Question 1

what are the 3 layers of the glomerular membrane? give 2 main components of it?

Accepted Answer

lamina rara interna and externa and lamina densa and type IV collagen and heparan sulfate proteoglycan

Question 2

In adults can degenerated podocytes be replaced?

Accepted Answer

no

Question 3

what protein is produced in the thick ascending limb? what does it do?

Accepted Answer

Tamm-Horsfall glycoprotein or uromodulin - thought to inhibit calcium crystallisation - most abundant protein excreted.

Question 4

where is EPO produced?

Accepted Answer

interstitial cells in peritubular capillary bed of renal cortex

Question 5

what are filtration slits bridged by?

Accepted Answer

slit diaphragms

Question 6

what is ultrafiltration?

Accepted Answer

filtration through a filter capable of removing very minute particles

Question 7

What is normal GFR?

Accepted Answer

120ml/min per 1.73m^2

Question 8

What is used to measure renal plasma flow? limitations ?

Accepted Answer

P-aminohippurate - is filtered and actively secreted toxins can interfere with secretion

Question 9

Describe what tubuloglomerular feedback is?

Accepted Answer

increase NaCl to macula densa increase NaCl uptake by cells, increase ATP into extracellular space. ATP direct vasoconstrictor effect acts on P2X receptors on afferent arteriole when Na to low at macula - NO and proglandins I2/E2 increased - dilate afferent arteriole

Question 10

name the transporters present on alpha and beta intercalated cells?

Accepted Answer

alpha - H+/K+ antiporter - apical, H+ATPase on apical, HC03-CL- antiporter on basolateral, Cl- leakage on basolateral beta - Hco3-cl- antiporter on apical, H+Atpase on basolateral and cl- leakage on basolateral

Question 11

Name transporters on principal cells ?

Accepted Answer

ENaC - apical and K+ leakage - apical, N/KATPase basolateral and K leakage baso

Question 12

what makes up the PCT? where are weak organic acids or bases secreted?

Accepted Answer

PCT, straight tubule (pars recta) - in final part secretion of weak organic bases and acids

Question 13

what does loop of henle consist of anatomically?

Accepted Answer

pars recta of proximal tubule, thin descending and ascending and thick ascending and macula densa

Question 14

what key ion is absorbed in thick ascending limb?

Accepted Answer

Mg

Question 15

where are intercalated cells found?

Accepted Answer

late distal tubule and cortical collecting ducts (numbers decrease as descend)

Question 16

what are the 2 layers of the renal medulla?

Accepted Answer

outer - outer and inner stripe Inner

Question 17

what is defect in NKCC2 called? whats it characterised by?

Accepted Answer

Bartter syndrome type 1 - hypokalemia, alkalosis and normal to low BP

Question 18

What is defect in NaCL cotransporter in DCT called? characterised by?

Accepted Answer

Gitelman's syndrome - hypokalemic metabolic alkalosis, hypomagnesemia

Question 19

overexpression of ENac in prinicpal cells?

Accepted Answer

Liddle's syndrome

Question 20

What is glomerulotubular balance?

Accepted Answer

extent of Na reabsorption in a given nephron segment is roughly proportional to Na delivery to that segment

Question 21

Apart from nephrons what else modulates fluid reabsorption?

Accepted Answer

peritubular capillaries

Question 22

does TAL have Na/H antiporter on apical surface?

Accepted Answer

Yes

Question 23

what is the thin descending limb relatively impermeable to?

Accepted Answer

NaCl reabsorption

Question 24

What parts of nephron are relatively permeable to urea? and whats not? What is the net result of the urea recycling process?

Accepted Answer

Thin loops relatively permeable (ascending us greater than descending) But TAL and beyond are impermeable up to final section of inner medullary collecting duct. Add urea to inner medullary interstitum increasing osmolarity

Question 25

how can you increase medullary oxygenation?

Accepted Answer

give furosemide - inhibits 02 consumption in TAL increasing medullary oxygenation

Question 26

what enzyme in macula densa is critical for renin secretion and results in hyporeninemia when it is inhibited? where is macula densa found?

Accepted Answer

COX-2 and between TAL and DCT

Question 27

what enhances ADH secretion? name 2 ADH antagonists?

Accepted Answer

nicotine and conivaptan and tolvaptan

Question 28

what do AG2 and ADH increase the synthesis of in order to provide compensatory vasodilation?

Accepted Answer

prostaglandins

Question 29

Give 2 examples of loop diuretics?

Accepted Answer

furosemide and bumetanide Inhibits NaKCCsymporter

Question 30

how do most diuretics reach sites of action?

Accepted Answer

by being secreted into the proximal tubule

Question 31

name 2 side effects of loop diuretics?

Accepted Answer

ototoxic, hypokalemia (increase toxicity of digoxin)

Question 32

Name 2 thiazide diuretics? What do they bind to?

Accepted Answer

bendroflumethiazide, hydrochlorothiazide. bind to Na/Cl cotransporters - cause NaCl loss

Question 33

what substances excretion is compromised by diuretic use?

Accepted Answer

uric acid

Question 34

Give 2 SE of thiazide diuretics?

Accepted Answer

erectile dysfunction and impaired glucose tolerance (inhibits insulin secretion)

Question 35

Name 2 aldosterone antagonists?

Accepted Answer

spironolactone and eplerenone

Question 36

name 2 se of aldosterone antagonists?

Accepted Answer

gynaecomastia and hyperkalemia

Question 37

Name a K sparing diuretic?

Accepted Answer

amiloride - inhibits Na reabsorption and decreases K excretion. blocks ENaC

Question 38

name a carbonic anhydrase inhibitor? what is it used for?

Accepted Answer

acetazolamide and increases excretion of HCo3- to treat glaucoma.

Question 39

name an osmotic diuretics? when is it used?

Accepted Answer

mannitol and acute renal failure

Question 40

how do you improve dysuria?

Accepted Answer

have citrate increases urine Ph by generating HCO3-

Question 41

what prevents crystallisation in urine?

Accepted Answer

alkanisation

Question 42

what is used to tx salicyclate overdose?

Accepted Answer

NaHCO3 - alkanisation increases secretion of weak acids

Question 43

2 drugs that increase urate secretion?

Accepted Answer

probenecid and sulfinpyrazone

Question 44

what is tx for hyperkalemia?

Accepted Answer

insulin to shift K+ into cells and salbutamol acts synergically with insulin

Question 45

what 3 muscles are posterior to the kidney from medial to lateral?

Accepted Answer

Psoas major quadratus lumborum, transverse abdominis

Question 46

what 3 sites constrict the ureter?

Accepted Answer

junction of renal pelvis and ureter crossing of pelvic brim bladder wall entry

Question 47

how many minor calyces are there? and major calyces?

Accepted Answer

12 and 4

Question 48

what is the relation of vessels in the renal hilum?

Accepted Answer

veins in front of artery which is in front of ureter

Question 49

what is the renal sinus?

Accepted Answer

cavity within kidney occupies by renal pelvis, calyces, blood, lymphatics and nerves - located in centre of kidney

Question 50

what is the symp and parasymp nerve supply for the ureter? where do afferents go to? referred pain?

Accepted Answer

sns - T11-L1 pns - s2-s4 afferent enter L1 L2 - referred pain in scrotum, anterior thigh.

Question 51

what might be injured during a hysterectomy?

Accepted Answer

ureter

Question 52

what shape is Left supradrenal gland? and right one?

Accepted Answer

L is semilunar R is triangular

Question 53

what is the blood supply to the adrenals? venous drainage? lymph drainage?

Accepted Answer

sup = inf phrenic artery mid = aorta inf = renal artery single suprarenal vein to left renal vein or IVC para aortic nodes

Question 54

what are the muscle wall layers in the ureter?

Accepted Answer

inner longitudinal outer circular for upper 2/3s lower 1/3 same muscle arrangement as bladder

Question 55

what is the urachus?

Accepted Answer

median umbilical ligament

Question 56

where does external urethral sphincters motor neurone originate from?

Accepted Answer

onufs nucleus - s2-s4

Question 57

describe the bladder filling/storage reflex?

Accepted Answer

1. guarding reflex - afferent A delta fibres - sacral spinal cord and to PAG then barrington's nucleus in pons - onufs nucleus - pudendal nerve - EUS contracts 2. sensory mechanoreceptors - spinal cord L1-L3 - SNS - decrease PNS activity detrusor relaxation

Question 58

describe bladder emptying?

Accepted Answer

critical level of distension - afferents to pontine micturition center (PMC) or barringtons nucleus - inhibitory interneurons to onufs and excitatory projections to PNS. EUS relaxes and detrusor contracts

Question 59

what is the peritoneum that hangs of the uterine tube called?

Accepted Answer

broad ligament

Question 60

what does the round ligament do? decribe its path?

Accepted Answer

anchors uterus in position - extends from sides of uterus to where to where they are attached immediately below and in front of uterine tubes and curve upwards and laterally beneath the anterior lAyers of broad ligament to reach pelvic brim - go through deep inguinal ring and end in labia majora

Question 61

whats the male equivalent of the round ligament? what does it do?

Accepted Answer

gubernaculum - anchors the testes in place so they cannot move

Question 62

what ligament anchors the cervix to the lateral pelvic walls and what structures lie in it?

Accepted Answer

transverse cervical ligament and uterine arteries which is ontop(bridge over water) and ureter

Question 63

what is the pneumonic for the pelvic blood supply?

Accepted Answer

I like Going places in my very own underwear Iliolumbar Lateral sacral Gluteal - sup - all above are post branch rest is anterior branch Pudendal (internal) Inferior vesicle (uterine in female) Middle rectal Vaginal Obturator Umbilical

Question 64

where does middle rectal come from? and what is inf gluteals other name? what artery does umbilical artery give of?

Accepted Answer

branch of internal pudendal, sciatic artery superior vesical artery

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