Brush and Sisco are competitors in the home and small business strongbox market. Each company produces safes designed to protect the contents from fire. Since about 1930, Brush has manufactured

835

*835and sold fire-resistant security storage boxes. Brush claims to have used the mark "Fire-Safe" for more than 30 years, although its trademark application indicates only that the mark was used at least as early as 1984. Brush is the owner of two federally registered trademarks:

1. U.S. Trademark Registration No. 1,395,406, granted in 1986, for "all purpose non-metallic lockable containers for storing valuables;" and

2. U.S. Trademark Registration No. 1,572,870, granted in 1989, for "fire resistant containers in the nature of safes, security chests, and filing cabinets.

Question 1

Why does oliguria occur in the early stages of acute tubular

necrosis (ATN)?

Question 2

Is renal impairment induced by lithium therapy in bipolar affective

disorders irreversible? How often does it occur?1128

Question 3

Can you please explain why a patient with chronic renal failure (CRF)

might present with either oliguria or polyuria?

Question 4

What are uraemic frost conditions?

Question 5

What is the role of terlipressin or novapressin in the management of

hepatorenal syndrome?

Question 6

Why is there a difference in the clinical presentation of oedema due to

renal failure and oedema due to cardiac failure, and how is this related

to the loose nature of the interstitial tissue in the periorbital area? The

answer given was that it is because, in cardiac failure, there is orthopnoea

and the most dependent portion in this case is the legs, which is why the

oedema occurs there. You also mentioned that in renal failure there is no

orthopnoea and the patient doesn't have to sit up, hence the difference.

This does not seem to take into account right ventricular heart failure

(RVF), where there is no question of orthopnoea. Pedal oedema is found in

right ventricular failure. Is the answer not that, in congestive heart failure

(CHF) there is pump failure (and the heart cannot pump blood against

gravity) hence oedema in the dependent areas, whereas in renal failure

there is no pump failure and the heart does not lose its capacity to pump

blood against gravity. The oedema in this case develops in those tissues

that have a loose interstitium, one such site being the periorbital area of the

face. This is the reason for the difference in clinical presentation.123

Question 7

What treatment is recommended for recurrent attacks of generalized

swelling, with angio-oedema, in a middle-aged female patient?

Question 8

Is an osmotic diuresis, due to hyperglycaemia for instance, a cause of

both hyponatraemia and hypernatraemia. Please explain how this can be

the case.

Question 9

What is the mechanism of 2-agonists (albuterol) in correcting

hyperkalaemia in emergency? How does it cause a shift of potassium?

Question 10

Why do we give sodium lactate along with sodium bicarbonate in

acidotic patients? How does sodium lactate then act?