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Titi Pipi > Renal & Acid-base > Flashcards

Renal & Acid-base Flashcards

1
Q

Normal plasma osmolarity is:

a. 220 mOsm/L
b. 180 mOsm/L
c. 320 mOsm/L
d. 280 mOsm/L

A

d. 280 mOsm/L

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2
Q

What is the osmolarity and osmotic pressure of a 7.2% saline solution?

a. 2460 mOsm/L and 47,478 mmHg
b. 2200 mOsm/L and 35,320 mmHg
c. 3000 mOsm/L and 51,348 mmHg
d. 1800 mOsm/L and 28,220 mmHg

A

a. 2460 mOsm/L and 47,478 mmHg

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3
Q

Hypo-osmotic dehydration can occur with:

a. Sweating during heavy exercise
b. Primary loss of sodium such as diarrhea or vomiting or aldosterone deficiency
c. Reduced secretion of ADH
d. Excess of sodium in ECF

A

b. Primary loss of sodium such as diarrhea or vomiting or aldosterone deficiency

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4
Q

Excessive secretion of ADH can lead to:

a. Hyperosmotic overhydration
b. Hypo-osmotic dehydration
c. Hypo-osmotic overhydration
d. Hyperosmotic dehydration

A

c. Hypo-osmotic overhydration

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5
Q

Three major factors that cause increased capillary filtration of fluid and protein into the interstitium:

a. Increased capillary permeability, increased capillary hydrostatic pressure and decreased plasma colloid osmotic pressure
b. Decreased capillary permeability, increased plasma colloid osmotic pressure and increased capillary hydrostatic pressure
c. Decreased plasma colloid osmotic pressure, increased capillary permeability, and decreased capillary hydrostatic pressure
d. Increased capillary permeability, decreased capillary hydrostatic pressure and decreased plasma colloid osmotic pressure

A

a. Increased capillary permeability, increased capillary hydrostatic pressure and decreased plasma colloid osmotic pressure

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6
Q

Name safety factors that prevent fluid accumulation in interstitial spaces:

a. high compliance of interstitium, ability of lymph flow to decrease and washdown of interstitial fluid protein concentration
b. ability of lymph flow to increase to up to 10- fold, high compliance of interstitium and washdown of interstitial fluid protein concentration
c. low compliance of interstitium, washdown of interstitial fluid and ability of lymph flow to increase up to 10- fold
d. ability of lymph flow to increase to 10- to 50-fold, low compliance of interstitium and washdown of interstitial fluid protein concentration

A

d. ability of lymph flow to increase to 10- to 50-fold, low compliance of interstitium and washdown of interstitial fluid protein concentration

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7
Q

Describe the difference in mechanisms that cause pitting and non-pitting edema.

A

In pitting edema, free fluid accumulates around proteoglycan “brush piles” and when you press on it, you can push fluid out of the area and then it flows back in when pressure is removed. Non-pitting edema involves either fibrinogen accumulation in free fluid or cellular swelling.

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8
Q

Albumin is restricted from glomerular filtration due to its:

a. Molecular diameter
b. Negative charge
c. Molecular weight
d. All of the above
e. Only a and b

A

b. Negative charge

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9
Q

The net filtration rate is a summary of which forces?

A

a. Glomerular hydrostatic pressure b. Bowman’s capsule pressure c. Glomerular oncotic pressure

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10
Q

Which of the following forces favor filtration?

a. Glomerular hydrostatic pressure and Bowman’s capsule colloid osmotic pressure
b. Glomerular colloid osmotic pressure and Bowman’s capsule hydrostatic pressure
c. Bowman’s capsule hydrostatic pressure and glomerular oncotic pressure
d. b and c

A

a. Glomerular hydrostatic pressure and Bowman’s capsule colloid osmotic pressure

Under normal circumstances, glomerular hydrostatic pressure is 60mmHg and Bowman’s capsule colloid osmotic pressure is zero.

Forces that opose filtration are Bowman’s capsule hidrostatic pressure (18mmHg) and glomerular capillary osmotic pressure (32mmHg).

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11
Q

Increased afferent arteriolar resistance results in:

a. Decreased GFR
b. Increased GFR
c. Decreased glomerular hydrostatic pressure d. Increased glomerular hydrostatic pressure
e. a and c
f. b and c

A

e. a and c

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12
Q

Moderately increased efferent arteriolar resistance results in:

a. Increased resistance and decreased GFR
b. Decreased glomerular hydrostatic pressure
c. Increased glomerular hydrostatic pressure and increased GFR
d. Severe constriction and reduced GFR

A

c. Increased glomerular hydrostatic pressure and increased GFR

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13
Q

Which of the following hormones and autocoids increase GFR?

a. Norepinephrine and endothelin
b. EDNO and prostaglandins
c. Epinephrine and EDNO
d. Blockage of PGs and Angiotensin II

A

b. EDNO and prostaglandins

EDNO (endothelium-derived Nitrus Oxide) is released by vascular endothelium it allows kidneys to excrete normal amount of Na and water and decreases vascular resistance.

Pg cause vasodilation and increase blood flow and GFR

Angiotensin II constricts efferet arterioles.

Endothelin is a powerful vasoconstrictor decreasing GFR, it is tipically released during many disease states.

Ne and E constrict peripheral arteries, decreasing GFR

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14
Q

Describe how a high-protein diet can contribute to increased GFR and renal blood flow.

A
  • Increased protein breakdown leads to increased amino acid in the bloodstream. Increasd amino acid reasborption in the kidney tubules stimulates increased sodium reabsorption in the proximal tubules
  • Decreased sodium delivered to the macula densa
  • The tubulo-glomerular feedback mechanism mediates a decrease in resistance of afferent arterioles
  • Decreased afferent arteriolar resistance raises renal blood flow and increases GFR
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15
Q

Urolithiasis can result in:

a. Increased glomerular osmotic pressure
b. Increased Bowman’s capsule hydrostatic pressure
c. Decreased GFR
d. a and c
e. b and c
f. All of the above

A

e. b and c

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16
Q

A(n) ______ in sodium chloride concentration at the macula densa cells causes ________ resistance in the afferent arterioles.

a. Increase, increase
b. Decrease, decrease
c. Increase, decrease
d. Decrease, increase

A

b. Decrease, decrease

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17
Q

Angiotensin II causes:

a. Constriction of the efferent arterioles which increases glomerular hydrostatic pressure
b. Opens up efferent arterioles which increases GFR
c. Increased GFR by increasing Bowman’s capsule hydrostatic pressure
d. Vasodilation which enhances GFR

A

a. Constriction of the efferent arterioles which increases glomerular hydrostatic pressure

18
Q

In myogenic autoregulation of renal blood flow, stretch of arteriole walls causes _______ resulting in ____________.

a. Intracellular movement of potassium ions and increased GFR
b. Intracellular movement of calcium ions and vasodilation
c. Intracellular movement of calcium ions and vasoconstriction
d. Vasodilation and increased GFR

A

c. Intracellular movement of calcium ions and vasoconstriction

19
Q

The detrusor muscle is made of smooth or skeletal muscle.

A

smooth muscle

20
Q

The external sphincter is made of smooth or skeletal muscle.

A

skeletal muscle

21
Q

True or False. Parasympathetic nerve input to the bladder is supplied through the hypogastric nerves.

A

False – Parasympathetic nerve input to the bladder is supplied through the pelvic nerves.

22
Q

True or False. The principal nerve supply for the bladder is supplied through the pelvic nerves.

A

True

23
Q

Sensory signals from the bladder stretch receptors are conducted to the ________ segments of the cord through the _________ nerves.

a. lumbar, pelvic
b. lumbar, hypogastric
c. sacral, pelvic
d. sacral, hypogastric

A

c. sacral, pelvic

24
Q

Overflow incontinence can occur if:

a. the sacral region of the spinal cord is damaged
b. sensory nerves from the bladder to the spinal cord are damaged
c. hypogastric nerve innervation is interrupted
d. inhibitory signals are interrupted

A

b. sensory nerves from the bladder to the spinal cord are damaged

25
Q

Chlorothiazide acts mainly on _________ to block __________.

a. the early distal tubules, Na-Cl co-transporter
b. the proximal tubule, carbonic anhydrase
c. cortical collecting tubule, aldosterone
d. the loop of Henle, 1-Na, 2-Cl, 1-K co-transporter

A

a. the early distal tubules, Na-Cl co-transporter

26
Q

Spironolactone acts mainly on _________ to block ____________.

a. the early distal tubules, Na-Cl co-transporter
b. the proximal tubule, carbonic anhydrase
c. cortical collecting tubule, aldosterone
d. the loop of Henle, 1-Na, 2-Cl, 1-K co-transporter

A

c. cortical collecting tubule, aldosterone

27
Q

Furosemide acts mainly on ___________ to block ______________.

a. the early distal tubules, Na-Cl co-transporter
b. the proximal tubule, carbonic anhydrase
c. cortical collecting tubule, aldosterone
d. the loop of Henle, 1-Na, 2-Cl, 1-K co-transporterd

A

d. the loop of Henle, 1-Na, 2-Cl, 1-K co-transporterd

28
Q

Why are ruminants less likely to develop hyperkalemia in acute renal failure?

A

Excess potassium can be excreted in saliva.

29
Q

List at least 5 causes of tubular necrosis in ruminants.

A

Among many others: NSAID toxicity, oxytetracycline, oak (Quercus spp.) poisoning, redroot pigweed (Amaranthus retroflexus) poisoning, oxalate-containing plants, heavy metals, imidocarb dipropionate toxicity, myoglobinemia, hemoglobinemia….

30
Q

List at least 3 causes of glomerulonephritis in ruminants

A

Persistent infections with BVDV, DIC, pregnancy toxemia, enzootic bovine leukosis, fascioliasis

31
Q

When significant loss of nephrons occurs, adaptation occurs by the following except:

a. hypertrophy of blood vessels
b. hypertrophy of glomeruli
c. decreased GFR
d. vasodilation of blood vessels

A

c. decreased GFR

32
Q

Osteomalacia can occur in chronic renal failure due to:

a. Decrease in serum phosphate
b. Increase in serum phosphate
c. Lack of vitamin D
d. Increased ionized calcium concentration
e. a, c and d
f. b and c

A

b. Increase in serum phosphate

33
Q

Hypertension can occur with renal disease to which of the following?

a. Decreased GFR
b. Increased GFR
c. Increased sodium reabsorption
d. Increased vascular resistance
e. a, c and d
f. a and c

A

e. a, c and d

34
Q

When hypertension occurs, sodium and water excretion returns to normal due to:

a. aldosterone secretion
b. increased arterial pressure
c. angiotensin II release
d. increase in renal vascular resistance

A

b. increased arterial pressure

35
Q

How is the GFR determined?

A

1) By the sum of hydrostatic and colloid osmotic forces across the glomerular membrane (this gives the net filtration pressure), and 2) the glomerular capillary filtration coeficient (Kf) - product of permeability and filtering surface are of the capillaries

36
Q

What happens if there is an increase in the glomerular capillary osmotic pressure?

A

Decreases GFR. Two factors influence glomerular capillary colloid osmotic pressure: (1) arterial plasma colloid osmotic pressure (2) fraction of plasma filtered by the glomerular capillaries (filtration fraction). Increasing arterial plasma colloid osmotic pressure raises the glomerular capillary colloid osmotic pressure, which in turn decreases the GFR. Also, increasing renal blood flow, a lower fraction of the plasma is filtered out of the glomerular capillaries, causing a slower rise in the glomerular capillary colloid osmotic pressure and less inhibitory effect on the GFR. Consequently, even with a constant glomerular hydrostatic pressure, a greater rate of blood flow into the glomerulus tends to increase the GFR and a lower rate of blood flow into the glomerulus tends to decrease the GFR.

37
Q

What happens if there is an increase in the Bowman’s capsule hydrostatic pressure?

A

Decreases GFR In pathologies associated with obstruction of the urinary tract, Bowman’s capsule pressure increases markedly, causing serious reduction of GFR. The outflow obstruction of the urinary tract and raise in Bowman’s capsule pressure, besides reducing GFR, it can eventually cause hydronephrosis (distention and dilation of the renal pelvis and calyces) and damage or destroy the kidney unless the obstruction is relieved.

38
Q

Mention the site of action and effects of aldosterone on tubular reabsorption.

A

Acts on the collecting tubule and duct and increases NaCl and water reabsorption. It also increases K and H secretion.

39
Q

Mention the site of action and effects of Angiotensin II on tubular reabsorption.

A

Acts on the proximal tubule, think ascending loop of Henle / distal tubule and collecting tubule. It increases NaCl and water reabsorption and H secretion.

40
Q

Mention the site of action and effects of antidiuretic hormone on tubular reabsorption.

A

Acts on the distal tubule, collecting tubule and duct. It increases water reabsorption.

41
Q

Mention the site of action and effects of atrial natriuretic peptide on tubular reabsorption.

A

Acts on the distal tubule, collecting tubule and duct. It decreases NaCl reabsorption.

42
Q

Mention the site of action and effects of parathyroid hormone on tubular reabsorption.

A

Acts on the proximal tubule, thick ascending loop of Henle and distal tubule. It decreases PO4 and increases Ca reabsorption.

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