Auscandoc
Hey #nephrology mastodon (#nephrodon ?). My niece has just started medical school and she’s asking me, her “I-did-my-physiology-thirty-years-ago” Family Physician uncle, osmolality questions. Bless her. @ChristosArgyrop I think all options are wrong but what she has selected is least wrong(?) as I’d expect low osmolality.
Sep 14, 2024 at 9:21pmWeb
Show threadChristos Argyropoulos MD PhDSep 15, 2024
@auscandoc High Urine Osmolality means that the kidneys are responding to the ADH and that the levels of the ADH is high. So her answer is correct
Show threadAuscandocSep 15, 2024

@ChristosArgyrop Which reinforces that these young uns are smarter than me. 👍

Thanks.

Show threadChristos Argyropoulos MD PhDSep 15, 2024
@auscandoc it is actually a tricky question
Show threadAuscandocSep 15, 2024
@ChristosArgyrop Now you’re just being kind 🙃
Show threadChristos Argyropoulos MD PhDSep 15, 2024
@auscandoc there are 2 groups of answers here and a singleton. The first group of answers effectively says reduced aldosterone action, the second one says reduced ADH effect and the singleton increased ADH
Show threadChristos Argyropoulos MD PhDSep 15, 2024
@auscandoc if the first group was correct ie a form of hypoaldosteronism , then the K would be high , not low. If ADH was not working or not being secreted, the urine osmolality would be low.
The grouping of questions means there are only 3 answers. But one cannot select an answer in any of the 2 groups as correct and label the other one as incorrect. So both answers in both groups are incorrect, leaving the singleton as the only correct answer. The question maker is either a fool or a genius.
Show threadAuscandocSep 15, 2024
@ChristosArgyrop I think that’s the art of the open book exam question.
Show threadAuscandocSep 15, 2024
@ChristosArgyrop Thanks for replying…. For my own further education, the bit that is puzzling me is the normal serum osmolality. I interpret as as SIADH (but maybe it’s not?). I always (perhaps incorrectly?) assumed the low K (and Na) was due to the water overload. This why I expect the osmolality to be low in this scenario.