ( ) La pielonefritis es una contraindicación absoluta$ #@1$ ( ) La reacción `Xagal` es una complicación frecuente 1.#) 3uál de la armaciones siguientes es cierta respecto al s2ndrome nefrótico del adultoT a) o es una complicación habitual de la poli+uistosis juvenil$ b) Las complicaciones trombóticas son frecuentes$ c) %s la expresión cl2nica habitual de la poli+uistosis juvenil$ d) 3ursa generalmente con l2pidos plasmáticos bajos$ e) 9ás del OAB de los enfermos responden denitivamente al tratamiento con esteroides$ 1.%) %n la 'lomerulonefritis post ela fasetococia, indi+ue el tiempo de duración de los signos más importantes: #@!$ a)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Cipertensión arterial #@#$ b)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Cematuria #@@$ c)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ .roteinuria #@$ d)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Cipocomplementemia 1.,) %n relación con el t*rmino de 'lomerulonefritis rápidamente progresiva, seFale la respuesta X%4757%45: a) %s un s2ndrome caracterizado por una p*rdida progresiva " rápida de la función renal asociada a una glomerulonefritis mesangial " daFo tubulo intersticial$ b) %s un s2ndrome +ue cursa con p*rdida progresiva " rápida de la función renal cu"a principal caracter2stica es la presencia de semilunas en la biopsia renal$ c) %s un s2ndrome +ue afecta a las arterias renales con presencia de microtrombos$ d) %s un s2ndrome cu"a principal caracter2stica es la afectación glomerular con depósitos masivos de inmunocomplejos en arterias " glom*rulos$ e) %s un s2ndrome asociado a la presencia de anticuerpos antimembrana basal glomerular$ #@/$ 1..) 6odas las nefropat2as primarias enumeradas a continuación se maniestan t2picamente como s2ndrome nefrótico, %>3%.6= una$ eFálela: #@H$ a) 'lomerulonefritis de m2nimos cambios$ #@I$ b) 'lomerulonefritis segmentaria " local$ #@O$ c) 'lomerulonefritis poliferativa focal$ #A$ d) 'lomerulonefritis membranosa$ #1$ e) 'lomerulonefritis membrano proliferativa$ 1.0) 9encione las caracter2sticas a las inmunoorescencias de: (completar) a$ %n la nefropat2a de cambios m2nimos$ b$ 'lomeruloesclerosis segmentaria " focal$$$ c$ 'lomerulonefritis membranosa d$ 'lomerulonefritis membrano proliferativa$$ 1,0)
e$ 'lomerulonefritis mesangial por 8g5$$ #!$ 10() La artritis reumatoidea está relacionado con nefropat2as, existen # formas de producir glomerulonefritis (menciónelos): $$ • $$ • $$ • 101) 7entro de las causas secundarias de s2ndrome nefrótico, mencione dos en cada uno de ellas ##$ 3ambios m2nimos: $ #@$ '%&: $$ #$ 'lomerulonefritis membranosa: $$ #/$ 'lomerulonefritis membranoproliferativa: $ 102) 7iagnostico diferencial entre 845 pre renal " renal$ #H$ .4% 4%5L 4%5L #I$ a$ =smolaridad urinaria: #O$ b$ odio urinario: #/A$ c$ ndice de falla renal: #/1$ d$ &%a: 103) 4elacione la columna de la derecha con la iz+uierda:
#/!$ #/#$ #/@$ #/$ #//$ #/H$ #/I$ #/O$ #HA$ #H1$ #H!$ #H#$
1) 5ngeitis de 3huro strauss$ !) 'lomerulonefritis a cambios m2nimos$ #) 'ranulomatosis de Regener$ @) ilomeruloesclerosis focal " segmentaria$ ) 3lomerulonefritis rápidamente progresiva$ /) .-rpura de hoenlein0Cenoch$ H) lomerulonefritis membranosa$ I) .oliarteritis nodosa$ O) Lupus %ritematoso ist*mico$ 1A) 2ndrome de 'oodpasture$ 11) lomerulonefritis membranoproliferativa$ 1!) 'lomerulonefritis mesangial #H@$ ( ) Los niveles de 85 circulantes están elevados en el AB #H$ ( ) %n el sedimento ha" glucosuria$ #H/$ ( ) Ca" hipocomplementemia en el HB #HH$ ( ) Cemorragia pulmonar$ #HI$ ( ) !AB cursa con hematuria$ #HO$ ( ) %levación de 8g% " más de 1AAA eosinólosJL #IA$ ( ) La proteinuria es altamente espec2ca$ #I1$ ( ) La afectación anatomopatoiógica es mu" variada$ #I!$ ( ) Los 30535 son mu" espec2cos " sensibles$ #I#$ ( ) e asocia al X8C$ #I@$ #I$ 104) %n un paciente con 8nsuciencia 3ardiaca 3ongestiva se aprecian los siguientes datos de laboratorio: a 1@I mmolJL, ? !$H mmolJL, 3l OO mmolJL, 3A! 6otal @! molJL, La causa más probable de la disminución del .otasio es: a$ 5lcalosis 9etabólica$ b$ 6ratamiento con diur*ticos$ c$ %xcesiva producción de 4enina$$ d$ obrecarga de L2+uido$ e$ 6odas las anteriores$ 10#) 4especto a las armaciones siguientes mar+ue con (X) si es verdadero " (&) si es falso: #I/$ ( ) %n hipernatremia el tratamiento es con solución hipotónica o diur*ticos$ #IH$ ( ) %n hiperPalemia el gluconato de calcio disminu"e el ? s*rico$ #II$ ( ) %n hipocalemia el segmento 6 del %?' del %?' está prolongado$ #IO$ ( ) %n 8nsuciencia renal generalmente el 9agnesio está elevado$ 10%) on s2ntomas de hiponatremia: #OA$ a) Letarg2a$ #O1$ b) %dema$ #O!$ c) Ciperreexia$ #O#$ d) 5 " G son correctas$ #O@$ e) inguna de los anteriores$ #O$ 10,) on manifestaciones gastrointestinales en el s2ndrome ur*mico son todas las siguientes excepto: #O/$ a) 7iarrea o estreFimiento$ #OH$ b) auseas " vómitos$ #OI$ c) 5liento ;r*mico$ #OO$ d) Cepatitis$ @AA$ e) 5norexia$ @A1$
.aciente de @# aFos con fracaso renal agudo +ue acaba, de comenzar tratamiento de hemodiálisis$ 7urante la misma, se +ueja de fuerte dolor de cabeza +ue empeora a medida +ue la diálisis progresa$ %l paciente comienza a estar confuso, in+uieto " con nauseas$ 9ientras se le toma la presión arterial presenta una convulsión +ue dura aproximadamente #A segundos$ @A!$ La causa más probable del problema podr2a ser: @A#$ a) Cipovolemia$ @A@$ b) %dema cerebral$ @A$ c) 3risis Cipertensiva$ @A/$ d) Cipopotasemia$ @AH$ e) inguna de las anteriores$ 100) %n nefrolitiasis el constitu"ente +u2mico de fosfato ácido de calcio hidratado, es llamado tambi*n como " el fosfato amónico magn*sico hexahidratado, como $ $ @AI$ 2(() %n relación a 6uberculosis renal, mar+ue con (X) si es verdadero " (&) si es falso: @AO$ ( ) %l bacilo de ?och alcanza al riFón por v2a linfática$ @1A$ ( ) %l tuberculoma es mu" rara en el riFón$ @11$ ( ) La 'lomerulonefritis membranosa es complicación a tuberculosis$ @1!$ ( ) La respuesta inmune en 6G3 es mediada por inmunidad celular$ 2(1) %n tumores renales, mar+ue con (X) si es verdadero " (&) si es falso: @1#$ @1@$ ( ) 68 8 9A corresponde al estadio @1$ ( ) La etapicación seg-n 4obson corresponde a la clasicación 69$ @1/$ ( ) 6umor ma"or de H cm en monorreno se plantea nefrectomia parcial$ @1H$ ( ) obre vida a aFos en estadio 888 es de @A 0 /AB$ 2(2) %n 8nsuciencia 3ardiaca, existe alternativas del 8onograma plasmático$ 9ar+ue con (X) si es verdadero " (&) si es falso: @1I$ ( ) La natremia está habitualmente disminuida, alrededor de 1#A m%+JLi2$ @1O$ ( ) La cloremia no sufre variaciones paralelas a las de 1a natremia$ @!A$ ( ) La potasemia reeja el estado de contenido potásico total$ @!1$ ( ) %xiste habitualmente una oliguria con densidad " osmolalidad altas$ 2(3) %n el 2ndrome Cepatorenal (C4), mar+ue con (X) si es verdadero " (&) si es falso: @!!$ ( ) %xiste vasodilatación renal severa " disminución del 8&'$ @!#$ ( ) La s2ntesis renal de .' está aumentado en paciente cirrótico con ascitis$ @!@$ ( ) %l riFón del paciente con C4 es trasplantable$ @!$ ( ) Cabitualmente ha" hipematremia con hipoPalemia$ @!/$ 2(4) on cambios siológicos matemos durante el embarazo en el riFón, excepto: @!H$ a) La ltración glomerular aumenta desde las 0H semanas$ @!I$ b) %l 455 aumenta su actividad entre$ " 1A veces$ @!O$ c) %l nivel de ácido -rico desciende desde las 1! semanas, @#A$ d) La excreción de glucosa está elevada$ 10.)
@#1$
%n relación a la pre eclampsia mar+ue la respuesta incorrecta: @#!$ a) e presenta generalmente en prim2paras despu*s de la semana !A$ @##$ b) La lesión histológica caracter2sticas es la `endoteliosis glomerular` @#@$ c) %l s2ndrome de C%LL. es complicación de la .*c8ampsia$ @#$ d) La g*nesis reside probablemente en una implantación anómala del @#/$ trofoblasto$ @#H$ e) La hiperuricemia es el signo más sensible " precoz de la enfermedad$ @#I$ 2(%) %n relación a a glomerulonefritis de Regener ('R), mar+ue con (X) si es verdadero " (&) si es falso: @#O$ ( ) %l pulmón se afecta en un 1AAB de los casos$ @@A$ ( ) La proteinuria patológica es el signo +ue más destaca$ @@1$ ( ) on frecuentes la afectación cutánea en forma de p-rpura$ @@!$ ( ) La metilprednisolona en forma de `pulsos` es el tratamiento de elección$ @@#$ 2(,) La pericarditis " el taponamiento cardiaco es una complicación de la uremia era$ on criterios de taponamiento cardiaco, excepto$ @@@$ a) igno de ?ussmaul$ @@$ b) Cipotensión arterial$ @@/$ c) 6a+uicardia$ @@H$ d) .ulso paradójico$ @@I$ e) 4x de pulmones normal$ @@O$ 2(.) %l riFón de mieloma, mar+ue con (X) si es verdadero " (&) si es falso: a$ %s una gammopatia clonal$ ( ) b$ %l mieloma m-ltiple se llama tambi*n enf de Pahler ( ) c$ e desarrolla en varones " de edad avanzada ( ) d$ La función renal se altera en el 1AAB ( ) e$ La afectación renal en AB es desencadenado por la hipercalcemia ( ) @A$ 2(0) %n el 8X conversatorio se conclu"e como poliangeitis microscópica debido a excepto: a$ 535 mielorofenxidasa ([) b$ Cemoptisis c$ 'lomenlorulonefritis rápidamente progresiva$ d$ 535 .4# ([) e$ .roteinuria rango nefrotico$ @1$ 21() %n el _ convertorio, paciente con L% se conclu"e en nefropat2a lupica 8X @!$ 3u"a histolog2a se caracteriza por: a$ ' 9esangeal$ b$ ' focal " segmentaria$ c$ ' membranoproliferativa$ d$ ' membranosa$ e$ ' rápidamente progresiva$ 211) %n osteodistroa renal: @#$ 5 +ue se llama osteod$ 4enal de alta remodelaciónT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @@$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 2(#)
@$ G) 7e baja emodelaciónT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @H$ La forma histológica más frecuente es:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @I$ 212) %n transplante renal: @O$ 5 +ue se llama is+uemia caliente " frióT $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/A$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/1$ %n +ue consiste la prueba de 34= 9563C$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/!$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/#$ La complicación infecciosa mas frecuente en el .ost operatorio es: :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 213) Los tumores renales malignos más frecuentes se originan a partir de:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @/@$ " el estadio ! se caracteriza por:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$ @/$ " el tratamiento indicado seria por:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @//$ @/H$ 3onversatorios cl2nico0 .atológicos: 214) 3onversatorio A1: @/I$ La .aciente con 2ndrome hepatorenal (C4): 1) La hiponatremia es explicado por:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ " el e+uivalente en mgJdl del i 3a de A$11H m9olJl es: (desarrolle)$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$ @/O$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @HA$ !) %l riFón de la paciente para nes de trasplante puede utilizarseT 8 ( ) =( ) @H1$ por+ueT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @H!$ :$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$ 21#) 3onversatorio A!: @H#$ %l motivo de ingreso de la paciente fue impotencia funcional en miembros inferiores$ %l aFo !AA1 diagnosticaron tromboebitis$ .regunta: U %n +u* consiste el 74=9% 568&=&=L.87=T @H@$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$ @H$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @H/$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 21%) 3onversatorio A#
@HH$ .ac$ Xarón con diagnóstico de 'lomerulonefritis membranoproliferativa ('9) con 843$ severa$ La indicación de .ulsoterapia indicada seriaT:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @HI$ .or+ueT$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 21,) 3onversatorio A@ @HO$ La 833$ .roduce glomerulonefritis crónica: 8 ( ) = ( ) @IA$ i es armativo expli+ue:$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @I1$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @I!$ 21.) 3onversatorio A @I#$ Loxocelismo e 845: 1) 9ecanismo de Lesión 4enal ( mencione A!): @I@$ 0 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @I$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ !) %n caso de = 4emisión de la 845$ U 3ual ser2a el mecanismo de lesión renal crónicaT @I/$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ @IH$ 210) .aciente mujer de 1! aFos acude a emergencia con vómitos persistentes " con signos de deshidratación$ potasio s*rico de 1$Om%+JL$: a) .lantee el diagnóstico del e+uilibrio ácido0base: b) %l reto del potasio debe realizarse con cifras de: c) %n el caso problema presacriba el tratamiento,indicando el medicamento,concentración,vol-men,tiempo " conducta posterior a seguir$ @II$ @IO$ @OA$ 22() e llama peso seco "Jo peso ideal en hemodialisis cuando:$$ $%n el proceso de hemodiálisis el Zb$ signica $ " la supercie del ltro se calcula de acuerdo a: 221) %n el diagnostico nefrotico el organismo es insuciente para evitar la hipoalbuminemia$%n diálisis peritoneal existe p*rdida de prote2nas en forma abundante,sin embargo no ocurre a+uella situación$%xpli+ue por+ueT @O1$ 222) %xiste hipocalcemia en la 843$ " s2ndrome nefrótico$ %xpli+ue la diferencia de producción en cada uno de ellas: 223) .aciente varón de @A aFos con diagnostico de 5$4$ e ingesta crónica de 58%s$ %s portador de 843$ presenta palidez moderada, disminución de apetito$Laboratorio informa:7ensidad urinaria 1AA, creatinina s*rica #mgJdl, 7ep$$ de creatinina: 1 mlJ min$ a) 3omente la densidad urinaria: @O!$ b) 7ena el estad2o de la función renal: @O#$ c) %n este caso la 5$4$ podr2a ser causa de la 843T (comentario) @O@$ @O$ @O/$ @OH$
@OI$ .4%';65 7% 3=9.L%9%6538=: (X5L=4 A# .;6=) @OO$ 224) %numere A# factores de e+uilibrio de tarling$ AA$ A1$ 00000000000000000000000000000000000 000000000 00000000000000000000000 A!$ A#$ 00000000000000000000000000000000000 A@$ A$ 22#) %numere A# causas de Ciponatr*mia ormovol*mica$$ A/$ AH$ 00000000000000000000000000000000000 000000000 00000000000000000000000 AI$ AO$ 00000000000000000000000000000000000 1A$ 11$ 22%) %numere A# signos electrocardiográcos de la CiperPal*mia 1!$ 1#$ 00000000000000000000000000000000000 000000000 00000000000000000000000 1@$ 1$ 00000000000000000000000000000000 1/$ 1H$ 22,) %numere A# factores reguladores del metabolismo del 3alcio$ 1I$ 1O$ !A$ !1$ 00000000000000000000000000000000000 000000000 00000000000000000000000 !!$ !#$ 00000000000000000000000000000000000 !@$ 22.) %numere A# causas de 5cidosis 9etabólica 5nion '5. alto$$ !$ !/$ !H$ !I$ 00000000000000000000000000000000000 000000000 00000000000000000000000 !O$ #A$ 00000000000000000000000000000000000 #1$ #!$ ##$ .4%';65 7% 7%544=LL= (X5L=4 A.;6=)$ #@$ 220) .aciente con d*cit de potasio de 1$ m%+Jl, indi+ue el tratamiento correcto #$ (.reparado, 7osis, Xelocidad " tiempo de infusión) #/$ #H$ #I$ #O$ @A$ @1$ @!$
3ual es el exceso de 5gua para corregir una atr*mia de 11 a 1#A m%+Jl, en un paciente de HA?g de peso$ @#$ @@$ @$ @/$ @H$ 6%43%4 %>\9% 7% %&4=L='5 !A101 231) on causas de 'lomerulonefritis membranosa$ 9ar+ue con X o & 23()
232)
@I$ ( ) %nfermedad de 3elulas falciformes @O$ ( ) %nfermedad de 3rohn A$ ( ) 9ielodisplasia 1$ ( ) %nfermedad poli+uistica del adulto %n infecciones primarias$ 7ena lo siguiente:
a) 4eca2da: b) 4einfección: La formación de cálculos s pueden presentar por diferente mecanismos (mencionelos) " además ponga un ejemplo de cada uno de ellos$
233)
La hipercalciuria es uno de los mecanismos importantes de formación de litiasis renal$ 9encione los # mecanismos$
234) 23#)
%n relación al tumor de Rilms (nefroblastoma) 9ar+ue con X " &
!$ ( ) eoplasia de alto grado de malignidad #$ ( ) e origina en el mesangio del glom*rulo @$ ( ) on tumores raros en niFos de !0@ aFos $ ( ) on tumores bilaterales en el OB de los casos$ 23%) %n el sedimento urinario el cuerpo graso oval, estructuralmente está compuesto de: .aciente varón de @ aFos con s2ndrome nefrótico, recibe prednisona @A mgJm!Jdia$ %s rehospitalizado por edema generalizado " ampliando estudios se tiene proteinuria !@hrs: IAAmg, examen de orina leuc:1A01@x3, densidad 1A1 glucosa [[, proteinogram electrofor*tico en orina HIB de selectividad$
23,)
/$ .reguntas: a) .lantee las posibilidades diagnosticas (!) : b) .lan de trabajo dirigido: c) 6ratamiento: .aciente mujer de @O aFos con hepatopat2a crónica, presenta tos mas expectoración a veces hemoptoica de mas o menos un mes de evolución$ 8ngresa a hospitalización reriendo # semanas de enfermedad, postración en cama$ 5 la evaluación presenta palidez marcada, anasarca, diuresis !@hrs: #AA cc, C6=: 1B, X': @ mmJhr " tiene criterios para apo"o dial2tico$
23.)
H$ .reguntas: d) .lantee las posibilidades diagnosticas (!) : e) 3omentario de la cifra del Cto en este caso: f) La cifra de X' no es real por consiguiete corrija para el nivel de hematocrito +ue presenta el paciente
