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Physiology 2 - Renal > Final Exam review > Flashcards

Final Exam review Flashcards

1
Q

Safety factors that prevent edema include all except:
A.
Accumulation of interstitial proteins.
B.
Washdown of interstitial fluid proteins.
C.
Variable lymphatic drainage.
D.
Low interstitial compliance.

A

A.
Accumulation of interstitial proteins.

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2
Q

The kidneys normally receive about what percentage of cardiac output?
A.
14%
B.
21%
C.
29%
D.
10%

A

B.
21%

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3
Q

The functions of the kidney are many and varied. Which of the following is NOT a function of the kidney?
A.
Regulation of fluid volume and body fluid composition.
B.
Release of ADH.
C.
Excretion of metabolic waste and foreign chemicals.
D.
Secretion of certain hormones.

A

B. Release of ADH

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4
Q

What percent of nephrons are juxtamedullary?
A.
They are 50-50 split with cortical nephrons.
B.
In humans, about 15% are juxtamedullary nephrons.
C.
In humans, there are no juxtamedullary nephrons.
D.
In humans, about 85% of the nephrons are extramedullary.

A

B.
In humans, about 15% are juxtamedullary nephrons.

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5
Q

Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?
A.
Manic-depressive disorder treated with lithium
B.
Chronic obstructive lung disease treated with a terbutaline inhaler and aminophylline
C.
Rheumatoid arthritis requiring high-dosage prednisone
D.
Renal disease

A

D.
Renal disease

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6
Q

The osmolarity of plasma is primarily due to:
A.
Potassium
B.
Magnesium
C.
Sodium
D.
Protein
E.
Calcium

A

C.
Sodium

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7
Q

Hyponatremia due to cortisol and aldosterone deficiency, aldosterone deficiency causes sodium wasting, and cortisol deficiency results in the increased antidiuretic hormone. Which pathology is the most likely cause?
A.
Addison’s disease
B.
Diabetes insipidus
C.
Delirium or dementia
D.
Trauma with long bone fractures

A

A.
Addison’s disease

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8
Q

Differences between intracellular and extracellular fluid composition include all of the following except:
A.
Sodium levels are higher in the extracellular fluid.
B.
Potassium levels are much higher in the intracellular fluid.
C.
Phosphate levels are greater in the extracellular fluid.
D.
The osmolarity of intracellular and extracellular fluids are similar.
E.
All the above are correct.

A

C.
Phosphate levels are greater in the extracellular fluid.

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9
Q

A serum sodium of 120mEq/liter is?
A.
Normal
B.
An indication of hyponatremia
C.
Due to hypertonic irrigating solutions
D.
An indication of hypernatremia

A

B.
An indication of hyponatremia

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10
Q

The major reabsorptive area of the nephron (where most reabsorption occurs) is:
a.
The proximal tubule
b.
The thick ascending limb of Henle’s loop
c.
The distal convoluted tubule
d.
The collecting ducts
e.
None of the above

A

a.
The proximal tubule

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11
Q

Because protein molecules are too large to be reabsorbed by normal mechanisms, a special mechanism called ________________ is used to save proteins.
a.
Symport
b.
Secondary active transport
c.
Pinocytosis
d.
Passive transport

A

c.
Pinocytosis

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12
Q

Net filtration pressure favoring filtration into Bowman’s space is closest to:
a.
40 mm Hg
b.
20 mm Hg
c.
10 mm Hg
d.
60 mm Hg

A

c.
10 mm Hg

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13
Q

All the following statements are true about the glomerular basement membrane except
a.
Large molecules easily pass through
b.
Maintains a strong negative charge
c.
Plasma protein filtration is prevented due to the strong negative electrical charge
d.
The membrane charge is due to glycoproteins

A

a.
Large molecules easily pass through

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14
Q

Decreased glomerular filtration causes overabsorption of sodium ions (Na+) and chloride ions (Cl − ) in the ascending limb of the loop of Henle resulting in a reduction in the delivery of these ions in the ultrafiltrate to the ________________, which are specialized cells designed to detect small changes in osmolality.
a.
Macula densa
b.
Afferent arteriole
c.
Mesangial cells
d.
Vasa recta

A

a.
Macula densa

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15
Q

Active transport of Cl is a feature of:
a.
The descending limb of Henle’s loop
b.
The thick ascending limb of Henle’s loop
c.
The proximal tubule
d.
The distal tubule

A

b.
The thick ascending limb of Henle’s loop

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16
Q

Glomerular filtration is also dependent on the following physiologic factors except:
a.
The pressure in the Bowman capsule
b.
The level of ADH present in the ultrafiltrate
c.
The colloid osmotic pressure of the plasma proteins
d.
The pressure inside the glomerular capillaries

A

b.
The level of ADH present in the ultrafiltrate

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17
Q

Which of the following statements about creatinine is/are true?
a.
Clearance can be used to estimate GFR.
b.
It is a byproduct of skeletal muscle metabolism.
c.
It is secreted in the proximal tubule to a limited extent.
d.
All the above
e.
None of the above

A

d.
All the above

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18
Q

Increased sodium delivery to the macula densa will:
a.
Increase water loss in collecting tubules.
b.
have no effect on GFR.
c.
increase GFR.
d.
decrease GFR.

A

d.
decrease GFR.

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19
Q

Filtration, which results from pressures forcing fluids and solutes through the glomerulus, is the first step in the formation of urine. The quantity of glomerular filtrate formed each minute in all nephrons is called the glomerular filtration rate (GFR). Normal GFR is approximately:
a.
5-6 L/min
b.
1.0-1.2 L/min
c.
125ml/min
d.
20-25% of cardiac output

A

c.
125ml/min

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20
Q

Urea passively diffuses from medullar collecting duct during water deficits when?
A.
The macula densa releases ADH
B.
In the presence of ADH
C.
Blood glucose levels are high
D.
The cortical osmolarity is 300mOsmol/L

A

B.
In the presence of ADH

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21
Q

Following this quiz, you go to the local pub drown your sorrows. After eating 2 bowls of the saltiest popcorn ever and drinking several cheap brews you are surprised that you have a strong urge to visit the restroom several times during your time there. Perplexed (because you didn’t study), you ask your wiser friend who explains why - despite a large sodium load - you still must urinate. The reason is:
A.
The alcohol has destroyed the hypertonic interstitium of the renal medulla.
B.
Alcohol has inhibited the release of ADH.
C.
Alcohol has inhibited the renin angiotensin pathway.
D.
Alcohol has inhibited angiotensin-converting enzyme.

A

B.
Alcohol has inhibited the release of ADH.

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22
Q

For which situations below would you expect to see increased stimulation for the release of ADH? (Pick all that apply)
A.
Ethanol, alpha-adrenergic agonists, and atrial natriuretic peptide.
B.
Hypovolemia
C.
Hypernatremia
D.
Elevations in osmolarity

A

B.
Hypovolemia
C.
Hypernatremia
D.
Elevations in osmolarity

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23
Q

The minimal obligatory urine volume of a normal 70 kg human is:
A.
50ml/day
B.
1200ml/day
C.
1L/day
D.
0.5L/day

A

D.
0.5L/day

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24
Q

________________ is a potent vasoconstrictor cleaved from angiotensin I primarily in the _______________ by the action of angiotensin-converting enzyme:
A.
Arginine Vasopressin, adrenal gland
B.
Cortisol, spleen
C.
Angiotensin II, primarily in the pulmonary endothelium
D.
Epinephrine, liver

A

C.
Angiotensin II, primarily in the pulmonary endothelium

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25
Q

Osmoreceptors which help regulate ADH secretion are mainly found where?
:A.
Hypothalamus
B.
Aorta and carotid vessels
C.
Left ventricle
D.
Adrenal medulla

A

A. Hypothalamus

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26
Q

RAAS activation produces which result in the body? (Pick 3)
A.
Increases circulating fluid volume.
B.
Promotes H2O and Na+ retention.
C.
Increases GFR.
D.
Increases blood pressure.

A

A.
Increases circulating fluid volume.
B.
Promotes H2O and Na+ retention.

D.
Increases blood pressure.

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27
Q

The renal medullary interstitial fluid is hyperosmolar compared to cortical interstitial fluid. Which factor contributes to this?
A.
Urea
B.
Active transport mechanisms
C.
ADH level
D.
All influence medullary osmolarity
E.
None of the above.

A

D.
All influence medullary osmolarity

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28
Q

Which statement about the macula densa is FALSE?
A.
It is in the proximal tubule.
B.
Specialized cells detect sodium concentration of the fluid in the tubule.
C.
Decreased fluid flow and sodium delivery and the macula densa responds by increasing renin release to increase GFR.
D.
Elevated tubule sodium triggers contraction of the afferent arteriole, reducing glomerular filtration rate.

A

A.
It is in the proximal tubule.

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29
Q

In which of the patients below would you expect to see decreased aldosterone secretion?
A.
A thirsty patient walking in the desert
B.
A patient with Conn’s syndrome
C.
A patient with hyperkalemia
D.
A patient taking Lisinopril
E.
None of the above

A

D.
A patient taking Lisinopril

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29
Q

Where is bicarb reabsorbed at?

A

Proximal tubule

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30
Q

Potential causes of metabolic alkalosis?

A

sodium depletion
long term diuretic
decreased aldosterone

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31
Q

Affects of acidosis

A

Decreased cardiac contractility,
Rightward shift in oxy-hemoglobin dissociation curve,
decreased responsiveness to catecholamines, K increases 0.6mEq/L for each 0.1 unit decrease in pH

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32
Q

The following 7.32, hco3 25, paco2 50

A

acidotic acute respiratory acidosis

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33
Q

Possible effective treatments for someone who has metabolic alkalosis

A

stop NG suction
IV hydrochloric acid
discontinue diuretics
Spironolactone if increased mineralocorticoid activity
Administer K

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34
Q

Name some body buffers

A

Bicarb
Hemoglobin
Intracellular proteins
Phosphate
Ammonia

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35
Q

Hydrogen ion pump exists in which tubule and is able to create a large hydrogen ion gradient

A

Distal tubule

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36
Q

Acidosis will have what effect on serum potassium

A

increases K 0.6 mEq/L for each 0.1 unit decrease in pH

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37
Q

Something that facilitates the hydration of carbon dioxide in plasma and erythrocytes. Carbonic acid which then spontaneously dissociates which spontaneously dissociates to hydrogen ion and bicarb. What do you need for this process.

A

Carbonic anhydrase

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38
Q

what do diuretics lead to?

A

Contraction alkalosis

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39
Q

What causes alkalosis?

A

The loss of acids through various things we do…like suctioning OG tubes, vomiting and diuretic administration.

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40
Q

Where in the tubule does carbonic anhydrase work?

A

The proximal tubule

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41
Q

Where is the majority of filtered bicarb reabsorbed?

A

80-90% of filtered bicarbonate is reabsorbed in the proximal tubule….with 10-20% reabsorbed in the distal tubule

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42
Q

Where is the sodium chloride symporter?

A

Distal convoluted tubule

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43
Q

How do most clinically used diuretics work?

A

By decreasing the rate of sodium reabsorption from the tubules which causes sodium output to increase (natriuresis) which then results in diuresis (water output)

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44
Q

What are osmotic diuretics

A

Mannitol/urea, glycerin, isosorbide, work in the proximal tubule by drawing fluid into the tubules

For AKI, HTN, acute oliguria

Causes increased intravascular volume which may cause pulmonary edema in CHF patients

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45
Q

What are loop diuretics?

A

Furosemide/bumetanide/ethacrynic acid… inhibit the Na-2Cl-K co-transporter in the TAL of Henle….the countercurrent multiplier gets disrupted and the interstitium cannot become hyperosmolar

Causes metabolic alkalosis, decreased lithium clearance, decreased K, decrease Ca, hypovolemia

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46
Q

What is the most used diuretic?

A

Thiazides (HCTZ)

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47
Q

How do thiazide diuretics work?

A

Inhibit sodium chloride reabsorption in the early distal tubule by affecting the NaCl cotransport mechanism

Cause Increased Ca, hyperglycemia, decreased K, and Hypochloremic metabolic alkalosis

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48
Q

What are carbonic anhydrase inhibitors?

A

Acetazolamide….Reduce reabsorption of Na+ in the proximal convoluted tubule by decreasing HCO3 and H2O reabsorption.

Causes mild metabolic acidosis

49
Q

What is mainly used to treat glaucoma?

A

Carbonic anhydrase inhibitors

50
Q

What is the disadvantage of carbonic anhydrase inhibitors?

A

It causes acidosis through bicarbonate loss in the urine.

51
Q

What are aldosterone antagonists?

A

spironolactone (Aldactone), potassium-sparing, Decreases reabsorption of Na+ and decreases K+ secretion by competing for aldosterone (inhibits aldosterone) binding sites in the distal segment of the distal tubule.*

52
Q

How are Na+ Channel blockers used for diuresis?

A

amiloride and triamterene….Decrease activity of Na/K ATPase in the collecting tubules and thereby decrease Na+ reabsorption

53
Q

What is the #1 cause of renal failure?

A

DIABETES, 2nd leading cause is hypertension

54
Q

What is the muscle relaxant of choice for renal patients?

A

Cis-atracurium as it is degraded by Hoffman elimination

55
Q

Succinylcholine is safe in patients with K<____ mEq/L, will transiently increase K+ by almost ____ mEq/L

A

Safe with K < 5, will increase K by 0.5-1

56
Q

What muscle relaxant should you avoid?

A

Pancuronium

57
Q

What is the best analgesic because it doesn’t have any active metabolites?

A

Fentanyl

58
Q

How does ANP work?

A

Decrease renin release, thereby decreasing circulating levels of angiotensin II and aldosterone. Promotes natriuresis and diuresis.

59
Q

What is counter-regulatory to the RAAS system?

A

Natriuretic peptides

60
Q

What are the actions of ANP

A

Inhibits renin release, increased GFR/vasodilation to promote diuresis, inhibits aldosterone secretion, inhibits ADH release, Acts directly on the collecting duct to decrease NaCl reabsorption

61
Q

Where does ANP directly act to decrease NaCL reabsorption

A

The collecting duct

62
Q

What is NOT in dialyzing fluid?

A

Phosphate, urea, urate, sulfate, or creatinine

63
Q

What is High in dialyzing fluid?

A

Bicarb and glucose

64
Q

What is low in dialysis fluid?

A

K, Na, Cl

65
Q

Where does chloride transportation occur?

A

Active Na and Cl transport in the TAL increases the osmolality of the interstitial space

66
Q

Where are the macula densa cells?

A

The TAL and distal tubule

67
Q

What do the macula densa do

A

They are epithelial cells in the high cortical TAL and distal convoluted tubule that detect sodium concentration of the fluid in the tubule.

68
Q

In response to elevated sodium, the macula densa trigger _____ of the afferent arteriole, reducing flow of blood to the glomerulus and the glomerular filtration rate.

A

Constriction

69
Q

What cannot cross Bowman’s capsule?

A

Cells and proteins more than 60 to 70 kDa cannot cross.

70
Q

What does the basement membrane block?

A

Negatively charged proteins are thus repelled and are unable to pass through it. Molecules greater than 50-100 angstroms will not pass through

71
Q

What are the two major determinants of filtration pressure?

A

Glomerular capillary pressure (PGC) and glomerular oncotic pressure (pgc).

72
Q

Renal blood flow is around ____% of cardiac output

A

20%

73
Q

What are the two major regulatory functions performed by the juxtaglomerular apparatus?

A

The high distal tubular [NaCl]-induced afferent arteriolar vasoconstriction

the low tubular [NaCl]-induced renin release

74
Q

What does a decrease in sodium chloride concentration initiate in the macula densa/JG?

A

1) It increases renin release from the juxtaglomerular cells of the afferent and efferent arterioles, which are the major storage sites for renin, and,

2) It decreases resistance to blood flow in the afferent arterioles, which raises glomerular hydrostatic pressure and helps return GFR toward normal.

75
Q

When renin is released in response to decreased NA, it ____ the efferent arteriole, thus increasing GFR.

A

Constricts

76
Q

Renin ___ the efferent arteriole in response to decreased NA to the JG apparatus.

A

Constricts

77
Q

ANP ____ the afferent arteriole and also does what to the efferent?

A

vasodilates the afferent

Constricts the efferent

78
Q

What would you see in a preop uremic patient?

A

Increased bleeding risk, Anorexia, nausea, vomiting, pruritus, anemia, fatigue, coagulopathy, edema, pericarditis, acidosis, high nitrogenous wate products (urea, uric acid, creatine), increase in K, anemia, a compensatory increase in C.O

79
Q

When are buffers the most efficient?

A

When pH = pKa

80
Q

What does the the Henderson–Hasselbalch equation describe?

A

The relationship between pH, PaCO2, and serum bicarbonate.

81
Q

The solubility coefficient for CO2 is what?

A

0.03 mmol/mm Hg

82
Q

What is by far the most powerful of the acid-base regulatory systems?

A

Kidneys

83
Q

What are the buffers for acidosis?

A

Brain/arterial receptors, increased RR, decrease co2, decrease H2CO3 (carbonic acid), increase PH

84
Q

What are the buffers for alkalosis

A

Decreased RR, increase co2, increase H2CO3, decrease PH

85
Q

The _____ _____ _____ is the most powerful extracellular buffer in the body.

A

Bicarbonate buffer system

86
Q

What type of cells are especially important in eliminating hydrogen ions while reabsorbing bicarbonate in acidosis?

A

Type A intercalated cells

87
Q

What cells have functions opposite to those of type A cells and secrete bicarbonate into the tubular lumen while reabsorbing hydrogen ions in alkalosis?

A

Type B intercalated discs

88
Q

what are the three primary systems that regulate the H+ concentration in the body fluids to prevent acidosis or alkalosis?

A

1) Chemical acid base buffer systems
2) respiratory center
3) Kidneys (Most important)

89
Q

What causes metabolic alkalosis?

A

Na Depletion: more Na absorbed in proximal tubule, contraction alkalosis with long term diuretic use

Increased aldosterone (mineralcorticoid): increases Na reabsorption and H secretion in distal tubule

90
Q

What causes an elevated anion gap in metabolic acidosis?

A

Three diseases (uremia, ketoacidosis, lactic acidosis)

Toxins (methanol, ethylene glycol, salicylates, paraldehyde)

Due to decreased excretion of non-volatile acids

91
Q

What conditions of metabolic acidosis have a normal anion gap?

A

Anything with HCO3 loss:

Renal tubular acidosis
Diarrhea
Carbonic anhydrase inhibition
Ureteral diversions
Early renal failure
Hydronephrosis
HCl administration
Saline administration

92
Q

What is considered a high anion gap?

A

> 13mEq/L

93
Q

When is Sugammadex not indicated?

A

Severe renal insufficiency/failure
Peds
ICU patients

94
Q

How is the Sugammadex complex mainly excreted?

A

Excreted by the kidneys mainly
Forms a stable complex with Roc that is then eliminated by the kidneys. In ESRD this complex remains in circulation for days

95
Q

What is the key factor in causation of perioperative renal failure

A

Hypovolemia

96
Q

When is gout most common?

A

When diet is rich in protein, fat, and alcohol

97
Q

Signs and symptoms of uremic syndrome?

A

Anorexia
Nausea
Vomiting
Pruritus
Anemia
Fatigue
Coagulopathy
Acidosis
Increase in K, Phos, Phenols
Increased CO

98
Q

Rate of movement of a solute across a membrane in dialysis depends on these three things

A

Concentration gradient of solute
Permeability of surface area of membrane
Length of time they remain in contact

99
Q

Four components of the JGA

A

Smooth muscle in afferent
Smooth muscle in efferent
Extraglomerular mesangial
Macula densa in DISTAL TUBULE

100
Q

Conn’s syndrome

A

Aldosterone secreting tumor that causes HTN, hypernatremia, hypokalemia

101
Q

2 functions of the vasa recta

A

Remove reabsorbed fluid from the interstitium

Minimize solute uptake from the medulla (maintain hypertonicity)

101
Q

Osmolality is defined as:
Answers:A.
Gram molecular weight per liter of solution
B.
Number of particles per 22.14 liters
C.
Osmoles per liter of solution
D.
Osmoles per kilogram of solution

A

D.
Osmoles per kilogram of solution

102
Q

The proximal tubule does bulk reabsorption of what 2 things?

A

Solutes and H2O

103
Q

The descending loop of Henle is highly permeable to what and utilizes what mechanism?

A

Utilizes the countercurrent mechanism and is highly permeable to H2O

104
Q

The Ascending loop of Henle uses what mechanism and is not permeable to what?

A

Uses the countercurrent mechanism and is NOT permeable to H2O

105
Q

The distal convoluted tubule is the location for what important part of the kidney and fine tunes the concentration of what?

A

Location of JGA

Fine tunes solute concentration

106
Q

The collecting duct regulates the final concentration of what and has what three things working in that area?

A

Final concentration of urine

ADH, aldosterone, ANP work here

107
Q

What can be used to treat glaucoma, high altitude sickness and central sleep apnea

A

Carbonic anhydrase inhibitors

108
Q

What medications are bad to use in combination with potassium sparing diuretics?

A

NSAIDs, Beta blockers, ace inhibitors

109
Q

What labs assess GFR

A

BUN
Serum Cr
CrCl

110
Q

What labs assess tubular function?

A

FxNa
Osmolality
Gravity
Concentration

111
Q

True or false: BUN goes through both filtration and reabsorption?

A

True

112
Q

True or false: CrCl goes only through filtration?

A

True

113
Q

What can excessive administration of 0.9% NaCl cause?

A

Hyperchloremic metabolic acidosis

114
Q

What do alpha 1 agnonists cause in the kidneys?

A

Decreased renal blood flow

115
Q

Which is constricted with vasopressin: afferent or efferent arterioles?

A

Efferent arterioles

116
Q

How can you decrease K via ventilation?

A

Hyperventilate

Decreases K by 0.5mEq/L

117
Q

When is dialysis indicated?

A

Severe metabolic acidosis
volume overload
hyperkalemia
symptomatic uremia
overdose with a drug that can be cleared

118
Q

What narcotics should not be given with renal disease?

A

Morphine
Meperidine

Physiology 2 - Renal (1 decks)

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