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Renal > Control of Body Fluid Osmolality and Volume > Flashcards

Control of Body Fluid Osmolality and Volume Flashcards

1
Q

Volume expansion controlled by

a. Intrarenal hydrostatic pressure
b. Intrarenal oncotic pressure
c. Renal sympathetic nerve
d. RAAS

A

D

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2
Q

Volume contraction maybe associated with which of the following:

a. Hyperosmolarity
b. Isoosmolarity
c. Hypoosmolarity
d. AOTA

A

D

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3
Q

The patient’s osmolarity is 380. What is causing the osmolal gap?

a. Alcohol
b. Sodium
c. Glucose
d. Urea

A

A

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4
Q

Effect of angiotensin II

a. Inhibit thirst mechanism
b. Inhibit ADH
c. Stimulate aldosterone
d. Stimulate ANP

A

C

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5
Q

Aldosterone effects

a. Increase number of open Na+ & K+ channels at apical membrane
b. Increase rate of Na+-K+ ATPase pump
c. Both
d. Neither

A

C

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6
Q

An 80 yr old woman is treated for congestive heart failure with loop diuretic. Her serum K is low at 2.6 mEq/L, which of the following explains her hypokalemia?

a. Increase activity of distal Na-K ATPase
b. Increase GFR
c. Increase distal flow
d. Decrease proximal K reabsorption

A

*

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7
Q

Viral diarrhea with water replaced

a. Isotonic expansion
b. Hypotonic contraction
c. Hypotonic expansion
d. Isotonic contraction

A

C

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8
Q

What is the total after BW?

a. 2260
b. 3720
c. 5880
d. 6180

A

D

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9
Q

If a person …, blood has pH 7.20, [HCO3-] ~17, PCO2=72. If the serum anion gap is normal and if urine anion gap is negative, what is wrong?

a. Glomerular basement membrane
b. Proximal cells
c. Distal cells
d. Collecting duct cells

A

D

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10
Q

The water content in the body is generally higher in

A. females than males
B. a two-year old baby than a newborn
C. a lean than an obese person
D. an eighteen year old than a twenty-five year old male

A

C

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11
Q

The interstitial fluid volume of a 70 kg male would be about

A. 18 liters
B. 14.5 liters
C. 10.5 liters
D. 3.5 liters

A

C

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12
Q
  1. Major difference between the composition of interstitial fluid and that of plasma

A. higher sodium concentration in interstitial fluid
B. higher protein concentration in plasma
C. higher chloride concentration in plasma
D. higher calcium concentration in interstitial fluid

A

B

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13
Q

A patient has the following data:
Plasma [ Na+] 125 meq/L
[glucose] 108 mg/dl
BUN 140 mg/dl

  1. What would be the above patient’s plasma osmolality?

A. 250 mosmoles/kg
B. 256
C. 300
D. 306

A

D

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14
Q

A patient has the following data:
Plasma [ Na+] 125 meq/L
[glucose] 108 mg/dl
BUN 140 mg/dl

Which of the following is true with regarding the above patient?

A. There will be a shift of water from ICF to ECF.
B. There will be a shift of water from ECF to ICF.
C. ADH release is stimulated
D. Aldosterone release is inhibited

A

B

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15
Q
  1. What would be the effect of adding 1.5 liters of distilled water to the intravascular compartment?

A. One half liter of infused distilled water would shift to the ICF
B. One liter of the infused distilled water would shift to the ICF
C. Both of the above
D. neither of the above

A

D

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16
Q

A five-year old boy with a two day history of diarrhea and poor intake was brought to the emergency room of the PGH. On initial physical examination he had sunken eyeballs and dry tongue and buccal mucosa. His last urine output was noted at about 15 hours prior to consultation. He was assessed to be in severe dehydration. Which of the following would be a good choice of intravenous fluid to effectively expand his fluid ECF volume?

A. 5% dextrose solution
B. isotonic saline solution
C. half normal saline solution
D. any one of the above

A

B

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17
Q

Insensible water loss from the body includes

A. sweat
B. water from oxidation of food
C. water evaporating from the skin
D. stool

A

C

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18
Q
  1. During prolonged heavy exercise, most of the water loss from the body is through

A. urine excretion
B. sweating
C. the lungs
D. evaporation from the skin

A

B

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19
Q

Control of ECF osmolality is mainly mediated by

A. sympathetic nervous system
B. renin-angiotensin-aldosterone mechanism
C. antidiuretic hormone
D. atrial natriuretic hormone

A

C

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20
Q
  1. Which of the following is true in a patient with generalized edema?

A. his interstitial fluid volume is expanded
B. his total body sodium is increased
C. both of the above
D. neither of the above

A

C

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21
Q
  1. The following are actions of angiotensin ll except

A. stimulates thirst
B. increases peripheral resistance
C. enhances sodium excretion
D. causes water retention

A

C

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22
Q
  1. Most potent stimulus for antidiuretic hormone secretion

A. increase in ECF osmolality
B. angiotensin ll
C. decrease in blood volume
D. decrease in pH

A

A

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23
Q
  1. Which of the following statements regarding cellular action of ADH is true?

A. ADH primarily affects the intercalated cells of the proximal tubule
B. ADH attachment to apical membrane receptors lead to cAMP activation which leads to formation of water channels
C. Aquaporin2 water channels insert into the apical membrane of collecting duct cells rendering this segment water permeable
D. all of the above

A

C

24
Q

A patient presents with massive pedal edema and ascites due to nephritic syndrome. His sodium concentration is 136 mEq/l, Posm 277 mOsm/kg H20. Urinalysis reveals Uosm 300 mOsm/kg H20, sodium 5 mEq/l, and potassium 60 mEq/l. Urine volume is 2L/day.

21. His free water clearance is 
A. 0.17 liter/day
B. 1.7 liters/day
C. 17 liters/day
D. Not enough data to calculate the CH20
A

A

25
Q

A patient presents with massive pedal edema and ascites due to nephritic syndrome. His sodium concentration is 136 mEq/l, Posm 277 mOsm/kg H20. Urinalysis reveals Uosm 300 mOsm/kg H20, sodium 5 mEq/l, and potassium 60 mEq/l. Urine volume is 2L/day.

If he drinks a liter of water a day, will he develop hyponatremia?
A. Yes, because his CH20 1 liter.
C. Yes, because his electrolyte-free water clearance 1L.

A

D

26
Q

A patient with congestive heart failure may retain more fluid because of:
A. AVP release
B. Decreased effective arterial blood volume
C. RAAS Activity
D. SNS Activity

A

B

27
Q 
A falsely low urine specific gravity using the reagent strip 
A. acidic urine
B. glucosuria
C. ketonuria
D. proteinuria
A

B

28
Q

A 30-year old male was found unconscious in a highway, probably a victim of hit and run. He was brought to the emergency room of the Philippine General Hospital and was found to have a systolic BP if 70 mmHg and feeble pulses. He was noted to be probably in shock. How will this affect Na reabsorption in the PCT?
A. Decreased Na reabsorption due to increased sympathetic nerve activity
B. Increased Na absorption secondary to increased renin-angiotensin-aldosterone system
C. Increased Na reabsorption secondary to increased renal interstitium
D. All except B
E. All except C

A

C

29
Q 
Compared to plasma, interstitial fluid has more: 
A. K+
B. Na+
C. Mg2+
D. Cl-
A

D

30
Q 
How many tablets of NaCl (1 tablet = 1 gram NaCl) will you give a patient who has an estimated Na+ deficit of 102 mmoles?
A. 2
B. 4
C. 6 
D. 10
A

C

31
Q 
Which of the following will stimulate renin release?	
A. aldosterone
B. antidiuretic hormone
C. increased salt intake
D. increased sympathetic activity
A

D

32
Q

What is positive water balance?

A

When water intake exceeds water loss.

33
Q

What is negative water balance?

A

When water loss exceeds intake

34
Q

Another name for ADH

A

Vasopressin

35
Q

Where is ADH secreted?

A

Hypothalamus,

specifically the supraoptic and paraventricular nuclei

36
Q

Where is ADH stored after secretion?

A

Posterior pituitary

37
Q

What are the two primary physiological regulators of ADH?

A

Osmolality of body fluids,

Volume and pressure of the vascular system

38
Q

Nausea: inhibits or stimulates ADH?

A

Stimulates

39
Q

ANP: inhibits or stimulates ADH?

A

Inhibits

40
Q

Angiotensin II: inhibits or stimulates ADH?

A

Stimulates

41
Q

Changes as minor as 1% in (osmolality of body fluids/blood volume or pressure) are sufficient to stimulate ADH secretion

A

Osmolality of body fluids

42
Q

The anterior hypothalamus has osmoreceptors that sense changes in body fluid osmolality by shrinking or swellelling. T/F

A

T

43
Q

ADH is degraded rapidly in plasma. T/F

A

T

44
Q

The osmoreceptors for ADH are located where?

A

The hypothalamus

45
Q

The receptors for blood volume or pressure changes are located where?

A

The left atrium, pulmonary vessels, aortic arch and carotid sinus

46
Q

Where are the high pressure receptors for blood volume and pressure located?

A

Carotid sinus and aortic arch

47
Q

Where are the low pressure receptors for blood volume and pressure located?

A

Left atrium and and large pulmonary vessels

48
Q

Low blood pressure can (increase/decrease) the set point for the body’s osmolarity.

A

Decreases

49
Q

High blood pressure can (increase/decrease) the set point for the body’s osmolality

A

Increases

50
Q

Low blood pressure (stimulates/inhibits) ADH secretion

A

Stimulates

51
Q

High blood pressure (stimulates/inhibits) ADH secretion

A

Inhibits

52
Q

What is the receptor for ADH in the principal cells of the collecting ducts and the late distal tubule?

A

V2 receptor

53
Q

ADH increases the trasnport of which aquaporin to the apical membrane of principal cells?

A

AQP2

54
Q

ADH increases AQ2 by which cell signaling mechanism?

A

GPCR which stimulates adenosine cyclase and increases cAMP

55
Q 
Decrease in ECF volume, increase in the following except:
A. aldosterone 
B. ADH 
C. sympathetic 
D. ANP
A

D

A rise in ECF volume inhibits vasopressin (or ADH) and aldosterone secretion, and a decline in ECF volume produces an increase in the secretion of these hormones. In addition, expansion of the ECF volume increases the secretion of ANP and BNP by the heart, and this causes natriuresis and diuresis

Renal (9 decks)

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